Are psychiatric educators "losing the mind"?

Psychiatry is part of medicine, and developing competence to deal with the mental life of patients is an essential part of general medical as well as psychiatric subspecialty education. As psychiatry's neurobiological data base, therapeutic armamentarium, scope of interest, and philosophical views expand and competitive pressures for time in residency training are intensified, teaching in the mental sciences and opportunities for residents to develop solid psychodynamic diagnostic and therapeutic skills are rapidly disappearing. However, brain science does not yet, and probably never will, fully explain the mind. The author urges psychiatric educators not to give up the mind or, worse yet, lose it by default.     

Ontogeny of MAP2 and GFAP antigens in primary cultures of embryonic chick brain. Effect of substratum, oxygen tension, serum and Ara-C

Brain cells from embryonic chick (stage 28-29) were cultivated for 16 days under serum-free conditions. Nerve cells were found to mature during the first 7 days in culture, as indicated by the presence and developmental pattern of the relative amount of dendritic-specific microtubule-associated protein type 2 (MAP2). Maximal amounts of MAP2 antigen were found to be directly correlated with the number of cells plated out. Astroglia cell proliferation and differentiation, as measured by the amounts of glial fibrillary acidic protein (GFAP), were found to stabilize after a certain astrocyte cell density was reached. Variation in culture plate coating procedure, oxygen tension and addition of serum or of the cytostatic drug Ara-C were found to differently affect viability and maturation processes of astroglia and of nerve cells. Moreover, optimal culture conditions for long-term brain cell cultures are described.     

Nitric oxide formation caused by Ca2+ release from internal stores in neuronal cell line is enhanced by cyclic AMP.

The influence of an elevated level of cyclic AMP on the formation of nitric oxide was investigated in a neuronal cell line (108CC15; NG108-15), in which we had previously shown that nitric oxide mediates the activation of soluble guanylyl cyclase upon stimulation with the hormones bradykinin, endothelin, and serotonin. Maximal amplitude and duration of cyclic GMP response to bradykinin were about 2-fold greater in cells with cyclic AMP levels increased by forskolin pretreatment than in control cells with basal levels of cyclic AMP. Phosphodiesterase inhibitors (isobutylmethylxanthine or M&B 22,948 (zaprinast)) similarly increased the maximal amplitude of the cyclic GMP response to bradykinin, but, in contrast, slowed down the decay phase of the cyclic GMP response to a much greater extent. The cyclic GMP responses to bradykinin were suppressed with the same potency by L-arginine analogues in control and in forskolin-treated cells (IC50 of NG-monomethyl-L-arginine 2 microM, of nitro-L-arginine 0.7 microM). The transient rises of cyclic GMP levels induced by bradykinin and endothelin, which both cause release of Ca2+ from internal stores, were similarly enhanced by forskolin pretreatment. However, the transient cyclic GMP response to serotonin which is due to Ca2+ influx into the neuronal cell line via 5-hydroxytryptamine3 (5-HT3) receptors was not affected by raising the cyclic AMP levels by forskolin pretreatment. Thus, cyclic AMP seems to enhance nitric oxide formation which depends on Ca2+ release from internal stores.     

Time-dependent changes of insufficiency fractures of the sacrum: intraosseous vacuum phenomenon as an early sign

Sacral insufficiency fractures develop over a period of time and show time-dependent changes. We report on 15 CT examinations of 5 patients with early-stage insufficiency fractures of the sacrum. In 4 patients only irregular sclerosis without distinct fracture lines was present in 7 of 8 fractures. Of these 4 patients; 3 exhibited intraosseous gas inclusions in a ventral part of a lateral mass; 5 of 8 fractures disclosed a ventral cortical break. When distinct fracture lines had developed in 1 patient, intraosseous vacuum phenomenon had disappeared. Fracture lines evolve over weeks to months and show central bone absorption. The fractures can heal as demonstrated in 4 of 6 fractures in 3 patients, can persist over 1 year without significant changes or can progress to pseudoarthrosis with bone destruction similar to neuropathic joint disease. Intraosseous vacuum phenomena can persist to this stage. Intraosseous vacuum phenomenon is recognized as a potential finding in the early stage of sacral insufficiency fracture, which also is true for irregular sclerosis and ventral cortical disruption. Correspondence to: A. Stäbler     

Staphylococcal toxic shock toxin specifically binds to cultured human epithelial cells and is rapidly internalized.

Staphylococcal toxic shock syndrome toxin (TST) was labeled with 125I under mild conditions without apparent destruction of the molecule. [125I]TST bound specifically to human epithelial (Chang) cells in culture; the binding was inhibited by a 100-fold excess of unlabeled toxin. Scatchard analysis of the binding data indicated about 10(4) receptor sites per cell and a dissociation constant (Kd) of 4 X 10(-9) M. When cells pretreated with TST at 4 degrees C were swiftly transferred to 37 degrees C, the amount of surface-bound toxin rapidly declined, as determined by release of noninternalized label from the cell surface. Half-time (t1/2) of internalization was about 1.5 min. Ultrastructural studies showed that toxin labeled with ferritin-conjugated antibodies entered the cytoplasm via coated pits forming coated vesicles in the first 2 min of incubation at 37 degrees C. The coated vesicles coalesced with transport vesicles that are ultrastructurally unlike receptosomes. Thus, the unusual ultrastructural pattern of this internalization suggests that TST is initially internalized by receptor-mediated endocytosis and then enters an alternate pathway involving translocation in special transport vesicles, perhaps to other cells.     

Predominance of null mutations in ataxia-telangiectasia

Ataxia-telangiectasia (A-T) is an autosomal recessive disorder involving cerebellar degeneration, immunodeficiency, chromosomal instability, radiosensitivity and cancer predisposition. The responsible gene, ATM, was recently identified by positional cloning and found to encode a putative 350 kDa protein with a Pl 3-kinase-like domain, presumably involved in mediating cell cycle arrest in response to radiation-induced DNA damage. The nature and location of A-T mutations should provide insight into the function of the ATM protein and the molecular basis of this pleiotropic disease. Of 44 A-T mutations identified by us to date, 39 (89%) are expected to inactivate the ATM protein by truncating it, by abolishing correct initiation or termination of translation, or by deleting large segments. Additional mutations are four smaller in-frame deletions and insertions, and one substitution of a highly conserved amino acid at the Pl 3-kinase domain. The emerging profile of mutations causing A-T is thus dominated by those expected to completely inactivate the ATM protein. ATM mutations with milder effects may result in phenotypes related, but not identical, to A-T.      

High throughput parallel analysis of hundreds of patient samples for more than 100 mutations in multiple disease genes

As more mutations are identified in genes of known sequence, there is a crucial need in the areas of medical genetics and genome analysis for rapid, accurate and cost-effective methods of mutation detection. We have developed a multiplex allele-specific diagnostic assay (MASDA) for analysis of large numbers of samples (> 500) simultaneously for a large number of known mutations (> 100) in a single assay. MASDA utilizes oligonucleotide hybridization to interrogate DNA sequences. Multiplex DNA samples are immobilized on a solid support and a single hybridization is performed with a pool of allele-specific oligonucleotide (ASO) probes. Any probes complementary to specific mutations present in a given sample are in effect affinity purified from the pool by the target DNA. Sequence-specific band patterns (fingerprints), generated by chemical or enzymatic sequencing of the bound ASO(s), easily identify the specific mutation(s). Using this design, in a single diagnostic assay, we tested samples for 66 cystic fibrosis (CF) mutations, 14 beta-thalassemia mutations, two sickle cell anemia (SCA) mutations, three Tay-Sachs mutations, eight Gaucher mutations, four mutations in Canavan disease, four mutations in Fanconi anemia, and five mutations in BRCA1. Each mutation was correctly identified. Finally, in a blinded study of 106 of these mutations in > 500 patients, all mutations were properly identified. There were no false positives or false negatives. The MASDA assay is capable of detecting point mutations as well as small insertion or deletion mutations. This technology is amenable to automation and is suitable for immediate utilization for high-throughput genetic diagnostics in clinical and research laboratories.      

Preliminary observations on polar body extrusion and pronuclear formation in human oocytes using time-lapse video cinematography

In this study, we have used time-lapse video cinematography to study fertilization in 50 human oocytes that had undergone intracytoplasmic sperm injection (ICSI). Time-lapse recording commenced shortly after ICSI and proceeded for 17-20 h. Oocytes were cultured in an environmental chamber which was maintained under standard culture conditions. Overall, 38 oocytes (76%) were fertilized normally, and the fertilization rate and embryo quality were not significantly different from 487 sibling oocytes cultured in a conventional incubator. Normal fertilization followed a defined course of events, although the timing of these events varied markedly between oocytes. In 35 of the 38 fertilized oocytes (92%), there were circular waves of granulation within the ooplasm which had a periodicity of 20-53 min. The sperm head decondensed during this granulation phase. The second polar body was then extruded, and this was followed by the central formation of the male pronucleus. The female pronucleus formed in the cytoplasm adjacent to the second polar body at the same time as, or slightly after, the male pronucleus, and was subsequently drawn towards the male pronucleus until the two abutted. Both pronuclei then increased in size, the nucleoli moved around within the pronuclei and some nucleoli coalesced. During pronuclear growth, the organelles contracted from the cortex towards the centre of the oocyte, leaving a clear cortical zone. The oocyte decreased in diameter from 112 to 106 microm (P < 0.0001) during the course of the observation period. The female pronucleus was significantly smaller in diameter than the male pronucleus (24.1 and 22.4 microm respectively, P = 0.008) and contained fewer nucleoli (4.2 and 7.0 respectively, P < 0.0001). After time-lapse recording, oocytes were cultured for 48 h prior to embryo transfer or cryopreservation. Embryo quality was related to fertilization events and periodicity of the cytoplasmic wave, and it was found that good quality embryos arose from oocytes that had more uniform timing from injection to pronuclear abuttal and tended to have a longer cytoplasmic wave. In conclusion, we have shown that time-lapse video cinematography is an excellent tool for studying fertilization and early embryo development, and have demonstrated that human fertilization comprises numerous complex dynamic events.