Reaction time prolongation in the early stage of presenile onset Alzheimer's disease

Summary Simple reaction times (RT) to clicks, flashes and numerical signals were measured in four groups of subjects: 21 patients with mild presenile onset dementia of the Alzheimer type (PDAT, mean age 56 years), 14 patients with chronic cardiovascular disease and incipient cognitive deficit (mean age 55 years), 15 healthy older controls (mean age 53 years) and 16 younger controls (mean age 23 years). Both patient groups had significantly prolonged RTs, the PDAT group especially to the numerical signal (149%), compared with the age-matched controls.     

Isolation and sequence of a cDNA encoding the precursor of a bombesinlike peptide from brain and early embryos of Xenopus laevis.

A cDNA encoding the precursor of a bombesinlike peptide was isolated from brain of Xenopus laevis. The predicted end product resembles neuromedin B, which was originally isolated from mammalian spinal cord. The mRNA for this precursor was also present in gastrointestinal tract and in ovaries. Moreover, it could be detected in early embryos (stage 2 and stage 10) of X. laevis. These findings suggest novel roles for peptides of the bombesin family in oocyte maturation and early amphibian development.     

Evaluating the effects of a community coalition's efforts to reduce illegal sales of alcohol and tobacco products to minors

Minors' access to alcohol and tobacco is a major public health concern because of the many deaths and disabilities associated with use and the ease with which minors purchase these products. We evaluated the effects of a community-based substance abuse coalition's efforts to reduce alcohol and tobacco products to minors. The intervention —implemented entirely by coalition members—consisted of adults and minors issuing citations to clerks in supermarkets, convenience stores and liquor stores, who were willing to sell alcohol and tobacco products to minors and issuing commendations to clerks who refused to sell. For those liquor stores receiving the citizen's surveillance, there was a marked decrease in alcohol sales to minors, from 83% to 33%; and in those liquor stores not experiencing the intervention, there was a smaller decrease in alcohol sales, from 45% to 36%. This study's findings suggest that citizen surveillance and feedback may be effective in reducing alcohol sales to minors when the intervention is fully implemented, but may be ineffective, at least in these doses, with tobacco sales.     

Eukaliuric natriuresis and diuresis in response to disprocynium24: studies on the tubular site of action

We previously described that 1,1’-diisopropyl-2,4’-cyanine (disprocynium24, DP24) exerts an eukaliuric diuresis and natriuresis in the anesthetized rat. The purpose of the present study was to localize the tubular site of action of DP24. Employing micropuncture experiments in anesthetized rats, we first tested the effect of systemic application of DP24 (300 μg/kg+300 μg/kg h, i.v.) on whole kidney excretion rates as well as on fluid, sodium and potassium ion delivery to the early distal tubule (V_ED, Na⁺ _ED, K⁺ _ED). It was found that the eukaliuric diuresis and natriuresis in response to DP24 was accompanied by a substantial increase in V_ED and Na⁺ _ED, suggesting a predominant tubular site of action upstream to the early distal tubule, most likely in the proximal tubule. DP24 caused a comparable fractional, although minor absolute increase in K⁺ _ED as compared to Na⁺ _ED . Second, application of DP24 into the first surface loop of the proximal tubule significantly increased V_ED and Na⁺ _ED at a concentration of about 10^–7 M, indicating that DP24 may act from the intratubular site. Third, microperfusion of tubular segments revealed that effects of DP24 on the proximal convoluted tubule and the loop of Henle accounted for about 70 and 30%, respectively, of its diuretic and natriuretic action upstream to the early distal tubule. With regard to the loop of Henle, the quantitative effect of DP24 on fluid and Na⁺ reabsorption proposed a predominant effect on the straight part of the proximal tubule rather than the thick ascending limb. Intratubular DP24 did not affect reabsorption in the distal tubule. In summary, the present findings indicate that: (1) the diuretic and natriuretic effect of DP24 resides predominantly in the proximal tubule, and (2) DP24 may act from the intratubular site. Since DP24 increased V_ED and Na⁺ _ED without apparently affecting sodium or potassium ion transport in the distal tubule, the mechanism of the eukaliuric response remains unclear. Received: 13 February 1998 / Accepted: 11 May 1998     

Bronchoalveolar lavage cell profile in methotrexate induced pneumonitis

BACKGROUND: Pneumonitis is a rare but potentially life threatening side effect of methotrexate treatment for rheumatoid arthritis which needs to be distinguished from interstitial lung disease due to rheumatoid arthritis. METHODS: To examine the value of bronchoalveolar lavage (BAL) in diagnosing methotrexate pneumonitis, the BAL cell profile of four patients with methotrexate pneumonitis was compared with findings in 16 patients with rheumatoid arthritis treated with methotrexate without clinical or radiological evidence of lung disease and eight patients with interstitial lung disease secondary to rheumatoid arthritis treated with methotrexate. RESULTS: Methotrexate pneumonitis was associated with an increase in the lymphocytes in the BAL fluid to 33-68% of total BAL cells. BAL lymphocytosis was also found in five patients in each of the two control groups. The four patients with methotrexate pneumonitis had a disproportionate increase in CD4+ cells to 72-84% of total lymphocytes and in the CD4/CD8 ratio to 17.0, 6.6, 8.7, and 4.0, respectively, figures which exceeded those of the two control groups. CONCLUSIONS: Methotrexate pneumonitis was associated with lymphocytic alveolitis with a preferential increase in CD4+ cells. This pattern differs from that in interstitial lung disease due to rheumatoid arthritis and may therefore assist in making an early diagnosis of methotrexate pneumonitis.


     

Efficacy and cost effectiveness of harmonic scalpel compared with electrocautery in posterior instrumentation of the spine

Different methods to reduce blood loss during spinal surgery have been described already. Although the use of the harmonic scalpel (HS), an ultrasonically activated coagulator, has been described in endoscopic spinal surgery, its efficacy in posterior instrumentation of the spine remains unclear. The aim of this study was to determine if blood loss was lower using the HS than electrocauterization (EC) and to evaluate the cost effectiveness of the HS in reducing the need for transfusion in patients undergoing posterior instrumentation of the spine. The two groups were matched in a blinded manner, without knowledge of blood loss and were similar with respect to mean age, diagnosis and operation data. All instrumentations were done by the same surgeon. After matching was completed (HS group n=50, EC group n=50) blood loss and overall costs for blood products were analyzed by independent observers. The following were significantly lower with the HS than with EC: (1) blood loss (1106±985 ml vs 2176±1764 ml, P<0.001), (2) frequency of cell saver use (13 vs 28 patients, P=0.001), (3) average cost of blood products (€72 vs €219, P<0.001), (4) predonation of autologous fresh frozen plasma (2.58±2.78 vs 4.5±2.2 U, P=0.002) and red blood cells (0.38±0.75 vs 0.88±1.1 U, P=0.009). The overall costs, including the costs for the HS, remained neutral. The use of the HS in posterior spinal surgery leads to significantly lower blood loss, and less need for and cost of blood products, compared to EC in cases with major anticipated blood loss.No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.     

Prevalence and risk factors for gastroesophageal reflux disease in an impoverished minority population

BACKGROUND AND AIMS: An epidemiological link between an increased body mass index and complaints of typical heartburn symptoms has been identified. It appears that increasing waist circumference, rather than overall weight is most important. Studies to date have not included minority, impoverished communities. Our aim was to determine the impact of obesity on the prevalence of reflux disease in an impoverished community while controlling for known confounders. METHODS: DESIGN Cross-sectional survey delivered by in-home interviews, convenience sampling, and targeted mailing. Data queried include demographics, medical history, lifestyle habits, and symptoms of reflux disease. Height, weight, hip and waist circumference measured in participating subjects. PARTICIPANTS: 503 subjects living in the zip code immediately surrounding Temple University Hospital. Included only adults living in the hospital's zip code for at least 3 years. RESULTS: The highest quartile of waist circumference (≥42 in.) demonstrated a strong association with GERD (AOR = 2.15; 95% CI 1.18-3.90). Smoking increased the odds by 1.72 (95% CI 1.13-2.62). There was no relationship between body mass index, waist-hip ratio, or diet and reflux classification. CONCLUSIONS: Increasing waist circumference, but not overall body mass index or waist-hip ratio, and smoking are risk factors for prevalent GERD. No association between reflux disease and lifestyle choices such as coffee drinking and fast food dining were found. LIMITATIONS: Potential for recall bias and disease misclassification. Possible methodological errors in self-measurement of waist and hip circumference.