Comparison of conversation, freeplay, and story generation as methods of language sample elicitation.

The spontaneous language sample forms an important part of the language evaluation protocol (M. Dunn, J. Flax, M. Sliwinski, and D. Aram, 1996; J. L. Evans and H. K. Craig, 1992; L. E. Evans and J. Miller, 1999) because of the limitations of standardized language tests and their unavailability in certain languages, such as Afrikaans. This study examined 3 methods of language elicitation, namely conversation (CV), freeplay (FP), and story generation (SG), on the following 5 measures to determine which method is best for clinical practice: number of utterances, variety of syntactic structures, mean length of the utterance (MLU), number of syntactic errors, and proportion of complex syntactic utterances as elicited from ten 5-year-old, Afrikaans-speaking boys. FP elicited significantly more utterances than did SG but elicited a smaller proportion of complex syntactic structures than did CV and SG. Furthermore, SG elicited longer utterances than did CV or FP. It is recommended that SG be used in clinical practice with 5-year-olds if the clinician wishes to observe maximum behavior. Where typical behavior is to be evaluated, the clinician can select a language elicitation method that best suits the client's personality and communication style, bearing in mind that FP does elicit a larger language sample.     

Trends in Labor Induction in the United States: Is It True That What Goes Up Must Come Down?

Commentary on: Zhang J, Yancey MK, Henderson CE. U.S. national trends in labor induction, 1989–1998. J Reprod Med 2002;47:120–124.
MacDorman MF, Mathews TJ, Martin JA, Malloy MH. Trends and characteristics of induced labour in the United States, 1989–98. Paediatr Perinat Epidemiol 2002;16:263–273.
Kozak LJ, Weeks JD. U.S. trends in obstetric procedures, 1990–2000. Birth 2002;29:157–161. Abstract: Three recent studies examined the national trend in labor induction in the United States. All show a doubling in the rate of induction during the 1990s, although vital statistics data show a consistently higher trend than that obtained from national hospital discharge data. Neither data source adequately documents the full range of indications for induction, its timing, hospital staffing considerations, and other factors that may play a role. Although rates of induction of labor may be leveling off, despite a lack of scientific evidence for its widespread use, rates are likely to remain at current levels for the next few years.     

Structure of the BoLA-DRB3 gene and promoter.

The cattle major histocompatibility complex (MHC) class II DR gene product is a heterodimer encoded by the BoLA-DRA and -DRB3 genes. Several groups have isolated cDNA and genomic clones for these genes, but their full genomic organization has not been described. We used a combination of long-range polymerase chain reaction (PCR), cloning and sequencing to define the organization of the DRB3 gene on existing genomic clones and in genomic DNA. We estimate the size of the coding region to be 11.4 kbp. Sequencing of full-length PCR clones from two different haplotypes confirmed that they carried complete DRB3 genes and allowed the design of probes and primers to isolate and characterize the DRB3 promoter and 3' end. Fragments carrying the 5' end of the DRB3 gene and its promoter were identified on bacterial artificial chromosome (BAC) clones carrying the BoLA-DR genes. A 10-kbp promoter fragment was subcloned from one clone and a 1.7-kbp region including exon 1 and the promoter was sequenced. A 3-kbp fragment encoding exons 4-6 and the entire 3' untranslated region of the DRB3 gene was isolated from lambda clone A1 and sequenced. This provides us with improved characterization of the DRB3*0101 and DRB3*2002 alleles, and also subcloned 5' and 3' flanking regions of the polymorphic DRB3 gene for use in functional studies.     

MANAGEMENT OF VARICELLA-ZOSTER VIRUS INFECTION DURING PREGNANCY AND THE PERIPARTUM

This paper reviews the important concepts about varicella-zoster virus (VZV) infection, varicella (chickenpox), and herpes zoster (shingles, zoster) during pregnancy and the peripartum period. The majority of the U.S. population has had chickenpox during childhood, leaving only about 10% of adults over the age of 15 susceptible to the virus. However, nonimmune adults, including pregnant women, are at greater risk for complications and mortality when they contrac varicella. The virus is also teratogenic. The implication of VZV infection during pregnancy and the perinatal period are presented. Risks such as varicella pneumonia and congenital defects can be serious even though the incidence during pregnancy is low, one to five per 10,000 pregnancies. Management and treatment plans are presented. Counseling and education aimed at prevention or modification of the infection in the mother and baby is outlined.     

Comparison of the potential therapeutic effects of interleukin 2 or interleukin 4 secretion by a single tumour.

Engineering of a variety of rodent tumour cells to secrete either interleukin 2 (IL-2), or interleukin 4 (IL-4), has been demonstrated to reduce their tumorigenicity. However the mechanisms of action of secreted IL-2 and IL-4 have not been compared in a single rodent tumour. Here we demonstrate that the weakly immunogenic murine fibrosarcoma FS29 had reduced growth rate and in some cases was rejected by syngeneic animals, when modified to secrete either IL-2 or IL-4, but not IL-5. Immunohistochemical analysis of tumour nodules undergoing regression showed stimulation of a largely lymphocytic infiltrate by IL-2 and a macrophage and granulocyte infiltrate, with a small number of lymphocytes by IL-4. Indeed, secretion of low levels of IL-2 and IL-4 in combination resulted in optimal rejection, suggesting that the two cytokines might mobilise different and complementary effector cell mechanisms. Both IL-2 and IL-4-secreting cells failed to induce the rejection of admixed, unmodified FS29 cells. The loss of cytokine secreting cells from such admixtures occurred more rapidly for IL-2-secreting cells. Injection of IL-4-secreting, but not IL-2-secreting FS29 cells could protect mice from a delayed challenge with unmodified FS29 cells. These data suggest that IL-4 secretion stimulates the better long-term host anti-tumour response.     

Gastrointestinal damage associated with the use of nonsteroidal antiinflammatory drugs.

BACKGROUND. Long-term use of nonsteroidal antiinflammatory drugs (NSAIDs) may lead to inflammation of the small intestine associated with occult blood and protein loss. The aim of this study was to investigate the prevalence and structural correlates of this enteropathy. METHODS. We examined the stomach, duodenum, and small intestine of 713 patients post mortem. Of these patients, 249 had had NSAIDs prescribed during the six months before death and 464 patients had not. All visible small intestinal lesions were removed for histologic examination, and specific etiologic factors were sought. The prevalence of nonspecific small-intestinal ulcers and ulcers of the stomach and duodenum was compared in the two groups of patients. RESULTS. Nonspecific small-intestinal ulceration was found in 21 (8.4 percent) of the users of NSAIDs and 3 (0.6 percent) of the nonusers (difference, 7.8 percent; 95 percent confidence interval, 5.0 to 10.6 percent; P less than 0.001). Three patients who were long-term users of NSAIDs were found to have died of perforated nonspecific small-intestinal ulcers. Ulcers of the stomach or duodenum were found in 54 (21.7 percent) of the patients who used these drugs and 57 (12.3 percent) of those who had not (difference, 9.4 percent; 95 percent confidence interval, 3.9 to 15.1 percent; P less than 0.001). CONCLUSIONS. Patients who take NSAIDs have an increased risk of nonspecific ulceration of the small-intestinal mucosa. These ulcers are less common than ulcers of the stomach or duodenum, but can lead to life-threatening complications.     

Reconstruction of a functional and esthetic nail

The most common cause of nail bed deformity is trauma, but other causes are infection, tumor, ischemia, or congenital anomalies. This article includes discussions of nonadherence, split nail, reconstruction of the eponychium, crooked and hooked nail, bony irregularity, pachyonychia, ischemic deformities, and absence of the nail. New problems are encountered daily and other deformities have no method of correction recorded in the literature. For these cases, we provide suggested treatments based on the anatomy and physiology of the nail.