A statistical method for analyzing rating scale data: the BBB locomotor score

The Basso, Beattie and Bresnahan (BBB) locomotor rating scale is widely used to test behavioral consequences of spinal cord injury (SCI) to the rat. Sensitivity of this rating scale can differentiate hind limb locomotor skills over a wide range of injury severities. While the 21-point BBB scale is ordinal in nature, the present discussion recommends the use of parametric statistics to evaluate the locomotor results. Specifically, it defines appropriate statistical analysis of these data in order to facilitate interpretation of results between laboratories and to provide a common methodology for the correct interpretation of SCI behavioral data.     

Ethanol impairs behavioral strategy use in naive rats but does not prevent spatial learning in the water maze in pretrained rats

Abstract Rationale . Ethanol impairs performance in the water maze in rats. A detailed behavioral analysis is required to fully evaluate the nature of the impairment. Objectives. A detailed behavioral analysis was carried out to evaluate the effect of ethanol on performance in the water maze task in male hooded rats given 2.0 or 6.0 g/kg ethanol by gavage. Multiple measures of water maze strategies learning and spatial learning were studied. Methods . Water maze trials were recorded on videotape and digitized for offline analysis. Some rats were naive at the start of spatial training, whereas other rats received water maze strategies pretraining prior to spatial training to familiarize them with the general behavioral strategies required in the task. Results . Naive ethanol-treated rats exhibited both spatial learning and water maze behavioral strategies impairments. There was no evidence of a spatial learning impairment that was independent of an associated behavioral strategies impairment. Further, ethanol impaired the ability of naive rats to swim to a stable visible platform. Pretrained ethanol-treated rats performed significantly better than naive ethanol-treated rats on almost all measures, and were indistinguishable from controls on most measures. Conclusions . These results suggest that ethanol may impair water maze performance in naive rats by interfering with their ability to acquire and use required water maze behavioral strategies and generate adaptive swim paths. Ethanol does not prevent robust spatial learning in rats that are familiar with required water maze behavioral strategies. Electronic Publication     

Long-term followup and outcome of continent catheterizable vesicocstomy using the Rink modification

PURPOSE: Multiple techniques have been described to create a Mitrofanoff channel in the pediatric population. A small subset of patients only requires creation of a catheterizable channel without bladder augmentation. These patients are ideal candidates for a procedure that avoids the use of intestine, especially in the absence of a suitable appendix. We used a modification of the Casale vesicostomy, as described by Rink, to create a continent vesicostomy in these children. We report our long-term experience with this technique. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all patients who underwent continent vesicostomy at our institution between 1992 and 2000. Patient diagnosis, stomal site, associated bladder procedures, stomal continence, followup and complications associated with continent vesicostomy were documented. RESULTS: Of the 31 patients who underwent continent vesicostomy, as described by Rink, 14 were female and 17 were male. Average age was 9 years (range 2.5 to 22). Primary diagnosis included neuropathic bladder in 15 cases, the prune-belly syndrome in 6, cloacal exstrophy/anomaly in 5 and other in 5. The stoma was placed in the lower abdomen in 17 patients, in the umbilicus in 7 and in a neoumbilicus in 7. Simultaneous procedures included ureteral reimplantation in 8 cases, bladder augmentation in 5, bladder neck surgery in 4 and reduction cystoplasty in 2. Mean followup was 41 months. All patients achieved excellent stomal continence. Complications included stomal stenosis requiring revision in 14 cases (45%). Stenosis developed in 60% of the patients with neuropathic bladder and in 86% with an umbilical stoma. Eventually 6 patients underwent conversion to an alternative catheterizable channel. CONCLUSIONS: Continent vesicostomy can be performed successfully when there is any underlying bladder pathology with 100% stomal continence. Despite the higher rate of stomal problems with this type of Mitrofanoff channel we think that continent vesicostomy is a reasonable alternative in patients with a large bladder requiring only catheterizable channel creation. Because of the excellent results reported with the Monti-Yang technique, we would currently recommend this procedure over continent vesicostomy when bowel is used for bladder reconstruction.     

Colour duplex Doppler ultrasonography evaluation of non‐vasculogenic male erectile dysfunction: An Indian perspective

We present the study of colour duplex Doppler ultrasonography on Indian patients with non‐vasculogenic erectile dysfunction. Patients with a history suggestive of psychogenic impotence along with a normal clinical response to intracavernosal papaverine were presumed to have non‐vasculogenic erectile dysfunction. In our patients, the incidence of psychogenic impotence was much higher and the mean age of patients presenting with erectile dysfunction was lower as compared to patients from developed countries reported in research. The Doppler flowmetry showed much higher mean peak systolic velocities (PSVs) with a negative correlation between age and PSV. End diastolic velocity, resistive index and acceleration time values conformed to the literature.     

Interleukin-12 neutralization alters lung inflammation and leukocyte expression of CD80, CD86, and major histocompatibility complex class II in mice infected with Histoplasma capsulatum

Histoplasma capsulatum induces a cell-mediated immune response in lungs and lymphoid organs of mammals. Resolution of primary infection in mice depends on interleukin-12 (IL-12), since neutralization of this monokine increases susceptibility to infection. The present study was designed to determine if blockade of IL-12 disrupts the protective immune response by altering the influx of lineage-specific cells into infected lungs and the numbers of cells expressing CD80, CD86, CD119, and major histocompatibility complex class II (MHC II) molecules. In mice given anti-IL-12, there was a 2.5-fold decrease in total numbers of T cells on days 3 to 10 of infection and a 4-fold increase in Mac-1/Gr-1(+) cells on days 7 and 10 compared to infected controls. CD80(+) lung cells from anti-IL-12-treated mice were 2- to 3-fold greater than those from controls on days 7 and 10, whereas the total numbers of CD86(+) cells were 2- to 3-fold less and MHC II(+) cells were 1.5- to 2-fold less on days 3 and 5. Cells expressing CD119 were reduced 1.5-fold on day 5. Treatment with monoclonal antibodies (MAb) to CD80, CD86, or both reduced the fungal burden slightly compared to that in rat immunoglobulin G-treated controls, whereas after IL-12 neutralization, blocking of CD80 reduced the tissue burden by 2. 5-fold and this correlated with a decrease in IL-4. Regardless, mortality was not altered by treatment with MAb to CD80 or CD86. We conclude that (i) IL-12 neutralization alters the nature of the inflammatory response in lungs and the expression of CD80 and CD86 on lineage-specific cells, (ii) the immune response during infection with H. capsulatum is controlled via mechanisms independent of the CD80 and CD86 costimulatory pathways, and (iii) decreased expression of CD86 and MHC II may modulate generation of optimal protective immunity.     

Clear Cell Carcinoma of the Ovary: A Distinct Histologic Type with Poor Prognosis and Resistance to Platinum-Based Chemotherapy in Stage III Disease

Between 1982 and 1992, 24 women with Stage III clear cell ovarian cancer were identified from the tumor registry. Thirty-four women with Stage III papillary serous tumors treated between 1987 and 1989 were used as a comparison. All patients underwent cytoreductive surgery followed by conventional platinum-based chemotherapy. In the women with clear cell histology, nine (37.5%) had endometriosis in the surgical specimen compared with one (3%) in the papillary serous group (P= 0.002). Ten women (42%) with clear cell histology experienced a thromboembolic event during the course of treatment, compared to six (18%) in the papillary serous group (P= 0.05). In the group with clear cell histology, overall, 70% of women had progressive disease. Fifty-two percent experienced clinical progression while receiving platinum-based chemotherapy. In addition, four patients were found to have progressive disease at second-look laparotomy. Only two patients had a pathologic complete response. In the group with papillary serous histology, 29% overall had progressive disease while on chemotherapy (P= 0.005). The median survival for the women with clear cell histology was 12 months compared to 22 months for those with papillary serous (P= 0.02). For women with clear cell histology, univariate analysis was used to evaluate prognostic factors. Age less than 50 was a poor prognostic factor (P= 0.045). The presence of endometriosis, thromboembolic event, or optimal cytoreduction were not prognostic factors (P= 0.67,P= 0.34,P= 0.39). Patients with advanced clear cell ovarian cancer have a poor response to conventional platinum-based chemotherapy and overall prognosis is poor.     

Haemodynamic Effects of Low Doses of Female Sex Steroids

Summary: Haemodynamic changes were monitored serially in 3 groups of healthy young women taking (i) a combined oestrogen-gestagen oral contraceptive containing a low dose of oestrogen, (ii) an oestrogen alone and (iii) a gestagen alone. Similar significant increases in plasma volume occurred in those women taking the combined preparation and in those taking the oestrogen. A small but significant decrease in forearm blood flow occurred in subjects taking the combined oral contraceptive. Cardiac output, blood pressure, heart rate and hand blood flow did not alter significantly in any of the 3 groups of subjects, while body weight increased in the subjects taking gestagen alone.
It is concluded that the combined oestrogen-gestagen oral contraceptives containing 50 μg. of oestrogen result in minimal haemodynamic side effects, and hence are safer than the older combined preparations containing a higher dose of oestrogen. The increase in plasma volume observed was due to oestrogen rather than gestagen. No additional information was obtained concerning the site of sex steroid action in the cardio-vascular system.     

Establishing good practices in continuing care: a descriptive study of community nursing services for people with HIV infection

This paper presents findings from a 2-year study of community nursing services for people affected by HIV infection in six health authorities in England The research, commissioned by the Department of Health, England, aimed to identify the main bridges and barriers to effective home nursing care, focusing on discharge co-ordination, district nursing and multi-agency collaboration Using a triangulated, case study approach, the main methods of data collection included non-participant observation, case note analysis, semi-structured staff interviews, a postal questionnaire of district nurses and a series of focus groups with service users Study sites included three cities and surrounding districts in the north west, north and south east of England Findings suggest there is considerable room for improvement in discharge planning and that good practice is not the preserve of specialist units District nurses are shown to be willing providers of the majority of home nursing care to this client group, but there is a need for more focused training, greater use of care co-ordinators and more emotional and managerial support     

The theory/practice 'gap': taking issue with the issue

Theory/practice issues have a long-standing history in nurse education, and are a chronic source of controversy to which there is no easy or perfect solution We have argued that it is the tension between theory and practice and research which can be usefully exploited in teaching and research Students need to be introduced to the debates surrounding the genesis and generation of nursing knowledge They need to gain an appreciation of what counts as nursing knowledge at different points in time and the politics which drive the legitimation of nursing theory and practice Such an approach has much to offer in helping students deal with reality shock and make sense of their experience as they confront the ambiguities, uncertainties and contradictions that characterize the stock-in-trade of professional life