Group protocol to mitigate disaster stress and enhance social support in adolescents exposed to Hurricane Hugo.

Literature reports that cognitive understanding and social support can mitigate stress in both adults and adolescents. As a subcomponent of the Carolina Adolescent Health Project (CAHP), this research evaluated the efficacy of a Cognitive Social Support (CSS) group protocol designed to mitigate the disaster stress of adolescents who had been exposed seriously to Hurricane Hugo. A purposive sample of 259 students participated in and evaluated the CSS. This article reports the specific structure, content, process, rationale, and cost of the CSS. Evaluations indicated that 82% of the students evaluated the small-group component of the CSS as "very good" or "excellent," while 70% rated the large-group component as "very good" or "excellent."     

Operative venodilation: a previously unsuspected factor in the cause of postoperative deep vein thrombosis

Intraoperative venodilation in veins distant from the site of operation has been shown to occur in animals and has been directly correlated with focal venous endothelial damage. This exposure of subendothelial collagen could serve as initiation sites for thrombus formation. This study tests the hypothesis that human beings (1) significant operative venodilation occurs and that it correlates with postoperative deep venous thrombosis (DVT); (2) operative venodilation can be pharmacologically controlled; and (3) this control reduces the incidence of postoperative DVT. Twenty-one patients undergoing total hip replacement had their contralateral cephalic vein continuously monitored with modified ultrasonographic instrumentation, with a continuous on-line recorder graphing venous diameter. Patients were randomly assigned to receive 0.5 mg of dihydroergotamine and 5000 U of heparin (DHE/Hep) for prophylaxis or placebo, with investigators "blinded" Postoperatively, all patients underwent ascending phlebography. Patients in whom postoperative DVT developed (11) had a mean operative venodilation of 28.9% +/- 3.93%, and those in whom DVT did not develop (10) had a mean venodilation of 11.6% +/- 1.55% (p = 0.001). Only 17% (2/12) dilating less than 20% baseline diameter had DVT compared with 100% (9/9) dilating greater than 20% of baseline diameter (p = 0.002). Patients receiving venotonic agent DHE had significantly less venodilation and DVT (p less than 0.001) compared with patients receiving the placebo. Patients who had DVT and whose veins dilated greater than 20% were older than patients who did not have DVT and whose veins minimally dilated: p = 0.04 and p = 0.07, respectively. Although there was a trend toward increased venoconstriction in patients receiving DHE/Hep (p = 0.09), there was no correlation of venoconstriction with ultimate thrombotic outcome. Maximal venodilation occurs during handling of soft tissue (muscle), and this occurs significantly sooner than maximal venoconstriction, which occurs during bone manipulation. We conclude that excessive operative venodilation is a new and important etiologic factor that leads to postoperative DVT. Operative venodilation can be pharmacologically controlled with the venotonic agent DHE. The combination DHE/Hep reduces postoperative DVT by the reduction of operative venodilation in the presence of low doses of an anticoagulant. These findings offer a new approach for predicting postoperative DVT and an object rationale for developing effective prophylaxis.     

The functional activities of IgG and IgM anti-A and anti-B

The rate constants for association and dissociation, and the equilibrium constants, were determined for ¹²⁵I-labelled anti-A and anti-B of both IgG and IgM molecular types. The following results and conclusions were obtained:

1. The equilibrium constants were within the range 06×10⁸–13.0×10⁸ l/mole, and were of the same order for both IgG and IgM antibodies.

2. The initial rate constants for association were in the range 2.1×10⁵–4.8×10⁵ l/mole/sec, and the energy of activation (E_a) 6700–9000 cal/mole. These results indicate that the rate of association is approaching the limit set by the rate of diffusion of the reactants.

3. The initial rate constants for dissociation were 1 × 10^-4–5 × 10^-4/sec and E_a = 20,000–36,000 cal/mole. These latter values suggest that more than one bond must be broken simultaneously during dissociation.

4. Ionic strength and pH changes have only a minor effect on the constants; this indicates absence of ionic groups on A and B antigen sites.

5. The changes in enthalpy were –5400 to –21,800 cal/mole; the reactions are mainly enthalpy driven and this accounts for the fact that anti-A and anti-B agglutination titres increase as the temperature is decresed.

6. There was heterogeneity of the values of the standard change in free energy, enthalpy and entropy within each example of antibody.

7. The approximate concentrations of antibody at the end-points of the agglutination titres were: for IgG antibody, 0.2 μg/ml; for IgM antibody, 0.01 μg/ml.

     

Longitudinal histopathologic assessment of rejection after bladder-drained canine pancreas allograft transplantation

In preparation for assessment of percutaneous biopsies in our clinical pancreas transplant program, a working knowledge of the histopathologic changes after transplantation was obtained in a longitudinal open biopsy study of 16 dogs receiving bladder-drained whole pancreas allografts. Edema, extravasation of polymorphs, and lymphocytes associated with focal parenchymal injury were early, invariable, and probably nonspecific findings. The initial feature of unmodified rejection was the appearance of capillary and small vein endothelial changes with mainly perivascular inflammatory cell infiltration. Acinar cell loss occurred early and was progressive, whereas islets and ducts were relatively preserved, indicating that acinar tissue may be more vulnerable to lytic necrosis when damaged. Functional rejection, determined by fasting urinary amylase levels, was at a stage of extensive and irreversible necrosis. Functioning grafts in immunosuppressed dogs had minor and transient endothelial changes with absence of class II antigen staining of parenchymal cells.     

Host immune status in uraemia. I. Cell-mediated immune mechanisms.

An experimental model of stable uraemia has been used to determine the effect of uraemia on cell-mediated immune mechanisms in the rat. Controlled resection of renal tissue allowed the establishment of a 'moderate' (blood urea 100-200 mg/100 ml) and 'severe' grade of uraemia (BU > 200 mg/100 ml). The immune responsiveness of isolated lymphocyte suspensions from uraemic animals was similar to that of sham-operated animals but lymphocyte function in both groups was suppressed compared with control non-manipulated animals. This was particularly evident in the graft vs host reaction. The host vs graft which assumes the cell-mediated immune status in the live animals, was also depressed in the uraemic animals but in contrast to the previous results sham-operated animals exhibited normal responses. The results underscore the importance of surgically induced anergy as a factor complicating the assessment of immune function in uraemia and may explain some of the inconsistencies observed in the evaluation of cell-mediated immunity by in vitro analysis of lymphocyte suspensions and tests of immune function in the intact host.     

Long-term wear of ceramic matrix composite materials for hip prostheses under severe swing phase microseparation

The purpose of this study was to evaluate the long-term wear performance of alumina matrix composite (AMC) heads against alumina matrix composite inserts and alumina matrix composite heads against alumina (Al) inserts with the use of a hip-joint simulator incorporating severe swing phase joint microseparation. The wear of AMC on Al produced an average wear rate of 0.61 mm3/million cycles over the 5-million-cycle test duration. The wear of AMC on AMC produced an average wear rate of 0.16 mm3/million cycles over the 5-million-cycle test duration. Both the AMC on alumina and AMC on AMC produced significantly lower wear than previously tested HIPed alumina, where an average wear rate of 1.84 mm3/million cycles was reported over 5 million cycles. The wear mechanisms and wear debris of AMC on AMC and AMC on Al were similar to those observed in previous alumina retrieval studies with stripe wear caused by intragranular fracture and wear debris consisting of predominantly uniform 10-20-nm-sized particles and a few irregular particles up to 3 microm in size.     

Cholinergic stimulation of ouabain-sensitive respiration in rat submandibular gland

Oxygen consumption of slices of rat submandibular gland was monitored with an oxygen electrode method. Carbachol stimulated an immediate increase in tissue respiration that was inhibitable by ouabain. The stimulation required the presence of calcium in the incubation medium and was blocked by atropine. The calcium ionophore A23187 also stimulated ouabain-sensitive oxygen consumption in the tissue slices. The results show that the mechanism using the extra energy during cholinergic stimulation is the sodium pump. Amiloride at a 1, 10, or 100 microM concentration had no effect on stimulation of ouabain-sensitive respiration by carbachol. Since amiloride, which is known to block the sodium reabsorption process in the ductal segment, has no effect on the stimulation, the increased sodium pump activity is probably located in the acinar region and is associated with the primary fluid secretion process.     

Ribosomal binding sites on poliovirus RNA

Eucaryotic ribosome binding sites on type 1 poliovirus RNA were obtained by isolation of T1 RNase-resistant RNA fragments from 80 S ribosomes that had been bound under conditions specific for initiation of translation and prevented from translocation with sparsomycin. The fragments were analyzed by two-dimensional polyacrylamide gel electrophoresis. Three ribosome-protected (RP) oligonucleotides and several non-ribosomal-protein-protected (NP) oligonucletides were analyzed. Secondary T1 digestion of the RP fragments revealed that at least three separate species existed. By comparison of these secondary digests to T1 digests of RNaseIII fragments mapped on the polio RNA, and by electron microscopic observation of ribosomes bound to polio RNA, preferred ribosome binding sites were localized to near 115 bases from the 5′ end, just to the 3′ side of midgenome, and 780 bases from the 3′ end.     

Impaired Microvascular Function in Normal Children: Effects of Adiposity and Poor Glucose Handling

Clustering of cardiovascular risk factors is thought to occur early in life. The endothelium is an important regulator of microvascular function. We investigated the relationship between microvascular function and cardiovascular risk factors in 145 normal, healthy children aged 11-14 years. Skin microvascular responses, measured using laser Doppler imaging, to iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), were negatively correlated with percentage body fat ( r =−0.20, P < 0.05 and r =−0.18, P < 0.05, respectively). Subjects were stratified into quintiles based on 2-h, post-feeding glucose levels. Subjects in the upper glucose quintile (range 7.4-11.4 mmol l⁻¹) showed significantly lower vasodilatation to both ACh (   P < 0.005  ) and SNP (   P < 0.02  ) than those in the lower quintile (range 3.9-4.9 mmol l⁻¹). Waist-to-hip ratio and the fasting insulin resistance index were significantly greater in subjects in the upper quintile than those in the lower quintile ( P < 0.001 and P < 0.05, respectively). Additionally, in subjects in the upper glucose quintile, fasting triglyceride correlated with fasting insulin ( r = 0.59, P < 0.001) and with the fasting insulin resistance index ( r = 0.49, P < 0.009), and plasma levels of cholesterol and 2-h glucose were also correlated ( r = 0.40, P < 0.05). In a cross-section of normal children, microvascular function was negatively associated with adiposity. Additionally, in a subgroup of subjects, there was a clustering of high post-feeding glucose, impaired microvascular function, increased insulin resistance and higher central fat distribution. These findings suggest that risk factors for adult cardiovascular disease begin to cluster in normal children, which might have important consequences for development of atherosclerosis later in life.