Medical student abuse: perceptions and experience

Summary. A questionnaire containing 18 vignettes of common clinical educational situations with potentially abusive treatment of medical students and a 10-item attitude assessment about abusive behaviour were administered to the first-and fourth-year medical students at a mid-west US university medical school. The first- and fourth-year groups did not differ significantly on perceived abusiveness of most of the vignettes, although several of the individual vignettes were perceived significantly differently by the two groups. As hypothesized, the fourth-year students had experienced such situations more frequently. Attitudes towards abusive behaviour did not differ between the two groups. The authors contrast teaching interactions perceived as educationally useful and not abusive with those seen as abusive and not useful and offer explanations for the differences observed. Finally, the possible implications of the results for medical education are discussed.     

USE OF ATRACURIUM OR VECURONIUM TO PROLONG THE ACTION OF TUBOCURARINE

Forty patients received tubocurarine in a dose greater thanED₉₀. When neuromuscular function had recovered to amplitudeof the first contraction of the train-of-four equals 10% ofcontrol, a small increment of atracurium or vecuronium was administered,repeating the same increment at each subsequent recovery to10%. The intensity and duration of the neuromuscular block followingthe first increment was always greater than that of subsequentincrements. The duration and intensity of the block was progressivelyreduced with subsequent increments until the responses to furtherincrements were unchanged. These final means at steady statewere: group 1 (atracurium 1.1 mg) 6.4 (0.3) min; group 2 (atracurium2.0 mg) 8.2 (0.9) min; group 3 (vecuronium 0.25 mg) 5.8 (0.4)min; group 4 (vecuronium 0.5 mg) 13.2 (0.4) min.     

Application of monoclonal antibodies against major basic protein (BMK-13) and eosinophil cationic protein (EG1 and EG2) for quantifying eosinophils in bronchial biopsies from atopic asthma

A monoclonal antibody prepared against the eosinophil major basis protein (MBP) was compared with the anti-eosinophil cationic protein (ECP) antibodies (EG1 and EG2) in immunostaining of bronchial biopsies from atopic asthma and controls. Anti-MBP (designated BMK-13) did not cross-react with other eosinophil basic proteins (i.e. ECP, eosinophil peroxidase [EPO] or eosinophil-derived neurotoxin [EDN]) and stained more than 98% of peripheral blood eosinophils irrespective of their degree of activation. EG2 stained 15% of resting and 75% of activated eosinophils; EG1 recognized 74% and 78% of resting and activated cells, respectively. The numbers of BMK-13, EG1 or EG2-positive staining cells in bronchial biopsies from asthma were significantly greater than atopic non-asthmatics (P less than 0.02, P less than 0.01 and P less than 0.05, respectively) and normal non-atopic controls (P less than 0.001). For each of the various groups studied, the rank order for the number of eosinophils stained was BMK-13 greater than EG1 greater than EG2. BMK-13 stained significantly more cells from bronchial biopsies of atopic asthma and atopic non asthma when compared to EG2 (P less than 0.001 and P less than 0.05, respectively). Since only a proportion of BMK-13+ cells were EG2+, these results suggest that not all tissue eosinophils are actively secreting. Thus, BMK-13 can serve as a useful pan-eosinophil marker in tissue sections since it appears to stain most eosinophils.     

IL-5 production by allergen-stimulated T cells following grass pollen immunotherapy for seasonal allergic rhinitis

We have previously identified the hevein preprotein as a common allergen for latex allergic healthcare workers. The B cell epitopes in the hevein protein that are recognized by IgE of latex-allergic individuals have not been identified. In this study, we examined the hevein preprotein using epitope mapping. Overlapping synthetic peptides of 10 amino acids (two aa overlap) were synthesized on a derivatized cellulose membrane using Fmoc chemistry. The peptide spots were probed with pooled sera from 10 latex-allergic patients, and the IgE-reactive peptides identified with anti-IgE MoAbs. We identified six B cell epitopes within the full length hevein preprotein which bound IgE from latex-allergic patients. Two were located in the N-terminal 5-kD hevein domain and four were observed in the 14-kD C-domain. A broad epitope was located between the N-terminal amino acids 13–24. This epitope had nearly complete homology to wheat germ agglutinin (WGA). Immunological cross-reactivity to WGA was confirmed by Western blot analysis with purified WGA, and this reactivity could be inhibited by latex proteins or WGA. Of the five remaining epitopes, four had homologies to other proteins in the pathogenesis-related family of plant proteins (PR-4). The data demonstrate that hevein has multiple IgE epitopes. The significant homology of these epitopes to a broad family of plant defence proteins further explains the increased prevalence of food allergies in latex-allergic individuals.     

Ultrastructural, Protein, and Lipid Changes in Liver Associated with Chlordecone Treatment of Mice

Pretreatment of mice with chlordecone (CD) reduced hepatic accumulationof a subsequent dose of [¹⁴C]CD without significantly changing[¹⁴C]CD biotransformation. To determine if CD-induced changesin hepatic [¹⁴C]CD accumulation were coincident with alteredcell composition, we examined the effects of CD on hepatic proteinand lipid content, on fatty acid profiles of liver and kidney,and on the ultrastructure of hepatocytes. SDS-polyacrylamidegel electrophoresis detected an apparent CD dose-related increasein a microsomal protein with a molecular weight of about 23kDa. Total liver or kidney lipid contents were not altered byCD but relative amounts of several hepatic fatty acids werechanged. CD caused marked hepatic mitochondrial swelling, increasedamounts of endoplasmic reticulum, apparently increased numbersof peroxisome-like structures, and decreased numbers of lipiddroplets in cytoplasm of hepatocytes. Numbers of lipid dropletswere not decreased in perisinusoidal fat storage cells. In addition,the numbers of cytoplasmic lipoprotein vesicles were apparentlyincreased in some hepatocytes. Overall these changes indicatedan increased hepatocyte secretory activity and suggested thatCD changed hepatocellular lipid transport, storage, and metabolismpathways.