Analysis of the Neutralizing Antibody Response to the Measles Virus Using Synthetic Peptides of the Haemagglutinin Protein

Infection or immunization with measles virus induces a protective immune reaction including neutralizing antibodies against the haemagglutinin and fusion protein. The reactivity of the polyclonal IgG response of sera obtained from late convalescent donors was studied, using overlapping 15mer peptides covering the complete sequence of the measles virus haemagglutinin. Most sera reacted with a similar set of peptides generating a characteristic binding pattern. The reactive peptides correspond to a region mediating cell hemolysis (aa310–325), to regions which serve as targets to neutralizing antibodies and to a putative transmembrane region (aa35–58). The latter region contains also a human T-cell epitope providing evidence of a non-random association of T- and B-cell epitopes. We also immunized different strains of mice and rabbits with measles virus. In contrast to the human sera, animal sera with strong neutralizing activities did not react with any of the H-protein peptides. The mostly weak reactivities with the linear sequences contrast with the strong neutralizing activities of the human or animal antibodies, suggesting that these primarily recognize the fusion protein or conformational epitopes of the haemagglutinin protein.     

Helping Smokers Quit: Understanding the Barriers to Utilization of Smoking Cessation Services

Context: Counseling smokers to quit smoking and providing them with pharmaceutical cessation aides are among the most beneficial and cost‐effective interventions that clinicians can offer patients. Yet assistance with quitting is not universally covered by health plans or offered by all clinicians. Analysis of stakeholders' perspectives and interests can identify the barriers to more widespread provision of cessation services and suggest strategies for the public policy agenda to advance smoking cessation. Methods: Review of literature and discussions with representatives of stakeholders. Findings: All stakeholders—health plans, employers, clinicians, smokers, and the government—face barriers to broader smoking cessation activities. These range from health plans' perceiving that covering counseling and pharmacotherapy will increase costs without producing commensurate health care savings, to clinicians' feeling unprepared and uncompensated for counseling. Like other preventive measures aimed at behavior, efforts directed at smoking cessation have marginal status among health care interventions. State governments can help correct this status by increasing Medicaid coverage of treatment and expanding coverage for state employees. The federal government can promote the adoption of six initiatives recommended by a government subcommittee on cessation: set up a national quit line, develop a media campaign to encourage cessation, include cessation benefits in all federally funded insurance plans, create a research infrastructure to improve cessation rates, develop a clinician training agenda, and create a fund to increase cessation activities through a new $2 per pack cigarette excise tax. Both the federal and state governments can increase cessation by adopting policies such as the higher cigarette tax and laws prohibiting smoking in workplaces and public places. Conclusions: Public policy efforts should assume greater social responsibility for smoking cessation, including more aggressive leadership at the state and federal levels, as well as through advocacy, public health, and clinician organizations.     

Causes and signs of temporomandibular joint pain and dysfunction: an electromyographical investigation

The spontaneous muscular activity of the masseter and two non-masticatory muscles, and their activity under conditions of noise and flickering light, were recorded in 30 patients with mandibular dysfunction, and in 25 control subjects. The mood of the subjects during the investigation, and the possible presence of emotional disturbances was evaluated by means of questionnaires. The enhanced muscular activity of the masseter muscle differentiated patients from the control group, although it does not constitute a pathognomic sign. Unilaterality of complaints, and dysfunctions of differing intensity were not reflected in differential EMG findings. One-fifth of the patients exhibited neck muscle activity occurring simultaneously with the masseter activity. The effect of the applied stimuli on the muscular activity was not homogeneous, leading to activation in some cases and inhibition in others. Symptoms of anxiety could be observed in seven TMJ patients. Anxious patients showed higher levels of muscular activity and emotional irritability during the experiment than non-anxious patients.     

Clinical Results of Far‐Field R‐Wave Reduction with a Short Tip‐Ring Electrode

Background: Far‐field R‐wave (FFRW) sensing of the atrial lead of AAI or DDD pacemakers causes incorrect mode switches and remains a problem in patients with atrial arrhythmias in whom low voltage sensing is essential. We studied a pacing electrode with a short tip‐ring distance (1.1 mm). We compared our findings with recordings from a conventional electrode with a larger tip‐ring distance (10 mm). Methods: Thirty‐six consecutive patients with an indication for DDD pacing were implanted with the short tip‐ring electrode. Another 23 patients received the conventional electrode. FFRW and P‐wave amplitudes during pacing and intrinsic ventricular depolarization were measured at implantation. Measurements were repeated before hospital discharge and at follow‐up between 10 and 14 days after implantation. Results: P‐wave amplitude was slightly smaller in the short tip‐ring group (2.71 ± 1.04 vs 3.17 ± 1.30 mV in the conventional group, respectively, P = NS). All P‐waves exceeded 1.2 mV. FFRW during pacing was 0.07 ± 0.05 in the short tip‐ring group and 0.54 ± 0.32 mV in the conventional group (P < 0.001). FFRW during intrinsic rhythm was 0.08 ± 0.04 and 0.55 ± 0.31 mV, respectively (P < 0.001). The ratio between P‐wave and FFRW was 48.6 ± 27.2 in the short tip‐ring group and 7.3 ± 4.4 in the conventional group (P < 0.001). FFRW and P‐wave amplitudes did not change at hospital discharge or during follow‐up. Conclusion: FFRW can be suppressed without compromising P‐wave sensing by using a pacing electrode with a short tip‐ring distance. Whether reduced FFRW amplitude results in clinical endpoints remains to be determined.     

The effect of acute protein deprivation upon erythropoiesis in rats

1. Hemoglobin concentration, blood volume, and erythrocyte radioiron uptake were measured in rats subjected to acute protein deficiency.

2. Removal of protein from the diet was followed promptly by hemoconcentration, diminution in blood volume, and drastic reduction in erythropoiesis.These changes were reversible, after 35 days, upon addition of protein tothe diet.

3. Protein intake is more essential for maintenance of normal erythropoiesisthan is total caloric intake.

4. The data suggest that hemoglobin concentration within the vascularsystem is more important than red cell volume in regulating erythropoieticrate.

Submitted on June 27, 1957 Accepted on September 15, 1957     

Transtelephonic Monitoring of a Tachycardia-terminating Pacemaker

A 66-year-old female with recurrent supraventricular tachycardia which worsened progressively was treated with an implanted tachycardia-terminating pacemaker after treatment with antiarrhythmic drug therapy had failed. The pacemaker had the capacity to detect and respond to tachyarrhythmias. Reliable sensing and termination of the patients tachycardia was accomplished in over 100 inductions of the tachyarrhythmia. Use of this tachycardia-terminating pacer has given us several new insights that may be important in the care and follow-up of all pacemaker patients.