Prehospital tracheal intubation in severe facial trauma: a short window of opportunity.

A case of severe facial injury is described. The pre-hospital management including pre-hospital anaesthesia and intubation and the importance of advanced anaesthetic skills in rare trauma cases is discussed. In addition the rare situation where large bone fragments are retrieved from the scene and potentially used in reconstruction is mentioned.

GABA(A) receptors containing (alpha)5 subunits in the CA1 and CA3 hippocampal fields regulate ethanol-motivated behaviors: an extended ethanol reward circuitry.

GABA receptors within the mesolimbic circuitry have been proposed to play a role in regulating alcohol-seeking behaviors in the alcohol-preferring (P) rat. However, the precise GABA(A) receptor subunit(s) mediating the reinforcing properties of EtOH remains unknown. We examined the capacity of intrahippocampal infusions of an alpha5 subunit-selective ( approximately 75-fold) benzodiazepine (BDZ) inverse agonist [i.e., RY 023 (RY) (tert-butyl 8-(trimethylsilyl) acetylene-5,6-dihydro-5-methyl-6-oxo-4H-imidazo [1,5a] [1,4] benzodiazepine-3-carboxylate)] to alter lever pressing maintained by concurrent presentation of EtOH (10% v/v) and a saccharin solution (0.05% w/v). Bilateral (1.5-20 microgram) and unilateral (0.01-40 microgram) RY dose-dependently reduced EtOH-maintained responding, with saccharin-maintained responding being reduced only with the highest doses (e.g., 20 and 40 microgram). The competitive BDZ antagonist ZK 93426 (ZK) (7 microgram) reversed the RY-induced suppression on EtOH-maintained responding, confirming that the effect was mediated via the BDZ site on the GABA(A) receptor complex. Intrahippocampal modulation of the EtOH-maintained responding was site-specific; no antagonism by RY after intra-accumbens [nucleus accumbens (NACC)] and intraventral tegmental [ventral tegmental area (VTA)] infusions was observed. Because the VTA and NACC contain very high densities of alpha1 and alpha2 subunits, respectively, we determined whether RY exhibited a "negative" or "neutral" pharmacological profile at recombinant alpha1beta3gamma2, alpha2beta3gamma2, and alpha5beta3gamma2 receptors expressed in Xenopus oocytes. RY produced "classic" inverse agonism at all alpha receptor subtypes; thus, a neutral efficacy was not sufficient to explain the failure of RY to alter EtOH responding in the NACC or VTA. The results provide the first demonstration that the alpha5-containing GABA(A) receptors in the hippocampus play an important role in regulating EtOH-seeking behaviors.

Radiation-induced apoptosis of human prostate cancer cells is independent of mutant p53 overexpression.

BACKGROUND: Previous studies have demonstrated that androgen-independent prostate cancer cancer cells undergo apoptosis in response to ionizing irradiation. The p53 protein controls cell cycle arrest and apoptosis by acting as a checkpoint control that halts the cell cycle in G1, while DNA damage is present. In this study the effect of overexpression of mutant p53 protein, on radiation-induced apoptotic cell death of human prostate cancer cells PC-3 was investigated. MATERIALS AND METHODS: PC-3 cells were transfected with the plasmid encoding the mutant p53 sequence, and the neomycin resistance gene. Selected transfectant clones, were characterized at the molecular level (gene integration, and level of mRNA and protein expression) and cloned transfectants expressing high levels of p53 protein were treated with increasing doses of ionizing irradiation. The cellular response to radiation was determined on the basis of: a) clonogenic survival (colony forming ability of irradiated cells); b) induction of apoptosis as determined by the terminal transferase assay; c) apoptotic DNA fragmentation; and d) induction of expression of genes associated with prostate-apoptosis. RESULTS: Both mutant p53 transfectant and parental PC-3 cells underwent apoptosis in response to ionizing irradiation following similar kinetics of induction of DNA fragmentation. In addition, the magnitude of induction of expression of prostate apoptosis associated genes, SGP-2 and TGF-beta, was similar in the mutant p53 overexpressing and parental PC-3 cells and coincidental with DNA fragmentation. CONCLUSIONS: These findings seriously challenge the involvement of p53 in radiation-induced apoptosis in human prostate cancer cells and suggest that p53 mutations provide no selective advantage in the development of radioresistance of prostate tumor cells within the context of p53 independent apoptotic pathway.

Lack of comutagenicity by norharman and other compounds on revertants induced by photolabeling with 2-azido-9-fluorenone oxime.

Mutations were induced by photolabeling 2-azido-9-fluorenone oxime in Salmonella typhimurium tester strain TA1538. Since the critical adducts were formed directly by the photogenerated nitrene, metabolic activation was bypassed. The bacteria themselves possessed the deep rough cell wall and uvrB- mutations, thereby minimizing comutagenic effects resulting from transport or DNA repair. This technique thus permitted detection of comutagenicity resulting from alteration in the binding of the mutagen to its critical receptor. No compound tested increased mutagenicity. Cholic acid had no effect at low dose, but inhibited mutagenicity at 10(-4) M, while trans-retinol no effect at any concentration. Harman, norharman and ethidium reduced the number of mutants only slightly at concentrations from 10(-6) to 10(-5) M.

Azido analogs of acridine: photoaffinity probes for frameshift mutagenesis in Salmonella typhimurium.

In order to identify a photoaffinity probe for 9-aminoacridine frameshift mutagenesis, 20 azido analogs of acridine were synthesized and tested in Ames' Salmonella tester strains, TA1535, TA1537, TA1538 and their corresponding excision-repair-coefficient strains TA1975, TA1977 and TA1978, to determine their mutagenicity and toxicity relative to 9-aminoacridine. The substituent-mutagenicity patterns observed for these compounds agree very well with those obtained previously for non-azidoacridines. The results presented here show that the 2-azido-analog of 9-aminoacridine demonstrates biological activity similar to 9-aminoacridine prior to photolytic activation. With light activation, however, the 9-amino-2-azido derivative becomes more effective at producing frameshift mutations characteristic of 9-aminoacridine. Furthermore, this photolytic enhancement of mutagenesis appears to be due to the repairable lesion suggesting that covalent attachment of the drug occurs.

Preweaning treatment with methamphetamine induces increases in both corticosterone and ACTH in rats.

Treatment with methamphetamine (MA) on postnatal days P11-20 induces adult spatial learning and memory deficits without affecting monoamine levels in various brain regions. In this study, we examined the pituitary and adrenal response of animals administered MA four times daily on P11, P11-15, or from P11 to P20. Corticosterone (CORT) and adrenocorticotropin hormone (ACTH) levels were assessed over a 1-hour period following MA exposure. On P11, MA produced marked elevations of both CORT and ACTH; this is during the stress hyporesponsive period (SHRP). On P15 and P20, the maximal effect of MA on CORT titers was observed at 30 min, with lower, but still significantly increased, levels at 60 min compared to controls. Males receiving MA on P15 had higher levels of ACTH than did control males, while no differences were noted among females. On P20, MA treatment resulted in higher levels of ACTH relative to vehicle-injected controls, but levels were not different from controls that were only weighed at each drug administration. MA treatment inhibited body, but not brain weight gain, resulting in hippocampal weights that were heavier in the MA-treated animals when expressed as a percent of body weight. The elevations of adrenal steroids by MA, during late phases of hippocampal neurogenesis, may contribute to neuronal alterations that are later manifested in deficits of learning and memory.

Variability and consistency of rates of primary and repeat cesarean sections among hospitals in two states.

Hospitals in New York and Illinois have wide variations in their primary and repeat cesarean section rates. A number of factors account for these differences. To investigate whether hospitals with higher or lower rates tend to continue these patterns over time, their rates in 1988 were compared with those in 1983. It was found that a hospital's cesarean section rate was consistent, but some regression to the mean process did occur. By 1988, teaching hospitals had lower rates than nonteaching hospitals; this difference is likely due to the greater response to calls for increasing trials of vaginal birth after a previous cesarean section by teaching hospitals. Over time this should contribute to further moderating of the rates. Data were from the Illinois and New York State Departments of Health.

Malpractice premiums and primary cesarean section rates in New York and Illinois.

The fear of malpractice liability is mentioned frequently as a cause of increased cesarean section rates, but without quantitative investigations. This perception may be studied at an aggregate level by comparing malpractice insurance premiums, a proxy for liability risk, with primary cesarean section rates. Both New York and Illinois are divided into territories for insurance rates; the premium was uniform within each territory over the period studied for each specialty. Premiums for obstetricians were linked to birth and procedure data from New York and Illinois hospitals for 1981 and 1983, respectively, to determine whether there was a correlation between premium levels and the primary cesarean section rate. A statistically significant difference was found between mean cesarean rates by insurance premium territories in each State. A correlation was observed between increased insurance rates among territories and increased cesarean section rates. Based on these results, a substantial impact was found on delivery decisions resulting from the fear of malpractice suits.

Pain control after cesarean birth. Efficacy of patient-controlled analgesia vs traditional therapy (IM morphine).

A clinical trial compared the efficacy of a mechanical device to deliver patient-controlled analgesia (PCA) (n = 25) with intramuscularly administered morphine (n = 17) for postcesarean pain management. Hypotheses were: (1) patient-controlled administration of narcotics will be superior (increased satisfaction, reduced pain, decreased sedation, increased ambulation, decreased length of stay), and (2) functional vital capacity will increase post-operatively with PCA. No differences in demographic variables were identified (P = less than or equal to .001). Differences in satisfaction (greater in PCA group, P = less than or equal to .05), ambulation (greater in PCA group, P = less than or equal to .001), amount of medication used (greater in PCA group, P = less than or equal to .001), and sedation level (less in PCA group, P = less than or equal to .05) were identified. No differences in vital capacity were identified. The hypothesis related to the superiority of PCA was accepted, while the association between PCA and increased vital capacity was not supported. The use of mechanical PCA devices provides an effective and safe means of managing postcesarean pain.

Risk compensation and the Illinois seat belt use law.

The question of whether drivers alter their behavior due to vehicle safety improvements or public policy changes (laws, enforcement) has been debated for some years. The possibility of risk compensation (offsetting behavior) has been offered: drivers may go faster or operate in a less safe manner in response to such a change. Three 1991 publications purportedly find risk compensation due to mandatory seat belt use laws. However, these conclusions are questionable due to the weaknesses in statistical methods that were used (before/after comparisons, regression). This paper examines whether risk compensation occurred due to the 1985 use law in Illinois. It also compares the results of the before/after method to a preferred technique (ARIMA, developed by Box and others). These approaches are applied to monthly totals and rates of fatalities, injuries classified by level of severity, and total accidents from 1980-1991. Three types of accident are analyzed: vehicle/pedestrian, vehicle/bicycle, and all others. If nonoccupants have suffered adverse consequences, risk compensation could provide the explanation. Much less evidence of offsetting behavior was found. No statistically significant increase in accidents occurred. While other types of safety changes may alter driver behavior, this did not seem to occur in Illinois due to the belt use law.

Impact of the 65 mph speed limit on accidents, deaths, and injuries in Illinois.

At the end of April 1987, Illinois raised the speed limit from 55 to 65 mph on rural interstates and limited-access highways. This paper examines the effects of this change. It applies ARIMA techniques to a monthly time series of accidents, injuries, and fatalities dating from five years before the limit increase to four years after. Two types of rural highways are examined: those where the speed limit was raised and those where it remained at 55 mph. The impact of higher limits on mean speeds, speed variance, traffic diversion, traffic generation, speed spillover, and issues of benefits and costs are considered. The findings suggest the higher limit led to 300 additional accidents per month in rural Illinois, with associated increases in deaths and injuries. This impact was apparent on both 65 and 55 mph roads. There is some evidence of traffic diversion from 55 to 65 mph highways plus traffic generation and speed spillover.

Impact of the Illinois child passenger protection act: a retrospective look.

This paper considers the Illinois child restraint use law which took effect in July 1983. This law requires parents to use safety seats for children under age 4, and seat belts or safety seats for those aged 4 or 5. ARIMA time series models and a monthly data set of fatalities and injuries from 1980 through 1986 were utilized. The law reduced the total number of children under 5 killed or injured in traffic crashes by 10% along with a 17% decline in the number of child injuries per crash. No spillover effect was found for older children.

Impact from changes in Illinois drivers license renewal requirements for older drivers.

In late 1989, Illinois revised the length of license term and renewal requirements for older drivers. The term was shortened from 4 to 2 years for those ages 81-86 and 1 year for those ages 87 and up. A mandatory road test which had been required at renewal for all drivers ages 69 and over, was eliminated for those ages 69 to 74. Data are available to explore the impact of these changes on crashes, fatal crashes, crash rates, and licensure rates of senior drivers. Comparisons are made between 1987-1989 averages and 1995 for three age groups: 70-74, 75-80 (the control group that had no changes in requirements), and 81 and up. It does not appear that eliminating the road test for those ages 69 to 74 had any negative impact. On the contrary, it does not appear that the more frequent renewal period for those ages 81 and up produced any benefit compared to the control group. As the number of older drivers continue to increase into the future, the analysis of licensing requirements and their impact is important.

Uses of the HOME inventory for families with handicapped children.

The use of the HOME Inventory with families of children with handicaps was described. Normative and psychometric information for the Infant-Toddler, Early Childhood, and Middle Childhood versions of the Inventory was provided for groups of children with diverse handicaps and groups of children with mental retardation. Moderate correlations were observed between HOME and family social status measures, minimal between HOME and life stress measures, and low to moderate between HOME and social support measures. Low to moderate correlations were observed between HOME and child competence measures.

Birth outcomes to rural Illinois residents: is there a crisis?

In recent years, the supply of obstetric services in rural areas has been a concern. At the same time, the demand for such services has been affected by the reduction in population and economic base. This article explores the extent of these trends in Illinois and whether they have led to a deterioration in amount of prenatal care and birth outcomes. Using birth certificate and infant death data for residents of rural Illinois counties in 1983 and 1988, prenatal care and birth outcomes for each year are compared within rural areas and to the rest of the state, as well as between the two time periods. Although rural residents began prenatal care later, they obtained similar qualities of care as their urban counterparts. The data revealed no adverse impact on birth outcomes of residing in increasingly rural areas, nor was there a deterioration during the time period. An attempt was made to identify rural counties that lost providers and/or facilities and those that gained them. Although such a classification scheme is subjective, similar results ensued. While indirect costs such as time and effort to obtain care may have increased, at 1988 levels of care availability there was no crisis in Illinois.

Experiences in day care and social competence among maltreated children.

The experience of 39 preschool-age maltreated children from 13 child care facilities was examined to determine the extent to which the children's social development was related to the quality of day-care service. Maltreated children assigned by the Arkansas Department of Social Services to three different types of child care facilities were observed: specialized day-care programs, regular day-care centers and family day homes. The children scored below average in intelligence and were rated by their parents as displaying higher than normal rates of disturbed behavior. While no comparison group of non-maltreated children was included in the study, observations of the maltreated children in the child care setting revealed substantially more positive than negative social behavior. The children were reasonably effective in interacting with adult caregivers in day care. The maltreated children were also productive in most encounters with peers. Ratings of the quality of care received in day care were significantly correlated with the children's social competence in child care. Aspects of social behavior in maltreated children were related to the organization of the program, the physical facilities, traits of the caregiver, and caregiver expectations for the children.

The HOME inventory: a new scale for families of pre- and early adolescent children with disabilities.

A preliminary form of a new version of the Home Observation for Measurement of the Environment (HOME) is presented. It is designed for use with families of children aged 10-15. The 80-item preliminary version of the Preadolescent HOME (PA-HOME) was field tested on 117 children with varying disabilities. The 80 items were selected from a pool of over 250 items by means of several field tests and accompanying item analyses. Both factor analyses and item analyses were used to help pare down items and produce a scale with acceptable psychometric properties. The psychometric properties of the PA-HOME are quite similar to those reported for the other three versions of the HOME Inventory. It appears to be a reasonably reliable scale with moderate correlations with other measures of the family environment, such as SES, social support, and marital stability. It has low to moderate correlations with measures of child competence in this sample of children with disabilities. The correlations are of the same general magnitude of correlations between the Infant-Toddler, Early Childhood, and Middle Childhood versions of HOME in samples of younger children with disabilities.