Host Selection, Growth, and Survival of Melonworm (Lepidoptera: Crambidae) on Four Cucurbit Crops Under Laboratory Conditions.

The melonworm, Diaphania hyalinata L. (Lepidoptera: Crambidae), is one of the most serious insect problems affecting cucurbit production. We evaluated the relative preference and suitability of yellow squash, zucchini, cucumber, and watermelon to melonworm by measuring its oviposition, larval feeding preference, survivorship, and developmental responses in the laboratory. Whole plants were used for oviposition study, whereas host leaf discs were used for all the other studies. Watermelon feeding resulted in the longest larval development period (14.3 d), greatest prepupal weights and survivals rates (92%; first instar to adult) among the four crops. However, for watermelon, adult oviposition preference (199.5 eggs/♀), egg survival (70%), and larval feeding (4.1% defoliation) were numerically or statistically lowest, and larval head capsule widths and whole-body lengths were smallest. When differences occurred among these variables, yellow squash, zucchini, and cucumber were each typically higher (or quicker to develop) than watermelon. So why do melonworm adults not prefer watermelon, or at least select it as frequently as squash and cucumber when ovipositing? The answer likely is that there might be some variation in the important chemical components among these cucurbits. We suggest that comparison of kairomones and allomones from watermelon and related cucurbits would be very useful for determining the combination resulting in the lowest risk of damage to the more susceptible cucurbits (assuming the levels can be modified without seriously affecting the crops).

Time to clinical response: an outcome of antibiotic therapy of febrile neutropenia with implications for quality and cost of care.

PURPOSE: To determine whether antibiotic regimens with similar rates of response differ significantly in the speed of response and to estimate the impact of this difference on the cost of febrile neutropenia. METHODS: The time point of clinical response was defined by comparing the sensitivity, specificity, and predictive values of alternative objective and subjective definitions. Data from 488 episodes of febrile neutropenia, treated with either of two commonly used antibiotics (coded A or B) during six clinical trials, were pooled to compare the median time to clinical response, days of antibiotic therapy and hospitalization, and estimated costs. RESULTS: Response rates were similar; however, the median time to clinical response was significantly shorter with A-based regimens (5 days) compared with B-based regimens (7 days; P =.003). After 72 hours of therapy, 33% of patients who received A but only 18% of those who received B had responded (P =.01). These differences resulted in fewer days of antibiotic therapy and hospitalization with A-based regimens (7 and 9 days) compared with B-based regimens (9 and 12 days, respectively; P <.04) and in significantly lower estimated median costs ($8,491 v $11,133 per episode; P =.03). Early discharge at the time of clinical response should reduce the median cost from $10,752 to $8,162 (P <.001). CONCLUSION: Despite virtually identical rates of response, time to clinical response and estimated cost of care varied significantly among regimens. An early discharge strategy based on our definition of the time point of clinical response may further reduce the cost of treating non-low-risk patients with febrile neutropenia.

Incidence, cost, and outcomes of bleeding and chemotherapy dose modification among solid tumor patients with chemotherapy-induced thrombocytopenia.

PURPOSE: To describe the incidence and outcomes of bleeding and chemotherapy dose modifications associated with chemotherapy-induced thrombocytopenia (platelets < 50,000/microL). PATIENTS AND METHODS: Six hundred nine patients with solid tumors or lymphoma were followed-up during 1,262 chemotherapy cycles complicated by thrombocytopenia for development of bleeding, delay or dose reduction of the subsequent cycle, survival, and resource utilization. The association between survival and bleeding or dose modification was examined using the Cox proportional hazards model. Predisposing factors were identified by logistic regression. RESULTS: Bleeding occurred during 9% of cycles among patients with previous bleeding episodes (P <.0001), baseline platelets less than 75,000/microL (P <.0001), bone marrow metastases (P =.001), poor performance status (P =.03), and cisplatin, carboplatin, carmustine or lomustine administration (P =.0002). Major bleeding episodes resulted in shorter survival and higher resource utilization (P <.0001). Chemotherapy delays occurred during 6% of cycles among patients with more than five previous cycles (P =.003), radiotherapy (P =.03), and disseminated disease (P =.04). They experienced similar clinical outcomes but used significantly more resources. Dose reductions occurred during 15% of cycles but were not associated with poor clinical outcomes or excess resource utilization. Significantly shorter survival and higher resource utilization were observed among the 20% of patients who failed to achieve an adequate response to platelet transfusion. CONCLUSION: The incidence of bleeding is low among solid tumor patients overall but exceeds 20% in some subgroups. These subgroups are easily identifiable using routinely available clinical information. A clinical prediction rule is being developed. Poor response to platelet transfusion is a clinically and financially significant downstream effect of thrombocytopenia and warrants further investigation.

Fetal gonadoblastoid testicular dysplasia.

The case of a 950-g male infant born at 28 weeks of gestation with bilateral gonadoblastoma-like testicular lesions who lived for one hour is presented. The infant had a 46, XY karyotype and multiple congenital anomalies.

1,4-pentadienyl-3-sulfonamides: frameworks for "disfavored" radical cascade cyclizations.

[reaction: see text]. 1,4-pentadienyl-3-sulfonamides afford products including those resulting from disfavored 5-endo-trig reactions when subjected to radical cyclization conditions. Products resulting from pathways featuring 4-exo-trig cyclizations are also detected, even when the 4-exo-trig reaction leads to a highly strained bicyclo[3.2.0] ring system.

Identifying risk factors for imminent death in cancer patients with acute dyspnea.

A substantial proportion of cancer patients presenting to an emergency center (EC) or clinic with acute dyspnea survives fewer than 2 weeks. If these patients could be identified at the time of admission, physicians and patients would have additional information on which to base decisions to continue therapy to extend life or to refocus treatment efforts on palliation and/or hospice care alone. The purpose of this study was to identify risk factors for imminent death (survival

The effect of sinefungin and synthetic analogues on RNA and DNA methyltransferases from Streptomyces.

Sinefungin is an antibiotic structurally related to S-adenosylmethionine. It has been described as an inhibitor of RNA transmethylation reactions in viruses and eukaryotic organisms, but not in bacteria. We show here that sinefungin strongly inhibits RNA methyltransferase activity, but not the biosynthesis of these enzymes in Streptomyces. All the methylated bases found in Streptomyces RNA (1-methyladenine, N6-methyladenine, N6,N6-dimethyladenine and 7-methylguanine) are inhibited by this antibiotic. Experiments with sinefungin analogues show that specific changes in the ornithine radical of the molecule still preserve its inhibitory capability. The substitution of the adenine radical by uridine causes the loss of the inhibitory effect. These results and our former studies on Streptomyces DNA methylation, suggest that nucleic acid modification is the main target of sinefungin in Streptomyces.

Comparison of percutaneous and surgical placement of central venous catheters in neonates.

A comparison of randomized placement of percutaneous and surgical central venous catheters was made in 53 low birthweight infants. Twenty-eight infants received percutaneous central venous lines, and 21 infants underwent surgical placement of catheters. The incidence of complications did not differ between the groups. The mean length of time the catheter was in place also was similar. Percutaneous placement of central venous catheters appears to compare favorably with the traditional surgical approach.

Influence of data display formats on physician investigators' decisions to stop clinical trials: prospective trial with repeated measures.

OBJECTIVE: To examine the effect of the method of data display on physician investigators' decisions to stop hypothetical clinical trials for an unplanned statistical analysis. DESIGN: Prospective, mixed model design with variables between subjects and within subjects (repeated measures). SETTING: Comprehensive cancer centre. PARTICIPANTS: 34 physicians, stratified by academic rank, who were conducting clinical trials. INTERVENTIONS: PARTICIPANTS were shown tables, pie charts, bar graphs, and icon displays containing hypothetical data from a clinical trial and were asked to decide whether to continue the trial or stop for an unplanned statistical analysis. MAIN OUTCOME MEASURE: Percentage of accurate decisions with each type of display. RESULTS: Accuracy of decisions was affected by the type of data display and positive or negative framing of the data. More correct decisions were made with icon displays than with tables, pie charts, and bar graphs (82% v 68%, 56%, and 43%, respectively; P=0.03) and when data were negatively framed rather than positively framed in tables (93% v 47%; P=0.004). CONCLUSIONS: Clinical investigators' decisions can be affected by factors unrelated to the actual data. In the design of clinical trials information systems, careful consideration should be given to the method by which data are framed and displayed in order to reduce the impact of these extraneous factors.

Advance directives in critically ill cancer patients.

Although advance directives have been used since the 1970s, the discussion of these documents has become more common since the enactment of the Patient Self-Determination Act in 1991. This study evaluated the frequency of advance directives in critically ill patients at a tertiary cancer center and found that cancer patients had a relatively low completion rate of advance directives (27%). The finding that advance directives were more common among Caucasians than other ethnic groups signifies the importance of considering cultural differences when addressing end-of-life issues with patients. The documents also were found more often in older patients with serious diseases. The relationship between hospital mortality and advance directives is complex. The most seriously ill patients and patients with leukemia had the highest mortality and the highest rate of advance directives. Further research on the interactions among mortality, advance directives, and severity of illness is needed. This research contributes to the body of knowledge available on advance directives and particularly sheds light on advance directives in critical ill cancer patients.

Distribution of Zelus longipes (Hemiptera: Reduviidae) in south Florida corn fields and its functional response to corn-infesting picture-winged flies (Diptera: Ulidiidae).

The milkweed assassin bug, Zelus longipes (L.) (Hemiptera: Reduviidae), is a generalist predator and a potential biological control agent of picture-winged flies (Diptera: Ulidiidae), which cause considerable economic damage to sweet corn yields in Florida. We studied the potential of Z. longipes as a biocontrol agent of four ulidiid pests in corn fields: Euxesta stigmatias Loew, Euxesta eluta Loew, Euxesta annonae F., and Chaetopsis massyla Walker. Within-plant and within-field distributions of Z. longipes and ulidiids and functional responses of Z. longipes to ulidiid prey were determined. Highest numbers of Z. longipes and ulidiids in the R1, R2, and R3 corn stages were generally in the basal or middle leaves at 09:00 h EST, ears at 13:00 h EST, and top and tassel at 17:00 h EST. Hence, there seemed to be a coordinated migration of Z. longipes and ulidiids from the lowest to the highest parts of the corn plant during the day. Within the corn field, aggregated (clumped) distributions were most common for Z. longipes and ulidiids especially in the later R2 and R3 stages based on Taylor's power law, Iwao's patchiness regression, index of dispersion, and Lloyd's patchiness indices of dispersion. However, predator and prey populations were lower in the R1 stage, and there were inconsistent results for dispersion indices among times of day and between predators and prey. Ulidiid distributions in R1 were mostly regular (uniform) at 13:00 h EST, but aggregated at 09:00 h and 17:00 h. However, Z. longipes R1 distributions were mostly aggregated at 13:00 h, but random or regular at 09:00 h and 17:00 h EST. Handling times for male and female Z. longipes were 1.0-1.39 h and 0.67-0.97 h, respectively, and each had a type II functional response to E. stigmatias, E. eluta, and E. annonae and consumed about five flies per day. Although the population abundance of Z. longipes can vary between seasons, it appears to be a promising biocontrol agent of ulidiid flies in corn.

[Fatal Sweet syndrome associated to chronic idiopathic systemic inflammatory response syndrome]. / Síndrome de Sweet de evolución fatal asociado a síndrome de respuesta inflamatoria sistémica crónico idiopático.

Sweet syndrome is one of the cutaneous processes more frequently associated to systemic diseases. Its association to the systemic inflammatory response syndrome has rarely been described. We report a case of chronic and relapsing Sweet syndrome associated to a chronic and idiopathic systemic inflammatory response syndrome that lasted seven years and proved fatal to the patient. Among the rare cases of Sweet syndrome associated to a systemic inflammatory response syndrome that have been described there have not been any fatal cases as occurred with our patient.

Transcription of INO2 and INO4 is regulated by the state of protein N-myristoylation in Saccharomyces cerevisiae.

Inositol regulates transcription of Saccharomyces cerevisiae genes required for de novo synthesis of acylCoAs and phospholipids. Removal of inositol results in transcriptional activation by heterodimeric complexes of two bHLH proteins, Ino2p and Ino4p. In the presence of inositol, transcription is repressed by Opi1p. MyristoylCoA:protein N-myristoyltransferase (Nmt1p) is an essential enzyme whose activity is influenced by cellular myristoylCoA pool size and availability. nmt451Dp contains a Gly451-->Asp substitution that produces temperature-dependent reductions in affinity for myristoylCoA and associated reductions in acylation of cellular N-myristoylproteins. The conditional lethality produced by nmt1-451D is rescued at temperatures up to 33 degreesC by withdrawal of inositol. We tested the hypothesis that N-myristoylproteins function to regulate INO2, INO4 and/or OPI1 transcription, thereby affecting the expression of inositol-sensitive genes that influence myristoylCoA metabolism. The effect of nmt1-451D on INO2 , INO4 and OPI1 promoter activities was examined by introducing episomes, containing their 5' non-transcribed domains linked to reporters, into isogenic NMT1 and nmt1-451D cells. The activity of INO2 is significantly higher, INO4 significantly lower and OPI1 unaffected in nmt1-451D cells, both in the presence and absence of inositol. These changes are associated with a net increase in expression of some inositol target genes, including FAS1 . FAS1 encodes one of the subunits of the fatty acid synthase complex that catalyzes de novo acylCoA (including myristoylCoA) biosynthesis. Augmented expression of FAS1 overcomes the kinetic defects in nmt451Dp. FAS1 expression is Ino2p-dependent in NMT1 cells at 24-33 degreesC. In contrast, FAS1 expression becomes Ino2p-independent in nmt1-451D cells at temperatures where efficient acylation of cellular N-myristoylproteins is jeopardized. The ability to maintain expression of FAS1 in nmt1-451Dino2 Delta cells suggests the existence of another transcription factor, or factors, whose expression/activity is inversely related to overall levels of cellular protein N-myristoy-lation. This factor is not functionally identical to Ino2p since other inositol-responsive genes (e.g. CHO1 ) maintain INO2 -dependent expression in nmt1-451D cells.

Autoregulation of brain blood flow during hypotension and hypertension in infant lambs.

To determine the limits of aortic blood pressure in infant lambs for autoregulation of global and regional brain blood flow, we studied 10 unsedated lambs during hypotension and 10 unsedated lambs during hypertension. In lambs 6 to 13 d old, we produced graded changes in aortic blood pressure by inflating a balloon occluder placed around either the inferior vena cava or the descending aorta. Using radiolabeled microspheres, we measured global and regional brain blood flow at the baseline, and then with each graded change in aortic blood pressure. In an additional step, we administered atropine to determine if its antimuscarinic properties alter the fall in brain blood flow with severe hypotension, or alter the rise in brain blood flow with severe hypertension. We concluded that in the unsedated infant lamb, global brain blood flow remains stable between mean aortic blood pressures of 6.0 to 10.0 kPa (45 to 82 torr), a range from approximately 38% below to 12% above normal mean aortic blood pressure. We noted that this autoregulatory range is essentially unchanged from that described for the fetal lamb at 80% of term gestation--even though the mean aortic blood pressure rises during this period of maturation by more than 2.7 kPa (20 torr). We found that the lower limit of autoregulation varies among the different brain regions and is lowest in the thalamus, pons, and medulla. We saw little variation of the upper limit among the brain regions. Finally, we determined that atropine does not alter brain blood flow during severe hypotension or severe hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Phenobarbital and cerebral blood flow during hypotension in newborn pigs.

Phenobarbital sodium (PhS) has been used in anticonvulsant concentrations in premature newborns in attempts to prevent peri- and intraventricular hemorrhages (PIVH). Its effectiveness in preventing PIVH in clinical situations is still uncertain; however, PhS has reduced PIVH after hypertension in newborn beagles, and it has lowered cerebral blood flow (CBF) during hypertension in newborn beagles and piglets. We hypothesized that PhS might reduce CBF during systemic hypotension. Twelve control and 12 PhS-treated piglets (1 to 2 d old) were used for microsphere determinations of CBF during 1) steady state; 2) 30 min after PhS (treatment group) or saline infusion (controls); and 3 and 4) during two levels of graded hypotension. Mean arterial blood pressure (MABP) was 61 +/- 13 (SD) mm Hg (controls) and 57 +/- 13 (SD) mm Hg (PhS) during steady state. Thirty min after the PhS or saline infusion, MABP and CBF remained unchanged in both groups. CBF during hypotension at MABP of 41 +/- 5 (SD) mm Hg was significantly higher in controls than was CBF at MABP of 39 +/- 6 (SD) mm Hg in the PhS-treated group (p = 0.044); CBF in the two groups during the second hypotensive phase was not significantly different. However, LOWESS regression suggested that the CBF from the controls dropped as the arterial pressure decreased to less than 37 mm Hg, whereas PhS treatment lowered CBF during hemorrhagic hypotension compared with controls at blood pressures greater than 37 mm Hg but did not lower CBF further at lower systemic blood pressures.(ABSTRACT TRUNCATED AT 250 WORDS)

Medical futility and appropriate medical care in patients whose death is thought to be imminent.

Often it is very difficult to make decisions involving the termination of aggressive cancer care in the case of patients who are no longer benefiting. Among these patients, our ability to "do everything possible" to continue life is in conflict with "doing the right thing"; the greatest benefit to these patients derives from delivering excellent supportive care and assisting them in understanding and accepting end-of-life issues. Furthermore, in a cost-conscious environment with limited resources, all patients and, indeed, all of society, benefit when aggressive and often costly cancer care is limited to those patients who are likely to benefit. However, these issues are complex, blending treatment science and ethics, and thus, the physician frequently has no objective reference point on which to base the decisions. This paper integrates the principles of ethics (respect for autonomy, beneficence, nonmaleficence, and justice) and three difficult issues encountered by physicians in clinical decision-making in terminal cancer patients in the American healthcare system. These issues include: medical futility and appropriate care, applications of outcomes research in clinical decision-making, and impact of cost, particularly in a managed care environment, on treatment choice. These topics are illustrated with reference to patients presenting to our emergency center with stage IV lung cancer and dyspnea, and the application of an outcomes model under development to predict imminent death in these patients is discussed. Outcomes models may provide patients, their families, and their physicians with objective data on which to base end-of-life decision-making. Minimizing aggressive treatment of terminally ill patients may provide better life quality and will reduce costs during the patients' end of life. Ethics plays a crucial role in integrating medical science, patient choice, and cost in making appropriate decisions.

Reversal of venous blood flow with atrial tachycardia and hydrops in fetal sheep.

The purpose of this project was to characterize the reversal of blood flow in the proximal inferior vena cava (IVC) seen in fetal sheep with pacing-induced atrial tachycardia and hydrops. We successfully operated on seven pregnant ewes at 118-130 d gestation to attach ECG and pacing wires, insert vascular catheters, and place Doppler flow probes around the common aortic trunk and the IVC. We also performed two-dimensional and Doppler ultrasonographic exams at baseline, after initiation of pacing, and daily thereafter. All fetuses developed hydrops. Ultrasonographic appearance of ascites and pleural effusion occurred within 4 h in four fetuses and within 48 h in all fetuses. Atrial pacing did not affect arterial pH or arterial O2 tension, but arterial CO2 tension increased by a small amount. Mean IVC pressure increased 75%, whereas mean aortic pressure remained the same. Concentrations of plasma protein and albumin and the hematocrit did not change with atrial pacing. Doppler ultrasound examination and Doppler IVC flow tracings showed that flow reversal began immediately with atrial pacing and disappeared immediately with cessation of pacing. Reversed flow was 21% of forward flow. Inspection of simultaneous recordings of ECG, Doppler aortic and IVC flows, and aortic and IVC pressure tracings revealed that the reversed blood flow occurred in diastole in conjunction with atrial contraction and, therefore, could not be due to tricuspid insufficiency. Our findings of increased venous pressure and reversed venous blood flow suggest that ventricular function is impaired and further suggest that oxygen supply to the ventricles may not be sufficient for the increased demand.

Influence of an advance directive on the initiation of life support technology in critically ill cancer patients.

OBJECTIVE: To determine whether the presence of an advance directive at admission to an intensive care unit (ICU) influenced the decision to initiate life support therapy in critically ill cancer patients. DESIGN: Matched-pairs case-control design. SETTING: The University of Texas M. D. Anderson Cancer Center ICU. PATIENTS: Of 872 patients treated in the ICU from 1994 to 1996, 236 (27%) were identified as having advance directives. One hundred thirty five patients who had advance directives were successfully matched to 135 patients who did not on the basis of type of malignancy, reason for admission to ICU, severity of illness, and age. These pairs comprised the study group. INTERVENTIONS: Life-supporting interventions were compared between the matched groups using the McNemar and Wilcoxon matched-pairs signed ranks tests. MEASUREMENTS AND MAIN RESULTS: No significant difference was found in the frequency with which the following interventions were applied in patients with and without advance directives (respectively): mechanical ventilation, 44% vs. 42%; inotropic support, 31% vs. 31%; pulmonary artery catheterization, 11% vs. 12%; cardiopulmonary resuscitation, 7% vs. 12%; and renal dialysis, 3% vs. 7%. There were also no differences in ICU (75% vs. 73%, respectively) or hospital (56% vs. 59%, respectively) survival. More patients with advance directives than those without had do-not-resuscitate orders within the first 72 hrs (19% vs. 11%, p =.046) and patients with advance directives had shorter ICU durations and lower ICU charges than patients without advance directives. CONCLUSIONS: After controlling for type of malignancy, reason for admission to the ICU, severity of illness, and age, the decision to initiate life-supporting interventions did not differ significantly among patients with and without advance directives. The presence of an advance directive, however, may have helped guide decisions earlier regarding duration of therapy and resuscitation status.

Characterization of Rrh4273I, a restriction-modification system of Rhodococcus rhodochrous ATCC 4273 (Nocardia corallina) which recognizes the same sequence as the Streptomyces albus G SalI restriction-modification system.

Rhodococcus rhodochrous ATCC 4275 (Nocardia corallina) has a restriction-modification system with the same recognition sequence, methylation site and cleavage site as the SalI restriction-modification system. Both the restriction endonuclease and the DNA-methyltransferase (DNA-MTase) have been partially purified and characterized. The nuclease has requirements of activity similar to SalI, and a native Mr of about 46,000. The DNA-MTase is a protein with an Mr of about 67,000. No DNA homology was detected between the cloned salI restriction-modification genes of Streptomyces albus and R. rhodochrous chromosomal DNA.

The effects of dopamine infusion on regional blood flow in newborn lambs.

The purpose of this project was to investigate the effects of high rates of dopamine infusion on cardiac output and regional blood flow in the lamb. We studied eight unanesthetized newborn lambs (mean age 7 +/- 2 days) during a 15-min baseline period and while infusing dopamine at 5-, 20-, 80-, and 160 micrograms/kg/min. We measured cardiac output and mean aortic, pulmonary arterial and left atrial pressures, and organ blood flow using radionuclide-labeled microspheres at each rate of dopamine infusion. Cardiac output increased significantly with increasing rates of infusion up to 80 micrograms/kg/min but decreased at 160 micrograms/kg/min. Aortic, pulmonary arterial, and left atrial pressures increased at rates of infusion above 5 micrograms/kg/min. Blood flow to all organs was unchanged at the 5 micrograms/kg/min rate of infusion of dopamine while blood flow to the brain and heart increased at the 80 micrograms/kg/min rate of infusion and blood flow to the gut and kidney decreased. We conclude that dopamine is an effective inotropic agent in the newborn lamb but that an inotropic:afterload mismatch exists at high infusion rates. Despite an increase in cardiac output at low rates of infusion, dopamine did not selectively vasodilate the vascular bed of any organs tested. Furthermore, at high rates of infusion dopamine actually impaired blood flow to the gut and kidney.