Structural observations of time dependent oscillatory behavior of CuIICl2 solutions measured via extended X-ray absorption fine structure.

Cell surface ECTO-NOX proteins exhibit a clock-related, temperature-independent entrainable pattern of periodic (24 min) oscillations in the rate of oxidation of NAD(P)H. Aqueous solutions of copper salts also oxidize NAD(P)H with a similar temperature-independent pattern. For both, five maxima are observed, two of which are separated by 6 min and the remaining three are separated by 4.5 min. In D2O, the pattern is retained but the period length is proportionately increased to 30 min in direct relationship to the 30 h circadian day observed with D2O-grown organisms. With copper solutions, periodic changes in redox potential correlate precisely with the periodic changes in the rates of NAD(P)H oxidation. Consequently, the local environment of the Cu2+ ion in copper chloride solutions was investigated by X-ray absorption spectroscopy. Detailed extended X-ray absorption fine structure (EXAFS) analyses revealed a pattern of oscillations closely resembling those of the copper-catalyzed oxidation of NADH. With CuCl2 in D2O, a pattern with a period length of 30 min was observed. The findings suggest a regular pattern of distortion in the axial and/or equatorial oxygen atoms of the coordinated water molecules which correlate with redox potential changes sufficient to oxidize NADH. A metastable equilibrium condition in the ratio of ortho to para nuclear spin orientation of the water associated hydrogen atoms would be kinetically consistent with a 24-30 min timeframe. The temperature independence of the biological clock can thus be understood as the consequence of a physical rather than a chemical basis for the timing events.

Radiofrequency current delivery by way of a bipolar tricuspid annulus-mitral annulus electrode configuration for ablation of posteroseptal accessory pathways.

OBJECTIVES: This report describes a novel technique for ablation of "difficult" posteroseptal pathways. BACKGROUND: Although radiofrequency ablation of accessory atrioventricular (AV) pathways is successful in > or = 90% of cases, particular difficulty may be encountered with some bypass tracts in the posteroseptal region. METHODS: In eight patients with posteroseptal accessory pathways (two concealed), radiofrequency catheter ablation using conventional unipolar current applications from favorable sites along the tricuspid or mitral annulus, or both, was unsuccessful. Subsequently, a bipolar technique was adopted, with current application between the distal electrodes of two catheters positioned against the septal region at sites of early activation along both mitral and tricuspid annuli. RESULTS: The bipolar configuration proved effective in all cases. The number of bipolar lesions required for success was one (five patients), five (two patients) and nine (one patient). In five patients, bipolar current application abolished pathway conduction using positions at which delivery of unipolar lesions had been ineffective or caused transient block. The AV or ventriculoatrial interval at successful sites varied from 20 to 65 ms, and the time from delta wave onset to local ventricular activation was zero or negative. There were no complications attributable to the bipolar technique. During follow-up of 8 to 36 weeks, pathway conduction has not recurred in any patient. CONCLUSIONS: Bipolar radiofrequency current delivery across the septal region using a tricuspid annulus-mitral annulus electrode configuration may abolish accessory pathway conduction when conventional unipolar applications have proved ineffective. The technique may reduce procedure duration, radiation exposure and overall failure rate in these problematic cases.

Effects of procainamide on the signal-averaged electrocardiogram in relation to the results of programmed ventricular stimulation in patients with sustained monomorphic ventricular tachycardia.

OBJECTIVES: The aim of this study was to assess the ability of the signal-averaged electrocardiogram (ECG) to predict the efficacy of procainamide. BACKGROUND: The main role of the signal-averaged ECG has been the identification of postinfarction patients at risk of sudden death. Prediction of the efficacy of antiarrhythmic drugs represents another potential clinical application of this technique. METHODS: The study examined the effects of procainamide on the time domain and spectral temporal analysis of the signal-averaged ECG in relation to the results of programmed ventricular stimulation studies in 31 patients with inducible sustained monomorphic ventricular tachycardia. RESULTS: Procainamide significantly prolonged the total and the initial QRS complex and low amplitude signal durations (mean +/- SD 135 +/- 30 vs. 161 +/- 46 ms, p < 0.0001; 87 +/- 16 vs. 98 +/- 20 ms, p < 0.0001, and 48 +/- 23 vs. 63 +/- 36 ms, p < 0.001, respectively) whereas the root-mean-square voltage of the total QRS complex and of the last 40 ms of the QRS complex was significantly reduced (mean +/- SD 112 +/- 36 vs. 87 +/- 36 microV, p < 0.0001; 21 +/- 19 vs. 13 +/- 12 microV, p < 0.002, respectively). The results of spectral temporal mapping of the signal-averaged ECG were similar before and after procainamide administration. Procainamide prevented the inducibility of sustained ventricular tachycardia or prolonged the cycle length of ventricular tachycardia by > or = 100 ms in 16 patients (52%) (responders). The fractional prolongation of the total QRS duration was significantly greater in responders (26 +/- 15%) than in nonresponders (10 +/- 10%) (p < 0.002) and, when this prolongation was > or = 15%, identified responders with a sensitivity of 94%, a specificity of 87% and an overall predictive accuracy of 90%. CONCLUSIONS: The effects of procainamide on inducibility of ventricular tachycardia during programmed ventricular stimulation can be predicted by the degree of drug-induced prolongation of the signal-averaged QRS complex.

Simple selection criteria for drug-like chemical matter.

A simple pharmacophore point filter has been developed that discriminates between drug-like and nondrug-like chemical matter. It is based on the observation that nondrugs are often underfunctionalized. Therefore, a minimum count of well-defined pharmacophore points is required to pass the filter. The application of the filter results in 66-69% of subsets of the MDDR database to be classified as drug-like. Furthermore, 61-68% of subsets of the CMC database are classified as drug-like. In contrast, only 36% of the ACD are found to be drug-like. While these results are not quite as good as those obtained with recently described neural net approaches, the method used here has clear advantages. In contrast to a neural net approach and also in contrast to decision tree methods described recently, the pharmacophore filter has been developed by using "chemical wisdom" that is unbiased from fitting the structural content of specific drug databases to prediction models. Similar to decision tree methods, the pharmacophore point filter provides a detailed structural reason for the classification of each molecule as drug or nondrug. The pharmacophore point filter results are compared to neural net filter results. A statistically significant overlap between compounds recognized as drug-like validates both approaches. The pharmacophore point filter complements neural net approaches as well as property profiling approaches used as drug-likeness filters in compound library analysis and design.

Synthesis of iodine-125 labeled (+/-)-15-(4-azidobenzyl)carazolol: a potent beta-adrenergic photoaffinity probe.

(+/-)-15-(4-Azidobenzyl)carazolol (2), a potent beta-adrenergic photoaffinity ligand developed in our laboratories, has been radioiodinated to theoretical specific activity (2175 Ci/mmol) and shown to label covalently beta-adrenergic receptor peptides in avian and amphibian erythrocyte membrane preparations. The radioiodinated analogues of the desired compound (2) were optimally prepared by two synthetic steps from (+/-)-15-(4-aminobenzyl)carazolol (8). The latter was iodinated with carrier-free Na125I and chloramine T to yield two major isotopomers (the monoiodinated derivatives 9 and 10), which were separated by thin-layer chromatography and converted via diazonium salt formation to their respective 4-azides, 12 and 6. These azides can be used interchangeably in ligand binding or photoaffinity labeling experiments. Compound 8 was obtained by catalytic reduction of the nitro derivative (7), which was arrived at by direct reaction of 1,1-dimethyl-2-(4-nitrophenyl)ethylamine (3) with 4-(2,3-epoxypropoxy)carbazole (5). Of the desired isomers, (+/-)-15-(4-azido-3-iodobenzyl)carazolol (6) could be synthesized from 1,1-dimethyl-2-(4-azido-3-iodophenyl)ethylamine (4) by direct reaction with 5. This and the preceding sequence of reactions were carried out by using nonradioactive materials, and separation and purification of products were accomplished by high-performance liquid chromatography. The compounds described have been shown to be potent beta-adrenergic antagonists by virtue of their ability to inhibit beta-adrenergic stimulation of adenylate cyclase or to compete for the binding of another beta-adrenergic ligand, [125I]cyanopindolol, to the beta-adrenergic receptors of frog erythrocytes. The photoactive azide derivatives of these compounds (6 and 12) have been shown to covalently incorporate into the beta-adrenergic receptor binding subunit of frog and turkey erythrocyte membrane preparations. Incorporation of the ligands into these polypeptides can be blocked specifically by both beta-adrenergic agonists and antagonists.

Relative reactivity of DTPA, immunoreactive antibody-DTPA conjugates, and nonimmunoreactive antibody-DTPA conjugates toward indium-111.

Anti-human serum albumin antibody (Ab) was reacted with cyclic DTPA dianhydride (cDTPAA) at various cDTPAA/Ab molar ratios between 1 and 40. Using a carrier In titration method for DTPA and DTPA-antibody conjugate (Ab-DTPA), we determined that the above reactions produced between 0.1 and 11 DTPA molecules per either immunoreactive antibody (sAb) or nonimmunoreactive antibody (nAb). The percentage of sAb remaining after the above reactions was between 88 and 62%. The reaction of no-carrier-added 111In with the reaction mixture from cDTPAA/Ab molar ratios of 1 to 40 gave radiochemical yields less than or equal to 25% for the respective Ab-DTPA. The rest of the 111In activity was associated with free DTPA. Our results indicate that Ab-DTPA containing greater than 1 DTPA molecule per Ab is more reactive than that containing less than 1 DTPA but is about as reactive as free DTPA. This allows us to label in the presence of free DTPA and consequently prevent colloid formation. The percentage of 111In activity incorporated into sAb-DTPA from the reactions at these molar ratios was similar to that found from the uv analysis. This indicates that the reactivity of sAb-DTPA and nAB-DTPA from the same conjugation reaction is similar. As a result, we were able to conjugate about one DTPA molecule to the Ab without causing deactivation of the Ab and label it with 111In in the presence of excess DTPA. We obtained a specific activity of 6 muCi 111In per microgram of Ab using research grade 111In without further purification.

The effects of reflex parasympathetic stimulation on the QT interval and QT dispersion.

The effect of phenylephrine-induced reflex parasympathetic stimulation on QT interval and its dispersion was studied in 16 healthy subjects with a history of paroxysmal supraventricular tachycardia, both during sinus rhythm and during atrial pacing. Results demonstrate that rapid reflex parasympathetic stimulation does not influence QT interval duration or QT dispersion, and also emphasize the inappropriateness of Bazett's formula, the need for comparison of QT intervals during identical heart rates, and the importance of analyzing all 12 leads of a standard electrocardiogram when assessing the effects of various interventions on the QT interval.

Localization of accessory pathways from the 12-lead electrocardiogram using a new algorithm.

A new algorithm (St. George's algorithm), based on the polarity and morphology of QRS complexes rather than delta waves, was developed for localizing accessory pathways to 1 of 9 sites on the atrioventricular annuli. This was compared with algorithms previously proposed by Skeberis et al (localizing to 1 of 7 sites) and Milstein et al (localizing to 1 of 4 sites). The preexcited 12-lead electrocardiograms recorded during sinus rhythm in 106 consecutive patients (including 60 retrospectively analyzed patients and 46 prospectively analyzed patients) who underwent successful radiofrequency catheter ablation of a single accessory pathway were analyzed by 3 blinded observers using all 3 algorithms. The results were compared with the actual localization of accessory pathways as derived from endocardial mapping during catheter ablation. In all 106 patients, the accuracy of the 3 algorithms for 4 sites on the atrioventricular annuli (as considered by Milstein's method) was 72%, 79%, and 92% for Milstein's, Skeberis', and St. George's algorithms, respectively. For 7 sites (as considered by Skeberis' method), the accuracy was 65% (Skeberis' algorithm) and 88% (St. George's algorithm), and for 9 sites (as considered by our method) the accuracy was 86% (St. George's algorithm). In 46 prospectively analyzed patients, the accuracy of the 3 algorithms for 4 sites was 70% (Milstein's), 67% (Skeberis'), and 87% (St. George's); for 7 sites the accuracy was 61% (Skeberis') and 85% (St. George's), and for 9 sites the accuracy was 85% (St. George's). The reproducibility of St. George's and Skeberis' methods was better than that of Milstein's method.(ABSTRACT TRUNCATED AT 250 WORDS)

Structural elements pertinent to the interaction of cyclosporin A with its specific receptor protein, cyclophilin.

Cyclophilin (163 amino acids; 17,737 daltons) is a ubiquitous cytosolic protein that specifically binds the potent immunosuppressive drug cyclosporin A (CsA). To characterize the structural details of this interaction, extensive use has been made of two-dimensional (2D) NMR methods. For studies on CsA, these methods are being used to assign the conformational space accessible to CsA by analysis of the spectra from the multiple CsA conformers present in slow exchange in mixed solvent systems. These same 2D NMR methods also have been used for extensive studies of the major bovine thymus cyclophilin (CyP) isoform and its complex with stoichiometric amounts of CsA. In the former case, these studies have revealed 81% of the 156 expected HN-H alpha crosspeaks. The complete spin-coupled spin systems for one-third of these amide resonances have been assigned according to amino acid type. After exhaustive D2O exchange, there remain 44 amide protons which exhibit 2D NMR features indicative of a hydrophobic domain with beta-sheet secondary structure. The CsA-complexed form of CyP exhibits a discrete structure and set of resonances in slow exchange with the drug-free CyP. The amino acids that have been specifically identified to be affected by the interaction are limited in number and include three Phe residues, the unique Trp at position 120, and two Ala residues.

Isolation, identification and synthesis of an endogenous arachidonic amide that inhibits calcium channel antagonist 1,4-dihydropyridine binding.

This study was part of a broad search for endogenous regulators of L-type calcium channels. The screening for active fractions was done by measuring inhibition [3H]1,4-dihydropyridine (DHP) binding to rat cardiac and cortex membranes. An inhibitory fraction, termed lyophilized brain hexane-extractable inhibitor (LBHI), was isolated from hexane extracts of lyophilized calf brain. The active substance was purified by a series of chromatographic steps. 13C nuclear magnetic resonance (NMR), 1H coherence spectroscopy (COSY) NMR and fast atom bombardment (FAB) mass spectroscopy suggested that LBHI was N-arachidonic acid-2-hydroxyethylamide. Synthesis of this substance and subsequent high performance liquid chromatography (HPLC) and NMR analysis confirmed this structure. Synthetic LBHI (SLBHI) inhibited [3H]DHP binding to rat cortex membranes with an IC50 value of congruent to 15 microM and a Hill coefficient of congruent to 2. Saturation analysis in the presence of SLBHI showed a change in KD (equilibrium dissociation constant), but not maximal binding capacity (Bmax). SLBHI produced an increased dissociation rate, which, along with the Hill slope of > 1, suggested a non-competitive interaction with the DHP binding site. The results suggest that arachidonic acid derivatives may be endogenous modifiers of the DHP calcium antagonist binding site.

Radiofrequency catheter ablation of accessory atrioventricular pathways: primary failure and recurrence of conduction.

OBJECTIVE: To identify possible factors associated with primary failure of radiofrequency ablation of accessory pathways or recurrence of accessory pathway conduction. PATIENTS AND METHODS: Radiofrequency ablation of accessory pathways failed in 25 of 243 patients, and recurrence of accessory pathway conduction occurred in an additional 13 patients. Factors possibly related to primary failure and recurrence were analysed. RESULTS: Primary failure and recurrence were less frequent in patients with left sided pathways (7% v 19%; 4% v 24%; P = 0.04). The factors that might relate to primary failure included an unstable catheter position (seven patients), a possible epicardial pathway (six patients), or misdiagnosis of accessory pathway location (two patients). The major factors for recurrence included the stability of the local atrial electrogram < or = 0.5 together with the stability of the local ventricular electrogram < or = 0.8, and prolonged time to pathway conduction block > or = 12 seconds). Thirty one patients underwent repeat ablation which was successful in 28. CONCLUSIONS: Primary failure and recurrence were more frequent in patients with right sided pathways. An unstable catheter position and a possible epicardial pathway location are the main contributing factors for primary failure, while unstable local electrograms and prolonged time to block are independent predictors for recurrence.

Catheter ablation for successful management of left posterior fascicular tachycardia: an approach guided by recording of fascicular potentials.

OBJECTIVE: To assess whether catheter ablation of fascicular tachycardia can be facilitated by the recording of sharp deflections arising from the mid-septum---inferior apical septum of the left ventricle. PATIENTS AND METHODS: Seven consecutive patients (mean age 29 (range 16-43) years) with ventricular tachycardia originating from the left posterior fascicle underwent electrophysiology study and detailed mapping of endocardial activation. Selection of ablation sites in the last five patients was based on the recording, during left posterior fascicular tachycardia and sinus rhythm, of a discrete potential preceding the earliest ventricular electrogram, which was thought to represent conduction through the posterior fascicle. RESULTS: Patients were treated with low energy direct current or radiofrequency current ablation. The median fluoroscopy and procedure times were 23 (range 6-42) min and 110 (range 50-176) min, respectively. In a follow up period of 4 to 16 months, six patients were asymptomatic and one had minor symptoms. No patient had any change in intraventricular conduction. Similar potentials were also recorded from the left posterobasal septum in three of eight patients who underwent catheter ablation of left free wall accessory pathways. CONCLUSION: Fascicular potentials can be reproducibly recorded in left posterior fascicular tachycardia and may serve as a reliable marker for successful ablation procedures. The relation of these potentials with the substrate of the tachycardia, however, remains obscure.

The management of pulmonary tuberculosis in adults notified in Scotland in 1993.

The management of pulmonary tuberculosis (TB) in Scotland in 1993 was studied by asking the physicians responsible for all 321 adult cases of the disease notified that year to complete a standardized questionnaire relating to drug treatment and bacteriology. The response rate to the questionnaire was 100%. Isoniazid and rifampicin were used together in initial therapy in 98.4% of cases, while pyrazinamide was prescribed in 90.3% of cases, broadly in keeping with existing treatment guidelines. However, considerable variability was observed both in the drug regimens employed, and in the duration of initial and continuation phases of chemotherapy. Treatment regimens were therefore frequently at variance with published recommendations. Among patients prescribed drug regimens other than those recommended satisfactory completion of therapy was less common. Microbiological confirmation was provided for 84% of cases in which clinical samples were submitted. However, in approximately 11% of cases, no clinical samples were submitted. Closer adherence to existing treatment guidelines and more rigorous pursuit of microbiological confirmation should further improve the overall management of pulmonary TB in Scotland.

Actinoidins A and A2: structure determination using 2D NMR methods.

The structural analysis of the intact glycopeptide antibiotics, actinoidins A (1a) and A2 (1b), by two-dimensional 1H NMR is described. The location of the single chlorine at the A3 position and the sites of attachment of the four carbohydrate substituents in actinoidin A are elucidated based on correlation spectroscopy (COSY), double quantum coherence experiments (DQCE), homonuclear Hartmann-Hahn experiments (HOHAHA) and nuclear Overhauser spectroscopy (NOESY). Similar 2D correlation and NOE NMR experiments are then performed on the novel analog, actinoidin A2, to determine its structure. The structural difference between actinoidins A and A2 is shown to reside in the presence of L-rhamnose in actinoidin A2 in place of L-acosamine in actinoidin A. All questions concerning the stereo-chemistry of the chiral centers in both the heptapeptide core and the carbohydrate moieties in each of these antibiotics could be successfully addressed with the exception of Gl', the alpha-carbon on the N-terminal amino acid which is known to have the R-configuration from previous studies.

Parvodicin, a novel glycopeptide from a new species, Actinomadura parvosata: discovery, taxonomy, activity and structure elucidation.

An extensive taxonomic investigation identified strain SK&F-AAJ-271 as a new species, designated Actinomadura parvosata. Fermentations of this organism produce a complex of acidic, lipophilic glycopeptide antibiotics, the parvodicins. Structures for seven of the isolated components were derived from a combination of mass spectral, high-field NMR and chemical techniques. The O-acetyl functionality present in two of the isolated components is a structural feature unique among the known members of this class of antibiotics. The parvodicins are active in vitro against a range of Gram-positive bacteria. The most active parvodicin, C1, produces high serum levels in vivo and has the potential for a long duration of action.

The shoulder pain and disability index: the construct validity and responsiveness of a region-specific disability measure.

BACKGROUND AND PURPOSE: The purposes of this study were (1) to assess the construct validity of the Shoulder Pain and Disability Index (SPADI) and (2) to determine whether the SPADI is more responsive than the Sickness Impact Profile (SIP), a generic health status measure. SUBJECTS: The sample consisted of 94 patients who were diagnosed with a shoulder problem and referred to six outpatient physical therapy clinics. METHODS: Clinically meaningful change was determined by use of an ordinal rating scale designed to determine whether the patient's shoulder function was improved, the same, or worse following treatment. Spearman rho correlations were calculated for the initial visit SPADI and SIP scores. The standardized response mean (SRM) was used to measure responsiveness for the patients who were judged to be improved. One-tailed paired t tests (alpha = .01) were used to determine whether differences existed among SRM values. RESULTS: Correlations between the SPADI and SIP scores ranged from r = .01 to r = .57. The SRM value was higher for the SPADI total score (SRM = 1.38) than for the SIP total score (SRM = 0.79). CONCLUSION AND DISCUSSION: Most correlations between SPADI and SIP scores provided support for the construct validity of the SPADI. The SPADI does not appear to strongly reflect occupational and recreational disability and is more responsive than the SIP.

Influence of the infarct site on the identification of patients with ventricular tachycardia after myocardial infarction based on the time-domain and spectral turbulence analysis of the signal-averaged electrocardiogram.

In a significant proportion of patients with sustained ventricular tachycardia (VT) following anterior myocardial infarction, the areas of slow conduction are activated early during cardiac depolarization. Therefore, they may not be detected by the standard time-domain analysis of the signal-averaged electrocardiogram (SAECG) which is limited to the terminal part of the QRS complex. Spectral turbulence analysis of the SAECG is a new frequency domain technique which examines the whole QRS complex and may improve identification of patients with sustained VT following anterior infarction. We compared the results of time-domain and spectral turbulence analyses of the SAECG in 53 postinfarction patients with sustained VT and in 53 age-, gender- and infarct site-matched patients without VT. The receiver operator characteristic curves have shown that the time-domain analysis resulted in better identification of patients with VT following inferior than following anterior infarction (e.g., at the sensitivity level of 90%, the corresponding values of specificity were 96 and 90%, respectively), whereas the spectral turbulence analysis performed better in the anterior site of infarction. When both time-domain and spectral turbulence analyses were combined, the accuracy of the SAECG for identification of patients with VT following anterior infarction improved, reaching a specificity of 97% at the sensitivity level of 90%. In conclusion (1) spectral turbulence analysis of the SAECG results in better identification of patients with VT following anterior than following inferior infarction, and (2) the combination of time-domain and spectral turbulence analyses of the SAECG may improve identification of patients with VT following anterior infarction.

X-ray filter assembly for fluorescence measurements of x-ray absorption fine structure.

Fluorescence detection, in principle, permits the detection of the extended x-ray absorption fine structure (EXAFS) of more dilute atoms than can be obtained in absorption. To take advantage of this it is necessary, in practice, to eliminate the background that normally accompanies the fluorescence signal. We describe an x-ray filter assembly that accomplishes this purpose. The unique characteristic of the assembly is a slit system that minimizes the fluorescence background from the filter. The theory of the slit assembly is presented and is found to agree with measurements made on the Fe EXAFS of a dilute sample. The filter assembly has a better effective counting rate in this case than that of a crystal monochromator design.

The impact of coronary stenting on immediate procedural complication and long-term clinical restenosis at Waikato Hospital.

AIM: Clinical data on coronary stenting from within New Zealand is scarce and, in particular, the impact of current stent technologies is unknown. We reviewed all angioplasties undertaken at Waikato Hospital over a two year period to determine the clinical effect of coronary stenting on the local population. METHODS: Data from all patients who underwent coronary angioplasty at Waikato Hospital between July 1, 1995 and July 1, 1997 were included. Stents were deployed either to remedy sub-optimal results, or were electively used for saphenous vein grafts or restenotic lesions. Patient follow-up was obtained through a combination of database review, chart search and GP or patient contact. RESULTS: 662 lesions were dilated in 441 patients. 91 lesions were stented, 52.7% for sub-optimal results following balloon angioplasty. 98% of patients were followed up at six months. Whilst procedural success rate was higher in stented patients compared to unstented patients (96.7% vs 87.5% respectively, p=0.009) the in-hospital sub-acute occlusion rate was also increased (6.8% vs 1.9% respectively, p=0.007). At six months, coronary restenosis requiring repeat angioplasty was infrequent (10.9% overall) with no significant difference between the two groups (8.1% vs. 11.2% for stented vs unstented patients respectively, p=NS). CONCLUSIONS: The use of stents appears effective in improving immediate procedural success rates. Despite stented patients being at higher risk initially, their complication and six month clinical restenosis rates were similar.

The power of sex: some reflections on the Caldwell's "African sexuality" thesis.

PIP: J.C. Caldwell et al. would like to construct a model of African society which is capable of generating ideas about the nature of sex behavior. Such a model would explain population and fertility patterns as well as those relevant to the spread of HIV. However, the author is concerned with the values and morality of sexuality in East Africa. She stresses that her intention is not to comprehensively rebut Caldwell's work, but simply to reflect upon the nature of sexuality in East Africa while drawing upon the works of Caldwell. The author's goal is to highlight areas of disagreement and to present and re-present evidence from the ethnographic record in order to move toward more satisfactory descriptive criteria with which to begin to think, as an anthropologist, about sexual morality in Africa. Sections consider Africa's alternative civilization, the lineage model, respect, the metaphor of mingling, affection, and alliance and contract.^ieng