Response and habituation of the human amygdala during visual processing of facial expression.

We measured amygdala activity in human volunteers during rapid visual presentations of fearful, happy, and neutral faces using functional magnetic resonance imaging (fMRI). The first experiment involved a fixed order of conditions both within and across runs, while the second one used a fully counterbalanced order in addition to a low level baseline of simple visual stimuli. In both experiments, the amygdala was preferentially activated in response to fearful versus neutral faces. In the counterbalanced experiment, the amygdala also responded preferentially to happy versus neutral faces, suggesting a possible generalized response to emotionally valenced stimuli. Rapid habituation effects were prominent in both experiments. Thus, the human amygdala responds preferentially to emotionally valenced faces and rapidly habituates to them.

Occurrence and risk factors of oral candidiasis treated with oral antifungals in seniors using inhaled steroids.

Oral candidiasis (OC) is a frequent side effect of inhaled corticosteroids (iCSTs). This study estimated occurrence and significance of risk factors of OC treated with antifungals in users of iCSTs under conditions of normal use. This retrospective analysis used data drawn from drug insurance plan records in Quebec, Canada. The sample contained 27,000 seniors using anti-asthma medications during 1990. Three years of data (1989-1991) were searched for use of oral antifungals concurrent with exposure to iCSTs. A case-control study examined factors leading to increased probability of first incidence of OC in new users of iCSTs. Three-year occurrence for OC was 7%. Increased risk for a first occurrence of OC was significantly associated with higher doses of iCST, increased length of iCST exposure, use of antibiotics, use of oral steroids, having three or more prescribers, a history of use of both high and low strengths of iCST, and concurrent use of oral steroids and diabetes medications. The occurrence of OC is relatively high. Knowledge of factors leading to increased risk could facilitate the targetting of patients who need timely intervention, under conditions of normal use.

Epidermal growth factor suppresses renal tubular apoptosis following ureteral obstruction.

OBJECTIVES: Acute unilateral ureteral obstruction (UUO) results in ipsilateral hydronephrosis characterized by a decrease in epidermal growth factor (EGF) mRNA expression and EGF protein levels in the distal renal tubules. UUO results in programmed cell death with increases in the characteristic markers of apoptosis. To suppress the apoptotic response during UUO, recombinant EGF was administered during renal obstruction and the ensuing molecular and histologic changes were studied. METHODS: Mature Sprague-Dawley rats underwent left ureteral obstruction and the kidneys were harvested at 24, 48, and 72 hours. Markers of apoptosis included DNA laddering pattern on agarose gel electrophoresis, in situ gap labeling of fragmented DNA for quantitative apoptotic body determination, polyadenylated mRNA expression of SGP-2, and in situ hybridization for sulfated glycoprotein-2 (SGP-2) mRNA. Studies were repeated in rats following administration of 10, 20, and 40 micrograms of subcutaneous recombinant EGF on a daily basis after UUO. RESULTS: Subcutaneous injection of EGF into unilaterally obstructed rats promotes renal tubular epithelial cell regeneration, as demonstrated by increased cortical mitotic activity. Systemic EGF supplementation in these unilaterally obstructed rats also resulted in a decrease in the intensity of the DNA laddering pattern associated with renal tubular apoptosis. An in situ labeling procedure to identify apoptotic nuclei in the ureterally obstructed kidneys revealed a 50% reduction in apoptosis after EGF administration. Northern blot analysis and in situ hybridization for SGP-2 mRNA or clustering gene product also revealed a decreased expression in the obstructed and EGF-treated renal parenchyma. CONCLUSIONS: These data suggest that EGF, apart from its known role as a mitogenic substance for renal tubular epithelial cells, is also a critical in vivo renal cell survival factor for the developmentally mature kidney.

Perceived control and treatment outcome with chronic adolescent offenders.

The relationship between perceived control and treatment outcome was explored with chronic adolescent offenders who exhibit internalizing or externalizing behavior problems. Data were examined from the records of 307 male adolescents between the ages of 14 and 18 committed to a state training school for hard-core offenders. Adolescent offenders with externalizing behavior problems, such as aggression, showed a more favorable treatment outcome when they attributed overall successes to their own behavior and when they viewed themselves as worried or anxious. They showed a less favorable treatment outcome when they viewed themselves as generally happy. Adolescent offenders with internalizing behavior problems, such as anxiety or depression, tended to show less favorable treatment outcomes when they viewed themselves as being high in physical competence and when they attributed failures to themselves.

Comparison of conduct-disordered behavior in crack-dealing versus nondealing juvenile offenders.

Currently, little research has investigated psychosocial functioning among juvenile crack dealers, and there appear to be few studies comparing dealers to nondealing juvenile offenders. The current study examined whether juvenile crack dealers display more severe conduct-disordered behavior than their nondealing delinquent peers. The records of 130 adolescent males committed to a residential training school were studied. Analyses indicated that crack dealers were younger when first arrested, had more arrests and commitments, and met more DSM-III-R conduct-disorder criteria than their nondealing delinquent peers. In addition, the DSM-III-R conduct-disorder criteria met by dealers were more severe, and dealers were more likely to be rearrested within six months following release. Overall, significant differences between crack dealers and nondealing juvenile offenders were found; dealers displayed a more delinquent history and a more serious and violent conduct disorder than their nondealing yet delinquent peers.

Incidence of bacterial meningitis in Asia using enhanced CSF testing: polymerase chain reaction, latex agglutination and culture.

To enhance the detection of bacterial meningitis in an East Asian surveillance study, we employed cerebrospinal fluid (CSF) bacterial culture, latex agglutination (LA) and polymerase chain reaction-enzyme immunoassay (PCR-EIA) testing for Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae (Sp). The sensitivity and specificity of CSF PCR-EIA testing was compared to LA and culture. A meningitis case was defined by one positive result for any of the three tests. The sensitivity of H. influenzae CSF PCR-EIA, LA, and culture was 100%, 40% and 57.5% respectively; and for Sp CSF PCR-EIA, LA and culture, the sensitivity was 100%, 58.3% and 66.7%, respectively. Hib and Sp specificity was 100% by each method. CSF PCR-EIA was more sensitive than culture or LA for the detection of Hib and Sp meningitis cases increasing their incidence by 74% and 50% compared to culture respectively. CSF PCR-EIA should be included for the detection of bacterial meningitis in surveillance studies.

Permanent disability: the legacy of tort litigation.

The therapeutic alliance essential during the long process between the injury and the final appeal in the resulting tort is discussed. The core thesis is that once the patient with orthopaedic problems initiates litigation, he or she starts to become invested in permanent disability, and the slide down the slippery slope of a lifetime of disability has begun. This is not a lament about the role of lawyers, courts, and litigation. They are facts, part of the working conditions of the orthopaedic physician. What happens after acknowledging these facts is the topic of discussion. How can one do the best job of damage control in the face of a totally toxic situation? How can the physician become a stabilizing force in the spin toward permanence in disability?

Urology peer review at the National Institutes of Health.

PURPOSE: Urology is a field with many subspecialties and, as a consequence, urological research grant applications are distributed to a variety of different study sections at the National Institutes of Health (NIH). It has long been the conviction of urological investigators that urological grant funding suffers as a result of this distribution. We investigated the composition of these study sections to identify the prevalence of urological expertise (or lack thereof). The review challenges the concept that urological research grant applications are being subjected to adequate peer review. MATERIALS AND METHODS: Aided by personnel from the National Institute for Diabetes, and Digestive and Kidney Diseases, and the National Cancer Institute, 22 study sections to which urological grants are distributed were identified. A 3 to 5-year retrospective MEDLINE analysis of all the scientific publications of each study section member was done. Urological experts were identified by the criterion of having more than 1 urological publication published per year or a proportional equivalent. An equivalent analysis was performed for the study sections reviewing cardiology grants to serve as a comparison. RESULTS: Data analysis revealed that only 12 of 351 study section members reviewing urological grants are urological experts (3.4%). Only 3.1% of the collective published productivity of these members is in the broadly defined field of urological investigation. Omitting the published productivity of these 12 experts, less than 1% of the published works of the remaining 339 members reflects interest or expertise in urological investigations. Of the 22 study sections only 8 have urological expertise represented in their membership. Except for 1 study section, representation of urological experts was usually limited to 1 individual reflecting a 5.9 to 11.1% minority in these study sections. CONCLUSIONS: The lack of urological expertise represented on the NIH study sections reviewing basic and clinical urological research grant applications has far reaching ramifications. Consequently, grant applications on genitourinary diseases that commonly afflict a preponderance of Americans are inadequately reviewed at the NIH. Only through the provision of appropriate peer reviewers will this problem be solved.

The role of corticosteroid therapy in children with pneumococcal meningitis.

The records of 97 infants and children with pneumococcal meningitis treated in Dallas, Tex, from 1984 to 1990 were reviewed to determine whether corticosteroid therapy improved disease outcome as has been demonstrated in patients with Haemophilus meningitis. Forty-one patients received corticosteroid therapy, 39 of whom were given dexamethasone in the conventional 4-day regimen. There were no significant differences in the demographic and clinical characteristics of steroid- and non-steroid-treated patients. In addition, there were no significant differences between treatment groups with regard to presence of seizures, subdural effusions, hydrocephalus, and positive cerebrospinal fluid cultures 24 hours after the start of treatment. When steroid therapy was given before or concurrently with antibiotic therapy, none of 30 steroid-treated vs 16 of 52 non-steroid-treated patients developed evidence of neurologic or cardiovascular instability after the first parenteral antibiotic dose was given. Among 86 survivors examined, significantly fewer steroid-treated patients had an adverse neurologic long-term outcome, including hearing impairment, compared with non-steroid-treated patients (four of 35 vs 14 of 43). This was also true for those patients with overwhelming meningeal infection. We believe that corticosteroid therapy is also beneficial in infants and children with pneumococcal meningitis.

Occluded-ear simulator with variable acoustic properties.

Ear simulators were designed to replicate acoustical characteristics of the average adult ear. Due to variability of ear-canal geometry and eardrum impedance among individuals, the possibility of any one person exhibiting such "average" characteristics--especially if that person is a child and/or has a conductive pathology--is remote. Thus, ear simulators have been of only peripheral value when prescribing a hearing aid (a high output impedance device) to fit the acoustical requirements of a particular patient. Reported herein is development of a programmable artificial ear (PAE) that can account for individual differences in ear-canal geometry and eardrum impedance. It consists of a 2.0-cc coupler, microphone, amplifier, computer, PAE code, and a computer card and/or software for digitization and Fourier transformation. Required input data includes ear-canal dimensions, eardrum impedance, and output impedance of the hearing aid being tested. Sound-pressure recordings produced in the 2.0-cc coupler by the hearing aid are adjusted by the computer to what they would have been had the recordings been made at the eardrum of a particular patient wearing the same hearing aid. Good agreement was observed between experiment and theory for one test case involving a totally occluding miniature earphone.