Effect of end-stage renal disease on decreased heart rate variability.

We compared short-term heart rate variability (HRV) in 60 patients with end-stage renal disease (ESRD) with 33 age-matched healthy controls and also assessed the contribution of known determinants of HRV in the ESRD patients. HRV was markedly decreased in the ESRD patients and the predictor variables of cardiac diseases, diabetes mellitus, age, heart rate, gender, and smoking explained only a small portion of HRV, suggesting that ESRD itself is an independent factor for decreased HRV.

Management involvement with compliance: when distributive management fails, everyone pays.

In this article I discuss the importance of management retaining and exercising its responsibilities for control over studies, especially studies that have been distributed to contractors and subcontractors, hence the title, "Distributive Management." While the clearest examples for distributive management are found in environmental fate and crop residue studies for EPA, similar examples may be found in contemporary toxicology and carcinogenicity studies. The cost of failure to exercise control over contracted studies has been estimated by the EPA at between $600 M and $1,200 M. These are costs that will be borne by the public through higher prices and higher taxes.

The National Commission on AIDS.

A decade after the first cases were recognized in the United States, AIDS continues to vex policymakers and fascinate the public. It has been said that AIDS acts as a prism, refracting a spectrum of controversial topics. For bioethicists, these topics include: equity in the allocation of resources for treatment and research; forgoing life-sustaining care and proxy decision making; informed consent in the context of HIV testing and screening; the ethical duties of health care workers to provide care for persons with HIV disease; and competing obligations of health care professionals to patients and to third parties who may be put at risk.

Intraoperative autotransfusion in cardiac operations. Effect on intraoperative and postoperative transfusion requirements.

The Southern Arizona Regional Red Cross Blood Program, in cooperation with two cardiac surgery groups, examined the effect of intraoperative autotransfusion on red cell, plasma, and platelet usage during and after cardiac operations. The study evaluated whether intraoperative autotransfusion influenced intraoperative or postoperative blood usage and whether regular use was more effective than selective use. The study demonstrated that intraoperative autotransfusion reduces intraoperative and postoperative blood use and that regular use of intraoperative autotransfusion is more effective than selective use.

Identification of the protein product of the c-mos proto-oncogene in mouse testes.

The mouse c-mos proto-oncogene RNA is expressed primarily in mouse gonadal tissues and embryos. Until now, the c-mos protein has not been identified. Utilizing two different site-directed affinity purified anti-peptide antibodies, we have identified a 43 kDa c-mos protein in mouse testes and in germ cell preparations derived from testes. This 43 kDa testicular protein was found to be structurally related to a bacterially expressed c-mos protein by peptide mapping. Immunoblots of whole mouse sections were employed to establish that the c-mos protein is expressed primarily in the testes.

Post-transcriptional processing suggests that c-mos functions as a maternal message in mouse eggs.

Transcripts of the c-mos proto-oncogene were recently found to accumulate to high levels in mouse oocytes. We report here that the oocyte c-mos RNA is polyadenylated in concert with oocyte maturation, retained in mature ovulated eggs and zygotes but degraded by the late two cell embryo stage. These results suggest that c-mos functions as a maternal mRNA which is translated during oocyte maturation or fertilization and may play a role in these or other early developmental processes.

Expression of c-mos RNA in germ cells of male and female mice.

We have investigated the cell types in mouse testis and ovary in which the c-mos protooncogene is normally transcribed. Blot hybridization analysis of electrophoretically fractionated RNAs from testes of mice with defects in germ-cell development and from prepubertal and adult mice indicated that c-mos was transcribed during male germ-cell development. Analysis of purified populations of spermatogenic cell types detected c-mos RNA in the earliest haploid postmeiotic germ cell, the round spermatid, indicating that c-mos was expressed transiently during spermatogenesis. c-mos RNA was detected by blot hybridization in the ovaries of prepubertal mice and decreased in relative concentration following gonadotropin-stimulated proliferation of granulosa cells. These results suggested that c-mos was transcribed in oocytes and were confirmed by detection of high levels of c-mos RNA in isolated grown oocytes. Thus, c-mos is expressed in both male and female germ cells, suggesting possible roles for this protooncogene in meiosis, germ-cell development, fertilization, and early embryogenesis.

Care of the young hemophiliac. New socioeconomic demands and the changing patient-physician relationship.

Over the past two decades, greater knowledge about hemophilia and vastly improved treatment have led to a veritable revolution in the care of this crippling disease. In prospect is an era in which both short- and long-term sequelae may be avoided altogether. Much of the progress has been effected through novel methods of care delivery in which the relationship of the physician and his patient begins to resemble more a partnership between equals than the traditional dependency of the chronically handicapped on his doctor. Yet with, and because of, these changes ethical and legal aspects are inevitably introduced, some of which are discussed in the article. These deal with issues of public policy, distributive justice, avoidance of harm, risk imposition and risk-taking, confidentiality, and paternalism. When applicable, the discussion surrounds a prototypical case which illustrates the real dilemmas which treaters and patients may have experienced or may encounter. Following each issue is a discussion intended to show how the ethical and legal dimensions may be analyzed in a way which allows certain justifiable decisions. These analyses are themselves based upon ethical premises which are commonly accepted, legal precedent, or both. While some of these considerations are relevant to the older hemophiliac as well, most deal with topics affecting those most likely to benefit from the advances and to contend with the challenges of this new era of hemophilia care: the young hemophiliac and his physician.

Development of homozygosity for chromosome 11p markers in Wilms' tumour.

Somatic alterations in the genome are found in many human tumours. Chromosome rearrangements or base substitutions that activate cellular oncogenes appear to act dominantly. In contrast, recessive alleles apparently contribute to childhood retinoblastoma, as homozygosity (or hemizygosity ) for chromosome 13 is often established in tumours, by either mitotic nondisjunction or recombination. Parallels exist between retinoblastoma and childhood Wilms' tumour (WT). Retinoblastoma is often inherited and accompanied by a deletion of chromosome 13 (band q14), while WT is occasionally associated with aniridia and deletion of chromosome 11 band p13. Most Wilms' tumours are sporadic and not accompanied by these findings, although interstitial deletion of chromosome 11 in tumour, but not normal, cells has been reported. In view of these parallels, we compared constitutional and tumour DNAs from WT patients by using chromosome 11p DNA probes. We report here that although heterozygosity in constitutional DNAs was often preserved in tumour DNAs, one case developed homozygosity for chromosome 11p markers in tumour cells, implying the involvement of chromosomal events in revealing a recessive WT locus. This observation suggests the action of such general mechanisms in a tumour other than retinoblastoma.

Molecular cloning and nucleotide sequence of a transforming gene detected by transfection of chicken B-cell lymphoma DNA.

A transforming gene detected by transfection of chicken B-cell lymphoma DNA has been isolated by molecular cloning. It is homologous to a conserved family of sequences present in normal chicken and human DNAs but is not related to transforming genes of acutely transforming retroviruses. The nucleotide sequence of the cloned transforming gene suggests that it encodes a protein that is partially homologous to the amino terminus of transferrin and related proteins although only about one tenth the size of transferrin.

Histiocytic medullary reticulosis associated with acute Epstein-Barr (EB) virus infection.

A 22-month-old girl developed a rapidly fatal erythrophagocytic syndrome associated with evidence of acute EB viral infection. The association of hemophagocytic syndromes with viral, bacterial, and parasitic infections is discussed. All cases diagnosed as histiocytic medullary reticulosis should include attempts to detect possible association with infectious agents in addition to the assessment of host response.

Longitudinal esophageal bands associated with esophageal aperistalsis: speculations on pathogenesis.

A 6-year-old girl with ataxia telangiectasia syndrome was found to have multiple bands longitudinally traversing her esophagus, and esophageal aperistalsis. In the past, the patient was also known to have had esophageal candidiasis. The bands may have been congenital or may have been produced when linear ulcers caused by fungal esophagitis undermined mucosal strips and then healed, leaving tissue bands attached only at their extremities to the esophageal wall. The esophageal motor dysfunction may have been attributable to esophageal candidiasis, or may have been a hitherto unrecognized component of the ataxia telangiectasia syndrome.

Elongation of fatty acids in Mycobacterium tuberculosis.

Cell-free extracts of the H37Ra strain of Mycobacterium tuberculosis contain a soluble enzyme system which catalyzes an elongation reaction of long-chain fatty acids. The predominant reaction involves the addition of a single C(2) unit to the acceptor fatty acid; the elongation takes place exclusively at the carboxyl end of the acceptor molecule. The endogenous acceptor lipid can be removed by solvent extraction of the enzyme system. The lipid-depleted enzyme can be fully reactivated with external acyl coenzyme A, after which elongation with acetyl coenzyme A takes place. The elongation reaction is avidin-insensitive and does not require adenosine triphosphate. Reduced nicotinamide adenine dinucleotide is the source of reducing equivalent, whereas reduced nicotinamide adenine dinucleotide phosphate is without effect.