Systematic mapping of icosahedral short-range order in a melt-spun Zr36Cu64 metallic glass.

By analyzing the angular correlations in scanning electron nanodiffraction patterns from a melt-spun Zr(36)Cu(64) glass, the dominant local order was identified as icosahedral clusters. Mapping the extent of this icosahedral short-range order demonstrates that the medium-range order in this material is consistent with a face-sharing or interpenetrating configuration. These conclusions support results from atomistic modeling and a structural basis for the glass formability of this system.

Retrospective study of gross and histopathologic lesions associated with closed chest cardiopulmonary resuscitation in dogs.

OBJECTIVES: To investigate and characterise the incidence of iatrogenic complications secondary to closed chest cardiopulmonary resuscitation in dogs. MATERIALS AND METHODS: Necropsy reports and histologic sections of tissues were retrospectively examined from 180 dogs that had received closed chest cardiopulmonary resuscitation to determine lesions associated with resuscitation. RESULTS: The most common complication was pulmonary haemorrhage (81/163, 49.7%, 95% confidence interval: 42.1 to 57.3), although only nine dogs had pulmonary haemorrhage of at least moderate severity. Liver fractures occurred in 16 of 180 cases (8.9%, 95% confidence interval: 5.5 to 14.0). Blood loss of >15% of blood volume into the abdomen and/or thorax occurred in 13 of 180 cases (7.2%, 95% confidence interval: 4.2 to 12.1). CLINICAL SIGNIFICANCE: Significant haemorrhage secondary to cardiopulmonary resuscitation may decrease the chances of achieving the return of spontaneous circulation or may cause or compound ischemic damage to critical organs if the return of spontaneous circulation is achieved. Following successful cardiopulmonary resuscitation, animals should be screened for cavitary or pulmonary haemorrhage, as significant haemorrhage could be a factor in recurrence of cardiac arrest.

The urine anion gap: the critical clue to resolve a diagnostic dilemma in a patient with ketoacidosis.

Usually, ketoacidosis presents few if any diagnostic or therapeutic problems; in this article, we report a case where ketoacidosis was clinically occult and biochemically obscure. The patient presented with acute pancreatitis associated with a modest antecedent alcohol intake. Metabolic acidosis with a normal anion gap (10 meq/L) was observed together with moderate hyperglycemia and a 2 + (but not 4 +) test for serum ketones. None of the usual causes of metabolic acidosis with a normal anion gap was identified nor was there an obvious explanation for a reduction in unmeasured anion gap (e.g., hypoalbuminemia, dysproteinemia, or the presence of abnormal halides). Despite the initial normal anion gap, ketoacidosis was suspected clinically and this was confirmed by the elevated serum B-hydroxybutyrate of 8 mmol/L. We deduced that the serum unmeasured anions, which should have been increased by at least 8 meq/L, were being underestimated because of the effect of hypertriglyceridemia on the serum chloride determination. When the serum chloride was reestimated by a method not influenced by hyperlipidemia, the value was 102 mmol/L not 112 mmol/L and, when reevaluated, the anion gap was indeed appropriately elevated. In addition, the urine anion gap (Na + K - Cl) was 103 meq/L in the absence of renal disease. This indicated that the expected large quantity of urinary ammonium must have been masked by an even greater quantity of unmeasured anion; in this case proven by direct measurement to be B-hydroxybutyrate. Finally, metabolism of the alcohol ingested, which yields hepatic NADH, could explain, in part, the modest hyperglycemia and the absence of a 4 + test for serum ketones.(ABSTRACT TRUNCATED AT 250 WORDS)

Leguminous seeds in the dietary management of hyperlipidemia.

Seven male hyperlipidemic patients substituted approximately 140g dried beans daily for other sources of starch in their diet over a 4-month period. After this, mean fasting serum triglyceride levels were reduced by 25 +/- 5% (p less than 0.01) while total serum cholesterol levels were 7 +/- 2% (p less than 0.5) lower than the values measured during the previous five clinic attendances (12 +/- 2.5 months). However, low- and high-density lipoprotein cholesterol levels remained unaltered. While taking beans a nonsignificant fall (0.7 kg) was seen in body weight. Nevertheless no change was seen in macronutrient intake determined by 1-wk diet histories recorded both before and four times during the study, although cholesterol intake decreased by 80 mg (p less than 0.02). Reintroduction of dried leguminous seeds into a Western diet may be a useful adjunct to the management of hyperlipidemia.

Metabolic effects of a low-glycemic-index diet.

Six healthy male volunteers underwent 2-wk metabolically controlled high-glycemic-index (GI) and low-GI diets in random order. Over the low-GI diet significant reductions were seen in serum fructosamine (7.0 +/- 1.0%, p less than 0.01), 12-h blood glucose profile (37 +/- 7%, p less than 0.01), and total serum cholesterol (15 +/- 3%, p less than 0.01). As a measure of insulin secretion, 24-h urinary C-peptide levels were 32 +/- 10% lower (p less than 0.05) after the low-GI than after the high-GI diet. Lower C-peptide levels were maintained after a standard carbohydrate challenge after the low-GI diet despite higher blood glucose levels. Differences in blood glucose were not seen after a 5-g intravenous glucose challenge. These results are of interest with respect to the effect that prolonged postprandial reductions in nutrient fluxes and insulin secretion may have on carbohydrate and lipid metabolism and renal function.

Low glycemic index carbohydrate foods in the management of hyperlipidemia.

Reduction in the mean glycemic index (GI) of diets of 12 hyperlipidemic patients from 82 +/- 1 to 69 +/- 2 units (p less than 0.001) for a 1 mo period resulted in a significant reduction in total and LDL serum cholesterol and serum triglyceride by comparison with the mean lipid values for the preceding and following control months. The change in GI of the diet was achieved largely through manipulation of the cereal products and was not related to large differences in the amount of dietary fiber. In addition, apart from a small mean increase in unsaturated fat and calorie intake during the control periods, no difference was seen between the proportion of macronutrients on either treatment as determined by 1 wk diet histories recorded on alternate weeks throughout the 3 mo study. Selection of low glycemic index foods may therefore be a useful adjunct to the management of hyperlipidemia.

Low-glycemic index diet in hyperlipidemia: use of traditional starchy foods.

To define those patients most likely to benefit from the hypolipidemic effect of low-glycemic-index (GI) traditional starchy foods, 30 hyperlipidemic patients were studied for 3 mo. During the middle month, low-GI foods were substituted for those with a higher GI with minimal change in dietary macronutrient and fiber content. Only in the group (24 patients) with raised triglyceride levels (types IIb, III, and IV) were significant lipid reductions seen: total cholesterol 8.8 +/- 1.5% (p less than 0.001), LDL cholesterol 9.1 +/- 2.4% (p less than 0.001), and serum triglyceride 19.3 +/- 3.2% (p less than 0.001) with no change in HDL cholesterol. The percentage reduction in serum triglyceride related to the initial triglyceride levels (r = 0.56, p less than 0.01). The small weight loss (0.4 kg) on the low-GI diet did not relate to the lipid changes. Low-GI diets may be of use in the management of lipid abnormalities associated with hypertriglyceridemia.

Low-glycemic-index starchy foods in the diabetic diet.

Eight patients with noninsulin-dependent diabetes underwent two 2-wk study periods in random order during which they were provided with carbohydrate foods with either a high or low glycemic index (GI). Over both high-GI and low-GI periods there were significant reductions in body weight, serum fructosamine, and cholesterol. Reductions in fasting blood glucose, HbA1c, and urinary c-peptide-to-creatinine ratio were significant only over the low-GI period despite a smaller mean weight loss. Reductions in triglyceride were significant only over the high-GI diet. Inclusion of low-GI foods into diets of patients with diabetes may be an additional measure that favorably influences carbohydrate metabolism without increasing insulin demand.

Hypocholesterolemic effect of vegetable protein in a hypocaloric diet.

Eleven obese volunteers took part in a 12-week study during 8 weeks of which 2 meals of their control 1000 kcal diets were replaced by a soya based liquid formula (1 month) or a milk based liquid formula (1 month). The mean weight loss per month was 2.5 kg (P less than 0.05). On the soya formula total and LDL cholesterol levels were reduced significantly over the month by 10.0 +/- 2.7% (P less than 0.01) and 17.5 +/- 5.6% (P less than 0.02), respectively. Neither the milk based formula or the control low calorie diet lowered serum cholesterol significantly over the diet period. No change was seen in serum triglycerides on any of the 3 diets. No difference was seen between treatments in 24-h urinary C-peptide excretion. The results indicated that use of a vegetable protein supplement in a weight loss program which induced moderate weight loss was associated with a reduction in blood lipids, whereas moderate weight loss on a control low calorie diet or milk based formula was not.

Factors affecting the acceptance of deoxyguanosine-treated thymus allografts.

dGuo-treated mouse embryo thymus lobes depleted of lymphoid and dendritic cells are not rejected by normal allogeneic mice despite expression of class I and class II major histocompatibility (MHC) antigens on thymic epithelial cells. Our results suggest that host mice are not tolerant to donor antigens, but treated lobes survive because thymic epithelial cells are not immunogenic. Multiple grafts of dGuo-treated lobes are rejected perhaps because numbers of residual dendritic cells reach a threshold necessary for priming. Mice previously primed by injection of spleen cells reject dGuo-treated thymus lobes, and crossreactions between major and minor histocompatibility antigens can be demonstrated. The acceptance of dGuo-treated thymus allografts by normal mice provides a system for investigating the requirements for priming.

Temperature modulation of alpha- and beta-adrenoceptors in the isolated frog heart.

1. The effects of adrenaline on the isolated frog's heart at 27 degrees C are not antagonized by phentolamine (1.5 x 10(-6)M) but are abolished at 7 degrees C.2. At 27 degrees C isoprenaline was more potent than noradrenaline, but at 7 degrees C noradrenaline was more potent than isoprenaline.3. Phenoxybenzamine (1.5 x 10(-5)M) or dibenamine (1.5 x 10(-5)M) at 7 degrees C abolished the work output induced by adrenaline. When the temperature was raised to 24 degrees C, adrenaline caused an increase in work output.4. It is concluded that in the isolated frog heart there are at least two pools of adrenoceptors, the availability of which can be governed by temperature.

A kinetic study of the in vitro uptake of [3H]dopamine over a wide range of concentrations by rat striatal preparations.

The uptake of [3H]dopamine was investigated in a number of rat striatal preparations. Kinetic analysis of the rate of uptake by striatal slices indicated that at least two different saturable mechanisms for the catecholamine exist in this region, in addition to a first-order component. One of the uptake mechanisms has a high affinity for [3H]dopamine and the other a low affinity. Distinct high and low affinity systems were also observed for the uptake of [3H]dopamine by dispersed cell preparations of the rat striatum. Striatal synaptosomes appeared to have only a high affinity mechanism and a first-order component. The high affinity mechanisms are active transport mechanisms but the low affinity mechanisms are not unequivocably active transport systems. It is concluded that at least two sites for the uptake of [3H]dopamine exist in the striatum and that the low affinity system is unlikely to be found at the presynaptic nerve ending and is not due to the presence of blood vessels.

The interleukin-2 receptor and its expression in the acute leukaemias and lymphoproliferative disorders.

The expression of the interleukin-2 receptor (IL-2R) was investigated in a total of 117 cases of acute leukaemia and lymphoproliferative disorder. The results confirm reports that the interleukin-2 receptor can be expressed on cells of myeloid lineage and in cases of Hairy Cell Leukaemia. They extend knowledge of the expression of the IL-2R in cases of lymphoproliferative disorders.

Effect of nibbling versus gorging on cardiovascular risk factors: serum uric acid and blood lipids.

Nibbling has been reported to decrease serum cholesterol under fasting conditions, as well as the incidence of cardiovascular disease. It has been suggested that these effects are partly attributable to reduced concentrations of serum insulin, which are also observed. However, data on the effects of nibbling on serum lipids throughout the day are not available, nor is it known how nibbling affects serum uric acid as a further insulin-related risk factor for cardiovascular disease. We have attempted to address these issues. Seven healthy men consumed identical diets in a randomized crossover design either as three meals daily (control) or as 17 meals daily (nibbling) for 2 weeks. On day 13, serum lipid levels were measured over the course of the day (12 hours) together with the 24-hour urinary excretion of mevalonic acid as an indicator of hepatic cholesterol synthesis. Concentrations of uric acid in serum and 24-hour urinary excretion of uric acid were also determined. Mean (+/- SE) percent treatment differences in day-long total, low-density lipoprotein (LDL), and non-high-density lipoprotein (HDL) cholesterol, and apolipoprotein (apo) B were significant, with lower values on the nibbling diet as compared with the control diet (8.1% +/- 1.6%, P = .002; 12.2% +/- 2.6%, P = .005; 10.1% +/- 1.6%, P < .001; and 9.9% +/- 2.6%, P = .008, respectively). No significant difference was seen in the total to HDL cholesterol ratio or in urinary mevalonic acid excretion.(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence for a direct anti-inflammatory action of calcitonin: inhibition of histamine-induced mouse pinnal oedema by porcine calcitonin.

Porcine calcitonin (PCT) caused a potent inhibition of histamine-induced vascular leakage in the mouse pinna. These effects were observed at doses of PCT lower than those required to affect plasma calcium concentrations. In contrast PCT did not inhibit responses of the mouse pinna to 5-hydroxytryptamine despite observed falls in plasma calcium concentrations. It would appear that PCT inhibits histamine-induced oedema in the mouse by a direct action which may partially or fully explain the anti-inflammatory action of PCT, observed by other workers, in some acute inflammatory conditions.

Parental smoking and middle ear effusions in children.

A study was conducted on seventy children to ascertain any relationship between parental smoking and the presence of middle ear effusions in the children. Information was collected using a questionnaire, clinical examination and audiological tests. Both groups of children (with and without effusions) had similar age, sex and social class distributions. It was found that the presence of middle ear effusions in the children was associated with an increased incidence of parental smoking. Those children with an abnormal tympanometry result were more likely to have at least one parent who smoked than those with normal tympanometry results. There was no relationship between resolution of the effusion and parental smoking. It is therefore suggested that as part of the management of this condition parents should be advised of the effects of smoking on the condition and encouraged to avoid smoking in the same environment as their children.

A description of independent living projects in the United States: various programmatic strategies for fiscal coping.

Independent living facilities in the United States provide numerous services to a large number of residential clients using a diversity of human service personnel. The facilities are often homogeneous in the range of services offered, the large nature of the facility, client population, staff, and sometimes budget. Most facilities feel that various styles of residential programs should be researched. A clearly defined service delivery model and fiscal models for prudent operations appears to be lacking in most agencies. Almost all the programs rent part of their building space to outside business interests. An absence of Federal money would eliminate or vastly reduce the services of most of the surveyed programs.

Senior house officers in medicine: postal survey of training and work experience.

OBJECTIVES: To describe working conditions for senior house officers in medicine in Scotland and to relate these to the quality of clinical training they receive. DESIGN: Postal questionnaire survey. SUBJECTS: All senior house officers in medicine and related specialties in post in Scotland in October 1995 (n = 437); 252 (58%) respondents. MAIN OUTCOME MEASURES: Questionnaires covered hours, working patterns, measures of workload, an attitudes to work scale, and experience of education and training. RESULTS: In the week before the questionnaire, doctors on rotas had worked a mean of 7.4 (95% confidence interval 5.8 to 9.0) hours in excess of their contracts, compared with 3.7 (2.0 to 5.5) hours for those on partial shifts. The most common reason for this was "the needs of the patients or the service." Those on partial shifts reported significantly less continuity of care with patients than those on rotas (Mann-Whitney U test, z = -4.2, P < 0.0001) or full shifts (z = -2.08, P = 0.03). Doctors in general medicine reported significantly higher measures of workload (number of acute admissions, number of times called out, and fewest hours' uninterrupted sleep) than those in subspecialties. Consultants' clinical teaching and style of conducting a ward round were significantly related to factors extracted from the attitudes to work scale. CONCLUSIONS: The quality of senior house officers' training is detrimentally affected by a variety of conditions, especially the need for closer support and supervision, the need for greater feedback, and the lack of time that consultants have to dedicate to clinical training. Efforts should be made to improve these conditions and to reinforce a close working relationship between trainee and supervising consultant.

Traveling healthy: a guide for counseling the international traveler.

Pretravel medical history and itinerary review coupled with education and counseling precedes a mutual plan between the provider and the traveler for appropriate immunizations, prophylaxis for malaria, and precautions against travelers' diarrhea. This article provides a useful tool for taking a travel history, an overview of the immunizations recommended, and behavioral practices for prevention of illness and injury. Traveler-friendly resources are available for pretravel advice, health care abroad, emergency medical transport, special needs travelers, and U.S. State Department advisories. Planning should begin as early as possible to allow time for vaccine series, separation of vaccines to avoid adverse interactions, as well as prophylactic antimalarials that need to be initiated in advance of travel. Travelers with special needs should prepare ahead for access to care, medications, and medical identification. Returning travelers need to be counselled to report their travel to their provider if seeking medical attention post travel.

The continuing dental education (CDE) activities of a regional cohort of Irish dentists--a baseline study.

The need for continuing dental education (CDE) throughout one's career is becoming increasingly accepted by the modern practitioner. The current paper is part of a longitudinal investigation of the various conceptual, practical and attitudinal aspects of CDE. (Based on the responses of a representative sample of 146 dentists, it documents the level of participation in CDE among practitioners in the South and Mid-West regions of Ireland, at a baseline examination). Only 41% of respondents belonged to more than one professional association, while 55% subscribed to more than one journal. The Irish Dental Association and the present journal dominated these statistics. There was a generally low level of involvement in elements of CDE, such as attendance at scientific conferences, professional courses and occasional meetings. There was a high degree of consistency in the respondents' participation in CDE-related activities. Thus dentists who belonged to a number of organisations and subscribed to various journals, also tended to more frequently attend relevant conferences, courses and meetings. With some exceptions, specialist and hospital-based dentists were more likely to be involved in CDE activities.