Regional anaesthesia practice for arteriovenous fistula formation surgery.

We conducted a survey and semi-structured qualitative interviews to investigate current anaesthetic practice for arteriovenous fistula formation surgery in the UK. Responses were received from 39 out of 59 vascular centres where arteriovenous access surgery is performed, a response rate of 66%. Thirty-five centres reported routine use of brachial plexus blocks, but variation in anaesthetic skill-mix and practice were observed. Interviews were conducted with 19 clinicians from 10 NHS Trusts including anaesthetists, vascular access and renal nurses, surgeons and nephrologists. Thematic analysis identified five key findings: (1) current anaesthetic practice showed that centres could be classified as 'regional anaesthesia dominant' or 'local anaesthesia/mixed'; (2) decision making around mode of anaesthesia highlighted the key role of surgeons as frontline decision makers across both centre types; (3) perceived barriers and facilitators of regional block use included clinicians' beliefs and preferences, resource considerations and patients' treatment preferences; (4) anaesthetists' preference for supraclavicular blocks emerged, alongside acknowledgement of varied practice; (5) there was widespread support for a future randomised controlled trial, although clinician equipoise issues and logistical/resource-related concerns were viewed as potential challenges. The use of regional anaesthesia for arteriovenous fistula formation in the UK is varied and influenced by a multitude of factors. Despite the availability of anaesthetists capable of performing regional blocks, there are other limiting factors that influence the routine use of this technique. The study also highlighted the perceived need for a large multicentre, randomised controlled trial to provide an evidence base to inform current practice.

Local anaesthesia for endovascular repair of ruptured abdominal aortic aneurysm.

BACKGROUND: Case series and a post hoc subgroup analysis of a large randomized trial have suggested a potential benefit in treating ruptured abdominal aortic aneurysms (rAAAs) using endovascular aneurysm repair (EVAR) with local anaesthesia (LA) rather than general anaesthesia (GA). The uptake and outcomes of LA in clinical practice remain unknown. METHODS: The UK National Vascular Registry was interrogated for patients presenting with rAAA managed with EVAR under different modes of anaesthesia between 1 January 2014 and 31 December 2016. The primary outcome was in-hospital mortality. Secondary outcomes included: the number of centres performing EVAR under LA; the proportion of patients receiving this technique; duration of hospital stay; and postoperative complications. RESULTS: Some 3101 patients with rAAA were treated in 72 hospitals during the study: 2306 underwent on open procedure and 795 had EVAR (LA, 319; GA, 435; regional anaesthesia, 41). Overall, 56 of 72 hospitals (78 per cent) offered LA for EVAR of rAAA. Baseline characteristics and morphology were similar across the three EVAR subgroups. Patients who had surgery under LA had a lower in-hospital mortality rate than patients who received GA (59 of 319 (18·5 per cent) versus 122 of 435 (28·0 per cent)), and this was unchanged after adjustment for factors known to influence survival (adjusted hazard ratio 0·62, 95 per cent c.i. 0·45 to 0·85; P = 0·003). Median hospital stay and postoperative morbidity from other complications were similar. CONCLUSION: The use of LA for EVAR of rAAA has been adopted widely in the UK. Mortality rates appear lower than in patients undergoing EVAR with GA.

The design and implementation of a study to investigate the effectiveness of community vs hospital eye service follow-up for patients with neovascular age-related macular degeneration with quiescent disease.

IntroductionStandard treatment for neovascular age-related macular degeneration (nAMD) is intravitreal injections of anti-VEGF drugs. Following multiple injections, nAMD lesions often become quiescent but there is a high risk of reactivation, and regular review by hospital ophthalmologists is the norm. The present trial examines the feasibility of community optometrists making lesion reactivation decisions.MethodsThe Effectiveness of Community vs Hospital Eye Service (ECHoES) trial is a virtual trial; lesion reactivation decisions were made about vignettes that comprised clinical data, colour fundus photographs, and optical coherence tomograms displayed on a web-based platform. Participants were either hospital ophthalmologists or community optometrists. All participants were provided with webinar training on the disease, its management, and assessment of the retinal imaging outputs. In a balanced design, 96 participants each assessed 42 vignettes; a total of 288 vignettes were assessed seven times by each professional group.The primary outcome is a participant's judgement of lesion reactivation compared with a reference standard. Secondary outcomes are the frequency of sight threatening errors; judgements about specific lesion components; participant-rated confidence in their decisions about the primary outcome; cost effectiveness of follow-up by optometrists rather than ophthalmologists.DiscussionThis trial addresses an important question for the NHS, namely whether, with appropriate training, community optometrists can make retreatment decisions for patients with nAMD to the same standard as hospital ophthalmologists. The trial employed a novel approach as participation was entirely through a web-based application; the trial required very few resources compared with those that would have been needed for a conventional randomised controlled clinical trial.

Pollen counts and suicide rates. Association not replicated.

OBJECTIVE: To replicate a previously reported association between pollen counts and county suicide rates in the continental United States, across space and time. METHOD: The authors evaluated the relationship between airborne pollen counts and suicide rates in 42 counties of the continental United States, containing a pollen-counting station participating in the Aeroallergen Monitoring Network in the United States (N = 120,076 suicides), considering years' quarter, age group, sex, race, rural/urban location, number of local psychiatrists, and median household income, from 1999 to 2002. The county-level effects were broken into between-county and within-county. RESULTS: No within-county effects were found. Between-county effects for grass and ragweed pollen on suicide rates lost statistical significance after adjustment for median income, number of psychiatrists, and urban vs. rural location. CONCLUSION: Future research is necessary to reappraise the previously reported relationship between pollen levels and suicide rates that may have been driven by socioeconomic confounders.

The use of allied health therapies on competition horses in the North Island of New Zealand.

AIM: To obtain data on the use of allied health therapy within competitive equestrian sport in the North Island of New Zealand. METHODS: Data were collected during January 2010 by survey at show jumping and dressage championships in the North Island, and from racing yards in the Central Districts of New Zealand. The survey consisted of 30 open, closed and multiple-choice questions, and was conducted face-to-face, by the same interviewer. Information on the demographics of riders or trainers and horses in each discipline (show jumping, dressage, and Thoroughbred racing), the use of allied health therapy (physiotherapy, chiropractic and equine sports massage) on horses, and knowledge of training and qualifications of the allied health therapists was obtained. Univariable and multivariable logistic regression were used to examine relationships between demographic variables and the use of allied health therapists. RESULTS: In total, 110 riders or trainers participated in the survey. The relative contribution of responses across disciplines was 39/110 (36%), 41/110 (37%) and 30/110 (27%) for show jumping, dressage, and Thoroughbred racing respectively. Allied health therapists were used by 68/110 (62%) respondents to treat their horses. The most common types of allied health therapy used were chiropractic (25/68; 37%) and physiotherapy (16/68; 24%). The main reasons for using allied health therapies were for back pain (22/68; 32%) and lameness (17/68; 25%). Only 5/68 (7%) respondents chose a type of allied health therapy based on veterinary advice, and 49/68 (72%) stated that their veterinarian and allied health therapist did not work together when treating their horses. The final multivariable model for use of allied health therapists included the explanatory variables discipline of the rider or trainer and the number of horses in training per season. CONCLUSIONS AND CLINICAL RELEVANCE: The use of allied health therapies for the treatment of competition and racehorses was widespread. Many riders or trainers perceived allied health therapy to be beneficial, however many therapists and veterinarians do not work together and therefore the integrative treatment approach to rehabilitation is lost.

Biochemical and pharmacological characterization of different recombinant acid alpha-glucosidase preparations evaluated for the treatment of Pompe disease.

Pompe disease results in the accumulation of lysosomal glycogen in multiple tissues due to a deficiency of acid alpha-glucosidase (GAA). Enzyme replacement therapy for Pompe disease was recently approved in Europe, the U.S., Canada, and Japan using a recombinant human GAA (Myozyme, alglucosidase alfa) produced in CHO cells (CHO-GAA). During the development of alglucosidase alfa, we examined the in vitro and in vivo properties of CHO cell-derived rhGAA, an rhGAA purified from the milk of transgenic rabbits, as well as an experimental version of rhGAA containing additional mannose-6-phosphate intended to facilitate muscle targeting. Biochemical analyses identified differences in rhGAA N-termini, glycosylation types and binding properties to several carbohydrate receptors. In a mouse model of Pompe disease, glycogen was more efficiently removed from the heart than from skeletal muscle for all enzymes, and overall, the CHO cell-derived rhGAA reduced glycogen to a greater extent than that observed with the other enzymes. The results of these preclinical studies, combined with biochemical characterization data for the three molecules described within, led to the selection of the CHO-GAA for clinical development and registration as the first approved therapy for Pompe disease.

A cross-sectional survey of Thoroughbred stud farm management in the North Island of New Zealand.

AIM: To obtain initial baseline data on the management of Thoroughbred stud farms in the North Island of New Zealand. METHODS: Data on the management of Thoroughbred stud farms were collected from a sample of 22 stud farms located in the south Auckland/Waikato region (n=15) and lower North Island (n=7) of New Zealand, using a face-to-face survey. The studmaster provided information on the size, scope and management of the farms during the 2004/2005 breeding season. Analysis was based on the location of the farm and size of the breeding operation (number of resident mares). RESULTS: Effective farm size ranged from 20 to 526 ha and averaged 167 (standard error (SE) 36) and 88 (SE 49) ha in the south Auckland/Waikato and lower North Island areas, respectively. Some farms in the Auckland/Waikato region stood shuttle stallions. The median number of stallions per farm was three (range 0-9), and the median mare-to-stallion ratio was 43 (range 10-250). The farms had a mean of 50 (range 7-180) wet mares and 21 (range 0-100) dry mares. The number of mares per breeding stallion increased with increasing size of breeding operation (p=0.04), being 28 (95% confidence interval (CI) = 10-56) vs 40 (95% CI=16-74) vs 74 (95% CI=44-113) for moderate (or=200 mares in total) operations, respectively. Seventy-one percent of farms aimed to breed dry mares early in the breeding season, and used a combination of lights, hormone therapy, and rising plane of nutrition to achieve this. Foaling took place in foaling paddocks monitored using a night foaling attendant (17/22) or with foaling alarms (5/22). At birth, 17/22 studmasters routinely administered antibiotics, 14/22 administered tetanus antitoxin, 9/22 administered an enema to foals, and 2/22 did not routinely administer prophylactic treatments. Weaning occurred at 5 (range 3.7-7) months of age, and foals were confined to a box for 1-2 weeks on 16/22 farms. Weaned foals were drenched with anthelmintics every 7 (range 4-9) weeks, and were fed 2.9 (range 1-6) kg of concentrate feed while at pasture until intensive management associated with preparation of the horses for auction began 13 (range 6-20) weeks before the yearling sales. Eight farms weighed the weanlings, at least monthly, to monitor growth. CONCLUSIONS AND CLINICAL RELEVANCE: The management of Thoroughbred horses was relatively consistent throughout the regions surveyed. Utilisation of breeding stallions tended to be more efficient on the larger stud farms in the south Auckland/Waikato region. Even though foals are grown at pasture they are often provided with large quantities of concentrate feed.

Specific effects of gamma-linolenic, eicosapentaenoic, and docosahexaenoic ethyl esters on bone post-ovariectomy in rats.

Long chain polyunsaturated fatty acids (LCPUFAs) are involved in the regulation of bone metabolism. Increased dietary consumption of n-3, and possibly some n-6, LCPUFAs may limit postmenopausal bone loss. The aim of this study was to determine the effects on bone of specific fatty acids within the n-3 and n-6 LCPUFA families in ovariectomized (OVX) rats. Rats were OVX or sham-operated and fed either a control diet (OVX and sham) or a diet supplemented with 0.5 g/kg body weight/day of gamma-linolenic (GLA), eicosapentaenoic (EPA), docosahexaenoic (DHA) ethyl esters or a mixture of all three (MIX) for 16 weeks. Bone mineral content (BMC), area, and density and plasma concentrations of insulin-like growth factor-I, vitamin D, selected biochemical markers of bone metabolism, and parathyroid hormone (PTH) were determined. The OVX-induced decrease in lumbar spine BMC was significantly attenuated by DHA but not by EPA or GLA supplementation or supplementation with a mixture of all three LCPUFAs. Endosteal circumferences of tibiae were significantly greater in DHA and EPA compared to OVX. Plasma C-terminal telopeptide of type I collagen and osteocalcin concentrations were not significantly different in the DHA group compared to OVX. Femur BMC decreased by a significantly greater amount in GLA than OVX, and final plasma PTH concentrations were significantly higher in GLA compared to all other groups. In conclusion, DHA ameliorated OVX-induced bone mineral loss. GLA exacerbated post-OVX bone mineral loss, possibly as a result of PTH-induced bone catabolism.

A randomized trial comparing the efficacy of four treatment regimens for uncomplicated falciparum malaria in Assam state, India.

A four-arm drug sensitivity study compared chloroquine, sulfadoxine-pyrimethamine (SP), mefloquine and mefloquine-artesunate in Sonitpur and Karbi Anglong districts in Assam state, India. Two criteria were used to ascertain outcome: success of clinical treatment and parasitologic cure. In Sonitpur, at 14 days, there were 36/56 early and late treatment failures plus late parasitologic failures to chloroquine and 16/56 for SP. In Karbi Anglong, combined treatment failure at 14 days was 16/56 to chloroquine and 8/60 to SP. Mefloquine and mefloquine-artesunate demonstrated 93.9% and 93.6% sustained responses respectively at 42 days. High failure rates to both chloroquine and SP preclude the use of these drugs as first-line treatment for uncomplicated falciparum malaria in this region. A mefloquine-artesunate combination presents an effective alternative utilizing the currently recommended higher dose of mefloquine.

Safety, efficacy, and cost of intraoperative cell salvage and autotransfusion after off-pump coronary artery bypass surgery: a randomized trial.

OBJECTIVE: We evaluated, in a randomized controlled trial, the safety and effectiveness of intraoperative cell salvage and autotransfusion of washed salvaged red blood cells after first-time coronary artery bypass grafting performed on the beating heart. METHODS: Sixty-one patients undergoing off-pump coronary artery bypass grafting surgery were prospectively randomized to autotransfusion (n = 30; receiving autotransfused washed blood from intraoperative cell salvage) or control (n = 31; receiving homologous blood only as blood-replacement therapy). Homologous blood was given according to unit protocols. RESULTS: The groups were well matched with respect to demographic and comorbid characteristics. Patients in the autotransfusion group had a significantly higher 24-hour postoperative hemoglobin concentration (11.9 g/dL; SD, 1.41 g/dL) than those in the control group (10.5 g/dL; SD, 1.37 g/dL) (mean difference, 1.02 g/dL; 95% confidence interval, 1.60-0.44 g/dL; P = .0007), as well as a 20% reduction in the frequency of homologous blood product use (11/31 vs 5/30; P = .095). Autotransfusion of washed red blood cells was not associated with any derangement of thromboelastograph values or laboratory measures of clotting pathway function (prothrombin time, activated partial thromboplastin time, and fibrinogen levels), increased postoperative bleeding, fluid requirements, or adverse clinical events. There was no statistical difference between groups in the total operation, hospitalization, and management costs per patient (median difference, USD 1015.90; 95% confidence interval, -USD 2260 to USD 206; P = .11). Conclusions Intraoperative cell salvage and autotransfusion was associated with higher postoperative hemoglobin concentrations, a modest reduction in transfusion requirements, no adverse clinical or coagulopathic effects, and no significant increase in cost compared with controls. This study supports its routine use in off-pump coronary artery bypass grafting surgery.

Characterization of exhaust particles from military vehicles fueled with diesel, gasoline, and JP-8.

Diluted exhaust from selected military aircraft ground-support equipment (AGE) was analyzed for particulate mass, elemental carbon (EC) and organic carbon (OC), SO4(2-), and size distributions. The experiments occurred at idle and load conditions and utilized a chassis dynamometer. The selected AGE vehicles operated on gasoline, diesel, and JP-8. These military vehicles exhibited concentrations, size distributions, and emission factors in the same range as those reported for nonmilitary vehicles. The diesel and JP-8 emission rates for PM ranged from 0.092 to 1.1 g/kg fuel. The EC contributed less and the OC contributed more to the particulate mass than reported in recent studies of vehicle emissions. Overall, the particle size distribution varied significantly with engine condition, with the number of accumulation mode particles and the count median diameter (CMD) increasing as engine load increased. The SO4(2-) analyses showed that the distribution of SO4(2-) mass mirrored the distribution of particle mass.

Digestible energy intake, dry matter digestibility and effect of increased calcium intake on bone parameters of grazing Thoroughbred weanlings in New Zealand.

AIMS: To measure the nutritive value of pasture in terms of digestible energy intake (DEI) and dry matter (DM) digestibility, and the effects of increased calcium (Ca) intakes on apparent mineral absorption and bone characteristics in grazing weanling Thoroughbreds. METHODS: DM intake (DMI) and DEI were determined in 16 weanling Thoroughbreds grazing pasture from their daily faecal DM output, measured over 8 days, divided by the DM indigestible fraction (1-digestible DM) determined in a 6-day digestibility trial. The DM, gross energy content, crude protein, soluble carbohydrate, acid detergent fibre, neutral detergent fibre, lipid, Ca, phosphorus (P), sodium (Na), potassium(K), sulphur (S) and magnesium (Mg) composition of perennial ryegrass/white clover pasture and faeces were determined and their digestibility and/or apparent absorption calculated. Calcium intake and bone growth studies used 17 weanlings, randomly divided into three groups and fed perennial ryegrass/white clover pasture and 0.5 kg grain, with or without a CaCO3 supplement, for 84 days. The animals in Group 1 (n=6) were on a low Ca diet (3.5 g/kg DM) and were fed pasture only; those in Group 2 (n=5) were on a medium Ca diet (6.3 g/kg DM);and those in Group 3 (n=6) were on a high Ca diet (12.0 g/kg DM). After 44 days the apparent absorption of Ca was determined from the differences between the Ca intakes and faecal Ca outputs. At periods just before and after Ca supplementation the horses were anaesthetised and the left radius, third metacarpus(Mc3) and first phalanx of the left foreleg were scanned using a peripheral quantitative computed tomography scanner to determine cortical mineral content, density, area, periosteal circumference and bone strength. To investigate gastrointestinal tract transit time and DM digestibility, five randomly selected horses were administered Swiss screen bags on several occasions via a nasogastric tube. Each 60 x 10mm bag contained 3.21 (SE 0.37) g of frozen minced grass. Bags were recovered from the freshly passed faeces and frozen until analysis. RESULTS: The DM digestibility of the pasture was 0.62, while the DMI and DEI of weanlings (300 kg, gaining 0.7 kg/day) were 5.5 kg/day and 63 MJ/day, respectively. Increasing Ca intake had no significant effect on DEI, DM digestibility or on the apparent absorption of Ca, P, Na and K, but decreased the apparent absorption of Mg from 0.50 to 0.38. Regardless of Ca intake, the apparent absorption of Ca was 0.56. During the Ca administration trial there were significant increases overtime in the bone strength (strain stress index) of the proximal phalanx, Mc3 and radial diaphysis. However, the increase in bone strength was not associated with increase in dietary Ca, as neither the medium- nor high-Ca intake groups differed significantly from the low-Ca controls. The mean transit time for the Swiss screen bags was 25.46 (SE 0.09) h, and transit times were similar whether the horses were grazing or confined in loose boxes, being 26.64 (SE 0.23) h and 24.33 (SE 0.13) h, respectively. The DM digestibility determined using the bags was 0.54, which was significantly lower than the 0.62 determined by direct faeces collection. CONCLUSIONS: Good growth rates were achieved in Thoroughbred weanlings grazing perennial ryegrass/white clover pasture containing 3.5 g Ca/kg DM and a DE of 11.4 MJ/kg DM. Increasing dietary Ca intake 3.5-fold for 3 months had negligible impact on bone growth and development.

The quality of routine examinations of the newborn performed by midwives and SHOs; an evaluation using video recordings.

OBJECTIVE: To evaluate the quality of the routine examination of the newborn as carried out by senior house officers (SHOs) and midwives. DESIGN: Randomised controlled trial set in a district general hospital in Southeast England. Eligible babies were randomised to a midwife (11) or an SHO (8) who were then video recorded undertaking the routine newborn examination. MAIN OUTCOME MEASURES: Quality of 62 observed technical and communication components of the newborn examination, as agreed between independent consultant paediatrician and senior midwife raters. RESULTS: Major differences were found in the rated quality of examinations between midwives and SHOs for the examinations of the heart and lungs, for the overall quality of the examination, and in areas of communication skills. Quality of examination of the hips was assessed as poor for both professional groups. Where there were significant differences between examiners, the quality of the midwives' examinations was higher. Inter-rater agreement between the consultant paediatricians and senior midwives ranged from excellent to poor for different items of the examination with a mean kappa value of 0.42 across all items indicating moderate agreement. CONCLUSIONS: The quality of midwife examinations exceeded that of SHOs. All midwives who examine receive formalized training in the examination of the newborn; SHOs may benefit from similar specific training. Training for both professional groups may need to be reviewed, particularly in relation to agreement on 'gold standards' for the screening of developmental dysplasia of the hip.

Surgery and permanent 125I seed paraspinal brachytherapy for malignant tumors with spinal cord compression.

PURPOSE: To evaluate the functional outcome, predictors of response, and toxicity from spinal surgery and 125I brachytherapy in patients with malignant tumors resulting in spinal cord compression. METHODS AND MATERIALS: Between July 1985 and September 2001, after surgical resection, 30 patients underwent 31 intraoperative paraspinal brachytherapy procedures at Barrow Neurological Institute. Twenty-four (with 25 procedures) had follow-up at our clinic and form the basis for this report. Surgical procedures were based on the location of the impinging lesion: corpectomy or spondylectomy in 13 cases and laminectomy in 12. Permanent 125I seeds in absorbable suture were placed with open exposure after resection. RESULTS: Spinal cord compression was cervical in 4 (16%), thoracic in 14 (56%), and lumbar in 7 (28%) of the 25 cases. One patient underwent two separate procedures at different spinal sites. Of the 25 brachytherapy sites, 22 also received external beam radiotherapy (EBRT): 5, EBRT with a planned brachytherapy boost; 4, brachytherapy and prompt EBRT after recovery; and 13, brachytherapy as salvage for local failure after prior EBRT. Three had no EBRT: 1 had lymphoma treated with chemotherapy, 1 had remote previous EBRT for a childhood tumor, and 1 refused EBRT. The mean follow-up was 19.8 months. The 2- and 3-year actuarial local control rate was 87.4% and 72.9%, respectively. Four sites (16.0%) experienced local failure. The mean time to recurrence for these 4 patients was 20.3 months. Three of the four had failed prior EBRT, with surgery and brachytherapy used for salvage. The 2- and 3-year actuarial overall survival rates were 24.0% and 16.0%, mean 19.2 months. An ambulatory function score was assigned pre- and postoperatively: I, normal ambulation; II, abnormal not requiring assistance; III, abnormal requiring assistance; and IV, unable to ambulate. All patients with score I, 91% of those with score II, 67% of those with score III, and 67% of those with score IV were ambulatory after the procedure; 84% had either normal or improved ambulation postoperatively. Morbidity was restricted to four postoperative events: one cerebrospinal fluid leak, two wound infections treated in situ without removal of seeds or instrumentation, and one pulmonary embolus. No myelopathies or other neurologic sequelae were encountered. CONCLUSION: This is the largest series in the literature exploring surgery and 125I brachytherapy in the treatment of malignant spinal cord compression. We found this to be well tolerated and to result in durable local control and ambulatory function. Our results suggest a benefit to aggressive local therapy in selected patients with spinal cord compression.

Linear hyperechogenicity within the basal ganglia and thalamus of preterm infants.

Linear hyperechogenicity (LHE) within the basal ganglia and thalamus is an uncommon sonographic finding in preterm infants and is of unclear significance. The study objectives were to determine the clinical characteristics and neurodevelopmental outcome in preterm infants who develop LHE. Ten preterm and 20 control infants were evaluated developmentally at 18 months adjusted age using the Bayley Scales of Infant Development. LHE was diagnosed at 4 weeks (range = 1-11). Antenatal glucocorticoid therapy was more common in infants with LHE than in the control infants (90% vs 45%). Four (44%) of nine LHE infants and no control infants were positive for cytomegalovirus (P = 0.02, and three of 10 LHE infants and no control infants had a hypothyroid (P = 0.03). The mental development scores and behavioral evaluation results were lower in the infants with LHE than in the control infants (73.7 +/- 9.7 vs 83.7 +/- 9.4, P = 0.01 and 23.7 +/- 20.1 vs 43.9 +/- 25.4, P = 0.04, respectively). The infants without LHE also had poorer motor quality (22.8 +/- 20. 5 vs 55.7 +/- 37.4, P = 0.02) and lower emotional regulation scores (25.7 +/- 16 vs 42.3 +/- 24, P = 0.06) than the control infants. Preterm infants with LHE are at an increased risk of adverse neurodevelopmental outcome and, in particular, cognitive and behavioral performance. The sonographic evolution of LHE may be a marker of a diffuse insult to the brain.

Outdoor allergens.

Outdoor allergens are an important part of the exposures that lead to allergic disease. Understanding the role of outdoor allergens requires a knowledge of the nature of outdoor allergen-bearing particles, the distributions of their source, and the nature of the aerosols (particle types, sizes, dynamics of concentrations). Primary sources for outdoor allergens include vascular plants (pollen, fern spores, soy dust), and fungi (spores, hyphae). Nonvascular plants, algae, and arthropods contribute small numbers of allergen-bearing particles. Particles are released from sources into the air by wind, rain, mechanical disturbance, or active discharge mechanisms. Once airborne, they follow the physical laws that apply to all airborne particles. Although some outdoor allergens penetrate indoor spaces, exposure occurs mostly outdoors. Even short-term peak outdoor exposures can be important in eliciting acute symptoms. Monitoring of airborne biological particles is usually by particle impaction and microscopic examination. Centrally located monitoring stations give regional-scale measurements for aeroallergen levels. Evidence for the role of outdoor allergens in allergic rhinitis is strong and is rapidly increasing for a role in asthma. Pollen and fungal spore exposures have both been implicated in acute exacerbations of asthma, and sensitivity to some fungal spores predicts the existence of asthma. Synergism and/or antagonism probably occurs with other outdoor air particles and gases. Control involves avoidance of exposure (staying indoors, preventing entry of outdoor aerosols) as well as immunotherapy, which is effective for pollen but of limited effect for spores. Outdoor allergens have been the subject of only limited studies with respect to the epidemiology of asthma. Much remains to be studied with respect to prevalence patterns, exposure and disease relationships, and control.

Rapid isolation of plant Ty1-copia group retrotransposon LTR sequences for molecular marker studies.

The terminal sequences of long-terminal repeat (LTR) retrotransposons are a source of powerful molecular markers for linkage mapping and biodiversity studies. The major factor limiting the widespread application of LTR retrotransposon-based molecular markers is the availability of new retrotransposon terminal sequences. We describe a PCR-based method for the rapid isolation of LTR sequences of Ty1-copia group retrotransposons from the genomic DNA of potentially any higher plant species. To demonstrate the utility of this technique, we have identified a variety of new retrotransposon LTR sequences from pea, broad bean and Norway spruce. Primers specific for three pea LTRs have been used to reveal polymorphisms associated with the corresponding retrotransposons within the Pisum genus.

Psychoneuroendocrine immunology: perception of stress can alter body temperature and natural killer cell activity.

Psychoimmunology has been credited with using the mind as a way to alter immunity. The problem with this concept is that many of the current psychoimmunology techniques in use are aimed at alleviating stress effects on the immune system rather than at direct augmentation of immunity by the brain. Studies in animals provide a model that permits us to approach the difficulties associated with gaining an understanding of the CNS-immune system connection. A particular advantage of using animals over humans is that psychological and social contributions play a less prominent role for animals than for human subjects, since the animals are all inbred and reared under identical controlled conditions. If the insightful information provided by animal studies is correct, then psychotherapy for the treatment of diseases might be made more effective if some aspect of this knowledge is included in the design of the treatment. We emphasize conditioning as a regimen and an acceptable way to train the brain to remember an output pathway to raise immunity. We propose that a specific drug or perception (mild stress, represented by rotation, total body heating or handling) could substitute and kindle the same output pathway without the need for conditioning. If this view is correct, then instead of using conditioning, it may be possible to use an antigen to activate desired immune cells, and substitute a drug or an external environmental sensory stimulus (perception) to energize the output pathway to these cells. Alternatively, monitoring alterations of body temperature in response to a drug or perception might allow us to follow how effectively the brain is performing in altering immunity. Studies with animals suggest that there are alternative ways to use the mind to raise natural or acquired immunity in man.

Bath PUVA: an effective treatment for psoriasis.

At the Psoriasis Education and Research Centre, PUVA baths were introduced as an alternative therapy in 1990. Psoriatic patients soaked for 15 minutes in a solution of tap water and Ultra MOP. Forty-five patients were followed for 30 treatments. Skin types were recorded and progress was documented by PASI (Psoriasis Area and Severity Index) scores. Side effects and total amount of UVA received were documented. The purpose of this study was to record the efficacy of our protocol for PUVA baths on different skin types while evaluating all aspects of the treatment.

Isolation, synthesis, and antiplatelet aggregation activity of resveratrol 3-O-beta-D-glucopyranoside and related compounds.

Resveratrol 3-O-beta-D-glucopyranoside (1) has been isolated from the seeds of Erythrophleum lasianthum (Caesalpinioidae, Leguminosae), a South African plant used in traditional medicine, and has shown antiplatelet aggregation activity. The synthesis of 1, related hydroxystilbenes, and their glucosides has been undertaken to provide larger quantities, for further biological evaluation, and has been accomplished via Wittig reactions followed by glucosylation under phase transfer catalysis.