Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder.

STUDY DESIGN: Randomized, double blind, placebo-controlled trial with a crossover design. OBJECTIVE: To evaluate cranberry tablets for the prevention of urinary tract infection (UTI) in spinal cord injured (SCI) patients. SETTING: Spinal Cord Injury Unit of a Veterans Administration Hospital, MA, USA. METHODS: Subjects with spinal cord injury and documentation of neurogenic bladder were randomized to receive 6 months of cranberry extract tablet or placebo, followed by the alternate preparation for an additional 6 months. The primary outcome was the incidence of UTI. RESULTS: Forty-seven subjects completed the trial. We found a reduction in the likelihood of UTI and symptoms for any month while receiving the cranberry tablet (P<0.05 for all). During the cranberry period, 6 subjects had 7 UTI, compared with 16 subjects and 21 UTI in the placebo period (P<0.05 for both number of subjects and incidence). The frequency of UTI was reduced to 0.3 UTI per year vs 1.0 UTI per year while receiving placebo. Subjects with a glomerular filtration rate (GFR) greater than 75 ml min(-1) received the most benefit. CONCLUSION: Cranberry extract tablets should be considered for the prevention of UTI in SCI patients with neurogenic bladder. Patients with a high GFR may receive the most benefit. SPONSORSHIP: Spinal Cord Research Foundation, sponsored by the Paralyzed Veterans of America.

Experimental and theoretical study of the infrared spectra of BrHI- and BrDI-.

Gas phase vibrational spectra of BrHI- and BrDI- have been measured from 6 to 17 microm (590-1666 cm(-1)) using tunable infrared radiation from the free electron laser for infrared experiments in order to characterize the strong hydrogen bond in these species. BrHI-.Ar and BrDI-.Ar complexes were produced and mass selected, and the depletion of their signal due to vibrational predissociation was monitored as a function of photon energy. Additionally, BrHI- and BrDI- were dissociated into HBr (DBr) and I- via resonant infrared multiphoton dissociation. The spectra show numerous transitions, which had not been observed by previous matrix studies. New ab initio calculations of the potential-energy surface and the dipole moment are presented and are used in variational ro-vibrational calculations to assign the spectral features. These calculations highlight the importance of basis set in the simulation of heavy atoms such as iodine. Further, they demonstrate extensive mode mixing between the bend and the H-atom stretch modes in BrHI- and BrDI- due to Fermi resonances. These interactions result in major deviations from simple harmonic estimates of the vibrational energies. As a result of this new analysis, previous matrix-isolation spectra assignments are reevaluated.

Clinical spectrum of posterior ischemic optic neuropathy.

PURPOSE: To describe the systemic and visual characteristics and prognosis in patients with posterior ischemic optic neuropathy (PION). DESIGN: Observational case series. METHODS: Retrospective chart review in a multicenter setting. Seventy-two patients (98 eyes) with a clinical diagnosis of PION. Co-morbid systemic diseases and visual function were recorded at both initial presentation and after mean visual follow-up of 4.1 years and systemic follow-up of 5.4 years. RESULTS: PION occurred in three main settings: in the perioperative period following a variety of surgical procedures (28 patients), associated with giant cell (temporal) arteritis (6 patients), and associated with nonarteritic systemic vascular disease (38 patients). Patients with perioperative and arteritic PION were more likely to have severe, bilateral visual loss that did not improve. Among eyes with nonarteritic PION, 34% experienced improvement in vision, 28% remained stable, and 38% worsened. Among patients with nonarteritic PION, carotid artery disease and a history of stroke (with or without carotid artery disease) were both associated with a statistically significant increased risk of poor final visual outcome. CONCLUSIONS: There are three distinct subtypes of PION: perioperative, arteritic, and nonarteritic. Patients with PION that is unassociated with surgery should undergo an evaluation for systemic vascular diseases, including giant cell arteritis, that may or may not be apparent at the time of vision loss. The visual prognosis for patients with perioperative or arteritic PION is poor, whereas that for nonarteritic PION is similar to that for patients with nonarteritic AION.

Injuries in the military: a review and commentary focused on prevention.

BACKGROUND: In November 1996, the Armed Forces Epidemiological Board (AFEB) Injury Prevention and Control Work Group issued a report that cited injuries as the leading cause of morbidity and mortality among military service members. This article reviews the types and categories of military morbidity and mortality data examined by the AFEB work group and the companion Department of Defense (DoD) Injury Surveillance and Prevention Work Group. This article further uses the injury data reviewed to illustrate the role of surveillance and research in injury prevention. The review provides the context for discussion of the implications of the AFEB work group's findings for the prevention of injuries in the military. METHODS: The AFEB work group consisted of 11 civilian injury epidemiologists, health professionals and scientists from academia, and other non-DoD government agencies, plus six military liaison officers. Injury data from medical databases were provided to the civilian experts on the AFEB work group by the all-military DoD Injury Surveillance and Prevention Work Group. The AFEB work group assessed the value of each database to the process of prevention and made recommendations for improvement and use of each data source. RESULTS: Both work groups found that injuries were the single leading cause of deaths, disabilities, hospitalizations, outpatient visits, and manpower losses among military service members. They also identified numerous data sources useful for determining the causes and risk factors for injuries. Those data sources indicate that training injuries, sports, falls, and motor vehicle crashes are among the most important causes of morbidity for military personnel. CONCLUSIONS: While the work group recommends ways to prevent injuries, they felt the top priority for injury prevention must be the formation of a comprehensive medical surveillance system. Data from this surveillance system must be used routinely to prioritize and monitor injury and disease prevention and research programs. The success of injury prevention will depend not just on use of surveillance but also partnerships among the medical, surveillance, and safety agencies of the military services as well as the military commanders, other decision makers, and service members whose direct actions can prevent injuries and disease.

Essential roles for the Abl and Arg tyrosine kinases in neurulation.

The Abl and Arg tyrosine kinases play fundamental roles in the development and function of the central nervous system. Arg is most abundant in adult mouse brain, especially in synapse-rich regions. arg(-/-) mice develop normally but exhibit multiple behavioral abnormalities, suggesting that arg(-/-) brains suffer from defects in neuronal function. Embryos deficient in both Abl and Arg suffer from defects in neurulation and die before 11 days postcoitum (dpc). Although they divide normally, abl(-/-)arg(-/-) neuroepithelial cells display gross alterations in their actin cytoskeleton. We find that Abl and Arg colocalize with each other and with actin microfilaments at the apical surface of the developing neuroepithelium. Thus, Abl and Arg play essential roles in neurulation and can regulate the structure of the actin cytoskeleton.

Factor analysis of the PIC profiles of clinic-referred children.

The PIC profiles of 175 children over a wide age range were factor analyzed in order to determine the underlying personality dimensions measured by the instrument. The subjects were referred to an interdisciplinary university clinic for a variety of learning, cognitive, and emotional problems. A principal components analysis with oblique rotation yielded three major factors: Internalized Personality Disturbance, Cognitive Development, and Externalized Behavior Disorder. A small fourth factor that involved mainly the Somatic Concern scale was revealed also. Implications of the factors for the interpretation and clinical use of the PIC profiles are discussed.

[Clinical and electrophysiological aspects of median intra-His bundle block with normal electrocardiogram at rest]. / Aspects cliniques et électrophysiologiques des blocs tronculaires hissiens médians à électrocardiogramme de repos normal.

The clinical and electrophysiological features and the natural history of median intra-His block with a normal resting electrocardiogram were studied: 11 patients had a fixed split H1-H2 potential with a spontaneous or induced block between H1 and H2. The patients (5 men and 6 women) were aged 17 to 70 years (average 53 years). Associated pathology included 2 cases of aortic stenosis (1 severe), 1 case of ischaemic heart disease (effort angina), 1 case of mitral valve prolapse and 2 cases of hypertension. The presenting symptoms were syncope (4 cases), dizziness (2 cases), effort angina (1 case) and tiredness (3 cases); 1 patient was asymptomatic. Holter monitoring (24 hours) was performed in 8 patients and s-owed paroxysmal conduction defects in 6 cases; 4 Mobitz II 2nd degree AV block, 1 3rd degree AV block with narrow QRS complexes and 1 case of blocked atrial extrasystoles at coupling intervals longer than 480 ms and sinus cycle lengths of over 800 ms. Exercise testing by bicycle ergometry (4 patients) was normal in 1 case and revealed Mobitz II 2nd degree AV block in 3 cases. Baseline electrophysiological studies showed an A-H1 interval ranging from 60 to 100 ms (average 78 ms), a H1-H2 interval of 20 to 40 ms (average 31 ms) and a H2-V interval of 30 to 50 ms (average 32 ms). Block between H1 and H2 was observed: "spontaneously" during electrophysiological investigation in 6 cases, after IV atropine in 1 case, during overdrive atrial pacing at rates slower than 150/min in 7 cases, after atrial extrastimulus with a functional intra-His refractory period of over 420 ms in 7 cases, after ajmaline in 3 of the 4 cases in which this test was performed. A cardiac pacemaker was implanted in 10 patients in whom the initial symptoms have all regressed; the remaining patient considered to be "epileptic" had another syncopal attack under therapy and was finally paced. This series demonstrates that the diagnosis of median intra-His block depends on precise electrophysiological criteria and should be looked for even when the presenting symptoms are atypical; some of our patients complained only of tiredness. The value of Holter monitoring and careful endocavitary investigation is emphasised. Median intra-His block should be distinguished from longitudinal and functional His bundle dissociation.

[Doppler echocardiographic diagnosis and evaluation of tricuspid regurgitation]. / Diagnostic et évaluation des régurgitations tricuspides par échocardiographie Döppler.

The reliability of pulsed Doppler echocardiography in the diagnosis and quantification of tricuspid regurgitation was assessed by analysis of blood flow in the inferior vena cava in 28 patients. The inferior vena caval flow was sampled in the retrohepatic portion of the vessel from the subxiphoid region. Recordings from 10 normal patients were used to define criteria of normality. This was characterised by two anterograde components (one systolic and one diastolic); atrial contraction gave rise to an end diastolic retrograde component. In tricuspid incompetence, retrograde systolic blood flow was recorded. A Doppler index was calculated from the ratio of the maximal amplitude of systolic reflux to the maximal amplitude of anterograde diastolic flow. In the absence of tricuspid regurgitation, this index approximated 0. The average of this ratio over 10 consecutive beats was compared with the semi quantitative assessment of tricuspid regurgitation from selective right ventricular angiography. There were no false positive results, specificity was, therefore, 100 p. 100. Six minimal regurgitations were not detected: sensitivity was therefore 74 p. 100. All moderate and severe regurgitations were detected, and the sensitivity for these cases was 100 p. 100. There was a close correlation (R = 0,89, p less than 0,01) between the Doppler index and the degree of regurgitation assessed by selective right ventricular angiography.

[Non-invasive study of aortic insufficiency by Doppler echocardiography]. / Exploration non effractive des insuffisances aortiques par échocardiographie Döppler.

The possibilities of diagnosis and quantification of aortic regurgitation by pulsed Doppler analysis of blood flow in the aortic arch were examined in 60 patients aged between 9 and 67 years old. Aortic flow curves were recorded from the suprasternal area with the sample volume positioned at the junction of the horizontal part of the aortic arch and the descending aorta. Normal flow curves are characterised by an anterograde systolic wave with a brief proto-diastolic reflux. In aortic regurgitation holodiastolic reflux is observed. An index of regurgitation may be calculated from the ratio of the amplitude of end diastolic reflux measured on the R wave of th ECG and the maximal amplitude of anterograde systolic flow. This ratio eliminates the factor related to the incident angle between the ultrasound beam and the direction of blood flow. The values of this ratio were compared to the semi quantitative assessment of aortic regurgitation from ascending aortic angiography. The only false negatives were observed in patients with negligible regurgitation (grade I). One false positive result was obtained in a patient in whom it was difficult to obtain the recording and in whom the value of the ratio was very low (0,02). Global specificity was 91 p. 100 and sensitivity was 82 p. 100. The sensitivity for average or severe regurgitation was 100 p. 100. The correlation coefficient between the Doppler index or regurgitation and the semi quantitative angiographic estimation was 0,69. In patients with pure aortic regurgitation the correlation reached 0,85 (p less than 0,001). The differences between the different groups then became highly significant.

Studies of the binding interactions of cis-diamminedichloroplatinum(II) with amines and nucleosides by nitrogen-15 nuclear magnetic resonance.

The 15N chemical shifts and couplings have been measured for several platinum(II)-amine complexes. The 15N chemical shift changes found on coordination of azine-type nitrogens to platinum appear to be related to those that occur on protonation of the same nitrogens. Both the 15N chemical shifts and the one-bond 15N-195Pt coupling constants depend on the nature of the cis and trans ligands. cis-[Pt(NH3)2Cl2] ("cis-platinum") forms a complex with cytidine through N3. Guanosine becomes bound to platinum of cis-[Pt(NH3)2Cl2] at N7 and at least one other nitrogen. Adenosine appears to bind cis-[Pt(NH3)2Cl2] to at least some degree through N1, N3, N7, and the 6' -NH2.

15N NMR study of a mixture of uniformly labeled tRNAs.

15N NMR spectra were taken of 15N-enriched tRNA extracted from bakers yeast; ammonium sulfate was used as a nitrogen source. The increase in the degree of denaturation of tRNA, which occurs with increase in temperature from 30 degrees C to 70 degrees C, resulted in no large changes in 15N chemical shifts at acidic and neutral pH but quite pronounced changes in proton-15N nuclear Overhauser effects.

Non-invasive diagnosis of mitral regurgitation by Doppler echocardiography.

The value of Doppler echocardiography for the non-invasive diagnosis of mitral regurgitation was studied blindly in 161 consecutive invasively investigated adult patients. Regurgitation was graded from 0 to 3 at selective left ventricular angiography. The Doppler echocardiographic examination was considered to be positive when a disturbed systolic flow was found within the left atrium behind the aorta or the anterior leaflet of the mitral valve. The test was considered to be negative in the absence of a regurgitant jet. The level of the signal to noise ratio was checked by the recording of the ventricular filling flow. The study was performed in 131 cases from the left side of the sternum and in 101 cases from the apex. There were no false positives and thus the specificity was 100 per cent. The 20 false negatives were all in patients with grade 1 regurgitation. Thus only some (33%) instances of mild regurgitation were misdiagnosed, and the sensitivity for moderate to severe mitral regurgitation was 100 per cent.

Induction of swelling in pea internode tissue by ethylene.

Ethylene inhibits polar cell expansion of etiolated pea (Pisum sativum) internode tissue and results in a radial cell expansion, swelling. A special gas-tight growth chamber was developed to monitor continuously the induction of cell expansion inhibition of excised internode segments in the presence of ethylene. Following a complex induction period which lasts about 3 hours, a low, but steady-state growth rate is achieved. Ethylene removal experiments indicate that the gas induces an irreversible change in the cell expansion mode. If the tissue was transferred to an ethylene-free chamber after the steady-state rate had been achieved, this rate continued in the absence of the gas. If the gas was removed during an intermediate phase, that intermediate rate of growth continued after removal. In other experiments, segments were incubated with intact apical hooks and the induction period was much shorter than with isolated segments. Changes in imino acid metabolism have been correlated with the induction of swelling. Although total proline and hydroxyproline levels were not affected by ethylene treatment, incorporation of [(14)C]proline into a wall-associated protein was inhibited during the period when swelling occurred. These results suggest that ethylene is affecting proline pool sizes.