[Translated article] Influence of lateralized reverse shoulder prosthesis design on tuberosity union in proximal humerus fractures.

INTRODUCTION: Proximal humerus fractures are the third most frequent type of fracture in elderly patients. Nowadays, surgical treatment is indicated one third of the time, being the reverse shoulder prosthesis an option especially in complex comminuted patterns. In this study we analyzed the effects of a lateralized reverse prosthesis in tuberosity union and its relationship with the functional results. MATERIAL AND METHODS: Retrospective case study of patients with proximal humerus fractures treated with a lateralized design reverse shoulder prosthesis with one-year minimum follow-up. Tuberosity nonunion was defined as a radiological concept: absence of tuberosity, distance >1cm from the tuberosity fragment to the humeral shaft or tuberosity above the humeral tray. Subgroup analysis was performed, group 1 (n=16) tuberosity union vs. group 2 (n=19) tuberosity nonunion. Groups were compared with the following functional scores: Constant, American Shoulder and Elbow Surgeons and Subjective Shoulder Value. RESULTS: A total of 35 patients were included in this study with a median age of 72.65 years. Postoperative radiographic analysis at one year after surgery revealed a tuberosity nonunion rate of 54%. Subgroup analysis revealed no statistically significant differences in terms of range of motion or functional scores. However, there were differences regarding the Patte sign (p=0.03) which was positive in a larger proportion of patients in the group with tuberosity nonunion. CONCLUSION: Even though there was a large percentage of tuberosity nonunion with the use of a lateralized prosthesis design, patients obtained good results in a similar manner to those found in the union group in terms of range of motion, scores, and patient satisfaction.

Influence of lateralized reverse shoulder prosthesis design on tuberosity union in proximal humerus fractures. / Influencia de las prótesis inversas con diseño lateralizado en la consolidación de las tuberosidades en fracturas de húmero proximal.

INTRODUCTION: Proximal humerus fractures are the third most frequent type of fracture in elderly patients. Nowadays, surgical treatment is indicated one third of the time, being the reverse shoulder prosthesis an option especially in complex comminuted patterns. In this study we analyzed the effects of a lateralized reverse prosthesis in tuberosity union and its relationship with the functional results. MATERIAL AND METHODS: Retrospective case study of patients with proximal humerus fractures treated with a lateralized design reverse shoulder prosthesis with one-year minimum follow-up. Tuberosity nonunion was defined as a radiological concept: absence of tuberosity, distance>1cm from the tuberosity fragment to the humeral shaft or tuberosity above the humeral tray. Subgroup analysis was performed, group 1 (n=16) tuberosity union vs. group 2 (n=19) tuberosity nonunion. Groups were compared with the following functional scores: Constant, American Shoulder and Elbow Surgeons and Subjective Shoulder Value. RESULTS: A total of 35 patients were included in this study with a median age of 72.65 years. Postoperative radiographic analysis at one year after surgery revealed a tuberosity nonunion rate of 54%. Subgroup analysis revealed no statistically significant differences in terms of range of motion or functional scores. However, there were differences regarding the Patte sign (p=0.03) which was positive in a larger proportion of patients in the group with tuberosity nonunion. CONCLUSION: Even though there was a large percentage of tuberosity nonunion with the use of a lateralized prosthesis design, patients obtained good results in a similar manner to those found in the union group in terms of range of motion, scores, and patient satisfaction.

The bell jar / La campana de cristal

Review of the book: The bell jar, of Sylvia Plath. Random House, 2020.

Reseña del libro: La campana de cristal, de Sylvia Plath. Literatura Random House, 2020.

Correlation of the Renal Cortex Volume With the Glomerular Filtration Rate in Live Donors for Renal Transplantation.

INTRODUCTION: As a pretransplantation evaluation, renal function is determined by the glomerular filtration rate (GFR) with the use of renal scintigraphy (RS) and the estimated glomerular filtration rate (eGFR). To date, there are few studies that correlate renal cortex volume with eGFR determined with renal gammagram (GR) and eGFR by equations (Cockroft-Gault, Modification of Diet in Renal Disease, and Chronic Kidney Disease Epidemiology Collaboration equation) in Latin American living donors. AIM: This study sought to determine whether there is correlation of the volume of the renal cortex by Herts equation with the GFR determined with renal gammagram (GFR-GR). PATIENTS AND METHODS: This was an analytical, observational, and cross-sectional study. A review of the donor charts from January 1, 2014, to December 1, 2014, with a complete clinical file, kidney measurements, predonation tomography volume, and eGFR by different formulas and by renal scintigraphy. RESULTS: Thirty-three donors were included, 51.5% male and 48.5% female. The mean age was 38.58 ± 10 years, with an average volume of 127.83 ± 28.30 mL, with diethylenetriamine-pentaacetate (DTPA) of 54.80 ± 7.13 mL/min/1.73 m2 in the donated kidney. Spearman correlation showed the best association with the Herts equation (r = 0.346) reaching significance (P = .049) when comparing the different equations against the GFR with DTPA. Using the Bland-Altman method, the lowest variability and best significance was verified with the same equation compared to the other formulas (P = .0002). CONCLUSIONS: There is no consensus regarding which is the best formula for calculating the GFR of both kidneys. Of the different formulas, the one that best correlated with the GFR was the Herts method, which uses the volume of the kidney.

Effects of preoperative dexamethasone on postoperative pain, nausea, vomiting and respiratory function in women undergoing conservative breast surgery for cancer: Results of a controlled clinical trial.

The objective was to evaluate whether preoperative administration of dexamethasone improved postoperative nausea and vomiting (PONV), pain and respiratory function tests in women undergoing conservative surgery for breast cancer. This was a controlled clinical trial conducted between June 2013 and October 2014. Eighty patients were evaluated. Patients received a preoperative dose of 8 mg of dexamethasone (n = 40) or placebo (n = 40). The data on PONV and pain intensity was obtained and forced spirometry tests were performed, 1 hr before and at 1, 6, 12 and 24 hr after surgery. Any use of additional analgesic/antiemetic drugs was recorded. Patients were followed until 30 days after surgery for any surgical or medical complications. The pain intensity was lower in the treatment group for all periods; PONV was lower at 6, 12 and 24 hr; Additional analgesics/antiemetics were required less frequently (all p < .05). Both groups exhibited a restrictive ventilatory pattern immediately after surgery, which was reversed in the following hours. However, spirometric values were higher in the dexamethasone group. There were no pulmonary or metabolic complications after surgery. Our conclusions were that dexamethasone significantly reduced the incidences of PONV, pain and improved respiratory parameters, and reduced the need for additional postoperative analgesic and antiemetic drugs.

Body weight changes after adjuvant chemotherapy of patients with breast cancer: results of a Mexican cohort study.

Weight gain is observed in breast cancer patients receiving chemotherapy and is a well-known complication. Several factors that contributing to weight gain have been identified. However, there is a lack of information about factors associated with weight changes following adjuvant chemotherapy. A retrospective cohort of 200 pre- and post-menopausal Mexican patients treated for breast cancer was made. Anthropometric variables were measured before/after treatment. Biomarkers, cellular differentiation and chemotherapy were similar between groups. Weight gain occurred in 85.6% of pre-menopausal and 72.6% of post-menopausal women (p = .03). At the end of chemotherapy, weight and body mass index (BMI) did not differ significantly between pre-menopausal (69.3 ± 12.6 kg; 26.6 ± 4.8 kg/m2 ) and post-menopausal women (69.5 ± 10.9 kg; 27.3 ± 4.4 kg/m2 ) (p = .91 and 0.34). Dexamethasone doses were higher in pre-menopausal (85.7 ± 39.1 g) than post-menopausal patients (79.2 ± 22.5 g; p = .13). Weight loss was observed in 9.2% of pre-menopausal and 20.2% of post-menopausal patients (p = .04). A multivariate analysis revealed that age (OR = 2.7; 95% CI = 1.26-5.79; p = .01), menopausal status (OR = 2.29; 95% CI = 1.09-4.80; p = .03), dexamethasone dosage (OR = 2.1; 95% CI = 1.04-4.23; p = .03) and daily caloric intake (OR = 2.3; 95% CI = 1.12-5.10; p = .02) were independent variables that inducted weight gain. Pre- and post-menopausal women gained weight, but more pre-menopausal patients showed gain. An effort should be made to administer lower steroid doses to reduce weight gain.

ß-Blockers have differential effects on the murine asthma phenotype.

BACKGROUND AND PURPOSE: Our previous studies have shown the ß2 -adrenoceptor and its endogenous ligand, adrenaline, are required for development of the asthma phenotype in murine asthma models. Chronic administration of some, but not other, ß-blockers attenuated the asthma phenotype and led us to hypothesize that biased signalling was the basis of their differential effects, experimentally and clinically. EXPERIMENTAL APPROACH: We used mice with no detectable systemic adrenaline (PNMT(-/-) ) and wild-type (WT) mice to study the effects of four ß-blockers, alprenolol, carvedilol, propranolol and nadolol, in an ovalbumin sensitization and challenge (Ova S/C) murine model of asthma. The parameters measured were inflammatory cell infiltration, mucous metaplasia and airway hyperresponsiveness. To interpret the pharmacological action of these ligands quantitatively, we conducted computer simulations of three-state models of receptor activation. KEY RESULTS: Ova S/C PNMT(-/-) mice do not develop an asthma phenotype. Here, we showed that administration of alprenolol, carvedilol or propranolol in the absence of interference from adrenaline using Ova S/C PNMT(-/-) mice resulted in the development of an asthma phenotype, whereas nadolol had no effect. Ova S/C WT mice did develop an asthma phenotype, and administration of alprenolol, propranolol and carvedilol had no effect on the asthma phenotype. However, nadolol prevented development of the asthma phenotype in Ova S/C WT mice. Computer simulations of these four ligands were consistent with the isolated three-state receptor model. CONCLUSION AND IMPLICATIONS: ß-Blockers have different effects on the murine asthma phenotype that correlate with reported differences in activation or inhibition of downstream ß2 -adrenoceptor signalling pathways.

Clasificación del estado físico de los pacientes según la sociedad americana de anestesiología (saa) en adultos atendidos por emergencia odontológica / Health status of patients attended by dental emergency using the classification of american society of anesthesiologists(asa)

Determinar el estado físico de los pacientes atendidos por emergencia odontológica en la Clínica Periférica Azcapotzalco de la U.N.A.M. usando la clasificación ASA. Se incluyeron 102 historias clínicas de emergencia odontológica de pacientes adultos atendidos en la Clínica Periférica Azcapotzalco turno vespertino de la Facultad de Odontología de la U.N.A.M. en el año lectivo 2009-2010, se registraron variables sociodemográficas, motivo de la consulta y el estadio ASA de cada paciente. Se utilizaron proporciones, medidas de tendencia central y de dispersión. La información se capturó y analizó en el programa SPSS 15.0. Casi dos terceras partes de la población (65.7%) atendida se clasificó como ASA I, el 26.5% se situaron en ASA II y el 7.8% obtuvieron clasificación ASA III. El principal motivo de consulta fue dolor dental (96.1%). 1) La mayoría de los pacientes atendidos de urgencia dentaria fueron clasificados como ASA I...

To establish the health status of patients attended by dental emergency in the Azcapotzalco peripheral clinic of UNAM, using ASA classification. Materials and We included 102 emergency medical records of adult patients treated at the Azcapotzalco peripheral clinic in the afternoon shift at the Faculty of Dentistry, UNAM in the 2009-2010 school year, we recorded demographic variables, reason for consultation and ASA stage of each patient. We used proportions, measures of central tendency and dispersion. The information was captured and analyzed in SPSS 15.0 software. Almost two thirds of the population (65.7%) were classified as ASA I, 26.5% were at ASA II and 7.8% were ASA III. The main reason for consultation was dental pain (96.1%). 1) Most of emergency patients seen were classified as ASA I...

Evaluación de competencias comunicativas para la compresión de emociones, afectos e intenciones en personas condiferentes cuadros clínicos / Evaluation of subtle markets of mentalistic inferences and subtle communicative skills in people with different clinical disorder

En este estudio quereos elaborar un protocolo de pruebas para evaluar competencias comunicativas de compresión de emociones e intenciones a personas con diferentes cuadros clíncios. Se aministró a tres muestras: participatnes con desarrollo normal, participantes con SA y participantes con TOC. Se realizó un ANOVA de 3X5 con medidas repetidas en un factor. Se encontraron diferencias estadísticamente significtivas tanto en los factores principales como en la interacción. Para el factor principal tipo de población se encontraron diferencias estadísticamente significativas para el total de la batería, mostrando que los participantes con desarrollo nomal presentan elmejor rendimietno, los participantes con TOC, puntucaciones intermedias y los participantes con S.A, las puntuaciones inferiores El análisis factorial muestra un solo factor que explica el 61% de la varianza, lo que indica qe todas las pruebas evalúan un campo restringido de contenidos. Los resultados indican que la batería puede contribuir al diagostico diferencial de estas competencias de cmpresión de emociones, afectos e intenciones al encontrase un perfil de ejecución particular en los participantes con SA y TOC(AU)

In this reseach the emotional and pragmatic competences of people with different clinical disorders are studied. Our goal were to build a set o test for the detection of subtle markersof entalistic inferences and subtle pragmatic skills in persons with normal development, persons with AS and persons with OCD. A repeated measures 3x5 ANOVA was conducted. Significantly differnces were found so in the main factors as in the interaction. For the factor kind of population significantly differences were found in the whole set of test; people with normal development showed the best scores, people with OCD scored significantly lower and people with AS had the significantly lowest scres in the test. The factorial analysis demosntrated a main factor which explains 61% of the variance. This reveals that all the test evaluate the same resptricted group of issues. The main findidngs were that the set of tests may conribute to the differntial diagnosis in this competences of understanding of emotions, affects and intentions, showing a particular cognitive profile in people with AS(AU)

Birth of mice after in vitro fertilization using C57BL/6 sperm transported within epididymides at refrigerated temperatures.

The transportation of cryopreserved spermatozoa is an economical, efficient, and safe method for the distribution of mouse strains from one facility to another. However, spermatozoa from some strains, including C57BL/6 (B6), are very sensitive to freezing and thawing and frequently fail to fertilize eggs by conventional in vitro fertilization methods at the recipient mouse facility. Since many genetically engineered mice have the B6 genetic background, this sensitivity poses a major obstacle to studies of mouse genetics. We investigated the feasibility of transporting spermatozoa within epididymides under non-freezing conditions. First, we examined the interval that B6 and B6D2F1 (BDF1) spermatozoa retained their ability to fertilize when stored within epididymides at low temperatures (5 degrees C or 7 degrees C). Fertilization rates were >50%, irrespective of the spermatozoa used, when epididymides were stored for 3d at 7 degrees C. B6 spermatozoa, but not BDF1 sperm, had better retention of fertilizing ability at 7 degrees C versus 5 degrees C. We then transported freshly collected B6 and BDF1 epididymides from a sender colony to a recipient colony using a common package delivery service, during which the temperature was maintained at 5 degrees C or 7 degrees C for 2d. Sufficiently high fertilization rates (68.0-77.5%) were obtained for all experimental groups, except for B6 spermatozoa transported at 5 degrees C. These spermatozoa were successfully cryopreserved at the recipient facility and, yielded post-thaw fertilization rates of 27.6-66.4%. When embryos derived from the B6 spermatozoa that were transported at 7 degrees C were transferred into recipient females, 52.7% (38/72) developed to term. In conclusion, transportation of epididymides at refrigerated temperatures is a practical method for the exchange of mouse genetic resources between facilities, especially when these facilities do not specialize in sperm cryopreservation. For the B6 mouse strain, the transportation of epididymides at 7 degrees C rather than 5 degrees C, is recommended.

Release of nitric oxide in the central nervous system mediates tonic and phasic contraction of the cat lower oesophageal sphincter.

Nitric oxide (NO) in the brainstem is implicated in the control of swallowing and oesophageal peristalsis. This study examines the role of brainstem NO in the maintenance of lower oesophageal sphincter (LOS) tone, relaxation and contraction. In urethane-anaesthetized cats, oesophageal peristalsis and sphincter pressures were continuously monitored. Drugs were administered into the fourth ventricle. Oesophageal peristalsis and sphincter relaxation and contraction were induced by superior laryngeal nerve stimulation or intra-oesophageal balloon distention. Basal sphincter pressure was significantly reduced after the i.c.v. administration of the nitric oxide synthase (NOS) inhibitor, l-Ng-monomethyl arginine. The inhibitor's d-isomer had no significant effect on basal sphincter pressure, while l-arginine partially reversed the effect. The NOS inhibitor had no effect on sphincter relaxation, whereas the contraction of the sphincter following relaxation was significantly inhibited. Central nitric oxide synthase inhibition reduces basal LOS tone and contraction amplitude but has no effect on swallow or balloon distention induced sphincter relaxation. Therefore, central release of NO acts in the pathway to stimulate dorsal motor nucleus of the vagus neurones projecting to excitatory neurones in the sphincter. Inhibition of nitric oxide synthase in the CNS does not prevent relaxation of the LOS, suggesting that other pathways that do not utilize NO are important in the induction of LOS relaxation.

Hydration and protein folding in water and in reverse micelles: compressibility and volume changes.

The partial specific volume and adiabatic compressibility of proteins reflect the hydration properties of the solvent-exposed protein surface, as well as changes in conformational states. Reverse micelles, or water-in-oil microemulsions, are protein-sized, optically-clear microassemblies in which hydration can be experimentally controlled. We explore, by densimetry and ultrasound velocimetry, three basic proteins: cytochrome c, lysozyme, and myelin basic protein in reverse micelles made of sodium bis (2-ethylhexyl) sulfosuccinate, water, and isooctane and in aqueous solvents. For comparison, we use beta-lactoglobulin (pI = 5.1) as a reference protein. We examine the partial specific volume and adiabatic compressibility of the proteins at increasing levels of micellar hydration. For the lowest water content compatible with complete solubilization, all proteins display their highest compressibility values, independent of their amino acid sequence and charge. These values lie within the range of empirical intrinsic protein compressibility estimates. In addition, we obtain volumetric data for the transition of myelin basic protein from its initially unfolded state in water free of denaturants, to a folded, compact conformation within the water-controlled microenvironment of reverse micelles. These results disclose yet another aspect of the protein structural properties observed in membrane-mimetic molecular assemblies.

Induction of cortical swallowing activity by transcranial magnetic stimulation in the anaesthetized cat.

Transcranial magnetic stimulation (TMS) over human fronto-central areas of scalp can activate short latency responses in the muscles of the face, pharynx and oesophagus. However, the physiological relationship between this early activity and the swallowing activity programmed by the brainstem central pattern generator (CPG) remains unclear. The aim of this study was to explore the relationship between TMS-induced early muscle and late swallowing activities in the feline model. Twelve adult cats were studied under light anaesthesia. Mylohyoid and oesophageal EMG, together with pharyngeal, upper oesophageal sphincter (UOS) and upper oesophageal manometry, were recorded to single-pulse TMS of cat cortex. TMS at low stimulation intensities evoked consistent short latency EMG responses in the mylohyoid and oesophageal muscles (6.1 +/- 1.2 ms and 12.7 +/- 0.7 ms, respectively), and early contractile activity in the UOS (latency 31.8 +/- 3.6 ms). By contrast, TMS at high intensities induced swallowing activity as indicated by mylohyoid EMG, and UOS relaxation (latencies 1.1 +/- 0.4 s and 0.8 +/- 0.1 s, respectively). Both the early muscle and late swallowing activities were intensity-dependent, increasing stimulus strength producing a reduction in latency and greater number of swallows. The characteristics of the early response suggest an oligosynaptic projection from cortex to swallowing muscles. The induction of swallows at high intensities suggests a requisite for greater recruitment of cortical motoneurones, or associated swallowing regions.

Adiabatic compressibility of AOT

The self-assembly of amphiphilic molecules into supramolecular aggregates involves a number of complex phenomena and forces. Recent developments of highly sensitive, densimetric and acoustic methods on small volume samples have provided novel sensitive probes to explore the physical properties of these complex fluids. We have investigated, by high precision densimetry and ultrasound velocimetry, reverse micelles of [sodium bis(2-ethylhexyl)sulfosuccinate] in oil (isooctane and decane), at increasing water concentration and at variable micellar volume fractions. The size of these spherical micelles has been determined by small angle x-ray scattering. Using these results, in the framework of the effective medium theory, we have developed a simple model of micellar compressibility, allowing the calculation of physical parameters (aggregation number, volume, and compressibility) of the surfactant monomolecular film as well as that of the micellar waters. In particular, we show that the central aqueous core designated as "free" water, located at a distance from the oil-water interacting interface, is twice as compressible as "bulk" water. One notable feature of this work is the influence of the nature of the oil on the above parameters.

Central nervous system nitric oxide induces oropharyngeal swallowing and esophageal peristalsis in the cat.

BACKGROUND & AIMS: The functional role of brainstem nitric oxide (NO) in swallowing and esophageal peristalsis remains unknown. We examined the effects of blockade of central nervous system (CNS) NO synthase (NOS) on swallowing and on primary and secondary peristalsis. METHODS: (1) The effect of intravenous (IV) NOS inhibitor N(G)-nitro-L-arginine (L-NNA) on swallowing and swallowing-induced peristalsis was examined. (2) An NOS inhibitor (N(G)-monomethyl-L-arginine [L-NMMA]) was administered into the fourth ventricle intracerebroventricularly (ICV), and its effects on swallowing and primary and secondary peristalsis were examined. RESULTS: (1) IV L-NNA significantly reduced the number of oropharyngeal swallows and the induction of primary peristalsis in the smooth muscle portion of the esophageal body; the change was not significant within the striated muscle portion. (2) L-NMMA given ICV significantly reduced the number of oropharyngeal swallows and the incidence of primary peristalsis in both smooth and striated muscle, but the reduction in amplitude was significant only for the smooth muscle contraction. There was a significant reduction in both the amplitude and incidence of secondary peristalsis, only in the smooth muscle portion. CONCLUSIONS: CNS NO is an important neurotransmitter in the induction of oropharyngeal swallowing and esophageal peristalsis. The neural substrates mediating striated and smooth muscle peristalsis may be both anatomically and neurochemically distinct.

Effect of an o-raffinose cross-linked haemoglobin product on oesophageal and lower oesophageal sphincter motor function.

The present experiments evaluate the effects on oesophageal motility of an o-raffinose cross-linked haemoglobin-based oxygen carrier (HBOC) purified from outdated donated human blood cells (HemolinkTM), with attention to dose-response (0.6-2.4 g kg-1), oxygenation status and low molecular weight components (4.4-36.4% 64 kDa or less). In ketamine-anaesthetized cats, lower oesophageal sphincter (LES) function and oesophageal peristalsis were monitored 0.5 h before, during and up to 3.5 h after HBOC infusion, and in some cats at 24 h. (1) All products significantly inhibited LES relaxation and increased peristaltic velocity in the distal smooth muscle oesophagus, without consistently altering resting LES pressure. (2) Effects on peristaltic velocity reached a maximum at the smallest dose, whereas the effects on LES relaxation had a maximum effect at 1.2 g kg-1. (3) Effects were not significantly altered by the haemoglobin oxygenation status or presence of low molecular weight components. (4) Repetitive oesophageal contractions occurred. In the cat, an o-raffinose cross-linked human haemoglobin product produces changes in oesophageal body and LES function, which are independent of the HBOC oxygenation status and composition of the low molecular weight components tested. Changes may persist for at least 24 h. These motility changes are likely due to scavenging of nitric oxide by the haemoglobin.

Superior laryngeal nerve stimulation in the cat: effect on oropharyngeal swallowing, oesophageal motility and lower oesophageal sphincter activity.

Superior laryngeal nerve (SLN) stimulation can activate the brainstem swallowing mechanism to produce a complete swallowing sequence consisting of oropharyngeal, oesophageal and lower oesophageal sphincter (LOS) components. However, little is known of the effect of SLN stimulation (peripheral-sensory input from the pharynx) on the characteristics of oesophageal motor activity, especially in the smooth muscle portion. The present study examined the effect of varying stimulus train length and frequency on each of the three components of the reflex. Acute studies were performed in urethane anaesthetized cats. Oesophageal motility was monitored using conventional manometric techniques, and oropharyngeal swallowing by the mylohyoid electromyogram. SLN stimulus train length (1-10 sec) and frequency (5-30 Hz) were varied independently. Increased train length or frequency resulted in (1) an increase in oropharyngeal swallowing and incidence of the complete swallowing response, (2) an increase in latency to onset of the oesophageal peristaltic wave, (3) reduction of the amplitude of the evoked peristaltic contraction in the smooth muscle portion, without altering its velocity, (4) increased LOS relaxation, and increased LOS after-contraction. The LOS contraction was abolished by atropine (100 micrograms kg-1). Therefore, increased SLN stimulation not only results in excitation of the central swallowing program and the oropharyngeal stage of swallowing, but has major effects on the oesophageal and LOS stages of swallowing. Afferent SLN stimuli can impact on the control mechanisms for each stage, to inhibit or excite the stages in different ways.

Effects of nitric oxide synthase blockade on esophageal peristalsis and the lower esophageal sphincter in the cat.

The present study explores the role of nitric oxide (NO) in control of esophageal peristalsis and lower esophageal sphincter (LES) function in the cat. Studies were performed on 20 ketamine-anesthetized cats with manometric recording at the LES, 0, 2, 4, and 6 cm above the LES (smooth muscle section), and 12 and (or) 14 cm above the LES (striated muscle section). L-Ng-Nitro-arginine (L-NNA, 10(-6)-10(-4) mol/kg) was given intravenously, and the effects on swallow-induced esophageal peristalsis were assessed. (i) L-NNA increased the velocity of swallow-induced peristalsis in the smooth muscle esophagus; the effect was dose dependent, more prominent distally, and completely reversed by L-arginine (10(-3) mol/kg). (ii) L-NNA decreased the amplitude of peristaltic contraction in the very distal esophagus; the decrease also was dose dependent but not returned to normal by L-arginine. (iii) L-NNA inhibited LES relaxation (reversed by L-arginine) and decreased the LES "after-contraction" amplitude (unaffected by L-arginine). (iv) L-NNA was associated with the appearance of repetitive contractions. Basal LES tone was unaffected by L-NNA. In conclusion, NO is an important mediator for the timing of peristalsis in the distal smooth muscle esophagus and for LES relaxation in the cat, a species whose contraction amplitude is largely determined by cholinergic excitation. The role of NO in controlling esophageal body and LES contraction amplitude, and in preventing repetitive contractions, requires further study.

Electrical slow wave activity of the cat stomach: its frequency gradient and the effect of indomethacin.

The present study was performed to establish the intrinsic frequency of the slow waves in different regions of the cat stomach, to define the propagation velocity of the slow wave along the stomach, and to determine whether endogenous prostaglandins can affect the slow wave frequency. In 20 cats, electrical activity was recorded from the anterior wall of the intact stomach in vivo and in vitro, and in vitro after cutting the stomach into 16 pieces to isolate each pair of electrodes. In vivo, slow waves (4.1 +/- 0.5 cpm) were seen only from mid corpus to pylorus, the apparent propagation velocity decreasing towards the antrum. In vitro: (a) after cutting, the slow wave frequency increased, to a maximum in 1 h (12 +/- 1.8 cpm; range 10.2-17.3), with the highest frequency always in the mid or orad corpus, usually on the greater curvature (GC), (b) with indomethacin (10(-5) M) the increase in slow wave frequency was prevented or reversed, and there was a frequency gradient with the highest frequency (4.4 +/- 1.2 cpm) uniformly located in the most proximal active site on the GC, and (c) slow waves on the GC were more stable, regular and continuous than on the lesser curvature (LC), the difference being most evident in the corpus. The results suggest that the cat stomach behaves as a system of electrically coupled oscillators of different frequencies. The dominant oscillator of highest frequency is situated in the proximal corpus of the GC, with the remainder of the distal stomach entrained at this frequency. All gastric slow wave oscillators can be driven to higher frequencies by endogenous prostaglandins. The decreasing velocity of slow wave propagation distally suggests that oscillator properties and/or coupling among oscillators differs in the cat.

An open letter to the hemophilia community from the Community Advocacy Working Group.

AIDS: The Community Advocacy Working Group (CAWG) writes an open letter to the hemophiliac community, outlining the legislative efforts on behalf of the community since 1988, the current legislative campaign of the National Hemophilia Foundation (NHF), and the creation of CAWG. CAWG was created to resolve differences between the NHF platform and the Community of Ten Thousand (COTT) platform to avoid contradictory efforts in Congress. The NHF has betrayed CAWG, and this betrayal has damaged their legislative efforts. CAWG suggests that the NHF has a hidden agenda: they want to give members of the community an incentive to oppose the class action lawsuit and any other AIDS litigation, a position held since 1985 when they began to help the fractionators in court. CAWG states that the clear loser of these cross-purpose platforms and hidden agendas would be families with hemophilia who are enduring HIV disease. CAWG requests that only materials produced or endorsed by CAWG be used by community members in their congressional visits.^ieng