Anatomy and biomechanics of gluteus maximus and the thoracolumbar fascia at the sacroiliac joint.

Biomechanical models predict that recruitment of gluteus maximus (GMax) will exert a compressive force across the sacroiliac joint (SIJ), yet this muscle requires morphologic assessment. The aims of this study were to document GMax's proximal attachments and assess their capacity to generate forces including compressive force at the SIJ. In 11 embalmed cadaver limbs, attachments of GMax crossing the SIJ were dissected and their fascicle orientation, length and attachment volume documented. The physiological cross-sectional area (PCSA) of each attachment was calculated along with its estimated maximum force at the SIJ and lumbar spine. GMax fascicles originated from the gluteus medius fascia, ilium, thoracolumbar fascia, erector spinae aponeurosis, sacrum, coccyx, dorsal sacroiliac and sacrotuberous ligaments in all specimens. Their mean fascicle orientation ranged from 32 to 45° below horizontal and mean length from 11 to 18 cm. The mean total PCSA of GMax was 26 cm(2) (range 16-36), of which 70% crossed the SIJ. The average maximum force predicted to be generated by GMax's total attachments crossing each SIJ was 891 N (range 572-1,215), of which 70% (702 N: range 450-1,009) could act perpendicular to the plane of the SIJ. The capacity of GMax to generate an extensor moment at lower lumbar segments was estimated at 4 Nm (range 2-9.5). GMax may generate compressive forces at the SIJ through its bony and fibrous attachments. These may assist effective load transfer between lower limbs and trunk.

The Tidal Commitments: extending the value base of mental health recovery.

The emerging concept of recovery in mental health is often only loosely defined, but appears to be influenced more by specific human values and beliefs, than scientific research and 'evidence'. As a contribution to the further development of the philosophical basis of the concept of recovery, this paper reviews the discrete assumptions of the Tidal Model, describes the development of the Model's value base -- the 10 Commitments -- and illustrates the 20 Tidal Competencies, which aim to generate practice-based evidence for the process of recovery.

Wounding Induces the Rapid and Transient Activation of a Specific MAP Kinase Pathway.

Mechanical injury in plants induces responses that are involved not only in healing but also in defense against a potential pathogen. To understand the intracellular signaling mechanism of wounding, we have investigated the involvement of protein kinases. Using specific antibodies, we showed that wounding alfalfa leaves specifically induces the transient activation of the p44MMK4 kinase, which belongs to the family of mitogen-activated protein kinases. Whereas activation of the MMK4 pathway is a post-translational process and was not blocked by [alpha]-amanitin and cycloheximide, inactivation depends on de novo transcription and translation of a protein factor(s). After wound-induced activation, the MMK4 pathway was subject to a refractory period of 25 min, during which time restimulation was not possible, indicating that the inactivation mechanism is only transiently active. After activation of the p44MMK4 kinase by wounding, transcript levels of the MMK4 gene increased, suggesting that the MMK4 gene may be a direct target of the MMK4 pathway. In contrast, transcripts of the wound-inducible MsWIP gene, encoding a putative proteinase inhibitor, were detected only several hours after wounding. Abscisic acid, methyl jasmonic acid, and electrical activity are known to mediate wound signaling in plants. However, none of these factors was able to activate the p44MMK4 kinase in the absence of wounding, suggesting that the MMK4 pathway acts independently of these signals.

Expression of vascular endothelial growth factor and its receptors flt and KDR in ovarian carcinoma.

BACKGROUND: Two thirds of patients with ovarian carcinoma have advanced disease at diagnosis and have poor prognoses because of the presence of highly invasive carcinoma cells and rapidly accumulating ascitic fluid. Vascular endothelial growth factor (VEGF), a potent mitogen of endothelial cells, is produced in elevated amounts by many tumors, including ovarian carcinomas. The known human receptors for VEGF, flt and KDR, are both cell surface tyrosine kinases and are expressed predominantly on endothelial cells. Acting through these receptors, VEGF may stimulate angiogenesis and promote tumor progression. PURPOSE: We aimed to clarify the function of VEGF in tumor development by identifying the cells in ovarian carcinoma tissue that express VEGF and its receptors. METHODS: VEGF, flt, and KDR expression was localized by in situ hybridization and immunohistochemistry in frozen sections of primary tumors from five patients with ovarian carcinoma and from metastases of ovarian carcinoma from three different patients. Reverse transcription followed by polymerase chain reaction (RT-PCR) and an enzyme-linked immunosorbent assay were used to analyze VEGF, flt, and KDR expression in six epithelial cell lines derived from ovarian carcinoma ascites from five additional patients. RESULTS: Messenger RNAs (mRNAs) encoding VEGF, flt, and KDR were detected in primary ascitic cells and in three of four ovarian carcinoma cell lines examined by RT-PCR. Two novel complementary DNAs that may encode truncated, soluble forms of flt were cloned from one primary source. VEGF levels of 20-120 pM were found in culture media conditioned by the cell lines. Elevated expression of VEGF mRNA was found in all primary tumors and metastases, especially at the margins of tumor acini. VEGF immunoreactivity was concentrated in clusters of tumor cells and patches of stromal matrix. flt immunoreactivity was confined to tumor blood vessels, but flt mRNA was not detected by in situ hybridization. In contrast, KDR mRNA was detected not only in vascular endothelial cells but also in tumor cells at primary malignant sites. CONCLUSIONS: VEGF is expressed by tumor cells in primary and metastatic ovarian carcinoma and accumulates in the stromal matrix. Its receptors, flt and KDR, are expressed by some tumor cells that coexpress VEGF. This is the first localization of KDR expression in nonendothelial cells. IMPLICATIONS: Coexpression of VEGF and KDR by tumor cells in ovarian carcinoma raises the possibility of autocrine stimulation and of therapeutic strategies targeting this receptor-ligand interaction.

Isolation and N-terminal sequence determination of a novel gamma/delta T cell surface antigen.

An antigen complex unique for porcine gamma/delta T cells has previously been identified using the monoclonal antibodies MAC319 and MAC320. Here we use digestion with the proteolytic enzyme bromelain to selectively release the MAC319 antigen as a soluble fragment, for further characterisation. A cytofluorometric inhibition assay was developed to follow the purification of this fragment, as the conformation sensitivity of the MAC319 epitope prevented the use of immunoblotting techniques. The antigen has been purified using a combination of anion-exchange and hydrophobic-interaction columns, followed by separation on a size-exclusion column. Fractions from the size-exclusion column containing the antigen consisted of one major band at Mr 95,000. This species was shown to be specifically absorbed onto MAC319-coupled Sepharose, thereby identifying the MAC319 antigen. N-terminal amino acid sequencing of this band has revealed a previously unidentified sequence. This fragment was also shown to be glycosylated, most likely with a single sugar moiety. Enzymatic removal of the sugars showed that they did not appear to be necessary for binding of the polypeptide to the MAC319 antibody.

Conserved reiterated domains in Clostridium thermocellum endoglucanases are not essential for catalytic activity.

The complete nucleotide sequence of the Clostridium thermocellum celE gene, coding for an endo-beta-1,4-glucanase (endoglucanase E; EGE) with xylan-hydrolysing activity has been determined. The structural gene consists of an open reading frame (ORF) of 2442 bp commencing with a GTG start codon and followed by a TAA stop codon. The nucleotide sequence obtained has been confirmed by comparing the predicted amino acid sequence with that derived by N-terminal amino acid sequencing of the purified protein. The EGE sequence contains a region homologous to the reiterated domain found at the C terminus of other endoglucanases from the same organism. BAL 31 deletions of the structural gene have revealed the extent to which this conserved sequence is necessary for endoglucanase and xylanase activity. A region of DNA, upstream from the structural gene has also been sequenced and a ribosome-binding site and putative promoter sequences have been identified. A second ORF which ends 349 bp 5' to the GTG start codon of the celE gene has also been identified. The encoded product contains a C terminus homologous to other C. thermocellum endoglucanases.

A low molecular weight endometrial secretory protein which is increased by ovine trophoblast protein-1 is a beta 2-microglobulin-like protein.

Ovine trophoblast protein-1 (oTP-1), stimulates the secretion of several proteins in explant culture of day-12 cyclic ovine endometrium. We partially purified and identified one of these proteins, an 11,000 Mr, pI approx. 6 protein by N-terminal amino acid sequencing and immunoprecipitation using antibody to human beta 2-microglobulin. The protein was purified from cultures of endometrium collected from day-16 pregnant ewes. The N-terminal amino acid sequence was 40-55% homologous to beta 2-microglobulin from a variety of species. Antibody to human beta 2-microglobulin immunoprecipitated the protein and another protein of similar molecular weight but more acidic pI. Using immunoprecipitation of radiolabelled proteins from culture, we demonstrated that oTP-1 increased production of this protein by 40% (P less than 0.05). We conclude that oTP-1 increases the secretion of a beta 2-microglobulin-like protein from day-12 non-pregnant endometrium in culture.

Interferon sequence homology and receptor binding activity of ovine trophoblast antiluteolytic protein.

Sequencing of the 40 N-terminal amino acids of the blastocyst protein responsible for blocking corpus luteum regression in early pregnancy in sheep revealed a 37% homology with human alpha-interferon; 28% of the remaining amino acid changes were conservative. 125I-Labelled human alpha-interferon bound to membrane receptors from sheep uteri with an approximate Kd of 4 x 10(-11) M; binding was inhibited by unlabelled alpha-interferon or purified blastocyst antiluteolytic protein. The blastocyst antiluteolytic protein therefore closely resembles the interferon-alpha family of antiviral proteins.

Localization and endogenous concentration of endothelin-like immunoreactivity in human placenta.

The aim of this study was to investigate the localization of endothelin-like immunoreactivity (ET-IR) in human placenta, chorion and amnion and to compare the endogenous concentration of immunoreactive endothelin (ET) in these tissues before and after the onset of labour. ET-IR was detected in the endothelium of stem vessels in placental villi, as well as in decidual stromal cells in the basal maternal plate, by immunocytochemistry using primary polyclonal rabbit antibody. A specific radioimmunoassay was used to detect endogenous concentration of ET in homogenized placental tissues. The endogenous concentration of ET-IR was significantly greater in amnion than in chorion and placenta (amnion 249 +/- 13 fmol/g; chorion 190 +/- 11 fmol/g; placenta 169 +/- 14 fmol/g; means +/- S.E.M.; n = 12; P less than 0.01). No significant difference was seen before or after the onset of labour. The detection of ET-IR in placenta, chorion and amnion suggests that the ETs may play a role in the paracrine control of human uterine function.

Aromatase-immunoreactivity is localised specifically in neurones in the developing mouse hypothalamus and cortex.

Local formation of oestrogens from androgens by aromatase cytochrome P-450 within brain cells is crucial for the sexual differentiation of the mammalian CNS. Aromatase activity has been detected in several brain regions of the developing rodent brain. In the present study, we used a mouse-specific, peptide-generated, polyclonal aromatase antibody to determine whether neurones and/or glial cells in the developing brain are involved in androgen aromatization and if aromatase-immunoreactive (Arom-IR) cells exhibit a sex-specific distribution and regional-specific morphological characteristics. For these experiments, gender-specific cell cultures were prepared from embryonic day 15 mouse hypothalamus and cortex. Specificity of the immunoreaction was confirmed by Western-blot analysis and by inhibition of aromatase activity using tissue homogenates from mouse ovaries and male newborn hypothalamus and from male hypothalamic cultures with known aromatase activity, respectively. Arom-IR cells were found in both hypothalamic and cortical cultures. Double-labeling experiments revealed that Arom-IR cells co-stained only for the neuronal marker MAP II, but never for glial markers. Therefore aromatase immunoreactivity is specifically neuronal. Regional differences in the morphology of Arom-IR neurones were observed between both brain regions. In hypothalamic cultures, IR-neurones represented a heterologous population of phenotypes (magnocellular, small bipolar and multipolar neurones with long processes showing varicose-like structures or without processes). Cortical Arom-IR neurones were always oval in shape with short or no IR-processes. Sexual dimorphisms in numbers of Arom-IR neurones were found in the hypothalamus with significantly higher cell numbers in male cultures.(ABSTRACT TRUNCATED AT 250 WORDS)

Aromatase-immunoreactive neurons in the adult female chicken brain detected using a specific antibody.

Estrogen formation in the brain catalysed by the cytochrome P450arom is required for the control of estrogen-dependent neural mechanisms regulating reproductive behaviour. A polyclonal antibody was raised against a 15-amino acid fragment of the chicken ovarian P450arom protein, to localise aromatase-immunoreactive (AR-IR) cells in the adult female chicken brain. Specificity of antibody reaction was established by Western blot and by inhibition of aromatase activity in homogenates of chicken ovarian follicles determined by a radiometric assay. The AR-IR material in the brain was localised in the perikarya and some of their adjacent cytoplasmatic processes. Intense immunoreactivity was observed in the preoptic region as well as in other hypothalamic nuclei. AR-IR cells were also found in extrahypothalamic areas; in particular, in the area entorhinalis and hippocampus. These results confirm histologically that aromatization of testosterone in the adult female chicken brain occurs in preoptic nuclei closely associated with the regulation of reproductive behaviour. The mapping of AR-IR cells in the female chicken brain now allows study of its regulation under different physiological and environmental conditions, and its relation to classic target areas expressing estrogen receptors.

Attachments of the posterior layer of lumbar fascia.

STUDY DESIGN: Superficial and deep laminae of the posterior layer of lumbar fascia were dissected. The lumbar portion was measured for evidence of segmental thickenings. Superior attachments were dissected, documented, and photographed. OBJECTIVES: To verify the existence of posterior accessory ligaments and establish the superior attachments and fiber angles of the posterior layer of lumbar fascia. SUMMARY OF BACKGROUND DATA: There have been two small dissection studies on the posterior layer. Their findings are conflicting in several areas of clinical significance. Thickenings in the lumbar region were described in one study, but have not been verified. The superior attachments of the posterior layer have not been formally documented. METHODS: Study 1: In 21 embalmed cadavers, the lumbar region of the posterior layer was dissected. The lumbar spinous processes and adjacent fascia were marked. The fascia was removed and examined, and its thickness measured with a manual micrometer. Results were statistically analyzed. Study 2: Superior attachments of the posterior layer in 20 cadavers were dissected and photographed. Capacity to transmit tension was estimated and documented photographically, and fiber angles measured in situ. RESULTS: Study 1: There was no evidence of macroscopic segmental thickening in the posterior layer. Study 2: The superficial lamina was continuous superiorly with the rhomboids, and the deep lamina with the tendons of splenius cervices and capitis. These previously undocumented attachments were of variable thickness and fibrosity, and capable of transmitting tension. CONCLUSIONS: Both superficial and deep laminae of the posterior layer are more extensive superiorly than previously thought. This may have implications for certain tests used in assessment and management of low back pain such as the slump and "nonorganic" tests. The thickness of the superior attachments is variable. Their capacity for load bearing is yet to be quantified.

Impact of gemifloxacin on the normal human intestinal microflora.

Gemifloxacin is a new fluoroquinolone that has been shown to possess a broad spectrum of antimicrobial activity against gram-positive and gram-negative microorganisms including methicillin-susceptible and methicillin-resistant staphylococci, Streptococcus pneumoniae, Haemophilus influenzae and most members of the family Enterobacteriaceae. The aim of the present study was to investigate the effect of gemifloxacin on the human intestinal microflora. Gemifloxacin was given in oral doses of 320 mg for 7 days to 10 healthy subjects and 5 subjects received a once-daily dose of matched placebo for 7 days. Faecal samples were collected prior to administration (days -8 and -6), during the administration period (days 2 and 4) and after withdrawal of administration (days 8, 11, 21, 28 and 56). In the aerobic intestinal microflora the numbers of enterobacteria were suppressed during the gemifloxacin administration and the numbers of enterococci and streptococci were also decreased. No other aerobic microorganisms were affected. In the anaerobic microflora the numbers of anaerobic cocci and lactobacilli were suppressed during the gemifloxacin administration while no other changes occurred. The microflora was normalized 49 days after the administration of gemifloxacin had stopped. No selection or overgrowth of resistant bacterial strains or yeasts occurred. The ecological impact of gemifloxacin was shown to be selective and similar to that of ciprofloxacin, levofloxacin and ofloxacin.

The proper focus of nursing: a critique of the "caring" ideology.

Some nurse educators in the United Kingdom are following the lead of North American theorists by asserting that caring "is" the core of nursing. This paper offers a focused critique of the caring ideology, through an examination of: (a) the views of a founding figure in the "caring" movement, and (b) a proposal for the integration of a "caring curriculum" within Project 2000. An overview of the "caring" literature prefaces an examination of Watson's notion of a "science of caring". Finally, Kirby and Slevin's recent proposals for a "curriculum of care" are examined in terms of their necessity and practicality.

Chaos and the way of Zen: psychiatric nursing and the 'uncertainty principle'.

The biological sciences have been dominated by 'classicist' science-predicated on the post-Enlightenment belief that a real world exists, which behaves according to notions of causality and consistency. Although medicine, and by implication psychiatric nursing, derives its explanatory power from such a science, much of its focus-illness-is not amenable to causal explanation or prediction. The theoretical developments of the 'new physics' have been used to redefine science and, as a result, have challenged traditional constructions of reality. The new physics are usually framed in terms of the physical world, or to construe consciousness. In this paper I shall consider the implications of chaos-a relative of the new physics-for psychiatric nursing practice. As nursing appears to crave a 'certainty principle' to govern the theoretical underpinnings of practice, this study considers how chaos might contribute to a metaparadigm of nursing.

Locus of control in women with a diagnosis of manic-depressive psychosis.

This study reports the evidence of women with a diagnosis of manic-depressive psychosis, from two standardized locus of control scales: Rotter's Internal-External scale and Reid & Ware's 3-Factor Internal-External Scale. The study compares a patient sample with a 'normative' group reported previously in the locus of control literature. A further comparison between subjects with a history of depression only, and subjects with a history of mania and depression, is also reported. Findings suggest that different factors, within the global locus of control construct, each involving a different form of cognitive vulnerability, may be part of the clinical picture of manic-depressive psychosis. The implications of these findings for nursing intervention are discussed.

Nurses' perceptions of multidisciplinary teamwork in acute psychiatric settings.

The findings of a pilot telephone survey of senior nurses' views of multidisciplinary teamwork (MDT) practice in 26 acute psychiatric admission wards within the ambit of one English health authority are reported. The survey was conducted in two stages. The first stage focused on obtaining the senior nurse's general perceptions of the organization of the work of the multidisciplinary team, and in the second stage more detailed responses to the original questions were obtained. The findings suggest that the composition and operations of the acute ward team are limited, and the relationship between the MDT and patients and their families do not entirely support the concept of increased collaboration with patients and their families. The findings are discussed within the context of the perceived crisis in acute psychiatric care in England and the ambitions for more egalitarian 'mental health' services.

An inquiry into moral virtues, especially compassion, in psychiatric nurses: findings from a Delphi study.

A three-round Delphi study was conducted to gather data on ethical reasoning among psychiatric nurses (N = 26 in round one (R1), decreasing to N = 14 in the final round (R3)). Transcripts of questionnaires were carefully read and compared. Responses were manually sorted into categories, themes and patterns of interest. Eight debates emerged from the data. This article discusses two in detail: the nature of moral virtues and the meaning of compassion in psychiatric nursing. A sympathetic overview of virtue ethics is also provided. The nurses' responses included a lot of virtue terms, such as, 'honest', 'fair', and 'care". However, 'nurses' moral virtues' was ranked low in importance as a notion invoked in ethical decision making in the round-one ranking exercise. Only half of the sample believed that the moral character of a psychiatric nurse is important in ethical decision-making. Further, most of the round-one sample thought the virtues could not be acquired. Compassion was identified as crucial to psychiatric nursing and the nurse-client relationship, though, as expected, many diverse meanings were attributed to this notion. While the Delphi method proved adequate for our purposes, problems with regard to accurately understanding the respondents' intended meanings highlighted a major weakness of this technique, in common with other methods relying on questionnaires. Further inquiry is needed regarding the role of moral virtues and virtue ethics in both psychiatric nursing and nurse education.

The concept of serious mental illness: modern myths and grim realities.

Current mental health practice and legislation is influenced significantly by the ill-defined concept of serious mental illness (SMI). Although the concept of SMI originally appeared to include a consideration of a range of forms of mental illness, including dementias, by custom and practice the term has come to mean, often, only people with a psychotic diagnosis. This paper reviews the influence of the term SMI, considering the way older people, younger people and other subgroups within the 'adult' population have been marginalized by the narrow definition of the concept. The paper concludes with a consideration of some of the ethical implications of mental health nurses focusing on an ill-defined 'illness' grouping, and the impact that such a narrow focus might have on the ambition to establish 'health for all by the year 2000'.

The conceptual basis of mental health nursing.

This paper traces the historical roots of mental health nursing relating these to contemporary practice in the case of people with all forms of mental illness. An attempt is made to explain the current interest in the nurse's interpersonal role with reference to specific theoreticals models and the development of care practices which emphasise social systems or social relationships. Emphasis is given to reports in the British literature, although some reference is made to North American nursing commentators. It is argued that although research evidence is weak, strong indications exist to suggest that the nurse's primary role lies in the imagination of their interpersonal relationship with the patient in an attempt to effect lasting change in the patient's capacity to live an ordinary life.