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A re-appraisal of the role of layer VI of the visual cortex in the generation of cortical end inhibition.

These experiments examine the effect of blockade of layer VI of the cat striate cortex on the length tuning of hypercomplex cells in the overlying layers II, III and IV. It has previously been suggested that local inactivation of layer VI results in the complete loss of length selectivity in all hypercomplex cells in layers II, III and IV above the blocked region, by removal of an inhibitory mechanism within layer IV, driven from layer VI. However, we have found that, using iontophoretic application of the inhibitory substance GABA to block the activity of layer VI, 29% of hypercomplex cells were unaffected by blockade of the underlying layer VI. The predominant effect on hypercomplex cells was a reduction in visual responsiveness, seen in 71% of cells, with responses reduced on average by 43%. In 50% of these cells (35% of the population) this reduction was apparently specific to responses to the optimum bar length; responses to longer stimuli were unaffected. Iontophoretic application of the potent GABAA analogue muscimol in layer VI showed a similar spectrum of effects on hypercomplex cells. In these cases, however, the cortical blockade was slowly increased to encompass the recorded cell. In each case, any decreases in length selectivity were also the result of a decreased visual responsiveness. Thus, decreases in length selectivity seen when using either GABA or muscimol were almost exclusively the result of decreased responsiveness to the optimal length of bar stimulus, rather than an increase in response to non-optimal, long stimuli. This suggests the loss of a facilitatory influence from layer VI to layer IV, rather than the loss of inhibition.

Animals↗

Osteopenia and phenylketonuria.

Trabecular bone mineral content was assessed by quantitative computed tomography in eleven young adults with phenylketonuria who had been treated from early childhood with a diet restricted in natural protein and supplemented with amino acids, minerals and vitamins. There was a significant reduction in the bone mineral content of patients compared with the normal population. Prospective studies are indicated in younger patients to ensure optimum bone mineralisation is achieved by adulthood.

Adult↗

Dependence of expected heterozygosity on locus number with stabilizing selection and drift.

I determine expected levels of heterozygosity in two allele multilocus models with mutation, stabilizing selection and drift. In the range 2 to 32 loci, the per locus heterozygosity can depend on the locus number. The per locus heterozygosity for ten loci can be as low as three fourths of the per locus heterozygosity in the limit, as the number of loci gets large. Simulations indicate that this dependence on locus number is not due to the population approaching equilibria at which the mean differs from the optimum, but is due to changes in the substitution rate as a function of the number of loci.

Animals↗

Fluctuating environments and the role of mutation in maintaining quantitative genetic variation.

We study a class of genetic models in which a quantitative trait determined by several additive loci is subject to temporally fluctuating selection. Selection on the trait is assumed to be stabilizing but with an optimum that varies periodically and might be perturbed stochastically. The population mates at random, is infinitely large and has discrete generations. We pursue a statistical and numerical approach, covering a wide range of ecological and genetic parameters, to determine the potential of fluctuating environments to maintain quantitative genetic variation. Whereas, in contrast to some recent claims, this potential seems to be rather limited in the absence of recurrent mutation, fluctuating environments might, in combination with it, often generate high levels of additive genetic variation. We investigate how the genetic variation maintained depends on the ecological parameters and on the underlying genetics.

Genetic Variation↗

Population-based survey and analysis of trends in the prevalence of diabetic nephropathy in Type 1 diabetes.

AIMS: To determine the prevalence of the various stages of diabetic nephropathy in Type 1 diabetes in a population-based survey. To make direct comparison with results from previous published studies to assess current trends. METHODS: Identification of all Type 1 patients using a population-based diabetes register. Urine samples for albumin assay were obtained at clinic visit and by postal request. Prevalence rates were calculated specifically for direct comparisons with previously published surveys. RESULTS: This study and European data from the 1990s show a clear reduction in the cumulative prevalence of microalbuminuria and established nephropathy compared with surveys from Copenhagen (1985), Pittsburgh (1986-8) and Boston (1992). In North Wales in 1999 the overall cumulative prevalence of microalbuminuria was 27.2% (95% confidence interval (CI) 24.3-30.1%) and established nephropathy was 9.6% (7.7-11.5%). Comparisons with data from EURODIAB and from Spain indicated similar results, although the prevalence of microalbuminuria was lower in North Wales than in the EURODIAB study. Significantly lower rates of nephropathy were seen in more recent Swedish cohorts. Diabetic nephropathy remains more common in males. Microalbuminuria before 10 years duration of diabetes was seen at all post-pubertal ages. CONCLUSIONS: Rates of nephropathy in Europe in the 1990s are lower than a decade ago. Modern methods of management are therefore associated with demonstrable benefit at the population level. The lowest rates of nephropathy are associated with optimum glycaemic control in Swedish data, indicating the importance of metabolic in addition to haemodynamic factors.

Albuminuria↗

Enhanced expression of beta2-microglobulin and HLA antigens on human lymphoid cells by interferon.

Mononuclear cells from the blood of healthy normal humans were kept in cultures under nonstimulating conditions for 16 hr in the presence or absence of human interferon. The relative quantities of HLA antigens and beta(2)-microglobulin on the cultured cells were determined by quantitative immunofluorescence (fluorescence-activated cell sorter) and by the capacity of cells to absorb out cytotoxic antibodies against the relevant antigens. Interferons of different origin and purities enhanced the expression of HLA antigens and beta(2)-microglobulins, whereas membrane immunoglobulins and antigens recognized by antiserum raised against human brain and T cells were the same on interferon-treated and control cells. Similar interferon effects were observed on an Epstein-Barrvirus-negative Burkitt lymphoma cell line. The enhanced expression of histocompatibility antigen subsequent to intereferon treatment was observed on B- and T-enriched lymphocyte populations and was found to be dose dependent with the optimum with "physiological" concentrations of interferon. Pretreatment of lymphocytes with interferon for 2 hr was found to be as effective as having interferon present during the total culture period. The interferon-induced enhancement of antigen expression on cells was dependent on active protein synthesis.

Adolescent↗

Early-phase clinical trials in migraine: efficacy, safety and dose-finding.

Early-phase clinical trials with any new chemical entity have three main objectives: to establish that the drug is effective in the target disease and patient population; to assess tolerability and safety; and to select the optimum dose or doses for further evaluation. Clinical trials in migraine and other headache disorders pose additional problems because of the lack of specific objective diagnostic tests and the reliance on patient assessments of symptom relief. For these reasons particular care must be taken in selection of patients, design of the trials, choice of end-points and statistical analytical methodology. A wide range of doses must be evaluated to ensure that the dose-response curves for both efficacy and safety/tolerability are fully defined. Successful early-phase trials should then allow the optimum dose or doses of the drug to be identified for further evaluation in large-scale outpatient studies.

Analgesics↗

Effect of distance and social disadvantage on the response to invitations to attend mammography screening.

STUDY OBJECTIVES: To investigate whether public response to an invitation to attend mammography screening can be increased by strategic relocation of the clinics. METHODS: Women invited to attend mammography screening were classified by attendance, socioeconomic status, and distance from their screening clinic. A geographic information system was used to investigate whether the response could be increased by relocating clinics to facilitate access. SETTING: The metropolitan city of Perth in Western Australia with six fixed site, publicly funded, mammography screening clinics. MAIN RESULTS: Women from disadvantaged areas, not screened previously by the mammography screening programme, had a higher response to an invitation to attend screening if they lived within 3 km of their closest clinics (12%) than if they lived further away (8%). Theoretically, the response of the target population could be increased if the existing clinics were replaced by six new clinics located closer to disadvantaged areas. CONCLUSIONS: Public health planners should be aware of the use of geographic information systems to model optimum locations of health care facilities, and be willing to assess the potential target population response to those locations.

Demography↗

Psychiatric screening of alcohol and drug patients: the validity of the GHQ-60.

The 60-item General Health Questionnaire (GHQ) and the National Institute of Mental Health Diagnostic Interview Schedule (DIS) were administered to 501 patients presenting for assessment or treatment of alcohol or drug problems at the Addiction Research Foundation, Toronto, Canada. The GHQ proved to be a useful, if limited, instrument for routine screening for psychiatric disorders other than substance abuse in this population. The sensitivity or "utility" of the test at the optimum threshold score was considerably lower in this sample than in medical or community samples. Receiver Operating Characteristic (ROC) analysis suggests a need for an upward revision of the cut-off score to 23/24 inpatients with alcohol or drug problems. At this threshold, sensitivity was 69%, specificity 75%, positive predictive value 77%, negative predictive value 66%, and overall misclassification rate 29%. A definition of "caseness" was used that included all DIS Axis I disorders with the exception of substance use and "cognitive impairment." Sensitivity of the GHQ was highest for the affective disorders (79%). False negatives accounted for the bulk (61%) of the misclassification rate. At the threshold score of 23/24, positive predictive values were greater for the unemployed and for patients with either no current substance use disorder or with both alcohol and drug disorders.

Adult↗

Type II odontoid fractures in the elderly: early failure of nonsurgical treatment.

The optimum treatment of Type II odontoid fractures in the geriatric population remains controversial. Coexisting medical conditions encountered in the elderly patient often increase operative risk and make cervical immobilization difficult to tolerate. Previous studies have shown increased morbidity and mortality and decreased fusion rates for Type II odontoid fractures treated with cervical orthoses in the geriatric population, whereas low morbidity and mortality rates with operative management have recently been documented. To investigate the role of surgical and nonsurgical treatment, a retrospective analysis was performed of patients with Type II odontoid fractures who were at least 65 years old and were consecutively admitted to a single medical center from 1994 to 1998. Twenty patients met inclusion criteria. In 12 patients nonsurgical management with a cervical orthosis was attempted. The nonsurgical management failed early in six patients, with one associated death. Eleven patients were treated surgically with either anterior odontoid screw fixation or posterior C1-2 transarticular screw fixation and modified Gallie fusion. Postoperatively one patient required revision of the C1-2 transarticular screws, and there was one death. In conclusion Type II odontoid fractures in this elderly population were associated with early 10% morbidity and 20% mortality rates. Nonsurgical management of Type II odontoid fractures failed early in six (50%) of 12 patients, whereas surgical treatment failed early in one of 11 (9%) patients. Both the nonsurgical and surgical treatments resulted in approximately 10% morbidity and 10% mortality rates.

Aged↗

Asian American and Pacific Islanders Mental Health Issues: A Historical Perspective.

PURPOSE OF THE PAPER. This paper reviews literature documenting these complexities and emphasizes the need to adopt a dynamic, multidimensional framework in conceptualizing Asian American ethnic identity and acculturation. In particular, the paper highlights the importance of evaluating the role of intergenerational and sociohistorical influences that can shape and change an individual's acculturative and ethnic identity experiences. SUMMARY OF THE METHODS UTILIZED. The author reviewed the last ten years of literature on Asian American mental health. PRINCIPAL FINDINGS. Mental health professionals recognize the importance of assessing a client's level of acculturation and ethnic identification. However, research findings demonstrate complex relationships among acculturation, ethnic identity, and psychological functioning. CONCLUSIONS. It is proposed that the inclusion of these factors within a multidimensional framework represents a needed step in advancing our understanding of Asian American identity and acculturation. The clinical and research implications of these issues are discussed. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS. This paper calls attention to the absence of an optimum, mental healthy resolution of ethnic identity formation that can be applied to all Asian Americans and the shared as well as unique qualities of each Asian American. KEY WORDS. Asian American; Pacific Islander; mental health; acculturation.

Journal Article↗

Relationship of international normalized ratio to bleeding and thromboembolism rates in Taiwanese patients receiving vitamin K antagonist after mechanical valve replacement.

BACKGROUND AND PURPOSE: Asians may be less vulnerable to thrombotic disease than Caucasians. Optimum international normalized ratio (INR) anticoagulant therapy guidelines for Asian populations remain to be established. This study investigated the risk factors for major bleeding or thromboembolism (TE) in Taiwanese patients receiving mechanical aortic and/or mitral valve replacement, including INR < or > 2.0. METHODS: The records of 563 Taiwanese patients receiving mechanical aortic and/or mitral valve replacement between 1996 and 2001 were retrospectively studied. Patient follow-up data was divided into several 6-month periods: 6-month increments after surgery if no bleeding or TE occurred and the 6 months preceding the adverse event when an event occurred. Data including warfarin sodium dosage and estimated INR unit for each time period were collected and analyzed. RESULTS: A total of 3,391 records were retrieved for analysis with an average follow-up period of 3.3 +/- 1.4 years. The mean warfarin sodium dose was 2.86 +/- 1.09 mg/day and the INR was 1.86 +/- 0.66. Major bleeding events occurred in 20 patients (1.07% per patient-year) and TE events in 38 patients (2.04% per patient-year), accounting for a 3.11% rate of overall events (bleeding or TE) per patient-year. Multivariate risk analysis revealed follow-up age > 60 years and receiving mitral valve replacement were risk factors for overall events (odds ratio = 1.84, p = 0.021 for follow-up age > 60 years; odds ratio = 1.36, p = 0.019 for receiving mitral valve replacement), while gender, double valve replacement, valve type, INR < 2.0, and atrial fibrillation were not. CONCLUSIONS: Our data suggest that low-intensity anticoagulant therapy (INR < 2.0) in Taiwanese patients was not associated with increased TE and bleeding rates compared to higher intensity anticoagulant therapy. Follow-up age over 60 years and valve replacement at the mitral site were associated with increased rate of overall events.

Anticoagulants↗

Small scale field trials of Bacillus sphaericus (strain 2362) against anopheline and culicine mosquito larvae in southern Mexico.

Experimental breeding sites simulating natural conditions were used to evaluate the efficacy of 2 formulations of Bacillus sphaericus (strain 2362) against Anopheles albimanus and culicine (mostly Culex coronator and Cx. quinquefasciatus) mosquito larvae of southern Mexico. Three doses of each formulation were used in a first field trial: 2, 3 and 4 g/m2 (granular) or 2, 3 and 4 ml/m2 (liquid); and in a second field trial: 0.125, 0.24 and 0.5 g/m2 (granular) or 0.125, 0.25 and 0.5 ml/m2 (liquid). The optimum concentrations of each formulation for effective control of larval populations over periods of 3-4 months were 0.125 ml/m2 of liquid product for Culex spp. and 2 g/m2 of granular product for An. albimanus (ca. 70% mean reduction).

Animals↗

Flow cytometric DNA analysis of colon adenocarcinomas: a comparative study of preparatory techniques.

DNA quantitation of solid tumors requires either nuclear extraction or disaggregation into single cells for flow cytometric (FCM) analysis. We investigated methods for disaggregating colon carcinomas comparing mechanical and enzymatic techniques in fresh tumors and compared these to extraction of nuclei from paraffin blocks. Mechanical dissociation resulted in the highest yield of tumor cells, especially tumor cells with abnormal DNA content. In addition, mechanically disaggregated intact cells, particularly when dual labeled with cytokeratin, produced optimum DNA histograms. Cytokeratin staining allowed gating on epithelial cell populations and excluded contaminating diploid inflammatory and stromal cells, improving our ability to calculate synthesis phase fractions (SpF). Human colon tumor nuclei extracted from paraffin-embedded tissue resulted in greater variation of DNA histograms and less sensitivity in identifying aneuploid cells compared to mechanically dissociated intact cells from fresh tumors. The quality of the histograms and the ability to identify aneuploid cell populations were improved by modifying the standard "Hedley" technique by additional enzyme incubation. Mechanical dissociation of fresh tumors was the preferred technique for FCM DNA analysis. Nuclear extraction from paraffin blocks resulted in some loss of sensitivity in identifying aneuploid cell lines and decreased ability to measure SpF.

Adenocarcinoma↗

Fluoride and bovine bone extract influence cell proliferation and phosphatase activities in human bone cell cultures.

The effects of fluoride (20 mumol/L) and bovine bone extract (17 micrograms/ml) were determined on cultures of human bone cells, embryonic chick bone cells, and human skin fibroblasts. The incorporation of [3H]thymidine into DNA was measured 16 hours after the addition of factors. After three to five days treatment, Triton X-100 extracts of the cells were assayed for acid phosphatase activity, in the presence and absence of tartrate, and for alkaline phosphatase activity. Fluoride stimulated [3H]thymidine incorporation and specific activity of alkaline phosphatase in human bone cells and chick bone cells but not in human skin cells. Fluoride also stimulated the cell population doubling rate of the human bone cells with an optimum of approximately 20 mumol/L. Bovine bone extract stimulated thymidine uptake into DNA several-fold and decreased alkaline phosphatase activity in all three types of cultured cells. The specific activity of tartrate-resistant acid phosphatase was increased in bone cells but not in skin fibroblasts. These results suggest that fluoride specifically stimulates the proliferation and differentiation of osteoblasts, while the growth factors in bovine bone extract primarily stimulate proliferation of bone cells. Cultures of human bone cells respond similarly to chick calvarial cells when treated with fluoride or bovine bone extract.

Acid Phosphatase↗

Group B beta-hemolytic streptococcus: randomized controlled treatment study at term.

A randomized controlled investigation was undertaken to evaluate the role of maternal oral antibiotic therapy in decreasing the incidence of maternal and neonatal colonization at term with group B beta-hemolytic streptococcus (GB-BHS). Data were collected to determine the optimum transfer media and the colonization rate in the study population. At delivery 1441 maternal-infant pairs were evaluated. One hundred sixty-eight women (11.6%) and 55 infants (3.8%) were colonized. Forty-four women colonized with GB-BHS at 38 weeks' gestation were randomly assigned to a treatment (500 mg potassium penicillin or erythromycin ethylsuccinate q.i.d.) or a control group to determine the value of antepartum oral antibiotic therapy in preventing infant colonization. There was a significant reduction in maternal (P = 0.008) and infant (P = 0.004) colonization rates in the treatment group. There were no observed complications of antibiotic therapy in mothers or infants. This study suggests that routine cultures for GB-BHS should be done at 38 weeks' gestation. Mothers colonized at this time may be considered candidates for prophylactic antibiotic treatment.

Carrier State↗

Diagnostic accuracy of the 13C-urea breath test for childhood Helicobacter pylori infection: a multicenter Japanese study.

OBJECTIVES: In adults, the 13C-urea breath test (UBT) has been widely used as a noninvasive test of Helicobacter pylori infection because of its high sensitivity and specificity. However, this test is less well established in pediatric practice. The optimum cutoff value and test protocol of the 13C-UBT remains to be established in the pediatric population. The primary purpose of this study was to evaluate diagnostic accuracy of the 13C-UBT for children and to determine its optimum cutoff value. METHODS: A total of 220 Japanese children aged 2-16 yr (mean = 11.9) who underwent upper GI endoscopy and gastric biopsies were finally studied. Endoscopic diagnoses included gastritis (n = 131), gastric ulcer (n = 15), duodenal ulcer (n = 72), and combined ulcer (n = 2). H. pylori infection status was confirmed by biopsy tests including histology, urease test, and culture. With the 13C-UBT, breath samples were obtained at baseline and at 20 min after ingestion of 13C-urea without a test meal and were analyzed by isotope ratio mass spectrometry. Based on biopsy tests, a cutoff value was determined using a receiver operating characteristic curve. In 26 children (seven children infected and 19 noninfected), paired breath samples were also measured by nondispersive infrared spectometry (NDIRS). RESULTS: Biopsy tests demonstrated that 89 children (40%) were infected with H. pylori and 131 children were not infected. There were no statistical differences in mean delta 13C values at 20 min between male and female H. pylori-infected and noninfected patients. A receiver operating characteristic analysis defined the best cutoff value as 3.5 per thousand. The overall sensitivity and specificity at a cutoff value of 3.5 per thousand were 97.8% (95% CI = 92.1-99.7%) and 98.5% (95% CI = 96.4-100%), respectively: high sensitivity and specificity were demonstrated in all three age groups (< or =5, 6-10, and > or = 11 yr). There was a close correlation between the values with isotope ratio mass spectrometry and NDIRS methods (r = 0.998, p < 0.001). CONCLUSIONS: The 13C-UBT with a cutoff value of 3.5 per thousand is an accurate diagnostic method for active H. pylori infection. The test with the NDIRS method is inexpensive and might be widely applied in clinical practice.

Adolescent↗

Evolutionary capacitance may be favored by natural selection.

Evolutionary capacitors phenotypically reveal a stock of cryptic genetic variation in a reversible fashion. The sudden and reversible revelation of a range of variation is fundamentally different from the gradual introduction of variation by mutation. Here I study the invasion dynamics of modifiers of revelation. A modifier with the optimal rate of revelation mopt has a higher probability of invading any other population than of being counterinvaded. mopt varies with the population size N and the rate theta at which environmental change makes revelation adaptive. For small populations less than a minimum cutoff Nmin, all revelation is selected against. Nmin is typically quite small and increases only weakly, with theta-1/2. For large populations with N>1/theta, mopt is approximately 1/N. Selection for the optimum is highly effective and increases in effectiveness with larger N>>1/theta. For intermediate values of N, mopt is typically a little less than theta and is only weakly favored over less frequent revelation. The model is analogous to a two-locus model for the evolution of a mutator allele. It is a fully stochastic model and so is able to show that selection for revelation can be strong enough to overcome random drift.

Adaptation, Biological↗