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[Influencing factors on the course of supervised visitations in a parental counselling office].

We report about a youth welfare service tool called supervised visitation (SV). SVs are intended to maintain contact and emotional relationship between child and absent parent. In the present study, we assessed a number of supposed influencing factors on course and result of SV. 55 % of the SV cases could eventually be transferred to regular contact without supervision. The majority of SV cases could be finished after a couple of months. The number of accompanying counselling sessions was often higher than the number of SVs themselves, a result stressing the significance of counselling. Younger as well as older children did benefit from SV. Opposed to some of the literature, in our study the success of SV did not depend on kind of referral or custody, specific indications, or the length of contact interruptions. We found a tendency though that a high number of risk factors is a potential risk for SV success.

Adolescent↗

[The energetics and economics of the cardiac pump function].

In anesthesiology and intensive care medicine it is often necessary to treat disorders involving cardiac failure or low-output syndrome. However, in patients who are endangered by ischemic heart disease, any pharmacologic therapy with positive inotropic agents should improve cardiac output without increasing myocardial oxygen demand significantly: the heart should perform its task as efficiently as possible. In the present study a mathematical model of myocardial efficiency was developed. The implications of this theoretical concept of myocardial efficiency were evaluated in animal experiments. THEORETICAL MODEL. Cardiac efficiency is predominantly dependent on preload, afterload, and inotropic state. Quantitatively, it can be calculated from end-diastolic volume, left ventricular systolic pressure (Psyst), stroke volume (SV), and ejection time. The implications of the theoretical analysis are: (1) the inotropic state, which leads to optimal myocardial efficiency, is specifically determined by preload and afterload: for each preload and afterload one matched inotropic state is necessary to achieve optimal efficiency; (2) an increase in blood pressure leads to a decrease in myocardial efficiency even if the inotropic state is optimally matched to preload and afterload; and (3) an increase in end-diastolic volume improves the efficiency of myocardial pump work. ANIMAL EXPERIMENTS. The validity of the theoretical model was studied in animal experiments with emphasis on the following items: (1) is theoretically optimal efficiency of myocardial pump work achieved by physiologic regulation of myocardial performance? (2) how does sympathetic stimulation influence myocardial efficiency? and (3) how do cardiodepressive agents such as beta-blockers or volatile anesthetics influence myocardial efficiency? METHODS. Experiments were performed on nine mongrel dogs after induction of piritramide--nitrous oxide anesthesia. Standard hemodynamics: heart rate, Psyst, maximum left ventricular pressure rise (dP/dtmax), and SV (thermodilution) as well as coronary blood flow (pressure difference catheter) and myocardial oxygen consumption (Fick principle) were measured. In order to create a broad range of different hemodynamic settings, blood withdrawal and retransfusion of blood and/or colloid osmotic solutions were used to modify intravascular volume. Additionally, the inotropic state was varied by infusion of catecholamines (isoproterenol 0.4-0.8 microgram.kg-1.min-1 or norepinephrine 1-2 micrograms.kg-1.min-1). Experimental myocardial failure was induced by adding halothane (0.8-1.5 MAC) to the basic anesthesia, beta-blockade with propranolol (125-250 micrograms.kg-1), and combination of beta-blockade with a pressure load imposed on the myocardium (propranolol 125-250 micrograms.kg-1 + norepinephrine 1-2 micrograms.kg-1.min-1). RESULTS. During variation of the intravascular blood volume by normo-, hypo-, and hypervolemia, the myocardial efficiency very closely matched the theoretically predicted values of optimal efficiency: the average observed efficiency was 98.8% of predicted optimal efficiency. Increasing afterload with norepinephrine did not alter this close relationship, although absolute values of efficiency decreased as predicted by the theoretical model. Application of isoproterenol resulted in SVs that exceeded optimal values by 41.5%. In contrast, during experimental myocardial failure SVs were too small to achieve the necessary values for optimal pump work; observed myocardial efficiency was therefore significantly lower than optimal efficiency. CONCLUSIONS. For pharmacological interventions, it can be concluded that maximal efficiency of cardiac pump work requires maximal end-diastolic filling in combination with minimal afterload. (ABSTRACT TRUNCATED AT 400 WORDS)

Anesthesia, Inhalation↗

Immunological relationships between specific sperm proteins and secretory polypeptides from seminal vesicles.

Rat and bovine testicular and posttesticular spermatozoa, in situ or removed from the seminal pathways were studied for the presence and the binding of seminal vesicle secretory proteins. A protein cross-reactive with an antibody against rat seminal secretory sulfhydryloxidase was found in mitochondria of pachytene primary spermatocytes which are sequestered during spermiogenesis and collected in the residual bodies of late spermatids. This indicates the replacement of one generation of mitochondria by another during spermiogenesis. Using an antibody against the SVS II polypeptide from rat seminal vesicles, an intrinsic immunoreactive protein was detected in the principal piece of the sperm tail as well as an extrinsic protein (presumably secreted by the epididymis) on the sperm head. The actin-capping capacity of SVS II indicates the functional relation of this immunoreactive membrane protein with actin or an actinrelated protein. Ampullary bovine spermatozoa, contrary to their epididymal precursors contain immunoreactive major protein, secreted from bull seminal vesicles, firmly incorporated into the (sub) plasmalemmal protein in the middle piece. In this case, a secretory protein from seminal vesicles is incorporated into the sperm proteins. This is presumably an important process, related with the initiation of hypermotility of spermatozoa.

Animals↗

Diagnosis and treatment of the slit ventricle syndrome.

Slit ventricles are a complication of a functioning shunt. This article examines the diagnosis and treatment of slit ventricles and slit ventricle syndrome, the pathophysiology involved, a rationale for treatment, and the direction of therapy in the near future. The authors conclude that determining which type of SVS is present is the first step in treatment and that the best treatment is a strategy aimed at the specific type of SVS that is responsible for the symptoms.

Brain Diseases↗

[Prospective payment per case and length of stay at coordinated private hospitals].

BACKGROUND: In 1991 the Valencian Health Service (SVS) introduced a system of prospective payment per process to reimburse some surgical interventions to coordinated private hospitals which, until then, had invoiced by retrospective payment per hospital stay. The impact of this change on the mean length of stay in seven groups of surgical interventions is evaluated. METHODS: Retrospective analysis of the mean stay of 2025 admissions in private hospitals coordinated under both systems of payment (payment per process 66%, October 91 to February 92; payment by stay 64%, March 91 to February 92) for seven groups of surgical procedures: cataract surgery, cholecystectomy, hernioraphy, prostate resection, tonsillectomy-adenoidectomy, varicose vein and proctologic procedures was carried out. RESULTS: Mean hospital stay decreased (mean = 5.4 days; p < 0.001) in all the groups reimbursed under PRP (from 72% in proctologic conditions to 43% for adenoidectomy-tonsillectomy) avoiding 8727 stays. The coinciding period under both systems demonstrated a decrease of mean hospital stay similar to the total period. CONCLUSIONS: The coordinated hospitals demonstrated a surprisingly rapid capacity to modify their organizative behaviour or influence the styles of clinical practice or both to adopt the patterns of length of stay which optimize profits according to the system of payment used by the SVS.

Hospitals, Private↗

[The Zurich prospective dementia study 1987-1993].

1987-1993 the Zurich prospective dementia study examined twice yearly 308 nursing-home patients: 192 with senile dementia of Alzheimer-type, 18 with Parkinsonism, 20 with Parkinson dementia and 78 controls, with the Zurich variant of the mini-mental state and rated their dementia state by CDR, activities of daily living with ADL and social behavior with an SVS-scale. At the end of the study or at death the average age was 86.2 years (range 63-103 and 159 autopsies were performed which confirmed the clinical diagnoses at least partly in 70%. Of the 62 cases with autopsies who had been studied more than two years 25 showed M.Alzheimer, 8 M, Parkinson, 7 vascular dementia and 13 a combination of those three diagnoses 40% of these Alzheimer patients exhibited no deterioration in the SVS for two years, 40% respectively 30% during one, resp. two years in the CDR, 20% resp. 40% in the ADL and 23% resp. 5% in the MMS. This demonstrates that good nursing-home care can stabilize behaviour and to a lesser extent even cognitive abilities of a large minority of patients with a pathologically confirmed progressive dementing illness.

Activities of Daily Living↗

[Medical responsibilities concerning maternal breast-feeding].

OBJECTIVE: The objective of this study was to determine the knowledge of high ranking officers in Servei-Valencià-Salut (SVS) about breast-feeding (BF) and national and international regulation related to it, in addition to determining what sanitary policies were undertaken by them to promote BF. PATIENTS AND METHODS: A survey was sent by mail to all high ranking officers (HO) of SVS and all pediatric chief staff services (PC) in our community. To analyze data between both groups a Chi square test and odds ratio in the qualitative variables and variance in the quantitative. RESULTS: Of the surveys sent, 100% were answered by the PC and 44% the HO. Breast-feeding was ranked as superior to artificial feeding by 100% of PC and 73% of HO (p < 0.05). Both groups believed in the necessity of carrying out policies to promote BF in developed countries. Only two PC seemed to know the 1981 OMS's code. All PC carried out policies of BF promotion in their area of influence, while in the HO the percentages varied from 64% to 0% according to their position in the health service organization. CONCLUSIONS: It is necessary to spread the knowledge of and to apply the OMS/UNICEF normatives and to involve al HO with real decision-making power in the development of sanitary policies.

Breast Feeding↗

Pre-existing vascular disease in the radial artery and other coronary artery bypass conduits.

BACKGROUND: There is increasing interest in the radial artery (RA) as a coronary artery bypass graft (CABG). However, few studies have examined the prevalence of pre-existing disease in this vessel. METHODS: Histological specimens from 177 RA were compared with 168 of internal mammary artery (IMA) and 86 of long saphenous vein (LSV) from the same patients undergoing CABG. The degree of stenosis, active atheroma, intimal thickening, and medial hyaline sclerosis was assessed. - RESULTS: 99% of IMAs, 98% of RAs and 100% of SVs had less than 30% stenosis. 91% of IMAs, 42% of RAs and 70% of SVs had less than 5% stenosis. Medial sclerosis was present in 10% of IMAs, 36% of LSVs and 46% of RAs. Medial calcification was present in 9% of RAs, 1% of LSVs and not in IMAs. CONCLUSION: The majority of conduits did not have evidence of severe disease. There is an increased prevalence of mild intimal thickening, medial sclerosis and medial calcification in RAs compared with IMAs and LSVs. The implications for longer-term graft patency are uncertain.

Arteriosclerosis↗

Effects of mean and swing pressures on piston-type high-frequency oscillatory ventilation in rabbits with and without acute lung injury.

To determine whether low mean airway pressure (MAP) and/or stroke volume (SV) settings cause lung injury during piston-type high-frequency oscillatory ventilation (HFOV), we investigated the influence of various combinations of MAP and SV on the amplitude of the pressure swing at four different sites in the normal lung of rabbits. We also examined the effects of these factors on progression of lung injury in lavaged surfactant-deficient lungs. We measured changes in the mean pressure (MP) and swing pressure (SP) during HFOV at MAPs ranging between 5-30 cm H2O in combination with SVs ranging from 5-30 mL in 13 rabbits at four different sites: 1) the proximal airway, 2) the distal end of the endotracheal tube, 3) the bronchi, and 4) the pleural space. Lung lavage was performed in 8 rabbits and differences in MP and SP between normal and surfactant-deficient rabbits were investigated. In the remaining 5 rabbits, lungs were lavaged and subjected to two trials of sustained inflation to 30 cm H2O for 15 s to reverse atelectasis, and the resulting SP was measured. In normal lungs, SP increased at the bronchial and pleural sites as MAP was increased. Alterations in SV did not affect MP in normal or lavaged lungs. In the lavages, surfactant-deficient lungs at MAPs < or = 15 cm H2O, there were significant increases in SP at the distal end of the endotracheal tube and the bronchial sites. SP decreased to the prelavaged level following sustained inflation to 30 cm H2O for 15 s. We conclude that low MAP settings are insufficient to open alveoli in the low-compliance lung and allow for development of atelectasis rather than air trapping. SP was markedly increased in the presence of atelectasis, possibly leading to excessive expansion of the airway. In the clinical setting, such overexpansion of the distal airways may contribute to lung injury. Our findings suggest that physicians should use caution in reducing MAP during piston-type HFOV until lung compliance has normalized, especially in infants with respiratory distress syndrome.

Air Pressure↗

Synaptophysin: leading actor or walk-on role in synaptic vesicle exocytosis?

Synaptophysin (Syp) was the first synaptic vesicle (SV) protein to be cloned. Since its discovery in 1985, it has been used by us and by many laboratories around the world as an invaluable marker to study the distribution of synapses in the brain and to uncover the basic features of the life cycle of SVs. Although single gene ablation of Syp does not lead to an overt phenotype, a large body of experimental data both in vitro and in vivo indicate that Syp (alone or in association with homologous proteins) is involved in multiple, important aspects of SV exo-endocytosis, including regulation of SNARE assembly into the fusion core complex, formation of the fusion pore initiating neurotransmitter release, activation of SV endocytosis and SV biogenesis. In this article, we summarise the main results of the studies on Syp carried out by our and other laboratories, and explain why we believe that Syp plays a major role in SV trafficking.

Animals↗

Seminal vesicle masses detected incidentally during transrectal sonographic examination of the prostate.

PURPOSE: The aim of this study was to review the incidence and type of seminal vesicle (SV) masses discovered during transrectal sonography (TRUS) of the prostate. METHODS: Patients were a consecutive series of men referred for TRUS of the prostate because of lower urinary tract symptoms or elevated prostate-specific antigen levels, who were found on TRUS to have SV masses. Patients with prostate cancer involving the SVs were excluded. Cystic lesions were sampled by fine-needle aspiration and solid lesions by core biopsy, all under sonographic guidance. RESULTS: Of the 450 patients who underwent TRUS between January 1997 and December 2001, 10 (2%) were found to have SV masses; 5 masses were cystic and 5 were solid. Cytologic evaluation of aspirated specimens revealed benign findings in all 5 cysts. Four of the 5 patients with solid SV masses had chronic schistosomiasis, and the mass in the fifth patient was a metastatic deposit from a renal cell carcinoma. CONCLUSIONS: SV masses may be responsible for lower urinary tract symptoms in a small fraction of cases. A cystic mass is presumptively benign, whereas a solid lesion has a small probability of being malignant, especially if the patient has a primary neoplasm elsewhere. Schistosomiasis should always be considered when making a differential diagnosis in patients who live in areas where infestation is endemic.

Adult↗

Instructive induction of prostate growth and differentiation by a defined urogenital sinus mesenchyme.

Instructive influences of fetal mesenchyme were examined in heterotypic tissue recombinants consisting of urogenital sinus mesenchyme (UGM) from male and female rats and distal ductal tips from adult rat prostate. Tissues were grown under the renal capsule of male hosts for periods up to 28 days. Resultant growths exhibited typical prostate histology. Expression of lobe-specific proteins for the ventral (prostatic steroid binding protein [PSBP]) lateral (seminal vesicle secretion II [SVS II]), and dorsal prostate (secretory transglutaminase [TGase]) were examined by immunocytochemistry. Male or female UGM combined with terminal segments of the ventral or dorsal prostate and immunolabeled with antibodies to lobe-specific proteins demonstrated expression of all three secretory products. The pattern of staining was consistent with a compound inductive response from the UGM. Unique to this study was our ability to use a defined mesenchymal tissue (female ventral mesenchymal pad [VMP]). This tissue is specifically associated with ductal branching morphogenesis and cytodifferentiation of the ventral prostate. Distal ductal tips from the dorsal lobe of the adult male prostate when recombined with female VMP and grown in vivo exhibited transformation of secretory phenotype, and the epithelium expressed mRNAs for PSBP. Immunocytochemistry of serial sections did not demonstrate labeling for TGase in the new epithelial growth. Ultrastructural analysis of the heterotypic recombinants indicated that the epithelium had similar characteristics to those of normal ventral prostate. Early stages of the mesenchymal-epithelial interactions resulted in dedifferentiation of the adult epithelium to solid cords of stratified cells. These findings illustrate the potent instructive capacity of a defined fetal UGM to influence development and cytodifferentiation of adult prostate epithelium.

Animals↗

Photoperiod-induced changes in the proteins secreted by the male genital tract of the rodent Octodon degus.

The proteins secreted by the male genital tract were analyzed in the seasonally breeding rodent Octodon degus. The protein patterns from the fluids collected from sexually active animals were compared with those from animals in resting period, with others which were previously castrated, and with castrated animals which received testosterone replacement treatment. Fluids from cauda epididymides (CE), seminal vesicles (SV) and prostate glands (PG) were collected, and analyzed by polyacrylamide gel electrophoresis followed by different staining methods and densitometry. Modifications were detected in the protein patterns of resting or castrated animals. In CE fluid, the decrease of one protein band (45 Kda) and the uprising of another (210 Kda) were recognized after castration. In animals during resting period the changes were not as marked as in castrated animals. SV secretion demonstrated a similar response to resting phase and castration, because Protein SVS I (200 Kda) decreased or were not observed when these conditions occurred. PG fluid proteins were also modified after castration. In general, the more severe changes in the protein spectrum were induced by castration, despite radioimmunoassay showing that testosterone fall is even higher in resting period animals than in those castrated. Testosterone replacement resulted in recovery of a protein profile which is very similar to that of sexually active males. Results suggest that the androgenic control of male tract secretions would be rather different in this seasonal hystrichomorph when compared to the regulation system described for myomorph rodents.

Animals↗

Effects of liquid chromatography mobile phase buffer contents on the ionization and fragmentation of analytes in liquid chromatographic/ionspray tandem mass spectrometric determination.

The effects of liquid chromatography mobile phase buffer contents on the ionization and fragmentation of drug molecules in liquid chromatographic/ionspray tandem mass spectrometric (LC/MS/MS) determination were evaluated for simvastatin (SV) and its hydroxy acid (SVA). The objective was to improve further the sensitivity for SV by overcoming the unfavorable condition caused by the formation of multiple major adduct ions and multiple major fragment ions when using ammonium as LC mobile phase buffer. Mobile phases (70:30 acetonitrile-buffer, 2 mM, pH 4.5) with buffers made from ammonium, hydrazine or alkyl (methyl, ethyl, dimethyl or trimethyl)-substituted ammonium acetate were evaluated. Q1 scan and product ion scan spectra were obtained for SV in each of the mobile phases under optimized conditions. The results showed that, with the alkylammonium buffers, the alkylammonium-adducted SV was observed as the only major molecular ion, while the formation of other adduct ions ([M + H](+), [M + Na](+) and [M + K](+)) was successfully suppressed. On the other hand, product ion spectra with a single major fragment ion were not observed for any of the alkylammonium-adducted SVs. The affinity of the alkylammoniums to SV and the basicity of the alkylamines are believed to be factors influencing the formation and abundance of molecular and fragment ions, respectively. Methylammonium acetate provided the most favorable condition among all the buffers evaluated and improved the sensitivity several-fold for SV in LC/MS/MS quantitation compared with that obtained using ammonium acetate buffer. Better precision for SV in both Q1 and SRM scans was observed when using methylammonium buffer compared with those using ammonium buffer. The mobile phase buffer contents did not seem to affect the ionization, fragmentation and chromatography of SVA. The results of this evaluation can be applied to similar situations with other organic molecules in ionspray LC/MS/MS determination.

Anticholesteremic Agents↗

Characterization of synaptic vesicles and related neuronal features in nerve growth factor and ras oncogene differentiated PC12 cells.

PC12 cells can differentiate into neuron-like cells after treatment with either nerve growth factor (NGF) or transduction with a retrovirus which expresses the K-ras oncogene. The concomitant treatment of NGF plus ras differentiates PC12 cells further than either agent alone with respect to neurite outgrowth, acetylcholinesterase levels, and most strikingly, the number of synaptic vesicle (SV) clusters. These SV clusters in PC12 cell neurites closely resemble those in the presynaptic terminals of neurons. Such SV clusters have not been described in cell lines previously. The SV clusters from all three differentiated groups (NGF, ras, and NGF plus ras) were similar in size, shape, and configuration, except that the ones in the doubly treated group occur in higher frequency and have more vesicles. The synaptic nature of these vesicle clusters was demonstrated by their regulated depletion after potassium stimulation. Furthermore, these vesicle clusters stained positively for two SV-associated proteins, synapsin I and synaptophysin, by EM immunocytochemistry (ICC). Such SV clusters in a cell line are very useful for characterizing the regulated release of SVs and the distribution of SV-related antigens in intact cells. Analysis by SDS-gel electrophoresis and immunoblotting indicated that synapsin I levels are higher in all three differentiated groups compared to untreated cells; whereas synaptophysin levels are lower in cells exposed to NGF alone or with NGF and ras double treatment. Possible convergence and/or divergence on the mechanisms of NGF and ras differentiation in PC12 cells are discussed.

Acetylcholinesterase↗

Time-domain combination of MR spectroscopy data acquired using phased-array coils.

A new method for efficiently processing MRS data acquired with phased-array coils is presented. The method consists of performing phase compensation (i.e., redefining the signal phase relative to a common reference) of the signals in the time domain prior to combining the signals. The resulting spectra are equivalent to those obtained by previously published methods for phased-array spectral data processing (i.e., processing the signals individually and then combining them in the frequency domain). The method allows spectra acquired with phased-array coils to be processed as efficiently as those acquired with non-phased-array coils. Both single voxel spectroscopy (SVS) and chemical shift imaging (CSI) data sets may be processed by this method.

Magnetic Resonance Spectroscopy↗

Quantification of intramyocellular lipids in obese subjects using spectroscopic imaging with high spatial resolution.

Quantification of intramyocellular lipids (IMCL) in obese subjects by single-voxel spectroscopy (SVS) or conventional spectroscopic imaging (SI) often fails due to overlap of IMCL spectral lines by extramyocellular lipids (EMCL), and signal contamination from subcutaneous fat and bone marrow. This study demonstrates that these problems can be solved by high-resolution SI with 128 phase-encoding steps and a read gradient during acquisition. The small voxels obtained in this way facilitated differentiation between EMCL and IMCL. This method offers the possibility of studying different muscle groups and the variation of lipids within one muscle.

Adult↗

In vivo magnetic resonance volumetric and spectroscopic analysis of mouse prostate cancer models.

BACKGROUND: Mouse prostate cancer modeling presents unique obstacles to the study of spontaneous tumor initiation and progression due to the anatomical location of the tissue. RESULTS: High resolution (130 microm(x) x 130 microm(y) x 300 microm(z)), three-dimensional MRI allowed for the visualization, segmentation, and volumetric measurement of the prostate from normal and genetically engineered animals, in vivo. Additionally, MRS performed on the prostate epithelia of probasin-ErbB-2Delta x Pten(+/-) mice identified changes in the relative concentrations of the metabolites choline and citrate, which was not observed in TRAMP mice. METHODS: T1-weighted MRI was performed on normal, TRAMP, probasin-ErbB-2/Her2/Neu (probasin-ErbB-2Delta), and probasin-ErbB-2Delta in the context of decreased Pten activity (probasin-ErbB-2Delta x Pten(+/-)) mice. Volume-localized single-voxel proton magnetic resonance spectroscopy (SVS (1)H MRS) was also performed. CONCLUSIONS: The data presented supports the use of combined MRI and MRS for the measurement of biochemical and morphometric alterations in mouse models of prostate cancer.

Animals↗