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[Longitudinal changes in rigidity in old age].

This investigation attempted to deal with the question of longitudinal changes in the rigidity of attitudes and behaviour in a sample of elderly persons (68--90 years old). This was done by collecting data twice (1969/70 and 1976) from 86 subjects on a serie of measures of rigidity. At the same time additional data were collected on external variables such as intelligence, anxiety, state of health, extraversion, neuroticism, etc. Analyses of variance with the factors "time of measurement" and "sex" indicated a change in the predicted direction for the majority of the measures used. After an internal of six years, the capacity for adaptive and spontaneous flexibility had decreased, whereas intolerance and dispositional rigidity had increased. On the Riegel-scales R1 and R2, a rise in age was accompanied by a rise in rigidity, as measured in terms of statement in the form of personal judgments. Agreement with other judgments in the form of more generally formulated statements, on the other hand, decreased. Sex differences were found for Brengelmann's NR-scale and the Gottschaldt Hidden Figure test. Women were found to be less rigid than men, but also revealed less adaptive flexibility. A comparison of the test scores of longitudinal subjects and a comparable group of control group subjects yielded no signs of differences which would be traced back to a biased selection of the longitudinal sample.

Adaptation, Psychological↗

[Prevalence of human immunodeficiency virus and risk behaviours among opioid users seen in an emergency room].

INTRODUCTION: As prevalence of HIV-1 among drug users in Spain is high and it is difficult to contact them because of their hidden behaviors, emergency rooms are one of the health facilities where they can be located. A cross-sectional interview study was planned. The aims of the study were to estimate prevalence of HIV-1 and to describe risk behaviors. METHODS: The sample included all patients that in spring 1992 were detected and referred by the doctor as being current opiate users, defined as any use in the 30 days prior the interview. Drug users who did not know their HIV status or were negative for more than six months were asked to provide a urine sample to test HIV serology. A descriptive analysis with simple stratification was carried out. Row and adjusted odds ratio were used to analyse association between different variables and HIV status. Logistic regression was used to examine variables associated with HIV infection and risk behaviors (injecting drug use, sharing needles, and no use of condom). RESULTS: Three hundred and eighty three opiate users were interviewed. It was possible to know HIV status of 94% of the subjects. Of them, 61% were positive (219). The best adjusted logistic model to predict associated variables with HIV included being female, primary school level, sickness absence, to attend because of organic pathology, and more years of parenteral use. Seventy five percent of the sample injected drugs during the past 30 days, and among them 30% shared syringes. The variables associated with a higher probability of having injected heroin or cocaine in the last 30 days were to have completed at least primary education, to be unemployed or reliant on illegal activities, not to be in drug treatment, and a larger number of drugs used in the last 30 days. A higher probability of sharing syringes was associated with a lower educational level, not to be in drug treatment, to live alone and a higher number of drugs used during last 30 days. Twenty one percent of the subjects who were sexually active always or nearly always used condom with regular partners and 56% with casual partners. Women were more likely to use condom than men with casual partners. Subjects who shared syringes during last 30 days were nearly three times more likely not to use condom with casual partners. CONCLUSIONS: Although a high prevalence of HIV-1 was estimated among opioid users seen in an emergency room, it is not higher than estimates for intravenous drug users recruited from treatment centres, prison or needles exchange programs. A high frequency of risk behavior was also observed indicating a need to develop specific prevention programs for drug users.

Adolescent↗

Preference and motivation of laying hens to eat under different illuminances and the effect of illuminance on eating behaviour.

1. In experiment 1, 10 laying hens were given the choice to eat food pellets from any of 4 food bowls illuminated by overhead, incandescent luminaires at <1, 6, 20 or 200 lux. During a trial hens were allowed to eat for 5 min. After each minute had elapsed (from the start of eating) the light sources were extinguished and the illuminances re-assigned to the food bowls in a random manner. Each hen received two trials, one where the food was freely available and another where it was hidden in a sand and gravel mix. 2. The hens chose to eat for most time in the brightest (200 lux) and least in the dimmest (<1 lux) environments for both free and hidden food (free: 5.9, 10.5, 10.4, 15.7s for increasing illuminance; Hidden: 5.5, 9.8, 9.1 and 15.7s. 3. In experiment 2, 9 hens were trained to peck at either an illuminated or unilluminated panel to access a food reward behind a guillotine door for 3 s. Five hens were trained to peck the illuminated panel to access food brightly lit (200 lux) or the unilluminated panel to access food dimly lit (<1 lux); 4 hens were trained vice versa. The flock was then divided into three groups of three, and three treatments imposed on each group in a Latin-square arrangement. In treatment 1, one peck at either panel allowed access to the chosen light environment (F1:F1). In treatment 2, 5 pecks were required to access food brightly lit on a variable ratio, but only one to access food dimly lit (ratio V5:F1). In treatment 3, the variable ratio was increased to V10:F1 to access food in the light. 4. Over 40 trials for each hen, the mean number of attempts to eat food in the light (where the panel which allowed access to food brightly lit was pecked at least once) was 34.5 for F1:F1, 12.1 for V5:F1 and 8.5 for V10:F1. The mean number of food rewards taken in bright light was 34.5, 3.1 and 1.8, respectively. For both variables, the difference between F1:F1 and V5:F1 was significant but not between V5:F1 and V10:F1. By interpolation of the 'attempts' data, it was estimated that hens would work 2.3 times harder to gain access to food brightly lit than for food dimly lit. 5. In experiment 3, the influence of the same illuminances applied over a food bowl as in experiment 1 (<1, 6, 20 or 200 lux) on the number of pecks/min, food consumed/min, food consumed/peck and the force of pecks was examined. 6. The amount of food consumed was lowest in the dimmest environment (3.1 vs 7.5, 7.4 and 7.1 g/ min for increasing illuminance, respectively); as was the number of pecks (35.6 vs. 125.0, 123.1, and 125.4 pecks/min respectively for increasing illuminance). The amount consumed per peck did not vary significantly with illuminance. The mean peck force showed a trend to be lowest in the dimmest environment (5.3 vs. 6.6, 7.0 and 6.6 N respectively, for increasing illuminance). 7. Overall, the hens showed a preference and appeared motivated to eat in bright as opposed to dim light. The hens were unwilling to eat at low illuminances although the 'efficiency' of eating (g/peck) was not impaired significantly. These data may have implications for novel lighting systems and those where hens are required to eat in the dark or in very dim light.

Animal Feed↗

Variable alternative spliced exon (VASE)-containing and VASE-lacking neural cell adhesion molecule in the dorsal and ventral hippocampus of SAMP8 mice.

The neural cell adhesion molecule (NCAM) is involved in the development and synaptic plasticity of the brain. Differential splicing of the variable alternative spliced exon (VASE) in the fourth immunoglobulin domain can dramatically change the functional properties of NCAM. This paper discusses our analysis of the levels of different expression of VASE-containing NCAM (NCAM-VASE(+)) and VASE-lacking NCAM (NCAM-VASE(-)) mRNAs in the dorsal and ventral hippocampus of senescence-accelerated mice (SAM). We further investigated the individual level of NCAM-VASE(+) and NCAM-VASE(-) in relation to the capacity for spatial learning and memory as assessed by a Morris water maze task. The results showed that the levels of both NCAM-VASE(+) and NCAM-VASE(-) were increased significantly in dorsal but not ventral hippocampus in aged SAMP8 mice. The mean latencies to find the hidden platform of the learning task on the last day were positively correlated with the levels of NCAM-VASE(+) in the dorsal hippocampus of SAMP8, which reveals that the mice with high levels of NCAM-VASE(+) have poor learning performances. These results suggest that the up-regulation of NCAM-VASE(+) could be involved in the impairments of spatial learning and memory.

Aging↗

State-specific monoclonal antibodies identify an intermediate state in epsilon protein kinase C activation.

Evaluation of the activation state of protein kinase C (PKC) isozymes relies on analysis of subcellular translocation. A monoclonal antibody, 14E6, specific for the activated conformation of epsilonPKC, was raised using the first variable (V1) domain of epsilonPKC as the immunogen. 14E6 binding is specific for epsilonPKC and is greatly increased in the presence of PKC activators. Immunofluorescence staining by 14E6 of neonatal rat primary cardiac myocytes and the NG108-15 neuroblastoma glioma cell line, NG108-15/D2, increases rapidly following cell activation and is localized to new subcellular sites. However, staining of translocated epsilonPKC with 14E6 is transient, and the epitope disappears 30 min after activation of NG-108/15 cells by a D2 receptor agonist. In contrast, subcellular localization associated with activation, as determined by commercially available polyclonal antibodies, persists for at least 30 min. In vitro, epsilonRACK, the receptor for activated epsilonPKC, inhibits 14E6 binding to epsilonPKC, suggesting that the 14E6 epitope is lost or hidden when active epsilonPKC binds to its RACK. Therefore, the 14E6 antibody appears to identify a transient state of activated but non-anchored epsilonPKC. Moreover, binding of 14E6 to epsilonPKC only after activation suggests that lipid-dependent conformational changes associated with epsilonPKC activation precede binding of the activated isozyme to its specific RACK, epsilonRACK. Further, monoclonal antibody 14E6 should be a powerful tool to study the pathways that control rapid translocation of epsilonPKC from cytosolic to membrane localization on activation.

Animals↗

Differential effects of intracerebroventricular AF64A injection, nucleus basalis of Meynert lesion, and scopolamine on place navigation and open-field behavior of rats.

The present study was conducted to compare the behavioral effects of intracerebroventricular AF64A injection, electrolytic lesion of the nucleus basalis of Meynert (NBM), and systemic scopolamine treatment, all of which are typical experimental models of central cholinergic system dysfunction, on place navigation performance and open-field behavior in rats. The animals were trained in a circular pool to escape from opaque water onto the hidden platform fixed at a particular location for 5 days. Significant performance deficits were observed in all the models tested. However, it is of importance that any impairments relating to information storage within a day or across days were not obtained. Choline acetyltransferase activity was decreased in the hippocampus of AF64A-injected rats and in the cortex of NBM-lesioned rats, respectively, but those changes did not simply associate with the reductions of the performance. These results suggest that the central cholinergic system is only partially involved in cognitive process. In the open-field test, ambulation, rearing, defecation, and urination were measured for 5 min. Patterns of changes in the open-field behavior were clearly different among the 3 models, indicating variability of the effects of these cholinergic manipulations on motor activities and emotionality.

Animals↗

Ambulance arrival to patient contact: the hidden component of prehospital response time intervals.

STUDY OBJECTIVE: To determine the time between ambulance arrival at the scene to paramedic arrival at the patient (arrival to patient contact) and the effect of barriers to paramedic movement on this time interval. DESIGN: A prospective, observational study. Time intervals were collected by independent third-party riders on emergency (Code 1 and Code 2) calls. Potential barriers to paramedic movement were recorded. SETTING: Public utility model urban emergency medical services system. TYPE OF PARTICIPANTS: Two hundred thirty-two emergency ambulance calls were observed, and data were analyzed from 216. INTERVENTIONS: None. RESULTS: The median arrival-to-patient contact interval for all calls was 1.33 minutes (interquartile range, 0.67 to 4.13 minutes). Barriers prolonged the arrival-to-patient contact interval (P < .001, Kolmogorov-Smirnov test). The median arrival-to-patient contact interval was 2.29 minutes (1.01 to 4.82 minutes) for 122 runs with barriers and 0.82 minutes (0.37 to 1.96 minutes) for 94 runs without barriers. CONCLUSION: The arrival-to-patient contact interval adds a variable and potentially lengthy amount of time to the total prehospital response time interval, and barriers impeding paramedic movement to the patient prolong this time interval. In 25% of all observed paramedic calls, the arrival-to-patient contact interval was more than four minutes. Measurement of the time from ambulance arrival on the scene to paramedic arrival at the patient is necessary to appropriately determine the relationship among total prehospital response time, paramedic interventions, and patient outcome.

Ambulances↗

Bakery foods are the major dietary source of trans-fatty acids among pregnant women with diets providing 30 percent energy from fat.

OBJECTIVE: To estimate intake and identify major dietary sources of trans-fatty acids consumed by healthy, pregnant women. DESIGN: Cross-sectional prospective study using a food intake questionnaire designed specifically to estimate trans-fatty acid intakes calculated from a trans-fatty acid food database developed by food analysis. SUBJECTS/SETTING: Healthy, pregnant women (n=60) were recruited in Vancouver, BC, Canada. STATISTICAL ANALYSES PERFORMED: Using the Statistical Package for the Social Sciences version 9.0, descriptive statistics were applied to all variables and paired t tests were used to determine differences in intakes between second and third trimester of pregnancy. RESULTS: The mean fat intakes (in g/person/day) for the second and third trimesters, respectively, were: 85.8 and 73.9 total fat, 31.5 and 26.4 monounsaturated, 29.7 and 26.3 saturated, 13.6 and 12.2 polyunsaturated, and 3.8 and 3.4 trans. Fat represented 28% of dietary energy in both trimesters. The major sources of trans-fatty acids were bakery foods (33% of trans-fatty acid intake), fast foods (12%), breads (10%), snacks (10%), and margarines/shortenings (8%). APPLICATIONS/CONCLUSIONS: Women following diets providing about 30% energy from fat consumed about 90% of trans-fatty acids as invisible fat, with less than 10% from table spreads. Dietitians should educate pregnant clients about hidden sources of trans-fatty acids and emphasize the importance of dietary fat composition.

Adult↗

The spontaneous smile in dynamic motion.

INTRODUCTION: The purpose of this study was to record and analyze the dynamic nature of spontaneous smiles. METHODS: Fifteen children (9 girls and 6 boys; average age, 10.5 years) were filmed with a hidden camera while they watched a funny cartoon video. Spontaneous smiles were recorded, and the video frames were digitized. Time-graphs of the measurements were constructed, and plots of the movement of the mouth points were drawn. RESULTS: Facial measurements showed that the upper lip elevated by 28%, relative to the rest position, and the mouth increased in width by 27%. The corners of the mouth moved laterally and superiorly at an angle of approximately 47 degrees . Time analysis showed that the smiles developed in a staged fashion. The first stage (attack phase) was the shortest, lasting an average 500 ms. It was followed by a sustaining phase that included waxing and waning. The smile ended with a fade-out stage. The second and third stages were of variable duration and could be interrupted by the attack phase of a subsequent smile. CONCLUSIONS: The dynamics of the spontaneous smile and the findings of this study raise concerns about the validity of a single photographic capture for esthetic assessment and treatment planning.

Adolescent↗

Screening for psychosocial problems among primary care patients: a pilot study.

The symptoms that a patient presents to the doctor are often not the underlying concern that prompted the consultation. The success of consultations involving a hidden diagnosis depends on how well the patient can express his or her concerns to the doctor and on how skilfully the doctor can encourage this. This study tested the feasibility and acceptability of having patients complete a brief health index questionnaire designed to help them describe their underlying concerns to the doctor. In two family medicine centres 996 patients were asked to complete a questionnaire while waiting to see the doctor; 724 (73%) did so. An evaluation of their responses showed the method to be acceptable to most. The doctors judged that it added valuable information in 41% of all consultations and in 73% of consultations in which the patient presented with psychologic complaints. There was, nevertheless, considerable variation among the physicians in their acceptance of the approach. This variability is discussed in the light of alternative models of how, in practical terms, to treat the psychosocial dimensions of a patient's complaint.

Adult↗

Learning algorithms based on linearization.

The aim of this article is to investigate a mechanical description of learning. A framework for local and simple learning algorithms based on interpreting a neural network as a set of configuration constraints is proposed. For any architectural design and learning task, unsupervised and supervised algorithms can be derived, optionally using unconstrained and hidden neurons. Unlike algorithms based on the gradient in weight space, the proposed tangential correlation (TC) algorithms move along the gradient in state space. This results in optimal scaling properties and simple expressions for the weight updates. The number of synapses is much larger than the number of neurons. A constraint for neural states does not impose a unique constraint for synaptic weights. Which weights to assign credit to can be selected from a parametrization of all weight changes equivalently satisfying the state constraints. At the heart of the parametrization are minimal weight changes. Two supervised algorithms (differing by their parametrizations) operating on a three-layer perceptron are compared with standard backpropagation. The successful training of fixed points of recurrent networks is demonstrated. The unsupervised learning of oscillations with variable frequencies is performed on standard and more sophisticated recurrent networks. The results presented here can be useful both for the analysis and for the synthesis of learning algorithms.

Algorithms↗

SAFE Homes: is it worth the cost? An evaluation of a group home permanency planning program for children who first enter out-of-home care.

OBJECTIVE: To evaluate the SAFE Homes (SH) program, a short-term group care program for children between 3 and 12 years of age who enter care for the first time. The program aims to improve case outcomes by consolidating resources to facilitate assessment and treatment planning. METHODS: The 1-year outcomes of 342 children who received SAFE Home services and 342 matched foster care (FC) control children were compared. The 684 subjects used in this report were selected from a larger pool of 909 subjects using propensity score matching to control for hidden bias in treatment group assignment. We hypothesized that SAFE Homes would result in greater continuity of care for children (e.g., fewer placements, more placements with siblings and in towns of origin), identification of more relatives for substitute care when needed, reduced use of high-cost restrictive care settings (e.g., residential, inpatient), and reduced rates of re-abuse through earlier detection and provision of services to meet child and family treatment needs. RESULTS: Prior to the initiation of the SAFE Homes program, 75% of the children who entered care in the State experienced three or more placements in the first year. The outcomes of both the SH and FC cases were significantly improved over pre-SAFE Home State statistics. The FC group, however, had comparable or better outcomes on most variables examined. In addition, the total cost for out-of-home care for the children in FC was significantly less, despite the fact that the two groups spent similar amounts of time in care (average time in care: 7 months). This finding held when the total placement cost was calculated using the State reimbursement rate of 206.00 US dollars per day for SAFE Home care (SH: 20,851 US dollars +/- 24,231 US dollars; FC: 8,441 US dollars +/- 21,126 US dollars, p < .001), and a conservative SAFE Home program fee of 85.00 US dollars per day that only considered the child care and custodial staffing costs uniquely associated with the program (SH: 13,314 US dollars +/- 21,718 US dollars; FC: 8,441 US dollars +/-21,126 US dollars, p < .001). CONCLUSION: Improvements in outcomes related to continuity of care can be attained through staff training. The SAFE Home model of care is not cost-effective for first-time placements.

Child↗

[The effect of encephalogram bispectral index monitoring during total intravenous anesthesia with propofol in outpatient surgery].

OBJECTIVE: To assess the effect of monitoring the encephalogram bispectral index (BIS) during outpatient surgery. Outcome measures were amount of propofol administered, awakening and discharge. MATERIAL AND METHODS: Forty consecutive outpatient surgery patients were studied. The patients gave informed consent and received general intravenous anesthesia with propofol administered through a laryngeal mask using a computerized system (Diprifusor(R)). Two groups were formed: in group A, BIS was monitored, although the information was hidden from the anesthesiologists, who used the usual signs (loss of blinking reflex, pupil size and hemodynamic response) to guide anesthesia; in group B the anesthesiologists used BIS monitoring to guide propofol administration. Measurements were blood pressure, heart rate and BIS at six times during the procedure (T1-T6). Other data recorded were age, weight, height, propofol consumption in relation to weight and duration of procedure, consumption of rocuronium and alfentanil, duration of propofol infusion, time from withdrawal of propofol until eye opening, duration of stay in the post-anesthesia intensive care unit and time until total recovery. A questionnaire assessed the presence of intraoperative awareness and degree of satisfaction. The data were analyzed by Student's t and a chi square tests, with statistical significance at p < 0.05. RESULTS: Demographic variables (age, weight and height) were similar, as were duration of propofol infusion, total dose of alfentanil and rocuronium, evolution of blood pressure and heart rate. Statistically significant differences in BIS were observed at two times, T4 and T5; total propofol administered was 32.6% lower in group B; and time until eye opening was significantly shorter in group B. No significant differences were observed for time until full recovery. No instances of intraoperative awareness were reported and satisfaction was high in both groups. CONCLUSION: BIS monitoring allows for propofol titration that leads to a mean reduction of 32.6% in consumption, shortening the time until eye opening without causing intraoperative awareness or reducing patient satisfaction.

Adult↗

Radioimmunoassay for quantitative measurement of factor VIII-heavy chain.

An immunoassay has been developed for the measurement of factor VIII heavy chain (FVIII-HC). IgG from a human inhibitor plasma with specificity for FVIII-HC and FVIII-light chain (FVIII-LC) was coated to microplates with loose wells. After washing, the plates were incubated with sample and after another wash 125I-FVIII-HC was added so that the amount of bound tracer was dependent on the amount of FVIII-HC in sample. When EDTA was included in the assay buffer the assay response was increased 3-fold for normal human plasma. This indicated that the antibody was reactive with a determinant hidden in the FVIII-HC/FVIII-LC complex as EDTA splits the complex. The sensitivity of the assay was 0.004 units/ml (1 unit/ml in normal human plasma pool). Together with a previously published assay for FVIII-LC it has now become possible to measure the relative amounts of FVIII-HC and FVIII-LC in haemophilia A plasma and to study the separate expression of FVIII-HC and FVIII-LC by recombinant DNA technology. Patients with severe haemophilia A had FVIII-HC levels below 0.01 units/ml. However, inhibitor patients in high dose FVIII-treatment showed up to 50 times higher levels of FVIII-HC than FVIII-LC and FVIII:C, indicating the presence of FVIII/anti-FVIII-LC immune complexes. Thus, dependent on assay specificity plasma samples can show very variable content of FVIII:antigen.

Factor VIII↗

Influence of total intravenous and inhalational anaesthesia on haemostasis during tympanoplasty.

BACKGROUND: Surgical trauma leads to systemic changes in haemostasis. Haematological changes activated by surgery may become so prominent that changes caused by anaesthesia might be hidden or underestimated. Therefore, we have undertaken a prospective study to compare the behaviour of selected factors involved in the coagulation and fibrinolytic systems. METHODS: Forty healthy adult patients scheduled for otological surgery were enrolled in the study. Upon receiving informed consent, they were randomly assigned to receive either inhalational (IA) or total intravenous anaesthesia (TIVA). Platelet function (PFA100TM), disseminated intravascular coagulopathy (DIC) panel, and generalized d-dimer (GFC) were studied during certain periods of anaesthesia to identify the changes in haemostasis. RESULTS: Statistically, no significant change in DIC parameters were encountered between the two groups. No statistical difference was found between the two groups in the measured coagulation parameters, but statistically GFC showed slight activation in the 1st hour of surgical intervention. CONCLUSION: Presuming a minimal traumatic effect of surgical procedure on the determined variables, we conclude that different anaesthetic techniques have a negligible effect on platelet activation and fibrinolysis. The clinical relevance of coagulation activation and fibrinolysis during different anaesthetic techniques remains to be investigated.

Adult↗

The role of parents and temperament on children's estimation of physical ability: links to unintentional injury prevention.

OBJECTIVE: Unintentional injuries, the leading cause of pediatric mortality, are caused by a complex set of intrapersonal and environmental factors. The role of three critical variables--parental supervision, children's temperament, and estimation of children's physical abilities--was examined. METHODS: Sixty-four 6- and 8-year-old children completed a laboratory experiment with a parent. Both children and parents judged the child's ability to complete reaching, stepping, and crouching tasks. Parents also completed a parent-report measure of children's temperament. RESULTS: Both children and parents overestimated children's ability, although children did so more than parents. Parents of temperamentally impulsive and undercontrolled children judged that their children could complete tasks that were actually beyond the child's ability. Temperament also affected children's judgments while parents were known to be present or absent: Temperamentally impulsive and undercontrolled children were more accurate in their judgments when parents were standing next to them than when parents were hidden from view behind a one-way mirror. CONCLUSIONS: The mechanism by which parental supervision might protect children from injury appears to be at least twofold: (a) Parents overestimate children's ability less frequently than children themselves, suggesting supervising parents could intervene to prevent children from attempting dangerous activities; and (b) children judge their physical abilities more cautiously when parents are present. Implications for temperament theory and for injury prevention are discussed.

Child↗

Global ischaemia: hippocampal pathology and spatial deficits in the water maze.

Spatial deficits were assessed in male Wistar rats which had undergone 4 vessel occlusion for 5, 10, 15 or 30 min. Relationships between the extent of brain damage, the duration of 4-vessel occlusion, and the behavioural impairment consequent upon ischaemia were investigated. Starting 13-18 days after occlusion, rats were trained to find a hidden platform in a Morris water maze. All ischaemic groups were impaired on some performance indices relative to controls, in both acquisition and retention of the platform location. Increasing the duration of ischaemia increased behavioural deficits on some measures, but there was no clear-cut evidence that longer durations of ischaemia resulted in increased behavioural impairments. Histological assessment, at two coronal levels in hippocampus and four coronal levels in cortex and striatum, revealed CA1 cell loss in all ischaemic groups, which varied between 10-100% across the range of durations employed. CA1 cell loss increased as both a linear and quadratic function of increasing the duration of ischaemia. In rats subjected to 5-15 min ischaemia, cell loss was almost exclusively confined to the CA1 area. In rats subjected to 30 min ischaemia there was additional, variable damage in hippocampal areas CA2, 3 and 4, substantial cell loss in the striatum (50-70%) and some neuronal damage in the cortex (largely in layer III). However correlations between CA1 cell loss in ischaemic rats and indices of spatial ability were non-significant, despite avoiding bias in the analysis by ensuring that only those rats with submaximal CA1 cell loss estimates and behavioural impairments were included. Given the lack of correlation between damage to the CA1 region and behaviour, it is suggested that CA1 cell loss may not be the only determinant of the water maze deficits displayed by 4-vessel occlusion ischaemic rats.

Animals↗

Anatomic basis for delayed diagnosis of appendicitis.

Gangrene or perforation of the appendix is often caused by failure to make an early diagnosis of appendicitis. Variability in the anatomic location of the appendix can be responsible for atypical manifestations of appendicitis and diagnostic errors. Over a 52-month period, 125 appendectomies were done for suspected appendicitis at a military hospital. After excluding cases in which the location of the appendix was not provided, 106 cases were available for review. Fifteen patients (14%) did not have appendicitis. The appendix was found in the true pelvis, was behind the ileum or ileocolic mesentery, or was both retrocolic and retroperitoneal in 11 of 16 patients (69%) with gangrenous or perforative appendicitis. In contrast, the appendix was in one of these three sites in only four of 75 patients (5%) with simple appendicitis (P less than .001). Both physicians and patients were responsible for diagnostic delays, but the paucity of symptoms and signs in patients with a "hidden" appendix was the most likely cause of failure to diagnose appendicitis before perforation.

Adolescent↗