Modulation of the amplitude of NAD(P)H fluorescence transients after synaptic stimulation.

In brain slices, excitatory synaptic stimulation results typically in transient initial decreases in NAD(P)H fluorescence, followed by longer-lasting NAD(P)H increases that overshoot pre-stimulus NAD(P)H levels before returning slowly to baseline. We concluded recently that mitochondrial metabolism (rather than NADH generation by glycolysis) was responsible for the "overshoot" phase of responses evoked in murine hippocampal slices. The present study examined factors that may influence the amplitude of the overshoot phase, without necessarily directly influencing mitochondrial or glycolytic metabolism. The amplitudes of overshoots were influenced strongly by changes in pre-stimulus NAD(P)H fluorescence levels produced by a prior electrical stimulus. In contrast, these changes in pre-stimulus redox state had little effect on the amplitude of evoked initial NAD(P)H decreases. Resting NAD(P)H fluorescence levels differed significantly across sub-regions of each slice, however, this is not due to differences in resting redox state, and the relative amplitude of NAD(P)H overshoots were not different in different slice regions. Exposure to an A1 receptor agonist (CPA) reduced the amplitude of postsynaptic potentials, and preferentially reduced the amplitude of NAD(P)H overshoots, before initial oxidizing components of biphasic transients were reduced significantly. These results suggest that amplitudes of NAD(P)H overshoots may not be good quantitative measures of the intensity of a discrete stimulus, under some conditions where the stimulus is small relative to recent activity in the slice. Comparison of flavoprotein autofluorescence with NAD(P)H levels seems useful when making quantitative comparisons of responses from different regions of slices, where optical properties and ongoing activity may be substantially different.

Circulating leptin levels are not associated with cardiovascular morbidity and mortality in women with diabetes: a prospective cohort study.

AIMS/HYPOTHESIS: Leptin, an adipocyte-secreted hormone, plays an important role in regulating neuroendocrine and immune function as well as insulin resistance and metabolism. Our objective was to examine the relationship between leptin levels and cardiovascular morbidity and overall mortality in women with type 2 diabetes. SUBJECTS AND METHODS: This prospective cohort study included 1,194 women with a confirmed diagnosis of type 2 diabetes, who provided a blood sample at baseline in 1989-1990. Participants were followed for 12 years for the development of health outcomes including cardiovascular disease (CVD) events as well as total mortality. RESULTS: There were 218 new CVD events and 228 deaths from all causes. Cox proportional hazards analysis was used to estimate the relative risks (RRs) for each quintile level of leptin compared with the lowest quintile. Leptin levels were positively associated with several CVD risk factors including BMI and inflammatory markers, but were not independently associated with the incidence of CVD or total mortality in women with diabetes. The multivariate RRs (95% CIs) for CVD across the quintiles of leptin were 0.96 (0.61-1.53), 0.99 (0.61-1.61), 1.04 (0.63-1.71), 1.02 (0.59-1.75) (p for trend = 0.83). CONCLUSIONS/INTERPRETATION: Although circulating leptin levels are associated with obesity and inflammatory markers, they are not significantly related to the risk of CVD or mortality in women with diabetes.

Hajdu--Cheney syndrome: evolution of phenotype and clinical problems.

Hajdu-Cheney syndrome is a rare, autosomal dominant disorder comprising acroosteolysis of the distal phalanges with associated digital abnormalities, distinctive craniofacial and skull changes, dental anomalies, and proportionate short stature. The clinical and radiologic characteristics of Hajdu-Cheney syndrome develop and progress with age. Many of the medical problems that arise in this syndrome cluster in specific age ranges. Case reports of six affected individuals in two additional families and a summary of the English literature is presented with emphasis on the changing physical findings and medical sequelae over time.

The challenges and conflictsof facilitating learning in practice: the experiences of two clinical nurse educators.

This is a descriptive paper discussing the experiences of two clinical educators in practice.It highlights some of the practice issues around accountability, advocacy and roleconflicts in clinical teaching roles. The issue of training nurses fit for pr actice giventhe recommendations of Fitness for Practice (UKCC 1999) and Making a Difference (Department of Health 1999) is discussed within the context of the reality of the clinical environment. The number of learners in the clinical area has increased in the last fewyears, and will continue to do so with the increase in nurses promised by t he NHS Planand new initiatives to attract nurses back into the profession. As a result of this the clinical environment, already stretched with service demands, requires additional support to facilitate the development of learners. Recommendations are m ade for the future of generic practice facilitative roles in the light of the current debate to get nurse educators back into practice.

Analgesic effects of endomorphin-1 and endomorphin-2 in the formalin test in mice.

Two recently isolated peptides, endomorphin-1 (Tyr-Pro-Trp-Phe-NH2) and endomorphin-2 (Tyr-Pro-Phe-Phe-NH2), are highly selective micro-opioid receptor agonists with analgesic actions in the tail-flick test. To further assess the analgesic properties of these peptides, the effects of endomorphin-1, endomorphin-2, and morphine were examined in the formalin test. Male Swiss Webster mice were injected i.c.v. with endomorphin-1, endomorphin-2, or morphine (0, 1, 3, 10 microg) 5 min before injection of 20 microl of 5% formalin s.c. into the plantar surface of one hind-paw. The mice were observed for 60 min after formalin injection. Endomorphin-1 and endomorphin-2 produced dose-dependent analgesia that was shorter in duration than for morphine. Increased locomotion was observed after morphine, but not after endomorphin-1 or endomorphin-2. These findings extend previous results and suggest that endomorphins may have therapeutic potential for the treatment of acute pain.

A typology of residential fire survivors' multidimensional needs.

This article presents an analysis of the tangible, psychological, and general needs of adults and their children reported by residential fire survivors approximately 14 weeks postfire. Three hundred and seven survivors, who identified that they needed help for themselves or their children, differed from 133 survivors who did not request help. Those needing help were more likely to be women with children younger than age 18 living in their household, have low-income status, less education, and to have already received services from church groups. The classification of self-identified needs of fire survivors included the need for specific tangible and social service assistance, psychological and spiritual support, and nonspecific assistance. This classification contributes to our understanding of the relationship between needs and loss, grief, and changes in family and life situations postfire.

Complementary therapy in the NHS: service development in a local district general hospital.

The Lewisham Hospital Complementary Therapy Centre opened in July 1994 to provide an NHS osteopathy, acupuncture and homoeopathy service to patients referred by general practitioners and hospital consultants. This centre provides a development opportunity for a Nurse Practitioner role which combines clinical and educational responsibilities with research and service development. Funded by the local Health Authority as a pilot scheme, the service attracted over 600 referrals in the first three operational months. Treating conditions such as arthritis, back pain and gynaecological problems, initial evaluation of the service suggests that patients feel the service is beneficial.

A prospective study of methylprednisolone and prednisone as immunosuppressive agents in clinical renal transplantation.

A prospective double blind crossover study was carried out in 65 patients comparing methylprednisolone (Medrol) and prednisone as immunosuppressive agents in clinical renal transplantation to determine their relative merits vis-a-vis graft survival, hypertension, weight gain, sepsis and patient preference in the posttransplant period. Patients receiving renal allografts were randomly assigned to receive initial treatment with one of the drugs. Once maintenance doses were employed, the drug was switched for a 3-month period. There was no difference in overall graft survival at 1 year, 68% versus 56% (p greater than 0.4), for the two patient groups. Likewise, there was no difference in blood pressure during the maintenance therapy crossover period, mean BP 129/86 during Medrol therapy and 129/86 during prednisone therapy. Overall weight gain was not statistically different with the two drugs, 3.8 kg with prednisone and 2.3 kg with Medrol, p greater than 0.1. However, when Medrol was used in the late posttransplant period, the patient had a significantly smaller weight gain, 0.95 kg versus 3.5 kg with prednisone, p greater than 0.05. The incidence of bacterial sepsis was significantly greater (p less than 0.02) during the early posttransplant period in those patients treated with Medrol. Finally, the majority of patients (65%) had no preference for either drug. Of those with a preference, the majority (69%) preferred Medrol. We conclude that therapy with Medrol does not offer superior graft survival, less hypertension or overriding patient preference but does apparently lead to an increased incidence of bacterial sepsis in the early posttransplant period. Thus it appears that prednisone is the initial drug of choice as an immunosuppressive steroid in clinical renal transplantation.

Role perception of the staff nurse in the intensive care unit.

A group of 201 ICU staff nurses were questioned regarding those activities they perceived as (1) most important, (2) most time-consuming, and (3) most professional. This information was collected to provide a data base for defining the role of the ICU staff nurse and evaluating the implications for nursing administration and staff development. The results indicated that the nurses are doing what they perceive to be important, but not what they perceive to be professional. There were differences in ranking relationships when the basic educational preparation of the nurse was considered as a variable. The results indicate that role perception was more a function of job requirements than a function of educational background. Comparing functional groupings of activities, the nurses ranked direct patient care activities high in time consumption and for importance when compared to nondirect patient care activities, but neither was ranked high for professionalism. This implies a disparity between perception of importance vs. professionalism.

Foley catheter tip cultures: a valuable diagnostic aid in the immunosuppressed patient.

Cultures of forty-three Foley catheter tips from immunosuppressed renal transplant patients have been analyzed and correlated with the subsequent development of urinary tract infection. Fifteen cultures produced no growth and two showed only coagulase-negative staphylococci; none of these patients subsequently developed a urinary tract infection. Twenty-four of the cultures showed at least one organism known to be a frequent urinary pathogen; sixteen (67 per cent) of these patients developed a urinary tract infection within ten days of the culture, and all sixteen had an infection caused by an organism present on the Foley tip. None of the organisms were identified by simultaneous catheter specimen urine cultures. Foley tip cultures in the immunosuppressed renal transplant patients are predictive of urinary sepsis and diagnostic of the causative organism.