The undertreatment of pain: scientific, clinical, cultural, and philosophical factors.

This essay provides an explanation and interpretation of the undertreatment of pain by discussing some of the scientific, clinical, cultural, and philosophical aspects of this problem. One reason why pain continues to be a problem for medicine is that pain does not conform to the scientific approach to health and disease, a philosophy adopted by most health care professionals. Pain does not fit this philosophical perspective because (1) pain is subjective, not objective; (2) the causal basis of pain is often poorly understood; (3) pain is often regarded as a "mere" symptom, not as a disease; (4) there often are no "magic bullets" for pain; (5) pain does not fit the expert knowledge model. In order for health care professionals to do a better job of treating pain, some changes need to occur in medical philosophy, education, and practice.

Structural investigations of hydrogen cyanide polymers: new insights using TMAH thermochemolysis/GC-MS.

Hydrogen cyanide polymers form spontaneously from HCN and traces of base catalysts. It is probable that these polymers played an important role in the early stages of chemical evolution. Nevertheless, their full structural characterization has still not been accomplished. A number of mass spectrometric methods have now been applied to this structural problem including FAB-MS, thermal desorption EI-MS, ESI-MS, APCI-MS and off-line TMAH thermochemolysis/GC-MS. This latter method causes bond cleaveage and in situ methylation producing a suite of products which provides valuable insight into the substructural features of HCN polymers and also promises to serve as a sensitive diagnostic tool for detecting the presence of HCN polymers in samples from diverse sources.

Transformation of 3- and 4-Picoline under Sulfate-Reducing Conditions.

A microbial population which transformed 3- and 4-picoline under sulfate-reducing conditions was isolated from a subsurface soil which had been previously exposed to different N-substituted aromatic compounds for several years. In the presence of sulfate, the microbial culture transformed 3- and 4-picoline (0.4 mM) within 30 days. From the amounts of ammonia released and of sulfide that were determined during the transformation of 3-picoline, it can be concluded that the parent compound was mineralized to carbon dioxide and ammonia. During the transformation of 4-picoline, a UV-absorbing intermediate accumulated in the culture medium. This metabolite was identified as 2-hydroxy-4-picoline by gas chromatography-mass spectrometry and nuclear magnetic resonance analysis, and its further transformation was detected only after an additional month of incubation. The small amount of sulfide produced during the oxidation of 4-picoline and the generation of the hydroxylated metabolite indicated that the initial step in the metabolic pathway of 4-picoline was a monohydroxylation at position 2 of the heterocyclic aromatic ring. The 3- and 4-picoline-degrading cultures could also transform benzoic acid; however, the other methylated pyridine derivatives, 2-picoline, dimethyl-pyridines, and trimethylpyridines, were not degraded.

Biological and chemical interactions of pesticides with soil organic matter.

There is little doubt that organic matter plays a major role in the binding of pesticides in soil, and that this phenomenon is usually the most important cause for interaction of pesticides in the soil environment. Fulvic or humic acids are the chemicals most commonly involved in the binding interactions. Binding can occur with the original pesticide or a transformation product, the reaction being caused by abiotic agents or biotic agents (microbial or plant enzymes). The reactions or processes involved appear to be the same as those responsible for the formation of humic substances, i.e. for the humification process. Binding of pesticides to organic matter can occur by sorption (Van der Waal's forces, hydrogen bonding, hydrophobic bonding), electrostatic interactions (charge transfer, ion exchange or ligand exchange), covalent bonding or combinations of these reactions. Our investigation focused primarily on the binding of substituted phenols and aromatic amines to humus monomers and humic substances. In model reactions, we demonstrated the formation of covalent linkages between pesticides and humus constituents and fulvic or humic acids in the presence of phenol oxidases or clay minerals. With chlorinated phenols and carboxylic acids, it was possible to isolate and identify cross-coupling products and to elucidate the site and type of binding. The binding of chlorinated phenols to humic substances was determined by using 14C-labelled chemicals and by measuring the uptake of radioactivity by the humic material. These experiments provide a base for explaining the formation of bound residues in certain cases and for assuming the toxic potential of the immobilized pollutants.

Geranium defensive agents. III. Structural determination and biosynthetic considerations of anacardic acids of geranium.

Ozonolysis, dithioether derivatization, and EI and CI mass spectrometry were used to establish the location of the double bond in the side chain of the two major anacardic acids in geranium (Pelargonium hortorum) trichome exudate. The point of unsaturation was shown to be between C-5 and C-6 counting from the methyl end of the side chain, contradicting the earlier hypothesis that the olefmic bond was probably at the 9-10 position based upon expected biosynthetic considerations. The two major components are thus 6-[(Z)-10'-pentadecenyl]salicylic acid (C22H34O3) and 6-[(Z)-12'-heptadecenyl] salicylic acid (C24H38O3). This may indicate that the precursor of these anacardic acids is a saturated fatty acid since the location of a double bond at the 5-6 position is unusual among the unsaturated fatty acids. Capillary GLC and HPLC of the trichome exudate indicated the presence of small amounts of other anacardic acid analogs possessing such features as odd numbers of carbon atoms and saturated side chains.

Incorporation of rat brain adenylate cyclase into artificial phospholipid vesicles.

Adenylate cyclase was solubilized from rat brain particulate fraction with the nonionic detergent, Nonidet P-40. Incubation of detergent-solubilized adenylate cyclase with liposomes prepared from egg yolk phosphatidylcholine results in virtually quantitative incorporation of the enzyme activity into phospholipid vesicles. Incorporation of adenylate cyclase into liposomes results in an approximately 10- to 20-fold purification relative to the solubilized preparation giving a final specific activity of about 50 nmol of cAMP min-1 mg-1. The detergent-solubilized adenylate cyclase migrates as a broad band between 14 and 33% sucrose on density gradient centrifugation, separated from the endogenous phospholipid. Following overnight incubation of the solubilized enzyme with exogenous phospholipid, all enzyme activity is found in a narrow band between 7 and 9% sucrose, co-migrating with the phospholipid. The adenylate cyclase could not be released from the liposomes by extraction with high ionic strength, low ionic strength-EDTA, or sonication. Treatment of liposomal adenylates cyclase with soluble proteases or immobilized trypsin destroys enzyme activity. Thus, it is likely that a functionally important part of the enzyme molecule is exposed on the outer surface of the liposome. Optimal conditions for the incorporation of adenylate cyclase into liposomes, and some effects of manipulating the phospholipid composition on enzyme activity are reported.

Asymmetric diphenol formation by a fungal laccase.

A laccase isolated from the fungus Rhizoctonia praticola catalyzed the cross-coupling of two differently halogenated phenols. When 2,4-dichlorophenol and 4-bromo-2-chlorophenol were incubated together with the enzyme, three dimers were formed and isolated by thin-layer chromatography. The molecular weights of these compounds were determined by mass spectrometry as 322, 410, and 366, which correspond with the respective dimers of each of the phenols and with a hybrid formed from both, tentatively assigned the structure 3,3',5'-trichloro-5-bromo-2,2'-diphenol. Gas chromatography-mass spectrometry analysis of these products and of their methylated derivatives lent support to these structural assignments.

Polymerization of phenolic intermediates of pesticides by a fungal enzyme.

The fungus Rhizoctonia praticola produces an extracellular phenol oxidase (laccase) which polymerizes phenolic intermediates of various pesticides. The enzyme catalyzes the formation of oligomeric products from halogenated phenolic intermediates of phenoxyalkanoate herbicides and from naphtholic products derived from carbamate insecticides. These findings permit further investigations into the mechanism and role of oxidative coupling leading to the incorporation of xenobiotic compounds into soil organic matter.

Deuterolysis of amino acid precursors: evidence for hydrogen cyanide polymers as protein ancestors.

Deuterolysis experiments suggest that hydrogen cyanide polymers rather than aminoacetonitriles are major precursors of alpha-amino acids obtained from spark reactions and other studies on chemical evolution. These results are consistent with the hypothesis that the original heteropolypeptides on the earth were synthesized spontaneously from hydrogen cyanide and water without the intervening formation of alpha-amino acids.

Heteropolypeptides from poly-alpha-cyanoglycine and hydrogen cyanide: a model for the origin of proteins.

Poly-alpha-cyanoglycine, a homopolymer synthesized from the N-carboxyanhydride of alpha-cyanoglycine, is converted by cumulative reaction of hydrogen cyanide to heteropolypeptides that can be hydrolyzed to protein amino acids, including glycine, alanine, valine, aspartic acid, and glutamic acid. These results are consistent with the hypothesis that the original heteropolypeptides on the earth arose spontaneously from hydrogen cyanide and water without the intervening formation of alpha-amino acids.