Nicotine modulates neurogenesis in the central canal during experimental autoimmune encephalomyelitis.

Nicotine has been shown to attenuate experimental autoimmune encephalomyelitis (EAE) through inhibiting inflammation in microglial populations during the disease course. In this study, we investigated whether nicotine modified the regenerative process in EAE by examining nestin-expressing neural stem cells (NSCs) in the spinal cord, which is the primary area of demyelination and inflammation in EAE. Our results show that the endogenous neurogenic responses in the spinal cord after EAE are limited and delayed: while nestin expression is increased, the proliferation of ependymal cells is inhibited compared to healthy animals. Nicotine application significantly reduced nestin expression and partially allowed for the proliferation of ependymal cells. We found that reduction of ependymal cell proliferation correlated with inflammation in the same area, which was relieved by the administration of nicotine. Further, increased numbers of oligodendrocytes (OLs) were observed after nicotine treatment. These findings give a new insight into the mechanism of how nicotine functions to attenuate EAE.

The role of partners in selecting a residency.

To study the influence of medical students' partners (that is, those to whom they are married or engaged, or with whom they are living as "significant others") on students' selections of their residency programs, the authors surveyed fourth-year medical students and their partners at 20 medical schools in 1986. Forty-six percent of 770 eligible couples responded to the questionnaire; data from 314 couples were used in this study. Sixty-five percent of the medical students were men. Eighty-five percent of the partners were employed outside the home. The partner was the most influential person in the students' choice of a residency. Twenty-six percent (81) of the couples mutually made the decision and over 50% (186) tried to satisfy equally both partners' needs. However, the women medical students had less influence over the decision and were more apt to sacrifice their needs for their partners' (p less than .05). The women students were also significantly less satisfied with their role in the decision-making process (p less than .05). Attention to these issues by both medical students and residency programs could help couples deal with the stresses involved in choosing a residency location.

Ethical issues in a drug information center.

The frequency and nature of ethical issues faced by pharmacists have not been well documented. To address these issues a retrospective study of the potential ethical problems encountered by pharmacists in a drug information center was conducted. Of the 744 calls received over a 13-month period, 50 raised ethical issues. Consumer calls were more likely to raise ethical issues than were health-provider calls. The calls mainly fell into five categories: drug identification, assessment of a physician's recommendations for consumers, conflict between callers' needs and legal or public-health considerations, therapeutic issues in the pharmacist-patient relationship, and paternalistic treatment of "difficult" callers. These questions raised ethical issues related to confidentiality, truth telling, and pharmacists' societal obligations. Pharmacists may confront an increased number of ethical issues as more drug information centers provide consumer services. Although there is no empirical evidence regarding pharmacists' ability to deal with ethical issues, there are reasons to believe that training in medical ethics will better equip pharmacists to recognize, analyze, and resolve ethical dilemmas.

Treatment of hypertensive emergencies of pregnancy.

The terminology, pathophysiology, and therapy of acute hypertensive emergencies of pregnancy are reviewed. A hypertensive emergency of pregnancy can be defined to include any of the following: (1) an acute increase in blood pressure to values greater than 160/110 mm Hg, (2) development of symptoms consistent with severe preeclampsia, or (3) symptoms consistent with known complications of uncontrolled blood pressure. A hypertensive emergency requires hospitalization, immediate antihypertensive treatment to reduce maternal blood pressure without substantially decreasing placental perfusion and compromising the fetus, and delivery of the infant as soon as possible. Hydralazine has been shown to decrease blood pressure effectively in hypertensive emergencies of pregnancy. Although many institutions consider hydralazine the antihypertensive agent of choice in pre-eclampsia/eclampsia, there have been no comparative studies to document that hydralazine is the safest or most efficacious agent and only one human study evaluated its effects on maternal blood pressure, fetal heart rate, growth retardation, and uterine activity. Based on available data, minibolus doses or infusion over 20-30 minutes of diazoxide may prove to be safe and effective alternatives to hydralazine, but more data are needed. Nitroprusside may have a role in the short-term treatment of patients unresponsive or intolerant to hydralazine, but human studies are needed before nitroprusside can be recommended routinely. Methyldopa cannot be considered a first-choice agent for the rapid reduction of blood pressure because of its slow onset of action. Further studies are needed before propranolol, i.v. nitroglycerin, captopril, clonidine, minoxidil, naldolol, atenolol, or metoprolol can be recommended. Until further studies are conducted, hydralazine will continue to be the treatment of choice for hypertensive emergencies of pregnancy.