Time quantified detection of fetal movements using a new fetal movement algorithm.

Primarily, the objective is to develop an automated ultrasound fetal movement detection system that will better characterize fetal movements. Secondarily, the objective is to develop an improved method of quantifying the performance of fetal movement detectors. We recorded 20-minute segments of fetal movement on 101 patients using a UAMS-developed fetal movement detection algorithm (Russell algorithm) and compared this to a Hewlett-Packard (HP) M-1350-A. Movements were recorded on a second-per-second basis by an expert examiner reviewing videotaped real-time ultrasound images. Videotape (86,592 seconds) was scored and compared with the electronic movement-detection systems. The Russell algorithm detected 95.53% of the discrete movements greater than 5 seconds, while the HP system (M-1350-A) detected only 86.08% of the discrete movements (p = 0.012). Both devices were less efficient at detecting the short discrete movements, obtaining sensitivities of 57.39 and 35.22, respectively. Neither system fully identifies fetal movement based on the second-per-second system. Improved methods of quantifying performance indicated that the Russell algorithm performed better than the HP on these patients.

Case report: CT and MRI of intracranial dermoid causing headache.

This case shows an unusual intracranial cause of chronic headache in a 30-year-old female. Computerized tomography and magnetic resonance imaging were used to demonstrate an intracranial, dermoid cyst located in the left middle cranial fossa. Droplets of fat-like material, which leaked from this cyst, were present in the basilar subarachnoid spaces and left sylvian fissure. Since the surgical excision of the cyst, the patient has not had any severe headaches.

Time-quantified fetal movement detection with two-transducer data fusion.

OBJECTIVE: Our purpose was to develop an automated ultrasound-based fetal movement detection system to better define fetal movements. STUDY DESIGN: One hundred one patients had fetal movements recorded over a 20-minute period. Results of movement detection by a single-transducer system (Russell 1) and a two-transducer fusion system (Russell 2) were compared with those of Hewlett-Packard (HP-M-1350-A), maternal perception, and expert ultrasonography review. RESULTS: A total of 86,592 seconds of videotape was scored for fetal movement. Russell 2 had a second-per-second sensitivity of 57.21% compared with Russell 1 at 40.95%, the HP-M-1350-A at 31.44%, and maternal perception at 30.80%. Russell 2 detected 67.57% of discrete movements compared with 57.52%, 41.98%, and 37.92%, respectively, in other systems. CONCLUSION: Russell 2 represents a significant improvement over existing systems in detection of fetal movements on a second-per-second basis.

Tolerance and long-term efficacy of a fixed combination of atenolol and nifedipine in the treatment of angina pectoris. Stuart Clinical Research Group.

To monitor the tolerance and long-term efficacy of a low-dose fixed combination of 50 mg atenolol and 20 mg nifedipine (slow release formulation) in patients with stable angina pectoris, 157 patients received treatment twice daily in a multi-centre, open-label fashion for periods up to 12 months following a four week run-in period on atenolol 50 mg twice daily. A total of 122 patients completed the study and had data from all treatment visits. In these patients the median number of weekly anginal attacks was halved, compared to the run-in period on atenolol alone following one month's fixed combination treatment, and this benefit was maintained throughout the 12-month study period. In addition, GTN consumption similarly declined on the fixed combination in comparison with the run-in period. Treatment with the fixed combination was not associated with any long-term increase in the frequency of reported side-effects or adverse biochemical changes compared to run-in. The fixed combination of atenolol 50 mg and nifedipine 20 mg reduced anginal frequency and GTN consumption compared to atenolol alone without causing any increase in adverse effects.

Retrobulbar anesthesia and eyelid closure--effect on corneal angiogenesis.

We evaluated the effect of corneal anesthesia produced by retrobulbar injections of bupivicaine and epinephrine on corneal neovascularization in the rat. The eyelids were sutured closed to prevent dessication and ulceration of the insensitive corneas. The amount of corneal neovascularization induced in animals receiving a retrobulbar anesthetic did not differ from those receiving control solutions. However, rats receiving retrobulbar injections exhibited greater corneal neovascularization than those that did not. Rats that had their eyelids sutured or patched closed also had more neovascularization than animals that did not. Likewise, rats that had sutures placed in the upper and lower eyelids, without palpebral immobilization, manifested more neovascularization than rats without sutures. These studies suggest that corneal anesthesia does not affect neovascularization induced by silver/potassium nitrate cauterization and that retrobulbar injections and eyelid closure enhance corneal neovascularization.

Heterogeneity in human prothrombin: analysis of cause.

Two fractions of human prothrombin can be isolated from single donor plasma by the technique of heparin-agarose chromatography in (sodium) citrate buffer, pH 7.5, as previously reported for pooled plasma. The two fractions, designated H-II1 and H-II2, are found in a ratio of approximately 4:1. Both forms comigrate in sodium dodecyl sulfate gel electrophoresis; however, under nondenaturing electrophoretic conditions, each fraction migrates as a discrete entity with a different mobility. The larger fraction (H-II1) has a faster mobility towards the anode. Isoelectric focusing in urea of H-II1 reveals that it has two components, a minor component with a pl of 5.25 (H-II1a) and a major component with a pl of 5.40 (H-II1b). H-II2 has a pl of 5.6 H-II1 and H-II2 possess the same amino terminal residue (alanine, 0.87-0.92 mole/mole) and the same number of gamma -carboxyglutamic acid residues (9.8-10.5). Their amino acid composition is indistinguishable. However, the two fractions of prothrombin differ in their content of neutral sugar and of sialic acid residues. Removal of sialic acid with neuraminidase abolishes the electrophoretic heterogeneity. Thus, the charge heterogneity of the three variants of prothrombin found in normal human plasma appears to result exclusively from differences in the number of sialic acid residues attached to the protein moiety of the molecule.

Structural polymorphism of I-E subregion antigens determined by a gene in the H-2K to I-B genetic interval.

THE generation of immune responses in mice is influenced by Ir genes located in the I region of the major histocompatibility complex (MHC)(1). In some instances maximum responses require complementation by two genes, one in the I-A or I-B and the other in the I-E or I-C subregion(2,3). The effects of these genes are thought to be mediated by Ia alloantigens, which are cell surface molecules whose expression is controlled by the I region(4). This is based on the observations that anti-Ia sera inhibit in vitro immune responses(5,6), and soluble factors that enhance in vitro immune responses express Ia alloantigenic determinants(7,9). Jones et al.(10), using two-dimensional gel electrophoresis, observed that the expression of I-E subregion antigens is controlled by two genes, one in the I-A subregion, the other in the I-E subregion, and that the polymorphism of these antigens is influenced by an I-A subregion gene. As an explanation, the authors proposed that only one of the two polypeptide chains present in I-E immunoprecipitates is an I-E subregion product, the second being a product of the I-A subregion. Antisera obtained by cross-immunisation of I-E subregion-disparate strains of mice immunoprecipitates a molecular complex consisting of two chains, designated alpha and beta, with molecular weights of 32,000 and 29,000 respectively(11-14). Previous studies suggested that I-E antigens isolated from B10.A(5R) and B10.D2 mice had identical alpha-chains but different (beta)-chains(15). However, as these mice differed at multiple genetic regions, it was not possible to show which I subregion(s) determined the polymorphism of the E(beta) chain. Therefore, we investigated the effects of the I-A subregion on the polymorphism of I-E subregion antigens. We have now shown by peptide mapping that the I-E subregion polymorphism which Jones et al. found to be controlled by the I-A subregion probably reflects structural polymorphism of beta-chains controlled by an I-A subregion gene.

Murine Ia and human DR antigens: homology of amino-terminal sequences.

Murine Ia and human DR antigens were isolated and purified by immunoprecipitation and sodium dodecyl sulfate/polyacrylamide gel electrophoresis with allo- and xenoantisera, respectively. The I-A subregion antigen consists of two chains, designated Aalpha and Abeta, with molecular weights of 35,000 and 26,000, respectively. The I-C subregion antigen likewise consists of two chains, designated Calpha and Cbeta, with molecular weights of 32,000 and 29,000, respectively. Under nonreducing conditions, the Cbeta chain migrates appreciably more rapidly on sodium dodecyl sulfate/polyacrylamide gels than the reduced Cbeta chain, reflecting the presence of an intrachain disulfide bond. The human DR antigen is also a two-chain unit and contains DRalpha and DRbeta components with molecular weights of 34,000 and 28,000, respectively. The DRbeta chain migrates more rapidly before reduction than afterward, like the murine Cbeta chain. The DRbeta and Cbeta chains are also strikingly homologous if a single amino acid shift is imposed on one of those chains. Thus, human DR antigens strongly resemble the murine I-C subregion antigens.

Chemical characterization of murine Ia alloantigens determined by the i-E/i-C subregions of the H-2 complex.

Alloantisera directed against the alloantigens determined by the I-E and I-C subregions of the murine major histocompatibility complex precipitate two components that have molecular weights of 35,000 and 29,000. These components, when analyzed by partial NH2-terminal sequencing, show no homology to two components of similar size determined by the I-A subregion. However, the large chain determined by the murine I-E and/or I-C subregion is homologous to the large chain of the human HLA-D region alloantigen, although the small chains isolated from these two species do not display any such homology.

Nurse practitioners in primary care. 3. The southern Ontario randomized trial.

A group of nurses who formerly had performed office functions received a special university-based educational program designed to prepare them to assume much of primary care management as nurse practitioners. The associated family physicians would shift their role to general supervision and attention to difficult clinical problems. To test this new form of practice, two complementary randomized trials have been conducted in south-central Ontario. The particular trial reported here was intended to assess the influence of the educational program on the changing roles of the professional personnel. The nurses of 14 family medical practices, with the physicians' support and commitment to participation, applied for the new training. Seven applicants were randomly selected to receive the training and their corresponding practices became the experimental group, while the remaining nurses and practices were retained as controls. During the subsequent year of investigation important changes occurred in professional roles of the experimental group. Nurse practitioners spent more time in clinical activities than conventional office nurses. The shift was not at the expense of time devoted to clinical work by physicians. Doctors delegated more professional activities to nurse practitioners than to conventional nurses. Except for remuneration (affected by legal constraints) job satisfaction among experimental physicians and nurses remained high after one year of experience with the new method.