Transneuronal tracing of neural pathways controlling activity of diaphragm motoneurons in the ferret.

Previous studies have shown that neurons in addition to those in the medullary respiratory groups are involved in activating phrenic motoneurons during a number of behaviors, including vomiting and reaction to vestibular stimulation. However, the location of premotor inspiratory neurons outside of the main medullary respiratory groups is largely unknown, particularly in emetic species. In the present study, the transneuronal tracer pseudorabies virus was injected into the diaphragm of the ferret, and the locations of retrogradely-labeled motoneurons and transneuronally-labeled pre-motoneurons in the brainstem and cervical and thoracic spinal cord were mapped. Injections of a monosynaptic tracer, cholera toxin, were also made in order to verify the location of motoneurons innervating the diaphragm. Phrenic motoneurons identified with pseudorabies virus and cholera toxin were confined largely to the C5-C7 levels of spinal cord, and often gave rise to prominent polarized dendritic arbors that extended across the midline. At post-inoculation survival times > or = three days, transneuronally-labeled interneurons were located in the cervical and thoracic spinal cord and portions of the brainstem, including the midline pontomedullary reticular formation and the lateral medullary reticular formation. Double-labeling studies revealed that although the infected midline neurons were located in the proximity of serotonergic neurons, only a small number of the virus-containing cells were positive for serotonin. These findings suggest that neurons in the midline of the medulla and pons influence the activity of phrenic motoneurons, perhaps during inspiratory behaviors unique to emetic animals (such as vomiting).

The sources of innovation in the woollen and worsted industry of eighteenth-century Yorkshire.

This article examines the economic developments that induced producers to seek our innovations during a transformative period in the Yorkshire woollen industry. The analysis examines both the increase in the scale of the typical operation and the tremendous effect that fashion had on the industry. Particular attention is given to the ways in which the workings of real markets and product innovation focused entrepreneurial energy on the production process, and what that tells us about the origins of the Industrial Revolution.

Confronting the 21st century's hidden crisis: reducing human numbers by 80%.

PIP: While there are some recent indications that fertility rates are beginning to decline, the current composite for most of the less-developed world is still nearly 4.1, double that needed for zero population growth. Only about 20% of the current world population (about 1.2 billion people) could be said to have a generally adequate standard of living, defined here as something approximating that of industrialized Western Europe, Japan, or North America. The other 80% (approximately 4.5 billion), incorporating most of the inhabitants of the developing nations, live in conditions ranging from mild deprivation to severe deficiency. Assertions that the earth might be able to support a population of 10, 15, or even 20 billion for an indefinite period of time at a standard of living superior to the present one are demonstrably false and misleading. It is therefore necessary to confront the inescapable fact that human numbers will have to be reduced by 80% or more, from the all-but-inevitable 9-11 billion in the mid-21st century to something approaching 2 billion by the end of the 22nd century, some 200 years from now. If it is indeed inevitable that global population size is destined to reach 10-12 billion within the next half century, even efforts to reach a somewhat larger optimum population in the 4-5 billion range would still require a very significant decrease in human numbers, roughly on the order of 60%. In pragmatic terms, the initial stabilization and subsequent 80% reduction in human numbers suggested earlier could be brought about with relative ease by establishing a worldwide average fertility rate of approximately 1.5-1.7 over the next several generations lasting well into the 22nd century at least.^ieng

A comparative double-blind randomised study of single dose fosfomycin trometamol with trimethoprim in the treatment of urinary tract infections in general practice.

A double-blind, double-dummy trial comparing a single dose treatment with fosfomycin trometamol (FT, 3 g) versus trimethoprim (TMP, 200 mg) was carried out in women with uncomplicated urinary tract infections. From 51 clinically evaluable patients, 44 were bacteriologically assessable at the 6-week follow-up. The results were as follows in the FT group (n = 22): eradication in 17 (77.3%); recurrence in 2 (9%); reinfection in 2 (9%), and persistence in 1 (4.5%). For the TMP group (n = 22) the results were: eradication in 12 (54.5%); recurrence in 1 (4.5%); reinfection in 1 (4.5%), and persistence in 8 (33.3%). There were no significant adverse events reported with either agent.

Prevalence of Gardnerella vaginalis: an estimate.

To assess the prevalence of Gardnerella vaginalis in the community 300 women aged 16-59 were randomly selected from a general practice's age-sex register and invited to attend for a health check. Out of 282 women who were eligible to attend, 192 did so. They were asked whether they had any vaginal symptoms, and swabs were taken from 182 women for culture for G vaginalis. Sixty women were positive for G vaginalis, of whom 26 had symptoms. Infections with G vaginalis may be present in women who have no symptoms. By careful questioning, examination, and side room testing general practitioners may be able to diagnose these infections in such women consulting them for other reasons.

Identifying vaginitis in general practice.

PIP: Clinicians conducted a study of 154 women who presented themselves at a health center of the University of Wales College of Medicine with symptoms of vaginitis. A nurse examined the vagina with a speculum to note the appearance of the cervix, the color and amount of discharge, and the presence of odor and inquired about soreness during the examination. The nurse took 3 endocervical swabs and 2 high vaginal swabs. Upon microscopic examination, any vaginal discharge with epithelial cells stippled with small coccobacilli indicated a possible Gardnerella vaginalis infection. Laboratory personnel identified G. vaginalis either alone or in combination with other organisms in 53% of the women. Those with G. vaginalis alone or in combination with anaerobes reported more symptoms than those women who had negative cultures. In addition, women with G. vaginalis alone and those G. vaginalis in combination with other organisms had more discharge, described as yellow and runny, than those with negative cultures. 77% of the women infected with G. vaginalis had a high cheese or fishy odor. 75% of the women with G. vaginalis came to the health center between 2-4 weeks or even longer after they 1st noticed symptoms. On the other hand, women who were infected with C. albicans presented to the health center within a week of the start of the symptoms. Clinicians had previously treated erroneously many of the women with G. vaginalis with an antifungal agent. These women should be treated with metronidazole or, if a yeast infection is also present, with an antifungal agent and metronidazole. All women who present themselves to a nurse or physician with vaginal symptoms should have a history taken, an examination, and vaginal discharge samples taken and evaluated in the laboratory.^ieng

Contribution of Gardnerella vaginalis to vaginitis in a general practice.

In a study of 154 adult women who presented to their general practitioner with vaginal symptoms 30 (20%) had Gardnerella vaginalis on its own and 51 (33%) had G vaginalis in combination with anaerobes or known pathogens. Thirty one (20%) patients were culture negative. Those who were culture negative had fewer symptoms and signs of vaginitis than those with G vaginalis alone or G vaginalis plus anaerobes. Those with known pathogens had more symptoms and signs than those with G vaginalis alone or G vaginalis plus anaerobes. Those with known pathogens plus G vaginalis had the most severe signs and symptoms of vaginitis. It is concluded that G vaginalis can cause vaginitis on its own, and it makes vaginitis worse when present with other organisms. G vaginalis was also found in 30 (21%) of the 138 control patients who, although they presented "asymptomatically," had worse signs than control patients without G vaginalis. It seems that G vaginalis can occur in a spectrum ranging from the uncomplaining patient to those with severe vaginitis.

Irritable urethral syndrome: follow up study in general practice.

Two years after a microbiological study of the urethral syndrome 25 of 31 women had had further symptoms, but only two had sought medical help for their symptoms in the year after the study. Analysis of patients' records showed that women with the urethral syndrome had higher consultation and sterilisation rates and more psychosomatic symptoms and relationship problems than matched control patients. Using the Nottingham health profile women with the urethral syndrome were more likely to mention that health problems affected their sex lives and were more likely to see themselves as having health problems than control patients. Women who have the urethral syndrome are considerable drain on the doctor's time, and management needs to be directed towards the anxious patient who makes such demands. Seeing the condition as the "irritable urethral syndrome" may help both doctor and patient to recognize the psychosomatic aspect of the problem.

Clinical judgment in the diagnosis and management of frequency and dysuria in general practice.

In a study of 40 women with the urethral syndrome and 46 women with conventional urinary tract infection, none of whom was pregnant, general practitioners predicted the diagnosis correctly before the report on the midstream urine specimen was received, as evidenced by their management. They seemed to do this by balancing the symptom of dysuria with the psychological make up of the patient: patients with the urethral syndrome suffered appreciably less dysuria than patients with urinary tract infection; patients with the urethral syndrome suffered appreciably more psychological illness. This ability to distinguish between the two disorders has important clinical and economic implications.

A comparative trial of pivmecillinam/pivampicillin and amoxycillin/clavulanate in the therapy of urinary tract infection in a general practice population.

Fifty-eight patients seen in general practice presenting with symptoms of acute urinary tract infection were entered consecutively into an open randomized trial of 200 mg pivmecillinam plus 250 mg pivampicillin twice daily or 250 mg amoxycillin plus 125 mg clavulanate 3-times daily for 5 days. The results were analyzed in 41 patients with significant bacteriuria (23 on pivmecillinam/pivampicillin and 18 on amoxycillin/clavulanate). Both antibiotic combinations produced good overall bacteriological cure, but there were a considerable number of persisting symptoms despite the absence of significant bacteriuria. Eight patients in the pivmecillinam/pivampicillin group and 5 in the amoxycillin/clavulanate group had side-effects, principally thrush, vomiting and abdominal pain, and 1 patient from each group ceased treatment for this reason. Sensitivity profiles of urinary isolates (41 trial, 135 non-trial) to both combinations and to ampicillin and mecillinam showed that the majority were fully sensitive to amoxycillin/clavulanate and to a lesser extent to pivmecillinam/pivampicillin; resistance was highest to ampicillin.