Characterization and simulation of optical sensors.

Numerical simulation is gradually becoming an advantage in active safety. This is why the development of realistic numerical models enabling to substitute real truth by simulated truth is primordial. In order to provide an accurate and cost effective solution to simulate real optical sensor behavior, the software Pro-SiVIC™ has been developed. Simulations with the software Pro-SiVIC™ can replace real tests with optical sensors and hence allow substantial cost and time savings during the development of solutions for driver assistance systems. An optical platform has been developed by IFSTTAR (French Institute of Science and Technology for Transport, Development and Networks) to characterize and validate any existing camera, in order to measure their characteristics as distortion, vignetting, focal length, etc. By comparing real and simulated sensors with this platform, this paper demonstrates that Pro-SiVIC™ accurately reproduces real sensors' behavior.

Assessing student reflection in medical practice. The development of an observer-rated instrument: reliability, validity and initial experiences.

INTRODUCTION: This study describes the development of an instrument to measure the ability of medical students to reflect on their performance in medical practice. METHODS: A total of 195 Year 4 medical students attending a 9-hour clinical ethics course filled in a semi-structured questionnaire consisting of reflection-evoking case vignettes. Two independent raters scored their answers. Respondents were scored on a 10-point scale for overall reflection score and on a scale of 0-2 for the extent to which they mentioned a series of perspectives in their reflections. We analysed the distribution of scores, the internal validity and the effect of being pre-tested with an alternate form of the test on the scores. The relationships between overall reflection score and perspective score, and between overall reflection score and gender, career preference and work experience were also calculated. RESULTS: The interrater reliability was sufficient. The range of scores on overall reflection was large (1-10), with a mean reflection score of 4.5-4.7 for each case vignette. This means that only 1 or 2 perspectives were mentioned, and hardly any weighing of perspectives took place. The values over the 2 measurements were comparable and were strongly related. Women had slightly higher scores than men, as had students with work experience in health care, and students considering general practice as a career. CONCLUSIONS: Reflection in medical practice can be measured using this semistructured questionnaire built on case vignettes. The mean score allows for the measurement of improvement by future educational efforts. The wide range of individual differences allows for comparisons between groups. The differences found between groups of students were as expected and support the validity of the instrument.

Are professional attitudes related to gender and medical specialty?

OBJECTIVES: The importance of professional attitudes in medical care has long been recognized; however, medical training has not stressed attitude development until recently. In previous studies among medical students, we found that gender and specialty preference are important factors in attitudes. In this study, patient-centredness of trainees in general practice and surgery and of final-year clerks preferring one of these specialties was assessed in one medical school in The Netherlands. The effect of gender, specialty and training level on attitude was investigated. DESIGN: In 1995, attitudes of 37 general practice trainees, 31 surgery trainees and 120 clerks were measured anonymously using questionnaires containing the Doctor-Patient Scale. This attitude scale measures patient-centredness vs. doctor-centredness. Response rates were 78%, 58% and 84%, respectively. SETTING: University of Utrecht. SUBJECTS: Medical students. RESULTS: Attitudes were related to specialty. General practice trainees showed more patient-centredness than surgery trainees. In accordance with previous findings among younger students, no differences were found between final-year clerks and vocational trainees. In contrast to previous studies, gender was not related to patient-centredness. CONCLUSIONS: Professional attitudes, in particular patient-centredness, seem to be related to specialty preference in the final year of graduate medical training and specialty as a career choice. It remains unclear whether professional socialization reinforces existing attitudes or whether existing attitudes result in specialty preference.

Is one paracetamol suppository of 1000 mg bioequivalent with two suppositories of 500 mg.

A common belief is that one tablet or suppository containing, e.g. 100 mg of a drug can be substituted, without any changes in the therapeutic effect, with two units of the same brand containing 50 mg of the drug. In the present study a single dose of paracetamol was administered to healthy volunteers as (a) two tablets of 500 mg, (b) two suppositories of 500 mg, and (c) one suppository of 1000 mg. There were statistically significant differences in all bioavailability parameters (t(max), C(max) and AUC) between the three treatments. The relative bioavailability of the 500 mg suppositories was 77% and that of the 1000 mg suppositories 66%. The absorption rate from suppositories was markedly lower than from the tablets. Especially low absorption rate was obtained with the suppository of 1000 mg. The two strengths, although having the same trade name, were not therefore bioequivalent.

Pooling of clodronate urinary excretion data: a new pharmacokinetic method to study drugs with highly variable gastrointestinal absorption.

Gastrointestinal absorption of bisphosphonates is highly variable from individual to individual (between-subject variation) and from day to day (within-subject variation), a fact that creates problems both in research and in clinical use of these drugs. We conducted a randomized, two-period cross-over pharmacokinetic (phase I) study to assess the relative bioavailability of two different clodronate preparations: an 800 mg tablet and a 400 mg capsule. Urinary excretion of clodronate correlates with gastrointestinal absorption. To minimize the confounding effect of the high variability of gastrointestinal absorption, we chose as the primary parameter the cumulative amount of clodronate excreted into urine (A(e0-t)) during 9 days (7 days of treatment, 2 days of follow-up). The 90% confidence interval calculated for the population medians of A(e0-t) was 0.83-1.09, well within the 90% confidence interval stipulated for bioequivalence for the area under the curve values (0.80-1.25). This new procedure for pooling urinary excretion data offered a clear advantage over previous methods, and thus could presumably be used to study other drugs as well that are not metabolized and may show highly variable gastrointestinal absorption.

Prolonged-release hydroxypropyl methylcellulose matrix tablets of furosemide for administration to dogs.

Furosemide is a problematic drug in a prolonged-release product because its absorption is site specific, taking place mainly in the upper parts of the alimentary tract. The aim of the study reported here was to develop prolonged-release furosemide formulations for dogs. The type of preparation selected was a hydroxypropyl methylcellulose (HPMC) matrix tablet. Evaluation was based on dissolution studies, on in vivo disintegration studies in the canine stomach and on bioavailability studies in Beagle dogs. The variables tested were the viscosity grade of the polymer, the amount of polymer and presence or absence of an alkaline compound (potassium carbonate) in the formulation. When potassium carbonate was included, furosemide was absorbed so slowly that drug administration once daily would give plateau drug plasma concentrations, even though the elimination half-life of furosemide is only about one hour. In vitro dissolution tests gave a wrong indication of the in vivo behaviour of the products. Thus, in vivo studies are important from the very beginning in the development of new drug products for dogs.

Production of recombinant insulin-like growth factor-II in the development of a radioimmunoassay in rainbow trout (Oncorhynchus mykiss).

Rainbow trout (Oncorhynchus mykiss) insulin-like growth factor-II (IGF-II) cDNA was amplified by reverse transcription-polymerase chain reaction and cloned into an expression vector (parHS3) for production by Escherichia coli. Recombinant rainbow trout IGF-II (rtIGF-II) was recovered from bacterial inclusion bodies, solubilized, and purified by gel filtration chromatography under reducing conditions. After refolding of the peptide by dialysis at basic pH, we obtained a final yield of 820 micrograms/liter culture medium. The rtIGF-II appeared as a single band estimated at 80% and with molecular mass of 7.5 kDa. A homologous radioimmunoassay (RIA) for the measurement of IGF-II in trout plasma has been developed using rtIGF-II as antigen, radiolabeled tracer, and standard. RIA sensitivity was 0.1 ng/ml and the ED50 was 0.75 +/- 0.06 ng/ml. Intra- and interassay coefficients of variation were 4.04% (n = 6) and 4.56% (n = 9), respectively, at ED50 levels. Cross-reactivities of 1 and 0.1% were found for recombinant coho salmon (Oncorhynchus kisutch) IGF-I and coho salmon insulin, respectively. No cross-reactivities were found for recombinant human IGF-I and IGF-II, porcine insulin, or a variety of salmonid pituitary hormones. The interference of IGF binding proteins (IGFBP) in the RIA has been tested with and without extraction (acid/ethanol extraction or C-25 acid chromatography) of fed and fasted trout plasma samples. Parallel displacement curves were obtained for unextracted and C-25-extracted plasma but not for acid/ethanol-extracted plasma. Comparison of IGF-II levels from these samples showed a possible interference of IGFBP in the RIA in fed (19.6 +/- 1.56 ng/ml unextracted and 25.25 +/- 1.21 ng/ml extracted) and fasted (21.58 +/- 1.02 ng/ml unextracted and 9.86 +/- 1.68 ng/ml extracted) trout plasma. Finally, the displacement curves for unextracted plasma from rainbow trout, Couch's sea bream (Pagrus pagrus), and carp (Cyprinus carpio) were parallel to that of the rtIGF-II standard and not strictly parallel for tilapia (Oreochromis niloticus) and catfish (Silurus glanis) plasma. No significant cross-reaction occurred with eel (Anguilla anguilla) plasma. The rainbow trout IGF-II RIA reported in this study has low variability and is highly sensitive. Therefore it is a reliable method for measuring IGF-II levels in salmonids and some nonsalmonid fish species.

Prolonged-release hard gelatin capsules of furosemide for the treatment of dogs.

The object of this study was to examine whether prolonged-release hard gelatin capsule formulations could be developed for dogs. Different viscosity grades of hydroxypropyl methylcellulose (HPMC) and sodium carboxymethylcellulose (NaCMC) were used to control drug release. Furosemide was chosen because of its wide use in the management of heart failure in dogs. In vitro, selecting different viscosity grades allowed good control of drug release, whereas in vivo the difference between formulations was clearly smaller. Although all formulations gave prolonged release, both inter- and intra-individual variation in the plasma concentration-time curves was high. It is difficult to develop prolonged-release formulations for drugs such as furosemide with highly variable pharmacokinetic properties. However, hard gelatin capsules containing hydrophilic polymers could still be a suitable choice for some drugs.

Hypothalamic and thyroidal regulation of growth hormone in tilapia.

A radioimmunoassay (RIA) for recombinant tilapia growth hormone (GH) was established and validated. The ability of various hypothalamic factors to regulate GH secretion in the tilapia hybrid (Oreochromis niloticus x Oreochromis aureus) was studied. Somatostatin1-14 (SRIF1-14; 10-100 micrograms/kg) was found to reduce circulating GH levels in a dose-dependent manner. SRIF1-14 (0.1-1000 nM) inhibited GH release from perifused pituitary fragments (ED50 0.83 nM). Human growth hormone-releasing hormone fragment 1-29 (hGHRH1-29; 100 micrograms/kg) doubled circulating GH levels and modestly stimulated GH secretion in vitro. Carp growth hormone-releasing hormone (cGHRH) stimulated GH secretion in vitro to a similar degree at the same dose (1 microM). Injection of salmon gonadotropin-releasing hormone (sGnRH) superactive analog (10-100 micrograms/kg) increased plasma GH levels sixfold. sGnRH also stimulated GH release in vitro (ED50 142.56 nM). Dopamine (0.1-10 microM) and the D1 DA receptor agonist SKF 38393 increased GH secretion from perifused pituitary fragments dose-relatedly. Thyrotropin-releasing hormone (TRH) had no effect on GH secretion from perifused pituitary fragments, but increased plasma GH levels, as did bovine thyroid stimulating hormone (bTSH). The increased plasma GH in the bTSH-treated fish coincided with a dramatic increase in T4; however, TRH increased GH without changing T4 levels. T3 increased the synthesis of GH by isolated pituitaries (incorporation of [3H]leucine). SRIF1-14 seems to be a most potent hypothalamic regulator of GH secretion in tilapia; sGnRH and DA both increased GH secretion, although sGnRH elicited considerably greater responses at lower doses. Two forms of GHRH increased GH levels, although the unavailability of the homologous peptide prevented an accurate evaluation of its importance in regulating GH secretion. The thyroid axis (TRH, TSH, and T3) stimulates both synthesis and release of GH, although TRH did not appear to have a direct effect on the level of the pituitary.

Absence of a tiGH effect on adaptability to brackish water in tilapia (Oreochromis niloticus).

The aim of this study was to investigate the possible role of growth hormone in the adaptation of tilapia (Oreochromis niloticus) to brackish water and to analyze its interactions with prolactin in this process. Plasma levels of growth hormone do not change upon transfer to brackish water. Treatment of intact tilapia in fresh water with growth hormone prior to transfer did not enable the fish to preadapt to brackish water: the duration of the hydromineral imbalance after transfer was the same in treated animals and controls. The major osmoregulatory role of prolactin in fresh water led us to test the hypothesis that prolactin might antagonize the effect of growth hormone on adaptation to brackish water. Growth-hormone-treated hypophysectomized animals, however, exhibited no increased osmoregulatory capacity as compared to hypophysectomized controls, confirming the absence of a growth-hormone-related osmoregulatory effect. When prolactin and growth hormone were coinjected, growth hormone also proved unable to oppose the Na+ retaining effect of prolactin, in both brackish and fresh water. Surprisingly, hypophysectomized animals adapt better to brackish water than do sham-operated animals. This result is discussed in light of the effects of prolactin and cortisol on osmoregulation in brackish water and we suggest that an important event which allows O. niloticus to adapt to hyperosmotic environment is the reduction of plasma PRL upon transfer to brackish water.

The effects of gonadal development and sex steroids on growth hormone secretion in the male tilapia hybrid (Oreochromis niloticus × O. aureus).

Profiles of plasma growth hormone (GH) in male tilapia hybrid (Oreochromis niloticus x O. aureus) were measured and compared at different times of the year. The profiles did not appear to be repetitive, however, differences in their nature were observed at the different seasons; the most erratic profiles were seen in the height of the reproductive season (July), while the peaks were more subdued in the spring and disappeared in the autumn. Peaks in male fish were more prominent than in the females when measured in July. Perifused pituitary fragments from fish with a high GSI responded to salmon gonadotropin-releasing hormone (sGnRH) analog (10 nM-1 µM), while those from fish with a low GSI barely responded to even the highest dose. Exposure of perifused pituitary fragments from sexually-regressed fish to carp growth hormone-releasing hormone (cGHRH; 0.1 µM) or sGnRH (I µM) stimulated GH release only after injection of the fish with methyl testosterone (MT; 3 injections of 0.4 mg kg (1)). The same MT pretreatment did not alter the response to dopamine (DA; 1 or 10 µM). GH pituitary content in MT-treated fish was lower than in control fish, which may be explained by the higher circulating GH levels in these fish, but does not account for the increased response to the releasing hormones. Castration abolished the response of cultured pituitary cells to sGnRH (I fM-100 nM) without altering either their basal rate of secretion or circulating GH levels. Addition of steroids to the culture medium (MT or estradiol at 10 nM for 2 days) enabled a GH response to sGnRH stimulation in cells from sexually regressed fish. Pituitary cells which had not been exposed to steroids failed to respond to sGnRH, although their response to forskolin or TPA was similar to that of steroid-exposed cells. It would appear, therefore, that at least one of the effects of the sex steroids on the response to GnRH is exerted proximally to the formation of cAMP, or PKC, presumably at the level of the receptor. An increase in the number of receptors to the GH-releasing hormones, following steroid exposure, would explain also the changing nature of the GH secretory profile in different stages of the reproductive season.

Location and characterization of growth hormone binding sites in the central nervous system of a teleost fish (Oncorhynchus mykiss).

The binding of 125I-chinook salmon growth hormone (125I-sGH) to rainbow trout brain membranes was studied. Specific binding was detected on telencephalon, thalamus-midbrain, cerebellum-medulla and hypothalamus. In all brain regions, specific binding was dependent on membrane protein concentration, being linear in the range of 250-2500 micrograms of membrane proteins (derived from 30-300 mg wet weight tissue). Scatchard analysis evidenced a single class of high affinity (8.2 +/- 0.3-10 +/- 0.5 x 10(9) M-1) and low capacity (25.8 +/- 6.1-62 +/- 4.5 fmol/g-tissue) GH-binding sites. Specific binding was competitively displaced by recombinant trout GH (rtGH) in a dose dependent-manner. Bovine GH appeared 40-50 fold less potent than cold rtGH for displacing 125I-sGH. Chinook PRL, chinook GtH and bovine FSH did not compete for GH-binding sites in all brain regions examined. Binding studies performed in starved fish indicate that starving conditions decreases the binding of radiolabelled sGH to brain membrane preparations. Our results demonstrate the presence of specific and saturable GH-binding sites on the hypothalamic and suprahypothalamic areas of central nervous system. This finding supports the view that GH plays a direct role on the development and/or function of brain tissue in vertebrate species.

Comparison of the effects of hypertonic sucrose and intracellular potassium depletion on growth hormone receptor binding kinetics and down-regulation in IM-9 cells: evidence for a sequential block of receptor--mediated endocytosis.

To better understand the complex kinetics of human GH (hGH) binding to its receptors, we have further investigated, in IM-9 cultured human lymphocytes, the cellular locus corresponding to the slowly dissociating component of hormone binding, and to the homologous down-regulation of hGH receptors. First, we have detailed the biphasic kinetics of dissociation of bound hormone in control cells at 30 C. When the association at 30 C was extended from 0.5 to 3 h, the time required for half-dissociation of the fast component was slightly decreased (from 30 to 15 min) but that of the slow component increased considerably (from 6 h to 30 h). Concomitantly, the size of the slowly dissociating component increased from 50 to 80% of total. This indicates a maturation of bound hormone, from a rapidly to a slowly dissociating pool and, in the latter, an increase in the apparent affinity that may reflect a molecular rearrangement. Next, we have compared the effect of two procedures reported to inhibit receptor-mediated endocytosis at the level of coated pits. As previously reported, depletion of intracellular K+ abolished the slowly dissociating component and the down-regulation of hGH receptors. In contrast, upon incubation with 0.4 M sucrose, which like K+ depletion virtually abrogated hGH internalization, the dissociation kinetics remained non-first order, and the down-regulation of hGH-receptor was only slightly reduced. Thus, these procedures appear to block receptor-mediated endocytosis at two successive compartments of the cell surface. In conclusion, we propose that some conformational change of hGH-receptor at the cell surface (possibly associated with clustering) may considerably slow down their dissociation and may be sufficient for down-regulation.

Teaching the plantar reflex.

The efficacy of an instructional videotape about the interpretation of the plantar response was evaluated during a two week neurological clerkship. Experimental groups saw the videotape, control groups did not. All students (n = 65) assessed plantar responses of two to four different patients. Their judgment was compared with that of one senior neurologist. Only the students who had seen the videotape showed a significant improvement in performance on a second test (t-test, t = -2.26, p = 0.031). In addition, these students more frequently took account of the flexion synergy (Fisher exact test, p less than 0.001). Video can be an efficient tool in medical education.

Sphingosine, an inhibitor of protein kinase C, suppresses the insulin-like effects of growth hormone in rat adipocytes.

Insulin, human growth hormone (hGH), and phorbol 12-myristate 13-acetate all stimulate lipogenesis in rat adipocytes preincubated without hGH for 4 hr. As previous data suggested that protein kinase C plays an important role in the action of insulin and in the insulin-like effects of hGH in rat adipocytes, we tested the effects of sphingosine, a potent inhibitor of protein kinase C, on the lipogenic activity of both hormones. At 50 microM, sphingosine had no effect on basal lipogenesis but completely abolished the action of phorbol 12-myristate 13-acetate and decreased by 65% and 89%, respectively, the effects of hGH and insulin. At higher concentrations (100 microM), sphingosine abolished both basal and hormone-stimulated lipogenesis; this effect was partially reversible after washing the cells. Similar effects of sphingosine on basal and stimulated glucose uptake were seen in parallel, suggesting that sphingosine inhibits lipogenesis at the glucose-uptake step in rat adipocytes. N-Acetylsphingosine and sphingomyelin, two analogs of sphingosine that are inactive on protein kinase C, did not inhibit lipogenesis induced by hGH, insulin, or phorbol 12-myristate 13-acetate. Sphingosine did not inhibit insulin binding to rat adipocytes at concentrations up to 200 microM but decreased hGH binding to its receptors by 44% at 50 microM. These data suggest a direct link between the inhibition of protein kinase C and that of lipogenesis and provide new evidence for the involvement of protein kinase C in the mechanism of action of growth hormone and insulin in rat adipocytes.

Acridine orange, an inhibitor of protein kinase C, abolishes insulin and growth hormone stimulation of lipogenesis in rat adipocytes.

To determine whether protein kinase C plays a role in the actions of insulin and growth hormone in rat adipocytes, we tested the effect of acridine orange, a potent inhibitor of kinase C, on the lipogenic activity of both hormones. This compound completely inhibited the effects of insulin, growth hormone and phorbol ester 12-myristate 13-acetate, whereas 9-acridine carboxylic acid, an analog of acridine orange which does not inhibit kinase C, had no effect. Acridine orange did not act through inhibition of hormone binding. These data are consistent with the involvement of kinase C in the action of insulin and growth hormone on lipogenesis in rat fat cells.

The physiology of growth hormones (GHs) in pregnant women and partial characterization of the placental GH variant.

This work was undertaken to study the heterogeneity of GH in serum and placental and pituitary extracts and to study GH physiology in pregnant women. Two distinct monoclonal antihuman GH (anti-hGH) antibodies (MAb) coded 5B4 and K24 were selected for their high binding affinity and specificity. The 5B4 MAb recognized the epitope comprising the NH2-terminal end of hGH, and the K24 MAb recognized an internal epitope. Both MAbs were used in RIAs to measure serum GH concentrations in various circumstances, including pregnancy. The two RIAs yielded slightly different serum GH results in normal men and nonpregnant women, but the overall correlation between the data was excellent. Since the RIAs were not affected by human placental lactogen, the evolution of serum GH in pregnant women could be studied. In such women, serum GH levels progressively declined to undetectable levels during the second half of pregnancy, while a pregnancy-associated serum GH-like antigen [tentatively called human placental growth hormone (PGH)] appeared in the circulation at midpregnancy and increased thereafter up to term. PGH contained the NH2-terminal epitope of pituitary GH, but lacked the internal one. Consequently, it reacted selectively with the 5B4 MAb only. After delivery, PGH disappeared from maternal serum within 1 h. Amniotic fluid contained low GH concentrations; cord serum contained high GH levels, but no PGH. Thus, PGH appears to be secreted selectively into the maternal compartment. PGH was purified from term placenta extracts. According to its chromatographic behavior, it appears more basic than pituitary 22K and 20K GHs. Size dimorphism was demonstrated; PGH was composed of two entities of 22K and 25K, respectively. Pure PGH, obtained in small quantities by preparative electrophoresis, was found to bind to hepatic GH receptor with an apparent high potency compared to that of pituitary GH, PGH, thus, should act in vivo as a GH agonist sharing most of its biological properties. These results lead to the conclusion that PGH is likely to replace the pituitary hormone in governing maternal metabolism during the second half of pregnancy.

An interactive patient simulation for the study of medical decision-making.

An interactive patient simulation for the study of medical decision-making was developed which is basically a flexible question and answer simulation between a doctor and a simulator conducting the simulation. To insure a thorough insight into the management of cases over time, provisions were made for doctors to interact with the simulated patients as many as five times. The simulation was tested on 16 family doctors and 16 specialist physicians to evaluate its realism and construct validity. The realism scores were highly favourable for both groups. With regard to construct validity, the hypothesis that the two specialty groups would manifest themselves in decision-making as distinct and homogeneous groups was tested. This hypothesis was confirmed in the case of specialist physicians, but not in the case of family doctors.