Are the Twelve Steps more acceptable to drug users than to drinkers? A comparison of experiences of and attitudes to Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) among 200 substance misusers attending inpatient detoxification.

The present study is a cross-sectional interview-based investigation comparing experiences of and attitudes towards Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) in a sample of 200 patients attending inpatient substance misuse detoxification services. Two hundred consecutive admissions were recruited; 100 each from one drug and one alcohol in-patient treatment service in which attendance at AA/NA was a voluntary adjunct to a generic treatment programme. Although there were no differences in the history of AA/NA attendance, the drug users (who were on average younger) reported significantly more positive attitudes towards AA/NA, more willingness to attend during their in-patient treatment and greater intention to attend following completion of their detoxification. In particular, despite no differences in spiritual/religious orientation, the drug users reported more positive views of the Twelve Steps. As AA/NA remain popular and accessible forms of substance misuse support, it is critical that we develop a clearer understanding of their impact and of the scope for their integration with generic forms of substance misuse treatment.

A contact-dependent animal-to-vegetal signal biases neural lineages during Xenopus cleavage stages.

The central nervous system (CNS) of Xenopus is derived from three of four tiers of blastomeres of the 32-cell embryo, and each blastomere in these tiers produces a characteristic number of primary spinal neurons. The C-tier blastomeres constitute the boundary between those that contribute to the CNS (A-, B-, and C-tiers) and those that do not (D-tier). To test whether the neural lineages descended from the C-tier are established by intrinsic information or by cell-cell interactions, single B-tier blastomeres were deleted and the lineage of their C-tier neighbors mapped. The contributions of C-tier blastomeres to subdivisions of the CNS and to specific spinal neurons were significantly reduced. Contributions of these blastomeres to other tissues were mostly normal, indicating that those C-tier progeny that no longer contribute to CNS are distributed in small numbers throughout the rest of the clone. To test whether the changes in neural lineages after B-tier deletions were the result of the C-tier blastomere changing position, contacting new neighbors, or losing contact with inductive B-tier neighbors, intact embryos were transiently dissociated within their vitelline membranes at different time points prior to the midblastula transition. This treatment disrupted cell-cell contact, but not gap junction-mediated dye coupling or the positions of neighboring cells. C-tier CNS lineages were reduced as after deletion of the B-tier neighbor, suggesting that the neural fate of C-tier cells depends upon specific B-tier interactions. To determine whether these interactions occurred specifically between B-tier and C-tier neighbors, barriers were inserted transiently between individual B/C pairs; similar reductions in C-tier CNS lineages were observed. These data demonstrate that an animal-to-vegetal, contact-dependent signal passes from B-tier to C-tier blastomeres and is required for the normal C-tier contribution to the CNS. This cell-cell interaction occurs many hours before the onset of zygotic transcription or neural induction and may bias the field of cells that can respond to neural induction.

Renal allograft rupture with iliofemoral thrombophlebitis.

Spontaneous rupture of a renal allograft in the early posttransplant period is associated with tachycardia, hypotension, oliguria, swelling, pain, a falling hematocrit level, and tenderness at the transplant site. Occasionally, the ruptured allograft can be saved by control of the hemorrhage. Deep vein thrombophlebitis, a common occurrence after prolonged surgery and cortocosteroid therapy, is less common in renal allograft transplantation, but may be associated with renal vein thrombosis. The simultaneous occurrence of deep vein thrombophlebitis, renal vein thrombosis, and allograft rupture contraindicates anticoagulent therapy. We present a patient in whom ipsilateral deep vein thrombophlebitis developed eight days after a cadaveric renal allograft, followed in two days by hypotension, a falling hematocrit level, oliguria, and a painfall mass at the allograft site. Surgical exploration revealed a ruptured allograft with iliofemoral and renal vein thrombosis and profuse hemorrhage. A transplant nephrectomy was performed.