[Six years of experiences from a department of geriatric psychiatry]. / Erfaringer fra en alderspsykiatrisk avdeling gjennom seks år.

After a project period from 1994 to 1997, all hospital-based psychogeriatric services in the Norwegian county of Telemark have been located to one department in the central hospital. The department has three differentiated bed units and one out-patient unit. This article describes the psychogeriatric department before and after the project, and includes an evaluation of the quality of service. The changes following the reorganization have been evaluated with an internal analysis, questionnaires to primary health care personnel and an examination of medical and psychiatric records. In 1995 and 1997, questionnaires were sent to general practitioners and district nurses in Telemark County. An independent consultant examined 40 medical and psychiatric records in 1995 and 1997, evaluating them according to selected quality standards. The response rates among doctors were 59% in 1995 and 48% in 1997. The responses show that primary health care doctors and nurses make use of the department's services and that they are increasingly satisfied with the quality of these services. The examination of medical and psychiatric records shows insufficient documentation of psychiatric symptoms and activities of daily life in 1995, but significant improvements by 1997. There are drawbacks to the evaluation method employed. However, we find it warranted to conclude that the reorganization has been functional and that the quality of services has improved.

A cell-surface heparan sulfate proteoglycan mediates neural cell adhesion and spreading on a defined sequence from the C-terminal cell and heparin binding domain of fibronectin, FN-C/H II.

FN-C/H II is a heparin binding synthetic peptide from the C-terminal cell and heparin binding domain of fibronectin (FN) that mediates neuronal cell adhesion, spreading, and neurite outgrowth. Cellular interactions with FN-C/H II are inhibited by soluble heparin, suggesting that a cell-surface proteoglycan may mediate interactions with FN-C/H II (Haugen et al., 1990). To test this hypothesis further, heparan sulfate (HS) or chondroitin sulfate (CS) was removed from the cell surface by enzyme treatment. Heparitinase but not chondroitinase treatment of cells inhibited rat B104 neuroblastoma cell adhesion and spreading on FN-C/H II. Additionally, heparitinase treatment decreased the spreading of cells on the 33/66 kDa fragments containing the C-terminal heparin binding domain of FN. Furthermore, antibodies generated against a mouse melanoma HS proteoglycan (HSPG) inhibited B104 cell adhesion to FN-C/H II and the 33/66 kDa FN fragments. 35S-HSPG isolated from B104 cells directly bound to FN-C/H II both in solid phase assays and by affinity chromatography, but failed to bind to a control peptide from this region, CS1. The binding of 35S-HSPG was predominantly mediated by the HS and not the core protein of the HSPG. SDS-PAGE of iodinated HSPG demonstrated a single 78 kDa core protein following heparitinase digestion, which migrated at 51 kDa under nonreducing conditions. Anti-HSPG antibodies recognized the 78 kDa core protein by immunoblotting, and stained the surface of rat B104 neuroblastoma cells and cells of the primary neonatal rat nervous system. These results identify a cell-surface HSPG that likely mediates neuronal cell binding interactions with FN-C/H II.

Central and peripheral neurite outgrowth differs in preference for heparin-binding versus integrin-binding sequences.

Neurons of the CNS and PNS differ in their response to fibronectin (FN) and proteolytic fragments of FN. The 33 kDa C-terminal cell and heparin-binding fragment of FN, in particular, is a strong promoter of CNS neurite outgrowth. To define further the neurite-promoting activity of the 33 kDa fragment, and to investigate further the differences between PNS and CNS responses to FN and the 33 kDa fragment, we contrasted neurite outgrowth by CNS and PNS neurons on three synthetic peptides representing sequences from this fragment of FN: two heparin-binding peptides, FN-C/H I and FN-C/H II (McCarthy et al., 1990), and an integrin-binding peptide, CS1 (Humphries et al., 1987). Spinal cord (SC) neurons, from the CNS, differed from dorsal root ganglion (DRG) neurons, from the PNS, with respect to substratum preference for heparin-binding versus integrin-binding peptides. SC neurite outgrowth was greatest on the heparin-binding peptide FN-C/H II, while DRG neurite outgrowth was greatest on the a4 beta 1 integrin-binding peptide CS1. To test whether the difference in substratum preference was due to differences in the molecular mechanism by which SC and DRG neurons interact with the 33 kDa fragment of FN, anti-beta 1 integrin antibodies and/or soluble heparin were added to the cultures as potential inhibitors of integrin-mediated or proteoglycan-mediated interactions with FN. SC neurite outgrowth was much more sensitive to the effect of heparin than anti-beta 1 integrin, indicating SC neurite outgrowth may involve predominantly a heparin-sensitive mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)

Recognition of the A chain carboxy-terminal heparin binding region of fibronectin involves multiple sites: two contiguous sequences act independently to promote neural cell adhesion.

Cellular interactions with fibronectin-treated substrata have a complex molecular basis involving multiple domains. A carboxy-terminal cell and heparin binding region of fibronectin (FN) is particularly interesting because it is a strong promoter of neurite outgrowth (Rogers, S.L., J.B. McCarthy, S.L. Palm, L.T. Furcht, and P.C. Letourneau, 1985. J. Neurosci. 5:369-378) and cell attachment (McCarthy, J.B., S.T. Hagen, and L.T. Furcht. 1986. J. Cell Biol. 102:179-188). To further understand the molecular mechanisms of neuronal interactions with this region of FN, we screened two peptides from the 33-kD heparin binding fragment of the FN A chain, FN-C/H II (KNNQKSEPLIGRKKT) and CS1 (Humphries, M.J., A. Komoriya, S.K. Akiyama, K. Olden, and K.M. Yamada. 1987. J. Biol. Chem. 262:6886-6892), for their ability to promote B104 neuroblastoma cell-substratum adhesion and neurite outgrowth. Both FN-C/H II and CS1 promoted B104 cell attachment in a concentration-dependent and saturable manner, with attachment to FN-C/H II exceeding attachment to CS1. In solution, both exogenous FN-C/H II or CS1 partially inhibited cell adhesion to the 33-kD fragment. Similar results were obtained with anti-FN-C/H II antibodies. In contrast, soluble GRGDSP did not affect B104 cell adhesion to FN-C/H II. These results indicate that both FN-C/H II and CS1 represent distinct, RGD-independent, cell adhesion-promoting sites active within the 33-kD fragment, and further define FN-C/H II as a novel neural recognition sequence in FN. B104 adhesion to FN-C/H II and CS1 differs in sensitivity to heparin, yet each peptide inhibited adhesion to the other peptide, suggesting cell adhesion is somehow related at the cellular level. Within the A chain 33-kD fragment, FN-C/H II and CS1 are contiguous, and might represent components of a larger domain with greater neurite-promoting activity since only the 33-kD fragment, and neither individual peptide, was effective at promoting B104 neurite outgrowth. These data further support the hypothesis that cell responses to FN are mediated by multiple sites involving both heparin-sensitive and -insensitive mechanisms.

[Dementia in the elderly. A 3-year project]. / Demenstilstander hos eldre. Et treårig pilotprosjekt.

In order to meet the need of proper examination and treatment of memory problems in the elderly a specialized unit of psychogeriatrics has been established as a pilot project. In the period from September 1986 to April 1988, 146 persons were examined, 42% as outpatients and 58% as inpatients. The average age was 75.3 years. 54% had dementia senilis and 16% other sorts of dementia. 30% were not demented: 14% had a psychiatric illness, 8% organic damage or illness of the brain and 7% were confused. Overdose or wrong use of psychopharmacological drugs was a frequent problem, and cutting out the medication, regulating the dose, or changing to another medicine had surprising consequences. The further treatment was planned in cooperation with the patient's family and the community health service. A follow-up after nine months indicated that this was a positive procedure for the patients, and that the unit was a professional resource to the local health services in the whole district. The hospital has now been allocated funds from the Government to function as a competence centre for part of Eastern Norway.

Interleukin-2 enhances chick and rat sympathetic, but not sensory, neurite outgrowth.

Interactions between the immune and nervous systems could be important for normal development and function of both. To determine if a lymphokine, interleukin-2 (IL-2), represents a link between these two systems, sympathetic and sensory neurons from embryonic chick and neonatal rat were cultured in media containing human recombinant IL-2. In chick sympathetic chain and rat superior cervical ganglia cultures, IL-2 enhanced the number of neurons with neurites and the length of those neurites significantly over control cultures. Sensory neurons from chick and rat dorsal root ganglia were not affected by culture in IL-2. Sympathetic neuron response to IL-2 was concentration-dependent, with an optimum around 2-0.2 U/ml (100-10 pM). Immunofluorescence with an anti-IL-2 receptor antibody demonstrated specific staining of sympathetic neurons, but not sensory neurons, implying that sympathetic neurons may have a receptor for IL-2 on their surface.