A common pathway mediates retinoic acid and PMA-dependent programmed cell death (apoptosis) of neuronal cells

To assess the maternal and neonatal risk associated with high-order cesarean sections, a case-control study was carried out in two university affiliated maternity wards. The outcome of 154 pregnancies of women undergoing cesarean section for the 4th time or more was compared with 148 women sectioned for the 2nd or 3rd time and 132 women of similar age and parity after spontaneous birth. The main outcome measures were maternal operative and postoperative morbidity and neonatal prematurity and its complications, Apgar scores, and the need for intensive care. Women undergoing multiple (> or = 4) cesarean sections had significantly more intra-abdominal adhesions (P < 0.0001) than women sectioned for the 2nd or 3rd time. However, the time interval from incision to delivery and the total duration of operation were similar. The postoperative course was not adversely affected by multiple cesarean sections. A high incidence (16.2%) of preterm cesarean deliveries was noted in the study group. This was due to non-elective repeat cesarean delivery rather than to poor timing of scheduled cesarean sections. The significantly increased (P < 0.05) need for neonatal intensive care was explained by the higher occurrence of prematurity. Low Apgar scores (< or = 7) at 1 and 5 min were significantly (P < 0.01) related to multiple cesarean sections, even after controlling for the effect of gestational age. We conclude that multiple cesarean sections pose little risk for the mother, but may be associated with increased neonatal risk, attributed mainly to preterm non-elective cesarean sections.     

Microsatellite instability in squamous cell carcinoma of the head and neck

Genomic instability or microsatellite instability (MI) in simple repeated sequences was initially recognised in colonic carcinomas and subsequently in other tumours. MI has been associated with mutations in genes concerned with replication and DNA repair. We investigated 34 microsatellite markers in squamous cell carcinoma of the head and neck (SCCHN). Fifty-six tumours, were studied, of which 25 were investigated with ten or more microsatellite markers. In this study we consider two or more microsatellite alterations in a tumour to be diagnostic of MI. We demonstrated that 7/25 (28%) of the tumours had MI at two or more loci and three of these tumours exhibited evidence of 20 or more loci with MI. No correlations were found between MI and previous treatment, site, histological differentiation, positive nodes at pathology, a history of alcohol intake or survival. MI has been demonstrated in T1N0 stage tumours, indicating that these changes may occur early in the disease process. A negative correlation was found between MI and a history of smoking (P = 0.02). Two or more markers of MI were found in three of four non-smokers compared with one of 13 in the smoking group of patients, which suggests a novel mechanism of carcinogenesis in non-smokers.     

Preparing tomorrow's health sciences librarians: feasibility and marketing studies

The University of North Carolina at Chapel Hill is devising and evaluating five curricular models designed to improve education for health sciences librarianship. These models fit into a continual learning process from the initial professional preparation to lifelong learning opportunities. Three of them enhance existing degree and certificate programs in the School of Information and Library Science (SILS) with a health sciences specialization, and two are new programs for working information professionals. The approaches involve partnerships among SILS, the Health Sciences Library, and the program in Medical Informatics. The planning process will study the feasibility of the proposed programs, test the marketability of the models to potential students and employers, and make recommendations about implementation.     

Book Reviews

By Dr. Alexander J. Patton, P.E.. and Dr. John C. Russell, M.D. Available from Garland Law Publishing, 136 Madison Avenue, New York, NY 10016. The cost is $95.00.     

Recovery of a 62-year-old man from prolonged cold water submersion

Layer III pyramidal neurones were injected with Lucifer Yellow in cortical slices taken from the medial subdivision of the frontal eye field (FEF) of the macaque monkey. The average area covered by basal dendritic fields, in the dimension parallel to the cortical layers, was 115.1 +/- 2.9 x 10(3) microm2, significantly larger than that observed among layer III cells in eye movement-related visual areas of the parietal lobe. Furthermore, the dendritic fields of pyramidal cells in the FEF were considerably more complex than those of their counterparts in the parietal lobe, as evaluated by Sholl analysis. Spine density varied along the basal dendritic tree, reaching a maximum of 8.5 +/- 0.8 spines/10 microm at a distance of 70-90 microm from the centre of the cell body. Such highly complex basal dendritic fields of layer III pyramidal neurones in the FEF may enable the integration of a diverse set of inputs from visual, motor, polysensory and memory-related periprincipal cortical areas.     

Usefulness of molecular markers for detecting population bottlenecks via monitoring genetic change

It is important to detect population bottlenecks in threatened and managed species because bottlenecks can increase the risk of population extinction. Early detection is critical and can be facilitated by statistically powerful monitoring programs for detecting bottleneck-induced genetic change. We used Monte Carlo computer simulations to evaluate the power of the following tests for detecting genetic changes caused by a severe reduction in a population's effective size (Ne): a test for loss of heterozygosity, two tests for loss of alleles, two tests for change in the distribution of allele frequencies, and a test for small Ne based on variance in allele frequencies (the 'variance test'). The variance test was most powerful; it provided an 85% probability of detecting a bottleneck of size Ne = 10 when monitoring five microsatellite loci and sampling 30 individuals both before and one generation after the bottleneck. The variance test was almost 10-times more powerful than a commonly used test for loss of heterozygosity, and it allowed for detection of bottlenecks before 5% of a population's heterozygosity had been lost. The second most powerful tests were generally the tests for loss of alleles. However, these tests had reduced power for detecting genetic bottlenecks caused by skewed sex ratios. We provide guidelines for the number of loci and individuals needed to achieve high-power tests when monitoring via the variance test. We also illustrate how the variance test performs when monitoring loci that have widely different allele frequency distributions as observed in five wild populations of mountain sheep (Ovis canadensis).     

Three cases of fatal firearm use following external hinge removal from locked gun cabinets

In order to potentially decrease the number of homicides and suicides that result from firearms, one must decrease the accessibility of guns. We describe three cases that were obtained from the Onondaga County Medical Examiners Office in New York that occurred between January 1990 to March 1993. In two suicides and a double homicide, firearms were quietly obtained from commercially manufactured locked gun cabinets by removing the door hinges, which were located on the outside of the cabinet, with a screwdriver. The incidence of obtaining firearms by this method is not known. No other similar cases are reported in the literature. Removing hinges that are placed on the outside of the cabinet may be a common method of obtaining firearms to commit either homicide or suicide in the home, but perhaps not recognized. More information is needed. If additional cases are identified, then prevention in terms of gun cabinet design, may save lives in the future.     

The acquisition of psychotherapeutic skill: an empirical study

The acquisition of psychotherapy skillfulness is an important aspect of training programs in psychiatry and clinical psychology. Psychotherapy supervision is employed to teach and monitor the development of these clinical skills. The Supervisor Report (SR) is a questionnaire designed to systematically assess therapeutic behaviors and global psychotherapeutic skillfulness of therapists conducting psychodynamic psychotherapy. SRs were employed to examine changes in trainees' skillfulness over the course of training. T-tests were applied to evaluate differences between the average scores of trainees in the first half of their training compared to the last half of their training. Comparisons of the scores for Psychotherapeutic Techniques and assessments of Global Skillfulness were in the predicted direction: Trainees in the advanced portion of their training were rated as more skillful than at the beginning. This study provides some evidence that psychotherapy skillfulness is acquired over time in training.