How can pain of surgery be limited?

Pentavalent rhenium-188 dimercaptosuccinic acid [188Re(V)DMSA] is a beta-emitting analogue of 99mTc(V)DMSA, a tracer that is taken up in a variety of tumours and bone metastases. The aim of this study was to develop the kit-based synthesis of the agent on a therapeutic scale, to assess its stability in vivo, and to obtain preliminary biodistribution and dosimetry estimates, prior to evaluation of its potential as a targeted radiotherapy agent. The organ distribution of 188Re in mice was determined 2 h after injection of 3 MBq 188Re(V)DMSA prepared from eluate from a 188W/188Re generator. Three patients with cancer of the prostate and three with cancer of the bronchus, all with bone metastases confirmed with a standard 99mTc-hydroxymethylene diphosphonate (99mTc-HDP) scan, were given 370 MBq 188Re(V)DMSA and imaged at 3 h and 24 h using the 155-keV gamma-photon (15%). Blood and urine samples were collected to determine clearance and to analyse the speciation of 188Re. Organ residence times were estimated from the scans, and used to estimate radiation doses using MIRDOSE 3. In mice, 188Re(V)DMSA was selective for bone and kidney. In patients, it showed selectivity for bone metastases (particularly those from prostate carcinoma) and kidney, but uptake in normal bone was not significantly greater than in surrounding soft tissues. Of the normal tissues the kidneys received the highest radiation dose (0.5-1.3 mGy/MBq). The images were strongly reminiscent of 99mTc(V)DMSA scans in similar patients. High-performance liquid chromatography analysis of blood and urine showed no evidence of 188Re in any chemical form other than 188Re(V)DMSA up to 24 h. In conclusion, 188Re(V)DMSA and its 186Re analogue warrant further clinical assessment as generator/kit-derived agents for treatment of painful bone metastases. These agents should also be assessed in medullary thyroid carcinoma and other soft tissue tumours which have been shown to accumulate 99mTc(V)DMSA.     

Relationship of trauma patient volume to outcome experience: can a relationship be defined?

OBJECTIVES: Five years experience recorded in a multi-institutional pediatric trauma registry was analyzed to define the relationship between case volume and outcome as measured by mortality. METHODS: A total of 30,930 records with complete data were categorized by contributing hospital. Patients with fatal injury as indicated by an injury severity score of 75 or any abbreviated injury scale of 6 were excluded. Each center's experience was stratified by injury severity using injury severity score > or = 15 as indicative of severe injury. Centers were then classified as low volume (LV, 100-500 cases), mid volume (MV, 501-1,000 cases), or high volume (HV, > 1,000 cases). Proportion of patients with severe injury (injury severity score > 15) and mortality were compared among groups using the chi(2) test with significance accepted at p < 0.05. Using the Pediatric Risk Indicator to adjust for mortality risk, the combined hospital experience of each volume group was further analyzed to assess performance with specific levels of increasing injury severity. RESULTS: Findings demonstrated a trend of increasing mortality with increasing volume, despite a consistent proportion of severe injury. Risk adjusted mortality for each volume class indicates best outcome in the mid level group. CONCLUSIONS: Regardless of overall volume of patients encountered, there is a consistent proportion of severe injury. The increasing mortality with the most severe injuries seen in the high volume centers may reflect overdemand on resources.     

Extinction can be enhanced by a concurrent excitor.

Five experiments used rat subjects to investigate the impact on extinction of the presence of other conditioned stimuli. In Experiments 1 (Pavlovian magazine approach) and 2 (instrumental discriminative training), an excitatory stimulus (X) was extinguished alone, in conjunction with a previously reinforced other stimulus (A), in conjunction with previously nonreinforced other stimulus (B), or it was spared extinction. Responding during extinction was greatest to AX, and subsequent testing of X alone showed AX extinction to have produced the most decrement to X. Experiment 3 found similar results using a within-subject design. Experiment 5 continued separate reinforced presentations of A during extinction. This procedure not only promoted extinction of X but also converted it into a conditioned inhibitor. These experiments bear on the mechanisms of overshadowing and stimulus processing, as well as provide information on the determinants of extinction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What can be done to improve the journal review process.

Presents suggestions for improving the journal review process by providing explicit, uniform guidelines for editors and reviewers. The author also recommends providing (1) information to authors about recommending reviewers, (2) a meaningful appeals procedure, (3) identity of reviewers, and (4) forms for authors to provide feedback to reviewers. Two of these practical steps can be implemented immediately and informally. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Monoclonal antibody Cat-301 selectively identifies a subset of nuclei in the cat's somatosensory thalamus

Recently it has been demonstrated that the monoclonal antibody Cat-301 is capable of identifying functionally related neurons in the mammalian visual thalamus. We have examined the possibility that this antibody might display a similar capacity in nonvisual thalamic areas. We demonstrate that in the cat's somatosensory thalamus the distribution of Cat-301-positive cells and neuropil is restricted to a subset of nuclei. These include the ventroposterior medial, ventroposterior lateral, and ventroposterior inferior nuclei. Staining with Cat-301 provides a clear visualisation of the entire somatotopic map within these nuclei. The somatosensory sector of the thalamic reticular nucleus and the perireticular nucleus, which may have a somatosensory sector, are also Cat-301-positive. In contrast, cells that do not express the Cat-301 antigen are located in the ventroposterior oralis nucleus, the ventroposterior shell region, the medial and lateral divisions of the posterior nuclear group, and the inner small cell region adjacent to the thalamic reticular nucleus. In comparison with previous physiological studies, cells that express the Cat-301 antigen most likely represent subpopulations in only a few of the somatic submodality-specific groups. These include cells in the small-field and Pacinian cutaneous-responsive groups, excluding cells in the wide-field cutaneous-, muscle-, joint-, and noxious-responsive groups. Taken together these findings indicate that monoclonal antibody Cat-301 is capable of selectively identifying neurons with distinct functional properties in the mammalian somatosensory thalamus.     

Theory evaluation can be unintentional self-portraiture: A reply to Williams.

B. A. Williams's (see record 1990-21741-001) commentary on C. P. Shimp et al (see record 1990-21730-001) derives from his matching law perspective and shows chiefly that associative learner and the matching law are different. The choice of which theoretical approach is better depends on one's background views about the nature and purpose of theory, the nature of a free-operant behavior stream, and the suitability of classical methods and results for identifying and resolving critical theoretical problems such as identifying suitable analytical units and adequately characterizing how reinforcement reorganizes the local structure of the behavior stream. Williams' perspective, that of a molar position, needs further conceptual clarification and empirical support before it can be convincing. An alternative molecular view seems attractive for offering the promise of conceptually integrating molar and molecular empirical phenomena. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Renal sonography: can it be used more selectively in the setting of an elevated serum creatinine level?

The objectives of our study were to (1) assess the outcomes resulting from the use of sonography in patients referred to our institution's ultrasound laboratory for an elevated serum creatinine level and (2) determine relevant clinical parameters in these patients to better triage them for sonography. We retrospectively identified and determined outcomes of 60 patients (20 women, 40 men; mean age, 61 years; range, 33 to 100 years) referred for sonographic evaluation because of an increased serum creatinine level (> or = 1.3 mg/dL). Ultrasound findings (hydronephrosis, renal size, and echogenicity) were correlated with clinical outcomes. Twenty-one patients (35%) had hydronephrosis, with 14 of these patients confirmed to be obstructed and five not obstructed. Two were indeterminate for obstruction. Eight of 14 obstructed patients were successfully treated. All obstructed patients had a suggestive history for obstruction with at least one of the following: pelvic mass (n = 9), stone disease (n = 4), or flank pain (n = 1). Only 2 of 44 patients, who were not obstructed, had any of these parameters (statistically significant difference, P < 0.0001). Thirty of the patients, who were not obstructed, had more likely alternative causes for renal failure, with sonography having no effect on patient management. Renal size and echogenicity had little effect on patient management. Sonography was efficacious in guiding management in patients with a suggestive history for obstruction (eg, pelvic mass, stone disease, or flank pain) but not in most patients who had no suggestive history and other more likely causes for renal failure.     

Restriction endonucleases can be used to confirm a structure of unusual DNA duplexes

Cyclic and polycyclic oligonucleotides were synthesized using chemical ligation. Two types of catenanes with one and several intertwinings were produced. The yield of these molecules depended on the ligation conditions and nucleotide sequence of the ligated oligonucleotide and its template. Structure of ligation products was investigated and confirmed using restriction endonuclease MvaI. Interaction of the synthesized molecules with restriction endonucleases SsoII, EcoRII and HindIII was also studied.     

Biliary reflux can be a contributory cause of esophagitis

In recent years duodenogastric reflux has been recognised as a possible cause of oesophagitis. Alone or in combination, bile salts, trypsin, pepsin, and hydrochloric acid have all been shown to cause oesophagitis. Duodenal content in the oesophagus can be measured by means of a new fibre-optic sensor, Bilitech 2000, a device measuring the occurrence of bilirubin and yielding 24-hour readings from the distal oesophagus. Studies in which the device has been used have shown oesophageal bilirubin to be increased in patients with oesophagitis, especially in the subgroup with such complications as oesophageal stricture or ulceration, or Barrett's oesophagus. The evidence suggests that unsatisfactory response to proton pump inhibitors in reflux patients might be due to an increase in duodenal reflux, and should be treated surgically with fundoplication or biliary diversion. This may also be true of oesophagitis patients with complications, though this remains to be shown in clinical studies.     

Intrathyroidal parathyroid glands can be a cause of failed cervical exploration for hyperparathyroidism

BACKGROUND: The incidence of intrathyroidal parathyroid glands remains controversial. The purpose of this study was to determine the incidence in a series of patients with hyperparathyroidism. METHODS: Three hundred nine patients underwent parathyroidectomy. Patients were divided into two groups: uniglandular disease versus hyperplasia. RESULTS: Eighteen of 309 patients (6%) had abnormal intrathyroidal parathyroid glands. The incidence was 3% (7 of 222) in patients with uniglandular disease versus 15% (11 of 73) in those with hyperplasia. With a mean follow-up of 54 months, 12 patients are eucalcemic, 5 have persistent hypocalcemia, and 1 has recurrent hypercalcemia. There were no recurrent laryngeal nerve injuries. CONCLUSIONS: These data suggest that an intrathyroidal adenoma is an uncommon cause of failure, whereas abnormal intrathyroidal parathyroid tissue may be a more common cause of failure in patients with hyperplasia.     

Comparison of alcohol-preferring and nonpreferring selectively bred rat lines. I. Ethanol initiation and limited access operant self-administration

Several lines of alcohol-preferring and alcohol-nonpreferring rats have been developed using selective breeding based on 24-hr homecage ethanol consumption. However, it remains unclear if the selection based on two-bottle choice resulted in similar ethanol self-administration when measured using an operant procedure. In this paper, we compare our previous work using alcohol-accepting (AA) and alcohol-nonaccepting (ANA) rats with data obtained using the identical procedures in the (P) and (NP) rat lines, and both replicate lines of the high alcohol drinking (HAD1 and HAD2) and low alcohol drinking (LAD1 and LAD2) lines. All rats from each line were initiated to self-administer 10% ethanol using the sucrose fading procedure. After initiation, increasing concentrations of ethanol up to 30% ethanol were tested. The results indicated that only in the LAD1 and LAD2 lines was ethanol presentation not able to maintain lever pressing after initiation. Compared with the AA line, the P, HAD1, HAD2, and NP lines all self-administered more ethanol in the operant paradigm after initiation. The ANA line self-administered less ethanol than the AA line, but more than the LAD lines. Correlational analysis of homecage consumption with operant ethanol self-administration suggested that approximately 62% of the genetic variance in operant self-administration resulted from genes selected for the homecage drinking. At the same time, it was clear that there were genetic influences on operant self-administration that were not selected for by homecage ethanol drinking.     

Self-presentation can be hazardous to your health: Impression management and health risk.

People's concerns with how others perceive and evaluate them can lead to behaviors that increase the risk of illness and injury. This article reviews evidence that self-presentational motives play a role in several health problems, including HIV infection; skin cancer; malnutrition and eating disorders; alcohol, tobacco, and drug use; injuries and accidental death; failure to exercise; and acne. The implications of a self-presentational perspective for research in health psychology, the promotion of healthful behaviors, and health care delivery are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Molecular approaches to diagnosis of Chagas' disease: use of defined antigens and a target ribosomal RNA sequence

We evaluated the performance of two defined antigens in the serological diagnosis of Chagas' disease. One of them is a recombinant protein named B13 isolated from a genomic library of Trypanosoma cruzi in the expression vector lambda gtll. We show that the gene corresponding to B13 is conserved in the evolutive stages of the two "polar" strains of T. cruzi. The protein epitopes cloned in B13 are represented in 140 kDa, 116 kDa and 35 kDa polypeptides of trypomastigotes. The other antigen chosen for serodiagnosis is a lipopeptidophosphoglycan (LPPG). This glycoconjugate is also widely distributed in T. cruzi strains. The use of a rabbit serum to LPPG allowed the demonstration that this molecule bears epitopes in common to LPPG-like components and to 80-90 kDa glycoproteins of trypomastigotes. Both B13 and LPPG were evaluated in serodiagnosis by ELISA and RIA using a panel of normal human, Chagasic and Leishmaniasis sera. It was observed that B13 presents high sensitivity and specificity for Chagasic sera. For LPPG it was also concluded that this reagent discriminates between individuals infected and non-infected with T. cruzi. A heterogeneity in the level of antibodies to LPPG in Chagasic patients was detected. No correlation was found between the clinical form of Chagas' disease and the preferential reactivity to B13 or LPPG. We also report preliminary studies towards the characterization of a 100 bp sequence of the 24S alpha rRNA as a target for DNA-based detection systems for diagnosis. We show that polymerase chain reaction of total DNA of different trypanosomatids lead to the specific amplification of a 100 bp fragment only for T. cruzi. Northern blots confirmed the presence of the target region in the mature 24S alpha rRNA. Titration experiments based on the direct amplification of RNA with Taq DNA polymerase allowed the detection of 50 parasites. Studies are in progress to increase the sensitivity of the proposed system.     

Psychology can be indispensable to health care reform and the patient-centered medical home.

The Patient Protection and Affordable Care Act (PPACA) was passed into legislation in March 2010, making health care reform a reality. Perhaps the most well-developed model of primary care that aligns with the PPACA's agenda is the patient-centered medical home (PCMH). Integrated care, as defined by collaborative care between mental health and primary care providers and systems, will undoubtedly play a critical role in the success of the PCMH. The role of psychology and integrated care in the PCMH as well as training implications for psychologists are discussed. This article is intended to challenge our discipline to embrace psychology as a health care profession that must prepare for and solidify its added value in the health care delivery models of the future. Requisite skill sets for primary care psychologists and existing training opportunities are presented. Finally, possible mechanisms for training psychologists in integrated care and the professional roles primary care psychologists can expect to fill are proposed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)