Neural systems affected in developmental dyslexia revealed by functional neuroimaging

Spiral ganglion neurones in rat cochlea express three different isoforms of the P2X2 receptor subunit which assemble into ATP-gated ion channels. Two of these P2X2R subunit isoforms have previously been detected in other auditory tissues. The third isoform (designated P2X2-3R) has not been described. This isoform lacks 39 bp immediately prior to the stop codon, corresponding to a 13 amino acid deletion of the extreme C-terminus domain. Using direct in situ RT-PCR, expression of P2X2R mRNA was confined to a subpopulation of type I spiral ganglion neurones. This study supports a role for extracellular ATP as a neurotransmitter for a discrete population of auditory neurones where variation in P2X2R isoform assembly may confer functional heterogeneity, including enhanced desensitization.     

Benefit of 6 months long-term physical training in polymyositis/dermatomyositis patients

OBJECTIVE: The benefit of long-term physical training in patients with chronic polymyositis or dermatomyositis (PM/DM) was studied prospectively. METHODS: Eight patients with chronic PM/DM participated in a training programme for 6 months. A group of five PM/DM patients without any physical training was observed for control purposes. RESULTS: While there was no significant change in serum creatine phosphokinase (CPK) levels, the 'activities of daily living (ADL)' score improved significantly (P < 0.03), peak isometric torque (PIT) generated by muscle groups in the lower extremities rose significantly (P < 0.03) and there was a statistically highly significant increase in peak oxygen uptake (VO2max) relative to body weight (P < 0.02) due to the long-term training. The patients improved their aerobic capacity by 28%, which is clinically significant. In the untrained patients, no improvement in these target parameters was observed. CONCLUSION: In clinically stable DM/PM patients, long-term physical training can safely be performed and is recommended as part of a comprehensive rehabilitation management, particularly in view of the cardiopulmonary risk in these patients.     

A survey of physicians'' education in caring for the dying: identified training needs

Laparoscopic hernia repair costs more than open repair. This increase in cost largely is because of the use of disposables. Indirect cost benefits of laparoscopic procedure because of a more rapid return to normal activity are different to calculate but may be present for select groups of patients.     

The effect of epidural injection of betamethasone or bupivacaine in a rat model of lumbar radiculopathy

STUDY DESIGN: The effect of epidural injection of betamethasone or bupivacaine was investigated in an animal model of lumbar radiculopathy. OBJECTIVE: To investigate the effects of an epidural steroid (betamethasone) or a local anesthetic (bupivacaine) in an animal model of radiculopathy produced by nerve root irritation. SUMMARY OF BACKGROUND DATA: Epidural injections are commonly used for the treatment of low back pain and sciatica. However, efficacy remains controversial, and there is a paucity of basic information to support clinical use or the injections. METHODS: Fifty-one rats were used. The left L4 and L5 nerve roots were loosely ligated with chromic gut, and either betamethasone, bupivacaine, betamethasone in combination with bupivacaine, or saline was injected using an epidurally placed catheter. The effects of epidural injection were evaluated using response to noxious stimuli and immunohistochemical methods. RESULTS: In betamethasone-treated rats (either alone or in combination with bupivacaine), thermal hyperalgesia was significantly less (P < 0.010 after surgery than that in saline- or bupivacaine-treated groups, in which the hyperalgesia was maximum at 2-3 postoperative weeks before resolving 5 weeks after surgery. Immunohistochemical analysis did not correlate with these results. CONCLUSIONS: Epidural steroid injection has a significant effect on the thermal hyperalgesia produced in a model of radiculopathy, which may provide clinical support for advocates of epidural steroids.     

In search of value: an international comparison of cost, access, and outcomes

The United States spent the most resources on health care of all the twenty-nine industrialized countries in 1996 by a wide margin. Managed care and other recent initiatives have been credited with slowing the rate of increase in the U.S. health care spending in recent years. Although the rate of increase slowed, it was still more rapid than the rate in most other industrialized countries between 1990 and 1996. Among the twenty-nine industrialized countries, the United states had the lowest percentage of its population eligible for publicly mandated insurance in 1995. Since 1960 Greece, Korea, and Mexico have surpassed the United States on this measure. AMong the twenty-nine industrialized countries, only the United States had less than half of its population eligible for publicly mandated health insurance in 1995. The United States appears to be comparable to the other G7 countries in terms of access to physicians, in-patient hospital services, and pharmaceuticals. However, on outcomes indicators such as life expectancy and infant mortality, the United States is frequently in the bottom quartile among the twenty-nine industrialized countries, and its relative ranking has been declining since 1960.