Obesity

Obesity is a chronic disease, which similar to diabetes and hypertension, requires long-term treatment. The patient must be willing to make major changes in eating habits, lifestyle, and physical activity to achieve long-lasting results.     

Authorship: the coin of the realm, the source of complaints

CONTEXT: Disputes associated with achieving recognition for work done may affect both morale and subsequent resource allocation to medical researchers. OBJECTIVE: To assess authorship disputes brought to the Ombuds Office. SETTING: The Ombuds Office, Harvard Medical School, Dental School, School of Public Health, and affiliated hospitals. MAIN OUTCOME MEASURE: Change in number of queries related to authorship between 1991 to 1992 and 1996 to 1997. RESULTS: Disputes increased from 8 (2.3%) of 355 issues brought to the office in 1991 to 1992 to 59 (10.7%) of 551 issues in 1996 to 1997. They also increased from involving 0.06% of the total population of faculty, staff, and students affiliated with the schools in 1991 to 1992 to 0.33% of the total population in 1996 to 1997. Such problems appear to occur more often for women (53% of complaints in 1994-1995 through 1996-1997) and for non-US citizens (21 % of complaints in 1991-1992 through 1996-1997). CONCLUSIONS: Authorship disputes are increasingly frequent. Institutions should increase enforcement of published authorship standards and place more emphasis on managerial skills for laboratory and research department heads.     

Comparison of erythrocyte uridine sugar nucleotide levels in normals, classic galactosemics, and patients with other metabolic disorders

By limiting galactosylation mechanisms, a cellular deficiency of the uridine sugar nucleotide, UDPgalactose, has been implicated as a cause of the long-term complications seen in patients with classic galactosemia despite dietary treatment. As a result, great interest has been generated in the accurate assessment of UDPgalactose, as well as UDPglucose, from which UDPgalactose may be derived by the function of a ubiquitous, active UDPgalactose-4-epimerase. Since several series of values for the concentration of these compounds in red blood cells (RBCs) of galactosemics have been flawed by the use of methods subsequently shown to be unsuitable, we have quantified erythrocyte UDPgalactose and UDPglucose levels by an accurate high-performance liquid chromatography (HPLC) assay in 116 normals, 76 galactosemics, and 39 patients with other metabolic disorders. These large groups have permitted the evaluation of age, diet, and genotype as influential factors in the steady-state RBC levels of the sugar nucleotides. The data show that age is an important determinant of RBC levels, with children younger than 10 years having higher values than individuals older than 10 years. Mean UDPgalactose levels in galactosemic children younger than 10 years and those older than 10 years were 30% and 18% lower, respectively, than levels in comparable normals. Although the mean differences were highly significant, there was considerable overlap of individual values. There was no difference in UDPglucose levels between galactosemics and normals.(ABSTRACT TRUNCATED AT 250 WORDS)     

Survival and disability at 7-8 years of age in New Zealand infants less than 28 weeks gestation

AIMS: To determine the survival and disability rates at 7-8 years in infants of less than 28 weeks gestation born in New Zealand in 1986 and admitted to a neonatal unit. METHODS: In 1986, all infants with birthweight less than 1500 g and admitted to neonatal units were enrolled in a prospective audit of retinopathy of prematurity. Surviving infants, including the subset born at less than 28 weeks gestation, have been assessed at a home visit. Parents completed a comprehensive questionnaire and children underwent a visual assessment and were tested on the Wechsler Intelligence Scale for Children. RESULTS: Of 126 liveborn infants less than 28 weeks gestation, 80 (64%) survived to 7-8 years. Sixty eight children (97% survivors resident in New Zealand) were assessed: 72% had no, and 86% no or only mild disability, 77% had some visual problem, with close to one-third having myopia, strabismus or requiring spectacles and 32% received Ministry of Education funded special needs assistance. CONCLUSIONS: There have been few long-term follow-up studies of infants of less than 28 weeks gestation born in a defined geographical area. The outcome for New Zealand infants is comparable with that in other published data.     

Sources of diagnostic uncertainty for chronically psychotic cocaine abusers

OBJECTIVE: This study determined the sources and frequency of diagnostic uncertainty for patients with chronic psychosis and active cocaine abuse or dependence and assessed the usefulness of prospective follow-up in clarifying diagnosis. METHODS: A total of 165 male patients with chronic psychoses and cocaine abuse or dependence on inpatient units of a Veterans Affairs medical center were evaluated using the Structured Clinical Interview for DSM-III-R (SCID-R), urine tests, hospital records, and interviews with collateral sources. An algorithm allowing key SCID-R items and diagnostic criteria to be designated as provisionally met or uncertain was applied, resulting in a provisional diagnosis and a list of alternate diagnoses. The assessment was repeated 18 months later in an attempt to resolve diagnostic uncertainty. RESULTS: In 30 cases (18 percent), initial assessment produced a definitive diagnosis, including 21 cases of schizophrenia, six of schizoaffective disorder, and three of psychostimulant-induced psychotic disorder. In the other 135 cases, a definitive diagnosis could not be reached because of one or more sources of diagnostic uncertainty, including insufficient periods of abstinence (78 percent), poor memory (24 percent), and inconsistent reporting (20 percent). Reassessment at 18 months led to definitive diagnoses in 12 additional cases. CONCLUSIONS: It was frequently difficult to distinguish schizophrenia from chronic substance-induced psychoses. Rather than concluding prematurely that psychotic symptoms are, or are not, substance induced, clinicians should initiate treatment of both psychosis and the substance use disorder in uncertain cases. The persistence or resolution of psychosis during abstinence and additional history from the stabilized patient or collateral sources may clarify the diagnosis.     

Salvia divinorum and the unique diterpene hallucinogen, Salvinorin (divinorin) A

Salvia divinorum is a vision-inducing mint used by the Mazatec people of Oaxaca, Mexico. It is grown in California and other parts of the United States where it is employed as a legal hallucinogen. Traditional opinion has been that the plant has mild psychotropic activity, at best. However, when ingested in the correct manner, it is quite powerful. The fresh leaves are chewed as a quid and kept in the mouth. They may also be eaten raw or prepared as an aqueous infusion. When dried, they are smoked in the manner of marijuana. The neoclerodane diterpene, salvinorin A (also known as divinorin A), has been demonstrated in animals and humans to be its major active ingredient. Essentially inactive if taken orally, the compound is effective in doses of 200 to 500 mcg when smoked in a manner similar to cocaine free base. This makes salvinorin A the first documented diterpene hallucinogen and the most potent naturally occurring hallucinogen thus far isolated. This is somewhat remarkable, since the compound is not an alkaloid. This article reviews the use of S. divinorum and its chemistry. In addition, it discusses the effects of the plant and salvinorin A in animals and humans, as well as their potential to become drugs of abuse.     

Factors influencing survival after gamma knife radiosurgery for patients with single and multiple brain metastases

BACKGROUND: Significant changes are restructurng the U.S. health care delivery system. National health reform is now extending itself into the public sector. Increased health and medical costs by federal and state governments are forcing a reevaluation of major entitlement programs, especially Medicaid. METHODS/RESULTS: Because Medicaid is the single largest item in many state budgets, states are now enrolling Medicaid patients into managed and coordinated care arrangements as a means to control costs and increase access to care. HMOs are not only competing for private patients but also actively seeking the Medicaid population. Nationally, almost one-fourth of all Medicaid patients are now enrolled in managed care plans. Various models and approaches have been developed by individual states. CONCLUSIONS: Because managed care enrollment in the Medicaid program has increased substantially in recent years, selected services including vision care are no longer rendered by any practitioner willing to accept Medicaid fees. Freedom of choice is now restricted to pre-selected and panel practitioners participating with the managed care program. The rules, regulations, billing procedures, fees, and program requisites will differ under managed care programs. Private optometric practitioners must consider entering economic and organizational relationships and linkages that make them attractive to managed care organizations.     

Bone morphogenetic proteins and bFGF exert opposing regulatory effects on PTHrP expression and inorganic pyrophosphate elaboration in immortalized murine endochondral hypertrophic chondrocytes (MCT cells)

We isolated cDNA clones encoding five S-RNases (S1-, S3-, S5-, S6-, S7-RNases) from pistils of Pyrus pyrifolia (Japanese pear), a member of the Rosaceae. Their amino acid sequences were aligned with those of other rosaceous S-RNases sequenced so far. A total of 76 conserved amino acid residues were stretched throughout the sequence, but were absent from the 51-66 region which was designated the hypervariable (HV) region. The phylogenetic tree of rosaceous S-RNases showed that S-RNase polymorphism predated the divergence of Pyrus and Malus. Pairwise comparison of these S-RNases detected two highly homologous pairs, P. pyrifolia S1- and S4-RNases (90.0%) and P. pyrifolia S3- and S5-RNases (95.5%). The positions of amino acid substitutions between S1- and S4-RNases were spread over the entire region, but in the pair of S3- and S5-RNases, amino acid substitutions were found in the 21-90 region including the HV region. The substitutions in this restricted region appear to be sufficient to discriminate between S3 and S5 pollen and to trigger the self-incompatible reaction.     

SSX: a multigene family with several members transcribed in normal testis and human cancer

The behavioral effects were studied of monoclonal antibodies (MA) against A3G7 protein, which is known to be associated with the processes of nervous cell differentiation. Elaboration, storage, and retention of acoustic startle (ASR) habituation and freezing behavior were tested in adult rats. The MA applied in a dose of 50 ng on cerebellar vermis selectively impaired only the ASR long-term habituation storage whereas its dose of 5 mcg impaired both long-term habituation storage and fear-conditioned freezing. Application of 10 mcg of MA disrupted the elaboration and storage of the ASR short- and long-term habituation as well as fear-conditioned freezing. The results are considered as experimental verification of systemogenesis theory and hypothesis about a common molecular basis of learning and development.