The state of the state mental hospital 1996

OBJECTIVES: This analytical review is intended to update the author's earlier writings on the position of the state mental hospital within the spectrum of services for long-term mental patients and to provide perspective for the next generation of service planners. METHODS: Findings and commentary are organized around four major questions. First, what is the prevailing view of state mental hospitals today, and how does it compare with the view that existed in the first half of this century? Second, what individuals tend to be served in state mental hospitals today? Third, what has been the fate of mentally ill persons who are no longer served in state mental hospitals? Fourth, what is an appropriate role for the state mental hospital in today's uncertain and rapidly changing systems of care? Source material consists of periodical articles suggested in MEDLINE searches, plus newspaper reports, recent books on mental health service systems, and a variety of writings found in the "fugitive" literature generally not indexed in traditional archives. RESULTS AND CONCLUSIONS: Individual state mental hospitals vary in the composition of their resident populations, the content of their services, and the overall quality of their care. Although they have been superseded by community-based service structures in some places, they continue in general, as the result of their multifunctionality, to occupy a critical place in systems of care. Renewed efforts to integrate them as full partners within those systems must be undertaken.     

Regulation of thrombospondin in the regenerating mouse facial motor nucleus

Thrombospondin (TSP) is a multifunctional extracellular matrix protein that plays a role in neuronal migration and axonal outgrowth in the developing central nervous system. In the current study we have examined the localization and regulation of TSP immunoreactivity (TSP-IR) during neuronal regeneration in the axotomized facial motor nucleus using Western blotting and light and electron microscopy. Transection of the facial nerve led to a gradual increase in TSP-IR in the regenerating motoneurons, peaking 4-7 days after injury (DAI). In addition to regenerating neurons, axotomy also caused a rapid upregulation of TSP-IR on activated microglia throughout the facial nucleus, with a maximum of 2-3 DAI, and a second increase at 14-21 DAI on microglial aggregates surrounding degenerating motoneurons and in neuronophagic microglia. In summary, injury leads to the induction of thrombospondin on axotomized neurons and activated microglia, peaking at the times of maximal posttraumatic microglial proliferation and during neuronal phagocytosis. Since thrombospondin is a multimodal extracellular matrix protein with a variety of cell attachment sites, thrombospondin might serve to link microglia and injured neurons, followed by microglial proliferation and removal of the neuronal debris.     

Crystallins from rat lens are especially susceptible to calpain-induced light scattering compared to other species

PURPOSE: To compare the susceptibility of crystallins from various animal species to formation of light scattering elements after proteolysis by calpain II enzyme (EC 3.4.22.17). METHODS: Lens, total soluble proteins from: 12-day and 4-week old rat, fetal and adult bovine, 16-day embryonic and 10-week chicken, and young human cortex and nucleus were proteolyzed by either endogenous lens calpain or addition of purified calpain II for 24 h followed by incubation for up to 11 days. Absorbance of light at 405 nm estimated light scattering by crystallins; SDS-PAGE and 2D-electrophoresis assessed proteolysis on the crystallins. RESULTS: Most rapid light scattering occurred with total soluble proteins from young rat lens, either after adding purified calpain or by activating endogenous lens calpain with calcium. (Only rat lens showed activation of endogenous calpain II.) beta-crystallin polypeptides from rat, bovine, human, and to a more limited extent, chick lens were partially proteolyzed by addition of purified calpain II. In spite of this proteolysis, total soluble proteins from chicken, bovine, and human lenses showed no obvious light scattering by action of calpain. Crystallins from older rat lens showed approximately 50% of the light scattering displayed by crystallins from younger rats after 3 days, but only when purified calpain was added. CONCLUSIONS: Our results indicate an unusually high susceptibility of crystallin polypeptides from young rat lens to formation of light scattering elements after limited proteolysis. Thus, young rat lens provides a unique opportunity to investigate how properties of crystallins influence the development of light scattering found in cataract.     

The course and outcome of viral hepatitis B in drug-addicted patients

In this paper, characterization is given of clinical and biochemical features of VH B course against the background of narcomania. Recordable in such patient populations are high percentage of delta hepatitis (14.2%), unusual severity of the intoxication syndrome, protracted course with exacerbations (12.2%) and recurrences (8%), outcome being a chronic hepatitis (14.2%), slower normalization of biochemical indicators, persistently low ratio of AIAT activity in diluted and whole blood sera. The persistence of viral markers in drug addicts discharged from the hospital (68%) is fraught with danger of spreading viral hepatitis of prophylactic measures are not strictly observed.     

Tumor necrosis factor alpha interferes with the cell cycle of normal and papillomavirus-immortalized human keratinocytes

We have shown that normal and human papillomavirus (HPV) type 16 immortalized human foreskin keratinocytes are growth inhibited by tumor necrosis factor alpha (TNF-alpha), whereas HPV-18- and SV40-immortalized keratinocytes are resistant to this cytokine (1). In this report, we investigated the expression of mitotic regulatory proteins, such as cyclin A, cyclin B, and p34cdc2. After exposure to TNF-alpha, normal and HPV-16-immortalized cells exhibited a dramatic decrease in the expression of these proteins. In contrast, no alteration in the levels of these proteins was observed after treatment of the resistant cell lines, as well as two HPV-positive cervical carcinoma cell lines. Expression of cyclin E does not seem to be modulated by TNF-alpha in any of the cells tested. On the other hand, cyclin D1, expression is slightly increased in normal keratinocytes and in the HPV-16-immortalized cells, whereas no alteration was observed in the HPV-18-transfected cells. The phosphorylation state of pRb correlated with cell growth; sensitive cells, which accumulate in G0-G1, after exposure to TNF-alpha, exhibited an accumulation of hypophosphorylated pRb, whereas no effect on pRb phosphorylation was observed for HPV-18-immortalized cells. These results clearly correlate with TNF-alpha-induced growth arrest in G0-G1.     

Noncriterial recollection: familiarity as automatic, irrelevant recollection

Recollection is sometimes automatic in that details of a prior encounter with an item come to mind although those details are irrelevant to a current task. For example, when asked about the size of the type in which an item was earlier presented, one might automatically recollect the location in which it was presented. We used the process dissociation procedure to show that such noncriterial recollection can function as familiarity--its effects were independent of intended recollection.     

Development and testing of a quality of life model for long-term female cancer survivors

OBJECTIVES: To document the effects of pelvic radiotherapy on bowel, bladder, and sexual function, as reported by the patient. METHODS: A confidential questionnaire was distributed to 202 prostate cancer patients. Mean age was 70 years (range, 49 to 87) and mean follow-up was 33 months (range, 12 to 72). Radiation was given by a standard four field box technique on a linear accelerator to 60 to 66 Gy over 6.5 weeks. Treatment was limited to the prostate and seminal vesicles for small well-differentiated tumors, but otherwise included internal and external iliac nodes. RESULTS: Responses were obtained from 192 patients (95%). No or mild change in bowel function was reported by 64% of patients, 25% reported moderate change, and 11% reported severe change. Rectal urgency was a concern for 20%, and 5% reported fecal soiling in the preceding 6 months. Hematochezia at least once a week was reported by 9% and daily by 5%. Frequent hematochezia decreased from 17% in the second and third post-treatment years to 4% after 3 years (P = 0.02). Transfusions or laser surgery for proctitis was required by 4%. No patient required a colostomy for rectal complications. Urinary stream was unchanged or improved for 83%. Nocturia was unchanged or improved in 70%. Some form of protection for urinary incontinence was required by 2%, and 0.5% noted frequent hematuria and 2% moderate to severe dysuria. Potency prior to radiotherapy was reported by 82% and was lost following radiotherapy in 35%. Technical factors, including treatment volumes and total dose, did not correlate to the risk of moderate or severe complications. CONCLUSIONS: The sequelae of pelvic radiotherapy as viewed from the patient's perspective reveal a major alteration in bowel function in 11%, significant bladder symptoms in 4%, and loss of potency in 35%.     

Clinical and experimental studies on preventing and treating anaphylactic asthma with Zusanli point immunotherapy

We have studied on preventing and treating anaphylactic asthma with Zusanli (S36) point immunotherapy (ZPIT). Sixty-nine patients were observed. The results showed that the clinical curative effect of ZPIT was not only much higher than that of conventional desensitization therapy, but also the patients' total IgE level was reduced, anti-acarid IgE was lowered, SIgA level was raised, the absolute eosinophilic granulocyte level dropped and pulmonary function recovered. Animal experiment results showed that the ZPIT could more effectively suppress the guinea pigs' anaphylactic asthma allergized by albumin and more obviously resist the guinea pigs' bronchial spasm induced by histamine and acetylcholine than the conventional desensitization therapy and injected normal saline. The immunomodulating action of the ZPIT are elucidated from clinical study and animal experiment in the paper.     

Sak57, an acidic keratin initially present in the spermatid manchette before becoming a component of paraaxonemal structures of the developing tail

We have previously reported that Sak57 (for Spermatogenic cell/Sperm-associated keratin of molecular mass 57 kDa) is an acidic keratin found in rat spermatocytes, spermatids, and sperm. Sak57 displays conserved amino acid sequences found in the 1A and 2A regions of the alpha-helical rod domain of keratins in human, rat, and mouse. We now report indirect immunofluorescence, confocal laser scanning microscopy and immunogold electron microscopy data showing that Sak57 is associated with the microtubular mantie of the manchette, a transient microtubular structure largely regarded as formed by tubulin and microtubule-associated proteins. The immunocytochemical localization of Sak57 was detected with a polyclonal antiserum to a multiple antigenic peptide (MAP) containing an amino acid sequence known to be present in the 2A region of the alpha-helical rod domain. During spermiogenic steps 8-12, Sak57 immunoreactive sites were restricted to microtubular mantie of the manchette which encircles the spermatid nucleus during shaping and chromatin condensation. At later stages (spermiogenic steps 12-14), Sak57 immunoreactive sites in the spermatid head region disappeared gradually as specific immunoreactivity appeared along the already assembled axoneme of the developing spermatid tail. Immunogold electron microscopy confirmed the presence of Sak57 immunoreactivity among microtubules of the manchette and on outer dense fibers and the longitudinal columns linking the ribs of the fibrous sheath. Mature spermatids (spermiogenic step 19) displayed tails with an immunofluorescent banding pattern contrasting with the lack of Sak57 immunoreactivity in the head region. Results from this study suggest that, during early spermiogenesis, a microtubular-Sak57 scaffolding is associated with the spermatid nucleus during shaping and chromatin condensation. During late spermiogenesis, the dispersion of the manchette coincides with the progressive visualization of Sak57 in the paraaxonemal outer dense fibers and longitudinal columns of the fibrous sheath in the developing spermatid tail.     

Hospitalization for acute pyelonephritis in Manitoba, Canada, during the period from 1989 to 1992; impact of diabetes, pregnancy, and aboriginal origin

Population-based rates of hospitalization for acute pyelonephritis were estimated over 3 years with use of provincial administrative data on health care. Retrospective review of records of ICD9-CM discharge codes of pyelonephritis and urinary infection was performed in two acute care institutions to validate the discharge diagnosis; 80% of patients with a discharge diagnosis of pyelonephritis and 7% to 20% of patients with a discharge diagnosis of urinary infection met clinical criteria for admission for acute pyelonephritis. Mean rates of hospitalization +/- SD for acute pyelonephritis were 10.86 +/- 0.51 per 10,000 population among women and 3.32 +/- 0.27 per 10,000 population among men. From 18% to 31% of hospitalized women aged 20-39 years pregnant; 36% of 797 hospitalized women and 21% of 402 hospitalized men 40 years of age or older were diabetic. The hospitalization rates among Native American women with treaty status were five to 20 times greater than those among other women, which was partially attributable to a significantly greater frequency of pregnancy and diabetes in the former women. Hospitalization for acute pyelonephritis is common, and pregnancy and diabetes contribute substantially to hospitalization rates. The increased hospitalization rate among Native American women with treaty status is not fully explained by pregnancy or diabetes.