bluuebunny/crossref_metadata_2025 huggingface dataset:
Expedition Health and Safety: A Risk Assessment
Authors: Anderson Sarah R , Johnson Chris J H
Published: July 2017

Little has been published on the risks of participating in an expedition. A questionnaire survey was conducted to quantify those risks and to determine how expedition organizers plan for medical mishaps.

246 expeditions, taking 2381 participants to more than one hundred countries, were studied retrospectively. 65 expeditions (26%) reported no medical incidents; the remaining 181 reported 835 in 130 000 man-days (6.4 per 1000 man-days). 59% of the medical incidents seen on expeditions were preventable, one-third of these being due to gastrointestinal upsets. 78% of medical incidents were classified as minor and only 5% (40) as serious. There was no excess of serious incidents in any particular organizational group or environment.

The findings of this survey suggest that the health risks of participating in a well-planned expedition are similar to those encountered during normal active life.
General Practitioners’ Attitudes to Sexual Activity in Under-Sixteens
Authors: Garside R , Ayres R , Owen M R , Pearson V H , Roizen J
Published: July 2017

In the UK, under-sixteen-year-olds with some exceptions can be provided with contraceptive care even if unwilling to inform their parents. Nonetheless, many teenagers express doubts about confidentiality in these circumstances, as well as fear of being judged. The attitudes of general practitioners in North and East Devon towards the Gillick ruling regarding the treatment of under sixteens for sexual health matters were assessed. They were asked to indicate their level of agreement or disagreement with a series of statements. 235 (73%) responded, and only 15 (6.5%) rejected the notion that the same duty of confidentiality applies to under-sixteens as to older patients. 76% did, however, prefer parents to know they had been consulted about contraception. Only 7 GPs believed that provision of contraception encourages under-age sex.

Despite GPs’ general acknowledgment of the importance of confidentiality in relation to sexual activity, teenagers may well be discouraged from seeking advice if they expect strong pressure to tell their parents.
Expectations and quality of life of cancer patients undergoing radiotherapy
Authors: Koller Michael , Lorenz Wilfried , Wagner Katja , Keil Astrid , Trott Diana , Engenhart-Cabillic Rita , Nies Christoph
Published: July 2017

Expectations, real or false, affect the way patients respond to their illnesses. We assessed therapy-related expectations in relation to global quality of life in 55 cancer patients before and after radiotherapy. Factor analysis indicated that therapy-related expectations come into three broad categories—pain/emotional control, healing and tumour/symptom control. 35 patients expected ‘healing’ even though curative treatment was intended in only 19 and all patients had been fully informed. The expectation of healing was associated with high quality of life, and the same was true of perception of healing after radiotherapy. In the group as a whole, quality of life was little altered by radiotherapy, but it became substantially worse in those patients who had expected healing but perceived that this had failed, even though physician-assessed Karnofsky status did not change. These findings indicate that the expectation of healing, in cancer patients, is a component of a good global quality of life, whereas more limited expectations (pain control, tumour control) relate to lower quality of life. Patients’ expectations deserve further study as a novel approach to improving care.
Instrumental psychosis: the Good Soldier Svejk syndrome
Authors: Tyrer Peter , Babidge Nicholas , Emmanuel Jo , Yarger Nishi , Ranger Maya
Published: July 2017

The possession of severe mental illness, mainly schizophrenia and affective psychosis, may be perceived in positive terms. We have identified a group of patients, most of them with a history of previous psychotic disorder, who present with deliberately created symptoms and behaviour, and who are defined as having instrumental psychosis. Because most such patients have had a psychotic disorder in the past the symptoms are very like those of a real psychosis. A parallel is drawn with the fictional anti-hero of the Czech nation, the Good Soldier Svejk, who demonstrated both real and instrumental psychosis. A rating scale, the ‘pseudopsychosis inventory’, was devised to identify the main components of this disorder and was applied in 15 consecutive patients presenting with putative psychotic disorders in whom assessment could be made by two raters within five days. The inter-rater reliability of the items of the scale was good (intra-class correlation coefficient 0.68). An epidemiological study with this scale in 45 patients with a putative psychotic disorder suggested the presence of instrumental psychosis in 2.
Neurological complications of cervical spine manipulation
Authors: Stevinson Clare , Honan Will , Cooke Brian , Ernst Edzard
Published: July 2017

To obtain preliminary data on neurological complications of spinal manipulation in the UK all members of the Association of British Neurologists were asked to report cases referred to them of neurological complications occurring within 24 hours of cervical spine manipulation over a 12-month period.

The response rate was 74%. 24 respondents reported at least one case each, contributing to a total of about 35 cases. These included 7 cases of stroke in brainstem territory (4 with confirmation of vertebral artery dissection), 2 cases of stroke in carotid territory and 1 case of acute subdural haematoma. There were 3 cases of myelopathy and 3 of cervical radiculopathy.

Concern about neurological complications following cervical spine manipulation appears to be justified. A large long-term prospective study is required to determine the scale of the hazard.
Life and times of the impact factor: retrospective analysis of trends for seven medical journals (1994-2005) and their Editors’ views
Authors: Chew Mabel , Villanueva Elmer V , Van Der Weyden Martin B
Published: July 2017

Summary

Objective

(1) To analyse trends in the journal impact factor (IF) of seven general medical journals ( Ann Intern Med, BMJ, CMAJ, JAMA, Lancet, Med J Aust and N Engl J Med) over 12 years; and (2) to ascertain the views of these journals’ past and present Editors on factors that had affected their journals’ IFs during their tenure, including direct editorial policies.

Design

Retrospective analysis of IF data from ISI Web of Knowledge Journal Citation Reports—Science Edition, 1994 to 2005, and interviews with Editors-in-Chief.

Setting

Medical journal publishing.

Participants

Ten Editors-in-Chief of the journals, except Med J Aust, who served between 1999 and 2004.

Main outcome measures

IFs and component numerator and denominator data for the seven general medical journals (1994 to 2005) were collected. IFs are calculated using the formula: (Citations in year z to articles published in years x and y) / (Number of citable articles published in years x and y), where z is the current year and x and y are the previous two years. Editors’ views on factors that had affected their journals’ IFs were also obtained.

Results

IFs generally rose over the 12-year period, with the N Engl J Med having the highest IF throughout. However, percentage rises in IF relative to the baseline year of 1994 were greatest for CMAJ (about 500%) and JAMA (260%). Numerators for most journals tended to rise over this period, while denominators tended to be stable or to fall, although not always in a linear fashion. Nine of ten eligible editors were interviewed. Possible reasons given for rises in citation counts included: active recruitment of high-impact articles by courting researchers; offering authors better services; boosting the journal's media profile; more careful article selection; and increases in article citations. Most felt that going online had not affected citations. Most had no deliberate policy to publish fewer articles (lowering the IF denominator), which was sometimes the unintended result of other editorial policies. The two Editors who deliberately published fewer articles did so as they realized IFs were important to authors. Concerns about the accuracy of ISI counting for the IF denominator prompted some to routinely check their IF data with ISI. All Editors had mixed feelings about using IFs to evaluate journals and academics, and mentioned the tension between aiming to improve IFs and ‘keeping their constituents [clinicians] happy.’

Conclusions

IFs of the journals studied rose in the 12-year period due to rising numerators and/or falling denominators, to varying extents. Journal Editors perceived that this occurred for various reasons, including deliberate editorial practices. The vulnerability of the IF to editorial manipulation and Editors’ dissatisfaction with it as the sole measure of journal quality lend weight to the need for complementary measures.
From trades to professions
Authors: Black Nick
Published: July 2017

This is the last of four articles that provides the background to one of the walks in a new book, Walking London's Medical History, which aims to tell the story of how health services developed, to help preserve our legacy of buildings and to inform current debates about health care. Walking London's Medical History is available from the RSM Press website: http://www.rsmpress.co.uk/bkblack2.htm
Palliative care in chronic obstructive pulmonary disease: a review for clinicians
Authors: Seamark David A , Clare J Seamark , Halpin David M G
Published: July 2017

Chronic obstructive pulmonary disease (COPD) is a progressive condition characterized by airflow obstruction which ultimately kills many patients. It is common in both men and women and there is a 24—30% 5-year survival rate in the UK for those with severe disease. The annual death rate in the UK from COPD approaches that from lung cancer. Patients’ symptoms can be improved by drug therapy, but stopping smoking is also an effective way of improving the outcome in patients at all stages of COPD.

Predicting prognosis has been difficult in COPD due to the variable illness trajectory. However, assessment of severity of lung function impairment, frequency of exacerbations and requirement for long term oxygen therapy can help identify patients entering the final 12 months of life. Symptom burden and impact on activities of daily living for patients with COPD are comparable with that of cancer patients, and palliative care approaches are equally necessary, yet few publications exist to guide clinicians in this area. An evidence base exists for the management of dyspnoea with oxygen therapy and opioid drugs. There is less evidence for the effective treatment of depression and anxiety, fatigue and pain, and treatment is based on experience and considered best practice. This review discusses the problems that patients experience and offers practical guidance.

The management of patients should be shared between primary and secondary care, with multidisciplinary teams being involved at an early stage. Patients and their families require honest and clear communication about the condition and what to expect in the future. The strict application of advance care planning and directives may not be feasible or appropriate, but there is evidence that attitudes towards resuscitation and artificial ventilation can be explored without distress. The requirement by patients and carers for surveillance and timely support is acknowledged, but how to provide such input is as yet unclear, with little evidence to support the widespread implementation of nurse-led management interventions. The hospice movement has become increasingly involved in the management of life-threatening, non-malignant disease and should be involved in the multidisciplinary care of patients dying from COPD.
The Department of Health's research governance framework remains an impediment to multi-centre studies: findings from a national descriptive study
Authors: Kielmann Tara , Tierney Alison , Porteous Rosemary , Huby Guro , Sheikh Aziz , Pinnock Hilary
Published: July 2017

Objective

We describe our experience of using the standard application form, designed to streamline applications for multicentre research, to seek approval from all primary care organizations (PCOs) in England and Wales to undertake a single telephone interview with a health service manager.

Design

We sent applications ( n=316), by email to each PCO, or consortium of PCOs, attaching a completed standard application form, the 15 required documents, and the approval we had been granted by the lead NHS organization. We maintained detailed records of the responses to our application, subsequent correspondence, additional paperwork requested, and time spent on the approval process.

Setting

The UK Research Governance Framework, which regulates all research conducted in health and social care settings.

Participants

All PCOs in England and Wales.

Interventions

None.

Main outcome measures

Time taken to obtain approval to undertake a telephone interview with a health service manager.

Results

We were unable to establish contact with 13 (4%) PCOs. Six months after submitting our application we had received approval from 259/316 (82%) PCOs and were still awaiting a verdict from 41 (13%). The median time to approval was 56 days (IQR 42-72). Overall, an estimated 318 staff-hours were spent completing supplementary forms, providing additional information and chasing up dormant applications.

Conclusions

Recent initiatives to ‘streamline’ research governance approval have failed to address the problems that face researchers undertaking multi-centre studies. There is an urgent need to develop a simpler process that allows low risk research to take place without threatening staff morale and endangering the quality of the research outputs. In the meantime, we advise researchers to allow far greater time than might reasonably be envisioned to obtain research governance approval.
A matter of faith, not science’: analysis of media coverag of prostate cancer screening in Australian news media 2003-2006
Authors: Mackenzie Ross , Chapman Simon , Holding Simon , McGeechan Kevin
Published: July 2017

Objective

Despite a near universal absence of evidence-based policies supporting population screening for prostate cancer, the prostate-specific antigen (PSA) test is aggressively promoted in the media as a life-saving form of screening. The objective of this study was to examine media coverage of prostate-cancer screening in Australia.

Design

Frame analysis of all direct or attributed quotes about prostate cancer.

Setting

Australian capital city newspapers (February 2003-December 2006) and Sydney television news (January 2003-December 2006).

Main outcome measures

Quotes regarding prostate cancer screening: n=436 in newspapers and television news.

Results

Seven rhetorical frames were identified. 86% of all quotes framed prostate screening and its outcomes as desirable, associating PSA testing as being consonant with other early-detection cancer-control messages. Adverse surgical sequelae to screening were often minimized, scientific progress highlighted and gender equity appeals appropriated. Those questioning screening were vilified, with epidemiology being framed as an inferior form of knowledge than clinical experience.

Conclusions

Australian men are exposed to unbalanced and often non-evidence-based appeals to seek PSA testing. There is a disturbing lack of effort to redress this imbalance.
Learning how to control biases in studies to identify adverse effects of drugs
Authors: Vessey Martin
Published: July 2017

Additional material for this article is available from the James hind Library website [ www.jameslindlibrary.org ], where it was previously published.
The use of orchids in Chinese medicine
Authors: Bulpitt Christopher J , Li Yan , Bulpitt Pauline F , Wang Jiguang
Published: July 2017

In this article, the therapeutic uses of five Chinese medicines that contain orchids are discussed, together with a brief report of some of the animal experimentation undertaken. The impression that these preparations have no therapeutic use may be incorrect. However, herbal preparations have not usually been subject to the rigorous characterization and standardization necessary for clinical study, and persuading practitioners that substances in use for many centuries still need to be tested in randomized controlled clinical trials is proving a significant challenge.
An historical perspective on meta-analysis: Dealing quantitatively with varying study results
Authors: O'rourke Keith
Published: July 2017

Additional material for this article is available from the James Lind Library website [ www.jameslindlibrary.org ], where it was previously published.
Drivers of violent conflict
Authors: Thayer Bradley A
Published: July 2017

Please e-mail letters for publication to Dr Kamran Abbasi [ kamran.abbasi@rsm.ac.uk ]. Letters should be no longer than 300 words and preference will be given to letters responding to articles published in the JRSM. Our aim is to publish letters quickly. Not all correspondence will be acknowledged.
Development of a Guide to Recommended Print Materials for Diabetes Patient Education
Authors: Frey Mary L. , Hiss Roland G.
Published: July 2017

There are hundreds of current booklets, pamphlets, and manuals available for diabetes patient educa tion. Everyone, it seems, is writing them from large pharmaceutical com panies and publishing houses to small rural hospitals.

A national review of those materials has led to the development of an an notated resource booklet entitled "Recommended Print Materials for Diabetes Patient Education, 1984. " This article discusses the overall results of the review and the methodology used in its formation.
Defining Foci of Cellular Alteration in Short-Term and Medium-Term Rat Liver Tumor Models
Authors: Popp James A. , Goldsworthy Thomas L.
Published: July 2017

Evaluation of foci of cellular alteration is utilized in short-term and mid-term rat liver models to assess chemicals for potential carcinogenic effects. Such foci are morphologically defined and readily identified by a variety of histological stains. No single morphological marker appears capable of identifying all foci because of their phenotypic heterogeneity. Since most rodent hepatocarcinogens induce an increase in the size and/or the number of foci prior to tumor appearance, foci are believed to be precursors to hepatic tumors. The size, number, phenotype and conversion rate of foci to tumors is chemical dependent. Despite certain limitations, the quantitation of rat liver foci provides a useful means to study the mechanism of action of selected chemicals and assess their carcinogenic potential.
Critical Parameters in the Quantitation of the Stages of Initiation, Promotion, and Progression in One Model of Hepatocarcinogenesis in the Rat
Authors: Pitot Henry C. , Campbell Harold A. , Maronpot Robert , Bawa Nimrat , Rizvi Tahir A. , Xu Yi-Hua , Sargent Linda , Dragan Yvonne , Pyron Mark
Published: July 2017

Critical parameters in the quantitation of altered hepatic foci (AHF) developing during multistage hepatocarcinogenesis in the rat include: 1) the enumeration of AHF induced by test agents as well as those AHF occurring spontaneously in livers of untreated animals; 2) the volume percentage or fraction of the liver occupied by all AHF as a reflection of the total number of altered cells within the liver and the degree of tumor promotion which has occurred; and 3) the phenotype of individual AHF as determined by multiple markers with serial sections. These parameters, especially the number of AHF, should be corrected by the presence of spontaneous AHF which increase with the age of the animal, more so in males than females. While accurate estimation of the background level of spontaneous AHF can be important in demonstrating that a carcinogenic agent does not possess the ability to increase the numbers of AHF above the background level, a better method to distinguish the effectiveness and relative potencies of agents as initiators or promoters is reviewed. The relative effectiveness of four different markers–γ-glutamyltranspeptidase (GGT), a placental form of glutathione S-transferase (GST), canalicular ATPase, and glucose 6-phosphatase (G6Pase)–was described for the chemicals C.I. Solvent Yellow 14 and chlorendic acid as promoting agents in males and females. C.I. Solvent Yellow 14 is a more effective promoting agent in females than males, and AHF exhibit extremely low numbers scored by GGT. On the other hand, the numbers of AHF present in livers of male rats promoted by this agent are more than twice those seen in livers of female animals, possibly owing to the effectiveness of this agent as an initiator in the male but not the female. Very few AHF, especially in the male, are scored by GGT during chlorendic acid promotion. The distribution of phenotypes with these markers also differs in the spontaneous AHF appearing in the livers of animals fed 0.05% phenobarbital on either a crude NIH-07 or AIN-76 purified diet. Such studies emphasize the extreme dependence of the promoting stage of hepatocarcinogenesis on environmental factors of sex, diet, and the molecular nature of the promoting agent itself. The hallmark of the final stage of progression in the development of hepatocellular carcinomas is aneuploidy, which may be reflected by phenotypic heterogeneity within individual AHF, termed foci-in-foci. The implications of such quantitative analyses during hepatocarcinogenesis induced by specific agents in relation to the specific action of the agent at one or more of the stages of hepatocarcinogenesis are discussed.
Medium-Term Bioassay System for Detection of Carcinogens and Modifiers of Hepatocarcinogenesis Utilizing the GST-P Positive Liver Cell Focus as an Endpoint Marker
Authors: Ito Nobuyuki , Tatematsu Masae , Haegawa Ryohei , Tsuda Hiroyuki
Published: July 2017

We have developed a medium-term bioassay system of 8 weeks duration utilizing male Fischer 344 (F344) rats for detection of liver carcinogens and modifiers of hepatocarcinogenesis. The system consists of a single intraperitoneal injection of diethylnitrosamine (DEN, 200 mg/kg), 6-weeks-administration of test chemical beginning 2 weeks after the DEN injection, and 2/3 partial hepatectomy (PH) performed at week 3. Carcinogenic potency of test chemicals is predicted based on the results of quantitative analyses of immunohistochemically-demonstrated glutathione S-transferase placental form (GST-P) positive liver cell foci. At present, a total of 140 chemicals have been tested using this system, and the findings show a good correlation with reported carcinogenic activities in long-term tests. Furthermore, the reliability of the system has been extensively examined: the results from the medium-term bioassay were compared with those from long-term experiments using the same doses of selected chemicals; the data from presently-used 2-dimensional analysis were compared with calculated values utilizing mathematical formulae for three-dimensional analysis: conformity of phenotypic expression of enzymes in preneoplastic lesions was examined in relation to their growth activity. In conclusion, although the results with non-hepatocarcinogens were less than satisfactory, the present experimental protocol, which requires far fewer animals and shorter duration than a long-term carcinogenicity test, appears of advantage for rapid screening of the large number of environmental chemicals which may possess hazard potential for induction of liver cancer in man.
The Significance of Chemically-Induced Hepatocellular Altered Foci in Rat Liver and Application to Carcinogen Detection
Authors: Williams Gary M.
Published: July 2017

This review describes the pathogenesis and significance of chemically-induced hepatocellular altered foci in rat liver. The measurement of induction of foci can be used for carcinogen detection and the measurement of the modulation of foci by chemicals other than the inducing agent identifies enhancers or inhibitors of liver carcinogenesis.
Documenting Foci of Hepatocellular Alteration in Two-Year Carcinogenicity Studies: Current Practices of the National Toxicology Program
Authors: Maronpot Robert R. , Harada Takanori , Murthy A. S. K. , Boorman Gary A.
Published: July 2017

Altered hepatocellular foci (AHF) can be reliably identified in hematoxylin and eosin (H&E)-stained sections of liver from interim and final sacrifice intervals in 2-yr carcinogenicity studies in rats. While most AHF can be categorized on the basis of a defined set of descriptive terms, viz., basophilic, eosinophilic, clear, vacuolated, and mixed foci, exposure to hepatocarcinogenic agents may induce unique types of AHF which should be distinguished from those that occur more commonly. It is proposed that unique treatment-associated AHF be classified as atypical AHF and that they be completely described in the pathology narrative accompanying the study. Since profound changes in the number and size of AHF have been documented in Fischer 344 rats with mononuclear cell leukemia, it is recommended that liver focus data from leukemic animals be censored in assessing potential effects of treatment on AHF. At the present time, there are insufficient data to allow routine use of AHF in regulatory decision-making in the absence of a liver tumor response. However, such data may form part of weight-of-evidence considerations used by regulatory bodies when accompanied by a concomitant liver tumor response.
Observations on Altered Hepatocellular Foci in National Toxicology Program Two-Year Carcinogenicity Studies in Rats
Authors: Harada Takanori , Maronpot Robert R. , Morris Richard W. , Boorman Gary A.
Published: July 2017

Retrospective characterization of morphological and stereological features of altered hepatocellular foci (AHF) in hematoxylin & eosin (H&E)-stained sections was performed on 6 conventional 2−yr carcinogenicity studies conducted in Fischer 344 (F344) rats by the National Toxicology Program (NTP). In 3 of these studies where there was clear evidence of hepatocarcinogenicity [1−amino−2,4−dibromoanthraquinone (ADBAQ), C.I. Acid Red 114, methyl carbamate], there was greater morphological variability in AHF than in the studies of chemicals that were not hepatocarcinogenic [4−hydroxyacetanilide, epinephrine, dimethoxane]. In addition to having the expected types of AHF, rats treated with ADBAQ, C.I. Acid Red 114, and methyl carbamate had atypical basophilic AHF. In addition, atypical eosinophilic AHF were present in rats treated with ADBAQ. Both types of atypical AHF showed a morphological spectrum and sequential changes suggesting they could develop into hepatocellular neoplasms. For the 3 liver tumor positive studies, there were dose-and time-dependent increases in stereological parameters for the atypical as well as commonly occurring clear, vacuolated, and mixed cell AHF. Consistent stereological changes were not found for commonly occurring basophilic and eosinophilic AHF. Aside from some decreases in stereological measurements in some rats treated with 4−hydroxyacetanilide and epinephrine, there were no significant quantitative changes in AHF in the three liver tumor negative studies. These results show that hepatocarcinogens may induce unique types of AHF in conventional 2−yr carcinogenicity/toxicity studies in rats and may cause quantitative increases in commonly occurring clear, vacuolated, and mixed cell AHF. Such qualitative and quantitative changes are potentially useful predictors of hepatic neoplasia.
Carcinogenicity of Potassium Bromate Administered in the Drinking Water to Male B6C3F1 Mice and F344/N Rats
Authors: DeAngelo Anthony B. , George Michael H. , Kilburn Steve R. , Moore Tanya M. , Wolf Douglas C.
Published: July 2017

Ozone has been proposed for water disinfection because it is more efficient than chlorine for killing microbes and results in much lower levels of carcinogenic trihalomethanes than does chlorination. Ozone leads to formation of hypobromous acid in surface waters with high bromine content and forms brominated organic by-products and bromate. The carcinogenicity and chronic toxicity of potassium bromate (KBrO3) was studied in male B6C3F1 mice and F344/N rats to confirm and extend the results of previous work. Mice were treated with 0, 0.08, 0.4, or 0.8 g/L KBrO3 in the drinking water for up to 100 wk, and rats were provided with 0, 0.02, 0.1, 0.2, or 0.4 g/L KBr03. Animals were euthanatized, necropsied, and subjected to a complete macroscopic examination. Selected tissues and gross lesions were processed by routine methods for light microscopic examination. The present study showed that KBr03is carcinogenic in the rat kidney, thyroid, and mesothelium and is a renal carcinogen in the male mouse. KBr03 was carcinogenic in rodents at water concentrations as low as 0.02 g/L (20 ppm; 1.5 mg/kg/day). These data can be used to estimate the human health risk that would be associated with changing from chlorination to ozonation for disinfection of drinking water.
Analysis of Lung Damage Induced by Trichloroethylene Inhalation in Mice Fed Diets with Low, Normal, and High Copper Content
Authors: Giovanetti Anna , Rossi Luisa , Mancuso Mariateresa , Lombardi Carmine C. , Marasco Maria Rita , Manna Fedele , Altavista Pierluigi , Massa Eddy M.
Published: July 2017

Copper is both an essential nutrient required for the activity of several enzymes and a toxic element able to catalyze free radical formation. Trichloroethylene (TCE) is a xenobiotic that generates epoxidic intermediates by bioactivation through the cytochrome P-450 system. In this study, the influence of a dietary copper imbalance on the TCE-induced lung damage was investigated. Weaning mice were fed copper-deficient, copper-sufficient, and copper-excessive diets. After 4 wk, mice were exposed for 30 min to 6,500 ppm of TCE and euthanatized 48 hr later. Lung damage in the TCE-treated mice consisted of vacuolations of Clara cells and was quantitatively evaluated by counting the vacuolated cells per micrometer of basal lamina. At the ultrastructural level, vacuolations appeared as the result of hydropic swelling of the endoplasmic reticulum cisternae. The copper-deficient mice presented the highest number of vacuolated Clara cells. These mice also showed alteration of the capillary endothelium and interstitium and decreased pulmonary copper-zinc-superoxide dismutase activity. Occurrence of oxidative stress in lungs of both copper-sufficient and copper-deficient mice following TCE treatment was indicated by a decrease in reduced glutathione and an increase in its oxidized form.
T-2 Toxin-Induced Apoptosis in Hematopoietic Tissues of Mice
Authors: Shinozuka Junko , Suzuki Masami , Noguchi Noriko , Sugimoto Testuro , Uetsuka Koji , Nakayama Hlroyuki , Doi Kunio
Published: July 2017

We examined T-2 toxin-induced lesions in the bone marrow and splenic red pulp as many as 48 hr after oral inoculation with 10 mg/kg body weight of T-2 toxin in female ICR:CD-1 mice. Histopathologically, the bone marrow and splenic red pulp showed a significant hypocellularity. In the bone marrow, the number of myelocytes significantly decreased due to the loss of immature granulocytes, erythroblasts, and lymphocytes. The nuclei of the remaining cells showing pyknosis or karyorrhexis were positively stained by the TdT-mediated dUTP nick end labeling (TUNEL) method, and these TUNEL-positive cells showed ultrastructural characteristics of apoptosis. With agarose gel electrophoresis, DNA ladders were clearly detected in bone marrow samples. The number of TUNEL-positive cells in splenic red pulp increased earlier than it did in the splenic white pulp. Thus, T-2 toxin induced-lesions in the hematopoietic tissues and in the lymphoid tissues were brought about by apoptosis of component cells. We believe that damage to the hematopoietic microenvironment may also play an indirect role in the induction of apoptosis in the bone marrow.
Atriocaval Mesothelioma in a Male Sprague-Dawley Rat
Authors: Peano Sergio , Conz Angelo , Carbonatto Michela , Goldstein Jed , Nyska Abraham
Published: July 2017

The histological, immunohistochemical, and electron microscopic characteristics of a spontaneous case of atriocaval mesothelioma are described in a 102-wk-old male Sprague-Dawley rat. The immunohistochemical characteristics of the tumor are compared with those of a pericardial mesothelioma in a female Sprague-Dawley rat.
Lysozyme-Containing Renal Tubular Hyaline Droplets in F344 Rats Bearing a Rat Fibrosarcoma-Derived Transplantable Tumor
Authors: Yamate Jyoji , Iwaki Masae , Nakatsuji Shunji , Kuwamura Mitsuru , Kotani Takao , Sakuma Sadashige
Published: July 2017

Renal tubular hyaline droplets developed in male and female F344 rats bearing a rat fibrosarcoma-derived transplantable tumor (SS). The droplets accumulated exclusively in the proximal renal tubular epithelia as eosinophilic granules of various sizes in hematoxylin and eosin-stained sections. The granules stained bright red with azan-Mallory stain. Immunohistochemically, the droplets were positive for lysozyme to various degrees but were negative for a2u-globulin, albumin, and a 1-antitrypsin. These findings indicated the involvement of lysozyme, a low-molecular-weight protein, in the droplet formation. The morphological and immunohistochemical findings of the hyaline droplets bore a close resemblance to those reported in rats as a secondary lesion to spontaneous histiocytic sarcomas. Others have speculated that renal tubular hyaline droplets in histiocytic sarcoma-bearing rats are formed in lysosomes through cellular overload of lysozyme secreted excessively by the tumor cells. However, neoplastic cells of SS tumors were negative to lysozyme. The pathogenesis of renal hyaline droplets appearing in SS tumor-bearing rats remains to be investigated.
An acoustic analysis of the effects of surgical therapy on voice quality
Authors: Berke Gerald S. , Gerratt Bruce R. , Hanson David G.
Published: July 2017

An automated computer system was used to measure changes in vocal quality resulting from laryngeal surgery. Five acoustic parameters were computed and seven listeners made judgments on vowel samples recorded before and after surgery from 37 patients. Presurgery and postsurgery changes in the five acoustic measures were compared with the perception of change in vocal harshness. A multiple regression analysis showed that four of the five acoustic measures accounted for a large amount of the variance in the judgment of change of voice quality following surgery. The measures may provide a quick and relatively sensitive method that may be clinically useful in measuring change in vocal quality.
Small fenestra stapedectomy technique: Reducing risk and improving hearing
Authors: Bailey H. A. Ted , Pappas James J. , Graham Sharon S.
Published: July 2017

During the past 25 years many variations have emerged in stapedectomy, most of which centered around either a change in the prosthesis itself or in the type of oval window seal. The small fenestra stapedectomy technique (SFT) represents a change in surgical procedure rather than in prosthetic design. This technique offers the opportunity to improve hearing results while reducing risks in stapedectomy surgery. Four areas of significant improvement are seen in patients in whom the SFT was used: (1) improved hearing in the high frequencies of 2000, 4000, and 8000 Hz, (2) improved speech discrimination scores, (3) a significant reduction in the number of reported vestibular complaints, and (4) a reduction in the number of serious postoperative sensorineural hearing losses.
Familial central neurofibromatosis
Authors: Jones Robert M. , Stewart Irwin F. , House William F.
Published: July 2017

The condition of central neurofibromatosis, while well documented in neurology literature, has tended to be amalgamated into acoustic neuromas associated with peripheral neurofibromatosis (or Recklinghausen's disease) in otolaryngology literature. The history of a unique family that has demonstrated four generations of bilateral acoustic neuromas has been outlined to show that central neurofibromatosis is a distinct entity related but not identical in clinical and biochemical aspects to Recklinghausen's disease. This article in intended to acquaint the otolaryngologist with the presentation and management of central neurofibromatosis.
Epidemiology of Suicide and Parasuicide
Authors: Platt Stephen
Published: July 2017

The epidemiology of suicide (1970–1990) and parasuicide (1970–1989) in Great Britain is reviewed. A wide variation in suicide rates exists across Europe, and the rates in England and Wales fall considerably below the median. Although suicide accounted for only 0.7% of all deaths in 1990 in people aged over 15, it was the second most common cause of death among males aged 15–34 years. In 1990, the suicide rate for males was 19% above that in 1970, while in females the rate in 1990 was much lower than it had been during the 1970s. Male suicide rates exceed female rates in all 10-year age groups. The lowest rates of suicide in both sexes and in all age groups occur among married people, and the rates among semi-skilled (class IV) and unskilled (class V) manual workers are higher than those in the other four social classes. The leading methods of suicide are poisoning, hanging and domestic gas, though deaths by domestic gas poisoning had disappeared completely by 1990 with the detoxification of gas. Men use violent methods to a greater extent than women. Only two British centres, in Oxford and Edinburgh, have monitored episodes of hospital-treated parasuicide during the period of review. Both British cities have parasuicide rates greatly in excess of the European median. Between 1970 and 1989, annual parasuicide rates were higher for females than for males. Self-poisoning has been the predominant method used in parasuicide. Parasuicide is a behaviour mainly encountered during adolescence and young adulthood, and parasuicide rates decline with advancing age. The lowest rates of parasuicide are found among the married, and the highest among the divorced. A direct relationship exists between parasuicide and social class; the lower the social class, the higher the rate of parasuicide. The rates of parasuicide are considerably higher among the unemployed, with females at greater risk than males.
The Management of Patients at Risk for Suicide
Authors: Abou-Saleh Mohammed T.
Published: July 2017

The management of suicidal patients with recurrent mood disorder involves a comprehensive clinical and psychosocial evaluation. This will determine treatment strategies including: acute care; continuation and prophylactic therapy with drugs; psychological treatment (including education to patients and their families). Risk factors for suicide and parasuicide are evaluated including: demography; psychosocial factors; personality characteristics; clinical characteristics; evaluation of preceding clinical state; seasonality. Treatment of the underlying illness is the most powerful method of preventing suicide. Reference will be made to the recent National Institute of Mental Health Collaborative Studies on the value of pharmacotherapy and psychotherapy in the long-term management of mood disorders.
The Prevention of Suicide in Patients with Recurrent Mood Disorder
Authors: Peet Malcolm
Published: July 2017

Recurrent mood disorder carries a risk of suicide of ~ 15%. Patients who do commit suicide have often received inadequate antidepressant or prophylactic lithium treatment. Long-term treatment with lithium normalizes the excess mortality associated with recurrent mood disorders, including that from suicide. A reduced availability of the most lethal methods of suicide may contribute epidemiologically to a reduced rate of suicide, and therefore the differences in overdose toxicity between antidepressants may be pertinent. Education of mental health workers regarding the effective treatment of mood disorders can help to reduce the rate of suicide. Patient education and psychological support can lead to improved compliance with prophylactic medication and early detection of relapse, but more formal psychotherapy does not appear to be helpful. Specialized mood disorder clinics lead to better patient care than is possible in a routine psychiatric out-patient clinic.
Platelet α2-adrenoreceptors in depression: a critical examination
Authors: Grossman Fred , Manji Husseini K. , Potter William Z.
Published: July 2017

During the past decade, results from radioligand studies comparing platelet α2-adrenoreceptors in depressed patients and healthy volunteers have been inconsistent, especially when related to the known functional characteristics of these receptors. Despite the availability of radioligands for α2-adrenoreceptors, inherent methodological problems exist which make data from these studies difficult to interpret. The authors review the overall data from radioligand studies using [3H] Clonidine and [3H] yohimbine of platelet α2-adrenoreceptors in depressed patients and healthy volunteers. Theoretical and methodological issues are critically examined in the light of recent findings. Finally, alternative strategies for studying α2-adrenoreceptors in clinical populations are considered.
Guidelines for treating depressive illness with antidepressants: A statement from the British Association for Psychopharmacology
Authors: Montgomery Stuart A. , Bebbington P. , Cowen P. , Deakin W. , Freeling P. , Hallstrom C. , Katona C. , King D. , Leonard B. , Levine S. , Phanjoo A. , Peet M. , Thompson C. , Thompson C.
Published: July 2017

Depression is a common illness which affects some 3% of the population per year. At least 25% of those with marked depression do not consult their general practitioner and in half of those who do the illness is not detected. Depression is easy to recognize when four or five of the core symptoms have been present for 2 weeks which often coincides with some occupational and social impairment. The core symptoms are depressed mood, loss of interest or pleasure, loss of energy or fatigue, concentration difficulties, appetite disturbance, sleep disturbance, agitation or retardation, worthlessness or self blame and suicidal thoughts. A diagnosis of depression is made when five of these core symptoms, one of which should be depressed mood or loss of interest or pleasure, have been present for 2 weeks. Four core symptoms are probably sufficient. Response to antidepressants is good in those with more than mild symptoms. When there are only few or very mild depressive symptoms evidence of response to antidepressants is more uncertain. Antidepressants are effective, they are not addictive and do not lose efficacy with prolonged use. The newer antidepressants have fewer side effects than the older tricyclics, they are better tolerated and lead to less withdrawals from treatment. They are less cardiotoxic and are safer in overdose. Antidepressants should be used at full therapeutic doses. Treatment failure is often due to too low a dose being used in general practice. It may be difficult to reach the right dose with the older tricyclics because of side effects. To consolidate response, treatment should be continued for at least 4 months after the patient is apparently well. Stopping the treatment before this is ill-advised as the partially treated depression frequently returns. Most depression is recurrent. Long-term antidepressant treatment is effective in reducing the risk of new episodes of depression and should be continued to keep the patient well.
Discriminative stimulus effects of the nicotine antagonist mecamylamine in rats
Authors: Garcha H. S. , Stolerman I. P.
Published: July 2017

The discriminative stimulus effects of the nicotine antagonist mecamylamine have been investigated to characterize further its behavioural effects and its interactions with (–)-nicotine. Rats were trained to discriminate the effects of mecamylamine from saline in a two-bar operant conditioning procedure with food reinforcers presented on a tandem schedule of reinforcement. Mecamylamine (3.5 mg/kg s.c.) acquired strong stimulus control over behaviour and there was only a small reduction in overall rates of responding. The mecamylamine stimulus generalized completely to some ganglion-blocking drugs (order of relative potency: pentolinium > mecamylamine > pempidine) but it did not generalize to other ganglion-blockers (hexamethonium, trimetaphan and chlorisondamine). The mecamylamine stimulus also failed to generalize to (–)-nicotine, to muscarinic antagonists (atropine and scopolamine) or to excitatory amino acid antagonists (dizocilpine, phencyclidine and D-CPPene). Mecamylamine, pempidine, hexamethonium, trimetaphan, (–)-nicotine, scopolamine, phencyclidine, dizocilpine and D-CPPene were tested up to doses that reduced overall rates of responding. Tests also showed that (–)-nicotine did not antagonize the response to mecamylamine. The discriminative stimulus produced by mecamylamine may originate at nicotinic receptors but whether these are located centrally or peripherally is unclear. There was no evidence that either muscarinic or excitatory amino acid receptors were involved in mediating the effect.
Effects of ipsapirone and cannabidiol on human experimental anxiety
Authors: Zuardi A. W. , Cosme R. A. , Graeff F. G. , Guimarães F. S.
Published: July 2017

The effects of ipsapirone and cannabidiol (CBD) on healthy volunteers submitted to a simulated public speaking (SPS) test were compared with those of the anxiolytic benzodiazepine diazepam and placebo. Four independent groups of 10 subjects received, under a double-blind design, placebo or one of the following drugs: CBD (300 mg), diazepam (10 mg) or ipsapirone (5 mg). Subjective anxiety was evaluated through the Visual Analogue Mood Scale (VAMS) and the State-trait Anxiety Inventory (STA)). The VAMS anxiety factor showed that ipsapirone attenuated SPS-induced anxiety while CBD decreased anxiety after the SPS test. Diazepam, on the other hand, was anxiolytic before and after the SPS test, but had no effect on the increase in anxiety induced by the speech test. Only ipsapirone attenuated the increase in systolic blood pressure induced by the test. Significant sedative effects were only observed with diazepam. The results suggest that ipsapirone and CBD have anxiolytic properties in human volunteers submitted to a stressful situation.
The anxiety factor in depression
Authors: Nutt David
Published: July 2017

Anxiety symptoms are commonly associated with depression, and contribute to a poorer patient prognosis. An increase in serotonergic function is implicated in the pathogenesis of anxiety and there is good evidence that the selective serotonin re-uptake inhibitors (SSRIs) may be useful in clinical management. Sertraline, a novel SSRI, has been shown to be effective in the treatment of anxiety symptoms in both pure and mixed anxiety disorders. Studies have also shown sertraline to be effective in obsessive-compulsive disorder. A recent study (Moon et al., 1994) shows sertraline to have comparative therapeutic efficacy with that of clomipramine with respect to reduction of anxiety symptoms in depression. However, it also highlights important differences in side-effect profiles, with a high incidence of cardiovascular effects and subsequent dropouts reported in the clomipramine group. Limited comparative data with other SSRIs suggest there is no evidence of any aggravation of anxiety symptoms during treatment with sertraline, as has been reported with fluoxetine. Sertraline has been shown to have a normalising effect on sleep disturbance in depression without evidence of daytime sedation. Therefore, given the high prevalence of anxiety symptoms in depression, sertraline would be a useful therapeutic option in clinical management.