Sixth Subject Research Articles

Is the 2016 ESC diagnostic algorithm useful for assessing the prevalence of chronic heart failure in population-based studies?

Chronic heart failure (CHF) is a major healthcare problem. However, there are no epidemiological studies assessing the prevalence of CHF in the general population with diagnosis based on algorithms recommended for clinical practice. The aim of the HF-Pomorskie survey was to assess the prevalence of three basic components of the 2016 ESC diagnostic algorithm for CHF (symptoms, N-terminal pro B-type natriuretic peptide [NT-proBNP], and abnormalities on echocardiography) and to determine whether this algorithm may be applicable to studies in general population samples. The study was performed in a representative sample of 313 adults (170 women and 143 men) aged between 20 and 90 years (mean 55.2 years [15.3]) in Northern Poland. A questionnaire to determine New York Heart Association [NYHA] class, laboratory tests including NT-proBNP, as well as transthoracic echocardiography and spirometry examinations were performed in all subjects. Dyspnea (NYHA class II-IV) was reported by 13.7% of recruited participants. Dyspnea and elevated levels of NT-proBNP (>125 pg/ml) were found in 7.7% of all examined subjects, while dyspnea, elevated NT-proBNP levels accompanied by systolic or diastolic abnormalities on echocardiography occurred in 4.8%. In the group without dyspnea (86.3% of all examined subjects), every sixth subject had an elevated level of NT-proBNP. On the other hand, 5.8% of studied subjects reported a previous diagnosis of CHF, which was confirmed using the current ESC algorithm in 78% of them. The prevalence of CHF assessed by the 2016 ESC diagnostic algorithm in the representative sample of adults was equal to 4.8%. The clinical algorithm for the diagnosis of CHF is fully applicable to the representative surveys in the general population. However, due to logistic and economic factors, echocardiography examination and NT-proBNP determination can be limited to patients reporting dyspnea or previous diagnosis of CHF.

The rectum, anal sphincter and puborectalis muscle show different contraction wave forms during prolonged measurement with a simulated feces

Contractile patterns in rectum, puborectalis muscle and anal sphincter must be studied to understand defecation. Six subjects had contractile waveforms studied with Fecobionics. Symptom questionnaires, balloon expulsion test and anorectal manometry were done for reference. The Fecobionics bag was filled in rectum to urge-to-defecate volume and measurements were done for 4 h before the subjects attempted to evacuate the device. Pressures and bend angle (BA) variations were analyzed with Fast Fourier Transformation. Four normal subjects exhibited low frequency waves (< 0.06 Hz) for pressures and BA. The waves were uncoordinated between recordings, except for rear and bag pressures. Peak wave amplitudes occurred at 0.02–0.04 Hz. Pressures and the BA differed for peak 1 (p < 0.001) and peak 2 amplitudes (p < 0.005). The front pressure amplitude was bigger than the others (rear and BA, p < 0.05; bag, p < 0.005) for peak 1, and bigger than bag pressure (p < 0.005) and BA (p < 0.05) for peak 2. One subject was considered constipated with lower front pressure amplitudes compared to normal subjects and increased amplitudes for other parameters. The sixth subject was hyperreactive and differed from the other subjects. In conclusion, the rectum, anal sphincter and puborectalis muscle showed different contraction waves during prolonged measurements. The data call for larger studies to better understand normal defecation, feces-withholding patterns, and the implications on anorectal disorders.

Corporate Social Responsibility (CSR) Based on Islamic Social Reporting in an Effort to Increase Company Value: a Literature Review

This research aims to investigate the concept of Corporate Social Responsibility (CSR) based on Islamic social reporting and its impact on increasing company value. This research is a type of qualitative descriptive research using the literature study method, with the aim of knowing the results of implementing ISR-based Corporate Social Responsibility (CSR) to increase company value. The research results show that the implementation of corporate social responsibility (CSR) is based on Islamic Social Reporting in an effort to increase company value by referring to several core topics discussed in (1) Finance and Investment; (2) Products and services; (3) Employees; (4) Community Involvement; (5) Environment; (6) Corporate Governance, this sixth subject is issued by the Accounting and Audit Organization for Islamic Financial Institutions (AAOIFI).

ANALISIS KESULITAN SISWA DALAM MENYELESAIKAN SOAL OPERASI PECAHAN DITINJAU DARI GAYA BELAJAR

This study aims to: (1) find out the learning styles of students, (2) find out the difficulties experienced by students in solving fractional operations problems. This type of research is a descriptive qualitative research. The subjects of this study were seventh grade students of SMP Mubarokul Ulum with a total of 22 students who had received fractions material. The data collection procedure begins with filling out a learning style questionnaire. After getting the data on student work, two students with visual learning styles were selected, two students with auditory learning styles and two students with kinesthetic learning styles to be tested, interviewed and documented. The results showed that: (1) out of 22 students, two students had a visual learning style, eight students had an auditory learning style, 10 students had a kinesthetic learning style and there was a discovery of a new learning style, namely a blend of Visual-Kinesthetic learning styles totaling one student. and Auditorial-Kinesthetic learning style amounted to one student. (2) The difficulties experienced by the first subject with the type of visual learning style tend to be difficult in using concepts and the second subject tends to have difficulty in solving verbal problems. The third and fourth subjects who have an auditory learning style tend to have difficulty in solving verbal problems and the fifth subject with a kinesthetic learning style type that tends to have difficulty using concepts while the sixth subject tends to have difficulty using principles

Students' Errors Analysis in Solving Problems in the Material of Sequences and Series based on Hadar's Criteria in terms of Students' Mathematical Understanding

This study aims to describe students' errors in solving problems in the material of Sequences and Series based on Hadar's criteria in terms of students' mathematical understanding. The type of research used is qualitative research with a descriptive approach. There are 6 research subjects, namely 2 students with high mathematical understanding, 2 students with moderate mathematical understanding, and 2 students with low mathematical understanding. The instrument used in data collection was an understanding test containing 7 questions, a series and series problem test containing 3 questions, as well as interview guidelines. The results showed that all subjects who worked on questions related to determining the P-th term in the series geometry and in working on problems related to determining the cattle population tend to make technical errors. Meanwhile, in working on problems related to determining the number of terms in an arithmetic sequence, the subject did not experience any errors in completing the answer except for the fifth subject and the sixth subject who did not answer at all.

The Vascular Supply to Human Brown Adipose Tissue

Brown adipose tissue (BAT) engages in non‐shivering thermogenesis in response to cold exposure. Several aspects of its function require significant arterial and venous supplies. For example, the arterial system delivers endocrine signaling molecules and metabolic substrates including glucose and non‐esterified fatty acids to both stimulate and fuel BAT thermogenesis. Heat produced from BAT is then presumed to transfer to the blood passing through the tissue to protect core body temperature in response to the initiating cold stimulus. However, whether human BAT contains such a vascular system is unknown. The purpose of this study was to characterize the arterial and venous supply to supraclavicular BAT. Six healthy subjects [4 men; age: 30.7 ± 5.8 yrs.; body mass index: 21.7 ± 3.5 kg/m2; total body fat % (dual‐energy x‐ray absorptiometry scan): 23.5 ± 6.2 %] underwent time‐of‐flight magnetic resonance angiography (MRA) of the arterial and venous systems and quantitative fat/water MR imaging (FWMRI) to identify BAT. Angiography images were reconstructed at 0.5×0.5×2.0 mm resolution. FWMRI was performed using a 21‐echo spoiled gradient‐echo sequence, with computation of the fat signal fraction using the manufacturer’s algorithms. FWMRI images were reconstructed at 1.0×1.0×4.0 mm resolution and then resized to match the resolution of the MRA data. The supraclavicular BAT depot was hand‐defined from the apex of the lung to its superior margin in the FWMRI images. Coronal, axial, and sagittal maximum intensity projections (MIPs) of the BAT regions were overlaid onto co‐registered MIPs of the arterial and venous angiograms. In five subjects, there was a single, tortuous branch of the second part of the subclavian artery that supplied the BAT depot; in the sixth subject there was insufficient conspicuity to trace this artery back to the subclavian artery. The arterial diameters ranged from 1.5–2.5 mm. In no case was the artery observed to pass completely through the supraclavicular BAT depot. In two subjects, there was a single 3.5 mm diameter vein returning from the head and passing through the medial portion of the BAT. In the other four subjects, there were 3–4 veins with 2–4 mm diameters that returned from the head and that passed through both the medial and lateral portions of the BAT depot. Individuals with the largest diameter arteries also tended to have the most extensive venous systems. These preliminary data suggest that MRA and FWMRI may be used to quantify the arterial and venous supplies of the human supraclavicular BAT depot. The extensive venous supply to BAT, coupled with the absence of arteries passing fully through this BAT depot, together suggest that the primary thermogenic role of the supraclavicular BAT depot is in rewarming blood returning from the head to the central circulation.Support or Funding InformationNIDDK/NIH R01‐DK‐105371, NCATS/NIH UL1‐TR000445

Utility of a Commercially Available Blood Steroid Profile in Endocrine Practice.

Background:A blood steroid profile has recently become available on commercial basis in India. In this study, we report our initial experience with the use of steroid profile in the evaluation of disorders of sex development (DSD) and suspected cases of congenital adrenal hyperplasia (CAH) and discuss the potential scenarios in endocrine practice that may benefit from this steroid profile.Materials and Methods:The study included six subjects. Patient 1 was a 46, XX girl who presented with peripubertal virilization, patient 2 was a girl who presented with normal pubertal development, secondary amenorrhea, and virilization, and patient 3 was a girl who presented with primary amenorrhea and virilization. These three patients were suspected to have CAH but had non-diagnostic serum 17 OH-progesterone levels. Patient 4 and 5 were 46, XY reared as girls who presented with primary amenorrhea alone and primary amenorrhea and virilization, respectively, and sixth subject was a heathy volunteer. All subjects were evaluated with blood steroid profile by Liquid chromatography tandem mass spectrometry (LC-MS/MS).Results:Patient 1 and 2 were diagnosed to have 11 β-hydroxylase deficiency by using the steroid profile. Patient 3 was suspected to have CAH, but the steroid profile excluded the diagnosis and helped to confirm the diagnosis as polycystic ovary syndrome. In patient 4 and patient 5, although steroid profile ruled out the possibility of steroidogenesis defects, it did not help to reach at the specific diagnosis.Conclusion:The blood steroid profile used in this study is most useful for the diagnosis of 11 β-hydroxylase deficiency. The utility of this test is limited in the evaluation of 46, XY patients with under-virilization.

PD42-01 REPORT ON THE FEASIBILITY OF ULTRASOUND TO REPOSITION KIDNEY STONES IN HUMANS

You have accessJournal of UrologyStone Disease: New Technology1 Apr 2015PD42-01 REPORT ON THE FEASIBILITY OF ULTRASOUND TO REPOSITION KIDNEY STONES IN HUMANS Jonathan Harper, Barbrina Dunmire, Bryan Cunitz, Franklin Lee, Ryan Hsi, Jeff Thiel, James Lingeman, Michael Coburn, Hunter Wessells, Mathew Sorensen, and Michael Bailey Jonathan HarperJonathan Harper More articles by this author , Barbrina DunmireBarbrina Dunmire More articles by this author , Bryan CunitzBryan Cunitz More articles by this author , Franklin LeeFranklin Lee More articles by this author , Ryan HsiRyan Hsi More articles by this author , Jeff ThielJeff Thiel More articles by this author , James LingemanJames Lingeman More articles by this author , Michael CoburnMichael Coburn More articles by this author , Hunter WessellsHunter Wessells More articles by this author , Mathew SorensenMathew Sorensen More articles by this author , and Michael BaileyMichael Bailey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2586AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ultrasonic propulsion is a new technology we have developed which uses focused ultrasound energy to transcutaneously reposition kidney stones. Safety and effectiveness has been demonstrated in a porcine model. We report the findings from the first use of this technology in humans. METHODS Studies were conducted with the approval of the University of Washington IRB and FDA Investigational Device Exemption. Thirteen awake, non-anesthetized subjects were studied without restriction of patient body habitus, stone size, or stone location. Ultrasound imaging and a pain questionnaire were completed before, during, and following propulsion. An additional two subjects underwent stone repositioning during ureteroscopy (URS). All subjects were followed weekly for three weeks. RESULTS Of the 15 subjects, 11 were male, average age was 55+/- 9 years, BMI 28.5 +/- 2.7, and stone size 1-13 mm. There were 5 left and 10 right kidneys treated. Two patients reported skin discomfort and sensation at depth with a few pushes. Otherwise, there was no pain or adverse effects associated with the treatment. Stones were localized and some degree of movement was seen in all but one subject. Stone locations included the lower pole (>20), interpolar (>10), upper pole (>5), and renal pelvis/UPJ (>5). Average skin-to-stone distance was 6.5 cm, as the probe was small enough to push under the ribs with subjects on their side; although when this was not possible, such as during URS, stones were imaged and repositioned at depths greater than 12 cm. Stones were repositioned to a new location in all 6 post-lithotripsy patients, while 4 of the 6 passed over 30 stone fragments within a few days of treatment. One passed two 2mm fragments immediately after the completion of treatment. One of the 6 felt pain consistent with passing a stone, but did not observe stone passage. The sixth subject was lost to follow-up. De novo stones were less often moved to a new location. Stones as large as 7-8 mm were repositioned in awake patients and during URS. In four of the 15 subjects, what was noted in clinical imaging as a single stone greater than 5 mm was found to be several passable stones upon repositioning with ultrasound. CONCLUSIONS Ultrasonic propulsion can safely and without pain reposition kidney stones in humans. Treatment was therapeutic in four subjects and provided diagnostic information in four. Overall, the initial clinical trial was successful and warrants continued research and development. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e885 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Harper More articles by this author Barbrina Dunmire More articles by this author Bryan Cunitz More articles by this author Franklin Lee More articles by this author Ryan Hsi More articles by this author Jeff Thiel More articles by this author James Lingeman More articles by this author Michael Coburn More articles by this author Hunter Wessells More articles by this author Mathew Sorensen More articles by this author Michael Bailey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Glycosylation of Human Milk Lactoferrin Exhibits Dynamic Changes During Early Lactation Enhancing Its Role in Pathogenic Bacteria-Host Interactions

Human milk lactoferrin (hmLF) is the most abundant glycoprotein present in human milk and displays a broad range of protective functions in the gut of newborn infants. hmLF is N-glycosylated, but little is known about the lactation stage-related development of the glycosylation phenotype. hmLF glycosylation from milk samples from five donors during the first 10 weeks of lactation was assessed and observed to be more diverse than previously reported. During this period dynamic changes in glycosylation were observed corresponding to a decrease in glycosylation in the second week followed by an increase in total glycosylation as well as higher order fucosylation thereafter. Gene expression analysis was performed in milk somatic cells from a sixth subject. It was found that fucosyltransferase expression increased during entire period, whereas expression of genes for the oligosaccharyl transferase complex decreased in the second week. The effect of hmLF glycosylation was examined for the protein's ability to affect bacterial binding to epithelial cells. hmLF significantly inhibited pathogen adhesion and purified hmLF glycans significantly reduced Salmonella invasion of colonic epithelial cells to levels associated with non-invasive deletion mutants. This study indicates that hmLF glycosylation is tightly regulated by gene expression and that glyco-variation is involved in modulating pathogen association.

Prevalence of Diabetes Mellitus and Impaired Glucose Tolerance in Luanda - Angola

Aim: To determine the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in Luanda, an urban community of Angola-Africa. Methods: A random sample of 709 subjects aged 30 to 69 years (52% women) was selected from Ingombotamunicipality. This cross-sectional home survey was conducted from March 2009 to April 2011, using a sampling design of stage conglomerates. A two-stage survey was carried out. First, clinical and anthropometric data were obtained and fasting capillary glucose level was determined. The cut-off point was 5.55 mmol/l. Subjects who screened positive (fasting capillary glucose ≥ 5.55 mmol/l and <11.1 mmol/l) and each sixth consecutive subject who screened negative (fasting capillary glucose <5.55 mmol/l) were submitted to the second phase of survey, consisting of the 75g oral glucose tolerance test (75 g OGTT). Data was analyzed using SAS statistical software. Results: The prevalence rates of diabetes mellitus and IGT were 7.1% and 12.9%, respectively. The age group with the highest frequency of diabetes was 60 to 69 years (33%) followed by the age group 40 to 49 (30%). The frequency of impaired glycemic homeostasis increased with aging both in men and women. Overweight and obesity were usual findings in the majority of subjects with diabetes (62%) and subjects with impaired glucose tolerance (61.9%). Conclusions: The prevalence of diabetes mellitus was classified within an intermediary range (7.1%) and the prevalence of impaired glucose tolerance is within an high range, suggesting a future increase in the frequency of diabetes in this population.

Real‐time motion and B0 correction for localized adiabatic selective refocusing (LASER) MRSI using echo planar imaging volumetric navigators

A method is presented to correct the effects of motion and motion‐related B0 perturbations on spectroscopic imaging in real time through the use of a volumetric navigator. It is demonstrated that, for an axial slice, lifting the chin significantly disrupts the B0 homogeneity in the zero‐order (frequency), first‐order Y (coronal) axis and second‐order ZY term. This volumetric navigator is able to measure and correct in real time both head pose and zero‐ to first‐order B0 inhomogeneities. The volumetric navigator was validated in six volunteers who deliberately lifted and then dropped their chin during the scan. These scans show that motion correction alone is not sufficient to recover the spectral quality. By applying real‐time shim adjustments, spectral quality was fully recovered to linewidths below 0.08 ppm and the signal‐to‐noise ratio to within acceptable limits in five of six subjects. In the sixth subject, 83% of the spectra within the volume of interest were recovered, compared with the worst case nonshim‐corrected scan, where none of the voxels fell within these quality bounds. It is shown that the use of a volumetric navigator comes at no additional cost to the scan time or spectral signal‐to‐noise ratio. Copyright © 2011 John Wiley &amp; Sons, Ltd.

Frequency of co‐teaching in different teacher categories

Co‐teaching – or the use of more than one teacher in a classroom – has been commonly recommended as a means to promote inclusive education. The aim of the present study was to survey the actual frequency of co‐teaching among different teacher categories in the comprehensive school level in one Finnish city. The data were collected through a questionnaire answered by two representative samples of teachers including 117 resource room teachers in the first survey, and 317 teachers of various teacher categories in the second. The results showed that co‐teaching was a widespread phenomenon among resource room teachers and special class teachers but less frequent among other teacher groups. Overall, it was used only infrequently, typically from two to three hours a week. On a weekly basis it was implemented by every second special education teacher, every third classroom teacher and every sixth subject teacher. A comparison with a study from the early 1980s confirmed that the relative popularity of co‐teaching had increased only slightly during the years. Although co‐teaching is used sparsely, the teachers reported almost uniquely positive experiences obtained from it. It is argued that the promotion of co‐teaching needs additional incentives if it is hoped to make it more common.

MANAGEMENT AND OUTCOME OF EXTREME END STAGE VENOUS ACCESS IN CHILDREN WITH INTESTINAL FAILURE (IF) ASSESSED FOR SMALL BOWEL TRANSPLANTATION (SBTX)

3- year survival after SBTx has improved to between 73% and 88%. Impaired venous access is an indication for SBTx in children with chronic IF, whereas thrombosis of the superior vena cava (SVC) was a contra-indication to SBTx, historically. Aim: To report our experience in management of children with extreme end stage venous access. Subjects: 6 children (all males), mean age of assessment 30 months (range 13 - 52). Diagnosis: Total intestinal aganglionosis1, protracted diarrhoea1, short bowel syndrome4 of which gastroschisis2 and malrotation with mid gut volvulus2. All presented with thrombosis of the SVC and or inferior vena cava and malnutrition because of interruption of parenteral nutrition. All had venograms and/or MR angiograms to access venous access. All had a documented history of 6-18 central venous line (CVL) insertions previously. Methods: Venous access was achieved as follows: Transhepatic venous catheters (THVC) (5), Right atrial (RA) CVL via midline sternotomy4, Azygous venous system2, dilatation of left subclavian vein following passage of a guide wire and then placing a CVL to reach the RA1 and SVC dilatation, stent insertion and placement of a CVL in situ1. Complications included pleural effusion, which resolved after chest drain insertion, following RA insertion1, displacement of THVC needing repositioning2, and balloon dilatation of SVC stent after 16 and 22 months to restore patency. Outcome: 4 children with permanent IF on assessment were offered SBTx, 3 of which were transplanted and were established on full enteral nutrition while the family of one child declined the procedure (and he died 3 years later). In the remaining 2 children in whom bowel adaptation was still a possibility, attempts were made to provide adequate venous access as feeds and manipulations of intestinal motility drugs were undertaken. One child received SBTx 3 years after his first assessment, as bowel adaptation failed and the other child (the sixth subject) died in the immediate post operative period following a THVC insertion, but the cause of death is inconclusive. RA lines in transplanted children proved adequate for the management of uncomplicated transplantation, although the usual infusion protocol had to be modified to take account for the lack of access. Conclusion: It is possible to re-establish central venous access using unconventional techniques. However it is difficult and time consuming to assemble a skilled team consisting of one of more: surgeons, cardiologists, interventional radiologist, transplant anaesthetists. If SBTx is inevitable it is imperative as well as easier and safer with adequate venous access and we advocate liaison with a SBTx centre at an early stage.

What is This ‘Art Therapy’?

:The intent of this paper is to introduce and discuss the intricate work of art therapists. Those considering a career in art therapy may find this an informative piece. I will begin by describing my experience with art and its symbols and relating my (mis)conceptions about art therapy. Next will be a brief overview of how art therapy operates and a discussion on its invaluable contributions to the therapeutic profession. Third, I will look at the skills and knowledge deemed useful to the therapist. The prominent characteristics of an art therapist's work is the fourth topic which will be examined. Subsequently, the issue of whether to work in a private office or in the public sphere with an agency will be explored. The sixth subject will be the educational requirements necessary to practice art therapy. An elaboration on the future of art therapists, and the options it holds, will be the final area of inquiry.

THE PERSON WHO MOST INFLUENCED ME

Having chosen biology as my main sixth form subject, I looked forward with some trepidation to being taught by Miss Reynolds, the senior biology mistress, who had a reputation for expecting high standards and not tolerating any nonsense. But I knew that she was a good teacher; how good I was soon to find out. I had little idea what career I wanted to follow. Indeed, I think most of us at that time looked forward only to continuing the educative process in some rather vague and comforting way. Whatever …

The manufacture and use of bamboo tools by monkeys: Possible implications for the development of material culture among east asian hominids

This research examined the manufacture and use of bamboo tools by capuchin monkeys (Cebus apella). We presented groups of subjects with bamboo, and apparatus that accommodated the use of probing and cutting tools. Four monkeys manufactured probing tools by breaking bamboo strips, detaching shoots from larger branches, and removing leaves and stubs. A fifth subject used probing tools but did not modify them. In a second experiment five capuchins manufactured bamboo cutting tools. A sixth subject used cutting tools but did not modify them. These results demonstrate a simple bamboo-tool technology in capuchins. We hypothesize that east Asian Homo erectus could have used similar or more advanced manufacturing techniques to produce bamboo tools suitable for purposes that included probing and cutting.

Control of Ia afferent input to triceps surae (soleus) locomotor nucleus precedes agonist muscle activation during gait

Modulation of the triceps surae (soleus) H-reflex was investigated during treadmill walking to elucidate the temporal relationship between reflex facilitation and initiation of agonist muscle activation. Constant effective stimulation of the tibial nerve evoked the H-reflex. Contact foot switches monitored phases of the gait cycle. H-reflex changes were assessed at predetermined intervals across a window that anticipated the onset of soleus muscle electromyographic (EMG) activation. In five of six healthy subjects, multiphase statistical models revealed a ‘breakpoint’, reflecting a significant rise in H-reflex amplitude, beginning with stimuli delivered 144.1, 142.9, 148.8, 186.4 and 140.5 ms, respectively, prior to mean onset of EMG activity in the soleus muscle. In the sixth subject, no breakpoint was identified although the H-reflex amplitude gradually increased across the analysis window. These findings suggest that facilitation of the H-reflex is established well in advance of the descending corticomotoneuronal command to recruit spinal motoneurons in the motor act (i.e. prior to threshold spinal motoneuron depolarization). It is argued that a central programme controlling afferent input to the locomotor nuclei is part of the ‘preparatory set’ which precedes execution of the motor act.

Variation in MR signal intensity across normal human knee cartilage.

Signal intensity (SI) of individual pixels on sagittal magnetic resonance (MR) images of normal human knee cartilage was quantified to investigate whether it was related to cartilage proteoglycan content. In five subjects, images were acquired with spin-echo sequences with a TR msec/TE msec of 1,000 or 700/20 and a three-dimensional gradient-echo (GRE) sequence (60/15). In a sixth subject, the GRE sequence alone was used with 15 degrees, 30 degrees, and 50 degrees flip angles. In all subjects, SI was maximal in pixel layers of the medial zone and minimal at both cartilage edges, resulting in the presence of a bell-shaped curve of interpixel (zonal) SI variation across the cartilage thickness. The magnitude of SI was dependent on the pulse sequence and flip angle, but the bell shape of the SI variation curve was independent of them. For example, in the medial tibial cartilage, the peak SI was highest with the 1,000/20 spin-echo sequence, intermediate with the 700/20 sequence, and lowest with the GRE sequence. The differences were statistically significant. The bell-shaped SI variation curve resembled the curve for zonal variation in cartilage proteoglycan content but not the curves for collagen or free water content. The physiologic basis for this resemblance and the potential usefulness of the findings for early diagnosis of diseases such as osteoarthritis are discussed.

Preliminary Study of the Efficacy of Insulin Aerosol Delivered by Oral Inhalation in Diabetic Patients

To maximize deposition of an aerosolized dose of insulin (mean +/- SD = 0.99 +/- 0.06 U/kg of body weight) in the lungs of subjects with non-insulin-dependent diabetes mellitus (NIDDM), and investigate its efficacy in normalizing plasma glucose levels during the fasting state. Nonrandomized, placebo-controlled trial. A primary care facility. Six nonobese, nonsmoking volunteers with NIDDM. No subjects withdrew from the study. Aerosolized insulin was administered by oral inhalation after a 12-hour period of fasting. Aerosol was generated by a raindrop nebulizer from regular 500 U/mL pork insulin. During inhalation, inspiratory flow was regulated at 17 L/min. Plasma samples were collected after inhalation and analyzed for insulin and glucose levels. Plasma insulin and glucose levels. Deposition of the aerosol was maximized within the lungs, with 79% +/- 17% of the inhaled dose depositing below the larynx. Geometric mean fasting plasma insulin level was 71 pmol/L (11.8 microU/mL), rising to 269 pmol/L (44.8 microU/mL) after insulin inhalation. Average time to peak insulin level was 40 +/- 34 minutes. The mean fasting plasma glucose level (12.63 +/- 2.59 mmol/L [225.5 +/- 46.3 mg/dL]) was reduced to within the normal range in five subjects and was almost normal in the sixth subject (5.52 +/- 0.89 mmol/L [98.6 +/- 15.9 mg/dL]). Average maximum decrease in plasma glucose from baseline was 55% +/- 10% (n = 6) vs 13% +/- 9% after placebo aerosol inhalation (n = 3). No side effects were reported following insulin or placebo aerosol inhalation. These preliminary results indicate that a dose of approximately 1.0 U of aerosolized insulin per kilogram of body weight, delivered by oral inhalation and deposited predominantly within the lungs, is well tolerated and can effectively normalize plasma glucose levels in patients with NIDDM.

Methods for the analysis of thiodiglycol sulphoxide, a metabolite of sulphur mustard, in urine using gas chromatography —mass spectrometry

Two methods have been developed for the analysis of thiodiglycol sulphoxide, a metabolite of sulphur mustard, in urine. The first method recovers thiodiglycol sulphoxide from urine by extraction from a solid absorbent tube and clean up on Florisil. In the second method thiodiglycol sulphoxide is reduced to thiodiglycol with acidic titanium trichloride prior to extraction. This method detects thiodiglycol, thiodiglycol sulphoxide, and their acid-labile esters, as the single analyte thiodiglycol. In both cases the recovered analytes were converted to the bis(pentafluorobenzoyl) derivative of thiodiglycol and detected by gas chromatography mass spectrometry using negative ion chemical ionisation. The limits of detection were 1 ng per 0.5-ml sample of urine. Urine from five normal human subjects showed low background levels of thiodiglycol sulphoxide in the range 2–8 ng/ml. However, a sixth subject was found to be excreting levels of thiodiglycol sulphoxide as high as 36 ng/ml. The first method has been used in toxicokinetic studies of sulphur mustard and the second method is intended to be used for the retrospective confirmation of mustard poisoning in casualties of chemical warfare.