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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2004.04.047 Byline: Emily S. Lukacz (a), Jean M. Lawrence (b), Raoul J. Burchette (b), Karl M. Luber (c), Charles W. Nager (a), J. Galen Buckwalter (b) Keywords: Psychometric; Quality of life; Urogynecologic research; Visual Analog Scale Abstract: The purpose of this study was to assess the validity of Visual Analog Scales in urogynecologic research. Author Affiliation: (a) Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California, San Diego, Calif (b) Department of Research and Evaluation, Kaiser Permanente, Pasadena, Calif (c) Department of Obstetrics and Gynecology, Kaiser Permanente, San Diego, Calif Article History: Received 3 December 2003; Revised 20 January 2004; Accepted 19 April 2004 Article Note: (footnote) Supported by the National Institutes of Health (1RO1HD041113-01A1). Presented at the Twenty-fourth Annual Meeting of the American Urogynecologic Society, Hollywood, Fla, September 11-13, 2003. Reprint requests: Reprints will not be available from the authors.

Nausea and vomiting during pregnancy may not be entirely psychosomatic, but a woman's psychological response to it may make it worse. Some psychological treatments such as hypnosis can be effective treatments for the condition.

A small-scale biomechanical disc culture system was designed to stimulate intervertebral disc (IVD) ‘motion segment’ in culture environment with load-controlled compression and combined load (compression + shear). After 7 days of diurnal mechanical loading, cell viability of discs stimulated with static compression load (0.25 MPa) and static combined load (compression (0.25 MPa) + shear (1.5 N)) were similar (> 90 per cent) to unloaded controls. Mechanically stimulated discs showed decrease in static/dynamic moduli, early stress relaxation, and loss of disc height after 7 days of diurnal loading. Histological data of discs indicated load-induced transformations that were not apparent in controls. The feasibility of studying the mechanobiology of intact IVD as a motion segment was demonstrated. Media conditioning (improve tissue stability in long-term culture) and application of biochemical gene expression assays (differential tissue response to types of mechanical stimulation) are proposed as future improvements. The study suggests that the limitations in studying mechanobiology of IVD pathology in vitrocan be overcome and it is possible to understand the physiologically relevant mechanism of IVD pathology.

It has been known for a very long time that aging is the most prominent risk factor for the initiation and progression of osteoarthritis. This might be related to continuous mechanical wear and tear and/or result from time/age-related modifications of cartilage matrix components. Also a mere loss of viable cells over time, due to apoptosis or any other mechanism, might contribute. More recent evidence, however, supports that stressful conditions for the cells might promote chondrocyte senescence and might be in particular important for the progression of the osteoarthritic disease process. One of the most important implications of this hypothesis is that it points to issues of cellular degeneration as the basis for understanding of the initiation and the progression of osteoarthritis. Equally important, it emphasizes that whatever treatment we envisage for osteoarthritis, we must take into account that we are dealing with aged/(pre) senescent cells which no longer have the abilities of their juvenile counterparts to respond to the many mechanical, inflammatory, and traumatic assaults to the tissue. Thirdly, this directs treatment options to deal with the senescence of cells, which are only conceptually available today. Clearly, if accumulation of wear and tear over time is the major scenario of osteoarthritis, any therapy will largely be hopeless as moving and loading the joints is unavoidable as implication of their use. However, this review intends to open up the idea that age-related changes are less a fate, but rather a challenge for therapeutic intervention which can be taken.

Intracortical chondromas are exceedingly rare lesions that have the histopathologic appearance of enchondromas, but are located within cortical bone. Two new cases of intracortical chondroma, one symptomatic and the other found incidentally, are presented and the entity's brief literature reviewed.Intracortical chondromas are exceedingly rare lesions that have the histopathologic appearance of enchondromas, but are located within cortical bone. Two new cases of intracortical chondroma, one symptomatic and the other found incidentally, are presented and the entity's brief literature reviewed.

ABSTRACTTreatment and rehabilitation of the cognitive, psychological, and motor sequelae of central nervous system dysfunction often relies on assessment instruments to inform diagnosis and to track changes in clinical status. Typically, these assessments employ paper-and-pencil psychometrics, hands-on analog/computer tests, and rating of behavior within the context of real-world functional environments. Virtual reality offers the option to produce and distribute identical “standard” simulation environments in which performance can be measured and rehabilitated. Within such digital scenarios, normative data can be accumulated for performance comparisons needed for assessment/diagnosis and for treatment/rehabilitation purposes. In this manner, reusable archetypic virtual environments constructed for one purpose can also be applied for applications addressing other clinical targets. This article will provide a review of such a retooling approach using a virtual classroom simulation that was originally developed as a controlled stimulus environment in which attention processes could be systematically assessed in children with attention-deficit/hyperactivity disorder. This system is now being applied to other clinical targets including the development of tests that address other cognitive functions, eye movement under distraction conditions, social anxiety disorder, and the creation of an earthquake safety training application for children with developmental and learning disabilities.

Abstract The epidemiology of prolapse and incontinence questionnaire (EPIQ) was developed to screen for female pelvic floor disorders (PFD). Content and face validity, reliability, internal consistency and criterion validity of the EPIQ to detect the presence of pelvic organ prolapse (POP), stress urinary incontinence (SUI), overactive bladder (OAB) and anal incontinence (AI) is presented. Cronbach’s alpha; Spearman’s, kappa, intraclass correlations, factor analysis and Chi-Squared tests were used for analysis. Questions related to PFD proved internally consistent (α = 0.91) and reproducible (correlations >0.70) for all but three items on the EPIQ. Positive and negative predictive values of the EPIQ to detect PFD were: POP = 76% and 97%, SUI = 88% and 87%, OAB = 77% and 90% and AI = 61% and 91% respectively. EPIQ is a psychometrically validated screening instrument that may identify women at high risk of having pelvic floor disorders in large undiagnosed populations.

Osteoarthritis is the most common disabling condition of humans in the western world. It has been known for a very long time that aging is the most prominent risk factor for the initiation and progression of the disease, but the explanations for this phenomenon have changed over time. The most longstanding theory is that osteoarthritis develops because of continuous mechanical wear and tear. However, osteoarthritis can also be the result of time/age-related modifications to cartilage matrix components. One of the simplest biological explanations for the initiation and progression of osteoarthritic cartilage degeneration is a mere loss of viable cells, due to apoptosis or other mechanisms. Overall, the most likely scenario is that the cells and the matrix of articular cartilage get older over time, and eventually the tissue enters a senescence-like state that makes it more prone to enter the osteoarthritic degeneration pathway. Thus, patients with osteoarthritis might progress more quickly to the senescence phenotype compared to others. Moreover, stressful conditions associated with the osteoarthritic disease process might further promote chondrocyte senescence. Primary osteoarthritis in this model would be a "premature" degeneration of the joint due to a premature chondrocyte senescence. By analogy to neurodegenerative disorders, one could refer to osteoarthritis as the "M. Alzheimer" of articular cartilage. One of the most important implications of this hypothesis is that it points to issues of cellular degeneration as the basis for understanding the initiation and progression of osteoarthritis. Equally important, it emphasizes that whatever treatment we envisage for osteoarthritis, we must take into account that we are dealing with aged/(pre)senescent cells that no longer have the ability of their juvenile counterparts to counteract the many mechanical, inflammatory, and/or other assaults to the tissue.

Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) can produce a higher incidence of neuropsychological complications than other types of highly invasive noncardiac vascular surgery. Cognitive complications most likely arise from either embolization or hypoxia. An alternative surgical procedure has been developed that allows CABG to be performed without stopping the heart (“off-pump” CABG, or OPCABG). This study examined the neuropsychological performance of patients undergoing OPCABG, hypothesizing that patients undergoing OPCABG would show fewer cognitive deficits than patients whose hearts were stopped. A 1-hr neuropsychological battery was administered preoperatively to 43 patients before prospective randomization to either CPB CABG or OPCABG, and again to 34 of those patients 2 to 3 months postoperatively by an examiner blind to surgical condition. Neuropsychological status did not change 2.5 months postsurgically in either OPCABG or CABG groups. However, both groups showed dramatic presurgical cognitive deficits in multiple domains, particularly verbal memory and psychomotor speed. This corroborates previous research suggesting that patients requiring CABG surgery may evidence significant presurgical cognitive deficits as a result of existing vascular disease. (JINS, 2003, 9, 913–924.)

Virtual reality (VR) technology offers new options for the creation of sophisticated tools that could be applied in the areas of assessment and rehabilitation of cognitive and functional processes. VR systems allow for the precise presentation and control of dynamic, multisensory, three-dimensional (3-D) stimulus environments, as well as the recording of all behavioral responses that occur within them. Assessment and rehabilitation scenarios that would be difficult if not impossible to deliver using conventional neuropsychological methods are now being developed that take advantage of these VR assets. If empirical studies demonstrate effectiveness, virtual environments (VEs) could be of considerable value for better understanding, measuring, and treating persons with impairments due to traumatic brain injury, neurological disorders, and learning disabilities. This article describes the progress of a VR research program at the USC Integrated Media Systems Center and Information Sciences Institute that has developed and investigated the use of a series of VEs designed to target (i) molecular visuospatial skills using a 3-D, projection-based ImmersaDesk system, and (ii) attention (and soon memory and executive functioning) processes within ecologically valid functional scenarios utilizing a head-mounted display (HMD). Results from completed research, rationales and methodology of works in progress, and our plan for future work is presented. Our primary vision has been to develop VR systems that target cognitive processes and functional skills that are of relevance to a wide range of patient populations with central nervous system (CNS) dysfunction, as well as for the assessment of unimpaired performance. We have also sought to select cognitive/functional targets that intuitively appear well matched to the specific assets available with currently available VR technology.

The article focuses on the use of virtual reality (VR) technology in studying attention processes. It mentions that VR technology is recognized as useful equipment for assessing functional abilities and cognitive processes. It states that a VE targeting attention processes pertained as the "Virtual Classroom" was developed to examine children with attention deficit hyperactivity disorder (ADHD). It says that VR technology can ameliorate the reliability of different neuropsychological evaluation.

Tendon regions subjected almost exclusively to tension differ from regions subjected to high levels of compression as well as tension. Regions not exposed to compression consist primarily of spindle‐shaped fibroblasts surrounded by densely packed longitudinally oriented collagen fibrils formed principally from type‐I collagen. In contrast, regions subjected to compression have a fibrocartilagenous structure and composition: they consist of spherical cells surrounded by a matrix containing hyaline cartilage proteoglycans (aggrecan) and type‐II collagen as well as type‐I collagen. Reducing their adhesion to the matrix may help cells in the latter regions establish and maintain a spherical shape and minimize their deformation when the tissue is subjected to mechanical stress. We hypothesized that expression of tenascin‐C, an anti‐adhesive protein, is part of the adaptation of tendon cells to compression that helps establish and maintain fibrocartilagenous regions. To test this hypothesis, we compared segments of bovine flexor tendons subjected to repetitive compression (distal) with segments that are not subjected to compression (proximal) to determine whether they differed in tenascin‐C content and expression. RNA and protein analyses showed that tenascin‐C expression was elevated in the distal tendon. Tendon cells from the distal segment expressed more tenascin‐C mRNA than did cells from the proximal segments for as long as 4 days in cell culture, indicating that increased tenascin‐C expression is a relatively stable feature of the distal cells. Moreover, purified tenascin‐C inhibited the attachment of cultured tendon cells to fibronectin. These observations support the hypothesis that tenascin‐C expression is a cellular adaptation to compression that helps establish and maintain fibrocartilagenous regions of tendons by decreasing cell‐matrix adhesion.

Letters to the editor in response to articles from past issues such as "The Waitress Test," "The Subprime Swindle," and "The White Whale," are presented.

Recent studies have identified cognitive deficits in semantic memory and verbal language abilities among women with Alzheimer's disease (AD). Few studies to date have explored gender differences in episodic memory function in AD. The present study compared the performance of men and women diagnosed with AD on a battery of neuropsychological measures. Results indicated the presence of gender-related cognitive deficits on tasks of confrontation naming, expressive world knowledge, and both episodic and semantic memory for women with AD, relative to findings in men.

OBJECTIVES: We hypothesized that oral estrogen replacement therapy would be less common among elderly women meeting criteria for Alzheimer's disease (AD) than among nondemented elderly women. For women with AD, we hypothesized that estrogen users would perform better on a cognitive task than would nonusers. DESIGN: A case-control study of estrogen replacement therapy, in which hierarchical procedures were used to control for potentially confounding effects of age and education. When cognitive performances were compared between estrogen users and nonusers with AD, the duration of dementia symptoms was an additional control variable. SETTING: Alzheimer's Disease Research Center at the University of Southern California, Los Angeles. SUBJECTS: Subjects were a volunteer sample of consecutively enrolled elderly women, recruited primarily from the community, who met clinical criteria for probable AD (n=143) or met criteria for nondemented control status (n=92). Seventy case patients who have subsequently died met histopathologic criteria for AD; one other demented woman who did not meet the autopsy criteria for AD was excluded from all analyses. MAIN OUTCOME MEASURES: Current use of estrogen replacement at the time of enrollment as reported by control subjects or by the primary caregivers of AD case patients. Among cases, performances on a brief cognitive screening instrument were compared between estrogen users (n=10) and nonusers (n=128) for whom this information was available. RESULTS: Alzheimer's disease case patients were significantly less likely than control subjects to use estrogen replacement (7% vs 18%), but groups did not differ with regard to the total number of prescription medications or to the most frequently prescribed class of drug (thyroid medication). Demented case patients using estrogen did not differ significantly from those not using estrogen in terms of age, education, or symptom duration, but their mean performance on a cognitive screening instrument was significantly better (Mini-Mental State examination scores of 14.9 vs 6.5). CONCLUSIONS: Findings are consistent with contentions that postmenopausal estrogen replacement therapy may be associated with a decreased risk of AD and that estrogen replacement may improve cognitive performance of women with this illness.

• OBJECTIVE. —We evaluated scores on a brief psychometric screening instrument—the Mini-Mental State Examination (MMSE)—for possible effects of gender, hypothesizing that women with Alzheimer's disease (AD) would perform more poorly than men. A significant gender difference was to be explored with post hoc item analyses. DESIGN. —Case-study design. A hierarchical regression procedure controlled for the possible influence on MMSE performance of demographic variables (eg, age, duration of dementia symptoms, education, and family history of dementia) before the effect of gender was analyzed. SETTING. —Data were gathered by trained neuropsychological examiners from subjects enrolled in the Alzheimer's Disease Research Center at the University of Southern California, Los Angeles. SUBJECTS. —One hundred forty-two subjects who met strict criteria for probable AD and 121 nondemented elderly subjects were included in the study. All subjects underwent periodic neuropsychological testing. We extracted MMSE scores and demographic data to test the hypothesis that women would perform more poorly than men on the MMSE. CRITERION MEASURE. —The MMSE was chosen because of its wide use in clinical and research settings to screen for the presence or severity of dementia. RESULTS. —After controlling for the demographic variables for subjects with AD, we observed a significant difference in the predicted direction for total MMSE score, but there was no significant gender effect on the MMSE for the nondemented elderly sample. Among subjects with AD, gender-associated differences were limited to only a subset of MMSE items. CONCLUSIONS. —Results imply that MMSE performance may differ between men and women with AD and that differences might pertain only to discrete areas of cognitive functioning. Although gender effects were relatively small, findings indicate the relevance of gender to studies of AD.

H.1. symptom modifying drugs: The primary outcome variable is a specific aspect of joint pain, although a 'signal' symptom or some measure of function may also be studied. Trials of drugs with a rapid onset of effect can be as short as 1-4 weeks but may be as long as 12 weeks. Longer trials (up to 2 years) may be needed to evaluate longer-term toxicity, determine optimal long-term dosing regimens, or establish long-term benefit. Supplemental escape analgesia should be minimized, monitored and discontinued prior to evaluation of efficacy. Some agents that provide symptom relief may not provide benefit until weeks after initiation of therapy. Under these circumstances, trials will vary from 3-12 months in length. If the agent is administered in courses, episodic readministration of the drug may be needed in long-term trials. Longer trials (up to 2 years) may be required to exclude toxicity or establish long-term benefit. H.2. structure modifying drugs: These drugs are intended to prevent, retard, stabilize or reverse development of the morphologic changes of OA. Although this has been called 'chondroprotection', the term is misleading and should be avoided, because all structures of the joint are involved in OA, not articular cartilage alone. The benefits of disease modifying therapy may not be apparent until years after the onset of treatment. The selection of high-risk groups may shorten the time of investigation. Improvement in symptoms (i.e., joint pain) is not a requisite for the efficacy of a drug in this category. In these studies, it may be necessary to permit concomitant use of drugs for relief of symptoms (NSAIDs, analgesics). The confounding effects of glucocorticoids and NSAIDs in these trials is not yet understood and very restricted use of IA depocorticosteroids is recommended. Demonstration of structure modification will require the use of direct measures of joint anatomy, such as radiography, particularly measurement of the radiographic joint space. As stated above, the plain radiograph is presently the most reproducible and readily available method for assessment of disease modification. Studies are needed to validate surrogate markers of disease activity, since they may help shorten Phase 2 structure modifying drug trials. As an alternative to radiography, some trials may utilize arthroscopy. As we approach the beginning of the twenty-first century, concepts of clinical trials of OA drugs are changing. Methodology and techniques for the evaluation of new agents for OA have been refined dramatically over the last decade. We look forward to the future with excitement as we anticipate the development of new agents that may alter the symptoms and course of OA. The above recommendations are intended to help us ascertain which of these new agents are effective.

BACKGROUND: We hypothesized that women with Alzheimer disease (AD) would perform worse on a test of semantic memory but not on tests of other cognitive domains. We did not expect that women without dementia would perform more poorly than men without dementia on the same task. OBJECTIVE: To explore the specificity of a semantic memory deficit among women with AD by exploring gender differences among a group of subjects with vascular dementia (VD). DESIGN: A case-control study in which differences between men and women were explored using regression models to control for the potentially confounding effects of age, education, duration of dementia, and severity of dementia. SETTING: Alzheimer's Disease Research Center Consortium of Los Angeles and Orange Counties, California. Subjects: Volunteers, recruited from the community or clinic referrals, who met clinical criteria for AD (n=159) or VD (n=117) or met criteria for control status without dementia (n=134). MAIN OUTCOME MEASURES: Five neuropsychological measures, commonly used in the diagnosis and assessment of dementia. RESULTS: Women with VD scored lower than men with VD on 3 tests. However, when controlling for potential confounds, the gender difference was maintained only for the semantic memory task. Women with AD showed a strong trend to perform worse than men with AD on the test of semantic memory only. No gender differences were found among subjects without dementia. CONCLUSIONS: Findings support the existence of a semantic memory deficit for women with AD and suggest that a similar deficit may exist among women with VD.

Proteoglycans were extracted from the adult human meniscus under dissociative conditions and purified by CsCl-density-gradient centrifugation. The preparations of highest density contained proteoglycan that possessed the ability to interact with hyaluronic acid, was of large subunit size and was composed of chondroitin sulphate, keratan sulphate and sialic acid-containing oligosaccharides. This ‘cartilage-like’ proteoglycan also exhibited subunit and aggregate structures analogous to those of hyaline-cartilage proteoglycans when examined by electron microscopy. However, the composition of this proteoglycan was more comparable with proteoglycans from immature cartilage than from age-matched cartilage. The preparations from lower density, which were enriched in dermatan sulphate, contained smaller proteoglycan that was not able to interact with hyaluronic acid. This non-aggregating proteoglycan may be structurally distinct from the ‘cartilage-like’ proteoglycan, which does not contain dermatan sulphate.

Antibody to native bovine nasal cartilage proteoglycan monomer was shown by enzyme-linked immunosorbent assay to react with the purified hyaluronic acid binding region of the monomer. Antibody was digested with pepsin to produce F(ab')2 and labeled with glutaraldehyde-activated ferritin. F(ab')2 and F(ab')2-ferritin were reduced and alkylated to render them monovalent (Fab'). Antibody Fab' binding to native proteoglycan monomer was studied by electron microscopy of monomer reacted with ferritin-labeled antibody Fab' spread in a cytochrome c film. Ferritin-labeled antibody Fab' bound primarily at one end of the proteoglycan monomer. This binding was partly inhibitable by unlabeled monovalent antibody Fab', demonstrating immunospecificity. The end of the monomer with bound ferritin sometimes appeared as the thin segment, previously observed to bind to hyaluronic acid. These observations indicate that the hyaluronic acid binding region is at only one end of each proteoglycan monomer and that ferritin-labeled antibody Fab' selectively attaches to this part of native proteoglycan monomers. This methodology should be useful for future structural studies of isolated proteoglycans.

Cardiac and aortic arch anomalies are a well-known cause of tracheal and esophageal compression producing stridor and dysphagia. We present a rarely encountered aortic arch anomaly in a 12-month-old infant who suffered from intermittent pulmonary wheezing. A discussion of the subsequent evaluation including an esophageal contrast study, computed tomography, angiocardiography, and bronchoscopy, will emphasize the diagnostic importance of these examinations. Preoperatively, a variant of Celoria type B aortic arch interruption was established by cardiac catheterization. The ascending aorta solely supplied both carotid arteries. Both subclavian arteries arose from the descending aorta, and all flow to the descending aorta was supplied via bilateral markedly enlarged vertebral arteries as a bilateral subclavian steal. Three areas of tracheal compression were noted at bronchoscopy. The patient's anomalous circulation was improved by the placement of a Gore-Tex graft connecting the ascending and descending aorta. A right-sided arterial ligament was divided in order to further relieve tracheal compression.

We performed two studies of cognitive abilities among men and women who met clinical criteria for Alzheimer's disease (AD). Among 46 AD patients, performance of women on a composite neuropsychological battery was more impaired than that of men when the potentially confounding effects of demographic variables were controlled; the largest group differences were due to significantly worse performance by women with AD on a naming task. Based on these initial findings, we next analyzed an independent data set of 647 demented subjects enrolled in the multicenter Consortium to Establish a Registry for Alzheimer's Disease, hypothesizing that the naming performance of women with AD would be significantly worse than that of men with this illness. Analyses controlling for demographic variables, or separately controlling for dementia severity, confirmed that women with AD performed significantly less well on the naming task and on verbal fluency. Women also performed less well on delayed recall, but there were no significant differences on other tasks. Factor analysis confirmed significant differences on a language factor, implying that men retain verbal skills better than women do during the initial stages of AD. Elderly non-demented women performed as well as or better than nondemented men on all comparisons. We conclude that there are modest differences in how men and women with AD perform on cognitive tasks and that differences may be discrete rather than global in nature.

Hypothesizing that agraphia in Alzheimer's disease (AD) reflects disturbances in multiple cognitive domains, we evaluated writing samples from 33 patients meeting strict criteria for probable AD. We found agraphia to be common on a standard narrative writing task. When compared with 41 education- and age-matched normal control subjects, AD patients had significantly lower writing scores, wrote significantly fewer words, mentioned significantly fewer categories of information, and were significantly more likely to make writing errors. On stepwise regression procedures, neuropsychological measures of visuoperceptual impairment and disease severity were the strongest predictors of agraphia, but other analyses indicated that measures of language, praxis, and attention could also contribute significantly to agraphia. On two writing tasks, we failed to confirm the previous contention that agraphia is a marker for familial AD. However, there was a highly significant interaction between family history, oral naming, and writing: patients with non familial AD, but not those with a family history of dementia, showed a strong correlation between naming and writing performance. We conclude that agraphia in AD can be variously determined and that agraphia is not a reliable marker for familial disease.

There is a vast clinical need for the development of an animal model to study the fundamentals of healing of injured or diseased diarthrodial joints (knee, hip, shoulder, wrist, etc). Current prosthetic replacements do not offer acceptable treatment for injuries and diseases of these joints in young active individuals. New clinical treatment modalities, based on sound biologic principles, are sought for the development of repair or healing tissues engineered to have similar biomechanical properties as normal articular cartilage. In this paper we present a brief review of this need, and propose a grafting procedure which may lead to a successful animal model for studies of long term repair of major osteochondral defects. This grafting procedure uses an autologous periosteum-bone graft or an autologous-synthetic bone replacement graft. We have applied these grafts for in vivo repair of large surgically created defects in the high weight bearing area of the distal femoral condyle of mature New Zealand white rabbits. Further, an interdisciplinary study, including histochemistry, biochemistry (composition and metabolic activities), and biomechanics (biphasic properties), was performed to assess the feasibility of our animal model to generate viable repair tissues. We found our grafting procedure produced, 8 weeks postoperatively, tissues which were very similar to those found in normal articular cartilage. However, our histological studies indicate incomplete bonding between the repair tissue and the adjacent cartilage, and lack of an appropriate superficial zone at the articular surface. These deficiencies may cause long term failure of the repair tissue. Further studies must be undertaken to enhance development of a strong bond and a collagen-rich surface zone. This may require the use of growth factors (e.g., transforming growth factors β) capable of simulating extra collagen production, or the use of serum derived tissue glue for bonding. At present, we are pursuing these studies.

Calf (2-3-month-old) and steer (approximately 18-month-old) bovine articular chondrocytes were isolated and cultured as high density monolayers. The proteoglycans synthesized on day 5 during a 15-h period of labeling with [35S]sulfate or [3H]glucosamine were isolated and characterized. The majority (greater than 70%) of the newly synthesized proteoglycans were found in the medium. When viewed in the electron microscope, medium-derived proteoglycans of high buoyant density were longer in calf than in steer. The medium and extracts of the cell layer were pooled and the radiolabeled proteoglycans were fractionated by isopycnic density gradient centrifugation performed under dissociative conditions. The low buoyant density fraction contained, in both calf and steer, small-sized nonaggregating proteoglycans containing chondroitin sulfate. The high buoyant density fraction contained greater than 90% of the newly synthesized proteoglycans. The majority were able to interact with hyaluronic acid to form aggregates. Calf high buoyant density fraction proteoglycans were larger, had longer chondroitin sulfate chains and lower ratios of keratan sulfate chains/chondroitin sulfate chains than steer high buoyant density fraction proteoglycans. These maturation-related differences are typical of those present in the proteoglycans of the calf and steer cartilage matrix from which the chondrocytes were isolated. Experiments with beta-D-xylosides showed that steer cultures had the capacity to synthesize twice as many chondroitin sulfate chains/cell as calf cultures. At each xyloside concentration used, chondroitin sulfate chains were longer in calf than steer. At both ages, chain size decreased with increase in rate of synthesis; the relationship between chain size and rate of synthesis was, however, quite different at the two ages. The results of these studies suggest that articular chondrocytes have an inherent program that determines the quality of proteoglycans synthesized at different ages.

The nature of the association between the ABO blood groups and disease is being investigated in the population of the State of Iowa.1 The demonstration of statistically significant associations between the ABO blood groups and several diseases suggests that the ABO blood groups may be a tool useful in investigation of genetic factors in still other disorders. This paper is a report of the findings in patients with psychoses and intracranial neoplasms (brain tumors). MATERIALS AND METHODS The ABO blood types of the patients resident in Mount Pleasant and Independence Mental Health Institutes were determined by the research team, using a slide technique. The patient's blood type, diagnosis, and other relevant information abstracted from the patient's chart were recorded on punch cards. The diagnoses had previously been established by staff members of the Mental Health Institutes and were based upon the standard nomenclature of mental disorders recommended by the

Since 1935 when Whipple et al1 described a procedure for resecting the head of the pancreas, discussion has continued concerning the indications for this operation. That this question remains unresolved is indicated by the differences of opinion expressed by competent surgeons in the current medical literature. At one extreme is the pessimistic view that pancreatoduodenectomy is rarely if ever indicated for treatment of carcinoma of the head of the pancreas.2 In contrast is the optimistic view suggesting that the operation should be used to treat carcinoma of the head of the pancreas as well as carcinoma of the ampulla of Vater.3 High operative mortality and postoperative morbidity rates are the principal reasons for the continued caution concerning the indication for this operation. Reported operative mortality rates vary between 6.5%4 and 47%.5 To justify an operative risk of this magnitude it is necessary to have evidence

WITH REGARD to duodenal ulcer, the interest of the internist is usually directed toward research and clinical problems related to the diagnosis and the medical management. Much time and money are spent in the continuing search for better diets, antacids, anticholinergic, and other drugs. During the past 20 years the interest of the surgeon has shifted from an almost purely mechanistic to a physiologic approach to duodenal ulcer. This is reflected in the volume of the reports dealing with the role that acid peptic secretion plays in the pathogenesis. It has become almost standard practice to evaluate operations for ulcer in terms of their impact on acid peptic secretion.In view of the volume of clinical and basic research dealing with these matters, it is surprising that the progress which has been made in the prevention and the treatment of duodenal ulcer during the past 20 years is so modest.

The use of blood volume determinations in clinical medicine has been limited by the technical difficulties, the time required, and the expense involved. The technique which will be described makes it feasible to use blood volume measurements in the same way that blood cell counts or blood chemistries are used. This communication is concerned with the reliability of this technique and its application in clinical medicine; it will not deal with the indications for or interpretation of blood volume determinations which will be dealt with in a later report.A portable and semiautomatic instrument is used to make the blood volume determinations, employing the radioisotope dilution principle. The design, electronics, mechanical characteristics, and operation of the instrument have been described in detail by Williams et al.1 The results of the in vitro and in vivo studies by these authors establish that whole blood volume and red blood cell volume

Thirty-four consecutive patients with panic disorder or agoraphobia with panic attacks were treated with nortriptyline at the LAC-USC Medical Center's Anxiety Disorders Clinic. Fourteen (67) of the 21 completers totally lost their panic attacks, five (24) showed partial improvement, and two (10) showed no improvement. The relationship of treatment outcome to pretreatment and posttreatment measures of depression is discussed, in addition to the potential role of nortriptyline in treating panic attacks in clinical practice. (J Clin Psychopharmacol 1988;8:204–207)

Proteoglycan monomer and link protein were prepared from bovine fetal epiphyseal cartilage. Proteoglycan aggregates were reassembled from proteoglycan monomers and hyaluronic acid in the presence or in the absence of link protein at pH 7 and at pH 5. The proteoglycan solutions were spread on nitrocellulose films and examined by electron microscopy. At pH 7, the aggregates formed in the presence of link protein showed dramatic differences in their dimensions, compared with the link protein-free aggregates. The link protein-containing aggregates were five times longer and contained three times as many monomers per aggregates. The mean distance between monomers was twice as long and the spacing between monomers was more regular in the link protein-containing aggregates. Essentially the same differences between link protein-free and link protein-containing proteoglycan aggregates were observed at pH 5. These results show that link protein increases proteoglycan aggregate size by facilitating the binding of more monomers to hyaluronic acid and influences the spacing of monomers along hyaluronic acid chains.