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Diabetes is a major risk factor for cardiovascular disease. To examine how diabetes interacts with a mildly compromised lipid metabolism, we introduced the diabetogenic Ins2C96Y/+(Akita) mutation into mice expressing human apoE4 (E4) combined with either an overexpressing human LDL receptor gene (hLDLR) or the wild-type mouse gene. The hLDLR allele caused 2-fold reductions in plasma HDL-cholesterol, plasma apoA1, and hepatic triglyceride secretion. Diabetes increased plasma total cholesterol 1.3-fold and increased apoB48 secretion 3-fold, while reducing triglyceride secretion 2-fold. Consequently, diabetic E4 mice with hLDLR secrete increased numbers of small, cholesterol-enriched, apoB48-containing VLDL, although they have near normal plasma cholesterol (<120 mg/dl). Small foam cell lesions were present in the aortic roots of all diabetic E4 mice with hLDLR that we analyzed at six months of age. None were present in nondiabetic mice or in diabetic mice without hLDLR. Aortic expression of genes affecting leukocyte recruitment and adhesion was enhanced by diabetes. ApoA1 levels, but not diabetes, were strongly correlated with the ability of plasma to efflux cholesterol from macrophages. We conclude that the diabetes-induced proinflammatory changes in the vasculature and the hLDLR-mediated cholesterol accumulation in macrophages synergistically trigger atherosclerosis in mice with human apoE4, although neither alone is sufficient.

Ever since Gaunilo of Marmoutiers first published Reply on Behalf of the Fool, we have possessed evidence that St. Anselm of Canterbury's famous "Ontological Argument" is invalid, as Gaunilo provides the textbook argument for invalidity by counterexample. However, the issue of where Anselm made his mistake is a matter of dispute, with philosophers throughout western history offering differing views. This paper offers an explanation of Anselm's fallacy, first by analyzing the assumptions and premises of Anselm's Ontological Argument and then by looking at Gaunilo's Lost Island Argument, thereby demonstrating that the argument is unsatisfactory and fallacious due to the phenomenal nature of revelation, a key assumption in Anselm's thinking. By demonstrating that revelation can only give phenomenal knowledge of God, it can be shown that the Ontological Argument holds true only for the concept of God unless, by some unknown mechanism, a form of noumenal revelation may be utilized instead. [ABSTRACT FROM AUTHOR]

By facilitating reproducible first dimension separations, commercial immobilized pH gradient (IPG) strips enable high throughput and high-resolution proteomic analyses using two-dimensional gel electrophoresis (2DE). Amersham, Biorad, Invitrogen, and Sigma all market linear pH 3-10 IPG strips. We have applied optimized 2DE protocols with both membrane and soluble brain protein extracts to critically evaluate all four products. Resolved protein spots were quantitatively evaluated after carrying out these protocols using IPG strips from the four companies. Biorad and Amersham IPG strips resolved a high number of membrane and soluble proteins, respectively. Furthermore, Amersham IPG strips eluted the largest amount of protein into the second dimension gels and had the most protein remaining in the strip after 2DE. Biorad and Amersham IPG strips maintained a consistent linear pH 3-10 gradient, whereas those from Invitrogen appeared nonlinear or “compressed” within the central pH region. The gradient range within Sigma IPG strips appeared to be slightly less than pH 3-10, due to one extended pH unit within the gradient. Overall, all four commercially available IPG strips have the ability to resolve both membrane and soluble brain proteomes. The difference is that Amersham and Biorad do so more consistently and with better spot resolution. It appears that the physical/chemical nature of commercially available IPG strips can vary considerably, leading to marked differences in subsequent protein resolution in 2DE. These differences likely reflect variations in the uptake of proteins into the strips, and differences in the focusing and elution of proteins from the first to the second dimension. These differences would appear, in part, to underlie some inter-lab variations in the effective resolution of proteomes.

Allylic alcohols, such as methyl styryl carbinol (MSC), are required as single enantiomers for use as chiral building blocks, flavor additives, and aroma compounds in perfumes. This paper investigates the use of dynamic kinetic resolution (DKR) for this purpose, by determining concentration−time data for all species in the racemization, kinetic resolution (KR), and DKR of MSC in toluene. Racemization was catalyzed by ruthenium p-cymene combined with a number of different bases, while Novozym 435 catalyzed the KR. Results showed that the racemization is the rate-limiting step in MSC DKR because the hydrogenation step of the catalyst cycle is deactivated by the KR products. Furthermore, the racemization bases and ruthenium p-cymene made the KR less enantiospecific by either catalyzing nonenantiospecific allylic acetate formation or interfering with enzyme enantiospecifity. Nevertheless, DKRs using ruthenium p-cymene combined with triethylamine, trioctylamine, or P1-t-Oct gave enantiopure (R)-allylic acetate yields above 68% at 80−97% ee.

Novel surfaces derivatized with tertiary amine oxides have been prepared and tested for their ability to resist nonspecific protein adsorption. The oxidation of tertiary amines supported on triazine units was carried out using mCPBA to give a format allowing conjugation of biologically active ligands alongside them. Adsorption to these surfaces was tested and compared to adsorption to a set of commercial and custom oligo-/poly(ethylene glycol) (OEG/PEG) supports by challenging them with a protein display library presented on bacteriophage . The new class of amine oxide surfaces is found to compare favorably with the performance of the OEG/PEG supports in the prevention of nonspecific binding.

A systematic review was undertaken to identify published evidence relating to patient satisfaction in emergency medicine. Reviewed papers were divided into those that identified the factors influencing overall satisfaction in emergency department patients, and those in which a specific intervention was evaluated. Patient age and race influenced satisfaction in some, but not all, studies. Triage category was strongly correlated with satisfaction, but this also relates to waiting time. The three most frequently identified service factors were: interpersonal skills/staff attitudes; provision of information/explanation; perceived waiting times. Seven controlled intervention studies were found. These suggested that increased information on ED arrival, and training courses designed to improve staff attitudes and communication, are capable of improving patient satisfaction. None of the intervention studies looked specifically at the effect of reducing the perceived waiting time. Key interventions to improve patient satisfaction will be those that develop the interpersonal and attitudinal skills of staff, increase the information provided, and reduce the perceived waiting time. Future research should use a mixture of quantitative and qualitative methods to evaluate specific interventions.

Exact coordination of growth plate chondrocyte proliferation is necessary for normal endochondral bone development and growth. Here we show that PTHrP and TGFbeta control chondrocyte cell cycle progression and proliferation by stimulating signaling pathways that activate transcription from the cyclin D1 promoter. The TGFbeta pathway activates the transcription factor ATF-2, whereas PTHrP uses the related transcription factor CREB, to stimulate cyclin D1 promoter activity via the CRE promoter element. Inhibition of cyclin D1 expression with antisense oligonucleotides causes a delay in progression of chondrocytes through the G1 phase of the cell cycle, reduced E2F activity, and decreased proliferation. Growth plates from cyclin D1-deficient mice display a smaller zone of proliferating chondrocytes, confirming the requirement for cyclin D1 in chondrocyte proliferation in vivo. These data identify the cyclin D1 gene as an essential component of chondrocyte proliferation as well as a fundamental target gene of TGFbeta and PTHrP during skeletal growth.

BACKGROUND: Diarrhoea in AIDS is associated with anorexia and weight loss. The importance of gastrointestinal transit in such symptoms has not been addressed. AIMS: To assess jejunal to caecal transit times in subjects with AIDS related diarrhoea and weight loss and correlate these with measures of absorptive capacity and intestinal permeability. METHODS: Jejunal to caecal transit times were assessed in 20 seronegative controls and 60 HIV seropositive subjects from serum analysis of 3-O-methyl-D-glucose and sulphapyridine after ingestion of the monosaccharide and sulphasalazine in aqueous solution. The method also allows an estimation of gastric emptying times for liquids. Intestinal absorptive capacity and permeability were assessed by a combined test using 3-O-methyl-D-glucose, D-xylose, L-rhamnose, and lactulose. RESULTS: Gastric emptying was significantly delayed in all groups of patients with AIDS. Mean jejunal to caecal transit times were not significantly different between controls (246 (62) minutes) and patients without diarrhoea (AIDS, well: 278 (103) minutes; AIDS, wasting: 236 (68) minutes), cytomegalovirus colitis (289 (83) minutes), pathogen negative diarrhoea (192 (100) minutes), or microsporidiosis (190 (113) minutes), although 30% of patients had values below the control range. Patients with cryptosporidiosis differed significantly from controls (135 (35) minutes, p&lt;0.0001), seven of 10 having rapid transit times. Absorptive capacity was reduced and intestinal permeability significantly increased in AIDS, but did not correlate significantly with transit times. CONCLUSION: Small bowel transit is accelerated in many patients with AIDS, particularily in protozoal diarrhoea, but is not the sole explanation for malabsorption of monosaccharides.

We report a method which we have used routinely for the determination of chlormequat residues in pears. After extraction with methanol, determination was performed, without clean-up, by ion-exchange HPLC using an SCX column eluted with aqueous ammonium formate–methanol, and HPLC-MS with an electrospray interface. MS and MS-MS were employed concurrently, using selected ion monitoring and selected reaction monitoring, respectively, of the 35Cl and 37Cl isotopes of the chlormequat cation and the CID transitions of each of these precursors to the common product ion at m/z 58. The method was suitable for determinations at concentrations of chlormequat cation of 0.04 mg kg–1. Concentrations determined using the four signals were in good agreement (mean RSD 3%). The mean recovery of chlormequat cation at 0.16 mg kg–1, measured using the m/z 122→58 signal, was 86% (RSD 7%) under repeatability conditions and 88% (RSD 15%) in routine application of the method over a 3 month period. Analysis of an in-house reference sample of pears, similarly analysed over the 3 month period, gave an RSD of 10% with a mean of 0.14 mg kg–1. Mean recovery at 0.016 mg kg–1, under repeatability conditions on two occasions, was 101% (RSD 6%) and 56% (RSD 12%).

OBJECTIVES--To use routinely collected data to provide a reliable estimate of the size and psychiatric morbidity of the homeless population of a given geographical area by using capture-recapture analysis. DESIGN--A multiple sample, log-linear capture-recapture method was applied to a defined area of central London during 6 months. The method calculates the total homeless population from the sum of the population actually observed and an estimate of the unobserved population. Data were collected from local agencies used by homeless people. SUBJECTS--Homeless people in north east Westminster residing in bed and breakfast accommodation and hotels or sleeping rough who had contacted statutory or voluntary agencies in the area. RESULTS--2150 contacts by 1640 homeless people were recorded. The estimated unobserved population was 3293, giving a total homeless population for the period of around 5000 (SD 1250). Mental health problems were significantly less prominent in the unobserved compared with the observed population (23% (754) v 40% (627), P < 0.0001). For both groups the prevalence varied greatly with age and sex. CONCLUSIONS--Capture-recapture techniques can overcome problems of ascertainment in estimating populations of homeless and homeless mentally ill people. Prevalences of mental illness derived from surveys that do not correct for ascertainment are likely to be falsely inflated while at the same time underestimating the total size of the homeless mentally ill population. Population estimates derived from capture-recapture techniques may usefully provide a good basis for including homeless populations in capitation calculations for allocating funds within health services.

Habitat loss and habitat fragmentation can have major effects on the distribution and abundance of species (Saunders et al. 1987), often in unpredictable ways (Klein 1989; Tilman et al. 1994; Lacy and Lindenmayer 1995; Cunningham and Moritz 1998). An understanding of responses of species, which lead to persistence or extinction in such disturbed systems, is important for the effective management of many taxa in fragmented multi-use landscapes. One way to examine population dynamics in fragmented systems is to analyse the genetic characteristics of subpopulations in remnant habitat patches (Sarre 1995), borrowing from the population genetics literature for the interpretation of key effects. For example, it is well established that a small, completely isolated population will lose genetic variation rapidly due to genetic drift (Lacy 1987). However, loss of genetic variation within, and increasing differentiation between, subpopulations will be counteracted by inter-population dispersal. Theoretical models of metapopulation structure which describe connectivity and stability can be examined using various demographic input parameters. Importantly, such models can also produce predictions for genetic structuring, making the combined use of modelling and empirical genetic data an extremely powerful tool in examining the effects of habitat fragmentation. On this basis, we have recently commenced a series of integrated demographic and genetic studies of the Greater Glider Petauroides volans at Tumut in southern New South Wales. The study area near Tumut in southeastern New South Wales is characterized by an array of remnant patches of eucalypt forest (0.2?125 ha in size) that were created 15?65 years ago by the establishment of an extensive (50 000 ha) plantation of exotic softwood, Radiata Pine Pinus radiata and known as the Buccleuch State Forest (Routley and Routley 1975). Large areas of continuous native eucalypt forest occur at the boundaries of the plantation (Fig. 1), including those within the Brindabella and Kosciuszko National Parks, and the Bondo and Bungongo State Forests.

OBJECTIVES: To determine prevalence of mental disorder among male unconvicted prisoners and to assess the treatment needs of this population. DESIGN: Semi-structured interview and case note review of randomly selected cross section of male remand population. Non-attenders were replaced by the next name on prison roll. SETTING: Three young offenders' institutions and 13 adult men's prisons. SUBJECTS: 750 prisoners, representing 9.4% cross sectional sample of male unconvicted population. MAIN OUTCOME MEASURES: Prevalence of ICD-10 diagnoses of mental disorder, and associated treatment needs. RESULTS: Psychiatric disorder was diagnosed in 469 (63%) inmates. The main diagnoses were: substance misuse, 285 (38%); neurotic illness, 192 (26%); personality disorder, 84 (11%); psychosis, 36 (5%); other and uncertain, 36 (0.5%). Subjects could have more than one diagnosis. The average refusal rate was 18%. In total 414 inmates (55%) were judged to have an immediate treatment need: transfer to an NHS bed, 64 (9%); treatment by prison health care services, 131 (17%); motivational interviewing for substance misuse, 115 (15%); and therapeutic community placement, 104 (14%). CONCLUSIONS: Mental disorder was common among male unconvicted prisoners. Psychosis was present at four or five times the level found in the general population. Extrapolation of our results suggests that remand population as a whole probably contains about 680 men who need transfer to hospital for psychiatric treatment, including about 380 prisoners with serious mental illness.

Since the introduction of computed tomography (CT), there have been numerous reports of brain abscess treated successfully without surgery. Because pathologic confirmation was lacking in these patients, diagnosis was based on CT abnormalities, usually ring enhancement. However, our recent clinical experience and the experimental work of others indicate that the “ring sign” on contrast-enhanced CT is not absolutely diagnostic of encapsulated brain abscess. Moreover, in the reported cases of alleged brain abscess cured medically, atypical clinical features suggest that some patients may have had cerebral infarction or cerebritis. Stricter clinical and radiologic criteria are needed before concluding that encapsulated brain abscess can be cured by medical therapy alone.

The role of receptor subtypes in opioid modulation of the hypothalamic-pituitary-adrenal (HPA) axis is well understood in the adult but has not been investigated in the developing fetus. Because the fetal HPA axis plays an important role in the development of several vital organs and in the onset of parturition, an understanding of the role of opioid receptor subtypes on the fetal HPA axis is important in the design of new obstetrical analgesics. In these studies, we examined the effects of highly selective mu, delta and kappa opioid agonists on plasma immunoreactive adrenocorticotropin (ir-ACTH) and immunoreactive cortisol (ir-cortisol) in the ovine fetus. Intravenous administration of the mu selective agonist [D-Ala2-N-Me-Phe4,Gly-ol]-enkephalin resulted in a 92% increase in ir-ACTH (P = .005) and ir-cortisol. The delta selective agonist, [D-Pen2,D-Pen5]-enkephalin, elicited a much smaller increase (52%) in ir-ACTH (P = .01). In contrast, there was a 7-fold increase in ir-ACTH (P < .001) and a significant increase in ir-cortisol (P = .02) with the kappa selective U50,488H. When the same agonists were administered intracerebroventricularly, there was no change in ir-ACTH or ir-cortisol. These data suggest that the kappa opioid receptor may be more important in the modulation of the fetal HPA axis and that the distribution of these opioid agonists from the lateral ventricle to the hypothalamus and pituitary is very limited.

We previously reported that U50488H, a kappa-selective opioid agonist, stimulates the release of adrenocorticotropin (ACTH) in the ovine fetus via the release of hypothalamic arginine vasopressin and corticotropin releasing factor. In this study we examined the effects of the endogenous kappa-preferring opioid peptide, dynorphin A1-13, on fetal ACTH release using the unanesthetized, chronically catheterized fetal lamb model. Fetal plasma samples were collected at timed intervals after fetal administration of dynorphin A1-13 (0.5 mg/kg, i.v.) and subsequently analyzed by radioimmunoassay for immunoreactive-ACTH and immunoreactive-cortisol. Dynorphin A1-13 produced a highly significant and rapid increase in immunoreactive-ACTH (P = .002) and immunoreactive-cortisol (P = .002) with peak levels of 383.3 +/- 43.8 pg/ml and 32.8 +/- 9.0 ng/ml, respectively, at 15 min after administration. A similar increase in plasma immunoreactive-ACTH was seen after the same dose of dynorphin A1-17 (P = .02) but not dynorphin A2-17. This ACTH response to dynorphin A1-13 was shown to be insensitive to the opioid antagonist, naloxone (12 mg/hr), as well as antagonists of corticotropin releasing factor and arginine vasopressin. These data suggest that dynorphin A1-13 in the ovine fetus may be acting through a mechanism distinct from the kappa-opioid system and that the dynorphins may serve as secretagogues of ACTH directly at the anterior pituitary through nonopioid receptors.

• Though rare, Serratia marcescens pneumonia is being reported with increasing frequency, especially in patients in intensive care units. We report three cases of S marcescens pneumonia that presented striking similarities for age, group, type of surgical procedure, and microbiological, hemodynamic, and respiratory patterns. All patients survived after prolonged ventilatory support.(Arch Surg 112:1220-1224, 1977)

Introduction: A fracture liaison service (FLS) is a coordinated system of care that streamlines osteoporosis management in the orthopaedic setting and can serve as an effective form of secondary preventative care in these patients. The present work reviews the available evidence regarding the impact of fracture liaison services on clinical outcomes.Methods: The literature was reviewed for studies reporting changes in the rates of bone mineral density scanning (DXA), antiresorptive therapy, new minimum trauma fractures, and mortality between cohorts with access to an FLS or not. Studies including intention to treat level data were retained. A Medline search for “fracture liaison” OR “secondary fracture prevention” produced 146 results, 98 were excluded based on the abstract, 38 were excluded based on full-text review. Ten level III studies encompassing 48,045 patients were included, of which 5 studies encompassing 7,086 were analyzed. Odds-ratios for DXA and anti-osteoporosis pharmacotherapy rates were calculated from data. Fixed and random effects analyses were performed using the Mantel-Haenszel method.Results: Four studies reported, on average, a 6-fold improvement in DXA scanning rates (Figure 1). Six studies reported, on average, a 3-fold improvement in antiresorptive therapy rates (Figure 2). Four large studies reported significant reductions in the rate of new fractures using time-dependent Cox proportional hazards models at 12 months (HR = 0.84, 0.95), 24 months (HR = 0.44, 0.65), and 36 months (HR = 0.67). Five large studies reported mortality improvements using time-dependent Cox proportional hazards models at 12 months (HR = 0.88, 0.84, 0.81) and 24 months (HR = 0.65, 0.67).Conclusions: The findings suggest that fracture liaison services improve rates of DXA scanning and antiresorptive therapy as well as reductions in the rates of new fractures and mortality among patients seen following minimum trauma fractures across many time points.

Introduction: Osteoporosis is often not clinically recognized until after a fracture occurs. Individuals who have 1 fracture are at increased risk of future fractures. Prompt initiation of osteoporosis treatment following fracture is critical to reducing the rate of future fractures. Antiresorptives are the most widely used class of medications for the prevention and treatment of osteoporosis. Many providers are hesitant to initiate antiresorptives in the acute post-fracture period. Concerns include interference with bone remodeling necessary for successful fracture healing, which would cause increased rates of non-union, malunion, and refracture. While such concerns should not extend to anabolic medications, physicians may also hesitate to initiate anabolic osteoporosis therapies due to high cost and/or lack of familiarity. This article aims to briefly review the available data and present a digestible narrative summary to familiarize practicing orthopaedic surgeons with the essential details of the published research on this topic.Results: The results of 20 clinical studies and key pre-clinical studies related to the effect of anti-resorptive medications for osteoporosis on fracture healing are summarized in the body of this narrative review.Discussion & Conclusions: While few level I studies have examined the impact of timing of initiation of osteoporosis medications in the acute post-fracture period, the few that have been published do not support these concerns. Specifically, data from level I clinical trials indicate that initiating bisphosphonates as early as 2 weeks post-fracture does not increase rates of non-union or malunion. By reviewing the available data, we hope to give clinicians the confidence to initiate osteoporosis treatment promptly post-fracture.

Erythrocytes from 24-hr-old chicks have, on the external surface of the plasma membrane, a structure which appears to possess all of the characteristics of previously described lanthanum-staining material. Removal of this layer by treatment with very low concentrations of phospholipase C results in failure of the cells to be agglutinated by the virus.

Global collaboration in translational science promises to accelerate the discovery, development and dissemination of new medical interventions. Here, we introduce a new international collaboration of translational science organizations and highlight our initial strategy to reduce or remove bottlenecks in translation.

Treatment of adult femoral shaft fractures typically involves operative stabilization with intramedullary implants, external fixation, or a plate and screw construct. However, when stabilization is delayed for any reason, use of a traction pin is recommended to stabilize the fracture, prevent significant shortening, as well as to help with pain control. In this paper, we present the rare complication of a severe gas gangrene infection caused by Clostridium perfringens that led to several amputations and ultimately death. We also discuss risks of temporary skeletal traction and techniques to overcome the morbidity of such a procedure.

OBJECTIVE: To investigate the association between bronchodilator treatment and death from asthma. DESIGN: Case-control study. SETTING: 33 health authorities or health boards in Great Britain. PARTICIPANTS: 532 patients under age 65 who died from asthma and 532 controls with a hospital admission for asthma matched for period, age, and area. MAIN OUTCOME MEASURES: Odds ratios for deaths from asthma associated with prescription of bronchodilators and other treatment, with sensitivity analyses adjusting for age at onset, previous hospital admissions, associated chronic obstructive lung disease, and number of other drug categories. RESULTS: After full adjustment, there were no significant associations with drugs prescribed in the 4-12 months before the index date. For prescriptions in the 1-5 years before, mortality was positively associated with inhaled short acting beta2 agonists (odds ratio 2.05, 95% confidence interval 1.26 to 3.33) and inversely associated with antibiotics (0.59, 0.39 to 0.89). The former association seemed to be confined to those aged 45-64, and the association with antibiotics was more pronounced in those under 45. Significant age interactions across all periods suggested inverse associations with oral steroids confined to the under 45 age group. An inverse association with long acting beta2 agonists and a positive association with methylxanthines in the 1-5 year period were non-significant. CONCLUSION: There was no evidence of adverse effects on mortality with medium to long term use of inhaled long acting beta2 agonist drugs. The association with short acting beta(2) agonists has several explanations, only one of which may be a direct adverse effect.

A recent EC directive has called for all member states to introduce legislation covering the assessment and restriction of air crew exposure to cosmic radiation. In the UK the Civil Aviation Authority, in conjunction with the Department of the Environment, Transport and the Regions issued guidelines suggesting the use of a predictive code such as CARI for this purpose. In order to validate the use of calculated route doses, an extensive programme of measurements is being carried out in conjunction with Virgin Atlantic Airways, using a prototype HAWK TEPC developed by Far West Technology. This programme began in January 2000 and by the end of February 2001 had resulted in the accumulation of data from 74 flights. In this paper the instrument design is discussed, together with the calibration program. An overview of the in-flight results is also presented, including comparisons between measurements and calculations, which indicates that CARI under-predicts the route doses by approximately 20%.

Echinococcal cysts are unusual in Canada, and most cases seen are in immigrants. In northern Canadian communities, Echinococcus granulosis infection occasionally is acquired from dogs that feed on the entrails of caribou or moose. Seventeen patients with Canadian-acquired hydatid cysts were seen over an 11-year period. One challenging case is described in detail. An 18-year-old aboriginal woman presented with jaundice, pain, lower extremity edema and coagulopathy from a 26 cm echinococcal hepatic cyst. She was successfully treated with a combination of oral albendazole, percutaneous drainage and surgery. One-year follow-up showed no recurrence of disease. The management options for echinococcal cysts are extensively reviewed.

There is a need to develop noninvasive assays to detect Helicobacter pylori infection in the gastric mucosa, Current dogma predicts that the presence of antibody within saliva should accurately reflect contemporary colonization of the gut mucosa. This study examined the clinical value of a saliva enzyme-linked immunoadsorbent assay (ELISA) for anti-H pylori antibody, compared with the serum ELISA assay, and found the sensitivity of the saliva assay was 89%, specificity 94%, accuracy 93%, positive predictive value 89% and negative predictive value 94%. Assessment following eradication therapy demonstrated that salivary antibody was a more sensitive indicator of colonization than was serum antibody. The immunoglobulin G antibody in saliva correlated best with colonization, and regression analysis was most consistent with a local production of antibody. These results indicate that detection of antibody in saliva contributes to diagnosis and management of H pylori infection.

Psychiatry and neurology are well-established as separate disciplines and they may view an issue of mutual concern, such as affective disorder in people with epilepsy, from such different premises that the important synthesis of behavioural neurology, or neuropsychiatry, will be made ineffective. Nosological problems stemming from the use of diagnostic manuals are discussed and revealed in case reports. Reports of affective disorder in persons with brain disorders are relatively rare, possibly as a consequence of nosological problems which stem from a maintenance of a tradition of “functional” disorder. New cases of bipolar disorder and organic mania are given with commentary on the preponderant lateralization of cerebral dysfunction to the right cerebral hemisphere in manic cases.