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This review article examines evidence supporting the use of oral therapies in treating idiopathic, actinic, and metabolically induced skin hyperpigmentation. A thorough review of the literature regarding oral treatments for hyperpigmentation was systematically conducted through PubMed. Keywords used in the primary search include “Hyperpigmentation,” “Melanosis” or “Melasma,” “Lightening,” “Oral,” and “Therapeutics.” The search was limited to the English language, and no timeframe restrictions were implemented. Numerous orally administered therapies have been proposed for the treatment of skin hyperpigmentation. There is an abundant body of literature demonstrating the efficacy of orally administered tranexamic acid, glutathione, isotretinoin, and proanthocyanidin. It is reasonable to expect that the most effective oral therapies will address known underlying causes of hyperpigmentation such as thyroid disease, diabetes, and hormonal imbalance. Improvement due to oral therapy of otherwise unresponsive skin hyperpigmentation or hyperpigmentation of unknown cause is less predictable. This review is limited by the strength of evidence contained within the available studies. Clinical studies investigating the treatments discussed within this article are limited in number, at times lack blinding in the study design, and are based on small sample sizes. Based on existing research, the most promising oral remedies for hyperpigmentation appear to be tranexamic acid, glutathione, isotretinoin, and proanthocyanidin. Additional studies to better establish safety and efficacy are necessary.

The COVID-19 pandemic altered the college experience and substantially impacted emerging adults’ navigation of this life stage. This concurrent mixed-methods study used an online survey, distributed to a southeastern university shortly after the transition to remote learning, to explore and understand college-attending emerging adults’ experiences during COVID-19. A total of 1,220 students ( Mage = 20.9) participated, and the diversity of the demographics was largely consistent with the university population. Participants completed questionnaires about psychopathology and COVID-related stressors, and they were given an opportunity to provide feedback to the university about the adjustment to COVID-19. The most common stressors included loss of routine, lack of social contact, and work/finances. Approximately two-thirds of participants reported anxiety and depression symptoms in the moderate to severe range, and about one-third reported suicidality. The authors discuss the implications of these findings for the ongoing crisis and offer recommendations for universities and college counselors.

International audience; This expert consensus statement on the interpretation of peripheral arterial and venous spectral Doppler waveforms was jointly commissioned by the Society for Vascular Medicine (SVM) and the Society for Vascular Ultrasound (SVU). The consensus statement proposes a standardized nomenclature for arterial and venous spectral Doppler waveforms using a framework of key major descriptors and additional modifier terms. These key major descriptors and additional modifier terms are presented alongside representative Doppler waveforms, and nomenclature tables provide context by listing previous alternate terms to be replaced by the new major descriptors and modifiers. Finally, the document reviews Doppler waveform alterations with physiologic changes and disease states, provides optimization techniques for waveform acquisition and display, and provides practical guidance for incorporating the proposed nomenclature into the final interpretation report.

Religious ideology and extremism have had an increasing influence on political agendas in the United States and much of the developed world in the past 60 years, with right-wing ideology becoming more prevalent this decade. This article serves as a review of studies investigating the correlations between political ideology, religiosity, right-wing authoritarianism, ingroups/outgroups, and prejudice in an attempt to describe and understand the well-established links between these dimensions. We discuss several group-level theories including Terror Management Theory, Social Identity Theory, Realistic Group Conflict Theory among others to frame the intercorrelations of these constructs in an effort to better understand the underlying mechanisms that drive individuals to embody religious and political beliefs. We then discuss individual-level cognitive and psychological differences such as intelligence, cognitive flexibility, and specific biological and neurological limitations of brain function that may influence people to adopt certain religious and political beliefs. Through a more comprehensive understanding of the underlying mechanisms of religious and political extremism, we may be better equipped to assuage the fear and denigration that is associated with many of these beliefs.

Background: It is well established that depression and non-communicable diseases are highly co-morbid and bi-directional in nature. ‘Lifestyle medicine’ has recently gained traction in the field of psychiatry, aimed at improvement of both physical and mental health. Online interventions can be an effective and inexpensive alternative or supplement to therapy that is delivered using more traditional modes, overcoming barriers that may prohibit people from accessing treatment by promoting flexibility and accessibility. Methods: This systematic review evaluates the existing evidence for the efficacy or effectiveness of lifestyle interventions for (1) individuals with depressive symptoms, (2) clinically depressed populations or discussing the outcomes of depression within a subset of a larger cohort that are delivered online or via smart phone. Included studies were randomised controlled trials, with active comparator conditions, in adult populations and with reported lifestyle and depression-related outcomes. The analysis examined attrition, engagement, adherence and behaviour change techniques employed to achieve the target behaviours. Results: Seven studies were included in the review and targeted behaviour change in five domains: alcohol reduction, improved sleep quality/insomnia reduction, increased physical activity, reduced/cessation of substance abuse and smoking cessation. Four of the studies achieved significant improvements in the targeted behaviour; of these three also reported significant improvements in depressive symptoms. No studies reported significant improvements in depressive symptoms without a change in the target lifestyle behaviour. Conclusion: The results of this review highlight the potential of online lifestyle interventions as adjunctive treatments for depression, and the possibility of achieving significant improvements in depressive symptoms when targeting lifestyle behaviour change.

The study examines the social context of a cannabis offer, an outcome rarely examined in research on substance use. Drawing from a survey conducted among 15-year-old students in a mid-sized Canadian city, we examine (a) the differences between three types of users (immediate, late, and nonusers) and (b) the factors associated with accepting a cannabis offer more quickly. The findings show that 40% of the sample received an offer, that 25% of those who accept an offer do so on the first occasion, and that among the others, it takes up to seven offers before accepting. The social context of the offer distinguishes between the types of users, and offers are accepted more quickly when adolescents are first offered by a close social contact, and when the offer occurs in familiar settings. The study also identifies a type of nonuser, those who are exposed to drugs but decide not to participate.

This study tested two cognitive models, learning styles and dual coding, which make contradictory predictions about how learners process and retain visual and auditory information. Learning styles-based instructional practices are common in educational environments despite a questionable research base, while the use of dual coding is less ubiquitous, and thus measured examination of the two methods has implications for practical application. The study involved 204 university students who were surveyed on their preferred learning style and then presented with information that they were prompted to process via either imagery or linguistic means. The results showed there was no significant interaction effect between learning style and condition, suggesting the most basic prediction of the learning styles hypothesis should be rejected. In a regression analysis, none of the four learning styles (visual, auditory, read/write, or kinesthetic) predicted students’ retention of the material. However, there was a highly significant main effect of condition with those in the visual condition retaining twice as much information as those in the auditory condition regardless of learning style, a result that strongly supports dual coding theory. Implications of the findings would suggest that learning styles instruction is an ineffective method for teachers to employ, and that, instead, incorporating principles of dual coding would have a much greater benefit to student learning.

Tissue acidosis is a key component of cerebral ischemic injury, but its influence on cell death signaling pathways is not well defined. One such pathway is parthanatos, in which oxidative damage to DNA results in activation of poly(ADP-ribose) polymerase and generation of poly(ADP-ribose) polymers that trigger release of mitochondrial apoptosis-inducing factor. In primary neuronal cultures, we first investigated whether acidosis per sé is capable of augmenting parthanatos signaling initiated pharmacologically with the DNA alkylating agent, N-methyl- N′-nitro- N-nitrosoguanidine. Exposure of neurons to medium at pH 6.2 for 4 h after N-methyl- N′-nitro- N-nitrosoguanidine washout increased intracellular calcium and augmented the N-methyl- N′-nitro- N-nitrosoguanidine-evoked increase in poly(ADP-ribose) polymers, nuclear apoptosis-inducing factor , and cell death. The augmented nuclear apoptosis-inducing factor and cell death were blocked by the acid-sensitive ion channel-1a inhibitor, psalmotoxin. In vivo, acute hyperglycemia during transient focal cerebral ischemia augmented tissue acidosis, poly(ADP-ribose) polymers formation, and nuclear apoptosis-inducing factor , which was attenuated by a poly(ADP-ribose) polymerase inhibitor. Infarct volume from hyperglycemic ischemia was decreased in poly(ADP-ribose) polymerase 1-null mice. Collectively, these results demonstrate that acidosis can directly amplify neuronal parthanatos in the absence of ischemia through acid-sensitive ion channel-1a . The results further support parthanatos as one of the mechanisms by which ischemia-associated tissue acidosis augments cell death.

Neuronal preconditioning in vitro or in vivo with a stressful but non-lethal stimulus leads to new protein expression that mediates a profound neuroprotection against glutamate excitotoxicity and experimental stroke. The proteins that mediate neuroprotection are relatively unknown and under discovery. Here we find that the expression of the AAA + ATPase Thorase is induced by preconditioning stimulation both in vitro and in vivo. Thorase provides neuroprotection in an ATP-dependent manner against oxygen–glucose deprivation (OGD) neurotoxicity or glutamate N-Methyl-D-aspartate (NMDA) receptor-mediated excitotoxicity in vitro. Knock-down of Thorase prevents the establishment of preconditioning induced neuroprotection against OGD or NMDA neurotoxicity. Transgenic overexpression of Thorase provides neuroprotection in vivo against middle cerebral artery occlusion (MCAO)-induced stroke in mice, while genetic deletion of Thorase results in increased injury in vivo following stroke. These results define Thorase as a neuroprotective protein and understanding Thorase signaling could offer a new therapeutic strategy for the treatment of neurologic disorders.

This study examined the effects of gender on RNA expression after ischemic stroke (IS). RNA obtained from blood of IS patients ( n = 51; 153 samples at ≤ 3, 5, and 24 hours) and from matched controls ( n = 52) were processed on Affymetrix microarrays. Analyses of covariance for stroke versus control samples were performed separately for both genders and the regulated genes for females compared with males. In all, 242, 227, and 338 male-specific genes were regulated at ≤ 3, 5, and 24 hours after IS, respectively, of which 59 were regulated at all time points. Overall, 774, 3,437, and 571 female-specific stroke genes were regulated at ≤ 3, 5, and 24 hours, respectively, of which 152 were regulated at all time points. Male-specific stroke genes were associated with integrin, integrin-liked kinase, actin, tight junction, Wnt/β-catenin, RhoA, fibroblast growth factors (FGF), granzyme, and tumor necrosis factor receptor (TNFR)2 signaling. Female-specific stroke genes were associated with p53, high-mobility group box-1, hypoxia inducible factor (HIF)1α, interleukin (IL)1, IL6, IL12, IL18, acute-phase response, T-helper, macrophage, and estrogen signaling. Cell death signaling was overrepresented in both genders, although the molecules and pathways differed. Gender affects gene expression in the blood of IS patients, which likely implies gender differences in immune, inflammatory, and cell death responses to stroke.

The article argues that many forms of diversity instruction, be it in the classroom or a conference room, have promoted an appreciation of differences without simultaneously promoting inclusion. Therefore, we advocate that diversity instruction should take a strategic approach to cultivating an appreciation of inclusion as well as diversity through considering the structure of the instruction, the authors of the work chosen, as well as who delivers the instruction. In essence, we present an alternative diversity teaching strategy that incorporates a value for inclusion.

Abdominal aortic aneurysms are rare in young women. We report the case of a 31-year-old woman who underwent open surgical repair of a symptomatic 7-cm abdominal aortic aneurysm (AAA). The patient had no identifiable AAA risk factors. Laboratory and pathological analyses demonstrated a nonspecific inflammatory component.

Research suggests Canada is a largely secular nation. Yet Reginald Bibby (2002) has recently proposed, surprisingly, that Canada is experiencing a religious renaissance. While "private spirituality" abounds in Canada, Bibby says his claim rests on increased levels of involvement in "organized religion." We have our doubts about Bibby's new optimism, and there are two sources of our scepticism. First, the cumulative weight of his own evidence is still more indicative of a continued preference for the consumption of religious fragments, a notion first popularized by Bibby (1987), than a renaissance of organized religion. Second, the credibility of his proposal is undermined by some nagging problems with the way he sorts, reports and interprets his data. To grasp whether something new is happening in Canada we need more precise and relevant data, and we make four methodological suggestions for acquiring the kinds of information needed.

Introduction —Adventitial cystic disease is an unusual cause of lower-extremity ischemia. It affects large arteries, typically where the artery is near a joint space, and the popliteal artery is most commonly involved. Methods —A 60-year-old man with venous insufficiency and prior deep vein thrombosis was referred for a lower-extremity venous evaluation. He had chronic degenerative joint disease, with bilateral knee osteoarthritis, but a history of exertional right calf pain was elicited. His right femoral and popliteal pulses were normal, but the posterior tibial pulse was diminished and the dorsal pedal artery pulse was absent. A lower-extremity duplex ultrasound examination was performed, including conventional and panoramic B-mode imaging, color Doppler and power Doppler imaging, and pulsed flow assessment. Results —Chronic deep and superficial venous thrombosis was identified in the right lower extremity. During the examination, the right popliteal artery was noted to be abnormal. Imaging showed the flow lumen in the popliteal artery to be visibly narrowed by more than 50%. Peak systolic velocities (PSV) in the proximal popliteal artery were 82 cm/sec, with a normal triphasic waveform, but the PSV increased to 221 cm/sec through the stenotic segment. The luminal narrowing was limited to an approximately 3 cm segment of the popliteal artery. There was no visible plaque or evidence of vascular calcification. The lumen appeared compressed by hypoechoic, septated cystic material. There was no flow within the well-visualized cystic structure. The findings were subsequently correlated with arteriography. Adventitial cystic disease of the popliteal artery was diagnosed. The patient underwent successful right popliteal artery cystectomy. Intra-operative and post-operative duplex evaluations demonstrated normal findings. Conclusion —Cystic adventitial disease is a rare disorder that can compromise arterial perfusion to the leg and it is one nonatherosclerotic cause of intermittent claudication. In some cases, the popliteal artery may occlude. Incidental arterial disease may be encountered frequently with lower extremity venous duplex scanning. With a careful examination by a thorough technologist, rare and interesting pathology, such as cystic adventitial disease, is possible.

Duplex ultrasound can be a valuable tool in detecting potentially life-threatening iliac artery aneurysms and pseudoaneurysms amenable to endovascular therapy. Four patients were found to have aneurysms other than abdominal aortic aneurysms, which were treated successfully with endovascular exclusion techniques. These included a 5.4 x 5.1-cm pseudoaneurysm arising from the distal anastomotic site of a previous aortic aneurysmorrhaphy; a 7.8 x 6.4-cm right common iliac artery aneurysm with an associated arteriovenous fistula that caused high-output heart failure, and a 4.1 x 5.0-cm aneurysm of the left internal and common iliac artery in a patient who had previous surgical repair of an aortic aneurysm with a bifurcated graft. A patient with a 7.5-cm aneurysm of the internal iliac artery also was treated, but the initial ultrasound diagnosis was made by a referring hospital. Treatment methods included placement of bifurcated endografts (two cases), use of a covered stent (one case), and use of a single iliac component from an aortic endograft (one case). Three internal iliac arteries were embolized with coils. In one patient, subsequent duplex surveillance identified a stenosis within a covered stent. This was treated with placement of a balloon-expandable stent.

Peripheral artery disease is associated with altered blood rheologic properties, including increased viscosity and decreased red blood cell (RBC) deformability. Pentoxifylline and cilostazol are available therapies for intermittent claudication. Improvement of blood viscosity and erythrocyte deformability have been cited as potential mechanisms of action for pentoxifylline. Cilostazol is a new drug with antiplatelet and vasodilating activity, but the mechanism by which it promotes an improvement in walking is not known. This study was performed to evaluate and compare the hemorheologic effects of pentoxifylline and cilostazol on viscosity, fibrinogen levels, and erythrocyte deformability when administered to adults with moderate to severe claudication. A double-blind, controlled study was conducted and included 59 patients (46 male, 13 female; mean age 65 yr) randomized to pentoxifylline 400 mg orally thrice daily (n=20), cilostazol 100 mg orally twice daily (n=19), or placebo (n=20); all subjects were observed for 24 weeks. Walking ability was assessed before, during, and at the conclusion of treatment by standard constant speed, variable grade treadmill testing. Erythrocyte deformability was measured by passage of washed RBCs, 10% hematocrit in phosphate buffered saline (PBS), through a polycarbonate membrane with 4.7 to 5.0 microm pores. Whole blood and plasma viscosity were measured using a cone/plate viscometer at variable shear rates (from 4.5 to 450 sec(-1)). Erythrocyte sedimentation rate was measured by a modified Westergren technique. Fibrinogen was assayed by a commercial reference laboratory. Plasma viscosities did not change significantly in any treatment group. Within-group comparisons demonstrated a significant (p

In this paper, four sets of data, collected by four different research teams over a period of 30 years are examined. Common item equating, which yielded correlations from .94 to .97 across datasets, was employed to justify pooling the data for a new analysis. Probabilistic conjoint measurement (Rasch analysis) was used to model the results. The detailed analysis of these pooled data confirms results reported in previous research about the ordered acquisition of moral stages and the relationship between moral stages and age, education, and sex. New findings include: (1) empirical evidence that transitions between “childhood” and “adult” stages of development involve similar mechanisms; (2) support for the notion of stages as qualitatively distinct modes of reasoning that display properties consistent with a notion of structure d’ensemble; and (3) evidence of a stage between Kohlberg’s stages 3 and 4. Consistent with reports from earlier research, the relationship between age and moral development is curvilinear. The relationship between educational attainment and moral development is linear, suggesting that educational environments have an equivalent impact across the course of development. Older males have slightly higher scores than older females after age and education are taken into account (accounting for 0.3% of the variance in moral ability).

Objective: To explore the views of therapists, nurses and doctors working in a variety of rehabilitation settings on the goal-setting process. Methods: Sixteen rehabilitation staff from three different settings attended a goal-setting workshop in which the difficulties associated with goal-setting were described with their potential solutions. Results: Five difficulties with goal-setting were identified. (1) Formal goal-setting was felt to be an activity unusual for many of the patients although intrinsic to the activity of many professional groups. (2) Goal-setting is often insensitive to people's roles in the community. (3) Goal-setting in the hospital environment does not transfer easily to the community. (4) External factors (e.g. staff turnover) over which staff felt they had little control were important in the success of a goal-setting programme. (5) Goals tend to be formulated and owned by the team, rather than the patient. Conclusions: Goal-setting is a very satisfactory activity for the team but to be as successful for the patient their needs must be acknowledged. People with mild disability and a short inpatient stay have different needs to those with acute onset severe permanent disability and those with chronic or progressive disability admitted from the community. Comparison of both process and outcome effects of different types of goal-setting is an area for future study.

Objective A renal artery duplex study is the screening study to evaluate for renal artery stenosis. A nondiagnostic study from a renal artery duplex study can be frustrating and labor intensive, with diminished revenue for the vascular laboratory. The purpose of this study is to evaluate patient and environmental factors in predicting a limited study. Methods A retrospective chart review of patients who underwent a renal artery duplex study in an Intersocietal Commission for the Accreditation of Vascular Laboratories-accredited vascular laboratory from July 2005 through June 2008 was performed. Patient age, body mass index, technologist experience, and the patient location where imaging was performed (inpatient versus outpatient) were collected and evaluated. A univariate and multivariate analyses were performed by use of the continuous and proportional measures. A p value of less than 0.05 was considered significant. Results A total of 390 patients had a renal artery duplex performed during this time period. Of the 390 duplex studies that were performed, 66% (258/390) were considered complete studies. The average age of patients with complete studies was 62 ± 16 versus incomplete 62 ± 15 ( p = NS). In the univariate analysis, complete studies were more likely to be performed by experienced technicians ( p = 0.04), in an outpatient setting ( p < 0.001), in patients with a lower body mass index ( p = 0.01). In the multivariate analysis, only body mass index ( p = 0.01) and outpatient status ( p = 0.002) were found to be significant predictors of a complete study. Conclusions One-third of the renal artery duplex studies were limited in our retrospective review. Experience of the ultrasound technician, lower body mass index of the patient, and the outpatient setting for the study appear to play a crucial role in obtaining a complete study. A prospective analysis of the factors will be necessary to confirm these findings.

This study investigated the academic effects of classwide peer tutoring (CWPT) for students with mild mental retardation (MMR) and their typical peers in inclusive classroom settings. Four students with MMR were integrated in two, general education elementary classrooms during spelling instruction. Dependent measures included performance on weekly tests and direct observations of academic engagement. The results demonstrated increased spelling accuracy and increased levels of engagement for students with MMR and their typical peers during CWPT when compared to traditional teacher-led instruction, suggesting that CWPT is an effective instructional strategy for improving their spelling performance.

An intervention strategy to enhance spelling performance, social interactions and decrease inappropriate behaviours of students with mild disabilities and typical peers in an inclusive instructional setting This study investigated the ability of Class Wide Peer Tutoring (CWPT) to enhance the social interactions and improve the spelling of three students with mild disabilities and three of their typical peers. Social interactions were assessed using the Multiple Option Observation System for Experimental Studies. Spelling performance was measured by weekly pre-post-tests. Using a single-subject design, the results indicated that the duration of positive social interactions emitted by the students with mild disabilities and their typical peers during the CWPT intervention were dramatically increased. In addition, CWPT produced large gains in academic achievement for both groups of students. The implications of the findings for the use of direct observation and CWPT to enhance the social interactions and spelling performance of students with mild disabilities in the regular education classroom are discussed.

Nitric oxide (NO) has revolutionized our conceptions about neurotransmission. NO is not stored in synaptic vesicles, is not released by exocytosis, and does not mediate its action by binding to cell surface receptors. Instead, NO simply diffuses to its targets, and its actions are mediated through molecules that accept or share its unpaired electron. NO has diverse biological roles, including functions as the nitrergic transmitter of the peripheral nervous system, the major regulator of blood vessel tone, and actions as the cytotoxic agent of activated macrophages. In the CNS, NO function is just beginning to be explored, but it seems to play prominent roles in plasticity and the regulation of complex behaviors. Under conditions of excessive formation. NO has emerged as an important endogenous neurotoxin. Strategies aimed at reducing NO formation may therefore have therapeutic benefit. NEUROSCIENTIST 4:96–112, 1998

La these de la religion civile a donne lieu a d'importants debats et developpements d'ordre theorique appliques ici a un cas jamais etudie auparavant : le Chili sous la dictature militaire d'Augusto Pinochet, de 1973 a 1989. Sous le regime militaire, l'Etat chilien tenta d'imposer sa propre interpretation de l'histoire chilienne en tenant un discours fonde sur la religion civile. Le general Pinochet s'attribua un role sacerdotal et presenta sa lutte contre le marxisme comme une croisade legitimee par Dieu. Sa recherche de soutien pour ses politiques de repression fit appel a un discours inspire de la notion de religion civile, sans toutefois connaitre un grand succes. Une revue de la litterature comparee a permis d'identifier les facteurs expliquant l'echec de cette tentative d'implanter une religion civile durable au Chili. La tendance a caracteriser la religion civile comme etant une croyance nationale non-sectaire est refutee. La presentation de la religion civile comme etant un ensemble de valeurs communes favorisant l'integration sociale est egalement rejetee. L'analyse a demontre que ces hypotheses perdent de leur validite lorsqu'elles sont appliquees aux regimes dictatoriaux. La religion civile du regime Pinochet fut un rousseauisme episodique.

Surprisingly, perhaps, controversy about the nature and dangers of cults or new religious movements remains a topic of considerable public concern and significant misunderstanding. Scholarship in the study of new religious movements, however, has reached a certain obvious maturity. This article summarizes and integrates the empirical data available in dispersed sources to provide a sociological profile of what reliably can be said about how people become interested in new religions, who tends to become interested in new religions, and some insights into why people join such religions.

SummaryNO has clearly revolutionized our thinking about aspects of neurotransmission and neuronal signaling. NO is emerging as an important regulator of a variety of physiologic processes; however, under conditions of excessive or inappropriate formation, NO is also emerging as an important mediator of pathologic nervous tissue damage. Uncovering and understanding the targets of NO that contribute to the neuropathologic process will hopefully lead to the development of selective therapeutic agents and to a better understanding of basic processes underlying normal and pathological neuronal functions.VLD is supported by grants from USPHS NS22643, NS33142, the American Foundation for AIDS Research, National Alliance for Research on Schizophrenia and Depression, American Heart Association, the Alzheimer's Association and the Muscular Dystrophy Association. T. M. D. is supported by grants from the USPHS NS01578, NS26643, NS33277, and the American Health Assistance Foundation, Paul Beeson Physician Scholars in ...

Nitric oxide is a unique biological messenger molecule. It mediates, in part, the immune functions of mac rophages ; it is produced by endothelial cells to mediate blood vessel relaxation; and it also serves as a neurotransmitter in the central and peripheral nervous system. Endothelial nitric oxide synthase and neuronal nitric oxide synthase are thought to be primarily constitutive, with activation induced by calcium entry into cells in the absence of protein synthesis, whereas the macrophage nitric oxide synthase is inducible with large increases in new nitric oxide synthase protein synthesis after immune stimulation. The molecular targets of nitric oxide are expanding, as are its physiological and pathophysiological roles in the nervous system. Nitric oxide may regulate neurotransmitter release, and it may play a key role in nervous system morpho genesis and synaptic plasticity and regulate gene expression. Under conditions of excessive formation, nitric oxide is emerging as an important neurotoxin in a variety of disorders of the nervous system. The Neuro scientist 1:7-18, 1995

During the last decade there has been increasing pressure to legislate legal rights for psychiatric patients especially in relation to consent to treatment. The attempt to subject the irrationality of psychotic illness to the due process of rational laws has caused problems. Revision of the Ontario Mental Health Act (MHA) has already led to situations in which patients are being incarcerated without treatment because of review board decisions regarding dangerousness and competence. The test in the revised MHA is whether the patient is competent to give or withhold consent for treatment. Existing guidelines for determination of competence to consent to treatment rely upon observer judgement and are open to challenge on grounds of subjectivity. The medical directors of the ten Ontario provincial psychiatric hospitals have therefore developed a guide and schema to operationalize the MHA definitions, a novel feature of which is the examination of competence in such a way as to elicit and capture the patient's own responses upon which an objective determination is made.

In a patient taking prophylactic anticoagulants after valve replacement, haemorrhage presents a therapeutic dilemma.

The author suggests that not the borderline syndrome itself but many of the worst behaviours of borderline patients are essentially iatrogenic. To do no harm should be the primary goal of any therapist encountering a patient exhibiting borderline features. Management of the patient-therapist relationship is paramount and may be in itself the most effective and safe treatment for both crisis situations and longer therapy. A conceptual model borrowing from and bridging self psychology and interpersonal theory is described. This model leads to a reframing or new interpretation of borderline symptoms and therapists’ reactions. Realtionship management guidelines and specific interventions are suggested.

This study determined the effect of various models of protective eyewear on the reaction time in the horizontal field of vision. Five protective eye devices for racquet sports were selected based on design characteristics. Eyewear was presented to 64 subjects in a random order along with no eyewear. Each subject's reaction time was measured for the random presentation of the visual stimuli by releasing a depressed telegraphic key wired to a digital clock. Stimulus anticipation was controlled using an interval timer generating random time intervals. Significant differences were noted between lights, eyewear, and the interaction of lights by eyewear. No differences were found between dominant and nondominant sides or between trials. Reaction time was unaffected in the central portion of the horizontal field and affected with some of the eyewear in the peripheral portion. It was concluded that the configuration of the protective eyewear was a significant factor affecting reaction time in the horizontal field of vision.

Summary1. Proteins of bone and cartilage from skull, femur, rib and vertebrae of female rats, Wistar strain, age 5 weeks and 2 1/2 years, respectively, were fractionated into TCA supernatant of base soluble protein, nonscleroprotein, soluble collagen, insoluble collagen, glycoprotein and elastin. 2. With an increase in age, there was a decrease of protein and hexosamine in TCA supernatant of base soluble protein, nonscleroprotein and soluble collagen of both bone and cartilage. 3. The amount of insoluble collagen in skull, femur and rib did not change with age; in vertebrae it increased and in cartilage, it decreased. 4. Certain glycoproteins, not present in the connective tissues studied, other than bone and cartilage, decreased in bone and increased in costal cartilage wtih increasing age.

SummaryThe conversion of C14-proline to C14-hydroxyproline has been used as a measure of the synthesis of collagen in sponge biopsy connective tissue in vitro. Krebs-Henseleit medium, pH 7.4, under an atmosphere of 95% O2–5% CO2 created the most satisfactory conditions we have employed for collagen synthesis in vitro. Elimination of NaCl from the incubation medium gave the most striking depression of collagen synthesis. Replacement of NaCl by other chemical compounds did not restore the synthesis of collagen to the control level. An amino acid mixture, containing essential amino acids, had an inhibitory effect on collagen synthesis. Freezing and crushing destroys most of the enzyme system or systems required for collagen synthesis. The data presented are compatible with the concept that all collagen hydroxyproline is derived from proline peptide.