Quantum chemical calculations on the Peterson olefination with alpha-silyl ester enolates.

The reaction of stabilized Peterson reagents (alpha-silyl ester enolates) with ketones has been studied theoretically and experimentally. Enolate geometry was studied by trapping experiments and NMR spectroscopy and was found to differ markedly with the nature of the base (LiHMDS vs LDA vs KHMDS). The chelating effect of the lithium counterion was found to be critical for the reaction.

A model of atropine-resistant theta oscillations in rat hippocampal area CA1.

Theta frequency oscillations are a predominant feature of rhythmic activity in the hippocampus. We demonstrate that hippocampal area CA1 generates atropine-resistant theta population oscillations in response to metabotropic glutamate receptor activation under conditions of reduced AMPA receptor activation. This activity occurred in the absence of inputs from area CA3 and extra-ammonic areas.

Experimental and calculated shift in pK(a) upon binding of phosphotyrosine peptide to the SH2 domain of p56(lck).

The pH dependence of the affinity of a 11-mer phosphotyrosine (pY) peptide (EPQpYEEIPIYL-NH2) for the SH2 domain of the tyrosine kinase p56(lck) was investigated with surface plasmon resonance (SPR). From SPR competition experiments the affinity in solution was obtained. The pH dependence of the affinity in solution can be well described by a proton linkage model with a single pK(a) shift upon binding, from 6.

The accessibility of computer-based health information for patients: kiosks and the web.

The Internet is a rich source of health information but it is not as accessible as many claim. This paper brings together three projects to illustrate technical and cost barriers and some options to overcome them. (1) A survey amongst a representative sample of 180 patients in rural Spain showed a marked age gradient in computer access.

Do patient information booklets increase perioperative anxiety?

Patient attitudes to medical information are changing. We audited patient attitudes to an information leaflet provided at the preadmission clinic as part of standard day-case protocol. The booklet is a simplified version of the booklet Anaesthesia and Anaesthetists--Information for Patients and Relatives published in London, UK, by the Association of Anaesthetists of Great Britain & Ireland.

Immunological and aetiological aspects of macular degeneration.

Aetiological and immunological aspects of AMD, a leading cause of blindness in Western countries, have been reviewed. Developmental studies suggest that anatomical features unique to the fovea result in a critical relationship between metabolic demand and blood supply at the macula, which is maintained throughout life. Recent studies show a sufficient degree of consistency in the link between smoking and both dry and wet AMD to regard it as causative.

Postoperative pain: a comparison of adolescent inpatient and day patient experiences.

This three-year study investigated the experience of postoperative pain and its management following elective surgery in an adolescent population aged 12-18 years (n=351) in 5 NHS trusts. In addition to the adolescents, one parent of each adolescent and a range of health professionals including surgeons, anaesthetists and registered nurses were interviewed concerning their views on acute pain in adolescent patients. The results presented in this paper are those related to the management of day and inpatient surgery in this adolescent population.

Lack of mental well-being in 15-year-olds: an undisclosed iceberg?

Background: Young people suffer from psychiatric symptoms and illness, and the frequency of both may be higher than currently is recognized. The frequency with which young people consult GPs with emotional problems is not established.

Objective: The purpose of this study was to identify the number of 15-year-olds who consult their GP directly or indirectly with psychiatric symptoms or illness.

Triamcinolone acetonide modulates permeability and intercellular adhesion molecule-1 (ICAM-1) expression of the ECV304 cell line: implications for macular degeneration.

Whilst animal studies and a pilot clinical trial suggest that intravitreal triamcinolone acetonide (TA) may be useful in the treatment of age-related macular degeneration (AMD), its mode of action remains to be fully elucidated. The present study has investigated the capacity of TA to modulate the expression of adhesion molecules and permeability using a human epithelial cell line (ECV304) as a model of the outer blood-retinal barrier (BRB). The influence of TA on the expression of ICAM-1 and MHC-I was studied on resting and phorbol myristate acetate (PMA)- or interferon-gamma (IFN-gamma)- and/or tumour necrosis factor-alpha (TNF-alpha)-activated cells using flow cytometry and immunocytochemistry.

Regulators of vascular permeability: potential sites for intervention in the treatment of macular edema.

Rather than being a non-specific reaction to a noxious stimulus, breakdown of the capillary blood-retinal barrier causing macular edema appears to be dependent on a number of active processes which may be open to pharmacological manipulation. Extracellular influences which may affect barrier function include serum and neighboring cell types, which act though cytokines, such as vascular endothelial growth factor and transforming growth factor-beta, and other factors. A number of intracellular pathways acting on the cytoskeleton and components of the intercellular junctional complexes have been identified which mediate agonist-induced leak of the vascular endothelium.

Safe use of remifentanil in a patient treated with the monoamine oxidase inhibitor phenelzine.

We report the safe use of remifentanil as part of the anaesthetic technique in a patient undergoing major head and neck surgery who was being treated for depressive illness with the non-specific monoamine oxidase inhibitor (MAOI) phenelzine.

Trends in hospitalization and mortality from rotavirus disease in New Zealand infants.

Background: Rotavirus illness is associated with significant morbidity and mortality worldwide. We have examined trends in diarrheal disease in New Zealand children to determine the disease burden attributable to rotavirus and to estimate the proportion of hospitalizations preventable by vaccination.

Methods: Hospital admissions data and laboratory records for 1994 to 1996, were obtained for children 0 to 4 years at four sites (serving -60% of the New Zealand population).

A randomized phase II trial of interferon-alpha2b versus 5-fluorouracil after trabeculectomy.

Purpose: The aim of the present study was to investigate the safety and potential efficacy of subconjunctival interferon-alpha2b (IFN-alpha), either alone or in combination with 5-fluorouracil (5-FU), in reducing the risk of failure of glaucoma surgery

Methods: A prospective, masked randomized phase II study was undertaken in which patients received three subconjunctival injections per week for 3-4 weeks postoperatively. Three treatments were compared: (i) IFN-alpha (1 x 10(6)IU per dose); (ii) 5-FU (5 mg per dose); and (iii) alternating IFN-alpha and 5-FU (BOTH). The primary outcome measures were: (i) rate of successful control of intra-ocular pressure without further surgery; and (ii) the incidence of side effects.

Postoperative pain assessment and management in adolescents.

A 3-year study investigated the experience and management of postoperative pain following elective surgery in an adolescent sample, using a variety of valid, reliable instruments and semi-structured interviews. In addition to the adolescent subjects, the views of one parent of each adolescent were sought and a sample of health professionals comprising surgeons, anaesthetists and nurses were interviewed about acute pain in adolescent patients. This paper presents some of the main findings pertaining to pain assessment and management.

Exudative macular degeneration and intravitreal triamcinolone: 18 month follow up.

Purpose: To evaluate the safety and efficacy of intravitreal triamcinolone after 18 months of follow up in patients with age-related macular degeneration and subfoveal or juxtafoveal choroidal neovascularization considered unsuitable for laser photocoagulation.

Methods: Thirty eyes of 28 patients, referred from general eye clinics as well as the private clinic of one of the authors to a hospital-based retinal out-patient clinic, were treated with an intravitreal injection of triamcinolone (4 mg). The primary outcome measure was the proportion of eyes with loss of six or more lines on a Bailey-Lovie Chart.