Different reference frames can lead to different hand transplantation decisions by patients and physicians.

Different frames of reference can affect one's assessment of the value of hand transplantation. This can result in different yet rational decisions by different groups of individuals, especially patients and physicians. In addition, factors other than frames of reference can affect one's evaluation of hand transplantation, which can result in different decisions.

APRIL and TALL-I and receptors BCMA and TACI: system for regulating humoral immunity.

We report that the tumor neurosis factor homolog APRIL (a proliferation-inducing ligand) stimulates in vitro proliferation of primary B and T cells and increases spleen weight due to accumulation of B cells in vivo. APRIL functions via binding to BCMA (B cell maturation antigen) and TACI (transmembrane activator and CAML-interactor) and competes with TALL-I (also called BLyS or BAFF) for receptor binding. Soluble BCMA and TACI specifically prevent binding of APRIL and block APRIL-stimulated proliferation of primary B cells.

TACI is a TRAF-interacting receptor for TALL-1, a tumor necrosis factor family member involved in B cell regulation.

We and others recently reported tumor necrosis factor (TNF) and apoptosis ligand-related leukocyte-expressed ligand 1 (TALL-1) as a novel member of the TNF ligand family that is functionally involved in B cell proliferation. Transgenic mice overexpressing TALL-1 have severe B cell hyperplasia and lupus-like autoimmune disease. Here, we describe expression cloning of a cell surface receptor for TALL-1 from a human Burkitt's lymphoma RAJI cell library.

Bringing psychiatric nursing into the twenty-first century.

Psychiatric nursing stands at a crossroads, in danger of losing both its identity and standing within the larger body of nursing. Enrollment in graduate programs is at an all time low and many traditional employment opportunities for psychiatric nurses are disappearing. Many explanations have been proposed to account for the crisis in psychiatric nursing practice.

Congenital anomalies in patients with Duane retraction syndrome and their relatives.

Purpose: Although the high incidence of skeletal, neural, and other ocular problems has been identified in previous reports of large cohorts of patients with Duane syndrome, there has not been any documentation of anomalies in close relatives. Patients with Duane syndrome have a greater than 50% incidence of associated abnormalities that include deafness, other ocular anomalies, cranial nerve palsies, and skeletal abnormalities. This study was undertaken to review the experience of our strabismus service with patients who have Duane retraction syndrome (DRS) and to delineate the associated anomalies in them and their first-degree relatives.

Severe B cell hyperplasia and autoimmune disease in TALL-1 transgenic mice.

TALL-1/Blys/BAFF is a member of the tumor necrosis factor (TNF) ligand superfamily that is functionally involved in B cell proliferation. Here, we describe B cell hyperplasia and autoimmune lupus-like changes in transgenic mice expressing TALL-1 under the control of a beta-actin promoter. The TALL-1 transgenic mice showed severe enlargement of spleen, lymph nodes, and Peyer's patches because of an increased number of B220+ cells.

RANK is the intrinsic hematopoietic cell surface receptor that controls osteoclastogenesis and regulation of bone mass and calcium metabolism.

We have generated RANK (receptor activator of NF-kappaB) nullizygous mice to determine the molecular genetic interactions between osteoprotegerin, osteoprotegerin ligand, and RANK during bone resorption and remodeling processes. RANK(-/-) mice lack osteoclasts and have a profound defect in bone resorption and remodeling and in the development of the cartilaginous growth plates of endochondral bone. The osteopetrosis observed in these mice can be reversed by transplantation of bone marrow from rag1(-/-) (recombinase activating gene 1) mice, indicating that RANK(-/-) mice have an intrinsic defect in osteoclast function.

T-cell co-stimulation through B7RP-1 and ICOS.

T-cell activation requires co-stimulation through receptors such as CD28 and antigen-specific signalling through the T-cell antigen receptor. Here we describe a new murine costimulatory receptor-ligand pair. The receptor, which is related to CD28 and is the homologue of the human protein ICOS, is expressed on activated T cells and resting memory T cells.

Activated T cells regulate bone loss and joint destruction in adjuvant arthritis through osteoprotegerin ligand.

Bone remodelling and bone loss are controlled by a balance between the tumour necrosis factor family molecule osteoprotegerin ligand (OPGL) and its decoy receptor osteoprotegerin (OPG). In addition, OPGL regulates lymph node organogenesis, lymphocyte development and interactions between T cells and dendritic cells in the immune system. The OPGL receptor, RANK, is expressed on chondrocytes, osteoclast precursors and mature osteoclasts.

Psychiatric nurse practitioner versus clinical nurse specialist: moving from debate to action on the future of advanced psychiatric nursing.

The psychiatric nursing literature recently has included a proliferation of discussions regarding the nature and direction of change impacting the future of advanced practice psychiatric nursing. The debate has focused most commonly on the role of the clinical nurse specialist versus the role of the nurse practitioner. The debate has produced little in the way of outcomes other than an entrenchment of positions.

The role of emergency free flaps for hand trauma.

Primary closure of a wound with free flap requires minimizing the risk of infection in an effort to cover vital exposed structures. Careful patient selection, radical débridement of the wound, and an experienced microsurgical team are important for the routine application of this technique. Primary reconstruction of all injured structures is an extension of this technique that enables efficient management of severe upper extremity problems in a single setting.

Patient and injury characteristics in the development of cold sensitivity of the hand: a prospective cohort study.

In this prospective cohort study, we questioned whether cold sensitivity occurring after all types of injuries decreases, increases, or remains constant. We also questioned which patient and injury characteristics are most associated with the development of cold sensitivity. The degree of cold sensitivity of 123 patients with acute hand and forearm injuries was repeatedly scored from a prevalidated questionnaire over 11 months after injury.

Kienböck disease and negative ulnar variance.

We compared the degree of ulnar variance, measured on standardized radiographs of the wrist, in forty-four patients who had Kienböck disease with that in ninety-nine control subjects who had been selected from a general clinic population and had radiographs of the wrist. The purpose of our study was to determine if there is a true relationship between negative ulnar variance and the development of Kienböck disease. Gender was not found to influence the degree of ulnar variance, but an association was found between age and negative ulnar variance in both the control subjects and the patients who had Kienböck disease.

Timing of critical thrombosis after replantation surgery of the digits.

The time at which critical thrombosis occurred was assessed in a group of 63 patients (76 digits) following replantation surgery. The influence of smoking and mechanism of injury were examined with respect to the risk of thrombosis. The highest risk of critical thrombosis after replantation occurred in the first 3 days after surgery, although some risk remained up to 2 weeks.

Haematoma block or Bier's block for Colles' fracture reduction in the accident and emergency department--which is best?

Objective: To offer clear guidance on the anaesthetic management of Colles' fractures in the accident and emergency (A&E) department in the light of the conflict between existing reports and current trends, and to address the issue of alkalinisation of haematoma blocks.

Methods: This was a two centre, prospective, randomised clinical trial with consecutive recruitment of adult patients with Colles' fractures requiring manipulation to receive either Bier's block or haematoma block. There was subsequent blinded randomisation to alkalinised or non-alkalinised haematoma block.

Use of outcome instruments to compare workers' compensation and non-workers' compensation carpal tunnel syndrome.

Validated outcome instruments were used to compare treatment outcomes of carpal tunnel syndrome (CTS) in workers' compensation and non-workers' compensation patients. A self-administered questionnaire consisting of the generic Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the disease-specific Carpal Tunnel Syndrome Instrument was mailed to 277 patients randomly selected from all 1050 new patients treated for CTS during a 1-year period. A total of 212 patients (61 workers' compensation and 151 non-workers' compensation) responded to the survey 7-22 (mean, 14) months after the initiation of treatment, yielding a response rate of 76%.

Assessment of service needs of adult psychiatric inpatients: a systematic approach.

In this study, a systematic needs-assessment approach to evaluating the institutional and community service requirements of adult psychiatric inpatients is reported. The Community Placement Questionnaire (CPQ) was completed by professional staff on all patients between the ages of 18-65 residing in a publicly-funded psychiatric hospital. Of the 105 patients surveyed, 65.

Assessment of the carpal tunnel outcome instrument in patients with nerve-compression symptoms.

The outcome movement in medicine has encouraged the development of patient-answered questionnaires as measures of well-being. A disease-specific questionnaire for carpal tunnel syndrome (CTS) was introduced by Levine et al. in 1993.

A nongenetic basis of cycle frequency in bipolar disorder: study of a monozygotic twin pair.

The authors describe a pair of monozygotic twins with bipolar disorder but with a different course of the illness including age of onset, sequence of episodes, and cycle length. Based on these findings, the clinical course of bipolar illness does not appear to be genetically determined.

Clinical and demographic variables related to "fitness to stand trial" assessments in Manitoba.

Objective: To assess the extent to which clinical and nonclinical variables have been used by mental health professionals in Manitoba to determine fitness to stand trial. Researchers at a forensic setting in another province have suggested that demographic variables account for as much of the variance in predicting the outcome of these assessments as clinical variables.

Method: These variables were assessed by the examination of 100 fitness assessments conducted at Winnipeg's Forensic Services unit during a 2-year period.