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10,002,000 | Formation of multinucleated giant cells from human monocyte precursors. Mediation by a soluble protein from antigen-and mitogen-stimulated lymphocytes. | [
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10,002,001 | Multinucleated giant cells are associated with granulomas arising from immunological and nonimmunological inflammatory reactions. They are an integral part of the host immune response to chronic infectious diseases. In the present study we have demonstrated that human lymphocytes when stimulated by specific antigens of T cell mitogens produce a soluble factor that causes peripheral blood monocytes to fuse and form multinucleated giant cells in vitro. Production of the giant cell factor by antigen-stimulated peripheral blood lymphocytes correlates with the existence of cell-mediated immunity to specific antigen. Monocyte-depleted blood lymphocytes, but not purified blood monocytes, produce the giant cell factor when cultured with antigens or T cell mitogens. Gel filtration and physiochemical studies indicate that the lymphocyte-derived giant cell factor is a heat-labile protein of approximately 60,000 mol wt. These findings suggest that multinucleated giant cells in granulomas may be formed by fusion of circulating monocytes in response to the release of a 60,000-mol wt protein from antigen-stimulated T lymphocytes. | [
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10,002,002 | Activation of the guinea pig alternative complement pathway by mouse IgA immune complexes. | [
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10,002,003 | Activation of the complement system by IgA was investigated with immune complexes containing a mouse IgA myeloma protein with specificity for phosphorylcholine linked to bovine serum albumin (PC-BSA). These IgA anti-PC-BSA immune complexes activated the alternative complement pathway in mouse and guinea pig serum, while human complement was not affected. The activation proceeded with consumption of C3 but little or no consumption of C5. C3 did not bind to the IgA immune complexes during complement activation although it did bind covalently to IgG immune complexes. It is suggested that IgA immune complexes do not supply a suitable surface for C3 binding and effective alternative pathway convertase assembly; therefore, cleavage is limited and occurs primarily in the fluid phase. Without C3 binding, C5 cleavage does not occur nor can the alternative pathway activation proceed to the amplification step. | [
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10,002,004 | Postnatal expansion of the natural killer and keller cell population in humans identified by the monoclonal HNK-1 antibody. | [
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10,002,005 | Human natural killer (NK) and killer (K) cells were directly enumerated using a monoclonal antibody (HNK-1) and an immunofluorescence assay. The frequency of cells bearing surface HNK-1 antigen was very low in the newborn (less than 1.0%) and increased progressively through childhood and into adult life. This was correlated with an age-related increase in functional NK and K cell activities. Males had a slightly higher proportion of HNK-1+ cells than females. In addition to HNK-1 expression on the surface membrane, a prominent cytoplasmic expression of HNK-1 antigen was found in some but not all surface HNK-1+ cells. The cytoplasmic accumulation of HNK-1 molecules appeared to occur in more mature cells of this lineage. | [
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10,002,006 | Meeting the challenge of research in family medicine: report of The Study Group on Family Medicine Research. | [
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10,002,007 | The challenge of research in family medicine is addressed in this paper by describing the rationale for research, appropriate content areas, resources available, and needs for the future. Family medicine has the opportunity to study health and disease in humans within their natural habitat over long periods of time, and to examine the multiple aspects of personal and family health care delivery. Resources for research include large primary care study populations, practitioner and faculty researchers, and technical support systems. The basic needs for the future are to increase the quantity and quality of researchers and to attract more funds designed for research. It is recommended that family medicine practitioners and teachers support research and participate more actively; that family medicine academic units provide their learners more research curricular time and their faculties more research activity time, and that they develop Family Medicine Research Centers; that family medicine professional organizations raise funds to support research, promote research opportunities for their members, and communicate to others the research activities, resources, and needs of family medicine; and that the requirements for residency training be modified to include elective research opportunities. | [
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10,002,009 | Accurate diagnosis of the adnexal mass requires knowledge of embryology, anatomy, and physiology. Bimanual pelvic examination remains the primary and most practical means of detecting and evaluating adnexal pathology. Selective use of diagnostic techniques will help determine the nature and extent of involvement. Prompt and specific diagnoses facilitate therapy and improve results. | [
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10,002,010 | Infant nutrition. | [
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] |
10,002,011 | The obstetrical experience of 20 years in one family practice. | [
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10,002,013 | It appears that the seed money allocation process instituted by the University of Washington Department of Family Medicine one year ago has facilitated the launching of several pilot studies by removing small but significant financial barriers. Expressions of concern about the equitable allocation of departmental resources for research have abated, and energies have focused increasingly on how to do research and less on how to fund it. The funds and in-kind resources allocated have helped promote collaboration between community practitioners and academic researchers. The seed money program has assisted relatively inexperienced researchers to obtain valuable research experience which will make future applications for external grant support more credible and competitive. | [
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10,002,014 | The New Zealand family physician and the hospital. | [
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10,002,015 | Telephone management training. | [
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10,002,016 | Career satisfaction. | [
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10,002,018 | The choice of sterilization procedure among married couples. | [
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10,002,019 | Surgical sterilization is playing a growing role in contraception among married couples. Both vasectomy and tubal ligation can be done as outpatient procedures. Neither procedure has overwhelming advantages over the other. This study sought to determine why one member of a couple, rather than the other, decided to undergo the sterilization procedure. There do not seem to be any significant demographic differences between those couples who choose vasectomy and those who select tubal ligation. Men may undergo vasectomy because they feel it is the easier procedure. A significant number of women also feel that vasectomy is easier, yet for various reasons they are motivated to undergo tubal ligation. In many couples, the choice is made because one partner will not consider becoming sterilized, and this is twice as likely to be the husband. Family physicians can play an important role in assisting couples to choose the best alternative. | [
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10,002,020 | A framework for relating alcoholism and depression. | [
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10,002,021 | A diagnosis of primary, as opposed to secondary, depression in alcoholics is not easy to make and not always a helpful clinical guide when it is made. A useful framework for understanding alcoholism and depression clinically is to distinguish between alcoholics who are actively drinking, newly sober, or in recovery. Medication for depression should never be given to an actively drinking alcoholic. Newly sober alcoholics and those in various stages of recovery are expected to be depressed. Medication is generally not needed to deal with depression due either to withdrawal or to life problems associated with recovery from alcoholism. The use of antidepressant medication may be appropriate only when depression continues after all other avenues of therapy have been exhausted. | [
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10,002,022 | Recognition and management of the overly affectionate patient. | [
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10,002,023 | Physicians should be aware that patients who offer excessive admiration, signs of affection, and flattery are exhibiting a form of seductive behavior. To understand and manage this behavior, the physician must recognize his or her susceptibility to the feelings of omnipotence it engenders. Setting realistic expectations, challenging these patients to be less dependent upon the physician, and recognizing the need for referral in certain situations is necessary in managing such patients. A mature physician strives toward developing self-reliance and independence in patients. | [
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10,002,024 | Prevalence and characteristics of frequent attenders in a prepaid Canadian family practice. | [
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10,002,025 | Frequent attenders in family practice represent a small proportion of the total population, yet they consume a large amount of services. A description of their characteristics and problems is needed in order to design a therapeutic intervention tailored to meet these needs. A comparative analytic survey of 9,313 patients was done in order to isolate three cohorts: 200 zero users in the previous year, 200 modal (one to two times per year) users, and 200 frequent users (nine or more times per year). It was found that frequent attenders (who represented 4.5 percent of the practice, yet generated 21 percent of the annual visits) differ from infrequent attenders in that they have twice the probability of being single; are more physically, socially, emotionally distressed; suffer from problems of self-esteem; show a slightly greater degree of family dysfunction; tend to be unemployed, retired, or mothers of infants; are externally controlled or tend to rely on others for help; receive low incomes, retirement pensions, or family benefits; tend to be high users of other physician, social work, nursing, and laboratory services; consume a significantly greater number of pills than their infrequent user counterparts; and tend to present more emotional and gastrointestinal complaints than their modal user counterparts. | [
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10,002,026 | The family physician's office: proposed design criteria for family centered medical care. | [
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10,002,027 | Four design criteria, home extension, personal extension, family centered environment, and patient education, are explored as guidelines for creating a therapeutic atmosphere in the family physician's office. They can be applied to the entryway, waiting and reception areas, hallways, examination rooms, nurses' station, laboratories, and the physician's private office. They are intended not to replace the traditional design criteria of efficiency, economy, safety, and convention, but to enhance their effectiveness. This occurs when the total environment, physical, administrative, and social, is consciously managed for the purpose of patient therapy and staff well-being. Attention to family centered design criteria facilitates this management and helps to ensure that many components of the health-care system benefit the patient. | [
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10,002,028 | Institutionally-based diabetes educational services for patients and their families in Florida. | [
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] |
10,002,029 | Pheochromocytoma, diagnosis and treatment update and case report. | [
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10,002,030 | Alternatives to the total knee: current status of corrective surgery of the knee without the use of implants. | [
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10,002,031 | The type and screen: it's here to stay. | [
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] |
10,002,032 | The 1982 Florida relative value studies. | [
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10,002,033 | Nursing care or nursing practice. | [
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] |
10,002,034 | Controlling the cost of medical care. | [
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10,002,035 | Goodbye? Mr. Chips. | [
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10,002,036 | Patient's contributory or comparative negligence. | [
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] |
10,002,037 | Proprioception in schizophrenia. | [
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10,002,038 | B. Ritzler (J. Abnorm. Psychol., 86: 501-504, 1977) failed to replicate previous weight-lifting studies showing a proprioceptive deficit in schizophrenics. However, Ritzler did not use the same standard weights that the previous studies employed. Could this difference in procedure have caused his failure to replicate? Two experiments were completed to provide additional information about this question and related issues. In Experiment I, chronic hospitalized schizophrenics and normals were tested with light and heavy weights. Rosenbaum's original modified method of limits and the method of constant stimuli were utilized. Both methods provided comparable results, which, like Ritzler's data, failed to show a differential impairment in the discrimination of the light weights for paranoid schizophrenics. In Experiment II, outpatient paranoid schizophrenics, outpatient nonparanoid schizophrenics, outpatient psychiatric patients, and aged normals were evaluated utilizing the same psychophysical procedure and standard weights employed in the original studies. No differential impairment was found for the light weights for any group. These results provide strong support for Ritzler's position that a proprioceptive deficit is not unique to schizophrenia. | [
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10,002,039 | Simultaneous tests of many hypotheses in exploratory research. | [
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10,002,040 | Many traditional statistical approaches to data analysis assume a relatively simple situation in which the investigator is testing a single hypothesis. Most research in psychiatry, on the other hand, is exploratory in nature and involves testing many hypotheses. Exploratory research presents special problems in data analysis, which are discussed in this overview. Special statistical approaches that are available to reduce error risk, such as the Bonferroni inequality, are described. The importance of selecting confidence levels appropriate to a particularly investigation, rather than arbitrary use of the .05 level, is also discussed. | [
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10,002,041 | Headache in a psychiatric population. | [
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10,002,042 | The frequency and quality of headaches reported by 300 psychiatric patients were analyzed and compared to findings drawn from a general practice sample. Migraine and tension headaches were commonly reported and were found to be considerably more severe and frequent among psychiatric patients than among those patients attending a general practice. However, few of the psychiatric patients regarded their headaches as a major problem. Those who were headache sufferers had significantly higher scores on a psychometric assessment of neurotic tendency and were more frequently diagnosed as suffering from neurons than were those who reported few or no headaches. There was no association between headache and the diagnosis of depression, but psychometric scores on depression were significantly higher among the headache cases. The scale may have been reflecting general psychiatric distress rather than depression as such. The possibility that headaches contribute significantly to psychiatric distress, and are not merely a symptom of such distress, is considered. | [
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10,002,043 | Dependency of tricyclic antidepressant efficacy on thyroid hormone potentiation: case studies. | [
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10,002,044 | Two patients are described who depended on potentiation of tricyclic antidepressant effectiveness by thyroid superfunction for remission of an episode of unipolar depression. In one case, the excess thyroid hormone was the product of hyperthyroidism; whenever the hyperthyroidism was treated, the remission induced by imipramine was negated. In the other case, triiodothyronine was exogenously administered. These case studies suggested that some patients may require larger doses than 25 microgram of triiodothyronine per day for effective antidepressant potentiation. Some endocrinological similarities between hyperthyroidism and depressive illness are discussed. | [
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10,002,045 | A case of self-inflicted eye injuries. | [
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10,002,046 | The case is described of a young man who repeatedly injured his left eye. There was a history of previous deliberate self-injury and of childhood epilepsy. A diagnosis of borderline personality disorder was made. Similarities to other reported patients who injured their eyes, to "wrist-cutters," and to "delicate self-cutters" are discussed. | [
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] |
10,002,047 | Psychiatric disorders in the context of evolutionary biology. The impairment of adaptive behaviors during the exacerbation and remission of psychiatric illnesses. | [
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10,002,048 | Surgical pathology and neuropathology: two viewpoints. | [
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10,002,049 | Presidential address. The role of neuronal golgi apparatus in a centripetal membrane vesicular traffic. | [
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10,002,050 | The adsorptive endocytosis of conjugates of the marker enzyme horseradish peroxidase (HRP) with lectins and cholera toxin was studied in cultured neurons, neuroblastoma cells, and, in vivo, in the rat, by electron microscopic cytochemical (HRP), quantitative autoradiographic, morphometric, and biochemical techniques. The uptake of ricin-HRP by cultured neuroblastoma cells is 100 to 200 times greater than free HRP; furthermore, ricin does not stimulate the fluid phase endocytosis of HRP. Conjugates of wheat germ agglutinin and cholera toxin with HRP are 10 to 40 times more sensitive than free HRP in tracing retrograde connections in the rat central and peripheral nervous system. Conjugates of various ligands with HRP undergo endocytosis into the cisternae of the Golgi apparatus (or Golgi-Endoplasmic-Reticulum-Lysosome-GERL) and in residual bodies of cultured neurons and in vivo, while free HRP is found only in residual bodies. We conclude that: 1) various ligands with affinities to plasma membrane moieties are more sensitive, and probably more reliable, markers of "membrane" flow than free HRP, and 2) the pathway involved in the adsorptive endocytosis of ligands is different from the pathway of fluid phase uptake of HRP. These findings are consistent with the view that, in addition to its established role in the centrifugal traffic of various moieties, the neuronal Golgi apparatus is also involved in a centripetal vesicular membrane traffic. We spectulate that the neuronal Golgi apparatus, and probably the Golgi apparatus of other cells, is at the "crossroads" of a vesicular membrane traffic, and may thus exert significant controls on biologic membrane equilibria. | [
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10,002,051 | Neuropathologic observations in electrolyte-induced myelinolysis in the rat. | [
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10,002,052 | A recent analysis of a group of patients with central pontine myelinolysis (CPM) disclosed that a rapid rise in serum sodium from a hyponatremic baseline preceded the clinical onset of the disorder. To test the view that electrolyte derangements may be crucial in the pathogenesis of CPM, rats were given hypertonic saline following a three-day period of hyponatremia. Symmetrical, predominantly demyelinative lesions were found the neocortex, claustrum corpus striatum, external capsule, anterior commissure, hippocampus and its fimbria, thalamus, brainstem, tegmentum, and superior vermis of the cerebellum. This report details the histopathology and topography of these lesions and compares them with human CPM. The findings support the view that rapid rise in serum sodium may be responsible for the development of CPM in man. | [
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10,002,053 | Impaired muscle differentiation in hamster hereditary polymyopathy: A study in explant cultures. | [
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10,002,054 | Muscle tissue cultures from normal and myopathic neonate hamsters were established by a new explant technique and their morphology compared. Many abnormal myogenic cells fused in early myopathic cultures. As the myopathic cultures became older, an abnormal contractile apparatus, which displayed reduced spontaneous contractility as compared to controls, was evident. These findings in explant cultures provide further support for the myogenic basis of hereditary hamster myopathy and demonstrate the usefulness of the explant technique for comparative studies of in vitro myogenesis. | [
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10,002,055 | Electrophysiological and pharmacological characteristics of the serotonin response on a vertebrate neuronal somatic cell hybrid. | [
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10,002,056 | We studied the effects of 5-hydroxytryptamine (5-HT, serotonin) on the vertebrate neuronal somatic cell hybrid TCX11. We compared electrophysiological and pharmacological properties of the 5-HT response to those of the dopamine (DA) response. The cells developed delayed rectification and the ability to generate action potentials. Both 5-HT and DA caused graded depolarizations associated with increases in membrane conductance. The cells, however, were 10 to 100 times more sensitive to 5-HT than to DA. Responses to the amines desensitized during sequential or continuous application, and each neurotransmitter could desensitize the cell to a subsequent dose of the other neurotransmitter (cross-desensitization). Reversal potentials for both amines ranged from 0 to 15 mV from cell to cell, but on any given cell, the reversal potentials for 5-HT and DA were equal. We applied a variety of drugs, including classical DA and 5-HT antagonists, and found no drug that blocked the response to one amine without a similar inhibition of the response to the other amine. We conclude that, on the hybrid TCX11, there is a receptor that mediates a depolarizing response with a conductance increase after interaction with 5-HT and DA. Our data suggest that the receptor is best classified as a serotonin receptor. | [
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10,002,057 | Encoding of target range and its representation in the auditory cortex of the mustached bat. | [
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] |
10,002,058 | The time course of acoustic events is a critical element for the recognition of biologically meaningful sounds. Echolocating bats analyze the time intervals between their emitted biosonar pulses and the echoes returning from objects to assess target distance (range). In this study, we have explored the auditory cortex of the mustached bat, Pteronotus parnellii rubiginosus, using pairs of acoustic stimuli mimicking the multiharmonic biosonar signals (pulses) used by this species and their echoes. A discrete field of auditory cortex dorsorostral to the tonotopically organized primary field contains neurons which are insensitive to pure tone, frequency-modulated (FM), or noise stimuli presented singly. Rather, they respond strongly to pairs of stimuli, specifically, the fundamental FM component of the pulse paired with an FM component of one of the higher harmonics of the echo. We call these neurons FM1-FMn facilitation neurons. There are three separate longitudinal clusters in this cortical area containing FM1-FM2, FM1-FM3, and FM1-FM4 neurons, respectively. Moreover, FM1-FMn neurons are specifically sensitive to the time delay between the two FM components, i.e., the time delay of the echo from the pulse. Thus, they can decode target range. Two types of delay-sensitive neurons were found. Tracking neurons, whose response to echo delay varied according to repetition rate and stimulus duration, were found rarely. Delay-tuned neurons, which were tuned to specific time delays (best delays) of the echo from the pulse, were much more evident. Both types of neurons are organized into columns with similar best delays, and the best delay of delay-tuned neurons was found to increase systematically along the cortical surface in the rostrocaudal direction. This area, therefore, contains a neural representation of target range along this best delay axis. Such an axis exists in each of the clusters of FM1-FM2, FM1-FM3, and FM1-FM4 neurons. This is a new type of cortical organization which is not tonotopic but which represents an important acoustic cue related to the time course of acoustic events. | [
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10,002,059 | Theory for the development of neuron selectivity: orientation specificity and binocular interaction in visual cortex. | [
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10,002,060 | The development of stimulus selectivity in the primary sensory cortex of higher vertebrates is considered in a general mathematical framework. A synaptic evolution scheme of a new kind is proposed in which incoming patterns rather than converging afferents compete. The change in the efficacy of a given synapse depends not only on instantaneous pre- and postsynaptic activities but also on a slowly varying time-averaged value of the postsynaptic activity. Assuming an appropriate nonlinear form for this dependence, development of selectivity is obtained under quite general conditions on the sensory environment. One does not require nonlinearity of the neuron's integrative power nor does one need to assume any particular form for intracortical circuitry. This is first illustrated in simple cases, e.g., when the environment consists of only two different stimuli presented alternately in a random manner. The following formal statement then holds: the state of the system converges with probability 1 to points of maximum selectivity in the state space. We next consider the problem of early development of orientation selectivity and binocular interaction in primary visual cortex. Giving the environment an appropriate form, we obtain orientation tuning curves and ocular dominance comparable to what is observed in normally reared adult cats or monkeys. Simulations with binocular input and various types of normal or altered environments show good agreement with the relevant experimental data. Experiments are suggested that could test our theory further. | [
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10,002,061 | Stimulation of the gerbil's gustatory receptors by saccharin. | [
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10,002,062 | The gustatory responses from the chorda tympani nerve of the Mongolian gerbil, Meriones unguiculatus, were tested with saccharin and some closely related compounds. Only two compounds, saccharin and 6-chlorosaccharin, stimulated the gerbil's taste receptors to any degree and in the same order in which they are sweet to man, saccharin greater than 5-chlorosaccharin. Those compounds which are tasteless to man did not stimulate and include N-methyl saccharin, phthalimide, and O-sulfobenzoic acid. These nonstimulating derivatives did not inhibit the saccharin electrophysiological response. The saccharin taste response pH optimum is from 5 to 8. At pH 7 and 8, saccharin is fully ionized and is binding to the receptor site by an anionic mechanism. Kinetic plots of the taste response at pH 7 indicate that saccharin is forming 1:1 complexes with it. In addition, mixtures of saccharin and sucrose stimulate in such a manner as to suggest that they are interacting at different receptor sites. | [
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10,002,063 | The microtrabecular lattice of the adrenal medulla revealed by polyethylene glycol embedding and stereo electron microscopy. | [
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10,002,064 | Mechanisms of septal lamination in the developing hippocampus analyzed by outgrowth of fibers from septal implants. II. Absence of guidance by degenerative debris. | [
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10,002,065 | In previous study (Lewis, E.R., and C. W. Cotman (1980) Brain Res. 96: 307--330; E. R. Lewis and C. W. Cotman, submitted for publication), we have shown that septal tissues grafted to the brain of a neonatal rat will extend fibers into special terminal laminae within the hippocampal formation of the recipient. As a consequence of the implantation surgery, neurons in the developing entorhinal cortex are ablated and it is possible that processes of implanted cells may be guided by degenerating afferent fibers in the host. In order to test this hypothesis, we have characterized the distribution of degeneration argyrophilia that results from the implant surgery and the time course of its removal and examined the growth of septal implants in a host brain devoid of observable degenerative debris. The pattern of degeneration argyrophilia shortly after the implantation surgery did not correspond to the pattern of implant-associated AChE staining in the host hippocampal formation. By 72 hr after surgery, the great majority of argyrophilic debris had been removed. Implants placed in a cavity created 72 hr after surgery demonstrated excellent viability and produced the typical pattern of AChE staining in the hippocampal formation of the host. This suggests that the presence of degenerating host axons is not necessary to guide the ingrowth of axons and establish septohippocampal laminated fields. | [
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10,002,066 | The specificity of extracellular glycoprotein complexes in mediating cellular adhesion. | [
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10,002,067 | Complexes containing glycoproteins and glycosaminoglycans were released into the culture medium by both smooth and skeletal muscle cells. The particles, termed adherons, from three smooth muscle cell lines promoted cell-substratum adhesion of a clonal sympathetic nerve cell line, PC12. In contrast, the glycoprotein complexes from three skeletal muscle preparations inhibited the adhesion of PC12 cells to Petri dish surfaces. The skeletal muscle adherons all sedimented in calcium-free sucrose gradients with an S value of 16, while the smooth muscle particles had a sedimentation value of 12. Although both classes of adherons contained fibronectin and collagen, hyaluronic acid was present only in those from skeletal muscle. An antiserum prepared against skeletal muscle adherons blocked myoblast adhesion to skeletal muscle adherons but did not alter PC12 adhesion to smooth muscle adherons. These data suggest that the glycoprotein complexes released by muscle have some intrinsic specificity with respect to their ability to mediate cellular adhesion. | [
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10,002,068 | Long loop and spinal reflexes in man during preparation for intended directional hand movements. | [
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10,002,069 | Regulation of neocortical muscarinic receptors: effects of drug treatment and lesions. | [
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10,002,070 | Evoked potentials in the clinical neurosciences. | [
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10,002,071 | The use of evoked potentials for the evaluation of disorders of the nervous system has become a most valuable aid to the neurosurgeon and neurologist, often providing information of critical value without recourse to invasive techniques. In order to employ these techniques, it is helpful to understand the principles of evoked potential electrogenesis and the methodology used for analysis of evoked potential clinical data. This article is aimed at providing the clinical neurosurgeon with this type of information and with a review of current clinical applications in this rapidly developing field. | [
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10,002,072 | Antibiotic prophylaxis of postoperative neurosurgical wound infection. | [
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10,002,073 | In an effort to reduce the incidence of postoperative wound infection, the recently proposed regimen of intravenous vancomycin and tobramycin and streptomycin irrigating solution was used in 878 neurosurgical operations. There were eight infections, for an infection rate of 0.9%. This infection rate was compared to the rate in the previously reported series using a sequential statistical analysis. The infection rate was found to be significantly greater than that previously reported. Controlled clinical trials will be required before the efficacy of antibiotic prophylaxis in clean neurosurgical procedures can be considered proven. | [
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10,002,074 | Microvascular perfusion and metabolism in injured spinal cord after methylprednisolone treatment. | [
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10,002,075 | The purpose of this study was to determine the effect of treatment with the synthetic glucocorticoid, methylprednisolone, on the microvasulature and metabolism of the traumatized spinal cord. Spinal cords of cats were compressed with a 170-gm weight for 5 minutes and were treated with either high-dose methylprednisolone (HDMP, 15 mg/kg/24 hrs) or megadose methylprednisolone (MDMP,60 mg/kg/24 hrs). Animals were sacrificed at 2, 8, or 24 hours following injury. Treatment with HDMP resulted in substantial preservation of injured spinal cord microvascular perfusion at 8 hours as compared with injured untreated cats. Compression trauma caused a partial derangement of energy metabolism and a shift toward anaerobic glycolysis in both treated and untreated groups for the entire 24-hour postinjury period. Tissue levels of adenosine triphosphate, phosphocreatine, and total adenylates in the HDMP-treated cats sacrificed at 8 hours after trauma were significantly elevated over untreated controls, but those in the 2- and 24-hour groups were not. Concentration of energy intermediates in MDMP-treated cat were either equal to or below those of injured untreated animals al all three postinjury time period. The postinjury metabolite pattern and concentrations seen in this study possibly result from differing levels of blood flow and neuronal activity in the injured untreated, HDMP-, and MDMP-treated spinal cords. Better tissue perfusion in the HDMP-treated cats might be expected to result in an improved tissue energy state in these animals. However, intensive high-dose glucocorticoid treatment has been demonstrated to augment spinal cord monosynaptic and polysynaptic reflex transmission and primary afferent excitability. Furthermore, acute single intravenous dose studies have shown this direct neuronal action to be dose-related. Thus, additional high-energy phosphate molecules that may be reformed as a result of HDMP treatment were perhaps used as the energy source for any increased neuronal activity caused by steroid administration. The beneficial effects of glucocorticoid treatment in experimental spinal cord trauma might derive from preserved cellular structural integrity. This could result in increased levels of neuronal activity, energy utilization, and production in treated as compared with untreated tissue. | [
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10,002,076 | Surgical treatment of 63 cases of conjoined nerve roots. | [
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] |
10,002,077 | The operative results of 63 cases of lumbar disc disease with surgically confirmed conjoined nerve roots are reviewed. The first 55 patients were treated by standard hemilaminectomy and discectomy, with only 30% reporting a good result. Of the last eight patients treated by hemilaminectomy, pediculectomy, and discectomy, seven patients returned to work. Te rationale for and the technique of pediculectomy are discussed in detail. Clinical, radiological, and surgical clues indicating the presence of the conjoined nerve root anomaly are reviewed. | [
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10,002,078 | Chiasmal apoplexy. Report of four cases. | [
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10,002,079 | Four patients with chiasmal syndromes were found to have intrachiasmal hematomas. Computerized tomography scans showed high-density suprasellar masses in all cases. Cryptic vascular anomalies were presumed to be responsible for spontaneous bleeding into the chiasm in three of the cases. In the remaining case, hemorrhage was due to an occult optic glioma. Surgical evacuation of clotted blood resulted in improved visual function in three of the four cases. | [
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10,002,080 | Presentation and management of mesencephalic hematoma. Report of two cases. | [
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10,002,081 | Two patients presenting with a mesencephalic hematoma are reported. Clinical features, particularly paralysis of all vertical eye movements and a marked tendency to fall backwards when standing, allowed accurate localization of these lesions. In one case, the etiology was a proven arteriovenous malformation, and the other was suspected to be due to hypertensive arteriolar rupture. Deterioration resulted from further expansion of the mesencephalic mass in one patient. A subtemporal approach allowed excellent exposure of the midbrain for evacuation of the hematoma. The other patient developed hydrocephalus due to obstruction of the aqueduct and was treated successfully by placement of a ventriculoperitoneal shunt. Both patients survived, although one remains moderately disabled. The authors emphasize the importance of initial observation and supportive care in the stable patient with a mesencephalic hematoma. Surgery is indicated for those who show evidence of deterioration from rebleeding or hydrocephalus. | [
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10,002,082 | Nontraumatic dissecting aneurysm of the vertebral artery. Case report. | [
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10,002,083 | A case is described of a nontraumatic dissecting aneurysm of the vertebral artery, which presented as a subarachnoid hemorrhage (SAH). Differentiation from vasospasm and from atherosclerosis is critical. Dissection between the adventitia and media should be noted in the differential diagnosis of SAH when an aneurysm or vascular malformation is not demonstrated angiographically. | [
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] |
10,002,084 | Cerebrovascular moyamoya disease associated with an intracranial pseudoaneurysm. Case report. | [
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10,002,085 | A 51-year-old woman became unconscious 19 hours after the onset of a headache. Computerized tomography disclosed an intracerebral hematoma in the left temporal lobe, with ventricular penetration. Antiography demonstrated the characteristic appearance of cerebrovascular moyamoya disease as well as an aneurysm-like shadow in the left temporal lobe, which proved on histological examination to be a pseudoaneurysm. | [
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10,002,086 | Spontaneous spinal epidural hematoma in a 22-month-old girl. | [
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10,002,087 | The authors report the case of a 22-month-old girl who developed cervical pain, neck stiffness, and quadriparesis over 12 days. An epidural hematoma was removed, with complete recovery after 6 months. There was no history of trauma. A search of the literature revealed eight previous cases of spontaneous spinal epidural hematomas in children under the age of 10 years. | [
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10,002,088 | Treatment of nontraumatic atlantoaxial dislocation and fibrous fusion. Case report. | [
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] |
10,002,089 | The authors describe a case of nontraumatic atlantoaxial dislocation secondary to acute rheumatic fever, in which there appeared to be fibrous fusion between the axis and the atlas in the subluxed position. The dislocation was reduced by means of combined traction and steroid therapy. Fibrous fusion occurred in the realigned position after immobilization. | [
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10,002,090 | Thoracic spinal cord ependymoma presenting with ejaculatory failure. Case report. | [
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10,002,091 | Acromegaly and spinal stenosis. Case report. | [
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10,002,092 | Spinal stenosis is a well defined clinical entity that is occasionally encountered in patients with acromegaly. Persistent elevation of growth hormone promotes hypertrophy of the bones and ligaments, resulting in widening of the thoracolumbar vertebral bodies, and developmental narrowing of the spinal canal. This report describes the case of a 54-year-old acromegalic man with a 30-year history of low-back pain. Who developed symptoms of spinal stenosis. This case and two similar cases from the literature are discussed, and the appropriate therapeutic approaches reviewed. | [
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10,002,093 | Lymphocytic adenohypophysitis of pregnancy simulating a pituitary adenoma: a distinct pathological entity. Report of two cases. | [
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] |
10,002,094 | Diffuse lymphocytic infiltration of the adenohypophysis occurring in temporal relation to pregnancy was found in two patients, each of whom had an intrasellar mass with suprasellar extension that caused compression of the optic chiasm. The pathology and etiology of this lesion is discussed. This entity should be considered when evaluating patients with a pituitary mass lesion that presents in temporal association to pregnancy, particularly if there is evidence of hypopituitarism rather than a hypersecreting, endocrine-active adenoma. | [
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10,002,095 | Frontal lobe perivascular schwannoma. Case report. | [
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10,002,096 | A 15-year-old youth presented with a history and computerized tomography picture of subarachnoid hemorrhage. Conservative management was undertaken after failure to demonstrate an aneurysm. Reevaluation and operation 15 months later disclosed a firm leathery schwannoma intimately related to the frontal lobe and extending into the cortex in the Virchow-Robin spaces. | [
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10,002,097 | Removal of retained ventricular shunt catheters without craniotomy. Technical note. | [
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10,002,098 | A technique is described in which insulated suction is used to extract infected retained ventricular catheters in cases of shunt infection. This procedure allows safe removal without craniotomy. Retained catheters are pulled through an insulated No. 11F or 13F suction tube attached to an electrocoagulation unit used for resection and coagulation of adhesions. The technique has been successful in two cases with retained catheters. | [
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10,002,099 | Growing skull fractures. | [
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