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The development of autonomy and superego precursors.

Superego precursors appear in the latter part of the first year, concomitant with the behavioural control necessitated and made possible by ego development, particularly of intentionality, communication, and mobility. During the second year of life wilful strivings intensify, complicated by the power struggles of the rapprochement crisis. A subtle process of negotiation accompanies the learning of parental rules and regulations, and the infant also learns that some rules and limits are non-negotiable. The development of the superego depends not only on 'identification with the aggressor' and self-directed aggression, but on positive identifications and internalizations of approval. While the real attitudes of the caregiver are communicated and are important, superego precursors, because of the infant's drives, defences, and ego immaturity, may be far removed from the reality of the caregiver's attitudes and intent. The parents' and infants' inter-identifications and empathy for each other contribute to the capacity for self-criticism, guilt, and remorse, attributes of the developing superego.

Adult↗

Environmental risk and prevention of Lyme disease.

An understanding of the environmental determinants of Lyme disease risk is essential to evaluate human disease potential and to recommend strategies for disease prevention. Tick vectors of Lyme disease require a vertebrate blood meal during each of three motile developmental stages (larva, nymph, and adult). Although the immature stages (larvae and nymphs) exhibit broad and overlapping host ranges, adult ticks are primarily dependent on deer for feeding and reproduction. Consequently, the distribution and abundance of these ticks often reflect those of deer. Several species of smaller mammals and some birds that host immature ticks are also competent reservoirs for Borrelia burgdorferi, which becomes established within the tick population during feeding. The relative abundance of these host species and their ability to infect ticks are key factors in determining the distribution of Lyme disease risk in the local environment. Available methods for reducing the risk of Lyme disease in the environment include the application of insecticides and use of deer fencing, which have been shown to be 83-97% effective in reducing risk. However, the adverse environmental impact of insecticides and high cost of deer fencing limit these methods to high-risk areas where human exposure is constant and unavoidable (i.e., residential or occupational). Personal protection in high-risk areas can lessen the likelihood of contact with ticks. Future prevention methods may include host-targeted insecticides, environmental alteration, and biologic control. Moreover, research is currently directed to identifying antigens for use in recombinant human vaccines.

Animals↗

An editor's view of telemedicine.

Should an editor hold a view about telemedicine, or should an editor be entirely disinterested? The editorial role has been defined by the International Committee of Medical Journal Editors and a long list of editorial responsibilities has been set out by the World Association of Medical Editors. This represents something of a counsel of perfection, although clearly an editor should not have a personal view, in the sense of promoting telemedicine or dismissing it. Since telemedicine editors are almost bound to be active in research, they should take particular care with manuscripts involving their own work, for example standing aside from the editorial process and delegating editorial decisions to other members of the editorial staff. At the beginning of the 1990s, there were few publications about telemedicine in the peer-reviewed literature. The subsequent years have seen a rapid growth in numbers of articles and the emergence of two specialist journals. These are all healthy signs. However, there have been remarkably few studies of telemedicine's cost-effectiveness, which must represent a sign of its immaturity. On balance, the evidence seems to indicate that telemedicine research is in a healthy state.

Bibliometrics↗

[Defense mechanisms in soldiers during the period of adaptation to the military environment].

An important role during the adaptation period to the military service in the first three months have the defense mechanisms, which belong to the adaptive functioning of an organism. The aim of this study was to determine the defense mechanisms of soldiers in adaptation to the military environment. The sample consisted of 144 adapted (group A) and 400 nonadapted (group NA) soldiers. The applied instruments were: Social-demographic questionnaire and DSQ-40 (Defense Style Questionnaire--short form). The results of this study show that soldiers of NA group use immature defense mechanisms and soldiers of group A use mature defense mechanisms. A significant correlation existed between soldiers of groups A and NA in the use of: mature defense style (p < 0.01), humor (p < 0.005) and sublimation (p < 0.001). It was concluded that there was a relationship between maturity of defense mechanisms and level of adaptation to the military service and factors of the family environment.

Adaptation, Psychological↗

Effect of aging on bone marrow-derived murine CD11c+CD4-CD8alpha- dendritic cell function.

Dendritic cells (DCs) are actively used as cellular adjuvant in cancer immunotherapy. However, although DC immunotherapies primarily target the elderly population, little is known about the effect of aging on DC functions. Here, we compared the T-cell stimulation, cytokine production, and tumor surveillance functions of bone marrow-derived CD11c(+)CD4(-)CD8alpha(-) DCs of old and young C57BL/6 mice. Old immature bone marrow-derived CD4(-)CD8alpha(-) DCs (imDCs) were 4 times less effective than were young DCs in stimulating syngeneic CD4(+) T-cell proliferation. Old imDCs also have decreased DC-specific/intracellular adhesion molecule type 3-grabbing, nonintegrin (DC-SIGN) expression compared to young DCs. Interestingly, mice treated with the ovalbumin peptide-pulsed young DCs exhibited significantly greater tumor regression than with ovalbumin peptide-pulsed old DCs. Old terminally differentiated bone marrow-derived DCs (tDC) also have increased interleukin-10, but decreased interleukin-6 and tumor necrosis factor-alpha production. Taken together, these results have important implications in the clinical application of DC-based tumor immunotherapy in elderly persons.

Aging↗

Impact of mannose-binding lectin on susceptibility to infectious diseases.

When the adaptive immune response is either immature or compromised, the innate immune system constitutes the principle defense against infection. Mannose-binding lectin (MBL) is a C-type serum lectin that plays a central role in the innate immune response. MBL binds microbial surface carbohydrates and mediates opsonophagocytosis directly and by activation of the lectin complement pathway. A wide variety of clinical isolates of bacteria, fungi, viruses, and parasites are bound by MBL. Three polymorphisms in the structural gene MBL2) and 2 promoter gene polymorphisms are commonly found that result in production of low serum levels of MBL. Clinical studies have shown that MBL insufficiency is associated with bacterial infection in patients with neutropenia and meningococcal sepsis. Low MBL levels appear to predispose persons to HIV infection. Numerous other potential infectious disease associations have been described. Therapy to supplement low MBL levels is being explored using either plasma-derived or recombinant material.

Communicable Diseases↗

Lactoferrin increases the output of neutrophil precursors and attenuates the spontaneous production of TNF-alpha and IL-6 by peripheral blood cells.

The aim of this report was to investigate the effects of bovine lactoferrin (BLF) taken orally (per os) by healthy individuals, on selected immune parameters. Three groups of volunteers (7 persons per group) were taken daily for 7 days, one capsule containing 2, 10 or 50 mg of BLF. A control group has taken placebo only. Venous blood was taken for tests a few hours before the first dose of BLF, one day and 14 days after the last dose of the preparation. For the evaluation of BLF action on the immune response system we have chosen 3 parameters: content of neutrophil precursors in the peripheral blood (in percentage), spontaneous production of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) by unstimulated blood cell cultures. We found that oral treatment of volunteers with BLF caused a transient (one day after last dose) increase of immature forms of neutrophils in the circulating blood. That increase was more than 2-fold in the case of 10 mg dose. However, statistically significant increases in the percentage of neutrophil precursors were also registered at doses of 2 and 50 mg of BLF. No change in the immature cell content was observed in the placebo group. The treatment with BLF also resulted in a profound decrease of the spontaneous production of IL-6 and TNF-alpha by cultures of peripheral blood cells. This decrease was significant (10 mg/dose) one day following the last dose of BLF and persisted for additional 14 days. These results confirmed our earlier data on the effects of per os treatment with a nutritional preparation containing BLF. Furthermore, we were able to closer establish the optimal dose of BLF affecting selected immune indices.

Adjuvants, Immunologic↗

The effects on offspring of premature parturition.

The time of parturition defines the length of the intrauterine period of fetal life, a requisite to achieve adequate adaptation to the external environment. Immaturity, a condition whose severity is inversely related to the length of pregnancy, is the main determinant of the increased morbidity and mortality associated with preterm birth. Despite great advances in medical technology and expertise, mainly after the introduction of the neonatal intensive care units, only one- to two-thirds of infants from the subsets with lower birthweight/gestational age reach survival at discharge. Distinct major neurological and sensorial sequelae, including cerebral palsy, retinopathy of prematurity, and hearing loss, as well as reduced neuropsychological abilities, leading to deficient academic achievement and deterioration of several aspects of health status, are still highly prevalent among the most immature children. Interestingly, decreasing mortality rates, which are not followed by detectable increases of disability, are being observed in recent years. Future advances may be expected from clinical and basic research on uterine contractility and cervical softening. Also, changes in reproductive technology procedures, a main factor in the incidence of multiple pregnancies, and a more refined approach to obstetric care, compose some of the clinical interventions which may reduce the problem.

Developed Countries↗

Introduction and comparison of two methods of assessment of coronary lesions in Atlantic salmon, Salmo salar L.

This study investigated and compared quantitative and semi-quantitative coronary lesion evaluation in Atlantic salmon, Salmo salar. A total of 121 immature farmed and 47 sexually mature wild Atlantic salmon were included. Coronary arteries from all fish were morphometrically evaluated using a semi-quantitative method. A subsample of 76 salmon was additionally evaluated using a quantitative method. Another subsample of 71 salmon was used for reliability testing of the semi-quantitative method. Ten cross-sections of coronary arteries located on the ventral surface of the bulbus arteriosus were semi-quantitatively scored with regard to myointimal coronary lesions. Quantitative measurements comprised maximal intimal thickness and area lesion (%) while semi-quantitative measurements comprised maximal intimal thickness and lesion degree (%). Scores for individual fish were expressed as the average of lesion score, denoted as mean range lesion. One person performed all evaluations blindly. Two pathologists tested repeatability of the semi-quantitative lesion score measurements blindly. Both semi-quantitative and quantitative variables increased significantly with increasing lesion score. Semi-quantitative estimation gave significantly higher maximal intimal thickness values than quantitative measurement. Semi-quantitative measurements were found to explain 63.2% of variation in quantitatively measured maximal intimal thickness. Due to lack of agreement, the two methods are not directly comparable and one method cannot replace the other. Repeatability within and between observers with regard to semi-quantitative classification was very good with Kappa values larger than 61.5%. The semi-quantitative method was a valid and reliable method for coronary lesion evaluation in Atlantic salmon.

Analysis of Variance↗

[The cerebral lesions in congenital toxoplasmosis. Study of 9 personal cases and 61 cases in the literature].

This study is a review of 70 cases of congenital toxoplasmosis; all of the patients were dead between birth and the age of nine. The anatomo-pathological examination of 9 personal cases (6 acute, 1 subacute, 2 chronic) is presented and compared with that of 61 cases from the literature. After a parasitological survey concerning the infectious agent, the author summarizes the macroscopic and the microscopic lesions of his personal cases. Those data are subsequently confronted to those referred to in the literature. The author makes an attempt to entangle the terminological confusion that exists between the different terms: cyst, pseudocyst, microglial nodule and granuloma. The frequency, the localization and the mechanisms of the main alterations - granuloma, necrosis, calcification, hydrocephaly - are studied as well as the vulnerability factors and the resistance of the subjects. The presence in 8 of the 9 chronic cases of calcified scar lesions in the inferior portion of the external wall of the lateral ventricles suggests a particular vulnerability of the spongioblasts in that area. In the acute cases the extensive necroses in the cerebral hemispheres seem to result from immunological reactions in an immature organism rather than from vascular thromboses that appear to be more a secondary phenomenon.

Acute Disease↗

New approaches to the delivery of health care to adolescents.

Adolescents are a new population group showing certain common characteristics which transcend the confines of geography, economics, education, culture and race. Certain health problems have emerged which are closely related to the life style of teenagers. These health needs are not met by existing health care delivery systems, and future planning must take into account the morals of young people. At present there is no unified approach to the development of health care programs for adolescents, but important explorations of effective methods are are taking place in a fragmentary way. The challenge is to provide the necessary technology and professional expertise in an accessible setting and then to weld these services into programs which will become cohensive and stable. Analyses of data show that adolescents seek help more often for primary and preventive care than for serious ilnesses. Services are particulary needed for addictive problems, emotional disorders, suicidal states, and conditions related to sexual activity. Consideration of the effect of adolescent behavior on the reproductive cycle is of the utmost importance. These sequelae of conception and veneral disease can be extremely serious for the immature girl and her baby. Therefore the opportunity for birth control, health education, abortion and prenatal care for teenagers should be priority goals in any program for adolescents. The provision of services for the young mother and her baby should be included in the overall plan. New approaches in the ambulatory care of adolescents include an age-specific operation, satellite clinics with hospital backup, and the inclusion of young people in the planning services. Care should be comprehensive and continuous, and a multi-disciplinary staff team would permit a more effective approach. The involvement of other teenagers as assistants in counseling has been found an effective method of communication; this relaitonship may bridge the generation gap when highly personal experiences must come to the surface. Financial and legal barriers should be removed so that care is available to all. Social systems which affect the adolescent should coordinate their activities at all levels. Examples of some innovative methods are available. The ideal approach to health care delivery for adolescents is not yet established; but it must obviously do more than merely cope with a series of crisis oriented episodes. A recognition of underground self-help methods is needed, even if in the last analysis these methods are found to be irrelevant and are discarded. The health of teenagers automatically and immediately affects the well being of the following generation. No effort to improve the situation should be spared.

Adolescent↗

Chronic lymphocytic leukemia: new insights into biology and therapy.

PURPOSE: To review the recent advances in the biologic and clinical research of chronic lymphocytic leukemia. DATA IDENTIFICATION: English-language literature search using MEDLINE (1980 to 1990) and CANCERLIT (1980 to 1990), review of meeting abstracts and reports, and an extensive manual search of bibliographies of identified articles. STUDY SELECTION: Approximately 800 articles, abstracts, and book chapters were selected for analysis. DATA EXTRACTION: The literature was reviewed and 227 articles were selected as representative of the important advances in chronic lymphocytic leukemia. RESULTS OF DATA SYNTHESIS: Chronic lymphocytic leukemia is a disease of lymphocytes that appear to be mature but are biologically immature. These B lymphocytes arise from a subset of CD5-B cells that appear to have a role in autoimmunity. The pathogenesis of chronic lymphocytic leukemia is likely a multistep process, initially involving a polyclonal expansion of CD5-B cells followed by transformation of a single cell. Chromosome studies indicate that trisomy 12 is the most common abnormality, followed by 14q+, 13q, and 11q. These abnormalities portend a poor prognosis. Recent progress in the treatment of chronic lymphocytic leukemia involves three new drugs: fludarabine, pentostatin, and 2-chlorodeoxyadenosine. Recent preliminary results of allogeneic bone marrow transplantation present insights into the potential curability of chronic lymphocytic leukemia. Therapy with intravenous immunoglobulin can prevent or delay moderate bacterial infections in persons with chronic lymphocytic leukemia. CONCLUSION: Major advances in the biologic research of chronic lymphocytic leukemia have resulted in new understanding of this complex disease. New therapies, such as those with intravenous immunoglobulin and fludarabine, may lead to improved outcome.

Agammaglobulinemia↗

The inadequacies of absolute prohibition of reproductive cloning.

This study reviews debates on human cloning and its benefits, considers international and domestic laws, and argues that the choice of reproductive means is a human right. In exercise of this right, a balanced approach should be adopted, in order to benefit human society while protecting human dignity adequately. The immaturity of cloning techniques indicates that at the present time human reproductive cloning is too risky. Thus a temporary ban on such cloning is appropriate, but the ban on relevant scientific research and animal experimentation is inappropriate as it denies the spirit of freedom of scientific inquiry, and hinders making the benefits of scientific advancement available to human society as a whole.

Canada↗

MMPI-A profiles of Hispanic adolescents.

A study was conducted to compare validity, clinical, content, and supplementary scale scores of Hispanic adolescents to normative data on the MMPI-A. Volunteers, 30 boys, 17 girls, were Hispanic adolescents, aged 14 to 18 years from school and after-school settings. Analysis indicated elevated T score means on F1 (66), F2 (68), F (68), L (61), Hs (61), D (63), Sc (62), A-hea (63), A-biz (63), A-lse (61), A-las (60), A-sch (61), and IMM (61) scales for boys. Scores for low aspirations, low self-esteem, immaturity, and school problems were all interrelated. For girls, scores on no scales were elevated, but on several scales mean T scores, Hs, Hy, Ma, Si, A-anx, A-obs, A-hea, A-ang, A-las, MAC-R, and ACK, were below average. This suggests the MMPI-A may underpathologize for girls. Consistent with previous findings, the boys scored higher on the Immaturity Scale than the girls. It was speculated that the boys' dislike for school and low aspirations were related to the lower education and employment of their fathers compared to those for the normative sample. The A-las, A-sch, and IMM scales may prove to be useful in identifying adolescent boys "at-risk" for dropping out of school, if replication with much larger samples confirms present findings.

Adolescent↗

The carbohydrate deposits detected by histochemical methods in the molecular layer of the dentate gyrus in the hippocampal formation of patients with schizophrenia, Down's syndrome and dementia, and aged person.

Post-mortem brain tissue was obtained from 28 patients with brain disorders, of which 15 had clinically diagnosed schizophrenia, 6 Alzheimer type dementia, 5 dementia with tangles and 2 cases of Down's syndrome. The controls were 22 cases from autopsies without brain disorders or with no known episodes of brain disorder. The tissues were stained for the detection of carbohydrate deposits in the hippocampal formation, using lectin, immunohistochemical and conventional staining methods. The staining revealed the existence of spherical deposits in the inner and middle molecular layers of the dentate gyrus in the hippocampal formation which contained fucose, galactose, N-acetyl galactosamine, N-acetyl glucosamine, sialic acid, mannose and chondroitin sulfate. The number of the deposits was higher in patients with brain disorder such as schizophrenia, Alzheimer type dementia, dementia with tangles or Down's syndrome, and in some aged individuals, in comparison to those in younger individuals. No deposits were detected in a few younger or aged individuals. Spherical deposits 3-10 microm in diameter may be an immature form of the corpora amylacea, since they were similar in the histochemical characteristics with lectin, immunohistochemical and conventional staining methods. However, differing staining ability by hematoxylin, periodic acid Schiff's reagent and antibodies against the intracellular degraded proteins such as ubiquitin and tau-protein was observed. The antibodies against ubiquitin and tau-protein showed clear reactivity with the corpora amylacea and no reactivity with spherical deposits, indicating that the corpora amylacea has an intracellular origin and spherical deposits an extracellular matrix origin. The results obtained in this study indicate that not only neuronal degeneration but also unusual glycometabolism in neurons may disturb the neuronal function and cause brain disorders, and that spherical deposits may cause dysfunction of the neuronal network in the dentate gyrus of the hippocampus which is closely linked with recognition and memory functions.

Adult↗

The structuring of interpersonal relations in schizophrenic adolescents: a decentering analysis of Thematic Apperception Test stories.

This study tested the hypothesis that schizophrenics employ more developmentally immature levels of decentering in their structuring of interpersonal relations. A 9-point scale of interpersonal decentering, developed originally by Feffer, was applied to Thematic Appercetion Test stories produced by schizophrenic adolescents and a control group of psychiatrically disturbed patients equivalent in age and intellectual functioning. Results provided convincing support for the hypothesis tested and suggest the theoretical utility of viewing interpersonal deficit in schizophrenia from a cognitive-developmental perspective.

Adolescent↗

Apnoea of immaturity. 2. Mortality and handicap.

One hundred and three consecutive infants less than or equal to 32 weeks' gestation with recurrent apnoea of immaturity were reviewed, and survival was assessed and related to timing of treatment. The sickest infants were treated after between one and three episodes of apnoea with bradycardia, and mortality was 70%. Of those in whom treatment was postponed because apnoea was considered mild, 34% subsequently required mechanical ventilation, and 23% died. Among a small group of 20 survivors seen at ages 9-24 months, 4 (20%) have major handicaps. The possible place for earlier treatment is discussed.

Apnea↗

[Factors influencing the results of osteodensitometry in searching for systemic osteoporosis].

Osteodensitometry (ODM) performed in 485 persons aged 15 to 83 years, referred for ODM due to their having various causes, has demonstrated a significant reduction in bone density in both males and females above 50 years of age. The density of each vertebra individually in patients without cancer and inflammation of the spine is different, even in youth. The difference between the density of the bodies of individual vertebra increases with age. The vertebral density difference is particularly great in osteoplastic metastases. All the processes accompanied by osteogenesis or calcification both within and around the bone increase ODM values excessively. ODM values are decreased by not only osteoporosis, but also by any other bone destruction (tumorous, inflammatory, non-inflammatory), the increased area of a portion under study due to neoplasia of an immature bone, and by intestinal gas at the level of lumbar vertebrae. The older the patient is, the more factors distorting the results of ODM are. The role of each factor is reflected in the present communication. Not only the densitometric, but also X-ray patterns of the area under study should be taken into account to give an objective and final assessment of a specific situation.

Absorptiometry, Photon↗