ENURESIS

Enuresis is a symptom rather than a disease. It may occasionally be the result of an organic condition but most cases are functional in origin. The organic cases are rather simply classified, the diagnosis should not be difficult, and the treatment is fairly well standardized. The functional cases, on the other hand, are of a variety of types which tax the physician and the family in understanding and treating the problem.The author presents some of the known facts about enuresis and discusses the accepted forms of therapy. An important requirement is a better understanding and study of the child from the medical, psychological and environmental viewpoint. In this way a more rational therapy may be advised.     

PSYCHIATRIC ASPECTS OF PSYCHOMOTOR EPILEPSY

Psychomotor or temporal lobe epilepsy is a frequently missed diagnosis. It is often confused with grand mal and petit mal epilepsy. At times it is the first symptom of an organic neurological disease. It is often masked as a psychiatric disorder or is associated with a mental illness without clinically detectable seizures.These psychic manifestations simulate all of the neuroses and major psychiatric states. Excitement states with amnesia may lead to violent antisocial behavior. All these manifestations may be aggravated by alcohol.Thalamic epilepsy shows itself in similar psychiatric manifestations and accounts for behavior disorder in children more than temporal lobe epilepsy. Atypical seizures with vegetative or emotional aura and a characteristic electroencephalogram differentiate it from temporal lobe epilepsy.Proper understanding of the varied manifestations, with positive electroencephalographic findings, leads to the correct diagnosis in most cases. All patients with unusual or atypical personality or psychiatric-like states should have careful electroencephalographic examination. Anticonvulsant therapy and other psychiatric treatment procedures can relieve most cases. Surgical therapy sometimes is necessary.     

RHEUMATOID ARTHRITIS—Current Therapy and Medical Management

Although no routinely effective therapy for patients with rheumatoid arthritis is available, certain established principles of management and a variety of medications do provide benefit.Conservative management programs may suffice in milder cases. Aspirin or other salicylates and physical therapy are the mainstays in such programs.The antimalarial drugs may be helpful in a small proportion of cases. Steroids have had beneficial effect rather consistently and, with the newer analogues, certain side effects have become less troublesome. The usual precautions with the use of these compounds must be observed as always. Chrysotherapy remains important in the treatment of severe cases, and its use should not be postponed until major destructive joint changes have occurred.     

RHEUMATOID ARTHRITIS-Current Therapy and Medical Management

Although no routinely effective therapy for patients with rheumatoid arthritis is available, certain established principles of management and a variety of medications do provide benefit. Conservative management programs may suffice in milder cases. Aspirin or other salicylates and physical therapy are the mainstays in such programs. The antimalarial drugs may be helpful in a small proportion of cases. Steroids have had beneficial effect rather consistently and, with the newer analogues, certain side effects have become less troublesome. The usual precautions with the use of these compounds must be observed as always. Chrysotherapy remains important in the treatment of severe cases, and its use should not be postponed until major destructive joint changes have occurred.     

Differential Network Analysis Applied to Preoperative Breast Cancer Chemotherapy Response

In silico approaches are increasingly considered to improve breast cancer treatment. One of these treatments, neoadjuvant TFAC chemotherapy, is used in cases where application of preoperative systemic therapy is indicated. Estimating response to treatment allows or improves clinical decision-making and this, in turn, may be based on a good understanding of the underlying molecular mechanisms. Ever increasing amounts of high throughput data become available for integration into functional networks. In this study, we applied our software tool ExprEssence to identify specific mechanisms relevant for TFAC therapy response, from a gene/protein interaction network. We contrasted the resulting active subnetwork to the subnetworks of two other such methods, OptDis and KeyPathwayMiner. We could show that the ExprEssence subnetwork is more related to the mechanistic functional principles of TFAC therapy than the subnetworks of the other two methods despite the simplicity of ExprEssence. We were able to validate our method by recovering known mechanisms and as an application example of our method, we identified a mechanism that may further explain the synergism between paclitaxel and doxorubicin in TFAC treatment: Paclitaxel may attenuate MELK gene expression, resulting in lower levels of its target MYBL2, already associated with doxorubicin synergism in hepatocellular carcinoma cell lines. We tested our hypothesis in three breast cancer cell lines, confirming it in part. In particular, the predicted effect on MYBL2 could be validated, and a synergistic effect of paclitaxel and doxorubicin could be demonstrated in the breast cancer cell lines SKBR3 and MCF-7.     

Functional gastrointestinal disturbances; recognition and treatment

The recognition of functional gastrointestinal diseases depends essentially on certain positive features characteristic of them. When there are evidences of associated functional disturbances in other organ systems or in the patient as a whole, or characteristic clinical syndromes are present, and there is lack of symptomatic or objective evidence of organic disease on careful examination, the diagnosis of functional gastrointestinal disorder is likely. Treatment of functional gastrointestinal disturbances rests fundamentally on the art of medicine in the treatment of the patient and not on the science of medicine in the treatment of a disease. The essential steps in successful treatment include convincing the patient of the diagnosis, improving and relieving symptoms and avoiding or adequately controlling recurrences.Psychotherapy is a keystone in the treatment of functional gastrointestinal disorders. Not often, however, are the services of a psychiatrist necessary. Given, as needed, mild sedatives, certain forms of specific treatment in specific conditions, general measures and good hygiene and sympathetic understanding, the patient may be expected to recover or improve.     

How do banded mongooses locate and select anvils for cracking encased food items?

Banded mongooses (Mungos mungo) extract encased food items by throwing them against anvils. Observations indicate that their chosen anvils are generally hard enough to crack open casings, suggesting an understanding of the physical properties that render an anvil suitable for cracking. We report results from two field experiments investigating spatial and physical aspects of anvil selection in a wild group of banded mongooses. Mongooses rapidly carried prey items to nearby anvils in their environment, without simply returning to the last anvil they passed, suggesting a detailed knowledge of anvil locations. Moreover, in choice experiments with hard or soft anvils, they always chose the appropriate anvil when both anvils were natural but chose indiscriminately when they were synthetic. These results support a recent suggestion that mongooses lack a generalized understanding of the functional properties of anvils but also indicate that they may mediate their decisions on the basis of familiarity. Together, our experiments suggest that mongooses employ simple rules of thumb that, in most cases, result in the selection of appropriate anvils. Where environmental problems are limited and predictable, selection will favor the evolution of such rules of thumb rather than a more generalized understanding of functional properties.     

Clinical and anorectal motility features in chronically constipated children

Constipation is a common problem in children. It can be a symptom of functional disorder in majority of cases, but sometimes a serious organic disease is a cause of constipation. Anorectal manometry plays an important role in the diagnostic procedure. It can be presumed that some values of manometric parameters could be very useful in treatment plan. The aim of this study was to confirm or exclude such limits in manometric finding, to make a plan of the therapy more accurate. Therefore the group of 81 constipated children was investigated. There were 58 patients suffering from functional constipation and 23 with organic disorders. The age of the patients was 3 to 15 years. Scoring system was applied to estimate severity of constipation and anorectal manometry was performed. Our results did not show significant correlation between clinical symptoms and signs and the values that we obtained using anorectal manometry. But, we recommend anorectal manometry because it is a safe method and contributes to clarify the diagnosis, which is very important for treatment plan.     

PSYCHOSIS AND SYSTEMIC LUPUS ERYTHEMATOSUS—A Review of the Literature and Case Reports

In a review of the literature of the last 60 years concerning the association between psychosis and systemic lupus erythematosus, reports of 227 cases of this association were found. The average incidence of psychosis in the various series of systemic lupus erythematosus that were reviewed was 22 per cent. In only 25 per cent of the cases in which the information was given was the psychosis associated with steroid therapy.The psychiatric manifestations are variable and may be associated with a neurological disorder. Psychosis may antedate by many years other features of lupus. The psychosis due to lupus may respond to steroid therapy. Since systemic lupus erythematosus sometimes may be an important differential diagnosis of functional psychosis, appropriate diagnostic studies should be carried out in psychotic patients who have an accelerated sedimentation rate or positive serological test for syphilis without apparent reason.     

Difficulties in evaluating systolic murmurs in children; with special reference to the functional systolic murmur

As a guide in distinguishing between organic and functional systolic murmurs, five characteristics of a murmur should always be noted, namely, (a) the location of maximal intensity of the murmur; (b) the intensity of the murmur itself; (c) the character of the murmur, that is, whether it is blowing, rumbling, rough or harsh; (d) the transmission of the murmur; and (e) the duration of the murmur and its time within the cardiac cycle. Functional systolic murmurs may be found at any of the "valve areas," are usually faint to moderately loud, are usually soft and blowing in quality, are usually only slightly transmitted, and are usually not heard immediately following the first heart sound. In doubtful cases, those in which history and physical examination alone are not sufficient to make a diagnosis of functional systolic murmur, further studies should be undertaken to determine the presence or absence of organic heart disease. Until a diagnosis of organic heart disease can be made with reasonable certainty, there should be no restriction of activity imposed, because of the likelihood of the development of cardiac neurosis in the patient.     

DIFFICULTIES IN EVALUATING SYSTOLIC MURMURS IN CHILDREN—With Special Reference to the Functional Systolic Murmur

As a guide in distinguishing between organic and functional systolic murmurs, five characteristics of a murmur should always be noted, namely, (a) the location of maximal intensity of the murmur; (b) the intensity of the murmur itself; (c) the character of the murmur, that is, whether it is blowing, rumbling, rough or harsh; (d) the transmission of the murmur; and (e) the duration of the murmur and its time within the cardiac cycle.Functional systolic murmurs may be found at any of the “valve areas,” are usually faint to moderately loud, are usually soft and blowing in quality, are usually only slightly transmitted, and are usually not heard immediately following the first heart sound.In doubtful cases, those in which history and physical examination alone are not sufficient to make a diagnosis of functional systolic murmur, further studies should be undertaken to determine the presence or absence of organic heart disease.Until a diagnosis of organic heart disease can be made with reasonable certainty, there should be no restriction of activity imposed, because of the likelihood of the development of cardiac neurosis in the patient.     

Optimal immune responses: immunocompetence revisited

The function of the immune system of an animal is to provide defence against infection, in order to maximize fitness. Understanding this and, particularly, how limiting resources are traded off between costly immune responses and other physiological demands, is central to properly understanding life-history traits and their evolution. Here, we propose that functional (rather than immunological) measures of immune responses should be used when investigating this. We further suggest that optimal immune responses are context specific, rather than generic; that is, a maximum immune response is not necessarily optimal. The nature of an optimal immune response will depend on the specific circumstances and infection status of the animal. Identifying and understanding such optimality requires that the effects of different immune strategies on fitness be considered.     

New type of organic matrix in cirals formed at the decalcified site: Structure and composition

This is the first demonstration that the organic matrix appears at the decalcified site of the skeleton in a juvenile coral of Fungia fungites (Linnaeus). This matrix was secreted by the calicoblastic layer and is composed of fibrous matters as seen in mesoglea. If formed a thick sheet at the advanced stage. The amino acid composition of this matrix was similar to that in the skeleton rather than mesogleal protein. Morphologic and functional features suggest that the organic sheet must be similar to the sheet which is secreted extracellularly by planula larva at the time of settlement. The sheet in F. fungites may have a role of protecting calicoblastic epithelium from exposure as a result of skeletal dissolution.     

Radiation Therapy for Skin Cancer

Local control, cosmesis and functional results were evaluated in 315 cases of skin cancer in 247 patients treated with radiation therapy. The initial recurrence rate for basal cell carcinoma was 7.8 percent and for squamous cell carcinoma was 14.9 percent. Ultimate local control was achieved in 98.7 percent of the cases of basal cell carcinoma and in 94.0 percent of the cases of squamous cell carcinoma with use of further irradiation or other therapeutic modalities. Ultimate local control rates were comparable to other therapeutic modalities. Cosmetic and functional results were excellent. Cartilage necrosis was not a significant problem. Radiation therapy may offer advantages in certain clinical situations and should be considered as a mode of therapy in the treatment of skin cancer.     

Post-Treatment HIV-1 Controllers with a Long-Term Virological Remission after the Interruption of Early Initiated Antiretroviral Therapy ANRS VISCONTI Study

Combination antiretroviral therapy (cART) reduces HIV-associated morbidities and mortalities but cannot cure the infection. Given the difficulty of eradicating HIV-1, a functional cure for HIV-infected patients appears to be a more reachable short-term goal. We identified 14 HIV patients (post-treatment controllers [PTCs]) whose viremia remained controlled for several years after the interruption of prolonged cART initiated during the primary infection. Most PTCs lacked the protective HLA B alleles that are overrepresented in spontaneous HIV controllers (HICs); instead, they carried risk-associated HLA alleles that were largely absent among the HICs. Accordingly, the PTCs had poorer CD8+ T cell responses and more severe primary infections than the HICs did. Moreover, the incidence of viral control after the interruption of early antiretroviral therapy was higher among the PTCs than has been reported for spontaneous control. Off therapy, the PTCs were able to maintain and, in some cases, further reduce an extremely low viral reservoir. We found that long-lived HIV-infected CD4+ T cells contributed poorly to the total resting HIV reservoir in the PTCs because of a low rate of infection of naïve T cells and a skewed distribution of resting memory CD4+ T cell subsets. Our results show that early and prolonged cART may allow some individuals with a rather unfavorable background to achieve long-term infection control and may have important implications in the search for a functional HIV cure.     

ORGANIC PHOSPHORUS POISONING IN GENERAL PRACTICE—Parathion,TEPP, HEPT,EPN and Others

Inhalation, skin absorption or ingestion of insecticides containing organic phosphorus may result in abrupt onset of serious illness several hours following exposure. Because of the acute onset, often at night, the patients usually are observed by the first available physician rather than by an industrial physician. Prompt recognition and adequate treatment are essential to prevent death.The organic phosphorus radical has the specific effect of inactivating cholinesterase in the body. When cholinesterase is reduced below a critical level continuous stimulation of the entire parasympathetic nervous system results. The major symptoms are diarrhea, vomiting, pulmonary edema, respiratory difficulty and tonic convulsions. Myosis is frequently present and when found is almost pathognomonic, especially if associated with other symptoms.Treatment consists essentially of heroic doses of atropine or a similar parasympathetic inhibitor, plus supportive therapy.Patients who do not die recover rapidly and completely, but they should not risk re-exposure until cholinesterase activity in the blood reaches a static level which may take as long as ten weeks.     

The evolution of flight in bats: narrowing the field of plausible hypotheses

The evolution of flapping flight in bats from an arboreal gliding ancestor appears on the surface to be a relatively simple transition. However, bat flight is a highly complex functional system from a morphological, physiological, and aerodynamic perspective, and the transition from a gliding precursor may involve functional discontinuities that represent evolutionary hurdles. In this review, I suggest a framework for a comprehensive treatment of the evolution of complex functional systems that emphasizes a mechanistic understanding of the initial state, the final state, and the proposed transitional states. In this case, bats represent the final state and extant mammalian gliders are used as a model for the initial state. To explore possible transitional states, I propose a set of criteria for evaluating hypotheses about the evolution of flight in vertebrates and suggest methods by which we can advance our understanding of the transition from gliding to flapping flight. Although it is impossible ever to know with certainty the sequence of events landing to flapping flight, the field of possibilities can be narrowed to those that maintain the functional continuity of the wing and result in improved aerodynamic performance across this transition. The fundamental differences between gliding and flapping flight should not necessarily be seen as evidence that this transition could not occur; rather, these differences point out compelling aspects of the aerodynamics of animal wings that require further investigation.     

Local and Regional Determinants of an Uncommon Functional Group in Freshwater Lakes and Ponds

A combination of local and regional factors and stochastic forces is expected to determine the occurrence of species and the structure of communities. However, in most cases, our understanding is incomplete, with large amounts of unexplained variation. Using functional groups rather than individual species may help explain the relationship between community composition and conditions. In this study, I used survey data from freshwater lakes and ponds to understand factors that determine the presence of the floating plant functional group in the northeast United States. Of the 176 water bodies surveyed, 104 (59.1%) did not contain any floating plant species. The occurrence of this functional group was largely determined by local abiotic conditions, which were spatially autocorrelated across the region. A model predicting the presence of the floating plant functional group performed similarly to the best species-specific models. Using a permutation test, I also found that the observed prevalence of floating plants is no different than expected by random assembly from a species pool of its size. These results suggest that the size of the species pool interacts with local conditions in determining the presence of a functional group. Nevertheless, a large amount of unexplained variation remains, attributable to either stochastic species occurrence or incomplete predictive models. The simple permutation approach in this study can be extended to test alternative models of community assembly.     

The claustrum: a historical review of its anatomy, physiology, cytochemistry and functional significance.

The claustrum (Cl) is a subcortical structure located in the basolateral telencephalon of the mammalian brain. It has been a subject of inquiry since the mid-nineteenth century. The Cl can be identified in a number of species, and appears as a phylogenetically related nucleus in Insectivores, Prosimians and Marsupials. Ontogenetic investigations have been the subject of much debate over the years. There are three hypotheses for claustral development. To date, the "hybrid theory" has garnered the most support. Pathological conditions specifically associated with the Cl, while few in number, are of interest from a functional perspective. Several cases of claustral agenesis have been reported. The implications of these clinical reports are discussed. Claustral neuroanatomy at the light-microscopic and electron-microscopic level is reviewed. The morphology of the claustral neuron consists of several types, which roughly corresponds to the neuron's location within distinct claustral subdivisions. The interconnectivity of the Cl with the cerebral cortex is rather complex and reflective of complex functional interrelationships. Several researchers have investigated the angioarchitecture of the Cl. It appears that vessels permeating the insula also vascularize the Cl. Literature investigating the neurotransmitters and overall chemical neuroanatomy of the Cl is extensive. These studies clearly demonstrate that the Cl is richly innervated with a wide and diverse array of neurotransmitters and neuromodulators. Lesion, stimulation and recording experiments demonstrate that the functional and physiologic capacity of the Cl is quite robust. A recurring theme of claustral function appears to be its involvement in sensorimotor integration. This may be expected of the Cl, given the degree ofheterotopic, heterosensory convergence and its interconnectivity with the key subcortical nuclei and sensory cortical areas. The Cl remains a poorly understood and under investigated nucleus. Therefore, a review of the world literature through 1986 prior to the advent of the "molecular revolution" is presented. This diverse and extensive body of knowledge is reviewed in the areas ofphylogeny, ontogeny, pathology, angioarchitecture, cytochemistry, anatomy and physiology. Theories of possible claustral function are also noted. It is hoped that this work will stimulate research scientists to further investigate the functional interrelationships of the Cl as well as to aim with far greater precision and accuracy towards a deeper understanding of its raison d'etre. The recent efforts in neurosciences by Sir Francis Crick and Christof Koch implicating the Cl in visual consciousness, is an important step in understanding just what its functions could encompass. Efforts in molecular neurosciences will be indispensable for a mechanistic understanding of these functions. Currently research efforts are underway from many perspectives. In considering the past scientific literature on the Cl, it is interesting to regard that this once obscure brain structure, may serve as a model system for the study of one of the most interesting and complex brain functions-consciousness.