Performing arts medicine.

Arts medicine has come of age, resulting from 3 important developments over the past decade: improved methods of diagnosis and treatment, an awareness that artists suffer from special problems related to their occupation and lifestyle, and the establishment of health programs emphasizing an interdisciplinary approach to these patients. We focus on the patterns of illness afflicting performing artists, specifically dancers, singers, actors, and instrumental musicians, and explain some of the things a health care team can do in treating these patients. The conditions governing these patients'' lives--early exposure to high expectations of excellence, incessant demands for perfection, long periods of intense practicing, fierce competition, high levels of anxiety associated with performance, and uncertain careers--need to be understood. Levels of disease and disability are remarkably high, but artists often ignore symptoms. We discuss the musculoskeletal, neurologic, vocal, psychological, and other syndromes found among performers and some of the difficulties in treating them. The prevention of injury, conservative management, collaboration with teachers, and a psychotherapeutic approach are desirable. Arts medicine programs for professional consultation exist in several major cities of the United States and abroad. Although research is needed regarding the effectiveness of health care services for performing artists, the scientific literature devoted to this field is growing.     

Kinetic mechanism of histidinol dehydrogenase: histidinol binding and exchange reactions

Salmonella typhimurium histidinol dehydrogenase produces histidine from the amino alcohol histidinol by two sequential NAD-linked oxidations which form and oxidize a stable enzyme-bound histidinaldehyde intermediate. The enzyme was found to catalyze the exchange of 3H between histidinol and [4(R)-3H]NADH and between NAD and [4(S)-3H]NADH. The latter reaction proceeded at rates greater than kcat for the net reaction and was about 3-fold faster than the former. Histidine did not support an NAD/NADH exchange, demonstrating kinetic irreversibility in the second half-reaction. Specific activity measurements on [3H]histidinol produced during the histidinol/NADH exchange reaction showed that only a single hydrogen was exchanged between the two reactants, demonstrating that under the conditions employed this exchange reaction arises only from the reversal of the alcohol dehydrogenase step and not the aldehyde dehydrogenase reaction. The kinetics of the NAD/NADH exchange reaction demonstrated a hyperbolic dependence on the concentration of NAD and NADH when the two were present in a 1:2 molar ratio. The histidinol/NADH exchange showed severe inhibition by high NAD and NADH under the same conditions, indicating that histidinol cannot dissociate directly from the ternary enzyme-NAD-histidinol complex; in other words, the binding of substrate is ordered with histidinol leading. Binding studies indicated that [3H]histidinol bound to 1.7 sites on the dimeric enzyme (0.85 site/monomer) with a KD of 10 microM. No binding of [3H]NAD or [3H]NADH was detected. The nucleotides could, however, displace histidinol dehydrogenase from Cibacron Blue-agarose.(ABSTRACT TRUNCATED AT 250 WORDS)     

Interaction of the serum amyloid A proteins with phospholipid

The serum amyloid A proteins (SAA) are transported in plasma in association with the high density lipoproteins. We have studied the solution properties of two of the polymorphic forms of SAA, SAA1 and SAA4, and compared the lipid-binding properties of SAA4 to those of the well characterized apolipoproteins, apo-A-I, apo-A-II, and apo-C-III. SAA4 was monomeric at pH 2.9 but considerable self-association was demonstrated at pH 8.2, even in the presence of 1.0 M guanidine HCl. SAA4 differed from the apolipoproteins in its ability to disrupt multilamellar dimyristoylphosphatidylcholine (DMPC) liposomes and generate bilayer discs. Apo-A-I, apo-A-II, and apo-C-III reduced the turbidity of DMPC dispersions at protein:lipid molar ratios of 1:200. SAA4, however, increased turbidity at molar ratios of 1:250 and 1:100 even when preincubated in guanidine HCl before addition to liposomes. Optical density decreased only at ratios of 1:50 and 1:25. At an SAA4:DMPC ratio of 1:50, discoidal particles (long axis, 28.1 nm; short axis, 4.4 nm) were formed which were similar to those produced by apo-C-III. Lipid binding induced changes in SAA4 conformation similar to those observed in the apolipoproteins. The alpha-helical content and intrinsic tryptophanyl fluorescence were increased and quenching of tryptophanyl fluorescence by acrylamide was reduced in the presence of DMPC. In addition, SAA4 as well as the apolipoproteins broadened the range and increased the temperature of the gel-liquid crystal transition temperature of DMPC.     

Tidal flows and sediment budgets for a salt-marsh system,Essex, England

Studies of tidal flows in salt-marsh creeks in Essex, England, show large variations in water velocity during different tidal cycles, particularly between tides below, at, and above marsh level. Water level, velocity and suspended sediment concentration have been monitored at 5-min intervals during 700 tidal cycles during the year March 1982–March 1983, and the data are being used to calculate sediment budgets for the creek system studied. Completed analyses for two of the tidal cycles show a large positive sediment flux. Because of the importance of velocity in controlling total discharge through a creek cross-section, and hence its effect on total sediment movement, we cannot extrapolate from these two below-marsh tides to any general conclusions about marsh erosion or accretion. We use these preliminary data both to demonstrate our methods and to indicate some of the complexities involved in the analysis.Acknowledgements: This work has been supported by the Natural Environment Research Council. We thank the Philip Lake Fund for financial assistance and the Department of Geography, Cambridge University, for much material support. Mr D. J. Fisher kindly gave access to his land, and Mr W. Bailey helped us greatly. We also thank Mr A. St Joseph for his help, Mr M. Diver for practical support, and Dr J. S. Pethick for discussion.     

3. Control of sex expression in conifers

Despite considerable progress in recent years in the promotion of flowering in conifers, relatively little is known about the endogenous control of sex expression or its practical manipulation to aid pollen and crop management in seed orchards. Well defined patterns of sexual zonation exist within the tree crown and shoot, and these appear to be associated with hormonal and possibly nutritional gradients. No firm conclusions, however, are possible regarding the specific role(s) of different PGRs in sex expression, this being as much as a problem of lack of critical study as the complexity of the process itself. Whether a PGR such as gibberellins or auxins, or a cultural treatment that itself may influence endogenous hormone levels, primarily promotes female or male flowering often depends on the position within the crown of the shoot being treated, and its timing in relation to stage of primordia development. Photoperiod also may be involved- short days favoring females and long days males, at least in some species- although its role in controlling sex expression is by no means clear. Practical manipulation of sex expression may be possible through selective crown pruning, different PGR combinations, treatment timing and/or photoperiod control, but the development of such techniques for operational use will require a better basic understanding of the endogenous regulatory mechanisms involved.     

Partial trisomy 20p resulting from a recombination of a familial pericentric inversion

Summary Recombination of an inherited pericentric inversion of chromosome 20 has given rise to a child with partial trisomy 20p. To our knowledge no previous familial inversions of this chromosome have been described in the literature.