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Drawing treatment straws for multiple sclerosis
the way in which his plan to require Medicaid coverage for abortions was disclosed. Although the Department of Health and Human Services sent a draft of the letter to state Medicaid representatives to the White House for approval, presidential aides did not bring it to his attention.
Individual
states are
clearly willing
to
:
show their anger at the Federal directive For instance, over abortion financing. Utah has simply refused to implement the mandate pending further legal rulings. Yet Medicaid officials stand by their interpretation. According to the new law "None of the funds, appropriated under this Act
Drawing treatment straws for multiple sclerosis
shall be expended for any abortion except when it is made known to the Federal entity or official to which funds are appropriated under this Act that such a procedure is necessary to save the life of the mother or that the pregnancy is the result of an act of rape or incest". Hanley argues that this language merely provides options for states. Several states, such as Arkansas, have constitutions that forbid the use of public funds for abortion, unless the mother’s life is in
Acute
fluoride
poisoning
Of 47 residents of Hooper Bay, Alaska, USA, who drank water from the public supply some time during May 21 to May 23, 1992, 43 became ill with diarhoea and
1 died and another recovered after a severe illness and a serum fluoride concentration of 480 u mol/L. Reporting this episode, Gessner et al’ note that in the USA 9411 public water systems supply fluoridated water to 135 million people; danger. and that previously reported outbreaks of acute fluoride poisoning have occurred in Richard Horton communities served by small-scale water systems. Such was the case in Hooper in Russia Bay; 470 residents collected drinking water from a 6340 L water tank filled The diphtheria epidemic that has been from a well and fluoridated from a drum spreading in Russia throughout the past of concentrate. Overfluoridation (to conyear has now reached the eastern extremcentration of up to 150 mg/L) was due to ity of the country, Sakhalin Island, where faulty mechanisms and operator error. 58 people have been hospitalised and two : Symptoms of acute fluoride poisoninghave died. According to Russia’s State nausea, vomiting, diarrhoea, abdominal Committee for Public Health and Epipain, and paraesthesiae-might readily be demiology, over 12500 people in Russia mistaken for infectious enteritis. When the became ill with diphtheria last year, of water supply is small-scale and fluoridatwhom 340 died. Most of the patients were ed, the possibility of fluoride poisoning adults, who had not been vaccinated. should be considered as a cause of apparOnly 20% of the cases (including 72 ent enteritis. : deaths) were children. Of recent years, there has been considerable public resistance to vaccination, John Bignall because of the shortage of disposable syringes. Immunisation against diphtheria . 1 Gessner BD, Beller M, Middaugh JP, is now compulsory in Moscow. : Whitford GM. Acute fluoride poisoning from a public water system. N Engl J Med 1994; 330: 95-99. Vera Rich
vomiting;
Diphtheria
:
When two reports describing the efficacy of interferon-&bgr; 1b were published in April, 1993,’-" and the Food and Drug Administration decided to fast-track the drug’s: product licence, Berlex laboratories had a dilemma. With only limited stocks of their: recombinant interferon (Betaseron) available, and with over 300 000 patients with multiple sclerosis in the US, how were :: patients to be selected for treatment? By lottery. The trial included ambulat- : ory patients with relapsing-remitting disease and, provided they had a doctor’s certificate to confirm these clinical features, the company invited individuals to . register for a draw. 74 000 patients: entered and 17 000 have so far received the drug, which is self-administered on alternate days subcutaneously. Over 20 000 further patients should receive Betaseron in 1994. : The primary end-point of the published triap1,2 was disease exacerbation rate. Treatment with interferon-&bgr; ibproduced a twofold reduction in the frequency of moderate-to-severe attacks, together with . fewer abnormalities detected by magnetic
Spinal cord repair in rats Two
papers
describing
encouraging
results with attempts at repair of damaged mammalian spinal cord appear in this week’s Nature. : Iwashita and colleagues’ resected a : resonance imaging, although disability rat: 1-5-2 mm length of the thoracic cord in ings were not significantly different neonatal rats and replaced it with a piece between treatment and control groups. of fetal spinal cord in the normal orienta: The authors concluded that interferon-&bgr; 1b tion. In one control group the graft was was "the only treatment that has substanin oriented the reverse direction. Other : tially altered the natural history of [multicontrol groups were grafted with the sciatple sclerosis] in a properly controlled ic nerve or were left ungrafted. In 14 of clinical trial". : the 22 rats grafted in the normal orientaWhat would happen if lotteries become tion that survived until histological examiaccepted as a means of fairly distributing nation, the graft united seamlessly with . scarce drug? Would adding serendipity to the two cut ends of the recipient cord. In probability give a new variable for calcu6 of these the graft showed organotypic lating efficacy? cytoarchitecture, albeit distorted. Injection of anterograde and retrograde tracers Richard Horton revealed axonal connections in both directions across the transplant. : 1 IFN&bgr; multiple sclerosis study group. The most remarkable finding was the . Interferon beta1b is effective in relapsingfunctional recovery in animals that remitting multiple sclerosis. I. Clinical results of a multicenter, randomised, double-blind, received successful grafts placed in the placebo-controlled trial. Neurology 1993; 43: orientation. There was good correct 655-61. hindlimb-forelimb coordination and main2 Paty DW, Li DKB, UBC MS/MRI study tenance of righting relexes. When the anigroup, and the IFNb sclerosis study group. II. mals walked, limbs struck the ground in MRI analysis results of a multicenter, the same order as in normal animals, and randomised, double-blind, placebo-controlled trial. Neurology 1993; 43: 662-67. when they were dropped in mid-air with
limbs pointing upwards, they landed upright on all four extremities. All animals not successfully grafted showed functional deficits of various
grades.
Although promising, the results have to be interpreted cautiously. As pointed out in an accompanying commentary,’ the rats were very young and the functional analysis was limited to a few selected cases. The second paper3 was an examination of the effect of nerve growth factors on the regeneration of the corticospinal tract in rats with cords partly transected at the thoracic level. Neurotrophin-3 increased regenerative sprouting of the tract, whereas brain-derived neurotrophic factor did not. Application of an antibody that neutralises myelin-associated neurite growth inhibitory proteins inceased the distance over which regeneration occurred. Vivien Choo
Y, Kawaguchi G, Murata M. Restoration of function by replacement of spinal cord segments in the rat. Nature 1994; 367: 167-70. 2 Björklund A. A question of making it work. Nature 1994; 367: 112-13. 3 Schnell L, Schneider R, Kolbeck R, Barda Y-A, Schwah ME. Neurotrophin-3 enhances sprouting of corticospinal tract during development and after adult spinal cord lesion. Nature 1994; 367: 170-73. 1 Iwashita
169
Individual
states are
clearly willing
to
:
show their anger at the Federal directive For instance, over abortion financing. Utah has simply refused to implement the mandate pending further legal rulings. Yet Medicaid officials stand by their interpretation. According to the new law "None of the funds, appropriated under this Act
Drawing treatment straws for multiple sclerosis
shall be expended for any abortion except when it is made known to the Federal entity or official to which funds are appropriated under this Act that such a procedure is necessary to save the life of the mother or that the pregnancy is the result of an act of rape or incest". Hanley argues that this language merely provides options for states. Several states, such as Arkansas, have constitutions that forbid the use of public funds for abortion, unless the mother’s life is in
Acute
fluoride
poisoning
Of 47 residents of Hooper Bay, Alaska, USA, who drank water from the public supply some time during May 21 to May 23, 1992, 43 became ill with diarhoea and
1 died and another recovered after a severe illness and a serum fluoride concentration of 480 u mol/L. Reporting this episode, Gessner et al’ note that in the USA 9411 public water systems supply fluoridated water to 135 million people; danger. and that previously reported outbreaks of acute fluoride poisoning have occurred in Richard Horton communities served by small-scale water systems. Such was the case in Hooper in Russia Bay; 470 residents collected drinking water from a 6340 L water tank filled The diphtheria epidemic that has been from a well and fluoridated from a drum spreading in Russia throughout the past of concentrate. Overfluoridation (to conyear has now reached the eastern extremcentration of up to 150 mg/L) was due to ity of the country, Sakhalin Island, where faulty mechanisms and operator error. 58 people have been hospitalised and two : Symptoms of acute fluoride poisoninghave died. According to Russia’s State nausea, vomiting, diarrhoea, abdominal Committee for Public Health and Epipain, and paraesthesiae-might readily be demiology, over 12500 people in Russia mistaken for infectious enteritis. When the became ill with diphtheria last year, of water supply is small-scale and fluoridatwhom 340 died. Most of the patients were ed, the possibility of fluoride poisoning adults, who had not been vaccinated. should be considered as a cause of apparOnly 20% of the cases (including 72 ent enteritis. : deaths) were children. Of recent years, there has been considerable public resistance to vaccination, John Bignall because of the shortage of disposable syringes. Immunisation against diphtheria . 1 Gessner BD, Beller M, Middaugh JP, is now compulsory in Moscow. : Whitford GM. Acute fluoride poisoning from a public water system. N Engl J Med 1994; 330: 95-99. Vera Rich
vomiting;
Diphtheria
:
When two reports describing the efficacy of interferon-&bgr; 1b were published in April, 1993,’-" and the Food and Drug Administration decided to fast-track the drug’s: product licence, Berlex laboratories had a dilemma. With only limited stocks of their: recombinant interferon (Betaseron) available, and with over 300 000 patients with multiple sclerosis in the US, how were :: patients to be selected for treatment? By lottery. The trial included ambulat- : ory patients with relapsing-remitting disease and, provided they had a doctor’s certificate to confirm these clinical features, the company invited individuals to . register for a draw. 74 000 patients: entered and 17 000 have so far received the drug, which is self-administered on alternate days subcutaneously. Over 20 000 further patients should receive Betaseron in 1994. : The primary end-point of the published triap1,2 was disease exacerbation rate. Treatment with interferon-&bgr; ibproduced a twofold reduction in the frequency of moderate-to-severe attacks, together with . fewer abnormalities detected by magnetic
Spinal cord repair in rats Two
papers
describing
encouraging
results with attempts at repair of damaged mammalian spinal cord appear in this week’s Nature. : Iwashita and colleagues’ resected a : resonance imaging, although disability rat: 1-5-2 mm length of the thoracic cord in ings were not significantly different neonatal rats and replaced it with a piece between treatment and control groups. of fetal spinal cord in the normal orienta: The authors concluded that interferon-&bgr; 1b tion. In one control group the graft was was "the only treatment that has substanin oriented the reverse direction. Other : tially altered the natural history of [multicontrol groups were grafted with the sciatple sclerosis] in a properly controlled ic nerve or were left ungrafted. In 14 of clinical trial". : the 22 rats grafted in the normal orientaWhat would happen if lotteries become tion that survived until histological examiaccepted as a means of fairly distributing nation, the graft united seamlessly with . scarce drug? Would adding serendipity to the two cut ends of the recipient cord. In probability give a new variable for calcu6 of these the graft showed organotypic lating efficacy? cytoarchitecture, albeit distorted. Injection of anterograde and retrograde tracers Richard Horton revealed axonal connections in both directions across the transplant. : 1 IFN&bgr; multiple sclerosis study group. The most remarkable finding was the . Interferon beta1b is effective in relapsingfunctional recovery in animals that remitting multiple sclerosis. I. Clinical results of a multicenter, randomised, double-blind, received successful grafts placed in the placebo-controlled trial. Neurology 1993; 43: orientation. There was good correct 655-61. hindlimb-forelimb coordination and main2 Paty DW, Li DKB, UBC MS/MRI study tenance of righting relexes. When the anigroup, and the IFNb sclerosis study group. II. mals walked, limbs struck the ground in MRI analysis results of a multicenter, the same order as in normal animals, and randomised, double-blind, placebo-controlled trial. Neurology 1993; 43: 662-67. when they were dropped in mid-air with
limbs pointing upwards, they landed upright on all four extremities. All animals not successfully grafted showed functional deficits of various
grades.
Although promising, the results have to be interpreted cautiously. As pointed out in an accompanying commentary,’ the rats were very young and the functional analysis was limited to a few selected cases. The second paper3 was an examination of the effect of nerve growth factors on the regeneration of the corticospinal tract in rats with cords partly transected at the thoracic level. Neurotrophin-3 increased regenerative sprouting of the tract, whereas brain-derived neurotrophic factor did not. Application of an antibody that neutralises myelin-associated neurite growth inhibitory proteins inceased the distance over which regeneration occurred. Vivien Choo
Y, Kawaguchi G, Murata M. Restoration of function by replacement of spinal cord segments in the rat. Nature 1994; 367: 167-70. 2 Björklund A. A question of making it work. Nature 1994; 367: 112-13. 3 Schnell L, Schneider R, Kolbeck R, Barda Y-A, Schwah ME. Neurotrophin-3 enhances sprouting of corticospinal tract during development and after adult spinal cord lesion. Nature 1994; 367: 170-73. 1 Iwashita
169