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The concentrations of inhibin and follistatin in amniotic fluid and in tissue extracts from the placenta, gonads and adrenals of fetal sheep were measured using radioimmunoassays. These tissue extracts were from whole fetuses from days 16 to 45 and from the individual organs from day 46 to 145 (term) and were assayed at multiple dilutions. The capacity of these extracts to alter FSH production of rat anterior pituitary cells in culture was also assessed at multiple dilutions. Immunoactive inhibin concentrations in amniotic fluid from both sexes increased during gestation and levels were significantly greater in males than females. Peak concentrations of immunoreactive inhibin of 11.2 +/- 1.9 ng/ml were found in males at 116-125 days of gestation. Follistatin concentrations did not change throughout gestation and no significant difference was noted between sexes. Mean follistatin levels throughout gestation were 3.0 +/- 0.9 ng/ml for males and 3.7 +/- 0.9 ng/ml for females. Despite the potential for FSH inhibition by inhibin and follistatin, amniotic fluid from both sexes at all stages of gestation stimulated FSH secretion in the pituitary cell bioassays, suggesting the presence of activin which was confirmed by the measurement of immunoactive activin (13.3 +/- 2.5 ng/ml) in a specific radioimmunoassay. Maximum concentrations of immunoactive and bioactive inhibin in placental extracts were observed in late gestation (2.2 +/- 0.6 and 3.8 +/- 1.6 ng/g respectively) and there was no significant difference between sexes. Follistatin concentrations in placental cotyledons ranged from 11.5 to 27.1 ng/g with no significant difference between sexes. In view of the higher follistatin concentrations compared with inhibin, it is likely that the capacity of placental extracts to suppress FSH production by pituitary cells in culture is due predominantly to follistatin. Immunoactive inhibin was observed in high concentrations in the fetal testis throughout gestation; with concentrations increasing to a maximum of 1993.0 +/- 519.7 ng/g at 126-135 days of gestation with a ratio of bioactive: immunoactive inhibin of 1:20. Although bioactive and immunoactive inhibin was also observed in fetal ovaries and adrenals from both male and female fetuses, concentrations were lower than those observed in fetal testes. Follistatin concentrations in the fetal testis were elevated between 70 and 95 days (97.6 ng/g) and then declined. Similar concentrations were found in the adrenal glands of both sexes (males 83.5-103.3 ng/g: females 55.3-95.8 ng/g).(ABSTRACT TRUNCATED AT 400 WORDS)

The aim of medical intervention in patients suffering from chronic diseases is to maintain a life of quality. Patients who have undergone coronary artery bypass surgery provide a good example of an intervention that will not necessarily result in the prolongation of life but the improved quality of life. Rehabilitation outcome should focus on the improved quality of life and the issue of who should be responsible for maintaining improved quality of life. In order to determine if self-responsibility was an aspect of improved quality of life 73 subjects and their spouses were followed up over a period of one year. Self-responsibility was identified as a significant variable (p=0.003) in patients with improved quality of life. Based on the evidence provided by this study it was concluded that unless patients accepted responsibility for their rehabilitation they would not have an improved quality of life.

The purpose of this study was to compare observational analysis of gait to six temporal distance measurements in order to rate the accuracy of the observational analysis.Ten hemiparetic and ten parkinsonian patients were asked to walk along a paper walkway with ink pads attached to their normal footwear. Measurements of velocity, cadence, step length, stride length, base width and foot angle were taken.Ten normal subjects were also evaluated on the paper walkway to give normal values as a baseline for comparison with the hemiparetic and parkinsonian patient’s measurements.Observational analysis was recorded on a gait assessment form and a video recording was made of each patient. Comparison was made between the results recorded on the gait assessment form and the objective data.Observational analysis was found to be fairly reliable for the assessment of some gait parameters but as no accurate data are produced it cannot be used to give scientific proof of the effectiveness of treatment.Step length was the most difficult parameter to evaluate observationally in the hemiparetic patients, whereas cadence, foot angle and base width were the most difficult in the parkinsonian patients. As velocity was an easy value to record objectively it should be used in all gait assessments.

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