The structure of health status among older adults: disease, disability, functional limitation, and perceived health

This article builds on earlier conceptualizations of the structure of health status to propose a more complex, multiequation model that examines the interrelationships among its various dimensions. As such, the focus is not merely on the identification of the direct effects of a variety of factors on perceived health status, but on how the constructs of disease, functional limitation, and self-rated health interrelate. In so doing, we expose the inherent problems of several complex and contaminated items routinely included in applications of established functional health status measures. The source of these problems lies in the lack of specificity or conceptual clarity for the individual items in these established measures. Potential biases are discussed, and several methods and strategies for addressing these problems are explored. Alternative scales are constructed and their psychometric properties are presented. Researchers who rely on public use data bases containing these scales should be aware of the potential biases and either modify the scales or use other appropriate methodologies to control for the measurement contamination.

Magnetic resonance imaging with Gadolinium-DTPA for assessment of bladder carcinoma and its response to treatment

Magnetic Resonance Imaging (MRI) with intravenous Gadolinium-DTPA (Gd-DTPA, Magnevist, Schering-AG) was performed in 44 patients, 32 with primary bladder carcinoma and 12 with suspected recurrence after treatment. Gd-DTPA often increased diagnostic confidence in the identification and staging of tumours confined to the bladder wall and was necessary to assess depth of bladder wall invasion when T2-weighted images were suboptimal. Enhancement after Gd-DTPA enabled distinction between necrotic and viable tumour and blood clot. There was little advantage in its use for tumours infiltrating perivesical fat or with metastases to lymph nodes or bone, in the absence of a fat suppression sequence. Gd-DTPA may therefore be useful in selected patients with tumours of Stage T3a or less in whom information about depth of bladder wall invasion is inadequately shown on pre-contrast sequences. Artefacts due to variable and inhomogeneous urine signal intensity, however, often degraded post-Gd-DTPA images of the bladder. Changes in the bladder due to radiotherapy were observed on MRI 3-4 months after treatment in patients referred for routine follow-up and in some patients with suspected recurrence. Mucosal hyperintensity, thickening and abnormal signal intensity of the muscular layers of the bladder wall, with enhancement after Gd-DTPA were demonstrated. Such changes obscured small volume or superficial recurrence of tumour after radiotherapy. Abnormal enhancement was also observed in pelvic organs and soft tissues irradiated several years earlier. Enhancement after Gd-DTPA does not therefore reliably distinguish between recurrent tumour and radiotherapy change.

Cytokines in renal inflammation

Cytokines play pivotal roles in most physiologic and pathologic processes. This paper reviews recent data on the role of cytokines in mediating renal inflammatory diseases. These data show that cytokines are involved in every phase of inflammatory injury. Cytokines induce expression of major histocompatibility complex class II and adhesion molecules on renal cells and are thereby involved in antigen presentation and leukocyte localization. Cytokines also induce the synthesis of leukocyte chemoattractants, eg, interleukin-8 and monocyte chemotactic peptide-1, in renal cells. Finally, cytokines, and in particular, platelet-derived growth factor and transforming growth factor-beta, appear to play a role in the long-term consequences of renal inflammation such as the induction of cell proliferation and the accumulation of extracellular matrix, both of which characterize glomerular and tubulointerstitial fibrosis. Better understanding of the disturbances of the cytokine network in renal inflammation may ultimately lead to novel therapeutic approaches to renal disease.

Changes in functional status and the risks of subsequent nursing home placement and death

This research examined the effects of changes in functional status on the risks for subsequent nursing home placement and death. Using data on the 3,646 baseline self-respondents to the Longitudinal Study on Aging who were successfully reinterviewed at the first follow-up (1986) and who were not in a nursing home at that time, a two-stage analysis was conducted. First, the risks for nursing home placement and death between the 1986 and 1988 follow-ups were modeled based on a static set of baseline (1984) indicators. Measures of the change in functional health status between baseline and first follow-up were then introduced to determine whether such change had significant net effects and enhanced model fit. Substantial improvement in model fit was obtained for both outcomes. The risk of nursing home placement was associated with deterioration in advanced (i.e., cognitive) ADLs and lower body function. Deterioration in basic ADLs and lower body function was associated with the risk of dying.

Low-Back Pain in Sports

In brief The younger the active patient who has prolonged, localized back pain near the midline, the more likely he or she has spondylolysis or other pars injury. A careful examination with appropriate x-rays is critical because of the high incidence of structural vertebral problems associated with children's low-back pain. Early diagnosis helps the patient to return to sports quickly; conservative therapy of relative rest and stretching is often successful.

Fertility following excision of a symptomatic craniopharyngioma during pregnancy: case report

A 27-year-old woman in the second trimester of pregnancy presented with bitemporal hemianopsia. Total resection of a craniopharyngioma restored normal vision, and she delivered a normal infant at term. Permanent hormonal replacement therapy was not needed. Subsequent spontaneous pregnancy and delivery indicate that fertility was preserved. Literature review shows this case to be unique. Even with new developments in stereotactic radiotherapy, total excision remains a potentially achievable surgical goal.

Managing Tibial Stress Fractures

In brief Tibial stress fractures often occur in Patients who participate in running and jumping sports. With rest, most stress fractures heal without incident, though midshaft fractures are more resistant to healing. Bone scans are usually required to confirm the diagnosis. Relative rest, strength training, proper footwear, and treating underlying risk factors are the mainstays of treatment. A new treatment option is a pneumatic brace that the patient can wear when he or she returns to play. Physicians should be prepared to counsel competitive athletes about the risks of returning to play too soon.

Kinesin is rapidly transported in the optic nerve as a membrane associated protein

We have investigated the membrane vs. cytosolic distribution of newly synthesized and total kinesin in rabbit retinal ganglion cell axons which comprise the optic nerve. We find that kinesin is rapidly transported into the axon and that this newly synthesized protein is completely membrane-associated while approximately two third of the total kinesin in the optic nerve is membrane associated. Of this membrane associated kinesin about half is resistant to removal by treatment with 100 mM Na2CO3 (pH 11.3) and none can be stripped by 1 M NaCl. The newly synthesized axonal kinesin is completely resistant to removal by Na2CO3 treatment. By these criteria, at least one third of the total and essentially all of the rapidly transported axonal kinesin appears to exist as an integral membrane protein, consistent with it functioning as the anterograde motor for rapid vesicle transport from the cell body through the axon.

Recurrent Lateral Ankle Sprains

In brief Active patients who have recurrent ankle sprains usually have a treatable underlying neuromuscular, structural, or rehabilitation-related condition. A thorough history, neurologic exam, and physical exam involving a visual survey, foot and ankle palpation, and manual stress tests will help reveal the specific diagnosis. Most patients need only conservative treatment, which usually involves strengthening and bracing. Resistant injuries may require surgery.

Dynamic elongation behavior in the medial collateral and anterior cruciate ligaments during lateral impact loading

The objectives of this experimental study were to determine (a) how quickly the medial collateral ligament (MCL) and the anterior cruciate ligament (ACL) elongate when a lateral impact force is imparted to the knee and if a person can react rapidly enough to provide protective muscle forces in the case of such an impact, (b) if the MCL and the ACL elongate simultaneously during a lateral impact, and (c) if resection of the ACL affects elongation of the MCL during a lateral impact. Eight whole-leg cadaver specimens were used. Each leg was mounted vertically in a testing-frame with the knee in 0 and 30 degrees of flexion. A submaximal impact was delivered from the lateral side by a pendulum instrumented with a force transducer. Elongation of the midsubstance of the MCL and the ACL was measured with Hall-effect displacement transducers. The ACL was resected and the entire test sequence was repeated. Following a lateral impact, elongation of the MCL and ACL reached peak values by 70 ms. This study indicated that contraction of the leg musculature would not protect the MCL and ACL from injury when a lateral impact load is applied to the knee. The MCL and the ACL never elongated simultaneously during a lateral impact. After lateral impact loading, the time required to reach maximum elongation (peak delay) averaged 52 ms in the anterior MCL fibers and 61 ms in the ACL when the knee was in 0 degrees of flexion. At 30 degrees of flexion, the peak delay averaged 38 ms in the anterior MCL fibers and 22 ms in the ACL.(ABSTRACT TRUNCATED AT 250 WORDS)

Membranoproliferative glomerulonephritis associated with hepatitis C virus infection

BACKGROUND AND METHODS

Hepatitis C virus (HCV) infection causes both acute and chronic liver disease and is also associated with mixed cryoglobulinemia. Whether HCV is also associated with renal disease, as is the hepatitis B virus, is not known. We describe the clinical, pathologic, virologic, and immunologic features of eight patients with HCV infection who were referred to nephrologists for glomerulonephritis. Four patients were treated with interferon alfa.

RESULTS

All eight patients had proteinuria, and seven had decreased renal function. Renal biopsy in all patients revealed membranoproliferative glomerulonephritis, characterized by the deposition of IgG, IgM, and C3 in glomeruli. Electron microscopy of the biopsy specimens showed cryoglobulin-like structures in three of four patients. All eight patients had HCV RNA detected in their serum, elevated serum aminotransferase concentrations, and hypocomplementemia, and the majority had cryoglobulins and circulating immune complexes in their serum. Cryoprecipitates from the three patients who were tested contained HCV RNA and IgG anti-HCV antibodies to the nucleocapsid core antigen (HCVc or c22-3). IgM rheumatoid factors, present in all patients, bound anti-HCV IgG in all six patients tested. Four patients received interferon alfa for 2 to 12 months; all had evidence of decreased HCV replication and improvement of their renal and liver disease.

CONCLUSIONS

Chronic HCV infection is associated with cryoglobulinemia and membranoproliferative glomerulonephritis. The pathogenesis is unknown, but may relate to deposition within glomeruli of immune complexes containing HCV, anti-HCV IgG, and IgM rheumatoid factors.

Visceral glomerular epithelial cells can proliferate in vivo and synthesize platelet-derived growth factor B-chain

In glomerular diseases associated with antibody- and complement-mediated injury to endothelial and mesangial cells, cell proliferation is an important early response that precedes matrix accumulation and glomerulosclerosis. In contrast, in diseases in which the visceral glomerular epithelial cell (vGEC) is the principal target of injury, cell proliferation is not a recognized consequence, although vGECs respond in vitro to a variety of growth factors and inflammatory mediators. To explore the possibility that low levels of vGEC proliferation may occur and participate in such diseases, serial studies were done in the passive Heymann nephritis model of membranous nephropathy, in which the vGEC is the primary target of antibody- and C5b-9-mediated injury. The results showed mitotic figures and positive staining for the proliferating cell nuclear antigen in cells whose location defined them as vGECs. The proliferating cell nuclear antigen-positive cells at the edge of the capillary wall were confirmed to be vGECs by double-immunostaining with antibodies to SPARC/osteonectin, which preferentially label vGECs in passive Heymann nephritis. Proliferation of vGECs in vivo was preceded by increased glomerular expression of platelet-derived growth factor (PDGF) B-chain protein and messenger RNA, both of which localized to vGECs. PDGF B-chain protein and messenger RNA were also detected in cultured vGECs. PDGF receptor beta-subunit protein or messenger RNA could not be demonstrated in vGECs in vivo or in vitro, and no growth response of cultured vGECs to PDGF was noted. These results suggest that proliferation of vGECs does occur in a model of glomerular injury induced by antibody and C5b-9 on vGECs. VGEC proliferation and production of PDGF may be involved in the restoration of the capillary wall but could also contribute to local capillary wall injury and proliferation of other cells in Bowman's capsule, interstitium, and tubules.

Biocompatibility of hemodialysis membranes: evaluation in an ovine model

We studied the cardiopulmonary, hematologic, and inflammatory response to hemodialysis with seven different membranes in sheep. We also compared acetate dialysate with bicarbonate dialysate and evaluated the role of thromboxane in mediating these responses to dialysis with Cuprophan membranes (Baxter Healthcare Corp., Renal Division, Deerfield, Ill.) in sheep. The data generated in these studies indicate that dialyzer membranes can be divided into three major categories, defined by propensity to activate complement. High complement activators such as Cuprophan (low surface-area CF-1511 and high surface-area ST-25 dialyzers) produced dramatic neutropenia and hypoxemia and significant (p < 0.01) increases in the plasma concentration of thromboxane and in mean pulmonary artery blood pressure. The magnitude of these effects appeared to be surface area related. The low-flux Fresenius F-6 polysulfone membrane (Fresenius USA Inc., Concord, Calif.) also resulted in the generation of significant levels of C3a. In contrast, low complement activators such as polyacrylonitrile (AN-69; Gambro Hospal, Inc., Lakewood, Colo.) and cellulose triacetate (CT-110G; Baxter) produced little or no neutropenia, small transient increases in thromboxane, and no rise in mean pulmonary artery pressure. Dialyzers with intermediate complement-activating potential such as cellulose acetate (CA-110; Baxter) and Hemophan (HT-100; Baxter) produced small to moderate degrees of neutropenia and small increases in thromboxane and mean pulmonary artery pressure. Treatment of sheep with sodium ibuprofen before dialysis with Cuprophan CF-1511 membranes prevented the initial increases in mean pulmonary arterial pressure and thromboxane generation and the decrease in arterial oxygen tension, but did not affect the degree of complement activation or neutropenia. In sheep undergoing Cuprophan dialysis, bicarbonate dialysate did not prevent the increase in circulating complement and the associated neutropenia otherwise seen during the early portions of dialysis with acetate dialysate. Bicarbonate dialysate did, however, reduce (not prevent) the initial increases in thromboxane and mean pulmonary arterial pressure, and the magnitude of the hypoxemia seen with the use of acetate dialysate. The results of these experiments therefore indicate that (1) reactions in sheep correlate well with data collected in human beings and the model can be an effective means for comparing novel dialysis membranes and pharmacologic interventions during dialysis and (2) although complement appears to be the transducer of the hematologic and immunologic response, thromboxane appears to be the final effector of the cardiovascular responses to hemodialysis with Cuprophan membranes.

PDGF-receptor localizes to mesangial, parietal epithelial, and interstitial cells in human and primate kidneys

There is evidence that platelet derived growth factor (PDGF) is a mediator of proliferative changes in renal arteries and mesangium in human disease, in the mesangium in experimental mesangial proliferative glomerulonephritis, and in the interstitium in a rodent model of angiotensin II mediated hypertension. We utilized a monoclonal antibody to the beta-subunit of the PDGF-receptor to localize constitutive expression of this receptor in human and nonhuman primate tissues. Tissues were fixed in cold 2 or 4% paraformaldehyde, and immunohistochemical techniques both at the light microscopic level and immunoelectron microscopy were employed. In the glomerulus, there is widespread expression of this molecule by mesangial cells, and there is frequent expression on the apical and lateral surface of parietal epithelial cells. There is also widespread expression of this molecule by cortical and medullary peritubular interstitial cells, but not by glomerular or peritubular capillary endothelium or other renal parenchymal structures. The identification of receptors capable of binding PDGF B-chain at each of these sites: (1) provides a basis for PDGF mediated mesangial proliferation in human disease; (2) provides a basis for PDGF mediated interstitial cell migration and/or proliferation and/or activation at sites of tubulointerstitial injury; and (3) suggests that glomerular parietal epithelial cells may be responsive to stimulation by PDGF.

Heparin suppresses mesangial cell proliferation and matrix expansion in experimental mesangioproliferative glomerulonephritis

Proliferation and extracellular matrix (ECM) overproduction by glomerular mesangial cells characterizes many types of glomerulonephritis and often precedes the development of glomerulosclerosis. Heparin is a potent inhibitor of mesangial cell growth in vitro. We examined whether standard heparin can inhibit mesangial cell proliferation in vivo in the mesangioproliferative anti-Thy 1.1 nephritis. Untreated control rats were compared to rats infused with heparin either early (day -2 to 1) or late (day 2 to 5) after induction of anti-Thy 1.1 nephritis. The results show that heparin treatment significantly reduced mesangial cell proliferation regardless of when it was initiated. Heparin (either early or late treatment) also reduced mesangial basic fibroblast growth factor (bFGF) expression and platelet-derived growth factor (PDGF) receptor up-regulation as reflected by immunostaining, whereas PDGF B-chain expression was reduced only by late heparin treatment. Furthermore, heparin treatment markedly inhibited the mesangial matrix expansion for a variety of ECM proteins, including laminin, type I and IV collagen, fibronectin and entactin. Heparin did not affect the initial mesangiolysis, glomerular macrophage influx, deposition of anti-Thy 1.1 IgG or fibrinogen, or the glomerular platelet influx. These results suggest that heparin, via its antiproliferative rather than anticoagulant effect, can inhibit mesangial cell proliferation, overexpression of polypeptide growth factors, and ECM protein overproduction in vivo. The beneficial effect of heparin can be demonstrated even if treatment is initiated after the development of nephritis. By virtue of these properties, heparin may be an effective agent in the treatment of human mesangioproliferative disease and in the prevention of glomerulosclerosis.

Rat glomerular mesangial cells synthesize basic fibroblast growth factor. Release, upregulated synthesis, and mitogenicity in mesangial proliferative glomerulonephritis

Mesangial injury and cell proliferation are frequent findings in various glomerular diseases in man. Previous studies have demonstrated that basic fibroblast growth factor (bFGF) is a potent mesangial cell mitogen in vitro. To further elucidate the role of bFGF in rat mesangial cell (RMC) proliferation, we examined whether RMC synthesize bFGF in vitro and whether bFGF is involved in mesangial proliferation in vivo. Cultured RMC expressed bFGF protein (23, 21.5, and 18 kD forms) and bFGF mRNA, and released biologically active bFGF into the culture medium after antibody- and complement-mediated injury. Normal rat glomeruli in vivo contained no detectable bFGF mRNA, but bFGF protein (23 and 21.5 kD) could be demonstrated, which immunolocalized to the mesangium. Glomerular bFGF decreased markedly during the acute phase of glomerulonephritis induced by anti-Thy 1.1 antibody, compatible with mesangial bFGF release after complement-mediated mesangiolysis. During the subsequent mesangial proliferative phase, glomerular bFGF protein and mRNA increased above normal. Intrarenal infusion of heparin did not affect the bFGF immunostaining of glomeruli at this stage, indicating a predominantly intracellular localization of the bFGF. The capability of bFGF to mediate proliferation in the anti-Thy 1.1 model was further supported by experiments in which intravenous bFGF given 24 h after a subnephritogenic dose of anti-Thy 1.1 antibody led to a 4.9- to 5.1-fold increase in glomerular cell proliferation (with > 60% of the cells identified as mesangial cells by double immunolabeling). No such increase was observed in normal rats injected with bFGF. These data show that mesangial cells produce and release bFGF after injury and that bFGF is mitogenic for injured mesangial cells in vivo. Release of mesangial cell bFGF thus may be an important mechanism involved in the initiation of mesangial cell proliferation in vivo.

Factors involved in the regulation of mesangial cell proliferation in vitro and in vivo

One of the central features of many human glomerular diseases is the proliferation of the smooth muscle cell-like mesangial cells. While a multitude of mitogens for mesangial cells has been proposed on the basis of in vitro experiments, the factors involved in the regulation of mesangial cell proliferation in vivo remain largely undefined. To investigate the regulation of mesangial cell proliferation in vivo we have studied the mesangioproliferative glomerulonephritis that is induced by injection of antibody directed against the Thy 1.1 antigen on the mesangial cell surface in rats. In this review, we discuss the role of three cytokines in the mesangioproliferative response, namely platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF), and transforming growth factor-beta (TGF-beta). All three cytokines are present in various inflammatory cells as well as in mesangial cells themselves, thereby allowing these factors to exert both paracrine and autocrine regulatory functions on mesangial cells. In vivo studies show that PDGF, bFGF and TGF-beta participate in either the mesangial cell proliferation or the mesangial matrix expansion that follows mesangial cell injury with anti-Thy 1.1 antibody. Based on currently available data we propose that bFGF may participate in the initiation, PDGF in the maintenance, and TGF-beta in the resolution of mesangial cell proliferation in vivo. Further analysis of the mitogens operative in vivo may ultimately result in the design of new therapeutic strategies to treat progressive glomerular mesangioproliferative diseases.

An in vivo comparison of anterior tibial translation and strain in the anteromedial band of the anterior cruciate ligament

The objective of this in vivo study was to determine if strain in the anteromedial band (AMB) of the anterior cruciate ligament (ACL) may be predicted by an external measurement of anterior tibial-femoral translation. A Hall effect strain transducer was implanted on the AMB of five human subjects with normal intact ACLs. AMB strain was then measured during anterior shear loading of the tibia relative to the femur, with the knee flexed to 30 and 90 degrees, simulating the loads applied in the Lachman and anterior drawer tests, respectively. The Knee Signature System, a commercially available arthrometer, was used to simultaneously measure anterior tibial translation relative to the femur. The resulting AMB strains and translations during anterior shear loading of the tibia with respect to the femur at 30 and 90 degrees were compared using a regression analysis to determine if AMB strain could be predicted from a measure of anterior tibiofemoral translation at either flexion angle. AMB strain at 150 N anterior shear load at 30 degrees flexion (3.0%) was significantly greater than that at 150 N anterior shear load at 90 degrees flexion (0.9%). During anterior shear loading at 30 degrees flexion, AMB strain correlated with anterior tibial translation (r2 = 0.59). However, there was no significant correlation between AMB strain and anterior tibial translation for anterior shear loading at 90 degrees flexion (r2 = 0.002). Therefore, AMB strain was not accurately predicted from an external measurement of tibial displacement at 90 degrees in this experiment.

Isometric versus tension measurements. A comparison for the reconstruction of the anterior cruciate ligament

This study was designed to compare the displacement patterns of an isometer, used to determine graft placement during reconstruction, with the actual tensions on an anterior cruciate ligament substitute. In cadaveric specimens, a Kevlar anterior cruciate ligament substitute was implanted in three separate femoral sites, each of which was subsequently fixed to two different tibial sites. The initial tension of the Kevlar substitute was set to 22 or 33 N at 20 degrees of knee flexion. The displacement patterns for each position were recorded during passive flexion-extension using the isometer. Using a custom-designed tensiometer, the tensile forces on the substitute after rigid fixation at the tibia and femur were measured. During passive flexion-extension, the maximum change in tension of the anterior cruciate ligament substitute, measured by the tensiometer, was correlated with the maximum change in displacement between attachment sites, measured by the isometer. The coefficient of determination was equal to 0.15, indicating that the isometer may not accurately predict the tensions developed in the substitute.

Morphometry of the semitendinosus and gracilis tendons with application to anterior cruciate ligament reconstruction

The length and cross-sectional area of human semitendinosus and gracilis tendons were measured in both single- and multi-strand configurations for the purpose of anterior cruciate ligament graft preparation. The average lengths of the semitendinosus and the gracilis tendons were 235 +/- 20 mm (mean +/- SD) and 200 +/- 17 mm, respectively. The cross-sectional area of a doubled semi-tendinosus tendon (two strands) was significantly less than that of a 10-mm-wide patellar tendon graft (P < 0.001). The cross-sectional area of the tripled semitendinosus tendon (three strands) and the 10-mm-wide patellar tendon were similar. Doubling of the combined semitendinosus and gracilis tendons (four strands) and tripling of this combination (six strands) resulted in a significantly greater cross-sectional area in comparison to the 10-mm-wide patellar tendon (P < 0.05, four strands; P < 0.001 six strands). This investigation demonstrates that anterior cruciate ligament grafts fashioned using multiple-strand combinations of the semitendinosus and gracilis tendons result in a cross-sectional area that is comparable to the bone-patellar tendon-bone graft. This is an important finding since cross-sectional area reflects the intra-articular volume of collagenous tissue. This information should be helpful to surgeons considering using the hamstring tendons as an anterior cruciate ligament graft.

Glomerular C3c localization indicates ongoing immune deposit formation and complement activation in experimental glomerulonephritis

In antibody-mediated glomerular disease, deposits of C3 (C3b) are common and are degraded by factor I to C3c and C3d. However, the kinetics of C3b degradation in glomerulonephritis have not been defined. To do this, we studied three models of complement-dependent glomerulonephritis with established C3 deposits (passive Heymann nephritis, cationized immunoglobulin G membranous nephropathy, and concanavalin A-anticoncanavalin A glomerulonephritis). C3b deposition was halted by administration of cobra venom factor, and the disappearance of C3c and C3d from glomeruli was measured with specific antibodies and quantitative fluorescence densitometry. Results showed that C3c deposits were reduced by over 85% within 24 hours in all three models. C3c clearance was unaffected by site or mechanism of deposit formation. C3d deposits persisted despite lack of ongoing complement activation. In passive Heymann nephritis when disease activity was monitored by urinary C5b-9 excretion, C3c was cleared in parallel with return of urine C5b-9 excretion to normal values. We conclude that glomerular deposits of C3c are cleared within 24 hours of cessation of complement activation. Positive staining for C3 utilizing antibody specific for the C3c portion documents recent complement activation usually reflecting new immune deposit formation.

Differences in the subcellular localization of calreticulin and organellar Ca(2+)-ATPase in neurons

It has become clear that calcium is an important mediator in the transduction of signals due to ligand binding to cell surface receptors. Cytosolic calcium is typically maintained at low levels in both muscle and non-muscle cells and intracellular sequestering of calcium appears to be important in this process. The identification of intracellular calcium pools has been the subject of much recent study, and it has been proposed that such pools would contain three components: a calcium-activated pump or Ca(2+)-ATPase, a calcium channel such as the inositol trisphosphate receptor or ryanodine receptor, and a high-capacity calcium-binding protein such as calsequestrin or calreticulin. We report here on the localization of two components, the organellar Ca(2+)-ATPase (SERCA) and calreticulin, in neuronal tissues. Using immunofluorescence and subcellular fractionation, we have found that for the most part, these two proteins do not co-localize in neuron cell bodies, dendrites, or axons; but may co-localize at the axon terminal.

HIV infection in athletes. What are the risks? Who can compete?

The activities of athletes and personnel who provide their medical care may place them at slightly greater risk for infection with human immunodeficiency virus (HIV) than their nonathletic peers. At this point, there is no reason to disallow participation of athletes who are HIV-infected. Thus, sports physicians need to assume that they are at risk for accidental exposure to HIV and use appropriate precautions. Most important, physicians can educate athletes, coaches, and trainers to practice "safe" athletics and medical care to minimize the risks of exposure to and transmission of HIV. Testing for HIV can be encouraged for athletes who may be at risk and should be done for any athlete who specifically requests it. Physicians should encourage further study to clarify the specific issues and risks of HIV infection created by athletic competition and prepare to deal with the changing knowledge about HIV and AIDS.