Selective transcriptional augmentation of hepatic gene expression in the rat with Heymann nephritis

The synthesis of albumin and other hepatic proteins, many regulated as part of the acute phase response, is increased in the nephrotic syndrome. It has been postulated that synthesis of all proteins secreted by the liver is increased by the same mechanism in the nephrotic syndrome. However, the observation that synthesis of some apolipoproteins is not increased suggests that only a specific group of proteins may be similarly regulated in nephrosis. We measured synthesis of albumin and of two acute phase proteins, fibrinogen and alpha 1-acid glycoprotein (alpha 1-AG), in rats with Heymann nephritis (HN), their mRNA concentration in liver, and the rate of transcription of their genes by hepatic nuclei. Albumin and fibrinogen mRNA levels almost doubled in HN, but alpha 1-AG mRNA was unchanged. Ribosomal RNA (28S) concentration and transcription were also increased significantly in HN. Transcription of albumin and fibrinogen also increased twofold, but transcription of alpha 1-AG was unchanged. Fibrinogen and albumin synthesis each increased more than fourfold in HN and correlated with one another. In contrast alpha 1-AG synthesis only increased by 50% and did not correlate with albumin synthesis. Both albumin and alpha 1-AG were lost in the urine of HN, and their plasma concentrations were reduced. Fibrinogen was not lost in the urine and its plasma concentration was significantly increased in HN. Synthesis of a group of proteins including both positive acute phase (fibrinogen) and negative acute phase (albumin) proteins is increased transcriptionally in the nephrotic syndrome. Synthesis of other proteins is increased posttranscriptionally.(ABSTRACT TRUNCATED AT 250 WORDS)

[Heart surgery in normothermia and aerobiosis: apropos of 530 patients]

Between February and October 1991, 530 consecutive patients underwent myocardial revascularization or valvular surgery with warm continuous antegrade and retrograde cardioplegia (37 degrees C). Three hundred and thirty three patients had isolated myocardial revascularization, 159 valvular surgery alone and 25 had combined valvular and coronary bypass. The global mortality was 5.1%, 3.7% for coronary bypass, 7.5% for valvular surgery and 8% for combined valvular and coronary surgery. A multivariate analysis identified the "reperfusion time" as the only predictive factor of hospital mortality (p < 0.001). Intraortic balloon counterpulsation was required postoperatively in 3.2% of cases, 5.2% of coronary bypass and 0.8% of the valvular patients. Inotropic drugs were used to come off cardiopulmonary bypass in 16.5% of coronary and 37.5% of valvular patients. There were 0.9% perioperative infarctions: 1.2% in the coronary bypass cases and 0.6% in the valvular cases. Spontaneous return to sinus rythm was observed in 87.9% of cases. The average "reperfusion time" was 20.48 +/- 0.7 mn. Analysis of the influence of aortic cross clamp time on cardiac morbidity in two groups of coronary patients (Group I: short cross clamp time less than 60 mn; Group II: long cross clamp time, 60 to 33 mn) showed that the hospital mortality, the prevalence of the use of inotropic drugs and balloon counterpulsation the postoperative cardiac index, the rate of spontaneous de fibrillation and the reperfusion time did not depend on the aortic cross clamp time. Cardiac morbidity.

Enduring negative psychological characteristics of male and female step-children toward the step-parent

Many divorced people remarry, and if either one or both of the remarried partners has a child or children from a former marriage, then the youth need adjust to not only the new marital structure, but to the new step-parent as well. The present research was conducted to determine: (1) enduring negative psychological characteristics of male and female step-children toward the step-parent, and (2) a comparison of the similarities and/or differences of each. Results suggested ten of the most frequently stated variables of both subject groups, similarities or significant differences between them by subject status, and their relevancy to the step-child-step-parent relationship.

Demographic change and housing demand in Spain: projections up to the year 2010

"The purpose of this study is to determine the future aggregate pressure of demographic factors on housing demand. Both the number and age compositions of Spanish households from 1980 to the year 2010 are projected. To determine the actual net increase of the number of households, the analysis considers both the formation and destruction of households. The magnitude and profile of the projection shows that in the present decade the net yearly growth in the number of households will be slightly smaller than that of previous years. In the first decade of the next century, there will be a drastic reduction in the net growth of new households."

Beyond cold cardioplegia

One hundred fifteen consecutive patients were operated on for myocardial revascularization or valvular disease or both with continuous antegrade and retrograde aerobic warm (37 degrees C) blood cardioplegia. Mean cross-clamp time was 56.3 +/- 21 minutes (+/- standard deviation). Mean reperfusion time was 18.4 +/- 11.8 minutes (range, 5 to 81 minutes). Five patients (4.3%) died, and 15 (13%) needed inotropic support. Two (1.7%) required intraaortic balloon support. Two patients (1.7%) had evidence of perioperative myocardial infarction, and 98 (85%) returned spontaneously to normal sinus rhythm. Sixteen patients had a cross-clamp time greater than 80 minutes. All 16 of them had an uneventful postoperative course except for 1 patient who required inotropic drugs. This method of myocardial protection is now used for all open heart procedures in our institution.

Seroepidemiology of HIV-1 infection in a Catalonian penitentiary

A seroepidemiological study of HIV-1 infection was carried out among all the subjects who were imprisoned in a correctional centre in Catalonia (Spain) between October 1987 and April 1988. Six hundred and thirty-one inmates (male, mean age 19.1 +/- 1.7 years) were surveyed. The overall prevalence of HIV-1 infection was 33.6%. Statistically significant differences were observed between intravenous drug users (IVDUs) and non-IVDUs (P less than 0.0000001) and between regular and irregular IVDUs (P less than 0.000001). The age at which the person started using drugs and the length of time spent in prison were also significantly associated with the prevalence of infection. No other variables, except the higher prevalence among the gipsy ethnic group, showed any statistically significant association with HIV-1 infection.

Effects of exercise and adrenaline on equine erythrocyte ATP content

To investigate the claim that equine erythrocytes released from the spleen are older cells than those found at rest in the circulation, the 2,3, diphosphoglycerate (2,3 DPG), adenosine triphosphate (ATP) and creatine concentration of erythrocytes before and following splenic emptying were examined. Normal values for thoroughbreds (43) and ponies (10) at rest were established. Following either exercise or intravenous injection of adrenaline in six thoroughbreds, there was an increase in erythrocyte creatine content and a decrease in ATP concentration. Exercise produced a slight increase in 2,3 DPG while no change occurred with adrenaline. In two splenectomised ponies adrenaline only produced a decrease in erythrocyte ATP, with no change in creatine or 2,3 DPG content. It was concluded that erythrocytes released from the spleen are not aged cells. However, the stimuli used produced a decrease in ATP content which may affect the properties of the erythrocytes.

MR imaging of acute spinal cord injury: results of an experimental study in dogs

A weight-drop model was used to induce 16 acute lesions of varying severity in the spinal cords of eight mongrel dogs. The subsequent 3- to 7-hr postinjury MR images (0.5 T) were assessed. T1-weighted images contributed little information. Injection of gadolinium tetra-azacyclododecane tetraacetic acid did not result in significant enhancement. T2-weighted sequences offered precise detection and delineation of the lesions, displaying fusiform hyperintense signal abnormalities that corresponded to both edema and hemorrhage. In low-impact injuries, abnormalities were small and centrally located, sparing the periphery of the spinal cord. In these cases hemorrhage was minimal and limited to the center of the lesion. In severe-impact injuries, MR showed widespread longitudinal extension with involvement of the periphery of the spinal cord. In the most severe injuries, a central heterogeneous signal component was frequently observed opposite the site of impact because of important hemorrhage within the cord. Overall, hyperintense areas correlated closely with lesion severity, as demonstrated by pathologic findings. T2-weighted MR images obtained at 0.5 T were found to be reliable in the evaluation of acute spinal cord trauma.

A low-protein diet restricts albumin synthesis in nephrotic rats

High-protein diets increase albumin synthesis in rats with Heymann nephritis but albuminuria increases also, causing serum albumin concentration to be suppressed further than in nephrotic animals eating a low-protein diet. Experiments were designed to determine whether dietary protein augmentation directly stimulates albumin synthesis, or whether instead increased albumin synthesis is triggered by the decrease in serum albumin concentration. Evidence is presented that dietary protein augmentation directly stimulates albumin synthesis, accompanied by a proportional increase in steady-state hepatic albumin mRNA concentration (AlbmRNA) and by an increase in AlbmRNA transcription. When the increased albuminuria resulting from dietary protein augmentation is blunted with enalapril, serum albumin concentration is shown to increase in nephrotic rats. Both albumin synthesis and AlbmRNA increase in these animals despite the greater serum albumin concentration. Albumin synthesis correlates inversely with both serum albumin and serum oncotic pressure in nephrotic rats fed 40% protein, but does not correlate with serum albumin concentration in nephrotic rats fed 8.5% protein (LP), even when serum albumin concentration is reduced. Albumin masses are preserved in LP primarily because of reduced albuminuria. Reduced serum oncotic pressure and dietary protein augmentation combine to stimulate albumin synthesis in nephrotic rats at the level of gene transcription.

[Acute myelomonocytic leukemia with eosinophils. Apropos of a case with a cytogenetic analysis and nosologic discussion]

Report of overwhelming leukemia with meningeal involvement in a 13-year-old. Cytologic and ultrastructural examinations showed features of myelomonocytic leukemia with abnormal eosinophils. The karyotype showed pericentric inversion of chromosome 16. Although these findings establish the diagnosis of acute myelomonocytic leukemia with abnormal eosinophils (M4Eo), this case ran an exceptionally severe course and exhibited some unusual cytologic features.

Sodium dependence of amino acid-stimulated acid secretion in the conscious rat

Gastric acid secretion in conscious gastric-fistulated rats was measured by non-recirculating constant gastric perfusion, and extragastric autotitration. Luminal L-amino acids stimulated acid secretion with a potency histidine greater than alanine greater than tryptophan. The response to histidine was concentration dependent, and was inhibited by low pH and by low luminal sodium. These results are consistent with the idea that a sodium-dependent uptake mechanism might, in part, mediate the acid secretory response to intragastric amino acids.

Experience with 407 transvenous, finned pacing leads with a sintered porous-surfaced electrode

Experience with 407 transvenous ventricular finned pacing leads with a sintered porous-surfaced electrode is reported. A low complication rate was encountered: 97% of patients were free from lead-related complications. Four patients (1%) required re-operation: two for lead displacement, one for failure to sense spontaneous ventricular activity and one for exit block. A further patient developed exit block which resolved spontaneously. The vast majority of patients had low chronic stimulation thresholds; for example at six months after implantation, the mean threshold for a group of pacemakers with a pulse duration of 0.5 ms was 1.4 +/- 0.7 V and for another group with a pulse duration of 0.8 ms it was 1.9 +/- 0.7 mA. However, six patients developed a transient high stimulation threshold during the month after implantation, and a high threshold developed in another patient at five months and persisted. Mean acute stimulation and sensing thresholds were satisfactory: 0.7 +/- 0.2 V at 0.5 ms pulse duration and 7.6 +/- 2.4 mV, respectively.

Enzymatic sulfation of steroids. XV. Studies differentiating between rat liver androgen, estrogen, bile acid, glucocorticoid and phenol sulfotransferases

Earlier reports left the number of enzymes that catalyzed phenol, androgen, estrogen, bile acid and glucocorticoid sulfation obscure. Here, we have utilized chromatographic, immunochemical and endocrinologic methods to compare and differentiate these enzymes in rat liver. Sulfotransferases I, II, and III--which sulfate glucocorticoids--were used in this comparison. We found that phenols were sulfated by phenol sulfotransferases 1 and 2, which were unrelated to the other enzymes studied here. Large amounts of phenol sulfotransferase 1 were found in both sexes. Large amounts of phenol sulfotransferase 2 were restricted to males. By contrast, the small amount of androgen sulfation found in both sexes appeared to be mediated by sulfotransferase II, which preferred 3 beta-hydroxysteroids, but also sulfated estrogens and glucocorticoids to lesser extents. The sulfation of estrogens presented a more complex picture. Most estradiol sulfotransferase activity in both sexes was due to an enzyme that sulfated estrone poorly, and did not sulfate the other steroids tested. This specific estradiol sulfotransferase was unrelated to the other sulfotransferases described here. Smaller amounts of estrogen sulfotransferase activity that sulfated estradiol and estrone equally well were present at concentrations dependent on the sex of test animals. This enzyme activity appeared to be due to sulfotransferases I, II and III. Most bile acid sulfotransferase activity eluted from DEAE-Sephadex A-50 columns with sulfotransferases I and II. However, data with males suggested that these enzymes were not responsible. Thus, phenols, androgens, estrogens and glucocorticoids were sulfated by six enzymes of differing substrate specificity: phenol sulfotransferases 1 and 2, specific estradiol sulfotransferase, and sulfotransferases I, II, and III. Unique bile acid sulfotransferases also appeared probable.

Surgical treatment of the thoraco-abdominal aneurysms

Three thoraco-abdominal aneurysms treated surgically are presented. They were operated between July 1975 and February 1978. The different surgical-techniques are emphasized, which in turn allow us to comment on the complications that these types of patients may have. All our three patients were operated following the "Retrograde Revascularization Technique" proposed by Dubost. We think that the ischemic time of the visceral arteries is less than following the more simplified, less time consuming and perhaps less traumatic "Graft Inclusion and Direct Vessel Reattachment Crawford-Technique". The incidence of paraplegia can be reduced by maintaining normal blood pressure and reattaching intercostal and lumbar arteries to the graft. Two of our patients survived without presenting any complication in the last four years. The third died in the immediate postoperative period, due to insoluble coagulation problems after massive blood transfusion during surgery.

Advances in the use of therapeutic pheresis for the management of rheumatic diseases

Twenty-two patients with rheumatoid arthritis, 3 with seronegative juvenile rheumatoid arthritis, 4 with systemic lupus erythematosus, and 4 with psoriatic arthritis have undergone therapeutic pheresis at our institution over the last 3 yr. Lymphoplasmapheresis appears to be the most effective form of pheresis in treating rheumatoid arthritis. After achieving a remission with 20 treatments performed in 11 wk, a flare may be preventable by pheresing patients 3 times a week every 6 wk provided the patient is on a concomitant, long-acting agent. Therapeutic pheresis has been disappointing in seronegative juvenile rheumatoid arthritis. Life-threatening complications of systemic lupus erythematosus may respond dramatically to pheresis. In treating less severe disease on a long-term basis, pheresis has demonstrated excellent steroid sparing properties. Nonspondylytic psoriatic arthritis responds slowly to pheresis, but arthritic remissions may be prolonged, even though skin response is variable. Experience in the use of pheresis for treating these diseases has allowed for the development of criteria for deciding whether to institute such therapy as an adjunct to more standard modes of treatment for individual patients. Also, a variety of "technical" factors can influence the outcome of therapy, and these must be managed appropriately. Therapeutic pheresis is a promising tool for investigating and treating rheumatic diseases.

The effects of "anti-platelet" drugs on bleeding time and platelet aggregation in normal human subjects

The effects on hemostasis of several commonly used drugs previously described as inhibiting platelet function were evaluated in a randomized, double-blind study of 54 normal volunteers. The subjects were each given a single dose of aspirin, chlorpromazine, glyceryl guaiacolate, diphenhydramine, indomethacin or lactose placebo. A single dose of aspirin significantly prolonged the template bleeding time and inhibited secondary platelet aggregation two and 24 hours after ingestion. Single doses of indomethacin and chlorpromazine affected aggregation at two hours but had no effect on bleeding time, although multiple doses of indomethacin did prolong bleeding time. Glyceryl guaiacolate inhibited aggregation one hour after ingestion but had no effect on bleeding time. Diphenhydramine did not affect either. These findings suggest that standard doses of many commonly used "anti-platelet" drugs may have little clinical effect on the hemostatic mechanism in normal man. Results of in-vitro platelet-drug incubations may not be directly applicable to in-vivo hemostasis.

Antibody-induced von Willebrand's disease: a newly defined inhibitor syndrome

A patient is described with clinical and laboratory evidence of von Willebrand's disease (VWD) in association with lymphosarcoma. He consistently had a bleeding time of over 20 min; factor VIIAHF, VIIAGN, and VIIVWF under 20%; and severe, diffuse hemorrhage, Following transfusion with cryoprecipitate, the patient had the expected rise in VIIAGN and VIIAHF. The patient's plasma contained an inhibitor which prevented aggregation of normal platelets by ristocetin, but which did not interfere with the measurement of VIIAGN or inactivate VIIAHF activity. The inhibitor was present in serum heated at 56 degrees C for 30 min, was present in a purified IgG fraction of serum, and was precipitated by anti-human IgG. The antibody did not interact directly with washed platelets, but appeared to interact with that portion of the factor VII protein that supports ristocetin aggregation (VIIIVWF). The data provide the first explanation for the pathophysiology of the acquired von Willebrand's syndrome.