Glucocorticoid receptor expression profiles in mononuclear leukocytes of periparturient Holstein cows

Cortisol-activated glucocorticoid receptors modulate cellular responses to stress by translocating from the cytosol to the nucleus and enhancing or repressing the transcription of target genes. The functional capacity of mononuclear leukocytes is inhibited in parturient dairy cows at a time when blood cortisol concentrations are high. Because the glucocorticoid receptor is autoregulatory in many cell types, the hypothesis of the current study was that glucocorticoid receptor expression by mononuclear leukocytes is altered around parturition in association with elevated blood cortisol. If true, the glucocorticoid receptor could be involved in suppressed functions of mononuclear leukocytes in parturient cows. The objectives of this study were to determine effects of parturition on lymphocyte and monocyte glucocorticoid receptor expression and to correlate expression with serum cortisol concentrations. Objectives were achieved by using fluorescence staining and flow cytometric analyses to monitor glucocorticoid receptors in peripheral blood mononuclear leukocytes collected multiple times from 13 periparturtient test cows (eight multi- and five primiparous) and 10 midgestation control cows (five multi- and five primiparous). Serum cortisol concentrations were determined by radioimmunoassay. Based on intensity of the fluorescent glucocorticoid receptor stain, parturition caused 42 and 47% reductions in lymphocyte and monocyte glucocorticoid receptor expression, respectively, compared with mean expression in corresponding cells from control cows. When mean prepartum values were compared with nadir values at parturition in the test cows, glucocorticoid receptor expression was reduced by 67% in lymphocytes and by 54% in monocytes. Mononuclear cell expression of glucocorticoid receptors was negatively correlated with serum cortisol concentrations. Results suggest that glucocorticoid receptors are down-regulated in bovine mononuclear leukocytes in association with increased adrenal secretion of cortisol at calving. It is possible that glucocorticoid receptor down-regulation is also associated with altered phenotype or function (or both) of lymphocytes and monocytes. This possibility should be substantiated because it could explain increased disease susceptibility in periparturient dairy cows.

Comparison of specialized and standard enteral formulas in trauma patients

STUDY OBJECTIVE

To compare selected nutrition and immunologic markers and infection in trauma patients receiving a specialized enteral formula with those receiving standard enteral therapy.

DESIGN

Prospective, randomized clinical trial.

SETTING

Level 1 trauma center at a county government hospital.

PATIENTS

Forty-one consecutive patients with major trauma who required enteral nutrition support. Thirty-seven patients completed the study. Four patients (two in each group) were excluded, as additional operative procedures prevented initiation of enteral feedings within 7 days of injury.

INTERVENTIONS

Nineteen patients fed the specialized enteral formula received supplemental arginine, linolenic acid, beta-carotene, and hydrolyzed protein for up to 10 days. Eighteen control patients received standard enteral nutrition.

MEASUREMENTS AND MAIN RESULTS

After study entry, patients who received the specialized enteral formula had fewer infections than those receiving standard enteral nutrition (3/19 vs 10/18; p < 0.05). The change in nitrogen balance was significantly better (p < 0.05) from day 1 (-11.8 +/- 1.8 g/day) to day 5 (-5.9 +/- 2.0 g/day) for the group who received the specialized formula compared with the group who received standard enteral nutrition (-7.3 +/- 1.7 g/day to -7.4 +/- 2.8 g/day). Similarly, the change in C-reactive protein serum concentration was significantly better (p < 0.05) from day 1 (18.0 +/- 2.1 mg/dl) to day 5 (11.8 +/- 1.5 mg/dl) in the group who received the specialized formula compared with the group who received standard enteral nutrition (17.6 +/- 1.2 mg/dl to 14.4 +/- 1.7 mg/dl). The CD4:CD8 ratio increased more in the group who received the specialized formula, although this difference did not reach statistical significance.

CONCLUSION

Trauma patients who received the specialized enteral formula demonstrated a decreased incidence of infection and increased improvements in nitrogen balance and other indexes of stress. Additional clinical trials demonstrating positive patient outcomes are necessary before these specialized enteral formulas are used as the standard of practice in critically ill patients.

Dreams of Freud and Jung: reciprocal relationships between social relations and archetypal/transpersonal imagination

Phenomenological and quantitative comparisons of the dreams of Freud and Jung become the basis for a more extended understanding of the relation between the psychodynamic and transpersonal/archetypal perspectives. Winnicott's distinction between the dimensions of being and doing/relating offers a developmental model of these perspectives based on a dialectic between two lines of growth-each with its own forms of health/pathology and its own primitive/advanced expressions. These dimensions, in both their positive and negative forms, are shown to be densely intertwined throughout the dreams (and characters) of Freud and Jung, whose theories emerge as reasonable reflections of their complementary ways of being in the world.

Static threshold variability in the peripheral visual field in normal subjects

We assessed the variability of point-wise static threshold values and the components of fluctuation outside the central 30 degrees field in 20 normal individuals tested on the Humphrey field analyzer. We found a mean short-term fluctuation of 2.37 dB, a long-term heterogeneous fluctuation of 5.28 dB, and a long-term homogeneous fluctuation of 1.10 dB. All components of fluctuation were greatest superiorly. Point-wise variation was highest superiorly and nasally and increased with greater eccentricity from fixation in all but the temporal quadrant. Also, point-wise variation was greater between individuals than between tests in a single individual. This study suggests that outside the central 30 degrees field, changes in individual threshold measurements in the superior and nasal quadrants should be greater than those in the temporal or inferior quadrants before they can be distinguished from normal variation.

A cognitive-psychological perspective on Gillespie's "Lights and lattices": some relations among perception, imagery, and thought

George Gillespie's valuable observations on light and lattice imageries are played in the context of current research and theory on cognitive imagery (Kosslyn, Pylyshyn), ordinary and lucid dreaming, representational geometric imagery in scientific thought, the author's previous writings on altered states of consciousness, and Gibson's views on perception and imagery. Gillespie's reports show categories of imagery deconstruction and abstraction that link these areas and suggest an integrative model of the varieties of symbolic imagery.

Influence of avian pancreatic polypeptide on pancreatic and biliary secretion in laying hens

White Leghorn hens, 14 to 29 wk of age, were surgically prepared with cannulae for collecting secretions from the cystic duct and the duct draining the ventral pancreatic lobe and for infusing the jugular vein with avian pancreatic polypeptide (aPP) or saline. A plasma infusion rate that produced a plasma level of 15 ng of aPP/mL was used. A comparison of values obtained during saline infusion with those obtained during aPP infusion indicated that pancreatic and biliary secretory volumes and pancreatic total protein concentration were significantly depressed by aPP. The pH of pancreatic and biliary secretions were not significantly affected by aPP. Because aPP also depresses gastric secretion and motility in hens, it is proposed that its physiological role may be to oppose or modulate the actions of other, stimulatory gastrointestinal hormones.

Reduction in myocardial acidosis using blood cardioplegia

The composition of the ideal cardioplegic solution is controversial. Blood cardioplegia is an attractive alternative to standard crystalloid solutions, though its superiority in preserving myocardial metabolism has not been demonstrated. Using a new pH electrode system, this study contrasts the effects of blood and crystalloid solutions upon the generation of myocardial acidosis during global ischemia. Thirty-eight mongrel dogs underwent a 120-min period of aortic cross clamping using systemic hypothermia. To maintain myocardial temperature below 15 degrees C, 19 dogs received multiple doses of a bicarbonate containing crystalloid cardioplegic solution (Group I), while 19 dogs received multiple doses of blood cardioplegia (Group II). Myocardial pH and temperature were continuously monitored in the subendocardial region of the left ventricle. There was no difference in baseline pH between Group I (7.13 +/- 0.05) and Group II (7.17 +/- 0.05, P:NS). With systemic cooling and the initial bolus of cardioplegia, myocardial pH rose to 7.42 +/- 0.04 in Group I and 7.42 +/- 0.06 in Group II (P:NS). After 120 min of global ischemia, myocardial pH decreased to 6.61 +/- 0.05 in Group I and 7.07 +/- 0.05 in Group II (P less than 0.001). Blood cardioplegia was most effective during the first hour of aortic cross clamp when myocardial pH rose by 0.13 +/- 0.04 pH units. In contrast, myocardial pH in Group I during the first hour of global ischemia fell -0.35 +/- 0.08 pH units (P less than 0.001 compared to Group II). During the second hour of cross clamp, myocardial pH declined both in Group I (0.26 +/- 0.03 pH units) and in Group II (0.24 +/- 0.05 pH units, P:NS). However, the accumulation of hydrogen ion during the second hour was significantly greater in Group I (+128.0 +/- 21.4 nm/liter) than in Group II (+36.6 +/- 9.0 nm/liter, P less than 0.001). Thus, myocardial acidosis was reduced during the administration of blood cardioplegia when compared to a bicarbonate-buffered crystalloid solution. The salutary effects of blood cardioplegia on myocardial metabolism stem from blood's significant buffering capacity and its ability to deliver oxygen.

The influence of cholecystokinin, vasoactive intestinal peptide and secretin on pancreatic and biliary secretion in laying hens

White Leghorn hens, 14-29 weeks old, were surgically fitted with cannulas for collecting pancreatic and biliary secretions, and a jugular cannula for continuous infusion of either cholecystokinin (CCK), vasoactive intestinal peptide (VIP), or secretin. As compared to secretory levels during saline infusion, CCK significantly stimulated biliary flow and biliverdin concentration in bile; VIP significantly depressed biliverdin concentration but enhanced bicarbonate secretion in both pancreatic and biliary secretions, and also increased total pancreatic flow. Secretin depressed biliary flow and increased pancreatic bicarbonate release. The principal hormonal regulator of biliary secretion appears to be CCK, and that of pancreatic secretion to be VIP.

Chemical denervation of the myenteric plexus of the muscular stomach of turkeys

1. The thin caudoventral muscle (TCM) of the muscular stomach of domestic turkeys was surgically exposed and painted with solutions of saline or 0.1, 0.25, 0.5, and 1.0% benzalkonium chloride (BC), a cationic surfactant shown to irreversibly damage neurons but not muscle tissue in mammals. 2. Following fluoroscopic observations of gastric motility for 2 weeks, turkeys were euthanized, the entire muscular stomach was excised and weighed, and serial frozen sections of the TCM were taken for evaluation of the number and size of neurons in the myenteric plexus. 3. Treatment with 0.5 and 1.0% BC resulted in loss of motility in the TCM, significant hypertrophy (P less than 0.001) of the CTM, a 70% decrease in number and 60% decrease in size of myenteric neurons, and a 4-fold increase in thickness of the serosa, compared with saline-treated controls.

Intraoperative assessment of the physiologic significance of coronary stenosis in humans

Coronary angiography is generally considered the gold standard in assessing the significance of coronary stenosis. The inadequacy of coronary angiography has frequently been demonstrated by intraoperative findings that differ from those projected by the catheterization report. To better assess the physiologic significance of coronary stenosis, we measured intramyocardial pH intraoperatively in 50 myocardial segments supplied by stenotic coronary arteries before and after revascularization in 42 patients undergoing coronary artery bypass grafting. The hemodynamic, electrocardiographic, and pH responses to atrial pacing were recorded intraoperatively before and after revascularization. The coronary angiograms, performed within 3 months before bypass grafting, were reviewed by a single independent observer. Preoperative and postoperative radionuclide ventriculograms were performed and also reviewed by an independent observer. In response to atrial pacing, a fall exceeding 0.02 pH units was considered to represent ischemia and was observed in 28 segments. Patients exhibiting this response comprised Group I. Twenty-two segments demonstrated a fall of less than 0.02 pH units or a rise in pH in response to atrial pacing. Patients having this response comprised Group II. Segments in Group I responded dramatically to revascularization, with the pH during atrial pacing rising from -0.09 +/- 0.01 to -0.02 +/- 0.01 (p less than 0.001). Nine patients demonstrated ischemic S-T changes during atrial pacing, all in Group I. Pre-pacing hemodynamic parameters were similar in both groups. Group I patients, however, demonstrated a significant fall in mean arterial pressure during atrial pacing, from 92.0 +/- 3.0 to 78.4 +/- 3.3 mm Hg (p less than 0.001) whereas Group II patients did not. Twelve segments that angiograms indicated were supplied by critically stenotic vessels (greater than 75%) failed to demonstrate a significant fall in their pH during atrial pacing. In these segments, intraoperative findings and postoperative results corroborated the metabolic findings. Coronary angiography, therefore, was only 45% specific in assessing physiologically significant obstructions. The degree of segmental wall motion abnormalities likewise correlated poorly with the pH changes. Unlike coronary angiography, the response of intramyocardial pH to pacing is an accurate metabolic tool to assess myocardial ischemia in humans.

Influence of cholecystokinin, vasoactive intestinal peptide and secretin on plasma concentration of avian pancreatic polypeptide in laying hens

The influence of saline infusion (i.v.) followed by infusion of either cholecystokinin, vasoactive intestinal peptide, or secretin on plasma concentration of avian pancreatic polypeptide (aPP) was studied in sixteen 18-26-week old Single Comb White Leghorn hens. Three concentrations were used for each hormone. Blood was drawn after both saline and hormone infusions and assayed for aPP content. No significant influence of any of the three hormones on plasma aPP level was found in either fed or fasted hens.

Behavioural methods in the treatment of sleep disorders--a pilot study

The efficacy of behavioural methods of treatment for severe sleep disorders was examined in a pilot study involving 35 children aged 1-5 years. Improvement occurred in 77%. Methodological issues concerning the selection of children for treatment, selecting adequate controls and outcome measures, and using parents as therapists, are discussed.

The influence of avian pancreatic polypeptide on gastric secretion and motility in laying hens

The effects of pancreatic polypeptide (PP) on digestive functions have been studied extensively in mammals. The only two previous studies on the effects of PP on avian (aPP) gastrointestinal function employed bolus injections (i.v.) of the hormone, which may have resulted in nonphysiological plasma levels of aPP. The present study was to determine the effect of aPP infused (iv) at levels simulating postprandial plasma concentrations. Young laying hens were prepared with chronic proventricular and jugular cannulas and with strain gauge transducers sutured to the serosa of the gizzard. In each experiment, a control saline infusion was followed by infusion sufficient to achieve either 7.5 or 15 ng aPP/ml of plasma. Volume, pH, and pepsin content of gastric secretions and frequency and amplitude of gastric contractions were determined. At 15 ng aPP/ml of plasma, secretory volume (P less than .01) and contractile frequency (P less than .001) were significantly depressed as compared to similar data during the saline infusion. At 7.5 ng aPP/ml of plasma, only contractile frequency (P less than .01) was depressed.

Observations on 100 patients with continuous intraoperative monitoring of intramyocardial pH. The adverse effects of ventricular fibrillation and reperfusion

Intramyocardial pH and temperature data recorded in 100 patients undergoing cardiac operations were analyzed to elucidate the effects of ventricular fibrillation and reflow. All patients underwent a single period of aortic clamping. Systemic hypothermia (25 degrees C) and intermittent cold crystalloid K+ cardioplegia were employed for myocardial protection. Baseline myocardial pH was 6.88 +/- 0.03 at a temperature of 36.5 degrees +/- 0.2 degree C. During the period of hypothermic ventricular fibrillation prior to aortic clamping, ventricular fibrillation did not affect myocardial pH in 45 patients (Group 1). In 21 patients (Group 2), it caused a significant drop in intramyocardial pH despite cooling. Group 2 patients had a higher incidence of valvular heart disease and left ventricular hypertrophy. They also exhibited low intramyocardial pH values during the subsequent periods of aortic clamping and reflow, indicating inadequate myocardial protection. During the period of reflow, reperfusion acidosis (pH less than 6.8 at 32 degrees C) was encountered in 39 patients (Group B) as opposed to 37 patients (Group A) whose pH remained well above 6.8 during that period. Group B patients had a higher incidence of valvular heart disease and left ventricular hypertrophy, tended to have more ischemic anterior walls prior to cardiopulmonary bypass, sustained longer periods of aortic clamping, had intramyocardial pH evidence of suboptimal protection during aortic clamping, were affected more adversely by ventricular fibrillation during reflow, and tended to have a higher operative mortality. Thus: Depending on the underlying myocardial disease, the adequacy of protection during aortic clamping, and the conditions of reflow, intramyocardial pH in man can fall significantly during ventricular fibrillation and reflow. The metabolic correlate of injury with reflow is a reperfusion acidosis that can reach as low as pH 5.98. When encountered, reperfusion acidosis can be minimized by prompt defibrillation.

Discriminant validity of the MMPI for borderline personality disorder

This study explores the discriminant validity of the MMPI in relationship to the DSM-III and the Diagnostic Interview for Borderlines (DIB) constructs of Borderline Personality Disorder (BPD). A two-way analysis of variance model assessed differences between inpatients (n = 42) and outpatients (n = 42) and between BPD and nonBPD patients. We compare the best discriminant model for the current samples with previous BPD discriminant functions. The present study assesses a wider range of psychopathology in which the MMPI appears to be relatively insensitive to the BPD construct while retaining the high specificity reported in previous studies. Implications for the use of the MMPI as a diagnostic instrument are discussed.

Delayed-onset heparin-induced thrombocytopenia. A potentially malignant syndrome

Delayed-onset thrombocytopenia developed in 12 patients while they were receiving either prophylactic or therapeutic heparin. Five of the patients had thrombocytopenia alone, and seven had thromboembolic complications which contributed to the death of one patient. These complications included deep venous thrombosis (four patients), pulmonary embolism (three patients), myocardial infarction (one patient), sagittal sinus thrombosis (one patient), and femoral artery occlusion (one patient). The diagnosis of heparin-induced thrombocytopenia was delayed for between one and 13 days after the initial complicating event. All patients had heparin-dependent platelet-aggregating factor in their plasma. The characteristics of the heparin-dependent platelet-aggregating reaction were the same in all patients, but the nadir of thrombocytopenia was lower in patients with delayed-onset heparin-induced thrombocytopenia and complicating thromboembolism. These findings highlight the necessity for early recognition of this syndrome and for the prompt withdrawal of heparin to prevent considerable patient morbidity.

Alcoholism among Aboriginal people

Much has been spoken and written about alcohol problems in Aboriginal communities, but little has been achieved in dealing with these problems effectively, as is clearly illustrated by the statistics in this article, which summarizes the over-all situation in New South Wales, analyses its historical development, and shows its present catastrophic proportions. An approach, based on 13 years of active and intensive involvement in this particular field, is presented which if properly implemented, could greatly alleviate this pressing problem.

Adrenergic factors influencing the mitotic rate in stratified squamous epithelium of the buccal mucosa of the rat

1. An in vivo stathmokinetic technique was used to determine the immediate effect of various adrenoceptor agonists and antagonists on the mitotic rate in the stratified squamous epithelium of the rat buccal mucosa. 2. The mitotic rate increased significantly in rats treated with propranolol and with practolol, whereas the mitotic rate decreased significantly in rats treated with metaraminol. In animals treated with isoprenaline and phentolamine the mitotic rate did not differ significantly from the control value. 3. The nature of the involvement of adrenergic mechanisms with cell proliferation is still uncertain but both alpha- and beta-adrenergic mechanisms appear to be associated with the control of cell proliferation.