Involvement of supraspinal and spinal CCK receptors in the modulation of antinociception induced by cold water swimming stress in the mouse

We have previously reported that supraspinally and spinally located CCK receptors are involved in antagonizing supraspinally administered opioid-induced antinociception. Cold water swimming stress (CWSS) produces antinociception and opioid receptors are involved in CWSS-induced antinociception. The present study was designed to determine if supraspinal and spinal CCK receptors were involved in modulating the CWSS- induced antinociception. Antinociception was assessed by the tail-flick test. CWSS caused a profound inhibition of the tail-flick response. Various doses of CCK injected intracerebroventricularly (i.c.v.) or intrathecally (i.t.) alone did not show any antinociceptive effect. The i.c.v. or i.t. pretreatment with CCK (0.05-0.5 ng) dose dependently attenuated the CWSS- induced inhibition of the tail-flick response. In addition, i.c.v. pretreatment with lorglumide (0.1-10 pg) but not PD135,158 (1-100 pg) dose dependently reversed CCK's inhibition of the tail-flick response induced by CWSS. However, both lorglumide and PD135,158 injected i.t. reversed the antagonism of CCK against the inhibition of the tail-flick response induced by CWSS in a dose-dependent manner. Our results suggest that, at the supraspinal level, CCK(A) but not CCK(B) receptors may be involved in antagonizing the CWSS-induced antinociception. In the spinal cord both CCK(A) and CCK(B) receptors appear to be involved in antagonizing the CWSS-induced antinociception.

Paradoxical phenomena of the McMurray test. An arthroscopic investigation

We evaluated 200 patients who had a positive McMurray test and found atypical McMurray test results in 24 patients (12%). These patients revealed pain or clicking or both either in the medial compartment of the knee when the leg was internally rotated or in the lateral compartment of the knee when the leg was externally rotated. The authors analyzed these paradoxical findings at arthroscopic examination to identify the relationship between the type of meniscal tear and the direction of leg rotation that elicited the catching and displacement of the torn meniscal portion during the McMurray test. Contrary to conventional McMurray test findings, three different types of meniscal tears were found on the side of the knee where pain or a clicking sound occurred. The three types were 1) anteriorly based posterior oblique tears with anterior displacement of the meniscus, 2) bucket-handle tears in the posterior half of the menisci, and 3) peripheral detachment of discoid menisci in the posterior half of the torn portions.

The influence of reduced dietary fat absorption induced by orlistat on the pharmacokinetics of digoxin in healthy volunteers

To assess the influence of an orlistat-induced reduction in dietary fat absorption on the pharmacokinetics of digoxin, an open-label, placebo-controlled, randomized, two-way crossover study was performed in 12 healthy volunteers. Each subject received single 0.4-mg doses of digoxin (soft gelatin capsules) administered orally on the fourth day of orlistat (120 mg three times daily for 6 days) and placebo (three times daily for 6 days) treatment, separated by at least an 11-day washout period. Serial blood samples were collected before and at appropriate intervals after each digoxin dose to determine plasma concentrations of unchanged digoxin. The 90% confidence intervals for the ratio of geometric least-squares means (for Cmax, AUC0-48, AUC0-t, and AUC) and for the difference of arithmetic least-squares means (for tmax and lambda z) indicate that the pharmacokinetics of digoxin was not altered by treatment with orlistat. This results suggests that a approximately 30% reduction in dietary fat absorption will not change the efficacy of digoxin in cardiac patients.

Discoid lateral meniscus associated with anomalous insertion of the medial meniscus

Discoid lateral meniscus in the knee joint is common. From July 1990 through September 1992, the authors performed arthroscopy on 534 symptomatic knee joints. Seventy-seven knees of 72 patients had discoid lateral meniscus. Of the 77 knees treated, 4 (5.5%) had discoid lateral meniscus associated with anomalous insertion of the anterior horn of the medial meniscus into the anterior cruciate ligament. The discoid lateral meniscus was reshaped in the 4 knees, and followup was done from 12 to 24 months (average, 20 months) after surgery. The results were satisfactory, except for 1 patient who damaged his knee in a traffic accident. The authors concluded that this anatomic variant of the medial meniscus was not related to the patients' symptoms, but that reshaping the discoid lateral meniscus did relieve their symptoms.

The influence of volumetric tumor doubling time, DNA ploidy, and histologic grade on the survival of patients with intracranial astrocytomas

PURPOSE

To improve the prediction of individual survival in patients with intracranial astrocytomas through the analysis of volumetric tumor doubling time (VDt) and DNA ploidy.

METHODS

A pilot study was retrospectively conducted on a group of 25 patients with intracranial astrocytomas in whom recurrent and/or progressive disease was observed on serial contrast-enhanced CT or MR examinations. VDt was computed using two or more data points from a semilogarithmic plot of tumor volume versus time. Size-adjusted survival was calculated using a method based on VDt and initial tumor volume to decrease the lead time bias attributable to differing tumor sizes at presentation.

RESULTS

Slower VDt was associated with significantly longer survival and size-adjusted survival as determined by a univariate Cox proportional hazard analysis. Aneuploidy was a significant indicator of poor survival. Aneuploid and multiclonal astrocytomas had poor size-adjusted survivals compared with diploid astrocytomas. Grade IV astrocytomas had significantly poorer survival and size-adjusted survival compared with lower grades (I to III), which individually were not significantly correlated. However, grade IV histology was not a significant independent predictor of size-adjusted survival in a multivariate Cox model, whereas VDt and DNA ploidy remained significant. VDt also had a significant direct linear correlation to survival and size-adjusted survival.

CONCLUSIONS

VDt and DNA ploidy were more sensitive than histologic grading as indicators of individual survival. Initial tumor size needs to be considered when staging and assessing survival in patients with intracranial astrocytomas.

Genomic structure of the mouse delta opioid receptor gene

Using mouse delta opioid receptor (DOR) cDNA sequence to probe genomic libraries in bacteriophage lambda and P1 vectors, clones traversing the entire DOR coding sequence and 5' and 3' flanking regions were isolate. Genomic sequence encoding mature DOR message, including 5' and 3' untranslated sequence, is divided by two introns of 26 kb and 3 kb, resulting in the gene occupying 32 kb of chromosomal DNA. Multiple putative transcription initiation sites were located, by RNase protection assay, in TATA-less G+C rich sequence between 390 and 140 nucleotides upstream from the ATG translation start codon. A polyadenylation site was located 1.24 kb downstream from the TGA translation stop codon. Examination of 1.3 kb of 5'flanking sequence revealed potential binding sites for several known transcription factors including: Sp1, Ap-2, NF-kappa B, NF-IL6, and NGFI-B.

Genomic structure analysis of promoter sequence of a mouse mu opioid receptor gene

We have isolated mouse mu opioid receptor genomic clones (termed MOR) containing the entire amino acid coding sequence corresponding to rat MOR-1 cDNA, including additional 5' flanking sequence. The mouse MOR gene is > 53 kb long, and the coding sequence is divided by three introns, with exon junctions in codons 95 and 213 and between codons 386 and 387. The first intron is > 26 kb, the second is 0.8 kb, and the third is > 12 kb. Multiple transcription initiation sites were observed, with four major sites confirmed by 5' rapid amplification of cDNA ends and RNase protection located between 291 and 268 bp upstream of the translation start codon. Comparison of the 5' flanking sequence with a transcription factor database revealed putative cis-acting regulatory elements for transcription factors affected by cAMP, as well as those involved in the action of gluco- and mineralocorticoids, cytokines, and immune-cell-specific factors.

Arthroscopic intraarticular interference screw technique of posterior cruciate ligament reconstruction: one-incision technique

Posterior cruciate ligament (PCL) reconstruction using a bone-patellar tendon-bone graft with double incisions has been described in the literature. We present the single-incision technique that may aid the surgeon in performing difficult PCL reconstructions and reduce the possibility of injuring the knee extensor mechanism. By using three proper portals, we have shown that it is possible to make a femoral tunnel and engage a bone peg of the graft in the tunnel without any extensor damage and without disturbing the divergence angle of the bony tunnels. We have performed 22 such operations with successful results.

Congenital bilateral absence of the acromion. A case report

Complete bilateral absence of the acromion, a condition not previously reported by others, was discovered in a 31-year-old housewife who had shoulder pain. Clinically, no abnormal physical sign was noted in the patient except for mild superior translation of the humeral heads. Radiographs showed bilateral absence of the lateral aspect of each scapular spine and acromion. The lateral ends of both clavicles were hypertrophied with convex and blunt margins. Even in the absence of the acromion, there was no significant clinical dysfunction of the shoulder joint.

New mRNA probes for hippocampal responses to entorhinal cortex lesions in the adult male rat: a preliminary report

Three new mRNA responses were found in the hippocampus of the adult male rat after entorhinal cortex lesions (ECL) that induce synaptic reorganization. Hippocampus cDNA libraries were screened by a subtractive hybridization strategy designed to detect ECL-induced mRNAs. Partial sequencing showed clones with similarities to mouse vimentin, ferritin, and polypeptide 7B-2. A sequence similar to mouse SNAP-25 sequence was also detected. Using a mouse SNAP-25 probe, rat SNAP-25 mRNA increased in the hippocampus after ECL.

The 5'-flanking region of the mouse vascular smooth muscle alpha-actin gene contains evolutionarily conserved sequence motifs within a functional promoter

The 5'-flanking, 5'-untranslated, and amino-terminal protein coding regions of the single-copy 13-kilobase mouse vascular smooth muscle (VSM) alpha-actin gene have been cloned and sequenced. Respectively, there is 73 and 89% homology from the start of transcription (+1) to a point 206 base pairs upstream when comparing mouse to chicken and mouse to human VSM alpha-actin 5'-flanking region sequences. Two proximal 16-base pair motifs containing putative cis-acting regulatory elements having the configuration CC(A/T)6GG were found to be 100% conserved and present in the same position upstream from the transcription start site in all three species. A third more distal CC(A/T)6GG-like motif was 100% conserved between only the mouse and human genes whereas a fourth motif was unique to the mouse gene. The two upstream motifs may be important in controlling VSM alpha-actin gene transcription in mammals. Cell transfection assays using hGH reporter gene fusion plasmids showed that all four CC(A/T)6GG elements were required for tissue-specific, core promoter activity and were able to direct hGH expression in both mouse BC3H1 myogenic cells and early-passage rabbit aortic smooth muscle cells. The core promoter was not active in mouse fibroblasts suggesting that the region between -372 and -143 may mediate tissue-restrictive expression of the VSM alpha-actin gene. A putative "cell density responsive element" may be located between -1074 and -372 since fusion plasmids containing this portion of the VSM alpha-actin 5'-flanking region were significantly more active in promoting hGH expression in inducible, density-activated BC3H1 myoblasts compared to aortic smooth muscle cells which are largely constitutive for VSM alpha-actin expression.

Quantitative DNA patterns in human preneoplastic breast lesions

In 12 cases of human mammary carcinoma in which a preneoplastic atypical ductal hyperplasia was also identified, quantitative DNA (QDNA) measurements of thionein-stained samples from both lesions were performed using the Cell Image Analysis 100 system. The QDNA values in the preneoplastic and neoplastic lesions from each case showed concordance (six as euploid and six as aneuploid/hyperdiploid). Such congruence suggests a stable inheritance of the somatic mutation(s) that is involved in carcinogenesis and that affects ploidy. If this relationship between concurrent preneoplasia and neoplasia in the ipsilateral breast is confirmed, it offers the possibilities of (1) identifying individuals at risk for developing neoplasias with defined biologic characteristics and (2) developing therapeutic regimens more appropriate to the risk assessment of each patient. It may be possible to conceive of a rational preventive regimen for cancer of the breast.

Quantitative analysis of keratin 18 in the urine of patients with bladder cancer

The level of urinary keratin was compared in patients with and without bladder cancer using the newly developed IRMAK-18. Patients with bladder cancer had higher levels of keratin (74.6 +/- 146.9) than normals (2.5 +/- 4.7). When the upper limit of normal was set at keratin less than 20 ng./ml., the test was highly specific (98%) for bladder cancer but had a sensitivity of only 46%. Adjusting to keratin less than 10 ng./ml. increased the sensitivity to 57% but decreased the specificity to 91%. Elevated keratins were associated with stage and grade, aneuploidy and disease history. The IRMAK-18 assay for keratin may be useful for monitoring the clinical progress of some patients.

Characterization of two monoclonal antibodies in an immunohistochemical study of keratin 8 and 18 expression

Two monoclonal antibodies, UCD/AB 6.11 and UCD/PR 10.11, were evaluated for their patterns of immunohistochemical reactivity in a survey of paraffin-embedded human tissues by the avidin-biotin-immunoperoxidase technique. By two-dimensional immunoblotting, UCD/AB 6.11 reacts with keratin number 18 and UCD/PR 10.11 identifies both keratin numbers 8 and 18, the major keratins found in human simple epithelial cells. Both antibodies have excellent signal-to-noise ratios, and specifically react with simple epithelia, transitional epithelia, mesothelia and tumors derived from such tissues, making them superior immunological reagents. They do not react with neural, muscle, hematopoietic, connective or most epidermal tissues. However, within a given tissue or cell type, differences in the distributions of the antigens recognized by these two antibodies can be observed, raising the possibility of differential expression, modification, or masking of the keratin epitopes revealed by UCD/AB 6.11 and UCD/PR 10.11.

Pharmacokinetics and antisecretory activity of trimoprostil in Heidenhain-pouch dogs

Trimoprostil, a prostaglandin E2 analog, was evaluated to determine if there was a relationship between plasma concentrations and inhibition of histamine-stimulated gastric acid secretion in dogs prepared with Heidenhain pouches. Trimoprostil was given p.o. followed by collection (drainage) of gastric juice from the pouch to determine acid output. In addition, serial blood samples were withdrawn to determine trimoprostil plasma concentrations. Trimoprostil was absorbed rapidly and eliminated with T1/2 ranging from 25 to 37 min. Trimoprostil was effective in inhibiting acid output compared with control. The maximal response and duration of activity were dependent on the concentration-time profile of trimoprostil. Trimoprostil produced a maximum inhibition of 98% and suppressed acid output for at least 3 hr. When plasma concentrations were related to the antisecretory response using a modified Hill equation, the response was found to lag behind plasma concentrations as evidenced by hysteresis loops. The predicted plasma concentration associated with a 50% inhibition of acid secretion (IC50) ranged from 0.58 to 0.79 ng/ml.

Comparison of gas chromatographic/mass spectrometric and microbiological assays for 5-fluorouracil in plasma

The concentrations of 5-fluorouracil in 99 plasma samples were determined by both microbiological and gas chromatographic/mass spectrometric assays. The values determined by the two methods were similar (correlation coefficient = 0.90). A regression of the natural logarithms of the concentrations (0.01-94 micrograms ml-1) determined by the two methods gave a line whose slope and intercept were not statistically different (p greater than 0.05) from 1 and 0 respectively. Thus, the microbiological assay has specificity over a sufficient concentration range to serve as a practical routine laboratory method for the determination of 5-fluorouracil.

Trimoprostil plasma concentration--gastric acid inhibition relationships: potentiation by food

A single, oral, 1.5-mg dose of trimoprostil was taken before a standard meal and a matching placebo was taken after a standard meal by 10 subjects (group A). A second group of 10 subjects took placebo before a meal and trimoprostil after the meal (group B), while a third group took placebo both before and after the standard meal (group C). Food-stimulated gastric acid production was measured by intragastric titration for 6.5 hr after dosing. Trimoprostil taken after the meal had a greater effect on gastric acid secretion than when taken before the meal: Duration of effect was 5 to 5.5 hr in group B and 2 to 2.5 hr in group A. Blood samples were drawn and assayed for trimoprostil by gas chromatography-mass spectrometry. Mean trimoprostil plasma concentration and mean inhibition of gastric acid secretion data were fit to two models by the Hill equation. The mean plasma concentration associated with 50% inhibition of gastric acid secretion was 1.25 ng/ml. Trimoprostil plasma concentrations between 3 and 4 ng/ml were associated with 70% to 80% gastric acid inhibition. Overall, there appears to be a pharmacokinetic-pharmacologic correlation between trimoprostil plasma concentrations and inhibition of gastric acid secretion. Trimoprostil (1.5 mg) in the presence of food appears to have a therapeutic advantage, in that it decreases acid secretion longer than when taken without food and suffers no loss of bioavailability.

Dose dependent pharmacokinetics of midazolam

The pharmacokinetics of midazolam and 1-hydroxymethylmidazolam were investigated following oral administration of 7.5, 15 and 30 mg doses of midazolam in solution to 12 healthy subjects. Compared to the 7.5 mg dose, the Cmax and AUC parameters of both midazolam and 1-hydroxymethylmidazolam increased proportionally after the 15 mg dose and more than proportionally after the 30 mg dose. The t1/2 for midazolam remained relatively constant between the 7.5 and 15 mg doses whereas it increased slightly but significantly after the 30 mg dose. These data indicated that the pharmacokinetics of midazolam and 1-hydroxymethylmidazolam were linear between the 7.5 and 15 mg oral dose range. However, after the 30 mg dose, the systemic availability of midazolam and the AUC for 1-hydroxymethylmidazolam appeared to be greater than that anticipated from the lower doses, possibly due to saturation of midazolam first-pass metabolism. This is not expected to have any clinical significance under the conditions of therapeutic use.

Clonazepam acetylation in fast and slow acetylators

Six slow acetylators (SAs) and six rapid acetylators (RAs), as determined by sulfamethazine (SMZ) phenotyping, were each given a 2-mg oral dose of clonazepam. Ninety-six-hour urine collections from these subjects were analyzed for clonazepam, 7-amino clonazepam (7-AM, clonazepam nitroreduced metabolite), and 7-acetamido clonazepam (7-ACT, N-acetylated 7-AM). The SA group excreted more 7-AM and less 7-ACT than the RA group; mean (+/- Sd) recovered as 7-AM was 22.7 +/- 5.0% for the SA group and 13.6 +/- 4.1% for the RA group and mean (+/- SD) recovered as 7-ACT was 1.5 +/- 0.4% for the SA group and 3.9 +/- 1.8% for the RA group. Both differences were substantial (p less than 0.02 by unpaired t test) and indicate that the rate of acetylation of 7-AM to 7-ACT in the biotransformation of clonazepam is determined by the acetylator phenotype.

Determination of an antisecretory trimethyl prostaglandin E2 analog in human plasma by combined capillary column gas chromatography-negative chemical ionization mass spectrometry

A method is described for measuring a trimethyl prostaglandin E2 analog, TM-PGE2, in human plasma. Trideuterated and monofluorinated analogs of TM-PGE2 and added to plasma as internal standard and carrier, respectively. The plasma is adjusted to pH 3.0 and is extracted with a mixture of benzene-dichloromethane (9:1). The residue, following removal of the extracting solvent, is reacted consecutively with pentafluorobenzyl bromide and bistrimethylsilyltrifluoroacetamide. The excess derivatizing reagents are removed by evaporation, and an aliquot of the reconstituted residue is analyzed by capillary column gas chromatography using methane as the carrier gas. A quadrupole mass spectrometer is set to monitor in the gas chromatographic effluent the (M - C7H2F5)-fragment ion of TM-PGE2 (m/e 449) and trideuterated TM-PGE2 (m/e 452) generated by methane negative chemical ionization. Quantitation of unknowns is based on a comparison of the m/e 449 to m/e 452 ion ratio in each unknown to that obtained from the analysis of control plasma spiked with known amounts of TM-PGE2 and fixed amounts of internal standard and carrier. The sensitivity limit of the assay is approximately 100 pg ml-1, which is equivalent to 1 pg injected. The assay was used to measure the concentration of TM-PGE2 in the plasma of two subjects following a single 10 micrograms kg-1 oral dose of the drug.