Protein metabolism in lactating goats subjected to the insulin clamp

A model of Leu and protein metabolism by the mammary gland and hind leg of lactating goats was constructed and evaluated from data collected by using [15N, 1-13C]Leu kinetics measured during amino acid (AA) infusion and a hyperinsulinemic-euglycemic clamp (IC). Goats were given continuous intravenous infusions of either saline or AA (65 g/d) for 7.5 d and from d 5 to 7.5 goats were subjected to IC. Arteriovenous kinetics were monitored on d 4 and 8 by continuous infusion (8 h) of [15N, 1-13C]Leu. Milk protein yield was increased by IC (+10%) and IC +AA (+21%), whereas AA infusion had no effect. The data were used to construct model equations that describe rates of protein synthesis and degradation, and from these equations, milk and muscle net protein synthesis were described. The model was unable to describe the observed responses in milk protein synthesis. Similar to observations in the literature, net protein gain by the hind leg increased with AA, IC, and IC + AA infusion, primarily through stimulation of protein synthesis by AA. For both tissues, IC depressed Leu oxidation, but only in the absence of AA infusion. Although the IC appears to regulate the ability of the mammary gland to coordinate blood flow and Leu catabolism in support of protein synthesis, our ability to construct a precise model describing mammary protein anabolism is still limited. In contrast, the response in protein anabolism of the hind-leg tissues of these midlactation goats was predicted well by the model, which indicate that the leg tissues were more sensitive to AA supply than the mammary gland.

Peripheral nerve ectopic meningioma at the elbow joint

A rare peripheral ectopic meningioma of the nerve in the elbow region is discussed. The clinical, radiological, surgical and pathological findings are reviewed.

Hibernoma: imaging characteristics of a rare benign soft tissue tumor

Hibernoma is a rare benign soft tissue tumor of brown fat. Awareness of the MR imaging appearances of this lesion may allow for improved preoperative diagnosis or at least inclusion of hibernoma as a possible benign differential diagnosis prior to surgery.

MR Imaging of sports-related pseudotumor in children: mid femoral diaphyseal periostitis at insertion site of adductor musculature

OBJECTIVE

The objective of this study was to review the imaging appearance of the femurs of five patients who had been referred from outside institutions after presenting with thigh pain and being given a preliminary diagnosis of primary malignant bone tumor. Typically, when making a diagnosis, physicians place emphasis on the characteristic appearances of diseases on MR imaging, but such appearances may be misleading. An awareness of the specific MR imaging pattern of stress-related partial muscle avulsion can lead to the correct diagnosis.

CONCLUSION

Femoral diaphyseal periostitis after a sports injury to the adductor musculature in children has a characteristic imaging appearance. This condition can initially appear to be misleadingly aggressive. Knowledge of the findings-particularly of the findings on MR imaging-in the proper clinical setting can help physicians make the correct diagnosis and eliminate unnecessary biopsy or inappropriate treatment.

Effects of smoking and abstention from smoking on fibrinogen synthesis in humans

Cigarette smoking and hyperfibrinogenaemia are both significant risk factors for the development of cardiovascular disease. Two studies are described here which aimed to establish the metabolic mechanism responsible for the raised plasma fibrinogen concentration observed in smokers. Chronic smokers had a significantly elevated absolute rate of fibrinogen synthesis (ASR) compared with non-smokers (22.7 +/- 1.3 mg/kg per day versus 16.0 +/- 1.3 mg/kg per day; means +/- S.E.M., P < 0.01), with plasma levels of fibrinogen significantly correlated with fibrinogen synthesis (r = 0.65, P = 0.04). Unlike fibrinogen, plasma albumin concentrations were lower in smokers than in non-smokers (45 +/- 0.4 versus 47 +/- 0.7 g/l, P < 0.05), but there was no difference in rates of albumin synthesis between the two groups. Two weeks cessation from smoking by previously chronic smokers was associated with a rapid and marked fall in plasma fibrinogen concentration (from 3.06 +/- 0.11 g/l to 2.49 +/- 0.14 g/l, P < 0.001), and a significant reduction in ASR (a 33% reduction, from 24.1 +/- 1.7 to 16.1 +/- 1.0 mg/kg per day, P < 0.001). These studies suggest a primary role for increased synthesis in producing the hyperfibrinogenaemia associated with smoking. Moreover, abstention from smoking for a period of only 2 weeks induces a significant decrease in the rate of fibrinogen synthesis by the liver, with a concomitant reduction in the plasma fibrinogen concentration.

Progressive melorheostosis in the peripheral and axial skeleton with associated vascular malformations: imaging findings over three decades

A 28-year old woman presented with Léri's disease (melorheostosis) and the rare combination of complex vascular malformations and lymphatic anomalies. Multifocal melorheostosis was segmental and unilateral, located in the left axial and peripheral skeleton, fifth thoracic vertebral body, fifth rib. left upper limb and lumbosacral spine (third lumbar body to first sacral segment). Sacral involvement was associated with spinal canal stenosis. Additionally the patient had multiple nevi and had suffered from left hemiplegia since birth. Lymphangiectasia of the mesentery and thorax led to chylothorax resistant to therapy for which the patient underwent a pleuropericardiectomy. Death ensued due to respiratory failure.

Validation of an outcomes instrument for tonsil and adenoid disease

OBJECTIVE

To design and validate a disease-specific health status instrument-the Tonsil and Adenoid Health Status Instrument-for use in children with tonsil and adenoid disease.

DESIGN

Prospective psychometric and clinimetric instrument validation in 3 stages.

SETTINGS

A tertiary academic pediatric specialty hospital and a tertiary academic hospital, in 2 different cities. PATIENTS/OTHER PARTICIPANTS: Children with tonsil and adenoid disease presenting for evaluation and treatment (n = 224). INTERVENTION/METHOD: Prospective instrument validation. Stage 1 consisted of initial item testing, reduction, and subscale construction; stage 2, reliability and validity testing, factor analysis, and final item reduction; and stage 3, responsiveness analysis.

MAIN OUTCOME MEASURES

Test-retest and internal consistency reliability; content, construct, and criterion validity; orthogonal principal components factor analysis; and response sensitivity analysis.

RESULTS

Factor analysis and item analysis confirmed 6 distinct subscales measuring different constructs (aspects) of disease-specific health status that are affected by tonsil and adenoid disease: eating and swallowing, airway and breathing, infections, health care utilization, cost of care, and behavior. For each subscale, the Tonsil and Adenoid Health Status Instrument demonstrated excellent test-retest reliability (r = 0.72-0.88) and internal consistency reliability (Cronbach alpha = .73-.87). Content validity was ensured during the design process. Construct validity was demonstrated by means of convergent and divergent validity with a global quality-of-life instrument (the Child Health Questionnaire, version PF28). Criterion validity was also satisfactory. Finally, the instrument was appropriately sensitive, with high standardized response means and effect sizes.

CONCLUSIONS

The Tonsil and Adenoid Health Status Instrument is a valid, reliable, and sensitive instrument with 6 distinct subscales. This instrument has significant utility for outcomes research in children with tonsil and adenoid disease.

Hypertonic perfusion inhibits intracellular Na and Ca accumulation in hypoxic myocardium

Much evidence supports the view that hypoxic/ischemic injury is largely due to increased intracellular Ca concentration ([Ca](i)) resulting from 1) decreased intracellular pH (pH(i)), 2) stimulated Na/H exchange that increases Na uptake and thus intracellular Na (Na(i)), and 3) decreased Na gradient that decreases or reverses net Ca transport via Na/Ca exchange. The Na/H exchanger (NHE) is also stimulated by hypertonic solutions; however, hypertonic media may inhibit NHE's response to changes in pH(i) (Cala PM and Maldonado HM. J Gen Physiol 103: 1035-1054, 1994). Thus we tested the hypothesis that hypertonic perfusion attenuates acid-induced increases in Na(i) in myocardium and, thereby, decreases Ca(i) accumulation during hypoxia. Rabbit hearts were Langendorff perfused with HEPES-buffered Krebs-Henseleit solution equilibrated with 100% O(2) or 100% N(2). Hypertonic perfusion began 5 min before hypoxia or normoxic acidification (NH(4)Cl washout). Na(i), [Ca](i), pH(i), and high-energy phosphates were measured by NMR. Control solutions were 295 mosM, and hypertonic solutions were adjusted to 305, 325, or 345 mosM by addition of NaCl or sucrose. During 60 min of hypoxia (295 mosM), Na(i) rose from 22+/-1 to 100+/-10 meq/kg dry wt while [Ca](i) rose from 347+/-11 to 1,306+/-89 nM. During hypertonic hypoxic perfusion (325 mosM), increases in Na(i) and [Ca](i) were reduced by 65 and 60%, respectively (P<0.05). Hypertonic perfusion also diminished Na uptake after normoxic acidification by 87% (P<0.05). The data are consistent with the hypothesis that mild hypertonic perfusion diminishes acid-induced Na accumulation and, thereby, decreases Na/Ca exchange-mediated Ca(i) accumulation during hypoxia.

Na-dependent changes in intracellular Ca in spontaneously hypertensive rat hearts

To determine whether Na/Ca exchange is altered in primary hypertension, Na-dependent changes in intracellular Ca, ([Ca]i), were measured in isolated perfused hearts from Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats. Intracellular Na, (Nai, mEq/kg dry wt), and [Ca]i were measured by NMR spectroscopy. Control [Ca]i was less in WKY than SHR (176 +/- 18 vs 253 +/- 21 nmol/l; mean +/- S.E., P < 0.05), whereas Nai was not significantly different. One explanation for this is that net Na/Ca exchange flux is decreased in SHR. If this hypothesis is correct, the rate of Ca uptake in SHR should be less than WKY when Na/Ca exchange is reversed by decreasing the transmembrane Na gradient. The Na gradient was reduced by decreasing extracellular Na, ([Na]o) and/or by increasing [Na]i. To increase [Na]i, Na uptake was stimulated by acidification while Na extrusion by Na/K ATPase was inhibited by K-free perfusion. Seventeen minutes after acidification, Nai had increased but was not significantly different in SHR and WKY (18.0 +/- 2.3 to 57.4 +/- 7.6 vs 20.3 +/- 0.6 to 66.5 +/- 4.8 mEq/kg dry wt, respectively). Yet [Ca]i was greater in WKY than SHR (1768 +/- 142 vs 1201 +/- 90 nmol/l; P < 0.05). [Ca]i was also measured after decreasing [Na]o from 141 to 30 mmol/l. Fifteen minutes after reducing [Na]o, [Ca]i was greater in WKY than SHR (833 +/- 119 vs 425 +/- 94 nmol/l; P < 0.05). Thus for both protocols, decreasing the transmembrane Na gradient led to increased [Ca]i in both SHR and WKY, but less increase in SHR. The results are consistent with the hypothesis that Na/Ca exchange activity is less in SHR than WKY myocardium.

Pancreatitis-induced ascitic fluid and hepatocellular dysfunction in severe acute pancreatitis

BACKGROUND

Multiple organ failure (MOF) is the most serious complication in severe acute pancreatitis, contributing to its high mortality. It has been suggested that changes of high-energy phosphates, intracellular pH, and intracellular cation homeostasis are closely related to hepatocellular injury associated with MOF.

METHODS

Phosphorus metabolites, intracellular pH (pHi), and intracellular Na+ concentration ([Na+]i) were measured in rat livers in vivo using 31P and 23Na NMR spectroscopy after deoxycholic acid (DCA)-induced pancreatitis or intraperitoneal injection (ip) of pancreatitis-induced ascitic fluid (PAF).

RESULTS

Two hours after induction of DCA-pancreatitis, the liver experienced significant intracellular acidosis (pHi = 6.99 +/- 0.16) and sodium loading (75 +/- 9 mM) and a reduction in its energy state (beta-ATP/Pi = 0.2 +/- 0.03 and Pi = 164 +/- 12). Although ip injection of PAF into healthy rats did not induce systemic hypotension, the livers under these conditions also developed severe disturbances in hepatocellular ion homeostasis and depletion of its bioenergetics. The longer the abdomen was exposed to the PAF, the worse the changes were. At 3 h after ip injection of PAF, hepatic [Na+]i significantly increased (42 +/- 3 mM) along with a significant decrease in pHi (7.30 +/- 0. 03). At 6 h after ip injection of PAF, the hepatic beta-ATP/Pi ratio decreased to 0.34 +/- 0.05 and Pi increased to 97 +/- 27.

CONCLUSIONS

PAF induced severe hepatocellular acidosis, rapid accumulation of hepatic intracellular sodium, impaired hepatic cytosolic phosphorylation potential, and increased hepatic utilization of ATP. These effects may account for the eventual development of liver dysfunction associated with necrotizing pancreatitis.

Quantitation of blood and plasma amino acids using isotope dilution electron impact gas chromatography/mass spectrometry with U-(13)C amino acids as internal standards

A method to quantitate blood and plasma amino acids by isotope dilution gas chromatography/mass spectrometry (GC/mS) is described. Samples were spiked with U-(13)C amino acids as internal standards and the tert-butyldimethylsilyl derivatives (tBDMS) separated by capillary column gas chromatography. Linear regression curves, generated for individual amino acids, gave correlation coefficients of 0.9999. The reproducibility of the method was assessed from the analysis of 10 replicate blood and plasma samples. For most amino acids a coefficient of variance (CV) of </=1% was obtained with the exception of aspartate which gave a value of 1.8%. This was probably due to the low concentration of this amino acid in the samples analysed. Recovery of amino acids added to plasma was between 96 and 103%. The use of electron impact ionization (EI) allows the method to be used in laboratories where only the more basic GC/mS is available and reduces the time spent on instrument maintenance. The method should prove useful in areas of work where accurate and precise amino acid concentrations are required.

Closing the distance

Geriatric technicians work in the field, providing a link between care providers and rural elderly patients. In this study, the new role enhanced patient outcomes and satisfaction.

The analysis of cyhexatin residues in apples, pears and kiwi fruit using inductively coupled plasma mass spectrometry as an initial screen for total tin, with confirmation by gas chromatography-mass spectrometry

Inductively coupled plasma-mass spectrometry (ICP-MS) has been used to determine concentrations of total tin in samples of apples, pears and kiwi fruit, following acid digestion. It was found that the background levels of tin in these fruits were normally below 0.06 mg/kg, which was equivalent to the target reporting limit for cyhexatin for this work of 0.2 mg/kg. The procedure was used to screen a total of 72 retail samples. Three apple samples contained tin at concentrations greater than 0.06 mg/kg. These three samples were re-analysed by a second confirmatory method using gas chromatography-mass spectrometry (GC-MS) as the determinative step. Results obtained by this method demonstrated that in fact, none of the samples contained cyhexatin residues at or above a reporting limit of 0.1 mg/kg. The use of ICP-MS as a preliminary screen substantially reduced the number of samples requiring analysis by GC-MS, thus reducing the cost of the survey (in terms of staff hours) by approximately 30%. The screening method could potentially be applied to other organometallic pesticide residues.

Ischemic preconditioning: effects on pH, Na and Ca in newborn rabbit hearts during Ischemia/Reperfusion

In adult hearts, ischemic preconditioning (PC) has been shown to decrease ischemia-induced changes in intracellular pH (pHi) and [Ca] ([Ca]i) and decrease associated injury. These results are consistent with the interpretation that PC decreases the stimulus for Na uptake via Na/H exchange, thereby decreasing intracellular Na (Nai) accumulation, and thus decreasing the change in force driving Na/Ca exchange, which otherwise contributes to ischemia-induced increases in [Ca]i. Given documented age-related differences in myocardial responses to ischemia, we tested the hypothesis that in newborn hearts, PC will diminish intracellular [H], Nai, and [Ca]i during ischemia/reperfusion. NMR was used to measure pHi, Nai, [Ca]i, ATP, and PCr in isolated newborn (4-7 days) rabbit hearts Langendorff-perfused with Krebs-Henseleit solution equilibrated with 95% O2/5% CO2 at 36+/-1 degrees C. Control hearts were perfused 30 min before initiating 40 min global ischemia followed by 40 min reperfusion. PC hearts were treated the same except four 5-min intervals of ischemia each followed by 10 min of perfusion which preceded global ischemia. At end ischemia, pHi was higher in PC than control hearts (6.31+/-0.03 v 5.83+/-0.05; P<0.05). Similarly, PC diminished Nai-accumulation during ischemia and reperfusion (P<0.05). Control Nai rose from 16.2+/-2.6 to 108.8+/-10.3 (mEq/kg dry weight) and recovered to 55.2+/-10.1 and the corresponding values for PC hearts were 25.6+/-6.2, 70.0+/-7.9 and 21.9+/-5.2. PC also improved [Ca]i recovery during reperfusion (P<0.05). Control [Ca]i rose from 418+/-43 to 1100+/-78 (nm/l) and recovered to 773+/-63, whereas in PC hearts the values were 382+/-40, 852+/-136 and 371+/-45, respectively. In addition, PC decreased coronary resistance during reperfusion (P<0.05) as reflected by lower perfusion pressures under constant flow conditions (65.9+/-1.5 v 56. 1+/-4.1 mmHg at end of reperfusion). Finally, PC improved recovery of left-ventricular developed pressure (LVDP-43.8+/-12.0 v 17.2+/-3. 0% of control; P<0.05) and diminished CK release (607+/-245 v 2432+/-639 IU/g dry weight; P<0.05) during reperfusion. The results are consistent with the hypothesis.

Ethylisopropylamiloride diminishes changes in intracellular Na, Ca and pH in ischemic newborn myocardium

Numerous studies suggest that in adult hearts myocardial ischemic injury is in part the result of proton stimulation of Na/H exchange which increases intracellular Na (Nai) and thus leads to increases in intracellular Ca concentration ( [Ca]i) due to changes in Na/Ca exchange flux. Corollary to the hypothesis, inhibition of Na/H exchange diminishes Na and Ca accumulation and improves heart function after ischemia. To test this hypothesis and its corollary in newborn hearts, NMR spectroscopy was used to measure intracellular pH (pHi), Nai, [Ca]i, and high energy phosphates in isolated, 4-7-day-old rabbit hearts, Langendorff-perfused with Krebs-Henseleit solution at pH 7.4+/-0.5 equilibrated with 95% O2/5% CO2 at 36+/-1 degrees C. Control hearts were perfused for 30 min before initiating 40 min of global ischemia followed by 40 min of reperfusion. In a second group of hearts ethylisopropylamiloride (EIPA-10 microM) was added to the perfusate 20 min before global ischemia to inhibit Na/H exchange. After 15 min ischemia, pHi in EIPA-treated hearts (6.41+/-0.04) was higher than that of the control hearts (6.20+/-0.08; P<0.05). EIPA also limited the increase in Nai and [Ca]i during ischemia and improved Nai and [Ca]i recovery during reperfusion (P<0.05). Nai (mEq/kg dry weight) rose from 18. 1+/-3.2 to 110.6+/-14.0 and recovered to 53.3+/-12.3 in the control group. The corresponding Nai values for EIPA-treated hearts were 16. 2+/-2.4, 39.6+/-9.6 and 12.6+/-3.5, respectively. In control hearts [Ca]i (nM/l) rose from 332+/-42 to 1157+/-89 and recovered to 842+/-55, whereas in EIPA-treated hearts the values were 255+/-32, 616+/-69 and 298+/-34, respectively. EIPA also preserved cellular ATP during ischemia and reperfusion and diminished inorganic phosphate during reperfusion (P<0.05). Finally, EIPA treatment improved recovery of left ventricular developed pressure (68.2+/-8.9 v 16.2+/-3.6% of control) and limited myocardial injury as indicated by decreased total creatine kinase release during reperfusion (348+/-132 v 2432+/-639 IU/g dry weight). Thus, as in adults, the results from newborn hearts are consistent with the hypothesis.

Hepatic protein synthesis in the sheep: effect of intake as monitored by use of stable-isotope-labelled glycine, leucine and phenylalanine

Rates of protein synthesis for the liver, plasma albumin and total plasma protein were quantified in sheep either offered a supra-maintenance intake or fasted for 3 d. The technique of continuous infusion over a 12 h period was employed with the simultaneous infusion of [1-13C]glycine, [1-13C]leucine and [2H5]phenylalanine. Blood and plasma samples were removed at timed intervals from the hepatic portal and hepatic veins plus the aorta. Enrichments of the free amino acids (AA) were determined in all blood and plasma samples as was the protein-bound AA in an apolipoprotein B100 extract. Protein-bound phenylalanine enrichments were also measured in albumin and total protein from plasma plus samples from liver biopsies. The apolipoprotein B100 enrichments agreed well with those of the free AA in hepatic (and hepatic portal) plasma but were lower than for arterial free AA and greater than liver homogenate free AA. This adds support to the concept that export proteins may preferentially use AA directly from extracellular sources. Intake had no significant effect on constitutive liver protein synthesis and the values agreed well with those obtained by other isotopic approaches. There were, however, significant declines, based on hepatic venous free phenylalanine enrichment, at the lower intake in both the fractional (3.4 v. 4.7% per d; P = 0.024) and absolute (2.4 v. 4.2 g/d; P = 0.011) synthesis rates of albumin, which matched the estimated decrease in total plasma albumin content (52 v. 67 g, P < 0.01). In contrast, there was a smaller reduction in total plasma protein mass (145 v. 151 g, P = 0.035) with no observed significant difference in kinetic parameters. Albumin synthesis was calculated to account for a maximum of 17% of total liver protein synthesis in the fed condition and this may fall to 8% during moderate fasts.

Primary total knee arthroplasty using the Genesis Total Knee Arthroplasty System: 3- to 6-year follow-up study of 105 knees

This prospective study analyzed data from 105 primary total knee arthroplasties performed in 90 patients using the Genesis Total Knee Arthroplasty System. The 34 men and 56 women with a mean age of 68.7 years (range, 41-86 years) were evaluated at a mean follow-up period of 4.25 years (range, 3-6 years). Fifty-five procedures (52%) used cemented femoral and tibial components, 49 (47%) used cementless femoral and cemented tibial components, and 1 (1%) used cementless femoral and tibial components. The preoperative mean pain and function scores were 50 (range, 12-79) and 41 (range, 5-80), respectively. At the most recent follow-up evaluation, the mean pain score increased to 97 (range, 67-100), and the mean function score increased to 88 (range, 40-100). Mean preoperative range of motion was 104 degrees (range, 50 degrees-130 degrees) and increased to 116 degrees (range, 80 degrees-130 degrees) at most recent follow-up evaluation. Clinically, there were 100 excellent results (95%). 4 good results (4%), and 1 poor result (1%).

Template-based automatic recognition of birdsong syllables from continuous recordings

The application of dynamic time warping (DTW) to the automated analysis of continuous recordings of animal vocalizations is evaluated. The DTW algorithm compares an input signal with a set of predefined templates representative of categories chosen by the investigator. It directly compares signal spectrograms, and identifies constituents and constituent boundaries, thus permitting the identification of a broad range of signals and signal components. When applied to vocalizations of an indigo bunting (Passerina cyanea) and a zebra finch (Taeniopygia guttata) collected from a low-clutter, low-noise environment, the recognizer identifies syllables in stereotyped songs and calls with greater than 97% accuracy. Syllables of the more variable and lower amplitude indigo bunting plastic song are identified with approximately 84% accuracy. Under restricted recordings conditions, this technique apparently has general applicability to analysis of a variety of animal vocalizations and can dramatically decrease the amount of time spent on manual identification of vocalizations.

Determination of protein synthesis in lymphocytes in vivo after surgery

1. The stimulation and depression of peripheral blood lymphocytes has previously been studied in vitro, showing an immune depression postoperatively; however, it is difficult to interpret these in vitro findings. Therefore, an in vivo technique has been established for determination of the fractional protein synthesis rate, as an index of metabolic activity in human peripheral blood lymphocytes, by using a stable isotope technique. 2. The rate of protein synthesis was calculated from the increase in enrichment of L-[2H5]phenylalanine in protein of a mixed population of mononuclear leucocytes, isolated by density gradient, after an intravenous flooding dose of L-[2H5]phenylalanine. A linear time course of isotopic incorporation into the cells was demonstrated. 3. The fractional rate of protein synthesis of a mixed population of mononuclear leucocytes was studied in relation to surgical interventions and to potential modifiers of the response. The fractional synthesis rate increased 24 h after open and laparoscopic cholecystectomy (49 +/- 19% and 40 +/- 14% respectively, P < 0.02), irrespective of postoperative total parenteral nutrition or preoperative glucose infusion. In contrast to surgery, insulin did not stimulate protein synthesis in peripheral mononuclear leucocytes.

Albumin but not fibrinogen synthesis correlates with galactose elimination capacity in patients with cirrhosis of the liver

Albumin and fibrinogen synthesis rates were measured in 15 subjects with different clinical stages of postviral cirrhosis and compared with galactose elimination capacity and aminopyrin breath test. Forty-three mg per kg body weight [2H5ring]phenylalanine with an isotopic enrichment of 10 atom% were intravenously injected. [2H5ring]phenylalanine enrichments in the plasma-free phenylalanine and the albumin and fibrinogen isolates were measured by gas chromatography-mass spectrometry. Fractional synthesis rates of albumin were normal in Child A cirrhosis (7.6 +/- 2.2%d), but were lower in both Child B (3.5 +/- 0.8%d) and C (4.5 +/- 2.8%d). Absolute rates of albumin synthesis were (103 +/- 30 mg/kg/d) in the child A group and substantially lower in the Child B (50 +/- 3 mg/kg/d) and C (36 +/- 20 mg/kg/d) group. The average fractional synthesis rate of fibrinogen was 16.7 +/- 7.5%d and the absolute synthesis rate 11.6 +/- 6.4 mg/kg/d. The values of the galactose elimination capacity and the aminopyrin breath test were below the normal range in all patients, gradually decreasing with an increase in the severity of the clinical stage of cirrhosis. Albumin synthesis rates significantly correlated with the Child scores, the galactose elimination capacity, and the aminopyrin breath test, whereas fibrinogen synthesis rates showed no such correlations.

Method for the determination of 15NH3 enrichment in biological samples by gas chromatography/electron impact ionization mass spectrometry

An alternative method for the determination of [15N]ammonia enrichment in biological fluids was developed. It is based on the use of glutamate dehydrogenase of bovine liver (EC 1.4.1.2.) with 2-oxopentanoic acid as substrate, to convert the ammonia present in the sample into norvaline, the enrichment of which can be measured by gas chromatography/mass spectrometry as its tertiary butyldimethylsilyl (TBDMS) derivative under electron impact selective ion recording (SIR) conditions. The principal advantage of the present approach is that it is simpler and quicker than the previously described methods, because the synthetic product, norvaline, is not present in biological fluids and pre-processing of the sample is unnecessary. The procedure includes a pre-incubation stage which allows removal of contaminant ammonia present in the reagents used for the enzyme reaction. The contributions of other sources of nitrogen to norvaline production have been checked and quantified: these may provide limitations of the technique when samples for analysis are low in ammonia (e.g. arterial or hepatic venous blood). To reduce these contributions, short times of incubation are proposed. The results from two experiments in vivo in which two sheep were infused with [15N]ammonium chloride in the mesenteric vein are presented and the biological implications which arise from the results are discussed. The validity of the procedures was demonstrated by the quantitative recovery from the mesenteric and portal veins of [15N]ammonia infused.

Effects of Na-K-2Cl cotransport inhibition on myocardial Na and Ca during ischemia and reperfusion

In the context of the "pump-leak" hypothesis (37), changes in myocardial intracellular Na (Nai) during ischemia and reperfusion have historically been interpreted to be the result of changes in Na efflux via the Na-K pump. We investigated the alternative hypothesis that changes in Nai during ischemia are the result of changes in the Na "leak" rather than changes in the pump. More specifically, we hypothesize that the increase in Nai during ischemia is in part the result of increased Na uptake mediated by Na/H exchange. Furthermore, we present data consistent with the interpretation that the Na-K-2Cl cotransporter is active (or, alternatively, displaced from equilibrium) during ischemia and may contribute an additional Na efflux pathway during reperfusion. Thus inhibition of Na efflux via Na-K-2Cl cotransport during ischemia and reperfusion could result in increased Nai and therefore decreased force driving Ca efflux via Na/Ca exchange and ultimately increased intracellular Ca concentration ([Ca]i). Nai (in meq/kg dry wt) and [Ca]i (in nM) were measured in isolated Langendorff-perfused rabbit hearts using nuclear magnetic resonance spectroscopy. Except, during the 65 min of ischemia, hearts were perfused with N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid-buffered Krebs-Henseleit solution equilibrated with 100% O2 at 23 degrees C and pH 7.4 +/- 0.05. During ischemia, Nai rose from 16.6 +/- 0.3 to 62.9 +/- 5.1 (delta Nai approximately 46) meq/kg dry wt and decreased during subsequent reperfusion (mean +/- SE, n = 3 hearts). To measure Na uptake ("leak") in the absence of efflux via the Na-K pump, in all of the protocols described below, the perfusate was nominally K-free solution containing 1 mM ouabain for 10 min before ischemia and during the 30-min reperfusion. After K-free perfusion, Nai rose from 20.2 +/- 0.5 to 79.1 +/- 5.3 (delta Nai approximately 59) meq/kg dry wt (n = 3) during ischemia and decreased during K-free reperfusion. When amiloride (1 mM) was added to the K-free perfusate to inhibit Na/H exchange, Nai rose from 16.3 +/- 0.9 to 44.7 +/- 5.1 (delta Nai approximately 28) meq/kg dry wt (n = 3) during ischemia; i.e., amiloride decreased Na uptake. When bumetanide (20 microM) was added to the nominally K-free perfusate to inhibit Na-K-2Cl contransport, Nai rose from 22.5 +/- 3.9 to 83.8 +/- 13.9 (delta Nai approximately 61 meq/kg dry wt (n = 3) during ischemia and did not decrease during reperfusion; i.e., bumetanide inhibited Na recovery during reperfusion (P < 0.05 compared with bumetanide free). For the same protocol, the presence of bumetanide resulted in increased [Ca]i during ischemia and reperfusion (P < 0.05); these increases in [Ca]i are interpreted to be the result of increased Nai. Thus the results are consistent with the hypotheses.

Personality, appraisal, and adaptational outcomes in HIV seropositive men and women

A cross-sectional exploratory design was used to assess the relationships of personality, socioeconomic status, and appraisal with functional and emotional outcomes in 77 men and 50 women with HIV infection. Multiple regression analysis showed that, among men, socioeconomic status moderated the negative relationship between self-esteem and disruption in usual activities. Consistent with Lazarus and Folkman's (1984) theory, appraisal of HIV threat mediated the negative relationship between self-esteem and mood disturbance for men and women, and the positive relationship between self-esteem and purpose in life for women. Appraisal did not mediate between personality variables and disruption in usual activities or life satisfaction for men or women.