NEM and filipin increase albumin transport in lung microvessels

This study was undertaken to evaluate the role of transcytosis as a bulk transfer mechanism for the passage of albumin from blood to tissue. Isolated rat lungs were continuously weighed and perfused with an albumin-serum buffer solution under strictly controlled hemodynamic conditions, which allowed measurements of microvascular pressure and of the capillary filtration coefficient (L(p)S). With the use of a tissue uptake technique, it was possible to determine lung albumin clearance under isogravimetric conditions (Cl(iso)), or at elevated filtration rates, to obtain an "apparent albumin reflection coefficient" (sigma(alb)). Experiments were performed during control and after reducing lung temperature from 35 degrees to 22 degrees C and after infusions of the transcytosis inhibitors N-ethylmaleimide (NEM) or filipin. Cooling moderately increased vascular resistance and reduced L(p)S and Cl(iso) largely in proportion to the induced increases in viscosity. At 35 degrees C, NEM (0.13 mM) caused a marked increase in L(p)5 and in Cl(150) and also caused a reduction in sigma(alb.) Furthermore, Cl(iso) increased for the highest dose of filipin tested (1.8 microg/ml). The demonstrated relative cooling insensitivity of the transfer of albumin across the endothelium in rat lungs does not support the contention of transcytosis of proteins across the endothelium. Furthermore, neither NEM nor filipin inhibited lung microvascular albumin transport, but actually increased lung endothelial permeability.

Bruising and the ketogenic diet: evidence for diet-induced changes in platelet function

Excessive bruising is a symptom noted by parents of some children treated with the ketogenic diet for epilepsy control, although this side effect is not reported in the literature. We evaluated our cohort of current and past diet-treated patients for symptoms of bruising or bleeding through chart review and prospective screening at clinic follow-up visits. A significant increase in bruising or other minor bleeding was reported and/or observed in 16 of 51 patients (31.4%). There were no differences in sex distribution or number of anticonvulsants used between patients with bruising/bleeding and those without this symptom, although the group with bruising/bleeding was significantly younger. No specific anticonvulsant was associated with bruising/bleeding. Six patients with diet-induced bruising/bleeding underwent an investigation for bleeding diathesis. Five of these patients had prolonged bleeding times and all had diminished responsiveness to various platelet aggregating agents, with no evidence of a release defect. The abnormalities all normalized in the 1 patient tested after ceasing the diet. No patients had serious hemorrhage. One patient had mild von Willebrand disease, which had been asymptomatic before diet initiation. Some patients were Stimate responsive, suggesting a treatment for more severe bouts of symptoms. These data suggest that a ketogenic diet-related bleeding tendency occurs in about one third of treated patients owing to preexisting factors defining susceptibility in combination with diet-induced depression of platelet responsiveness, possibly related to changes in platelet membrane lipid composition and/or concentration and resultant effects on function of membrane-embedded proteins. Patients on the diet undergoing anticoagulation or surgery should be evaluated carefully for symptoms of bleeding tendency.

Hepatitis C virus among genitourinary clinic attenders in Scotland: unlinked anonymous testing

Our objective is to gauge the prevalence of hepatitis C virus (HCV) antibodies among a population at risk of contracting sexually transmitted infections (STIs) and, thus, the efficiency with which the virus is transmitted sexually. The investigators undertook an unlinked anonymous HCV antibody testing study of residual syphilis serology specimens taken from attenders of genitourinary clinics in Glasgow, Edinburgh and Aberdeen during 1996/97. The results were linked to non-identifying risk information. Anti-HCV prevalences among non-injecting heterosexual men and women, and non-injecting homosexual/bisexual males ranged between 0 and 1.2%; the only exception to this was a 7.7% (4/52) prevalence among homosexual/bisexual males in Aberdeen. The overall anti-HCV prevalence for homosexual/bisexual males was 0.6% (4/668), for heterosexual males 0.8% (32/4135), for heterosexual females 0.3% (10/3035) and for injecting drug users 49% (72/148). Only 3 (all female) of the 46 non-injectors who were antibody positive were non-UK nationals or had lived abroad. HCV antibody positive injectors were less likely to have an acute STI and more likely to know their HCV status than non-injectors; no differences in these parameters were found between positive and negative non-injectors on anonymous HCV antibody testing. Our findings are in keeping with the prevailing view that HCV can be acquired through sexual intercourse but, for most people, the probability of this occurring is extremely low. Interventions to prevent the spread of HCV should be targeted mainly at injecting drug user (IDU) populations.

Distinctive patterns of static and dynamic gamma motor activity during locomotion in the decerebrate cat

Simultaneous recordings were made from gamma (gamma) motor axons and from muscle spindle afferents of the medial gastrocnemius (MG) muscle during locomotion in decerebrate cats. The gamma-neurons were identified as static or dynamic (gammas or gammad) by correlating their behaviour during midbrain stimulation with changes in muscle spindle afferent responses to muscle stretch. On the basis of their behaviour during locomotion, gammas neurons could be divided into two groups. One group (type-1) showed strongly and smoothly modulated discharge increasing in parallel with the active muscle shortening in ankle extension, but with phase advance. The other group (type-2) also showed a modulated pattern, but with increased firing centred on the flexion phase. The proportions of the two were 13 type-1 and 7 type-2. The type-1 firing pattern accurately predicted the difference in firing frequency for secondary afferents obtained by subtracting from the recordings made during active movements the response of the same units to the movements repeated passively in the absence of fusimotor activity. The type-2 pattern also became consistent with the difference signal, when operated on by a phase lag appropriate to the effects of bag2 intrafusal fibres. These results suggest that there may be some degree of separate control of chain and bag2 intrafusal fibres. The discharge of gammad axons was also found to fluctuate with the locomotor cycle, with a pattern very distinct from that of the gammas records. The gammad firing frequency rose very suddenly from zero to a maximum at the onset of muscle shortening and continued into the beginning of lengthening. The term 'interrupted' discharge is suggested as a useful description. The timing of this discharge was shown to be appropriate for sensitising the primary afferents to detect the onset of stretch.

Can children recall their experiences of admission to an intensive care unit?

OBJECTIVE

To perform a pilot study to prospectively determine children's ability to recall events experienced during admission to a paediatric intensive care unit.

METHODS

Children's recall of the intensive care experience was evaluated, using telephone interview, at four to eight weeks and six to twelve months following discharge. Separate scores were assigned to reflect children's recall of general events and painful events. Recall was classified as either limited or extensive. Statistical analysis was performed to detect change in recall status over time and the association between the ability to recall and relevant admission variables (previous admission status, type of admission, frequency/intensity of painful procedures, length of stay and administration of analgesia/sedation).

RESULTS

In a sample of 50 children, recall of general events was extensive 4-8 weeks after discharge in 29 (58%) children and extensive in 26 (52%) children 6-12 months after discharge. Recall of painful events was extensive 4-8 weeks after discharge in 15 (30%) children and 14 (28%) children at 6-12 months after discharge. Thirteen (33.3%) of the 39 children who received analgesia/sedation had extensive recall of painful events at 4-8 weeks after discharge; 12 (30.8%) children had extensive recall at 6-12 months after discharge.

CONCLUSIONS

Children have the ability to recall many of their experiences related to admission to a paediatric intensive care unit and can continue to recall many of these experiences twelve months after discharge. Despite current methods for guiding titration of opiate infusions and intermittent administration of benzodiazepines, many children can recall painful experiences and general events encountered within the intensive care unit.

Effect of protein binding on renal extraction of 131I-OIH and 99mTc-labeled tubular agents

The clearance of 99mTc-mercaptoacetyltriglycine (MAG3) is less than the clearances of o-131I-iodohippurate (OIH) and 99mTc-labeled DD- and LL-ethylenedicysteine (EC). This difference could be associated with the lower affinity of MAG3 for the tubular transport receptor, but MAG3 is more highly protein bound than OIH and the EC isomers; protein binding could also be an important factor governing tubular extraction. To separate the effects of protein binding from tubular receptor affinity, the extraction fractions (EFs) of MAG3, OIH, and the DD, LL, and DL isomers of 99mTc-EC were measured in an isolated perfused rat kidney model using a protein-free perfusate and perfusates containing bovine serum albumin.

METHODS

The right kidney was removed from the rat and perfused with modified Krebs-Henseleit buffers containing 7.5 or 2.5 g/dL bovine serum albumin or a protein-free perfusate. OIH was coinjected into the renal artery with each of the 99mTc-tracers. Protein binding was measured in each of the perfusates, and the venous outflow was collected to determine the EF.

RESULTS

The protein binding of MAG3 in the albumin perfusates ranged from 87% to 95%, significantly higher than the 20%-34% range of protein binding observed with the three EC complexes (P < 0.05). In the 2.5 g/dL albumin perfusate, the EF of MAG3 was 44%, significantly less than the 57%-77% EF of the three EC complexes; in the 7.5 g/dL perfusate, the MAG3 EF fell to 18% versus 39%-45% for the EC complexes (P < 0.05). However, in the protein-free perfusate, the EF of MAG3 was 64%, equal to or higher than the 46%-62% EF of the three EC complexes.

CONCLUSION

Protein binding modulates the tubular extraction of renal tracers. Protein binding and receptor affinity must be considered in the design of future renal radiopharmaceuticals as well as radiopharmaceuticals targeting other receptors.

Embolization of uterine leiomyomata: current concepts in management

Transcatheter bilateral uterine artery embolization is a relatively new, but fast increasing modality being offered as an alternative to surgery for the treatment of symptomatic uterine fibroids (myomata). Since its introduction in 1995, it is estimated that over 5000 procedures have been performed, despite little objective evidence of its efficacy in comparison with more traditional surgical procedures, e.g. hysterectomy, abdominal or laparoscopic myomectomy or hysteroscopic procedures. The enthusiastic uptake of uterine artery embolization is partly due to the fact that it can be performed as a day case, and is a means of avoiding surgery especially hysterectomy. However, the procedure is not without significant risks, and these are becoming clearer as more procedures are being reported. This review examines the procedure, its use and purported efficacy and discusses its complications and potential hazards.

Inattentive behavior in childhood: epidemiology and implications for development

Poor concentration is a relatively common childhood problem. The current North American psychiatric diagnostic classification system (Diagnostic and Statistical Manual of Mental Disorders, fourth edition; DSM-IV), American Psychological Association, 1994) differentiates children whose problems are distinguished primarily by symptoms of inattention (ADHD-I) from those whose difficulties are characterized by overactive, impulsive behavior by providing various subtypes within a broad diagnostic category. Yet, comparatively little is known about children who exhibit purely inattentive behavior. This study aims to redress this issue by using a large, community-based, epidemiological sample of 7-year-old children to compare the developmental functioning, social, and environmental backgrounds of children with pure inattentive behavior to that of children with pure overactive behavior and combined problems of inattentive and overactive behavior. Five hypotheses, centered on the validity of distinguishing inattentive behavior from overactivity, are tested. Children with pure inattentive behavior were more likely to have general cognitive delays, particularly in the area of language development, and were more likely to come from a family in which the father was of low occupational status. The results are discussed in relation to the implications for research and the identification of needs and intervention with children who exhibit pure inattentive behavior.

Variable heating rate thermogravimetric analysis as a mechanism to improve efficiency and resolution of the weight loss profiles of three model pharmaceuticals

The effect of variable heating rates on the efficiency or resolution of the derivative of the thermogravimetry profiles of three model pharmaceutical compounds was investigated. The variable heating system utilized computer controlled algorithms for the evaluation of crystalline sodium warfarin, DuP 532 and hydrated DuP 925 as model compounds with one, two and three step weight loss profiles, respectively. As the heating modes were increased through each of the eight settings, the minimum heating rate decreased while the efficiency and resolution and the analysis times increased. The observed weight loss remained relatively constant for each of the model compounds as the heating modes were increased. The efficiency of the derivative of the weight loss profile of crystalline sodium warfarin increased from 121 to 621 as the heating mode increased. The resolution between the two steps of the derivative of the weight loss profile of DuP 532 increased from 1.73 to 3.88 as the heating mode increased. For hydrated DuP 925, the resolution increased from 1.49 to 5.46 between steps 1 and 2 of the derivative of the weight loss profile and from 1.87 to 3.24 between steps 2 and 3 of the derivative of the weight loss profile. Variable heating rates provided a valuable aid in obtaining high efficiency/resolution thermograms. The enhanced efficiency/resolution permitted greater separation of the volatilization process, especially for samples with multi-step weight loss profiles. Increasing the heating mode afforded higher efficiencies/resolutions that typically reached a maximum value at mode 6.

Effects of cadmium chloride administration on the macroscopic and microscopic characteristics of ejaculates from Chios ram-lambs

The effects of cadmium chloride on the volume of the ejaculate, semen density, total number of spermatozoa per ejaculate, viability, grade of motility, and morphological abnormalities were studied in 3-month-old ram-lambs of the Chios breed. Two groups of seven animals each were used. For a period of 7 months, one group was treated with a daily oral dose (3 mg/kg b.w.) of cadmium chloride and the other group received the corresponding volume of doubly distilled water. Blood samples were collected for cadmium determinations, whereas semen was collected weekly. In the cadmium-treated animals, cadmium concentration in the whole blood was increased and the testes weight was lower. The volume of the ejaculate, the semen density and the total number of spermatozoa were significantly reduced by the administration of cadmium chloride. No differences were observed in the viability, the grade motility of spermatozoa, or the percentage of dead and morphologically abnormal spermatozoa between the control and the cadmium-treated animals. Histopathological examination in the cadmium-treated animals revealed the presence of lesions in the Sertoli cells, the seminiferous tubules, the primary and the secondary spermatocytes and the spermatides, whereas in the Leydig cells no significant lesions were evident.

The effect of vitamin C supplementation on coagulability and lipid levels in healthy male subjects

Although dietary intake and plasma levels of vitamin C have been inversely associated with cardiovascular disease, the mechanism through which it may exert its effect has not been fully explained. Since thrombosis plays an important role in the onset of cardiovascular disease, we investigated the effect of vitamin C on measures of hemostasis that have been associated with cardiovascular risk. The effect of vitamin C on lipid levels was also evaluated. In a randomized, placebo-controlled, crossover study, we determined the effect of 2 g daily of vitamin C supplementation on platelet adhesion and aggregation, levels of tissue plasminogen activator antigen, plasminogen activator inhibitor, fibrinogen, plasma viscosity, von Willebrand factor, and lipid levels in 18 healthy male volunteers with low normal vitamin C levels. No striking effects of vitamin C on the hemostatic measures were observed, although tissue plasminogen activator antigen levels were inversely related to Vitamin C levels. Von Willebrand factor levels were slightly higher with vitamin C, although within the normal range. Total cholesterol levels were 10% lower when subjects were receiving vitamin C compared to placebo (167+/-7 mg/dL vs. 184+/-7 mg/dL), P=0. 007), although the total cholesterol/HDL ratio was not significantly different. Higher levels of tissue plasminogen activator antigen, which in the present study were associated with lower vitamin C levels, have been shown in prospective studies to convey an increased risk of cardiovascular events. Further studies of the effect of vitamin C on hemostatic measures are required in higher risk populations or those with known cardiovascular disease.

Reactive synovitis of the knee joint: MR imaging appearance with arthroscopic correlation

OBJECTIVE

To evaluate the use of routine MR imaging sequences in detecting and characterizing secondary reactive synovitis of the knee joint using arthroscopy as the standard of reference.

DESIGN AND PATIENTS

Fifty consecutive patients with a history of knee pain who were referred for MR imaging and subsequently underwent arthroscopy of the knee comprised the study group. MR images were evaluated for the presence and appearance of synovitis reflected in synovial thickening and irregularity. Synovial thickening was graded on MR imaging as follows: 0=normal, 1=thin line of increased signal intensity, 2=increased signal intensity with frond-like or hair-like projections and a granular appearance of joint fluid. Standard knee imaging protocols were used.

RESULTS

The sensitivity, specificity, and accuracy of MR imaging in detecting synovitis compared with arthroscopy were 88%, 97%, and 95%, respectively. Grade 1 synovitis was best seen on proton-density-weighted images, demonstrating increased signal intensity of the synovium against the relatively low signal intensity of the joint fluid. Grade 2 synovitis was best seen on proton-density images and T2-weighted spin echo and fast spin echo images with fat saturation, demonstrating a granular and linear hair-like appearance of joint fluid. Axial and sagittal imaging planes were most helpful in the diagnosis of synovitis.

CONCLUSION

Routine MR pulse sequences are useful in identifying the presence and extent of synovial abnormalities. The detection of different stages of synovial pathology should become an important part of the evaluation of the post-traumatic patient as treatment may be altered as a result.

Functional testing: ACEI renography

Angiotensin-converting enzyme inhibition (ACEI) renography is the only imaging examination that tests directly for the presence of renovascular hypertension (RVH); other imaging examinations test only for the presence of renal artery stenosis (RAS). Consensus panels have recommended that ACEI renograms be interpreted as low, intermediate, or high probability for RVH. ACEI renography is highly accurate in patients with normal renal function and suspected RVH. In this patient population, the sensitivity and specificity of ACEI renography for RAS are approximately 90%; as an initial approach, angiography is not cost effective. Data from 10 studies evaluating cure or improvement in blood pressure in 291 patients undergoing revascularization showed the mean positive predictive value of ACEI renography to be 92%. When azotemic patients present with suspected RVH, as many as 50% of patients may have an intermediate probability ACEI renogram and the sensitivity of detecting RVH falls to approximately 80% even when intermediate and high probability tests are combined.

Calorie restriction increases light-dependent photoreceptor cell loss in the neural retina of fischer 344 rats

We investigated the effect of > or = 8 months of 40% caloric restriction (CR) on photoreceptor cell loss in 12, 18, and 24 month-old Fischer 344 rats (N = 154). Rats were reared at the NIA Biomarkers Program, National Center for Toxicological Research. Photoreceptor cell density, assessed histologically, declined with age in both the CR-fed and ad lib (AL)-fed cohorts (P < 0.000), but declines were more pronounced in the CR cohort (P < 0.0005). The deleterious effect of CR was most pronounced in the central as opposed to the peripheral retina (P = 0.008), suggesting a light-dependent mechanism. Photoreceptor cell density was inversely associated with rearing under bright light (300-750 lux) as compared with rearing under lower illuminance (< or = 200 lux) (P < 0.0005). However, the deleterious effect of bright light on photoreceptor cell density was more pronounced in the CR cohort (P = 0.04). Effects of CR on circadian activity are likely to increase the actual light exposure of the CR cohort and may explain the apparent inability of CR to delay retinal aging in albino rats.

Aluminum inhibits the lysosomal proton pump from rat liver

Lysosomes are cytoplasmatic organelles, delimitated by a single lipoprotein membrane, that contain several enzymes mostly belonging to the hydrolases in that they function mainly for intracellular digestion. Lysosomal internal pH is characteristically acidic and it is maintained around pH 4.5 by a proton pump, an ATPase, that uses energy from ATP hydrolysis to translocate H+ ions into lysosomes. In the presence of Al3+ the proton pump activity is markedly reduced compromising acidic vesicles functionality. Among different species utilized, Al2(SO4)3 and AlF3 were the most effective. Aluminum effect was not observed when the delta pH was produced artificially by nigericin.

Neighborhood deprivation affects children's mental health: environmental risks identified in a genetic design

The possibility that neighborhood conditions affect children's development has captured much attention because of its implications for prevention. But does growing up in deprived neighborhoods matter above and beyond a genetic liability to behavior problems, if genetically vulnerable families tend to concentrate in poor neighborhoods? A nationwide study of 2-year-old twins shows that children in deprived neighborhoods were at increased risk for emotional and behavioral problems over and above any genetic liability. Environmental factors shared by members of a family accounted for 20% of the population variation in children's behavior problems, and neighborhood deprivation accounted for 5% of this family-wide environmental effect. The results suggest that the link between poor neighborhoods and children's mental health may be a true environmental effect, and demonstrate that genetic designs are environmentally informative and can be used to identify modifiable risk factors for promoting child health.

One-year follow-up of opiate injectors treated with oral methadone in a GP-centred programme

AIMS

To examine changes in drug-related behaviour in opiate-dependent injectors treated with oral methadone, in a shared care scheme where consumption of the daily dose is usually supervised by a community pharmacist.

DESIGN

One-year cohort study.

SETTING

Recruitment from the main routes into methadone prescribing in Glasgow during 1996: General Practitioner Drug Misuse Clinic Scheme and the Drug Problem Service.

PARTICIPANTS

Current opiate injectors entering methadone treatment.

FINDINGS

Among the 204 injectors recruited, 148 (73%) were re-interviewed at 6 months and 118 (58%) at both 6 and 12 months. Twenty-nine per cent of the cohort remained continuously on methadone for 12 months. In that group, over the 12-month period, self-reported daily opiate injecting reduced from 78% to 2%; overdose in the previous 6 months from 24% to 2%; mean daily drug spend from 50 Pounds to 4 Pounds; and mean monthly number of acquisitive crimes reduced from 13 to three. Assuming participants lost to follow-up were unchanged, significant improvements in the total cohort were seen in daily opiate injecting (from 80% at recruitment to 43% at 12 months), overdose (from 27% to 15%), mean daily drug spend (from 63 Pounds to 38 Pounds) and mean monthly number of acquisitive crimes (from 18 to 11). Discontinuation of treatment was mainly due to imprisonment (39%) or sanctions by the prescriber (33%).

CONCLUSION

Treatment of opiate-dependent drug injectors with methadone in a community-wide general practitioner-centred scheme, with supervised daily consumption, was associated with major beneficial change for a substantial proportion of patients.