Routine assessment of patient progress: a multiformat, change-sensitive nurses' instrument for assessing psychotic inpatients

A new instrument, the Routine Assessment of Patient Progress (RAPP), is a standardized scale with a unique format that allows trained nurses to incorporate both interview and observational data into a comprehensive assessment of psychiatric inpatients. The scale was developed to accurately document treatment effects, assist in treatment planning, and provide ancillary judgments of psychopathology that may affect diagnosis. The RAPP demonstrates satisfactory interrater reliability and internal consistency. The RAPP total score and its two subscales correlated highly, where expected, with an observation-based nursing scale, global measures, and an interview-based psychopathology scale. RAPP scores demonstrated sensitivity to change over time in patient functioning. It reliably discriminated among patients discharged to settings with varying degrees of independent living. The use of the RAPP over several years on a psychiatric inpatient unit has shown it to be a practical clinical tool that eases nurses' charting demands, helps create care plans, and facilitates interdisciplinary communication.

A clinical study of clozapine treatment and predictors of response in a Canadian sample

OBJECTIVE

To study the clinical response to clozapine in patients with refractory schizophrenia.

METHOD

Open trial of clozapine in 61 consecutively-treated patients.

RESULTS

Following clozapine, the level of function of patients was improved relative to admission (p = 0.0001) and to the highest level in the previous year (p = 0.0001). Severity of illness was decreased (p = 0.0001). Overall, 31% of the patients were classified as responders to clozapine and the responders were all identified by 32 weeks of treatment. Poor functioning in the previous year was associated with less favourable response. At a mean interval of 26 months following discharge, 72% of the patients were continuing clozapine treatment.

CONCLUSIONS

This open trial of patients who were treated consecutively indicates a comparable degree of response to clozapine as observed in controlled clinical trials, and that level of functioning in the previous year was the best predictor of response.

On the Giant Octopus (Octopus giganteus) and the Bermuda Blob: Homage to A. E. Verrill

We have obtained samples of two large carcasses. One washed up on a beach in St. Augustine, Florida, in 1896 and has been occasionally attributed to a species of gigantic octopus (Octopus giganteus). The other carcass washed up on Bermuda in 1988 and has remained unidentified, although its gross morphology, except for a much smaller total mass, was remarkably similar to the Florida carcass. We have subjected both samples to electron microscopic and biochemical analyses. Our results show that both carcasses are masses of virtually pure collagen. Furthermore, neither sample has the biochemical characteristics of invertebrate collagen, nor the collagen fiber arrangement of octopus mantle. Instead, they are large pieces of vertebrate skin, the Bermuda sample from a poikilotherm and the Florida sample from a huge homiotherm. We conclude that there is no evidence to support the existence of Octopus giganteus.

Obstetric complications and severity of illness in schizophrenia

A history of obstetric complications (OCs) is common in schizophrenia and may lead to a severe form of the disorder. In order to test this possibility, three questions were identified: (1) Is a history of OCs in schizophrenia common in patients with a severe form of illness? (2) Do patients with OCs have more impaired function, greater severity of illness, and poorer treatment outcome than those with no identified OCs? (3) Are OCs associated with an early age at onset of illness? Obstetric history, clinical indices of functioning, and illness severity were obtained for 83 severely ill patients with schizophrenia. The proportion of patients with a history of OCs was greater in this study than has been reported previously. Subjects with a history of OCs had better functioning than those with no OCs at the time of admission but no group differences were found at discharge. No difference in age at onset of illness was found between patients with and without an OC history.

Methyldopa hepatotoxicity in pregnancy: a case report

A case of hepatotoxicity in a multiparous Native woman, who was begun on a regimen of methyldopa for control of chronic hypertension, is described. The patient was first seen for clinical evidence of hepatotoxicity approximately 3 weeks after initiation of treatment. At presentation the aspartate aminotransferase level was 1800 IU/L and alanine amniotransferase was 2415 IU/L. There was also a significant prolongation of clotting time, which required therapy. Resolution of symptoms occurred after cessation of the medication. Although methyldopa is considered to have a wide margin of safety in the treatment of chronic hypertension in pregnancy, potentially serious adverse effects can occur. It is important to monitor serum aminotransferase levels after initiation of methyldopa therapy.

Diagnostic reassessment and treatment response in schizophrenia

BACKGROUND

The reasons for poor treatment response in some patients with schizophrenia remain unclear. It is possible that misdiagnosis of nonschizophrenic disorders as schizophrenia could result in suboptimal pharmacotherapy in some patients.

METHOD

To assess this possibility, 110 severely ill, chronic patients with a referral diagnosis of schizophrenia were comprehensively assessed and rediagnosed according to DSM-III-R criteria. Global Assessment of Function (GAF) and Clinical Global Impressions (CGI) ratings were made at admission and at discharge from the ward, after the implementation of individualized treatment plans.

RESULTS

The diagnosis of schizophrenia was confirmed in 80 patients (73%) and revised to another type of psychotic illness in 30 patients (27%). The GAF and CGI ratings were similar at admission in patients with confirmed and revised diagnoses. All patients improved by the time of discharge (p = .0001); however, patients with a revised diagnosis improved more than those with confirmed schizophrenia (p = .02). Patients with a revised diagnosis were less likely to require continued hospitalization on chronic care wards (p = .004). At admission, medication regimens were similar in the two groups of patients. At discharge, patients with a revised diagnosis were less likely to have received neuroleptics (p = .007) and more likely to have received antimanic drugs (p = .0002) or electroconvulsive therapy (p = .0004).

CONCLUSION

These findings from a clinical sample suggest that diagnostic reassessment is an important first step in the management of apparently refractory schizophrenia.

Temporal lobe abnormalities in multigenerational families with schizophrenia

Brain structure in familial schizophrenia was studied with computerized tomography in 42 individuals from six multigenerational families. Sulcal enlargement in the lateral temporal cortex, and ventricular and cisternal enlargement in the medial temporal region were observed in psychotic individuals compared to unaffected family members. Genetic factors in familial schizophrenia may exert part of their effect through determining or altering temporal lobe structure.

Synthesis of a phenotypically abnormal type XI: type II collagen ratio by chondrocytes from canine osteoarthritic cartilage

Collagen synthesis by osteoarthritic cartilage from dogs that had undergone anterior cruciate ligament transection was measured in short-term organ cultures and chondrocyte suspension cultures. Slices of osteoarthritic cartilage from unstable knees 2, 6 or 12 weeks after anterior cruciate ligament transection converted approximately 10% of the total incorporated 14C-proline to 14C-hydroxyproline, while the value for cartilage from the contralateral knee or from knees of normal control dogs was generally less than 1%. The increase in collagen synthesis in the osteoarthritic cartilage was not related to the duration of knee instability, but was greater in grossly fibrillated cartilage than in the total pooled cartilage from the osteoarthritic joint. The collagen that was synthesized was predominantly type II, although some type XI and/or type V collagen was also synthesized. Chondrocytes isolated from osteoarthritic knee cartilage of dogs 12 weeks after anterior cruciate ligament transection showed changes in collagen synthesis similar to those seen in the cartilage organ cultures. As in the organ culture studies, type II collagen was the predominant species synthesized. When cell-associated collagen was considered, type II collagen accounted for 87+/-7% of the total collagen synthesized and retained by the osteoarthritic chondrocytes. The corresponding value for cells from the contralateral knee was 63+/-10%. Since the collagen fiber in articular cartilage is a heteropolymer of type II, type XI and type IX collagen, it is likely that the newly synthesized collagens in this model of osteoarthritis form fibers that are phenotypically different from those in normal articular cartilage.

Constitutive synthesis of 1,25-dihydroxyvitamin D3 by a human small cell lung cancer cell line

One of 16 human small cell lung cancer cell lines examined was shown to synthesize a metabolite resembling 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3]. The NCI H82 line converted 25-hydroxyvitamin D3 (25OHD3) into a compound indistinguishable from 1,25-(OH)2D3 in 3 different high performance liquid chromatography systems. Electron impact mass spectra for the trimethylsilylethers of the metabolite and authentic 1,25-(OH)2D3 were indistinguishable. Binding to an anti-1,25-(OH)2D3 antibody was identical for the metabolite and authentic 1,25-(OH)2D3, whereas administration to rats in vivo caused equivalent stimulation of calcium transport measured in vitro in duodenal sacs. Activity of the H82 1 alpha-hydroxylase appears to be substrate dependent and is not stimulated by PTH, suggesting that it is similar to the enzyme expressed by activated macrophages and other cell types at extrarenal sites. Inhibition by ketoconazole indicates that, like the renal and extrarenal enzymes, the H82 enzyme is cytochrome P450 dependent. These data indicate that the H82 small cell lung cancer cell line constitutively expresses 25-hydroxyvitamin D3-1 alpha-hydroxylase and can synthesize 1,25-(OH)2D3.

Effect of ethanol on immature ovine fetal breathing movements, fetal prostaglandin E2, and myometrial activity

In the mature ovine fetus, ethanol decreases fetal breathing movements (FBM), which is temporally related to increased prostaglandin E2 (PGE2) concentration, decreases blood glucose concentration, increases blood lactate concentration, and decreases uterine electromyographic (EMG) activity. The objective of this study was to determine the effects of ethanol on these variables in the immature fetal sheep. Experiments were conducted in pregnant ewes at 85-94 days of gestation (full term 147 days) that received a 1-h maternal infusion of 1 g ethanol/kg maternal body wt (n = 9) or an equivalent volume of saline (n = 5). The maximal maternal and fetal blood ethanol concentrations for the ethanol regimen were 1.305 +/- 0.165 and 1.458 +/- 0.137 mg/ml, respectively. Maternal infusion of ethanol (or saline) did not change the incidence of FBM, fetal plasma PGE2 concentration, heart rate, blood pressure, blood gases and pH, or uterine EMG activity. Ethanol decreased (P < 0.05) fetal blood glucose concentration from 1.18 +/- 0.10 to 0.87 +/- 0.07 and 0.89 +/- 0.09 mM at 1 and 3 h, respectively, but did not alter blood lactate concentration compared with saline infusion. These data support the hypothesis that the effects of ethanol on FBM, fetal plasma PGE2 and blood lactate concentrations, and uterine EMG activity are gestational age dependent.

Increased uteroplacental production of prostaglandin E2 during ethanol infusion

Experiments were conducted in 14 pregnant sheep to determine the effect of a 1-h maternal infusion of ethanol (1 g/kg maternal body wt) on placental efflux of prostaglandin E2 (PGE2), umbilical blood flow (Qum), and carbohydrate metabolism at 123-130 days gestation. This ethanol dosage regimen produced peak ethanol concentrations in fetal and maternal blood in the range of 1.48-1.64 mg/ml at the end of the infusion. Umbilical venous and fetal arterial PGE2 concentrations increased (P < 0.05) from 315 +/- 47 and 202 +/- 25 pg/ml to 740 +/- 172 and 489 +/- 67 pg/ml, respectively, at the end of the infusion. Placental secretion of PGE2 into the fetal circulation increased by 45% (P < 0.05). Uterine venous and maternal arterial PGE2 concentration increased (P < 0.05) from 370 +/- 27 and 262 +/- 28 pg/ml to 705 +/- 51 and 487 +/- 69 pg/ml, respectively. Fetal and maternal blood glucose concentration decreased (P < 0.05) from 0.98 +/- 0.11 and 2.88 +/- 0.25 mmol/l to 0.81 +/- 0.21 and 2.44 +/- 0.16 mmol/l, respectively. Fetal and maternal blood lactate concentration increased (P < 0.05) from 1.40 +/- 0.11 and 0.68 +/- 0.07 mmol/l to 1.67 +/- 0.14 and 1.82 +/- 0.16 mmol/l, respectively. Qum, fetal heart rate, fetal blood pressure, and fetal and maternal blood gases were unchanged by the ethanol infusion. These results support the hypothesis that the placenta is the major source of the elevated fetal and maternal plasma PGE2 concentrations produced in pregnant sheep by maternal ethanol administration.

Effects of difloxacin on the metabolism of glycosaminoglycans and collagen in organ cultures of articular cartilage

Fluoroquinolones, including difloxacin, are potent antibacterial compounds which, as a side effect, cause lesions in articular-epiphyseal cartilage complexes (AECC) of growing animals. To evaluate the effects of difloxacin on the structure of AECC and the metabolism of sulfated glycosaminoglycans (GAG) and collagen, explants of AECC were obtained from 18 healthy, 3-month-old Beagle dogs and cultured in medium which either had no difloxacin or had the drug at one of three concentrations (40, 80, or 160 micrograms/ml). Rates of synthesis of GAG and collagen were reduced by concentrations of difloxacin that were at or above 80 micrograms/ml. The rate of synthesis of total protein, however, was reduced only at the highest dose level. Catabolism of GAG and collagen was unaffected by the treatment. The principal ultrastructural changes in affected chondrocytes were distension of rough endoplasmic reticulum with electron-dense material that was probably protein, and vacuolation of cytoplasm. Structural changes were not observed in the extracellular matrix. It, therefore, appeared plausible that difloxacin affected chondrocytes by interfering with secretion of the matrix components, GAG and collagen.

Reduction of the severity of canine osteoarthritis by prophylactic treatment with oral doxycycline

OBJECTIVE

In vitro studies have indicated that levels of neutral metalloproteinases in osteoarthritic (OA) cartilage are elevated and that doxycycline (doxy) inhibits collagenolytic and gelatinolytic activity in extracts of OA cartilage. The purpose of the present study was to test the effect of oral doxy administration on the severity of cartilage degeneration in OA.

METHODS

OA was induced in 12 adult mongrel dogs by transection of the anterior cruciate ligament (ACL) 2 weeks after dorsal root ganglionectomy. Six dogs received doxy orally from the day after ACL transection until they were killed 8 weeks later; the other 6 served as untreated OA controls.

RESULTS

The unstable knee of each untreated dog exhibited extensive full-thickness cartilage ulceration of the medial femoral condyle. In sharp contrast, cartilage on the distal aspect of the femoral condyle of the unstable knee was grossly normal in 2 doxy-treated dogs, and exhibited only thinning and/or surface irregularity in the others. Degenerative cartilage lesions on the medial trochlear ridge, superficial fibrillation of the medial tibial plateau, and osteophytosis were, however, unaffected by doxy treatment. Collagenolytic activity and gelatinolytic activity in cartilage extracts from OA knees of untreated dogs were 5-fold and 4-fold greater, respectively, than in extracts from dogs given doxy.

CONCLUSION

Prophylactic administration of doxy markedly reduced the severity of OA in weight-bearing regions of the medial femoral condyle. It remains to be determined whether administration of doxy after OA changes have developed is also effective.

Effect of ethanol on the release of prostaglandins from ovine fetal brain stem during gestation

Prostaglandins (PGs) have been implicated as mediators of the ethanol-induced suppression of ovine fetal breathing movements (FBM). The objectives of the present study were to determine the ontogeny of the in vitro efflux of PGE2 and 6-keto PGF1 alpha in ovine fetal brain stem during the second half of gestation and to determine the effect of in vitro ethanol exposure on the efflux of these PGs. Ovine fetal brain stem tissue was obtained at mean gestational ages of 80 days (n = 6), 105 days (n = 10), and 135 days (n = 16) by rapid excision following maternal euthanization. Tissue slices (400 microM thickness) were prepared from the lower pons-medulla region of the brain stem. After a 1-hr equilibration period in artificial cerebrospinal fluid, efflux of PGE2 and 6-keto PGF1 alpha in the brain stem was determined using the brain slice-superfusion method, and the PGE2 and 6-keto PGF1 alpha concentrations in the superfusate were determined by specific radioimmunoassay. The mean spontaneous efflux of PGE2 and 6-keto PGF1 alpha expressed as pmol PG/gram wet weight of tissue/5-min collection period was, respectively, 31.9 +/- 4.2 and 26.6 +/- 2.4 at 80 days, 38.3 +/- 5.2 and 29.6 +/- 2.2 at 105 days, and 57.4 +/- 3.1 and 27.1 +/- 1.1 at 135 days of gestation. In vitro exposure to 20, 40, and 80 mM ethanol did not affect PG efflux in the brain stem at 80 and 105 days of gestation. In vitro ethanol exposure decreased PGE2 and 6-keto PGF1 alpha efflux at 135 days of gestation to 36.8 +/- 5.3% and 41.6 +/- 4.3% of spontaneous efflux within 15 min, respectively; this effect of ethanol was not dose-dependent. The data do not support the hypothesis that ethanol increases PG efflux in the ovine fetal brain stem. In view of these findings and the data implicating PGs in the mechanism of ethanol-induced suppression of FBM, it is possible that ethanol acts at either central sites rostral to the brain stem (i.e., upstream CSF) or peripheral sites to increase the synthesis of PGs and their efflux into the systemic circulation, with subsequent transfer to the respiratory control region(s) of the brain stem.

Diagnostic confusion in treatment-refractory psychotic patients

BACKGROUND

Two surveys of diagnostic practices in the United States suggest that many clinicians base their diagnoses on presenting symptoms and pay little attention to course and exclusionary criteria. Failure to correctly diagnose patients may result in inappropriate therapy and poor treatment response. The purpose of the present study was to investigate diagnostic practices.

METHODS

We made detailed assessments of 50 consecutively admitted treatment-refractory psychotic patients and carefully applied DSM-III-R criteria.

RESULTS

Referral diagnoses were changed in 23 of the 50 patients. Diagnoses of schizophrenia and schizoaffective disorder were made far less frequently and mood disorders (bipolar disorder and major depression) were diagnosed far more frequently by our group than by referring psychiatrists. Patients whose diagnosis was changed were more likely to be given mood-stabilizing medication and tended to show more improvement than patients whose diagnosis was not changed.

CONCLUSIONS

These findings raise the possibility that patients may not respond to treatment because incorrect diagnoses result in inappropriate treatment.

Characterization of type V collagenase (gelatinase) in synovial fluid of patients with inflammatory arthritis

Gelatin degrading matrix metalloproteinases in synovial fluid from 21 patients with inflammatory arthritis were shown to consist of two distinct gene products, 92 and 70 kDa gelatinases. The gelatinolytic activity of 92 kDa enzyme, which is released from stimulated neutrophils, was positively correlated to neutrophil count in the fluid. By contrast, 70 kDa molecule did not correlate with neutrophil cell count. Purification of these enzymes revealed they could degrade type XI collagen, a cartilage component resistant to interstitial collagenase. The elevated levels of 92 kDa gelatinase in rheumatoid arthritis samples compared to osteoarthritis suggest a role of this enzyme in cartilage destruction.

Hypothesis: can type IX collagen "glue" together intersecting type II fibers in articular cartilage matrix? A proposed mechanism

Type IX collagen is crosslinked to the surface of type II collagen molecules, and has been proposed as the glue that binds the collagen network of cartilage matrix. However, there is as yet no evidence that the crosslinks that have been described to date provide interfibrillar connections, and the only mechanism proposed for such connections between intersecting fibers is unlikely on stereochemical grounds. We propose that both type IX collagen and an intermediary molecule are necessary for network stabilization and that proteoglycans are likely candidates for the role of intermediary.

The effects of indomethacin and prostaglandin E2 on the ethanol-induced suppression of ovine fetal breathing movements

A study was performed to examine the role of prostaglandins (PGs) in the mechanism of the ethanol-induced suppression of FBM, in which the objective was to test the hypothesis that fetal administration of PGE2 can suppress the incidence of FBM following reversal of ethanol-induced suppression of FBM by indomethacin, a fatty acid cyclooxygenase inhibitor. Instrumented near-term pregnant ewes received 1-h maternal infusion of ethanol (1 g/kg maternal body weight) followed 0.5 h later by a 3-h fetal infusion of indomethacin (1 mg/kg fetal body weight/h), and then a 2-h fetal infusion of PGE2 (400 ng/kg fetal body weight/min). Prior to drug administration, FBM occurred approximately 36.1 +/- 2.6% of the time. FBM were suppressed during the period of ethanol infusion (9.6 +/- 1.7%); the ethanol-induced suppression of FBM was reversed by fetal indomethacin treatment (77.5 +/- 14.1%); shortly after the onset of fetal PGE2 infusion, the incidence of FBM decreased to a 2-h mean incidence of 14.1 +/- 4.2%, which was similar in magnitude to that observed after maternal ethanol infusion. After the completion of PGE2 infusion, the incidence of FBM rapidly increased to a peak incidence of 83.4 +/- 19.2%, which was indicative of a prolonged effect of indomethacin on FBM. The data indicate that PGs mediate the ethanol-induced suppression of ovine FBM and that the action of indomethacin to antagonize ethanol-induced suppression of FBM is primarily due to its inhibition of PG synthesis.

Doxycycline inhibits type XI collagenolytic activity of extracts from human osteoarthritic cartilage and of gelatinase

Doxycycline was shown to inhibit digestion of exogenous type XI collagen by homogenates of human osteoarthritic cartilage in vitro. On SDS-PAGE, the cleavage products generated by cartilage extracts were larger and less abundant, indicating less complete cleavage, when doxycycline (10 or 30 microM) was added to the samples. The inhibitory effect was concentration dependent. Purified gelatinase from canine kidney epithelial cells, which also digests type XI collagen, was inhibited in a similar manner by doxycycline. If tetracyclines inhibit this metalloproteinase activity in articular cartilage in vivo, they could modify cartilage breakdown in osteoarthritis.

Serum levels of type III procollagen peptide in Equidae before and after intestinal ischemia

Serum levels of type III procollagen peptide (P-III-P) were measured by radioimmunoassay in clinically normal adult ponies (n = 15) and horses (n = 10). The mean serum levels of P-III-P from the ponies, 10.4 +/- 2.9 (SD) ng/mL, and the horses, 12.2 +/- 2.6 (SD) ng/mL, were not significantly different. Segments of jejunum were made ischemic to induce fibrous peritoneal adhesions in two ponies, and serum P-III-P levels were measured on days 4, 5, 7, 14, and 21. An exploratory celiotomy on day 21 revealed that the ischemic injury had induced fibrosis of the mesentery and bowel, but no adhesions had formed. The fibrotic mesentery contained type III collagen. The highest mean serum level of P-III-P, 23.0 +/- 3.5 (SD) ng/mL on day 7, was more than 4 SD above the mean from the normal ponies. There was a significant difference in the serum P-III-P levels in the ponies on days 0 (7.1 +/- 1.6 ng/mL) and 7 (23.0 +/- 3.5 ng/mL). Serum levels of P-III-P may be useful to study fibrosis associated with intestinal ischemia.

Effects of ethanol exposure on the embryo-fetus: experimental considerations, mechanisms, and the role of prostaglandins

The purpose of this review is to critically examine the effects of ethanol on the embryo-fetus. There has been a tremendous amount of human epidemiological and experimental animal research on the characterization of the anomalies produced by chronic prenatal ethanol exposure and the identification of critical periods of vulnerability and critical amounts of ethanol necessary to produce fetal effects and (or) abnormal development. Few studies have examined the underlying mechanism(s) of the action of ethanol, and even fewer studies have examined the effects of single-dose ethanol exposure on the embryo-fetus. In this review, the current state of knowledge of the effects of chronic use of ethanol on the embryo-fetus is summarized. The primary focus of the review is on the embryonic-fetal effects of acute ethanol exposure, with particular emphasis on the ethanol-induced suppression of fetal breathing movements, as this effect appears to be a very sensitive index of acute exposure of the near-term fetus to ethanol. Factors to be considered in the selection of experimental animals to investigate the mechanism of action of ethanol and to study the acute effects of ethanol are discussed. Postulated mechanisms of action of ethanol on the embryo-fetus are evaluated with a focus on the role of prostaglandins. Finally, future directions in this field of research are proposed.

Cleavage of type XI collagen fibers by gelatinase and by extracts of osteoarthritic canine cartilage

Gelatinase (matrix metalloproteinase 2) purified from culture medium of MDCK cells by affinity chromatography on gelatin-sepharose was tested against type XI collagen. The purified enzyme-digested native type XI collagen in solution, and as reconstituted fibers, at 30, 34, and 37 degrees C. Both substrates yielded the same digestion products, as characterized by SDS-polyacrylamide gel electrophoresis, but the soluble collagen was cleaved at a higher rate. The first major product seen was an 87-kDa peptide, which was usually associated with one or two peptides migrating between it and alpha 3(XI). With time, a second group of 3 peptides appeared at 78, 75, and 73 kDa. After continued digestion, a third group of peptides was detected with prominent 69- and 67-kDa peptides and minor peptides at 71, 65, and 62 kDa. In overnight (20 hour) digestions, the 60-kDa digestion product accumulated and most of the larger digestion products could no longer be detected. Minor products at 71, 55, and 50 kDa were also noted in these limited digestions. Under the same conditions, denatured type XI was digested to fragments smaller than 13.5 kDa. The enzyme was inhibited by 1,10-phenanthroline or EDTA. Two purified components of cartilage matrix, type II collagen and proteoglycan subunit, as well as crude cartilage homogenates, were not effective inhibitors of the purified enzyme. Similar activity was extracted from canine articular cartilage, and the activity was much stronger in cartilage from osteoarthritic joints than from control joints.

On the identification of a conjugated diene component of duodenal bile as 9Z,11E-octadecadienoic acid

The lipid free radical marker, termed diene conjugation, in secretin-stimulated human bile obtained from the duodenum, was shown by high performance liquid chromatography and capillary gas chromatography-mass spectrometry, to be due mainly to 9Z,11E-octadecadienoic acid. The lack of evidence for possible conjugated diene isomers argues for an enzymatic origin of this product rather than being due to a random free radical mechanism, as is usually assumed.

Effects of alcohol (ethanol) on the fetus

Alcohol (ethanol) use during pregnancy can produce a wide spectrum of effects in the developing embryo/fetus that are dependent on the maternal drinking pattern. The effects of chronic ethanol exposure on the developing conceptus are reviewed with primary focus on ethanol teratogenesis, manifesting in the human as the fetal alcohol syndrome or fetal alcohol effects. The effects of acute ethanol exposure on the near-term fetus are described, including suppressed fetal breathing movements, electrocorticographic (ECoG) activity and electrooculographic (EOG) activity. The ethanol-induced suppression of fetal breathing movements is a very sensitive index of acute exposure of the near-term fetus to ethanol, and appears to involve a direct mechanism of action rather than an indirect mechanism involving suppression of electrocortical activity. The disposition of ethanol and its pharmacologically active proximate metabolite, acetaldehyde, and the activity of alcohol dehydrogenase and aldehyde dehydrogenase in the near-term maternal-fetal unit are described, and a pharmacokinetic model is proposed. The effects of short-term ethanol exposure on the near-term fetus include the development of tolerance to the ethanol-induced suppression of fetal breathing movements, low-voltage ECoG activity and EOG activity. The development of tolerance occurs more rapidly to the latter two fetal biophysical activities. The mechanism of tolerance development appears to be pharmacodynamic (functional) in nature, as there is no increase in the rate of ethanol elimination from the maternal-fetal unit. The role of prostaglandins (PGs) in the mechanism of the ethanol-induced suppression of fetal breathing movements is described. In the near-term fetus, there is a direct relationship between fetal blood ethanol concentration and fetal plasma PGE2 concentration, and an inverse relationship between the incidence of fetal breathing movements and each of fetal plasma and fetal cerebrospinal fluid (CSF) PGE2 concentrations. Indomethacin, a PG synthetase inhibitor, selectively blocks and reverses the ethanol-induced suppression of fetal breathing movements. These data support the postulates that the ethanol-induced suppression of fetal breathing movements is mediated by increased PGE2 concentration in the near-term fetus and that the ability of indomethacin to antagonize the ethanol-induced suppression of fetal breathing movements is due to its biochemical action to decrease fetal PGE2 concentration.(ABSTRACT TRUNCATED AT 400 WORDS)