Hepatic tumor imaging using iron oxide MRI: comparison with computed tomography, clinical impact, and cost analysis

BACKGROUND

The surgical management of hepatic tumors has traditionally relied on preoperative contrast-enhanced computed tomography (CECT) in combination with intraoperative ultrasonography (IOUS). Unfortunately, the ability to detect and characterize hepatic tumors by using CECT is limited, and IOUS frequently reveals additional disease that alters the operative approach. Recent advances in hepatic magnetic resonance imaging (MRI) may improve preoperative tumor detection and characterization; however, little is known about how MRI compares with CECT or about the clinical impact and cost considerations of liver MRI.

METHODS

A retrospective chart review was performed to compare iron oxide (Feridex [Fe])-MRI with CECT in the preoperative imaging of hepatic neoplasms, as well as to determine the clinical impact and overall healthcare costs associated with Fe-MRI.

RESULTS

Of approximately 1000 patients who underwent abdominal MRI at a single institution during a 20-month period, 57 were identified who underwent Fe-MRI evaluation of the liver. Indications for imaging included suspected metastases (n = 43), an indeterminate hepatic mass (n = 9), or primary hepatic cancer (n = 5). Overall, Fe-MRI identified a total of 157 lesions (mean, 2.75 per patient; range, 0-14). CECT was performed in 50 patients, of whom 35 had primary or metastatic cancer. Fe-MRI identified more lesions than CT (n = 136 vs. 77; P = .016), and the average size of lesion detected by Fe-MRI was significantly smaller than that by CECT (2.5 vs. 3.4 cm; P = .018). Comparison of CECT and Fe-MRI findings with IOUS and pathological specimens showed a significant difference in sensitivity (MRI, 86%; CECT, 58%; P<.001), and IOUS changed the operative approach in only 5% of those imaged with Fe-MRI. Overall, Fe-MRI altered the clinical management in 67% of patients imaged (n = 38 of 57), which corresponded to an overall net cost savings of $108,368 ($1,901 per patient).

CONCLUSIONS

Fe-MRI is a powerful imaging technique, with greater hepatic tumor detection sensitivity than CECT. Moreover, it is an economically feasible imaging method that will alter the clinical management in most patients imaged.

Improved preservation solutions for organ storage: a dynamic study of hepatic metabolism

BACKGROUND

Organ cold storage times may be extended by modifications to organ preservation solutions.

METHODS

Three preservation solutions were investigated for their ability to maintain viable hepatic bioenergetics in stored pig livers: modified University of Wisconsin (mUW); mUW+adenosine (1.34 g/L), and mUW+ iloprost (10(-8)mol/L), a prostacyclin analogue. Using human liver retrieval and storage techniques, pig livers were stored on ice for either 2 or 16 hr, after which phosphorus-31 spectra were collected every 2 min during the period of cold ischemia and hypothermic reperfusion (HtR). During HtR, metabolite concentration changes associated with phosphomonoesters, inorganic phosphate, gamma-nucleotide triphosphate (NTP), and beta-NTP were measured for all solutions.

RESULTS

After a 2-hr storage, beta-NTP regeneration in mUW+iloprost produced +57.7% (P<0.01) more beta-NTP, at a faster initial rate of +66.3% (P<0.001), compared with mUW, and mUW+adenosine regenerated +35.6% (P<0.05) more beta-NTP, compared with mUW. Storage for 16 hr did not slow the rates of regeneration, and the total NTP produced during the course of the experiment remained unchanged for the respective preservation solutions. Cessation of HtR invoked a net accumulation of nucleotide diphosphate, indicating differential kinetics of adenine nucleotide hydrolysis.

CONCLUSION

This large animal model study suggests significant improvements to human organ preservation solutions using prostacyclin analogues and adenosine with respect to hepatic bioenergetics.

Relation of triglyceride stores in skeletal muscle cells to central obesity and insulin sensitivity in European and South Asian men

AIMS/HYPOTHESIS

To compare the relation between intramyocellular lipid content, central obesity and insulin sensitivity in Europeans and South Asians.

METHODS

Cross-sectional study of 40 South Asian and European non-diabetic men matched for age and body mass index. We measured intramyocellular lipid by proton magnetic resonance spectroscopy of soleus muscle, insulin sensitivity by the short insulin tolerance test, per cent body fat by dual-energy x-ray absorptiometry and visceral fat by single-slice computed tomography of the abdomen.

RESULTS

South Asians compared with Europeans had a higher mean per cent body fat (26.8% vs 22.5%, p = 0.05) and lower insulin sensitivity (mean +/- SEM 2.4 +/- 0.2 vs 3.4%/min +/- 0.3, p = 0.013). Mean (+/- SEM) intramyocellular lipid content was higher in South Asians than in Europeans (72.1 +/- 7.5 vs 53.6 +/- 4.9 mmol/kg dry weight, p = 0.046). In Europeans intramyocellular lipid was correlated with per cent body fat (r = 0.50, p = 0.028), waist:hip ratio (r = 0.74, p < 0.001), visceral fat (r = 0.62, p = 0.004) and insulin sensitivity (r = -0.53, p = 0.016). In South Asians intramyocellular lipid was not significantly related to insulin sensitivity or obesity, and the strongest associations of insulin sensitivity were with fasting plasma triglyceride and waist:hip ratio.

CONCLUSION/INTERPRETATION

The association of intramyocellular lipid with insulin sensitivity and obesity in Europeans is consistent with the hypothesis that muscle triglyceride mediates the effect of obesity on insulin sensitivity. The absence of a similar relation of insulin sensitivity to intramyocellular lipid in South Asians suggests that other mechanisms underlie the high insulin resistance observed in this group.

Evidence for cortical dysfunction in clinically non-demented patients with Parkinson's disease: a proton MR spectroscopy study

OBJECTIVES

To investigate whether proton magnetic resonance spectroscopy (1H MRS) can detect cortical dysfunction in non-demented patients with Parkinson's disease, and to correlate changes with cognitive function on formal neuropsychological testing.

METHODS

Multivoxel 1H MRS was performed in 17 patients with levodopa treated idiopathic Parkinson's disease with out clinical dementia, and 10 age match ed control subjects. Measurements of N-acetylaspartate (NAA)/choline (Cho), NAA/creatine+phosphocreatine (Cr), and Cho/Cr were obtained from right and left temporoparietal cortex and occipital cortex. Fourteen patients with Parkinson's disease underwent a full battery of neuropsychological testing including performance and verbal subtests of the WAIS-R, Boston naming test, FAS test, and California verbal learning test.

RESULTS

There were significant temporoparietal cortex reductions in NAA/Cr ratios in right and left averaged spectra of the patients with Parkinson's disease (p=0.012 after Bonferroni correction) and in spectra contralateral to the worst clinically affected limbs of the patients with Parkinson's disease compared with controls (p = 0.003 after Bonferroni correction). There was a significant correlation between reduction in NAA/Cr ratios and measures of global cognitive decline, occurring independently of motor impairment (p=0.019).

CONCLUSIONS

This study suggests that 1H MRS can detect temporoparietal cortical dysfunction in non-demented patients with Parkinson's disease. Further longitudinal studies are needed to investigate whether these 1H MRS changes are predictive of future cognitive impairment in the subset of patients with Parkinson's disease who go on to develop dementia, or occur as part of the normal Parkinson's disease process.

Brain bioenergetics in murine models of scrapie using in vivo 31P magnetic resonance spectroscopy

The bioenergetic status of the brain in scrapie mouse models was investigated during the late, clinical phase of the disease, by in vivo phosphorus magnetic resonance spectroscopy (MRS). The only significant change observed in the scrapie-infected mice compared with controls was an increase in intracellular brain pH (7.20+/-0.06 vs 7.10+/-0.05). No other changes in energetic metabolism were observed in the infected mice beside a trend in the decrease of phosphomonoester (PME) level, possibly associated with an alteration in glycolytic intermediates. This study showed that even in the presence of severe cellular vacuolation and microglia infiltrate, cerebral bioenergetic is maintained.

Incorporation of metabolite prior knowledge for data analysis: biochemical implications of dynamic 31P NMR ex vivo pig liver studies

A semi-automated, metabolite prior-knowledge-based, lineshape fitting analysis has been developed to assess the dynamic biochemical changes found in ex vivo 31P NMR pig liver preservation studies. Due to the inherent experimental limitations of the ex vivo study and the complexity of the composite phosphorus resonances, metabolite information obtained in vitro was incorporated into the ex vivo analysis. This approach has allowed complete metabolite analysis (phosphomonoesters, inorganic phosphate, phosphodiesters and nucleotide triphosphates) in over 2000 spectra in a fraction of the time compared with more conventional analysis methods. The developed analysis will enable complete and rapid assessment of the biochemical changes in ongoing cold preservation studies of the pig liver which will result in thousands of ex vivo 31P NMR spectra. It is also envisaged that comparative studies on human donor livers will be carried out, in which this type of analysis would be the method of choice. Moreover, this kind of analysis approach could be advantageous in many complex in vivo NMR spectroscopy applications.

Mechanisms by which elevated intracellular calcium induces S49 cell membranes to become susceptible to the action of secretory phospholipase A2

Exposure of S49 lymphoma cells to exogenous group IIA or V secretory phospholipase A2 (sPLA2) caused an initial release of fatty acid followed by resistance to further hydrolysis by the enzyme. This refractoriness was overcome by exposing cells to palmitoyl lysolecithin. This effect was specific in terms of lysophospholipid structure. Induction of membrane susceptibility by lysolecithin involved an increase in cytosolic calcium and was duplicated by incubating the cells with calcium ionophores such as ionomycin. Lysolecithin also activated cytosolic phospholipase A2 (cPLA2). Inhibition of this enzyme attenuated the ability of lysolecithin (but not ionomycin) to induce susceptibility to sPLA2. Lysolecithin or ionomycin caused concurrent hydrolysis of both phosphatidylethanolamine and phosphatidylcholine implying that transbilayer movement of phosphatidylethanolamine occurred upon exposure to these agents but that susceptibility is not simply due to exposure of a preferred substrate (i.e. phosphatidylethanolamine) to the enzyme. Microvesicles were apparently released from the cells upon addition of lysolecithin or ionomycin. Both these vesicles and the remnant cell membranes were susceptible to sPLA2. Together these data suggest that lysolecithin induces susceptibility through both cPLA2-dependent and -independent pathways. Whereas elevated cytosolic calcium was required for both pathways, it was sufficient only for the cPLA2-independent pathway. This cPLA2-independent pathway involved changes in cell membrane structure associated with transbilayer phospholipid migration and microvesicle release.

Relation between proton magnetic resonance spectroscopy within 18 hours of birth asphyxia and neurodevelopment at 1 year of age

The aim of the study was to test the hypotheses that elevated cerebral lactate, detected by proton spectroscopy performed within 18 hours of suspected birth asphyxia, is associated with adverse outcome, and that increased lactate can be used to predict adverse outcome. Thirty-one term infants suspected of having had birth asphyxia and seven control infants underwent proton magnetic resonance spectroscopy, using three-dimensional chemical shift imaging, within 18 hours of birth. Adverse outcome was defined as death or neurodevelopmental impairment at 1 year of age or more. Nine infants had an adverse outcome. The other 22 and all of the control infants remained normal. Median (range) lactate/creatine plus phosphocreatine (lactate/creatine) ratios in the abnormal, the normal, and the control group were 1.14 (0.17 to 3.81), 0.33 (0 to 1.51), and 0.05 (0 to 0.6) respectively (P=0.003). Lactate/creatine >1.0 predicted neurodevelopmental impairment at 1 year of age with sensitivity of 66% and specificity of 95%, positive and negative predictive values of 86% and 88%, and a likelihood ratio of 13.2. Elevated cerebral lactate/creatine within 18 hours of birth asphyxia predicts adverse outcome.

Magnetic resonance imaging of total body fat

In this study we assessed different magnetic resonance imaging (MRI) scanning regimes and examined some of the assumptions commonly made for measuring body fat content by MRI. Whole body MRI was used to quantify and study different body fat depots in 67 women. The whole body MRI results showed that there was a significant variation in the percentage of total internal, as well as visceral, adipose tissue across a range of adiposity, which could not be predicted from total body fat and/or subcutaneous fat. Furthermore, variation in the amount of total, subcutaneous, and visceral adipose tissue was not related to standard anthropometric measurements such as skinfold measurements, body mass index, and waist-to-hip ratio. Finally, we show for the first time subjects with a percent body fat close to the theoretical maximum (68%). This study demonstrates that the large variation in individual internal fat content cannot be predicted from either indirect methods or direct imaging techniques, such as MRI or computed tomography, on the basis of a single-slice sampling strategy.

Metabolic changes underlying 31P MR spectral alterations in human hepatic tumours

Magnetic resonance spectroscopy (MRS) remains the technique of choice for observing tumour metabolism non-invasively. Although initially 31P MR spectroscopy showed much promise as a non-invasive diagnostic tool, studies of a wide range of hepatic tumours have conclusively shown that this technique cannot be utilized to distinguish between different tumour types. This lack of specificity and sensitivity appears to be a consequence of the fact that hepatic tumours develop with a range of modalities and not as a single abnormal disease process, and also because of the limited availability of MR detectable metabolic markers. This has led, in recent years, to a re-evaluation of the role of 31P MR spectroscopy, re-emerging as a non-invasive tool to follow the efficacy of the treatment regime. Furthermore, since the principal changes observed in tumours by 31P MRS appear to be an elevation in the concentration of phosphorylcholine (PCho) and phosphoethanolamine (PEth), new research using a combination of MRS and tissue culture of cell lines which carry a combination of known inducible oncogenes, are helping to elucidate some of the metabolic pathways that give rise to these metabolic alterations.

Critical assessment of in vivo 13C NMR spectroscopy and gas-liquid chromatography in the study of adipose tissue composition

Routine measurement of adipose tissue composition by repeated biopsy invokes both ethical and practical difficulties, limiting long-term serial studies of adipose tissue composition. In vivo 13C nuclear magnetic resonance (NMR) spectroscopy has been applied as a non-invasive alternative, although it has not as yet been fully validated. In this study we critically assess in vivo 13C NMR spectroscopy and gas-liquid chromatography for the analysis of adipose tissue composition. The advantages and drawbacks of both methods are discussed, in particular to the study of adipose tissue during dietary manipulation and development. Our results show that the NMR measurements of adipose tissue composition are highly reproducible, but they can significantly differ froM those obtained by gas-liquid chromatography (GLC) from the same volunteer. We show that the discrepancy between these two techniques arises from inherent limitations of both 13C NMR spectroscopy and GLC. Finally, we show that 13C NMR spectroscopy remains a useful non-invasive tool for the study of adipose tissue, and will enable us to perform long-term serial studies to further our knowledge of lipid metabolism.

Persistent increases in cerebral lactate concentration after birth asphyxia

In this prospective study proton magnetic resonance spectroscopy (1H MRS) was used to test the hypothesis that lactate can be detected later than 1 mo after birth in the brains of infants who display severe neurodevelopmental impairment 1 y after transient perinatal hypoxia-ischemia. Data were obtained from three groups of infants: 1) eight infants suffering birth asphyxia followed by perinatal encephalopathy and abnormal neurodevelopmental outcome at 1 y of age (defined as major neurologic impairment, Griffiths quotient <85%, and low optimality score); 2) 10 infants with signs of perinatal hypoxia-ischemia but normal neurodevelopmental outcome at 1 y; and 3) six control infants with uneventful perinatal courses and normal neurodevelopment at 1 y. Between one and four examinations (median 1) were performed at median (range) 11 (4-68) wk after birth, and the cerebral concentration ratio of lactate to creatine plus phosphocreatine (Cr) calculated from each spectrum. Lactate was detected later than the 1st mo after birth in seven of eight infants with abnormal neurodevelopmental outcome [maximum detected lactate/Cr was median (range) 0.44 (0.24-0.67)]. No lactate was detected later than the 1st mo after birth in infants with normal neurodevelopmental outcome, nor in five of six control subjects, although a small amount of lactate was detected in one control infant (lactate/Cr=0.04). These results suggest that the pathologic postasphyxial process, indicated by persistent cerebral lactate, may not be confined to the period immediately after injury.

Evaluation of the stability of the proton chemical shifts of some metabolites other than water during thermal cycling of normal human muscle tissue

MR temperature measurements made by the chemical-shift-of-water technique in peripheral muscle of volunteers have produced larger-than-expected coefficients of change and shown significant hysteresis effects as the temperature was cycled, although these effects were not reproduced in the present study. Previous work has suggested that susceptibility effects could be a contributor to the behavior of the chemical shift data. Here, we use proton spectroscopy of muscle in conjunction with temperature cycling to evaluate the relative shifts of the water peak and those of creatine, choline, and lipids. These latter are considered not to have significant temperature coefficients of chemical shift. The results show that these lines remain very stable as the temperature is cycled, suggesting that susceptibility effects are not present in this study. The method offers the possibility that the lines can be used as frequency references if there are any questions about the stability of other moieties.

Definition of the specific roles of lysolecithin and palmitic acid in altering the susceptibility of dipalmitoylphosphatidylcholine bilayers to phospholipase A2

Bilayers composed of phosphatidylcholine initially resist catalysis by phospholipase A2. However, after a latency period, they become susceptible when sufficient reaction products (lysolecithin and fatty acid) accumulate in the membrane. Temperature near the main bilayer phase transition and calcium concentration modulate the effectiveness of the reaction products. The purpose of this study was to examine the individual contributions of lysolecithin and palmitic acid to the susceptibility of dipalmitoylphosphatidylcholine vesicles and to rationalize the effects of temperature and calcium. Various fluorescent probes (Prodan, Laurdan, pyrene-labeled fatty acid, and dansyl-labeled phospholipid) were used to assess changes in the ability of the reaction products to perturb the bilayer and to affect the interactions with the enzyme. Un-ionized palmitic acid decreased bilayer polarity and perturbed the membrane surface exposing some of the Prodan to bulk water. Lysolecithin increased bilayer polarity and the rate of dipolar relaxation in response to the excited states of Laurdan and Prodan. A combination of the individual contributions of each product was observed when palmitic acid and lysolecithin were present together at low calcium, and the effects of lysolecithin dominated at high calcium. Palmitic acid, but not lysolecithin, promoted the binding of phospholipase A2 to the bilayer surface in the absence of calcium. Lysolecithin reduced the ability of fatty acid to enhance binding apparently by altering the structure of fatty acid domains in the membrane. Furthermore, increased temperature and ionization of the fatty acid tended to cause segregation of bound phospholipase A2 into domains poor in phospholipid content which presumably impeded bilayer hydrolysis. In contrast, un-ionized palmitic acid and lysolecithin promoted hydrolysis by augmenting a step distal to the adsorption of enzyme to the bilayer. This kinetic response to lysolecithin was calcium-dependent. A model accounting for these varied influences of the reaction products is presented.

Intracellular and extracellular skeletal muscle triglyceride metabolism during alternating intensity exercise in humans

1. The main purpose of this study was to evaluate non-invasively with magnetic resonance spectroscopy (1H-MRS) changes in the concentrations of intracellular (IT) and extracellular (between muscle fibres) triglycerides (ET) in skeletal muscles of trained males (age range: 24-38 years) during two standard exercise protocols of alternating velocities. 2. Protocol 1 consisted of locomotion in a shuttle manner between two lines 30 m apart at four different velocities (1, 2, 3, and 4 m s-1) which were alternated every minute in a standard routine for 90 min, whereas Protocol 2 included locomotion between two lines 20 m apart at only three velocities (2, 2.7 and 4 m s-1) until volitional exhaustion. The heart rate during both protocols fluctuated between 140 and 200 beats min-1. 3. Using pre-exercise muscle water to quantify individual total creatine (TCr) that was utilized as an internal standard and assuming that TCr does not change during exercise, subjects' mean IT and ET concentrations in soleus (Sol) muscle before Protocol 1 (n = 8) were 45.8 +/- 4.8 mmol (kg dry weight)-1 (mean +/- S.E.M.) and 93.1 +/- 14.1 mmol (kg dry weight)-1, respectively. After the exercise, the concentrations of IT and ET were not significantly different from the values at rest. Before Protocol 2 (n = 4), IT concentrations in Sol, gastrocnemius (Gast) and tibialis (Tib) muscles were 46.4 +/- 13.6, 35.0 +/- 12.1 and 23.1 +/- 4.8 mmol (kg dry weight)-1, respectively, and were not affected by the exhaustive exercise. The ET concentrations in Sol, Gast and Tib were 136.4 +/- 38.1, 175.3 +/- 86.5 and 79.3 +/- 20.0 mmol (kg dry weight)-1 respectively, and they did not change significantly after exhaustion. 4. The study showed that levels of IT and ET were not affected by alternating intensity exercise to fatigue. This suggests that IT and ET in human Sol, Gast and Tib muscles do not contribute significantly to the energy turnover during this type of exercise. Energy for this type of muscle contraction may arise primarily from muscle phosphocreatine (PCr) and glycogen breakdown, circulating glucose and fatty acids from triglycerides other than those encountered within and between muscle cells.

In vivo and in vitro hepatic phosphorus-31 magnetic resonance spectroscopy and electron microscopy in chronic ductopenic rejection of human liver allografts

BACKGROUND

In vivo hepatic phosphorus-31 magnetic resonance spectroscopy (MRS) provides non-invasive information about phospholipid metabolism.

AIMS

To delineate MRS abnormalities in patients with chronic ductopenic rejection (CDR) and to characterise spectral changes by in vitro MRS and electron microscopy.

PATIENTS AND METHODS

Sixteen liver transplant recipients (four with CDR; 12 with good graft function) and 29 controls (23 healthy volunteers; six patients with biliary duct strictures) were studied with in vivo 31P MRS. Peak area ratios of phosphomonoesters (PME) and phosphodiesters (PDE), relative to nucleotide triphosphates (NTP) were measured. In vitro MRS and electron microscopy were performed on biopsy specimens from five patients with CDR, freeze clamped at retransplantation. Phosphoethanolamine (PE), phosphocholine (PC), glycerophosphorylethanolamine (GPE), and glycerophosphorylcholine (GPC) concentrations were measured.

RESULTS

The 12 patients with good graft function displayed no spectral abnormalities in vivo; the four patients with CDR showed significantly elevated PME:NTP (p < 0.01) and PDE:NTP ratios (p < 0.005). Patients with biliary strictures had significant differences in PME:NTP (p < 0.01) from patients with CDR, but not in mean PDE:NTP. In vitro spectra from CDR patients showed elevated PE and PC, mirroring the in vivo changes in PME, but reduced GPE and GPC concentrations were observed, at variance with the in vivo PDE findings. On electron microscopy, there was no proliferation in hepatocyte endoplasmic reticulum.

CONCLUSIONS

The increase in PME:NTP reflects altered phospholipid metabolism in patients with CDR, while the increase in PDE:NTP may represent a significant contribution from bile phospholipid.

13C-Glycogen deposition during pregnancy in the rat following routine meal feeding

In vivo -NMR was employed to determine the hepatic fate of infused [1-]-d-glucose (200 mg/kg) following ad libitum or routine meal feeding (RMF) regimes imposed during pregnancy. Hepatic glycogen synthesis was measured immediately following the last meal in virgin, 10 and 20 day pregnant rats. No detectable incorporation of -glucose into glycogen was observed in 20 day pregnant and control fed virgin rats. In 20 day pregnant RMF rats, glycogen synthesis from -glucose occurred at a linear rate of 0.10/s (S.D. 0.018/s). By 50 min post-infusion, 13C-glycogen levels were 131% (p<0.01) higher than those seen for the 22 h starved and 2 h refed virgin group. Following 10 days of gestation, glucose incorporation into glycogen was maximal in both the ad libitum and RMF groups. Compared with the 20 day pregnant RMF group, the 10 day pregnant ad libitum and RMF rats produced 146% (p<0.001) and 315% (p<0.001) more incorporation of -glucose into the glycogen macromolecule, respectively. Hepatic glycogen values were similar for both 10 and 20 day pregnant ad libitum rats (65.7+/-4.7 and 58.8+/-4.5 mg/g weight) but lower in the RMF groups by 58% and 48%, respectively. In conclusion, meal feeding regimes in the pregnant rat alter carbohydrate control of the liver producing increased glycogen synthesis initially via direct incorporation of glucose into the macromolecule.

Mechanisms by which thionin induces susceptibility of S49 cell membranes to extracellular phospholipase A2

Whereas cells normally resist attack by PLA2, they become susceptible under certain pathological conditions. To ascertain the regulatory mechanisms that induce cellular susceptibility to PLA2, the effect of thionin on S49 cells was examined in the presence of PLA2. Thionin alone was unable to evoke hydrolysis of the lipid bilayer. Likewise, the addition of PLA2 alone caused production of only a minimal amount of free fatty acid. However, thionin and PLA2 together resulted in significant hydrolysis of the cell membrane. Thionin caused perturbation of the bilayer structure as suggested by the changes in the emission spectra of laurdan and the permeability of the membrane to propidium iodide. These changes correlated quantitatively with the susceptibility of the lipid bilayer to PLA2. Furthermore, thionin induced a modest increase in intracellular Ca2+. The source of this Ca2+ was the extracellular fluid since EDTA in the extracellular medium inhibited the Ca2+ influx. Moreover, cobalt chloride, a universal Ca2+ channel blocker, prevented the rise in intracellular Ca2+, the uptake of propidium iodide, and the susceptibility to PLA2 induced by thionin. In contrast, the changes in the laurdan emission caused by the thionin were not affected by the cobalt. Furthermore, incubation of the cells with the calcium ionophore A23187 also caused the cells to become susceptible to PLA2. We hypothesize that thionin causes S49 cell membranes to become susceptible to PLA2 by a Ca2+-dependent perturbation of the bilayer structure.

A longitudinal study of the attitudes of the medical profession towards competition and advertising

AIMS

To measure changes in the attitudes of medical practitioners toward the move from a collegial to a more competitive orientation of the medical profession and, in particular, toward the role of advertising.

METHOD

In the years 1985, 1988 and 1994, self-completion questionnaires were mailed to samples of medical practitioners. The questionnaires for each year were identical, containing forty Likert scales with questions relating to advertising, competition and commercial behaviour. Similar data were also gathered from members of the dental, veterinary, legal and accounting professions.

RESULTS

Over the three studies there has been an undramatic but steady movement towards acceptance of a competitive orientation in general and towards acceptance of informative advertising in particular. There remains substantial reservation towards the use of persuasive advertising. Although patients are viewed as being more demanding than in past times, practitioners still expect their relationships with patients to be long lasting.

CONCLUSION

The results suggest that acceptance of the move towards a more competitively oriented profession will continue. The results also suggest that in view of the kinds of advertising that are now used by medical practices, and of the change in attitudes that has occurred, control of advertising might cease to be a concern to the profession.

Assessment of quantitative artificial neural network analysis in a metabolically dynamic ex vivo 31P NMR pig liver study

Quantitative artificial neural network analysis for 1550 ex vivo 31P nuclear magnetic resonance spectra from hypothermically reperfused pig livers was assessed. These spectra show wide ranges of metabolite concentrations and have been analyzed using metabolite prior knowledge based lineshape fitting analysis which had proved robust in its biochemical interpretation. This finding provided a good opportunity to assess the performance of artificial neural network analysis in a biochemically complex situation. The results showed high correlations (0.865 < or = R < or = 0.992) between the lineshape fitting and artificial neural network analysis for the metabolite values, and the artificial neural network analysis was able to fully represent the trends in the metabolic fluctuations during the experiments.

In vivo and in vitro hepatic 31P magnetic resonance spectroscopy and electron microscopy of the cirrhotic liver

In vivo 31P magnetic resonance spectroscopy (MRS) provides direct biochemical information on hepatic metabolic processes. To assess in vivo changes in hepatic 31P MRS in liver transplant candidates, we studied 31 patients with cirrhosis of varying aetiology; 14 with compensated cirrhosis (Pugh's score < or = 7) and 17 with decompensated cirrhosis (Pugh's score > or = 8). Underlying cellular abnormalities were characterised using in vitro 31P MRS and electron microscopy. In vitro spectra were obtained from liver extracts, freeze-clamped at recipient hepatectomy, from all subjects. Electron microscopy of liver tissue was also performed in 17 cases. Relative to nucleotide triphosphates, elevations in phosphomonoesters and reductions in phosphodiesters were observed in vivo with worsening liver function. In vitro spectra showed elevated phosphoethanolamine and phosphocholine, and reduced glycerophosphorylethanolamine and glycerophosphorylcholine, mirroring the in vivo changes, but no distinction was noted between compensated and decompensated cirrhosis. With electron microscopy, functional decompensation was associated with reduced endoplasmic reticulum in parenchymal liver disease, but elevated levels in biliary cirrhosis. We conclude that in vivo spectral abnormalities in cirrhosis are consistent with alterations in phospholipid metabolism and quantity of endoplasmic reticulum. However, in individual patients the biopsy results do not always mirror in vivo findings.

The application of NMR spectroscopy to the study of apoptosis

Programmed cell death is a physiological process whereby multicellular organisms eliminate unwanted cells. The unravelling of this process has thus far remained in the hands of molecular and cell biologists. These studies have therefore led to a detailed understanding of the genetic nature and some control mechanisms regulating this complex process. However, the biochemical consequences of apoptosis within the cell still remain elusive. NMR spectroscopy, which allows the detection, identification and quantitation of a large number of metabolites and macromolecules, is being utilized to define some of these metabolic processes. The initial application of NMR spectroscopy, to solving the mysteries of apoptosis were confined to elucidating the macromolecular structure of the proteins involved in initiating programmed cell death. The ability of NMR to monitor energy metabolites non-invasively was so put to use in correlating the temporal changes in the rate of apoptosis to these metabolites. More recent studies have shown changes in both a range of small molecules and membrane components. The power of NMR spectroscopy is being used in more laboratories and is likely to become the method of choice for the possible detection of apoptosis in vivo once the NMR signals associated with the apoptotic process have been established in vitro.

A binding study of phospholipase A2 with lecithin, lysolecithin and their tetrahedral intermediates using molecular modeling

We used molecular modeling to examine the binding of 1,2-dioctanoyl-sn-glycero-3-phosphocholine (a lecithin), 1-octanoyl-sn-glycero-3-phosphocholine (a lysolecithin) and their tetrahedral intermediates in the catalytic site of phospholipase A2 (PLA2). We performed energy minimization on each complex, computed the binding energy, determined the relative binding energy among the complexes and calculated the difference in inter- and intramolecular energies of the components in the complexes. We found that the calculated orientation of the sn-1 ester bond of lysolecithin in the active site is similar to that of the sn-2 ester bond in lecithin, thus permitting PLA2 to hydrolyze lysolecithin using the same mechanism as it uses to hydrolyze lecithin. On the other hand, the binding of lecithin is energetically more favorable by 4.5 kcal/mol than the binding of lysolecithin to the enzyme, and the binding of the lecithin tetrahedral intermediate is also energetically more favorable by 19.7 kcal/mol than the binding of the lysolecithin tetrahedral intermediate to the enzyme, which explains why lecithin is a better substrate than lysolecithin in the catalytic site. These results indicate that the activation energy for the hydrolysis of lysolecithin is higher than that for lecithin, consistent with the observed slower rate for the hydrolysis of lysolecithin.