Wakeful response to command indicates memory potential during emergence from general anesthesia

OBJECTIVE

An important aspect of assessing anesthetic depth is determining whether a patient will remember events during surgery. We looked for a clinical sign that would indicate a patient's potential for memory formation during emergence from anesthesia. A clinical sign indicating memory potential could be a useful endpoint for measuring the performance of anesthetic depth monitors and for titrating administration of anesthetic agents.

METHODS

We evaluated patients' responses to commands to open the eyes, squeeze the hand four times, and count 20 numbers. These responses were correlated with results on recall, cued recall, and multiple-choice memory tests.

MAIN RESULTS

Patients did not have evidence of memory formation until they sustained wakefulness sufficiently long to complete at least four hand squeezes or count four numbers. Of 28 patients, 13 (46%) with this sustained wakeful response had memory. Of 22 patients, 0 (0%) had evidence of memory formation when they demonstrated a brief wakeful response, defined as being responsive to command but unable to complete more than one hand squeeze or count, or an intermediate response, defined as two or three hand squeezes or counts.

CONCLUSIONS

We conclude that a brief wakeful response to command indicates that a patient is unlikely to form memories, while a sustained wakeful response indicates that a patient may form memories. Thus, a patient's wakeful response to command could be a useful indicator of potential for memory.

Ingestion of host immunoglobulin by three non-blood-feeding nematode parasites of ruminants

Host immunoglobulin was detected in homogenates of adult worms or fourth stage larvae of Haemonchus contortus, Ostertagia ostertagi, O circumcincta and Dictyocaulus viviparus, but not in preparasitic third stage larvae of H contortus. All the worms had been washed in detergent before being homogenised to remove any immunoglobulin adhering to the cuticle. This procedure, the concentrations of immunoglobulin detected and observations on sections of the worms stained with fluorescent anti-sheep immunoglobulin, all suggested that the immunoglobulin had been ingested, even by the non-blood-feeding species. This finding suggests that the Ostertagia species and D viviparus may be susceptible to vaccination by the gut antigen approach, a method with considerable promise for blood-feeding parasites like H contortus and Boophilus microplus.

Protection studies with integral membrane fractions of Haemonchus contortus

Techniques for targetting glycoproteins integral to the luminal membrane of the intestinal cells of Haemonchus contortus were used to isolate fractions of whole parasites with protective antigen potential. Sheep immunization trials with various candidate fractions revealed one which selectively bound to lectins with specificity for N-acetylgalactosamine and which reduced mean challenge worm burdens by up to 72% and mean faecal egg counts by up to 93%. The luminal surface of the intestines of the Haemonchus recovered from sheep immunized with this antigen were coated with host immunoglobulin, suggesting that the protective effect was due to antibodies interfering with the function of the gut. Further biochemical characterization of this fraction, which has been termed Haemonchus galactose-containing glycoprotein complex (H-gal-GP complex), showed that it could be distinguished from previously described protective antigens of this parasite and that it was only detectable in detergent extracts of the worms.

Local eosinophil- and mast cell-related responses in abomasal nematode infections of lambs

Eosinophil numbers in peripheral blood and eosinophil potentiating activity (EPA) and sheep mast cell protease (SMCP) in efferent gastric lymph were monitored in lambs during infections with Ostertagia circumcincta. Worm burdens, eosinophil numbers in bone marrow, abomasal mucosa and gastric lymph node, as well as mast cell numbers and SMCP concentrations in mucosa and mucus, were determined in post mortem samples. In naive lambs, high and relatively uniform worm burdens were present 10 days after primary infection and these were associated with only mild blood and tissue eosinophilia. By day 21 worm burdens were markedly lower and more variable. There was more evidence of eosinophil and mast cell accumulation in mucosa, and numbers in bone marrow were also higher than on day 10. However, neither EPA nor SMCP were detectable in lymph. By contrast, EPA and SMCP were present in substantial amounts in draining lymph within 48 h of challenge (secondary) infection of previously exposed lambs. EPA was inversely related to worm burdens recovered on day 10, as were abomasal mucosal and mucus SMCP concentrations. Elevated eosinophil numbers were also consistently detected in blood, bone marrow, mucosa and gastric lymph node. The results suggest that host immune defence against secondary, but not primary, exposure to O. circumcincta involves a rapidly mobilised local inflammatory component.

Ventilatory sensitivity to CO2 in hyperoxia and hypoxia in older aged humans

Findings from studies of the effects of aging on the human respiratory controller are equivocal. This study assessed the ventilatory response to CO2 in hyperoxia and hypoxia in groups of younger (YS) and older (OS) humans. Two protocols were used. In the first, end-tidal PCO2 (PETCO2) was clamped at 1-2 Torr above rest (eucapnia), and, in the second, PETCO2 was clamped at 7-8 torr above resting PETCO2 (moderate hypercapnia). End-tidal PO2 was clamped at 100 Torr throughout except for two 2-min periods at 500 and 50 Torr. The ventilatory responses for each subject at each PO2 were fitted to the linear equation, VE = S(PETCO2 - B), where VE is minute ventilation, S is the response curve slope, and B is the response curve threshold. In eucapnia, there were no differences in hypoxic and hyperoxic VE between YS and OS. In hypercapnia, hypoxic VE was 24% lower in OS [39.93 +/- 2.71 (SE) l/min] than in YS (52.16 +/- 3.17 l/min). In hypoxia, S was significantly lower in OS (3.25 +/- 0.38 l.min-1.Torr-1) than in YS (4.76 +/- 0.37 l.min-1.Torr-1). We conclude that, in older humans, VE is lower in hypoxia during moderate hypercapnia, resulting mainly from a decreased peripheral chemoreflex CO2 sensitivity.

Evaluation of the VMM turbine for spirometry in the applied physiology laboratory

The volume measurement module turbine (VMM) was evaluated in 51 subjects for spirometry in applied physiology against the Stead-Wells spirometer (SW) and Wright peak flow meter (WM). The volume and flow ranges (VMM) were, FEV1 1.32 to 3.94 L (mean 2.62, confidence interval [CI] 2.46 to 2.78); forced vital capacity (FVC) 1.97 to 5.06 L (mean 3.50, CI 3.29 to 3.71); and peak expiratory flow rate (PEFR) 290 to 624 L.min-1 (mean 434, CI 407 to 461). The mean difference for FEV1 was 0.09 L (CI 0.05 to 0.14), FVC 0.04 L (CI -0.02 to 0.10), and PEFR 18.0 L min-1 (CI 8.7 to 27.3) less than SW or WM. Bias with FEV1 and FVC was not significant, though PEFR demonstrated a significant proportional error. The repeatability coefficients for FEV1 and FVC were 0.18 and 0.20, comparable to the SW; but for PEFR they were greater, 58.4 versus 33.8 L.min-1 by WM. The VMM turbine is accurate and reliable for the measurement of FEV1 and FVC over the ranges studied; however, care should be taken when interpreting PEFR.

Evaluation of aspects of the protection afforded to sheep immunised with a gut membrane protein of Haemonchus contortus

Experiments were undertaken to evaluate the type of protection conferred against Haemonchus contortus by immunising sheep with H11, a 'hidden' integral gut membrane protein isolated from this parasite. A serial kill experiment showed that worms began to be lost from immunised lambs between seven and 14 days after challenge with a single dose of larvae and adult female worms were more susceptible than male worms. Seven-day-old juveniles survived immunisation even though their intestinal cells became coated with sheep antibody. Immunisation was equally effective against both benzimidazole-resistant and susceptible strains of H contortus. When immunised lambs were subjected to a trickle infection, they were largely protected against the anaemia and egg output observed in the challenge controls. Moreover, they grew as fast and as efficiently as uninfected lambs fed on the same high protein diet and acquired a natural immunity during the course of the trickle infection.

Protection in lambs immunised with Haemonchus contortus gut membrane proteins

Substantial protection against Haemonchus contortus was induced in lambs by hyperimmunising them with an integral membrane extract of intestines dissected from adult worms. The procedure was effective in young growing animals but did not afford any cross protection against either Ostertagia circumcincta or Nematodirus battus. A serum transfer experiment suggested that the effector mechanism was serum antibody which bound to the brush border membrane of the parasites intestinal cells. Sheep which had acquired immunity to H contortus by previous exposure to a trickle infection did not recognise the gut membrane proteins, which suggested that these are normally hidden from the host.

Forced expiratory volume, height, and demispan in Canadian men and women aged 55-86

In a random cross-sectional study in London, Canada, forced expiratory volume in 1 second (FeV1.0), height, and demispan (fingerweb to central sternal notch) were measured on 182 men and 212 women of mean ages 70.4 (SD 8.5) and 71.3 (8.2). The mean FeV1.0 for men was 2.55 (0.66) l, and for women 1.80 (0.48) l and declined 29 ml.year-1 and 25 ml.year-1, respectively. The mean FeV1.0 standardized for measured height and calculated height for men was 2.54 (0.61) l and 2.55 (0.62) l in men, and 1.80 (0.46) l and 1.79 (0.45) l in women. There was no significant difference between the two methods of standardization, and the relationship of height to demispan in this independent elderly population was constant across age for both men (2.16) and women (2.17). Linear and proportional regression coefficients to predict FeV1.0 from height and demispan have been generated for this random sample aged 55 to 86 years.

Physiological responses of young and elderly men to prolonged exercise at critical power

The critical power (CP) of a muscle group or individual may represent the highest rate of work which can be performed for an extended period. We investigated this concept in young (n = 13, 24.5 years) and elderly (n = 12, 70.7 years) active men by first determining CP and then comparing responses elicited by 24 min of cycle exercise at power outputs (omega) corresponding to CP. Values from the final 2 min of the 24-min ride were expressed relative to maximal values established in a ramp test. CP for the elderly was only 65% that for the young, but on a relative basis, it was significantly higher both in terms of omega (67 vs 62% of omega max) and oxygen consumption (VO2) (91.5 vs 85.2% of maximum oxygen consumption). There were no group differences in relative values for ventilation (VE), heart rate or respiratory exchange ratio (R). During the 24-min ride, VO2 and R achieved a plateau in both groups, while VE, blood lactate and arterial PCO2 continued to change in the young. It was concluded that CP can be determined in active elderly men, but that CP may not represent a true non-fatiguing work rate in either young or elderly men.

Further observations on the phagocytosis of Candida albicans by hamster and human oocytes

Pathogenic yeast, Candida albicans, were incubated with hamster and human oocytes for up to 21 hours in order to determine the nature and time course of phagocytosis of these organisms. Aliquotes of the interacting cells were taken at various time intervals for electron microscopic examination. Some specimens had their zona pellucidae enzymatically removed prior to incubation with yeast, and these specimens showed the most extensive interaction and phagocytosis of Candida. The zona pullucida appears to be an effective barrier to yeast, at least over the time span studied. The observations are consistent with the hypothesis of an initial attachment of yeast via a surface component to oocyte microvilli followed by phagocytic uptake into an endosome. There is no compelling evidence of lysosomal degradation of the yeast over the time course of this study; however, the oocytes appear to undergo some degenerative changes at long incubation times.

Parasite-specific T cell responses of sheep following live infection with the gastric nematode Haemonchus contortus

Helper T cell lines recognizing antigen in the context of MHC Class II molecules were generated from peripheral blood mononuclear cells (PBMC) of sheep undergoing a primary or secondary infection with the nematode parasite Haemonchus contortus. The lines were used to identify 15-18, 25-29, 70-80 and greater than 100 kD immunodominant parasite larval antigens fractionated by SDS-PAGE under reducing conditions. Non-specific mitogenic activity in the antigen fractions was not detected. During primary infection PBMC did not respond to soluble antigens or those fractionated on SDS-PAGE, whereas T cell lines generated from these PBMC responded well. T cell lines and PBMC derived after a secondary infection responded similarly to fractionated larval antigen. This indicated that (a) the T cell lines had retained their antigen specificities (as represented by autologous PBMC reactivity) in spite of in-vitro cycles of restimulation with whole larval soluble antigen and subsequent expansion in recombinant human IL-2, and (b) proliferation of the antigen-specific PBMC was predominantly due to helper T cells. Variations between individual sheep in response to fractionated larval antigens was also observed. The pattern of helper T cell reactivity to SDS-PAGE larval antigens correlated poorly with B cell reactivity in the same animals by serum antibody Western blot analysis. These results demonstrate that helper T cell epitopes can be mapped in complex parasite antigen preparations in sheep and that this approach will be useful in the identification of parasite protective antigens in helminthiasis where the cellular or humoral nature of protection is not clearly defined.

Development of immunity to incoming radiolabelled larvae in lambs continuously infected with Ostertagia circumcincta

Infective larvae of Ostertagia circumcincta were radiolabelled with 75selenium by a method which did not affect their viability. Three groups of five-month-old lambs were infected daily with 1000 unlabelled infective larvae for four, eight and 12 weeks, respectively. After each period one of these groups and a group of worm-free controls were challenged with three consecutive daily doses of 1000 radiolabelled third stage larvae. The lambs were killed 13 days after the first dose of challenge larvae and their worm burdens examined. The first indication of immunity was retardation of developing worms observed at four weeks. Resistance to the establishment of incoming worms developed between four and eight weeks and a brief period of population turnover probably took place at this time. Simultaneously a greater inhibition of worm development occurred resulting in an increase in the number of parasites recovered as early fourth stage larvae. By 12 weeks the animals were almost completely immune to incoming worms. The development of resistance to incoming worms correlated with a rise in serum antibody titre and an increase in the number of intraepithelial globule leucocytes in the gastric mucosa.

Development of immunity to incoming radiolabelled larvae in lambs continuously infected with Trichostrongylus vitrinus

Infective third stage larvae (L3) of Trichostrongylus vitrinus were radiolabelled with 75 selenium by a method which did not affect their viability. Three groups of six-month-old lambs were infected daily with 1000 L3 for four, eight and 12 weeks, respectively. After each period, one of those groups (n = 5) and a group (n = 4) of worm-free controls were challenged with three consecutive daily doses of 1000 radiolabelled L3, killed 10 days after the first dose, and their worm burdens examined. After four weeks of continuous infection partial immunity to the establishment of challenge L3 was apparent, and by eight and 12 weeks, with the exception of one sheep, there was almost total resistance to incoming worms. Immunity was also expressed as an inhibition of the development of established worms.

The generation of ovine bone marrow-derived mast cells in culture

Ovine mast cells generated in vitro are morphologically and biochemically similar to mast cells localized to the gastrointestinal tract in vivo. Bone marrow (BM)-derived haemopoietic precursor cells were cultured in the presence of conditioned medium (CM) prepared from in vitro-activated lymphocytes from nematode-infected sheep. Mast cells developed rapidly after 2 weeks of culture and could persist for 2-3 months. The presence of sheep mast cell proteinase (SMCP) in the cultured cells correlated with the number of morphologically recognizable mast cells by Leishman-Giemsa staining and is definitive as, in vivo, this enzyme is unique to mast cells. The content of SMCP per cell increased as the cultures developed. In vivo, increased serum concentrations of SMCP are associated with mast cell function at the site of nematode infection. The availability of the cultured cells should now facilitate mast cell biochemical and functional studies.

Rapid, low-cost cleanup procedure for determination of semivolatile organic compounds in human and bovine adipose tissues

A gas chromatographic/mass spectrometric (GC/MS) method is described for determination of organic environmental pollutants in human and bovine adipose tissues. Compounds such as organochlorine pesticides, polychlorinated biphenyls, polynuclear aromatic hydrocarbons, polychlorinated aromatics, and brominated aromatics are extracted with organic solvents and separated from coextracted lipids on a Florisil column. The eluate is concentrated and compounds are identified and quantitated by GC/MS analysis. The method was evaluated in a single laboratory for ability to recover compounds of environmental and regulatory importance. Except for a few more polar compounds, such as phthalates and phosphates, recoveries averaged about 85%. The elution system maximized recovery and allowed minimal coelution of lipid materials. Detection limits for most compounds studied were in the range of 5-50 ng/g (ppb).

Mucosal IgA production and lymph cell traffic following prolonged low level infections of Ostertagia circumcincta in sheep

Some aspects of the local immune response to daily challenge with 2000 Ostertagia circumcincta larvae were studied by monitoring changes in the composition of gastric lymph of naive and previously infected sheep. The main changes in the naive group were increases in lymphoblast output and concentrations of pepsinogen whereas lymph albumin values decreased markedly and IgA concentrations were usually unchanged. In contrast, in the previously infected sheep, the continuous challenge stimulated only transient increases in lymphoblast and IgA containing cell traffic whereas lymph IgA and pepsinogen concentrations remained elevated throughout the experiment. By temporarily interrupting the challenge in a second group of previously infected sheep it was shown that elevated IgA and pepsinogen values were maintained only if larval intake was continuous.

Systemic release of a mast cell proteinase following nematode infections in sheep

An enzyme-linked immunosorbent assay (ELISA) for sheep mast cell proteinase (SMCP) has been developed. Concentrations of SMCP in homogenates of abomasal tissue from parasite-immune sheep (341 micrograms SMCP/g tissues) were raised when compared to those in normal (non-infected) abomasa (0.145 micrograms SMCP/g tissue). SMCP was not detected in sera from normal animals challenged with Haemonchus contortus but was present (less than 1.0 ng SMCP/ml) in sera from 8/11 immune sheep 2 h after intra-abomasal challenge with 1 x 10(6) exsheathed Haemonchus larvae. In two further experiments, the SMCP response in gastric lymph was monitored after homologous larval challenge in sheep immune to Ostertagia circumcincta and in normal controls. SMCP (less than 1.4 ng SMCP/ml) was detected in lymph from 2/3 and 4/5 immune animals between 1 and 4 days post-challenge with 50,000 larvae, but not from normal animals. SMCP was not detected in lymph from immune animals following challenge with 1000 Ostertagia larvae. The relatively low concentrations of SMCP in blood and lymph reflect the presence of proteinase inhibitor(s) which interfered with the ELISA.