Low-glycemic-index starchy foods in the diabetic diet

Eight patients with noninsulin-dependent diabetes underwent two 2-wk study periods in random order during which they were provided with carbohydrate foods with either a high or low glycemic index (GI). Over both high-GI and low-GI periods there were significant reductions in body weight, serum fructosamine, and cholesterol. Reductions in fasting blood glucose, HbA1c, and urinary c-peptide-to-creatinine ratio were significant only over the low-GI period despite a smaller mean weight loss. Reductions in triglyceride were significant only over the high-GI diet. Inclusion of low-GI foods into diets of patients with diabetes may be an additional measure that favorably influences carbohydrate metabolism without increasing insulin demand.

Continuing rearrangement but absence of somatic hypermutation in immunoglobulin genes of human B cell precursor leukemia

Southern blot analyses revealed that cells from nearly 30% of childhood B cell precursor acute lymphoblastic leukemias (ALLs) contained more than two rearranged, nongermline bands for Ig heavy chain genes. DNA corresponding to these bands was molecularly cloned from two cases which showed three and seven rearranged bands, respectively. Nucleotide sequence analysis of the cloned DNA demonstrated that each band represented different VDJ or DJ rearrangements. While the same DJ joints were shared by several rearrangements, different DJ joints were found in the majority of rearrangements, precluding V region substitution as an explanation for the multiplicity of heavy chain rearrangements in these leukemias. Most of the V region segments involved in these rearrangements were restricted to VH region families that have been shown previously to be preferentially rearranged in human fetal B lineage cells. Sequence analysis of multiple copies of the same VDJ rearrangements from different cells revealed no somatic mutation, a mechanism responsible for detection of extra rearranged Ig DNA bands in certain other B lineage tumors. The data suggest that in some cases of ALL Ig heavy chain genes begin and continue to rearrange de novo within the neoplastic B cell precursor populations derived from an original malignant cell transformed at a stem cell stage of differentiation.

Synthesis of new antiinflammatory steroidal 20-carboxamides: (20R)- and (20S)-21-(N-substituted amino)-11 beta,17,20-trihydroxy-3,21-dioxo-1,4- pregnadiene

The synthesis and antiinflammatory activities of new steroidal 20-carboxamides, (20R)- and (20S)-21-(N-substituted amino)-11 beta,17,20-trihydroxy-3,21-dioxo-1,4-pregnadiene are described. These compounds were prepared from the respective isomer of 20-dihydroprednisolonic acid, (20R)- and (20S)-11 beta,17,20-trihydroxy-3-oxo-1,4-pregnadien-21-oic acid, by coupling with primary amines after the activation of the steroid acid with N,N1-dicyclohexylcarbodiimide (DCC) and 1-hydroxybenzotriazole. Confirmation of the configurational assignment at C-20 of the 20-carboxamides was achieved by reduction of methyl (20R)- and (20S)-11 beta,17,20-trihydroxy-3-oxo-1,4-pregnadien-21-oate to the known stereochemistry at C-20 of (20R)- and (20S)-11 beta,17,20,21-tetrahydroxy-3-oxo-1,4-pregnadiene The topical antiinflammatory activities of these steroidal 20-carboxamides were assessed by the croton oil induced ear edema assay and their local and systemic antiinflammatory activities by the cotton pellet granuloma bioassay. Results of these investigations suggest a structure-activity relationship where carboxamide derivatives with the 20(R)-hydroxy configurations exhibit higher potency than those with the 20-(S)-hydroxy configurations. The amides of steroidal 21-oic acids with high local antiinflammatory potency exhibited systemic activities unlike the corresponding esters of steroidal 21-oic acids, which are devoid of systemic activities.

The effects of new local anti-inflammatory steroids on leucocyte migration and prostanoid liberation in rats

The local anti-inflammatory potency of steroid-21-oate esters derived from prednisolone was determined by cotton pellet granuloma bioassay. The doses which inhibited granuloma formation by 50% (ID50) were: prednisolone, 0.5 mg/pellet; methyl 20 alpha-dihydroprednisolonate, 5.8 mg/pellet; methyl 20 beta-dihydroprednisolonate, 1.2 mg/pellet; methyl 17,20 alpha-acetonidodihydroprednisolonate, 6.0 mg/pellet. When administered at these equipotent local anti-inflammatory doses, only prednisolone depressed plasma corticosterone and promoted thymus involution. Prednisolone reduced neutrophil migration into saline-soaked polyester sponges and depressed the levels of 6-keto PGF1 alpha, PGE2 and elastase in the sponge-induced inflammatory exudate. Methyl 20 alpha- and 20 beta-dihydroprednisolonate had no effect on cell migration, but depressed the levels of 6-keto PGF1 alpha and elastase. The liberation of 6-keto PGF1 alpha, PGE2 and elastase and neutrophil migration were inhibited by methyl 17,20 alpha- and beta-acetonidodihydroprednisolonate, but the effect of the beta-epimer on cell migration was transient. These data suggest that steroid acid esters which have local and topical anti-inflammatory properties exert their effect in a similar fashion to glucocorticoids with a ketol side-chain (e.g. prednisolone) with respect to liberation of prostaglandins and lysosomal enzymes. However, their effect on neutrophil migration was variable, depending on their structural features. Furthermore, the systemic effects of these new derivatives were drastically reduced indicating that they may be of potential benefit in prolonged treatment.

Topical anti-inflammatory activity of esters of steroid 21-oic acids

Prednisolone derivatives, methyl 20 alpha- and 20 beta-dihydroprednisolonate and methyl 17,20 alpha- and 17,20 beta-acetonidodihydroprednisolonate have been evaluated for their topical anti-inflammatory activity in the croton oil induced ear edema test. The order of anti-inflammatory potency was prednisolone greater than methyl 17,20 alpha-acetonidodihydroprednisolonate greater than methyl 17,20 beta-acetonidodihydroprednisolonate greater than methyl 20 beta-dihydroprednisolonate greater than methyl 20 alpha-dihydroprednisolonate. This order was paralleled by the compounds' octanol-aqueous partition coefficients. Furthermore, after two consecutive days topical administration of an equipotent anti-inflammatory dose, only prednisolone significantly decreased plasma corticosterone levels and relative thymus weight, while the new steroid derivatives had no effect on these parameters, indicating their lack of systemic side effects.

The modulation of peritoneal macrophage chemiluminescence by acute pleural inflammation, prostanoids and cyclo/lipoxygenase inhibitors

The chemiluminescent (CL) response of peritoneal macrophages was suppressed by induction 4 h earlier of an inflammatory reaction in the pleural cavity which was negated by prior administration of indomethacin, ketoprofen and BW 755C. These changes were accompanied by a concomitant rise in peritoneal PGI2 levels which was abolished by drug pretreatment. In vitro treatment of normal peritoneal macrophages with PGI2 inhibited their subsequent CL response. Indomethacin and ketoprofen produced elevated CL of macrophages obtained from untreated controls in vitro which was blocked by the lipoxygenase inhibitor NDGA. BW 755C and NDGA in vitro strongly inhibited macrophage CL and partially inhibited CL in a cell-free system. Use of these drugs in vivo demonstrated that indomethacin and ketoprofen augmented the CL response of peritoneal macrophages while BW 755C had no effect. These results suggest the inflammatory process per se can modulate the functions of macrophages in parts of the body remote from the inflammatory site. Moreover this modulation may be under the control of the prostanoid system.

An appraisal of the technique of polymorphonuclear leukocyte chemiluminescence as a means to detect compounds with antiinflammatory activity

The measurement of luminol-dependent chemiluminescence of inflammatory rat polymorphonuclear leukocytes (PMNs), when exposed to opsonized zymosan particles, has been used as a possible screening system for nonsteroidal antiinflammatory drugs (NSAID). An in vitro system may be used to detect NSAIDs, however the sensitivity is not of a high order. On the other hand an inhibitor of the lipoxygenase system (NDGA) and a dual lipo-cyclooxygenase inhibitor (BW755c) are easily detectable at low concentrations (10(-6)M). In parallel, an in vivo system has been developed, using rat PMNs from the same source, but pretreating the animals with drugs before induction of the inflammatory reaction and subsequent PMN collection. In this case NSAIDs, steroids, and dual lipo-cyclooxygenase inhibitors were readily detectable. It is suggested that this in vitro-in vivo system may prove useful in the detection of compounds that inhibit the lipoxygenase system or which have steroidal-like characteristics.

Modifications of host defence mechanisms by an acute non-immunological inflammatory reaction

Mice developing an acute non-immunological inflammatory reaction were examined for modification of specific and non-specific defence mechanisms on the basis of previous observations that these animals displayed an increased resistance to bacterial and parasitic infections but an impaired resistance to neoplasia. Local acute inflammation was induced by injection into the pleural cavity of a non-antigenic, endotoxin-free irritant--calcium pyrophosphate microcrystals or low-molecular-weight dextran. Effector functions of macrophages at remote sites from the inflammatory focus were markedly stimulated. This was shown by: (a) an accelerated elimination of Listeria monocytogenes in the liver and spleen of mice with inflammation; (b) the acquisition of cytostatic activity for tumour cells by peritoneal macrophages; and (c) an enhancement of chemiluminescence emission and superoxide production in response to phagocytosis. Natural killer activity of spleen and peritoneal cells was stimulated in a biphasic manner. In contrast, cytolytic T cell differentiation upon in vitro immunization of spleen cells against allogeneic tumour cells was impaired. All these effects were observed very early (2 h) after the onset of inflammation and were still detectable at least 3 days after the inflammatory process had disappeared.

Release of interleukin I and low-molecular-weight lymphocyte-activating factors by rat peritoneal macrophages and its enhancement by acute non-specific inflammatory processes

Peritoneal macrophages harvested from rats undergoing an acute non-specific inflammatory reaction induced by an injection of calcium pyrophosphate (CaPP) into the pleural cavity released increased amounts of interleukin I (IL-I)-like material. Lymphocyte-activating factors were also found in ultrafiltrates of the macrophage supernatants below 10 kd and 5 kd. A similar pattern of activity was observed when lysates of the macrophages were tested. In addition pre-exposure of normal peritoneal macrophages to an acute pleural inflammatory exudate before supernatant production enhanced the release of lymphocyte-activating factors found both in the unfractionated supernatant and a sub-5-kd ultrafiltrate. Thus these results demonstrate that an acute inflammatory reaction, initiated by a non-antigenic stimulus is able to stimulate macrophages remote from the inflammatory site to produce a factor which behaves like IL-I in a standard IL-I assay. The presence of low-molecular-weight factors (less than 5 kd) with similar activity may suggest that degradation of IL-I has taken place to yield active fragments. Acute inflammatory exudate also augments release of these factors which may be important in the pathogenesis of inflammation.

The modification of the oxidative metabolism of cells derived both locally and at distance from the site of an acute inflammatory reaction

During an acute nonspecific inflammatory reaction initiated in the pleural cavity by a nondiffusible stimulus (calcium pyrophosphate crystals), the oxidative metabolism, as measured by chemiluminescence and superoxide release, of cells harvested from both the inflammatory site and at points distant from it was studied. The oxidative metabolism of peritoneal macrophages, obtained from rats undergoing an inflammatory reaction (pleurisy), demonstrated a transient decrease in activity compared with the resident population when using both zymosan and phorbol myristate acetate as stimulants. This metabolic unresponsiveness induced by inflammation may be related to the concomitant changes in the levels of prostacyclin in the peritoneal cavity. It should be emphasized that the peritoneal cellular composition or number did not change during these events. On the other hand alveolar macrophages from inflamed animals showed no significant changes in their superoxide production or chemiluminescence compared to controls. The precise reason for these inflammation-induced changes is unknown; however the acute nonspecific inflammatory reaction was able to modulate the oxidative metabolism of cells not only at the site of inflammation, but at points distant from it.

Anti-inflammatory activity of the epimers of N-propyl 20 xi-dihydroprednisolonamide

The epimers of a steroid carboxamide, N-propyl 20 alpha- and 20 beta -dihydroprednisolonamide, were evaluated for their local and systemic effects on granuloma formation, pituitary-adrenal function and liver glycogen content in rats. When the carboxamides were administered locally, the 20 beta-epimer exhibited greater activity than the 20 alpha-epimer in suppressing cotton pellet granuloma formation. Neither epimer had suppressive effects on thymus weight and plasma corticosterone levels at the dose level used. When the carboxamides were administered systemically, they were pharmacologically inactive. Furthermore, in acute pharmacological studies, the carboxamides neither increased tyrosine aminotransferase activity and glycogen deposition in the liver nor decreased plasma corticosterone levels and relative thymus weight.

Modification of the chemiluminescent response of rat thymocytes to concanavalin A by the acute non-specific inflammatory process

Using the technique of concanavalin A-induced chemiluminescence (CL) as a measure of lymphocyte reactivity it has been demonstrated that the acute non-specific inflammatory process initiated by a non-diffusible, non-antigenic, endotoxin free irritant, was able to enhance the CL response of rat thymocytes. Maximum enhancement was observed 48 h after initiation of the inflammatory reaction. Serum derived from animals undergoing an acute inflammatory reaction as used above was fractionated using the technique of ultrafiltration to yield a fraction of molecular weight range 500-2000 daltons. When this fraction was cultured in vitro for 22 h with normal thymocytes, the CL response to concanavalin A was greatly enhanced when compared to thymocytes cultured in the presence of an equivalent fraction of normal serum. These findings demonstrate that during an acute non-immunological inflammatory reaction the function of the hosts thymocytes is enhanced. Furthermore, a low molecular weight factor (500-2000), with thymocyte stimulating activity, may be recovered from the serum of such animals very quickly (within 2 h) after initiation of the acute inflammation.

The reactivity of neutrophils at the site of an acute inflammatory reaction as measured by chemiluminescence

In this study the technique of luminol-enhanced chemiluminescence (LECL), which was shown to be dependent on the generation of superoxide anion, has been employed to investigate the reactivity of polymorphonuclear leukocytes found at the site of inflammation. Cells derived from the pleural cavity of rats undergoing an acute inflammatory reaction initiated by an intrapleural injection of calcium pyrophosphate or normal serum demonstrated a significantly higher chemiluminescent response compared to cells derived from animals injected with plasma, saline or phosphate-buffered saline. In addition in vitro studies showed that calcium pyrophosphate crystals could stimulate the cells per se and could increase their reactivity.

An in vitro effect of an acute non-specific inflammatory serum on rat lymphocytes proliferative response to PHA

This study has demonstrated that serum obtained from animals undergoing an acute inflammatory reaction induced by an intrapleural injection of dextran is able to modulate the proliferative response to PHA of lymph node and spleen cells in vitro. This response is dependent on the concentration of the inflammatory serum and on the time of collection of the serum during the acute inflammatory process. At low concentrations of serum (0.5%) stimulatory activity was observed at all time points. At higher concentrations (1%) inhibitory activity was present in 24 and 72 h sera. These results support the previous observation that the acute non-specific inflammatory reaction is able to modify the function of different cell types. It has been suggested that both stimulatory and inhibitory factors are present and the balance between these changes during the course of the inflammatory reaction.

Effects of supernatants and lysates of polymorphonuclear leucocytes: macrophage stimulatory factors

Polymorphonuclear leucocytes (PMN) were harvested from the site of a non-specific acute inflammatory reaction. When cultured in vitro for 24 h the cells liberated into the supernatant factors which could enhance the proliferation of normal macrophages in the absence and presence of the mitogen phytohaemagglutinin (PHA). Similar activity was found in lysates of these cells. Using the technique of ultrafiltration it was shown that the mitogenic factors present in both PMN supernatants and lysates were under 10 000 daltons molecular weight. In addition, the chemiluminescent responses of normal macrophages were also enhanced by PMN supernatant, lysate and their respective ultrafiltrates. Our results suggest that the PMNs, which are the most abundant cell type during acute inflammation, both contain and are able to liberate low-molecular-weight macrophage-stimulatory factors which may be important in our understanding of the pathogenesis of inflammation.

Direct and indirect in vivo stimulation of LAF-like production induced by acute nonspecific inflammatory processes

Peritoneal macrophages harvested from animals undergoing an acute non-immunological inflammatory reaction induced by an injection of calcium pyrophosphate ( CaPP ) or dextran into the pleural cavity showed an enhanced level of production of a lymphocyte activating factor (LAF) like material. On the other hand, macrophages harvested from the site of inflammation did not show enhanced production of this activity when compared to macrophages derived from normal controls. This enhanced activity was observed for up to two/three days after initiation of the inflammatory reaction and was obtained in both the presence and absence of lipopolysaccharide (LPS) during in vitro cultivation. Thus these results demonstrate that the acute inflammatory reaction, initiated by a non-antigenic stimulus ( CaPP ), is able to stimulate macrophages remote from the inflammatory site to produce a factor which behaves like LAF in a standard LAF assay.

Effects of supernatants and lysates of polymorphonuclear leukocytes--lymphocyte mitogenic factors

Rat polymorphonuclear leukocytes (PMNs), harvested from the site of a non-specific acute inflammatory reaction, liberated into culture fluids factors which not only enhanced the phytohaemagglutinin-induced proliferative response of thymocytes and lymph node cells, but were also mitogenic for these cells. This activity was associated with low molecular weight molecules (less than 10,000 daltons) and both these activities were also found in lysates of these PMNs. Our results suggest that inflammatory PMNs both contain and are able to release low molecular weight factors which can modulate lymphocyte function.

In vivo effects of an acute nonimmunological inflammation in rats on the lymphoproliferative response to mitogens

Lymphoid cells (spleen, lymph node and thymus) derived from rats after induction of an acute nonimmunological inflammatory reaction responded to various mitogens (Phytohemagglutinin, PHA; Concanavalin A, Con A; Lipopolysaccharide, LPS) with increased proliferation when compared with cells derived from normal animals. In the absence of mitogens, lymphoid cells from animals undergoing an acute nonimmunological inflammation demonstrated enhanced proliferation compared with cells from normal animals. These results clearly demonstrated that during acute nonimmunological inflammation the reactivity of lymphoid cells was increased.

Teaching psychiatry to nonpsychiatrists: II. A model curriculum

It is becoming increasingly clear that psychiatric and psychosocial needs of medical patients are not being adequately met. This need has led to an increasing emphasis on the psychiatric education of nonpsychiatrists at varying levels of experience. Given the many problems involved in these educational efforts, as well as the paucity of evaluation studies and the uncertainty of results, the authors argue that the systematic application of empirically-validated educational principles may lead to greatly improved effectiveness. In the first section of a two-part series, the authors reviewed educational methodology as it relates to the development of objectives, the selection of teaching procedures, and the use of evaluation techniques. The present paper, part-two, describes in detail a "model" curriculum for primary care residents that was developed according to these principles of educational methodology.

Teaching psychiatry to non-psychiatrists: I. The application of educational methodology

It is becoming increasingly clear that psychiatric and psychosocial needs of medical patients are not being adequately met. This need has led to an increasing emphasis on the psychiatric education of nonpsychiatrists, at varying levels of experience. Given the many problems involved in these educational efforts as well as the paucity of evaluation studies and the uncertainty of results, the authors argue that the systematic application of empirically validated educational principles may lead to greatly improved effectiveness. In this first section of a two-part series, the authors review educational methodology as it relates to the development of training objectives, the selection of teaching procedures, and the use of evaluation techniques. Part two presents a detailed "model" curriculum for primary care residents, developed according to the principles of educational methodology.

Leguminous seeds in the dietary management of hyperlipidemia

Seven male hyperlipidemic patients substituted approximately 140g dried beans daily for other sources of starch in their diet over a 4-month period. After this, mean fasting serum triglyceride levels were reduced by 25 +/- 5% (p less than 0.01) while total serum cholesterol levels were 7 +/- 2% (p less than 0.5) lower than the values measured during the previous five clinic attendances (12 +/- 2.5 months). However, low- and high-density lipoprotein cholesterol levels remained unaltered. While taking beans a nonsignificant fall (0.7 kg) was seen in body weight. Nevertheless no change was seen in macronutrient intake determined by 1-wk diet histories recorded both before and four times during the study, although cholesterol intake decreased by 80 mg (p less than 0.02). Reintroduction of dried leguminous seeds into a Western diet may be a useful adjunct to the management of hyperlipidemia.

Acute non-specific inflammation and modification of macrophage and lymphocyte functions

The acute inflammatory response is a common phenomenon experienced by the physician in a wide variety of clinical situations. One of the major problems facing the investigator in this field of research who wishes to look at the cellular and humoral responses involved, is that in most of the animal models previously used, the inflammatory reaction has been provoked in subcutaneous tissues. Thus, a quantitative assessment of leucocyte emigration and mediator production in the inflamed area is technically difficult without resorting to complicated and artificial methods. Inflammation provoked in the pleural cavity provides a useful tool in the study of these problems since the collection of cells and analysis of humoral factors in exudates is easily accomplished. Among the irritants that may be used, we focused our interest on calcium pyrophosphate (CaPP) crystals, a non-diffusible, non-antigenic and endotoxin-free irritant, because their deposition is implicated in pseudogout and chondrocalcinosis in man (MacCarty, 1973). Calcium pyrophosphate-induced pleurisy is typified by an acute reaction, dominated by polymorphonuclear leucocytes, reaching its maximal intensity at about 5 h and disappearing within 48 h (Willoughby et al., 1975). It was found to be independent of the complement system. Examination of the known mediators of inflammation revealed no significant participation of either histamine or 5-hydroxytryptamine. There was an early rise in PGE2 followed by a greater rise in PGF2 alpha as the reaction diminished (Capasso et al., 1975). More recently, we have demonstrated the presence of a small quantity of thromboxane and a large quantity of prostacyclin during the first 2 hours of this inflammatory process. It was also shown that this type of acute inflammation was accompanied by the very rapid liberation of acute phase proteins both locally, in the exudate, and systemically in the serum (Tissot et al., 1983). Some of these events were also examined during the pleural reaction to other types of irritants (Capasso et al., 1975) and gave similar results (Tissot et al., 1983).