Sodium fluoride dissolution of human calcium oxalate/phosphate stone particles

The dissolutive effects of sodium fluoride on human calcium stone particles were investigated in an in vitro model. Stone particles composed of 65% calcium oxalate and 35% calcium phosphate dissolved in a dose-dependent fashion with NaF exposure. Stone particles exposed to 60 mM NaF had a 17% reduction in particle mass after 24 hours and a 62% reduction after 7 days in comparison with experimental controls bathed in physiologic normal saline. The systemic toxicity of the dose of oral fluoride necessary to achieve the optimal tested urinary concentrations would likely preclude oral administration, but NaF may have an adjunctive role in upper urinary tract irrigation for residual stone fragments after lithotripsy or in chronic low-dose oral administration for prophylaxis against recurrent calcium nephrolithiasis.

Distribution of carboxypeptidase M on lymphoid and myeloid cells parallels the other zinc-dependent proteases CD10 and CD13

Monoclonal antibody (MoAb) M27 was generated after immunization of mice with the human B-lineage acute lymphoblastic leukemia cell line Pre-ALP. Under reducing conditions, MoAb M27 precipitated a 60-kD surface-membrane molecule from Pre-ALP cells. Expression cloning of Pre-ALP cDNA showed that M27 recognizes carboxypeptidase M (CPM), a cell-surface, zinc-dependent protease known to cleave off basic C-terminal amino acids from peptide hormones. Using M27 antibody, CPM was detected only at discrete B lymphocyte developmental stages, namely on committed precursors and on germinal center cells. CPM was also expressed on mature T cells, mainly after activation. These results provide the first description of a carboxy-peptidase on lymphoid cells. In addition, CPM was found on granulocytes and monocytes, but not on their progenitors. Strikingly, CPM was present only on CD38+ cells, irrespective of lineage affiliation. Of interest, CPM displayed a largely overlapping distribution with the CD10 and CD13 peptidases, with which it shares common substrates (enkephalins, bradykinin). Collectively, the present data show a previously unrecognized distribution pattern of CPM on lymphoid and myeloid cells and suggest that CPM may cooperate with CD10 and CD13 to regulate biologic activity of peptide hormones on leukocytes.

Hepatocellular carcinoma during pregnancy and its comparison with other pregnancy-associated malignancies

BACKGROUND

Cancer in pregnancy is rare and hepatocellular carcinoma (HCC) in pregnancy even rarer. The impact of pregnancy on the prognosis of patients with different types of cancer remains controversial. Reported cases of HCC in pregnancy are largely isolated and highly scattered. Thus, the effect of pregnancy on the prognosis of patients with HCC and the risk factors of developing HCC in pregnancy are not well documented.

METHODS

A series of five patients with HCC in pregnancy seen at two different centers is reported. A Medlar search for articles between 1957 and 1993 with the key words "Hepatocellular Carcinoma" and "Pregnancy" was conducted. All reported cases were combined and analyzed in terms of race, age, parity, hepatitis B surface antigen status, cirrhosis, serum alpha-fetoprotein (AFP) levels at presentation, history of taking oral contraceptive pills and fetal and maternal outcome. The impact of pregnancy on 12 other malignancies as reported in the medical literature also was reviewed.

RESULTS

To the authors' knowledge, The five cases reported here constitute the largest series of HCC in pregnancy. A literature search revealed 23 additional cases. Analysis of the 28 cases suggests that the rarity of HCC in pregnancy results from a combination of three factors: the male predominance of HCC, the late age at which the tumor usually presents in women, and decreased fertility in women with advanced cirrhosis (hepatitis is a predisposing factor for HCC development). Long term use of oral contraceptives and high parity enhance the risk. Elevated AFP level is useful for diagnosis. The median survival is shorter than for patients who are not pregnant. There is no significant difference in survival between pregnant and not pregnant women matched by tumor stage, age, and other clinical parameters in most malignancies except in some tumors like lymphoma, thyroid cancer, and nasopharyngeal carcinoma.

CONCLUSION

Pregnancy has an adverse effect on the prognosis of patients with HCC, lymphoma, thyroid cancer, and nasopharyngeal carcinoma but not of most other malignancies. Measurement of AFP level is recommended for screening HCC in pregnant women at high risk.

Hepatocellular carcinoma during pregnancy and its comparison with other pregnancy-associated malignancies

BACKGROUND

Cancer in pregnancy is rare and hepatocellular carcinoma (HCC) in pregnancy even rarer. The impact of pregnancy on the prognosis of patients with different types of cancer remains controversial. Reported cases of HCC in pregnancy are largely isolated and highly scattered. Thus, the effect of pregnancy on the prognosis of patients with HCC and the risk factors of developing HCC in pregnancy are not well documented.

METHODS

A series of five patients with HCC in pregnancy seen at two different centers is reported. A Medlar search for articles between 1957 and 1993 with the key words "Hepatocellular Carcinoma" and "Pregnancy" was conducted. All reported cases were combined and analyzed in terms of race, age, parity, hepatitis B surface antigen status, cirrhosis, serum alpha-fetoprotein (AFP) levels at presentation, history of taking oral contraceptive pills and fetal and maternal outcome. The impact of pregnancy on 12 other malignancies as reported in the medical literature also was reviewed.

RESULTS

To the authors' knowledge, The five cases reported here constitute the largest series of HCC in pregnancy. A literature search revealed 23 additional cases. Analysis of the 28 cases suggests that the rarity of HCC in pregnancy results from a combination of three factors: the male predominance of HCC, the late age at which the tumor usually presents in women, and decreased fertility in women with advanced cirrhosis (hepatitis is a predisposing factor for HCC development). Long term use of oral contraceptives and high parity enhance the risk. Elevated AFP level is useful for diagnosis. The median survival is shorter than for patients who are not pregnant. There is no significant difference in survival between pregnant and not pregnant women matched by tumor stage, age, and other clinical parameters in most malignancies except in some tumors like lymphoma, thyroid cancer, and nasopharyngeal carcinoma.

CONCLUSION

Pregnancy has an adverse effect on the prognosis of patients with HCC, lymphoma, thyroid cancer, and nasopharyngeal carcinoma but not of most other malignancies. Measurement of AFP level is recommended for screening HCC in pregnant women at high risk.

No association between HLA-DQ and -DR genotypes with nasopharyngeal carcinoma in southern Chinese

The pathogenesis of nasopharyngeal carcinoma (NPC) is multifactorial. Associations have been reported between HLA and NPC. We studied the HLA-DR and -DQ regions on the molecular level in 136 persons (51 NPC patients and 85 healthy controls) from southern China, a particularly high-prevalence area for NPC. Restriction fragment-length polymorphism (RFLP) was used to genotype the MHC class II DR beta, DQ alpha, and DQ beta regions of the subjects. Polymerase chain reaction (PCR) using sequence-specific primer (SSP) for DQ beta genes was also performed. By RFLP, no significant difference was observed with respect to DRB, DQA, and DQB genes. By PCR SSP typing, we confirmed that there was no significant difference between NPC patients and controls with respect to DQ beta alleles. Our study suggests that HLA-DQ and -DR genes are not associated with NPC in southern Chinese and there may be other gene loci that predispose them to have such a high prevalence of the disease.

Germ cell tumors express a specific alpha-fetoprotein variant detectable by isoelectric focusing

BACKGROUND

Many nonseminomatous germ cell tumors (NSGCTs) express elevated levels of serum alpha-fetoprotein (AFP), which is widely used for diagnosis and monitoring therapy. Alpha-fetoprotein is also expressed in patients with hepatocellular carcinoma (HCC). In these sera, several variants, some highly specific, recently have been detected by isoelectric focusing.

METHODS

Sera were collected from nine patients with NSGCTs, five pregnant women, and five patients with HCC. After isoelectric focusing, the proteins were transferred to nitrocellulose membrane by blotting and incubated with polyclonal rabbit antihuman AFP conjugated with horseradish peroxidase. The enhanced chemiluminescence detection system and Hyperfilm-ECL were used to render the protein bands visible and each was quantified as a percentage of the total AFP using a densitometer.

RESULTS

Isoelectric focusing of serum alpha-fetoprotein from the patients with NSGCTs (four testicular, five mediastinal) revealed a consistent pattern characterized by a specific band (band +III). A second band (band +II) that is also seen in sera from patients with hepatocellular carcinoma was present in all patients. The overall pattern was distinct from that of AFP from HCC and that produced during late pregnancy. The two characteristic bands (AFP +II and +III) were responsible for the great majority of total AFP in these patients; estimation of serial sera in patients undergoing treatment showed that total and "malignant" AFP changed in parallel. Banding patterns, apart from one patient, were identical in patients with testicular and mediastinal NSGCTs.

CONCLUSION

NSGCTs tumors express a highly consistent and specific pattern of AFP variants. More detailed analysis of AFP patterns in larger numbers of patients may provide further insight into the cellular heterogeneity of germ cell tumors.

A surrogate 15 kDa JC kappa protein is expressed in combination with mu heavy chain by human B cell precursors

A novel kappa protein, encoded by a germline JC kappa transcript, is expressed by normal and leukemic human B cell precursors. The transcript displays an open reading frame initiated by a non-AUG codon, and predicts a 15 kDa molecule which could be readily confirmed by in vitro translation. Cellular expression was demonstrated by immunofluorescence, precipitation and Western blotting. Furthermore, 2-D gel electrophoresis revealed that germline JC kappa can covalently associate with mu heavy chain at the surface of pre-B cells. We therefore propose that during B cell lymphopoiesis, two alternative pathways could be operative in which mu heavy chain can either associate with lambda 5 or germ-line JC kappa.

Calcium imaging of rhythmic network activity in the developing spinal cord of the chick embryo

Video-rate imaging of spinal neurons loaded with calcium-sensitive dyes was used to investigate the calcium dynamics and cellular organization of spontaneously active rhythm-generating networks in the spinal cord of E9-E12 chick embryos. Spinal neurons were loaded with bath-applied fura-2am. Motoneurons were also loaded by retrograde labeling with dextran-conjugated, calcium-sensitive dyes. Dye-filled motoneurons exhibited large fluorescent changes during antidromic stimulation of motor nerves, and an increase in the 340/380 fura fluorescence ratio that is indicative of increased intracellular free calcium. Rhythmic fluorescence changes in phase with motoneuron electrical activity were recorded from motoneurons and interneurons during episodes of evoked or spontaneous rhythmic motor activity. Fluorescent responses were present in the cytosol and in the perinuclear region, during antidromic stimulation and network-driven rhythmic activity. Optically active cells were mapped during rhythmic activity, revealing a widespread distribution in the transverse and horizontal planes of the spinal cord with the highest proportion in the ventrolateral part of the cord. Fluorescent signals were synchronized in different regions of the cord and were similar in time course in the lateral motor column and in the intermediate region. In the dorsal region the rhythm was less pronounced and the signal decayed after a large initial transient. Video-rate fluorescent measurements from individual cells confirmed that fluorescent signals were synchronized in interneurons and in motoneurons although the time course of the signal could vary between cells. Some of the interneurons exhibited tonic elevations of fluorescence for the duration of the episode whereas others were rhythmically active in phase with motoneurons. At the onset of each cycle of rhythmic activity the earliest fluorescent change occurred ventrolaterally, in and around the lateral motor column, from which it spread to the rest of the cord. The results suggest that neurons in the ventrolateral part of the spinal cord are important for rhythmogenesis and that axons traveling in the ventrolateral white matter may be involved in the rhythmic excitation of motoneurons and interneurons. The widespread synchrony of the rhythmic calcium transients may reflect the existence of extensive excitatory interconnections between spinal neurons. The network-driven calcium elevations in the cytosol and the perinuclear region may be important in mediating activity-dependent effects on the development of spinal neurons and networks.

Treatment of inoperable hepatocellular carcinoma with intrahepatic arterial yttrium-90 microspheres: a phase I and II study

Eighteen patients with inoperable hepatocellular carcinoma (HCC) were treated with intrahepatic arterial yttrium-90 microspheres. All these patients showed a lung shunting below 15% and a tumour-to-normal ratio higher than 2 as determined by diagnostic technetium-99m macroaggregated albumin (Tc-MAA) gamma scintigraphy. The treatment was given through an arterial port placed during laparotomy. The radiation doses to the liver and tumour were determined intraoperatively with a beta probe and liquid scintillation counting of multiple liver biopsies. The treatment was well tolerated without major complications. In all patients the tumour marker fell to a level which ranged from 41% to 0.2% of the pretreatment level. Tumour regression was found to be dose related. Progressive or static disease occurred in a higher proportion of patients whose tumours received < 120 Gy (P = 0.005). Survival was better in those whose tumours received > 120 Gy (median survival = 55.9 weeks) than those whose tumours received lower doses (median survival = 26.2 weeks). This difference is statistically significant with P = 0.005. We conclude that yttrium-90 microsphere therapy is safe and that tumour response is dose related. A tumour dose of > 120 Gy is recommended.

Selective internal radiation therapy with intra-arterial iodine-131-Lipiodol in inoperable hepatocellular carcinoma

From August 1990 to June 1993, 26 patients with inoperable hepatocellular carcinoma were treated with intra-arterial iodine-131-Lipiodol (131I-L).

METHODS

Iodine-131-Lipiodol was given through either an implantable arterial port (9 patients) or during hepatic angiography (17 patients). All 26 patients had multiple lesions, 3 had involved resection margin after surgical resection and 1 had diffuse infiltrative lesions. The median size of the largest tumor among 22 patients with a measurable lesion was 4.5 cm (2-9.5 cm). The end points are tumor response in terms of tumor size, change in serum alpha-fetoprotein level, toxicity of treatment and overall survival.

RESULTS

Twenty-three patients received a single treatment of 1.11-2.22 GBq (30-60 mCi)131I-L. Three patients received 2.22-4.44 GBq (60-120 mCi)131I-L in three fractions. Considering both radiological regression and reduction in serum alpha-fetoprotein level as objective response criteria, the overall response rate was 52% (13 out of 25 patients with evaluable disease). Ten out of 15 patients who had raised alpha-fetoprotein levels had more than 50% reduction and 8 patients had more than 90% reduction in alpha-fetoprotein level. Since analysis, 19 patients have died and 7 remain alive, giving a minimum median survival of 6 mo (range 1.2-16.6 mo), with 4 surviving more than 1 yr calculated from the day of treatment. There was only one patient who had late deterioration of liver function compatible with radiation hepatitis. There was no bone marrow toxicity documented in any patients.

CONCLUSION

Treatment with intra-arterial 131I-L was well tolerated in patients with inoperable hepatocellular carcinoma and produced an objective response of 52% with median survival of 6 mo. A fractionated dose of 131I-L was feasible and the radiation dose could be escalated safely.

Growth inhibitory and agonistic signals of interleukin-7 (IL-7) can be mediated through the CDw127 IL-7 receptor

The present study was aimed at identifying surface-membrane molecules involved in the regulation of human B-cell ontogeny. For this purpose, murine monoclonal antibodies (MoAbs) were generated against Pre-Alp, a pre-B acute lymphoblastic leukemia (ALL) cell line, and MoAb R34.34 was selected for further characterization. R34.34 recognized a molecule expressed on normal B-cell precursors (BCP) but not on mature B cells. The antibody also reacted with T lymphocytes, a subpopulation of monocytes from peripheral blood, and a subset of CD34+ cells. Immunoprecipitation analysis indicated that R34.34 recognizes an 80-kD molecular weight antigen. Antibody R34.34 was further found to be directed against an epitope interfering with binding of interleukin-7 (IL-7) to Pre-Alp cells. Expression cloning from a Pre-Alp cDNA library showed that R34.34 antigen is CDw127, the 75- to 80-kD IL-7 receptor. Proliferation of the B-lineage ALL cell lines Reh and Mieliki was inhibited by IL-7, and this effect was specifically reverted by MoAb R34.34. In addition, antibody R34.34 specifically inhibited IL-7-dependent proliferation of normal BCP, Pre-Alp cells, and peripheral T cells. These results imply that both inhibitory and proliferative effects of IL-7 can be mediated through the same receptor on various lineages. R34.34 antibody should be important for the analysis of signal transduction through CDw127.

Cytoreductive surgery for hepatocellular carcinoma

A prospective study was conducted on 26 patients for cytoreductive surgery of inoperable hepatocellular carcinoma. These patients underwent cytoreduction with liver resection, cryosurgery, microwave tissue coagulation and/or absolute alcohol injection. In-hospital mortality was 7.7%. The symptomatic relief and quality of survival were excellent. The median survival of patients after cytoreduction was 10.0 months and the survival was much better than those of 26 patients matched by sex, age, tumour size, Child-Pugh grading and Karnofsky scores who received systemic chemotherapy during the same period of the study (log rank test, P = 0.0001). There was no statistical difference between the survival curves of those patients who received (19 patients) and those who did not receive (7 patients) additional treatment by chemotherapy or selective internal radiation therapy after cytoreduction. This suggests that the gained survival benefit could have been derived mainly from the cytoreductive surgery rather than the additional treatments.

Cardiovascular causes of loss of consciousness in patients with presumed epilepsy: a cause of the increased sudden death rate in people with epilepsy?

BACKGROUND, METHODS, AND RESULTS: Syncope and seizures are often indistinguishable clinically. We present a series of 12 patients diagnosed as having epilepsy. Despite normal or nonspecific electroencephalographic findings, 11 of 12 patients were treated or offered treatment with long-term anticonvulsant agents. Subsequently, diagnoses of arrhythmic or neurally mediated syncope were made in all patients using Holter monitoring, long-term ambulatory loop electrocardiographic recording, or tilt-table studies. Arrhythmias included torsades de pointes (four patients), atrioventricular nodal reentrant supraventricular tachycardia (one patient), and sinus arrest (two patients). The remaining five patients had neurally mediated syncope with hypotension and bradycardia, including asystole in two patients. Treatment for the documented cardiovascular abnormalities resulted in the alleviation of syncopal symptoms.

CONCLUSIONS

Because the observed cardiovascular abnormalities are potentially fatal, this series suggests that undiagnosed cardiac syncope may contribute to the documented increased sudden death rate in patients with presumed epilepsy. Cardiac causes of loss of consciousness should be considered in patients with presumed epilepsy, atypical premonitory symptoms (such as nausea, lightheadedness, or palpitations), nondiagnostic electroencephalograms, and failure to respond to anticonvulsant therapy.

Diagnostic pharmaco-scintigraphy with hepatic intra-arterial technetium-99m macroaggregated albumin in the determination of tumour to non-tumour uptake ratio in hepatocellular carcinoma

Between October 1990 and March 1993, 124 patients who had hepatocellular carcinoma (HCC) underwent diagnostic pharmaco-scintigraphy with hepatic intraarterial technetium-99m macroaggregated albumin (TcMAA) to determine the tumourous to non-tumourous liver tissue uptake ratio (T/N ratio). There were 110 males and 14 females. Ages ranged from 16 to 73 with a median of 55 years. The range of T/N ratio was 0.7 to 19.3 with a median of 3.8. 12 patients with inoperable HCC were subsequently selected by predetermined criteria to undergo treatment with hepatic intraarterial yttrium-90 microspheres and the T/N ratios in these patients were validated by beta probe dosimetry and liquid scintillation count of multiple liver biopsies. The T/N ratio determined by preoperative diagnostic TcMAA scan correlated well with intraoperative beta probe dosimetry, with coefficient of correlation r = 0.82. Preoperative TcMAA scan also correlated well with liquid scintillation count of biopsy specimens, with r = 0.96. We conclude that TcMAA scan can be used to determine the T/N ratio in patients with HCC, thus allowing better selection of patients with inoperable tumours for loco-regional therapy.

A set of endoplasmic reticulum proteins possessing properties of molecular chaperones includes Ca(2+)-binding proteins and members of the thioredoxin superfamily

The major proteins in the lumen of the endoplasmic reticulum (ER) are thought to function in Ca2+ sequestration or as "molecular chaperones" in the folding and assembly of membrane or secreted proteins. Based on the ability of many chaperones to bind selectively to unfolded proteins and to dissociate from them upon ATP hydrolysis, we developed an affinity chromatography method to isolate proteins with these characteristics from pancreatic or liver ER. Seven ER proteins bound selectively to denatured protein columns and were specifically eluted by ATP (10(-6) M) but not by a nonhydrolyzable ATP analog. These proteins were identified with antibodies and microsequencing as the ER chaperone BiP (grp78), grp94, calreticulin, a novel 46-kDa protein that binds azido-ATP, as well as three members of the thioredoxin superfamily: protein-disulfide isomerase, ERp72, and a previously reported 50-kDa protein (p50). This set of seven proteins bound to and was eluted with ATP from a variety of denatured proteins, including histone, gelatin, alpha fetoprotein, thyroglobulin, lysozyme, casein, and IgG. The release of grp94, protein-disulfide isomerase, ERp72, calreticulin, and p50 was stimulated by Ca2+ in the presence of ATP. These proteins thus appear to function as Ca(2+)-dependent chaperones, which may account for the Ca2+ and ATP requirement for protein folding in the ER.

Crystal structures of cyclophilin A complexed with cyclosporin A and N-methyl-4-[(E)-2-butenyl]-4,4-dimethylthreonine cyclosporin A

BACKGROUND

Cyclophilin (CyP) is a ubiquitious intracellular protein that binds the immunosuppressive drug cyclosporin A (CsA). CyP-CsA forms a ternary complex with calcineurin and thereby inhibits T-cell activation. CyP also has enzymatic activity, catalyzing the cis-trans isomerization of peptidyl-prolyl amide bonds.

RESULTS

We have determined the structure of human cyclophilin A (CyPA) complexed with CsA to 2.1 A resolution. We also report here the structure of CyPA complexed with an analog of CsA, CsA (MeBm2t1-CsA), which binds less well to CyPA, but has increased immunosuppressive activity. Comparison of these structures with previously determined structures of unligated CyPA and CyPA complexed with a candidate substrate for the isomerase activity, the dipeptide AlaPro, reveals that subtle conformational changes occur in both CsA and CyPA on complex formation.

CONCLUSIONS

MeBm2t1-CsA binds to CyPA in an essentially similar manner to CsA. The 100-fold weaker affinity of its binding may be attributable to the close contact between MeBmt1 and the active site residue Ala103 of CyPA, which causes small conformational changes in both protein and drug. One change, the slight movement of MeLeu6 in CsA relative to MeBm2t1-CsA, may be at least partially responsible for the higher affinity of the CyPA-MeBm2t1-CsA complex for calcineurin. Our comparison between CyPA-CsA and CyPA-AlaPro suggests that CsA is probably not an analog of the natural substrate, confirming that the catalytic activity of CyPA is not related to its role in immunosuppression either structurally or functionally.

A cancer attitude survey among medical undergraduates in Hong Kong

A cancer attitude survey was administered to a cohort of 152 final-year medical undergraduates in Hong Kong from mid-1988 to mid-1990, on the first and last days of a four-week oncology module. Significant differences in pre- and post-module scores suggest that the course had significant impact on attitudes toward early diagnosis, treatment aggressiveness, and acceptance of death. The changes are generally regarded by the teachers as desirable. Comparison with a similar survey performed ten years earlier on a group of American second-year medical undergraduates shows significant differences in most of the pre-course scores. Factor analysis shows that the items in the survey could not be readily categorized by a limited number of factors, thus casting doubt on the validity of the instrument in reflecting attitudinal attributes as described in the original survey.

Cloning and characterization of NF-ATc and NF-ATp: the cytoplasmic components of NF-AT

Present evidence indicates a pathway of signal transmission in T cells that is outlined in figure 1. The elevation in intracellular calcium that is induced by interactions at the antigen receptor leads to the activation of the calcium-dependent phosphatase calcineurin. This in turn leads to the nuclear association of the cytosolic component of NF-ATc. The activation of calcineurin and the nuclear import of NF-ATc can both be blocked by cyclosporin A or FK506 in complex with their respective immunophilins. Once in the nucleus, NF-ATc interacts with NF-ATn to form an active transcriptional complex. NF-ATn is a ubiquitous protein, can be synthesized in response to PMA, and has many similarities to AP-1. The mechanism by which NF-ATc enters the nucleus is unknown, and although it appears to require calcineurin, NF-ATc has not yet been shown to be an in vivo substrate of calcineurin. Alternative mechanisms include the possibility that NF-ATc operates on some cytoplasmic anchor or that other proteins that are controlled by calcineurin carry out the nuclear import of NF-ATc. Although NF-ATp copurifies with NF-ATc, there is as yet no understanding of how NF-ATp is functioning in vivo. Now that these proteins are purified and cloned, the major goals will be to understand their role and the roles of other family members in thymic development.

Regionalization and intersegmental coordination of rhythm-generating networks in the spinal cord of the chick embryo

We have examined the regionalization and coordination of rhythm-generating networks in the isolated spinal cord of the chick embryo between embryonic days 9 and 13, by recording the pattern of rhythmic activity recorded from muscle nerves and ventral roots following a variety of lesions. We found that the capacity for rhythmic activity is distributed along the rostrocaudal axis of the cord but can be expressed in a single, isolated segment. Specializations within the lumbosacral cord were investigated by isolating particular regions and recording their motor output. The rostral part of the lumbosacral cord generates more cycles than the caudal part, and this difference becomes more pronounced with development. In the unlesioned cord, motoneuron activity is synchronized along the rostrocaudal axis. Lesion experiments revealed that the synchronization of motoneuron activity and the synaptic drive to caudal motoneurons is mediated in part by propriospinal pathways traveling in the ventrolateral white matter tracts and by synaptic interactions within the gray matter. The dorsal fiber tracts may also be involved but their effects appear to be weak. Lesions in dorsal-ventral and mediolateral planes were used to localize regions critical for rhythmogenesis and for the alternation of flexor and extensor motoneurons. Rhythmic activity with alternation persisted in spinal cords in which the dorsal and medial half had been removed. Severe medial or dorsal lesions, resulting in a thin strip of lateral or ventral gray matter, altered the phasing of motoneuron activity from alternating to synchronous without effects on cycle timing. These results suggest that the critical neural components for alternation are located close to and dorsomedial to the lateral motor column, and that the capacity for rhythmogenesis is distributed widely throughout the ventral gray matter and is not localized to specific nuclei.

Mucin synthesis and secretion in various human epithelial cancer cell lines that express the MUC-1 mucin gene

Previous studies have suggested that mucin gene expression is tissue-specific; however, the relationship between unique mucin gene products and the biochemical properties of mucins is unknown. The purpose of this study was to determine the biochemical and molecular characteristics of mucin synthesized by adenocarcinoma cell lines derived from breast (ZR-75-1), stomach (MGC-803), pancreas (Capan-2), and lung (Chago K-1). Mucin was quantitated by [3H]glucosamine labeling and Sepharose CL-4B chromatography. The mucinous nature of the labeled high molecular weight glycoproteins (HMG) was verified by alkaline borohydride treatment, cesium chloride density gradient ultracentrifugation, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Specific mucin gene expression was determined using cDNA probes for 2 distinct intestinal mucins (MUC-2 and MUC-3) and one breast cancer mucin (MUC-1). Specific core mucin proteins were confirmed by immunoblots using antibodies that recognize MUC-1, MUC-2, and MUC-3 core peptides. These experiments demonstrate that all cell lines contained HMG in the medium, cytosol, and membrane fractions. The HMG was mucinous in breast, pancreatic, and lung cell lines. In contrast, most of the HMG secreted by the gastric cell line was proteoglycan-like, due to its susceptibility to hyaluronidase, heparinase, and chondroitinase avidin-biotin complex. Ion-exchange (DEAE-Sephacel) chromatography of [3H]glucosamine-labeled HMG demonstrated that the acidic or basic nature of the mucin was different in all cancer cell lines tested. Despite these differences, mRNA and immunoblot analysis suggest that all cell lines predominantly express MUC-1 apomucin, small amounts of MUC-2 apomucin, and no MUC-3. Immunoprecipitation of MUC-1-type mucin using the 139H2 monoclonal antibody demonstrated that different sizes of mucin peptides were present in all cell lines, corresponding to the known length polymorphism of this mucin. The amount and nature of carbohydrate epitopes were analyzed by immunoblots using anti-T (peanut lectin), anti-Tn (91S8 monoclonal antibody), and anti-sialosyl Tn (JT10e monoclonal antibody). T and Tn antigens were significantly higher in breast and pancreatic cells as compared with lung and gastric cell lines. These findings correlated with increased activities of polypeptidyl N-acetylgalactosaminyl transferase and beta-1,3-galactosyltransferase.(ABSTRACT TRUNCATED AT 400 WORDS)

Real-time imaging of neurons retrogradely and anterogradely labelled with calcium-sensitive dyes

Membrane-impermeant calcium indicator dyes were used to retrogradely label dorsal root ganglia, spinal motoneurons and interneurons in the spinal cord of the chick embryo. The dyes were also used to label anterogradely primary afferent axons in the spinal cord and synaptic endings in the ciliary ganglion. Labelled neurons were imaged using digital videomicroscopy. Motoneurons and dorsal root ganglion cells exhibited a frequency-dependent change in fluorescence during antidromic stimulation. Single antidromic stimuli resulted in fluorescence transients that could be resolved in individual cells in real time. In addition, fluorescence changes could be recorded in motoneurons during episodes of bursting generated by rhythmic synaptic inputs from premotor networks. Stimulus-induced fluorescence signals were also detected in axons and synaptic endings labelled anterogradely. Optical signals were largely abolished in the absence of extracellular calcium. The results show that calcium changes can now be measured in identified populations of neurons and presynaptic terminals. The strong dependence of these signals on impulse activity suggests that the technique will be useful for monitoring the activity of identified neuronal populations. The calcium-dependent fluorescence signal probably results from cytosolic dye derived from diffusion which may limit the technique to situations in which the dye can be applied close (< 1 cm) to cell bodies.

Expression of beta-2-microglobulin by nasopharyngeal carcinoma

Serum beta-2-microglobulin (beta 2M) levels of 274 Chinese patients with different stages of nasopharyngeal carcinoma at presentation and that of 35 patients who developed distant metastases post-treatment were assayed. beta 2M level was found to increase with advancing stage of disease, with statistically significant differences among early-stage, advanced-stage, and metastatic disease. Elevated pre-treatment beta 2M levels were expressed more frequently by tumours with lower degree of histological differentiation. The sensitivity of serum beta 2M for diagnosis of nasopharyngeal carcinoma, however, is low.

Disposition of epirubicin in an oily contrast medium after intravenous and intrahepato-arterial administration in liver cancer: a preliminary report

The present study reports findings on the disposition of epirubicin after an intrahepato-arterial administration of the Lipiodol-drug complex, prepared by mixing the drug-aqueous phase with the iodized oil by ultra-sonification, in 14 patients with histologically proven hepatoma or hepatomegaly with serum alpha-fetoprotein level above 500 micrograms.l-1. The volume of Lipiodol used was 5 ml and the epirubicin dose was 50 mg.m-2. Blood samples were obtained at various time intervals up to 72 h post-dose. Serum concentrations of epirubicin were measured by liquid chromatography with fluorometric detection. The area under serum concentration-time curve (AUCinfinity0) was higher in the Lipiodol-epirubicin group (n = 8) while the clearance was faster and elimination t1/2 and mean residence time shorter in the plain epirubicin group (n = 3). However, interindividual variation in metabolism of epirubicin would affect serum level of the drug. In three patients who were given intravenous and intrahepato-arterial injections (90 mg.m-2) of plain epirubicin and Lipiodol-drug complex, the relative bioavailability of Lipiodol-epirubicin complex (F = 0.76 and 0.45) was lower than that of plain epirubicin (F = 0.80 and 0.73) in two patients while it was approximately 100% (F = 1.06 and 1.20) in one patient. It is likely that liver function of the patients might be modified by the disease state over a period of 3 months in the cross-over study. Further studies with larger patient samples are required to confirm if there is a targeting effect of the Lipiodol-drug complex toward hepatoma using a better formulation of the drug in Lipiodol.

Adenosine modulation of potassium currents in preganglionic nerve terminals of avian ciliary ganglia

Potassium currents in calyciform nerve terminals of the avian ciliary ganglion were analyzed using a single microelectrode voltage clamp. The modulatory affects of adenosine on these currents was also determined. Intracellular CsCl (1 M) blocked the steady-state outward current, indicating that it is mostly carried by K+. Tetraethylammonium (TEA, 10 mM) blocked over 40% of the outward current at a command potential of -30 mV. If Ca2+ influx was blocked by CoCl2 (5 mM), the steady-state outward current was reduced by over 16% in the nerve terminals suggesting that about one fifth of the outward current passes through calcium-activated potassium channels IK(Ca). Adenosine (50 mM) decreased the outward steady-state current over a wide range of command potentials in most terminals studied but failed to decrease this current in the presence of CoCl2 (5 mM). It is concluded that adenosine blocks IK(Ca) in nerve terminals.

Development of spinal motor networks in the chick embryo

We have examined the cellular and synaptic mechanisms underlying the genesis of alternating motor activity in the developing spinal cord of the chick embryo. Experiments were performed on the isolated lumbosacral cord maintained in vitro. Intracellular and whole cell patch clamp recordings obtained from sartorius (primarily a hip flexor) and femorotibialis (a knee extensor) motoneurons showed that both classes of cell are depolarized simultaneously during each cycle of motor activity. Sartorius motoneurons generally fire two bursts/cycle, whereas femorotibialis motoneurons discharge throughout their depolarization, with peak activity between the sartorius bursts. Voltage clamp recordings revealed that inhibitory and excitatory synaptic currents are responsible for the depolarization of sartorius motoneurons, whereas femorotibialis motoneurons are activated principally by excitatory currents. Early in development, the dominant synaptic currents in rhythmically active sartorius motoneurons appear to be inhibitory so that firing is restricted to a single, brief burst at the beginning of each cycle. In E7-E13 embryos, lumbosacral motor activity could be evoked following stimulation in the brainstem, even when the brachial and cervical cord was bathed in a reduced calcium solution to block chemical synaptic transmission. These findings suggest that functional descending connections from the brainstem to the lumbar cord are present by E7, although activation of ascending axons or electrical synapses cannot be eliminated. Ablation, optical, and immunocytochemical experiments were performed to characterize the interneuronal network responsible for the synaptic activation of motoneurons. Ablation experiments were used to show that the essential interneuronal elements required for the rhythmic alternation are in the ventral part of the cord. This observation was supported by real-time Fura-2 imaging of the neuronal calcium transients accompanying motor activity, which revealed that a high proportion of rhythmically active cells are located in the ventrolateral part of the cord and that activity could begin in this region. The fluorescence transients in the majority of neurons, including motoneurons, occurred in phase with ventral root or muscle nerve activity, implying synchronized neuronal action in the rhythm generating network. Immunocytochemical experiments were performed in E14-E16 embryos to localize putative inhibitory interneurons that might be involved in the genesis or patterning of motor activity. The results revealed a pattern similar to that seen in other vertebrates with the dorsal horn containing neurons with gamma-aminobutyric acid (GABA)-like immunoreactivity and the ventral and intermediate regions containing neurons with glycine-like immunoreactivity.

Phenotypic changes and proliferative activity of human gamma delta T cell receptor-bearing cells upon activation

We first compared the proliferative activity of alpha beta T cell receptor (TCR) (beta F1+) and gamma delta TCR (TCR delta-1+) human T cells after phytohaemagglutinin (PHA) stimulation by using double-colour immunofluorescence staining with Ki67 and anti-BrdU monoclonal antibodies (MoAbs). The dividing activity was higher within the alpha beta TCR cells: after 3 days of culture 69.9 +/- 5.9% of beta F1+ cells expressed Ki67, and 44.8 +/- 4.8% of these cells synthesized DNA as revealed by BrdU incorporation. In contrast, only 18.9 +/- 1.6% and 12.0 +/- 1.2% of TCR delta-1+ cells in the same samples were Ki67+ and BrdU+, respectively. Cells with V delta 1-J delta 1 usage (delta TCS-1+) showed a higher cycling activity than the rest of gamma delta TCR cells: after 3 days of PHA stimulation, 51.1 +/- 18.3% and 18.3 +/- 6.1% of such cells were in cycle and synthesized DNA, respectively. Next, we studied the expression of CD45 isoforms on peripheral blood alpha beta TCR and gamma delta TCR lymphocytes. Within the alpha beta TCR cells, two distinct subpopulations were distinguishable after labelling with SN130 (CD45RA) MoAb: 64.1 +/- 10.2% were bright, and 35.9 +/- 10.2% were dim or negative. Likewise, most TCR delta-1+ cells expressed SN130 (CD45RA): 87.5 +/- 3.0% were bright and 12.5 +/- 3.0% were dim. However, in contrast to alpha beta TCR+ cells, a high proportion (55.6 +/- 4.0%) of gamma delta TCR+ cells also expressed CD45RO molecules. Thus, most resting gamma delta TCR cells showed a pattern of CD45 isoform expression similar but not identical to that of 'memory' alpha beta TCR cells. Within the gamma delta TCR cell population the expression of CD45RO was heterogeneous because only 19.8 +/- 5.9% of cells bearing the V delta 1-J delta 1 form of the receptor (delta TCS-1+) were UCHL1 (CD45RO)+. Therefore, most gamma delta TCR cells with V delta 1-J delta 1 usage showed a CD45 isoform profile resembling that of 'naive' alpha beta TCR cells. These phenotypic features changed upon PHA stimulation: after 5 days of culture the proportion of TCR delta-1+ cells expressing UCHL1 increased to 86.0 +/- 3.1% and a two-fold increase in CD45RO expression was also observed in the delta TCS-1+ subpopulation.

Soluble interleukin-2 receptors in patients with nasopharyngeal carcinoma

The authors performed a retrospective analysis of serum soluble interleukin-2 receptor (sIL-2R) levels in 72 patients with nasopharyngeal carcinoma (NPC) using an enzyme immunoassay. Their objectives were to determine the value of serum sIL-2R in estimating the tumor burden, and its predictive value in response to therapy and prognosis. The data showed that serum sIL-2R levels in patients were significantly higher than that of healthy controls. The serum levels correlated with clinical staging and hence the tumor burden of NPC. Serial measurement of serum sIL-2R provided an accurate prognostic index of the clinical response to radiotherapy in at least 89% of patients with raised serum sIL-2R at initial diagnosis (defined as mean + 2 SD of healthy controls) and a reliable predictive index in all patients who subsequently developed distant metastasis despite initial radiotherapy. Simultaneous measurement of Epstein-Barr virus-related serology (IgA-VCA and IgG-EA) failed to demonstrate predictive value comparable with that of serum sIL-2R. The authors conclude that monitoring serum sIL-2R levels has clinical and prognostic significance in patients with NPC and that prospective studies are indicated.

Soluble interleukin-2 receptors in patients with nasopharyngeal carcinoma

The authors performed a retrospective analysis of serum soluble interleukin-2 receptor (sIL-2R) levels in 72 patients with nasopharyngeal carcinoma (NPC) using an enzyme immunoassay. Their objectives were to determine the value of serum sIL-2R in estimating the tumor burden, and its predictive value in response to therapy and prognosis. The data showed that serum sIL-2R levels in patients were significantly higher than that of healthy controls. The serum levels correlated with clinical staging and hence the tumor burden of NPC. Serial measurement of serum sIL-2R provided an accurate prognostic index of the clinical response to radiotherapy in at least 89% of patients with raised serum sIL-2R at initial diagnosis (defined as mean + 2 SD of healthy controls) and a reliable predictive index in all patients who subsequently developed distant metastasis despite initial radiotherapy. Simultaneous measurement of Epstein-Barr virus-related serology (IgA-VCA and IgG-EA) failed to demonstrate predictive value comparable with that of serum sIL-2R. The authors conclude that monitoring serum sIL-2R levels has clinical and prognostic significance in patients with NPC and that prospective studies are indicated.

Probabilistic secretion of quanta from nerve terminals in avian ciliary ganglia modulated by adenosine

1. The effects of adenosine on the probability of secretion of acetylcholine quanta and on presynaptic and postsynaptic action potentials was examined in the post-hatched avian ciliary ganglion. 2. Adenosine (20 microM) reduced the average size of the excitatory postsynaptic potential (EPSP) by 33%. This was due to a decrease in quantal content of the EPSP (m). The effect was blocked by theophylline (50 microM). 3. Adenosine deaminase (2.5 i.u./ml) increased the size of the EPSP by 70%, suggesting that endogenous adenosine modulates synaptic transmission in the ciliary ganglion. However, theophylline (20-100 microM) did not affect the EPSP in a low [Ca2+]o of 1 mM and high [Mg2+]o of 6 mM. 4. Plateau-type action potentials with a large calcium component were generated in the ciliary neurones by bathing the ganglion in tetraethylammonium ions (TEA, 10 mM). Adenosine (20 microM) reduced the duration of these action potentials on short exposures (less than 20 min) but increased the duration on longer exposure (greater than 30 min). Adenosine did not affect the normal action potential recorded in the absence of TEA. 5. Adenosine (20 microM) hyperpolarized the nerve terminal and as a consequence increased the size of the presynaptic action potential and reduced its after-hyperpolarization. 6. Plateau-type action potentials with a large calcium component were generated in the nerve terminals using TEA (10 mM). The duration of these action potentials was significantly reduced by adenosine (20 microM). 7. Adenosines action on nerve terminals, to hyperpolarize the membrane and reduce calcium influx, may contribute to its effect in reducing m of the EPSP.

Epstein-Barr virus in oropharyngeal and nasopharyngeal secretions of patients with nasopharyngeal carcinoma and control subjects

The frequency of oropharyngeal excreters of the Epstein-Barr virus among patients with nasopharyngeal carcinoma in Hong Kong was compared with those of healthy adults in Hong Kong and California. 6 (3%) of 177 patients, 11 (12%) of 92 Hong Kong residents, and 20 (15%) of 132 Californians were excreters. The virus was detected in the nasopharyngeal secretion of only 1 of 67 patients and in 2 of 73 healthy adults. No convincing evidence for neutralizing antibody in the throat wash and nasopharyngeal secretions of the patients could be obtained. Epstein-Barr viral gene sequencing could not be detected in the throat washes from 27 patients with nasopharyngeal carcinoma, 8 patients with infectious mononucleosis, and 15 healthy adults and in the nasopharyngeal secretions of 35 patients and 17 controls. We conclude that patients with nasopharyngeal carcinoma are no more likely to be oropharyngeal or nasopharyngeal excreters of the Epstein-Barr virus than healthy adults. One possible explanation for this unexpected finding is that the virus infections in nasopharyngeal carcinoma cells are predominantly nonproductive.

Intake and blood levels of some minerals in an elderly Chinese population

Twenty-four hour intakes of potassium, calcium, and iron, and plasma concentration of potassium, copper and zinc were determined in a cluster sample of 400 apparently healthy subjects aged 60 years and over living in the community. Potassium and calcium intakes were lower in older men and lower in men compared to women. Both were much lower than intakes reported among Caucasian elderly, while iron intakes are comparable. Plasma potassium concentration was lower than values from studies of all ages and from studies of Caucasian elderly subjects. Copper and zinc concentrations were comparable to published values for adults of all ages. The significance of low potassium and calcium intake among elderly subjects in the population is discussed.

An in vitro comparison of different bleaching agents in the discolored tooth

Extracted teeth with intact crowns were stained to compare and evaluate the effectiveness of four bleaching agent combinations. Forty-two permanent and 12 deciduous teeth were used. The bleaching agents were placed into coronal pulp chambers and then evaluated and rated at 1-, 3-, 7-, and 14-day and 6-month intervals. New sodium perborate combined with fresh Superoxol was the most effective bleaching agent with 93% success (the final shade was as light as the prestained shade). New sodium perborate and 1-yr-old Superoxol was 73% successful. New sodium perborate with distilled water and old sodium perborate with distilled water were both 53% successful. Deciduous teeth demonstrated a response to bleaching agents similar to that of permanent teeth. Color regression after 6 months was found in 4% of the cases. When it occurred, the degree of color regression was minimal.

Vitamin A and E status in healthy elderly Chinese in Hong Kong

Daily intakes of retinol and beta-carotene equivalents, plasma retinol, retinol binding protein and plasma vitamin E were estimated in a cluster sample of apparently healthy elderly subjects aged 60 years and over in Hong Kong leading an active life in the community. Intakes were available from 418 and plasma measurements from 385 subjects. There were no age or sex differences in intakes. Plasma retinol and retinol binding protein levels showed no sex- or age-related difference, while plasma vitamin E levels were higher in women. Retinol binding protein, plasma retinol and plasma vitamin E levels were comparable to published values for Chinese and Caucasians of all ages. Vitamin A and E status appears to be adequate in this elderly Chinese population.

Forearm bone loss in hemiplegia: a model for the study of immobilization osteoporosis

Hemiplegia is associated with excessive bone loss in the paralyzed arm. The forearm bone mineral content was measured at a proximal cortical site and a distal trabecular site of both the normal and hemiplegic arms in 74 patients with hemiplegia. By comparing the ratios of bone mineral content in the two arms, the effect of immobilization could be quantitated independently of the large population variance in bone mineral content. Bone loss, estimated from this single comparison of bone mineral content in the normal and hemiplegic arms, at the trabecular and cortical sites was positively correlated with the duration of stroke and negatively correlated with reduction in forearm function. At the trabecular site females had a proportionately greater bone loss than males, indicating an interaction between gender and immobilization associated bone loss at this site. The regression line of excess bone loss in the hemiplegic limb against time had a negative slope of 1.3% and 1.5% a year of the starting value for the trabecular and cortical sites, respectively, over the 15 years studied. This study indicates that a reduction in function is associated with significant bone loss occurring over prolonged periods that may account, at least in part, for the significant osteoporosis seen in elderly people and in subjects with conditions resulting in reduced mobility such as arthritis, obstructive airways disease, and neurological disease.

The formation of topographical maps in developing rat gastrocnemius muscle during synapse elimination

1. The rat lateral gastrocnemius muscle (LG) is a complex of four muscle compartments, each defined in terms of its unique innervation by a single primary nerve branch of the muscle nerve. A study has been made of the topographical distribution of motor units in the medial compartment of the LG (LGM) both before and after the loss of polyneuronal innervation that accompanies development. 2. Glycogen depletion methods showed that the distribution of single motor units depended on the rostro-caudal origins of their axons in the spinal cord: rostral axons possessed motor units almost exclusively confined to the medial half of the LGM; intermediate axons possessed motor units primarily in the intermediate and lateral part of the LGM; caudal axons possessed motor units that were not restricted to any particular part of the LGM. 3. Myosin ATPase staining showed that about 80% of the LGM consists of type II A fibres, whilst the remainder are type II B. Physiological determination of the contractile properties of motor units indicated two classes of units: those that were relatively fatigue resistant and did not show a sag property (like fast-twitch, fatigue-resistant fibres or FR) and those that were relatively fatigable and did show a sag property (like fast-twitch, fatigable fibres or FF). 4. Glycogen depletion was also used to determine the distribution of motor units in the LGM at 7 days post-natal, when most fibres still receive a polyneuronal innervation. The LGM primary nerve branch innervated a confined sub-volume of muscle fibres which is similar to the mature pattern. However, rostral axons possessed motor units that extended into the lateral half of the LGM, a position from which they are excluded in the adult. 5. These observations suggest that the axons of rostral and intermediate units form a topographical map within adult FR motor units (type II A fibres) in the LGM. The results suggest that competition between axon terminals for synaptic sites plays a role in the elimination of inappropriately positioned terminals and subsequent emergence of the topographical map.

Cost-effectiveness of office obstetrical ultrasound in family practice: preliminary considerations

This study reports costs incurred over a nine-and-one-half-month period following the introduction of obstetrical ultrasound into a group family practice serving primarily prepaid health plan patients. During this introductory period, 248 examinations were performed by family physicians and refereed by a radiologist for accuracy. The estimated cost to the practice was $95 per examination. This figure includes physician training expenses, professional fees, personnel, equipment and maintenance costs, costs for exams repeated due to technical error, and costs for additional consultation by a radiologist. Previously, all exams were referred to other consultants, and the charge was $185 per exam. Thus, in-office ultrasound exams performed by family physicians can provide cost savings while maintaining high standards of obstetric care.

Osteoarthritis of the proximal interphalangeal joint

Most patients with symptomatic osteoarthritis of the proximal interphalangeal joint should be managed nonoperatively. When operative intervention becomes necessary, therapeutic options include joint fusion or flexible implant arthroplasty. Both relieve pain; however, an implant, while preserving mobility, is subject to fatigue and ultimate failure.

Competition between segmental nerves at end-plates in rat gastrocnemius muscle during loss of polyneuronal innervation

1. The segmental innervation of the rat lateral gastrocnemius (l.g.) muscle is from lumbar nerves L4 and L5. A study has been made of changes in the innervation of the l.g. muscle by nerves L4 and L5 before and after removal of L4 during the loss of polyneuronal innervation which occurs over the first 2 weeks postnatal. 2. The rat l.g. muscle is a complex of three unipennate muscles; the lateral, intermediate and medial heads. Each of these has a characteristic distribution of type I and type II muscle fibres of different diameter by 12 days postnatal. Following the removal of nerve L4 at birth there is no change in the distribution of fibre types in the different heads of the l.g. muscle at 12 days postnatal. 3. The number of fibres in the l.g. muscle doubled between birth and 12 days postnatal and the maximum tetanic force generated by the muscle increased by fourfold. Removal of nerve L4 at birth did not alter the increase in fibre number and there was no difference between the tension generated by the l.g. muscle in the ipsilateral and contralateral limbs of operated animals. 4. The number of detectable motor units in a extracellular calcium concentration [( Ca]o) of 2 mM remained constant in L4 at about fifteen between birth and 12 days postnatal; the number of detectable motor units in L5 declined over this period from about fifteen to six in a [Ca]o of 2 mM. Following the removal of L4 at birth, the number of motor units in L5 increased to twenty by 3 days postnatal and remained there for at least 12 days in a [Ca]o of 2 mM. 5. The mean size of motor units and the range of motor unit sizes declined for both L4 and L5 during the postnatal period. Following the removal of L4, the mean size of motor units and the range of motor unit sizes in L5 failed to decline. 6. The number of motor units detected at birth in a raised [Ca]o of 3-5 mM increased in L4 and L5 to about twenty; this estimate in high [Ca]o remained constant during the postnatal period. Estimates of the size of the large, low threshold motor units declined whether these were made in low or high [Ca]o.(ABSTRACT TRUNCATED AT 400 WORDS)