A vaccine carrier derived from Neisseria meningitidis with mitogenic activity for lymphocytes

Protein carriers vary in their ability to increase the immunogenicity of poorly immunogenic or T-lymphocyte-independent antigens. We examined one such carrier, the outer membrane protein complex derived from Neisseria meningitidis serogroup B strain B11, in an attempt to determine why this outer membrane protein complex was more immunogenic in young infants and in relevant animal models than two other carriers used in conjugates made with Haemophilus influenzae type b polysaccharide, a T-cell-independent antigen. A single protein of the outer membrane protein complex, the class 2 porin protein, was purified and shown to function as a T-helper lymphocyte carrier protein. Unexpectedly, it was also found to have mitogenic activity for lymphocytes that was not due to lipopolysaccharide. This mitogenic activity appears to date to be unique to this carrier protein of the carrier proteins tested and may contribute to the ability of the H. influenzae type b conjugate vaccine made with the outer membrane protein complex to generate IgG anti-polysaccharide antibody responses in mice and infant monkeys and protective immune responses in infants less than 6 months of age.

Cross-sectional epidemiology of phlebitis and catheter-related infections

OBJECTIVES

To describe the characteristics and the problems arising from the use of vascular catheterization in a general hospital and to identify avoidable risk factors associated with catheter-related infections.

DESIGN

Cross-sectional, including the entire hospitalized population.

SETTING

A university-affiliated hospital.

RESULTS

Three-hundred fifty-three intravascular catheters were implanted in 315 of a total of 1,838 hospitalized patients (17.1%, confidence interval [CI] = 15.7-18.5). Of the 353 intravascular catheters, 26 (7.3%) were intra-arterial, 273 (77.3%) were peripheral, and 54 (15.3%) were central. The median (range) duration of the catheterization was 3 (1-11) days for arterial catheters, 1 (1-24) for peripheral catheters, and 5 (1-130) for central catheters. Fifty-three (15%, CI = 11.5-19.5) showed signs of infection. Independent risk factors associated with infection were the presence of infection located elsewhere (odds ratio [OR] = 8.7, CI = 4.13-18.3, p less than .0001), inappropriate catheter care (OR = 5.3, CI = 2.5-11.2, p less than .0001), inappropriate length of catheter use (OR = 3.5, CI = 1.4-9.02, p less than .01), and duration of hospitalization exceeding 14 days (OR = 2.6, CI = 0.9-7.83, p = .07).

CONCLUSION

The risk factors associated with catheter-related infections suggest that many are preventable by improved protocols for management. This hypothesis can easily be tested.

Case report: systemic lupus erythematosus (SLE) serositis mimicking acute cholecystitis

Systemic lupus erythematosus (SLE) is a well recognized cause of an acute abdomen. What is less well recognized is that the underlying pathology can be varied. The computed tomography (CT) and ultrasound appearances of the gall-bladder in a case of SLE serositis are shown. The imaging findings were strongly suggestive of primary gall-bladder disease although at laparotomy the gall-bladder showed serosal inflammation only.

Radionuclide limb blood flow in peripheral vascular disease: a review of 1100 measurements

Radionuclide limb blood flow measurements using 99Tcm-labelled human serum albumin and a gamma camera have been performed on normal volunteers and on patients with suspected or confirmed peripheral arterial disease. The normal range of flow was found to be 10.0-22.3 ml per 100 ml tissue per min. Flow in the symptomatic legs of patients with arterial disease varied from 9.0 ml per 100 ml tissue per min in mild claudication to less than 1.0 ml per 100 ml tissue per min in rest pain. The technique has been used as an initial screening procedure, to resolve diagnostic problems, to measure objectively the treatment response and to assess patients with critical ischaemia. The results of 1100 measurements are reported and the clinical utility in routine vascular surgical practice is discussed.

Survival of Dermatophilus congolensis in tropical clay soils submitted to different water potentials

The survival of a rifampicin-resistant mutant of Dermatophilus congolensis in vertisol and oxisol soils from Guadeloupe and in their constitutive clays was studied using a pneumatic device for controlling water potentials (pF). Experiments were carried out at two pF values simulating the wet season and the dry season. Survival time depended on the type of soil and its water content. Organic matter had a protective effect on the microorganism in oxisol but not in vertisol. The pathogenicity of D. congolensis was preserved in the soils which could therefore act as temporary reservoirs of this pathogen. Long-term survival of this organism in soils mixed with water suggests that ponds and dipping tanks may constitute sources of infection for cattle.

Early dropouts from psychotherapy

Ninety-six patients requesting psychotherapy were studied prospectively at the time of screening interview by four senior psychiatrists using a variation on Luborsky's Helping Alliance questionnaire and the Osgood Semantic Differential. Significant differences were found at the time of screening between early dropouts and continuers, among screeners' rate of early dropouts, and among patients' perceptions of screeners. The screener with a high early dropout rate was seen as being more passive and less potent, and offering less new understanding than other screeners. Patients who dropped out early experienced a less strong helping alliance, felt they gained less new understanding, liked the clinician less well, felt less well liked and less respected, and saw the interviewer as more passive and psychotherapy as less potent than did continuers.

Diagnostic and prognostic value of the determination of the aminopropeptide of type III procollagen in patients with primary liver cancer

Hepatic fibroplasia seems to play an important role in the course of primary liver cancer (PLC) since, for instance, encapsulated and fibrolamellar hepatocellular carcinomas show a definitely better prognosis. In this study, serum procollagen III amino-terminal peptide (PIIIP) levels, which reflect synthesis and release of procollagen type III, were measured with the aim of assessing hepatic fibrogenesis in PLC patients and determining whether serum PIIIP levels play a diagnostic or prognostic role in PLC. Twenty-five patients with PLC, 74 patients with cirrhosis and 38 healthy volunteers were studied. Serum PIIIP levels were determined by a radioimmunoassay (RIA) method. In PLC patients PIIIP serum levels were significantly higher than those of controls and cirrhotic patients (P less than 0.001 and P less than 0.01 respectively) but an analysis of individual values showed an important overlap between PLC and cirrhosis. No correlation was found between serum PIIIP levels and tumour histology, presence or absence of cirrhosis, Child status, possible aetiology of the disease, indices of hepatocellular inflammation, cholestasis and synthesis, or tumour markers. On the contrary, serum PIIIP levels correlated with tumour gross pattern (z = 3, P less than 0.001) and, inversely, with survival (r = 0.659, P less than 0.01), patients with serum PIIIP over 25 ng/mL showing a significantly worse prognosis. These data confirm that hepatic fibroplasia plays an important, but not yet fully understood, role in the course of PLC. From the clinical point of view, PIIIP determination does not add to the differential diagnosis between PLC and cirrhosis but helps to identify patients with larger liver replacements and worse prognoses.

Psychotherapy refusers

A systematic review of 414 terminated cases on a semiprivate psychotherapy service revealed that 16.7% of patients never began therapy despite being accepted after an extensive and lengthy screening process. This is lower than in previous studies. Except for ethnicity, comparison between the refusers and acceptors of 42 variables failed to replicate the correlations found in previous studies. In our sample, psychotherapy refusers were characterized by (1) having less family psychiatric history, (2) being more likely to elaborate their problems, (3) having less alcohol abuse history, (4) being less likely to be offered long-term individual therapy, and (5) having waited less time for their screening appointment. Such variables as age, gender, diagnosis, severity, income, and education were all nonsignificant. Although we offer some hypotheses for our significant correlations, we suspect that the interaction with the screener is more important than patient variables in determining acceptance of psychotherapy.

Minimal antiproliferative effect of recombinant müllerian inhibiting substance on gynecological tumor cell lines and tumor explants

Múllerian Inhibiting Substance (MIS) is a testicular hormone that promotes involution of the Múllerian duct during embryogenesis. The Múllerian duct gives rise to adult female reproductive ducts including the fallopian tubes, uterus, and upper vagina. Thus, testicular MIS ensures the regression of female sex organ primordia. Partially purified bovine MIS was reported to inhibit proliferation of tumor cells derived from human gynecological cancers. These observations suggest that MIS might be an effective anticancer agent for some human tumors. Recombinant human MIS (rHu-MIS) has recently become available. To assess the antiproliferative activity of rHu-MIS, we examined its effects on 11 ovarian, six endometrial, and two nongynecological human tumor cell lines. rHu-MIS had no effect on proliferation of these cell lines in five independent assays. Forty-three primary human tumor explants were also examined in human tumor colony forming assays, gel-supported primary culture assays, and subrenal capsule assays. rHu-MIS significantly inhibited the growth of five of these tumors including four ovarian and one small cell lung cancer explant. The four ovarian cancer responses include three of 13 (23%) explants tested in human tumor colony-forming assays and one of eight (12.5%) explants tested in gel-supported primary culture assays. We conclude that rHu-MIS may have antiproliferative activity against some human ovarian cancers.

[Narcolepsy, an epidemic?]

Narcolepsy, was first described in 1880, is a chronic, disabling disease characterized by excessive daytime sleepiness and abnormal REM manifestations. It is estimated that, in Brazil, 15,000 to 150,000 cases may exist, but is was only since the first sleep laboratories were installed in the country that the disease began to be recognized. It created a sudden increase in the number of diagnosis which actually simulates an epidemics in the medical records. The existence of a sleep laboratory, however, is not necessary for the diagnosis of the disease. An informed clinician can identify it during the interview. The goal of this paper is to inform about the clinical, diagnostic, and therapeutic aspects of the disease through the report of four selected cases.

A psychotherapy service: preserving a place for psychodynamic teaching

Striving for an educational balance between psychodynamics and psychotherapy led to the creation of a Psychotherapy Service. Psychodynamic teaching was preserved while biological teaching was increased. The history, philosophy, and structure of this service, combined with a chart review, give a picture of the kind of clinical experience and training available on such a service.

Pains and gains: a study of forced terminations

The forced termination of psychoanalysis, such as occurs when the analyst makes a geographic move, uniquely disrupts the analytic setting. This paper recounts the author's experience of terminating a full-time private practice of psychoanalysis and psychoanalytic therapy for such a move. The limited literature on the subject is reviewed with a focus on the use of technical variation in the forced termination situation. The author delineates three areas of interaction with patients where technical variation proved in her experience to be of value: dealing with countertransference and counter-reaction, providing information about the move, and the consideration and process of referral for continued therapy. As opposed to what would be predicted from a classical psychoanalytic perspective, the use of such technical maneuvers seemed to facilitate rather than impede analytic work. These variations in technique served at crucial times to maintain the analytic alliance, to preserve the patient's capacity to recognize and make use of transference, and to provide avenues for resolving past traumas in the transference and the actual loss of the analyst. The concept of the analyst as a new or useable object is proposed as providing a theoretical framework for understanding these observations.

Regulatory role of retinoic acid on cultured mouse keratinocyte inositol phospholipid metabolism: dose-dependent release of inositol triphosphate

The incorporation of precursor 14C-myoinositol into the three cellular inositol phospholipids (PtdIns, PtdInsP, and PtdInsP2) of cultured, rapidly proliferating keratinocytes is significantly enhanced by the exogenous addition of a high concentration (1 X 10(-7) M) of all-trans retinoic acid or its analog 13-Cis analog, whereas a similar incubation with a low concentration (1 X 10(-10) M) of the same retinoid resulted in an insignificant incorporation of the radio-precursor into the three inositol phospholipids. Incorporation was most marked into the more phosphorylated PtdIns4P and PtdIns4,5P2. These results indicate that retinoic acid affects the biosynthesis of the inositol phospholipids at high concentrations. In contrast, the hydrolysis of 14C-PtdIns4,5P2 and release of 14C-InsP3 from the prelabeled keratinocytes is markedly enhanced by a low physiologic concentration (1 X 10(-10) M) of retinoic acid or its 13-Cis analog. The hydrolysis is rapid, with an accompanying elevated transient release of 14C-InsP3. High concentration (1 X 10(-5) M), on the other hand, supresses 14C-InsP3 release. These results taken together underscore a bifunctional, dose-dependent effect of both the all-trans-RA and its 13-Cis analog on the synthesis and hydrolysis of keratinocyte PtdIns4,5P2. Furthermore, the results suggest that at low physiologic concentrations, these retinoids may function as agonists to perturb the membrane resulting in induced rapid hydrolysis of cellular PtdIns4,5P2, which is coupled to a "transient" generation of InsP3 (an intracellular second messenger). The rapid formation of this putative "second messenger" may in turn play a role in the cellular proliferative or differentiating biochemical events in the murine keratinocytes.

Tumor necrosis factor not detectable in patients with clinical cancer cachexia

Tumor necrosis factor (TNF) has been implicated in the pathogenesis of cachexia in neoplastic and infectious diseases. To assess the relationship between TNF and weight loss among cancer patients, we assayed TNF levels in serum from 19 patients who had lost 8%-40% of premorbid weight. The weight loss experienced by these patients was not attributable to anticancer therapy, gastrointestinal disorders, or other medical problems. TNF was measured using a quantitative sandwich enzyme-linked immunosorbent assay that is sensitive to human TNF in serum at concentrations greater than or equal to 40 pg/mL. No TNF was detected in serum samples from the 19 patients studied.

Recombinant human tumor necrosis factor induces acute reductions in food intake and body weight in mice

We examined the effects of treatment with rHuTNF on food consumption and body weight in C3H/HeJ mice. rHuTNF was administered intraperitoneally either by injections of 3, 12, or 24 micrograms twice a day or by implantation of osmotic pumps that released 0.75, 3, or 12 micrograms per day. Dose-dependent reductions in both food intake and weight were induced by rHuTNF. However, in spite of continued exposure to rHuTNF, the mice developed a resistance to rHuTNF and resumed their pretreatment food intake and weight. Non-immunological factors may play a role in the development of this tolerance, since it developed rapidly and faded within 2 wk of cessation of exposure to rHuTNF.

Turnover of inositol phospholipids in cultured murine keratinocytes: possible involvement of inositol triphosphate in cellular differentiation

The relationship between the turnover of inositol phospholipids (PtdIns) and the growth and differentiation of normal murine keratinocytes in culture was studied. Addition of myo-[U-14C]inositol to freshly plated cells resulted in a linear incorporation of radiolabel into the inositol phospholipids of the proliferating basal cells in culture during the initial 36 h, after which time the rate of radiolabel incorporation into the cells declined. The decrease in the incorporation of the radiolabel into the PtdIns, particularly the more highly phosphorylated PtdIns-4P and PtdIns4,5P2, correlated with the marked hydrolysis of these polyphosphoinositides and the rapid hydrolytic release of the inositol phosphates (InsP2 and InsP3). The transient accumulation of the InsPs correlated with the onset of differentiation of these cells. To ascertain whether the above observations of keratinocytes that were undergoing normal proliferative and differentiating phases in culture are consistent with the more synchronized populations of proliferative and differentiating cells, we investigated the turnover of PtdIns in a Ca2+-regulated system of homogenous populations of proliferating mouse keratinocytes in 0.09 mM Ca2+, and a differentiating population in 1.8 mM Ca2+. Our data from system revealed rapid hydrolysis of the PtdIns in the prelabeled low-Ca2+ proliferating cells immediately after a switch from the low to normal extracellular Ca2+ medium. Associated with this hydrolysis was the rapid and transient accumulation of the InsPs (maximum of 60 sec). The hydrolysis of the PtdIns and the accumulation of the InsP3 were not observed when the prelabeled proliferating cells were switched from a low to a low extracellular Ca2+ medium. These results suggest that the rapid hydrolysis of the PtdIns, particularly PtdIns4,5P2, which was accompanied by the hydrolytic release of InsP3, could be the initiating signal to program proliferating keratinocytes into differentiation.

Single breath of CO2 as a clinical test of the peripheral chemoreflex

Peripheral chemoreceptor responsiveness is usually examined clinically by hypoxic testing, but the usefulness of this approach is limited by safety considerations, and the interpretation of results may be confounded by the direct central nervous system effects of hypoxia. Therefore we examined the single-breath (SB) CO2 test to determine its reproducibility and applicability as a clinical test of peripheral chemoreceptor function. The technique involved the inhalation of a SB of 13% CO2 in air. The ventilatory response was determined from the increase in ventilation (VE) during the first 20 s after the test breath and from the difference in end-tidal PCO2 between the test breath and preceding control breaths. The peak increase in VE occurred during the second or third breath after the test breath, corresponding to a delay of approximately 10 s. The mean of 10 SB tests administered at 2- to 3-min intervals was taken as the subject's response. Five healthy subjects were tested in this manner on each of 6 consecutive days with the response having an interday coefficient of variation of 25 +/- 6% (SD). The response in 26 healthy females (aged 22-61 yr) was 0.32 +/- 0.11 l.min-1.Torr-1, and in 26 healthy males (aged 24-69 yr) the response was 0.38 +/- 0.14 (P NS). No significant correlation was found between the age of the subjects and their ventilatory response. Thirty-six of the subjects also underwent hyperoxic CO2 rebreathing tests, the response to which is dependent on central chemoreceptor function. No correlation was found between rebreathing and SB tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies against amino acids 1-15 of tumor necrosis factor block its binding to cell-surface receptor

Human tumor necrosis factor (hTNF) mediates a variety of biologic activities, which are dependent on the attachment of hTNF to cell-surface receptors. To identify regions of the hTNF protein involved in binding hTNF to its receptor, we prepared five synthetic peptides [hTNF-(1-15), hTNF-(1-31), hTNF-(65-79), hTNF-(98-111), and hTNF-(124-141)] and two hydroxylamine cleavage fragments [hTNF-(1-39) and hTNF-(40-157)] of hTNF. The hTNF-synthetic peptides and hTNF fragments were tested in hTNF receptor binding assays and in two biologic assays: cytolysis of tumor cells and suppression of lipoprotein lipase in adipocytes. Neither the synthetic peptides nor hTNF fragments were active agonists or antagonists in these assays. The synthetic peptides were also conjugated to thyroglobulin, and peptide-specific antisera were raised. All five peptide-thyroglobulin conjugates induced antibody responses to the immunizing peptide and to hTNF. Each antiserum was tested for antagonist activity in hTNF binding assays. Only antisera raised against hTNF-(1-15) or hTNF-(1-31) and antisera against whole hTNF blocked binding. IgGs purified from these three antisera also block hTNF-induced cytolysis and lipoprotein lipase suppression. We conclude that antibodies that recognize the N-terminus of hTNF block the attachment of hTNF to its cellular receptor and inhibit the biologic effects of hTNF.

Tumors secreting human TNF/cachectin induce cachexia in mice

Anorexia and weight loss are serious complications that adversely effect the prognosis of cancer patients. It has been suggested that TNF/cachectin may cause cachexia. To determine if TNF/cachectin can induce progressive weight loss in tumor-bearing animals, a clone of the human TNF/cachectin gene was isolated and inserted into a mammalian expression vector. This construct was transfected into CHO cells, and a cell line (CHO/TNF-20) that secretes TNF/cachectin was isolated. A cell line (CHO/CMV-Neo) that contains the same expression vector without the TNF/cachectin gene was also isolated. Nude mice injected intraperitoneally with CHO/TNF-20 cells died more quickly than mice injected with CHO/CMV-Neo cells. Eighty-seven percent of mice inoculated intramuscularly with CHO/TNF-20 cells developed severe cachexia and weight loss. All mice bearing CHO/CMV-Neo tumors maintained or increased their body weight. We conclude that mice bearing tumors that secrete TNF/cachectin develop progressive wasting and die more quickly than mice bearing control tumors.

Novel regulatory actions of 1 alpha,25-dihydroxyvitamin D3 on the metabolism of polyphosphoinositides in murine epidermal keratinocytes

The in vitro incubation of murine keratinocytes in the presence of 1 alpha,25-dihydroxyvitamin D3 enhanced the rapid hydrolysis of the prelabeled keratinocyte polyphosphoinositides (polyPtdIns) when compared to untreated cells. The rapid hydrolysis of the polyPtdIns and the release of the inositol phosphates (particularly InsP3 and InsP2) precede the onset of differentiation of these cells. These data therefore suggest that 1 alpha,25-dihydroxyvitamin D3 functions in vitro to initiate the rapid generation of InsP3 from cellular polyPtdIns; this in turn may mobilize intracellular Ca2+, thus providing the signal which program the murine keratinocytes from a proliferating mode into a differentiating mode.

Pharyngeal size in snorers, nonsnorers, and patients with obstructive sleep apnea

We measured pharyngeal cross-sectional area and its change with alterations in lung volume in 10 subjects who snored and had obstructive sleep apnea, 6 subjects who snored and did not have obstructive sleep apnea, and 9 subjects who did not snore. Pharyngeal area was measured with use of an acoustic-reflection technique. We found that snorers with and without sleep apnea had a significantly smaller mean (+/- SE) pharyngeal cross-sectional area (4.1 +/- 0.2 and 3.7 +/- 0.9 cm2, respectively) at functional residual capacity than nonsnorers (5.4 +/- 0.5 cm2, P less than 0.025). When lung volume decreased from functional residual capacity to residual volume, both nonsnorers and snorers with sleep apnea had a decrease in pharyngeal area (from 5.4 +/- 0.5 to 4.5 +/- 0.4 cm2 and 4.1 +/- 0.2 to 3.4 +/- 0.2 cm2, respectively), whereas snorers without sleep apnea had no such decrease, suggesting that their pharynxes were less collapsible at low lung volumes. We conclude that snorers with and without sleep apnea have smaller pharyngeal cross-sectional areas than nonsnorers and that snorers with sleep apnea have a further decrease as lung volume falls.

Physiological determinants of nocturnal arterial oxygenation in patients with obstructive sleep apnea

Among patients with similar degrees of obstructive sleep apnea (OSA) there is considerable variability in the degree of associated nocturnal hypoxemia. The factors responsible for this variability have not been clearly defined. Therefore we studied 44 patients with OSA to identify the physiological determinants of nocturnal arterial O2 saturation (SaO2). All patients underwent pulmonary function testing, arterial blood gas analysis, and overnight polysomnography. Mean nocturnal SaO2 ranged from 96 to 66% and apnea-hypopnea index from 11 to 128 per hour of sleep. Several anthropometric, respiratory physiological, and polysomnographic variables that could be expected to influence nocturnal SaO2 were entered into a stepwise multiple linear regression analysis, with mean nocturnal SaO2 as the dependent variable. Three variables [awake supine arterial PO2 (PaO2), expiratory reserve volume, and percentage of sleep time spent in apnea] were found to correlate strongly with mean nocturnal SaO2 (multiple R, 0.854; P less than 0.0001) and accounted for 73% of its variability among patients. Body weight, other lung volumes, and airflow rates influenced awake PaO2 and expiratory reserve volume but had no independent influence on nocturnal SaO2. In a further group of 15 patients with OSA a high correlation was obtained between measured nocturnal SaO2 and that predicted by the model (r = 0.87; P less than 0.001). We conclude that derangements of pulmonary mechanics and awake PaO2 (generally attributable to obesity and diffuse airway obstruction) are of major importance in establishing the severity of nocturnal hypoxemia in patients with OSA.

Prophylaxis of Pseudomonas aeruginosa infections in leukopenic mice by a combination of active and passive immunization

Mice rendered leukopenic with cyclophosphamide and then challenged with viable Pseudomonas aeruginosa were used to determine the protective efficacy of active immunization against exotoxin A and of passive immunization with human antiserum to Escherichia coli J5, a rough mutant of Escherichia coli O111:B4. Neither treatment alone provided a greater degree of protection than its respective control. However, the combination of these treatments produced a moderate, yet consistent, increase in the survival of infected immunosuppressed mice.

Observations on local heat treatment for cutaneous leishmaniasis

Local heat treatment was tested and found effective in three patients with diffuse cutaneous leishmaniasis (DCL), a form of disease poorly responsive to the usual chemotherapy. A water bath that circulated water through a pad wrapped around the lesion provided a temperature of 39 degrees C to 41 degrees C for a cumulative time of at least 20 hours, over a period of several days. In the DCL patients beneficial effect of heat treatment was documented by pre- and post-treatment biopsies and cultures. Several other patients with ordinary cutaneous leishmaniasis did not respond to the same form of treatment. It was concluded that different strains and/or species of leishmanial parasites vary in their sensitivity to elevated temperature. While local heat treatment may be curative in certain cases of cutaneous leishmaniasis, such therapy is still experimental and should be monitored by quantitative parasitological studies to document its usefulness.

Monocyte suppression of antigen-specific lymphocyte responses in diffuse cutaneous leishmaniasis patients from the Dominican Republic

Patients from the Dominican Republic with diffuse cutaneous leishmaniasis showed in vivo and in vitro anergy to leishmanial antigen. Relatives of these DCL patients living in the same endemic area frequently showed skin test and lymphocyte reactivity to leishmanial antigens. This further supports the concept of specific anergy in patients with diffuse cutaneous leishmaniasis. Adherent suppressor cells modulate the antigen-specific lymphocyte proliferative response. Suppressor cells could also be isolated by Percoll gradient centrifugation. Co-culturing of lymphocytes and monocytes from HLA-identical leishmanin responders and nonresponders also identified the suppressor cell as a monocyte. In one patient, this suppression disappeared when clinical cure had been accomplished.

Monocyte suppression of antigen-specific lymphocyte responses in diffuse cutaneous leishmaniasis patients from the Dominican Republic

Patients from the Dominican Republic with diffuse cutaneous leishmaniasis showed in vivo and in vitro anergy to leishmanial antigen. Relatives of these DCL patients living in the same endemic area frequently showed skin test and lymphocyte reactivity to leishmanial antigens. This further supports the concept of specific anergy in patients with diffuse cutaneous leishmaniasis. Adherent suppressor cells modulate the antigen-specific lymphocyte proliferative response. Suppressor cells could also be isolated by Percoll gradient centrifugation. Co-culturing of lymphocytes and monocytes from HLA-identical leishmanin responders and nonresponders also identified the suppressor cell as a monocyte. In one patient, this suppression disappeared when clinical cure had been accomplished.

[Cytologic demonstration of immunoreactivity characteristic of adenopituitary peptides in the digestive epithelium of the rat and man]

Using immunoperoxidase techniques, the possible localization of pituitary regulatory peptides in fundic, antral and duodenal mucosae was investigated in both rat and man. All results obtained were similar in the two species. No glycopeptide (FSH, LH, TSH) was detected in the digestive tract. With different antisera directed against beta-lipotropin, alpha-MSH, beta-MSH, endorphins, ACTH 1-24, ACTH 17-39, a positive reaction was only obtained in the antral mucosae with an antiserum specific for the synthetic fragment 17-39 of ACTH. However neither the common precursor, proopiomelanocortin, nor the complete sequence of ACTH seem to be present in endocrine cells of the digestive tract. On the other hand, three antisera, directed against human growth hormone (GH), visualized numerous endocrine cells scattered in the glandular epithelium of the fundic and antral mucosae. Most cells were identified as ECL type in the gastric mucosae. Others are probably of the gastrin cell type in the antral mucosa, since these cells could be visualized on adjacent sections either with the antiserum against GH, or with a specific antiserum for gastrin.

Toxoids of Pseudomonas aeruginosa exotoxin-A: photoaffinity inactivation of purified toxin and purified toxin derivatives

For the preparation of greatly detoxified but highly immunogenic toxoids, two enzymatically active, low-toxicity derivatives of Pseudomonas aeruginosa exotoxin-A were further inactivated by photoaffinity labeling. These derivatives were formed during toxin purification, when a relatively crude toxin preparation was concentrated by ammonium sulfate precipitation and subsequently dialyzed. These derivatives, designated peak-1 protein (PK-1) and peak-2 protein (PK-2) were antigenically indistinguishable from native toxin, but had isoelectric points (5.00 and 4.90, respectively) that were different from that of the native toxin (4.95). Although the enzymatic activities and molecular weights of PK-1 and PK-2 were similar to those of native toxin, their toxicities were greatly reduced (ca. 500-fold). Photoaffinity labeling of fully active toxin-A, purified by a process which limits the formation of these derivatives, decreased its enzymatic activity (ca. 30-fold) and toxicity (ca. 100-fold). Likewise, photoaffinity labeling of purified PK-1 and PK-2 decreased their enzymatic activities and toxicities (ca. 30-fold and 100-fold, respectively) and, thus, yielded toxoids that were ca. 50,000-fold less toxic than unpurified native toxin. These toxoids were irreversibly detoxified and highly immunogenic during 9 months of storage at 4 degrees C.

Determination of amphetamine and methylamphetamine by gas-liquid chromatography (head space)

1 A method for determining amphetamine and methylamphetamine in urine by gas-liquid chromatography is described. 2 Chromatography is performed on a 10% Apiezon L, 10% KOH column with alkali-flame detection (NPD). This method avoids the losses of these volatile substances which are known to occur when solvent extraction is used. An alkalinized urine sample (1 ml) is introduced into a sealed vial which is heated in a water bath at 70 degrees C for 20 min. A 1 ml portion of the gas phase in equilibrium with the liquid phase is chromatographed. 3 Amphetamine and methylamphetamine can be detected and measured in urine samples after single therapeutic doses of the drugs.

[Immunohistochemical localization of pituitary peptides in the rat pyloric antrum mucosa]

Several peptides normally produced in the anterior pituitary lobe were searched in rat antral mucosa by immunocytochemistry. Peptides derived from pro-opiomelanocortin were tested: some endocrine cells were immunoreactive with ACTH 17-39 antiserum, and only a few elements were stained with ACTH 1-24 and beta LPH antisera. No immunoreactive cells were observed using alpha MSH, beta MSH and beta endorphine antisera. Using an antiserum against beta endorphin, a few cells and nerve fibres were immunostained. The other pituitary hormones were also tested: numerous antral cells contained immunoreactive GH, and some cells immunoreactive PRL or compounds chemically related to these hormones. No cells were stained with antisera directed against glycoproteic hormones. This work showed that several peptides previously localized in the pituitary gland were found in the antral mucosa. Further studies are needed to identify the cell types containing these peptides and to determine their origin.

Heterogeneous pituitary adenomas. A light microscopic, immunohistochemical and electron microscopic study

The combined use of several histological procedures (i.e. conventional light microscopy, immunohistochemistry and electron microscopy) among 45 unselected pituitary adenomas demonstrated the existence of 9 tumors (20%) containing several identifiable adenohypophyseal cell types. The cellular associations were between 2 or 3 identifiable cell types. Mammosomatotrophic tumors were the most frequent but not the only mixed type (somatomammocorticotrophic, somatocorticotrophic tumors were also found). The cellular components varied in size but the cells appeared randomly distributed in the tumours. In all the adenomas there was an unidentified cell component (no reactivity with antisera used) varying from sparse to numerous elements. On adjacent sections the adenomatous cells reacted with a single specific antiserum, but in two cases the immunohistochemistry on contiguous paraffin embedded sections did not confirm this with certainty. These results confirm those of others and a new term is proposed to designate these tumors: heterogeneous pituitary adenomas. According to the nature and the proportions of the cell components the heterogeneous adenomas were subdivided into two groups: a group A which comprised adenomas formed by a major identifiable cellular type associated with one or two other less frequent cell types, and a group B formed by a predominant unidentifiable (no reactivity with immunochemical stainings) cell type associated with one or two other identified cell types. The present morphofunctional classifications of pituitary adenomas should be modified to include homogeneous adenomas with a single cell type and heterogeneous adenomas with several cell types.

Objective and subjective evaluations of a TV-program versus small group instruction for the Iowa Drug Information Service

The purpose of this study was to determine if the TV approach for instructing drug information systems is more efficient in terms of cost and learning effectiveness vs. traditional educational programming. The Iowa Drug Information Service system was selected as a typical representative for a study model. Second professional year pharmacy students (N = 66) were evaluated in a random selection, pre-test post-test, controlled experimental procedure. A 19 minute UTCHS in-house production served as the experimental variable. The control group received equivalent training (time and content) via lecture notes, and on-site practice coaching. Outcomes were assessed according to objective test score criteria and 10 subjective self-rating opinion scales. The data revealed that students subjected to the TV variable achieved significantly better post-exposure test scores (P = 0.002). A one-time cost of +500 was expended for complete TV production and three tapes, resulting in unlimited teaching capacity and recoverable within two years relative to instructor time expenditures for this system. Five of 10 opinion scales were significantly different in comparison, and students clearly preferred traditional teaching over our TV production. This investigation substantiates previous reports from medical disciplines wherein TV was an effective teaching approach but only mildly popular. The repetitive nature of didactic drug information systems training, superior TV outcomes, and cost-effectiveness warrants a mix of TV and limited personalized instruction as a policy approach.

Immune responses in mice against herpes simplex virus: mechanisms of protection against facial and ganglionic infections

We performed experiments with mice to determine the nature of the immune response(s) that prevents primary infections of the skin and the trigeminal ganglia with herpes simplex virus. Immunization with infectious herpes simplex virus, inactivated virus, or material enriched for viral glycoproteins protected hairless mice against primary facial and ganglionic infections. Live and inactivated viruses induced neutralizing antibodies, whereas glycoprotein material did not. Instead, glycoprotein material induced antibodies that were largely directed against two glycopolypeptides with molecular weights of 120,000 to 130,000. Hairless mice immunized with glycoprotein material responded faster than control mice in the synthesis of neutralizing antibodies after challenge with infectious virus. Congenital athymic BALB/c (nu/nu) mice were protected against primary facial infections after immunization with glycoprotein material, but glycoprotein-specific antibodies were not induced.

Macrophage dependence of polyriboinosinic acid-polyribocytidylic acid-induced resistance to herpes simplex virus infection in mice

The relative contributions of macrophages and lymphocytes to the induction of resistance to primary herpes simplex virus type 1 (HSV-1) infection by polyriboinosinic-polyribocytidylic acid complex [poly (I:C)] were investigated in C58 mice. The induction of resistance was found to be strongly dependent on macrophages compared to lymphocytes. Macrophage-deficient (silica-treated) mice produced less interferon and were not as responsive to prophylactic treatment of HSV-1 infections with poly (I:C) as were either normal, lymphocyte-deficient (cyclophosphamide-treated), or T-lymphocyte-deficient (anti-thymocyte serum-treated, adult-thymectomized) mice. Silica and cyclophosphamide treatments reduced the therapeutic activity of poly (I:C), whereas T-cell depletion did not have a significant effect. Similarly, the protection of mice with exogenous interferon was markedly reduced in silica-treated mice and moderately reduced in cyclophosphamide-treated mice, but unaffected in T-cell-deficient mice. Furthermore, suppression of HSV-1 plaque formation was obtained by cocultivation of infected mouse fibroblast monolayers with peritoneal (macrophage-rich) cells, but not with splenic (lymphocyte-rich) cells, from poly (I:C)-treated mice. Peritoneal cells did not protect heterologous (human) fibroblasts, suggesting that the protection of mouse embryo fibroblasts is mediated by interferon. Collectively, the data indicate that macrophages are required for the production of poly (I:C)-induced interferon and that macrophages and perhaps B-lymphocytes are important for mediating the protection against HSV-1 infection after interferon has been produced.