Alternative processing of the sarco/endoplasmic reticulum Ca(2+)-ATPase transcripts during muscle differentiation is a specifically regulated process

Expression of the muscle-specific 2a isoform of the sarco/endoplasmic reticulum Ca(2+)-ATPase (SERCA2) requires activation of an otherwise inefficient splice process at the 3'-end of the primary gene transcript. We provide evidence that SERCA2 splicing is a specifically regulated process, rather than the result of an increase in general splice efficiency or a decrease in polyadenylation efficiency at the 5'-most polyadenylation site. This is indicated by the fact that changes in general splice and polyadenylation efficiency, as observed during B-cell maturation, did not affect SERCA2 splicing. Furthermore, expression and overexpression studies did not support the hypothesis that changes in the level of the alternative splice factor ASF/SF2 or other arginine and serine rich proteins are sufficient to obtain the regulation of muscle- and neuronal-specific splicing.

Cell fusion to study nuclear-cytoplasmic interactions in endothelial cell apoptosis

Studies examining the regulation of nuclear rearrangements during apoptosis have led to conflicting results. Cytoplasmic control of nuclear events has been strongly suggested by cell-free experimental systems. In contrast, strict cytoplasmic control cannot account for the results of fibroblast-thymocyte fusion experiments in which dexamethasone induction of polykaryons led only to thymocyte nuclear apoptosis. Unresolved by these fusion studies was whether fibroblast nuclei were indifferent to heterologous cytoplasmic signals. Our objective was to resolve this discrepancy using cell fusion in a homologous system. Our strategy was to fuse endothelial cells with high levels of susceptibility to the induction of apoptosis (log phase cells arrested in G1 for 48 hours by isoleucine deprivation) with those manifesting low levels of susceptibility (serum-deprived, G0). Resultant fused and unfused cells were induced to undergo apoptosis by incubation with tumor necrosis factor-alpha and cycloheximide. Depending on the parental cell of origin, between 14 and 30% of dikaryons contained one apoptotic and one intact nucleus, indicating that strict cytoplasmic control was not occurring. In accord with this, the total frequency of nuclear apoptosis was unchanged after fusion. However, the distribution of apoptotic nuclei revealed a pronounced cytoplasmic influence, with a two- to fivefold increase in coordinate nuclear behavior. This pattern of nuclear apoptosis was consistent with a model of control in which both the state of nuclear susceptibility to apoptosis and expression of cytoplasmic pro-apoptotic regulators determined whether nuclear apoptosis would eventuate.

Combined spinal-epidural anesthesia for outpatient surgery. Dose-response characteristics of intrathecal isobaric lidocaine using a 27-gauge Whitacre spinal needle

BACKGROUND

Combined spinal-epidural anesthesia (CSE) may offer theoretic advantages for outpatient surgery, because it produces the rapid onset of spinal anesthesia, with the option to extend the blockade with an epidural catheter. In this study, the authors attempted to determine an appropriate initial dose of a short-acting local anesthetic, 2% lidocaine, to administer for outpatient knee arthroscopy using CSE.

METHODS

Data were collected from 90 patients undergoing outpatient knee arthroscopy. Using a double-blinded, prospective study design, patients were randomly assigned to receive CSE with an initial dose of intrathecal 2% lidocaine of 40, 60, or 80 mg. A 27-G 4 11/16-inch Whitacre needle was placed through a 17-G Weiss needle. Onset and regression of sensory anesthesia and motor blockade were measured by a blinded observer at frequent intervals.

RESULTS

All 90 patients had adequate anesthesia. Durations of thoracic and lumbar sensory and lower limb motor blockade were significantly shorter in the 40-mg group compared with the 60- or 80-mg groups (P < 0.0002 Mantel-Cox, Survivorship Analysis). Indices of neural blockade resolved 30-40 min more rapidly in the 40-mg group than in either the 60- or 80-mg group. Times to urinate, site upright in a chair, take oral fluids, and be discharged were all significantly shorter (between 30 and 60 min) in the 40-mg group compared with the 60- and 80-mg groups (P < 0.01). Seven patients required intraoperative epidural supplementation: three in the 40-mg group, three in the 60-mg group, and one in the 80-mg group.

CONCLUSIONS

Combined spinal-epidural anesthesia with a 40-mg initial intrathecal dose of lidocaine provided reliable anesthesia for knee arthroscopy. Duration of spinal anesthesia with lidocaine was dose related.

Measurement of erythrocyte membrane elasticity by flicker eigenmode decomposition

We have studied the flickering of erythrocytes at wavelengths comparable to the cell dimension. To do this we have analyzed the edge fluctuations of the cell to a resolution of 5 nm by combining phase contrast microscopy with fast image processing. By measuring the edge excitations simultaneously at four orthogonal positions around the cell, the eigenmodes of equal azimuthal mode numbers m = 0,1,2 could be separated. From a continuous time sequence of 100 s of video frames taken at 40 ms time intervals, we determined the time-auto correlation function for the modes m = 0,1,2 and calculated their mean square amplitudes <delta n2m> as well as their decay times tau m. To explain the results we also present the theoretically calculated energy eigenmodes of an erythrocyte, accounting for the constraint that the cell is in contact with the substrate along an annular ring, which agreed well with the experimental findings. We found that the softest mode is a "hindered translational" mode with m = 1 of the adhered cell, which is almost insensitive to the shear elastic modulus. Comparison of the calculated and measured amplitudes yielded an average value for the bending stiffness of kc = 4 x 10(-19) J, which is much larger than the value obtained by flicker analysis at short wavelengths (kc = 2.3 x 10(-20) J). It would, however, agree well with the value expected from the red cell membrane area compressibility modulus of K = 4.5 x 10(-1)N/m, which corresponds to a lipid bilayer containing approximately 50 mol % of cholesterol. In contradiction to our theoretical expectations we found that the flicker eigenmodes seemed not to be influenced by the membrane shear elasticity, which will be discussed in terms of an unusual coupling between the lipid bilayer and the cytoskeleton.

Components of variance for vibratory and thermal threshold testing in normal and diabetic subjects

Quantitative sensory testing (QST) is commonly used in the assessment of diabetic neuropathy. However, little data are available on the reliability of tactile and thermal testing devices. Reproducibility of QST measures between centers has not been previously reported. This study was designed to validate QST testing procedures and determine if these devices are suitable for large scale multicenter clinical trials. Finger and toe vibratory (Vf, Vt) and thermal (Tf, Tt) thresholds were determined for ten normal individuals by a two-alternative forced-choice procedure using the Optacon Tactile Tester (OTT) and Thermal Sensitivity Tester (TST). Threshold measurements were reproducible between technologists and had a day-to-day coefficient of variation of Vf 20%, Vt 23%, Tf 41%, and Tt 95%. Thresholds were determined for 140 normal individuals at six centers. Mean threshold values between centers were not significantly different. Center-to-center coefficients of variation (CV) were Vf 44%, Vt 45%, Tf 47%, and Tt 87%. There was no significant difference in threshold measures with regard to sex, side studied, presence of calluses, or skin temperature. Vf thresholds significantly correlated with age (p < 0.01). There was no correlation between either vibratory or thermal thresholds in normal individuals, and nerve conduction velocities (NCV). Thermal and vibratory thresholds were determined for 98 diabetic patients. Diabetic subjects without clinical evidence of neuropathy were not significantly different from normal individuals, but diabetic patients with neuropathy had increased thresholds compared to normals (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Temporal regulation of the Xenopus FGF receptor in development: a translation inhibitory element in the 3′ untranslated region

Early frog embryogenesis depends on a maternal pool of mRNA to execute critical intercellular signalling events. FGF receptor-1, which is required for normal development, is stored as a stable, untranslated maternal mRNA transcript in the fully grown immature oocyte, but is translationally activated at meiotic maturation. We have identified a short cis-acting element in the FGF receptor 3′ untranslated region that inhibits translation of synthetic mRNA. This inhibitory element is sufficient to inhibit translation of heterologous reporter mRNA in the immature oocyte without changing RNA stability. Deletion of the poly(A) tract or polyadenylation signal sequences does not affect translational inhibition by this element. At meiotic maturation, we observe the reversal of translational repression mediated by the inhibitory element, mimicking that seen with endogenous maternal FGF receptor mRNA at meiosis. In addition, the activation of synthetic transcripts at maturation does not appear to require poly(A) lengthening. We also show that an oocyte cytoplasmic protein specifically binds the 3′ inhibitory element, suggesting that translational repression of Xenopus FGF receptor-1 maternal mRNA in the oocytes is mediated by RNA-protein interactions. These data describe a mechanism of translational control that appears to be independent of poly(A) changes.

Reducing specialty bed use

Saint Joseph Hospital is a tertiary care teaching facility with 602 licensed beds. In 1992 it was noted that there was a significant rise in the use of specialty beds within the hospital. Guidelines for selection, initiation, and termination were nonexistent. In an effort to reduce high costs associated with specialty bed use a study was conducted to determine appropriate selection criteria and monitor patient outcomes.

Effect of adjuvants on immunogenicity of MN recombinant glycoprotein 120 in guinea pigs

The immunogenicity of recombinant gp120 from the MN strain of HIV-1, a candidate HIV-1 vaccine, was evaluated in guinea pigs using adjuvant formulations with different physical and chemical properties. The adjuvants tested included Freund's adjuvant (FA), alum, and the novel adjuvant QS-21. These studies demonstrated that QS-21 provides a number of advantages compared to the two other adjuvants tested. QS-21 formulations accelerated the production of antibodies to MN rgp120 and elicited complete seroconversion after a single immunization. QS-21 shifted the antigen dose-response curve for antibody production by as much as three orders of magnitude, enabling a more economical use of antigen. Antibody titers to MN rgp120 and to the principal neutralizing determinant in the V3 domain were higher in animals receiving QS-21 formulations than in animals immunized with the other adjuvants, and correlated well with higher virus neutralization titers in an in vitro assay. These results support the testing of QS-21 in future clinical trials of candidate HIV-1 vaccines.

The Atwood Hall Health Promotion Program, Federal Medical Center, Lexington, KY. Effects on drug-involved federal offenders

There is a critical need for the development of effective substance abuse and dependence treatment programs in prisons and jails. One aspect of treatment provision within this population that has received insufficient research attention is the inclusion of health promotion or wellness programs, including exercise and other health-related lifestyle modification training. Little is known about either the physiological or psychological consequences of such lifestyle modification programs among prisoners with substance use disorders. This study reports the effectiveness of an experimental wellness program included as part of a residential treatment unit in a federal correctional institute in the United States. A sample of 43 female offenders with a history of polysubstance abuse or dependence, who had volunteered to be part of a residential drug treatment program, were evaluated. Changes in health status and perceived psychological well-being between entry into the program and exit after maintaining participation for a minimum of 9 months were assessed. Pretest-posttest comparisons on a variety of physiological parameters indicated that significant improvements had occurred in the physical fitness of the group. Thematic analysis of qualitative self-reports by inmates exiting the program suggested that participants had also experienced significant enhancements in a number of areas pertaining to psychological well-being, including self-esteem, health awareness and concerns, healthy lifestyle adoption, and relapse prevention skills. These results suggest that including health promotion training in drug treatment programs for incarcerated offenders may have beneficial results.

Circulating, soluble adhesion proteins in cerebrospinal fluid and serum of patients with multiple sclerosis: correlation with clinical activity

Soluble adhesion protein intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and endothelial leukocyte adhesion molecule (E-selectin) were measured in serum and cerebrospinal fluid (CSF) of patients with relapsing-remitting multiple sclerosis (RRMS) in remission and in exacerbation, as well as patients with chronic progressive MS, stable MS, and in patients with other neurological and inflammatory diseases (ONDs). Serum ICAM-1 and E-selectin were significantly elevated in patients with MS over those with ONDs and controls. CSF VCAM-1 and E-selectin were found to be elevated over control and disease control samples. No increase in CSF ICAM-1 was observed. Results were analyzed longitudinally and by MS category. In paired CSF and serum samples from patients in exacerbation, elevated VCAM-1 correlated with increased serum VCAM-1 in 5 of 7 patients. Elevated CSF E-selectin did not correlate with elevations in serum E-selectin.

Genomic sequence sampling: a strategy for high resolution sequence-based physical mapping of complex genomes

We present a simple and efficient method for constructing high resolution physical maps of large regions of genomic DNA based upon sampled sequencing. The physical map is constructed by ordering high density cosmid contigs and determining a sequence fragment from each end of every clone. The resulting map, which contains 30-50% of the complete DNA sequence, allows the identification of many genes and makes possible PCR amplification of virtually any part of the genome. We apply this strategy to the automated analysis of the genome of the primitive eukaryote Giardia lamblia and evaluate its applicability to the physical mapping and DNA sequencing of the human genome.

Successful aging: how to help your patients cope with change

Collaborative work between physicians and social workers can be very valuable in helping patients to "age successfully." For many patients, the medical consequences of chronic disease are compounded by social problems, such as isolation and loss of self esteem. Social workers attempt to help people cope with the stresses of aging by gaining some degree of control over their lives. Keys to successful aging include being flexible and adaptable in the face of change, being connected in a confidante relationship with at least one other person, and feeling that life has a purpose beyond mere survival. Social workers provide such mental health services as counseling, support, and conflict resolution. They can also assist in the time-consuming work of finding needed community resources.

Pathogenesis of pulmonary fibrosis: platelet-derived growth factor precedes structural alterations in the Hermansky-Pudlak syndrome

Peptides that modulate mesenchymal cell function have been detected in the fibrotic lung disorders once physiologic dysfunction is present. Despite this close association with manifest disease, their role in initiating alveolar remodeling remains unknown. We examined the hypothesis that one potent peptide, platelet-derived growth factor (PDGF), would be present at the alveolar surface before the onset of physiologic dysfunction in patients in whom pulmonary fibrosis subsequently develops. Bronchoalveolar lavage and physiologic assessment were performed in asymptomatic patients with the Hermansky-Pudlak syndrome (n = 30), obligate heterozygous (n = 9), and normal volunteers (control group). Lavage cell number and profile were normal, but alveolar macrophages demonstrated characteristic autofluorescence and ultrastructural features of ceroid. Lavage fluid from physiologically normal patients with Hermansky-Pudlak syndrome and from those with occult restrictive disease demonstrated two PDGF-related peptides (14 kd and 38 kd). Radioligand binding and fibroblast proliferation assay demonstrated that the peptides were functional. By immunoassay the concentration of PDGF in lavage fluid was six times greater than control values (p < 0.01). In situ hybridization together with bioassay indicated that alveolar macrophages were one cellular source of PDGF. Similar results were obtained for heterozygotes. These data identify macrophage-derived PDGF peptides as important candidate molecules in the initiation of alveolar remodeling in the fibrotic lung disorders.

Physical aspects of aging: is there such a thing as 'normal'?

Traditional thinking about the process of aging is changing as the distinction blurs between normal aging and disease. One of the myths about aging is that all older people are alike. However, one of the maxims of geriatrics is that as people get older they become less alike. Several models have been proposed for the interactions between aging and disease. Although the issue of distinguishing normal aging from disease poses challenges in the clinical setting, the inclusion of aging into the equation can also make the care of older persons more intellectually stimulating.

Comparative effects of two different delivery systems on gonadotropin-releasing hormone (GnRH) antagonist-induced suppression of gonadotropins and testosterone in man

The Nal-Glu gonadotropin-releasing hormone (GnRH) antagonist, when given in daily subcutaneous (SC) doses of 5 mg or higher, maximally suppresses serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels to near undetectable levels and induces azoospermia in normal men; lower doses (1.5 and 3.0 mg) are less effective. Cost and convenience are important considerations in contraceptive development. Studies with GnRH agonists suggest that constant delivery is more effective in suppressing gonadal function than equal doses by single daily injection. In this study, we examined whether the constant infusion (CI) of a submaximal suppressive dose (1.5 mg) of Nal-Glu would be more effective in suppressing the pituitary-gonadal axis than its repeated single daily injections (SDI). This (1.5 mg) dose was selected because the 5 mg dose given once daily SC for 21 days led to maximal suppression of LH, FSH, and testosterone (T) levels, whereas 1.5 mg once daily for 21 days gave only partial suppression. It was felt that if continuous infusion was considerably more effective than intermittent administration of this submaximal dose, then the development of long-acting sustained release delivery systems for contraceptives based on GnRH antagonist analogs would allow both reduced cost and enhanced convenience. One and a half mg of Nal-Glu was administered SC either as a SDI or CI over 24 hours for 21 days to two groups of five normal men. Three measurements of serum LH, FSH, and T were performed before antagonist injection and 1, 2, 4, 8, 12, 16, and 24 hours after Nal-Glu injection on days 0, 1, 7, 21.(ABSTRACT TRUNCATED AT 250 WORDS)

Macrophage production of basic fibroblast growth factor in the fibroproliferative disorder of alveolar fibrosis after lung injury

In organ repair following injury, macrophages accumulate and granulation tissue, comprised of fibroblasts and endothelial cells, develops in the injured area. Basic fibroblast growth factor (bFGF), a potent stimulator of fibroblast and endothelial cell growth, has been linked to the fibroproliferative process. Macrophages are thought to play a central role in the fibroproliferative response, and prior studies indicate that they produce bFGF. Whereas it is plausible that macrophages produce bFGF in a fibroproliferative process, currently no data exists that directly identifies the macrophage as a source of bFGF in a fibroproliferative disorder. We used the model of acute intraalveolar granulation tissue formation following lung injury to determine if the macrophage was a cellular source of bFGF in a naturally occurring fibroproliferative process. To examine this hypothesis, patients with severe acute lung injury underwent bronchoalveolar lavage during the phase of lung repair. Polymerase chain reaction and Northern analysis of macrophage RNA revealed the presence of two species of bFGF messenger RNA (4.4 kb and 1.9 kb). Metabolic labeling studies of recovered macrophages revealed a newly synthesized 18-kd protein with antigenic similarity to bFGF. Immunohistochemical evaluation of lung tissue from patients who died following acute lung injury, showed numerous bFGF immunoreactive macrophages present within airspaces containing fibroblastic and vascular tissue proliferation. This investigation has identified the alveolar macrophage as a cellular source of bFGF in the fibroproliferative disorder of intraalveolar fibrosis following acute lung injury.

The chondroitin sulfate form of invariant chain can enhance stimulation of T cell responses through interaction with CD44

Invariant chain (Ii) is a nonpolymorphic glycoprotein that associates with major histocompatibility complex class II molecules and has been shown to mediate several functions in class II-restricted antigen presentation. A small proportion of Ii is modified by the addition of chondroitin sulfate (Ii-CS), and this form of Ii is associated with class II on the surface of antigen-presenting cells. In this report we show that expression of Ii-CS dramatically enhanced the ability of class II-positive EL4 transfectants to stimulate class II-dependent allogeneic and mitogenic T cell responses. Antibody blocking studies and the ability of CD44 to bind directly to Ii-CS suggest that Ii-CS can function as an accessory molecule during T cell responses through interactions with CD44.

Factors influencing deep vein thrombosis following total hip arthroplasty under epidural anesthesia

To determine intraoperative factors which may influence deep vein thrombosis rate, we studied surgeries performed by one surgeon on 441 consecutive patients undergoing primary total hip arthroplasty under epidural anesthesia. Operative limb venography was performed on the fourth or fifth postoperative day in 381 patients, who received 650 mg of aspirin daily as the only postoperative thromboprophylaxis. Of 381 (15%) patients, 58 had a positive venogram; 13 (3%) had proximal thrombi. Of 178 patients (9.5%) with surgery lasting less than 70 min, 17 developed deep vein thrombosis whereas 41 of 203 patients (20.3%) with surgery lasting more than 70 min developed deep vein thrombosis (P < 0.05). Corresponding proximal deep vein thrombosis rates increased from 1.7% to 4.9%. Deep vein thrombosis was observed in 12.5% of patients receiving intravenous low-dose epinephrine, 10.3% receiving intravenous sodium nitroprusside, 14.5% receiving both low-dose epinephrine and sodium nitroprusside concurrently, and 25% receiving intravenous fluid alone. Proximal deep vein thrombosis rates were 2.4%, 0%, 1.45%, and 9.3% in these groups, respectively. These data suggest that the intraoperative management of both surgery and anesthesia influence rates of deep vein thrombosis following total hip arthroplasty.

Validity of register data on acute myocardial infarction and acute stroke: the Skaraborg Hypertension Project

In the evaluation of a hypertension treatment program, the end-point surveillance included incidence of acute myocardial infarction and acute stroke identified from hospital in-patient registers and the national mortality register. To ascertain the validity, in-patient records containing the ICD-codes 410-411 and 430-438 were validated. First event of acute myocardial infarction and acute stroke suggested in the in-patient register could be confirmed in 96% and 94%, respectively. In-patient diagnoses of suspected acute myocardial infarction or other acute or subacute ischemic heart diseases, transient ischemic attack and unspecified heart diseases, transient ischemic attack and unspecified cerebrovascular disease revealed high proportions of what in fact turned out to be definite events (11%, 24% and 53% respectively). It is concluded that disease ascertainment for this cohort study claims validation of register data with hospital records.

Effect of improved assay sensitivity on luteinizing hormone pulse detection after gonadotropin-releasing hormone antagonist treatment in man

When serum levels of a hormone are at or below the detection limit of the measurement system, accurate characterization and quantitation of pulsatile hormone secretion may be difficult. This point is well illustrated in this study, which used two immunoassays with markedly different assay sensitivities to quantitate pulsatile LH secretion in men in whom serum LH levels had been suppressed by the administration of a GnRH antagonist. Five normal men received 5 mg Nal-Glu, sc, daily for 21 days. Blood was drawn at 10-min intervals over 8 h on days 0 and 21. Samples were assayed in triplicate in both a conventional LH RIA with a sensitivity of 0.6-1.0 IU/L and a two-site-directed ultrasensitive immunofluorometric assay (IFMA) with assay sensitivity ranging from 0.05-0.125 IU/L. LH pulses were analyzed by Cluster analysis (C) and were corroborated by the Detect algorithm (D). Nal-Glu suppressed LH (C) pulse amplitude from 4.0 +/- 0.7 to 0.40 +/- 0.03 IU/L by LH RIA and from 7.8 +/- 2.1 to 0.21 +/- 0.04 IU/L by LH IFMA. An apparent reduction in LH pulse number was observed in the RIA data on day 21 by both pulse detection methods [4.2 +/- 0.4 vs 2.4 +/- 0.2/8 h on days 0 and 21 by C (P < 0.005); 5.8 +/- 0.8 vs. 2.8 +/- 0.7 by D (P < 0.05)]. However, the IFMA measurements in the same samples using the more sensitive LH IFMA showed no difference in pulse number between days 0 and 21. The RIA data correlated well with the IFMA data, with a concordance coefficient ranging from 0.66-0.9. In summary, the Nal-Glu GnRH antagonist markedly decreases LH pulse amplitude, but not pulse frequency. These observations are consistent with competitive inhibition of GnRH action at the pituitary site by the Nal-Glu antagonist; they indicate that assay characteristics can significantly affect quantitation of hormone pulse pattern and underscore the need for ultrasensitive LH assays for accurate assessment of LH pulse characteristics when LH levels are low or suppressed.