Insulin receptor signaling engages bladder urothelial defenses that limit urinary tract infection

Urinary tract infections (UTIs) commonly afflict people with diabetes. To better understand the mechanisms that predispose diabetics to UTIs, we employ diabetic mouse models and altered insulin signaling to show that insulin receptor (IR) shapes UTI defenses. Our findings are validated in human biosamples. We report that diabetic mice have suppressed IR expression and are more susceptible to UTIs caused by uropathogenic Escherichia coli (UPEC). Systemic IR inhibition increases UPEC susceptibility, while IR activation reduces UTIs. Localized IR deletion in bladder urothelium promotes UTI by increasing barrier permeability and suppressing antimicrobial peptides. Mechanistically, IR deletion reduces nuclear factor κB (NF-κB)-dependent programming that co-regulates urothelial tight junction integrity and antimicrobial peptides. Exfoliated urothelial cells or urine samples from diabetic youths show suppressed expression of IR, barrier genes, and antimicrobial peptides. These observations demonstrate that urothelial insulin signaling has a role in UTI prevention and link IR to urothelial barrier maintenance and antimicrobial peptide expression.

Keratin 5 Basal Cells are Temporally Regulated Developmental and Tissue Repair Progenitors in Bladder Urothelium

Urothelium forms a distensible yet impermeable barrier, senses and transduces stimuli, and defends the urinary tract from mechanical, chemical and bacterial injuries. Biochemical and genetic labeling studies support the existence of one or more progenitor populations with the capacity to rapidly regenerate the urothelium following injury, but slow turnover, a low mitotic index, and inconsistent methodologies obscure progenitor identity. The progenitor properties of basal Keratin 5 urothelial cells (K5-UC) have been previously investigated, but those studies focused on embryonic or adult bladder urothelium. Urothelium undergoes desquamation and apoptosis after birth, which requires postnatal proliferation and restoration. Therefore, we mapped the fate of bladder K5-UCs across postnatal development/maturation and following administration of cyclophosphamide to measure homeostatic and reparative progenitor capacities, respectively. In vivostudies demonstrate that basal K5-UCs are age-restricted progenitors in neonates and juveniles, but not in adult mice. Neonatal K5-UCs retain a superior progenitor capacity in vitro, forming larger and more differentiated urothelial organoids than adult K5-UCs. Accordingly, K5-UC transcriptomes are temporally distinct, with enrichment of transcripts associated with cell proliferation and differentiation in neonates. Induction of urothelial proliferation is sufficient to restore adult K5-UC progenitor capacity. Our findings advance the understanding of urothelial progenitors and support a linear model of urothelial formation and regeneration, which may have significant impact on therapeutic development or tissue engineering strategies.

Tubular mitochondrial pyruvate carrier disruption elicits redox adaptations that protect from acute kidney injury

OBJECTIVE

Energy-intensive kidney reabsorption processes essential for normal whole-body function are maintained by tubular epithelial cell metabolism. Although tubular metabolism changes markedly following acute kidney injury (AKI), it remains unclear which metabolic alterations are beneficial or detrimental. By analyzing large-scale, publicly available datasets, we observed that AKI consistently leads to downregulation of the mitochondrial pyruvate carrier (MPC). This investigation aimed to understand the contribution of the tubular MPC to kidney function, metabolism, and acute injury severity.

METHODS

We generated tubular epithelial cell-specific Mpc1 knockout (MPC TubKO) mice and employed renal function tests, in vivo renal 13C-glucose tracing, mechanistic enzyme activity assays, and tests of injury and survival in an established rhabdomyolysis model of AKI.

RESULTS

MPC TubKO mice retained normal kidney function, displayed unchanged markers of kidney injury, but exhibited coordinately increased enzyme activities of the pentose phosphate pathway and the glutathione and thioredoxin oxidant defense systems. Following rhabdomyolysis-induced AKI, compared to WT control mice, MPC TubKO mice showed increased glycolysis, decreased kidney injury and oxidative stress markers, and strikingly increased survival.

CONCLUSIONS

Our findings suggest that decreased renal tubular mitochondrial pyruvate uptake hormetically upregulates oxidant defense systems before AKI and is a beneficial adaptive response after rhabdomyolysis-induced AKI. This raises the possibility of therapeutically modulating the MPC to attenuate AKI severity.

Human Ribonuclease 6 Has a Protective Role during Experimental Urinary Tract Infection

Mounting evidence suggests that antimicrobial peptides and proteins (AMPs) belonging to the RNase A superfamily have a critical role in defending the bladder and kidney from bacterial infection. RNase 6 has been identified as a potent, leukocyte-derived AMP, but its impact on urinary tract infection (UTI) in vivo has not been demonstrated. To test the functional role of human RNase 6, we generated RNASE6 transgenic mice and studied their susceptibility to experimental UTI. In addition, we generated bone marrow-derived macrophages to study the impact of RNase 6 on antimicrobial activity within a cellular context. When subjected to experimental UTI, RNASE6 transgenic mice developed reduced uropathogenic Escherichia coli (UPEC) burden, mucosal injury, and inflammation compared to non-transgenic controls. Monocytes and macrophages were the predominant cellular sources of RNase 6 during UTI, and RNASE6 transgenic macrophages were more proficient at intracellular UPEC killing than non-transgenic controls. Altogether, our findings indicate a protective role for human RNase 6 during experimental UTI.

Assessment of meat quality attributes of four commercial broiler strains processed at various market weights

As the demand for poultry meat continues to rise, industry production is constantly challenged with obtaining consumer needs. Integrators have answered this increasing demand by improving the growth rate of broilers allowing for increased production efficiently. The resulting broiler produces higher yields and a larger quantity of fresh poultry to satisfy consumer needs. However, this increase in efficiency has cost integrators as new quality issues continue to manifest through global production. Therefore, the objective of the current experiment was to evaluate the effect of genetic strain (standard and high yielding) and target weight on meat quality attributes such as pH, water holding capacity (WHC), and tenderness, alongside meat quality defects such as breast and tender myopathies. In the current study, 1,800 broilers from 4 commercial strains (2 high breast yielding (HY) and 2 standard yielding (SY) were raised sex separate to evaluate meat quality trends over time at 6 previously defined market weights. Birds were processed at weights ranging from 2,043 to 4,313 g in 454 g increments. HY strains produced higher breast and tender yields than those of SY strains (P < 0.05). There was an increase in breast and tender yield as target weight increased (P < 0.05) for both HY and SY strains. Differences were observed between strains for all fillet dimensions (P < 0.05); however, these measurements increased as target weight increased as expected. Woody breast (WB) had a higher severity (P < 0.05) in HY strains over SY strains, for both males and females. Differences were observed in white striping (WS; P < 0.05) for females in both strains, but no differences were observed in males. A main effect of target was noticed for both WB and WS (P < 0.05), expressing increased severity as target weight increased. Shear values were influenced more by target weight (P < 0.05), but inconsistent differences were observed between HY and SY groups. Meullenet-Owens Razor Shear (MORS) energy values increased slightly as target weights increased (P < 0.05) from 2,951 to 4,313 g in both males and females, but differences were minor and inconsistent with the smaller carcass weights. The MORS peak counts generally increased as target weight increased for both sexes. While strain had minimal effects on meat quality attributes, processing weight had a greater influence on quality, specifically muscle myopathies, WHC, and shear properties.

Tubular Mitochondrial Pyruvate Carrier Disruption Elicits Redox Adaptations that Protect from Acute Kidney Injury

Energy-intensive kidney reabsorption processes essential for normal whole-body function are maintained by tubular epithelial cell metabolism. Tubular metabolism changes markedly following acute kidney injury (AKI), but which changes are adaptive versus maladaptive remain poorly understood. In publicly available data sets, we noticed a consistent downregulation of the mitochondrial pyruvate carrier (MPC) after AKI, which we experimentally confirmed. To test the functional consequences of MPC downregulation, we generated novel tubular epithelial cell-specific Mpc1 knockout (MPC TubKO) mice. 13C-glucose tracing, steady-state metabolomic profiling, and enzymatic activity assays revealed that MPC TubKO coordinately increased activities of the pentose phosphate pathway and the glutathione and thioredoxin oxidant defense systems. Following rhabdomyolysis-induced AKI, MPC TubKO decreased markers of kidney injury and oxidative damage and strikingly increased survival. Our findings suggest that decreased mitochondrial pyruvate uptake is a central adaptive response following AKI and raise the possibility of therapeutically modulating the MPC to attenuate AKI severity.

Characterization of growth patterns and carcass characteristics of male and female broilers from four commercial strains fed high or low density diets

Over the last few decades, the poultry industry has seen the emergence of various market segments that are beneficial for rearing various flock sizes. Two concurrent experiments consisting of 1,200 broilers each were conducted to evaluate the effects of broiler size and diet on the performance of four commercially available broiler strains, including 2 standard yielding (SY) and 2 high yielding (HY) strains. Within each experiment (Experiment 1: males, Experiment 2: females), a small bird (38 and 40 d processing) and big bird (47 and 54 d processing) debone market were targeted to give variable carcass size. Two polyphasic diets were fed based on varying of amino acid densities. The low-density diet (L) consisted of 1.20, 1.10, 1.00, and 0.96% digestible Lys and the high-density diet (H) consisted of 1.32, 1.21, 1.10, and 1.06% across the 4-phases, respectively, with similar essential amino acid to digestible Lys ratios between the L and H diets in each phase. Weekly BW, BW gain, feed intake, and feed conversion ratio were assessed, as well as processing yields during both experiments. Broilers fed the H diets responded better than those fed the L diets, regardless of sex, with increased BW and decreased FCR (P < 0.05). Male HY strains provided the highest carcass yields (P < 0.05) compared to SY strains, with no differences observed in females (P > 0.05). High density diets (Diet H) also produced increases in carcass, breast, and tender yield (P < 0.05) for males, but that trend was not present in carcass yield for females (P < 0.05). Overall, strain impacted performance traits and carcass yields. Therefore, the use of specific strains and amino acid density for various market segments is beneficial for integrators to maximize return.

Urothelial progenitors in development and repair

Urothelium is a specialized multilayer epithelium that lines the urinary tract from the proximal urethra to the kidney. In addition to proliferation and differentiation during development, urothelial injury postnatally triggers a robust regenerative capacity to restore the protective barrier between the urine and tissue. Mounting evidence supports the existence of dedicated progenitor cell populations that give rise to urothelium during development and in response to injury. Understanding the cellular and molecular basis for urothelial patterning and repair will inform tissue regeneration therapies designed to ameliorate a number of structural and functional defects of the urinary tract. Here, we review the current understanding of urothelial progenitors and the signaling pathways that govern urothelial development and repair. While most published studies have focused on bladder urothelium, we also discuss literature on upper tract urothelial progenitors. Furthermore, we discuss evidence supporting existence of context-specific progenitors. This knowledge is fundamental to the development of strategies to regenerate or engineer damaged or diseased urothelium.

Impact of successful pediatric ureteropelvic junction obstruction surgery on urinary HIP/PAP and BD-1 levels

INTRODUCTION

In the pediatric patient whose ureteropelvic junction obstruction (UPJO) is not always symptomatic, imaging is the most common means of detecting surgical success. There is interest, however, in other means of post-operative monitoring. A panel of antimicrobial peptides (AMPs) has been previously found to be elevated in UPJO, but the impact of surgical correction on these AMPs is unknown.

OBJECTIVE

To determine if elevated levels of candidate urinary AMP biomarkers of urinary tract obstruction decrease following UPJO repair.

STUDY DESIGN

Pediatric patients undergoing surgical correction of an UPJO were recruited for participation. Bladder urine from uninfected consenting/assenting patients was collected immediately prior to surgery and then at least 6 months afterward. Based on prior studies demonstrating significant elevation of beta defensin 1 (BD-1), hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein (HIP/PAP), cathelicidin (LL-37), and neutrophil gelatinase-associated lipocalin (NGAL) in patients with UPJO versus control patients, we performed enzyme-linked immunosorbent assays on these four AMPs to compare their expression before and after surgical intervention. If found to significantly decrease, AMP levels were compared to healthy controls. AMP levels were normalized to urine creatinine. Results were analyzed with paired t test or Wilcoxon test using Graphpad software. Correlation was calculated using Pearson or Spearman correlation. A p-value of <0.05 was considered significant.

RESULTS

13 UPJO patients were included in this study; 9 were male (69%). Age at surgery was a median of 4.3 years (average 6.1, range 0.4-18.4 years). Follow-up urine samples were collected a median of 27.4 months after surgery (average 27.4; range 7.8-45.3 months). All 13 patients had clinical improvement and/or signs of improved hydronephrosis on post-operative imaging. HIP/PAP and BD-1 significantly decreased in post-surgical samples compared to pre-surgical samples (p = 0.02 and 0.01, respectively); NGAL and LL-37 did not significantly change. Overall, HIP/PAP decreased in 12 patients (92%) and BD-1 decreased in 11 patients (85%). BD-1 levels after successful repair were not different from healthy controls (p = 0.06).

DISCUSSION

Urinary biomarkers of obstruction should detect significant obstructive pathology as well as reflect its resolution. This would enable their use in post-operative monitoring and augment current methods of determining successful surgical outcome through imaging.

CONCLUSIONS

The AMPs HIP/PAP and BD-1 are significantly elevated in UPJO but then significantly decrease after pyeloplasty, with BD-1 returning to healthy control levels. As a result, these AMPs could serve as markers of successful surgical intervention.

Roles for urothelium in normal and aberrant urinary tract development

Congenital anomalies of the kidney and urinary tract (CAKUTs) represent the leading cause of chronic kidney disease and end-stage kidney disease in children. Increasing evidence points to critical roles for the urothelium in the developing urinary tract and in the genesis of CAKUTs. The involvement of the urothelium in patterning the urinary tract is supported by evidence that CAKUTs can arise as a result of abnormal urothelial development. Emerging evidence indicates that congenital urinary tract obstruction triggers urothelial remodelling that stabilizes the obstructed kidney and limits renal injury. Finally, the diagnostic potential of radiological findings and urinary biomarkers derived from the urothelium of patients with CAKUTs might aid their contribution to clinical care.

Loss-of-function variants in myocardin cause congenital megabladder in humans and mice

Myocardin (MYOCD) is the founding member of a class of transcriptional coactivators that bind the serum-response factor to activate gene expression programs critical in smooth muscle (SM) and cardiac muscle development. Insights into the molecular functions of MYOCD have been obtained from cell culture studies, and to date, knowledge about in vivo roles of MYOCD comes exclusively from experimental animals. Here, we defined an often lethal congenital human disease associated with inheritance of pathogenic MYOCD variants. This disease manifested as a massively dilated urinary bladder, or megabladder, with disrupted SM in its wall. We provided evidence that monoallelic loss-of-function variants in MYOCD caused congenital megabladder in males only, whereas biallelic variants were associated with disease in both sexes, with a phenotype additionally involving the cardiovascular system. These results were supported by cosegregation of MYOCD variants with the phenotype in 4 unrelated families by in vitro transactivation studies in which pathogenic variants resulted in abrogated SM gene expression and by the finding of megabladder in 2 distinct mouse models with reduced Myocd activity. In conclusion, we have demonstrated that variants in MYOCD result in human disease, and the collective findings highlight a vital role for MYOCD in mammalian organogenesis.

Molecular and macromolecular diffusion in human meniscus: relationships with tissue structure and composition

OBJECTIVE

To date, the pathophysiology of the meniscus has not been fully elucidated. Due to the tissue's limited vascularization, nutrients and other molecular signals spread through the extracellular matrix via diffusion or convection (interstitial fluid flow). Understanding transport mechanisms is crucial to elucidating meniscal pathophysiology, and to designing treatments for repair and restoration of the tissue. Similar to other fibrocartilaginous structures, meniscal morphology and composition may affect its diffusive properties. The objective of this study was to investigate the role of solute size, and tissue structure and composition on molecular diffusion in meniscus tissue.

DESIGN

Using a custom FRAP technique developed in our lab, we measured the direction-dependent diffusivity in human meniscus of six different molecular probes of size ranging from ∼300Da to 150,000Da. Diffusivity measurements were related to sample water content. SEM images were used to investigate collagen structure in relation to transport mechanisms.

RESULTS

Diffusivity was anisotropic, being significantly faster in the direction parallel to collagen fibers when compared the orthogonal direction. This was likely due to the unique structural organization of the tissue presenting pores aligned with the fibers, as observed in SEM images. Diffusion coefficients decreased as the molecular size increased, following the Ogston model. No significant correlations were found among diffusion coefficients and water content of the tissue.

CONCLUSIONS

This study provides new knowledge on the mechanisms of molecular transport in meniscal tissue. The reported results can be leveraged to further investigate tissue pathophysiology and to design treatments for tissue restoration or replacement.

Morphological ciliary muscle changes associated with form deprivation-induced myopia

Myopic children have larger ciliary muscles than non-myopic children, suggesting that the ciliary muscle may have an impact on or be affected by refractive error development. The guinea pig represents an attractive model organism for myopia development research. The purpose of the study was to investigate whether form deprivation-induced myopia in one or more strains of guinea pig causes thickening of the ciliary muscle as seen in human myopia. Thirty-nine guinea pigs were bred from in-house progenitors obtained from Cincinnati Children's Hospital (Cincinnati) and the United States Army (Strain 13). At 2-4 days of age the right eyes of animals were exposed to form deprivation for 7 days while the fellow eyes served as controls. Refractive error was determined with retinoscopy while vitreous chamber depth (VCD) and axial length (AL) were determined with A-scan ultrasound. Ciliary muscle characteristics (ciliary muscle length, cross-sectional area, volume, cell number, cell size, and smooth muscle actin concentration) were determined histologically with antibody labeling and analyzed according to whether the animal developed axial myopia (anisometropia > -2.00 D with VCD and/or AL differences > 0.1 mm) or was unresponsive. This analysis method yielded four groups with Group 1 having no induced myopia but with axial elongation (n = 11), Group 2 having myopia without vitreous or axial elongation (n = 8), Group 3 having myopia with either vitreous or axial elongation (n = 11), and Group 4 having myopia with both vitreous and axial elongation (n = 8). There were no post-treatment inter-ocular differences between strains or for the overall group of animals for any ciliary muscle variable; however, a higher response group number in multivariate ordinal regression was related to having a treated compared to fellow eye that had a lower smooth muscle actin concentration (p = 0.006), with a shorter ciliary muscle length (p = 0.042), and a less oblate eye shape (p = 0.010). Guinea pig ciliary muscle length and smooth muscle actin concentration were significantly less in the treated eyes of axially myopic animals suggesting that 7 days of form deprivation induced ciliary muscle cellular atrophy or inhibited ciliary muscle growth. Form deprivation myopia in the guinea pig does not result in the increase in ciliary muscle thickness associated with human juvenile and adult myopia.

Krt5+ urothelial cells are developmental and tissue repair progenitors in the kidney

Congenital urinary tract obstruction (UTO) is the leading cause of chronic kidney disease in children; however, current management strategies do not safeguard against progression to end-stage renal disease, highlighting the need for interventions to limit or reverse obstructive nephropathy. Experimental UTO triggers renal urothelial remodeling that culminates in the redistribution of basal keratin 5-positive (Krt5⁺) renal urothelial cells (RUCs) and the generation of uroplakin-positive (Upk)⁺ RUCs that synthesize a protective apical urothelial plaque. The cellular source of Upk⁺ RUCs is currently unknown, limiting the development of strategies to promote renal urothelial remodeling as a therapeutic approach. In the present study, we traced the origins of adult Upk⁺ RUCs during normal development and in response to UTO. Fate mapping analysis demonstrated that adult Upk⁺ RUCs derive from embryonic and neonatal Krt5⁺ RUCs, whereas Krt5⁺ RUCs lose this progenitor capacity and become lineage restricted by postnatal day 14. However, in response to UTO, postnatal day 14-labeled adult Krt5⁺ RUCs break their lineage restriction and robustly differentiate into Upk⁺ RUCs. Thus, Krt5⁺ RUCs drive renal urothelial formation during normal ontogeny and after UTO by differentiating into Upk⁺ RUCs in a temporally restricted manner.

The uroplakin plaque promotes renal structural integrity during congenital and acquired urinary tract obstruction

Urinary tract obstruction represents a common cause of kidney injury across the human life span, resulting in chronic kidney disease and end-stage renal disease. Yet, the extent of obstructive renal damage can be heterogeneous between individuals, implying the existence of unknown mechanisms that protect against or accelerate kidney injury. In this study, we investigated the role of urothelial remodeling in renal adaptation during congenital and acquired obstruction. In the Megabladder ( Mgb-/-) model of congenital obstruction and unilateral ureteral ligation model of acute obstruction, progressive hydronephrosis is strongly associated with dynamic reorganization of the renal urothelium, which elaborates a continuous uroplakin (Upk) plaque. This led us to postulate that the Upk plaque prevents parenchymal injury during urinary tract obstruction. To test this hypothesis, we interbred Mgb-/- and Upk1b-/- mice, which lack the critical Upk1b subunit for Upk plaque formation. Upk1b-/-; Mgb-/- mice experienced an accelerated onset of bilateral hydronephrosis with severe (>67%) parenchymal loss, leading to renal failure and mortality in adolescence. To investigate the function of the renal Upk plaque during acute obstruction, we destabilized the Upk plaque by Upk1b deletion or genetically depleted Upk+ cells following unilateral ureteral obstruction. Both of these strategies accelerated renal parenchymal loss following ureteral ligation, attesting to a conserved, stabilizing role for Upk plaque deposition in the acutely obstructed kidney. In aggregate, these complementary experiments provide the first evidence that the Upk plaque confers an essential, protective adaptation to preserve renal parenchymal integrity during congenital and acquired urinary tract obstruction.

Interleukin-6/Stat3 signaling has an essential role in the host antimicrobial response to urinary tract infection

The signaling networks regulating antimicrobial activity during urinary tract infection (UTI) are incompletely understood. Interleukin-6 (IL-6) levels increase with UTI severity, but the specific contributions of IL-6 to host immunity against bacterial uropathogens are unknown. To clarify this we tested whether IL-6 activates the Stat3 transcription factor, to drive a program of antimicrobial peptide gene expression in infected urothelium during UTI. Transurethral inoculation of uropathogenic Escherichia coli led to IL-6 secretion, urothelial Stat3 phosphorylation, and activation of antimicrobial peptide transcription, in a Toll-like receptor 4-dependent manner in a murine model of cystitis. Recombinant IL-6 elicited Stat3 phosphorylation in primary urothelial cells in vitro, and systemic IL-6 administration promoted urothelial Stat3 phosphorylation and antimicrobial peptide expression in vivo. IL-6 deficiency led to decreased urothelial Stat3 phosphorylation and antimicrobial peptide mRNA expression following UTI, a finding mirrored by conditional Stat3 deletion. Deficiency in IL-6 or Stat3 was associated with increased formation of intracellular bacterial communities, and exogenous IL-6 reversed this phenotype in IL-6 knockout mice. Moreover, chronic IL-6 depletion led to increased renal bacterial burden and severe pyelonephritis in C3H/HeOuJ mice. Thus, IL-6/Stat3 signaling drives a transcriptional program of antimicrobial gene expression in infected urothelium, with key roles in limiting epithelial invasion and ascending infection.

Cough in exercise and athletes

Cough is the most common respiratory symptom reported by athletes and can significantly impact on health status, ability to train and athletic performance. The presence of cough in an athlete is typically taken to indicate exercise-induced bronchoconstriction (EIB), yet in many athletes with chronic cough there is no objective evidence of airway hyper-responsiveness (AHR) or heightened airway inflammation. Moreover, cough in athletes often fails to respond to a therapeutic asthma strategy, thus further work is urgently needed to progress our understanding of the pathophysiology of exercise-associated cough in this unique population. This article provides an overview of the current state of knowledge of exercise-associated cough in athletes. The article summarises our understanding of pathophysiological basis of cough in this context and provides a pragmatic clinical approach to this problem.

Inflammation drives renal scarring in experimental pyelonephritis

Acquired renal scarring occurs in a subset of patients following febrile urinary tract infections and is associated with hypertension, proteinuria, and chronic kidney disease. Limited knowledge of histopathology, immune cell recruitment, and gene expression changes during pyelonephritis restricts the development of therapies to limit renal scarring. Here, we address this knowledge gap using immunocompetent mice with vesicoureteral reflux. Transurethral inoculation of uropathogenic Escherichia coli in C3H/HeOuJ mice leads to renal mucosal injury, tubulointerstitial nephritis, and cortical fibrosis. The extent of fibrosis correlates most significantly with inflammation at 7 and 28 days postinfection. The recruitment of neutrophils and inflammatory macrophages to infected kidneys is proportional to renal bacterial burden. Transcriptome analysis reveals molecular signatures associated with renal ischemia-reperfusion injury, immune cell chemotaxis, and leukocyte activation. This murine model recapitulates the cardinal histopathological features observed in humans with acquired renal scarring following pyelonephritis. The integration of histopathology, quantification of cellular immune influx, and unbiased transcriptional profiling begins to define potential mechanisms of tissue injury during pyelonephritis in the context of an intact immune response. The clear relationship between inflammatory cell recruitment and fibrosis supports the hypothesis that acquired renal scarring arises as a consequence of excessive host inflammation and suggests that immunomodulatory therapies should be investigated to reduce renal scarring in patients with pyelonephritis.

Ciliary Muscle Cell Changes During Guinea Pig Development

PURPOSE

Guinea pig ciliary muscle (CM) increases robustly in volume, length, and thickness with age. We wanted to characterize CM cells during development to determine the contributions of hypertrophy (cell size increase) and hyperplasia (cell number increase) during development.

METHODS

Six pigmented guinea pig eyes were collected at each of five ages: 1, 10, 20, 30, and 90 days. Refractive errors and axial lengths were determined. Eyes were temporally marked, enucleated, hemisected, and fixed. Nasal and temporal eye segments were embedded and 30-μm serial sections were collected; the two most central slides from each hemisection were analyzed with an epifluorescence microscope and Stereo Investigator software to determine normal morphologic parameters.

RESULTS

Refractive errors became less hyperopic (P = 0.0001) while axial lengths and CM lengths, cross-sectional areas, volumes, and cell sizes all increased linearly with log age (all P < 0.00001). Ciliary muscle cell numbers increased only during the first 20 days of life (P = 0.02). Nasal and temporal CM lengths (P = 0.07), cross-sectional areas (P = 0.18), and cell numbers (P = 0.70) were not different, but CM cell sizes were initially larger temporally and became larger nasally after age 30 days.

CONCLUSIONS

The mechanism of guinea pig CM cell growth during the first 90 days of life was characterized by early hyperplasia combined with hypertrophic cell growth throughout development that results in larger CM lengths, cross-sectional areas, and volumes. Nasal-temporal CM development was generally symmetric, but there was more CM hypertrophy nasally at older ages.

Expression and Significance of the HIP/PAP and RegIIIγ Antimicrobial Peptides during Mammalian Urinary Tract Infection

Recent evidence indicates that antimicrobial peptides (AMPs) serve key roles in defending the urinary tract against invading uropathogens. To date, the individual contribution of AMPs to urinary tract host defense is not well defined. In this study, we identified Regenerating islet-derived 3 gamma (RegIIIγ) as the most transcriptionally up-regulated AMP in murine bladder transcriptomes following uropathogenic Escherichia coli (UPEC) infection. We confirmed induction of RegIIIγ mRNA during cystitis and pyelonephritis by quantitative RT-PCR. Immunoblotting demonstrates increased bladder and urinary RegIIIγ protein levels following UPEC infection. Immunostaining localizes RegIIIγ protein to urothelial cells of infected bladders and kidneys. Human patients with UTI have increased urine concentrations of the orthologous Hepatocarcinoma-Intestine-Pancreas / Pancreatitis Associated Protein (HIP/PAP) compared to healthy controls. Recombinant RegIIIγ protein does not demonstrate bactericidal activity toward UPEC in vitro, but does kill Staphylococcus saprophyticus in a dose-dependent manner. Kidney and bladder tissue from RegIIIγ knockout mice and wild-type mice contain comparable bacterial burden following UPEC and Gram-positive UTI. Our results demonstrate that RegIIIγ and HIP/PAP expression is induced during human and murine UTI. However, their specific function in the urinary tract remains uncertain.

Loss of Notch2 and Notch3 in vascular smooth muscle causes patent ductus arteriosus

The overlapping roles of the predominant Notch receptors in vascular smooth muscle cells, Notch2 and Notch3, have not been clearly defined in vivo. In this study, we use a smooth muscle-specific deletion of Notch2 together with a global Notch3 deletion to produce mice with combinations of mutant and wild-type Notch2/3 alleles in vascular smooth muscle cells. Mice with complete loss of Notch3 and smooth muscle-expressed Notch2 display late embryonic lethality and subcutaneous hemorrhage. Mice without smooth muscle-Notch2 and only one wild-type copy of Notch3 die within one day of birth and present with vascular defects, most notably patent ductus arteriosus (DA) and aortic dilation. These defects were associated with decreased expression of contractile markers in both the DA and aorta. These results demonstrate that Notch2 and Notch3 have overlapping roles in promoting development of vascular smooth muscle cells, and together contribute to functional closure of the DA.

Strain-dependent oxygen diffusivity in bovine annulus fibrosus

The intervertebral disk (IVD) is the largest avascular structure in the human body. Transport of small molecules in IVD is mainly through diffusion from the endplates and the peripheral blood vessels surrounding IVD. Studies have investigated the structure, chemical components, and water content in IVD, but to our knowledge no study has investigated the effect of mechanical loading on oxygen transport in IVD. The objective of this study was to determine the strain-dependent behavior of oxygen diffusivity in IVD tissue. A one-dimensional steady-state diffusion experiment was designed and performed to determine the oxygen diffusivity in bovine annulus fibrosus (AF). The oxygen diffusivity was calculated using equation derived from Fick's law. A total of 20 AF specimens (d=6 mm, h approximately 0.5 mm) from bovine coccygeal IVD were used to determine oxygen diffusivity at three levels of compressive strain. The average oxygen diffusivity (mean+/-SD) of bovine AF in the axial direction was 1.43+/-0.242 x 10(-5) cm(2)/s (n=20) at 4.68+/-1.67% compressive strain level, 1.05+/-0.282 x 10(-5) cm(2)/s (n=20) at 14.2+/-1.50% strain level, and 7.71+/-1.63 x 10(-6) cm(2)/s (n=20) at 23.7+/-1.34% strain level. There was a significant decrease in oxygen diffusivity with increasing level of compressive strain (ANOVA, p<0.05). Oxygen diffusivity of bovine AF in the axial direction has been determined. The mechanical loading has a significant effect on oxygen transport in IVD tissues. This study is important in understanding nutritional transport in IVD tissues and related disk degeneration.

Pre-operative localization of breast microcalcification using high-frequency ultrasound

AIM

To determine whether high-frequency ultrasound (US) can be used to reliably localize breast microcalcification preoperatively in the absence of any associated mass lesion or distortion.

PATIENTS AND METHODS

Seventeen patients, found to have microcalcification at mammography, the majority screen detected, were studied using high-frequency (10 or 13 MHz) US to visualize the calcified particles. The approximate site of the microcalcifications was first determined from the mammograms. Once the calcifications had been localized, the skin overlying the site was marked with an indelible marker and the depth of the calcifications recorded for the surgeon. Successful excision of microcalcifications was confirmed with postbiopsy specimen X-ray.

RESULTS

Fifteen of the 17 patients (88%) underwent successful removal of the microcalcifications. The mean microcalcification cluster size was 160 mm with a mean number of calcifications of 20 at a mean depth of 15 mm. The mean size of the individual calcifications was 0.29 mm.

CONCLUSION

Our results show that high-frequency US is an effective non-invasive method of identifying and localizing breast microcalcification, and can be used as an alternative to hook wire stereotaxic localization in the majority of patients.

Characterization of cadherins expressed by murine thymocytes

Thymocytes develop in close apposition to the stromal cells of the thymus. The ontogeny of thymocytes is dependent on intimate interactions between these cells and the stromal cells. The molecular mechanisms involved in regulating thymocyte-stromal cell interactions remain to be clearly defined. In this study, we utilized a polymerase chain reaction strategy to identify members of the cadherin family of cell adhesion molecules that are expressed by CD4+ CD8+ thymocytes, the major cell type in the thymus. One classical cadherin (E-cadherin), three atypical cadherins (OB-cadherin) K-cadherin, and cadherin-8), and two novel cadherins (T1-cadherin and T2-cadherin) were found to be expressed by the CD4+ CD8+ thymocytes. The discovery that these cells display multiple cadherins opens a new area of investigation concerning the adhesive mechanisms involved in modulating thymocyte-stromal cell interactions. We speculate that cadherins will prove to play an essential role in the ontogeny of thymocytes.

Quality and interpretation of operative cholangiography in a district general hospital

The quality and interpretation of operative cholangiography were assessed in 128 patients undergoing cholecystectomy. The quality of each cholangiogram was assessed by calculating a cholangiogram score according to the anatomical structure visualized. Out of a maximum possible score of 5, 26% of cholangiograms achieved a score of less than or equal to 3 and were considered as technical failures. The sensitivity, specificity and negative predictive values regarding the surgeon's interpretation of the cholangiograms were high and compared well with the radiologist's assessment. However, the positive predictive value for the surgeon's assessment of the cholangiograms was 74% compared with 95% for the radiologist (P less than 0.02). Improvement in cholangiography can only be achieved by greater attention to detail and perseverance. After an adequate examination, the only criteria for common bile duct exploration should be the presence of filling defect(s).

A waiting time survey in general practice

Keeping patients waiting unnecessarily can be a cause of stress for both patient and doctor. Waiting time is a tangible aspect of your practice that patients will use to judge you, even more than your knowledge and skill. Determine your own actual waiting time, and see if you 'measure up'.

Small business, cash budgets and general practice

In practice management, general practice falls into the category of small business with all its attendant generic problems. Disciplined planning and good financial management are not often seen in small business. These are required if general practitioners are to continue (or return to) the provision of high quality medical services. An effective budget process, especially cash-flow budgeting, is the key to successful planning and financial management. Budgeting will bring Control, Co-ordination, and Credibility to your practice. It will enable you to set goals and to achieve them.

Nutritional myopathy in goats

A nutritional myopathy in unweaned fibre goats aged 2 to 4 mths is described in 3 flocks from the tablelands of New South Wales. Clinically affected animals were illthrifty and in circulatory failure prior to being found dead. At necropsy, there was pronounced ascites, pulmonary congestion and marked mottling of the liver. Chalky white streaks and patches were obvious in the myocardium, particularly in the right ventricular wall. Skeletal muscles varied from grossly normal to generally pale. Histologically, the myocardium exhibited areas of severe acute myonecrosis with mineralisation and adjoining areas of phagocytosis and fibrosis. In 2 of 3 flocks, some skeletal muscles showed a mild subacute myopathy. Marked hepatic congestion extended to periacinar haemorrhage and necrosis in some areas. Dietary imbalances of selenium, vitamin E and polyunsatured fatty acids were probable factors in the pathogenesis of the condition.

How to assess the business performance of your practice

The objective of this article is to provide motivation and practical guidance to those general practitioners who wish to assess the performance of their practice in the business and financial sense, but who believe that they lack the necessary training and resources.

BCG emulsion immunotherapy of equine sarcoid

Of 61 horses with sarcoids treated with intralesional injection of a double emulsion incorporating inactivated bacillus Calmette Guérin organisms, 36 (59 per cent) showed complete regression and 11 (18 per cent) showed partial regression. The majority of cases required only one treatment. Not all sarcoids were responsive to this therapy; those not responding were usually large or on horses with multiple sarcoids.

Oral toxicity of a bloom of the Cyanobacterium microcystis Aeruginosa administered to mice over periods up to 1 year

Cyanobacterial blooms in lakes have been reported causing livestock deaths and liver injury to human populations. In this study bloom material consisting of Microcystis aeruginosa was collected from a farm water storage after the death of sheep drinking from it. The cyanobacterial cells were lysed and a cell-free extract was provided to mice at a series of dilutions as their only source of drinking water. Mice of both sexes, with controls, were killed at intervals up to 1 yr of administration. Autopsies, histopathological examination, and analyses of plasma lactate dehydrogenase and alanine aminotransferase were carried out. Increased mortality was observed, particularly among males, together with chronic active liver injury and elevated alanine aminotransferase in blood. In control mice and those receiving lower concentrations of extract, hepatic amyloidosis with neutrophil infiltration, and bronchopneumonia, were seen with increasing age. The bronchopneumonia appeared earlier among mice receiving cyanobacterial extract. Four tumors were seen in 71 mice receiving a high concentration of extract for up to 1 yr, none in 150 mice receiving lower concentrations, and 2 in 73 control mice. No effects on male or female fertility, embryonic mortality, neonatal viability, or skeletal development were observed, but 7 out of 73 neonatal mice born to parents given cyanobacterial extract showed reduced brain size. No cases were seen in controls. We conclude that the major toxicity exhibited is liver injury. Further attention is needed for evaluation of carcinogenicity and embryonic damage.

Toxicity of the cyanobacterium Nodularia spumigena Mertens

The bloom forming cyanobacterium (blue-green alga) Nodularia spumigena produced a peptide hepatotoxin with an LD50 of 70 micrograms/kg i.p. in mice. The livers of lethally poisoned mice were haemorrhagic and enlarged, the weight doubling to about 10% of total body weight. Histologically there was centrilobular to midzonal disruption and lysis of hepatocytes resulting in haemorrhage and formation of blood lakes. Death occurred approximately 1 hr after i.p. injection. By 30 min significant increases had occurred in the plasma levels of lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase and glucose paralleling degeneration and necrosis of centrilobular hepatocytes. In vitro the toxin caused rapid dose-dependent deformation of freshly isolated rat hepatocytes, which was accompanied by the activation of phosphorylase a; 125 ng/ml of toxin being sufficient to cause these changes in 10(6) cells. This work demonstrates that, both in vivo and in vitro, Nodularia toxin shares many similarities in its action to the well characterized peptide toxins of another cyanobacterium, Microcystis aeruginosa.

Toxicity to mice and sheep of a bloom of the cyanobacterium (blue-green alga) Anabaena circinalis

A bloom of Anabaena circinalis shown to be lethal to mice (i.p. LD50 17.0 +/- 0.6 mg/kg) was tested for lethal potency when given orally to mice and intraruminally and intraperitoneally to sheep. The lethal oral dose in mice was at least 170 times the parenteral dose. The bloom was lethal when given i.p. to sheep but lethality was not observed when given intraruminally in doses up to 1710 mg/kg, equivalent to drinking 8.5 litres of thick algal bloom, a volume far in excess of that likely to be consumed naturally. In vivo testing of lethal potency by i.p. inoculation of mice is therefore an unreliable method for judging potential oral toxicity in livestock of blooms of Anabaena.

Kikuyu poisoning of cattle in New South Wales and its relationship to pasture fungi on kikuyu grass (Pennisetum clandestinum)

In the late summer and autumn of 1980 kikuyu poisoning of cattle was diagnosed on 9 farms in New South Wales resulting in 213 deaths among 1370 cattle at risk. Clinical, autopsy and histopathological findings are described and are consistent with those previously recorded. Kikuyu grass samples from 5 paddocks in which deaths were occurring were examined for the presence of fungi. Myrothecium spp were not present. Fusarium semitectum, F. moniliforme var subglutinans, Penicillium spp and a Phoma sp were the most common fungi isolated but with the exception of F. semitectum were not consistently present. F. semitectum was present in adjacent kikuyu grass paddocks in which deaths were not occurring. Two of the farms had army caterpillar (Mythimna convecta) infestations. Army caterpillar faeces present in these paddocks did not contain Myrothecium spp; the fungi present reflected the population present on the kikuyu grass. These findings do not suggest a mycotic cause for kikuyu poisoning.

Lethal potency and tissue distribution of 125I-labelled toxic peptides from the blue-green alga Microcystis aeruginosa

Toxic heptapeptides from a water bloom of the cyanobacterium Microcystis aeruginosa were purified by HPLC. The unoxidised fraction was iodinated with 125I plus 127I by the lactoperoxidase/H2O2 method, further purified by HPLC, and the non-iodinated and three iodinated fractions administered i.p. to male mice. All iodinated fractions were toxic, with symptoms and pathological lesions of the liver identical with those caused by non-iodinated peptide. Radioactivity was concentrated in the liver of mice at death.

Severe hepatotoxicity caused by the tropical cyanobacterium (blue-green alga) Cylindrospermopsis raciborskii (Woloszynska) Seenaya and Subba Raju isolated from a domestic water supply reservoir

Cylindrospermopsis raciborskii, a tropical blooming species of cyanobacterium (blue-green alga), was isolated from the domestic water supply reservoir on Palm Island, a continental island off the tropical northeast coast of Australia. This species, not previously known to be toxic, was shown to be severely hepatotoxic for mice. The 50% lethal dose at 24 h after injection was found to be 64 +/- 5 mg of freeze-dried culture per kg of mouse. The principal lesion produced was centrilobular to massive hepatocyte necrosis, but various degrees of injury were also seen in the kidneys, adrenal glands, lungs, and intestine. The possible implication of this finding in relation to an incident of hepatoenteritis in humans living on the island is discussed.

Disseminated fat necrosis mimicking gout

A case of disseminated fat necrosis in pancreatic disease which presented as an apparent arthritis is reported. The intravenous administration of aprotinin as a form is described.

Clinical and pathological changes in sheep experimentally poisoned by the blue-green alga Microcystis aeruginosa

Fifteen young sheep were inoculated intraruminally with various doses of an algal bloom of Microcystis aeruginosa. Lethally poisoned sheep died between 18 and 48 hours after inoculation. Findings included marked elevation of serum concentrations of certain enzymes and bilirubin, mild elevations of blood urea nitrogen and serum inorganic phosphorus with marked reduction in blood glucose, a mild neutrophilia with a marked left shift and marked changes in coagulation parameters. Necropsy findings included pale swollen, sometimes hemorrhagic, livers, edema involving the body cavities and widespread small hemorrhages. The primary site of toxicity was the liver which had centrilobular to near massive hepatocyte necrosis. Electron microscopic lesions were aggregation of endoplasmic reticulum with displacement of subcellular organelles towards the periphery of the hepatocyte, and vacuolation of the contents of more severely affected cells.

Keratoconjunctivitis of the koala, Phascolarctos cinereus, caused by Chlamydia psittaci

Chlamydia psittaci was cultured from 29 of 35 koalas (Phascolarctos cinereus) with keratoconjunctivitis. The disease progressed from acute to chronic stages over some months, with a known duration of at least 2 years. One recovered carrier was found. Up to 29% of koalas in some populations were clinically affected. A seasonal spread of infection was indicated by the high percentage of acutely affected cases found in summer. There was no evidence of susceptibility being related to age or sex. The sera of all chronically affected koalas had complement fixation test titres against chlamydial group antigen of 80 or above; in acute cases the titre ranged from 0 to 320. Of normal koalas, 84% were serologically negative, 16% had chlamydial antibody. A titre of 80 or more considered in conjunction with ocular disease could be taken as presumptive evidence of a chlamydial etiology. Chlamydial keratoconjunctivitis may be the ocular disease which was associated with the decline of koala numbers between the years 1885 and 1930.

Isolation, characterization and pathology of the toxin from a Microcystis aeruginosa (= Anacystis cyanea) bloom

The nature of the toxicity of a bloom of blue-green alga, M. aeruginosa (= Anacystis cyanea), that occurred in a man-made lake was investigated. Crude algal bloom extracts were toxic to laboratory mice when injected intraperitoneally. The lethal dose (LD100) of these extracts was 15-30 mg of lyophilized algal bloom per kilogram body weight. The toxin was purified by a procedure that included ammonium sulphate fractionation, solvent extraction, acid precipitation, Sephadex G25 and DEAE-Sephadex chromatography, and high-voltage electrophoresis at pH 6.5. The preparation gave a single spot on high-voltage electrophoresis at pH 9.0, had no free amino group, and was characterized by a simple amino acid composition of equimolar quantities of L-methionine, L-tyrosine, D-alanine, D-glutamic acid, erythro beta-methyl aspartic acid and methylamine. The LD50 for the purified toxin was estimated to be 0.056 mg/kg of mice, and the approximate LD100 is 0.070 mg/kg, based on the total material found from amino acid analysis. Parenteral administration of the purified toxin to mice produced extensive liver lobular haemorrhage and death within 1-3 h. Repeated inoculation of sublethal doses daily over some weeks produced progressive hepatocyte degeneration and necrosis and the development of fine hepatic fibrosis.

Studies on nematode infections of beef cattle in New South Wales

The occurrence and seasonal trends of nematode parasite infections in beef cattle on the Tablelands and North Coast regions of New South Wales are described, based on worm counts from 627 spring-born steers slaughtered at 2-monthly intervals from 6 to 24 months of age. The predominant parasites were Ostertagia ostertagi, Trichostrongylus axei and Cooperia spp. Large burdens of adult Ostertagia were seen in 12-month-old animals in late winter and early spring, and later in 18- to 20-month-old cattle in the following late summer and autumn. These infections often resulted in outbreaks of clinical parasitism. Massive numbers of inhibited early fourth stage larvae (EL4) also accumulated in the yearlings during their first spring, reached peaks in mid-summer and then declined. The possibility of their resumption of development to mature worms in the late summer and autumn period is discussed. Adult T. axei showed a similar seasonal trend to Ostertagia and may have increased the severity of outbreaks of clinical disease. Cooperia populations of EL4 and adult worms were highest in weaners during winter, but lower numbers thereafter indicated a strong resistance to re-infection. In addition, Haemonchus placei occurred frequently on the North Coast both as EL4 and adults in cattle of all ages up to 20 months. Of the other cattle nematodes, Oesophagostomum radiatum and Trichuris spp occurred in low numbers, mainly in weaners. Bunstomum phlebotomum and H. contortus occurred sporadically on the North Coast and Tablelands respectively. Intestinal Trichostronglyus spp, Oesophagostomum venulosum and Dictyocaulus viviparus were seen occasionally and Nematodirus spp were not seen. There was a poor relationship between worm counts and faecal egg counts. Cooperia spp dominated the egg counts, while those for other genera were generally low and did not reflect the relative abundance or seasonal changes in worm numbers.