Approach and Management of Hypertension After Kidney Transplantation

Hypertension is one of the most common cardiovascular co-morbidities after successful kidney transplantation. It commonly occurs in patients with other metabolic diseases, such as diabetes mellitus, hyperlipidemia, and obesity. The pathogenesis of post-transplant hypertension is complex and is a result of the interplay between immunological and non-immunological factors. Post-transplant hypertension can be divided into immediate, early, and late post-transplant periods. This classification can help clinicians determine the etiology and provide the appropriate management for these complex patients. Volume overload from intravenous fluid administration is common during the immediate post-transplant period and commonly contributes to hypertension seen early after transplantation. Immunosuppressive medications and donor kidneys are associated with post-transplant hypertension occurring at any time point after transplantation. Transplant renal artery stenosis (TRAS) and obstructive sleep apnea (OSA) are recognized but common and treatable causes of resistant hypertension post-transplantation. During late post-transplant period, chronic renal allograft dysfunction becomes an additional cause of hypertension. As these patients develop more substantial chronic kidney disease affecting their allografts, fibroblast growth factor 23 (FGF23) increases and is associated with increased cardiovascular and all-cause mortality in kidney transplant recipients. The exact relationship between increased FGF23 and post-transplant hypertension remains poorly understood. Blood pressure (BP) targets and management involve both non-pharmacologic and pharmacologic treatment and should be individualized. Until strong evidence in the kidney transplant population exists, a BP of <130/80 mmHg is a reasonable target. Similar to complete renal denervation in non-transplant patients, bilateral native nephrectomy is another treatment option for resistant post-transplant hypertension. Native renal denervation offers promising outcomes for controlling resistant hypertension with no significant procedure-related complications. This review addresses the epidemiology, pathogenesis, and specific etiologies of post-transplant hypertension including TRAS, calcineurin inhibitor effects, OSA, and failed native kidney. The cardiovascular and survival outcomes related to post-transplant hypertension and the utility of 24-h blood pressure monitoring will be briefly discussed. Antihypertensive medications and their mechanism of actions relevant to kidney transplantation will be highlighted. A summary of guidelines from different professional societies for BP targets and antihypertensive medications as well as non-pharmacological interventions, including bilateral native nephrectomy and native renal denervation, will be reviewed.

NUTORC-a transdisciplinary health services and outcomes research team in transplantation

The field of solid organ transplantation has historically concentrated research efforts on basic science and translational studies. However, there has been increasing interest in health services and outcomes research. The aim was to build an effective and sustainable, inter- and transdisciplinary health services and outcomes research team (NUTORC), that leveraged institutional strengths in social science, engineering, and management disciplines, coupled with an international recognized transplant program. In 2008, leading methodological experts across the university were identified and intramural funding was obtained for the NUTORC initiative. Inter- and transdisciplinary collaborative teams were created across departments and schools within the university. Within 3 years, NUTORC became fiscally sustainable, yielding more than tenfold return of the initial investment. Academic productivity included funding for 39 grants, publication of 60 manuscripts, and 166 national presentations. Sustainable educational opportunities for students were created. Inter- and transdisciplinary health services and outcomes research in transplant can be innovative and sustainable.

Antifungal effect of gaseous nitric oxide on mycelium growth, sporulation and spore germination of the postharvest horticulture pathogens, Aspergillus niger, Monilinia fructicola and Penicillium italicum

AIM

To evaluate the antifungal activity of nitric oxide (NO) against the growth of the postharvest horticulture pathogens Aspergillus niger, Monilinia fructicola and Penicillium italicum under in vitro conditions.

METHODS AND RESULTS

Different volumes of NO gas were injected into the Petri dish headspace to obtain the desired concentrations of 50-500 microl l(-1). The growth of the fungi was measured for 8 days of incubation in air at 25 degrees C. All concentrations of NO were found to produce an antifungal effect on spore germination, sporulation and mycelial growth of the three fungi, with the most effective concentration for A. niger and P. italicum being 100 and 500 microl l(-1) for M. fructicola.

CONCLUSIONS

Short-term exposure to a low concentration of NO gas was able to inhibit the subsequent growth of A. niger, M. fructicola and P. italicum.

SIGNIFICANCE AND IMPACT OF THE STUDY

NO gas has potential use as a natural fungicide to inhibit microbial growth on postharvest fruit and vegetables.

Image-guided endoscopic surgery: results of accuracy and performance in a multicenter clinical study using an electromagnetic tracking system

Image-guided surgery has recently been described in the literature as a useful technology for improved functional endoscopic sinus surgery localization. Image-guided surgery yields accurate knowledge of the surgical field boundaries, allowing safer and more thorough sinus surgery. We have previously reviewed our initial experience with The InstaTrak System. This article presents a multicenter clinical study (n=55) that assesses the system's capability for localizing structures in critical surgical sites. The purpose of this paper is to present quantitative data on accuracy and performance. We describe several new advances including an automated registration technique that eliminates the redundant computed tomography scan, compensation for head movement, and the ability to use interchangeable instruments.

Video compression of coronary angiograms based on discrete wavelet transform with block classification

A new method of video compression for angiographic images has been developed to achieve high compression ratio (~20:1) while eliminating block artifacts which leads to loss of diagnostic accuracy. This method adopts motion picture experts group's (MPEGs) motion compensated prediction to takes advantage of frame to frame correlation. However, in contrast to MPEG, the error images arising from mismatches in the motion estimation are encoded by discrete wavelet transform (DWT) rather than block discrete cosine transform (DCT). Furthermore, the authors developed a classification scheme which label each block in an image as intra, error, or background type and encode it accordingly. This hybrid coding can significantly improve the compression efficiency in certain eases. This method can be generalized for any dynamic image sequences applications sensitive to block artifacts.

Inverted papilloma: a report of 112 cases

Inverted papilloma is a benign sinonasal tumor which is locally aggressive and has a significant malignant potential. This report updates the experience of the two senior authors, who have treated 112 patients with inverted papilloma at the Mount Sinai Medical Center over a 20-year period. As clinical examination often underestimates tumor extent, preoperative radiographic assessment is of paramount importance in guiding selection of surgical therapy. Complete en bloc excision via lateral rhinotomy and medial maxillectomy was the method of treatment in the majority of patients (84%). In selected patients with limited disease, or in patients who refused en bloc excision, conservative therapy employing intranasal or transantral ethmoidectomy was performed. The recurrence rates for the two groups were 14% and 20%, respectively. Recurrent disease developed throughout the paranasal sinuses, with the maxillary antrum and ethmoid labyrinth constituting the major sites. In two patients presenting with anterior skull base erosion, craniofacial resection was undertaken to eradicate disease. The latter cases underscore the aggressive nature of the tumor if left untreated. The overall rate of squamous carcinoma in this series was 5%. Given the predilection for local recurrence, multicentricity, and the possibility of malignancy, the authors continue to recommend lateral rhinotomy and medial maxillectomy as the standard therapy for the majority of cases. Management principles as well as a review of the literature are discussed.

Large thyroglossal duct cyst with laryngeal extension

BACKGROUND

A thyroglossal duct cyst typically presents as a long-standing neck mass that becomes symptomatic when inflamed. Hoarseness is an uncommon complaint, and its association may suggest encroachment on and destruction of the larynx. Following removal of the cyst with the Sistrunk procedure, the larynx may need to be reconstructed.

METHODS

A case is reported of a patient who was initially seen with hoarseness and a long-standing midline neck mass. Computed tomography (CT) demonstrated a large cystic neck mass that eroded the thyroid cartilage and encroached on the pre-epiglottic space and right paraglottic space. Although the clinical impression was that of laryngeal neoplasm, the CT diagnosis was that of a cyst. At surgery, a thyroglossal duct cyst was found and successfully removed with the Sistrunk procedure. Because the thyrohyoid membrane and thyroid perichondrium were preserved, the glottis did not require reconstruction. This case is presented and the literature of thyroglossal duct cysts that extend into the larynx is reviewed.

CONCLUSIONS

The clinical and radiographic criteria that suggest encroachment of a thyroglossal duct cyst on the larynx are reviewed. The management and indications for laryngeal reconstruction are discussed.

Neurochemical basis of interleukin 2-modified discrimination behaviour

We trained one group of rats to discriminate 0.8 mg/kg intraperitoneal (i.p.) d-amphetamine from 1 ml/kg saline and the other to discriminate 0.3 mg/kg i.p. (+/-)-ethylketocyclazocine (EKC) from saline. Recombinant human interleukin 2 (rIL-2), 2 x 10(6) U/kg (or 8.2 nmol/kg) given i.p. 1 h prior to tests, potentiated responses elicited by 0.4 mg/kg d-amphetamine. This potentiation of d-amphetamine responses was suppressed by the opioid receptor antagonist naloxone (1 mg/kg) when administered i.p. together with IL-2. IL-2 (4 x 10(6) U/kg) alone produced EKC-like responses in the EKC-trained animals. The cytokine also potentiated 0.1 mg/kg EKC responses at 2 x 10(6) U/kg, an action that was suppressed by 1 mg/kg naloxone. Data from the present study show that IL-2 exerts the same neurochemical action as that previously observed with IFN-alpha for both d-amphetamine and EKC discrimination in rats.

The opioid mechanism of interferon-alpha action

Rats were trained to discriminate the opioid receptor agonist ethylketocyclazocine (EKC) (0.3 mg/kg body weight, intraperitoneally) from saline. Interferon-alpha (IFN-alpha), when substituted for EKC, elicited a dose-related increase in EKC-like responses. This generalization of EKC responses was blocked by the opioid antagonist naloxone (1 mg/kg). Potentiation of responses to a low dose (0.1 mg/kg) of EKC by IFN-alpha (1 x 10(6) U/kg or 0.22 nmol/kg) was also observed. Data thus indicate the involvement of opioid neurons on the action of IFN-alpha. d-Amphetamine (0.8 mg/kg) was shown to potentiate both EKC (0.1 mg/kg) and IFN-alpha (1 x 10(6) U/kg). The present study confirms our previously proposed opioid-mediated dopaminergic mechanism of IFN-alpha.

Hemodynamics of the rodent abdominal skin flap following primary ischemia

The effect of varying periods of ischemia and reperfusion times on subsequent blood flow was studied in the rodent abdominal skin flap. Using perfusion fluorometry, measurements of blood flow were quantified in 60 Sprague-Dawley rats undergoing clamp-induced ischemic periods ranging from 0 to 6 hours and reperfusion times ranging from 2 to 8 hours. Flaps subjected to ischemia times of 0, 2, 4, or 6 hours require 8 hours of reperfusion time before reaching baseline levels of blood flow. Blood flow in flaps subjected to 6 hours of ischemia was statistically less than the flow in flaps ischemic for 0, 2, and 4 hours and was directly related to length of reperfusion. These results demonstrate that flap perfusion does not fully take place immediately after clamp release. The factors thought to be responsible for these findings and the implications for the design and interpretation of flap ischemia experiments are discussed.

Opioid-dopaminergic mechanisms in the potentiation of d-amphetamine discrimination by interferon-alpha

In rats trained to discriminate 0.8 mg/kg IP d-amphetamine from 1 ml/kg saline, 4 x 10(6) U/kg of recombinant human interferon-alpha (rIFN-alpha) given intramuscularly 1 h prior to tests potentiated responses elicited by 0.4 mg/kg d-amphetamine. Coadministration of the opioid receptor antagonist naloxone (1 mg/kg IP) with rIFN-alpha suppressed the potentiation of d-amphetamine by the cytokine. Opioid-dopaminergic mechanisms are proposed to explain the action of rIFN-alpha.

Analgesic activity of anticancer agent suramin

Suramin exhibited morphine-like analgesic activity in mice. It antagonized both thermal (hot-plate) and acetic acid-evoked writhing responses with ED50 values 1/100 and 1/68, respectively, that of morphine. The suramin- and morphine-induced hot-plate analgesia was suppressed by administration of 0.5 mg/kg naloxone. However, lower doses (5-30 micrograms/kg) of naloxone produced dose-related potentiation or suppression of suramin and morphine analgesia. This potentiation effect may be due to the inhibition of writhing by naloxone itself rather than be a direct antagonism of the morphine effect.

Inhibition of adenylate cyclase by tetraplatin

In the investigation of effects of platinum-containing compounds on dopamine (DA)-activated adenylate cyclase system, tetraplatin and cisplatin were found to suppress the increase of enzyme activity by various activators. However, tetraplatin was a much more potent inhibitor than cisplatin, with its I50 values being 1/25, 1/45, and 1/130 that of cisplatin in the presence of DA/Gpp(NH)p, NaF/AlCl3, and forskolin/Gpp(NH)p respectively.

Beta-adrenoceptor binding studies with LY195448 and metabolites

LY195448(R) (a phenethanolamine derivative that has demonstrated cytotoxic activity against cell cultures in vitro but that exhibited a hypotensive side effect during phase I trials), its p-hydroxy and acid metabolites, and a noncytotoxic S-stereoisomer were evaluated with respect to competitive binding against the beta-adrenergic antagonist [3H]dihydroalprenolol in rat brain cortex and human cardiac tissues. When IC50 and Ki values were compared, the R-isomer of LY195448 in general was more potent than the S-stereoisomer. While LY195448(R) was about 10-fold more active than the p-hydroxy metabolite in cardiac tissues, the two compounds were nearly equipotent both in blocking the binding of radioligand to the brain and in reducing blood pressure in rats. In the cerebral preparation, the binding of the acid metabolite was weak, with its activity being equal to that of the S-stereoisomer.

The effect of the experimental antitumor agent caracemide on brain choline acetyltransferase

Caracemide was found to inhibit choline acetyltransferase (CAT) from rat brain. A concentration of 0.5 mM caracemide inhibited the enzyme by 93%, whereas a degradation product from caracemide, N-(methylcarbamoyloxy)acetamide, produced only a 50% inhibition. Two other degradation products, N-(methyl-carbamoyloxy)-N'-methylurea and N-hydroxy-N'-methylurea, lacked any inhibitory activity. With bovine brain CAT, caracemide showed noncompetitive inhibition with the substrate choline, Km 337 microM, Ki240 microM, Vmax 2.83 nmol acetylcholine formed/min/mg protein and mixed inhibition with the substrate acetyl-CoA, Km 21 microM, Ki 146 microM, Vmax 3.85 nmol acetylcholine formed/min/mg protein.

Inhibition of brain choline acetyltransferase by tetraplatin

Tetraplatin inhibited choline acetyltransferase (CAT) from rat and bovine brain with I50 values of 13.5 and 40 microM, respectively. At 0.5 mM concentration, tetraplatin exhibited inhibition of the rat brain enzyme by 89%, whereas cisplatin yielded only 18% inhibition. With bovine CAT, tetraplatin showed noncompetitive inhibition with the substrate choline, Km 337 microM, Ki 29 microM, Vmax 2.83 nmoles acetylcholine formed/min/mg protein, and competitive inhibition with the substrate acetyl-CoA, Km 21 microM, Ki 16 microM, Vmax 3.85 nmoles acetylcholine formed/min/mg protein.

Neurochemical and behavioral effects of N-ethyl-acetylcholine aziridinium chloride in mice

N-ethyl-choline aziridinium (ECA) and N-ethyl-acetylcholine aziridinium (EAA) were shown to be inhibitors of high affinity choline uptake in vitro (IC50 = 0.4 microM and 1.5 microM, respectively), and intraventricular administration showed that EAA was more selective in its inhibition of hippocampal choline uptake in vivo. EAA significantly reduced the activity of choline acetyltransferase in the hippocampus 3 to 28 days following intraventricular infusion, but not in the striatum or parahippocampal cortex. Neither muscarinic receptor binding nor glutamic acid decarboxylase activity were affected in any of the three brain regions. EAA (12 or 16 nanomoles, intraventricular) significantly impaired memory performance of mice in a radial arm maze when tested two weeks after treatment. A subgroup analysis implicated long-term reference memory as the mechanism disrupted.

Correlation between plasma cortisol and CSF catecholamines in endogenous depressed dexamethasone nonsuppressors

Nineteen endogenous depressive in-patients (13 with major depression and 6 with bipolar disorder-depressed) and 10 other patients with dysthymic disorder serving as the control group were given the dexamethasone suppression test (DST, 1 mg/subject). The results showed that the DST sensitivity in endogenous depressives was 73.7% and the specificity was 90%. After the patients were treated daily for 6 weeks with 150-200 mg imipramine, 88.9% of those endogenous depressive patients who previously had a positive DST response exhibited a negative response. Moreover, a significantly negative correlation was found between the CSF norepinephrine level and the pre-dexamethasone 4 p.m. plasma cortisol level in those endogenous depressed patients who had a positive DST response. Pre-treatment data also showed that the 4 p.m. plasma cortisol had a significant negative correlation with CSF dopamine. These findings suggest that endogenous depression with positive DST could be related not only to a lower norepinephrine level, but also to a lower dopamine level.

Passive avoidance deficits in mice following ethylcholine aziridinium chloride treatment

High-affinity choline uptake (HACU) appears to be the rate-limiting step in the synthesis of the neurotransmitter acetylcholine. The present experiment was designed to examine the effects of irreversible inhibition of HACU by ethylcholine aziridinium chloride (ECA) on passive avoidance retention in mice. Animals were injected intracerebroventricularly, and one-trial passive avoidance retention evaluated 21 days later. A significant retention deficit was observed in ECA-treated animals upon retest 24 hours after training. ECA-induced changes in retention were accompanied by significant reductions in choline acetyltransferase (CAT) activity in only two of seven brain regions tested, hippocampus (48% of control) and cerebellum (76% of control). The results support the involvement of hippocampal cholinergic activity in mediation of passive avoidance learning.

Evaluation of two distinctive beta-carbolines on serotonin binding in human platelets

6-MeOTHBC binds to both high and low affinity receptors in human platelets. The beta-carboline is less active than chlorimipramine at the low affinity site, and it is weaker than methysergide, a known 5-HT antagonist, at the high affinity site. The other beta-carboline, B-CCE, is not active at either receptor in platelets. The data supports the view that platelets could be used as a limited model for studying 5-HT-ergic neurons.

Haloperidol. Plasma levels and prolactin response as predictors of clinical improvement in schizophrenia: chemical v radioreceptor plasma level assays

The relationship between clinical response of schizophrenic patients to haloperidol and (1) blood levels of the medication, determined by both gas-liquid chromatography (GLC) and radioreceptor (RR) assays, or (2) prolactin response to the medication, was examined in an inpatient study using several fixed doses of haloperidol. Regression analysis disclosed a substantial curvilinear relationship between steady-state GLC-determined plasma haloperidol levels and decrease in Brief Psychiatric Rating Scale (BPRS) Psychosis factor scores; however, no substantial relationship was found between clinical response and RR plasma haloperidol levels or serum prolactin response to haloperidol. Our results suggest that steady-state plasma levels of haloperidol determined by the GLC chemical assay are a better predictor of decreases in BPRS Psychosis factor scores than RR assayed plasma haloperidol levels or prolactin response to haloperidol.

Retinal burns occurring at cataract extraction

Paramacular changes presumably induced by operating microscope light have been described previously in six patients who had undergone extracapsular cataract extraction with posterior chamber lens implantation. Twelve additional patients are reported, including pseudophakes and nonpseudophakes, macular and paramacular burns, and no visual loss and severe visual loss. Burns occurred in spite of filters and light barriers used in some cases. Light sources were tungsten bulb or halogen/fiberoptic. Three cases had essentially normal preoperative angiography. Currently recommended safety measures have not eliminated this complication.

Trace element levels in human alcoholic brain

Copper, magnesium, zinc and manganese levels in the temporal cortex of human alcoholic and control brains were measured by atomic absorption spectrophotometry using both the flame and graphite furnace. All of the 21 alcoholics were male with a mean age of 54.1 years; the 19 male controls had a mean age of 60.2 years. The only statistically significant change in ion levels was an increase in manganese concentration (expressed both as microgram/g wet weight and ng/mg protein) in the alcoholic group when compared to the control group. Five of the alcoholics had malignancies, while 16 of the controls had systemic malignancies. Covariance analysis showed there was no effect of age on the level of manganese in the temporal cortex.

Effects of 6-methoxytetrahydro-beta-carboline on 5-hydroxytryptamine binding in rat brain

6-MeOTHBC competes for 5-HT binding sites in rat brain in-vitro and in-vivo. The beta-carboline is significantly more active at the type 1 [3H]-5-HT, than the type 2 [3H]spiperone receptors, in-vitro. Following injection, 6-MeOTHBC significantly decreases [3H]-5-HT binding in the cortex. The ineffectiveness on [3H]spiperone binding in-vivo corresponds with the low affinity in-vitro. The effect of 6-MeOTHBC on central 5-HT binding may be a significant aspect of its 5-HT-ergic activity.

Prolactin response to single and multiple doses of haloperidol in schizophrenic patients

Serum prolactin and blood levels of haloperidol were assessed in schizophrenic patients after single acute oral doses of haloperidol and during fixed dose treatment with this medication. Although significant intrapatient correlations between prolactin responses to different doses of haloperidol were found, no statistically significant interpatient relationship between haloperidol dose and prolactin response emerged. There were statistically significant relationships between steady-state plasma and red cell haloperidol levels (measured by radioreceptor or gas liquid chromatographic techniques) and serum prolactin response, but not between blood levels after the acute haloperidol dose and prolactin response.

Serotonin levels and platelet uptake during premenstrual tension

Premenstrual tension was studied in 16 females, using both biochemical and psychological parameters during the pre- and postmenstrual phases. Uptake of serotonin (5-HT) and the levels of 5-HT in platelet-rich plasma and platelet-poor plasmas were determined. Degrees of distress experienced pre- and postmenstrually were quantified via the Moos menstrual distress questionnaire. The mean Vmax was significantly lower during the premenstrual (tension) phase (8.2 +/- 0.9 pmol/min) as compared to the postmenstrual (normal) phase (14.4 +/- 3.2 pmol/min). There was no significant difference in the Km values. A highly significant (p less than 0.001) reduction in the levels of 5-HT in platelet-rich plasma (-23.2%) and platelet-poor plasma (-19.1%) was found during the premenstrual phase. There were correlations between the kinetic parameters of 5-HT uptake and some of the Moos symptoms.

Kinetic evaluation of platelet monoamine oxidase following relaxation in chronic anxiety

The effect of relaxation training, utilizing EMG biofeedback, on platelet monoamine oxidase (MAO) activity was examined in patients with a history of chronic anxiety. Anxiety scores and MAO activity were significantly lowered after 4 weeks of therapy. Kinetic studies, using phenylethylamine as substrate, indicated a significant increase of the Km constant while the Vmax showed no significant or consistent variation. It is thought that this phenomenon represents an adaptive response by the individual to maintain a homeostatic level of the biogenic amines.

The residual effect of chronic neuroleptic treatment on the neuroleptic binding assay in rats

Chronic chlorpromazine administration to rats (25 mg/Kg/day) for 30 days followed by a washout period of 10 days resulted in an increase in both the measured maximum number of binding sites, Bmax, and the apparent dissociation constant, Kd, for the binding of 3H-spiroperidol to neural membranes of the brain. When membrane suspensions were progressively diluted before the binding assay, it was found that the apparent Bmax did not change with dilution, remaining higher in membranes of chlorpromazine-treated rats than in controls. The apparent increase in Kd, on the other hand, was found to be an artifact of the assay. Thus extrapolation of the measured or apparent Kd value to infinite dilution resulted in identical value for Kd regardless of the treatment.

Various inputs modify caudate neuronal activity

This study investigates the input of substantia nigra (SN), dorsal raphe (DR), and medial lemniscus (ML) on caudate nucleus (CN) neurons as well as a non-specific-polysynaptic input (acoustic AC). Ninety-one units demonstrating spontaneous activity were recorded extracellularly using anesthetized rats. SN, DR, ML, and AC stimulation altered the spontaneous discharges in 79%, 90%, 86%, and 85% of the CN neurons, respectively. Only ML stimulation elicited patterns of time-locked responses in 16% of the CN units. The CN neurons showed high convergence to the four types of stimulation. Based on these results, interconnections and interrelations between SN, DR, ML, and the CN are suggested.

Ultrastructural localization of LH-RH-immunoreactive synapses in the hamster accessory olfactory bulb

Electron microscopic immunocytochemistry was used to localize luteinizing hormone-releasing (LH-RH) immunoreactivity within the male golden hamster accessory olfactory bulb. Two LH-RH-immunoreactive fiber populations were identified in the accessory olfactory bulb. A superficial system of immunoreactive axons was localized to the vomeronasal nerve and glomerular layers, and a periventricular system appeared in granule cell and periventricular layers. LH-RH-immunoreactive varicosities were observed to contain large reactive vesicles (80-120 nm) as well as a variable degree of cytoplasmic reaction product. Additionally, small vesicles with unreactive lumens and mitochondria were often present. Intravaricose segments of immunoreactive fibers invariably displayed fewer reactive vesicles than did varicosities. Within both glomerular and periventricular layers, some LH-RH-immunoreactive varicosities were observed to form asymmetric contacts characterized by prominent postjunctional densities. In the glomerular layer, these junctions could be identified as synaptic by several features. The presence of LH-RH-immunoreactivity in presynaptic elements supports a neuromodulatory role for LH-RH. As the accessory olfactory system is critically involved in the initiation of mating behavior of the male golden hamster, LH-RH-immunoreactive synapses in the accessory olfactory bulb may function to regulate reproductive behavior.

Effects of neuroleptics on platelet monoamine oxidase activity

Platelet MAO activity in schizophrenics was significantly decreased, by about 15%, after 3 weeks of treatment with haloperidol. Treatment with thioridazine or butaperazine also tended to decrease platelet MAO activity. The neuroleptic-induced decrease began to appear within a few days of treatment and did not show tolerance over 1-2 months of treatment with haloperidol. Platelet MAO activity of schizophrenic patients measured during drug-free base-line was not significantly different from that of normal controls, but MAO activity of schizophrenics was significantly lower than normals after 3 weeks of treatment with neuroleptics. The extent of decrease in platelet MAO activity correlated negatively with base-line prolactin and its increase after 24 hr. With PEA as substrate, the decrease in activity correlated positively with steady state plasma haloperidol.

Cholinesterase enzymes in the blood of patients with Alzheimer's disease

Plasma pseudocholinesterase activity was about 100% higher in patients with Alzheimer's type dementia than in similar age controls. Red cell acetylcholinesterase activity tended to be lower in patients than controls. Administration of lecithin substantially increased plasma choline levels but did not alter activity of either of the cholinesterase enzymes.

Catecholamines and anxiety

Plasma catecholamines and heart rate were determined in drug-free groups of anxious patients and normal controls before and 20 min after intramuscular injection of 0.01 mg/kg of 1/1000 diluted epinephrine. Levels of anxiety after the injection were determined via the State Anxiety Scale of State Trait Anxiety Inventory. Both groups showed substantial increases in plasma levels of epinephrine and norepinephrine and heart rate after the injection. However, there were no significant differences between anxious patients and controls on plasma catecholamines and heart rate before or after the injection and post injection levels of State Anxiety. The anxious subjects showed a significant correlation between post injection heart rate and State Anxiety.

Electrophysiological support in favor of multiple opiate receptors in the caudate and the central gray of the rat

1. The present study compares the direct actions of morphine on two brain sites known to be rich in opiate receptors, namely, the caudate nucleus and the central gray. Recordings and morphine injections were made through a multibarrel glass micropipette using microiontophoresis. 2. Four different patterns of neuronal response to increasing currents of morphine were recorded in both brain regions. 3. Differences in the response to morphine between the two sites were detected in morphine-dependent rats. While the caudate neurons exhibited super-sensitivity to morphine, the neurons in the central gray displayed tolerance, and in some instances, dependence was evident when naloxone was administered. 4. The distribution of spontaneously active neurons within these two brain areas was found to be different in morphine-naive and morphine-dependent rats. 5. The electrophysiological findings of this study support the hypothesis of multiple opiate receptors.

Caudate neuronal response to microiontophoretically injected morphine in naive and morphine-dependent rats

1. The response of caudate nucleus neurons to morphine was found to be dose-dependent and could be divided into two classes: neurons which responded monophasically either by increase or decrease in their firing rate, and neurons whose response can be described as biphasic, exhibiting increase followed by decrease in their firing rate or vice versa, with the increase in morphine concentration. These responses were found in both naive and morphine-dependent rats. 2. Naloxone antagonized the effects of morphine in 74 out of 102 neurons tested. 3. Caudate neurons of morphine-dependent rats showed super-sensitivity to morphine compared to naive rats. 4. Differences were found in the distribution of the spontaneously active neurons between naive and morphine-dependent rats, indicating the existence of two different opiate receptor populations within the caudate nucleus.

Depression, antidepressants, and plasma DBH

Plasma levels of dopamine-beta-hydroxylase (DBH) were determined in 16 unmedicated patients with major depressive episodes (nonpsychotic) and in an equal number of normal subjects, before and after 4 weeks of treatment with tricyclic antidepressants. Some eight patients were treated with amitriptyline, and the remainder received desipramine. The controls remained medication free during the entire experimental period. Degrees of depression were quantified before and after treatment with the Hamilton Rating Scale of Depression (HRSD). There were no significant differences between the depressed patients and the controls on levels of DBH. Similarly, there were no within-group, pre-posttreatment differences on the enzyme levels in either group. Pre- and posttreatment HRSD scores did not correlate with corresponding plasma DBH levels. Plasma levels of amitriptyline, nortriptyline (product of amitriptyline in the body), and desipramine at the end of 4 weeks of treatment also failed to correlate with the enzyme levels.

Periaqueductal gray neurons response to microiontophoretically injected morphine in naive and morphine-dependent rats

The attempt of this study was to investigate the direct effects of increasing doses of morphine on the neuronal activity of the periaqueductal gray in morphine-naive and morphine-dependent rats. The microiontophoresis technique was used for this purpose. The four different responses induced by morphine exhibited dose-related patterns. Naloxone antagonized these responses in about 40% of the cases. Differences were found in the sensitivity of the neurons of morphine between naive and morphine-dependent rats. The phenomena of acute tolerance, chronic tolerance and dependence have been found. The results of this study indicate the presence of different neural populations in the periaqueductal gray in relation to their response to morphine, supporting the notion that subpopulations of opiate receptors exist within this brain area.

Catecholamines and monoamine oxidase activity in anxiety

Levels of platelet monamine oxidase activity, state anxiety and trait anxiety were quantified twice in 20 drug-free subjects with generalized anxiety and an equal number of healthy drug-free controls at 4-week intervals. Fifteen subjects in each groups also had plasma epinephrine and norepinephrine measured. The index group received relaxation training during the interval between the two evaluation sessions. Post-relaxation training values for monoamine oxidase, epinephrine, norepinephrine and the anxiety levels were found to be significantly lower than the pre-treatment values for the index group. No significant changes were seen in the control group values. For the index group, catecholamine levels and monoamine oxidase activity were seen to correlate significant before and after relaxation training.

Human brain monoamine oxidase: one molecular entity-multiple binding sites?

Monoamine oxidase (MAO) of human brain cortex was partially characterized by using different substrates and inhibitors. Two Km values were calculated for each of the three substrates tested, i.e., phenethylamine (PEA) benzylamine (BA) and 5-hydroxtryptamine (5-HT). Clorgyline and 5-HT, both known as MAO-A occupants, were able to abolish the second (high) Km deamination of PEA. 5-HT, while non-competitively inhibiting the deamination of low BA concentrations, competitively inhibited the deamination of high concentrations of this type B substrate. The kinetics of 5-HT deamination showed positive cooperation which indicates the involvement of subunits in the enzyme structure. The ability of some phospholipids to change the enzyme behaviour was considered as indication that these molecules might play a role in determining the ratio between the so-called A and B types of MAO, and in the regulation of the enzyme's activity.