Immune interactions and heterogeneity in transmission drives the pathogen-mediated invasion of grey squirrels in the UK

Mathematical models highlighted the importance of pathogen-mediated invasion, with the replacement of red squirrels by squirrelpox virus (SQPV) carrying grey squirrels in the UK, a well-known example. In this study, we combine new epidemiological models, with a range of infection characteristics, with recent longitudinal field and experimental studies on the SQPV dynamics in red and grey squirrel populations to better infer the mechanistic basis of the disease interaction. A key finding is that a model with either partial immunity or waning immunity and reinfection, where individuals become seropositive on the second exposure to infection, that up to now has been shown in experimental data only, can capture the key aspects of the field study observations. By fitting to SQPV epidemic observations in isolated red squirrel populations, we can infer that SQPV transmission between red squirrels is significantly (4×) higher than the transmission between grey squirrels and as a result our model shows that disease-mediated replacement of red squirrels by greys is considerably more rapid than replacement in the absence of SQPV. Our findings recover the key results of the previous model studies, which highlights the value of simple strategic models that are appropriate when there are limited data, but also emphasise the likely complexity of immune interactions in wildlife disease and how models can help infer disease processes from field data.

The dopamine receptor antagonist haloperidol disrupts behavioral responses of sea urchins and sea stars

Despite lacking a brain and having an apparent symmetrically pentaradial nervous system, echinoderms are capable of complex, coordinated directional behavioral responses to different sensory stimuli. However, very little is known about the molecular and cellular mechanisms underlying these behaviors. In many animals, dopaminergic systems play key roles in motivating and coordinating behavior, and although the dopamine receptor antagonist haloperidol has been shown to inhibit the righting response of the sea urchin Strongylocentrotus purpuratus, it is not known whether this is specific to this behavior, in this species, or whether dopaminergic systems are needed in general for echinoderm behaviors. We found that haloperidol inhibited multiple different behavioral responses in three different echinoderm species. Haloperidol inhibited the righting response of the sea urchin Lytechinus variegatus and of the sea star Luidia clathrata. It additionally inhibited the lantern reflex of S. purpuratus, the shell covering response of L. variegatus and the immersion response of L. variegatus, but not S. purpuratus or L. clathrata. Our results suggest that dopamine is needed for the neural processing and coordination of multiple different behavioral responses in a variety of different echinoderm species.

Effects of neurotransmitter receptor antagonists on sea urchin righting behavior and tube foot motility

Sea urchins, as echinoderms, occupy an interesting position in animal phylogeny in that they are genetically closer to vertebrates than the vast majority of all other invertebrates but have a nervous system that lacks a brain or brain-like structure. Despite this, very little is known about neurobiology of the adult sea urchin, and how the nervous system, is utilized to produced behavior. Here we investigate effects on the righting response of antagonists of ionotropic receptors for the neurotransmitters acetylcholine, GABA, and glycine, and antagonists of metabotropic receptors for the amines dopamine and norepinephrine. Antagonists slowed the righting response in a dose-dependent manner, with a rank order of potency of strychnine>haloperidol>propranolol>bicuculline>hexamethonium, with RT50s (concentrations that slowed righting time by 50%) ranging from 4.3 µM for strychnine to 7.8 mM for hexamethonium. It is also shown that both glycine and adrenergic receptors are needed for actual tube foot movement, and this may explain the slowed righting seen when these receptors are inhibited. Conversely, inhibition of dopamine receptors slowed the righting response but had no effect on tube foot motility, indicating that these receptors play roles more in the neural processing involved in the righting behavior, rather than the actual physical righting. Our results identity the first effects of inhibiting the glycinergic, dopaminergic, and adrenergic neurotransmitter systems in adult sea urchins and distinguish between the ability of sea urchins to right themselves, and the ability of sea urchins to move their tube feet.

Better Respiratory Education and Treatment Help Empower (BREATHE) study: Methodology and baseline characteristics of a randomized controlled trial testing a transitional care program to improve patient-centered care delivery among chronic obstructive pulmonary disease patients

BACKGROUND

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of hospitalizations. Interventional studies focusing on the hospital-to-home transition for COPD patients are few. In the BREATHE (Better Respiratory Education and Treatment Help Empower) study, we developed and tested a patient and family-centered transitional care program that helps prepare hospitalized COPD patients and their family caregivers to manage COPD at home.

METHODS

In the study's initial phase, we co-developed the BREATHE transitional care program with COPD patients, family-caregivers, and stakeholders. The program offers tailored services to address individual patients' needs and priorities at the hospital and for 3months post discharge. We tested the program in a single-blinded RCT with 240 COPD patients who were randomized to receive the program or 'usual care'. Program participants were offered the opportunity to invite a family caregiver, if available, to enroll with them into the study. The primary outcomes were the combined number of COPD-related hospitalizations and Emergency Department (ED) visits per participant at 6months post discharge, and the change in health-related quality of life over the 6months study period. Other measures include 'all cause' hospitalizations and ED visits; patient activation; self-efficacy; and, self-care behaviors.

DISCUSSION

Unlike 1month transitional care programs that focus on patients' post-acute care needs, the BREATHE program helps hospitalized COPD patients manage the post discharge period as well as prepare them for long term self-management of COPD. If proven effective, this program may offer a timely solution for hospitals in their attempts to reduce COPD rehospitalizations.

A case-crossover study of fine particulate matter air pollution and onset of congestive heart failure symptom exacerbation leading to hospitalization

Persons with congestive heart failure may be susceptible to ambient air pollution. The authors evaluated the association between exposure to particulate matter with an aerodynamic diameter of <2.5 microm (PM2.5) and onset of symptom exacerbation leading to hospital admission in Baltimore, Maryland. They used a case-crossover design for 135 case events occurring among 125 persons with prevalent congestive heart failure who were admitted to a single hospital through the emergency department during 2002. The case period was assigned using three index times: 8-hour and 24-hour periods of symptom onset and date of hospital admission. Controlling for weather, the authors detected a modest relative increase in risk for cases defined by 8-hour symptom onset for an interquartile-range increase in PM2.5 at a 2-day lag (odds ratio=1.09, 95% confidence interval: 0.91, 1.30). A corresponding increase in risk was not observed when admission date was used to define the case period. A series of simulations based on study data indicated that the study had adequate statistical power to detect odds ratios of 1.2 or higher. Although overall findings were not statistically significant, the identification of case events defined by an 8-hour onset period may be more relevant than either a 24-hour onset period or the admission date for estimating harmful effects of air pollutant exposure on cardiovascular health.

Aquatic snails from mining sites have evolved to detect and avoid heavy metals

Toxicants in polluted environments are often patchily distributed. Hence, rather than being passive absorbers of pollution, some organisms have evolved the ability to detect and avoid toxicants. We studied the avoidance behavior of Physella columbiana, an aquatic pulmonate snail, in a pond that has been polluted with heavy metals for more than 120 years. Populations of this snail are rare at reference sites and are only robust at heavy-metal-polluted sites. We hypothesized that the snails are able to persist because they have evolved the ability to minimize their exposure to metals by actively avoiding metals in their environment. Using a Y-maze flow tank, we tested the avoidance behavior of snails to heavy-metal-polluted sediments and single-metal solutions of cadmium, zinc, or lead. We also tested the avoidance behaviors of the snails' laboratory-reared offspring raised in nonpolluted conditions. In addition, we tested the avoidance behavior of a small population of snails from a reference pond. Although all the snails we tested were able to detect low concentrations of heavy metals, we found that snails from the polluted site were the most sensitive, that their offspring were somewhat less sensitive, and that snails from the reference site were the least sensitive. This suggests that the ability of polluted-site snails to avoid heavy metals is both genetic and environmental. The concentrations of metals avoided by the snails from the polluted site were below the levels found at hot spots within their natal pond. The snails may be able to persist at this site because they decrease their exposure by moving to less-polluted sections of the pond. One application of our findings is the use of aquatic snails and our Y-maze design as an inexpensive pollution detector. Environmental pollutants such as lead, zinc, and arsenic are a problem throughout the world. People in underdeveloped countries often lack sophisticated pollution detection devices. We have developed a behavioral assay of aquatic pollution that is easy to use, is extremely sensitive (detection below 10 ppb), and can be constructed for fewer than 100 US dollars. Pulmonate snails are widely distributed in tropical, subtropical, and temperate parts of the globe, and they are often common in polluted waters. For countries such as India and Bangladesh, which must test thousands of shallow wells for possible contamination with heavy metals, our assay would be a good initial test. Once snails detected metals, then those samples could be confirmed by spectrometers. We encourage scientists in underdeveloped nations to consider our assay as an option.

Vibrational structure of dihydrofolate bound to R67 dihydrofolate reductase

R67 is a Type II dihydrofolate reductase (DHFR) that catalyzes the reduction of dihydrofolate (DHF) to tetrahydrofolate by facilitating the addition of a proton to N5 of DHF and the transfer of a hydride ion from NADPH to C6. Because this enzyme is a plasmid-encoded DHFR from trimethoprim-resistant bacteria, extensive studies on R67 with various methods have been performed to elucidate its reaction mechanism. Here, Raman difference measurements, conducted on the ternary complex of R67.NADP(+).DHF believed to be an accurate mimic of the productive DHFR.NADPH.DHF complex, show that the pK(a) of N5 in the complex is less than 4. This is in clear contrast to the behavior observed in Escherichia coli DHFR, a substantially more efficient enzyme, where the pK(a) of bound DHF at N5 is increased to 6.5 compared with its solution value of 2.6. A comparison of the ternary complexes in R67 and E. coli DHFRs suggests that enzymic raising of the pK(a) at N5 can significantly increase the catalytic efficiency of the hydride transfer step. However, R67 shows that even without such a strategy an effective DHFR can still be designed.

Cervical cancer practice patterns and appropriateness of therapy

OBJECTIVE

This study was undertaken (1) to describe practice patterns for treatment of cervical cancer on a national scale, including patient characteristics associated with receiving appropriate versus inappropriate therapy, and (2) to determine whether mortality rate differences exist between patients who were treated appropriately and those who were treated inappropriately.

STUDY DESIGN

We defined treatment appropriateness in cases of cervical cancer according to general recommendations for therapy for each International Federation of Gynecology and Obstetrics stage. In an analysis of data obtained from the Surveillance, Epidemiology, and End Results Program for 1988 through 1994 we determined the associations of patient demographic characteristics and tumor characteristics with treatment appropriateness. The association between treatment appropriateness and overall mortality for as long as 7 years of follow-up was adjusted for age; marital status; Surveillance, Epidemiology, and End Results Program location; International Federation of Gynecology and Obstetrics stage of disease; lymph node status; tumor grade; and histologic classification.

RESULTS

Overall 90% of all patients were found to have received appropriate therapy. Important variables significantly associated with being treated inappropriately versus appropriately included age <40 years, positive nodal status, and International Federation of Gynecology and Obstetrics stage IB disease. Important variables significantly associated with receiving no therapy versus receiving appropriate therapy were age >/=60 years, International Federation of Gynecology and Obstetrics stage IV disease, positive nodal status, and unknown nodal status. In a comprehensive model that included demographic factors and tumor characteristics, the adjusted hazard ratio for mortality among patients who were treated inappropriately versus appropriately was 0.87 (95% confidence interval, 0.70-1.09). The adjusted hazard ratio for mortality among patients who did not receive therapy versus those who were treated appropriately was 2.92 (95% confidence interval, 2.44-3.48).

CONCLUSIONS

In an analysis of data from a tumor registry, cervical cancer practice patterns were generally found to follow accepted treatment guidelines. Appropriateness of therapy did not vary widely according to demographic variables. Although patients who received no therapy had an elevated risk of death with respect to that of patients who were treated appropriately, patients who were treated inappropriately had a mortality rate similar to that among those who were treated appropriately (perhaps because of limitations in Surveillance, Epidemiology, and End Results Program data). Results of this preliminary study suggest a need for further research on effectiveness of cervical cancer therapies in the general population.

Underascertainment of child abuse mortality in the United States

CONTEXT

Mortality figures in the United States are believed to underestimate the incidence of fatal child abuse.

OBJECTIVES

To describe the true incidence of fatal child abuse, determine the proportion of child abuse deaths missed by the vital records system, and provide estimates of the extent of abuse homicides in young children.

DESIGN AND SETTING

Retrospective descriptive study of child abuse homicides that occurred over a 10-year period in North Carolina from 1985-1994.

CASES

The Medical Examiner Information System was searched for all cases of children younger than 11 years classified with International Classification of Diseases, Ninth Revision codes E960 to E969 as the underlying cause of death and homicide as the manner of death. A total of 273 cases were identified in the search and 259 cases were reviewed after exclusion of fetal deaths and deaths of children who were not residents of North Carolina.

MAIN OUTCOME MEASURE

Child abuse homicide.

RESULTS

Of the 259 homicides, 220 (84.9%) were due to child abuse, 22 (8.5%) were not related to abuse, and the status of 17 (6.6%) could not be determined. The rate of child abuse homicide increased from 1.5 per 100000 person-years in 1985 to 2.8 in 1994. Of all 259 child homicides, the state vital records system underrecorded the coding of those due to battering or abuse by 58.7%. Black children were killed at 3 times the rate of white children (4.3 per 100000 vs 1.3 per 100000). Males made up 65.5% (133/203) of the known probable assailants. Biological parents accounted for 63% of the perpetrators of fatal child abuse. From 1985 through 1996, 9467 homicides among US children younger than 11 years were estimated to be due to abuse rather than the 2973 reported. The ICD-9 cause of death coding underascertained abuse homicides by an estimated 61.6%.

CONCLUSIONS

Using medical examiner data, we found that significant underascertainment of child abuse homicides in vital records systems persists despite greater societal attention to abuse fatalities. Improved recording of such incidences should be a priority so that prevention strategies can be appropriately targeted and outcomes monitored, especially in light of the increasing rates.

Unusual presentation of late regional cardiac tamponade after aortic surgery

Localized pericardial effusion leading to cardiac tamponade is seen occasionally in patients after cardiac surgery. This condition may be difficult to diagnose clinically because of unusual presenting symptoms and absence of conventional signs of cardiac tamponade. A case of localized pericardial effusion with presenting symptoms of fever and increasing fatigue is described in this study. The definitive diagnosis was made using transesophageal echocardiography. Surgical drainage of localized effusion resulted in prompt hemodynamic and symptomatic improvement.

An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations

OBJECTIVE

To study temporal trends and geographic variations in the use of surgery for spinal stenosis, estimate short-term morbidity and mortality of the procedure, and examine the likelihood of repeat back surgery after surgical repair.

DESIGN

Cohort study based on Medicare claims.

SETTING

Hospital care.

SUBJECTS

All Medicare beneficiaries 65 years of age or older who received a lumbar spine operation for spinal stenosis in 1985 or 1989 were followed through 1991 (10,260 patients from the 1985 cohort and 18,655 from the 1989 cohort).

MAIN OUTCOME MEASURES

Two outcomes were measured: (1) rates of operation for spinal stenosis by state and (2) on an individual level, operative complications (cardiopulmonary, vascular, or infectious), postoperative mortality, and time between first operation and any subsequent reoperation.

RESULTS

Rates of surgery for spinal stenosis increased eightfold from 1979 to 1992 for patients aged 65 and older and varied almost fivefold among US states. Mortality and operative complications increased with age and comorbidity. Complications were more likely for men and for individuals receiving spinal fusions. The 1989 cohort experienced a slightly higher probability of reoperation than the 1985 cohort for the first 3 years of follow-up.

CONCLUSIONS

A rapid increase in surgery rates for spinal stenosis was identified over a 14-year period. The wide geographic variations and substantial complication rate from this elective surgical procedure (partly related to patient age) suggest a need for more information on the relative efficacy of surgical and nonsurgical treatments for this condition. The risks and benefits of particular surgical procedures for specific clinical and demographic subgroups as well as individual patient preferences regarding surgical risks and possible outcomes should also be evaluated further. These issues are likely to become increasingly important with the aging of the US population.

Phase II study of prolonged oral etoposide in refractory ovarian cancer

A phase II study of prolonged oral etoposide at 50 mg m-2 was performed in patients with refractory ovarian cancer. A dose schedule algorithm was used to generate a calendar with the number of capsules to be administered each day and the date of blood tests. Fourteen of 15 patients were evaluable for response. Among the evaluable patients, 12 (86%) had poorly differentiated tumors, 13 (93%) had primary or secondary platin-resistant tumors, and 12 (86%) had progressed on a prior taxoid therapy. The median number of prior regimens was four (1-7). Despite the use of a 50-mg capsule of etoposide, the algorithm permitted the delivery of a median of 94% (89-107.5%) of the ideal calculated dose. The dose-limiting toxicity was myelosuppression with a grade 3 or 4 neutropenia in two-thirds of the patients. There were no deaths on the study and no significant neurologic or cardiovascular toxicity noted. There were no objective responses. The median survival of evaluable patients was 8.1 (95% CI 5.6-13.2) months.

Phonational profiles of male trained singers and nonsingers

The purpose of this study was to compare the mean speaking fundamental frequency (SFF), speaking frequency range, and mean speaking intensity for a group of trained male singers and a group of age-matched non-singers in three age ranges: 20 to 35 years old; 40 to 55 years old; and older than 65 years. Each subject was recorded as he read "The Rainbow Passage" and produced the vowel /a/ to the limits of his phonational frequency range. The data indicated that the mean SFF of the nonsingers was significantly lower among the middle-aged speakers than with the young or elderly. In contrast, the tenors exhibited no age-related SFF trends, and the young bass/baritones exhibited lower SFF levels than the middle-aged or elderly. The elderly nonsingers produced frequency ranges that were smaller than any other group. Finally, the young nonsingers used greater speech intensity than did the other groups.

The integration of voice science, voice pathology, medicine, public speaking, acting, and singing

The integration of voice science, voice pathology, medicine, public speaking, acting, and singing has been central to evolution in all fields. The Voice Foundation Symposia have played a seminal and central role in fostering integration among disciplines. The result has been an improvement in the knowledge and practice in each field. And the future promises to be even more informative and exciting.

Phonational profiles of female professional singers and nonsingers

Measures of the SFF, vocal intensity, phonational range, and habitual pitch level are reported for 39 professional singer and 39 nonsinger females, who were divided into three age groups (young, middle, and old age), with the professionals further divided into sopranos and altos. Each read the "Rainbow Passage" and spoke extemporaneously, from which measures of the SFF and vocal intensity were calculated; phonational range and habitual pitch levels were also determined. No significant differences were noted between the reading and speaking tasks. The SFF and intensity levels were significantly higher for the professionals in comparison to the nonsingers, but only for certain age groups. Moreover, whereas the nonsinger SFF levels varied significantly as a function of age, those for the professional singers did not. Although trends occurred, no significant differences were found for the mean phonational range or habitual pitch levels when the professionals and nonsingers were compared.

Trauma in the workplace. An overview

To attenuate the incidence of occupational deaths and injuries, which occur at a rate of approximately 25 deaths and 10,000 injuries daily, occupational health nurses must focus on injury control for the entire population of workers. Knowledge of the mechanics of injury and populations at risk for various types and severities of injuries is essential to developing injury prevention programs and appropriately responding to emergent injuries. The lack of a comprehensive and reliable surveillance method has been described as a major obstacle in evaluating the occupational injury problem, as well as measuring progress toward achievement of the 1990 Objectives in Occupational Safety and Health. Variations in the estimates have been attributed to different methodologies used in collecting surveillance data, including diverse definitions, inclusion criteria, and data sources. Lost workdays due to injuries reported for 1983 cost an estimated $33.4 billion in direct and indirect costs. Mining, construction, agriculture, and transportation are the most hazardous industries in terms of both fatalities and injuries. Activities appropriate for the occupational health nurse in preventing injury include retrospective analysis of injury patterns and costs, proactive inspection of the workplace for high risk factors, preplacement screening of workers, ergonomic analysis of jobs, evaluation of the type and use of personal protective equipment, provision of safety training, and collaboration with other agents of the firm in evaluating and designing injury reduction strategies and disaster plans.

Melatonin receptors on ovine pars tuberalis: characterization and autoradiographicai localization

Abstract The functional significance of the pars tuberalis (PT) of the mammalian adenohypophysis has remained an enigma (1, 2). One view of its function is that it acts as an auxiliary gland to support the endocrine role of the pars distalis (PD) (2), as it has been shown to contain immunocytochemically identifiable thyrotrophs and gonadotrophs (1). Many of the cells of the PT are, however, ultrastructurally unique suggesting an independent function for this tissue. Our recent demonstration that the PT of the rat is a major binding site for the ligand iodomelatonin lends further support to this idea (3). We have utilized the highly specific ligand [(125)l]melatonin, and have demonstrated that it binds exclusively, with very high affinity, to the PT but not the PD of the adult sheep adenohypophysis. These findings support the conclusion that the PT has a distinct role in relation to melatonin action and seasonal reproduction.

Out-of-pocket health expenses for Medicaid and other poor and near-poor persons in 1980

The Medicaid program (Title XIX of the Social Security Act) was designed to provide access to health services at little or no out-of-pocket expense to low-income persons who might otherwise not be able to afford them. Information was collected through household interviews in the National Medical Care Utilization and Expenditure Survey (NMCUES) on total out-of-pocket expenditures for health care by noninstitutionalized persons in the United States in 1980. This report presents data to assess the degree to which Medicaid enrollees incur out-of-pocket expenses. These levels of expenditures are compared to those experienced by other persons not eligible for Medicaid who are below or near the official poverty level. Data contained in this report were derived from the National Household Survey (HHS), a panel survey of 6,600 households representative of the civilian, noninstitutionalized U.S. population, which is only one of the three surveys that were conducted as part of NMCUES. The other two surveys are a State Medicaid Household Survey (SMHS) of Medicaid households in four States and the Administrative Records Survey (ARS), a survey of existing Medicare and Medicaid administrative records for sample households. Since data were derived only from HHS, the findings in this report are national (or regional) in scope and cannot be tied directly to differences in individual State Medicaid programs. The data on eligibility and expenditures are all self-reported and have not been verified by administrative records. One definite limitation of these data is the exclusion from the NMCUES sample of all institutionalized persons. As a result, out-of-pocket expenses for one particularly high-cost group are excluded, and total out-of-pocket expenditures for each health insurance coverage group are understated. Another potential limitation of this analysis is that, as with many surveys, limited data on key items (such as out-of-pocket expenses and income) were at times missing from respondent reports. These missing data were imputed according to standard statistical techniques (see Appendix III). A variety of findings is presented, including data on the effect of health insurance coverage, demographic characteristics, health status, and continuity of Medicaid enrollment on out-of-pocket expenses. Within insurance coverage categories, Medicaid-covered persons had the lowest out-of-pocket expenses. This was true even though they had the highest mean per capita charges for care. Among the demographic characteristics that were analyzed, age and race had the most impact on the level of out-of-pocket health expenses.(ABSTRACT TRUNCATED AT 400 WORDS)

Comparison of HL-A typing with NIH trays and the NIH technique with typing by the fluorochromasia cytotoxicity assay

A comparison of HL-A phenotypes determined with plates containing predispensed typing sera supplied by the NIH Serum Bank with phenotypes determined by the fluorochromasia cytotoxicity assay using local reagents showed that the NIH plates (as dispensed in 1972) had an insufficient number and variety of typing sera. Using NIH trays, it was difficult to detect HL-A9 and W19, both of which specificities are now known to have subtypes. The NIH trays also appeared to detect more HL-A antigens than were consistent with the current theory of two segregant series, each expressing a maximum of two antigens. The excess antigens could not be comparatively evaluated in view of the small number of sera defining each. With the NIH technique, it was impossible to interpret the reactions if the preparation had too many dead cells. A high proportion of dead cells was occasionally noted when lymphocytes had been previously frozen or obtained from lymph nodes. When the NIH and fluorochromasia techniques were compared using the same antisera and fresh lymphocytes, they proved equivalent in sensitivity.

Reactions of kidney cells with cytotoxic antisera: possible evidence of kidney-specific antigens

HL-A typing of cadaver kidney cell suspension by fluorochromasia cytotoxicity was successful in 76 out of 124 cases. In the 44 cases with confirmed phenotypes, 24 had identical results for lymphocytes and kidney cells. Twenty kidney cells had HL-A antigens not detected on that donor's lymphocytes, most commonly HL-A7 and HL-A8. In eight of these 20 cases, the additional kidney antigens brought the total to more than two per segregant sereis, in disagreement with an earlier report from this laboratory. The discrepancy was traced to a change in the method of complement preparation. The complement was successfully deprived of the resulting non-specific cytotoxicity for kidney cells by absorption with human red blood cells. Prior to absorption, the complement had rendered kidney cells susceptible to the lytic effect of anti-A and B red cell antibodies. Using the absorbed complement, a patient who had hyperacutely rejected two cadaver kidneys provided sera with an antibody reacting with, and absorbed by, the kidney cells but not the lymphocytes of the donors.