Community health improvement plan: Study protocol for Kansas City's intervention and implementation evaluation

Objectives

Community health improvement plans (CHIPs) are foundational public health practice, yet no studies have been conducted to understand implementation of these plans. This evaluation study of the Kansas City CHIP aims to 1) identify implementation strategies used in the CHIP, 2) assess changes in implementation, service, and client outcomes, 3) assess contextual factors associated with implementation, and 4) understand social networks of coalitions who implement the Kansas City CHIP.

Study design

This study protocol uses a unique, mixed methods approach to evaluating process and outcomes of the Kansas City CHIP. This study is supported by Proctor's Model of Implementation, RE-10.13039/100003582AIM (reach, effectiveness, adoption, implementation, maintenance), and the practical, robust implementation and sustainability model (PRISM).

Methods

Staff and community members involved in implementing the Kansas City, Missouri CHIP will be invited to participate in an annual online survey, a series of focus groups, and quarterly implementation logs to assess implementation and sustainability.

Results

RE-AIM and PRISM constructs are the primary and secondary outcomes of interest. Results of this study will be available from the first year of implementation in 2023, with future results provided annually.

Conclusions

This project will fill a much-needed gap in the literature by understanding how large-scale coalitions implement projects that aim to improve population health and health equity. CHIPs have the potential to improve population health, yet few studies have been conducted on CHIPs, with no studies to date assessing outcomes. To support effective implementation and sustainability as well as improve public health outcomes, researchers need to evaluate CHIPs and develop models of implementation that can quickly be integrated into practice to improve populations’ health.

Nasal oncocytoma in a domestic shorthair cat

An oncocytoma was diagnosed in the nasal cavity of a 12-year-old Domestic Shorthair cat who presented with periocular swelling and sneezing. Histologic examination from biopsy material revealed monomorphic sheets, anastomosing cords, tubules, and acini composed of large polygonal to oval cells that contained abundant finely granular eosinophilic cytoplasm. No vascular or lymphatic invasions were noted. Histochemical stains revealed positive staining of tumor cells with periodic acid-Schiff (PAS) (before and after diastase digestion) and phosphotungstic acid-hematoxylin. Immunohistochemical evaluation of the tumor cells demonstrated positive staining for cytokeratin and negative staining for vimentin, desmin, S-100, glial fibrillar acidic protein, and neuronal specific enolase. Ultrastructurally, the tumor cells contained large numbers of mitochondria within their cytoplasm, which confirmed a diagnosis of oncocytoma.

Effect of intravenous contrast for left ventricular opacification and border definition on sensitivity and specificity of dobutamine stress echocardiography compared with coronary angiography in technically difficult patients

BACKGROUND

The study evaluates whether Optison used during dobutamine stress echocardiography (DSE) will improve endocardial border definition and whether this will translate to an improvement in sensitivity and specificity of the test in patients with poor echocardiographic windows. DSE is extremely valuable in the workup of patients with coronary artery disease. The test is limited in patients with suboptimal endocardial border visualization. Frequent studies have demonstrated improved endocardial border visualization with intravenous contrast agents at rest.

METHODS AND RESULTS

We studied 229 patients: 112 had good rest echocardiography with no contrast and 117 had poor rest echocardiography with Optison injection during DSE. Percentage of endocardial border visualization, wall thickening, sensitivity, and specificity were compared in both groups, as was interobserver variability. Both groups were matched with respect to age, percentage of previous myocardial infarctions, resting wall motion abnormality, percentage of coronary stenosis, and number of diseased coronary arteries. Optison significantly improved endocardial border visualization, especially at peak stress. The ability to measure wall thickening was significantly higher in the contrast DSE group with suboptimal images versus the noncontrast group with optimal images (89% ability to measure wall thickening vs 71%, P =.01). This resulted in a comparable sensitivity (79% vs 71%, P = not significant [NS]), specificity (76% vs 82%, P = NS), and diagnostic accuracy (80% vs 76%, P = NS). Agreement on test interpretation was higher among 3 observers in contrast DSE versus noncontrast DSE groups (79% vs 69%, P =.01).

CONCLUSIONS

In patients with poor echocardiographic windows, the use of Optison during DSE improves endocardial border visualization, which translates to a comparable sensitivity and specificity to noncontrast DSE tests in patients with good echocardiographic windows.

Mixed germ cell tumor in the eye of a dog

A 3-year-old female neutered Staffordshire Bull Terrier presented with a mixed germ cell tumor involving the base of the iris and the ciliary body of the right eye. The tumor mass was composed primarily of packeted vacuolated, polygonal (hepatoid) cells and small round cells; epithelial cells lining tubuloacinar structures were a less prominent component. The hepatoid and round cells stained positively for alpha-fetoprotein and cytokeratin. The epithelial cells stained positively for cytokeratin only, and some contained cytoplasmic mucin droplets. The polygonal cells were interpreted as a hepatoid variant of yolk sac tumor, and the epithelial cells were considered a teratomatous component. Trabeculae of bone were observed within the mass and may have been metaplastic or a teratomatous element. Extragonadal germ cell tumors are rare in dogs and have previously been reported only in the suprasellar region. This is the first report of this tumor type in the eye of a nonhuman species.

Neoplastic transformation of human osteoblast cells to the tumorigenic phenotype by heavy metal-tungsten alloy particles: induction of genotoxic effects

Heavy metal-tungsten alloys (HMTAs) are dense heavy metal composite materials used primarily in military applications. HMTAs are composed of a mixture of tungsten (91-93%), nickel (3-5%) and either cobalt (2-4%) or iron (2-4%) particles. Like the heavy metal depleted uranium (DU), the use of HMTAs in military munitions could result in their internalization in humans. Limited data exist, however, regarding the long-term health effects of internalized HMTAs in humans. We used an immortalized, non-tumorigenic, human osteoblast-like cell line (HOS) to study the tumorigenic transforming potential of reconstituted mixtures of tungsten, nickel and cobalt (rWNiCo) and tungsten, nickel and iron (rWNiFe). We report the ability of rWNiCo and rWNiFe to transform immortalized HOS cells to the tumorigenic phenotype. These HMTA transformants are characterized by anchorage-independent growth, tumor formation in nude mice and high level expression of the K-ras oncogene. Cellular exposure to rWNiCo and rWNiFe resulted in 8.90 +/- 0.93- and 9.50 +/- 0.91-fold increases in transformation frequency, respectively, compared with the frequency in untreated cells. In comparison, an equivalent dose of crystalline NiS resulted in a 7.7 +/- 0.73-fold increase in transformation frequency. The inert metal tantalum oxide did not enhance HOS transformation frequency above untreated levels. The mechanism by which rWNiCo and rWNiFe induce cell transformation in vitro appears to involve, at least partially, direct damage to the genetic material, manifested as increased DNA breakage or chromosomal aberrations (i.e. micronuclei). This is the first report showing that HMTA mixtures of W, Ni and Co or Fe cause human cell transformation to the neoplastic phenotype. While additional studies are needed to determine if protracted HMTA exposure produces tumors in vivo, the implication from these in vitro results is that the risk of cancer induction from internalized HMTAs exposure may be comparable with the risk from other biologically reactive and insoluble carcinogenic heavy metal compounds (e.g. nickel subsulfide and nickel oxide).

Involving families in an urban HIV preventive intervention: how community collaboration addresses barriers to participation

This article addresses the increasing need within urban communities for effective, culturally relevant HIV prevention programs. The recruitment efforts of a family-based prevention program aimed at promoting health and preventing HIV risk exposure in urban, African American fourth and fifth grade children living in a community with high rates of HIV infection is detailed. The program, referred to as the CHAMP (Chicago HIV Prevention and Adolescent Mental Health Project) Family Program, is overseen by a collaborative partnership of community parents, school staff, and university-based researchers (Paikoff & McKay, 1995). The recruitment strategies developed as a result of this community-research collaboration are described. Preliminary results of the project's efforts to reach out to families within the targeted, inner-city community are presented.

The effects of mitomycin-C and stenting on airway wound healing after laryngotracheal reconstruction in a pig model

OBJECTIVE

To assess the effects of mitomycin-C (MTC) and endoscopic stenting on airway wound healing after laryngotracheal reconstruction.

DESIGN

A prospective, blinded, randomized controlled animal study.

SUBJECTS

Twenty-six domestic pigs (Sus scrofula) divided into four groups.

INTERVENTIONS

Each animal underwent single-stage laryngotracheal reconstruction (SSLTR) with auricular cartilage grafts and stenting. Group 1 animals were sacrificed on postoperative day 3, and group 2 animals on postoperative day 7. On postoperative day 7, groups 3 and 4 underwent endoscopy, stent removal, and application of MTC (0.5 mg/ml) or placebo (normal saline). Group 3 animals were sacrificed on postoperative day 14, group 4 animals on day 21. Two additional animals from each experimental group were prepared for election microscopy studies. Segments of reconstructed airway were evaluated grossly and histologically for all animals. Additional tonometric evaluation was performed on two stents to determine their compressive strength.

MAIN OUTCOME MEASURES

Healing, reepithelization, graft incorporation, and airway diameter.

RESULTS

Two-thirds of the animals demonstrated some degree of stent collapse on endoscopy. Granulation tissue formation was seen in all animals, and resolved with stent removal. No animal experienced airway compromise due to granulation tissue formation. Stenting was seen to induce a submucosal fibroproliferative response and scarring, with loss of normal glandular architecture, in all animals. MTC did not affect the acute inflammatory response, reepithelization of the graft site, or formation of the subepithelial fibroproliferative response. MTC treated animals, however, demonstrated better graft incorporation with fibrocartilage proliferation of the graft. Untreated animals demonstrated liquefactive necrosis of the graft, without evidence of neochondrification of the graft.

CONCLUSIONS

The pig airway is an adequate model of wound healing following SSLTR and stenting. Metallic ballon expandable stents can be successfully used following SSLTR, allowing for immediate postoperative extubation. However, the formation of a submucosal fibroproliferative response and mucosal scarring seen in our study raises some concerns with the current stent design. Before stenting is widely clinically applied, the optimum stent design needs to be developed. Finally, MTC seems to prevent the liquefactive necrosis of SSLTR grafts and promote neochondrification, allowing improved graft incorporation. Further studies are needed to asses the long-term effects of MTC on healing and restenosis, and its effects on cartilage growth and formation, following SSLTR.

Histological, chemical, and crystallographic analysis of four calcium phosphate cements in different rabbit osseous sites

Four calcium phosphate cement formulations were implanted in the rabbit distal femoral metaphysis and middiaphysis. Chemical, crystallographic, and histological analyses were made at 2, 4, and 8 weeks after implantation. When implanted into the metaphysis, part of the brushite cement was converted into carbonated apatite by 2 weeks. Some of the brushite cement was removed by mononuclear macrophages prior to its conversion into apatite. Osteoclastlike cell mediated remodeling was predominant at 8 weeks after brushite had converted to apatite. The same histological results were seen for brushite plus calcite aggregate cement, except with calcite aggregates still present at 8 weeks. However, when implanted in the diaphysis, brushite and brushite plus calcite aggregate did not convert to another calcium phosphate phase by 4 weeks. Carbonated apatite cement implanted in the metaphysis did not transform to another calcium phosphate phase. There was no evidence of adverse foreign body reaction. Osteoclastlike cell mediated remodeling was predominant at 8 weeks. The apatite plus calcite aggregate cement implanted in the metaphysis that was not remodeled remained as poorly crystalline apatite. Calcite aggregates were still present at 8 weeks. There was no evidence of foreign body reaction. Osteoclastlike cell remodeling was predominant at 8 weeks. Response to brushite cements prior to conversion to apatite was macrophage dominated, and response to apatite cements was osteoclast dominated. Mineralogy, chemical composition, and osseous implantation site of these calcium phosphates significantly affected their in vivo host response.

Androstenediol stimulates myelopoiesis and enhances resistance to infection in gamma-irradiated mice

The ionizing radiation-induced hemopoietic syndrome is characterized by defects in immune function and increased mortality due to infections and hemorrhage. Since the steroid 5-androstene-3beta, 17beta-diol (5-androstenediol, AED) modulates cytokine expression and increases resistance to bacterial and viral infections in rodents, we tested its ability to promote survival after whole-body ionizing radiation in mice. In unirradiated female B6D2F1 mice, sc AED elevated numbers of circulating neutrophils and platelets and induced proliferation of neutrophil progenitors in bone marrow. In mice exposed to whole-body (60)Co gamma-radiation (3 Gy), AED injected 1 h later ameliorated radiation-induced decreases in circulating neutrophils and platelets and marrow granulocyte-macrophage colony-forming cells, but had no effect on total numbers of circulating lymphocytes or erythrocytes. In mice irradiated (0, 1 or 3 Gy) and inoculated four days later with Klebsiella pneumoniae, AED injected 2 h after irradiation enhanced 30-d survival. Injecting AED 24 h before irradiation or 2 h after irradiation increased survival to approximately the same extent. In K. pneumoniae-inoculated mice (irradiated at 3-7 Gy) and uninoculated mice (irradiated at 8-12 Gy), AED (160 mg/kg) injected 24 h before irradiation significantly promoted survival with dose reduction factors (DRFs) of 1.18 and 1.26, respectively. 5-Androstene-3beta-ol-17-one (dehydroepiandrosterone, DHEA) was markedly less efficacious than AED in augmenting survival, indicating specificity. These results demonstrate for the first time that a DHEA-related steroid stimulates myelopoiesis, and ameliorates neutropenia and thrombocytopenia and enhances resistance to infection after exposure of animals to ionizing radiation.

Modulation of protein expression and activity by radiation: relevance to intracoronary radiation for the prevention of restenosis

Restenosis is a common complication of percutaneous transluminal coronary angioplasty. Recent studies have demonstrated a striking reduction in the neointimal hyperplasia characteristic of restenosis following intracoronary radiation (IR), but the mechanisms by which radiation reduces neointima formation following balloon overstretch injury are not elucidated fully. In addition to direct antimitotic effects mediated via oxygen free radicals, ionizing radiation can induce the expression of numerous genes and thereby mediate indirect effects. Additionally, IR prevents restenosis at the cost of decreased healing and increased thrombosis, and we suggest that these adverse reactions can be modulated by adjunct pharmacology or gene-based strategies. This review discusses several genes and proteins modulated by radiation in the context of arterial injury, and their possible therapeutic relevance.

Induction of nitric oxide production in infiltrating leukocytes following in vivo irradiation of tumor-bearing mice

Nitric oxide (NO) has been implicated both in regression and progression of tumors due to its production by both tumor cells and infiltrating leukocytes. Ionizing radiation causes the regression of tumors, and can augment the production of NO by macrophages in vitro. We examined the cellular and systemic production of NO in mice in which radiation-resistant RIF-1 fibrosarcoma cells were implanted subcutaneously and were then either irradiated or sham-treated at the tumor site. Ten days following implantation of the tumors, CD45- tumor cells and CD45+ leukocytes were derived from resected tumors immediately after irradiation with 60 Gy, a dose previously reported to reduce tumor growth. Leukocytes from tumors of irradiated hosts produced spontaneously up to four-fold more NO than did either leukocytes from unirradiated mice or CD45- tumor cells from either unirradiated or irradiated mice. Between days 10-14 following tumor implantation, serum NO2-/NO3- increased in both irradiated and unirradiated mice to an equal extent, culminating in levels higher than those of non-tumor-bearing mice. Though NO production is elevated in macrophages treated with 1-10 Gy of radiation in vitro, higher doses may be required by tumor-infiltrating macrophages in vivo and thus may indicate that tumor-infiltrating macrophages are deactivated.

High grade prostatic intraepithelial neoplasia in military working dogs with and without prostate cancer

BACKGROUND

High grade prostatic intraepithelial neoplasia (PIN) is the most likely precursor of human prostate cancer and is commonly found in men undergoing prostatic needle biopsy for suspected cancer. Recent work has demonstrated that pet dogs, like humans, develop PIN spontaneously and in association with prostate cancer. Pet dogs are the most domesticated animal, sharing the habitat and oftentimes the diet of their owners. If PIN and prostate cancer are strongly related to environmental factors, then the prevalence of these findings might differ in a population of dogs such as military working dogs which is not exposed to the habitat and diet of humans. In this study, we determined the prevalence of PIN in prostates of aged military working dogs with and without prostatic adenocarcinoma.

METHODS

Cases were selected from the military working dog slide and tissue archive at the Armed Forces Institute of Pathology, Washington, DC. The most recent 329 necropsies (1991 to 1996) were examined histologically by multiple reviewers; of these, 199 dogs (60%) were found to have evaluable prostatic tissue. In addition, the most recent 50 necropsies (1958 to 1996) with the diagnosis of prostatic cancer were examined, of which 25 cases (50%) were found to have evaluable prostatic adenocarcinoma. In most cases, a single large transverse section of prostatic tissue was available for review. Medical records for each dog were reviewed independently, and age, clinical history, indications for euthanasia, and other health problems were recorded.

RESULTS

High grade PIN was identified in 3% of dogs (6 of 199 dogs) without prostate cancer. A total of 50.8% of dogs in this study group (101 of 199 dogs) were known to be sexually intact, 26.7% of dogs (53 of 199 dogs) were castrated, and the status of the remaining 22.6% of dogs (45 of 199 dogs) was unknown. High grade PIN was present in 18 of 25 dogs (72%) with prostatic adenocarcinoma. Of these cases, 11 dogs (44%) were castrated, 4 dogs (16%) were intact, and the status of 10 dogs (40%) dogs was unknown. Gleason scores ranged from 6 to 10, with a mean of 8.4 and a median of 8.

CONCLUSIONS

High grade PIN is present in a small but substantial number (3%) of military working dogs. Of military working dogs with prostatic adenocarcinoma, 72% had high grade PIN. The true prevalence in each of these cohorts is likely to be higher given the sampling variation inherent in evaluating a single random histologic section. Aged male dogs seem to have substantial clinical utility as an animal model for prostatic carcinogenesis. We recommend that serial sectioning and total embedding of the prostate should be used to more thoroughly characterize premalignant and malignant diseases in aged military working dogs. This method will provide important data to determine whether a model of spontaneous PIN in elderly dogs may have clinical utility in developing strategies directed toward preventing and treating prostate.

MDR1/P-glycoprotein function. I. Effect of hypotonicity and inhibitors on rhodamine 123 exclusion

The MDR1 protein (P-glycoprotein) is a membrane ATPase whose expression results in resistance to several anti-tumor drugs. It has been proposed that the MDR1 protein, in addition to its pumplike properties, can function as (Gill et al. Cell 71: 23-32, 1992; Altenberg et al. Cancer Res. 54:618-622, 1994) or mediate the activity of (Hardy et al. EMBO J. 14: 68-75, 1995) a hypotonic stress-induced Cl- current. In addition, one study found that drug transport and Cl- channel-associated functions of MRD1 were separable and mutually exclusive and that, when cells were swelled, the MDR1 protein could not transport substrate. This hypothesis was tested in four pairs of isogenic cell lines with MDR1 transfectants expression 8,000-55,000 MDR1 antibody binding sites per cell. Cytoplasmic exclusion of rhodamine 123 was used as an indicator of MDR1 function to measure the effect of hypotonic stress, MDR1 inhibitors, and Cl- channel blockers on MRD1 transport function. It was found that MDR1 activity and its inhibition by cyclosporine A or flufenamic acid were unaffected by hypotonicity alone or in combination with Cl- channel blockers.

MDR1/P-glycoprotein function. II. Effect of hypotonicity and inhibitors on Cl- efflux and volume regulation

Resistance to anti-tumor drugs can be mediated by overexpression of the multidrug resistance 1 (MDR1) protein (P-glycoprotein). In three MDR1-transfected cell lines (Gill et al. Cell 71: 23-32, 1992; Altenberg et al. Cancer Res. 54: 618-622, 1994), a hypotonic stress-induced Cl- current has been demonstrated that can be inhibited by MDR1 substrates and Cl- channel blockers. We tested the hypothesis that MDR1 expression confers additional Cl- conductance by measuring regulatory volume decrease (RVD) in four pairs of isogenic cell lines and 36Cl efflux in two cell lines with and without hypotonic stress. The kinetics of RVD and response to Cl- channel blockers were indistinguishable in MDR and parental cells. Additionally, no significant difference was seen between 36Cl efflux rate constants under hypotonic conditions between NIH/3T3 and L1210 parental and MDR cells. We conclude that, in intact cells, the expression of MDR1 does not alter the rate of volume regulation or the rate 36Cl efflux under hypotonic conditions between parental and MDR cells.

A bone regeneration study: transforming growth factor-beta 1 and its delivery

Critical-sized defects (CSDs) were prepared in 60 rabbit skulls, divided evenly among five treatments and two time periods. The treatments consisted of rabbit demineralized bone matrix (DBM) and four different doses of transforming growth factor-beta 1 (TGF-beta 1) (0, 0.4, 4, and 40 micrograms) delivered in 3% carboxymethyl cellulose and Gelfilm. Quantitative assessments of bone formation in the CSDs were accomplished with computerized radiomorphometry and histomorphometry. Results indicated that rabbit DBM and 40 micrograms TGF-beta 1 promoted more new bone formation at 4 weeks than the other treatments. By 8 weeks, bone formation in the CSDs was equivalent for all but the 0-microgram dose of TGF-beta 1. The results from the study suggest a single therapeutic dose of TGF-beta 1 delivered in an appropriate carrier to a critical-sized intraosseous wound should promote bone formation.

Comparison of Polydioxanone and Silicone Plastic in the Prevention of Adhesive Otitis Media in the Mongolian Gerbil

Adhesion of the tympanic membrane to the promontory may occur in chronic otitis media or in the postoperative ear. Silicone plastic sheets are commonly used to form a physical barrier to adhesion. These sheets are generally well tolerated, but they are subject to occasional extrusion, encapsulation, or foreign body reaction. The ideal barrier to adhesion formation would be a nonreactive, flexible, absorbable substance that would obviate long-term toxicity considerations. In this study polydioxanone sheets were compared with silicone plastic sheets in the middle ear of the Mongolian gerbil. The eustachian tube was cauterized to create severe tympanic membrane retraction. A fabricated sheet of polydioxanone was implanted in the middle ear of 30 Mongolian gerbils and compared with silicone plastic sheets implanted in another group of 30 animals. A sham operation was performed on the other ear to serve as a surgical control. Evaluation of the temporal bones at 5, 10, and 15 weeks showed no significant differences in the rate of adhesion formation, effusion formation, or polymorphonuclear infiltration by the Fisher exact test. There was histologic evidence that polydioxanone was still providing an effective barrier at 10 weeks. The results of this study demonstrate that polydioxanone sheets are as effective and as well tolerated as silicone plastic sheets in an animal model. Further study of polydioxanone in this role is warranted.

Comparison of polydioxanone and silicone plastic in the prevention of adhesive otitis media in the Mongolian gerbil

Adhesion of the tympanic membrane to the promontory may occur in chronic otitis media or in the postoperative ear. Silicone plastic sheets are commonly used to form a physical barrier to adhesion. These sheets are generally well tolerated, but they are subject to occasional extrusion, encapsulation, or foreign body reaction. The ideal barrier to adhesion formation would be a nonreactive, flexible, absorbable substance that would obviate long-term toxicity considerations. In this study polydioxanone sheets were compared with silicone plastic sheets in the middle ear of the Mongolian gerbil. The eustachian tube was cauterized to create severe tympanic membrane retraction. A fabricated sheet of polydioxanone was implanted in the middle ear of 30 Mongolian gerbils and compared with silicone plastic sheets implanted in another group of 30 animals. A sham operation was performed on the other ear to serve as a surgical control. Evaluation of the temporal bones at 5, 10, and 15 weeks showed no significant differences in the rate of adhesion formation, effusion formation, or polymorphonuclear infiltration by the Fisher exact test. There was histologic evidence that polydioxanone was still providing an effective barrier at 10 weeks. The results of this study demonstrate that polydioxanone sheets are as effective and as well tolerated as silicone plastic sheets in an animal model. Further study of polydioxanone in this role is warranted.

Meniscal regeneration with copolymeric collagen scaffolds. In vitro and in vivo studies evaluated clinically, histologically, and biochemically

We sought to create a regeneration template for the meniscal cartilage of the knee to induce complete meniscal regeneration, and to develop the technique for implanting the prosthetic appliance in vivo. We designed a resorbable collagen-based scaffold and conducted in vitro and in vivo studies. In vivo, the scaffold was implanted in the knees of immature swine and mature canines and evaluated clinically, histologically, and biochemically. Because the canine stifle joint meniscus is more clinically relevant to the human meniscus, this paper emphasizes those results. We studied 24 mixed breed dogs (14 males and 10 females) with an average weight of 25.5 kg (range, 20 to 35) that were obtained from a USDA-licensed supplier. The dogs were deemed clinically and radiographically skeletally mature. None of the dogs had a preexisting knee joint abnormality. All dogs underwent an 80% subtotal resection of the medial meniscus bilaterally. A collagen template was implanted in one stifle (N = 24). The contralateral side served as a control: 12 dogs had a total resection alone and the other 12 dogs had an immediate replantation of the autologous meniscus. Results were tabulated at 3, 6, 9, and 12 months. At final evaluation, before the animals were euthanized, the results were submitted for statistical analysis as well as histologic and biochemical analyses. The results demonstrated that a copolymeric collagen-based scaffold can be constructed that is compatible with meniscal fibrochondrocyte growth in vitro and in vivo, that does not inhibit meniscal regeneration in an immature pig, and that may induce regeneration of the meniscus in the mature dog.(ABSTRACT TRUNCATED AT 250 WORDS)

A novel beta 4, alpha 6 integrin-associated epithelial cell antigen involved in natural killer cell and antigen-specific cytotoxic T lymphocyte cytotoxicity

Efficient immune responses require interactions between cell adhesion molecules on lymphocytes and counter-receptors on antigen presenting cells or target cells. While target-specific receptors or ligands have not been identified for natural killer (NK) cells, cell adhesion molecules have been implicated in the interaction between NK cell effectors and tumor cell targets. Herein, we describe monoclonal antibodies (mAbs) against a carcinoma cell line that efficiently block the cytolytic activity of interleukin 2-activated NK cell lines and clones. L280 mAb reacts with secretory epithelial cells in normal human tissues, but does not react with hematopoietic cells or other tissue types. Biochemical analysis revealed that L280 mAb immunoprecipitates the beta 4, alpha 6 integrin, as well as a novel 98-kD glycoprotein, and probably reacts with a carbohydrate epitope on these molecules. Involvement of the L280 antigen in cellular immunity is not restricted to NK cell-mediated cytotoxicity. L280 mAb also efficiently inhibits alloantigen-specific cytotoxicity against Colo-205 cells mediated by human histocompatibility leukocyte antigen (HLA)-A2 alloantigen specific alpha beta-TCR+ and gamma delta-TCR+ cytotoxic T lymphocyte (CTL) clones. Additionally, we demonstrate that L280 mAb blocks cytotoxicity mediated by influenza peptide-specific HLA-restricted CTL clones. These data indicate that the antigen recognized by L280 mAb is important in both NK and CTL function, and that an as yet unidentified receptor for this epithelial antigen is present on both NK and T lymphocytes. The restricted expression of L280 antigen indicates that this molecule may be important in immune reactions in epithelial tissues.

Systemic group B streptococcal disease in the neonate: characterization of an oral colonization model using the suckling rat

Aspiration or ingestion of contaminated amniotic fluid or vaginal secretions has been suggested as a cause of systemic group B streptococcal (GBS) infection in the neonate. Suckling rat studies disagree on whether systemic disease will develop after an oral challenge of GBS. Our goal was to determine if systemic GBS disease would occur following oral colonization in the suckling rat and the effect of bacterial, host and environmental factors. Suckling rat littermates received oral inoculation on one of the first four days of life with varying doses and strains of GBS. Studies confirmed gastric inoculation without aspiration. Mortality and bacteremia decreased with age, increased with dose, varied with strain, and increased with asphyxia. Autopsy confirmed sepsis, intestinal colonization, meningitis, and pneumonia. Bacteremia was associated with an abnormal immature: total neutrophil ratio at 24 hr, thrombocytopenia at 48 hr, and neutropenia at 72 hr after inoculation. GBS can cause systemic infection in the host after oral colonization which appears age-, dose, strain-, and environment-dependent. Evaluation of GBS entry in the susceptible host may facilitate therapies directed toward preventing mucosal invasion.

Myopathic alterations in extraocular muscle of rats subchronically fed pyridostigmine bromide

To determine if alterations in extraocular muscle morphology occur after subchronic oral administration of pyridostigmine bromide, rats were continuously fed 90 mg/kg in meal and examined at 1, 2, 4, 7, and 15 days. Within the first day, blood acetylcholinesterase activity was reduced by 87% and remained inhibited by 74-91% during the study. Light microscopy demonstrated that by day 1 approximately 3% of the extraocular myofibers were shrunken and invaded by inflammatory cells. The most severe degenerative changes consisting of vacuoles and inflammatory cell infiltration occurred at day 1 with progressively less severe changes at days 2 and 4. At days 7 and 15, 1.3-4.5% of the myofibers still exhibited damage. Ultrastructurally, all presynaptic areas were normal but the postsynaptic areas of affected myofibers at days 1, 2, and 4 showed myofilament and Z-band dissolution, mitochondrial inclusions, subneural fold and T-tubule/sarcoplasmic reticulum vacuolization and subneural fold depth reduction. By days 7 and 15, these changes were diminished in some cases and in others alterations appeared similar to day 1. We conclude that subchronic feeding of pyridostigmine bromide induces myopathic rather than neurogenic changes in rat extraocular muscle and that the myopathy is different in these muscles than in the diaphragm from the the same rats.

Future directions. Collagen-based prostheses for meniscal regeneration

Prosthetic meniscal replacement offers the ability to stabilize the meniscectomized knee and provide prophylaxis against early degenerative arthritis. Since prosthetic meniscal replacement may be performed in the setting of normal articular cartilage, a prosthesis will be required to match the exact joint configuration, induce the same lubricity, produce the same coefficient of friction, and absorb and dampen the same joint forces (without incurring significant creep or abrasion) as does the normal meniscus. This feat is currently beyond the capabilities of artificial materials alone. Alternatively, collagen-based prostheses acting as resorbable regeneration templates offer the possibility of inducing regrowth of new menisci. This paper presents a summary of hypotheses, considerations, and laboratory evidence for the use of collagen-based, resorbable matrices as regeneration templates.

Myopathic changes in diaphragm of rats fed pyridostigmine bromide subchronically

To determine if alterations in muscle morphology occur after subchronic oral administration of pyridostigmine bromide, rats were fed 90 mg/kg continuously in meal and examined at 1, 2, 4, 7, and 15 days. Within the first day, cholinesterase activity was reduced by 87% and remained inhibited by 74-91% for the entire course of the feeding. Light microscopy demonstrated that by the first day approximately 1 in 100 myofibers was shrunken and contained centralized nuclei. Electron microscopic examination showed that while presynaptic areas of neuromuscular junctions were relatively unaffected by this dose, postsynaptic areas invariably showed maximal changes. Ultrastructural alterations included disruption of myofilaments, mitochondrial changes consistent with accumulation of calcium, and nuclear alterations. These effects appeared not to be cumulative and were greatly diminished by 15 days even under constant drug administration and inhibition of cholinesterase activity. We conclude that subchronic feeding of pyridostigmine bromide induces primarily myopathic rather than neurogenic changes in the diaphragm and that some mechanism of accommodation may be activated that minimizes continued muscle injury.

Scanning electron microscopy of submandibular sialoliths: a preliminary report

This report compares the scanning electron microscopic appearances of the structures in two sialoliths, one surgically removed, the other naturally exfoliated. The first exhibited the typical structure of a lamellated outer layer with an amorphous core. The core contained a large number of structures resembling calcified filamentous organisms. The second consisted of a similar outer lamella but the core contained crystal-lined spaces, amorphous matrix and an heterogeneous array of crystal shapes: there were no structures resembling organisms.

Magnetic resonance evaluation of disease of the soft tissues in children

Magnetic resonance imaging was a sensitive modality for identifying pathology in the soft tissues of 32 children, and it consistently showed more abnormality than CT. Magnetic resonance images are not histology specific, but with careful attention to the location of the abnormality, to the definition of the margins, and to the evaluation of involvement of adjacent muscle, bone, subcutaneous fat, and skin, the correct diagnosis can be strongly predicted in most cases. The ability of magnetic resonance to image in multiple planes aids in the evaluation of the extent of lesions and their relationship to adjacent structures. With magnetic resonance imaging, one can accurately predict the extent of abnormality, and there is great potential for the study of disease of soft tissues.

A laboratory model for studying blast overpressure injury

Blast injury remains an important source of trauma in both civilian and military settings. We have studied a recently developed blast wave generator to evaluate its effectiveness for laboratory study of blast injury. In order to determine the reliability of the device and the pathology of the lesions caused by the short duration (0.5-1.0 msec), and high intensity (60-375 psi) pressure wave, laboratory rats were exposed to the pressure waves generated by the machine. The animals were divided into three groups: the first exposed to midthoracic blasts, the second to abdominal blasts, and a group of controls exposed to a gentle stream of gas. Group I showed gross and microscopic evidence of lung blast injury of "rib imprint" hemorrhages, intra-alveolar hemorrhage, marked increase in lung weight, prolonged apnea, and bradycardia. Group II showed typical blunt abdominal trauma at the closest ranges, but characteristic submucosal hemorrhages up to 4.0 cm from the blast nozzle. In both groups, a protective effect was seen in heavier animals. The blast wave generator permits reproducible blast injury in the laboratory that is safer and faster than current methods. The lung and bowel lesions induced are grossly and microscopically similar to injuries of blast exposure seen in clinical patients.

Adrenergic modulation of the delayed rectifier potassium channel in calf cardiac Purkinje fibers

We have investigated the modulation of the delayed rectifier potassium channel in calf cardiac Purkinje fibers by the neurohormone norepinephrine. We find that 0.5 microM norepinephrine increases this K channel current by a factor of 2.7. A maximal increase of about four was found for concentrations of 1 microM and above. Norepinephrine produced a small (less than 5 mV) and variable shift of the K channel reversal potential toward more negative values. The kinetics of the potassium channel are well described by a two-exponential process, both in the absence and presence of norepinephrine. However, norepinephrine substantially decreases the slower time constant with no significant effect on the fast time constant. Potassium channel activation curves in the presence of norepinephrine are very similar to control curves except at large positive potentials. A simple sequential three-state model for this channel can reproduce these data both with and without norepinephrine. The logarithms of the rate constants derived from this model are quadratic functions of voltage, suggesting the involvement of electric field-induced dipoles in the gating of this channel. Most of the kinetic effects of norepinephrine appear to be on a single rate constant.

Contribution of the receptor pathway to low density lipoprotein catabolism in humans. New methods for quantitation

Receptor-mediated catabolism of low density lipoprotein (LDL) by cultured cells depends on the presence of functionally significant arginine and lysine residues on the lipoprotein apoprotein. When these are blocked, the recognition process is abolished, and catabolism of the modified lipoprotein is restricted to other mechanisms. Accurate discrimination between the activities of the receptor and nonreceptor pathways in vivo depends critically on the metabolic properties of this chemically modified lipoprotein. Here we report our experiences with two lysine-modified LDL tracers, glucosylated LDL (GLC-LDL) and 2-hydroxyacetaldehyde-treated LDL (HOET-LDL). The fractional clearance rate of GLC-LDL (0.25 +/- 0.05 pools/day, n = 5) was 50% of that of control material (0.51 +/- 0.09 pools/day) injected simultaneously into normal subjects. The HOET-LDL was also retarded in its clearance. Here, however, the fractional clearances of the control (0.37 +/- 0.06 pools/day, n = 6) and modified lipoprotein (0.19 +/- 0.03 pools/day) were lower than those obtained by the glucosylation procedure. We suspect that the prolonged incubation required for glucosylation of LDL artifactually accelerated its catabolism. The HOET-LDL does not suffer from this defect and seems to be a better tracer of the receptor-independent pathway. In a group of 10 subjects, HOET-LDL was metabolically indistinguishable from 1,2 cyclohexanedione-treated, arginine-modified LDL.

Receptor-independent low-density lipoprotein catabolism. Evaluation of 2-hydroxyacetaldehyde-treated lipoprotein as a probe for its measurement

This study examines the protein modification procedures available for inhibiting receptor recognition of low-density lipoprotein (LDL). Glycosylation with glucose, idose or ribose blocks the interaction of the lipoprotein with the high-affinity LDL receptor on cultured fibroblast membranes and delays its clearance from the plasma of rabbits. However, the prolonged incubation required in the process also changes the metabolic properties of the lipoprotein. An alternative approach using 2-hydroxyacetaldehyde-treated LDL completely blocks receptor recognition. This modified tracer has the same metabolic properties as the reductively methylated lipoprotein in rabbits and appears to be a suitable probe for the measurement of the receptor-independent LDL catabolic pathway in humans.

Inbred mice as model hosts for cutaneous leishmaniasis. I. Resistance and susceptibility to infection with Leishmania braziliensis, L. mexicana, and L. aethiopica

The susceptibility of 12 strains of inbred mice representing a broad genetic spectrum to infection of Leishmania braziliensis, L. mexicana and L. aethiopica was determined. Levels of susceptibility were evaluated by gross morphology of lesions, evidence of resolution, persistence of parasites at the site of inoculation, and visceralization to the spleen or liver following inoculation in noses. Very different patterns of responses were noted among the infections with the three species of Leishmania. Among the strains of inbred mice infected with L. braziliensis, patterns of cutaneous lesion development indicated a broad range of susceptibilities and responses. Two strains of inbred mice (AKR/J and CBA/J) showed only a slight and transient swelling of the nose. The SWR/J, C57L/J, A/J, A/HeJ and DBA/1J showed initial swellings or nodules which eventually resolved. In contrast, the BALB/cJ mice were ranked as most susceptible, based on progressive dermal lesions and visceralization. Four strains of inbred mice (C3H/HeJ, C57BL/6J, CBA/J and CBA/CaJ) showed no evidence of infection. Lesion development in most strains of inbred mice infected with L. mexicana occurred later than with L. braziliensis but was then more rapidly progressive with no indication of resolution. Two strains (C3H/HeJ and C57BL/6J) showed no evidence of infection. Only slight swellings of the nose were seen in the 12 strains of inbred mice infected with L. aethiopica; however, parasites were isolated by culture from apparently normal noses in five groups (A/HeJ, AKR/J, BALB/cJ, DBA/2J and SWR/J).

Cholesterol feeding increases low density lipoprotein synthesis

This study examines the effects of increased dietary cholesterol (6 eggs/d) on the metabolism of low density lipoproteins in a group of seven healthy volunteers. Egg supplementation raised high density and low density lipoprotein cholesterol levels by 18 and 40%, respectively. The composition of the low density lipoprotein was unaltered and therefore the number of circulating particles must have increased. Kinetic studies indicated that this was due primarily to a 23% rise in the rate of synthesis of the lipoprotein. Catabolism was also affected. The fractional removal rate of native low density lipoprotein fell by 10% (P less than 0.05). However, the clearance of the 1,2 cyclohexanedione-treated lipoprotein remained unchanged (control fractional clearance rate [FCR] = 0.188 pools/d; cholesterol feeding FCR = 0.183 pools/d). Therefore, the reduction in low density lipoprotein catabolism appeared to be due to a fall in receptor activity. Consequently, an increased sterol load (34.2 mumol/kg per d vs. 27.7 mumol/kg per d in the control phase, P less than 0.02) was channelled into the receptor-independent route during egg feeding.