P2593Evaluation of an ambulatory heart failure service - a 2 years' experience

Background

Heart failure accounts for 1–2% of health care expenditure in the National Health Service in the United Kingdom. Approximately 60–70% of that cost is in hospitalization for treatment. Various methods have been employed to reduce hospitalization in chronic heart failure; however effectiveness and safety of these methods have yet to be evaluated. Our ambulatory heart failure unit, run by specialist heart failure nurses, seeks to reduce admissions to hospital for heart failure by administering intravenous (I.V) diuretics in a day unit setting for ambulatory patients.

Purpose

We have reviewed data from December 2016 to December 2018 of patients using the ambulatory heart failure services in our hospital and evaluated its safety and effectiveness.

Methods

Retrospective evaluation of data collected from the ambulatory heart failure unit over a 24-month period as well as hospital data on admissions and length of stay of heart failure patients. Qualitative data was also collected from patients using the ambulatory heart failure unit.

Results

Since the opening of the ambulatory heart failure unit in December 2016, we have had 393 patient episodes. Referrals were largely from the community (265, 67%) however 128 (33%) patients were referred from an inpatient setting. Patients were treated for a mean of 12 days with intravenous furosemide infusion. The minimum dose of furosemide used was 120mg over 1 hour whereas maximum dose was 360mg over 2 hours. This translated into 4351 hospital bed days saved in a 24-month period. 144 (37%) of patients had heart failure with preserved ejection fraction (EF >40%), and 239 (61%) had heart failure with reduced ejection fraction (EF <40%).

28 patients (7%) referred to the unit were deemed inappropriate for unit and required admission. A further 35 patients (9%) were admitted to hospital for other illnesses whilst being treated on the unit due to various reasons. 3 patients (0.8%) died in the community during the period they were receiving care on the unit. Of the 63 patients (16%) admitted to hospital 23 (6%) died during that hospital admission. The number of all cause mortality of our patients was 26 (7%) during the time they were treated on the unit.

Whilst the number of heart failure hospital admissions remained similar, the average length of stay in hospital for heart failure dropped by 0.99 days. Patient feedback on the unit was excellent, with patients feeling more independent and in control of their health.

Conclusions

The ambulatory heart failure unit reduces the burden on the hospital by reducing the length of stay of heart failure patients and may be preferred by patients. Intravenous diuretics on a day case basis are safe, as evident by unchanged overall mortality of heart failure patients.

Genetic Relationship of Stripe Rust Resistance Genes Yr34 and Yr48 in Wheat and Identification of Linked KASP Markers

The Australian continent was free from wheat stripe rust caused by Puccinia striiformis f. sp. tritici until exotic incursions occurred in 1979 and 2002. The 2002 incursion enabled the identification of a new stripe rust resistance gene (Yr34) in the advanced breeding line WAWHT2046. In this study, we developed and validated markers closely linked with Yr34, which is located in the distal region in the long arm of chromosome 5A. Four kompetitive allele-specific polymerase chain reaction (KASP) and three sequence-tagged site (STS) markers derived from the International Wheat Genome Sequencing Consortium RefSeq v1.0 scaffold-77836 cosegregated with Yr34. Markers sun711, sun712, sun725, sunKASP_109, and sunKASP_112 were shown to be suitable for marker-assisted selection in a validation panel of 71 Australian spring wheat genotypes, with the exception of cultivar Orion that carried the Yr34-linked alleles for sunKASP_109 and sunKASP_112. Markers previously reported to be linked with adult plant stripe rust resistance gene Yr48 also cosegregated with Yr34. Wheat genotypes carrying Yr34 and Yr48 produced identical haplotypes for the Yr34-linked markers identified in this study and those previously reported to be linked with Yr48. Phenotypic testing of genotypes carrying Yr34 and Yr48 showed that both genes conferred similar seedling responses to pre-2002 and post-2002 P. striiformis f. sp. tritici pathotypes. Further testing of 600 F₂ plants from a cross between WAWHT2046 and RIL143 (Yr48) with P. striiformis f. sp. tritici pathotype 134 E16A+Yr17+Yr27+ failed to reveal any susceptible segregants. Our results strongly suggest that Yr34 and Yr48 are the same gene, and that Yr48 should be considered a synonym of Yr34.

Generation of Paramoeba perurans clonal cultures using flow cytometry and confirmation of virulence

Amoebic gill disease (AGD) in farmed Atlantic salmon is caused by the amoeba Paramoeba perurans. The recent establishment of in vitro culture techniques for P. perurans has provided a valuable tool for studying the parasite in detail. In this study, flow cytometry was used to generate clonal cultures from single-sorted amoeba, and these were used to successfully establish AGD in experimental Atlantic salmon. The clonal cultures displayed differences in virulence, based on gill scores. The P. perurans load on gills, determined by qPCR analysis, showed a positive relationship with gill score, and with clonal virulence, indicating that the ability of amoebae to proliferate and/or remain attached on gills may play a role in virulence. Gill scores based on gross signs and histopathological analysis were in agreement. No association between level of gill score and specific gill arch was observed. It was found that for fish with lower gill scores based on histopathological examination, gross examination and qPCR analysis of gills from the same fish were less successful in detecting lesions and amoebae, respectively.

Changes in Nutritional and Functional Status in Longer Stay Patients Admitted to a Geriatric Evaluation and Management Unit

OBJECTIVES

Malnutrition and functional decline are common in older inpatients admitted to subacute care settings. However the association between changes in nutritional status and relevant functional outcomes remains under-researched. This study examined changes in nutritional status, function and mobility in patients admitted to a Geriatric Evaluation and Management (GEM) unit who had a length of stay (LOS) longer than 21 days.

DESIGN

A prospective, observational study.

SETTING

Two GEM units at St Vincent's Hospital Melbourne, Australia.

PARTICIPANTS

Patients admitted to the GEM units who stayed longer than 21 days were included in the study.

MEASUREMENTS

Patients were assessed on admission and prior to discharge using the Subjective Global Assessment (SGA), Functional Independence Measure (FIM) motor domain and the Modified Elderly Mobility Scale (MEMS).

RESULTS

Fifty-nine patients (Mean age 84.0 ± 7 years) met the required length of stay and were included in the study. Fifty-four per cent (n=32) were malnourished on admission (SGA B/C) and 44% (n=26) were malnourished on discharge. Twenty-two per cent (n=13) improved SGA category, 75% remained stable (n=44) and 3% deteriorated (n=2) from admission to discharge. Total Motor FIM scores significantly increased from admission to discharge in both the improved (p<0.001) and stable or deteriorated (p<0.001) nutritional status groups. Subjects who improved in nutritional status had a significantly higher MEMS score at discharge (p<0.001).

CONCLUSION

On admission to the GEM unit, just over half the included patients were rated as malnourished defined by SGA category. Nearly one quarter of the sample had improved their nutritional status at the time of discharge. Improvement in nutritional status was associated with greater improvement in mobility scores. Further studies are required to investigate the effectiveness of nutrition interventions, which will inform models of care aiming to optimise nutritional, functional, and associated clinical outcomes in patients admitted to GEM units.

Development and validation of a range of endogenous controls to support the implementation of practical Taqman real-time PCR-based surveillance for fish diseases within aquaculture

The use of Taqman real-time PCR-based technology has recently become more frequent in the detection of pathogens in the aquaculture industry. This interest has necessitated the development of robust and reliable pathogen-detection assays. The development of a range of endogenous control assays to be run alongside these diagnostic assays works to further increase confidence in the latter. This study describes the design of a range of endogenous control assays based on the elongation factor 1-α (EF1-α) gene specific to a range of fish species including Atlantic salmon, Salmo salar; rainbow trout, Oncorhynchus mykiss; brown trout, Salmo trutta; cod, Gadus morhua; haddock, Melanogrammus aeglefinus; saithe, Pollachius virens; whiting, Merlangius merlangus; Norway pout, Trisopterus esmarkii; carp (family Cyprinidae), roach, Rutilus rutilus; European eel, Anguilla anguilla; and herring, Clupea harengus, as well as a number of fish cell lines. Evidence is provided of the validation of these assays for specific species, a range of tissue types and cell lines as well as an example of the potential uses of these assays.

Detection of salmonid alphavirus RNA in wild marine fish: implications for the origins of salmon pancreas disease in aquaculture

Salmonid alphaviruses (SAVs), which include the aetiological agents of salmon pancreas disease (SPD) in farmed Atlantic salmon Salmo salar L. and sleeping disease (SD) in rainbow trout Oncorhynchus mykiss (Walbaum), are significant viral pathogens of European salmonid aquaculture. SAV is horizontally transmitted and the virus can survive for extended periods in seawater. A lack of convincing evidence for vertical transmission coupled to the fact that the SPD virus (SPDV) occurs in historically infected sites irrespective of fallow period duration suggests that a substantial reservoir of infection exists in the marine environment. We used a highly sensitive real-time PCR (qPCR) assay targeting a region of the SAV nsP1 gene to screen wild marine fish species for the presence of SAV in an attempt to identify such a potential reservoir. Screened fish species were caught in the vicinity of aquaculture activity in an area with a previous history of SAV infection (Shetland Isles, Scotland). SAV RNA was detected in internal organs (kidney and heart) from the flatfish species common dab Limanda limanda, long rough dab Hippoglossoides platessoides, and plaice Pleuronectes platessa. Based on these findings, sampling was extended to an area remote from aquaculture activity (Stonehaven Bay, NE coast of Scotland) from where heart tissues obtained from common dab also tested positive. While no virus could be cultivated from these samples, qPCR detections were shown to be SAV-specific by sequencing of an alternative gene region (E2) to that targeted by the qPCR assay. Analysis of these nucleotide sequences revealed minor differences to those previously obtained from farmed salmon, and subsequent phylogenetic analysis of an E2 dataset demonstrated a subtype V-like sequence.

The ontogeny of diving behaviour in New Zealand fur seal pups (Arctocephalus forsteri)

This study investigated the development of diving in 21 New Zealand fur seal pups, Arctocephalus forsteri (Lesson, 1828), prior to weaning at Cape Gantheaume, Kangaroo Island. Diving behaviour was examined using time–depth recorders, which were deployed during two time periods, 5 months prior to weaning (n = 6) and 2 months prior to weaning (n = 15). Scats were also examined to assess whether fur seal pups foraged prior to weaning. The maximum dive depth attained was 44 m, while the maximum dive duration was 3.3 min. Immediately prior to weaning, fur seal pups spent a greater proportion of their time diving at night, and concomitantly several measures of diving performance also increased. In general, pups dived successively deeper (6–44 m between June and September), and the average number of dives per day, dive frequency, and vertical distance travelled increased. Prey remains were present in approximately 30% of scats and indicated that some pups were foraging as early as June (5–6 months of age, approximately 4–5 months prior to weaning). Of the scats that contained prey remains, fish (South American pilchard, Sardinops sagax (Jenyns, 1842); Australian anchovy, Engraulis australis (White, 1790); and redbait, Emmelichthys nitidus Richardson, 1845) accounted for 43% of the prey items found, crustaceans accounted for 36%, and cephalopods (Gould's squid, Nototodarus gouldi (McCoy, 1888)) accounted for 20%.

Visually guided reaching: bilateral posterior parietal lesions cause a switch from fast visuomotor to slow cognitive control

The visually guided reaching of two patients with bilateral optic ataxia was explored in two experiments. In Experiment 1 simple delayed pointing was compared with immediate pointing. In the immediate pointing task both variable and constant errors increased with target eccentricity. In contrast to the performance of control subjects and contrary to their own beliefs, the patients both showed improved accuracy in the delay condition. This improvement was manifest as a reduction in both pointing variability and in the constant angular error towards the point of fixation. Both angular errors and their improvement with the delay were proportional to target eccentricity. Experiment 2 used a task in which the target was pre-viewed 5s prior to its re-exposure for pointing ('delayed real pointing'). On some trials a conflict was introduced between the present and previous visual information by changing the target's location during the delay. In contrast to control subjects, who ignored the pre-viewed location and aimed directly at the current target, both patients with optic ataxia initiated their movements towards the previously viewed target location. Evidently they relied on off-line information in preference to on-line visual information. In addition, the patients often failed to detect the changes in target location. One of the patients sometimes even guessed incorrectly that the target had changed its location, and her movement trajectory was then more affected by her false belief than by the target's actual location. These findings confirm that posterior parietal lesions severely disrupt direct visuomotor transformations, and suggest that the residual performance is mediated indirectly by expectations or beliefs about target position.

WHO Expert Committee on Biological Standardization

This report presents the recommendations of a WHO Expert Committee commissioned to coordinate activities leading to the adoption of international requirements for the production and control of vaccines and other biologicals and the establishment of international biological reference materials. The report starts with a discussion of general issues brought to the Committee's attention and provides information on the status and development of reference materials for various antibodies, antigens, blood products and related substances, cytokines, growth factors, and endocrinological substances. The second part of the report, of particular relevance to manufacturers and national regulatory authorities, contains recommendations for the production and quality control of meningococcal group C conjugate vaccines, guidelines for regulatory expectations for clinical evaluation of vaccines, guidelines for the production and quality control of inactivated oral cholera vaccines and guidelines on viral inactivation and removal procedures intended to assure the viral safety of human blood plasma products.

A series of case studies on the effect of a midfoot control ankle foot orthosis in the prevention of unresolved pressure areas in children with cerebral palsy

This paper reports on a series of case studies where improvements were sought in muscle tone and gait in children with cerebral palsy. A Midfoot Control Ankle Foot Orthosis (AFO) was developed to control foot position in a cohort of patients with cerebral palsy (CP). The concept of controlling midfoot and hindfoot with an encapsulated internal Supra-Malleolar AFO that fitted into an external AFO was shown to be effective in ambulant children with CP. Some initial problems of compliance were noted and postulated to be due to difficulties associated with previous orthotic devices. Evidence from the case studies suggest that the developed Supra-Malleolar AFO orthoses enables children with CP to maintain mobility without skin tissue damage, delays the need for surgery and at the same time maintains the length of the Triceps Surae (Gastrocnemius and Soleus) complex. Plans for further research are discussed which will contribute to the evidence base for this particular orthotic device.

Somatic hypermutation in autoimmune thyroid disease

Autoimmune thyroid disease is one of the most common autoimmune diseases. There is typically patient antibody (Ab) reactivity to one or more of the antigens thyroglobulin (Tg), thyroid peroxidase (TPO) and the thyroid simulating hormone receptor (TSHr). With the advent of combinatorial library technology, there has been an enormous increase in the number of sequences from Ab to Tg and TPO. The repertoire of both Tg and TPO Ab is restricted and indicates the importance of somatic hypermutation in the development of the high affinity Ab response. However, there are still too few sequences to determine patterns in which the mutation occurs, which residues are introduced during substitution and how individual substitutions affect the affinity of the Ab. Ab to the TSHr are of far greater pathological significance than those to Tg and TPO, but the current repertoire of Ab to the TSHr has yet to include the high affinity IgG Ab characteristic of patient serum Ab. Instructive analysis of the role of somatic hypermutation in the development of TSHr Ab therefore still awaits the isolation of the pathologically active repertoire. Despite this, the Ab response in thyroid autoimmunity remains one of the best characterised of human autoimmune diseases.

Recombinant human interleukin-4 (rhu IL-4) administered by the intravenous and subcutaneous routes in patients with advanced cancer--a phase I toxicity study and pharmacokinetic analysis

19 patients with advanced cancer were entered into a phase I study of recombinant human interleukin-4 (rhu IL-4). The predominant clinical side-effects included flu-like symptoms, gastrointestinal upset, lethargy and transient hypotension. In addition, there were several cases of capillary leak syndrome. 2 cases of gastrointestinal haemorrhage occurred; this was life threatening in 1 patient. The maximum tolerated dose (MTD) was 400 micrograms/m2/day. Biochemical toxicity was limited to asymptomatic elevation of liver enzymes suggesting IL-4 induced liver damage. Pharmacokinetic analysis following the intravenous bolus injection has shown that IL-4 is rapidly cleared (mean T1/2 = 19 +/- 8.7 min) from a small compartment (mean Vd = 4.9 +/- 3.68 l) probably indicating that IL-4 is retained in the systemic circulation or at most the extracellular fluid volume. 2 patients with non-Hodgkin lymphomas (NHL) showed a transient response to IL-4 whilst a third patient with NHL showed transient disease progression.

Adverse influence of fibrin sealant on the healing of high-risk sutured colonic anastomoses

The effect of fibrin glue sealing on sutured colonic anastomoses was studied using a 'high-risk' colon anastomosis model in the rat. Animals (n = 104) were randomized to have their sutured anastomosis sealed with fibrin glue or left untreated. They were assessed clinically until they were killed on the fourth day after surgery when contrast radiology, detailed post-mortem examination, anastomotic bursting pressure (ABP) and assessment of adhesion formation were performed. The clinical outcome was worse in the glued group (toxic or death from sepsis: 18 versus seven in the non-glued group; P = 0.0354), which also showed a significantly higher moderate to major leak rate (17 versus two in the non-glued group; P = 0.0009). The median ABP was significantly higher in the glued anastomosis group (96 versus 68 cmH2O in the non-glued group; P = 0.0367). Excessive perianastomotic adhesion formation was significantly greater in the glued group. Microscopic examination showed an extremely intense inflammatory reaction in the glued anastomoses compared with that in the untreated group. These results indicate that sealing of a sutured anastomosis with fibrin glue containing an antiproteinase impairs healing the of anastomotic wound, probably by resisting the ingrowth of vascular granulation tissue during the early stages of repair.

Phase II study with mitomycin, ifosfamide and carboplatin in inoperable non-small cell lung cancer

In a phase II study of non-small cell lung cancer a new chemotherapy combination of mitomycin 6 mg/m2 intravenously on day 1, carboplatin 400 mg/m2 intravenously on day 1 and ifosfamide with mesna 5 g/m2 intravenously over 24 hours on day 1 was evaluated. A maximum of four chemotherapy cycles was given at intervals of 4 weeks to 34 patients with progressive, inoperable disease. 1 complete and 10 partial remissions were documented, the overall response rate being 32.4%. In a further 13 patients (38.2%) the previously progressing tumours remained stable for at least 6 weeks. The median time to progression for responding patients was 184 days. The median survival time for the whole group has not yet been reached at 293 days. A considerable but easily manageable myelosuppression was the principal toxicity despite a "no dose reduction" policy. Indeed, the dose intensity of the chemotherapy actually given was extremely close (97%) to that intended on protocol. In conclusion, the regimen is active in patients with advanced non-small cell lung cancer but requires regular haematological monitoring to prevent morbidity resulting from myelotoxicity.

Effect of fibrin glues on the mechanical properties of healing wounds

Tissue glues are important in clinical practice. Fibrin based glues have many advantages over non-biological adhesives. The optimum formulation of these glues measured by their effect on mechanical properties of healing wounds has not been determined. Using a model involving standard dorsal skin incisions in adult male Wistar rats various glue formulations were compared by varying the fibrinogen, thrombin and factor XIII concentrations. Calcium (40 mumol/ml) and aprotinin (3000 kallidinogenase inactivator units, KIu/ml) concentrations were kept constant. Animals were killed at 8 days and wounds excised. Standard strips of these wounds were mechanically tested using an Instron tensiometer and the stress, strain, elasticity and work required to rupture wounds were calculated. Results indicate that a fibrin glue with a fibrinogen concentration of approximately 39 g/l and a thrombin concentration of 200-600 units/ml with no added factor XIII will result in wounds with significantly increased stress, energy absorption and elasticity values.

Computed tomographic and ultrasound appearances of focal spared areas in fatty infiltration of the liver

Computed tomography (CT) and ultrasound (US) appearances of diffuse and focal fatty infiltration of the liver (FIL) are well recognized. We have recently seen 10 cases with "fat spared" areas in FIL presenting as pseudo tumours of the liver. Characteristic appearances of fat free areas in FIL which help differentiate these areas from other focal liver lesions include (i) location in the medial segment of the left lobe of the liver, (ii) absence of mass effect on surrounding vessels and liver tissue, and (iii) presence of typical changes of FIL elsewhere in the liver on CT or US examination.

The enhanced induction of metallothionein by zinc, its half-life in the marine fish Pleuronectes platessa, and the influence of stress factors on metallothionein levels

Intraperitoneal injection of zinc raised levels of a hepatic metallothionein-like species. Assuming that this species was metallothionein (MT) then levels were raised from approximately 20 micrograms/g to 300 micrograms/g in 7 days, and levels thereafter remained high for the next 4 weeks. The half-lives of the protein in liver and kidney from starved fish, measured using in vivo incorporation of 35S cysteine at 11 degrees C, were approximately 27 days and 32 days respectively. The following agents failed to stimulate synthesis of MT in plaice: stress (due to catching), endotoxin, dexamethasone, cortisol and turpentine.

Operative recovery of vasal sperm from anejaculatory men: preliminary report

Sperm showing good motility and function, as demonstrated by the in vitro sperm penetration assay using hamster ova, were collected from the vas deferens of 3 men with ejaculatory failure. The collection procedure may be repeated over multiple ovulatory cycles. The sperm may be used to attempt artificial insemination or in vitro fertilization.

Multiple organ failure: clinical and experimental

The clinical scenario of multiple organ failure (MOF) is reviewed and its frequent correlation with sepsis emphasized. It is hypothesized that MOF is produced by the formation of immune complexes (IC) in response to infection with deposition on organs such as the liver, lung, and kidney. Such immune complexes trap macrophages which can directly damage endothelium. Such a pathologic picture is in keeping with that of MOF. Granular deposits of IgG, IgM, C3, C5, and fibrinogen have been identified in the organs of four patients dying of MOF and sepsis. Similar deposits have been identified using fluorescent antibody stains in the organs of rabbits following cecal perforation. It is hypothesized that sepsis may produce organ failure at a distance from the site of infection via deposits of immune complexes.

Attenuation of canine nephrotoxic glomerulonephritis with an extracorporeal immunoadsorbent

A novel immunoadsorbent is described in which soluble canine glomerular basement membrane (GBM) antigen was immobilized in collodion membranes adherent to small charcoal particles. As much as 80% of the added GBM antigen was retained in the collodion-charcoal. The binding of GBM antibody to immobilized GBM antigen in vitro and in vivo was demonstrated. For in vivo studies, an extracorporeal circulation system was established, and mongrel dogs were then injected intravenously with GBM collodion-charcoal for 4 h. Renal tissue was examined by fluorescence and light microscopy for the deposition of heterologous gamma globulin and glomerular inflammation before and after the extracorporeal procedure. Results showed less deposition of heterologous IgG and less inflammation in experimental dog kidneys than in control kidneys. There was no evidence of release of 131I-labeled GBM from the immunoadsorbent at the conclusion of perfusion experiments and no significant biochemical or hematologic alterations. Finally, extracorporeal immunoadsorbent treatment was capable of attenuating the early heterologous phase of passive canine nephrotoxic nephritis and may have a potential role in the therapy of anti-GBM-mediated nephropathy.

A re-examination of the nitrobenzene – 2,2,4-trimethyl pentane system in the consolute region and of the thermodynamical considerations concerning the value of ε′ at the consolute point

Failure to find maxima in ε′and ε″for aniline–cyclohexane in the consolute region by Lubezky and McIntosh (8) led to re-examination of the system nitrobenzene–2,2,4-trimethyl pentane for which anomalous values of ε′and ε″ have been reported. Earlier results by Lubezky and McIntosh (6) could not be repeated. A re-examination of thermodynamical arguments was then undertaken and the conclusion reached that these do not predict anomalous values of ε′.

Pancreatic islet isografts, allografts, and xenografts: comparison of morphology and function

Neonatal rat pancreatic islets were transplanted intraperitoneally into adult streptozotocin-diabetic rats and mice. Isologous pancreatic islet recipients (12 of 12) showed consistent and permanent reconstitution of normoglycemia and normal weight gain as well as readjustment to normal of intake of water, urine volume, and glucose excretion for greater than 10 months when compared to age-matched normal (ten) and diabetic (20) controls. Revascularized isologous islet grafts were found to be adherent to both visceral and parietal peritoneum. Pancreatic islet allografts (ten) and allografts and xenografts did not appear to differ markedly; both were characterized by dense round-cell infiltration within 5 days after transplantation.

The kidney in streptozotocin diabetic rats. Morphologic, ultrastructural, and function studies

In order to study the nephropathy associated with experimental streptozotocin diabetes, serila morphologic, ultrastructural, immunohistologic, and functional studies were done in diabetic Lewis rats to study the course of the nephropathy. Early in the course of diabetes, these animals developed an increase in mesangial matrix, with electron-dense material, IgG, and C3 in the mesangium. These alterations were progressive. Mesangial bars, proximal tubular vacuolization, and myeloid bodies were also present. Progressive increase in protein excretion and increase in creatinine clearance were observed. Hyperglycemia was accompanied by weight loss, persistent glycosuris, hyperphosphaturia, and hypercalcuria. Urinary glomerular basement membrane-like protein and major urinary protein were decreased. Normal age-matched controls showed no abnormalities. Some of the changes observed in diabetic rats are present in human diabetes.

Further studies on cold insoluble circulating immune complexes in rabbits immunized with bovine albumin

Cold insoluble circulating immune complexes of BSA and anti-BSA antibody are formed in vivo while immune catabolism of antigen is occurring. The effects of temperature, rate of precipitation and redissolvability of the cold insoluble antigen were studied in this model. Circulating BSA is soluble at 37 degrees, but may precipitate when the temperature is reduced. The solubility of antigen decreases at 24 degrees and below. Complete precipitation occurs in 5-7 days. The antigen in the cryoprecipitate is difficult to redissolve unless low pH citrate or glycine buffers are used.

Endogenous immune complex nephropathy associated with malignancy I. Studies on the nature and immunopathogenic significance of glomerular bound antigen and antibody, isolation and characterization of tumor specific antigen and antibody and circulating immune complexes

Three patients with clear cell renal carcinoma and one with another intrarenal malignancy were studied for the presence of glomerular localized immunoglobulins, complement components and tumor specific antigen and antibody by immunofluorescence. To determine the association and elucidate the pathogenic mechanisms involved in the relationship between tumors and glomerular deposits, antibody eluted from tumor tissue and renal glomeruli, cryoproteins, serum antibodies and rabbit antisera to tumor tissue were tested for specificity to antigen. The relationship between tumor antigens and the lipoprotein antigen localized in normal proximal tubular brush border (RTE) and the small bowel mucosa, was studied by immunofluorescence, absorption and blocking studies as well as complement fixation. Immunoglobulins and complement components were localized in the glomeruli and tumor membrane of all patients. Sera and glomerular fixed antibody from three patients with renal cell carcinoma localized to normal proximal tubular brush border and jejunal mucosa as well as to tumor membrane and the glomeruli and proximal tubules of all of these three patients. Anti RTE activity was also detected by complement fixation. Immunologic similarity between RTE and renal cell carcinoma antigen was confirmed by absorption studies. Furthermore, cryoprecipitable complexes of tumor antigen and specific antibody were isolated from the serum. The tumor antibody was immunologically similar to RTE. In the other case the rabbit anti-tumor antibody and the patient's serum fixed to the tumor membrane and kidney of the patient but did not show cross reactivity with the renal cell carcinoma or RTE. These studies suggest that the tumor antigen in renal cell carcinoma is similar to RTE and the glomerular deposits represent tumor antigen and antibody complexes. In addition these investigations support the hypothesis that tumor immune complexes are significant in the glomerular lesions, and that the origin of renal cell carcinoma is in the proximal tubule. The investigations also show that tumor antibodies are specific for tumors of the same morphological type but not for other tumors in the same tissue. Moreover, the renal glomerulus appears to be a chosen anatomic site for deposition of tumor antigens and antibodies and studies of the kidney may provide insight into the nature of tumor antigens and antibodies. Cryoprecipitation appears to be a valuable method in isolation of tumor complexes and characterization of tumor specific antigen and antibody.

Xenotransplantation of piscine islets into hyperglycemic rats

Xenotransplantation of piscine islets into hyperglycemic rats usually lowers the blood sugar level of the recipient. The duration of this effect is prolonged by irradiation of the host or by enclosing donor tissue in synthetic envelopes. This prolongation appears to be related to interference with the host's ability to reject the graft; the duration of the prolongation may be limited by the host tissue reaction surrounding the envelope. The availability of anatomically separate piscine islet tissue makes it potentially useful for xenotransplantation into mammals.

Cardiac heterotransplantation. Morphological and immunohistological studies

A vascularized heterograft model using outbred strains of animals was developed by transplanting mouse hearts heterotopically into rats. With this species desparity rapid but not immediate graft rejection was observed, with a predictably narrow range of graft survival times. Morphological and immunohistological studies showed early deposition of fibrinogen and vascular and myocardial inflammation without prominent or consistent localization of either IgG or C3. Later more extensive changes were observed, and deposition of IgG and C3 were more prominent in the grafts. Pretreatment of the recipient with cyclophosphamide alone or cyclophosphamide plus antigen prolonged graft survival; however, no statistically significant difference was noted between these groups. Morphological and immunohistological alterations preceded clinical rejection, and tissue injury appeared to be mediated by humoral and cellular immune mechanisms and by the coagulation system. This model is potentially useful for the study of heterotransplantation.

Sorption of Water, Ammonia, Ethyl Chloride, and Methane on Na—X Zeolite and Associated Framework Distortion

Length change and sorption isotherms have been determined for water, ammonia, ethyl chloride, and methane on compacted samples of zeolite NaX. Methane sorption at 0 °C and ethyl chloride sorption at −10°C were accompanied by little or no framework distortion as monitored by length change measurements; sorption of ammonia in the temperature range −50 to −70 °C produced more appreciable distortion; and water sorption at room temperature caused large changes. In each case the framework distortion was correlated with different stages in the sorption process. The sorption isotherms for the ammonia/NaX system indicated the possibility at high uptakes of two-dimensional condensation or multilayer formation. The critical temperature for two-dimensional condensation would be −70 °C.

Dielectric Behavior of the Aniline–Cyclohexane System in the Consolute Region

Measurements of ε′ and ε″ at 5 kHz are reported for the system aniline–cyclohexane in the region of the consolute temperature. No anomalously large values of ε′ and ε″were found in the region of concentration where the binodal curve is essentially flat. Traces of water increase the temperature for phase separation. An explanation in terms of the formation of molecular clusters is offered for the difference of behavior of this system and that of nitrobenzene – trimethyl pentane.