Diverse values of nature for sustainability

Twenty-five years since foundational publications on valuing ecosystem services for human well-being1,2, addressing the global biodiversity crisis3 still implies confronting barriers to incorporating nature's diverse values into decision-making. These barriers include powerful interests supported by current norms and legal rules such as property rights, which determine whose values and which values of nature are acted on. A better understanding of how and why nature is (under)valued is more urgent than ever4. Notwithstanding agreements to incorporate nature's values into actions, including the Kunming-Montreal Global Biodiversity Framework (GBF)5 and the UN Sustainable Development Goals6, predominant environmental and development policies still prioritize a subset of values, particularly those linked to markets, and ignore other ways people relate to and benefit from nature7. Arguably, a 'values crisis' underpins the intertwined crises of biodiversity loss and climate change8, pandemic emergence9 and socio-environmental injustices10. On the basis of more than 50,000 scientific publications, policy documents and Indigenous and local knowledge sources, the Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES) assessed knowledge on nature's diverse values and valuation methods to gain insights into their role in policymaking and fuller integration into decisions7,11. Applying this evidence, combinations of values-centred approaches are proposed to improve valuation and address barriers to uptake, ultimately leveraging transformative changes towards more just (that is, fair treatment of people and nature, including inter- and intragenerational equity) and sustainable futures.

Infrastructural nature

The assertion that 'ecosystems are infrastructure' is now common in conservation science and ecosystem management. This article interrogates that claim, which we argue underpins diverse practices of environmental investment focused on the strategic management of ecosystem functions to sustain and secure human life. We trace the genealogies and geographies of infrastructural nature as a paradigm of investment that coexists (sometimes in tension) with extractivist commodity regimes. We draw links between literatures on the political economy of ecosystem services and infrastructure and highlight three themes that hold promise for future research: labor, territory, and finance.

Abstract PD4-08: Post-diagnosis physical activity and comorbidities, not BMI, explain mortality risk in the after breast cancer pooling project

Background: In its 2014 position statement, ASCO concluded that obesity is associated with worse prognosis after cancer diagnosis. However in the same year, a comprehensive review by the World Cancer Research Fund concluded that there was limited evidence that greater body fatness increases risk of overall or breast cancer mortality, indicating that further investigation into lifestyle factors are needed. The After Breast Cancer (ABC) Pooling Project has reported, separately, significant mortality effects of pre-diagnosis BMI and of post-diagnosis physical activity (PA). We investigate whether the effect of BMI can be limited to subgroups characterized by comorbidities and physical activity.

Methods: Data are from the three US cohorts that were harmonized in the ABCPP (n=9513) including: the Women's Healthy Eating and Living (WHEL), Life After Cancer Epidemiology (LACE), and Nurses' Health (NHS) studies. Stepwise delayed entry Cox proportional hazards models examined each lifestyle predictor (BMI, PA, and comorbidities assessed after diagnosis) sequentially and together in multivariate models for breast cancer and all-cause mortality.

Results: In multivariate models without the other two target variables, PA was significantly associated with a 17% decrease in the risk of breast cancer mortality among women in the highest quartile of PA (MET hr/wk > 21.4), compared to the lowest quartile (MET hr/wk < 2.7) (HR=0.81,95% CI= 0.67,0.97). In the model with major comorbidities, there was a significant 40% increase in the risk of breast cancer mortality among women diagnosed with both diabetes and hypertension (HR=1.40, 95% CI= 1.01,1.93). In the model with BMI, there was no significant association with risk of breast cancer mortality. These results were essentially unchanged with all variables in a single model.

For all-cause mortality, the PA-only model showed a significant PA effect with the hazard decreasing from 20% to 40% across quartiles (Q2 HR=0.80, 95% CI=0.71,0.90, Q4 HR=0.62, 95% CI=0.54,0.71). In the comorbidity-only model, both diabetes and hypertension significantly increased hazard of all-cause mortality 80% and 33%, respectively. Having both diagnoses was associated with a significant, 2.3 fold increase in all-cause mortality (HR=2.34, 95% CI= 1.95,2.81).

In the BMI-only model, being underweight was associated with a significant 2.4 fold increase in risk of all-cause mortality, and there was a 20 and 37% increase in risk associated with being categorized as obese I or II (Obese I HR=1.23, 95% CI=1.07,1.40, Obese II HR=1.37, 95% CI=1.16,1.61).

With all three variables in the model, the risk associated with being obese decreased and became non-significant (Obese I HR=1.06, Obese II HR=1.05), while the significance, strength, and direction of the association of comorbidities and PA with all-cause mortality remained constant.

Conclusion: These data suggest that post-diagnosis comorbidities and lack of physical activity, rather than high BMI , are the important risk factors for all-cause and breast cancer specific mortality. While needing further validation, these suggest that physical activity interventions and monitoring treatment for comorbidities should become standard of care for breast cancer survivors.

Citation Format: Nelson SH, Marinac CR, Patterson RE, Nachuta SJ, Caan BJ, Chen WY, Shu X-O, Pierce JP. Post-diagnosis physical activity and comorbidities, not BMI, explain mortality risk in the after breast cancer pooling project. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD4-08.

Effects of hemoglobin-based blood substitutes on vasoactivity of rat aortic rings

Our objective is to characterize the vasoactive properties of a 10% alphaalpha diaspirin cross-linked human hemoglobin (alphaalphaHb) and to test the hypothesis that sodium nitroprusside (SNP)-induced relaxation is inhibited in the presence of alphaalphaHb. Experiments were performed on aortic rings from 18 Wistar rats; the rings were suspended in aerated Krebs solution. Changes in isometric tension were measured to increasing concentrations of alphaalphaHb (1.8 x 10(-9) to 10(-4) M) on phenylephrine (PE)-induced contraction (3 x 10(-7) M), on acetylcholine (ACh)-induced relaxation (10(-8) to 10(-6) M), on SNP-induced relaxation (10(-9) and 10(-8) M), and on PE-induced contraction with an endothelin-1 (ET1) receptor antagonist, BQ123 (10(-5) M). Control rings received no alphaalphaHb. A concentration-dependent increase of the PE-precontraction (1.3%, 6.8%, 17.4%, and 34%, respectively) as well as the inhibition and reversal of ACh-induced relaxation was observed after alphaalphaHb. The presence of alphaalphaHb decreased the SNP-induced relaxation in the presence or absence of endothelium. The relaxation induced by SNP was reduced with time in the presence, but not in the absence, of alphaalphaHb. In conclusion, although pharmacological modulation of the vasoconstriction is possible with nitric oxide donors, our findings suggest that in the clinical setting, large sustained donor doses may be required.

Increased nitric oxide synthase activity and expression in the human uterine artery during pregnancy

Evidence exists that NO plays a role in the vasodilation that occurs during pregnancy. The purpose of the present study was to determine whether the role of NO is associated with an increase in the activity and protein expression of NO synthase (NOS) in the human uterine artery. Uterine arteries were obtained from pregnant patients (P arteries) and nonpregnant patients (NP arteries). NOS activity was estimated with the L-[(3)H]-arginine-to-L-[(3)H]-citrulline conversion method and on the basis of changes in tissue levels of cGMP. Western immunoblotting and immunohistochemistry were used to assess NOS protein expression. Ca(2+)-dependent NOS activity was 8 times greater (P:<0.01) in P than in NP arteries. Although most of this pregnancy-induced increase in NOS activity was Ca(2+) dependent (64%), a considerable portion was Ca(2+) independent. Expressions of endothelial NOS (eNOS) and neuronal NOS, but not inducible NOS, were demonstrated in P and NP arteries. The eNOS was located in the endothelium and stained with a qualitative order of P arteries>NP arteries (follicular)>NP arteries (luteal). The neuronal NOS was located in the adventitia of P and NP arteries. Basal NO-dependent and bradykinin-stimulated levels of cGMP were higher (P:<0.05) in P than in NP arteries. These results indicate that an upregulation of eNOS protein expression could account for the increased NO synthesis/release in the human uterine artery during pregnancy.

A role for nitric oxide in endotoxin-induced depletion of the peripheral catecholamine stores

Endotoxemia is associated with increased sympathetic nerve activity and depletion of norepinephrine (NE) and epinephrine (EPI) contents in the adrenal gland and in sympathetically innervated tissues. Endotoxin (bacterial lipopolysacchride [LPS]) causes an increased production of nitric oxide (NO) by inducing nitric oxide synthase (iNOS) expression in various tissues. This increased production of NO contributes significantly to the hypotension associated with endotoxemia. At high concentrations, NO also can act as a neurotoxin. In this study we tested the hypothesis that increased production of NO is involved in depletion of catecholamine content in various tissues from rats treated with a nonlethal dose of LPS. Catecholamine content was measured by high-performance liquid chromatography with electrochemical detection (HPLC-EC) and NOS activity was measured by the 3H-I-arginine to 3H-I-citrulline conversion method. The NE content was decreased in rat adrenal gland, lung, spleen, tail artery, and aorta after LPS. The maximal decrease was at 24 h and returned to control levels at 6 days (144 h). There was no depletion of the NE content in the heart. The EPI content in the adrenal gland was greatly depleted (91%) from 12 to 72 h after LPS. LPS increased the NOS activity in all tissues examined. The time course for NOS activity showed an increase at 3 h, a further increase at 6 h, and a return to control level at 48 h after LPS. The increase in NOS activity occurred before maximal catecholamine depletion. Aminoguanidine, a relatively selective iNOS inhibitor, completely prevented NE depletion in all tissues and partially prevented adrenal EPI depletion induced by LPS. These results are consistent with the hypothesis that LPS-induced production of NO plays a role in depletion of tissue NE and EPI.

Regulation of adrenal angiotensin receptor subtypes: a possible mechanism for sympathectomy-induced adrenal hypertrophy

OBJECTIVE

Previous studies indicate that the adrenal gland plays a compensatory role in the maintenance of blood pressure in chemically sympathectomized rats. However, the mechanisms responsible for compensatory adrenal responses are poorly understood. This study examined the regulation of adrenal growth and type 1 A, 1 B, and type 2 angiotensin II (Ang II) receptor (AT1A, AT1B and AT2) expression in the adrenal gland induced by sympathectomy.

METHODS

Five-week-old male Sprague-Dawley rats were treated with either guanethidine (50 mg/kg per day, intraperitoneally) or vehicle for 5 weeks. Norepinephrine and epinephrine levels in the atrium of the heart were measured by high-pressure liquid chromatography. Plasma renin activity was determined by radioimmunoassay. Adrenal AT1 and AT2 receptor density was determined by radioligand binding assay. Adrenal AT1A, AT1B and AT2 mRNA levels were determined by Northern blot analysis.

RESULTS

Norepinephrine and epinephrine levels in the atrium of the heart were decreased 86% (P < 0.0001) and 58% (P < 0.05) by guanethidine treatment, respectively. Plasma renin activity was decreased 71% (P< 0.001) in guanethidine-treated rats compared with vehicle. In contrast, the ratio of adrenal to body weight was increased 38% in guanethidine-treated rats compared with vehicle (P< 0.001). Adrenal AT1 and AT2 receptor density was increased by guanethidine treatment (P< 0.05). Adrenal mRNA levels for AT2 (P< 0.001) and AT1A (P< 0.01), but not AT1B (P>0.05), were increased in guanethidine-treated rats compared with vehicle (P< 0.01). There were positive correlations between adrenal weight and AT2 (r = 0.9, P< 0.001) and AT1A (r = 0.6, P< 0.05) but not AT1B (r = - 0.01, P > 0.05) expression.

CONCLUSIONS

Impairment of the sympathetic nervous system with guanethidine withdraws the normal stimulation of this system on the circulating renin-angiotensin system, but upregulates the expression of adrenal Ang II receptors. Increased expression of adrenal AT2 and AT1A receptors may play an important role in adaptive adrenal hypertrophy and hormonal responses to sympathectomy.

Pregnancy augments nitric oxide-dependent dilator response to acetylcholine in the human uterine artery

The influence of pregnancy on the dilator effects of acetylcholine in the isolated human uterine artery was investigated. Acetylcholine (0.1 nM to 0.1 microM) produced concentration- and endothelium-dependent relaxation of norepinephrine (3 microM)-induced contraction. The relaxation was greater in arteries from pregnant patients (P arteries) than from non-pregnant patients (NP arteries). The maximal relaxation was 53.5+/-3.4% (n=21) in P arteries and 23.5+/-2.5% (n=35) in NP arteries. In both P and NP arteries the cholinergic relaxation was increased in the presence of superoxide dismutase and greatly reduced in the presence of the nitric oxide synthase inhibitors, NG-mono-methyl L-arginine (L-NMMA) and L-nitro-arginine-methylester (L-NAME). The effect of these nitric oxide synthase inhibitors was reversed by L-arginine. We conclude that pregnancy enhances acetylcholine-induced nitric oxide synthesis and release in the human uterine artery.

Regulation of type 1 ANG II receptor in vascular tissue: role of alpha1-adrenoreceptor

Angiotensin II (ANG II) and norepinephrine (NE) are important regulators of vascular function and structure. Recent studies showed that there are multiple interactions between these two potent vasoconstrictor agents. The present experiment was designed to investigate the effect of NE on the expression of the type 1 ANG II receptor (AT1) in the aorta and cultured vascular smooth muscle cells (VSMC) of rats. Rats were subcutaneously infused with either NE (0.5 microg x kg(-1) x min(-1), n = 6) or the alpha1-adrenoreceptor antagonist prazosin (3.5 microg x kg(-1) x min(-1), n = 6) for 2 wk. Body weight and tail cuff systolic blood pressure were not modified compared with the vehicle control (P > 0.05). Northern blot analysis showed that AT1 mRNA levels in aorta were decreased by 38% in NE-treated rats and increased 117% in prazosin-treated rats (P < 0.05) compared with control. To determine whether NE directly regulates expression of vascular AT1 mRNA and AT1 receptor density, Northern blot analysis and radioligand binding experiments were performed in cultured VSMC. Incubation of VSMC with NE (10(-7) M) led to 44% decrease in AT1 mRNA levels (P < 0.05) and 39% decrease in AT1 receptor density (P < 0.05). Prazosin, but not the alpha2-adrenoreceptor antagonist yohimbine, prevented NE-induced decrease in AT1 mRNA and AT1 receptor density in these cells. Taken together, our results indicate that vascular AT1 gene expression and receptor protein are regulated by ambient NE levels, and NE-induced downregulation of AT1 mRNA and receptor protein is mediated, at least in part, by activating alpha1-adrenoreceptors.

Differential effects of prolonged septicemia on isolated pulmonary arteries and veins from sheep

Isolated third-order pulmonary arteries and veins from sheep were examined for the effects of septicemia on norepinephrine-induced contractions, nitric oxide (NO)-mediated dilation, and basal cyclic GMP levels. The groups studied were as follows: control sheep (n = 7); sheep given live Pseudomonas aeruginosa (Ps, n = 6) for 48 h; and sheep given NG-mono-methyl-L-arginine during the last 24 h of Ps infusion (Ps-L-NMMA, n = 4). The norepinephrine-induced contractions were significantly greater (p < .05) in arteries from septic (Ps and Ps-L-NMMA) sheep. Basal cyclic GMP levels were similar in all of the arteries. The norepinephrine-induced contractions were significantly depressed (p < .05) in veins from septic (Ps and Ps-L-NMMA) sheep. Basal cyclic GMP levels in veins from Ps sheep were markedly elevated (p < .01). N omega-nitro-L-arginine methyl ester (L-NAME) ex vivo decreased cyclic GMP in both arteries and veins. Removal of endothelium enhanced contractions and decreased cyclic GMP in arteries and veins only from control sheep. The results show that septicemia differently affects the pulmonary artery and vein. The enhanced vasoconstriction of the artery is due to decreased endothelium-dependent NO release; the attenuated vasoconstriction of the vein is associated with NO-mediated increased cyclic GMP levels.

Changes in regional hemodynamics after nitric oxide inhibition during ovine bacteremia

We studied the action of nitric oxide synthase (NOS) inhibition on changes in regional blood flow during a continuous infusion of live bacteria. Eighteen ewes were chronically instrumented. After a 7-day recovery period, an infusion of 10(6) colony-forming units/min Pseudomonas aeruginosa was begun. At 24 h, cardiac output increased significantly above baseline in all groups (5.9 +/- 0.4 vs. 8.2 +/- 0.6 l.min 1.m-2), systemic vascular resistance decreased (1,362 +/- 120 vs. 821 +/- 145 dyn.g.cm-5.m-2), and cerebral, cephalic mesenteric, and hindlimb blood flows increased. The animals were then equally and randomly assigned to a bolus of a NOS inhibitor, either 25 mg/kg N omega-nitro-L-arginine methyl ester (L-NAME) or 20 mg/kg N omega-monomethyl-L-arginine (L-NMMA), followed by a continuous infusion of 7 mg.kg-1.min-1 L-NMMA or saline. After NOS inhibition, cardiac index decreased [5.6 +/- 0.1 (L-NAME) and 5.5 +/- 0.4 l.min-1.m-2 (L-NMMA)] and remained significantly decreased for 12 h. 1-NAME decreased carotid and mesenteric blood flows to 64% of the preseptic baseline, and they remained below baseline for 20 h. L-NMMA decreased blood flows only to preseptic baseline values. NOS inhibitors may affect blood flows independently of their hemodynamic effects.

Pregnancy-induced alterations of neurogenic constriction and dilation of human uterine artery

The responses to electrical field stimulation (EFS) of perivascular nerves in human uterine arteries were characterized. The arteries were removed from pregnant and nonpregnant patients undergoing hysterectomy. Tetrodotoxin, guanethidine, and phentolamine blocked EFS (2 min, 80 V, 0.1-ms duration)-induced constriction. The constrictions and the endogenous norepinephrine levels were lower (P < 0.01) in uterine arteries from pregnant than from nonpregnant patients. When arterial rings were precontracted, the response to EFS was biphasic, consisting of an initial constriction followed by a postconstriction relaxation. The EFS-induced relaxation was endothelium independent and was greater (P < 0.01) in uterine arteries from pregnant than from nonpregnant patients. The relaxation was enhanced by guanethidine and superoxide dismutase, inhibited by nitric oxide synthase inhibitors, blocked by tetrodotoxin, and unaffected by atropine, propranolol, or indomethacin. The results demonstrate that human uterine arteries respond to EFS with contraction and relaxation and that these responses may be mediated, respectively, by norepinephrine and, in part, by nitric oxide released from periarterial nerves. The decrease in neuronally mediated uterine arterial constriction and the increase in dilation could be physiological mechanisms for ensuring appropriate uteroplacental perfusion.

Isolated, perfused rabbit ear artery: a model for studying segmental vasoconstriction and dilatation

Severe increases in blood pressure (BP) are associated with a segmental pattern of constriction and dilatation in small arteries and arterioles, but the pathogenesis is poorly understood. We showed that the isolated, perfused rabbit ear artery typically develops segmental constriction and dilatation when intraluminal pressure is > 160-180 mm Hg during field stimulation of perivascular nerves (> 6 Hz) or extra- or intraluminal infusions of norepinephrine (NE > 10(-7) M) or phenylephrine (PE) (> 5 x 10(-7) M). Light, transmission, and scanning electron microscopy showed that the dilated vessel segments initially show endothelial injury with no smooth muscle lesions. After repeated or prolonged exposure to high intraluminal pressure, dilated segments manifest extensive and severe endothelial and smooth muscle damage. Dilated regions also became abnormally permeable to tracer particles (ferritin). Constricted segments did not show evidence of endothelial or smooth muscle injury or hyperpermeability. These changes, i.e., segmental vasoconstriction/dilatation, hyperpermeability, and vessel wall damage localized to dilated segments, are comparable to those that occur in small arteries and arterioles during severe hypertension. We discuss the potential usefulness of the isolated ear artery as a model for studying the pathogenesis and morphology of segmental vasoconstriction/dilatation.

Relaxation by calcitonin gene-related peptide may involve activation of K+ channels in the human uterine artery

The vasodilatory role of calcitonin gene-related peptide in activating K+ channels was examined in isolated, suffused human uterine arteries. Calcitonin gene-related peptide produced a concentration-dependent relaxation of norepinephrine (1 microM)-induced contractions. Calcitonin gene-related peptide was antagonized by glybenclamide (1-100 microM), an inhibitor of ATP-sensitive K+ channels, but not by tetraethylammonium (1 mM), an inhibitor of calcium(2+)-activated K+ channels. Glybenclamide (10 microM) produced a 6.7 fold and an 11-fold shift to the right of calcitonin gene-related peptide (0.1 to 100 nM) in uterine arteries from pregnant patients (n = 3) and nonpregnant patients (n = 6), respectively. Calcitonin gene-related peptide (10 nM) less effectively (P < 0.05) relaxed contractions produced by KCl (50 mM) (29.4 +/- 1.6%) than by norepinephrine and glybenclamide (10 microM) did not reverse this relaxation (22.2 +/- 6.8%, n = 4 nonpregnant patients). Pinacidil (1 microM), an ATP-sensitive K+ channel opener, relaxed norepinephrine-induced contractions of uterine arteries. Glybenclamide (10 microM) also antagonized pinacidil. These results suggest that calcitonin gene-related peptide relaxes norepinephrine-contracted human uterine arteries, at least in part, by activation of a K+ channel, perhaps of the ATP-sensitive type.

Quality assurance in the department of pediatrics. An application of quality management

A continuous quality improvement program can provide the means through which medical organizations can guide their activities. This article illustrates how a pediatrics department in an urban medical center incorporated continuous quality improvement into the management of health services. Key elements of the Quality Assurance program included the organization and facilities in the department of pediatrics, important processes related to patient care, and outcome measures. If a structure is established that allows participation in decision-making and mutual adjustment, trained professionals can perform up to their standards and those standards of their peers. Involvement of physicians in the design of quality management programs and other administrative strategies offer an opportunity to develop a working formula for ongoing success.

Possible physiologic role of calcitonin gene-related peptide in the human uterine artery

OBJECTIVE

The purpose of our study was to determine the potential physiologic role of calcitonin gene-related peptide as an endogenous vasodilator of human uterine arteries during pregnancy.

STUDY DESIGN

Isolated, suffused uterine arteries from pregnant patients (n = 9) and nonpregnant patients (n = 19) were used in the study.

RESULTS

Calcitonin gene-related peptide (1 nmol/L to 0.1 mumol/L) produced a concentration-dependent relaxation of norepinephrine (1 mumol/L)-induced contractions. The values of calcitonin gene-related peptide that inhibited norepinephrine-induced contractions by 50% were 0.9 +/- 0.7 nmol/L (n = 8) and 6.5 +/- 1.5 nmol/L (n = 12) in pregnant and nonpregnant arteries, respectively. The calcitonin gene-related peptide-induced relaxation was not affected by propranolol (1 mumol/L), indomethacin (5 mumol/L), methylene blue (10 mumol/L), or by the removal of the endothelium. The relaxant effect of calcitonin gene-related peptide was inhibited by human calcitonin gene-related peptide(8-37). The endogenous levels of calcitonin gene-related peptide were 110.2 +/- 13.5 pmol/L/gm wet weight in pregnant arteries and 14.8 +/- 3.2 pmol/L/gm wet weight in nonpregnant arteries.

CONCLUSIONS

These results demonstrate that the vasodilatory effect of calcitonin gene-related peptide is mediated by calcitonin gene-related peptide1 receptors and does not involve beta-adrenoceptors, vasodilator prostanoids, increased levels of guanosine 3',5'-cyclic monophosphate, or endothelium-derived relaxing factor. The findings that calcitonin gene-related peptide acts as a potent dilator and that pregnancy increases both the sensitivity to calcitonin gene-related peptide and the endogenous levels of calcitonin gene-related peptide support the view that calcitonin gene-related peptide has a physiologic role in dilating the uterine vasculature, especially during pregnancy.

Lack of reactivity of uterine arteries from patients with obstetric hemorrhage

Obstetric hemorrhage may occur throughout pregnancy and the puerperium. The purpose of this study was to investigate the reactivity of isolated, suffused uterine arteries from obstetric patients with uncontrollable uterine bleeding and to compare those blood vessels with uterine arteries from patients undergoing cesarean hysterectomy for other medical reasons (control patients). The uterine arteries from the control patients (n = 9) responded with maximal or near-maximal constriction to norepinephrine (30 mumol/L, 3.6 +/- 1 gm), potassium chloride (75 mmol/L, 10.2 +/- 3 gm), prostaglandin F2 alpha (30 mumol/L, 1.8 +/- 1 gm), and arginine vasopressin (1 mumol/L, 18.8 +/- 2.6 gm). In uterine arteries from five patients with uncontrollable bleeding, the constrictor responses to the same drugs were markedly depressed: norepinephrine (30 mumol/L, 0.5 +/- 0.2 gm), potassium chloride (75 mmol/L, 1.9 +/- 0.8 gm); prostaglandin F2 alpha (30 mumol/L, 0 gm), and arginine vasopressin (1 mumol/L, 0.2 +/- 0.05 gm). Uterine arteries from two patients exhibited no constrictor responses to norepinephrine (30 mumol/L), potassium chloride (75 mmol/L), prostaglandin F2 alpha (30 mumol/L), or arginine vasopressin (1 mumol/L). The impaired responses to the vasoconstrictor drugs were not reversed by indomethacin (1 mumol/L), which is an inhibitor of prostaglandin synthetase; methylene blue (10 mumol/L), which is a blocker of endothelium-derived relaxing factor activation of guanylate cyclase; or propranolol (1 mumol/L), a beta-adrenergic receptor antagonist. The levels of adenosine 3':5'-cyclic monophosphate were not elevated in the uterine arteries from the patients with obstetric hemorrhage. The impaired reactivity to the multiple vasoconstrictors implies that a mechanism involved in constriction common to all of the constrictors is depressed or blocked. Furthermore, the depression or lack of reactivity of these isolated uterine arteries is not mediated by vasodilatory prostaglandins, endothelium-derived relaxing factor, beta-adrenergic receptors, or elevated levels of adenosine 3':5'-cyclic monophosphate. The results suggest that obstetric hemorrhage involves, in part, a lack of constrictor reactivity of the uterine vasculature.

An overview of mental health services for American Indians and Alaska Natives in the 1990s

Native Americans appear to be at higher risk than other U.S. ethnic groups for mental health problems, including depression, substance abuse, domestic violence, and suicide. Despite recent increases in the federal budget for mental health services for Native Americans, less than 50 percent of the estimated need for ambulatory services is being met. Initiatives to improve the quantity and quality of mental health services for Native Americans in the 1990s include development of a national mental health plan, increased technical assistance to Native American communities, additional training and research, and continued attention to standards that promote high-quality, culturally relevant care. Tribes themselves are seen as the most appropriate locus for initiation of programs for preventing emotional problems in their communities.

Magnesium sulfate-induced relaxation of uterine arteries from pregnant and nonpregnant patients

The effects of magnesium sulfate at different concentrations were investigated in isolated rings of uterine arteries from pregnant and nonpregnant patients. Addition of magnesium sulfate (0.5 to 9.6 mmol/L) to the suffusion medium containing the normal concentration of 1.2 mmol/L magnesium sulfate produced concentration-dependent relaxation of norepinephrine (1 mumol/L)-induced or potassium chloride (35 mmol/L)-induced contractions. Magnesium sulfate was about three times more potent in causing inhibition of potassium chloride-induced contractions in uterine arteries from pregnant patients than in those from nonpregnant patients. The concentrations that inhibited 50% of the contraction induced by potassium chloride were 0.6 +/- 0.2 mmol/L (n = 4) in the arteries from pregnant patients and 1.6 +/- 0.2 mmol/L (n = 4) in the arteries from nonpregnant patients. At high concentrations (4.8 and 9.6 mmol/L), magnesium sulfate also was more potent in inhibiting norepinephrine-induced contractions in arteries from pregnant women than in arteries from nonpregnant women. The magnesium sulfate-induced relaxation was almost completely inhibited by calcium chloride (2 mmol/L) added to the suffusion medium containing the normal concentration of 2.5 mmol/L calcium chloride but was not affected by indomethacin (5 mumol/L), methylene blue (10 mumol/L), or removal of the endothelium. The results show that magnesium sulfate, at therapeutic blood concentrations, acts as a potent dilator of human uterine arteries, especially those from pregnant patients. The results are consistent with the view that magnesium sulfate may facilitate uteroplacental perfusion.

Cocaine inhibits baroreflex control of blood pressure by actions at arterial baroreceptors

Blood pressure and heart rate often increase during cocaine intoxication, but the mechanisms of these cardiovascular responses are poorly understood. The most often suggested theories are central nervous system mechanisms involving the blockade of neuronal transmitter uptake. Cocaine also has potent local anesthetic properties, and in this study we tested the possible role of peripheral actions of cocaine at baroreceptor afferents. Single fiber baroreceptors were recorded using an in vitro preparation of the rat aortic arch. Diameter, pressure, and baroreceptor discharge were recorded. Cocaine perfused through the lumen of the aortic arch at a suprathreshold pressure reduced baroreceptor discharge within 90 s of entering the lumen of the aorta. Slow ramps of pressure elicited complete pressure- and diameter-discharge curves every 5 min. Beginning at about 1 microM, cocaine inhibited baroreceptor function; threshold increased, the maximum discharge decreased, and at 100 microM cocaine, all discharge ceased. The vasodilator nitroprusside or the alpha 1-adrenoreceptor antagonist prazosin did not affect baroreceptor responses to cocaine. In in vivo tests in rabbits, cocaine that perfused through a vascularly isolated carotid sinus reduced the slope of the baroreflex relationship between carotid sinus pressure and systemic mean arterial pressure. Significant depression of baroreceptor function was found at concentrations similar to the plasma cocaine levels measured in clinical studies. The local anesthetic properties of cocaine may be involved in baroreceptor effects. Our studies suggest a possible contributing role of a new site of action of cocaine outside the central nervous system. Compromise of baroreceptor reflexes could facilitate the development of serious cardiovascular complications associated with cocaine abuse.

Values and priorities: their effect on knowledge utilization in public mental health programs

Developing and maintaining shared values and priorities in public mental health systems is crucial to clinical, program, policy and administrative success. The issues of establishing priority populations, mobilizing resources, and improving quality of care and personal leadership style are discussed as examples of the ways in which such consensus contributed to progress in Pennsylvania's public mental health system.

Cell polarity in sea urchin embryos: reorientation of cells occurs quickly in aggregates

Four apical components were used as markers for the apical end of the cell in studies centering on cell polarity in the early blastula stage of sea urchin embryos and in aggregates of cleavage stage cells. Cells were observed to maintain their polarity for several hours if dissociated and cultured in suspension. Orientation of cells in aggregates initially is random; however, within 3 hr the cells have reoriented so that their apical-basal axis corresponds to the correct inside-outside position in the aggregate. This reorientation occurs before formation of a basal lamina or a new hyalin layer in the aggregate, and appears to take place by a rotation or other movement of individual cells. The polarity within each cell is maintained during reorientation. An apical surface antigen is colocalized with concentrations of filamentous actin. Treatment of isolated cells with cytochalasin B causes the antigen to lose its apical position and eventually become distributed around the outside of the cell. Microtubules are visible radiating from two foci closely associated with the nucleus in untreated cells. Treatment of isolated cells with nocodazole leaves the apical cell surface marker and its associated actin undisturbed, but causes the nucleus to lose its apical position. Cytochalasin B and colchicine both prevent reorientation of cells in aggregates. Thus polarity appears to be a constant for the cells, and their reorientation in aggregates occurs prior to the polarized release of extraembryonic matrix and basal lamina.

Comparison of nitroprusside and hydralazine in isolated uterine arteries from pregnant and nonpregnant patients

The purpose of the present study was to determine the relative potency of nitroprusside and hydralazine with respect to inhibition of norepinephrine-induced contraction of isolated, uterine arteries from pregnant and nonpregnant patients. The arteries, obtained after hysterectomy, were dissected free from surrounding tissue, and arterial rings were prepared and mounted in tissue chambers filled with Kreb's-bicarbonate solution. Isometric tension was recorded. At concentrations of 10(-9) M to 10(-5) M, both nitroprusside and hydralazine produced concentration-dependent inhibition of the contractile response to norepinephrine. Nitroprusside and hydralazine were more potent in relaxing arteries contracted by a lower concentration (3 X 10(-6) M) of norepinephrine than by a higher concentration (10(-5) M) of norepinephrine. Regardless of the concentration of norepinephrine, nitroprusside was considerably more potent than hydralazine. The concentrations of nitroprusside that produced 50% inhibition (IC50) of the contractile response to norepinephrine (3 X 10(-6) M) in uterine arteries from pregnant and nonpregnant patients were 3.2 +/- 0.5 X 10(-9) M (n = 5) and 1.2 +/- 0.1 X 10(-9) M (n = 6), respectively. The IC50 values for hydralazine acting against norepinephrine (3 X 10(-6) M) in the uterine arteries from pregnant and nonpregnant patients were 5.1 +/- 0.5 X 10(-7) M (n = 5) and 4.0 +/- 0.5 X 10(-7) M (n = 6), respectively. Nitroprusside (10(-6) M), compared to hydralazine (10(-5) M), produced the greater maximal inhibition of norepinephrine-induced contraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Pregnancy: increased effect of verapamil in human uterine arteries

The effect of verapamil on the contractile response to norepinephrine in isolated, suffused uterine arteries from pregnant and nonpregnant humans was investigated. The arteries, obtained after hysterectomy, were dissected free from surrounding tissue and arterial rings were prepared and mounted in tissue chambers filled with Krebs-bicarbonate solution. Isometric tension was recorded. There was no significant difference between arteries from pregnant patients and arteries from nonpregnant patients when maximal contractile response and sensitivity to norepinephrine were compared. At concentrations of 0.3 and 3 microM, verapamil attenuated the response to norepinephrine in uterine arteries from both pregnant and nonpregnant patients. However, verapamil was significantly more potent in blocking the response to norepinephrine in arteries from pregnant patients.

Neuronal dopamine receptors of the rabbit ear artery: pharmacological characterization of the receptor

Dopamine and apomorphine were examined in the rabbit isolated perfused ear artery for both direct effects on vascular smooth muscle and effects on the response to field stimulation of sympathetic nerve terminals. The neuroinhibitory effect of both dopamine (EC50 = 37 nM) and apomorphine (EC50 = 44 nM) occurred at concentrations which did not produce vasoconstriction. The neuroinhibitory effect of dopamine was shown to be due to inhibition of noradrenaline release by measurement of 3H-overflow from prelabelled tissues. At relatively high concentrations dopamine produced vasoconstriction. In a superfused segment of ear artery, dopamine was found to be a full agonist at the alpha 1-adrenoreceptor, with an EC50 (15 microM) about 75 fold higher than the EC50 for noradrenaline. At concentrations up to 3 microM, apomorphine had no vasoconstrictor activity in the perfused ear artery. Representative examples of several classes of dopamine antagonists, including the phenothiazines, butyrophenones, diphenylbutylpiperidines and benzamides produced competitive antagonism of dopamine or apomorphine-induced inhibition, with nearly identical Kb values against these two agonists. The pharmacological characteristics of the neuronal dopamine receptor on the rabbit ear artery would indicate this receptor to be typical of the D2 subclass, and this tissue to be a useful model for quantitative studies on dopamine receptor agonists and antagonists.

Dopamine receptors: structure-activity relationship of d-tubocurarine analogues

d-Tubocurarine (dTC) and d-tubocurine acted as antagonists of the dopamine-induced inhibition of adrenergic neurotransmission in the isolated, perfused rabbit ear artery. N-Methyl-dTC and O,O,N-trimethyl-dTC (metocurine) did not exhibit dopaminergic antagonist activity. dTC contains one tertiary (3 degrees) nitrogen and one quaternary (4 degrees) nitrogen and d-tubocurine contains two 3 degrees nitrogens; whereas, both N-methyl-dTC and O,O,N-trimethyl-dTC have two 4 degrees nitrogens. The results suggest that a dTC analogue (e.g., metocurine) which lacks a 3 degrees nitrogen should be considered for use in patients treated with dopamine.

d-Tubocurarine as a dopaminergic antagonist in the rabbit ear artery

d-Tubocurarine has been reported to inhibit the action of dopamine on mollusc neurons. The purpose of the present study was to determine whether or not d-tubocurarine acts as an antagonist on mammalian dopamine receptors. The isolated, perfused rabbit ear artery was the experimental preparation used. In this preparation dopamine and apomorphine produced concentration-dependent inhibition of the response to electrical field stimulation of the periarterial sympathetic nerves. d-Tubocurarine antagonized the inhibitory effect of dopamine and apomorphine in a competitive manner. The calculated dissociation constants for d-tubocurarine acting against dopamine and apomorphine were 1.9 +/- 0.6 microM and 1.7 +/- 0.5 microM, respectively. d-Tubocurarine (1-100 microM), by itself, did not affect the response of the artery to sympathetic nerve stimulation. Other nicotinic antagonists hexamethonium, pancuronium and mecamylamine did not affect the dopamine action. These results suggest that d-tubocurarine could attenuate the therapeutic benefit of dopamine if both of these drugs are administered concomitantly.

Interactions of salsolinol and its mono-O-methylated analogs with adrenergic and dopaminergic receptors in the rabbit ear artery

We have examined the action of the tetrahydroisoquinoline derivatives salsolinol, 6-O-methyl salsolinol (6-O-Me-Sal) and 7-O-methyl salsolinol (7-O-Me-Sal) on adrenergic and dopaminergic receptors in the isolated and perfused rabbit ear artery. The racemic form of the three compounds and the S-(--)-isomer of 6-O-Me-Sal were used. Salsolinol (0.3-10 micrometers) produced concentration-dependent inhibition of the vasoconstrictor response to electrical stimulation of the periarterial sympathetic nerves but did not inhibit the vasoconstrictor response to exogenous norepinephrine. The inhibitory effect of salsolinol on neurotransmission was antagonized by yohimbine, but not by sulpiride or propranolol. The dissociation constant (KB) for yohimbine acting as an antagonist of salsolinol was 98 +/- 8 nM. 6-O-Me-Sal and 7-O-Me-Sal did not affect the response to nerve stimulation or norepinephrine administration; however, these mono-O-methylated analogs of salsolinol antagonized the inhibition of neurotransmission produced by dopamine. The KB values for 6-O-Me-Sal and 7-O-Me-Sal acting as antagonists of dopamine were 1.3 +/- 0.2 and 6.4 +/- 0.31 microM, respectively. S-(--)-6-O-Me-Sal, with a KB value of 0.64 +/- 0.06 microM, was about twice as potent as racemic 6-O-Me-Sal. We conclude that salsolinol acts as an agonist on prejunctional alpha adrenergic receptors and that 6-O-Me-Sal and 7-O-Me-Sal act as antagonists on dopaminergic receptors.

Standards affecting mental health care: a review and commentary

The author describes the increasing focus on regulation and the standards applied to the field of mental health. He discusses four distinct but overlapping types of standards: 1) clinical, 2) practitioner, 3) program and facility, and 4) payment. He emphasizes the increasing influence of legislation and judicial decisions and points out several trends in standard setting affecting mental health care. Psychiatrists and other mental health practitioners are called on to take a larger role in shaping these standards to ensure that the quality of patient care is not compromised.

Cholinergic Vesicles: Ability to Empty and Refill Independently of Cytoplasmic Acetylcholine

Incubation of minced mouse-forebrain tissues in lithium Krebs solution reduces the acetylcholine content of the vesicular fraction 70 percent without altering that of the cytoplasmic fraction. Depleted vesicular-bound acetylcholine can be restored with newly synthesized acetylcholine (formed from extracellular choline) independently of the cytoplasmic pool. Depletion of vesicular-bound acetylcholine does not facilitate the movement of preformed extracellular acetylcholine into vesicles.

Current issues in national insurance for mental health services

The current economic crisis has again placed in jeopardy the inclusion of mental health benefits under national health insurance. The author notes that progress has been made in establishing effective peer review systems and in demonstrating that costs of mental health services are reasonable. Yet the lack of agreement on diagnosis and appropriate treatment, the inadequacy of utilization, cost, and treatment outcome data, and the absence of professional self-regulation remain causes for concern in the effort toward eventual comprehensive coverage for mental disorders.