Cell-free DNA methylation analysis as a marker of malignancy in pleural fluid

Diagnosis of malignant pleural effusion (MPE) is made by cytological examination of pleural fluid or histological examination of pleural tissue from biopsy. Unfortunately, detection of malignancy using cytology has an overall sensitivity of 50%, and is dependent upon tumor load, volume of fluid assessed, and cytopathologist experience. The diagnostic yield of pleural fluid cytology is also compromised by low abundance of tumor cells or when morphology is obscured by inflammation or reactive mesothelial cells. A reliable molecular marker that may complement fluid cytology for the diagnosis of malignant pleural effusion is needed. The purpose of this study was to establish a molecular diagnostic approach based on pleural effusion cell-free DNA methylation analysis for the differential diagnosis of malignant pleural effusion and benign pleural effusion. This was a blind, prospective case-control biomarker study. We recruited 104 patients with pleural effusion for the study. We collected pleural fluid from patients with: MPE (n = 48), indeterminate pleural effusion in subjects with known malignancy or IPE (n = 28), and benign PE (n = 28), and performed the Sentinel-MPE liquid biopsy assay. The methylation level of Sentinel-MPE was markedly higher in the MPE samples compared to BPE control samples (p < 0.0001) and the same tendency was observed relative to IPE (p = 0.004). We also noted that the methylation signal was significantly higher in IPE relative to BPE (p < 0.001). We also assessed the diagnostic efficiency of the Sentinel-MPE test by performing receiver operating characteristic analysis (ROC). For the ROC analysis we combined the malignant and indeterminate pleural effusion groups (n = 76) and compared against the benign group (n = 28). The detection sensitivity and specificity of the Sentinel-MPE test was high (AUC = 0.912). The Sentinel-MPE appears to have better performance characteristics than cytology analysis. However, combining Sentinel-MPE with cytology analysis could be an even more effective approach for the diagnosis of MPE. The Sentinel-MPE test can discriminate between BPE and MPE. The Sentinel-MPE liquid biopsy test can detect aberrant DNA in several different tumor types. The Sentinel-MPE test can be a complementary tool to cytology in the diagnosis of MPE.

Cell-Free DNA Methylation Analysis as a Marker of Malignancy in Pleural Fluid

Background

Diagnosis of malignant pleural effusion (MPE) is made by cytological examination of pleural fluid or histological examination of pleural tissue from biopsy. Unfortunately, detection of malignancy using cytology has an overall sensitivity of 50%, and is dependent upon tumor load, volume of fluid assessed, and cytopathologist experience. The diagnostic yield of pleural fluid cytology is also compromised by low abundance of tumor cells or when morphology is obscured by inflammation or reactive mesothelial cells. A reliable molecular marker that may complement fluid cytology malignant pleural effusion diagnosis is needed. The purpose of this study was to establish a molecular diagnostic approach based on pleural effusion cell-free DNA methylation analysis for the differential diagnosis of malignant pleural effusion and benign pleural effusion.

Results

This was a blind, prospective case-control biomarker study. We recruited 104 patients with pleural effusion for the study. We collected pleural fluid from patients with: MPE (n = 48), PPE (n = 28), and benign PE (n = 28), and performed the Sentinel-MPE liquid biopsy assay. The methylation level of Sentinel-MPE was markedly higher in the MPE samples compared to BPE control samples (p < 0.0001) and the same tendency was observed relative to PPE (p = 0.004). We also noted that the methylation signal was significantly higher in PPE relative to BPE (p < 0.001). We also assessed the diagnostic efficiency of the Sentinel-MPE test by performing receiver operating characteristic analysis (ROC). For the ROC analysis we combined the malignant and paramalignant groups (n = 76) and compared against the benign group (n = 28). The detection sensitivity and specificity of the Sentinel-MPE test was high (AUC = 0.912). The Sentinel-MPE appears to have better performance characteristics than cytology analysis. However, combining Sentinel-MPE with cytology analysis could be an even more effective approach for the diagnosis of MPE.

Conclusions

The Sentinel-MPE test can discriminate between BPE and MPE. The Sentinel-MPE liquid biopsy test can detect aberrant DNA in several different tumor types. The Sentinel-MPE test can be a complementary tool to cytology in the diagnosis of MPE.

Phenotypes of disease severity in a cohort of hospitalized COVID-19 patients: Results from the IMPACC study

BACKGROUND

Better understanding of the association between characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19) and outcome is needed to further improve upon patient management.

METHODS

Immunophenotyping Assessment in a COVID-19 Cohort (IMPACC) is a prospective, observational study of 1164 patients from 20 hospitals across the United States. Disease severity was assessed using a 7-point ordinal scale based on degree of respiratory illness. Patients were prospectively surveyed for 1 year after discharge for post-acute sequalae of COVID-19 (PASC) through quarterly surveys. Demographics, comorbidities, radiographic findings, clinical laboratory values, SARS-CoV-2 PCR and serology were captured over a 28-day period. Multivariable logistic regression was performed.

FINDINGS

The median age was 59 years (interquartile range [IQR] 20); 711 (61%) were men; overall mortality was 14%, and 228 (20%) required invasive mechanical ventilation. Unsupervised clustering of ordinal score over time revealed distinct disease course trajectories. Risk factors associated with prolonged hospitalization or death by day 28 included age ≥ 65 years (odds ratio [OR], 2.01; 95% CI 1.28-3.17), Hispanic ethnicity (OR, 1.71; 95% CI 1.13-2.57), elevated baseline creatinine (OR 2.80; 95% CI 1.63- 4.80) or troponin (OR 1.89; 95% 1.03-3.47), baseline lymphopenia (OR 2.19; 95% CI 1.61-2.97), presence of infiltrate by chest imaging (OR 3.16; 95% CI 1.96-5.10), and high SARS-CoV2 viral load (OR 1.53; 95% CI 1.17-2.00). Fatal cases had the lowest ratio of SARS-CoV-2 antibody to viral load levels compared to other trajectories over time (p=0.001). 589 survivors (51%) completed at least one survey at follow-up with 305 (52%) having at least one symptom consistent with PASC, most commonly dyspnea (56% among symptomatic patients). Female sex was the only associated risk factor for PASC.

INTERPRETATION

Integration of PCR cycle threshold, and antibody values with demographics, comorbidities, and laboratory/radiographic findings identified risk factors for 28-day outcome severity, though only female sex was associated with PASC. Longitudinal clinical phenotyping offers important insights, and provides a framework for immunophenotyping for acute and long COVID-19.

FUNDING

NIH.

Comparison of three anti-coccidioides antibody enzyme immunoassay kits for the diagnosis of coccidioidomycosis

Coccidioidomycosis is a common cause of community-acquired pneumonia in endemic areas of the southwestern United States. Clinical presentations range from self-limited disease to severe, disseminated disease. As such, early and accurate diagnosis is essential to ensure appropriate treatment and monitoring. Currently available diagnostic testing has variable accuracy, particularly in certain patient populations, and new tests may offer improved accuracy for the diagnosis of coccidioidomycosis. Serum samples from patients with coccidioidomycosis and controls were tested for immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies using the MVista Coccidioides antibody detection EIA and two commonly used commercial enzyme immunoassay (EIA) kits: the IMMY Omega EIA and the Meridian Premier EIA. The sensitivity of the IgG antibody detection was 87.4% using the MVista test compared to 46.6% for IMMY and 70.9% for Meridian. The sensitivity for IgM antibody detection was 61.2% for the MVista test, 22.3% for IMMY and 29.1% for Meridian. For IgG antibody detection, specificity was 90% for the MVista EIA, 94.6% for IMMY, 96.4% for Meridian. For IgM antibody detection, specificity was 95.3% for the MVista test 98.2% for IMMY and 99.1% for Meridian. The MVista Coccidioides antibody EIA offers improved sensitivity, including among high-risk patient populations, for the detection of IgG and IgM antibodies in comparison to other currently available EIAs.

Abstract 5757: A new functional classification of lung and breast cancers based on siRNA mediated knockdown of 48 NRs and 72 CoRegulators

Introduction: Nuclear receptors (NRs) and their co-regulators (CoRegs) are master regulators of key transcriptional processes important in cancer pathogenesis and could provide molecular biomarkers for prognosis and personalizing new cancer targeted therapy. Aims and Methods: Our goal is to functionally classify a panel of 54 lung cancer, 20 breast cancer, and several immortalized human lung and breast epithelial cell strains based on their growth and survival response to siRNA mediated knockdown of 48 NRs and 72 CoRegs. Following knockdown of individual NR/CoRegs, changes in growth patterns are quantified and statistical methods are used to identify disease subgroups of similar responders. These subgroups are then integrated with our legacy datasets for clinical demographics, cancer cell oncogenotype and genome wide molecular characterization, and responses to standard and targeted chemotherapy. Results and Conclusions: A diverse, representative panel consisting of lung cancer, breast cancer, and normal epithelial cell lines was tested by siRNA transfection. After optimization to determine transfection conditions, all cell lines were screened using a focused siRNA library targeting all 48 NRs and 72 CoRegs (each gene is targeted by pools of 4 different siRNAs, Qiagen). Screening experiments were performed in triplicate, in 96 well plates, in a five-day MTS assay and assays were repeated 3 times. Correlation between replicates for the same cell line is &gt;0.84 and knockdowns were validated by qRT-PCR. We found: 1) NR/CoReg-specific knockdown could have no effect, increase, or decrease tumor cell viability in a cell line dependent manner. 2) Overall ∼70% of the NRs or CoRegs reduced cell viability in at least one tumor line when their expression was knocked down (examples included NURR1, PRMT1, RXRalpha, BRCA1). 3) NR/CoReg-specific tumor cell toxicity was validated independently by siRNA knockdown combined with a liquid colony formation assay. 4) Knockdown of several NR/CoRegs selectively killed tumor but not normal epithelial cells. 5) Tumor cell lines could be stratified into functionally unique categories based on their changes in growth following NR/CoReg-specific knockdowns. We conclude that siRNA mediated knockdown of a large number of NRs and their CoRegs identifies genes that show tumor cell selective toxicity, and that tumor lines vary in their siRNA response phenotypes. These data strengthen the concept for NR/CoReg targeted therapy of lung and breast cancer and also the need to “personalize” such therapy.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5757. doi:1538-7445.AM2012-5757

2D-PCR: a method of mapping DNA in tissue sections

A novel approach was developed for mapping the location of target DNA in tissue sections. The method combines a high-density, multi-well plate with an innovative single-tube procedure to directly extract, amplify, and detect the DNA in parallel while maintaining the two-dimensional (2D) architecture of the tissue. A 2D map of the gene glyceraldehyde 3-phosphate dehydrogenase (GAPDH) was created from a tissue section and shown to correlate with the spatial area of the sample. It is anticipated that this approach may be easily adapted to assess the status of multiple genes within tissue sections, yielding a molecular map that directly correlates with the histology of the sample. This will provide investigators with a new tool to interrogate the molecular heterogeneity of tissue specimens.

High-throughput sequence analysis of the tyrosine kinome in acute myeloid leukemia

To determine whether aberrantly activated tyrosine kinases other than FLT3 and c-KIT contribute to acute myeloid leukemia (AML) pathogenesis, we used high-throughput (HT) DNA sequence ana-lysis to screen exons encoding the activation loop and juxtamembrane domains of 85 tyrosine kinase genes in 188 AML patients without FLT3 or c-KIT mutations. The screen identified 30 nonsynonymous sequence variations in 22 different kinases not previously reported in single-nucleotide polymorphism (SNP) databases. These included a novel FLT3 activating allele and a previously described activating mutation in MET (METT1010I). The majority of novel sequence variants were stably expressed in factor-dependent Ba/F3 cells. Apart from one FLT3 allele, none of the novel variants showed constitutive phosphorylation by immunoblot analysis and none transformed Ba/F3 cells to factor-independent growth. These findings indicate the majority of these alleles are not potent tyrosine kinase activators in this cellular context and that a significant proportion of nonsynonymous sequence variants identified in HT DNA sequencing screens may not have functional significance. Although some sequence variants may represent SNPs, these data are consistent with recent reports that a significant fraction of such sequence variants are "passenger" rather than "driver" alleles and underscore the importance of functional assessment of candidate disease alleles.

Potential targets in prostate tumor–associated stroma

15529

Background: The past 20 years have seen a shift in the paradigm that the stromal compartment in tissues is merely a passive, supporting tissue for epithelial cells. Recent evidence shows that it plays a critical role not only in normal tissue development and homeostasis, but also in the progression of cancer. Further, as the stromal compartment is more readily accessible to vascular-delivered agents, this region might be particularly amenable to clinical intervention. As such, a broad-based study of the carcinoma-associated changes in stromal cells from patient samples could yield a wealth of information on the molecular mechansisms of tumorigenesis, and identify clinically important molecular targets. Methods: Five whole-mount frozen prostatectomy specimens were microdissected in four regions: normal epithelium, tumor epithelium, normal stroma, and tumor-associated stroma. Extracted and amplified mRNA was hybridized to the Human Genome U133 Plus 2.0 GeneChip (Affymetrix). Using the intersection of two statistical analysis packages (GCOS and RMA), we identified differentially expressed genes between the dissection groups. Quantitative RT-PCR was used to validate selected transcripts and immunohistochemistry to evaluate potential stromal molecular targets. Results: Tumor-associated stroma showed a distinctly different expression pattern compared to normal stroma with 675 differentially expressed transcripts, the majority of which were up-regulated. In contrast, tumor epithelium showed more down-regulation in the 829 transcripts that were differentially expressed relative to normal epithelium. Classes of up-regulated genes in the tumor-associated stroma showed a strong linkage to cell adhesion and migration as well as the calcium, MAPK, and TGF-beta signaling pathways. Quantitative RT-PCR was conducted to verify GeneChip findings and revealed over 80% concordance with the original data. Immunohistochemical staining further supported the expression differences. Conclusions: Global mRNA expression analysis of stromal cells within tumors provides insight into prostate cancer progression, and yields novel targets for future diagnostic and therapeutic intervention.

No significant financial relationships to disclose.

Ambulatory instrumentation suitable for long-term monitoring of cattle health

The benefits of real-time health diagnoses of cattle are potentially tremendous. Early detection of transmissible disease, whether from natural or terrorist events, could help to avoid huge financial losses in the agriculture industry while also improving meat quality. This work discusses physiological and behavioral parameters relevant to cattle state-of-health assessment. These parameters, along with a potentially harsh monitoring environment, drive a set of design considerations that must be addressed when building systems to acquire long-term, real-time measurements in the field. A prototype system is presented that supports the measurement of suitable physiologic parameters and begins to address the design constraints for continuous state-of-health determination in free-roaming cattle.

Articular chondrocyte tenascin-C production and assembly into de novo extracellular matrix

Tenascin-C is an oligomeric glycoprotein of the extracellular matrix that is expressed in a variety of processes including development, tissue remodeling, wound healing, cell adhesion/antiadhesion, and cell/matrix interactions. Tenascin has recently been acknowledged as a component of the extracellular matrix of articular cartilage, but its function remains unclear. In this study, bovine articular chondrocytes were grown in alginate beads for 35 days to examine the kinetics of tenascin synthesis and incorporation into de novo extracellular matrix. During the culture period, 6 harvest days were established in which culture medium was recovered, alginate beads were dissociated with an EDTA solution, and chondrocytes were collected and lysed by sonication. Total DNA determination performed on the cell lysates demonstrated chondrocyte survival and proliferation. Western blotting performed on the medium, EDTA/alginate, and lysate samples demonstrated the production of both the 220 and 320 kDa tenascin size variants and their differential compartmentalization within the culture system. Tenascin was incorporated into the alginate bead matrix at a constant rate of 3.8 micrograms/day. The 320 kDa variant was produced in higher quantity, but the 220 kDa fragment was twice as likely to be incorporated into the de novo matrix. Methylene blue/acid fuchsin staining and tenascin immunohistochemistry demonstrated the incorporation of tenascin into a progressively expanding matrix surrounding the chondrocytes. The results suggest a role for tenascin in the assembly of the chondrocyte matrix and as a soluble mediator of chondrocytes with possible diverse functions for the tenascin size variants.

Single-headed myosin II acts as a dominant negative mutation in Dictyostelium

Conventional myosin II is an essential protein for cytokinesis, capping of cell surface receptors, and development of Dictyostelium cells. Myosin II also plays an important role in the polarization and movement of cells. All conventional myosins are double-headed molecules but the significance of this structure is not understood since single-headed myosin II can produce movement and force in vitro. We found that expression of the tail portion of myosin II in Dictyostelium led to the formation of single-headed myosin II in vivo. The resultant cells contain an approximately equal ratio of double- and single-headed myosin II molecules. Surprisingly, these cells were completely blocked in cytokinesis and capping of concanavalin A receptors although development into fruiting bodies was not impaired. We found that this phenotype is not due to defects in myosin light chain phosphorylation. These results show that single-headed myosin II cannot function properly in vivo and that it acts as a dominant negative mutation for myosin II function. These results suggest the possibility that cooperativity of myosin II heads is critical for force production in vivo.

Cardiovascular, respiratory and metabolic effects of interval training at VLA4

The purpose of this study was to determine if training with short intervals at the velocity producing a lactate level of 4 mmol/l (VLA4) is sufficient to induce adaptations and better exercise tolerance. Five Standardbred mares (4-8 years) were interval trained on a treadmill 3 days a week for 12 weeks and subsequently detrained for 4 weeks. Standardized exercise tests were performed before, during and after the training period and muscle biopsies were taken. Measurements were made of heart rate, oxygen consumption, stride frequency, blood volume and blood lactate. Plasma volume was reduced after 2 weeks of training but then increased to the approximate pre-training value throughout the remaining training and post-training periods. No change was detected in the total cell volume whereas the total blood volume varied in consequence with the plasma volume variation. A significant reduction in heart rate response to exercise was seen after 4 weeks of training. VLA4 increased after 2 weeks of training and remained higher than the baseline value during the rest of the training period. Consequently, the blood lactate at 8 m/sec was decreased compared to baseline concentration after 8 and 12 weeks of training. The post-training VLA4 did not differ significantly either from the end of training or from the pre-training value. Mass specific oxygen consumption (VO2-200/BW) at V200 increased with training and decreased with detraining. The respiratory quotient at a velocity of 8 m/sec decreased from 1.18 +/- 0.02 before training to 1.07 +/- 0.02 (P < 0.05) at the end of training. No changes were found in muscle histo- or biochemical parameters. The results indicate that training at VLA4 is sufficient to cause adaptational changes in exercise tolerance related parameters.

Body weight, heart weight, and heart-to-body weight ratio in greyhounds

Heart and body weights were obtained from 230 Greyhounds during necropsy. Sex and age were recorded for each Greyhound. Twenty-nine racing and 21 nonracing Greyhounds among the 230 dogs were compared. Heart-to-body weight ratio was calculated. Statistical analysis was done to determine the effects of age, sex, and racing on heart and body weights and heart-to-body weight ratio. In adult Greyhounds, mean +/- SD body weight was 28.4 +/- 3.1 and 31.5 +/- 2.8 kg, heart weight was 355.6 +/- 52.8 and 381.4 +/- 50.8 g, and heart-to-body weight ratio was 1.3 +/- 0.2 and 1.2 +/- 0.2% for females and males, respectively. Heart and body weights were significantly different between sex and age groups and among nonracing and racing males. However, heart-to-body weight ratio was not significantly different among age, sex, or racing groups.

Ventral tegmental microinjections of quinpirole decrease ethanol and sucrose-reinforced responding

The effects of microinjections in the ventral tegmental area (VTA) of the dopamine D2/D3 agonist quinpirole on ethanol- and sucrose-reinforced responding were tested. Two groups of Long-Evans rats were trained to lever press on a fixed-ratio 4 schedule with 10% ethanol (v/v) (n = 8) and 75% sucrose (w/v) (n = 10) presented as the reinforcer. Weekly bilateral injections of quinpirole were tested in the ethanol group (0.0, 0.001, 0.01, 0.1, and 1.0 micrograms/microliters) and sucrose group (0.0, 0.01, 0.1, 1.0, and 10.0 micrograms/microliters). Quinpirole dose dependently decreased ethanol- and sucrose-reinforced responding, but the dose-effect curve for sucrose was shifted two orders of magnitude to the right of the ethanol curve. Temporal response patterns during control sessions for both reinforcers were characterized by initial high rates that terminated after approximately 10 min. VTA injections of quinpirole dose dependently delayed the onset of the first response and the initial high rate period, and resulted in an early termination of responding following onset. These data support the hypothesis that dopamine activity in the VTA is involved in the regulation of ethanol-reinforced responding in a manner similar to that of other reinforcers.

Mobilizing self-care resources: a nursing intervention for hypertension

This study was undertaken to assess the potential for mobilizing self-care resources in 10 persons with hypertension. Modeling and role-modeling theory provided the conceptual base for the experimental group. Ten persons with hypertension were matched with a comparison group. The results provide some evidence that theoretically sound nursing interventions can assist clients to mobilize self-care resources needed to enhance their well-being. Although further research with larger, randomly assigned samples is indicated, these findings suggest that nursing the person rather than the symptom might help people with hypertension contend with stressors, reduce stress, and deal with loss and grief.

Detection of DNA looping due to simultaneous interaction of a DNA-binding protein with two spatially separated binding sites on DNA

We describe different and relatively rapid biochemical techniques to detect protein-mediated DNA looping. These techniques, based on enhancement of DNA knotting and that of ligase-catalyzed cyclization, were used to show that the replication initiator protein of plasmid R6K can bring together two intramolecular gamma origin of replication sequences located as far apart as 2 kilobases. The site-site interaction causes looping out of the intervening DNA sequence as visualized by electron microscopy. Because the autoregulatory sequence of the initiator cistron also binds initiator protein, we investigated whether the gamma origin-bound protein can participate in autoregulation by interaction of the two sites through a protein bridge. We discovered that the two sites do not interact in vitro at their natural locations when on opposite faces of the double helix. Moving the two sites to the same face of the double helix by introducing a half turn into the intervening sequence allows protein-mediated site-site interaction to occur.

Enhancer-origin interaction in plasmid R6K involves a DNA loop mediated by initiator protein

Initiation of DNA replication from ori beta of plasmid R6K requires the presence of the ori gamma sequence in cis. We demonstrate that binding of initiator protein to the seven strong, tandem binding sites in gamma increases binding of the protein at the very weak binding site present in ori beta by cooperativity at a distance. The gamma-beta interaction via the initiator results in a DNA loop, as revealed by the novel technique of cyclization enhancement and as confirmed by exonuclease III protection, electron microscopy, and chemical footprinting. The protein-mediated gamma-beta interaction in vitro suggests that the cooperative interaction of gamma-bound protein with the beta sequence by DNA looping is an early step in the initiation of DNA replication at the beta origin of R6K.

Evidence for a junctional feet-ryanodine receptor complex from sarcoplasmic reticulum

Heavy sarcoplasmic reticulum vesicles, labelled with the Ca2+ release channel probe [3H]ryanodine, were solubilized in detergent, then centrifuged through sucrose gradients. A single peak of ryanodine binding activity was observed with an apparent sedimentation coefficient of 30S. Electron microscopy of the peak fraction showed disk structures of 25-28 nm diameter and 10 nm thickness. Proteins specifically enriched in the peak fraction were the Mr 160,000 and 260,000 and junctional feet proteins (Mr 320,000 and 300,000). This suggests that the feet proteins and ryanodine receptor may be specifically associated into a large oligomeric complex comprising subunits of Mr 160,000-320,000.

Coping With New Systems

The main purpose for the course was to facilitate students in adaptive growth producing changes. Feedback from students has indicated that they found the seminars very helpful. Group outcomes of the seminars were also noted. Of those students who participated in this project, several joined forces and organized the RN Council. This Council has been very influential in our school in the administration of the RN studies program. Most of these students have gone on for graduate education. This approach appears successful in enhancing continued growth. However, no systematic data have been collected about this intervention model. Sufficient interest has been generated in others so that a study is being developed and will be implemented in the new academic year. The purpose of this controlled study is to determine whether or not such a planned support group will facilitate goal attainment. Such data will add to the knowledge base of the nurse educator interested in the RN student, the RN student who returns to school, and peers who attempt to facilitate that process. In the meantime, the Old-Now-New You Process Model is being utilized to facilitate students, clients, and faculty in decision making in futuristic goal setting.

A model for assessing potential adaptation to stress

The purposes of this study were to determine if hospitalized medical-surgical patients could be classified reliably according to their potential to adapt to stress; and to explore the relationship between their adaptive potential and length of hospital stay. Forty-six patients were selected for participation by use of a table of random numbers. Three classes of significantly different adaptive potential were identified: the Alarm and Impoverished states were considered as stress states, while the state of Equilibrium was considered a nonstress state. Although it was possible to distinguish stress from nonstress states, using only physiological parameters, psychological parameters were required to distinguish between the two stress states. The differentiation among the three coping states was used to predict subjects' potential for mobilizing adaptive resources. Length of hospitalization was then related to classification of adaptive potential.

Fibrin assembly: a comparison of electron microscopic and light scattering results

To test the validity of a proposed two step fibrin assembly mechanism and directly visualize the molecular species present at various stages of fibrin formation, we have carried out an electron microscopic investigation. Assembly conditions duplicated those of a recent light scattering study and specimens were prepared at different time points with the use of a negative staining technique recently employed to visualize the trinodular structure of fibrinogen. Under near-physiological buffer conditions, protofibrils structurally similar to those postulated by Ferry have been found at early stages of fibrin assembly. In parallel with the light scattering results, a dramatic increase in fiber diameter was found in specimens prepared during the postulated lateral association stage of gelation. Light scattering and electron microscopic results both showed that high ionic strength reduces the rate and extent of fiber formation. Reptilase cleavage is shown to result in typical cross striated fibrin.