Social Touch, Social Isolation, and Loneliness in Borderline Personality Disorder During the COVID-19 Pandemic

BACKGROUND

Interpersonal impairments in borderline personality disorder (BPD) are characterised by a lack in the sense of belonging and the fear of being excluded. One feature of interactions that can promote a sense of social belonging is interpersonal touch. While some studies suggest that individuals with BPD experience social touch as less pleasurable than healthy individuals (HCs), there are no studies that investigated whether this difference is associated with feeling less socially connected. This question is particularly important during the COVID-19 pandemic, since one central behavioural recommendation is "social distancing". An increase in loneliness has been discussed as a consequence and it has been suggested that individuals with BPD may be particularly burdened. However, the primary goal of "social distancing" is not preventing social contacts, but physical proximity. In our study we investigated the interplay between feeling close to others, contact frequency and the appraisal of social touch in BPD. We were additionally interested in whether these factors contribute to the burden through "physical distancing".

METHODS

We assessed subjective and objective social isolation, the need, importance, and liking of social touch, as well as the burden through "physical distancing" policies in 130 women (61 BPD and 69 HCs).

RESULTS

Participants of the BPD group reported higher loneliness, less social contacts and a lower need for, importance and liking of social touch compared to HCs. Larger social networks, higher frequency of in-person contacts and higher liking and importance of social touch were associated with lower levels of loneliness. Both groups did not differ regarding their burden through "physical distancing". A higher need for and lower importance of social touch predicted a higher burden through "physical distancing".

CONCLUSIONS

A positive appraisal of social touch was associated with less loneliness, independently of an individual's objective social isolation. In BPD, impairments of this fundamental facet of social interaction might hamper forming and strengthening of social bonds and contribute to the patients' interpersonal dysfunction. Changing the attitude towards social touch and in consequence its liking and importance in social interaction might provide one avenue to improve the sense of social connectedness in these patients.

In vitro effects of particulate bone substitute materials on the resorption activity of human osteoclasts

Much research has been done on bone cells, but only a few studies deal with biomaterial-induced effects on human osteoclasts, which may take on an important role in the successful regeneration of bone. In order to highlight such effects, human peripheral blood mononuclear cells (PBMCs) were extracted from venous blood, differentiated to osteoclasts and then cultured in, the presence of five particulate hydroxyapatite (HA)/β-tricalcium phosphate (TCP) biomaterials, on bovine bone slices and glass cover slips. The biomaterials, AlgOSS 50/50 (50 % HA/50 % TCP), AlgOSS 20/80 (20 % HA/80 % TCP), Algipore (98 % HA), Cerasorb (100 % TCP) and Bio-Oss (100 % HA) were chosen to assess their influence on cell morphology and numbers. Light microscopic evaluation was performed during ongoing cell culture. After 21 d of cultivation, the biomaterial-induced effects on osteoclastic resorption of the bone slices were evaluated by scanning electron microscopy (SEM). Osteoclast-like cells were identified by TRAP staining. All five biomaterials showed larger area fractions of resorbed bone than the control (5.6 ± 6.8 %), as measured on SEM images. The purely hydroxyapatite-based Algipore (9.8 ± 9.7 %) and Bio-Oss (7.9 ± 8.8 %) showed significantly elevated area fraction rates (p ≤ 0.05) of bone resorption. Light microscope evaluation revealed a significant, but inhibiting effect of Cerasorb (p = 0.05). These data indicated that introducing of small biomaterial hydroxyapatite particles may have improved the performance of bone substitute materials.

Neural correlates of naturalistic social cognition: brain-behavior relationships in healthy adults

Being able to infer the thoughts, feelings and intentions of those around us is indispensable in order to function in a social world. Despite growing interest in social cognition and its neural underpinnings, the factors that contribute to successful mental state attribution remain unclear. Current knowledge is limited because the most widely used tasks suffer from two main constraints: (i) They fail to capture individual variability due to ceiling effects and (ii) they use highly simplistic, often artificial stimuli inapt to mirror real-world socio-cognitive demands. In the present study, we address these problems by employing complex depictions of naturalistic social interactions that vary in both valence (positive vs negative) and ambiguity (high vs low). Thirty-eight healthy participants (20 female) made mental state judgments while brain responses were obtained using functional magnetic resonance imaging (fMRI). Accuracy varied based on valence and ambiguity conditions and women were more accurate than men with highly ambiguous social stimuli. Activity of the orbitofrontal cortex predicted performance in the high ambiguity condition. The results shed light on subtle differences in mentalizing abilities and associated neural activity.

Accuracy of diagnostic tests in multiple sclerosis--a systematic review

New diagnostic criteria for multiple sclerosis (MS) have been recently proposed and further updates are upcoming. This systematic literature review summarizes diagnostic studies in suspected MS to clarify the value of diagnostic tests. We included studies of at least 40 patients followed up for 2 years. All studies are limited by the fact that no gold standard to validate diagnostic tests is available. A second relapse is used as a surrogate in relapsing-remitting MS, but long follow-up of at least 5 years is necessary to detect all cases. Many studies showed selection bias, partly because of the vague definition of a clinically isolated syndrome. Based on these limitations, sensitivity of magnetic resonance imaging (MRI) criteria was between 35% and 100%, and specificity was between 36% and 92%. Cerebrospinal fluid (CSF) oligoclonal banding showed sensitivities between 69% and 91% with specificities between 59% and 94%. Combination studies of MRI and CSF indicate enhanced sensitivity (56-100%) and specificity (53-96%). Studies on evoked potentials did not justify conclusions about their value. A combination of simplified MRI criteria with CSF might be the best approach for an early MS diagnosis. However, the value of a very early diagnosis stays questionable as patients' benefit of new diagnostic criteria has never been addressed.

Five years' experience in endovenous laser therapy of lower extremity varicose veins

The authors performed a total of 237 endolaser treatments for insufficiency of great and small saphenous veins and assessed 5-year results. It was found that this method, especially if performed with a 1470-nm-wavelength laser combined with instrumental removal of some lateral veins, was very effective. It was delicate for patients, and it significantly shortened the length of their work incapacity. The benefits of removal of insufficient veins in a whole leg during a single session with the patient under total anesthesia are stressed.

[Partial mastectomy vs. breast ablation in treatment of invasive lobulary carcinoma]

The aim of this paper is presentation a new knowledge about surgical therapy of the invasive lobular breast cancers. Invasive lobular carcinoma (ILC) accounts for 5% to 10% of all invasive breast cancers. Although breast conservation therapy using local excision and postoperative irradiation is a standard therapy for early invasive ductal breast cancer, the result of this strategy in ILC is not well documented. Overall survival and local recurrance (ILC) is not affected by the type of surgical treatment- breast conservation surgery or total mastectomy.

On the self-association potential of transmembrane tight junction proteins

Tight junctions seal intercellular clefts via membrane-related strands, hence, maintaining important organ functions. We investigated the self-association of strand-forming transmembrane tight junction proteins. The regulatory tight junction protein occludin was differently tagged and cotransfected in eucaryotic cells. These occludins colocalized within the plasma membrane of the same cell, coprecipitated and exhibited fluorescence resonance energy transfer. Differently tagged strand-forming claudin-5 also colocalized in the plasma membrane of the same cell and showed fluorescence resonance energy transfer. This demonstrates self-association in intact cells both of occludin and claudin-5 in one plasma membrane. In search of dimerizing regions of occludin, dimerization of its cytosolic C-terminal coiledcoil domain was identified. In claudin-5, the second extracellular loop was detected as a dimer. Since the transmembrane junctional adhesion molecule also is known to dimerize, the assumption that homodimerization of transmembrane tight junction proteins may serve as a common structural feature in tight junction assembly is supported.

[Investigations on isolation, purification and cultivation of human endometrial cells and on the in vitro inhibin expression in glandular epithelial cells]

The separate in vitro cultivation of isolated and purified human endometrial glands and stromal cells seems to be the most attractive experimental way of studying the endometrial function on cellular level. In this paper a new method has been described to establish monolayer cultures of isolated endometrial stromal and epithelial cell populations. After a first collagenase digestion, stromal and epithelial cells were separated by filtration. The glandular epithelial cells were further purified with two collagenase digestion steps, filtration, a differential sedimentation at unity gravity and a Ficoll gradient centrifugation. Stromal cells were isolated with the use of erylyse-buffer, filtration and differential sedimentation at unity gravity. A significant higher inhibin production was observed during late secretory compared to proliferative and early secretory phase. Therefore, glandular epithelial cells maintain in vitro their initial differentiation. The higher inhibin concentration during secretory phase implicates a substantial role in endometrial function and maturation. Therefore, inhibin could be used as a marker of endometrial differentiation. Experiments on isolated glandular epithelial cells should be performed within two weeks. The method described here allows the propagation in vitro of separate endometrium cell types which can be used to study endometrial function as well as implantation mechanisms.

Immunohistochemical expression of inhibin-alpha in human endometrium and the in vitro secretion of inhibin, estradiol and cortisol in cultured human endometrial glandular cells

BACKGROUND

Inhibins are multipotent dimeric glycoproteins, composed of an alpha-subunit and one of two possible beta-subunits (betaA or betaB). Aims of this study were (a): the immunohistochemical characterisation of normal human endometrium for the inhibin-alpha subunit; (b) the assessment of the secretion and metabolism of inhibin, E2 and cortisol; (c) the evaluation of any relationship between these three substances in cell culture medium of isolated and cultivated normal human endometrial glandular cells.

MATERIALS AND METHODS

Samples of human endometrium were obtained from 34 premenopausal patients. Nineteen endometrial specimen (proliferative [PP] n=8; early secretory [ES] n=7; late secretory phase [LS] n=4) were brought into cell culture. Fifteen endometrial specimen (PP n=5; ES n=5; LS n=5) were paraffin-fixed and used for the immunohistochemical analysis for inhibin-alpha. Stromal and epithelial cells were separated by collagenase digestions, filtrations, sedimentations and Ficoll-gradient centrifugation. E2 and cortisol were measured with radioimmunoassay (RIA) and inhibin with enzyme-immunoassay (EIA). Statistical analysis was performed with the non-parametric Mann-Whitney rank-sum test and linear regression analysis.

RESULTS

Inhibin-alpha showed a weak (positive) expression during proliferative phase, which increased significantly as the menstrual cycle continued. In secretory glands the mean inhibin concentration was higher than that from proliferative samples. A significant correlation was observed between inhibin and E2 (p<0.001) as well as cortisol and inhibin (p<0.0001) in glands from proliferative phase. Between inhibin and E2 (p<0.05) as well as inhibin and cortisol (p<0.002) a significant correlation in early secretory glands was also noted. In late secretory phase inhibin and E2 (r2=0.78650; p<0.0001), inhibin and cortisol (r2=0.58326; p<0.001) and E2 and cortisol (r2=0.52880; p<0.001) showed a significant correlation.

DISCUSSION

In conclusion, we found a cyclical expression of inhibin-alpha subunit in the endometrium demonstrated by immunohistochemical means. A higher in vitro secretion of inhibin from secretory glands was also observed. In addition, a significant correlation between inhibin with E2 and cortisol in PP and ES glands and a significant correlation between inhibin, E2 and cortisol in LS glands could also be demonstrated. We conclude that inhibin can be associated with E2 and cortisol metabolism, playing an important role in paracrine/autocrine mechanisms in the endometrium and possibly exerting its function through cortisol and E2. The cortisol concentration also correlates with E2, suggesting a link between these steroids in the endometrial function. The correlation of inhibin, E2 and cortisol suggest complex autocrine/ paracrine mechanisms in human endometrial glands, modulated and controlled by all these three substances.

Immunohistochemical expression of steroid receptors and glycodelin A in isolated proliferative human endometrial glandular cells after stimulation with tamoxifen and phytoestrogens (genistein and daidzein)

INTRODUCTION

The aims of this study were an evaluation of the distribution patterns of steroid hormone receptors (ER, PR) and glycodelin A (GdA) expression of proliferative endometrial glandular cells after stimulation with tamoxifen (TAM) and phytoestrogens (PE) (genistein, daidzein).

MATERIALS AND METHODS

Human endometrium was obtained from 4 premenopausal women. Glands were stimulated after isolation with single doses of TAM, genistein and daizein (0.1, 1 and 10 mumol/l) and characterised with ER, PR and GdA after 9 days of culture.

RESULTS

ER showed a significant decline with the highest TAM and genistein concentration (p < 0.05), whereas PR increased significantly with TAM and genistein concentrations of 1 mumol/l and 10 mumol/l (p < 0.05). GdA did not show any significant expression under TAM and genistein stimulation. Stimulation with daidzein resulted in no statistically relevant alterations in ER, whereas the PR significantly increased with all three concentrations (p < 0.05) and GdA also showed a significant increase with 1 mumol/l (p < 0.05).

DISCUSSION

TAM showed anti-estrogenic properties in premenopausal endometrium. PE showed a similar ER, PR expression pattern as TAM, so therefore PE (genistein and daidzein) could also act as antiestrogens. GdA marked a cell transformation from proliferative to secretory status or the antiestrogen effects of TAM and PE.

A reporter-cell assay for the detection of BMP-2 immobilized on porous and nonporous materials

Human recombinant bone morphogenetic protein-2 (rhBMP-2) immobilized on the surface of metal implants can facilitate osseointegration. Here, we describe a cell reporter assay useful for quantifying small amounts of immobilized rhBMP-2 on various materials. The peptide was dotted and heat-fixed on titanium, 316L stainless steel, nitrocellulose, or glass, and its distribution was monitored by in situ biotinylation followed by detection with the avidin-biotin method. Bioactivity of rhBMP-2 was demonstrated by means of a confluent layer of osteoblastic MC3T3-E1 cells that evenly covered rhBMP-2-free and rhBMP-2-loaded surface areas, as shown with epifluorescence microscopy of calcein acetoxymethyl (AM)-loaded cells. Expression of osteocalcin, fibronectin, actin, and vimentin increased where cells were located on rhBMP-2 dotted areas, but the signal:noise ratio was too low to bioassay the peptide. However, local pronounced expression of alkaline phosphatase was used to quantify BMP-2 in the range of 5-80 ng/dot by means of a cytochemical color reaction for alkaline phosphatase and image analysis of resulting dots. The lower detection limit was in the order nitrocellulose > glass > titanium > 316L steel. We conclude that the cell reporter assay is useful to assess biological activity of rhBMP-2 even after immobilization on three-dimensional implant materials.

[Initiation of oral anticoagulant treatment: comparison between different dosage regimens of warfarin and phenprocoumon]

A high "loading dosage" is often given during initiation of oral anticoagulant treatment in order to reach sufficient anticoagulation within short time. Increased bleeding risk as well as a transient prothrombotic tendency are complications of this treatment schedule. The aim of our study was to find proper dosage regimens of phenprocoumon and warfarin allowing initiation of oral anticoagulant treatment in a short time. For 50% of the patients 7.5 mg warfarin daily resulted in stable INR values within 4 days. Patients receiving higher (10 mg) or lower (5 mg) daily dosages of warfarin or 6 or 9 mg phenprocoumon daily during the first days of therapy reached the therapeutic range significantly later. Furthermore, no significant differences of prothrombin fragment F 1+2 were observed, indicating that no enhanced thrombin formation occurred. Thus, initiation of oral anticoagulant treatment using 7.5 mg warfarin daily is a simple and safe dosage regimen.

Initialphase der oralen Antikoagulanzientherapie: Vergleich verschiedener Dosierungen von Warfarin und Phenprocoumon

In der Initialphase der oralen Antikoagulanzientherapie werden häufig hohe, so genannte Loading-Dosierungen verordnet, um in kurzer Zeit einen möglichst starken antikoagulatorischen Effekt zu erzielen. Erhöhtes Blutungsrisiko und transiente prothrombotische Zustände sind die Folge. Bei Warfarin wird auch bei niedrig dosierter Einleitung der oralen Antikoagulanzientherapie relativ schnell der angestrebte therapeutische Bereich erreicht. Ziel der vorliegenden Untersuchung war es daher, den Einfluss verschiedener Dosierungen von Warfarin und Phenprocoumon auf das Zeitintervall bis zum Erreichen stabiler INR-Werte zu untersuchen und außerdem einen eventuellen Anstieg des Prothrombinfragments F 1+2 als Ausdruck erhöhter Thrombosegefährdung zu dokumentieren.

Wir konnten zeigen, dass die Einleitung der oralen Antikoagulanzientherapie mit 7,5 mg Warfarin (1,5 Tbl.) tgl. bei 50% der Patienten innerhalb von 4 Tagen eine stabile Einstellung erreichte. Höhere (10 mg) oder niedrigere (5 mg) Tagesdosen von Warfarin sowie Dosierungen von 9 oder 6 mg Phenprocoumon erreichten den therapeutischen Bereich erst deutlich später. Signifikante Unterschiede bzgl. Prothrombinfragment F 1+2 ergaben sich nicht. Damit imponiert die tägliche Gabe von 7,5 mg Warfarin als besonders einfache und sichere Methode zur Einleitung der oralen Antikoagulanzientherapie.

Sulphur-containing "perfumes" attract flower-visiting bats

We tested the attractiveness of individual scent compounds of bat-pollinated flowers to their pollinators, small flower-visiting bats of the genus Glossophaga (Phyllostomidae). Twenty compounds belonging to four different chemical substance classes were tested, both in the laboratory and in the field. In the laboratory, the bats (Glossophaga soricina) approached odour sources spontaneously and without preceding experience. Without ever receiving any reward they preferred the scent of a sulphur-containing compound, dimethyl disulphide, to several other odour components emitted by bat-pollinated flowers, and to scentless controls. In the field, at La Selva station in the tropical lowland rain forest of Costa Rica, G. commissarisi were attracted by two sulphur-containing compounds, dimethyl disulphide and 2,4-dithiapentane, to visit artificial flowers filled with sugar water. Thus, in nectarivorous bats the sense of smell obviously plays an important role in searching for and localising food sources, and even single components of the scent bouquets of bat-pollinated flowers are attractive. The preference for sulphur-containing odours seems to be innate.

Headspace analysis of volatile flower scent constituents of bat-pollinated plants

The flower scents of 11 bat-pollinated plant species have been investigated using the 'closed-loop-stripping'-adsorption technique. GC and GC/MS analyses of the headspace samples resulted in the identification of 49 compounds, comprising amongst others sulphur compounds, terpenoids and aliphatic compounds.

Visualization of a covalent intermediate between microsomal epoxide hydrolase, but not cholesterol epoxide hydrolase, and their substrates

Mammalian soluble and microsomal epoxide hydrolases have been proposed to belong to the family of alpha/beta-hydrolase-fold enzymes. These enzymes hydrolyse their substrates by a catalytic triad, with the first step of the enzymatic reaction being the formation of a covalent enzyme-substrate ester. In the present paper, we describe the direct visualization of the ester formation between rat microsomal epoxide hydrolase and its substrate. Microsomal epoxide hydrolase was precipitated with acetone after brief incubation with [1-(14)C]epoxystearic acid. After denaturing SDS gel electrophoresis the protein-bound radioactivity was detected by fluorography. Pure epoxide hydrolase and crude microsomes showed a single radioactive signal of the expected molecular mass that could be suppressed by inclusion of the competitive inhibitor 1,1,1-trichloropropene oxide in the incubation mixture. In a similar manner, 4-fluorochalcone-oxide-sensitive binding of epoxystearic acid to rat soluble epoxide hydrolase could be demonstrated in rat liver cytosol. Under similar conditions, no covalent binding of [26-(14)C]cholesterol-5alpha,6alpha-epoxide to microsomal proteins or solubilized fractions tenfold enriched in cholesterol epoxide hydrolase activity could be observed. Our data provide definitive proof for the formation of an enzyme-substrate-ester intermediate formed in the course of epoxide hydrolysis by microsomal epoxide hydrolase, show no formation of a covalent intermediate between cholesterol epoxide hydrolase and its substrate under the same conditions as those under which an intermediate was shown for both microsomal and soluble epoxide hydrolases and therefore indicate that the cholesterol epoxide hydrolase apparently does not act by a similar mechanism and is probably not structurally related to microsomal and soluble epoxide hydrolases.

[40 years breast carcinoma treatment in the Neubrandenburg region.Can an increase in prognostically more favorable stages be detected?]

The data of clinical presentation for women suffering from breast carcinoma were analysed for a period of 4 decades retrospectively. The authors have found a significant decrease in the duration of the history and an increase of early stages of the breast carcinoma. This increase was caused by the introduction of mammography. The mammography is the most important method for the diagnosis of breast carcinoma in asymptomatic women.

[Physical and mental development of children with congenital hypothyroidism]

69 children with congenital hypothyroidism, who were detected by neonatal screening in Lower Saxony, were reevaluated 1-12 years after diagnosis. They had been treated either by regional children's hospitals, local pediatricians or general practitioners. Substitution of thyroid hormone had started for the majority between day 7 and 14, for 17%, however, only later. Symptoms suggestive of hypothyroidism at birth were observed in 35 children, but only 3 cases were correctly diagnosed before the result of the screening was known. Further diagnostic tests to elucidate the cause of congenital hypothyroidism had been performed in 33 children. In 36 cases the etiology remained undiagnosed at the evaluation. Hormone therapy had been administered continuously in all cases. The somatic development of all children was normal. Bone age at the time of diagnosis was retarded in more than 50%, later it became normal in most cases. The psychomotor and intellectual development was satisfactory as assessed by psychometric tests. The mean value of the Intelligence Quotients in the children older than six years was 96.3. 5 children of this age group had an IQ below 85 and only one child had an IQ of more than 115. In the younger group the results were similar, but children younger than 4 years showed deficiencies in speech development. In summary, the somatic development of the re-examined children with congenital hypothyroidism was normal, but the psychomotor and intellectual development was only subnormal in some cases. It is therefore suggested that children with congenital hypothyroidism should be closely followed by experienced pediatricians, especially in the early years of life.

Hybrid hybridomas producing bispecific antibodies to CEA and peroxidase isolated by a combination of HAT medium selection and fluorescence activated cell sorting

A combination of fluorescence-activated cell sorting and HAT medium selection has been used to establish bispecific antibody (biAbs)-producing hybrid hybridomas. For this purpose hypoxanthine-guanine phosphoribosyl transferase (HGPRT)-deficient mutants were isolated from a hybridoma line (D11-DG2) producing anti-CEA antibodies by 8-azaguanine treatment. The resulting HAT-sensitive hybrid cells were stained with the fluorescence marker tetramethyl rhodamine isothiocyanate (TRITC) and fused by polyethylene glycol (PEG) with HAT-non-sensitive unstained hybrid cells producing antibodies to horseradish peroxidase (POD). Fluorescent fused hybrid hybridomas as well as non-fused stained anti-CEA cells were separated from the unstained anti-POD cells using a fluorescent activated cell sorter (FACS). Finally, non-fused enzyme-deficient anti-CEA cells were eliminated by cultivation in HAT selection medium which permits only an outgrowth of HAT-resistant hybrid hybridoma cells containing the genes for producing both antibodies.

Growth and pubertal development in nephropathic cystinosis

In a retrospective investigation growth and pubertal development were evaluated in 30 patients with nephropathic cystinosis. Growth was investigated during the stage of chronic renal insufficiency as well as after successful kidney transplantation and growth rates were related to kidney function. Pubertal development was evaluated in 17 patients between 12 and 25 years of age. Prepubertal growth rates were stable in a range between -2 and -3 height velocity SDS as long as glomerular filtration rate was above 20ml/min per 1.73m2. A decrease in glomerular filtration rate below this threshold was followed by further decrease in height velocity. After kidney transplantation a significant catch-up growth was seen if immunosuppression was performed with cyclosporine A and low dose prednisolone. This did not occur if conventional therapy with azathioprine and high-dose prednisolone was used. Onset of puberty was delayed in all patients. Gonadotropin and oestradiol levels in female patients showed normal fluctuations according to ovulatory cycles. In male patients after puberty there was an increase in gonadotropin levels above the normal range for adult men while testosterone levels remained in the low normal range. These results indicate that adult men with nephropathic cystinosis may develop hypergonadotropic hypogonadism.

Low-density lipoprotein catabolism does not respond to estrogen in the fetal and newborn rat

The elimination of native and methylated low-density lipoprotein (LDL) from serum and the effect of estradiol on the serum LDL-apoB pool, the uptake of homologous [125I]-LDL into liver and adrenals, and the fractional catabolic rate (FCR) of [125I]-LDL was studied in fetal (22nd day of gestation), newborn (15th day postpartum), and adult rats. In fetal rats the receptor-mediated LDL decay accounted only for 47%, whereas in adults it was calculated to 65%. In the latter, estrogen caused (1) a diminution of the serum LDL-apoB pool by 85%; (2) an enhancement of the LDL uptake into the liver and the adrenals by 5- and 10-fold, respectively, and (3) an acceleration of the [125I]-LDL decay in the serum with a rise of the FCR by 3-fold. In contrast, neither the LDL pool and uptake nor the LDL elimination (FCR) did respond to estrogen in fetal and newborn rats. In summary, the LDL catabolism of the rat is insensitive towards estrogen in the late gestational period and during the first 2 weeks of postnatal life [3].

The visceral yolk sac--an important site of synthesis and secretion of apolipoprotein B containing lipoproteins in the feto-placental unit of the rat

Rat fetuses exhibit a high serum LDL concentration at term. Delivery caused a marked decrease of the LDL apolipoprotein (apo) B concentration independent of whether this occurred on days 21, 22 or 23 of gestation. The interruption of the yolk sac circulation by a ligature in situ for 6 h led to the same alterations of the LDL-apo B concentration as Caesarean section. Immunoelectronmicroscopic studies provided evidence that the epithelial cells of the visceral yolk sac exhibited electron dense LDL-sized and apo B containing particles which were localized over the compartments of the Golgi complexes, endoplasmatic reticulum, secretory vesicles and intercellular spaces, but not over the cell nuclei, mitochondria or lysosomes. ApoB containing LDL-sized particles could be obtained by ultracentrifugation from the disrupted material of the microsomal fraction of yolk sac homogenates. Isolated segments of the yolk sac membranes were capable to secrete apoB containing lipoproteins floating in the d less than 1.020 g/ml as well as in the d = 1.020-1.064 g/ml fraction with a 10-fold higher amount of apoB in the higher density class. Incorporation experiments with [35S] methionine gave evidence that these lipoproteins were at least partially provided with newly synthesized apoB predominantly found in the LDL fraction. The size of the negatively stained particles in the d = 1.020-1.064 g/ml fraction secreted from yolk sac segments corresponded to that of LDL from fetal rat serum. In contrast their acylglycerol content was significantly higher, whereas the percentage contribution of total cholesterol and protein was markedly reduced in comparison with serum LDL of the fetus. In summary, biochemical and ultrastructural studies provide clear cut evidence that the rat yolk sac is able to synthesize and to deliver apo B containing lipoproteins in the density ranges of VLDL, IDL and particular of LDL thus contributing to the supply of serum lipoproteins in the rat fetus. By recalculation of recent tracer kinetic data (Plonné et al. (1990) J. Lipid Res. 31, 747) using a mathematical step function model it was possible to assess the contribution of the rat yolk sac to the LDL influx into the fetal serum.

Synthesis, secretion and immunoelectron microscopic demonstration of apolipoprotein B-containing lipoprotein particles in the visceral rat yolk sac

Electron microscopic investigations on the involvement of the fetal membranes of the rat (visceral yolk sac) in the lipid metabolism revealed the occurrence of lipoprotein-sized particles located in cisternal Golgi stacks, Golgi vesicles and secretory vesicles of the cells of the visceral yolk sac epithelium as well as in distended areas of the intercellular space between adjacent epithelial cells. Application of the protein A-gold technique with specific anti-apoB antiserum resulted in a specific location of immunogold both over the different compartments of the lipoprotein pathway (RER, Golgi complex, secretory vesicles) as well as over the distended intercellular spaces, thus confirming these particles to be lipoproteins in nature. Isolated visceral epithelial cells prepared by a tryptic digestion method exhibited some ultrastructural alterations, such as a loss of apical brush border, a change from columnar to spherical cell shape, a decrease in phagolysosomes, but an increase in autophagosomal structures after 6 h incubation at a vitality rate of at least 85%. Within this period the epithelial cells secreted measurable amounts of apoB-containing lipoproteins into the medium floating in the density classes d less than 1.006 g/ml, d = 1.006-1.020 g/ml and d = 1.020-1.064 g/ml. The production of the lipoproteins was partly inhibited by cycloheximide indicating the secretion of particles with performed as well as newly synthesized apoB. Negative staining of the particles revealed an average diameter of 34 nm of VLDL, 31 nm of IDL and 24 nm of LDL. In summary, our studies demonstrate that in the feto-placental unit of the rat the fetal membranes are capable of synthesizing and secreting lipoproteins. The cells of the visceral yolk sac epithelium were shown to be the producers of apoB-containing particles.

Increase in plasma total and lipoprotein cholesterol during incubation of whole blood samples at 37 degrees C--influence of LCAT inhibitors

Incubation of whole blood samples at 37 degrees C caused a time-dependent increase in plasma cholesterol concentrations. In samples from 40 fasting healthy males, plasma cholesterol rose by 13.6 +/- 3% during 24 h (P less than 0.001). Changes in cholesterol concentrations were found in both the HDL fraction and the VLDL/LDL fraction. The increase in lipoprotein cholesterol concentrations correlated positively with the initial levels of HDL cholesterol and apo A-I; and with the original levels of VLDL/LDL cholesterol, apo B and triglycerides. The increase in plasma total cholesterol was not related to the HDL cholesterol and apo A-I concentrations. It was more pronounced in samples with elevated plasma concentrations of total cholesterol, VLDL/LDL cholesterol, apo B and triglycerides. The elevation in plasma total cholesterol resulted from an increase in cholesteryl esters, whereas free cholesterol decreased. After LCAT inhibition no changes in total, free and esterified cholesterol were observed. Therefore, increase in plasma cholesterol seems to represent a LCAT-dependent cholesterol transport out of blood cells.

Efficacy of calcium carbonate and low-dose vitamin D/1,25(OH)2D3 in reducing the risk of developing renal osteodystrophy in children on continuous ambulatory peritoneal dialysis

Eight children with terminal renal insufficiency on continuous ambulatory peritoneal dialysis were followed for 12 months to evaluate laboratory parameters of mineral ion and bone metabolism. Calcium carbonate (range 47-295 mg/kg body weight per day) was given in combination with low doses of either vitamin D or 1,25(OH2D3. Blood urea nitrogen and serum phosphate concentrations remained well controlled throughout the observation period. A significant increase in serum calcium levels from 2.35 +/- 0.18 to 2.61 +/- 0.22 mmol/l (mean +/- SD) was observed during the first 6 months. Alkaline phosphatase activity and mid-C-regional parathyroid hormone, both indirect parameters of bone metabolism, revealed no evidence of severe secondary hyperparathyroidism. Our data indicate that calcium carbonate may be sufficient to induce relative hypercalcaemia in uraemic children, and thus reduce the risk of developing renal osteodystrophy. Unwanted side-effects of vitamin D preparations, i.e. increased intestinal phosphate absorption and hypercalcaemia after successful renal transplantation, may thus be avoided.

Adult height achieved in children after kidney transplantation

We evaluated posttransplantation growth, bone maturation, and adult height in 20 adolescents who had received kidney transplants at the age of 10.5 to 17 years. Nine patients (five male, four female) were treated with cyclosporine and low-dose prednisolone, and 11 children (six male, five female) were treated with azathioprine and high-dose prednisolone. The cumulative dose of steroids after transplantation was significantly lower in the cyclosporine-treated group. Bone age, according to the radius-ulna-short bones method of Tanner and Whitehouse, was almost the same in both groups at the time of transplantation (15.0 and 14.6 years for male subjects, 13.3 and 13.1 years for female subjects). Predicted adult height (Tanner-Whitehouse Mark II-method of Tanner et al) and target height were estimated at transplantation. Adult height was defined as achieved when bone age in male subjects had reached 18 years and, in female subjects, 16 years. Bone maturation of the cyclosporine-treated patients occurred at a normal rate (0.92 bone-age years per chronologic year), whereas the azathioprine-treated group exhibited a significantly slower rate (0.56 bone-age years per chronologic year). The growth rate per year for the cyclosporine-treated group was more than double that of the azathioprine-treated group (3.0 cm vs 1.4 cm). The adult height of the cyclosporine-treated group exceeded the predicted adult height by a mean of 1.3 cm, but the azathioprine-treated group missed it by 3.9 cm. Target heights could not be achieved in any group. Kidney function was significantly lower in the cyclosporine- vs the azathioprine-treated group, but no patients suffered from severe renal insufficiency. We conclude that cyclosporine and low-dose prednisolone are associated with normal bone maturation and a better prognosis for final height in children with renal transplants.

One year's experience with recombinant erythropoietin in children undergoing continuous ambulatory or cycling peritoneal dialysis

Fourteen patients (aged 5.9-22.1 years) undergoing continuous ambulatory or cycling peritoneal dialysis were treated with recombinant human erythropoietin (rhEPO), which was given intravenously once a week at a dosage of 300 units/kg. The mean haematocrit level increased from 18.5% to 27.5% and the reticulocyte count from 19% to 62% within 1 month. After an average time of 3.1 months rhEPO dosage could be adjusted to 100 units/kg per week to keep the haematocrit level at 30%. Only 1 patient had an exacerbation of hypertension, which required a dosage reduction; other side-effects were not noted.

Endocrine pancreatic secretion in patients after acute pancreatitis

In 14 nonobese patients after acute pancreatitis and with normal oral glucose tolerance, the response of insulin, C-peptide, and pancreatic glucagon after 100 g of oral glucose was assessed. The curves of insulin and C-peptide were significantly raised compared with those of controls, and no difference was found between the response of patients with a negative (n = 8) and a positive (n = 6) family history of type II diabetes. The curves of pancreatic glucagon did not differ from those found in controls. Our results indicate that a normal response to glucose after recovery from an attack of acute pancreatitis is maintained at the cost of increased insulin secretion.

Tracer kinetic studies of the low density lipoprotein metabolism in the fetal rat: an example for estimation of flux rates in the nonsteady state

To get insight into the low density lipoprotein (LDL)-apoB flux in the rat fetus near term and in the early postnatal period, homologous apoE-free 125I-labeled LDL was injected into the umbilical vein of the rat fetus immediately after Caesarean section. Since the serum LDL-apoB spontaneously declined after birth, a time-dependent two-pool model was used to calculate the flux rates in the neonate from the specific activities of LDL-apoB up to 15 h post partum. An approximate value of LDL-apoB flux in the fetus at birth was obtained by extrapolation of the kinetic data to the time of injection of the tracer. The data revealed that the turnover of LDL-apoB in the fetus (18.6 micrograms LDL-apoB/h per g body weight) exceeded that in the adult rat (0.4 microgram/h per g body weight) by at least one order of magnitude. Even 15 h after delivery, the LDL-apoB influx amounted to 2.5 micrograms/h per g body weight. The fractional catabolic rate of LDL-apoB in the fetus at term (0.39, h-1) slightly exceeded that in the adult animal (0.15, h-1) and reached the adult level within the first 3 h after birth and remained constant thereafter. In the rat fetus, LDL-apoB flux greatly exceeds that of VLDL-apoB. The data support the view of a direct synthesis and secretion of LDL, most probably by the fetal membranes.

Mitotic disturbance associated with mosaic aneuploidies

The association of various unsystematic aneuploidies with premature centromere division (PCD) was observed in a patient with conspicuous clinical features and combined immunodeficiency. Trisomies and monosomies of almost all autosomes and gonosomal aberrations were found separately or in combination in a majority of the proband's lymphocytes and fibroblasts. The chromosome number varied from 44 to 50. A high proportion of the metaphases showed PCD or had the appearance of C-anaphases. These findings probably represent a new mutant affecting mitosis and causing mosaic aneuploidies.

Neonatal pyruvate dehydrogenase deficiency with lipoate responsive lactic acidaemia and hyperammonaemia

A 2-day-old girl developed a severe lactic acidosis with a normal lactate/pyruvate ratio and hyperammonaemia. Plasma arginine and citrulline levels were below the limit of detection. In muscle total pyruvate dehydrogenase complex (PDHC) and pyruvate decarboxylase (E1) activities were reduced to a fraction of lower control values. The acute neonatal period was bridged with peritoneal dialysis, dichloroacetate therapy, supplements of arginine and branched chain amino acids, a complete vitamin B complex and lipoic acid. Lactate homeostasis responded to pharmacological supplements of lipoic acid. At age 1 year the child was hypotonic, showed severe developmental retardation, optic atrophy and cranial dysmorphism. She died aged 1 year 8 months with signs of respiratory paralysis but with normal lactate levels under assisted breathing. Pathological findings at autopsy were suggestive of Leigh syndrome, interstitial pneumonia and extensive fatty infiltration of hepatocytes. Regression analysis of data from 187 plasma amino acid determinations from the patient over a period of 1 year 8 months revealed a persistent-imbalance involving alanine, glutamic acid, glutamine, proline, citrulline and branched chain amino acids. Aspects of acute and long-term therapy in this patient and some implications of the imbalances in plasma amino acids are discussed.

The degradation of platelet-activating factor in serum and its discriminative value in atherosclerotic patients

Platelet-activating factor (PAF) is transformed in vivo rapidly into the biologically inactive lyso-PAF. This reaction as well as lipid parameters were quantified in serum from 40 survivors of myocardial infarction and 36 healthy controls matched for age and body weight. The PAF-degrading capacity was 23% (p less than 0.001) higher in patients compared with the control group. Using the degradation of PAF as an univariate discriminator more than 70% of subjects were classified correctly. This is comparable with the discriminatory value of the best lipid variables, apolipoprotein B and HDL-cholesterol. Statistically significant differences in the degradation of PAF were found also by comparing subgroups which were matched for plasma levels of total cholesterol, VLDL/LDL-cholesterol or apolipoprotein B. The ratio by 48% (p less than 0.0001) in the case group was identified as an additional good discriminator between both groups. In contrast, platelet aggregation tests which were performed in acetylsalicyclic acid treated platelet-rich plasma discriminated poorly between patients and controls.

Lipoprotein pattern in long-term diabetes of an at least 35 years' duration. Results of the Erfurt Study

All diabetic patients suffering from the disease for at least 20 years and living in the closed area of the Erfurt district in 1970 have been followed prospectively since that time. In 47 of them still alive in 1985, i.e. after more than 35 years of diabetes, serum lipid and apolipoprotein concentrations were measured and compared to those of non-diabetic subjects without cardiovascular diseases (n = 47) pair-matched by sex, age, and body weight. In males (n = 27) significantly (p less than 0.01) higher levels of HDL cholesterol and apolipoprotein A-I as well as lower concentrations of triglycerides and a lower total cholesterol/HDL cholesterol risk ratio than in nondiabetic control subjects could be found. In long-term diabetic females (n = 20), apolipoprotein A-I levels were also increased (p less than 0.02). Trends in HDL cholesterol and triglycerides were similar to those found in males but did not reach statistical significance. Higher concentrations of total cholesterol (p less than 0.02), LDL cholesterol (P less than 0.05), and apolipoprotein B (p less than 0.02), however, did not fit in with a beneficial lipoprotein pattern. The frequency of pathological lipoprotein patterns was not higher than among the non-diabetic control subjects (32% and 40%, respectively). According to these findings an antiatherogenic lipoprotein pattern might be considered, at least in males, as one of the determinants causing the multifactorial event of long-term survival in diabetes.

Serum lipids and apolipoproteins in relation to glycaemic control and diabetic nephropathy in long-term survivors of diabetes: results of the Erfurt Study

Follow-up data of all 208 long-term diabetics (duration of the disease at least 20 years) living in the closed area of the Erfurt district in 1970 had demonstrated the importance of lipoprotein pattern for longevity. Now the dependence of lipoprotein levels on both the diabetes-related conditions nephropathy and glycaemic control has been examined in 47 of them, still alive in 1985 that means 35 or more years after the onset of diabetes. Glycaemic control was assessed by measuring the glycosylated haemoglobin (n = 44). Diabetic nephropathy was assumed in case of persistent proteinuria. Poor glycaemic control (n = 16) was associated with increased levels of atherogenic lipoproteins as reflected by higher concentrations of total cholesterol, LDL cholesterol, apolipoprotein B, and triglycerides, as well as a changed HDL composition indicated by a decreased HDL cholesterol/apolipoprotein A--I ratio. Higher ratios of total cholesterol to HDL cholesterol and apolipoprotein B to apolipoprotein A--I point to an increased risk of developing atherosclerotic diseases in poorly controlled diabetics. 86% of the well controlled long-term diabetics had non-pathological values of LDL cholesterol, triglycerides, apolipoprotein B, HDL cholesterol, and apolipoprotein A--I but only 31% of the poorly controlled patients did so. Diabetic nephropathy in the absence of chronic renal failure (n = 10) was characterized by higher values of LDL cholesterol, triglycerides, total cholesterol/HDL cholesterol, and apolipoprotein B/apolipoprotein A--I. 80% of the subjects with a pathological lipoprotein pattern were proteinuric or in poor glycaemic control or both. Therefore, it is concluded that prevention of these two conditions might help to delay atherosclerosis via its beneficial influence on lipoprotein metabolism.

Preparation of apoE-free rat low density lipoprotein for catabolic studies

The use of serum from rat fetuses instead of serum from adult rats for preparation of LDL by preparative ultracentrifugation leads to an LDL fraction containing apoB-100 and apoB-95 as the only protein moieties without need for any further purification. The yield of LDL is five times greater compared to the use of adult rat serum. Lipid composition and particle size of LDL from fetal and adult rats are quite similar. The method described allows a simple way for preparation of sufficient amounts of apoE-free LDL for use in metabolic studies.

Plasma from atherosclerotic patients exerts an increased degradation of platelet-activating factor

Platelet-activating factor (PAF) is a naturally occurring phospholipid that exerts diverse biological activities. In the present study the degradation of PAF as well as lipid concentrations were measured both in plasma from 28 patients suffering from peripheral vascular disease and 18 healthy volunteers of comparable age. Beside some changes of the lipoprotein pattern it was also found that the capacity to degrade PAF is significantly elevated in the patient group. In view of this finding the question arises whether there is any link between the degradation of PAF and the development of atherosclerosis.