A mouse model of chronic primary pain that integrates clinically relevant genetic vulnerability, stress, and minor injury

Chronic primary pain conditions (CPPCs) affect over 100 million Americans, predominantly women. They remain ineffectively treated, in large part because of a lack of valid animal models with translational relevance. Here, we characterized a CPPC mouse model that integrated clinically relevant genetic (catechol-O-methyltransferase; COMT knockdown) and environmental (stress and injury) factors. Compared with wild-type mice, Comt+/- mice undergoing repeated swim stress and molar extraction surgery intervention exhibited pronounced multisite body pain and depressive-like behavior lasting >3 months. Comt+/- mice undergoing the intervention also exhibited enhanced activity of primary afferent nociceptors innervating hindpaw and low back sites and increased plasma concentrations of norepinephrine and pro-inflammatory cytokines interleukin-6 (IL-6) and IL-17A. The pain and depressive-like behavior were of greater magnitude and longer duration (≥12 months) in females versus males. Furthermore, increases in anxiety-like behavior and IL-6 were female-specific. The effect of COMT genotype × stress interactions on pain, IL-6, and IL-17A was validated in a cohort of 549 patients with CPPCs, demonstrating clinical relevance. Last, we assessed the predictive validity of the model for analgesic screening and found that it successfully predicted the lack of efficacy of minocycline and the CB2 agonist GW842166X, which were effective in spared nerve injury and complete Freund's adjuvant models, respectively, but failed in clinical trials. Yet, pain in the CPPC model was alleviated by the beta-3 adrenergic antagonist SR59230A. Thus, the CPPC mouse model reliably recapitulates clinically and biologically relevant features of CPPCs and may be implemented to test underlying mechanisms and find new therapeutics.

Role of Blood-Brain Barrier Dysfunction in Delirium following Non-cardiac Surgery in Older Adults

OBJECTIVE

Although animal models suggest a role for blood-brain barrier dysfunction in postoperative delirium-like behavior, its role in postoperative delirium and postoperative recovery in humans is unclear. Thus, we evaluated the role of blood-brain barrier dysfunction in postoperative delirium and hospital length of stay among older surgery patients.

METHODS

Cognitive testing, delirium assessment, and cerebrospinal fluid and blood sampling were prospectively performed before and after non-cardiac, non-neurologic surgery. Blood-brain barrier dysfunction was assessed using the cerebrospinal fluid-to-plasma albumin ratio (CPAR).

RESULTS

Of 207 patients (median age = 68 years, 45% female) with complete CPAR and delirium data, 26 (12.6%) developed postoperative delirium. Overall, CPAR increased from before to 24 hours after surgery (median change = 0.28, interquartile range [IQR] = -0.48 to 1.24, Wilcoxon p = 0.001). Preoperative to 24 hours postoperative change in CPAR was greater among patients who developed delirium versus those who did not (median [IQR] = 1.31 [0.004 to 2.34] vs 0.19 [-0.55 to 1.08], p = 0.003). In a multivariable model adjusting for age, baseline cognition, and surgery type, preoperative to 24 hours postoperative change in CPAR was independently associated with delirium occurrence (per CPAR increase of 1, odds ratio = 1.30, 95% confidence interval [CI] = 1.03-1.63, p = 0.026) and increased hospital length of stay (incidence rate ratio = 1.15, 95% CI = 1.09-1.22, p < 0.001).

INTERPRETATION

Postoperative increases in blood-brain barrier permeability are independently associated with increased delirium rates and postoperative hospital length of stay. Although these findings do not establish causality, studies are warranted to determine whether interventions to reduce postoperative blood-brain barrier dysfunction would reduce postoperative delirium rates and hospital length of stay. ANN NEUROL 2023;94:1024-1035.

A Role for Blood-brain Barrier Dysfunction in Delirium following Non-Cardiac Surgery in Older adults

Objective

Although animal models suggest a role for blood-brain barrier dysfunction in postoperative delirium-like behavior, its role in postoperative delirium and postoperative recovery in humans is unclear. Thus, we evaluated the role of blood-brain barrier dysfunction in postoperative delirium and hospital length of stay among older surgery patients.

Methods

Cognitive testing, delirium assessment, and cerebrospinal fluid and blood sampling were prospectively performed before and after non-cardiac, non-neurologic surgery. Blood-brain barrier dysfunction was assessed using the cerebrospinal fluid-to-plasma albumin ratio (CPAR).

Results

Of 207 patients (median age 68, 45% female) with complete CPAR and delirium data, 26 (12.6%) developed postoperative delirium. Overall, CPAR increased from before to 24-hours after surgery (median postoperative change 0.28, [IQR] [-0.48-1.24]; Wilcoxon p=0.001). Preoperative to 24-hour postoperative change in CPAR was greater among patients who developed delirium vs those who did not (median [IQR] 1.31 [0.004, 2.34] vs 0.19 [-0.55, 1.08]; p=0.003). In a multivariable model adjusting for age, baseline cognition, and surgery type, preoperative to 24-hour postoperative change in CPAR was independently associated with delirium incidence (per CPAR increase of 1, OR = 1.30, [95% CI 1.03-1.63]; p=0.026) and increased hospital length of stay (IRR = 1.15 [95% CI 1.09-1.22]; p<0.001).

Interpretation

Postoperative increases in blood-brain barrier permeability are independently associated with increased delirium rates and postoperative hospital length of stay. Although these findings do not establish causality, studies are warranted to determine whether interventions to reduce postoperative blood-brain barrier dysfunction would reduce postoperative delirium rates and hospital length of stay.

The preference for sugar over sweetener depends on a gut sensor cell

Guided by gut sensory cues, humans and animals prefer nutritive sugars over non-caloric sweeteners, but how the gut steers such preferences remains unknown. In the intestine, neuropod cells synapse with vagal neurons to convey sugar stimuli to the brain within seconds. Here, we found that cholecystokinin (CCK)-labeled duodenal neuropod cells differentiate and transduce luminal stimuli from sweeteners and sugars to the vagus nerve using sweet taste receptors and sodium glucose transporters. The two stimulus types elicited distinct neural pathways: while sweetener stimulated purinergic neurotransmission, sugar stimulated glutamatergic neurotransmission. To probe the contribution of these cells to behavior, we developed optogenetics for the gut lumen by engineering a flexible fiberoptic. We showed that preference for sugar over sweetener in mice depends on neuropod cell glutamatergic signaling. By swiftly discerning the precise identity of nutrient stimuli, gut neuropod cells serve as the entry point to guide nutritive choices.

Buchanan, Rupprecht, Kaelberer and colleagues show that the preference for sugar over sweetener in mice depends on gut neuropod cells. Akin to other sensor cells, neuropod cells swiftly communicate the precise identity of stimuli to drive food choices.

A gut-brain neural circuit for nutrient sensory transduction

The brain is thought to sense gut stimuli only via the passive release of hormones. This is because no connection has been described between the vagus and the putative gut epithelial sensor cell-the enteroendocrine cell. However, these electrically excitable cells contain several features of epithelial transducers. Using a mouse model, we found that enteroendocrine cells synapse with vagal neurons to transduce gut luminal signals in milliseconds by using glutamate as a neurotransmitter. These synaptically connected enteroendocrine cells are referred to henceforth as neuropod cells. The neuroepithelial circuit they form connects the intestinal lumen to the brainstem in one synapse, opening a physical conduit for the brain to sense gut stimuli with the temporal precision and topographical resolution of a synapse.

Overexpression of human NR2B receptor subunit in LMAN causes stuttering and song sequence changes in adult zebra finches

Zebra finches (Taeniopygia guttata) learn to produce songs in a manner reminiscent of spoken language development in humans. One candidate gene implicated in influencing learning is the N-methyl-D-aspartate (NMDA) subtype 2B glutamate receptor (NR2B). Consistent with this idea, NR2B levels are high in the song learning nucleus LMAN (lateral magnocellular nucleus of the anterior nidopallium) during juvenile vocal learning, and decreases to low levels in adults after learning is complete and the song becomes more stereotyped. To test for the role of NR2B in generating song plasticity, we manipulated NR2B expression in LMAN of adult male zebra finches by increasing its protein levels to those found in juvenile birds, using a lentivirus containing the full-length coding sequence of the human NR2B subunit. We found that increased NR2B expression in adult LMAN induced increases in song sequence diversity and slower song tempo more similar to juvenile songs, but also increased syllable repetitions similar to stuttering. We did not observe these effects in control birds with overexpression of NR2B outside of LMAN or with the green fluorescent protein (GFP) in LMAN. Our results suggest that low NR2B subunit expression in adult LMAN is important in conserving features of stereotyped adult courtship song.

Non-invasive activation of optogenetic actuators

The manipulation of genetically targeted neurons with light (optogenetics) continues to provide unprecedented avenues into studying the function of the mammalian brain. However, potential translation into the clinical arena faces a number of significant hurdles, foremost among them the need for insertion of optical fibers into the brain to deliver light to opsins expressed on neuronal membranes. In order to overcome these hardware-related problems, we have developed an alternative strategy for delivering light to opsins which does not involve fiber implants. Rather, the light is produced by a protein, luciferase, which oxidizes intravenously applied substrate, thereby emitting bioluminescence. In proof-of-principle studies employing a fusion protein of a light-generating luciferase to a light-sensing opsin (luminopsin), we showed that light emitted by Gaussia luciferase is indeed able to activate channelrhodopsin, allowing modulation of neuronal activity when expressed in cultured neurons. Here we assessed applicability of the concept in vivo in mice expressing luminopsins from viral vectors and from genetically engineered transgenes. The experiments demonstrate that intravenously applied substrate reaches neurons in the brain, causing the luciferase to produce bioluminescence which can be imaged in vivo, and that activation of channelrhodopsin by bioluminescence is sufficient to affect behavior. Further developments of such technology based on combining optogenetics with bioluminescence - i.e. combining light-sensing molecules with biologically produced light through luciferases - should bring optogenetics closer to clinical applications.

Abstract P6-07-02: Prediction of oncotype DX® recurrence score using pathology generated equations

BACKGROUND: Oncotype DX® is a quantitative reverse transcription polymerase chain reaction based assay that has been shown to have prognostic and predictive value in estrogen receptor (ER) positive breast cancers. The result is reported as a recurrence score (RS) ranging from 0–100, divided into low risk (&lt;18), intermediate risk (18–30), and high risk (≥31) categories. Prior studies have shown that RS is influenced by ER and progesterone receptor (PR) expression, HER2 status, proliferation index, and tumor grade. Our pilot study showed that RS can be predicted by an equation incorporating standard morpho-immunohistologic variables (referred to as Original Magee Equation; Mod Pathol. 2008;21:1255–1261).

METHODS: Using a dataset of 817 cases, we formulated three additional equations to predict the RS category for an independent set of 255 cases. Three models were built based on different hypotheses and data availability and are represented below.

New Magee Equation 1 (nME1): RS = 15.31385 + Nottingham score*1.4055+ ER H-score*(−0.01924) + PR H-score*(−0.02925) + (0 for HER2 negative, 0.77681 for equivocal, 11.58134 for HER2 positive) + Tumor size*0.78677 + KI67 index*0.13269.

New Magee Equation 2 (nME2): RS = 18.8042+ Nottingham score*2.34123 + ER H-score*(−0.03749) + PR H-score*(−0.03065) + (0 for HER2 negative, 1.82921 for equivocal, 11.51378 for HER2 positive) + Tumor size*0.04267.

New Magee Equation 3 (nME3): RS = 24.30812+ ER H-score*(−0.02177) + PR H-score*(−0.02884) + (0 for HER2 negative, 1.46495 for equivocal, 12.75525 for HER2 positive) + KI-67*0.18649.

RESULTS: The concordance between the risk category of oncotype DX® and our equations was 55.8%, 59.4%, and 54.4% for nME1, nME2, and nME3 respectively. With exclusion of the intermediate risk categories for both the actual RS and estimated RS, the concordance for each equation increased to more than 95%, reflecting the very low two step discordance (100% {76/76}, 98.6% {75/76}, and 98.7% {79/80} for nME1, nME2, and nME3 respectively). Even when the estimated RS fell in the intermediate category with any of the equations, the actual RS was either intermediate or low in more than 85% of the cases. The Pearson correlation coefficient between estimated and actual RS was similar for each of the equations (0.61661, 0.60386 and 0.59407 for nME1, nME2 and nME3, respectively).

CONCLUSIONS: Any of the 3 equations can be used to estimate the RS depending on available data. If the estimated RS is clearly high or low, the oncologists should not expect a dramatically different result from oncotype DX®, and the oncotype DX® test may not be needed. Conversely, an oncotype DX® result that is dramatically different from what is expected based on standard morpho-immunohistologic variables should be thoroughly investigated.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-02.

Rapid spine stabilization and synaptic enhancement at the onset of behavioural learning

Behavioural learning depends on the brain's capacity to respond to instructive experience and is often enhanced during a juvenile sensitive period. How instructive experience acts on the juvenile brain to trigger behavioural learning remains unknown. In vitro studies show that forms of synaptic strengthening thought to underlie learning are accompanied by an increase in the stability, number and size of dendritic spines, which are the major sites of excitatory synaptic transmission in the vertebrate brain. In vivo imaging studies in sensory cortical regions reveal that these structural features can be affected by disrupting sensory experience and that spine turnover increases during sensitive periods for sensory map formation. These observations support two hypotheses: first, the increased capacity for behavioural learning during a sensitive period is associated with enhanced spine dynamics on sensorimotor neurons important for the learned behaviour; second, instructive experience rapidly stabilizes and strengthens these dynamic spines. Here we report a test of these hypotheses using two-photon in vivo imaging to measure spine dynamics in zebra finches, which learn to sing by imitating a tutor song during a juvenile sensitive period. Spine dynamics were measured in the forebrain nucleus HVC, the proximal site where auditory information merges with an explicit song motor representation, immediately before and after juvenile finches first experienced tutor song. Higher levels of spine turnover before tutoring correlated with a greater capacity for subsequent song imitation. In juveniles with high levels of spine turnover, hearing a tutor song led to the rapid ( approximately 24-h) stabilization, accumulation and enlargement of dendritic spines in HVC. Moreover, in vivo intracellular recordings made immediately before and after the first day of tutoring revealed robust enhancement of synaptic activity in HVC. These findings suggest that behavioural learning results when instructive experience is able to rapidly stabilize and strengthen synapses on sensorimotor neurons important for the control of the learned behaviour.

Genetic control of neuronal activity in mice conditionally expressing TRPV1

Here we describe a knock-in mouse model for Cre-loxP-based conditional expression of TRPV1 in central nervous system neurons. Expression of Cre recombinase using biolistics, lentivirus or genetic intercrosses triggered heterologous expression of TRPV1 in a cell-specific manner. Application of the TRPV1 ligand capsaicin induced strong inward currents, triggered action potentials and activated stereotyped behaviors, allowing cell type-specific chemical genetic control of neuronal activity in vitro and in vivo.

Microsecond pulsed optical parametric oscillator pumped by a Q-switched fiber laser

We report on what is to our knowledge the first optical parametric oscillator (OPO) pumped by microsecond pulses from a wavelength-tunable solid-state laser. The singly resonant OPO (SRO) is based on a periodically poled LiNbO3 crystal and pumped with 2.1-micros-long pulses from an actively Q-switched Yb fiber laser. At an average fiber laser power of 3.6 W, the SRO generates 1.9-micros-long pulses with a repetition rate of 25 kHz and an average power of 560 mW at 3360 nm. The SRO was tuned from 1518 to 1634 nm (signal) and from 3145 to 3689 nm (idler) via the crystal temperature and poling period. By all-electronic tuning of the fiber laser wavelength over 19 nm, tuning of the mid-infrared idler wavelength over 195 nm was achieved.

Rapidly tunable continuous-wave optical parametric oscillator pumped by a fiber laser

We report on rapid, all-electronically controlled wavelength tuning of a continuous-wave (cw) optical parametric oscillator (OPO) pumped by an ytterbium fiber laser. The OPO is singly resonant for the signal wave and consists of a 40-mm-long periodically poled lithium niobate crystal in a four-mirror ring cavity. By tuning of the fiber-laser wavelength over 33 nm through an intracavity acousto-optic tunable filter, the OPO idler wavelength is tuned from 3160 to 3500 nm in 330 micros, corresponding to an idler frequency-tuning speed of 28 THz/ms. At a fiber-laser power of 6.6 W at 1074 nm, the singly resonant OPO generates 1.13-W cw idler radiation at 3200 nm.

Wide wavelength tuning of an optical parametric oscillator through electro-optic shaping of the gain spectrum

We present a novel technique for tuning an optical parametric oscillator (OPO) through electro-optically induced shape variations of the parametric gain spectrum in quasi-phase-matched lithium niobate (LN). The diode-pumped, triply resonant continuous-wave OPO is based on a 58-mm-long LN crystal that consists of three equally long sections, the outer sections being periodically poled with a 50% duty cycle. The center section is single-domain material and serves as a tunable phase shifter through the electro-optic effect. By application of a voltage of up to 1230 V, the OPO signal and idler wavelengths are tuned over 102 nm from 1560 to 1660 nm, in good agreement with theory.

Fiber-laser-pumped continuous-wave singly resonant optical parametric oscillator

We report on what is to our knowledge the first continuous-wave (cw) optical parametric oscillator (OPO) that is pumped by a tunable fiber laser. The OPO is singly resonant for the signal wave and consists of a 40-mm-long periodically poled LiNbO(3) crystal in a four-mirror ring cavity. At a pump power of 8.3 W provided by the wavelength-tunable Yb-doped fiber laser, the singly resonant OPO generates 1.9 W of 3200-nm cw idler radiation. The singly resonant OPO was tuned from 1515 to 1633 nm (signal) and from 3057 to 3574 nm (idler) by means of the crystal temperature and poling period. We obtained a wide idler tuning range, from 2980 to 3700 mn, by tuning the wavelength of the fiber laser from 1032 to 1095 nm.

2.5-GHz repetition-rate singly resonant optical parametric oscillator synchronously pumped by a mode-locked diode oscillator amplifier system

We report on an optical parametric oscillator (OPO) that is synchronously pumped directly by a diode laser. This laser is an actively mode-locked master-oscillator power-amplifier system that produces 20-ps pulses at 927 nm with a repetition rate of 2.5 GHz and an average power of 0.9 W. The OPO, which is a singly resonant device based on periodically poled lithium niobate, generates 7.8-ps pulses. The OPO threshold is 300 mW of average pump power, and the maximum average idler output power is 78 mW at a wavelength of 2100 nm. By changing the crystal temperature we can wavelength tune the output in the ranges 1530-1737 nm (signal) and 1986-2348 nm (idler). Rapid wavelength tuning of the OPO over 46 nm (signal) and 74 nm (idler) is achieved through tuning the cavity length over 28 microm by use of a piezoelectric transducer.

Diode-pumped singly resonant continuous-wave optical parametric oscillator with wide continuous tuning of the near-infrared idler wave

We demonstrate wide, continuous tuning of the single-frequency idler wave of a cw singly resonant optical parametric oscillator (SRO). The SRO consists of a periodically poled LiNbO(3) crystal for quasi-phase matching in a four-mirror signal-resonant ring cavity. The SRO, excited by 2.25 W of 924-nm radiation from an InGaAs diode laser, generates as much as 200 mW of single-frequency 2.1-mum idler radiation. We tune the idler frequency continuously within a range as large as 56 GHz by changing the wavelength of the diode pump laser. The versatility of this continuously tunable single-frequency infrared source is demonstrated by recording of N(2)O rovibrational absorption lines near 2.1 mum.

EGO-1 is related to RNA-directed RNA polymerase and functions in germ-line development and RNA interference in C. elegans

BACKGROUND

Cell-fate determination requires that cells choose between alternative developmental pathways. For example, germ cells in the nematode worm Caenorhabditis elegans choose between mitotic and meiotic division, and between oogenesis and spermatogenesis. Germ-line mitosis depends on a somatic signal that is mediated by a Notch-type signaling pathway. The ego-1 gene was originally identified on the basis of genetic interactions with the receptor in this pathway and was also shown to be required for oogenesis. Here, we provide more insight into the role of ego-1 in germ-line development.

RESULTS

We have determined the ego-1 gene structure and the molecular basis of ego-1 alleles. Putative ego-1 null mutants had multiple, previously unreported defects in germ-line development. The ego-1 transcript was found predominantly in the germ line. The predicted EGO-1 protein was found to be related to the tomato RNA-directed RNA polymerase (RdRP) and to Neurospora crassa QDE-1, two proteins implicated in post-transcriptional gene silencing (PTGS). For a number of germ-line-expressed genes, ego-1 mutants were resistant to a form of PTGS called RNA interference.

CONCLUSIONS

The ego-1 gene is the first example of a gene encoding an RdRP-related protein with an essential developmental function. The ego-1 gene is also required for a robust response to RNA interference by certain genes. Hence, a protein required for germ-line development in C. elegans may be a component of the RNA interference/PTGS machinery.

Singly resonant continuous-wave optical parametric oscillator pumped by a diode laser

We report on what is believed to be the first singly resonant cw optical parametric oscillator (SRO) that is directly pumped by a diode laser. The SRO consists of a 38-mm-long periodically poled LiNbO(3) crystal in a four-mirror signal-resonant ring cavity. Pumped by 2.5 W of 925-nm diode-laser radiation, the SRO generates 480 mW of single-frequency idler radiation at 2.1mum . The wavelengths of the signal and the idler output are tuned in the ranges of 1.55 to 1.70mum and 2.03 to 2.29mum, respectively, by tuning the wavelength of the diode laser from 924.0 to 925.4 nm.

Periodically poled potassium niobate for second-harmonic generation at 463 nm

We report on the fabrication and characterization of quasi-phase-matched potassium niobate crystals for second-harmonic generation. Periodic 30-mum -pitch antiparallel ferroelectric domains are fabricated by means of poling in an electrical field. Both birefrigence and periodic phase shift of the generated second harmonic contribute to phase matching when the d(31) nonlinear optical tensor element is used. 3.8 mW of second-harmonic radiation at 463 nm is generated by frequency doubling of the output of master-oscillator power-amplifier diode laser in a 5-mm-long crystal. The measured effective nonlinear coefficient is 3.7pm/V. The measured spectral acceptance bandwidth of 0.25 nm corresponds to the theoretical value.

Diode-pumped continuous-wave widely tunable optical parametric oscillator based on periodically poled lithium tantalate

We report on a diode-laser pumped cw optical parametric oscillator (OPO) based on quasi-phase-matched periodically poled lithium tantalate. Pumped by the 2.3-W single-frequency, nearly diffraction-limited 925-nm output of an InGaAs diode master-oscillator power amplifier, the pump and signal resonant OPO generates a single-frequency idler wave with an output of as much as 244 mW. The wavelengths of the signal and idler waves are widely tunable in the range 1.55-2.3mum by use of different poling periods (27.3 to 27.9mum) and by variation of the crystal temperature in the range 70-190 degrees C.

trans-2-phenylcyclopropylamine is a substrate for and inactivator of horseradish peroxidase

Horseradish peroxidase (HRP) is well known for mediating the electron-transfer oxidation of electron-rich aromatic 'donors' such as phenols and anilines, but has not been described to oxidize aliphatic amines. We here confirm the inability of HRP to oxidize typical aliphatic amines, even those which would exist significantly as free bases at the operative pH. In contrast, trans-2-phenylcyclopropylamine (2-PCPA) is both a substrate (turnover product is cinnamaldehyde) and a time-dependent inactivator of HRP. These activities of 2-PCPA are consistent with either a concerted or rapid sequential one-electron-oxidation/ring-opening to give an intermediate capable of covalent binding to the enzyme. 2-PCPA is the first known example of a simple aliphatic amine which serves as a substrate for HRP under turnover conditions.

Haemoprotein-mediated metabolism of enamines and the possible involvement of one-electron oxidations

1. Microsomal metabolism of 1-benzylpiperidine (1-BP), its cis-2,6-dimethyl (cis-2,6-DMBP), 4,4-dimethyl (4,4-DMBP), and alpha, alpha-dimethyl (alpha, alpha-DMBP) analogues, and phencyclidine (PCP) has been studied to assess the involvement of P450 oxidation of the enamine tautomers of the initial endocyclic iminium metabolites. 2. The selective prevention by cyanide of the metabolite production of 1-benzyl-3-piperidone but not 1-benzyl-3-piperidinol from 1-BP is consistent with the enamine as the source of the 3-one metabolite. 3. The parent amines and particularly the independently prepared iminium species induced a pattern of metabolism-dependent irreversible inactivation of P450 benz-phetamine demethylase activity, consistent with involvement of enamine C-3 oxidation in the inactivation process. 4. Substrate activity of the endocyclic enamines and alpha-aminoketones (presumably the enol-enamine tautomers) for horseradish peroxidase under conditions where simple aliphatic amines display no activity is consistent with metabolic one-electron oxidations of the enamines.

Incidence and pattern of jaundice in healthy breast-fed infants during the first month of life

The incidence and pattern of jaundice in 155 normal, full-term, breast-fed, white infants was examined. Infants were screened for jaundice on Days 2, 3, 5, 7, 9, 11, and 13 following birth using transcutaneous bilirubinometry (TcB). By Day 3, 49.7% of the infants were classified as jaundiced (> 10 mg/dl). Infants with low TcB indices on Days 2, 3, and 5 never developed jaundice as indicated by elevated TcB indices on Days 7, 9, 11, and 13. Hence, it may be possible to target infants at risk for severe jaundice prior to discharge. The observed rate of 10.3% for breast-milk jaundice (jaundice present at Day 13) is significantly higher than the highest reported rate of 2.4% (z = 6.43, p < .01). Furthermore, the pattern of jaundice in these infants does not appear to have two peaks, indicating that it is not possible to distinguish between exaggerated physiologic jaundice and breast-milk jaundice using TcB.

Transcutaneous bilirubinometer: intermeter reliability

This study examined intermeter reliability on two transcutaneous bilirubinometers on 30 white prephototherapy infants between 36 and 42 weeks' gestation with birthweights greater than 2500 g. All infants were screened with both meters, on the forehead, within a 5-minute period. Meter readings were taken within 30 minutes following infant heelstick for serum bilirubin. The Pearson correlations between serum bilirubin and jaundice meter measurements were .75 for meter 1 and .76 for meter 2. The correlation between jaundice meter indices from the two meters was .87, leaving 13% of the variance in one meter not accounted for by the correlation with the other meter. An examination of the differences between the two meters revealed that in the upper range (greater than or equal to 16) meter 1 was always higher than meter 2 by, on the average, 2.6 points (SD = 1.3). In readings of 15 or less, the differences between the meters were inconsistent. Additionally, in 16 of 30 cases, the action levels from the two meters led to the same conclusion; in the remaining 14 cases, meter 1 gave a positive reading (indicating the need to determine serum bilirubin) while meter 2 gave an equivocal reading (indicating user discretion in deciding whether serum bilirubin should be determined). These data indicate that each meter should be individually evaluated to determine action indices, and that jaundice meters should not be used interchangeably on the same infant.

[Hemorrhagic internal pachymeningitis. A clinical study of 131 cases]

Between 1980 and 1985, 131 patients suffering from haemorrhagic internal pachymeningitis had undergone surgery. Mean patient age was 59 years (range: 16-90 years). Operation technique was burr-hole craniotomy with closed-system drainage in 124 cases. In five cases primary, in 24 cases secondary removal of the capsule was performed. An Ommaya reservoir was implanted in eight cases. All patients were re-examined after an average of six months and classified into six groups according to the neurological findings. Comparison of initial findings and final results showed an improvement in the patients' condition in 83 cases (63%). There was no change in 20 patients (15%) and deterioration in seven (5%). Twenty-one patients (16%) died during the observation period.

An analysis of bowel perforation in patients with intussusception

A barium colon examination is recommended for the diagnosis and reduction of intussusception in children, except when bowel perforation is evident either radiographically or clinically. In our experience and contrary to recent reports neither radiographic evidence of bowel obstruction nor an age of less than six months is a contraindication. We reviewed 40 patients diagnosed as having had intussusception and found five children aged more than six months with perforations discovered at operation. Three of the five children had plain radiographic findings of small bowel obstruction as did nine other children. In four of the 12 children with evidence of small bowel obstruction a successful hydrostatic reduction of the intussusception was carried out. Barium studies were performed for diagnosis and therapy in eight children with ileo-colic intussusception aged six months or less, four of whom had evidence of small bowel obstruction. In five, including two with obstruction, reduction of the intussusception was successful. The major contraindication to barium examination is radiographic or clinical evidence of perforation.

Cyclophosphamide and dimethylsulfoxide in the treatment of squamous carcinoma of the lung. Therapeutic efficacy, toxicity, and pharmacokinetics

To determine whether dimethylsulfoxide (DMSO) can potentiate antitumor activity of cyclophosphamide (CYC) in patients with squamous cell carcinoma of the lung, 14 patients were treated with 5 l of a 5% or 6% DMSO solution PO over 3 days and 1,500 mg CYC/m2 IV as a 60-min infusion on the third day of treatment. Serial blood, CSF, and urine samples were collected to assess the pharmacokinetics of CYC. Courses were repeated every 3-4 weeks. No antitumor responses were observed. Toxicity was mainly hematologic and similar to that of CYC alone. There was one death from infection during granulocytopenia. Nonhematologic toxicity was moderate to severe and included nausea (14 patients) and vomiting (five patients). The plasma pharmacokinetics of CYC in this study are similar to previously reported results for CYC alone, but the 24-h urinary excretion of CYC in our study is much lower than previously reported. Further studies in tumors more responsive to CYC may be warranted.

Carcinoma of the lung and cigarette smoking. Effect on serum ribonuclease activity

Serum ribonuclease levels were determined in 54 patients with lung carcinoma, 74 long-term cigarette smokers, and 172 nonsmokers. The mean serum ribonuclease level was significantly higher in patients with lung carcinoma and long-term smokers compared with healthy nonsmokers (P less than .001). The serum ribonuclease activity level was not related to chronological age, sex, or race of the smoker or nonsmoker population. Forty (75%) of 53 patients with lung cancer and 49 (66%) of 74 smokers had elevated serum ribonuclease levels compared with 13 (7%) of 179 nonsmoker healthy controls (P less than .001). The highest incidence of elevation was noted in patients with epidermoid carcinoma (95%).