Extraction Time of Kidneys From Deceased Donors and Impact on Outcomes

Cold ischemia time (from flush to out-of-ice) and warm ischemia time (from out-of-ice to reperfusion) are known to impact delayed graft function (DGF) rates and long-term allograft survival following deceased donor kidney transplantation. We propose an additional ischemia time, extraction time, beginning with aortic cross-clamp and perfusion/cooling of the kidneys, and ending with removal of the kidneys and placement on ice on the backtable. During this time the kidneys rewarm, suffering an additional ischemic insult, which may impair transplant function. We measured extraction times of 576 kidneys recovered and transplanted locally between January 2006 and December 2008, then linked to Scientific Registry of Transplant Recipients (SRTR) data for outcomes. Extraction time ranged from 14 to 123 min, with a mean of 44.7 min. In SRTR-adjusted analyses, longer extraction time and DGF were statistically associated (odds ratio [OR] = 1.19 per 5 min beyond 60 min, 95% confidence interval [CI] 1.02-1.39, p = 0.03). Up to 60 min of extraction time, DGF incidence was 27.8%; by 120 min it doubled to nearly 60%. Although not statistically significant (OR = 1.19, 95% CI 0.96-1.49, p = 0.11), primary nonfunction rate also rose dramatically to nearly 20% by 120 min extraction time. Extraction time is a novel and important factor to consider when evaluating a deceased donor kidney offer and when strategizing personnel for kidney recovery.

Loss of pediatric kidney grafts during the "high-risk age window": insights from pediatric liver and simultaneous liver-kidney recipients

Pediatric kidney transplant recipients experience a high-risk age window of increased graft loss during late adolescence and early adulthood that has been attributed primarily to sociobehavioral mechanisms such as nonadherence. An examination of how this age window affects recipients of other organs may inform the extent to which sociobehavioral mechanisms are to blame or whether kidney-specific biologic mechanisms may also exist. Graft loss risk across current recipient age was compared between pediatric kidney (n = 17,446), liver (n = 12,161) and simultaneous liver-kidney (n = 224) transplants using piecewise-constant hazard rate models. Kidney graft loss during late adolescence and early adulthood (ages 17-24 years) was significantly greater than during ages <17 (aHR = 1.79, 95%CI = 1.69-1.90, p < 0.001) and ages >24 (aHR = 1.11, 95%CI = 1.03-1.20, p = 0.005). In contrast, liver graft loss during ages 17-24 was no different than during ages <17 (aHR = 1.03, 95%CI = 0.92-1.16, p = 0.6) or ages >24 (aHR = 1.18, 95%CI = 0.98-1.42, p = 0.1). In simultaneous liver-kidney recipients, a trend towards increased kidney compared to liver graft loss was observed during ages 17-24 years. Late adolescence and early adulthood are less detrimental to pediatric liver grafts compared to kidney grafts, suggesting that sociobehavioral mechanisms alone may be insufficient to create the high-risk age window and that additional biologic mechanisms may also be required.

The aggressive phenotype revisited: utilization of higher-risk liver allografts

Organ shortage has led to increased utilization of higher risk liver allografts. In kidneys, aggressive center-level use of one type of higher risk graft clustered with aggressive use of other types. In this study, we explored center-level behavior in liver utilization. We aggregated national liver transplant recipient data between 2005 and 2009 to the center-level, assigning each center an aggressiveness score based on relative utilization of higher risk livers. Aggressive centers had significantly more patients reaching high MELDs (RR 2.19, 2.33 and 2.28 for number of patients reaching MELD>20, MELD>25 and MELD>30, p<0.001), a higher organ shortage ratio (RR 1.51, 1.60 and 1.51 for number of patients reaching MELD>20, MELD>25 and MELD>30 divided by number of organs recovered at the OPO, p<0.04), and were clustered within various geographic regions, particularly regions 2, 3 and 9. Median MELD at transplant was similar between aggressive and nonaggressive centers, but average annual transplant volume was significantly higher at aggressive centers (RR 2.27, 95% CI 1.47-3.51, p<0.001). In cluster analysis, there were no obvious phenotypic patterns among centers with intermediate levels of aggressiveness. In conclusion, highwaitlist disease severity, geographic differences in organ availability, and transplant volume are the main factors associated with the aggressive utilization of higher risk livers.

The aggressive phenotype: center-level patterns in the utilization of suboptimal kidneys

Despite the fact that suboptimal kidneys have worse outcomes, differences in waiting times and wait-list mortality have led to variations in the use of these kidneys. It is unknown whether aggressive center-level use of one type of suboptimal graft clusters with aggressive use of other types of suboptimal grafts, and what center characteristics are associated with an overall aggressive phenotype. United Network for Organ Sharing (UNOS) data from 2005 to 2009 for adult kidney transplant recipients was aggregated to the center level. An aggressiveness score was assigned to each center based on usage of suboptimal grafts. Deceased-donor transplant volume correlated with aggressiveness in lower volume, but not higher volume centers. Aggressive centers were mostly found in regions 2 and 9. Aggressiveness was associated with wait-list size (RR 1.69, 95% CI 1.20-2.34, p = 0.002), organ shortage (RR 2.30, 95% CI 1.57-3.37, p < 0.001) and waiting times (RR 1.75, 95% CI 1.20-2.57, p = 0.004). No centers in single-center OPOs were classified as aggressive. In cluster analysis, the most aggressive centers were aggressive in all metrics and vice versa; however, centers with intermediate aggressiveness had phenotypic patterns in their usage of suboptimal kidneys. In conclusion, wait-list size, waiting times, geographic region and OPO competition seem to be driving factors in center-level aggressiveness.

Pregnancy outcomes in kidney transplant recipients: a systematic review and meta-analysis

Approximately 50,000 women of reproductive age in the United States are currently living after kidney transplantation (KT), and another 2800 undergo KT each year. Although KT improves reproductive function in women with ESRD, studies of post-KT pregnancies are limited to a few voluntary registry analyses and numerous single-center reports. To obtain more generalizable inferences, we performed a systematic review and meta-analysis of articles published between 2000 and 2010 that reported pregnancy-related outcomes among KT recipients. Of 1343 unique studies, 50 met inclusion criteria, representing 4706 pregnancies in 3570 KT recipients. The overall post-KT live birth rate of 73.5% (95%CI 72.1-74.9) was higher than the general US population (66.7%); similarly, the overall post-KT miscarriage rate of 14.0% (95%CI 12.9-15.1) was lower (17.1%). However, complications of preeclampsia (27.0%, 95%CI 25.2-28.9), gestational diabetes (8.0%, 95%CI 6.7-9.4), Cesarean section (56.9%, 95%CI 54.9-58.9) and preterm delivery (45.6%, 95%CI 43.7-47.5) were higher than the general US population (3.8%, 3.9%, 31.9% and 12.5%, respectively). Pregnancy outcomes were more favorable in studies with lower mean maternal ages; obstetrical complications were higher in studies with shorter mean interval between KT and pregnancy. Although post-KT pregnancy is feasible, complications are relatively high and should be considered in patient counseling and clinical decision making.

Comparison of three DNA extraction methods on bone and blood stains up to 43 years old and amplification of three different gene sequences

Extraction of amplifiable DNA-from degraded human material in the forensic context remains a problem, and maximization of yield and elimination of inhibitors of the Polymerase Chain Reaction (PCR) are important issues which rarely feature in comparative studies. The present work used PCR amplification of three DNA sequences (HLA DPB1, amelogenin and mitochondrial) to assess the efficiency of three methods for extracting DNA (sodium acetate, magnetic beads and glass-milk) from 32 skeletal samples and 25 blood stains up to 43 years old. The results, analyzed using multivariate statistics, confirmed that the extraction method was crucial to the subsequent detection of amplification products; the glass-milk protocol performed better than sodium acetate, which was better than magnetic beads. Successful amplification also depended on gene sequence, multiple copy mitochondrial sequences performing best; however, with the singly copy sequences, the longer HLA DPB1 (327 bp) being detected just as often as the shorter amelogenin (106/112 bp). Amplification products were obtained more frequently from blood stains than bone, perhaps reflecting differences inherent in the material, and from younger compared with older specimens, though plateauing seemed to occur after 10 years. PCR inhibitors were more frequent in sodium acetate extracts.

Measurement of red blood cell-bound C3b and C3d using an enzyme-linked direct antiglobulin test

Complement has a complex role in immune mediated red blood cell (RBC) destruction and usually induces extravascular hemolysis of C3b-coated RBCs by erythrophagocytosis and by acting synergistically with cell-bound immunoglobulins. A sensitive two-stage enzyme-linked direct antiglobulin test (ELDAT) was developed and used to measure RBC-bound C3b and C3d in 120 healthy adult individuals and in 60 patients suffering from a variety of conditions, including warm- and cold-type autoimmune hemolytic anemia, neoplasia, and collagen diseases. The results were compared with those of standard agglutination tests employing polyclonal and monoclonal antiglobulin reagents. Small amounts of C3b and C3d were detected on RBCs of the healthy individuals only by the ELDAT and probably reflected the continuing low-grade activation of complement necessary for the maintenance of homeostasis of a variety of physiological systems. The quantity did not vary with age or gender. In the patients, increased amounts of RBC-bound C3b and C3d were relatively common and probably resulted from autoantibody activity, immune-complexes, and nonspecific adsorption. There was no association between positive ELDAT results and the presence of active hemolysis. The ELDAT was far more sensitive than the agglutination tests for detecting RBC-bound C3b and also for C3d if the monoclonal reagent was employed.

Abnormalities of esterase and glycogen in developing macrophages in non-Hodgkin's lymphoma: a quantitative cytochemical study

Integrating microdensitometry has been used to quantitate changes in 4 cytoplasmic enzymes (NADH dehydrogenase, succinate dehydrogenase, acid phosphatase and alpha-naphthyl butyrate esterase), DNA, RNA and glycogen in developing macrophages from 17 patients with non-Hodgkin's lymphoma and 19 normal subjects. Cytochemical measurements were made at intervals over 6 days of suspension culture; over 16 000 individual cells were examined in total and the results subjected to analysis of variance. While the levels of enzymes and RNA of both groups showed increases over the period of culture, the levels of alpha-naphthyl butyrate esterase in the patients' cells were consistently lower than the corresponding values for the normal cells and glycogen levels were higher, these differences satisfying the pre-determined requirements for statistical significance. It is concluded that (a) maturational changes take place in cytochemical constituents of developing macrophages of non-Hodgkin's lymphoma (b) there are disturbances affecting the amounts of the specific enzyme alpha-naphthyl butyrate esterase and glycogen (c) these abnormalities may be part of a compromise of host defense mechanisms by the disease, although a pre-existing defect in esterase increasing the susceptibility to malignancy is another possibility, and (d) the methods used may be of value in future investigations of the cause of the disturbances and their correction.

Quantitative enzyme cytochemistry during human macrophage development

Integrating microdensitometry was used to study changes in the intracellular activity of 4 enzymes during macrophage development. Suspension cultures of blood monocytes from 19 healthy human subjects were examined at 0, 2, 4 and 6 d. Mononuclear phagocytes were harvested by glass adherence and standard methods were used for cytochemical staining for NADH dehydrogenase, succinate dehydrogenase, acid phosphatase and alpha-naphthyl butyrate esterase. All specimens from all subjects were stained at the same time and staining intensities in individual cells were measured at appropriate wavelengths. A highly significant increase in enzyme activity with culture time was found for all 4 enzymes. These increases in mitochondrial, lysosomal and ectoenzyme activities during development indicate the increasing functional capabilities of the macrophages.

Disordered macrophage development in Hodgkin's disease shown by quantitative cytochemistry

In order to investigate the disordered maturation of mononuclear phagocytes previously found in Hodgkin's disease, integrating microdensitometry was used to quantitate changes in seven cytochemical constituents (NADH dehydrogenase, succinate dehydrogenase, acid phosphatase, alpha-naphthyl butyrate esterase, DNA, RNA and glycogen) of developing macrophages from 19 patients and 19 normal subjects. Individual cells were studied at intervals over six days of suspension culture; the results were subjected to analysis of variance. In both groups, all the constituents studied except DNA showed highly significant increases over the period of culture. Consistently lower levels of alpha-naphthyl butyrate esterase (approximately 65%) and increased levels of glycogen were present in the Hodgkin's group. The results show that (1) maturational changes occur in the cytochemical constituents of developing macrophages of Hodgkin's disease, and (2) there are disturbances affecting the specific enzyme alpha-naphthyl butyrate esterase and glycogen that are likely to have profound implications for host defense mechanisms.

Quantitation of immune-mediated erythrophagocytosis and rosetting in developing macrophages

As part of our ongoing investigations of mononuclear phagocytes in health and disease, measurement of antibody-dependent erythrophagocytosis and rosette formation was carried out during human macrophage development in a suspension culture system. Cells derived from 12 normal human subjects were studied at the monocyte (day 0) and macrophage (day 6) stage of development. Analysis of variance demonstrated significant differences between monocytes and macrophages: the mean proportions of cells (+/- SEM) showing erythrophagocytosis were 0.09 (+/- 0.02) and 0.24 (+/- 0.06), respectively, and the average numbers of engulfed red cells (+/- SEM) were 1.12 (+/- 0.02) and 1.38 (+/- 0.11), respectively. No significant difference was detected in rosette formation. It is concluded that (1) immune-mediated activity of developing macrophages can be quantitated; (2) functional changes take place over 6 days of culture; (3) macrophages show more erythrophagocytic activity than monocytes, and (4) the method should be of value in making quantitative comparisons of their functional development in haematological and other disease states.

Increase in RNA and glycogen but not in DNA in developing human macrophages proven by integrating microdensitometry

In order to quantitate DNA, RNA and glycogen contents of developing macrophages, blood monocytes were obtained from 19 healthy human subjects and examined after 0, 2, 4 and 6 days of suspension culture. Cytochemical staining was carried out by standard methods using Feulgen, cuprolinic blue and PAS. All specimens from all subjects were stained at the same time. Examination was carried out in an integrating microdensitometer, the staining intensities of individual cells being measured at appropriate wavelengths. Over the 6 days of culture, highly significant increases took place in RNA and glycogen, but no significant change was found in DNA content. These findings are taken to indicate that increased protein synthesis and the building up of fuel reserves are features of macrophage development but that S phase DNA replication does not occur.

The effects of ageing and a vitamin E-deficient diet on the lipopigment content of rat hippocampal and Purkinje neurones

This study examined associations between a vitamin E-deficient diet, ageing and aspects of the morphology of neuronal lipopigment in rat hippocampal and Purkinje neurones. Groups of rats given a standard diet were killed at 6, 12, 18 and 25 months of age, while a group which had received a vitamin E-deficient diet from 1-18 months were killed at 18 months of age. Lipopigment within a neuronal cell body consists of a number of discrete regions of varying size. These were identified by fluorescence microscopy and a photograph for each individual neurone was projected onto paper, so that the outlines of the discrete regions of lipopigment could be drawn and subjected to morphometric measurements. Both ageing and vitamin E deficiency in relation to hippocampal neurones and vitamin E deficiency in relation to Purkinje neurones (in which ageing effects were not examined), were associated with a significant (< 0.05) increase in the mean total area (per rat) enclosed by the lipopigment outlines. For both vitamin E deficiency and ageing this increase was associated with both an increase in the number of relatively large discrete lipopigment regions and a decrease in the number of relatively small discrete lipopigment regions. The findings in relation to vitamin E deficiency could be explained by an increased rate of lipopigment formation, involving processes which also occur in ageing.

Immune-mediated interactions during macrophage development in non-Hodgkin's lymphoma

As part of an investigation of mononuclear phagocytes in malignant lymphoma, measurement of immune-mediated erythrophagocytosis and rosette formation was carried out on cells grown in suspension culture at the monocyte (Day 0) and macrophage (Day 6) stages; the culture medium contained autologous serum. Cells were derived from 10 patients with untreated non-Hodgkin's lymphoma (NHL) and from 12 normal individuals. The results were subjected to Analysis of Variance and demonstrated a significant difference between the two groups with respect to erythrophagocytosis but not to rosette formation. In the NHL group, the proportion of erythrophagocytic cells showed no significant increase between the monocyte and macrophage stages (0.07 to 0.09), in contrast to the marked increase seen in the normal group (0.09 to 0.24). In a pilot investigation to examine the possible role of factors in the serum, cells derived from the NHL patients were cultured with serum from healthy donors; they showed no significant difference in the immune-mediated functions from those grown in autologous serum. Overall, the results provide further quantitative evidence of defective macrophage maturation in NHL, presumably reflecting the compromise of host defence mechanisms.

Lipopigment in rat hippocampal and Purkinje neurones after chronic phenytoin administration

The accumulation of lipopigment may indicate ageing, certain diseases and cellular damage, while phenytoin, which has been claimed to cause selective clinical cerebellar dysfunction and degeneration, has been reported to produce increased lipopigment accumulation in rat Purkinje neurones. In the present study, 8 rats received phenytoin, 300 mg/kg/day for 20 weeks, and were compared with a control group of 9 rats in respect of lipopigment in Purkinje and hippocampal neurones. Neuronal lipopigment was identified by fluorescence microscopy. The results did not indicate that phenytoin administration was associated with an increase in the area corresponding to (i.e. within the outlines of) neuronal lipopigment in Purkinje neurones, although the relatively small number of animals limits the power of the study. However, in hippocampal neurones, a two-way analysis of variance for numbers of discrete regions of lipopigment demonstrated a significant interaction (P = 0.003) between, firstly, size categories of discrete regions of lipopigment and, secondly, phenytoin administration or a control procedure. In hippocampal neurones, phenytoin administration was accompanied by a decrease in the numbers of discrete lipopigment regions in the smaller size categories and an increase in the numbers in the larger size categories. This finding indicates the need for further investigation into the effects of phenytoin on brain regions other than the cerebellum, as intellectual deterioration may be related to chronic use of this drug.

Cellular dry mass during macrophage development in malignant lymphoma

In order to throw light on known mononuclear phagocyte disturbances in malignant lymphoma, scanning and integrating microinterferometry was employed to measure dry mass in developing mononuclear phagocytes after 0, 2, 4 and 6 days of suspension culture, using cells from 19 healthy subjects, 19 patients with Hodgkin's disease and 17 with non-Hodgkin's lymphoma. Analysis of variance showed that highly significant increases in dry mass (approximately twofold) occurred over the six-day period. No significant differences were found between the subject groups, nor were any attributable to age or sex. In terms of their dry mass, mononuclear phagocytes from lymphoma patients undergo developmental changes in suspension culture that are similar to normal, but a comparison with earlier cell volume studies suggests that differences in cellular water content may be present.

Ultrastructural morphometry of human leucocytes in health and disease

In this review, the literature on ultrastructural morphometry of each of the main types of human blood leucocytes has been considered, together with the technical and numerical procedures essential for valid analysis. Quantitative data have been reported for these cell types in health and comparisons have been made with those in disease states. In monocytes, and in macrophages developing from them, subtle ultrastructural differences have been detected and quantitated in malignant lymphoma; as the mononuclear phagocytes were not themselves neoplastic, the changes may have related to defects in host defence. Change in the ultrastructural characteristics of leukaemic monoblasts have also been reported. Lymphocytes and malignant lymphoid cells have been extensively investigated: differences between different types and subsets have been shown to be present in both normal lymphocytes and their malignant counterparts in leukemias and lymphomas. Particular attention has been paid to morphometric assessment of nuclear shape and size in these disorders and to its possible value as a diagnostic tool. Granulocytes have so far been the subject of few morphometric studies, although in hypereosinophilic syndrome, cellular changes have been defined and have thrown light on the abnormal pattern of degranulation. There have also been scattered reports on the cells of acute myelogenous leukaemia. The use of computers and sophisticated statistical packages has greatly facilitated the application of multiple comparison procedures and has permitted discriminant analysis to be carried out where appropriate. This review shows that ultrastructural morphometry of leucocytes will have an increasing application in clinical pathology.

Changes in cellular dry mass during macrophage development

Measurements of dry mass were made on developing human macrophages in suspension culture using a scanning and integrating microinterferometer. The mean dry mass (+/- SEM) of day 0 monocytes of 19 healthy individuals was 53.6 +/- 2.4 pg. There was a significant increase in cellular dry mass over the period of culture, mean values at 2, 4 and 6 days being 61.1, 79.8 and 110.4 pg, respectively. A comparison of the results with those obtained previously by ultrastructural morphometry inferred that there is a disproportionate increase in the water content of macrophages during development. The technique may have potential for investigating changes in mononuclear phagocytes in clinical states.

Morphometry of macrophage development in malignant lymphoma. Predictive value of discriminant analysis

Discriminant analysis of morphometric data on the ultrastructure of developing macrophages has been used to classify 62 individual subjects into one of the 3 groups of origin, namely normal, Hodgkin's disease and non-Hodgkin's lymphoma, each finding being compared with the known diagnosis. The data had been obtained from blood monocytes grown in suspension culture over a period of 6 days, and related to whole cell, nucleus, nucleoli and mitochondria. Over 80% of subjects were correctly classified as between the 3 groups and over 90% as to their normality or otherwise. Although the non-specific nature of changes in defence cells makes it unlikely that morphometric studies of macrophages will find a place in the diagnosis of specific malignancies, the present work indicates it could be useful in assessing host response and hence prognosis and response to treatment. Discriminant analysis of quantitative differences in cell structure could have wide clinico-pathological application.

Common statistical errors in morphometry

Morphometry is the quantitative measurement of morphological features. Data is usually obtained by probabilistic sampling techniques and is often markedly variable due to intrinsic variations in sampled specimens. Statistical analyses are required both to allow for and to control such variability. Care is needed in the analysis of morphometric data if false conclusions are to be avoided. Examination of any reasonably sized sample of publications in morphometry usually results in the detection of at least several common errors of statistical practice. Commonest errors involve statistics being carried out on untransformed percentage data, statistics on ratios, repeated multiple applications of tests designed for single comparisons, misuse of correlation and violations of statistical assumptions.

Morphometry of peptide-containing nerves in gut muscle layers: a quantitative approach to the study of autonomic neuro-muscular junctions

A method for the quantitative assessment of peptide-containing nerves in the gastrointestinal muscle layers is described. Tissue samples are sectioned obliquely, at 45 degrees, in the plane bisecting the long axes of longitudinal and circular muscle fibres, and peptide-containing nerve fascicles are revealed by immunofluorescence. Cross-sectioned fascicles are counted (number/area of muscle) and their length density per volume of muscle layer is calculated. The composition of immunostained nerve fascicles is also assessed, by counting peptide-containing fibres in each, while peptide transmitter co-distributions are studied in parallel using adjacent tissue sections. Thus, the approach described provides a means for the delineation of both quantitative tissue distribution and composition of autonomic neuro-muscular junctions in the gastro-intestinal tract.

Quantitative morphometric analyses of the exercised extensor digitorum longus muscle of the mouse

The metric properties of several important components of muscle, the capillaries, the myonuclei and also the cross-sectional areas of type I and type II fibres in the extensor digitorum longus muscle of the mouse have been studied using techniques appropriate for anisotropic tissues. Myonuclear volume density (Nv) was found to be increased by 70% whilst capillary length density (Lv) was increased by 50%. The results were analysed using multivariate statistical analysis (MANOVA) which is necessary for the multiple comparisons which inevitably occur in any morphometric investigation. The mitochondrial distribution within type I fibres was analysed using two-way ANOVA to study the effect of exercise on the mitochondrial contents of the inner, intermediate and outer zones of the muscle fibre. Significant differences in the mitochondrial content in the various zones were found. Exercise was found to increase mitochondrial contents in all three zones.

Abnormal macrophage development in Hodgkin's disease: a morphometric study

The development of macrophages from blood monocytes from 22 patients with untreated Hodgkin's disease and 20 normal subjects has been studied at intervals over a 6-day period of suspension culture in the presence of autologous serum and lymphocytes. Morphometric measurements were made on electron micrographs and the results subjected to multivariate and univariate analyses of variance. The cells from the Hodgkin's group showed highly significant differences from normal. The whole-cell volume, surface area, and cell membrane excess, as well as the mitochondrial volume and surface area, showed smaller increases over the period of culture, and the normal increase in mitochondrial profile numbers was not seen. It would appear that although the patients' monocytes transformed into macrophages in culture, their development was seriously deranged.

Disordered development of macrophages in non-Hodgkin's lymphoma

Macrophage development in 20 untreated patients with non-Hodgkin's lymphoma (NHL) has been studied and compared with that in 20 normal subjects. Morphometric measurements were carried out on ultrastructural features of cell, nucleus and mitochondria during 6 days suspension culture of blood monocytes in the presence of autologous serum and lymphocytes. The results were subjected to multivariate and univariate analysis of variance. Statistically significant differences were found between the subject groups with respect to the volumes and surface areas of cell, nucleus and mitochondria, to the excess surface membrane of cell and nucleus (as compared with equivalent spheres) and to the number of mitochondrial profiles per section. It would appear that the patients' cell grew less, showed less elaboration of surface features and had reduced nuclear and mitochondrial development, the latter affecting mitochondrial numbers rather than individual size. The findings provide further evidence that mononuclear phagocytes are deranged in NHL.

Ultrastructural features of acute monoblastic leukaemia cells: a multivariate morphometric analysis

Morphometric studies were carried out on five ultrastructural measures of size or quantity of some of the intracellular organelles in monoblasts obtained from six patients diagnosed as having acute monoblastic leukaemia and also on monocytes from six normal controls. The morphometric measures were analysed using a one way multivariate analysis of variance (MANOVA) to see whether acute monoblastic leukaemic cells differed from those of normals. It was found that there was a highly significant decrease both in the surface to volume ratio of mitochondria and also in the surface to volume ratio of the nucleus. The possible physiological significance of these structural changes is stressed.

Hypereosinophilic syndrome: case report and morphometric study

A clinical study of a patient with hypereosinophilic syndrome is presented. The blood eosinophil count reached 273 x 10(9) cells per litre. There were only mild symptoms but skin, lung and heart were affected. There was a good response to treatment. In a morphometric analysis, the patient's eosinophils were compared with those of 9 healthy subjects, using appropriate multiple comparison procedures. The patient's eosinophils showed significantly increased cell size and surface area. Mitochondrial volume and surface area were also increased and there were more mitochondrial profiles per section. The eosinophil granules showed a striking reduction in total volume, both the number of profiles and the profile area of individual granules being decreased. These findings are consistent with inappropriate activation and degranulation, a relatively orderly degranulation perhaps accounting for the mild symptoms. This investigation illustrates the value of morphometry in quantitating cellular changes in haematological disorders.

Human macrophage development: a morphometric study

The development of macrophages from the blood monocytes of ten normal subjects has been studied at intervals over a six day period. Suspension cultures were used to obtain randomly orientated cells and morphometric measurements were made on electron micrographs. In order to meet the requirements for normality of distribution and homoscedasticity, data were logarithmically transformed. A two-way analysis of variance was then carried out, taking subjects and time intervals as fixed effects, and using a least significant difference procedure to detect variations between culture time intervals. The whole cell and cytoplasmic volumes showed 3-4 fold increases during culture. The cell surface area more than doubled; this was partly attributable to the larger cell volume and partly to increased surface irregularity. The mitochondrial volume also showed a similar significant increase, attributable to an increase in both number and size of mitochondrial profiles, the cytoplasmic volume fraction remaining approximately constant. Although there was a statistically significant increase in nuclear surface area, the nuclear changes were relatively small. The results and the application of appropriate statistical methods have thus provided basic morphometric data for human macrophage development in culture. The experimental system should permit further investigation of factors governing impaired macrophage development in malignant disease.

Morphometry of eosinophils in human blood

Ultrastructural characteristics of human blood eosinophils have been analysed by morphometric methods in 18 healthy adults. Data were obtained relating to whole cell, nucleus, mitochondria and specific granules. No significant differences were found between the eosinophils of the 9 male and 9 female subjects. The results provide normal values against which changes in eosinophils in disease states may be assessed.

Quantitative studies on the nuclei of muscle of congenitally dystrophic mice

Stereological analyses of the pattern of distribution of heterochromatin and euchromatin in nuclei of muscle fibres are reported. Patterns of distribution found in myonuclei from extensor digitorum longus muscle of C57BL/6Jdy2J/dy2J dystrophic mice were compared with those found in myonuclei from the same muscle of clinically unaffected littermates and of normal control mice. Using a well-known spatial pattern analysis technique, clear differences between these types of nuclei were found. Such differences are clearly of value in helping our understanding of the pathological processes occurring in dystrophic muscle, and may be relevant to future identification and diagnosis of abnormal muscle.

Morphometry of blood monocytes in malignant lymphoma

Morphometric methods were used to study the ultrastructure of blood monocytes in 23 patients with Hodgkin's disease, 12 patients with non-Hodgkin's lymphoma, and 20 normal subjects. The results were analysed using both univariate and multivariate methods. Both analyses supported the interpretation that the total mitochondrial contribution to the cellular ultrastructure was less in Hodgkin's disease than in the other two groups, with smaller mitochondrial volume fractions, volumes, and surface areas being found. In the patients with non-Hodgkin's lymphoma univariate analysis suggested that monocyte nuclei were larger, with more euchromatin and a relatively smaller heterochromatin-euchromatin interface; the cell profile area was larger and the surface to volume ratio was smaller compared with normal subjects. Morphological changes have not previously been described in blood monocytes in malignant lymphoma, but they may be the counterpart of the known mononuclear phagocyte dysfunction.

Morphometry of monocytes of human blood

Morphometric methods have been used to analyse the ultrastructural characteristics of human blood monocytes in 20 normal adults. Data were obtained relating to whole cell, nucleus and mitochondria and, using a method not previously applied to blood cells, for the distribution of heterochromatin and euchromatin. The results provide a normal baseline against which monocyte changes in disease can be assessed.

Morphometric analyses on the muscles of exercise trained and untrained dogs

Nine adult dogs were subjected to an endurance training program consisting of gradually increasing periods of treadmill exercise. Biopsies of vastus lateralis muscles taken prior to an on completion of the training program were used to study the alterations in the capillary network and muscle-fiber nuclei. Combined morphometric and stereological analyses showed that the total length of capillaries (LV) and their total surface area (SV) per unit volume of muscle was significantly increased during training. Changes in the properties of myonuclei following training were also studied. Highly significant increases in the number of nuclei per unit volume of muscle (NV) were found. The increase in the numerical density of muscle-fiber nuclei would seem to indicate that the new nuclei were formed in the muscle during prolonged training. The relative amounts and distribution of heterochromatin and euchromatin were measured in trained and untrained dogs using a simple point-counting and random-transect technique. Their content of the different types of chromatin (volume functions and chromatin patch sizes in micrographs) were found to be altered significantly as a result of the training. The findings were consistent with the view that the amount of euchromatin within nuclei varies according to the degree of cellular activity.

Stereological analyses of capillaries in muscles of dystrophic mice

Stereological analyses of the distribution of capillaries in skeletal muscles of congenitally dystrophic mice are described and reported. Two methods are used, each based on a different mathematical model of the 3-dimensional distribution of lines in space. For these analyses specimens of extensor digitorum longus muscle from clinically affected C57BL/6Jdy2J/dy2J dystrophic mice, and from non-littermate controls, were used. The analyses were carried out on transverse and longitudinally orientated semithin sections of these muscles. Although the two methods employed are based on different mathematical models and yield results relevant to each particular model, it is clear that there is a more extensive capillary network present per unit volume of the dystrophic muscle than in control muscles. These findings are relevant to the theories which involve a vascular aetiology for muscular dystrophy. It is apparent that, in order to explore the structure of the capillary network more fully, there is a need for the development of more sophisticated stereological techniques for analysis of capillaries in skeletal muscle.

Quantitative studies on the numerical frequency of myonuclei in the muscles of exercised rats: evidence against the occurrence of fibre-splitting

The histological changes associated with exercise-induced muscular hypertrophy have variously been interpreted as due to fibre-splitting or satellite-cell activity. If due to fibre-splitting, than a marked fall in the number of nuclei per unit volume of muscle must occur. To see if this is the case, we have examined post-mortem specimens of extensor digitorum longus muscles in rats exercised by swimming for up to 30 min twice daily for 35 days. The mean cross-sectional area of muscle fibres was unaltered by exercise but mean length of capillary per unit volume of muscle was increased by 55% and number of nuclei per unit volume of muscle by 30%, both changes being significant. Mean nuclear volume increased by approximately 75%. Thus the muscles did adapt to exercise and new myonuclei were formed, contrary to expectations if fibre-splitting were the essential change. In this study the fibres seemed not to have increased in size and further studies, perhaps using autoradiographic analysis of tritiated thymidine-labelled satellite-cell nuclei, are needed to clarify the precise mechanisms involved.

A stereological analysis of capillaries in normal and hypertrophic muscle

A realistic model of the distribution of the partially orientated capillaries in skeletal muscles has been introduced for stereological analyses. Distributional parameters not previously estimated for capillary networks in muscles have been quantified. These include the lengths of capillary per unit volume of tissue ((L(v)) and a dimensionless index of orientation (omega). The present study demonstrates that surgical techniques for inducing skeletal muscle hypertrophy can be an effective stimulus for the proliferation of additional capillaries. In the hypertrophic muscles studied the capillaries become more highly orientated. This suggests that the growth of new capillaries occurs preferentially along the long axis of the muscle.

Stereological analysis of the number of nuclei in skeletal muscle fibres

A simple morphological method is described whereby the numbers of nuclei in different types of skeletal muscle fibre may be determined. The method allows for the anisotropy of skeletal muscle fibres and the non-random distribution of their nuclei. The advantages in the use of a morphological (rather than a biochemical) method are discussed, together with possible applications of the method in the study of changes which occur in skeletal muscle in adaptation to stress and in disease.

Quantitative studies on the contiguity of muscle fibre types in normal and hypertrophic skeletal muscles

Skeletal muscles consist of an heterogeneous population of muscle fibres. A method for deriving an index of contiguity for any of the fibre types is proposed. This term is defined as the proportion of the total boundary length (interface) of a fibre type which is in contact with fibres of the same type. It can be measured on any type of skeletal muscle independently of its composition. Values for the index of contiguity for the two major types of fibre in normal and hypertrophic extensor digitorum longus muscles of the mouse do not seem to differ.

Studies on the responses of different types of muscle fibre during surgically induced compensatory hypertrophy

The sizes of the different types of muscle fibre in the extensor digitorum longus (EDL) muscles of mice have been measured, EDL muscles showing compensatory hypertrophy following the removal of the tibialis anterior muscle 116 days previously being compared with normal contralateral controls. Contrary to previous findings, the hypertrophy was well maintained after 116 days and Type II fibres were enlarged preferentially.

Stereological analyses of the structure of mitochondria in pigeon skeletal muscle

The mitochondria in type-I and -II muscle fibres in the pectoralis major muscle of the pigeon (Columba livia) have been analysed using stereological techniques not previously applied in muscle biology. Mitochondrial volume fractions (VV) were estimated in different regions of each type of muscle fibre using randomly orientated sampling sectors within fibre profiles. These sectors were sub-divided into smaller sampling regions to provide accurate data on the intracellular distribution of mitochondria. Estimates of the external surface densities of mitochondria per unit volume of fibre, SV total surface, and also the densities of mitochondrial cristae, SV total cristae, were obtained using a specific technique derived for analysing anisotropic structures (Saltykov, 1958). The relative amounts of the random and orientated mitochondrial membranes were also estimated. Significant differences were found to exist between the different types of muscle fibres and considerable though constant variations in the intracellular arrangement of mitochondria were also found.

Ultrastructure of muscle spindles in C57BL/6J dy2J/dy2J dystrophic mice

The sensory organs of skeletal muscles, the muscle spindles, were examined using electron microscopy in dy2J/dy2J dystrophic mice. Despite widespread damage to the extrafusal (skeletomotor) fibres the intrafusal (spindle) fibres appeared normal and seemed resistant to the aetiological factors for murine dystrophy.

A stereological analysis of the effect of 19-nortestosterone (Durabolin) on rat skeletal muscle

It is known that some anabolic steroids are capable of increasing the sizes of skeletal muscles or increasing their mechanical performance. The present study was undertaken to establish quantitatively the alterations which occur in skeletal muscle fibres as a result of the injection of 19-nortestosterone (nandrolone phenyl proprionate). Specimens of diaphragm were obtained from the experimental and control animals and prepared for electron microscopy and stereological analyses. Following low doses of the steroid stereological analyses have shown that in Type I and in intermediate fibres their mitochondrial volume proportions increase though their myofilament contents decrease. With higher doses, stereological analyses have shown that the mitochondrial volume proportions were increased particularly in intermediate fibres whilst the myofilament content of Type I and II fibres was significantly reduced.

Compensatory muscular hypertrophy in the extensor digitorum longus muscle of the mouse

Hypertrophy of the extensor digitorum longus muscle after surgical removal of its companion tibialis anterior muscle has been studied in mice. Early, intermediate and late stages in the process of hypertrophy have been defined. The proportional increase in the man cross sectional area of fibres in a hypertrophic muscle consistently exceeded the proportional increase in the weight of the same muscle in all animals. This suggests that hypoplasis (loss of fibres) was occurring. This work was carried out with the aid of grants from the Medical Research Council and Science Research Council of Great Britain.