The effect of diagnosis and age on the DST: a metaanalytic approach

The authors present new data on the results of the pretreatment Dexamethasone Suppression Test (DST) in 164 drug-free inpatients, as well as on the effects of age on postdexamethasone cortisol values. Nonsuppression rates were 18% in schizophrenic patients (n = 44), versus 46% in patients with a major depression (n = 56). In addition, a significant correlation was found between age and the 4:00 PM postdexamethasone cortisol value among the depressed patients (r = 0.33). The authors then applied a metaanalysis to summarize 25 other studies that have addressed the schizophrenia/major depression dichotomy as it relates to the DST outcome. Nonsuppression rates were consistently different in schizophrenic patients (19%) when compared to patients with a major depression (51%) or normal controls (7%). These differences were highly significant as measured by the Mantel-Haenszel chi-square statistic. A metaanalysis applied to a series of correlations obtained from 14 other studies reporting an age/postdexamethasone cortisol relationship in affective patients indicated a modest, but significant correlation (r = 0.24) in a total of 1284 patients (p less than 1 x 10(-8)).

Changes in pulmonary mechanics after the administration of surfactant to infants with respiratory distress syndrome

We assessed pulmonary mechanics in 35 premature infants with respiratory distress syndrome just before and one hour after the administration of 90 mg of surfactant to each infant. Transpulmonary pressure was measured between the airway opening and an esophageal balloon with use of a differential transducer, and flow rates were measured by a pneumotachometer. Values for pulmonary mechanics were then calculated by microcomputer processing. The administration of surfactant produced a large decrease (56 percent) in the mean (+/- SEM) ratio of alveolar to arterial oxygen, from 7.1 +/- 0.5 to 3.1 +/- 0.2 (P less than 0.0001)--a change that indicates improvement in gas exchange. Associated changes in pulmonary mechanics were not demonstrable when 10 of the infants were studied during continuous mechanical ventilation. However, in the 25 infants examined during spontaneous breathing with continuous positive airway pressures (identical airway pressures before and after treatment), large and consistent improvements in pulmonary mechanics were found after the administration of surfactant. Tidal volume increased by 32 percent (P less than 0.03), minute ventilation by 38 percent (P less than 0.02), dynamic compliance by 29 percent (P less than 0.004), and inspiratory flow rates by 54 percent (P less than 0.01). We conclude that significant improvement in pulmonary mechanics results from surfactant-replacement therapy for respiratory distress syndrome, but that these mechanical changes are apparent only during spontaneous respiration and can be masked if measurements are made during mechanical ventilation.

The control of glomerular filtration rate and renal blood flow in chronically volume-expanded rats

1. Chronic volume expansion by dietary salt loading practically abolishes tubuloglomerular feed-back (TGF) by means of a humoral inhibitor in tubular fluid. Elimination of the vasoconstrictor influence of feed-back does not, however, increase glomerular filtration rate (GFR) and renal blood flow (RBF), implying that chronic salt loading induces additional preglomerular vasoconstriction. This being so, the feed-back response which, although absent in free-flowing nephrons, can still be elicited by loop of Henle perfusion with Ringer solution, should be essentially normal, except that nephron GFR at any loop perfusion rate should be lower than in controls. Persistence of RBF, GFR and nephron GFR autoregulation would imply that autoregulation is achieved by a preglomerular resistance control system independent of feed-back. 2. These hypotheses were tested by clearance and micropuncture experiments in rats chronically fed a diet containing 40 g NaCl (kg food)-1. 3. RBF and GFR autoregulation indeed persisted, the former down to 90 mmHg compared with 105 mmHg in controls. In controls, nephron GFR measured distally was autoregulated down to 90 mmHg whereas that measured proximally was autoregulated only above 105 mmHg. In high-salt rats nephron GFR from both sites was autoregulated to 90 mmHg. 4. Loop of Henle perfusion with homologous tubular fluid in high-salt rats confirmed attenuation of feed-back. Loop perfusion with Ringer solution yielded a response comparable to that in controls (maximal reduction of nephron GFR to 57%, compared with 56% in controls). Absolute nephron GFR at any loop perfusion rate was lower in high-salt rats than in controls. 5. These observations confirm the initial hypotheses. Considering feed-back and autoregulation as independent, preglomerular resistance control mechanisms, together with elementary haemodynamic considerations, allows formulation of a renal haemodynamics model whose quantitative predictions regarding characteristics of RBF, GFR and feed-back control are remarkably consistent with the literature.

Cerebrospinal fluid and urinary biogenic amines in depressed patients and healthy controls

The National Institute of Mental Health-Clinical Research Branch Collaborative Study investigated 132 drug-free, severely depressed patients and 80 healthy controls. Forty-five percent of the depressed patients excreted markedly elevated levels of urinary epinephrine (E) and metanephrine (MET), while only 5% of healthy controls did so. Using gaussian mixture distributions, we identified two subgroups of depressed patients: one excreting normal levels and the other excreting high levels of urinary E, MET, norepinephrine, and normetanephrine. Cerebrospinal fluid homovanillic acid levels were low in a subgroup of depressed patients. When analyzed by subgroup, the elevated E + MET group had markedly lower cerebrospinal fluid homovanillic acid levels than controls, whereas depressed patients with normal catecholamine levels did not. Since it has been postulated that there are two subgroups of depressed patients, those with low 3-methoxy-4-hydroxyphenylglycol (MHPG) levels and normal 5-hydroxyindoleacetic acid (5-HIAA) levels and those with normal MHPG levels and low 5-HIAA levels, several analyses were performed to see if such a group could be identified. Our analysis failed to find evidence of a subgroup of depressives with low MHPG and normal 5-HIAA levels or normal MHPG and low 5-HIAA levels.

Status of school children's hearing aids relative to monitoring practices

Data concerning hearing aid monitoring practices and hearing aid malfunction were collected for three groups of mainstreamed hearing-impaired children: 248 children receiving services from itinerant teachers of the hearing impaired, 43 who participated in a study involving extensive psychoeducational evaluation, and 10 children who attended a 6 week residential treatment program in which hearing aid function was checked at least twice each day. Comparisons of the three data sets revealed that even conscientious parental and professional monitoring practices prove inadequate. As a result, it is hypothesized that children must take active roles in the monitoring process. A program to help children develop hearing aid monitoring skills is outlined.

Fibrinolysis by rat mesothelial cells in vitro: the effect of mineral dusts at non-toxic doses

Rat mesothelial cell cultures were shown to have considerable plasminogen dependent and independent fibrinolytic activity in vitro using an 125I fibrin degradation assay. At non-toxic doses of the mineral dusts titanium dioxide, quartz and crocidolite asbestos, as assessed by 51Cr release, the fibrinolytic activity of mesothelial cells was inhibited. Quartz had the greatest inhibitory effect and crocidolite asbestos had the least. These results suggests that inhibition of mesothelial cell fibrinolysis does not, on its own, explain pleural fibrosis due to toxic mineral dusts.

Kinetics of the bronchoalveolar leucocyte response in rats during exposure to equal airborne mass concentrations of quartz, chrysotile asbestos, or titanium dioxide

The kinetics of the bronchoalveolar response was assessed in rats exposed, at equal airborne mass concentration (10 mg/m3), to titanium dioxide--a non-pathogenic dust--and the two pathogenic mineral dusts quartz and chrysotile asbestos. Rats were killed at intervals over a 75 day exposure period and groups of rats exposed for 32 and 75 days after recovery for two months. Bronchoalveolar lavage was carried out and the lavage fluid characterised for cellular content, macrophage activation, and concentrations of free total protein, lactate dehydrogenase, and N-acetyl-beta-D-glucosaminidase. Inhalation exposure to the two pathogenic dusts resulted in an increased number of leucocytes, macrophage activation, and increased levels of free enzymes and total protein. The pattern and magnitude of the responses to quartz and chrysotile differed. Chrysotile caused less inflammation than quartz, and the main cellular response peaked around the middle of the period of dust exposure whereas the highest levels of enzymes occurred towards the end. The difference in timing suggests that macrophages were not available for lavage towards the end of the exposure, owing to their playing a part possibly in deposition of granulation tissue. Quartz caused a greater cellular and enzyme response than chrysotile, particularly towards the end of the dust exposure phase. There was a noticeable progression of inflammation in the quartz exposed groups left to recover for two months, but not in the chrysotile recovery groups.

Abnormal rabbit heterophil chemotaxis following thermal injury. An in vivo model of an abnormality of the chemoattractant receptor for f-met-leu-phe

Previous studies have shown that the decreased neutrophil migratory responsiveness seen in burned patients correlates with the extent of thermal injury and the extent of the neutrophil-specific granule deficiency. To understand better the relationship between the neutrophil dysfunction, degranulation, and thermal injury, a rabbit model was studied. Eighteen rabbits were burned over 20% of their surface area. Assay of peripheral blood heterophils disclosed decreased migratory activity compared with preburn levels and decreased lysozyme content vs preburn levels, but no change in the beta-glucuronidase content. The specific binding of tritiated formyl-methionyl-leucyl-phenylalanine to peripheral blood heterophils was increased fivefold over that of control cells. These studies indicate that, following thermal injury, there is a selective decrease of specific granule contents and an increase in chemoattractant binding to the cell and also suggest an abnormality in chemoattractant receptor processing. The rabbit provides a convenient model for the study of compromised host defenses following thermal injury.

Effects of ingesting 6% and 12% glucose/electrolyte beverages during prolonged intermittent cycling in the heat

This study compared the effects of ingesting 6% (MC) and 12% (HC) glucose/electrolyte beverages, and a flavored water placebo (P) on markers of fluid absorption, palatability, and physiological function during prolonged intermittent cycling in the heat. On three occasions, 15 trained male cyclists performed two 60 min cycling bouts at 65% VO2max (E1 and E2). A brief exhaustive performance ride (approximately 3 min) was completed after E1 and E2, and after 20 min recovery (P1, P2, P3). Every 20 min, subjects consumed 275 mL of P, MC or HC. The first drink contained 20 mL of D2O, a tracer of fluid entry into blood plasma. Plasma D2O accumulation was slower for HC than for P and MC (P less than 0.001). HC caused more nausea (P less than 0.01) and fullness (P less than 0.05) than MC or P, and subjects said they would be less likely to consume HC during training or competition (P less than 0.10). Sweat rates, HR, Tre, Tsk, VO2, and PV were similar for all drinks. Performance of P1, P2, P3 were not different among drinks. However, four cyclists failed to maintain the prescribed work rate during E2 for HC but only one failed for MC and P. These data suggest that the slow absorption of a 12% glucose/electrolyte beverage during prolonged intermittent exercise in the heat may increase the risk of gastrointestinal distress and thereby limit performance.

Platelet monoamine oxidase in alcoholism

We studied platelet monamine oxidase (MAO) activity using 14C-tyramine as substrate in hospitalized alcoholic patients in the early phases of abstinence and in nonhospitalized normal control volunteers. Platelet MAO was determined in 75 patients (67 men, 8 women) with alcoholism and 123 normal control volunteers (52 men, 71 women). The platelet MAO activity in alcoholic patients was significantly lower than in normal control volunteers. We also observed that the mean platelet MAO activity in male alcoholics was significantly lower than in normal males. The analysis of platelet MAO in alcoholics revealed a mixture of two normal distributions. Alcoholic patients falling into the low MAO component were younger in age, with a lower age of onset of alcoholism, and had higher frequencies of family history of alcoholism. They thus resembled type II alcoholics described by other investigators. Platelet MAO may thus serve as a useful biological marker for subtyping alcoholism and identifying high-risk groups at an early stage. The findings of this study are consistent with previous reports of low platelet MAO activity in alcoholic patients.

Effects of electrostatic charge on the pathogenicity of chrysotile asbestos

Two groups of 48 rats of the AF/HAN strain were exposed for one year to respirable dust clouds of UICC chrysotile asbestos at a dose level of 10 mg/m3. One group was treated with dust carrying the normal electrostatic charge produced during dust generation, whereas the other was exposed to dust discharged by exposure to ionising radiation from a thallium-204 source. After dusting most animals were retained for their full life span. At the end of the dusting period those animals treated with normally charged dust had significantly more chrysotile retained in their lungs than animals exposed to discharged dust. Subsequently, animals treated with normally charged dust developed more pulmonary fibrosis and more pulmonary tumours. These findings suggest that the charge carried by airborne fibres should be taken into account when considering the health risks from exposure to chrysotile. Highly charged fibres are more likely to be deposited in lung tissue and thus constitute a greater hazard.

Resetting of tubuloglomerular feedback in acute volume expansion in rats

Loss of sensitivity or "resetting" of tubulo-glomerular feedback has been reported after both acute and chronic volume expansion in rats. In chronic volume expansion due to dietary salt loading, resetting was found to result from the appearance of an inhibitory factor in tubular fluid. The aim of the present study was to test the possibility that resetting after acute isooncotic volume expansion may also be due to such an inhibitor. Rats were acutely volume expanded (4.5% of body weight) by infusion of a solution of fresh plasma and Ringer's solution. Tubuloglomerular feedback activity was assessed in expanded and control animals by measuring early proximal flow (EPF) rate during perfusion of the loop of Henle at varying rates with proximal tubular fluid harvested from the control (control TF) and expanded animals (AVE TF). When loops of Henle in control animals were perfused with control TF at 10, 20 or 40 nl min-1, EPF fell from (mean +/- SD) 29.8 +/- 5.6 at zero loop flow to 27.5 +/- 7.5, 21.1 +/- 4.2 and 15.5 +/- 4.5 nl min-1 gKW-1 respectively. Perfusion at the same rates with control TF in expanded animals reduced EPF from 39.5 +/- 9.6 (at zero loop flow) to 35.9 +/- 11.3, 31.6 +/- 4.3 and 22.9 +/- 6.8 nl min-1 gKW-1 respectively. When loops of Henle in control animals were perfused with AVE TF, EPF fell from 28.6 +/- 9.5 (zero loop flow) to 23.5 +/- 8.6, 19.9 +/- 8.2 and 15.6 +/- 6.5 nl min-1 gKW-1 respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison of thiothixene with chlorpromazine in the treatment of mania

High potency neuroleptics have been advocated for acute mania because their side effect profile may allow for a more rapid dose escalation and symptom resolution. Low potency neuroleptics have also been advocated because their sedative properties might better calm the acutely agitated manic patient. The authors tested these hypotheses using a double-blind design comparing thiothixene with chlorpromazine in 29 manic patients on a standard dose of lithium. They found that thiothixene and chlorpromazine produced identical rates and degree of improvement, that side effect profiles differed for each drug but did not affect overall clinical response, and that most patients had a good response on much lower than expected doses. The implications for less aggressive use of neuroleptics to treat mania are discussed.

Insulin-induced hypoglycaemic response and release of growth hormone in depressed patients and healthy controls

As part of the Collaborative Study of the Psychobiology of Depression, we have examined the pretreatment growth hormone response (delta GH) to insulin (0.1 U/kg) and the magnitude of the hypoglycaemic response in a large number of well-defined depressed patients (N = 132) and healthy controls (N = 80). After applying rigorous exclusion criteria, data were analysed from 93 patients and 66 controls for blood glucose response and from 56 patients and 52 controls for delta GH. Depressed patients, either unipolar or bipolar, showed less of a fall in glucose than controls. A weak association was found between the magnitude of the fall in glucose and the severity of depression. No significant differences were found in values for delta GH between the unipolar or bipolar depressed patients and controls either for males, pre-menopausal or post-menopausal females, or the total female group. These data do not support previous claims of a lowered delta GH response to insulin in depressed patients. However, the resistance to hypoglycaemia seen in the depressed patients is consistent with previous reports.

Biosynthesis of Sucrose and Mannitol as a Function of Leaf Age in Celery (Apium graveolens L.)

In celery (Apium graveolens L.), the two major translocated carbohydrates are sucrose and the acyclic polyol mannitol. Their metabolism, however, is different and their specific functions are uncertain. To compare their roles in carbon partitioning and sink-source transitions, developmental changes in (14)CO(2) labeling, pool sizes, and key enzyme activities in leaf tissues were examined. The proportion of label in mannitol increased dramatically with leaf maturation whereas that in sucrose remained fairly constant. Mannitol content, however, was high in all leaves and sucrose content increased as leaves developed. Activities of mannose-6-P reductase, cytoplasmic and chloroplastic fructose-1,6-bisphosphatases, sucrose phosphate synthase, and sucrose synthase increased with leaf maturation and decreased as leaves senesced. Ribulose bisphosphate carboxylase and nonreversible glyceraldehyde-3-P dehydrogenase activities rose as leaves developed but did not decrease. Thus, sucrose is produced in all photosynthetically active leaves whereas mannitol is synthesized primarily in mature leaves and stored in all leaves. Onset of sucrose export in celery may result from sucrose accumulation in expanding leaves, but mannitol export is clearly unrelated to mannitol concentration. Mannitol export, however, appears to coincide with increased mannitol biosynthesis. Although mannitol and sucrose arise from a common precursor in celery, subsequent metabolism and transport must be regulated separately.

Predicting survival in infants with persistent pulmonary hypertension of the newborn

Since persistent pulmonary hypertension of the newborn (PPHN) often occurs as a life-threatening illness, it would be advantageous to identify the highest-risk infants within the first 24 hours of life so that transfer to centers with extracorporeal membrane oxygenation (ECMO) or high-frequency ventilation can be facilitated. Fifty-three infants with PPHN were evaluated retrospectively. A multivariate discriminant analysis of risk factors determined that lowest pH, critical PaCO2, highest inspiratory pressure (PI), maximum ventilator rate, and 5-minute Apgar score were significantly different between the 35 survivors (66%) and the 18 infants (34%) who had died when examined within the first 24 hours of life. A clinical scoring system was designed based on these five criteria, which predicted outcome accurately in 93% of infants. A logistic regression analysis was performed as a check on these results and found that lowest pH, critical PaCO2, and PI predicted outcome with great accuracy. These results suggest that the use of these scoring systems within the first 24 hours of age may help predict outcome in infants with PPHN.

Response of psychotic and nonpsychotic depression to phenelzine

The authors studied 52 depressed inpatients to examine treatment response to phenelzine, a monoamine oxidase (MAO) inhibitor. All patients were classified into one of three RDC categories (definitely psychotic, probably psychotic, and nonpsychotic). For the entire sample, the mean platelet MAO inhibition level achieved with phenelzine was greater than 80%. Response to treatment was determined by independent clinical assessment and by the change in rating scores from baseline; 68% of the nonpsychotic, 43% of the probably psychotic, and 21% of the definitely psychotic patients were classified as responders. This differential response rate is similar to that reported in the literature for tricyclic antidepressants.

Increased tubuloglomerular feed-back mediated suppression of glomerular filtration during acute volume expansion in rats

1. Volume expansion is currently believed to change the intrinsic properties of the juxtaglomerular apparatus such that the sensitivity of the tubuloglomerular feedback (TGF) mechanism is reduced, thus allowing glomerular filtration rate, and hence salt and water excretion, to rise. Recent studies conflict with this view and indeed the older literature reveals that the rise in glomerular filtration rate (GFR) under these conditions is far more modest than would be expected if TGF control were eliminated. 2. To investigate this problem, TGF control of filtration rate was examined by measuring single-nephron glomerular filtration rate (SNGFR) during loop of Henle perfusion at varying rates in rats under control conditions, after acute, moderate (4% of body weight), iso-oncotic volume expansion and in rats treated with antibodies to atrial natriuretic peptide (ANP) prior to the acute volume expansion. 3. With TGF control of filtration interrupted by filtrate collection from the proximal tubule, SNGFR in the expanded rats was massively increased compared with controls, although SNGFR measured in the distal tubule, and hence with TGF control intact, was only modestly increased, as was whole-kidney filtration rate. Loop perfusion at increasing rates up to 30 nl min-1 progressively decreased SNGFR in controls, and in the expanded rats the range over which control was exerted extended up to 60-80 nl min-1. For changes in loop flow around the spontaneous operating point, the sensitivity of the TGF mechanism, defined as delta SNGFR/delta loop flow, was similar in both groups. Treatment of rats with ANP antibodies prior to volume expansion substantially blunted the changes in renal salt and water excretion and the increase in SNGFR seen in the absence of loop perfusion. 4. These results are not consistent with a diminution of TGF function after volume expansion, rather with an enhancement. The latter is best accounted for by vasodilation of preglomerular resistance vessels on volume expansion, a result predicted by calculations from a model based on the serial arrangement of preglomerular and TGF-controlled vascular resistance elements and the established pharmacological actions of ANP.

Cell-surface markers on haemopoietic precursors. Reagents for the isolation and analysis of progenitor cell subpopulations

Within the last decade, major advances have been made in the analysis of cell-surface marker expression on haemopoietic progenitor cells as a result of the development of multiparameter cell sorting and monoclonal antibody techniques. Although some controversy exists with regard to the actual identification of the stem cell, markers specific for CFU-s and for particular subsets of progenitor cells have not yet been identified. An analysis of cell-surface markers on haemopoietic progenitor cells is complicated by at least three factors. First, it appears that, in mice, the clonal assays do not adequately identify the haemopoietic stem cell. Complete repopulation of all haemopoietic cell compartments in vivo over an extended period of time appears to be the only reliable method for identifying such a cell. Secondly cell-surface marker distribution on haemopoietic progenitors from normal tissues may be indicative of the cycling status of cells. Thus, expression of markers on progenitors from bone marrow or foetal liver which have been perturbed by drugs or viruses may merely reflect a change in their cycling status following drug or viral insult. Thirdly, substantial loss of cells occurs during the purification of particular cell types. For most cell separation procedures, only a minor proportion of the progenitor cells of interest are recovered and these may not be representative of the progenitor population as a whole. During differentiation to mature cells, antigenic determinants present on early progenitor cells may either be progressively lost or amplified. This differential expression of cell-surface molecules has provided a useful tool for the substantial enrichment of haemopoietic subsets, particularly CFU-E and CFU-s. To date, however, most early haemopoietic progenitor cells detected by in vitro CFC assays (day 8 CFC) cannot be completely segregated from one another. The ability to distinguish between such progenitors during the early stages of lineage commitment would provide a more detailed understanding of the relationship between lymphoid precursors, myeloid precursors and stem cells, and would lead to significant advances in developmental biology. Separation of cells at different stages of differentiation within a given lineage would provide an opportunity for studying regulatory mechanisms involved in gene expression in normal cell populations.

Differential responses to in vitro bud culture in mature Robinia pseudoacacia L. (black locust)

Buds excised from the stems of five dormant, mature (20- to 30-year old) black locust (Robinia pseudoacacia L.) trees were placed on MS basal medium with various levels of 6-benzylaminopurine. In all treatments, bud explants from two of the trees produced shoots which could be subcultured. Whole plants were obtained from cultures of these two trees. Explants from two other trees became vitrified or produced callus, respectively, when cultured on medium containing between 0.032 and 1.0 μM 6-benzylaminopurine; subculturable shoots were only obtained when the buds from these trees were cultured on medium containing 3.2 μM 6-benzylaminopurine. No shoot cultures which could be subcultured were obtained from the fifth tree used in these experiments. The whole plants produced in these experiments were transferred to a greenhouse, and were phenotypically normal five months after culture initiation (three months after transfer to the greenhouse).