Quality of life after major burns

The only presently available method of measuring the outcome of major burns is the mortality rate. We have developed a scale, administered by interview and physical examination, with which the quality of life in survivors may be measured. In an initial group of 32 patients, we took each patient's own preinjury level of performance as a baseline. The size of the burn had no significant effect on the postburn score achieved. Substantial numbers of patients achieved levels superior to their preburn score. Improvement in scores did not begin until 12 months had elapsed from the time of injury. We feel that scales such as this will help determine what happens to patients after their injury, pinpoint areas of weaknesses in the burn program, and enable better comparison of performance between clinical facilities.

Management of a complex diving accident

After the accidental ascent of a diving bell from 80 m, one diver died from pulmonary barotrauma and the other-though grossly ill-survived. After recompression therapy, this diver was tetraplegic with evidence of patchy microcirculatory damage of brain, cord, liver, kidneys, and gut. All systems eventually returned to normal, except the spinal cord, mainly because of the post-recompression phase of management, in which pharmacological doses of steroids, hyperbaric oxygen, and dextran were used. Although function returned in the upper limbs, the diver remained paraplegic.

Mechanism of rejection of virus persistently infected tumor cells by athymic nude mice

Cell lines known to be tumorigenic in the nude mouse were modified by rendering them persistently infected (P.I.) with a variety of RNA viruses, including measles, mumps, vesicular stomatitis virus, and influenza. Although as few as 100 HeLa or BHK cells produced tumors in 100% of nude mice, as many as 2 x 10(7) of the same cells P.I. with viruses failed to produce tumors. An active host response responsible for restricting the growth of the P.I. cells was suggested by the findings of marked mononuclear cell infiltrates at the inoculation sites and the inability of irradiated nude mice to reject them. An analysis of the in vitro cytotoxic activity of spleen cells from normal nude mice indicated that: (a) P.I. cell lines, but not uninfected cell lines, were susceptible to spontaneous cytotoxicity; (b) in vivo inoculation of P.I. lines induced an enhanced cytotoxic activity for P.I. targets in vitro, and this induction was not specific either for inducing virus or cell line; and (c) the effector cell had the characteristics for natural killer (NK) cells. Although the specificity of recognition of the various P.I. cell lines remains unclear, cold competition experiments indicated that blocking the killing of one P.I. cell line, e.g. HeLa-measles, could be achieved only by unlabeled homologous cells, i.e. HeLa-measles, and not by uninfected cells or other P.I. lines. A variant subline of BHK cells P.I. with VSV was selected for its ability to withstand the rejection process in nude mice. These cells formed metastatic and invasive tumors in nude mice. Although they were the most potent inducers in vivo of NK cell activity against various P.I. targets, they were the most resistant of the P.I. lines to NK cell cytotoxicity in vitro. In this system there was a good correlation between tumor rejection in vivo and susceptibility to NK cells in vitro. The present results suggest that NK cells may play a significant role in both rejection of tumor cells, and in resistance to viruses, particularly persistent infections.

Barrier Island Configuration

The 11 Virginia barrier islands are undergoing rapid changes in shore-line configuration. If this trend continues for another 100 years, two capelike features will develop. The process responsible for this island-chain pattern may be a standing edge wave trapped between Assateague Island and Cape Charles.

Long-term antiarrhythmic therapy with N-acetylprocainamide

The effects of long-term NAPA therapy were evaluated in 6 patients with chronic PVCs known to respond to this drug during a previous placebo-controlled, dose-ranging trial. Underlying cardiac status was evaluated every six months by switching each patient from NAPA to placebo. Placebo period PVC frequency after one year of NAPA therapy was reduced, compared to baseline placebo values. Mean PEP/LVET, measured while the patients received placebo, was elevated at the beginning of the study but was normal after one year of NAPA therapy. Comparison of NAPA and placebo period observations indicated a reduction in PEP/LVET when NAPA therapy was begun. This effect, however, could not be demonstrated one year later when mean placebo period PEP/LVET was normal. The apparent dependence of this effect on underlying status of left ventricular function suggests that the initial reduction in PEP/LVET represents an an indirect effect of NAPA rather than a direct inotropic action. NAPA therapy was well tolerated by the 6 patients and ANA titers became abnormal in only one, in marked contrast to reported experience with procainamide.

Measurement of mutagenesis in mammalian cells

A method using mammalian cells in vitro for detection and quantitation of mutagenic actions that appears to be useful for screening for carcinogenesis and genetic damage by environmental agents is presented. The method involves use of stable human--Chinese hamster ovary hybrid cells that have retained a single human chromosome not necessary for cell reproduction. Forward mutations are detected in genes necessary for production of specific human cell surface antigens. Such mutants form colonies in the presence of specific antisera and complement that destroy the unmutagenized cells. Use of the method is illustrated for the action of x-irradiation, N-methyl-N'-nitro-N-nitrosoguanidine, and caffeine. The method appears to be unique in that it permits assessment of lesions that cause loss of all or most of the chromosome as well as various localized gene mutations. The former action is particularly important because of the major involvement of chromosomal lesions in an extremely important class of human genetic disease.

Cellular immune response to human cytomegalovirus. I. Lymphocyte transformation studies in the rabbit

The lymphocyte transformation assay was used to monitor the cellular immune response of rabbits sensitized to cytomegalovirus (CMV). Peripheral blood lymphocytes from animals inoculated with purified virus were specifically stimulated by crude or twice-banded CMV. Blood cells from rabbits immunized to herpes simplex virus type 1 (HSV-1) responded to that antigen but not to CMV. Viable or heated CMV preparations stimulated unwashed blood cells as efficiently as washed cells. Furthermore, preincubation of stimulating antigen with anti-CMV serum did not prevent lymphocyte activation. Lymphoid cells readily stimulated by virus antigen were not stimulated by cells transformed by CMV or HSV-1.

Regional mapping of the gene for human lysosomal acid phosphatase (ACP2) using a hybrid clone panel containing segments of human chromosome 11

A clone panel containing various segments of human chromosome 11 has been selected and use for regional assignment of the gene for human lysosomal acid phosphatase (ACP2) to the short arm of chromosome 11, in the region 11p11 leads to 11p12. Further evidence has also been presented to update the regional assignment of the gene for lactate dehydrogenase A (LDHA) to 11p12 leads to 11p13, and to support a previous assignment of the genes for the two components of the human cell-surface antigens of the SA11 (previously designated AL) group, SA11-1 and SA11-3 (previously designated AL-a1 and AL-a3), to 11pter leads to 11p13. This regional clone panel will be useful for rapid regional mapping of other genes assigned to chromosome 11.

Isolation of a lactic dehydrogenase-A-deficient CHO-K1 mutant by nylon cloth replica plating

A mutant Chinese hamster ovary cell deficient in lactate dehydrogenase A activity has been isolated using a nonselective technique. The method uses histochemical staining to examine colonies directly for enzyme activity and nylon cloth replica plating to recover particular clones. The mutant cell has an apparent Km (pyruvate to lactate) that is nearly tenfold higher than the parental cell, while its Vmax has been reduced more than 80-fold. In mutant cell extracts with added porcine LDH-B enzyme, molecular dissociation and recombination of subunits produces two new active LDH tetramers (A1B3, A2B2). The electrophoretic mobility of at least one of the tetramers (A1B3) was different from those formed in the parental extracts. The evidence suggests the variant cell contains a mutation in the structural gene for LDH-A.

Further structural studies of the heavy chain of HLA antigens and its similarity to immunoglobulins

The papain-solubilized fragment of the heavy chain of HLA-B7, which is the NH2-terminal part of the whole polypeptide chain, can be divided into three regions by mild acid and cyanogen bromide cleavages. The first 100 amino acids terminating in a methionine residue contain the carbohydrate moiety; this segment is followed by two others of molecular weights 9,999 and 13,000, each containing an intrachain disulfide bridge. The two intrachain disulfide bridges are separated by a stretch of amino acids containing an acid-labile aspartyl-prolHLA-2, A28, and AW25 contain this acid-labile peptide bond in their larger subunit. Sequencing from the acid cleavage site of HLA-7 through the third half-cystine revealed consideralbe homology with amino acid sequences around a half-cystine in immunoglobulin variable regions.

Further studies on hybrid cell-surface antigens associated with human chromosome 11

A new human immunogenetic cell-surface activity associated with human chromosome 11 in the AL human-Chinese hamster ovary cell hybrid is described. Like a1, but not a2, it is present on the human erythrocyte. By mutagenesis and selection, specific, stable, variants of the AL hybrid have been prepared exhibiting various combinations of a1, a2, a3, and lactic dehydrogenase A activities. The antigens of the AL system can be demonstrated by the horseradish peroxidase system which offers a promising approach to scanning of tissue cells.

Synteny between glycinamide ribonucleotide synthetase and superoxide dismutase (soluble)

The auxotrophic mutant ade -C derived from Chinese hamster ovary cell CHO-K1 lacks the enzyme glycinamide ribonucleotide synthetase and requires exogenous supplement of purines for growth. Cells from this mutant were fused with normal human lymphocytes, and the resulting hybrids were isolated in purine-deficient medium. A total of 32 primary clones and 49 secondary clones were analyzed for various isozyme markers. Cytogenetic analysis with chromosome banding was also performed in some hybrid clones. The results provide evidence indicating that glycinamide ribonucleotide synthetase is syntenic with superoxide dismutase (soluble) and is located on human chromosome 21.

Genetics of cell-surface antigens: regional mapping of three components of the human cell-surface antigen complex, AL, on chromosome 11

Cytogenetic analysis has been performed on a series of deletion mutations on human chromosome 11 of AL hybrid clones in which specific markers have been lost as a result of treatment with mutagenic agents. Such analysis has localized the three previously identified components of the AL cell-surface antigen complex to the indicated regions of chromosome 11: a1 and a3:11p13 leads to 11pter; a2:11q13 leads to 11qter. Using these methodologies human lactic dehydrogenase A localization on the short arm as reported by others has been confirmed. Evidence is presented provisionally assigning this gene to 11p13 leads to 11pter.

Pericarditis complicating a case of meningococcal meningitis

The case is described of an 18-year-old schoolboy who developed pericarditis during the course of meningococcal meningitis; he had evidence of a preceding chronic meningococcaemia. Good recovery followed on systemic antibiotics only. The pericarditis was probably a direct septic complication of meningococcal meningitis.

Biochemical genetics of Chinese hamster cell mutants with deviant purine metabolism: isolation, selection, and characterization of a mutant lacking hypoxanthine-guanine phosphoribosyltransferase activity by nutritional means

Mutants of the Chinese hamster ovary cell derived from CHO-K1 have been selected for lack of hypoxanthine-guanine phosphoribosyltransferase (EC 2.4.2.8) (HGPRT) without the use of a drug-resistance protocol. The procedure depends on the use of a parental strain carrying a mutation making it unable to synthetize purines and thus dependent upon exogenously added purines for growth. The standard "BUdR-visible-light" procedure is then used to select those cells which can use adenine but cannot use hypoxanthine as a purine source. These cells are shown to be thioguanine resistant, to be unable to incorporate exogenously added hypoxanthine into purine nucleotides, to complement our other adenine-specific purine auxotrophs, Ade-H and Ade-I but not to complement a cell isolated by virtue of thioguanine resistance, and to lack the activity of HGPRT. The use of such multiply marked mutants and cells related to them for further analysis of purine nucleotide biosynthesis and interconversion is discussed.

Thyrotoxic vomiting

In seven patients vomiting played an important part in the presentation of thyrotoxicosis. Vomiting does not always indicate severe thyroid disease, and the diagnosis in patients presenting with this symptom may be long delayed.

Isolation of mutants lacking branched-chain amino acid transaminase

Variants of the Chinese hamster ovary cell have been isolated which can no longer grow when valine, leucine, or isoleucine is replaced in the culture medium by its respective alpha-keto acid: alpha-ketoisovaleric acid, alpha-ketoisocaproic acid, or alpha-keto-beta-methylvaleric acid. These variants lack branched-chain amino acid transaminase activity. Evidence is presented indicating these variants to be single gene mutants. Genetic evidence is also presented confirming previous biochemical evidence that a single enzyme carries out transaminase functions on valine, leucine, and isoleucine. The branched-chain transaminase-deficient (trans-) mutants can be reverted to wild-type behavior by treatment with mutagenic agents. These mutants promise to be useful in exploring regulatory mechanisms in biochemical, genetic, and cancer research.

Cell surface antigens. IV. Immunological coorespondence between glycophorin and the a1 human cell surface antigen

A stable human-Chinese hamster ovary cell hybrid has been produced which, in addition to the complement of Chinese hamster ovary (CHO-K1) chromosomes, contains only one human chromosome, No. 11. The human cell-surface antigens whose expression is controlled by human chromosome 11, and are expressed by this hybrid, have been defined as the AL immunogenetic complex. Although one component of this immunogenetic complex (a1) is also expressed by human red blood cells, a second component (a2) is not. Killing of an a1+ hybrid by anti-a1 serum and complement can be completely inhibited by glycophorin, the major glycoprotein component of the human erythrocyte membrane. In the presence of complement, antiserum prepared against glycophorin will kill only those cells which express a1. The anti-a1 killing activity of the anti-glycophorin can be absorbed out only by those cells which express a1. Therefore, it is concluded that the a1 cell-surface antigen has at least one antigenic component in common with glycophorin.

Genetics of somatic mammalian cells: genetic, immunologic, and biochemical analysis with Chinese hamster cell hybrids containing selected human chromosomes

Through hybridization of specific Chinese hamster cell auxotrophs with human cells and selection in media lacking the nutritional supplements required by the former cells, a series of stable hybrid clones can be prepared. These hybrids have genomes consisting of a common part--the complete or almost complete set of Chinese hamster chromosomes, plus a variable part--one or a few human chromosomes. The identity of the human chromosomes can be varied by utilizing different Chinese hamster auxotrophs and the appropriate selective media. The human chromosomes present can be determined by a combination of cytogenetic analysis with chromosome banding and testing for specific human marker genes. Hybrids containing single human chromosomes 11 and 12 and the combination of both 11 and 12 are described. The system appears to lend itself to various studies such as identification of human cell surface antigens, determination of their chromosomal loci, measurement of their distribution among cells of normal human tissues, study of interrelations among syntenic and asyntenic genes, and mutational analysis of the human genome.

Synteny between the pro+ marker and human glutamate oxaloacetate transaminase

Chinese hamster ovary cells with a specific auxotrophy for proline were fused with human cells from a variety of sources and the resulting hybrids analyzed for human genetic markers. Of 63 hybrid clones examined, 27 possessed both proline and cytoplasmic glutamate oxaloacetate transaminase markers; 36 had neither; and no clones were found possessing one and not the other. These results constitute evidence that the proline and glutamate oxalocetate transaminase markers are syntenic. Evidence for absence of synteny between these and a variety of other human genes is presented. Biochemical tracer experiments established that the proline biosynthetic pathway through glutamate has been restored in the Pro+ hybrids.

Genetics of somatic cell surface antigens. III. Further analysis of the AL marker

The AL antigen present on the surface of various human somatic cells, and on those hybrids of human and Chinese hamster ovary cells which have retained human chromosome number 11, has been resolved into at least two separate antigenic activities, a1 and a2. Specific antisera active against each antigen separately have been prepared. By treatment of the original AL+ hybrid with mutagenic agents and selection in particular antisera, stable clones are preparable whose phenotypic behavior corresponds to the antigenic compositions a1+ a2-, a1- a2+, and a1- a2-. The adsorption behavior of these variants for specific antisera is consistent with their phenotypic assignments.

Nucleolar phosphoproteins of normal rat liver and Novikoff hepatoma ascites cells

The nucleolar acid-soluble proteins from normal rat liver and Novikoff hepatoma ascites cells were labeled in vivo for 2 hr after the injection of [32P]orthophosphate and in vitro with [gamma-32P]adenosine triphosphate in systems containing 0.25 M sucrose, 5 mM MgCl2, 12.5 mM NaCl, and 0.05 M Tris-HCl buffer, pH 7.3, AT 37 DEGREES. Two-dimensional polyacrylamide gel electrophoresis and autoradiography showed that approximately 40 and 20 protein spots were labeled in vivo and in vitro, respectively. There were some marked differences in labeling in vivo between normal rat liver and Novikoff hepatoma acid-soluble nucleolar proteins. By 32P analysis of gel slices, the proportion of the total 32P incorporated into protein Spot A1-4 was greater in normal liver, and the proportion of 32P incorporated into some high-molecular-weight protein spots, such C23-24 and C26-27, was greater in the Novikoff hepatoma ascites cells. With the in vitro incubation system, the 32P uptake per mg protein was about twice as high in Novikoff hepatoma nucleolar proteins as in normal rat liver nucleolar proteins but, generally, the same proteins were labeled in both tissues.

Spleen cell-mediated cytotoxicity of hamster cells transformed by Herpes simplex virus: evidence for virus-specific membrane antigen

The nature of the host's immune response to isografts of hamster embryo fibroblasts (HEF) transformed by herpes simplex virus type 1 (HSV-1) was investigated by the microcytotoxicity assay. It was found that spleen cells from tumor-bearing hamsters killed homologous tumor cells but not HEF transformed by cytomegalovirus or PARA-(defective SV40)-adenovirus 7 (PARA-7). Cytotoxicity was lost as the tumor increased in size. Spleen cells from animals bearing isografts of HSV type 2 (HSV-2) transformed cells also killed HSV-1 target cells whereas spleen cells from PARA-7 tumor bearers did not. Further studies showed that animals immunized with HSV-1 or HSV-1-infected rabbit kidney cells produced spleen cells specifically cytotoxic for HSV-transformed cells. On the other hand, sera from virus-immunized hosts or tumor bearers had no effect on the cells in the presence of guinea pig complement. However, in blocking experiments such sera could significantly reduce spleen cell cytotoxicity. These experiments established that cells transformed by HSV could elicit a cellular immune response in the syngeneic host, and provided evidence that the immunity was directed against virus-specific antigens on the cell surface.

Difetarsone in outpatient treatment of Trichuris trichiura infestation

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