A new measure of contemporary life stress: development, validation, and reliability of the CRISYS

OBJECTIVE

To develop and validate a measure of contemporary life stressors.

STUDY SETTING

Three interview studies: Study 1 (pilot), 32 caregivers receiving case management services for a child with chronic illness; Study 2 (validation), 311 caregivers of children receiving general pediatric care at a university clinic; Study 3 (reliability), 17 caregivers of children with a complex medical diagnosis.

STUDY DESIGN

Study 1: item development via discussions with case managers; piloted with caregivers. Study 2 examined psychometric properties of the measure and correlated it with the CES-D, a measure of depressive symptomatology and the PRQ85-Part 2, a measure of perceived social support, to establish its convergent construct validity. Study 3 established the test-retest reliability of the measure over two weeks by correlating two administrations of the index.

DATA COLLECTION

Face-to-face interviews in homes (Study 1) or in clinic waiting rooms (Studies 2 and 3) and by telephone (Study 3 retest).

PRINCIPAL FINDINGS

The CRISYS is a flexible, multidimensional tool that demonstrates strong face, content, and construct validity, and excellent test-retest reliability. The format is easy to use and well accepted by respondents and is suitable for low-income populations.

CONCLUSIONS

Researchers will find the CRISYS useful when evaluating the success of a clinical model or a healthcare system, and the effectiveness of an insurance plan or a government program. Clinicians may also find that the CRISYS is an effective screen for family needs.

Reproducibility of retardation measurements with the nerve fiber analyzer II

PURPOSE

To evaluate the reproducibility of a scanning laser polarimeter, the Nerve Fiber Analyzer II (NFA II, Laser Diagnostic Technologies, San Diego, CA, U.S.A.).

METHODS

Five independent retardation maps of the peripapillary retina of five normal eyes were acquired by three experienced operators (including V.S.G.) on each of three separate days for a total of 45 retardation maps per patient. Two methods of image processing, one using a baseline image and another using the individual scans, were used to compare the reproducibility of three summary measures, average retardation, integral, and retardation ratio.

RESULTS

The average standard deviation (and its 95% confidence interval) of average retardation within a 10-pixel-width-band of the 9 baseline images was 0.43 degree (0.36-0.51 degree) with a mean coefficient of variation of 4.2% (3.8-4.5%). In a random effects model, each of the three retinal nerve fiber layer (RNFL) summary measures varied significantly by patient (p < 0.016), but not by operator (p > 0.19), or operator by patient interaction (p > 0.524). In addition, there was small, but statistically significant day-by-operator-within-patient (intraobserver) variation in the random effects model.

CONCLUSIONS

These results suggest that the NFA II provides reproducible measurements and that, on average, measurements obtained by separate operators on different days are similar.

Alpha 1-adrenergic control of chloride transport in the rat S1 proximal tubule

To identify in vivo the specific alpha-adrenergic receptor mediating direct neural control of chloride transport in the rat S1 proximal convoluted tubule (PCT), the major effector site of neural regulation, microperfusion was employed in conjunction with the alpha 1- and alpha 2-adrenergic receptor antagonists, prazosin and rauwolscine. Using a glomerular ultrafiltrate-like perfusate, prazosin markedly inhibited chloride transport by -42% (302 +/- 10 to 176 +/- 5 peq.mm-1.min-1, P < 0.0001). Using a sodium chloride perfusate, which measures the active component of chloride absorption (J(Cl)act) (control, 153 peq.mm-1.min-1) plus a constant passive (479 peq.mm-1.min-1) component, both prazosin and acute renal denervation reduced J(Cl)act by -38% and -44% (-58 and -67 peq.mm-1.min-1, each P < 0.05). In contrast, rauwolscine caused no significant change in J(Cl)act using either perfusate. Prazosin regulates chloride transport via protein kinase C (PKC), since preactivation of PKC by phorbol abolished inhibitory impact of prazosin. Inhibition of J(Cl)act by prazosin (-58 peq.mm-1.min-1) was fully additive to either the stimulation or inhibition (losartan) of angiotensin II (55 or -49 peq.mm-1.min-1), which uses the adenosine 3',5'-cyclic monophosphate (cAMP) second messenger system [observed changes, not significantly different from 0 and -99 peq.mm-1.min-1; expected changes, not significantly different from 0 and -107 peq.mm-1.min-1]. In conclusion, neural control of S1 PCT chloride absorption in vivo is mediated by alpha 1-adrenergic receptors, which can selectively regulate J(Cl)act by altering PKC activity, independently of the cAMP second messenger system.

Changes in physicians' attitudes toward AIDS during residency training: a longitudinal study of medical school graduates

Understanding the impact of training on the development of physicians' attitudes toward AIDS is important to furthering our knowledge of the mechanisms through which socialization affects professional outlook, as well as promoting an adequate supply of providers to treat people with AIDS (PWAs). This prospective panel study collected data on 383 physicians at two critical stages: as fourth-year medical students and as third-year residents. Aspects of residency training (e.g., residents' morale and positive faculty role models) were the most powerful predictors of increase in willingness to treat PWAs. Decline in willingness was primarily a product of negative social attitudes-homophobia and IVDU-phobia (aversion to intravenous drug users). Cynicism toward patient care acted as a trigger, activating the negative effects of IVDU-phobia; having an acquaintance who is HIV positive mediated the negative impact of homophobia. Notably, cynicism was associated with basic aspects of training (specific characteristics of the faculty and of the educational milieu). The findings support a view of socialization as a pervasive process implicating intrinsic aspects of training and having an impact on a broad spectrum of outlooks. Accordingly, interventions must address structural characteristics that transcend AIDS-specific concerns.

The impact of residency training on physicians' outlook on AIDS: a cohort analysis

The impact of training on physicians' commitment to professional values is examined, using a cohort design to assess the evolution of attitudes toward AIDS during residency training. Cohorts of surgeons training in the same six residency programs were followed at key junctures, and their outlooks on three AIDS-related attitudes were examined: willingness to treat people with AIDS (PWAs), concern about exposure to HIV, and perceived benefits of treating AIDS. The findings revealed a consistent, negative impact of training on all three attitudes. Cohort and period (historical) effects were limited: younger cohorts more often viewed treating PWAs as a clinically valuable experience, and greater concern about exposure was evidenced as training progressed. The findings yield new evidence of the importance of residency training to professional socialization. More knowledge of alterable aspects of residency training that play a role is key to assuring that physicians emerge with a dedication to fulfilling their social responsibilities.

Flow dependence of chloride transport in rat S1 proximal tubules

These studies examined whether the luminal flow dependency of chloride absorption in the S1 proximal tubule during glomerulotubular balance was due to change in active and/or passive transport of chloride. Using in vivo microperfusion in the Munich-Wistar rat and an essentially pure sodium chloride perfusate (devoid of bicarbonate and organic solutes), we found that an increase in luminal perfusion rate from 30 to 45 nl/min caused stimulation of total chloride absorption (active plus passive) by 87 peq.mm-1.min-1 (632 +/- 17 to 719 +/- 11, P < 0.001). When cyanide was added to this perfusate to eliminate active transport, the flow-induced change in passive transport was 58 peq.mm-1.min-1 (479 +/- 9 to 537 +/- 11, P < 0.001). The cyanide-inhibitable active transport component was therefore 29 peq.mm-1.min-1. With elimination of the transepithelial chloride gradient and, hence, passive transport by isethionate substitution, active transport increased by 63 peq.mm-1.min-1 (121 +/- 4 to 184 +/- 7, P < 0.001) as flow rate rose from 30 to 45nl/min. Removal of organic solutes from a glomerular ultrafiltrate-like perfusate had a minimal effect on flow-induced change in chloride transport (190 vs. 207 peq.mm-1.min-1). In conclusion, flow-dependent active and passive chloride transport in the S1 proximal tubule may both contribute to normal glomerulotubular balance.

Chloride transport in the rat S1 proximal tubule

In vivo microperfusion was used to elucidate the modes and regulation of the powerful chloride transport system resident in the rat early (S1) proximal convoluted tubule (PCT). From a complete, glomerular ultrafiltrate-like perfusate, omission of organic solutes reduced chloride absorption by 93 peq.mm-1.min-1 (302 +/- 10 to 209 +/- 24, P < 0.001). From a high-chloride perfusate (a relatively pure NaCl solution devoid of bicarbonate and organic solutes), luminal addition of the active transport inhibitor cyanide reduced chloride absorption by 153 peq.mm-1.min-1 (632 +/- 17 to 479 +/- 9, P < 0.001). Active transport was also estimated directly as 121 +/- 4 peq.mm-1.min-1 using a solution in which sodium isethionate isosmotically replaced bicarbonate and organic solutes, preventing development of a chloride gradient. Intravenous angiotensin II caused a stimulation of chloride absorption from a high-chloride perfusate by 55 peq.mm-1.min-1 (632 +/- 17 to 687 +/- 14, P < 0.05), which was partially cyanide-sensitive (510 +/- 6 peq.mm-1.min-1). In conclusion, the components of the normal S1 PCT chloride reabsorption (approximately 300 peq.mm-1.min-1) from the glomerular ultrafiltrate consist of the following: active transport (40-50%), which can be regulated by angiotensin II; sodium-coupled organic solute transport (30%); and passive, chloride concentration gradient-driven transport (20-25%).

Physician's attitudes toward AIDS at different career stages: a comparison of internists and surgeons

Physicians' responses to AIDS at different career stages and in different specialties were studied by surveying house staff (N = 438), faculty (N = 363), and applicants (N = 487) at six residency programs in internal medicine and six in surgery. House staff had more negative outlooks than senior medical students and faculty, reporting greater fear of exposure to AIDS and greater unwillingness to treat AIDS patients. Surgeons were more negative than internists on these dimensions. For all groups, concern about possible negative educational consequences of treating AIDS patients was largely a function of their amount of contact with AIDS patients. Comparing willingness to treat AIDS and nine other conditions, AIDS consistently ranked low, along with Alzheimer's disease, alcoholism, and drug dependency. The findings have practical implications for hospitals and training programs. In addition, they raise issues concerning the impact of training on professional socialization, and call into question physicians' commitment to the professional norm of treating all patients regardless of provider self-interest, patient social characteristics, or medical uncertainty.

Role of Na-dependent Cl/HCO3 exchange in basolateral Cl transport of rabbit proximal tubules

To analyze the rate of basolateral Cl exit and the magnitude and relative contributions of KCl cotransport and Na-dependent and -independent Cl/HCO3 exchange to Cl exit across the basolateral membrane (BLM) during transcellular Cl absorption, rabbit proximal convoluted tubules (PCT) were perfused with high-Cl, low-HCO3 plus formate solutions and bathed with plasma ultrafiltrate-like plus formate solutions. The initial rates of intracellular Cl activity (AiCl) reduction following bath Cl removal were compared when bath Cl was 0, when bath Na and Cl were 0, and when bath HCO3 and Cl were 0. The initial rate of AiCl reduction following bath Cl removal was 4.4 +/- 0.4 mM/s. After bath Na and Cl removal, this rate was reduced to 25.1 +/- 5.0%. After bath HCO3 and Cl removal, it was reduced to 18.0 +/- 4.8%. The difference between bath Na and Cl removal and bath HCO3 and Cl removal was not significant. Cl efflux following bath HCO3 and Cl removal may be due to a KCl symporter. The contribution of a KCl symporter was examined by raising bath K to 20 mM, thus eliminating the chemical driving force for KCl exit. After bath K increase, the initial rate of AiCl increase was 0.057 +/- 0.005 mM/s. These data suggest that Cl efflux at BLM of rabbit PCT is 1) large enough to explain transcellular Cl transport, 2) predominately due to an Na-dependent Cl/HCO3 exchanger, and 3) negligibly due to an Na-independent Cl/HCO3 exchanger or a KCl symporter.

Impact of employment-based health insurance on home attendants

This study examines 253 newly hired home attendants to measure the degree to which employment-based health insurance can affect health status and utilization of health care services among a working poor population that has little experience with health insurance and may face other significant barriers to care. Physician contacts increased after benefits were received; attendants who had no coverage during the prior year experienced the greatest average increase. More attendants also reported using emergency rooms. Neither hospitalizations nor health status were affected. These findings indicate that insurance benefits may substantially improve access to care for many working poor persons, regardless of other barriers they may face.

Health status and health care utilization among New York City home attendants: an illustration of the needs of working poor, immigrant women

In this paper, the health needs and health care utilization patterns of home attendants and their families have been studied as an illustration of those likely to be found among working poor, immigrant women and their children. Despite tremendous growth in the number of immigrants, studies to date provide only limited information regarding the specific health needs and patterns of health care utilization among such women and their children. As part of a longitudinal study on the impact of insurance on health status and health care utilization, 387 female, immigrant home attendants were interviewed. Data were also gathered on 355 of their minor children. These women and children were found to be less likely than other Americans to make use of basic health services, despite the fact that they are more likely to indicate fair or poor health status. This is true even in comparison to poor or uninsured Americans. Immigrant attendants in fair or poor health report an average annual visit rate of 4.1 ambulatory care visits for themselves and 2.2 for their children, as compared to 8.4 for poor adults and 4.4 for poor children in national samples. These findings illustrate the likelihood that poor, immigrant women make limited use of American medical care, and face barriers to health care that appear even greater than those faced by the uninsured and the poor.

Cloning and expression of a human 14-3-3 protein mediating phospholipolysis. Identification of an arachidonoyl-enzyme intermediate during catalysis

The major phospholipase A2 activity in sheep platelets is mediated by at least three chromatographically resolvable isoforms of a 30-kDa dimeric polypeptide which are responsive to physiologic increments in calcium ion and possess a dramatic substrate selectivity (Loeb, L. A., and Gross, R. W. (1986) J. Biol. Chem. 261, 10467-10470). Herein, we describe the cloning and expression of the human equivalent of one such isoform and demonstrate that it catalyzes the cleavage of the sn-2 fatty acid of choline and ethanolamine glycerophospholipids through the formation of a stable acyl-enzyme intermediate. Transesterification of the sn-2 acyl group of phosphatidylcholine to the recombinant 30-kDa polypeptide is over 50-fold selective for arachidonic acid, is augmented by calcium ion, and results in the formation of an arachidonoyl-thioester intermediate. Homology analysis demonstrated that the polypeptide mediating this transesterification is one member of a family of proteins collectively designated as 14-3-3 proteins. These results demonstrate that at least one intracellular mammalian phospholipase A2 employs a catalytic strategy distinct from that utilized by extracellular phospholipases A2 (i.e. formation of an acyl-enzyme intermediate by nucleophilic attack versus activation of a water molecule) and that arachidonic acid in endogenous phospholipid storage depots can, in principle, be sequentially transferred through an acyl-enzyme intermediate without the prior obligatory release of free arachidonic acid.

Do the sources of the urban elderly's social support determine its psychological consequences?

This article examines whether the psychological impact of different kinds of social supports varies according to who provides them. Data on 82 older adults' social relationships, measured as social provisions (Weiss, 1974), were used to evaluate whether the relationship between social provisions and emotional well-being varied when kin and, alternatively, nonkin, made the provisions. Findings showed that, although most social provisions were valuable regardless of their source, reassurance of worth was distinctly more beneficial when provided by nonkin than by kin, and reliable alliance, or instrumental assistance, was more strongly related to well-being when provided by kin than by nonkin. Analysis of social network structure showed that "multiplexity" was negatively related to well-being, and having duplicate providers for a given social provision was uniquely important in offsetting negative affect.

Do the sources of the urban elderly's social support determine its psychological consequences?

This article examines whether the psychological impact of different kinds of social supports varies according to who provides them. Data on 82 older adults' social relationships, measured as social provisions (Weiss, 1974), were used to evaluate whether the relationship between social provisions and emotional well-being varied when kin and, alternatively, nonkin, made the provisions. Findings showed that, although most social provisions were valuable regardless of their source, reassurance of worth was distinctly more beneficial when provided by nonkin than by kin, and reliable alliance, or instrumental assistance, was more strongly related to well-being when provided by kin than by nonkin. Analysis of social network structure showed that "multiplexity" was negatively related to well-being, and having duplicate providers for a given social provision was uniquely important in offsetting negative affect.

Mechanism of proximal NaCl reabsorption in the proximal tubule of the mammalian kidney

In the mammalian proximal tubule NaCl reabsorption occurs by both passive and active transport processes. Passive NaCl reabsorption occurs in the presence of a high luminal chloride and a low luminal bicarbonate concentration. These anion gradients provide the driving forces for diffusive Na and Cl movement. Na is driven by the lumen positive PD effected by the greater permeability of the tubular wall to Cl than to HCO3. Cl is driven by its high tubular concentration. Passive NaCl reabsorption accounts for only about 10% to 15% of total proximal NaCl transport. The remaining proximal NaCl is reabsorbed by active transport processes and occurs both in the presence or absence of anion gradients reabsorption. Two mechanisms of active NaCl reabsorption participate in active NaCl reabsorption along the proximal tubule. Firstly, active NaCl reabsorption is electrogenic. In the early proximal tubule Na enters to cell coupled to organic solute transport. This Na reabsorption generates a lumen negative PD and effects "coupled" electrogenic NaCl reabsorption. This mechanism is limited by the supply of organic solutes and is blunted by the greater Na than Cl permeability in the proximal tubule; it probably can account for no more than 10% of proximal NaCl reabsorption. In the terminal proximal tubule, the proximal straight tubule, the apical membrane appears to possess a channel for Na entry. This Na reabsorption also generates a lumen negative PD and effects "simple" electrogenic NaCl reabsorption. This mechanism is limited by the low transport capacity of this segment and probably accounts for no more than 5% to 10% of total proximal NaCl reabsorption. The great bulk of proximal NaCl reabsorption occurs along the entire proximal tubule by active, transcellular electroneutral NaCl reabsorption. The precise cellular transport mechanisms responsible for this process are only recently being defined. At the apical membrane parallel ion exchangers are responsible for NaCl entry into the cell. Na enters via the apical membrane Na-H antiporter. Cl most likely crosses the apical membrane by some combination of Cl-OH and Cl-HCO2 exchangers but not via a Cl-HCO3 exchanger. The relative contributions of Cl-OH and Cl-HCO2 exchange have not been defined. There are two important considerations in this question. First is the availbility of OH versus HCO2. Although there is an infinite supply of OH and a small equilibrium supply of HCO2, it is possible that the luminal concentration of HCO2 could be increased by an USL that raises the concentration of HCO2 to a degree sufficient to supply H2CO2 recycling for physiological transcellular Cl transport rates.(ABSTRACT TRUNCATED AT 400 WORDS)

Chloride transport across the basolateral membrane of rabbit proximal convoluted tubules

To examine the basolateral Cl transport mechanisms of proximal convoluted tubules (PCT), intracellular Cl activity (AiCl) was measured with double-barreled Cl-selective microelectrodes. When rabbit PCT were perfused in vitro with high Cl, low HCO3, and bathed with ultrafiltrate-like solutions, AiCl was 29.9 +/- 0.4 mM and basolateral membrane voltage (Vbl) was -47.7 +/- 0.4 mV (n = 247). Possible basolateral Cl transport mechanisms that we examined were as follows: Cl conductance, KCl cotransport, and Na-dependent Cl-HCO3 exchange. Cl conductance was negligible, since the voltage clamp of Vbl to 30 mV above and below the spontaneous Vbl did not change AiCl even in the absence of luminal Cl. KCl cotransport was suggested by 1) increasing bath K, increased AiCl, and 2) decreasing bath K decreased AiCl. KCl cotransport was Na independent and 4-acetamido-4'-isothiocyanostilbene-2,2'-disulfonic acid (SITS), barium, and furosemide insensitive. Na-dependent Cl-HCO3 exchange was suggested by 1) bath HCO3 reduction increased AiCl, which was greatly inhibited by bath Na removal or bath SITS, and 2) bath Na removal increased AiCl, which was completely blocked by bath SITS. We conclude that 1) Cl conductance is negligibly small at the basolateral membrane and 2) SITS-insensitive KCl cotransport and SITS-sensitive Na-dependent Cl-HCO3 exchange are present at the basolateral membrane.

Electroneutral NaCl absorption in the proximal tubule: mechanisms of apical Na-coupled transport

The proximal tubule utilizes multiple mechanisms to reabsorb filtered NaCl. In the early PCT electrogenic Na-coupled organic solute transport generates a lumen-negative PD which drives Cl- passively through the paracellular pathway. Preferential reabsorption of HCO3- and organic solutes in the early PCT elevates luminal Cl- concentration, which in the late PCT provides the driving force for passive reabsorption of both Na+ and Cl-. However, most of the NaCl reabsorbed in the PCT is mediated by an electroneutral mechanism in which equivalent amounts of Na+ and Cl- move transcellularly across apical and basolateral membranes. In the mammalian PCT the evidence overwhelmingly supports parallel Na+-H+ and Cl- -base exchangers as the mechanism by which Na+ and Cl- cross the apical membrane during electroneutral, transcellular NaCl reabsorption. OH-, HCO3-, formate and Ox- have all been suggested to be the anion exchanged for Cl-. An important physiologic contribution of formate has been shown in in vitro microperfusion studies [29]. Measurements of intracellular pH using fluorescent dyes [59, 60] support a quantitatively important role for formate and argue against a large contribution of OH- and HCO3-. The absence of a role for HCO3- is also supported by in vivo microperfusion studies using methoxazolamide [53]. The potential role of oxalate requires physiologic evaluation. To date, the experimental data suggest that Cl- -formate is probably the predominant anion exchange mechanism. One may ask why, in a process so critical as NaCl reabsorption, the tubule would choose to use a "toxin" rather than one of those ions more familiar to renal physiologists?(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of lumen pH on cell pH and cell potential in rabbit proximal tubules

To determine the effect of luminal pH on cell pH and basolateral cell membrane potential difference (Vbl) of rabbit proximal convoluted tubules, Vbl was measured by conventional microelectrodes and intracellular pH was measured microfluorometrically. Lowering lumen pH acidified the cell and depolarized Vbl. Three factors contributed to depolarization of Vbl. Lowering lumen pH decreased apical cell membrane potassium permeability (PK) as indicated by the following: 1) at lumen pH 7.4 raising lumen [K] depolarized Vbl; 2) lowering lumen pH eliminated the depolarization of Vbl induced by increasing lumen [K]. An additional effect was suggested by the following: lumen Ba2+ blunted, but did not eliminate, the Vbl response to lowering lumen pH. An effect on basolateral K permeability (PK) via its effect on cell pH was suggested by the fact that lowering lumen pH dramatically reduced the depolarization induced by increasing bath [K]. Lowering lumen pH might influence Vbl by inhibiting H+-HCO3- transport. Addition of 1 mM 4-acetamido-4'-isothiocyanostilbene-2,2'-disulfonic acid (SITS) to the bath solution hyperpolarized Vbl and enhanced the depolarization induced by lowering luminal pH. At luminal pH 6.0 SITS had no effect, suggesting elimination of H+ secretion. Addition of 1 mM luminal amiloride had no effect on Vbl or the response of Vbl to lowering luminal pH, but in the presence of amiloride SITS still hyperpolarized Vbl, suggesting amiloride-insensitive electrogenic H+ secretion. These results suggest that lumen pH-dependent depolarization of Vbl is due to 1) a decrease in apical PK; 2) cell acidification with secondary effects on basolateral PK; and 3) a decrease in apical electrogenic H+ transport.

Rapid development of vasopressin-induced hydroosmosis in kidney collecting tubules measured by a new fluorescence technique

The pre-steady-state kinetics of the vasopressin-induced increase in collecting tubule osmotic water permeability (Pf) has been measured by a new fluorescence technique. Isolated cortical collecting tubules (CCT) from rabbit kidney were perfused with physiological buffers containing the impermeant fluorophores fluorescein sulfonate (FS) and pyrenetetrasulfonic acid (PTSA). Tubules were subject to a 120 mOsm bath-to-lumen osmotic gradient in the presence and absence of 250 microU/ml vasopressin. The magnitude of transepithelial volume flow was determined from the self-quenching of FS, or from the ratio of PTSA/FS fluorescence, measured at 380 nm excitation and 420 +/- 10 nm (PTSA) and greater than 530 nm (FS) emission wavelengths. Pf was calculated from the magnitude of transepithelial volume flow, lumen and bath osmolarities, lumen perfusion rate, and tubule geometry. The instrument response time for a change in bath osmolality was less than 3 s. At 37 degrees C, CCT Pf was (in units of cm/s x 10(4] 13 +/- 2 (mean +/- SE, 16 tubules) before, and 227 +/- 10 after addition of vasopressin to the bath. CCT Pf began to increase in 23 +/- 3 s after vasopressin addition and was half-maximal after 186 +/- 20 s. At 23 degrees C, Pf was 9 +/- 1 (seven tubules) before, and 189 +/- 12 after vasopressin addition. Pf began to increase in 40 +/- 4 s and was half-maximal after 195 +/- 35 s. After vasopressin removal from the bath, Pf decreased to its baseline value with a half-time of 14 min. These results establish a direct fluorescence method to monitor instantaneous transepithelial Pf in perfused tubules and show a very fast stimulation of CCT Pf in response to vasopressin.

Osmotic gradient dependence of osmotic water permeability in rabbit proximal convoluted tubule

To assess steady-state transepithelial osmotic water permeability (Pf), rabbit proximal convoluted tubules were perfused in vitro with the impermeant salt, sodium isethionate at 26 degrees C. Osmotic gradients (delta pi) were established by varying the bath concentration of the impermeant solute, raffinose. When lumen osmolality was 300 mOsm and bath osmolality was 320, 360 and 400 mOsm, apparent Pf decreased from 0.5 to 0.10 to 0.08 cm/sec, respectively. Similar data were obtained when lumen osmolality was 400 mOsm. Five possible causes of the delta pi dependence of apparent Pf were considered experimentally and/or theoretically: (1) external unstirred layer (USL); (2) cytoplasmic USL; (3) change in surface area; (4) saturation of water transport; (5) down-regulation of Pf. Apparent Pf was inhibited 83% by p-chloromercuribenzene sulfonate (pCMBS) at 20 mOsm, but not at 60 mOsm delta pi, suggesting presence of a serial barrier resistance to water transport. Increases in perfusate or bath solution flow rate and viscosity did not alter apparent Pf, ruling out an external USL. A simple cytoplasmic USL, described by a constant USL thickness and solute diffusion coefficient, could not account for the delta pi dependence of apparent Pf according to a mathematical model. The activation energy (Ea) for apparent Pf increased from 7.0 to 12.5 kcal/mol when delta pi was increased from 20 to 60 mOsm, not consistent with a simple USL or a change in membrane surface area with transepithelial water flow. These findings are most consistent with a complex cytoplasmic USL, where the average solute diffusion coefficient and/or the area available for osmosis decrease with increasing delta pi. These results (1) indicate that true Pf (at physiologically low delta pi) is very high (greater than 0.5 cm/sec) in the rabbit proximal tubule; (2) provide an explanation for the wide variation in Pf values reported in the literature using different delta pi, and (3) suggest the presence of a flow-dependent cytoplasmic barrier to water flow.

SITS-sensitive basolateral anion current in rabbit proximal convoluted tubules

To assess the presence and nature of steady-state anion current across the basolateral membrane in in vitro rabbit proximal convoluted tubules bathed and perfused with a high-chloride, low-bicarbonate solution simulating late proximal tubular fluid, steady-state basolateral cell membrane potential difference (Vb1) was measured by conventional microelectrodes. The mean value of Vb1 was -52 mV. Addition of 1 mM 4-acetamido-4'-isothiocyanostilbene-2,2'-disulfonic acid (SITS) to the bath solution hyperpolarized Vb1 by 30 mV, suggesting the presence of basolateral anion current. Total chloride removal did not change Vb1 significantly, and formate, a presumptive stimulant of electroneutral sodium chloride transport, depolarized Vb1 both in the presence and absence of chloride, suggesting that the formate-stimulated change in Vb1 was chloride independent. In the total absence of chloride and bicarbonate, 1 mM bath SITS and 0.1 mM lumen and bath acetazolamide hyperpolarized Vb1 by 27-35 and 23 mV, respectively. These results suggest that the SITS-sensitive change in Vb1 is independent of chloride and associated with a basolateral anion current that is predominantly due to bicarbonate exit. In the absence of exogenous CO2, cell-to-bath HCO3-dependent anion current can be derived from metabolic CO2.

Estimation of intracellular chloride activity in isolated perfused rabbit proximal convoluted tubules using a fluorescent indicator

The methodology has been developed to measure cell chloride activity by fluorescence microscopy using the chloride-sensitive dye, 6-methoxy-1-(3-sulfonatopropyl)quinolinium (SPQ). SPQ was loaded into cells of the in vitro microperfused rabbit proximal convoluted tubule by a 10 min luminal perfusion with 20 mM SPQ at 38 degrees C. Fluorescence was excited with a broad band excitation filter (340 and 380 nm) and detected with a 435 nm cut-on filter. The signal to background (autofluorescence) ratio was 4.6 +/- 0.6. The halftime for SPQ leakage from cells at 38 degrees C was 8.6 +/- 1.1 min. In suspended tubules, SPQ did not affect O2 consumption significantly. Intracellular SPQ calibration was performed using the ionophores nigericin and tributyltin, high external potassium concentrations, and varying extracellular chloride concentrations. Cell fluorescence was related to intracellular chloride by a Stern-Volmer relation with a quenching constant of 12 M-1. Apparent chloride concentration in tubules perfused with solutions characteristic for the late proximal convoluted tubule was 27.5 +/- 5 mM (activity 20.6 mM). The halftime of the transient in cell chloride activity upon bath chloride addition was approximately 3 s (38 degrees C). Applications and limitations of this new fluorescence method to study cell chloride transport are discussed.

Regulation of cell pH by ambient bicarbonate, carbon dioxide tension, and pH in the rabbit proximal convoluted tubule

To study the regulation of cell pH by ambient pH, carbon dioxide tension (PCO2), and bicarbonate (HCO3), cell pH was measured in the isolated, in vitro microperfused rabbit proximal convoluted tubule using the fluorescent dye (2',7')-bis-(carboxyethyl)-(5,6)-carboxyfluorescein. For the same changes in external pH, changes in [HCO3] and PCO2 affected cell pH similarly ([HCO3]: pHi/pHe = 0.67, PCO2: pHi/pHe = 0.64, NS). Isohydric changes in extracellular [HCO3] and PCO2 did not change cell pH significantly. Changes in peritubular [HCO3] elicited larger changes in cell pH than changes in luminal [HCO3], which were enhanced by peritubular 4-acetamido-4'-isothiocyanostilbene-2,2'-disulfonate (SITS). The cell pH defense against acute increases and decreases in PCO2 was inhibited by sodium, but not by chloride removal. Peritubular SITS inhibited the cell pH defense against increases and decreases of PCO2, whereas luminal amiloride inhibited cell pH defense against increases in PCO2.

CONCLUSIONS

(a) Steady-state cell pH changes in response to changes in extracellular [HCO3] and PCO2 are quantitatively similar for a given change in extracellular pH; (b) the rate of the basolateral Na/(HCO3)3 cotransporter is a more important determinant of cell pH than the rate of the apical membrane mechanism(s); (c) cell pH defense against acute changes in PCO2 depends on the basolateral Na/(HCO3)3 cotransporter (acid and alkaline loads) and the luminal Na/H antiporter (acid loads).

Basolateral membrane Na/base cotransport is dependent on CO2/HCO3 in the proximal convoluted tubule

The mechanism of basolateral membrane base transport was examined in the in vitro microperfused rabbit proximal convoluted tubule (PCT) in the absence and presence of ambient CO2/HCO3- by means of the microfluorometric measurement of cell pH. The buffer capacity of the cells measured using rapid NH3 washout was 42.8 +/- 5.6 mmol.liter-1.pH unit-1 in the absence and 84.6 +/- 7.3 mmol.liter-1.pH unit-1 in the presence of CO2/HCO3-. In the presence of CO2/HCO3-, lowering peritubular pH from 7.4 to 6.8 acidified the cell by 0.30 pH units and lowering peritubular Na from 147 to 0 mM acidified the cell by 0.25 pH units. Both effects were inhibited by peritubular 4-acetamido-4'-isothiocyanostilbene-2,2'-disulfonate (SITS). In the absence of exogenous CO2/HCO3-, lowering peritubular pH from 7.4 to 6.8 acidified the cell by 0.25 pH units and lowering peritubular Na from 147 to 0 mM decreased cell pH by 0.20 pH units. Lowering bath pH from 7.4 to 6.8 induced a proton flux of 643 +/- 51 pmol.mm-1.min-1 in the presence of exogenous CO2/HCO3- and 223 +/- 27 pmol.mm-1.min-1 in its absence. Lowering bath Na from 147 to 0 mM induced proton fluxes of 596 +/- 77 pmol.mm-1.min-1 in its absence. The cell acidification induced by lowering bath pH or bath Na in the absence of CO2/HCO3- was inhibited by peritubular SITS or by acetazolamide, whereas peritubular amiloride had no effect. In the absence of exogenous CO2/HCO3-, cyanide blocked the cell acidification induced by bath Na removal, but was without effect in the presence of exogenous CO2/HCO3-. We reached the following conclusions. (a) The basolateral Na/base n greater than 1 cotransporter in the rabbit PCT has an absolute requirement for CO2/HCO3-. (b) In spite of this CO2 dependence, in the absence of exogenous CO2/HCO3-, metabolically produced CO2/HCO3- is sufficient to keep the transporter running at 30% of its control rate in the presence of ambient CO2/HCO3-. (c) There is no apparent amiloride-sensitive Na/H antiporter on the basolateral membrane of the rabbit PCT.

The beginnings of space medicine

The beginnings of space medicine are those of aviation medicine and involved, among many pioneers, Dr. Harry G. Armstrong and the Aeromedical Laboratory. Space Medicine has advanced in a short 23 years from arguments about man being capable of survival in space through animal and manned flights to flight durations of 6 months. The public and private arguments about man's capability to survive and work in space and the early decisions about flight duration and safety are chronicled from a personal point of view.