An H+-ATPase in opposite plasma membrane domains in kidney epithelial cell subpopulations

Vectorial solute transport by epithelia requires the polarized insertion of transport proteins into apical or basolateral plasmalemmal domains. In the specialized intercalated cells of the kidney collecting duct, the selective placement of an apical plasma membrane proton-pumping ATPase (H+-ATPase) and of a basolateral membrane anion-exchange protein results in transepithelial proton secretion. It is currently believed that amino-acid sequences of membrane proteins contain critical signalling regions involved in sorting these proteins to specific membrane domains. Recently, it was proposed that intercalated cells can reverse their direction of proton secretion under different acid-base conditions by redirecting proton pumps from apical to basolateral membranes, and anion exchangers from basolateral to apical membranes. But others have found that antibodies raised against the red cell anion-exchange protein (Band 3) only labelled intercalated cells at the basolateral plasma membrane, providing evidence against the model of polarity reversal. In this report, we have examined directly the distribution of proton pumps in kidney intercalated cells using specific polyclonal antibodies against subunits of a bovine kidney medullary H+-ATPase. We find that some cortical collecting duct intercalated cells have apical plasma membrane proton pumps, whereas others have basolateral pumps. This is the first direct demonstration of neighbouring epithelial cells maintaining opposite polarities of a transport protein. Thus, either subtle structural differences exist between proton pumps located at opposite poles of the cell, or factors other than protein sequence determine the polarity of H+-ATPase insertion.

Overweight as a risk factor or a predictive sign of histological liver damage in alcoholics

This study analyzes whether increased body weight is related to histological liver damage in chronic alcoholic patients. Data from 152 recently abstinent alcoholics without evidences of liver failure were analyzed. Liver biopsies were scored for the presence of fat, necrosis, fibrosis, inflammation, and Mallory material. Total histological score correlated significantly with body weight (BW), length of alcoholism (L), and age (A) but not with the amount of ethanol ingested (E). Forward stepwise multiple regression analysis with histological score as the dependent variable gave significant F values for BW and L but not for A. Patients with severe damage had higher BW than patients with mild damage. The group with BW greater than 110% showed a higher histological score. These results confirm the association between increased BW and liver damage in asymptomatic alcoholic patients suggesting that overweight is a risk factor for alcoholic liver disease.

Stimulation of inositol phosphate production by propranolol in human neutrophils

1. Propranolol has been reported to be beneficial in treating patients suffering from a variety of diseases including migraine, psychosis and schizophrenia. The mode of action of propranolol in the treatment of the above diseases is not clear. 2. An investigation into the possible effect of propranolol on receptor activated inositol phospholipid hydrolysis was carried out using human neutrophils. Receptor activated inositol phosphate production by formyl-methionyl-leucyl-phenylalanine has also been studied. 3. DL-propranolol caused a time and concentration dependent increase in inositol phosphate generation which was similar to that obtained for chemotactic peptide in neutrophils. The EC50 for propranolol was 2 microM compared to 0.5 microM for chemotactic peptide. 4. These results indicate the possibility that propranolol has a direct action on inositol phospholipid hydrolysis in addition to its beta-blocking effect.

A simple technique to accurately determine intra-abdominal pressure

The determination of intra-abdominal pressure (IAP) may be useful in a variety of clinical situations. Despite this, invasive IAP monitoring is seldom performed due to the risks involved. Using a standard canine model of increased IAP, we evaluated the accuracy of transurethral bladder catheter pressure in reflecting IAP. Throughout the range of IAP studied (10 +/- 5 to 70 +/- 10 mm Hg), bladder pressure did not differ significantly from the direct measurement of IAP. We conclude that the measurement of bladder pressure using a standard transurethral bladder catheter provides an accurate determination of IAP.

Inhibitory action of spermidine on formyl-methionyl-leucyl-phenylalanine stimulated inositol phosphate production in human neutrophils

The effect of the polyamine, spermidine, on formyl-methionyl-leucyl-phenylalanine stimulated hydrolysis of polyphosphoinositides was examined in purified human neutrophils by measurement of inositol phosphate production from radioactively labelled inositol. Spermidine inhibited formyl-methionyl-leucyl-phenylalanine stimulated inositol phosphate production by neutrophil in a dose dependent manner. Inhibition of formyl-methionyl-leucyl-phenylalanine stimulated inositol phosphate accumulation by spermidine was maximal at 10 microM and the IC50 value for this effect was 4.2 microM spermidine. This action of spermidine, thought to be mediated by a membrane component other than phospholipase C, may reflect a control mechanism modulating the response of the polyphosphoinositide system.

Use of the isolated perfused kidney model to assess the acute pharmacologic effects of cyclosporine and its vehicle, cremophor EL

"Nephrotoxicity" secondary to cyclosporine and its clinically used vehicle, Cremophor EL, was examined in the isolated perfused rat kidney model. This model allows the serial determination of renal hemodynamic and tubular functional studies over a 3-hr duration using a normothermic, low hematocrit (13-15%) perfusion system. Initial studies indicated that the addition of small quantities of Cremophor EL resulted in marked renal vasoconstriction with decreased renal blood flow and deterioration in renal tubular function. These effects were highly significant and were of the same magnitude whether or not cyclosporine was present in the system. Cyclosporine was therefore examined after being dissolved in another vehicle, methanol. A 10% (v/v) amount of plasma was necessary in the perfusate to prevent significant adsorption of cyclosporine to the perfusion apparatus. Cyclosporine at concentrations below 100 ng/ml resulted in minor changes in renal hemodynamics. Beginning at 100 ng/ml glomerular filtration rate dropped significantly and renal vascular resistance increased three-fold. Fractional excretion of sodium significantly increased and the urine:plasma inulin ratio significantly decreased. We conclude that the clinically used drug vehicle, Cremophor EL, has significantly adverse effects on renal hemodynamics and tubular function. In addition, CsA causes similar renal toxicity in a dose-dependent fashion. Simultaneous administration of these two nephrotoxic agents could contribute to the high incidence of acute renal failure seen after transplantation. These observations suggest that an alternate vehicle with less renal toxicity might significantly decrease the incidence of this clinical problem.

The threshold-of-interference test: a new test of interhemispheric suppression in brain injury

A new procedural version of the Willeford competing sentences test (Willeford. Audiol Hear Educ 1976;2:12-20) is introduced here for use with brain damaged patients. The threshold-of-interference test seeks the minimal level of the competing sentences at which the patient can no longer repeat the message at the test ear. Findings are reported for normal controls and for brain damaged adults, with clinical data and computerized axial tomography scan evidence. The threshold-of-interference test appears to be efficient, quick in administration, and particularly useful in exposing auditory processing anomalies, especially in right hemisphere damage.

Interhemispheric suppression: a test of central auditory function

Two groups of brain damaged adults, those with cerebrocranial injury (CCI) and victims of cerebrovascular accident (CVA) were tested with the competing sentences test of Willeford (In: Central Auditory Dysfunction. New York: Grune and Stratton, 1977: Chap 2). The main purpose was the exposure of functional disorders of communication in such patients who test within normal or near-normal limits on routine audiological testing and also on tests for aphasia. Of 142 serially admitted CCI patients, 43%, many with diffuse lesions, gave abnormal responses, mostly at the left ear, with 19 of them showing total extinction at that ear. On two sound field competing message tests the CCI patients were significantly poorer than normal controls. CVA patients with confirmed right hemisphere lesions tended strongly toward left ear suppression, while left hemisphere damaged patients often showed bilateral drop in scores. It is clear that brain damaged patients can have central dysfunction of auditory processing despite normal findings on routine audiological tests and tests for aphasia. The implications for activities of daily living and for habilitation are discussed.

Interaction of West Nile virus with primary murine macrophages: role of cell activation and receptors for antibody and complement

We have measured growth of West Nile virus in mouse primary peritoneal macrophages (resident, thioglycolate elicited, and Mycobacterium bovis BCG activated) and in macrophagelike (P338D1) and nonmacrophage (L929, PS clone D) cell lines infected in the absence or presence of specific antibodies (immunoglobulin G ([IgG], IgM), and complement. Monoclonal antibodies directed against Fc receptors (IgG1/2b, 2.4G2) and type 3 complement receptors (Mac-1) were used to define the role of each receptor. Virus yield depended on a balance between enhancement and neutralization and was influenced by the physiologic state of the macrophage, the receptor pathway of viral entry, the mouse strain and age of donor. BCG-activated macrophages displayed a greater ability to restrict West Nile virus than nonactivated cells only in the presence of antiviral IgM, with or without complement; the Fc receptors for various classes of IgG mediated striking enhancement. These studies identify some of the complex innate and acquired factors that determine the interaction between West Nile virus and primary macrophages in vitro.

Interruption of cholinergic afferent pathways to the amygdala failed to alter electrical kindling

We investigated the hypothesis that the cholinergic system is involved in the process of amygdala kindling. Electrical kindling of the amygdala was associated with an increase in the concentration of acetylcholine in the kindled amygdala and the ipsilateral hippocampus but was not associated with any alteration of choline acetyltransferase activity. Destruction of cholinergic neurons in the lateral preoptic area significantly decreased the activity of choline acetylase in the ipsilateral amygdala, but had no effect on the duration of time to kindling. We interpret these findings as indicating that the cholinergic system is affected by the kindling process, but does not seem to be crucial to the phenomenon.

Polymorphic expression of a neutrophil differentiation antigen revealed by monoclonal antibody 7/4

The rat monoclonal antibody (ab) 7/4 produced against neutrophil-rich cultured bone-marrow populations defines a polymorphic neutrophil differentiation antigen (ag). Ag 7/4 expression was characterized on cells from C57BL/6 and Swiss PO outbred mice using fluorescence-activated cell sorter (FACS) analysis and radioimmune binding assays. All neutrophils in bone marrow, blood, and inflammatory exudates were labeled by ab 7/4 and appeared to express similar amounts of ag 7/4 quantitated by saturation radioimmune binding assays. However, discrete populations of dimly (8-12% of nucleated cells) and brightly (30-40%) 7/4 labeled cells could be resolved by FACS analysis of bone marrow only. No binding was detected to resident or inflammatory macrophages, lymphocytes, eosinophils, mast cells and mature erythroid cells in hemopoietic or lymphoid tissues. Nine inbred mouse strains tested expressed high levels of ag 7/4, while six other strains expressed insignificant levels. The expression of ag 7/4 on bone-marrow cells from F1, F2, and backcross generation mice was consistent with control by a single, autosomal dominant gene.

Viruses recovered from mosquitoes and wildlife serum collected in the Murray Valley of South-eastern Australia, February 1974, during an epidemic of encephalitis

Pools of mosquitoes collected in the Murray Valley in February, 1974, during an encephalitis epidemic yielded 239 isolates of 11 distinct viruses. These included 39 isolates of MVE virus, an incriminated causative agent of encephalitis in man, and 111 isolates of Kunjin virus, a probable causative agent. An additional isolate of MVE virus was recovered from the serum of a white-faced heron, Ardea novaehollandiae. The other 9 viruses comprised the Alpha-viruses Ross River and Sindbis, the Flavivirus, Edge Hill, the Bunyaviruses, Koongol and Wongal, the undefined Kowanyama virus, and 3 previously undescribed viruses. One isolate of MVE virus was recovered from a total of 180 Culex australicus, and all other isolates of all viruses were from Culex annulirostris. The combined apparent infection rate of MVE and Kunjin viruses in Cx annulirostris was 1/913. The concurrent activity of so many seemingly transient arboviruses, their wide geographical distribution and temporal considerations all weaken the widely held hypothesis that during the pre-epidemic period MVE virus is introduced into the Murray Valley by viraemic waterbirds from distant areas of tropical enzooticity.

The use and limitation of monoclonal antibodies against mononuclear phagocytes

Monoclonal antibodies have been used to study receptors on the plasma membrane of macrophages, as well as the processes of membrane synthesis, internalization, recycling and macrophage differentiation and activation. Various immunisation and screening procedures have been employed. Most reagents produced so far are not restricted to macrophages in their binding specificity. Monoclonal antibodies have been of great use in characterising murine Fc receptors and in studying the composition of the membrane of pinocytic vesicles. Antibody F4/80 has been used to examine the behaviour of the 160K membrane protein it defines during macrophage differentiation and activation. This antigen is absent on macrophage precursors, is expressed in relatively large amounts on mature macrophages, but expression is diminished on activated populations. No macrophage subset heterogeneity has been defined by ag F4/80 or 2 other monoclonal antibody-defined macrophage antigens, as all bone marrow-derived macrophage clones express these antigens. Anti-macrophage antibodies have already proved useful as diagnostic markers and in cell separation. Reagents such as these will help to sort out relationships between macrophages and other presumptive mononuclear phagocytes.

A critique of volunteer-staffed suicide prevention centres

This study compares the Los Angeles Suicide Prevention Center program with that of the Samaritan Centre in the London area. The author interviewed senior personnel and reviewed the training program for volunteers in both centres. He also monitored calls but was prohibited from listening in on the callers' conversation in the Samaritan program due to their strict policy of confidentiality and anonymity. The purpose of the study was to learn the nature of the calls with special emphasis on suicide risk and degree of crisis; to assess the functioning of the volunteers in detail and compare it with professionals; to assess the usefulness of the programs in lowering the suicide rate and in other functions, particularly dealing with crises and case finding. It was found that the involvement with callers is very similar in both centres; that only a small percentage of callers had a significant suicidal drive; that many of the callers were in crisis and a useful service was provided for them; that the volunteers coped extremely well with disturbed callers even though their responses were often different from professionals. There is no evidence that these and similar, primarily telephone, services lower the suicide rate; they seem to be more effective as crisis centres than as suicide prevention centres.

Water immersion in nephrotic syndrome

Five adults suffering from nephrotic syndrome were immersed up to the neck in 1.3 m of warm water for four hours. There was a mean weight loss of 2 kg; 1 kg was lost through sweat and 1 kg was lost through urine. Thirty-five millimoles of sodium was excreted in the urine in four hours, 15 times more than on control days. The urine became hypotonic to plasma in the first two hours of immersion. Aldosterone levels did not change on immersion in three patients, but fell from elevated levels in two others. It is concluded that water immersion up to the neck in nephrotic patients warrants further investigation as a therapeutic agent in those cases that are not responding to conventional diuretic therapy.

The effects of brief hospitalization upon the psychiatric patient's household

This paper describes the social results of a randomized controlled trial of brief versus standard hospitalization for acute psychiatric inpatients. All the data reported were obtained through the use of a new semi-structured standardized interview schedule, The Patient Behaviour Assessment Schedule (PBAS). Overall, there were no significant differences between groups in the extent of Objective Burden and Subjective Distress experienced by the informant's household. The groups were differentiated, however, on a number of individual items. At the 2-week evaluation Brief Care informants expressed more distress than Standard Care informants arising out of the patient's slowness, but were less distressed by the effect of the patient's behaviour on their work performance. At the follow-up interview Standard Care informants were more affected in their social life and pursuit of leisure activities, while expressing less distress as a result of the patient's overdependence. The sensitivity of the PBAS Distress Scales is demonstrated by comparing the informant's differential emotional response to role and nonrole aspects of the patient's behaviour at different points in time.

Expression of the macrophage-specific antigen F4/80 during differentiation of mouse bone marrow cells in culture

We have defined the expression of the macrophages (m phi)-specific antigen (Ag) F4/80 during differentiation in culture. The progenitor cells-the colony-forming unit in culture and cluster-forming cell-lacked Ag F4/80 but gave rise to colonies of F4/80-positive adherent m phi, as shown by fluorescence-activated cell sorting and clonal assays with L cell-conditioned medium as the source of growth factor. Ag F4/80 first appeared on a nonadherent precursor found in mass liquid BM cultures after 3 d. Once adherent, m phi expressed high levels of Ag F4/80 and other markers. The role of L cell-conditioned medium and of adherence on expression of Ag F4/80 was also examined. Clonal analysis of F4/80 and other Ag, Mac-1, and 2.4G2 (FcR) showed that all cells in all independent colonies come to express these markers. These studies establish that F4/80 is a marker for the more mature stages of m phi development and that Ag expression increases progressively during maturation in vitro. Heterogeneity of Ag expression can be ascribed to variation in development and not to independent subsets of the m phi.

Orienting, habituation, sensitisation, and dishabituation in the electrodermal system of consecutive, drug free, admissions for schizophrenia

Thirty-three consecutive admissions for schizophrenia with PSE diagnoses and free of neuroleptics were compared with 31 hospital staff for distinguishing features of bilateral electrodermal activity to a sequence of mild tones followed by a sequence of conspicuous tones with variation of temporal parameters. To mild tones most patients were either non-responders or non-habituators whereas most controls were habituators or non-habituators. To conspicuous tones patients as a group were more responsive but without the features of sensitisation to a test stimulus shown by controls. Patients as a group had more non-specific response and higher levels of skin conductance which showed less adaptation than controls. To a large extent previously reported difference in response latencies, rise-times and half-recovery times would appear to be a function of habituation rate. Patient -control differences may reflect anxiety and stress in patients, though lateral asymmetries in activity have a deeper salience for the nature of schizophrenia.

Effect of propranolol and phenothiazines on electrodermal orienting and habituation in schizophrenia

Bilateral electrodermal orienting responses were measured to repeated auditory stimuli in schizophrenic patients and controls. In 3 studies phasic activity to moderate intensity sounds of patients on no drugs or phenothiazines was predominantly hyper- or hypo-responsive. Controls showed moderate or slow habituation. Propranolol was found to facilitate habituation in slow habituators and to reinstate responses in half of non-responders, especially when given as the sole drug. The effects seldom had a counterpart in changes in non-specific responses or levels of skin conductance. Modulatory influences on stimulus and response processing and on lateral asymmetries in responses may underlie propranolol's efficacy in treating schizophrenia.

Infectious drug resistance during an outbreak of samonellosis

The sudden acquisition of aminoglycoside resistance among Salmonella group C1 isolates causing summer diarrhoea raised the possibility oif plasmid-mediated reistance. The demonstration of circular DNA species in the resistant, but not in the sensitive salmonellae and the transfer by conjugation of antibiotic resistance to a sensitive strain of Escherichic coli, was consistent with plasmid-mediated resistance.

Ureteroneocystostomy in the treatment of reflux in neurogenic bladders

There were 15 patients with neurogenic bladders, representing 23 renal units with reflux, who underwent reimplantation with the Politano-Leadbetter technique. The over-all success rate was 30 per cent. Failures, including persistent reflux or obstruction, were demonstrated on at least 1 side of all bilateral reimplantations and 3 of 7 unilateral procedures. These results are compared to those in the recent literature. We conclude that case selection, limiting the operation to only those patients with balanced bladders, will ensure uniformly good results. External sphincterotomy in patients with reflux may alter the clinical course, either obviating the need for reimplantation or creating a balanced bladder. Other forms of therapy, such as urinary diversion, are indicated only in those patients who persist with markedly abnormal bladders and renal deterioration.

Suicidal behaviour in Halifax, Nova Scotia: with some general observations

A brief report of suicide statistics — completed suicides, attempts with lethal intent (a new category), and other attempts — is presented. The highest risk group in Halifax County is the male from late adolescence to early middle life.

Statistics from Canada and Nova Scotia reveal a marked increase in the rate of completed suicides in the young adult male during the past twenty years.

It is noteworthy that completed suicides and attempts with lethal intent frequently occur in persons with no clear evidence of significant depressive illness and that many patients with severe depressive illness are never seriously suicidal.

Many persons and some families have a pattern of reacting to stress and/or psychiatric illness with suicidal behaviour. There is often little correlation between the seriousness of the stress and/ or illness and the seriousness, of the suicidal behaviour.

Most suicide's were considered to be not preventable by ordinary techniques of management. Various patterns of behaviour relevant to preventability are described.

A brief description of reactions of physicians and nurses to suicidal behaviour is given. There is a negative reaction of both groups to suicidal attempts which are not serious, particularly to repeaters; and this reaction is much stronger in nurses than in physicians.

There is also a brief description of unusual complications of suicidal attempts and of the very high medical costs of caring for those who make attempts.

The development of left-hand superiority for discriminating braille configurations

Discrimination of braille configurations was performed better by the left hand of right-handed sighted children over age 10, paralleling a previous study in which the names of braille letters were learned. Left-hand superiority occurred sooner in males, but they were not better at the task than females, more of whom maintained a left-hand advantage as adults. As in vision, configurations differing in orientation were more difficult to discriminate than those differing in number or displacement, but this order of difficulty was the same for both hands.

Microwave lens effects in humans. II. Results of five-year survey

Individuals selected on the basis of likelihood of occupational exposure to microwaves were subjected to a biomicroscopic examination of the lens. Control personnel were also examined along with them, the examiners having no knowledge of the exposure history of any examinee prior to or during the examination. Objective evidence of lens abnormality (opacities, vacuoles, or posterior subcapsular iridescence) was recorded and a comparison made between the two groups on the basis of that evidence. The comparison showed the two groups to be essentially the same and did not support the hypothesis that human lens damage is occurring in the military environment in this country. Instead, it tended to support the assumption that the existing safety level of 10 MW/sq cm is adequate.