Drone images afford more detections of marine wildlife than real-time observers during simultaneous large-scale surveys

There are many advantages to transitioning from conducting marine wildlife surveys via human observers onboard light-aircraft, to capturing aerial imagery using drones. However, it is important to maintain the validity of long-term data series whilst transitioning from observer to imagery surveys. We need to understand how the detection rates of target species in images compare to those collected from observers in piloted aircraft, and the factors influencing detection rates from each platform. We conducted trial ScanEagle drone surveys of dugongs in Shark Bay, Western Australia, covering the full extent of the drone's range (∼100 km), concurrently with observer surveys, with the drone flying above or just behind the piloted aircraft. We aimed to test the assumption that drone imagery could provide comparable detection rates of dugongs to human observers when influenced by same environmental conditions. Overall, the dugong sighting rate (i.e., count of individual dugongs) was 1.3 (95% CI [0.98-1.84]) times higher from the drone images than from the observers. The group sighting rate was similar for the two platforms, however the group sizes detected within the drone images were significantly larger than those recorded by the observers, which explained the overall difference in sighting rates. Cloud cover appeared to be the only covariate affecting the two platforms differently; the incidence of cloud cover resulted in smaller group sizes being detected by both platforms, but the observer group sizes dropped much more dramatically (by 71% (95% CI [31-88]) compared to no cloud) than the group sizes detected in the drone images (14% (95% CI [-28-57])). Water visibility and the Beaufort sea state also affected dugong counts and group sizes, but in the same way for both platforms. This is the first direct simultaneous comparison between sightings from observers in piloted aircraft and a drone and demonstrates the potential for drone surveys over a large spatial-scale.

Classifying hard and soft bone tissues using drilling sounds

The purpose of this study was to investigate if the sounds generated during bone drilling could be used to classify between hard (cortical) and soft (cancellous) tissues. Bone drilling is performed in many surgical procedures throughout the world. Inadvertent deviation from the correct drill direction may result in injuries to sensitive anatomical structures such as nerve and vessels. Therefore, to increase the safety of such procedures, it is necessary to identify different bone tissues. The cortical and cancellous tissues of six bovine tibia pieces were drilled and the generated sounds were recorded. Each record was analyzed in different frequency regions based on the spectrograms. From each region, short-time Fourier transform (STFT) coefficients were computed and averaged accordingly to obtain n bins. The total bins of all frequency regions were chosen as the features. A support vector machine (SVM) algorithm was selected for classification and the performance was evaluated in two training/testing scenarios: leave one bone out (LOBO) and bone specific (BSP). The average total accuracy on the testing data was 70.9% and 83% for LOBO and BSP respectively. The results indicated that the drilling sounds obtained from various bone pieces could be used to develop a classification model that had promising performance on identifying hard and soft components of a new bone piece.

Hepatitis B virus regulatory HBx protein binding to DDB1 is required but is not sufficient for maximal HBV replication

Robust hepatitis B virus (HBV) replication is stimulated by the regulatory HBx protein. HBx binds the cellular protein DDB1; however, the importance of this interaction for HBV replication remains unknown. We tested whether HBx binding to DDB1 was required for HBV replication using a plasmid based replication assay in HepG2 cells. Three DDB1 binding-deficient HBx point mutants (HBx(69), HBx(90/91), HBx(R96E)) failed to restore wildtype levels of replication from an HBx-deficient plasmid, which established the importance of the HBx-DDB1 interaction for maximal HBV replication. Analysis of overlapping HBx truncation mutants revealed that both the HBx-DDB1 binding domain and the carboxyl region are required for maximal HBV replication both in vitro and in vivo, suggesting the HBx-DDB1 interaction recruits regulatory functions critical for replication. Finally we demonstrate that HBx localizes to the Cul4A-DDB1 complex, and discuss the possible implications for models of HBV replication.

Dynamic Physical Constraints: Emulating Hard Surfaces with High Realism

In this paper, we present a novel haptic technique for emulating hard surfaces with high realism; such a technique has significant potential utility in certain orthopedic surgery applications such as joint replacement surgery where the goal is to prevent incursions beyond a virtual surface during bone cutting operations. The Dynamic Physical Constraint (DPC) concept uses a unidirectional physical constraint that is actively positioned to limit movement between two manipulator links; the concept is applicable to providing virtual constraints in both 2D and 3D workspaces. Simulation results demonstrate the potential feasibility of the concept, and a prototype device was built for testing. The DPC device provides a convincing sensation of a real, hard virtual surface which can be smoothly tracked when the end effector is in contact with the surface. Incursion across the surface with the prototype was well submillimetric and within the accuracy constraints required for joint replacement applications.

Abstract B25: DDB1 is a cell-nonautonomous tumor suppressor targeted by HBx in the liver

Hepatocellular carcinoma (HCC) is the fifth most frequent cancer and the third leading cause of cancer death worldwide. A major aetiologic risk factor for HCC is chronic infection of hepatitis B virus (HBV), which encodes a small regulatory x protein (HBx) critical for HBV-induced hepatocarcinogenesis. How HBx contributes to HCC is not clear, but is likely dependent on its association with host factors to activate transcription and regulate mitogenic pathways.

Here we demonstrate that deletion of one such HBx-interacting protein, the Damaged DNA Binding Protein 1 (DDB1), in liver parenchymal hepatocytes leads to development of HCC in mice, after prolonged inflammation resulting from continuous loss of DDB1-deficient hepatocytes and regeneration of DDB1-proficient hepatocytes. Expression of HBx in this regenerating liver impairs the proliferation of regenerated DDB1-proficient hepatocytes, and significantly accelerates the onset of tumorigenesis. Surprisingly, tumors arising from these animals are made up of cancer cells displaying no disruption of the DDB1 gene. This cell-nonautonomous function of DDB1 inactivation in HCC initiation can be further enhanced by deletion of the tumor suppressor p53 or administration of chemical carcinogen.

Our results indicate that cancer initiating mutations are not necessarily present in cancer initiating cells, but can be exploited by oncogenic signals such as HBx expression and p53 mutation to promote cancer progression.

Citation Information: Cancer Res 2009;69(23 Suppl):B25.

Finding and defining the ideal patellar resection plane in total knee arthroplasty

Asymmetric resection of the patella during total knee arthroplasty (TKA) correlates with anterior knee pain, bony impingement and patellar maltracking. Despite this, there is no consensus regarding the desired landmarks; the cut is often done freehand; and there has been no quantitative comparison of proposed resection planes. The objectives of this study were to: determine the intra- and inter-surgeon repeatability of two radiographic resection definitions (medial-divot, MD, and medial-lateral extents, MLE); calculate two additional definitions from the radiographic patellar circumferences (parallel to the anterior surface, ANT, and perpendicular to the anteroposterior tangent points, PERP); compare the clinical resection line to the previous four definitions before and after introducing the MD method clinically; and identify distinguishing features of patellae with better vs. worse resection angles. We hypothesized that the MD method would improve repeatability both radiographically and clinically, that the different radiographic definitions would produce comparable angles, and that we could identify distinguishing features. For the radiographic study, three surgeons drew lines on 40 preoperative X-rays plus 9 interspersed repetitions of 3 of these X-rays. For the clinical study, we compared the patellar resection angle for 20 patients immediately before and after implementing the new method. Given that the clinical goal is to have equal distances from the resection surface to the anterior surface, we compared all results to the ANT definition as the theoretically ideal definition. Confirming the first hypothesis, intra-surgeon repeatability (10 repetitions of 3 X-rays) and inter-surgeon repeatability (3 surgeons x 40 X-rays) were both significantly better using the new MD method compared to the MLE method (p<0.001). Contrary to the second hypothesis, clinical use of the MD method did not improve resection symmetry. Contrary to the third hypothesis, the PERP definition was significantly different from the other three definitions. In agreement with the fourth hypothesis, female patellae and more deformed patella had significantly greater asymmetry (p<0.001). Given the inherent variability shown in drawing the 'patellar horizon', we encourage researchers to draw the line several times and average the results when comparing tilt or the resection angle to this horizon. Based on the distinguishing characteristics of asymmetrically resurfaced patellae in our series, we recommend that clinicians be particularly careful when resecting laterally deformed patellae and the patellae of female patients.

Hepatitis B virus HBx protein localized to the nucleus restores HBx-deficient virus replication in HepG2 cells and in vivo in hydrodynamically-injected mice

Identifying the requirements for the regulatory HBx protein in hepatitis B virus (HBV) replication is an important goal. A plasmid-based HBV replication assay was used to evaluate whether HBx subcellular localization influences its ability to promote virus replication, as measured by real time PCR quantitation of viral capsid-associated DNA. HBx targeted to the nucleus by a nuclear localization signal (NLS-HBx) was able to restore HBx-deficient HBV replication, while HBx containing a nuclear export signal (NES-HBx) was not. Both NLS-HBx and NES-HBx were expressed at similar levels (by immunoprecipitation and Western blotting), and proper localization of the signal sequence-tagged proteins was confirmed by deconvolution microscopy using HBx, NLS-HBx, and NES-HBx proteins fused to GFP. Importantly, these findings were confirmed in vivo by hydrodynamic injection into mice. Our results demonstrate that in these HBV replication assays, at least one function of HBx requires its localization to the nucleus.

Premature cell cycle entry induced by hepatitis B virus regulatory HBx protein during compensatory liver regeneration

The cycles of cell death and compensatory regeneration that occur during chronic hepatitis B virus (HBV) infection are central to viral pathogenesis and are a risk factor for the development of liver cancer. The HBV genome encodes one regulatory protein, HBx, which is required for virus replication, although its precise role in replication and pathogenesis is unclear. Because HBx can induce the G(0)-G(1) transition in cultured cells, the purpose of this study was to examine the effect of HBx during liver regeneration. Transgenic mice expressing HBx (ATX) and their wild-type (WT) littermates were used in the partial hepatectomy (PH) model for compensatory regeneration. Liver tissues collected from ATX and WT mice at varying sacrifice time points after PH were examined for markers of cell cycle progression. When compared with WT liver tissues, ATX livers had evidence of premature cell cycle entry as assessed by several variables (BrdUrd incorporation, proliferating cell nuclear antigen and mitotic indices, and reduced steady-state p21 protein levels). However, HBx did not affect apoptosis, glycogen storage, or PH-induced steatosis. Together, these results show that HBx expression can induce cell cycle progression within the regenerating liver. Our data are consistent with a model in which HBx expression contributes to liver disease and cancer formation by affecting early steps in liver regeneration.

Enhancement of hepatitis B virus replication by the regulatory X protein in vitro and in vivo

The 3.2-kb hepatitis B virus (HBV) genome encodes a single regulatory protein termed HBx. While multiple functions have been identified for HBx in cell culture, its role in virus replication remains undefined. In the present study, we combined an HBV plasmid-based replication assay with the hydrodynamic tail vein injection model to investigate the function(s) of HBx in vivo. Using a greater-than-unit-length HBV plasmid DNA construct (payw1.2) and a similar construct with a stop codon at position 7 of the HBx open reading frame (payw1.2*7), we showed that HBV replication in transfected HepG2 cells was reduced 65% in the absence of HBx. These plasmids were next introduced into the livers of outbred ICR mice via hydrodynamic tail vein injection. At the peak of virus replication, at 4 days postinjection, intrahepatic markers of HBV replication were reduced 72% to 83% in mice injected with HBx-deficient payw1.2*7 compared to those measured in mice receiving wild-type payw1.2. A second plasmid encoding HBx was able to restore virus replication from payw1.2*7 to wild-type levels. Finally, viremia was monitored over the course of acute virus replication, and at 4 days postinjection, it was reduced by nearly 2 logs in the absence of HBx. These studies establish that the role for HBx in virus replication previously shown in transfected HepG2 cells is also apparent in the mouse liver within the context of acute hepatitis. Importantly, the function of HBx can now be studied in an in vivo setting that more closely approximates the cellular environment for HBV replication.

Praxiteles: a miniature bone-mounted robot for minimal access total knee arthroplasty

We have been working to develop a compact, accurate, safe, and easy-to-use surgical robot for minimally invasive total knee arthroplasty (TKA). The goal of our bone-mounted robot, named Praxiteles, is to precisely position a surgical bone-cutting guide in the appropriate planes surrounding the knee, so that the surgeon can perform the planar cuts manually using the guide. The robot architecture is comprised of 2 motorized degrees of freedom (DoF) whose axes of rotation are arranged in parallel, and are precisely aligned to the implant cutting planes with a 2 DoF adjustment mechanism. Two prototypes have been developed and tested on saw bones and cadavers--an initial one for open TKA surgery and a new version for MIS TKA, which mounts on the side of the knee. A novel bone-milling technique is also presented that uses passive guide and a side milling tool.

Correlating motor performance with surgical error in laparoscopic cholecystectomy

BACKGROUND

Analysis of motor performance in minimally invasive surgery (MIS) is a new field with applications in surgical training, surgical simulators, and robotics. Force/torque and derivatives of tool tip position (velocity, acceleration, and jerk) are examples of measures of motor performance (MMPs). Few studies have measured MMPs or have correlated MMPs with surgical performance during MIS on humans. The objectives of this study were to determine the feasibility of a novel multimodal system to quantify MMPs in laparoscopic cholecystectomy and to attempt to correlate MMPs with the magnitude of error as a measure of surgical performance.

METHODS

Novice and expert surgeons performed laparoscopic cholecystectomies in two groups of three patients each. MMPs were obtained using a combination of optical and electromagnetic tool tip tracking and a force/torque sensor on a modified Maryland dissector. Error scores for laparoscopic cholecystectomy were calculated using a previously validated system. Novice and expert measurements were compared, and correlations were made between error scores and MMPs.

RESULTS

Error scores were similar between novices and experts. Novice surgeons had a significantly greater mean velocity (566 +/- 83 vs 85 +/- 32 mm/s, p = 0.006) and acceleration (2,600 +/- 760 vs 440 +/- 174 mm/s2, p = 0.050) compared to expert surgeons. Force (16.5 +/- 4.6 vs 18.3 +/- 6.0 N, p = 0.829), position (121 +/- 25 vs 135 +/- 72 mm, p = 0.863), and jerk (19,600 +/- 7,410 vs 2,430 +/- 367 mm/s3, p = 0.138) were similar between groups. A positive correlation was found in novice surgeons between error score and jerk (Pearson correlation, 0.999; p = 0.035).

CONCLUSIONS

It is feasible to quantify MMPs in laparoscopic cholecystectomy. Novice and expert surgeons can be differentiated by MMPs; moreover, there may be a positive correlation between jerk and error score in novice surgeons.

Provisioning by tourists affects the behaviour but not the body condition of Mareeba rock-wallabies (Petrogale mareeba)

Feeding free-ranging native animals is a form of wildlife-based tourism that is particularly popular in Australia as a result of the cryptic nature of many native species. The colony of Mareeba rock-wallabies (Petrogale mareeba) at 'Granite Gorge', North Queensland, where tourists feed a spatially defined subset of animals daily, was studied to determine the effects of provisioning on their behaviour and body condition. Provisioned P. mareeba had higher activity levels, including higher aggression levels, and spent more time performing contact behaviours (including mutual and non-mutual allogrooming) than did non-provisioned animals. Possible explanations for increased aggression include competition over provisioned food and territorial defence. Increased contact behaviours may serve to reduce tension caused by provisioning. The diurnal activities of the provisioned rock-wallabies were dictated by the activities of tourists. Provisioned rock-wallabies emerged from their shelters to receive food much earlier each afternoon than did the unprovisioned animals. The level of autogrooming exhibited by the provisioned wallabies was much higher than that of the unprovisioned animals, presumably as a thermoregulatory response to the high afternoon temperatures. Although provisioned P. mareeba feed more, their higher activity levels explain the lack of difference in the body condition between the two groups.

Influence of interaction force levels on degree of motor adaptation in a stable dynamic force field

Studies have shown that the point-to-point reaching movements of subjects seated in a dark, rotating room demonstrate errors in movement trajectories and endpoints, consistent with the direction of the Coriolis force perturbations created by room rotation. Adaptation of successive reaches and the presence of postrotation aftereffects have indicated that subjects form internal models of the Coriolis field dynamics in order to make appropriate movement corrections. It has been argued that these findings are inconsistent with predictions of peripheral stabilization assumed in equilibrium-point models of motor control. A possibility that has been raised, however, is that the Coriolis field findings may in fact stem from changes in control commands elicited due to the magnitude and destabilizing nature of the Coriolis perturbations. That is, it has been suggested that a perturbation threshold exists, below which central reactions are not necessary in order to maintain movement stability. We tested the existence of a perturbation threshold in normal-speed reaching movements. Twelve normal human subjects performed non-visually guided reaching movements while grasping a robotic manipulandum. The endpoints and trajectory deviations of their movements were measured before, during, and after a position-dependent force field (similar to a Coriolis field in terms of the time history of applied forces) was applied to their movements. We examined the responses to a range of perturbation field strengths from small to considerable. Our experimental results demonstrated a substantial adaptation response over the entire range of perturbation field magnitudes examined. Neither the amount of adaptation after 5 trials nor after 25 trials was found to change as disturbance magnitudes decreased. These findings indicate that there is an adaptive response even for small perturbations; i.e., threshold behavior was not found. This result contradicts the assertion that peripheral stabilization mechanisms enable the central controller to ignore small details of peripheral or environmental dynamics. Our findings instead point to a central dynamic modeler that is both highly sensitive and continually active. The results of our study also showed that subjects were able to maintain baseline pointing accuracies despite exposure to perturbation forces of sizeable magnitude (more than 7 N).

Automated high-frequency posture sampling for ergonomic assessment of laparoscopic surgery

BACKGROUND

Despite widespread acknowledgement that strain injuries do occur to surgeons, ergonomic assessments in minimally invasive surgery are comparatively rare. Current assessment techniques rely on labor-intensive manual recording techniques, so there is a need for an automated system.

METHODS

We used an optoelectronic measurement system to make postural measurements at frequencies of ~5 Hz and then converted these measurements to ergonomic stress scores using a modified Rapid Upper Limb Assessment (RULA) method.

RESULTS

We successfully recorded postures at least once per second during 96% of the time the surgeon was performing tissue manipulation tasks. We found that the ergonomic stress scores were comparatively high throughout the procedure, particularly for the wrist.

CONCLUSION

An automated high-frequency postural measurement system is feasible for making ergonomic assessments in an intraoperative setting. Such a system will also be a critical component in validating surgical simulations for use in training and credentialing surgeons and in designing and evaluating equipment.

The effects of physical constraints in laparoscopic surgery

In order to provide guidelines for the development and evaluation of advanced laparoscopic instrumentation (including teleoperated devices), we assessed the impact of constrained motion on surgeons' ability to perform standardized pick-and-place and suturing tasks when using an emulation of a perfectly transparent teleoperator under direct, binocular vision. The surgeons' performance when using the emulator represents an upper bound on performance using any conceivable teleoperator with one-to-one force and motion scaling. Our analysis examines the mean differences in task completion time between three open tool configurations and two laparoscopic tool configurations with various degrees of freedom (DOFs). Fifteen laparoscopic surgeons participated in the study. We show that avoiding reversed hand and tool motions and adding DOFs significantly improves suturing performance. In the pick-and-place task, avoiding the reversed motions also improves performance, but adding DOFs to an open tool configuration does not. For both tasks, subjects who use open tools constrained to four DOF complete their tasks in approximately 38% less time than when using standard four-DOF laparoscopic tools. The marginal benefit to overall surgical time of adding two additional degrees of freedom is likely to be small (approximately 2%), although surgeons may then feel confident in attempting more difficult procedures.

Polypyrrole-heparin composites as stimulus-responsive substrates for endothelial cell growth

Heparin is a potent anticoagulant which can be immobilized on biomaterial surfaces to increase their hemocompatability. In the present work, we have electrochemically synthesized composites comprising heparin and the electrically conducting polymer polypyrrole. The incorporation and exposure of heparin were controlled by varying key conditions of polymer synthesis (i.e., applied current and synthesis time). The resulting composite polymers were electroactive after synthesis and the amount of heparin exposed in the polymer could be increased (up to threefold) by switching the polymers from their oxidized to reduced states. Polymer reduction was achieved by either application of negative potentials (-0.4 to -0.7 V for 90 s) or exposure to aqueous reductant (0.1M sodium dithionite for 30 min). Heparin-polypyrrole composites remained stable after autoclaving, displaying no significant loss of electroactivity, and had a shelf life of at least 2 years postautoclaving. Finally, the composites were found to be excellent substrates for the growth of human endothelial cells.

Human endothelial cell attachment to and growth on polypyrrole-heparin is vitronectin dependent

Composite materials comprised of the electrically conducting polymer, polypyrrole, with a variety of biologically active molecules, e.g. proteins or polysaccharides, are emerging as a novel class of "smart" biomaterials. In the present work we have studied the utility of a heparin-polypyrrole composite as a substrate for human umbilical vein endothelial cell (HUVEC) growth. We found that the polymer composites were well suited to support cell attachment and growth; displaying low surface hydrophobicity (water contact angle of approximately 20 degrees ) and roughness, Rq of approximately 10-12 nm. Doubling times for HUVEC on heparin-polypyrrole were greater than observed for gelatin-coated tissue culture polystyrene (44 and 36 h, respectively), however, the cells did proliferate to cover the polymer in an even monolayer. The initial mechanism of attachment and subsequent proliferation of HUVEC on heparin-polypyrrole was critically dependent on the presence of the serum adhesion glycoprotein vitronectin. Polymers that were composed of polypyrrole and sodium nitrate were more hydrophobic than heparin-polypyrrole and they did not support HUVEC growth. Given the relative ease with which these polymer composites can be electrochemically synthesized, the diverse range of cellular "signal agents", e.g. growth factors, that can be incorporated within them, and the high degree of control that can be achieved in the release-surface exposure of these agents, we suggest that polypyrrole composites could serve a useful role as "smart" biomaterials in the near future.

Lowering hospital charges in the trauma intensive care unit while maintaining quality of care by increasing resident and attending physician awareness

OBJECTIVE

The goal of this study was to determine if trauma intensive care unit (TICU) charges could be reduced through informal daily bedside resident-attending physician discussions regarding relative patient costs of diagnostic and therapeutic alternatives.

DESIGN

This was a prospective pre- and postinterventional study.

SETTING

The study took place in a TICU in a level I, community-based, university-affiliated teaching hospital.

PATIENTS

Ninety-one consecutive patients were admitted to the TICU during a 6-month period.

MATERIALS AND METHODS

The TICU charges were tracked over two consecutive 3-month periods. The first 3 months served as control. No attempt was made to alter cost of care, and residents were unaware that a study was in progress. During the ensuing 3-month period, attendings explicitly discussed with residents relative costs of diagnostic and therapeutic interventions in an attempt to lower charges. Composition of the surgical trauma team remained constant throughout the study.

MEASUREMENT AND MAIN RESULTS

The median and mean age, Injury Severity Score, intensive care unit length of stay, and sex ratio were not statistically different between the two study groups. Total median daily charges of the postintervention group were reduced over the control group by $818/intensive care unit day (p = 0.0002). The major categories in which charges were reduced included medications ($151/day, p = 0.003), laboratory tests ($120/day, p = 0.072), chest x-ray films ($61/day, p = 0.001), respiratory therapy ($185/day, p = 0.21), and miscellaneous charges ($141/day, p = 0.055). Mortality rates and number of major complications were not statistically different between groups.

CONCLUSIONS

Increased awareness of cost factors and specific attempts to achieve patient cost reduction resulted in a demonstrable decrease in daily TICU charges, without compromising the quality of care.

Considerations in applying dynamic programming filters to the smoothing of noisy data

Dynamic programming techniques are useful in smoothing and differentiating noisy data signals according to an optimization criterion and the results are generally quite robust to noise spectra different from that assumed in the construction of the filter. If the noise properties are sufficiently different, however, the generalized cross-validation function used in the optimization can exhibit either multiple minima or no minima other than that corresponding to an insignificant amount of smoothing; in these cases, the smoothing parameter desired by the user typically does not lie at the global minimum of the generalized cross-validation function, but at some other point on the curve which can be identified heuristically. I present two cases to demonstrate this phenomenon and describe what measures one can take to ensure that the desired smoothing parameter is obtained.

A proposed etiology for tourniquet-induced neuropathies

Pneumatic tourniquets are used in limb surgery to provide a bloodless operating field, but they can also cause nerve injuries. These injuries are thought to be mechanically induced, although no previous work has quantified such a mechanism. This paper hypothesizes that axial compression of the nerve leads to damage at the nodes of Ranvier and presents simulation results based on this hypothesis which are in substantial agreement with clinical observations.

Avoiding tourniquet-induced neuropathy through cuff design

Pneumatic tourniquets are routinely used in limb surgery to provide a bloodless operating field, but they are known to cause nerve injuries. Simulation results based on the hypothesis that axial compression of nerves is responsible for a certain class of these mechanically induced injuries are in substantial accord with clinical observations. A model of the limb and tourniquet that treats the tissue as a linearly elastic solid is presented and is used to predict the induced axial strains. The smallest axial strains are induced by a tourniquet design for which the applied pressure distribution rolls off as gradually as possible; according to the axial-strain hypothesis, such a design will markedly decrease a tourniquet's inherent potential for injury. Use of a wider cuff in and of itself will not reduce axial strain, so if the hypothesis is correct, a wider cuff would not be intrinsically safer than a regular cuff, a result that is contrary to current opinion.

Cholera toxin B-gold, a retrograde tracer that can be used in light and electron microscopic immunocytochemical studies

The purpose of this study was to test whether a new retrograde tracer, the B subunit of cholera toxin conjugated to colloidal gold particles (CTB-gold), was taken up and transported by neurons in the central nervous system of the rat. Retrograde transport of CTB-gold was assessed from axon terminals, from damaged nerve fibers, and from axons of passage. For light microscopy, CTB-gold was visualized by silver intensification; for electron microscopy, sections were silver-intensified with or without subsequent gold toning. Retrogradely transported CTB-gold was detected in neurons after survival times of 12 hours to 42 days and appeared as black punctate deposits in perikarya and proximal dendrites at the light microscope level. Ultrastructurally, the deposits were usually associated with lysosomes. Injections of CTB-gold into the caudal ventrolateral medulla or into the lateral horn of the spinal cord gave small well-defined injection sites and resulted in retrograde labelling in medullary neurons in the same locations as similarly placed injections of wheat germ agglutinin-horseradish peroxidase. When injected into the superior cervical ganglion, CTB-gold was transported to nerve cell bodies in the spinal cord, but application of CTB-gold to the cut cervical sympathetic trunk did not label neurons in the spinal cord. Injection of CTB-gold into the nodose ganglion retrogradely labelled neurons in the dorsal motor nucleus of the vagus and the nucleus ambiguus. CTB-gold was not transported anterogradely from injections sites within the medulla. Nerve fibers and cell bodies containing neuropeptides, monoamines, or neurotransmitter-synthesizing enzymes were readily immunostained after silver intensification of retrogradely transported CTB-gold. Immunoreactivity for neuropeptides and enzymes was also demonstrated ultrastructurally after silver intensification and gold toning. These results show that CTB-gold is retrogradely transported from nerve terminals and fibers of passage but not from damaged axons. CTB-gold gives well-localized injection sites and persists in neurons for weeks. Transported CTB-gold is easily visualized and its detection is compatible with light and electron microscopic immunocytochemistry. These properties make CTB-gold a valuable tool for studying the connectivity and neurochemistry of pathways in the central nervous system.

Monoclonal alkaline phosphatase-anti-alkaline phosphatase (APAAP) complex: production of antibody, optimization of activity, and use in immunostaining

A mouse monoclonal antibody, FMC55 (an IgG1), to alkaline phosphatase was prepared and evaluated in immunostaining. Clones producing antibody to alkaline phosphatase were selected using a micro-ELISA which identified antibodies forming active soluble complexes (APAAP) with the enzyme. Conditions that influenced the formation of the complex were investigated by using a quantitative assay in which the complex was captured by a bridging anti-mouse antibody. The ratio of FMC55 to enzyme had a major influence on the activity of the complex. Although all complexes had some activity, those that contained excess antibody had reduced ability to bind to anti-mouse antibody because of competition with excess unlabeled antibody. The optimal complex was formed with 3 micrograms of FMC55 per unit of enzyme. This complex contained neither free enzyme nor free antibody. The molecular weight by gel permeation chromatography was 600,000, giving a composition of two enzyme and two antibody molecules or one enzyme and three antibody molecules. The size of the complex was not altered by adding excess antibody or excess enzyme. Immunoblotting showed that FMC55 bound only to the Mr 140,000 homodimeric form of alkaline phosphatase. The APAAP complex was used in combination with biotin-streptavidin-peroxidase reagent to detect two antigens labeled with two different mouse monoclonal antibodies in the same tissue preparation.

Antigen expression during early human granulocyte development studied with immuno-electron microscopy

Expression of the hapten fucosyl-N-acetyllactosamine was correlated with ultrastructural development in human granulocyte precursors using the monoclonal antibody FMC 10 with immunogold techniques. The antigen was detectable from the myeloblast/early neutrophilic promyelocyte stage onwards and was associated with striking development of the rough endoplasmic reticular system. In addition, low levels of labelling were seen on monocytes, eosinophils and some basophil precursors. Contraction and alignment of the cisternae of the rough endoplasmic reticulum during the promyelocyte stage of neutrophilic differentiation gave the appearance of a plasma cell. However, on closer examination it was apparent that true plasma cells did not react with this antibody.

The relationship between GABA immunoreactivity and labelling by local uptake of [3H]GABA in the striate cortex of monkey

An antiserum to GABA was used in the macaque monkey to determine whether neurons that accumulate exogenously applied [3H]GABA in vivo are also immunoreactive for GABA. Following the injection of [3H]GABA into different laminae of striate cortex in two untreated animals and in one animal treated with amino-oxyacetic acid, selective accumulation of the labelled amino acid was demonstrated in perikarya by autoradiography. Radiographically labelled neurons (n, 519) and their unlabelled neighbours were tested in consecutive 0.5 micron thick sections by immunocytochemistry for GABA immunoreactivity. Injection of [3H]GABA did not increase the number of neurons showing GABA immunoreactivity. On the contrary many of the cells that accumulated [3H]GABA were immunonegative. These neurons were mostly located in layers IVC and VA following [3H]GABA injection into layers II-III, and in layers upper III and II following injection into layers V and VI. A comparison of the position of these neurons with known local projection patterns in the striate cortex of monkey suggests that GABA-immunonegative neurons may nevertheless become labelled by [3H]GABA if most of their local axon terminals fall within the injection site. The interlaminar projection of GABA-immunopositive neurons, which probably contain endogenous GABA, could be deduced from the position of the [3H]GABA injection site that leads to their autoradiographic labelling. Although the present study confirmed our previous results on the interlaminar connections of neurons that accumulate [3H]GABA, it demonstrated that [3H]GABA labelling alone may not be a sufficient criterion to assess the GABAergic nature of neurons in the striate cortex of monkey.

Identified axo-axonic cells are immunoreactive for GABA in the hippocampus and visual cortex of the cat

Chandelier or axo-axonic cells (AACs) are specialized interneurons terminating on the axon initial segments of pyramidal neurons. Two AACs have been localized by Golgi impregnation, one in the CA1 region of the hippocampus and one in the visual cortex of cat, for structural analysis and for the identification of their transmitter. They had 323 and 268 terminal bouton rows, respectively, probably making synapses with an equal number of initial segments. The distribution of the dendrites of the hippocampal cell was strikingly similar to that of pyramidal cells suggesting a similar input. Using an antiserum to GABA and postembedding GABA-immunocytochemistry, developed for Golgi-impregnated neurons, both cells were found to be GABA-immunoreactive. The strategic location of their synapses and the presence of GABA in AACs suggest that in normal cortical tissue they play a major role in GABA-mediated inhibition.

Antisera to gamma-aminobutyric acid. III. Demonstration of GABA in Golgi-impregnated neurons and in conventional electron microscopic sections of cat striate cortex

Two methods are described for the immunocytochemical demonstration of immunoreactive gamma-aminobutyric acid (GABA) in the visual cortex of the cat, an area that contains several types of GABAergic neurons and requires combined methods for their characterization. The first method is illustrated by a representative example of a Golgi-impregnated and gold-toned interneuron of the "bitufted" type situated in layer VI and having an ascending axon. After recording the three-dimensional features of the cell, semithin (0.5 micron) sections of the perikaryon were cut and GABA was demonstrated in the cell body by the unlabeled antibody enzyme method. While immunocytochemistry was used to determine the probable transmitter of the neuron, Golgi-impregnation of the same cell was used to identify its neuronal type. Since aldehyde-osmium fixation was used, further electron microscopic (EM) analysis of the neuron's synaptic connections was possible. The second procedure demonstrated GABA in EM sections of aldehyde-osmium-fixed cortex using protein A-gold as an immunocytochemical marker. Immunoreactivity was found in certain neurons, dendrites, axons, and boutons forming type II synaptic contacts that from previous studies have been thought to be GABAergic. Thus ultrastructural analysis using optimal conditions can now be supplemented with the identification of the transmitter in the same section.

Antisera to gamma-aminobutyric acid. I. Production and characterization using a new model system

Antisera to the amino acid gamma-aminobutyric acid (GABA) have been developed with the aim of immunohistochemical visualization of neurons that use it as a neurotransmitter. GABA bound to bovine serum albumin was the immunogen. The reactivities of the sera to GABA and a variety of structurally related compounds were tested by coupling these compounds to nitrocellulose paper activated with polylysine and glutaraldehyde and incubating the paper with the unlabeled antibody enzyme method, thus simulating immunohistochemistry of tissue sections. The antisera did not react with L-glutamate, L-aspartate, D-aspartate, glycine, taurine, L-glutamine, L-lysine, L-threonine, L-alanine, alpha-aminobutyrate, beta-aminobutyrate, putrescine, or delta-aminolevulinate. There was cross-reaction with gamma-amino-beta-hydroxybutyrate, 1-10%, and the homologues of GABA: beta-alanine, 1-10%, delta-aminovalerate, approximately 10%, and epsilon-amino-caproate, approximately 10%. The antisera reacted slightly with the dipeptide gamma-aminobutyrylleucine, but not carnosine or homocarnosine. Immunostaining of GABA was completely abolished by adsorption of the sera to GABA coupled to polyacrylamide beads by glutaraldehyde. The immunohistochemical model is simple, amino acids and peptides are bound in the same way as in aldehyde-fixed tissue and, in contrast to radioimmunoassay, it uses an immunohistochemical detection system. This method has enabled us to define the high specificity of anti-GABA sera and to use them in some novel ways. The model should prove useful in assessing the specificity of other antisera.

Antisera to gamma-aminobutyric acid. II. Immunocytochemical application to the central nervous system

An antiserum to gamma-aminobutyric acid (GABA) was tested for the localization of GABAergic neurons in the central nervous system using the unlabeled antibody enzyme method under pre- and postembedding conditions. GABA immunostaining was compared with glutamate decarboxylase (GAD) immunoreactivity in the cerebellar cortex and in normal and colchicine-injected neocortex and hippocampus of cat. The types, distribution, and proportion of neurons and nerve terminals stained with either sera showed good agreement in all areas. Colchicine treatment had little effect on the density of GABA-immunoreactive cells but increased the number of GAD-positive cells to the level of GABA-positive neurons in normal tissue. GABA immunoreactivity was abolished by solid phase adsorption to GABA and it was attenuated by adsorption to beta-alanine or gamma-amino-beta-hydroxybutyric acid, but without selective loss of immunostaining. Reactivity was not affected by adsorption to glutamate, aspartate, taurine, glycine, cholecystokinin, or bovine serum albumin. The concentration (0.05-2.5%) of glutaraldehyde in the fixative was not critical. The antiserum allows the demonstration of immunoreactive GABA in neurons containing other neuroactive substances; cholecystokinin and GABA immunoreactivities have been shown in the same neurons of the hippocampus. In conclusion, antisera to GABA are good markers for the localization of GABAergic neuronal circuits.

Chromogranin immunoreactivity in the central nervous system. Immunochemical characterisation, distribution and relationship to catecholamine and enkephalin pathways

Chromogranin A, the major soluble protein of the chromaffin granules, was isolated from bovine adrenals and used for immunization of rabbits. Chromogranin (CHR) immunoreactivity was studied by immunochemical and immunohistochemical methods in the adrenal, pituitary, brain and spinal cord of cattle, sheep, rats and guinea pigs using two antisera neither of which cross-reacted with dopamine beta-hydroxylase. Detailed studies were done using tissues from sheep only because very weak immunoreaction was obtained in tissues from the latter two species. Immunoblots of soluble proteins separated by two-dimensional polyacrylamide gel electrophoresis showed that the sera recognized a family of polypeptides in the adrenal which differed in size, but had almost identical isoelectric points. The patterns of immunoreactive proteins in extracts from the adrenal and pituitary were similar. Only two bands corresponding to the major high molecular weight bands in adrenal could be detected in the hippocampus which appeared to have a lower concentration of antigen. Other brain areas also showed two major immunoreactive proteins, one with a molecular weight similar to chromogranin A, and one smaller. Adrenal chromaffin cells, peripheral noradrenergic nerve axons and terminals in the pineal gland, a proportion of the anterior pituitary cells and the neurosecretory terminals of the posterior pituitary were strongly immunoreactive. In addition, CHR-immunoreactivity was widely distributed in the brain and spinal cord. The reactivity was readily visible in some nerve cell bodies and in well-defined pathways and terminal fibre networks. There were neurons whose perikarya were intensely stained but whose terminal projections appeared to be negative, while in other cases, the terminals appeared rich in CHR, while the perikarya were barely stained. All chromogranin immunoreactivity was abolished by absorption of the sera with a lysate from the chromaffin granules, but was not affected by absorption with Met- or Leu-enkephalin, dynorphin1-17, Met-enkephalin-Arg6-Phe7 or BAM-22P. Electron microscopic experiments revealed that the CHR-reaction in cell bodies was almost exclusively confined to the Golgi apparatus, while in synaptic boutons it was found in large dense-cored vesicles common to many types of terminals. In the hippocampal mossy fibre terminals, the immunoreactive granulated vesicles sometimes appeared to have fused with the plasma membrane of the boutons suggesting that the CHR was being secreted by exocytosis. The CHR-immunoreactivity was found to overlap partially with the distribution of many other neuroactive substances.(ABSTRACT TRUNCATED AT 400 WORDS)

Different populations of GABAergic neurons in the visual cortex and hippocampus of cat contain somatostatin- or cholecystokinin-immunoreactive material

The coexistence of gamma-aminobutyric acid (GABA), glutamate decarboxylase (GAD), and cholecystokinin (CCK)- or somatostatin-immunoreactive material in the same neurons was studied in the hippocampus and visual cortex of the cat. One-micrometer-thick serial sections of the same neuron were reacted to reveal different antigens by the unlabeled antibody enzyme method. All CCK- and somatostatin-immunoreactive neurons in the cortex and all CCK-immunoreactive and the majority of somatostatin-immunoreactive neurons in the hippocampus that could be examined in serial sections were also immunoreactive for GABA. In neurons that were immunoreactive for GAD it was often possible to demonstrate immunoreactivity for one of the peptides as well as for GABA. GABA-immunoreactive neurons, as revealed by an antiserum to GABA, were present in all layers of the cortex and hippocampus, and their shape, size, and distribution were similar to GAD-immunoreactive neurons. All GAD-immunoreactive neurons were also positive for GABA, but the latter staining revealed additional neurons. CCK/GABA- and somatostatin/GABA-immunoreactive neurons were present mainly in layers II and upper III and in layers V and VI in the visual cortex. CCK/GABA-immunoreactive neurons were most frequently present in the strata oriens, pyramidale, and moleculare of the hippocampus and in the polymorph cell layer of the dentate gyrus. Somatostatin/GABA-immunoreactive neurons were localized mainly in the stratum oriens and in the hilus of the fascia dentata. The two peptides could not be found in the same neuron. The majority of neurons that were GABA immunoreactive did not stain for either peptide. The presence of CCK- and somatostatin-immunoreactive material in GABAergic cortical neurons raises the possibility that neuroactive peptides affect GABAergic neurotransmission.

The enkephalins are amongst the peptides hydrolyzed by purified acetylcholinesterase

We have shown that purified acetylcholinesterase has the ability to hydrolyze a number of peptides including the physiologically occurring enkephalins. The enkephalins lost both the amino- and carboxyl-terminal amino acids, but several other peptides were not degraded. The enzyme was purified using an affinity chromatographic matrix that recognised one component of the active centre that is specific to cholinesterases, the anionic-binding site. The acetylcholinesterase was extracted from four tissues of diverse origin to minimise the risk of co-purifying a peptidase. The enzyme was essentially homogeneous on polyacrylamide gels, and there was only one protein that bound diisopropylfluorophosphate in the samples. The peptidase activity was not affected by the aminopeptidase inhibitor puromycin, but it was inhibited by acetylcholine at concentrations that also reduced the esterase activity. It was concluded that acetylcholinesterase also has the capacity for a novel type of hydrolysis of peptide bonds. The ability of acetylcholinesterase to hydrolyse naturally occurring compounds of different chemical nature, like esters and peptides, may help explain the long-standing puzzle of why the enzyme is more widely distributed than acetylcholine, once thought to be its sole natural substrate. The localization of the enzyme probably more accurately reflects the distribution of all its substrates, although their identity remains to be determined.

Isolation of the secretory form of soluble acetylcholinesterase by using affinity chromatography on edrophonium-Sepharose

A single molecular form of soluble acetylcholinesterase was isolated from a variety of mammalian tissues by use of a novel affinity matrix. This matrix was synthesised by coupling the reversible cholinesterase inhibitor, edrophonium chloride, to epoxy-activated Sepharose. This simple synthesis produced a matrix which was exceptionally stable and had the novel property of selectively binding only one molecular form of acetylcholinesterase. Soluble proteins from a variety of mammalian tissues, including brain, adrenal glands, cerebrospinal fluid, and blood, were separated by centrifugation. These contained combinations of acetylcholinesterase (EC 3.1.1.7) and cholinesterase (EC 3.1.1.8), varying from a single form of acetylcholinesterase to multiple forms of both acetylcholinesterase and cholinesterase. The edrophonium-Sepharose matrix bound only one form of acetylcholinesterase. This form of acetylcholinesterase corresponded in molecular size and electrophoretic mobility to the unique form found in cerebrospinal fluid, i.e. secretory acetylcholinesterase. Cholinesterase was not bound to the matrix.

Acetylcholinesterase in neural tube defects: a model using chick embryo amniotic fluid

Acetylcholinesterase was measured in amniotic fluid from normal chick embryos and embryos with neural tube defects. Neural tube defects were induced in the chick embryos by three procedures, removal of albumen, mechanical disruption of the closed neural tube or injection of tetanus toxin. The concentration of acetylcholinesterase in amniotic fluid from untreated normal embryos changed throughout the period examined (5-14 days incubation) but was stable at 0.5 U1(-1) over the time period 6-11 days. Amniotic fluid taken from treated embryos with neural tube defects at 8 days always contained a higher concentration of acetylcholinesterase than fluid from sham operated but otherwise normal embryos, mean 40.9 U1(-1), S.E.M. = 10. U1(-1), versus 1.0 U1(-1), S.E.M. = 0.2 U1(-1). The range of values (6.1-393 U1(-1)) was clearly separated from the normal values, range 0.0-5.5 U1(-1). In 13 cases with developmental abnormalities other than neural tube defects, the concentration of acetylcholinesterase was elevated in only one. Two different forms of acetylcholinesterase, as shown by gel electrophoresis, were present in fluid form both normal and defective embryos. These forms were also present in blood plasma, cerebrospinal fluid and in the high speed supernatant from brain extracts, the latter tissue contained an additional form of greater electrophoretic mobility. After irreversible inhibition, enzyme activity in amniotic fluid recovered slowly; only half the control value was reached by 140 h compared with complete recovery in the tissues of the embryo within 19 h. Histochemical staining for acetylcholinesterase showed that the spinal cord in the region of the lesion contained high concentrations of the enzyme. The possible sources of acetylcholinesterase in amniotic fluid are discussed. This chicken model of neural tube defects provides support for the use of acetylcholinesterase tests in the detection of neural tube defects clinically, and provides a model for experimentation with this system.

Combined analysis of acetylcholinesterase and alpha-fetoprotein improves the accuracy of antenatal diagnosis of neural-tube defects

Acetylcholinesterase (AChE), butyrylcholinesterase (BChE) and alpha-fetoprotein (AFP) were measured in 293 amniotic fluids from the second and third trimesters of pregnancy in a prospective study of their diagnostic value in the detection of neural-tube defects (NTD). In normal samples, the mean AChE and BChE concentrations were 3.0 u/L (SEM = 9.1 u/L) and 15.2 u/L (SEM = 1.2 u/L) in the second trimester, and 1.6 u/L (SEM = 0.1 u/L) and 7.8 u/L (SEM = 0.6 u/L) in the third trimester. AFP levels fell throughout the second trimester to unmeasurable levels in the third. AChE levels were markedly elevated in samples from NTD pregnancies at all gestational ages, and a cut-off level of the mean + 3 SD optimally separated normal from abnormal samples. This cut-off correctly predicted 10 of 11 fetuses with neural lesions; there were three false positive results. A similar cut-off for AFP predicted nine of 11 cases of neural lesion with two false positive results. For BChE, a cut off of 50 u/L predicted eight of 11 neural lesions with two false positive results. The specificity, sensitivity, and predictive value positive (PVP) were calculated for each test. The assays of AFP and AChE were useful when used individually (PVP congruent to 80%), but a Bayesian combination of these two tests produced a superior PVP (98%). Because the cost of AChE assay is low, and the test is so simple, it is suggested that an AChE analysis should be performed whenever an amniocentesis is requested for the diagnosis of NTD.

Glucocorticoid receptors in the guinea pig

In cytoplasmic fractions of liver and kidney prepared from adrenalectomized guinea pigs, tritiated dexamethasone ([3H]DM) is bound with a very low affinity (Kd 4 degrees C greater than or equal to 2 X 10(-7) M). By competition studies, the specificity of this binding was shown to be comparable with that for [3H]DM binding to glucocorticoid receptors in other species. In addition, cytoplasmic preparations from guinea pig liver and kidney appear to inhibit the binding of [3H]DM to rat glucocorticoid receptors under a variety of experimentally determined circumstances. It is proposed that such inhibitory activity may reflect a system of [3H]DM sequestration, perhaps by metabolizing enzymes with a high combining power for glucocorticoids. Both low affinity glucocorticoid receptors and avid binding to sites of metabolism may represent additive cellular bases for the apparent corticoresistance of the guinea pig.