Variability in Surgical Case Volume Performed During ACGME-Accredited Orthopaedic Foot and Ankle Fellowship Training

INTRODUCTION

Previous studies have demonstrated a positive correlation between case volume and outcomes in foot and ankle surgery. This study elucidates surgical case volume benchmarks for Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic foot and ankle fellowship training in the United States.

METHODS

The ACGME provided case logs for orthopaedic residents and foot and ankle fellows (2018-2021). Variabilities in reported fellowship case volumes were defined as the fold-difference between 90th and 10th percentiles. Reported case volumes were compared between training cohorts with parametric tests.

RESULTS

Case logs from 65 orthopaedic foot and ankle fellows and 3146 orthopaedic residents were included. Fellows reported 1.3- to 1.5-fold more foot and ankle cases during fellowship training than during residency training (P < .001). On average, orthopaedic foot and ankle fellows reported 405.4 cases and most were arthrodesis (17%), forefoot reconstruction (17%), mid/hindfoot reconstruction (13%), tendon repair/transfer (12%), and trauma ankle hindfoot (11%). Case categories with the highest variabilities were amputation (14.8-fold difference), infection/tumor (11.6-fold difference), arthroscopy (9.2-fold difference), and calcaneus (8.7-fold difference).

DISCUSSION

Case volume benchmarks can assist trainees and faculty during orthopaedic foot and ankle training. More research is needed to determine case minimum requirements needed for autonomous practice in foot and ankle surgery.

LEVEL OF EVIDENCE

Level III.

Irreparable Subscapularis Tears: Current Tendon Transfer Options

PURPOSE OF REVIEW

Irreparable subscapularis tears, especially in younger patients with higher functional demands, present a challenging entity. Pectoralis major and latissimus dorsi tendon transfers are commonly considered for surgical management of this pathology, yet no consensus exists regarding the superior option. The purpose of this article is to review the most current tendon transfer techniques for irreparable subscapularis tears.

RECENT FINDINGS

For decades, transfer of the pectoralis major has been considered the gold standard technique for irreparable subscapularis tears. This transfer was found to reduce pain and improve functional outcome scores, yet range of motion and force of internal rotation were not maintained in long-term follow-up studies. The latissimus dorsi tendon transfer for the same indications has demonstrated biomechanical superiority in recent cadaveric studies with promising short-term results clinically. Both pectoralis major and latissimus dorsi tendon transfers improve outcomes of patients with irreparable subscapularis tears. Future comparative studies are still needed to determine superiority amongst techniques.

Surgical Construct Type Is Associated With Time to Fusion and Reoperation Rate in Double and Isolated Talonavicular Arthrodeses

BACKGROUND

This study evaluates the effect of surgical construct on postoperative outcomes in patients undergoing isolated talonavicular (TN) or double (TN and subtalar ST) arthrodesis. TN constructs included plate and screw, screw and staple, and isolated staple constructs. Subtalar constructs included 1- and 2-screw constructs.

METHODS

Retrospective chart review identified 52 patients who underwent double or isolated TN arthrodesis between 2016 and 2021 by a single fellowship-trained foot and ankle surgeon with minimum 6 months of follow-up (mean = 1.62 years, range = 0.50-4.39 years). Data collected included demographics, medical history, surgical indication, surgical constructs used, complications, reoperations, patient-reported outcome measures, and radiographic measures.

RESULTS

Overall complication and reoperation rates were 26.3% and 12.3%, respectively. Among TN constructs, time to ST (P = .026) and TN (P = .018) fusion was significantly slower among patients receiving a plate and screw construct. Complication rate did not differ, but reoperation rate was significantly higher for plate and screw TN constructs (P = .039). Postoperative Foot and Ankle Outcome Score (FAOS) Quality of Life (P = .028) and Total (P = .016) scores were significantly better among plate and screw TN constructs.

CONCLUSION

Utilization of screw and staple or isolated staple construct have significantly quicker time to fusion and lower reoperation rates than plate and screw constructs for the TN joint.

LEVEL OF EVIDENCE

Level III: Retrospective cohort study.

Does glenohumeral offset affect clinical outcomes in a lateralized reverse total shoulder arthroplasty?

BACKGROUND

Reverse total shoulder arthroplasty (rTSA) exhibits high rates of success and low complication rates. rTSA has undergone numerous design adaptations over recent years, and lateralization of implant components provides theoretical and biomechanical benefits in stability and range of motion (ROM) as well as decreased rates of notching. However, the magnitude of implant lateralization and its effect on these outcomes is less well understood. The purpose of this study was to evaluate how increasing glenohumeral offset affects outcomes after rTSA, specifically in a lateralized humerus + medialized glenoid implant model.

METHODS

Primary rTSA using a lateralized humeral + medialized glenoid implant model performed at a single academic institution between 2012 and 2018 were retrospectively reviewed. Patient-reported outcome (PRO) parameters and clinical outcomes including ROM were evaluated both pre- and postoperatively. Pre- and postoperative radiographs were analyzed for measurement of glenohumeral offset, defined as the acromial-tuberosity offset (ATO) distance on the anteroposterior radiograph.

RESULTS

A total of 130 rTSAs were included in the analysis, with a mean follow-up of 35 mo. The mean postoperative absolute ATO was 16 mm, and the mean delta ATO (difference from pre- to postoperatively) was 4.6 mm further lateralized. Among all study patients, improvements in all ROM parameters and all PROs were observed from pre- to postoperative assessments. When assessing for the effects of lateralization on these outcomes, multivariate analysis failed to reveal a significant effect from the absolute postoperative ATO or the delta ATO on any outcome parameter.

CONCLUSIONS

rTSA using a lateralized humeral + medialized glenoid implant model exhibits excellent clinical outcomes in ROM and PROs. However, the magnitude of lateralization as measured radiographically by the ATO did not significantly affect these outcomes; patients exhibited universally good outcomes irrespective of the degree of offset restoration.

Use of the Pain Catastrophizing Scale to Predict Other Patient-Reported Outcome Measures Among Plantar Fasciitis and Chronic Ankle Instability Patients

Category:

Ankle; Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

The Pain Catastrophizing Scale (PCS) is a measure of how patients emotionally respond to pain. It is composed of three subscales - rumination, magnification, and helplessness - which address intrusive thoughts of pain, expectations of negative outcomes, and inability to cope with pain. The primary purpose of this study is to (1) compare baseline PCS scores with other baseline PROMs in patients with plantar fasciitis (PF) or chronic ankle instability (CAI).

Methods:

We retrospectively reviewed the records of 201 patients who reported at least one pre-treatment PCS subscore (rumination=200, magnification=199, helplessness=196, total=194) and were diagnosed with PF (n=116) or CAI (n=98) between 2015 and 2020 in a single fellowship-trained foot and ankle surgeon's clinic. Forty-one (20.4%) patients underwent operative treatment by the primary surgeon and 29 (14.4%) were treated operatively prior to being seen by the primary surgeon. Demographics, comorbidities, treatments, other baseline patient-reported outcome measures (PROMs) (e.g., Visual Analogue Scale [VAS], Pain Disability Index [PDI], 12-Item Short Form Survey [SF-12], 8-Item Somatic Symptom Scale-8 [SSS-8]), and postoperative outcomes were recorded. The average follow-up was 183.92 (range, 0-1,820) days, while the average follow-up duration for the patients treated operatively was 190.56 (range, 15-468) days.

Results:

The PCS total score and its subscores significantly correlated with the total score and/or subscores of each PROM. Higher PCS total score significantly correlated with worse VAS (p<.001), SF-12 mental (p=.007), PDI total (p<.001), and SSS-8 (p<.001). Only the PCS magnification subscore was significantly greater among patients who did (n=41) undergo surgery (p=.043). Those who had previously undergone foot and/or ankle surgery had significantly higher PCS rumination (p=.012), magnification (p=.006), helplessness (p=.008), and total (p=.003) scores. Likewise, those with a history of substance abuse also had significantly higher PCS scores (p=.005; p=.003; p=.006; p=.003).

Conclusion:

Significant correlations between PCS scores and other baseline PROMs indicate that strong pain catastrophizers with PF or CAI could be at risk for poor treatment outcomes. PCS scores could be used to tailor treatments for such high-risk patients, as there is evidence regarding the positive impact of cognitive behavior therapy on high pain catastrophizers.

Pain Catastrophizing Scale Associated With Other Patient-Reported Outcome Measures in Plantar Fasciitis and Chronic Ankle Instability Patients

BACKGROUND

The Pain Catastrophizing Scale (PCS) is a measure of how patients emotionally respond to pain. It is composed of 3 subscales-rumination, magnification, and helplessness-which address intrusive thoughts of pain, expectations of negative outcomes, and inability to cope with pain. Our purpose is to compare baseline PCS scores with other baseline patient-reported outcome measures (PROMs) in patients with plantar fasciitis (PF) or chronic ankle instability (CAI).

METHODS

We retrospectively reviewed 201 patients who reported at least 1 pretreatment PCS subscore and were diagnosed with PF or CAI between 2015 and 2020 in a single fellowship-trained foot and ankle surgeon's clinic. Demographics, comorbidities, treatments, other baseline PROMs (i.e., visual analog scale [VAS], Pain Disability Index [PDI], 12-Item Short Form Survey [SF-12], 8-Item Somatic Symptom Scale [SSS-8]), and postoperative outcomes were recorded.

RESULTS

The PCS total score and its subscores significantly correlated with the total score and/or subscores of each PROM. Higher PCS total score significantly correlated with worse VAS (P<.001), SF-12 mental (P=.007), PDI total (P<.001), and SSS-8 (P<.001) scores. Only the PCS magnification subscore was significantly greater among patients who did (n=41) undergo surgery (P=.043). Those who had previously undergone foot and/or ankle surgery had significantly higher PCS rumination (P=.012), magnification (P=.006), helplessness (P=.008), and total (P=.003) scores. Likewise, those with a history of substance abuse also had significantly higher PCS scores (P=.005; P=.003; P=.006; P=.003).

CONCLUSION

The correlations between PCS scores and other baseline PROMs indicate that strong pain catastrophizers with PF or CAI may be at risk for poor treatment outcomes. PCS scores could be used to help with treatment for such high-risk patients.

Clinical and radiographic outcomes after reverse total shoulder arthroplasty in patients 80 years of age and older

BACKGROUND

Previous studies have found less favorable outcomes for patients aged 80 years and older after primary reverse total shoulder arthroplasty (rTSA). However, they are based on small sample sizes with no control group for comparison. The purpose of this study is to compare the clinical, functional, and radiographic outcomes after primary rTSA in patients aged 80 years and older with a younger cohort of patients aged 60-79 years.

METHODS

Patients undergoing primary rTSA between 2004 and 2018 were identified within a multi-institutional database with a minimum of 2 years of follow-up. All patients received the same platform prosthesis. Patients were divided into 2 groups based on age: 80 years and older (n = 369) and 60-79 years (n = 1764). Statistical analyses were performed to compare the 2 age cohorts based on pre- and postoperative function and range of motion (ROM) scores, adverse event rates, pain scores, and patient satisfaction.

RESULTS

Patients aged 80 years and older had lower preoperative functional and ROM scores relative to patients aged 60-79 years. The differences observed in active abduction, active forward elevation, and Constant scores exceed the minimal clinically important difference (MCID). The evaluation of function and ROM at latest follow-up showed that patients in both age cohorts had significant improvements that exceeded both the MCID and substantial clinical benefit, but older patients still scored lower relative to younger patients, with the differences in active abduction and Constant scores exceeding the MCID. Despite the lower scores observed in older patients, both groups report similar satisfaction (93% in older patients vs. 92% in younger patients, P = .379). There were no differences between the 2 age cohorts with regard to humeral radiolucent lines (9.2% vs. 8.7%, P = .765), scapular notching (11.0% vs. 10.3%, P = .727), adverse events (3.5% vs. 3.3%, P = .863), and revisions (0.8% vs. 1.8%, P = .188).

CONCLUSIONS

Patients aged 80 years and older can expect significant improvements in function and ROM after primary rTSA, with satisfaction similar to that of patients aged 60-79 years. Patients in both age cohorts have similar rates of adverse events and revisions, and the rates observed in patients 80 years and older are much lower than what has previously been reported in the literature. rTSA in patients age 80 years and older is a beneficial surgery with outcomes similar to those found in younger patients, and age should not be a limiting factor when considering rTSA.

Effects of obesity on clinical and functional outcomes following anatomic and reverse total shoulder arthroplasty

BACKGROUND

Limited data exist regarding the clinical and functional outcomes following primary total shoulder arthroplasty in obese patients. The purpose of this study is to determine the effects of obesity on the clinical and functional outcomes following primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) in a large patient population with mid-term follow-up.

METHODS

Patients in a multi-institutional shoulder registry receiving either primary aTSA (n = 1520) or rTSA (n = 2054) from 2004 to 2018 with a minimum follow-up period of 2 years were studied. All patients received the same single-platform shoulder prosthesis. Study groups were assigned based on implant type (anatomic or reverse), and further stratification was based on patient body mass index (BMI), with obese patients having a BMI ≥ 30 and non-obese patients having a BMI < 30. Patients were evaluated and scored preoperatively and at latest follow-up by use of 5 scoring metrics and range of motion (ROM).

RESULTS

The mean follow-up period was 5 years (range, 2-14 years). Obese patients comprised 41% of the aTSA group and 35% of the rTSA group. Significant postoperative improvements in visual analog scale pain scores, ROM, and all 5 scoring metrics occurred in both obese and non-obese patients (P < .05). Obese patients in both groups reported higher preoperative and postoperative visual analog scale pain scores and less preoperative and postoperative ROM compared with non-obese patients. Compared with non-obese patients, obese patients receiving aTSA reported significantly worse postoperative Simple Shoulder Test, Constant-Murley, American Shoulder and Elbow Surgeons, University of California, Los Angeles, and Shoulder Pain and Disability Index scores compared with non-obese patients, and those receiving rTSA reported significantly worse American Shoulder and Elbow Surgeons and Shoulder Pain and Disability Index scores (all P < .05). However, these differences did not exceed the minimal clinically important difference or substantial clinical benefit criteria. Radiographic analysis showed that in the rTSA group, obese patients had significantly less postoperative scapular notching and a lower scapular notching grade compared with non-obese patients (P < .05).

DISCUSSION

Both non-obese and obese patients can expect clinically significant improvements in pain, motion, and functional outcome scores following both aTSA and rTSA. Obese patients reported significantly more postoperative pain, lower outcome scores, and less ROM compared with non-obese patients after both aTSA and rTSA at a mean follow-up of 5 years. However, statistically significant differences were not found to be clinically significant with respect to established minimal clinically important difference and substantial clinical benefit criteria. Therefore, obese and non-obese patients experience similar clinical outcomes following total shoulder arthroplasty, regardless of BMI. However, obese patients have more comorbidities, greater intraoperative blood loss, and less scapular notching compared with non-obese patients.

Reduced EDHF responses and connexin activity in mesenteric arteries from the insulin-resistant obese Zucker rat

AIMS/HYPOTHESIS

The objective of this study was to examine the effect of insulin resistance on endothelium-derived hyperpolarising factor (EDHF) and small mesenteric artery endothelial function using 25-week-old insulin-resistant obese Zucker rats (OZRs) and lean littermate control rats (LZRs). The involvement of gap junctions and their connexin subunits in the EDHF relaxation response was also assessed.

METHODS

Mesenteric arteries were evaluated using the following assays: (1) endothelial function by pressure myography, with internal diameter recorded using video microscopy; (2) connexin protein levels by western blotting; and (3) Cx mRNA expression by real-time PCR.

RESULTS

Relaxations in response to acetylcholine were significantly smaller in mesenteric arteries from the OZRs than the LZRs, whereas there was no difference in relaxations in response to levcromakalim. Responses to acetylcholine were not altered by nitric oxide inhibitors, but were abolished by charybdotoxin in combination with apamin, which blocked the EDHF component of the response. 40Gap27 significantly attenuated the response to acetylcholine in the LZRs, but had no effect in the OZRs. Connexin 40 protein and Cx40 mRNA levels in mesenteric vascular homogenates were significantly smaller in the OZRs than in the LZRs, with no difference in connexin 43 or Cx43 mRNA levels.

CONCLUSIONS/INTERPRETATION

These findings demonstrate that endothelial dysfunction in mesenteric arteries from the insulin-resistant OZRs can be attributed to a defect in EDHF. The results also suggest that the defective EDHF is at least partly related to an impairment of connexin 40-associated gap junctions, through a decrease in connexin 40 protein and Cx40 mRNA expression in the OZRs.

Impaired Nitric Oxide Function in the Basilar Artery of the Obese Zucker Rat

The effect of insulin-resistance syndrome on vascular function has been examined in isolated basilar arteries using the obese Zucker rat (OZR) and age-matched lean littermate controls (lean Zucker rat; LZR) at 36 weeks of age. The OZR showed significantly reduced oral glucose tolerance and increased body weight, blood pressure, proteinuria, plasma levels of triglycerides, cholesterol, and insulin compared with the LZR. The contractile response to serotonin was significantly increased in the OZR. Furthermore, contractions to serotonin in LZR but not OZR were enhanced in the presence of the nitric oxide synthase inhibitor Nomega-nitro-L-arginine methyl ester (NAME). Relaxations to acetylcholine (ACh), histamine, and A23187 were significantly reduced in precontracted arteries from the OZR. In the presence of NAME, histamine responses were significantly reduced whereas ACh and A23187 responses were almost abolished. Relaxations to free-radical nitric oxide (NO) and papaverine were not different in arteries from the OZR, even though responses to sodium nitroprusside were reduced in the OZR. Western blot and immunofluorescent quantitative analyses of eNOS content in cerebral microvessel fractions and basilar artery preparations, respectively, were not significantly different between OZR and LZR. The results suggest impairment in endothelial function resulting in reduced NO function in the basilar artery from the OZR.

Laparoscopic cholecystectomy in the new millennium

BACKGROUND

Laparoscopic cholecystectomy has become the gold standard for the treatment of symptomatic cholelithiasis. Many authors-including investigators at our institution, who reported one of the initial experiences with laparoscopic cholecystectomy in July 1992-have documented a definite learning curve associated with this procedure. We present a follow-up study of our experience with laparoscopic cholecystectomy and compare these data to an earlier study of the initial experience with laparoscopic cholecystectomy at the Beth Israel Medical Center.

METHODS

We retrospectively reviewed 300 consecutive patients from March 1998 through March 1999. The patient population was epidemiologically similar to that of the original study with regard to age, sex, and American Society of Anesthesia (ASA) classification. However, whereas the initial population included only patients with chronic disease, in our study 13.7% of the patients had been admitted through the emergency room with acute stone disease of the biliary tract.

RESULTS

We found a 5.7% conversion rate, a 1% rate of major complication, and a 5.7% rate of minor complication rates, as compared to the initial study's rates of 12%, 4%, and 10%, respectively. Whereas none of the patients in the original study left the hospital on the day of surgery and only 49% were discharged within 1 day, in our group, 29 patients (10%) underwent ambulatory procedures and an additional 186 patients (62%) were discharged on the 1st post-operative day. The average duration of the operation was 90 min, which did not represent a statistical improvement over the time of 93 min reported in the earlier study.

CONCLUSIONS

Since 1992, both the conversion rate and length of stay have declined at our hospital, but operative time has remained essentially the same. These findings probably reflect a bimodal learning curve, the increase in the number of cholangiograms and additional intraoperative procedures now performed, the greater severity of gallbladder disease currently treated with laparoscopic cholecystectomy, and increases in the number of attending physicians as well as the level of residents who perform this procedure.

ABT-761 (Abbott)

Abbott's ABT-761 is a 5-lipoxygenase inhibitor with 8-fold increased potency over Bay-X-1005 and 150-fold over zileuton [171665]. It has a longer duration of action than its closest competitor, ZD-2138 (AstraZeneca), and has entered phase III trials for asthma [224216]. ABT-761 is the follow-up compound for zileuton and, due to its increased potency, requires only once-daily dosing [187700]. ABT-761 has shown excellent oral bioavailability and an extended duration of plasma levels in man, and initial results for a single 200 mg po dose have shown a significant protective effect against exercise- and adenosine-induced bronchoconstriction in asthmatics [215839]. The drug is well tolerated in healthy volunteers and shows linear pharmacokinetics. The pharmacokinetics in children are similar to that of adults.

Altered non-adrenergic non-cholinergic neurotransmission in gastric fundus from streptozotocin-diabetic rats

The influence of streptozotocin-induced diabetes has been investigated on responses to non-adrenergic, non-cholinergic (NANC) nerve stimulation in rat gastric fundus. NANC relaxations in precontracted muscle strips from diabetic rats were smaller than those from control rats. In addition, the relaxations in diabetic but not control rats were followed by rapidly-developing frequency-dependent contractions. In the presence of alpha-chymotrypsin and N(G)-nitro-L-arginine methyl ester (L-NAME), the NANC contractions were markedly enhanced in diabetic rats. Treatment with the aldose reductase inhibitor, sorbinil, did not affect NANC relaxations or contractions in tissues from diabetic rats, and responses remained significantly different from those from control rats. The findings suggest that diabetes impairs relaxations to NANC nerve stimulation in the rat gastric fundus, and that a contractile NANC neurotransmitter(s) is released in diabetic rats. The results also suggest that diabetes-induced alterations in the NANC nerve response are not caused by increased activity of the aldose reductase pathway.

The P(2)-purinoceptor antagonist suramin is a competitive antagonist at vasoactive intestinal peptide receptors in the rat gastric fundus

The P(2)-purinoceptor antagonist, suramin, was used to investigate the possible involvement of adenosine 5'-triphosphate (ATP) in the inhibitory non-adrenergic non-cholinergic (NANC) innervation of the rat gastric fundus. ATP (1-30 microM) produced biphasic responses consisting of concentration-dependent relaxations followed by concentration-dependent contractions. Suramin (200 microM) significantly reduced relaxations and abolished contractions to ATP. Under NANC conditions, electrical field stimulation (EFS) induced frequency-dependent relaxations. Suramin (200 microM) and the peptidase alpha-chymotrypsin (1 u ml(-1)) had the same effects on EFS-induced relaxations: their duration was reduced, but their magnitude was unaffected. Cumulative relaxations to vasoactive intestinal peptide (VIP; 0.1-100 nM), and to the VIP analogue pituitary adenylate cyclase activating peptide 1-27 (PACAP; 0.2-100 nM), were almost completely abolished by alpha-chymotrypsin (1 u ml(-1)), and were inhibited by suramin (3-200 microM) in an apparently competitive manner. Schild plot analysis indicated that suramin had pA(2) values of 5.1+/-0.2 (Hill slope=0.9+/-0.2) and 5.6+/-0.1 (Hill slope=1.0+/-0.1), against VIP and PACAP, respectively. Concentration-dependent relaxations to nitric oxide (1-30 microM) and cumulative relaxations to isoprenaline (0.1-300 nM) were not affected by suramin (200 microM). No conclusions can be made regarding the possible involvement of ATP in EFS-induced NANC relaxations. The results suggest that suramin acts as a competitive antagonist at VIP receptors in the rat gastric fundus.

Evidence that adenosine 5'-triphosphate is the third inhibitory non-adrenergic non-cholinergic neurotransmitter in the rat gastric fundus

In the rat gastric fundus, non-adrenergic, non-cholinergic (NANC) relaxations are mediated by nitric oxide (NO), vasoactive intestinal polypeptide (VIP), and a third, as yet unidentified, neurotransmitter. The possible involvement of adenosine 5'-triphosphate (ATP) in the NANC relaxations was examined using pyridoxalphosphate-6-azophenyl-2',5'-disulphonic acid (PPADS), apamin and desensitization to alpha,beta-methylene ATP. NANC responses were studied in the absence and presence of N(G)-nitro-L-arginine methyl ester (NAME; 100 microM) and alpha-chymotrypsin (1 u ml(-1)), to inhibit responses to NO and VIP, respectively. PPADS (100 microM), apamin (1 microM) and desensitization to alpha,beta-methylene ATP (10 microM, three additions) all significantly (P<0.05) reduced NANC relaxations to electrical field stimulation (0.5 - 4 Hz, 30 s trains) in longitudinal strips of rat gastric fundus and almost abolished the residual relaxation remaining in the presence of NAME and alpha-chymotrypsin. PPADS had no effect on responses to the NO-donor, sodium nitroprusside (SNP), or VIP. Apamin slightly reduced relaxations to SNP, but did not affect those to VIP, whereas desensitization to alpha,beta-methylene ATP markedly reduced responses to both SNP and VIP. The effects of PPADS and apamin in this study provide strong evidence that the third inhibitory NANC neurotransmitter in the rat gastric fundus is ATP.

Insulin reversal of impaired nitrergic transmission in the anococcygeus muscle from diabetic rats

The aim of this study was to investigate whether insulin could reverse the impairment in nitrergic neurotransmission in the anococcygeus muscle from streptozotocin-induced diabetic rats. Relaxations to nitrergic nerve stimulation and sodium nitroprusside were significantly reduced in precontracted muscles from 8- and 4-week diabetic rats compared to the corresponding control rats. Treatment of diabetic rats with Lente insulin (1-12 units/day s.c.) for the final 4 weeks of the 8-week diabetes duration reversed the reductions, but treatment of diabetic rats with insulin for the last week only did not. The impairment of relaxations was also not altered by in vitro exposure of muscles from 8-week diabetic rats to soluble insulin (0.02 units/ml, 2 h). The findings suggest that in vivo insulin treatment can reverse the existing diabetes-induced impairment of nitrergic transmission in rat anococcygeus muscle. However, short-term treatment with insulin, either in vivo or in vitro, does not reverse the impairment.

The effects of diabetes on nitric oxide-mediated responses in rat corpus cavernosum

Nitric oxide (NO)-mediated responses were investigated in corpora cavernosa isolated from 8-week diabetic rats. Relaxations to field stimulation were abolished by N(G)-nitro-L-arginine (NOARG, 100 microM). Responses to stimulation and sodium nitroprusside were reduced in tissues from diabetic rats compared to control rats, when data were expressed as g tension, but not when expressed as g/g tissue. The endothelium-dependent vasodilator, acetylcholine, failed to relax tissues. Stimulation-induced contractions were smaller in the diabetic group compared to the control group when data were expressed as g tension, but not g/g tissue. Contractions were enhanced by NOARG, and inhibited by acetylcholine (300 microM), by a similar degree in both groups. NOARG reduced the inhibitory effect of acetylcholine in tissues from control, but not diabetic rats. The results suggest diabetes caused a general impairment in responsiveness of rat corpus cavernosum, which may be a consequence of tissue weight change. A role for endothelium-dependent NO could not be identified; however, NO-mediated modulation of noradrenergic transmission by acetylcholine, may be defective in diabetes.

Diabetes does not alter the activity and localisation of nitric oxide synthase in the rat anococcygeus muscle

Functional studies have revealed diabetes specifically impairs smooth muscle reactivity to nitric oxide in the rat anococcygeus muscle. The present study was conducted to examine whether concurrent prejunctional defects in nitrergic neurotransmission exist in anococcygeus muscles from diabetic rats. Nitric oxide synthase (NOS) activity was assessed by the conversion of 3H-L-arginine to 3H-L-citrulline in homogenates of anococcygeus muscles obtained from 8-week diabetic rats and control rats. NOS activity measured in all tissue samples was dependent on the presence of calcium (2 mM), NADPH (1 mM), tetrahydrobiopterin (100 microM) and flavin adenine dinucleotide (10 microM); however, removal of calmodulin (50 U/ml) did not reduce L-citrulline production. Both N(G)-nitro-L-arginine (100 microM) and N(G)-nitro-L-arginine methyl ester (100 microM) produced significant inhibition of enzyme activity. NOS activity measured in tissue samples from diabetic rats (369.6 +/- 75.9 fmol L-citrulline/mg protein) did not significantly differ from that measured in samples from control rats (423.9 +/- 110.6 fmol L-citrulline/mg protein). However, NOS activity measured after removal of the cofactor tetrahydrobiopterin, was significantly greater in samples from control rats than that from the diabetic group. NOS-immunoreactive and NADPH-diaphorase reactive nerve terminals were found to be sparsely distributed throughout longitudinal sections or whole mounts of anococcygeus muscles from both control and diabetic rats. Quantification of NADPH-diaphorase positive fibres intersecting transects of whole tissue mounts, revealed no significant difference in fibre number between the treatment groups. All NOS-immunoreactive fibres also showed vasoactive-intestinal-polypeptide immunoreactivity. In conclusion, the findings together provide no evidence to indicate that diabetes can induce prejunctional changes in NOS activity or localisation, concurrent with the reported postjunctional impairment in smooth muscle reactivity to nitric oxide, in the rat anococcygeus muscle.

The aldose reductase inhibitor sorbinil does not prevent the impairment in nitric oxide-mediated neurotransmission in anococcygeus muscle from diabetic rats

This study investigated whether increased polyol pathway activity could contribute to alterations in nitrergic neurotransmission in anococcygeus muscles from 8-week diabetic rats. In the presence of guanethidine (10-30 microM) and clonidine (0.01-0.05 microM), relaxations obtained to nitrergic nerve stimulation (0.5-5 Hz, 10-s train), to sodium nitroprusside (5-500 nM) and to nitric oxide (0.1-3 microM) were significantly reduced in muscles from diabetic rats compared to responses from control rats. Treatment of diabetic rats with the aldose reductase inhibitor sorbinil (42 mg/kg per day via feed for 8 weeks) did not affect impaired reactivity to nitrergic nerve stimulation, sodium nitroprusside or nitric oxide. The results suggest increased polyol pathway activity does not contribute to the alterations in nitrergic neurotransmission in anococcygeus muscles from diabetic rats.

HSP binding and mitochondrial localization of p53 protein in human HT1080 and mouse C3H10T1/2 cell lines

In normal cells, the tumor suppressor actions of p53 protein are mediated by specific DNA binding and protein-protein interactions within the nucleus. Mutant p53 proteins, however, often assume an aberrant conformation devoid of tumor suppressor activity and newly capable of binding to the cognate or inducible HSP70. Recent reports from our laboratory and others show that additional unknown proteins may also complex with mutant p53. In this study, we characterize p53:HSP complexes and their subcellular location in the transformed cell lines, human HT1080 and murine C3H10T1/2, which both contain aberrant p53 conformers. Immunoprecipitation and SDS-PAGE of p53 from whole cell lysates revealed the additional presence of a broad 70 kDa band and a 90 kDa band in both lines, while p53 isolated from nuclear lysates was free from other proteins. 2D-PAGE was used to isolate and identify HSP members from cytoplasmic and nuclear lysates by immunoprecipitation, Western blotting and protein sequencing. Anti-p53 immune complexes from cytoplasmic lysates contained not only HSC70 but also GRP75, GRP78 and a weakly basic 90 kDa protein, which may be related to HSP90. The inducible form of HSP70 was not complexed to p53 protein, even though expressed in these cells. Analysis of anti-HSP70, anti-GRP75 and anti-HSP90 immune complexes suggests that HSP members exist as performed complexes in the cytoplasm, but not the nucleus. The presence of the mitochondrial and endoplasmic reticular chaperones, GRP75 and GRP78, in p53:HSP complexes suggested that p53 might be found in these cytoplasmic organelles which was confirmed in mitochondria by biochemical and immunoelectron microscopic evidence. These studies suggest that newly identified members of p53:HSP complexes represent components of a chaperone program which affects the subcellular distribution of p53 protein in these transformed lines.

Effect of diabetes on relaxations to non-adrenergic, non-cholinergic nerve stimulation in longitudinal muscle of the rat gastric fundus

1. The effect of 8-week streptozotocin-induced diabetes has been examined on relaxations to non-adrenergic, non-cholinergic (NANC) nerve stimulation in longitudinal strips of rat gastric fundus. 2. In the presence of noradrenergic and cholinergic blockade and raised tissue tone, electrical field stimulation (0.5-4 Hz, 30 s trains) induced frequency-dependent relaxations that were significantly smaller in gastric fundus strips from diabetic rats than in strips from control rats. 3. NG-nitro-L-arginine methyl ester (NAME, 100 microM) significantly reduced NANC relaxations in muscle strips from both control and diabetic rats, but the reduction was greater in muscle strips from diabetic rats than in those from control rats at frequencies of 2 and 4 Hz. alpha-Chymotrypsin (1 u ml-1) slightly reduced relaxations to nerve stimulation in muscle strips from both control and diabetic rats. 4. The duration of NANC nerve relaxations (1-4 Hz, 30 s trains) was smaller in muscle strips from diabetic rats than in those from control rats. The duration of NANC relaxations was reduced by alpha-chymotrypsin (1 u ml-1) in muscle strips from control rats but not in muscle strips from diabetic rats. 5. Relaxations to both nitric oxide (NO; 1-30 microM) and vasoactive intestinal polypeptide (VIP; 0.1-30 microM) were concentration-dependent and did not differ between muscle strips from control and diabetic rats. 6. The results suggest that streptozotocin-induced diabetes impairs relaxations to NANC nerve stimulation in the rat gastric fundus, which are largely mediated by NO and to a lesser extent by VIP. The impairment appears to occur at the prejunctional level, as smooth muscle reactivity to NO and VIP is not altered.

Effect of diabetes and elevated glucose on nitric oxide-mediated neurotransmission in rat anococcygeus muscle

1. Nitric oxide (NO)-mediated neurotransmission is impaired in anococcygeus muscle from 8-week streptozotocin-induced diabetic rats. This study investigated the effects of insulin treatment, and the duration of diabetes on this impairment. In addition, the effect of in vitro exposure to elevated glucose has been investigated on NO-mediated relaxations, in muscles from untreated rats. 2. Relaxant responses to field stimulation (0.5-5 Hz, 10s train), sodium nitroprusside (SNP; 5 and 10 nM) and NO (1 and 3 microM) were significantly impaired in anococcygeus muscles from 8-week diabetic rats, compared to responses from control rats. Insulin treatment (5 u Lente day-1, s.c.) of diabetic rats prevented the development of this impairment. 3. Consistent with findings in 8-week diabetic rats, relaxation induced by field stimulation, SNP and NO were attenuated in tissues from 2-week and 4-week diabetic rats compared to corresponding control responses, whereas relaxations to papaverine (3 and 10 microM) were not reduced. In contrast, diabetes of 3-days duration did not affect relaxations to field stimulation, SNP or NO. 4. Incubation of anococcygeus muscles from untreated rats in medium containing elevated glucose (44.1 mM) for 6 h, significantly impaired relaxations to field stimulation compared to responses obtained after normal glucose (11.1 mM) incubation. Relaxations to SNP and to NO were not affected by 6 h exposure to elevated glucose. Similarly, incubation in hyperosmolar solutions containing mannose or sucrose for 6 h, impaired relaxations to field stimulation, but not to SNP or NO. 5. The results indicate that the diabetes-induced impairment of NO-mediated neurotransmission in the rat anococcygeus muscle develops between 3 days and 2 weeks after the induction of diabetes with streptozotocin. Prevention of the impairment by insulin treatment suggests that it is specific for the diabetic state. In addition, the impairment may be related to hyperglycaemia and the consequent rise in osmolarity, since in vitro exposure to high glucose as well as to other hyperosmolar media impaired NO-mediated relaxations to field stimulation.

Sexual dimorphism in copackaging of luteinizing hormone-releasing hormone and galanin into neurosecretory vesicles of hypophysiotrophic neurons: estrogen dependency

Hypophysiotrophic neurons projecting to hypophyseal portal vessels in the median eminence of the hypothalamus maintain the operation of the master gland, the pituitary, by secreting releasing and release-inhibiting hormones into the bloodstream. LHRH, synthesized in neurons of the rat prosencephalon, is one of the key substances that governs the anterior pituitary-gonadal axis. Recently, it has been shown that the peptide galanin (GAL) is coproduced in a subpopulation of LHRH neurons and is a potent modulator of central processes regulating reproduction. A better understanding of the secretory mechanisms involved in pulsatile hormone release from LHRH axons of the median eminence requires exploration of the organelle domain that displays the cosynthesized peptides in terminal boutons. This study shows that LHRH- and GAL-immunoreactive axons overlap heavily in the lateral part of the median eminence. Double fluorescent labeling revealed colocalization of the peptides at the level of single axon terminals. By means of dual colloidal gold immunolabeling, LHRH and GAL were detected in the same secretory vesicles at the ultrastructural level. The incidence of colocalizing vesicles was high in the female (45%) and low in the male (3%) rat. Ovariectomy resulted in a dramatic decline in the number of LHRH/GAL-coexpressing vesicles (23%), which was reversed (55%) by the administration of estradiol. The observations indicate a sex-related difference in the packaging of LHRH and GAL and suggest that the events are estrogen dependent. Furthermore, the simultaneous release of GAL and LHRH from the colocalizing vesicles provides a mechanism that might ensure the potentiating effect of GAL on LHRH by synchronizing events at the receptor sites in the anterior pituitary.

Endothelin-1 and the regulation of vascular tone

1. In 1988, Yanagisawa et al. reported the presence of a potent peptide from the supernatant of porcine endothelial cells. This was later named endothelin-1 (ET-1) and was found to belong to a new family of vasoconstrictor peptides. There are at least three isoforms of endothelin: ET-1, endothelin-2 and endothelin-3. 2. ET-1 is produced from a larger precursor molecule by endothelin converting enzyme (ECE); there may be a number of ECE but the most physiologically relevant appears to be a membrane-bound neutral metalloprotease. The endothelin precursor is produced on demand and is regulated at the mRNA level. 3. Two subtypes of mammalian endothelin receptors have been cloned and sequenced: ETA receptors which mediate vasoconstriction and ETB receptors which mediate both vasoconstriction and vasodilatation. However, functional studies have indicated that other subtypes of endothelin receptors may exist. 4. ET-1 has a wide range of biological actions apart from its direct effects on vascular tone, including constriction of non-vascular smooth muscle, cardiac effects, mitogenesis and stimulation of the release of hormones such as atrial natriuretic peptide and prostacyclin. At low concentrations which have no direct vasoconstrictor action, ET-1 potentiates the effect of other vasoconstrictor agonists. 5. The precise role of ET-1 in health and disease is not well defined at present; however, there are indications that it may have a role in the pathogenesis of some cardiovascular disease states, including subarachnoid haemorrhage, renal ischaemia and certain types of hypertension.

Hydroxocobalamin and haemoglobin differentiate between exogenous and neuronal nitric oxide in the rat gastric fundus

In longitudinal strips of rat gastric fundus, hydroxocobalamin (30 microM) significantly reduced relaxations to sodium nitroprusside (100 nM), nitric oxide (NO; 5 microM) and S-nitrosocysteine (3 microM), whereas responses to non-adrenergic, non-cholinergic (NANC) nerve stimulation were only slightly reduced. The stimulation-induced relaxations were markedly reduced by the NO synthase inhibitor NG-nitro-L-arginine (100 microM). Hydroxocobalamin (30 microM) enhanced relaxations to S-nitrosoglutathione (1 and 3 microM), and had no effect on responses to vasoactive intestinal polypeptide (1 nM). Haemoglobin (10 microM) significantly reduced relaxations to sodium nitroprusside, NO, S-nitrosocysteine and S-nitrosoglutathione, but did not affect responses to NANC nerve stimulation or vasoactive intestinal polypeptide. The results suggest that hydroxocobalamin and haemoglobin can differentiate between exogenous and neuronally released NO, and that the transmitter released from nitrergic nerves in the rat gastric fundus is not free NO or the nitrosothiols, S-nitrosocysteine and S-nitrosoglutathione.

Effect of aminoguanidine on the impaired nitric oxide-mediated neurotransmission in anococcygeus muscle from diabetic rats

The contribution of advanced glycation end-product (AGE) formation to alterations in nitrergic neurotransmission caused by 8-week streptozotocin-induced diabetes has been examined in the rat anococcygeus muscle. Relaxant responses to nitrergic nerve stimulation (0.5-5 Hz, 10-sec train), to nitric oxide (NO; 0.1-3 microM), to the NO donor, sodium nitroprusside (SNP; 5-500 nM), and to the cell-permeable analogue of cyclic guanosine monophosphate (cGMP), 8-bromo-cGMP (15 and 30 microM), were significantly smaller in muscles from diabetic rats than from control rats. Pretreatment with aminoguanidine hemisulphate (1 milligram drinking water) to inhibit AGE formation, did not alter the relaxant responses to nitrergic nerve stimulation, NO or SNP in tissues from control rats, or responses to NO or SNP in tissues from diabetic rats, however relaxations to nitrergic nerve stimulation were further reduced in tissues from diabetic rats. In anococcygeus muscles from untreated animals, a 20-min exposure to aminoguanidine (1 mM) in vitro had no effect on relaxations to nitrergic nerve stimulation. The results suggest that diabetes impairs nitrergic transmission in the rat anococcygeus at least partly through alterations in the cGMP-relaxation pathway. The impaired neurotransmission does not appear to be related to the formation of AGEs.

Sympathomimetic actions of methylenedioxymethamphetamine in rat and rabbit isolated cardiovascular tissues

The aim of this study was to investigate the actions of methylenedioxymethamphetamine (MDMA) in several isolated cardiovascular tissues. In spontaneously beating rat atria, concentration-dependent positive chronotropic responses to MDMA and amphetamine were blocked by the neuronal-uptake inhibitor desipramine (1 microM) and the beta-adrenoceptor antagonist propranolol (1 microM). In atria incubated with [3H]noradrenaline to label transmitter stores, 10 microM MDMA and 1 microM amphetamine increased the resting outflow of radioactivity, while 1 microM desipramine had no effect on resting outflow. The MDMA- and amphetamine-induced release of radioactivity were blocked by 1 microM desipramine. MDMA, amphetamine and desipramine each enhanced the electrical stimulation-induced (2 Hz, 30-s train) release of radioactivity; the enhancing effects of MDMA and amphetamine were blocked by 1 microM desipramine. In rat isolated perfused hearts, MDMA (1 and 10 microM) increased heart rate by a similar amount to the increase caused by noradrenaline (10 and 50 nM). MDMA also induced dysrhythmias in 7 out of 11 rat isolated perfused heart preparations. In rabbit isolated perfused and superfused ear arteries preloaded with [3H]noradrenaline, MDMA increased the resting release of radioactivity by 230 +/- 18% (n = 6) of control resting release; the increase was accompanied by a rise in perfusion pressure of 17 +/- 7 mmHg (n = 6). MDMA also facilitated the vasoconstrictor responses to noradrenaline (3-9 ng) and perivascular nerve stimulation (1-5 Hz, 10-s train). MDMA-induced vasoconstriction and the facilitation of vasoconstrictor responses to noradrenaline and electrical stimulation were blocked by 1 microM desipramine.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in the responsiveness to endothelin-1 in isolated atria from diabetic rats

This study investigates the influence of diabetes on the cardiac responsiveness to endothelin-1. The effects of endothelin-1 on rate and force of contraction were examined in isolated right and left atria, respectively, obtained from either streptozotocin (65 mg/kg)-treated rats (diabetic) or vehicle (0.02 M citric acid)-treated rats (control). The positive chronotropic and inotropic effects of endothelin-1 did not change in atria from diabetic rats at 2 and 4 weeks, but were reduced at 8 and 12 weeks. The positive chronotropic response to noradrenaline, but not to sympathetic nerve stimulation, was also reduced in 12-week diabetic rats. Endothelin-1 caused a decrease in the positive chronotropic and inotropic responses to sympathetic nerve stimulation and to noradrenaline; these inhibitory effects of endothelin-1 were not altered in 2-, 4-, 8- or 12-week diabetic rats. The study demonstrates that atrial responses to endothelin-1 and to noradrenaline are reduced by streptozotocin-induced diabetes, but the alteration depends on the duration of diabetes.

Nitric oxide-mediated neurotransmission is attenuated in the anococcygeus muscle from diabetic rats

The effect of STZ-induced diabetes of 8-weeks duration was examined on nitric oxide-mediated neurotransmission in the rat anococcygeus muscle. In the presence of noradrenergic blockade and raised tissue tone, relaxant response to nerve stimulation (0.5-5 Hz, for 10 s), sodium nitroprusside (5 and 10 nmol/l) and nitric oxide (1 and 3 mumol/l) were significantly reduced in anococcygeus muscles from diabetic rats compared to responses from control rats (p < 0.05). In contrast, relaxations to papaverine (3 and 10 mumol/l) were not reduced in tissues from diabetic rats. The nitric oxide synthesis inhibitor NOLA (100 mumol/l) abolished relaxant responses to nerve stimulation but had no effect on responses to any of the relaxant agents used. Exposure to NOLA at 10 mumol/l reduced stimulation-induced relaxations; this reduction was significantly greater in tissues from the diabetic group than from the control group (p < 0.05), probably as a consequence of the smaller relaxant responses in muscles from diabetic rats. Contractile responses to nerve stimulation (1-10 Hz, for 10 s), but not noradrenaline (0.03-30 mumol/l), were significantly greater in anococcygeus muscles from diabetic rats than from control rats (p < 0.05). NOLA (100 mumol/l) significantly enhanced stimulation-induced contractions (p < 0.05), however the enhancement was significantly less in tissues from diabetic rats (p < 0.05). The results suggest that STZ-induced diabetes impairs smooth muscle reactivity to nitric oxide in the rat anococcygeus muscle.

Light and electron microscopic immunocytochemical localization of PKC delta immunoreactivity in the rat central nervous system

Protein kinase C (PKC) is one of the major cellular signal transduction systems. Since at least nine different PKC isoenzymes have been described, the purpose of the present studies was to identify the regional, cellular, and subcellular distributions of PKC delta in the rat central nervous system (CNS) by light and electron microscopic immunocytochemistry. We have found that PKC delta immunoreactivity is present in all major subdivisions of the rat CNS. Within each of the subdivisions, PKC delta immunoreactivity is localized to perikarya that monitor sensory and motor functions. More specifically, PKC delta is found in the olfactory bulb, cerebral cortex, lateral septum, thalamus, vestibular and cochlear nuclei, inferior olive, nucleus of the solitary tract, cerebellum, and superficial layers of the dorsal horn in the spinal cord. In most cases, the distribution of this isoenzyme is distinct from that of the conventional isoforms. Within the CNS, PKC delta is localized primarily in neurons; however, neurons of the same type are not uniformly labeled. This is most evident in the cerebellum, where alternating columns of Purkinje cells are immunostained. While PKC delta is prominent in perikarya, occasional immunostaining is seen in dendrites, fibers or axons, and nerve terminal. Electron microscopic analysis of the posterolateral nucleus of the thalamus reveals that the cell nucleus, the rough endoplasmic reticulum, and the plasma membrane are all immunopositive. Since each of the PKC subspecies may have different substrate, lipid, and other co-factor requirements, the regional, cellular, and subcellular distribution of each of these isoforms should help to define their functional environments.

Interactions of methylenedioxymethamphetamine with monoamine transmitter release mechanisms in rat brain slices

This study investigates the effects of methylenedioxymethamphetamine (MDMA) and amphetamine on monoamine release from rat superfused brain slices in both the presence and absence of vesicular stores of transmitter. MDMA caused the release of radioactivity from slices incubated with [3H]5-hydroxytryptamine, [3H]noradrenaline or [3H]dopamine with EC50 values of 1.9 mumol/l (95% confidence limits 1.5-2.3 mumol/l), 4.5 mumol/l (2.3-8.7 mumol/l), and greater than 30 mumol/l, respectively. In contrast, amphetamine (0.1-300 mumol/l) was more effective in releasing radioactivity from slices incubated with [3H]dopamine than [3H]noradrenaline or [3H]5-hydroxytryptamine. When Ca2+ was excluded from the superfusion fluid, the MDMA-induced release of radioactivity from slices incubated with [3H]dopamine was unaltered, but that from slices incubated with [3H]noradrenaline or [3H]5-hydroxytryptamine was enhanced. MDMA (10 mumol/l) facilitated the stimulation-induced (5 Hz, 1 min) outflow of radioactivity from slices incubated with [3H]noradrenaline or [3H]5-hydroxytryptamine to 7.5-fold and 2.1-fold of control values, respectively, but had no effect on that from slices incubated with [3H]dopamine. Amphetamine (1 mumol/l) increased the stimulation-induced outflow from slices incubated with [3H]noradrenaline, but not that from slices incubated with [3H]5-hydroxytryptamine or [3H]dopamine. Inhibition of monoamine oxidase by a 30-min incubation with pargyline (100 mumol/l) enhanced the releasing action of MDMA on all three monoamines. Pargyline (100 mumol/l) also enhanced the facilitation caused by MDMA, of the stimulation-induced outflow of radioactivity from slices incubated with [3H]noradrenaline, [3H]5-hydroxytryptamine or [3H]dopamine. In some experiments, slices were obtained from reserpinised rats (2.5 mg/kg s.c. 24 h prior) and pre-exposed for 30 min to the monoamine oxidase inhibitor parglyine (100 mumol/l). Under these conditions, electrical stimulation evoked a small residual stimulation-induced outflow of radioactivity from slices incubated with [3H]noradrenaline, and failed to evoke an outflow of radioactivity from slices incubated with [3H]5-hydroxytryptamine or [3H]dopamine. However, a Ca(2+)-dependent stimulation-induced outflow of radioactivity was evoked in the presence of either MDMA (10 mumol/l) or amphetamine (1 mumol/l) from slices incubated with either [3H]dopamine or [3H]noradrenaline, but not from slices incubated with [3H]5-hydroxytryptamine. The stimulation-induced outflow of radioactivity from slices incubated with [3H]noradrenaline was enhanced in the presence of desipramine (1 mumol/l), however this enhancement was less than that caused by 10 mumol/l MDMA or 1 mumol/l amphetamine. The Ca(2+)-dependent response to electrical stimulation in the presence of MDMA from slices incubated with [3H]noradrenaline was greatly reduced when rats were pretreated with a higher dose of reserpine (10 mg/kg s.c.).(ABSTRACT TRUNCATED AT 400 WORDS)

Galanin-immunoreactive axons innervate somatostatin-synthesizing neurons in the anterior periventricular nucleus of the rat

The anterior periventricular nucleus (PeN) regulates GH secretion by synthesizing and releasing somatotropin release-inhibiting factor (SRIF) into the portal circulation. This territory of the diencephalon is heavily innervated by axons of galanin (GAL)-immunoreactive (IR) neurons. The connections between GAL-IR fibers and hypophysiotropic SRIF neurons were studied by means of immunocytochemical double labeling at the light and electron microscopic levels. Retrograde axonal labeling with Fluoro-Gold revealed the anterior PeN as the main site of hypophysiotropic SRIF-synthesizing neurons. These cells were densely surrounded by GALergic axons that made contacts with their cell bodies and dendrites. At the ultrastructural level, diaminobenzidine-labeled SRIF neurons received synapsing GAL-IR axons marked with silver-gold particles. Both axo-somatic and axo-dendritic forms of connections were observed. These morphochemical data revealed an interaction between GAL- and SRIF-synthesizing neurons in the anterior PeN. Furthermore, the presence of synaptic connections between these neuronal systems suggests a role for GAL in the control of SRIF secretion and, in turn, in the regulation of GH release.

Endothelin-1 may be a physiologic modulator of vasoconstriction in rat kidney

The effect of endothelin-1 (ET-1), in concentrations well below threshold and near physiologic levels, has been examined on vasoconstrictor responses to perivascular nerve stimulation and norepinephrine in rat isolated kidney, perfused through the renal artery with physiologic salt solution. A 60-min exposure to ET-1 (1, 10, and 100 pM) had little or no effect on the basal perfusion pressure but enhanced responses to nerve stimulation (4 Hz, 10-s train) by 123 +/- 12% (n = 6), 125 +/- 8% (n = 6), and 226 +/- 49% (n = 7) of the control response, respectively. Responses to nerve stimulation were consistent in the absence of ET-1. Vasoconstrictor responses induced by norepinephrine (30-300 pmol) increased with time in control experiments, but the increase was markedly greater in the presence of 10 and 100 pM ET-1. The vasoconstrictor responses caused by nerve stimulation and norepinephrine were greatly increased by the nitric oxide (NO) synthase inhibitor NG-nitro-L-arginine (NOLA, 100 microM). In the presence of NOLA, ET-1 (1 pM) enhanced the responses to nerve stimulation (1-8 Hz, 10-s trains) by a significantly greater amount than in the absence of NOLA, suggesting that the enhancement by ET-1 is suppressed by NO release. The responses to norepinephrine (3-100 pmol) were also enhanced by 1 pM ET-1 in the presence of NOLA. The data suggest that ET-1 in physiologically relevant concentrations may have a role in the modulation of vascular reactivity in the renal circulation.

Attenuation of vasoconstriction by endogenous nitric oxide in rat caudal artery

1. The effects of NG-nitro-L-arginine (L-NNA), NG-nitro-L-arginine methyl ester (L-NAME), haemoglobin and methylene blue have been examined on vascular reactivity in the rat isolated caudal artery. The effects of L-NNA and sodium nitroprusside were also investigated on the stimulation-induced (S-I) efflux of noradrenaline in the rat caudal artery. 2. L-NNA (10 microM) and L-NAME (10 microM) significantly attenuated the vasodilator responses to acetylcholine (1 nM-1 microM), but had no effect on vasodilator responses to papaverine (1-100 microM). 3. Vasoconstrictor responses to sympathetic nerve stimulation (3 Hz, 10 s), noradrenaline (0.01-1 microM), methoxamine (1-10 microM), 5-hydroxytryptamine (0.01-0.3 microM), phenylephrine (0.1-10 microM), endothelin-1 (10 nM) and KCl (40 mM) were significantly enhanced by 10 microM L-NNA. L-NAME (10 microM) caused a significant enhancement of vasoconstrictor responses to noradrenaline and sympathetic nerve stimulation in endothelium-intact, but not in endothelium-denuded tissues. 4. Haemoglobin and methylene blue (both 10 microM) enhanced the vasoconstrictor responses to sympathetic nerve stimulation and noradrenaline. The enhancements were absent in endothelium-denuded arterial segments. 5. In endothelium-denuded arterial segments precontracted with phenylephrine, the vasodilator responses to the nitric oxide donor, sodium nitroprusside (0.1-300 nM) were decreased by increasing the level of precontraction. 6. L-NNA (10 microM) had no effect on the S-I efflux of radioactivity from arteries in which transmitter stores had been labelled with [3H]-noradrenaline. 7. These results suggest that endothelial nitric oxide attenuates vasoconstrictor responses in the rat caudal artery through activation of soluble guanylate cyclase to decrease smooth muscle contractility. Therefore, the findings provide evidence that nitric oxide acts as a functional antagonist to oppose vasoconstriction.

Measurement of capillary cholesterol as an aid to the management of hypertensive patients with hyperlipidaemia--an assessment of the Reflotron

The Reflotron dry chemistry method of capillary cholesterol measurement has been widely adopted as a rapid means of population screening. We attempted to use it to monitor changes in cholesterol in a trial of intensive dietary intervention in hyperlipidaemic hypertensives. Four hundred and eighty-nine capillary cholesterol levels measured by the Reflotron were compared with levels for venous samples obtained simultaneously and assayed by the Biochemistry Department using conventional laboratory methods. The mean difference between them was 0.3 mmol/l +/- 0.8 (SD). Approximately one-third of the variability in the difference between the two methods was explained by the variables, Reflotron machine used and time (R2 = 54%, adjusted R2 = 34%). We conclude that the Reflotron is not suitable for accurate assessment of the modest changes in cholesterol which occur in individual patients during dietary intervention.

Renal vasoconstriction is modulated by nitric oxide

1. The effect of the nitric oxide synthesis inhibitor, NG-nitro-L-arginine (NOLA), has been examined on vascular reactivity in the rat isolated perfused kidney. 2. NOLA (10 mumol/L) had no effect on basal perfusion pressure, but significantly enhanced the vasoconstrictor responses to sympathetic nerve stimulation (1-16 Hz, 10 s) and noradrenaline (10-300 pmol). The enhancements were greater with the lower frequencies of stimulation and lower doses of noradrenaline. 3. The enhancing effect of 10 mumol/L NOLA on vasoconstrictor responses to nerve stimulation was partially prevented by 100 mumol/L L-arginine while 100 mumol/L D-arginine had no effect. 4. The results suggest that nitric oxide attenuates vasoconstrictor responses in the rat kidney, and provide evidence that nitric oxide has a physiological role in the modulation of vascular reactivity.

Morphological characterization of immortalized hypothalamic neurons synthesizing luteinizing hormone-releasing hormone

An immortalized LHRH cell line has recently been developed by genetically targeting these neurons for tumorigenesis. One of the subclones, the GT1-7 cells, was characterized at both the light and electron microscopic levels to study the cellular and subcellular organization of these cells, particularly as they relate to biosynthesis, processing, and secretion. The cells were fixed onto slides 18-36 h after plating. LHRH and GnRH-associated peptide (GAP) immunoreactivities (IR) were detected by immunocytochemistry using colloidal gold labeling. These cultured cells exhibited the classical neuronal appearance of LHRH neurons, and they established numerous interconnections. Neighboring neurons were coupled by tight junctions, while more distant cells were interconnected with neural axon-like processes and collaterals. This cellular organization is suggestive of a neural network where neuronal activity is coordinated. At the ultrastructural level, the nondividing cells possessed indented nuclei, well developed Golgi complexes, and abundant numbers of ribosomes and secretory granules. Clathrin-coated vesicles were found in fusion with the plasma membrane. The ribosomes and secretory vesicles were particularly prominent, suggestive of high rates of protein biosynthesis and secretion. All of the cells immunostained for both LHRH and GAP; however, GAP IR was always more pronounced than that for LHRH. This finding was corroborated by biochemical data reported in a companion paper. The GAP IR was associated with ribosomes and secretory vesicles. By comparison, LHRH IR was restricted mainly to the secretory vesicles. Using colloidal gold particles of different sizes to denote LHRH or GAP IR, it was determined that both GAP and LHRH IR were colocalized within the same secretory vesicle. Taken together, these data suggest that pro-LHRH is biosynthesized on the ribosomes, packaged as an intact protein into the secretory vesicles, processed to LHRH and GAP-(1-56) within these vesicles, and transported to the periphery of the cell in preparation for secretion. These morphological data emphasize the utility of using these immortalized LHRH neuronal cells to dissect the cellular and subcellular architecture involved in biosynthesis, processing, and secretion. In addition, our results provide the first detailed evidence for the intracellular pathway involved in pro-LHRH biosynthesis, processing, and secretion in these cultured neuronal cells.

Endothelial nitric oxide attenuates vasoconstrictor responses to nerve stimulation and noradrenaline in the rat tail artery

The effects of the nitric oxide synthesis inhibitor, NG-nitro-L-arginine (NOLA), have been examined in perfused segments of rat tail artery. NOLA (1 and 10 microM) significantly enhanced the vasoconstrictor responses to perivascular nerve stimulation (5 Hz, 10 s) and noradrenaline (10 ng). The enhancing effects of NOLA were prevented by L-arginine, but not by D-arginine, and were absent in endothelium-denuded artery segments. The results suggest that nitric oxide derived from endothelial cells attenuates vasoconstrictor responses to both nerve stimulation and noradrenaline.

Interactions between endothelin-1 and other chronotropic agents in rat isolated atria

In isolated spontaneously beating right and left atria and in electrically driven left atrium from rat, endothelin-1 increased the rate and force of contraction, but significantly decreased the positive chronotropic and inotropic responses to sympathetic nerve stimulation. The decrease may be partly dependent on the positive cronotropic and inotropic effects of endothelin-1, since other agents with chronotropic activity (noradrenaline, isoprenaline, serotonin and Bay k 8644) also decreased stimulation-induced chronotropic responses. Endothelin-1 caused a significant rightward shift of the linear portion of the log concentration-response curve for the chronotropic actions of noradrenaline and isoprenaline. The changes in the log concentration-response curve were not a consequence of the direct chronotropic effect of endothelin-1, since they were still evident when the chronotropic action of endothelin-1 was offset by carbachol. Furthermore, the chronotropic agent, Bay k 8644, did not shift the linear portion of the log concentration-response curves for noradrenaline and isoprenaline. The mechanism of the effects of endothelin-1 in rat atria is not known, but they were not changed by blockade of alpha-adrenoceptors or of L-type voltage-sensitive Ca2+ channels.

Chronic cocaine treatment does not alter rat striatal D2 autoreceptor sensitivity to pergolide

Rat superfused striatal slices, preloaded with [3H]dopamine, were electrically stimulated and the stimulation-induced outflow of radioactivity was taken as an index of dopamine release. In the presence of 10 microM nomifensine, exposure of striatal slices to unlabelled dopamine (0.3 microM) for 6 min prior to stimulation, significantly reduced stimulation-induced outflow. In contrast, a 21-min exposure to dopamine did not significantly alter stimulation-induced outflow. These results suggest that D2 receptors modulating dopamine release in the rat striatum may be rapidly desensitized in vitro. Rats were pretreated for 14 days with cocaine HCl (10 mg/kg/day i.p.) or saline. A progressive enhancement of locomotor activity in cocaine-treated rats over the pretreatment period compared to that in saline-treated rats indicated a behavioural sensitization to cocaine. The inhibitory effect of pergolide (1, 10 and 100 nM) on stimulation-induced outflow from striatal slices obtained from cocaine-pretreated rats was not different from that in slices obtained from saline-pretreated rats. Therefore no evidence was obtained for either a desensitization or a supersensitivity of striatal D2 autoreceptors by chronic cocaine administration.

Modulation of norepinephrine-induced vasoconstriction by endothelin-1 and nitric oxide in rat tail artery

The effects of endothelin-1 (ET-1) and an inhibitor of the synthesis of nitric oxide (NO) have been examined on vasoconstrictor responses to nerve stimulation and norepinephrine in the rat isolated perfused tail artery. In endothelium-denuded preparations, a 60-min exposure to 0.3 nM ET-1 had no effect on the basal perfusion pressure, but significantly enhanced responses to stimulation (1 Hz, 10 s) and norepinephrine (10 ng) to 124 +/- 9% (n = 6) and 139 +/- 14% (n = 8), respectively, of control responses. In endothelium-intact preparations, inhibition of NO synthesis by NG-nitro-L-arginine (NOLA, 10 microM) enhanced responses to stimulation (5 Hz, 10 s) and norepinephrine (10 ng) to 171 +/- 12% (n = 6) and 222 +/- 9% (n = 4), respectively, of control responses. The NOLA-induced enhancements were prevented by 100 microM L-arginine but not by 100 microM D-arginine, and did not occur in endothelium-denuded arteries. In other experiments, segments of rat tail artery were perfused in a low-volume (3.5 ml) recirculating system. The basal perfusion pressure was consistent for at least 60 min. In endothelium-denuded segments, vasoconstrictor responses to nerve stimulation (0.5 Hz, 10 s) or norepinephrine (10 ng) remained constant. However, in endothelium-intact segments, responses to stimulation and norepinephrine gradually increased to 158 +/- 13% (n = 6) and 152 +/- 8% (n = 5), respectively, of initial responses, after 45 min of recirculation. The increases were not related to NO, as they remained unchanged in the presence of 10 microM NOLA. Thus, it appears that a vasoconstriction-enhancing factor, possibly ET-1, is released from endothelial cells and accumulates in the perfusion fluid.

Differential sensitivities of avian and mammalian neuromuscular junctions to inhibition of cholinergic transmission by omega-conotoxin GVIA

Nerve stimulation-induced contractions of the chick biventer cervicis muscle were slowly reduced by omega-conotoxin. However, omega-conotoxin had no effect on skeletal muscle function after i.v. injection in mice or on nerve stimulation-induced contractions of focally innervated muscle of the rat diaphragm or the rabbit proximal oesophagus, or the multiply innervated extra-ocular rectus muscle from rabbit. The lack of effect of omega-conotoxin on mammalian neuromuscular junctions was not due to the high safety factor in transmission or to a high local concentration of Ca2+ originating from the muscle, and could not be accounted for in terms of the operation of facilitatory or inhibitory feedback modulation of transmitter release from motoneurone terminals. It is concluded that the Ca2+ channels of mammalian motoneurone terminals differ from those of avian motoneurone terminals and other omega-conotoxin-sensitive nerve terminals.

Effects of methylenedioxymethamphetamine on the release of monoamines from rat brain slices

The effects of 3,4-methylenedioxymethamphetamine (MDMA) on monoamine release were investigated in superfused slices of rat striatum and hippocampus. MDMA (10 microM) increased the resting release of radioactivity from slices incubated in [3H]dopamine, [3H]5-hydroxytryptamine or [3H]noradrenaline. These effects of MDMA (10 microM) were blocked by the neuronal uptake inhibitors, cocaine (10 microM), fluoxetine (1 microM) and desmethylimipramine (1 microM), respectively. MDMA (10 microM) enhanced the stimulation-induced efflux of radioactivity from slices incubated in [3H]noradrenaline but not from slices incubated in [3H]5-hydroxytryptamine or [3H]dopamine. These results demonstrate for the first time a direct noradrenaline-releasing action of MDMA and differential effects of MDMA on the stimulation-induced release of noradrenaline, dopamine and 5-hydroxytryptamine from rat superfused brain slices.