PD-L1 overexpression induces STAT signaling and promotes the secretion of pro-angiogenic cytokines in non-small cell lung cancer (NSCLC)

BACKGROUND

Monoclonal antibodies (ICI) targeting the immune checkpoint PD-1/PD-L1 alone or in combination with chemotherapy have demonstrated relevant benefits and established new standards of care in first-line treatment for advanced non-oncogene addicted non-small cell lung cancer (NSCLC). However, a relevant percentage of NSCLC patients, even with high PD-L1 expression, did not respond to ICI, highlighting the presence of intracellular resistance mechanisms that could be dependent on high PD-L1 levels. The intracellular signaling induced by PD-L1 in tumor cells and their correlation with angiogenic signaling pathways are not yet fully elucidated.

METHODS

The intrinsic role of PD-L1 was initially checked in two PD-L1 overexpressing NSCLC cells by transcriptome profile and kinase array. The correlation of PD-L1 with VEGF, PECAM-1, and angiogenesis was evaluated in a cohort of advanced NSCLC patients. The secreted cytokines involved in tumor angiogenesis were assessed by Luminex assay and their effect on Huvec migration by a non-contact co-culture system.

RESULTS

PD-L1 overexpressing cells modulated pathways involved in tumor inflammation and JAK-STAT signaling. In NSCLC patients, PD-L1 expression was correlated with high tumor intra-vasculature. When challenged with PBMC, PD-L1 overexpressing cells produced higher levels of pro-angiogenic factors compared to parental cells, as a consequence of STAT signaling activation. This increased production of cytokines involved in tumor angiogenesis largely stimulated Huvec migration. Finally, the addition of the anti-antiangiogenic agent nintedanib significantly reduced the spread of Huvec cells when exposed to high levels of pro-angiogenic factors.

CONCLUSIONS

In this study, we reported that high PD-L1 modulates STAT signaling in the presence of PBMC and induces pro-angiogenic factor secretion. This could enforce the role of PD-L1 as a crucial regulator of the tumor microenvironment stimulating tumor progression, both as an inhibitor of T-cell activity and as a promoter of tumor angiogenesis.

Preventive and responsive plans to COVID-19 epidemic in a leading teaching hospital in Milan, Italy

Issue

Following the SARS-Cov-2 outbreak in Wuhan, China, the first case of COVID-19 was reported in Codogno, Lombardy, Italy, on 20 February 2020. The ongoing epidemic has exposed the health care system to a severe stress. San Raffaele Hospital (OSR) in Milan, Italy - a leader in the emergency management, may provide a benchmarking experience useful for other countries.

Description of the Problem

OSR has established a task force including the health care director, the Infections Prevention and Control Committee (IPCC) and the head of ward and outpatients' facilities management area in order to assess the situation and to define a multi-step strategy. The management process has been divided in two steps. Firstly, a preventive phase was devised, in a preparedness perspective, to avoid the spread of the infection to the Healthcare Professionals (HCP). Secondly, a reorganizational phase was implemented to guarantee assistance to infected patients, especially the critical ones.

Results

Before the outbreak, the IPCC updated OSR's procedures, based on the WHO's, national and regional guidance, planned a lectures series and an online survey to train healthcare professionals and proposed to stack Personal Protective Equipment (PPE) to face the expected shortage. The Head of the facilities management area defined separate pathways in the Emergency Department in order to isolate patients with respiratory symptoms, set up a new ward, with 26 beds and dedicated personnel, as well as two Intensive Care Units, with 13 beds, Some wards were merged and more healthcare workers were moved to the COVID-19 units.

Lessons

The coordination between task force members has been crucial for translating the multi-step strategy in a quick reorganization of the whole hospital. Despite early preparations, we could not anticipate the evolution of the outbreak and its logistic impact, especially on the PPE procurement.

Key messages

A major Hospital was proved to be capable to respond to the changing healthcare requests. Organizational flexibility is crucial for proper emergency management.

Telemedicine and mental health: coming of age?

Telemedicine is the practice of medicine from distance using information technology and include mainly teleconsultation via video and/or chat, teleexpertise to request the opinion of a specialist, and remote patient monitoring to improve the follow-up of patients. The use of telemedicine in mental health and most specially psychiatry has been one of the first use case described in the scientific literature, via video teleconsultation, due to the absence of physical patient examination. One of the oldest telepsychiatry case from the literature was published in 1973 for patients assessed from 1968 with the Massachusetts General Hospital in Boston, USA.

Despite its medical and technical ease, telepsychiatry is still not widely spread and integrated into healthcare systems due to organisational and implementation challenges. More recently, telepsychology and other telemedicine interventions in mental health have been growing across the globe, including for mental wellbeing promotion and prevention of mental health conditions in specific environments. The rise of consumer digital healthcare directly through mobile app and dedicated websites is also to be considered in the wide opportunities of telemedicine opportunities to address mental health issues at a global scale. Various models needs thus to be considered between digital only care and blended approach mixing face-to-face and digital ways, as well as telemental health delivered only via the existing healthcare system or via new private digital players. The objective of the presentation is to describe the spectrum of existing telemedicine interventions in mental health, the digital features enabling its adoption and the assessment of its impact on clinical and public health outcomes.

Use and impact of smartphone apps in mental health

As smartphone usage is more and more ubiquitous, the app market is flourishing in all fields, including health. Indeed, the availability and use of smartphone apps (SAs) in health has exponentially grown in recent years. It has been estimated that in 2018 there were over 97,000 health apps available and that, 15% and 8% of US phone users aged 18-29 and 30-49 years respectively had health apps installed on their mobile devices. Health apps might potentially support people health paths in multiple ways: channeling health education, enabling personal health data tracking, self-monitoring and goals setting, facilitating access to health records or compliance to treatment, fostering effective communication with healthcare providers and health services, as well as supporting clinical decision-making.

Despite such large potential, still scant evidence is available on the impact of SAs on clinical outcomes in different fields of medicine, including mental health. With an estimated prevalence of around 450 million people currently suffering from mental disorders and 1 in 4 people in the world affected at some point in own life, mental disorders are a leading cause of ill-health and disability worldwide whose prevention and care might be enhanced by mHealth technology.

The general aim of the presentation is to provide an overview on the use and impact of SAs in the field of mental health. Specific objectives are: i) to present a conceptual framework on how SAs might support mental disorders prevention, diagnosis and treatment, ii) to report on SAs use in mental health in different settings, iii) to collect and pool available evidence from observational and experimental studies on the impact of SAs use on different mental health outcomes, iv) to explore the quality, effectiveness and attributes of top-rated smartphone mental health apps and lastly, v) to suggest gaps in knowledge to be filled by future research.

Orbital exenteration and conjunctival melanoma: a 14-year study at the Jules Gonin Eye Hospital

Purpose

To report our 14-year experience with orbital exenteration and assess risk factors for poor prognosis by focusing on conjunctival melanoma.

Patients and method

A retrospective study was conducted in our tertiary care centre (Jules Gonin Eye Hospital, Lausanne, Switzerland) between 2003 and 2017. Inclusion criteria were patients aged  ≥18 years with a follow-up >12 months, without metastatic spread at the time of surgery. Data recorded were age, gender, tumour histology, surgical technique, postoperative complications, surgical margin status, local recurrence, postoperative radiation beam therapy and metastatic status.

Results

Twenty-five patients with a mean age of 63.2 years (38–92) were included. Conjunctival melanoma was the most frequently identified tumour (n = 14, 56%) followed by conjunctival squamous cell carcinoma (n = 4, 16%), sebaceous carcinoma (n = 3, 12%), choroidal melanoma (n = 2, 8%) and basal cell carcinoma (n = 2, 8%). Eighteen tumours (72%) originated from the conjunctival tissue. Clear surgical margins were achieved in 21 (84%) patients. Fourteen (56%) patients experienced distant metastases and died from metastatic spread after a mean follow-up of 52.3 months (6–120). The 1-, 3- and 5-year overall survival (OS) was 96%, 72% and 60%, respectively. In the univariate analysis, positive surgical margins, local recurrence and metachronous metastases were associated with a decreased OS (p = 0.002, p = 0.005 and p = 0.007, respectively). In the multivariate analysis, positive surgical margins and metachronous metastases were also associated with a decreased OS (p = 0.02 and p = 0.042, respectively). Conjunctival melanoma was not associated with a poorer prognosis (p = 0.280).

Conclusion

Free surgical margins are needed to increase OS. To achieve clearer surgical margins, neoadjuvant targeted therapies/immunotherapies may be considered.

Bovine xenograft application for treatment of a metatarsal nonunion fracture in an alpaca (Vicugna pacos)

CASE HISTORY

A 15-year-old female huacaya alpaca (Vicugna pacos) was referred because of a non-weight-bearing lameness (4/4) in the left pelvic limb caused by a grade three open metatarsal fracture. The referring veterinarian treated the fracture with conservative management using bandages, but it progressively evolved to a non-union.

CLINICAL FINDINGS AND DIAGNOSIS

Clinical examination revealed external wounds on the medial and lateral surfaces of the metatarsus. Radiographs confirmed an open, nonarticular, displaced, diaphyseal fracture of the left metatarsus.

TREATMENT AND OUTCOME

Cancellous bone was sourced from bovine proximal and distal femur epiphyses, followed by a thermal shock procedure to achieve decellularisation, to produce a xenograft. Open reduction and internal fixation of the fracture using locking plates was performed. Alignment of the fracture fragments was corrected and the xenograft was placed at the debrided fracture site to stimulate and harness osteogenesis in situ. Clinical and radiographic follow-up was performed up to 40 weeks postoperatively. Clinical evaluations revealed that the alpaca gradually increased weight bearing following bandage removal 10 days after surgery. Serial radiographs showed correct alignment of the left metatarsus, progressive bone modelling and, complete bone union at 12 weeks. Ten months postoperatively the alpaca showed no signs of lameness and resumed normal activity.

CLINICAL RELEVANCE

For management of a metatarsal non-union, a combination of bovine xenograft application and angular stable internal fixation progressed toward an excellent long-term recovery.

Water immersion is associated with an increase in aquaporin-2 excretion in healthy volunteers

Here, we report the alterations in renal water handling in healthy volunteers during a 6 h thermoneutral water immersion at 34 to 36 degrees C. We found that water immersion is associated with a reversible increase in total urinary AQP2 excretion.

Alemanno's brachial plexus block ten years later: topographic study of the anesthetized areas

AIM

The study analyzes the extension of anesthesia induced by Alemanno's brachial plexus block technique on the various areas of competence of the different nerves.

METHODS

The study was conducted on 58 patients in ASA classes 1 and 2 scheduled to receive shoulder arthroscopy. At the end of the operation, about 2 hours after induction of anesthesia, extension of anesthesia was evaluated by the pin-prick test.

RESULTS

Anesthesia was achieved in 100% of cases for the circumflexus, musculocutaneous and radial nerves; the median nerve escaped in 7% of cases, the medial cutaneous nerve of forearm in 20%, the ulnar nerve in 27.5%, the medial cutaneous nerve of arm and intercostobrachial nerves in 46%; no major complications were associated with the technique.

CONCLUSION

Alemanno's technique is recommended for operations on the shoulder and humerus, whereas more peripheral techniques may be preferable for interventions on the forearm and hand.

Nephrotic edema

This article starts with a concise synopsis of the history of edema. The role of underfilling, overflow, antidiuretic hormone, and acquaporins is subsequently discussed. Emphasis is given to the use of diuretics in edematous patients. The role and risks of albumin infusion are illustrated. The new hypothesis of pulse reverse osmosis is discussed. The final section deals with the measurement of colloid osmotic pressure in the clinical setting.

Endocrine activity of the corpus luteum and placenta during pregnancy in Chalcides chalcides (Reptilia, Squamata)

The structure of the corpus luteum and the steroidogenic activity of the corpus luteum and placenta in the viviparous reptile Chalcides chalcides have been investigated. The corpus luteum has a compact structure, almost without internal vascularized connective septa. It begins to degenerate after the middle of pregnancy, when plasma progesterone (P) remains high. The sections of the corpora lutea taken during early pregnancy showed an intense 3beta-HSDH reaction, whereas the sections taken in late pregnancy gave weak reactions localized exclusively in the peripheral luteal cells. In contrast, sections of placentae taken at the beginning and in the middle of pregnancy always gave negative 3beta-HSDH reactions, whereas those of late pregnancy were always strongly positive, localized in the maternal component of the placenta. In vitro, the corpora lutea from early pregnancy secreted significant amounts of P, whereas appreciable amounts of P were not detected in incubates of early pregnancy placentae. Near the time of delivery, P levels decreased in the culture medium of the corpora lutea, but increased in that of the placentae. The addition of pregnenolone (a precursor of P biosynthesis) to the culture medium caused an increase in the luteal and placental P levels, whereas the addition of trilostane (an inhibitor of 3beta-HSDH) reduced them. The placenta of C. chalcides is suggested to have an endocrine function and to replace the corpus luteum in the production of P when the gland degenerates in late pregnancy.

Value of cerebrospinal fluid cytochemical examination for the diagnosis of congenital toxoplasmosis at birth in France

BACKGROUND

Because of routine screening and treatment of pregnant women for Toxoplasma infection in France, most neonates born to mothers who seroconverted during pregnancy are either not infected or asymptomatic. Early diagnosis relies mainly on radiologic, ophthalmologic and biologic tests. Cerebrospinal fluid (CSF) cytochemical evaluation is one of several tests performed in parallel to increase the overall sensitivity of the diagnostic evaluation. Our goal was to assess the value of cytochemical examination and to confirm whether using a portion of available CSF for this analysis is legitimate.

METHODS

The individual performance of each of the two cytochemical tests and their combined value when used in parallel were assessed. These findings were then compared with the anti-Toxoplasma IgM and IgA serum titers and the clinical, ophthalmologic and radiologic findings at birth.

RESULTS

CSF cytochemical analysis was possible in only 52% of the 233 children in the study. Our results in 112 children indicated poor sensitivity estimates. There was no significant change in the posttest probability of infection compared with the pretest estimation of risk in cases of a negative finding. After a mean follow-up of 80 months there was no evidence that CSF cytochemistry helped predict the risk of sequelae.

CONCLUSION

In our setting cytochemical examination did not significantly contribute to the diagnosis of congenital infection at birth. Because of the limited quantity of CSF available, we suggest the use of other methods with higher yield.

Effects of fluvoxamine and citalopram in maintaining abstinence in a sample of Italian detoxified alcoholics

A 16-week, randomized study was performed to test the efficacy of two selective serotonin reuptake inhibitors (SSRIs) fluvoxamine and citalopram, in decreasing relapse and craving in alcoholics, and to investigate possible differences in their clinical profile. After detoxification, each of the 81 patients (55 males and 26 females) was randomly assigned to one of three groups: 23 subjects did not receive any pharmacological treatment, 25 were treated with fluvoxamine, 150mg/day, and 33 with citalopram, 20 mg/day. All patients received standard cognitive-behavioural therapy. Craving was assessed twice a month using a 10-step scale. Every intake of alcohol was considered a relapse and the subject was taken out of the study. At the end of the study, both the fluvoxamine and citalopram groups showed a statistically higher rate of continuous abstinence (63.6 and 60.7%, respectively) compared to the group without pharmacological treatment (30.4%). Relapse severity did not differ among the three groups. Only citalopram showed a significant effect on craving throughout the study period. This study confirmed the efficacy of SSRIs as an adjunct to psychotherapy to prevent relapse in alcoholics. The relationship between the effects of these SSRIs on abstinence and craving, as well as the differences between their profiles, are discussed.

A new instrument for residency program evaluation

The purpose of the study was to develop a comprehensive program evaluation instrument. Following pilot work with residents, a 69-item instrument consisting of statements with 5-point strongly agree to strongly disagree response options was distributed to 107 residents; 104 responded. Psychometric analyses revealed no ceiling or floor effects; 9 items were deleted. There were three subscales: workload (19 items; alpha = .76); educational environment (29 items; alpha = .72) and lifestyle issues (12 items; alpha = .62). Mean item scores were significantly higher for educational environment (3.53; SD 0.28) than for workload (2.78; SD 0.39) and lifestyle (2.96; SD 0.42). Items with the lowest scores reflected issues that were largely fixable. The 60-item instrument appears to be psychometrically sound, comprehensive, and exportable.

The symbolism of salt in paintings

Many artists have used the symbol of salt in both religious and profane works, yet very few studies have explored the symbolism of salt as used in works of art. In this study, Panofsky's method has been adopted to evaluate works of art through an organic process articulated into three stages: (1) pre-iconographic, (2) iconographic and (3) iconological. The method was used for (a) religious paintings of the Old and New Testaments and (b) mythological and profane themes. Various salt-cellars were also studied. In particular, the paper examines the following themes: Isaac blessing Jacob, the return of Esau, Samuel consecrating David, the Last Supper, the suppers at Emmaus and at the house of Simon, the birth of St. John the Baptist, the Baptism of Constantine, the prodigal son, Bacchus-Apollo, the nuptial banquet of Love and Psyche, the death of the Cavalier of Celano, the king drinks, the landlord's visit, 'Phitopolis faisant servir des mets en or au roi Pithès', certain still life paintings and various salt-cellars including those of Cellini and Giulio Romano. The paper discusses the works of many artists including Raphael, Leonardo and his school (Boltraffio, Giampietrino, d'Oggiono, Solario), Hendricksz, Corenzio, Jean-Baptiste and Philippe de Champaigne, Damaskinos, Tintoretto, Titian, Romanino, Rubens, Bellini, Bloemaert, Veronese, Sustris, Just of Ghent, Jan Van Hemessen, Poussin, Loir, Giotto, Jordaens, Brueghel and Mimmo Paladino with his enchanted mountain. From the data examined it emerged that salt is a primary iconological presence in various works of art.

Fluvoxamine alone in the treatment of delusional depression

OBJECTIVE

The aim of this study was to evaluate the efficacy of fluvoxamine in the treatment of delusional depression.

METHOD

Fifty-nine inpatients who met the DSM-III-R criteria for major depression with psychotic features were treated with fluvoxamine for 6 weeks. Patients were assessed at baseline and weekly thereafter with the Hamilton Depression Rating Scale and the Dimensions of Delusional Experience rating scale.

RESULTS

Of the 57 subjects completed the trial, 84.2% (N=48) recovered. The index episodes of the patients who did not respond to fluvoxamine were of significantly longer duration than those of the responders.

CONCLUSIONS

Fluvoxamine has a response rate similar to that of the currently most efficacious treatments for delusional depression, including antidepressants plus antipsychotics and ECT.

A comparison between delusional and non-delusional depressives

Delusional depressive episodes may represent more sever degrees of depressive manifestations or a distinct subtype of depressive illness. To test these two alternative hypotheses, characteristics on demographic, clinical and symptomatic variables, presence of personality disorders and familial loading were compared in 57 delusional and 57 non-delusional depressive patients. The delusional group did not differ on symptomatological intensity degree, clinical and familial loading characteristics. They did differ on higher distribution of Cluster 1 personality disorders. In the delusional sample the presence of mood incongruent psychotic features and hallucinations were evaluated as possible indicators of different subtypes of delusional depression.

Renal handling of sodium after an oral protein load in adult humans

This investigation was designed to study (1) renal sodium handling after an oral protein load and (2) its relationship to some known determinants of the hemodynamic response (glucagon, insulin, growth hormone, renin, aldosterone, and plasma amino acid concentration). To this end of group of 8 adult subjects was studied before (three 30-min clearances) and after a meat meal (MM; five 30-min clearances at 30, 60, 90, 120 and 180 min). The MM provided 2 g/kg BW of protein. Within 30 min from the MM an hyperfiltration response was seen, which was paralleled by a 2-fold increase in plasma alanine concentration while total plasma amino acid concentration was not different from the baseline values. The hemodynamic response was associated with a normally operating tubuloglomerular feedback mechanism independent of renin-aldosterone activity, but possibly associated with an early increase in plasma glucagon concentration and later on with a modest increase in postmeal plasma insuling concentration.

Brain-Gut Peptides and the Renal Hemodynamic Response to an Oral Protein Load: A Study of Gastrin, Bombesin, and Glucagon in Man

With the aim of disclosing a possibility for gastrin and bombesin to participate in the postprandial regulation of the renal hemodynamic response, 10 healthy males were studied before and after a meat meal (2 g/kg BW of proteins as cooked red meat). We evaluated the time course changes of glomerular filtration rate (GFR) renal plasma flow (RPF) and the plasma concentrations of gastrin, bombesin, glucagon, and total amino acids. After the meat meal a significant increase in GFR and RPF was seen, within 30min, along with an increase in plasma gastrin and glucagon. Bombesin and amino acid concentrations increased at a later time. The data suggest but cannot demonstrate a causal role for gastrin and glucagon in the genesis of the hyperfiltration response to acute protein administration.

Glucagon-independent renal hyperaemia and hyperfiltration after an oral protein load in Child A liver cirrhosis

The work was designed to study the effects of a meat meal on glomerular filtration rate (GFR), renal plasma flow (RPF), and plasma concentrations of glucagon, insulin, growth hormone, renin, aldosterone, total amino acids, and NH3 in healthy humans (H) as well as in patients with Child A liver cirrhosis (LC). The meat meal produced renal hyperaemia and hyperfiltration without changes in the filtration fraction. Fractional Na excretion in urine increased significantly after the meat meal only in LC. Hyperinsulinaemia and hyperglucagonaemia were seen at baseline in LC and were not affected by the meat meal, whereas in H glucagon concentration increased significantly over baseline within 30 min from the meat meal and insulin within 60 min. Growth hormone concentration was normal at baseline in LC and increased significantly 120-180 min after the meal, whereas it was not affected in H. Renin and aldosterone were stable in both H and LC. Plasma amino acid concentration began to increase 60 min after the meat meal, when hyperfiltration was present. The data indicate that in human Child A cirrhosis of the liver renal haemodynamic response to a meat meal is independent of changes in glucagon.

Perspectives in clinical psychopharmacology of amitriptyline and fluvoxamine. A double-blind study in depressed inpatients

The efficacy of fluvoxamine was compared to that of amitriptyline in a double-blind 6-week fixed-dose trial of 56 inpatients with major depressive episode. The two drugs were comparable in their antidepressant efficacy. We tested the percentage of improvement in Hamilton-D scores during the first and the second weeks of treatment as predictors of efficacy for the last week. Improvement rates during the second week significantly predicted the outcome. We also investigated whether or not some symptomatological characteristics would permit prior prediction of the outcome with amitriptyline or fluvoxamine, dividing our sample into responders and nonresponders to the two drugs. The four groups showed differences in their symptomatological profiles.

Frontal and callosal neuropsychological performances in schizophrenia. Further evidence of possible attention and mnesic dysfunctions

Some level of frontal and callosal dysfunction has been reported in patients with schizophrenia. In the present study 68 normal controls and 117 schizophrenic patients were administered the Wisconsin Card Sorting Test (WCST), which involves the function of the frontal areas, and the Auditory Comprehension Test (ACT) which involves the corpus callosum and to a lesser degree attention and mnesic mechanisms. WCST correctly discriminated 69.8% of schizophrenics and 74.2% of controls, ACT 86.7% of schizophrenics and 90.2% of controls. Moreover, schizophrenics correctly classified by the WCST performed more poorly than schizophrenics incorrectly classified by the WCST on the related ACT indices for the attention and mnesic mechanisms. There were no differences in present age, age at onset, duration of the illness, diagnostic subtype and course of the disease between correctly and incorrectly classified schizophrenics by the WCST and the ACT. These data indicate a prevalent malfunctioning of attention and mnesic mechanisms in schizophrenia. Finally there seems to be no relationship between these neurofunctional abnormalities and demographic and clinical characteristics of the disease.

Renal Hemodynamics, Plasma Amino Acids and Hormones after a Meat Meal in Progressive Nephron Loss

Ten patients with chronic renal failure (GFR 29–97 ml/min), on free diets providing 1 g/kg B.W. of proteins, ingested an oral protein load (meat meal, 2 g/kg B.W.). GFR and RPF increased significantly over baseline with no change in filtration fraction. Within 30 min of the meal and for the next 3 h a statistically significant increase was observed in the plasma concentrations of the following amino acid groups: essential, nonessential, total, branched-chain, ketogenic, glycogenic, glycogenic and ketogenic, basic, acid, polar and non-polar. At 30 min the smallest increase was seen in acid and polar amino acids (6.7% and 7.6%, respectively). At 180 min the largest increase (78.8%) was seen for glycogenic and ketogenic amino acids and total plasma amino acids were 1.58 times baseline. After the meat meal plasma glucagon and insulin rose significantly, while growth hormone, plasma renin activity and aldosterone did not vary.

Renal hemodynamics, plasma amino acids and hormones after a meat meal in progressive nephron loss

Ten patients with chronic renal failure (GFR 29-97 ml/min), on free diets providing 1 g/kg B.W. of proteins, ingested an oral protein load (meat meal, 2 g/kg B.W.). GFR and RPF increased significantly over baseline with no change in filtration fraction. Within 30 min of the meal and for the next 3 h a statistically significant increase was observed in the plasma concentrations of the following amino acid groups: essential, non-essential, total, branched-chain, ketogenic, glycogenic, glycogenic and ketogenic, basic, acid, polar and non-polar. At 30 min the smallest increase was seen in acid and polar amino acids (6.7% and 7.6%, respectively). At 180 min the largest increase (78.8%) was seen for glycogenic and ketogenic amino acids and total plasma amino acids were 1.58 times baseline. After the meat meal plasma glucagon and insulin rose significantly, while growth hormone, plasma renin activity and aldosterone did not vary.

Predicted creatinine clearance to assess glomerular filtration rate in chronic renal disease in humans

The work was designed to assess the suitability of both measured endogenous creatinine clearance (CCR) and predicted creatinine clearance (P-CCR) to evaluate GFR in chronic renal disease (CRD) by utilizing the renal clearance of inulin (CIN) as gold standard. A total of 124 subjects were studied (62 healthy, 62 with CRF). CCR significantly overestimated GFR in healthy subjects as well as in CRF, whereas P-CCR was identical to GFR. The CCR/CIN ratio which calculates the fractional creatinine clearance and provides a rough estimation of the contribution of creatinine secretion in explaining the differences between CCR and GFR was increased in CRD and especially in CRD of glomerular origin. The ration P-CCR/CIN was significantly lower than CCR/CIN in healthy subjects and in patients with CRD of glomerular origin. The data are against the use of CCR in assessing GFR in healthy subjects and in patients with CRD.

Tubular function by lithium clearance, plasma amino acids and hormones following a meat meal in childhood

Tubular function was measured by lithium clearance (CLi) and by its derived formulae before and after the transient increase (lasting 90 min) in glomerular filtration rate (GFR) following a meat meal (2g protein/kg body weight) in 12 normal children. Three baseline and 4 clearances after the meal were obtained, each lasting 30 min. The mean baseline CLi was 23.1 +/- 1.64 ml/min/1.73 m2. At peak GFR response (60 min from starting the meal), CLi averaged 27.6 +/- 2.4 ml/min/1.73 m2 (p less than 0.025 vs. baseline) and it was further increased (32.2 +/- 5.04 ml/min/1.73 m2, p less than 0.01 vs. baseline) 120 min after starting the meal, while GFR returned to baseline values. Fractional lithium excretion averaged 0.23 +/- 0.04 at baseline and increased continuously after the meat meal and, at completion of the study, it averaged 0.38 +/- 0.07 (p less than 0.025 vs. baseline). The distal absolute and fractional sodium reabsorption increased throughout the studies following the meal and peaked at 120 min. The functional changes were associated with a statistically significant increase in the plasma concentration of insulin, glucagon, and total amino acids after the meal. The latter at the end of the study was almost doubled (5,600 +/- 780 versus 3,200 microM at baseline, p less than 0.01). The data indicate that the tubulo glomerular feedback mechanism operates normally after a meat meal. The finding on increased distal sodium reabsorption might point to the existence of an insulin-dependent mechanism.

Changes induced by progesterone treatment in the sulphatides of the frog oviduct

Sulphatides have been studied by histochemical and biochemical procedures in the oviduct of the frog in different experimental conditions. In ovariectomized or hypophysectomized animals, compared to sham-operated, an increase in sulphatides was observed. The progesterone treatment did not significantly modify this lipid fraction in ovariectomized frogs, while in hypophysectomized frogs it induced a further increase. Densitographic profiles of the sulphatides, obtained by thin-layer chromatography (TLC) and also recorded by Tesak equipment, were similar in ovariectomized or hypophysectomized frogs following hormone treatment because they showed three distinct fractions in both experimental groups of animals. The appearance of a third fraction never previously observed was probably induced by the progesterone treatment. Moreover, under the effects of this hormone, the phospholipid fractions (phosphatidylcholine and phosphatidylethanolamine) also showed different densitographic profiles.

Sialic acid and neuraminidase activity in the frog oviduct: comparative biochemical investigation in the different tracts during the reproductive cycle

1. A biochemical study was carried out on the protein-bound and lipid-bound sialic acid, and neuraminidase activity in the different tracts of the oviduct of the frog Rana esculenta during the reproductive cycle. 2. Plasma sexual steroids were also investigated by RIA. 3. Fluctuations in neuraminidase activity are related to that of glycoprotein sialic acid and plasma estradiol. Glycolipid sialic acid does not have a close relationship either with neuraminidase or plasma estradiol. 4. Very high plasma concentration of progesterone before ovulation and, on the contrary, its drop after ovulation were observed. 5. The results are discussed and hypotheses advanced to explain fluctuations of the studied parameters during the reproductive cycle.

The renal hemodynamic response following a meat meal in children with chronic renal failure and in healthy controls

The renal hemodynamic response to a meat meal (2 g/kg BW) was studied in 11 healthy children and in 10 children with a mean plasma creatinine concentration of 2.6 +/- 0.1 mg/dl due to chronic renal failure (CRF) of various etiologies. In the healthy status, after a meat meal, the glomerular filtration rate (GFR) increased significantly from a baseline value of 119.0 +/- 5.0 to a peak of 159 +/- 5.8 ml/min x 1.73 m2; in CRF baseline GFR averaged 49 +/- 4.0 and at peak 76.6 +/- 7.2 ml/min x 1.73 m2 (p less than 0.005). The peak GFR response was reached earlier in healthy subjects than in CRF (p less than 0.05) and did not correlate with age or with baseline GFR. Renal plasma flow (RPF) in healthy controls increased from 532 +/- 32 at baseline to 646 +/- 42.9 ml/min x 1.73 m2 after the meal (p less than 0.005). Also in CRF after a meat meal there was a significant increase in RPF from 278 +/- 51 to 65 +/- 66 ml/min x 1.73 m2 (p less than 0.005). The filtration fraction was not affected. The percent increase over baseline values of GFR and RPF at the peak was significantly higher in diseased children. Renal reserve averaged 28.1 +/- 5.3 ml/min in diseased children and 39.7 +/- 5.2 ml/min (p less than 0.01). The data indicate that (1) a meat meal is a suitable method to recruit renal reserve in normal children and in children with chronic renal failure, and (2) the renal reserve is normal in chronic renal failure.

Neuropsychological assessment of functional central nervous system disorders. I. Hemispheric functioning characteristics in schizophrenia and affective illness

The neuropsychological characteristics of a group of schizophrenic and affective patients were assessed by mean of a comprehensive neuropsychological tool, the Luria-Nebraska Neuropsychological Batter (LNNB), to determine the lateralized hemispheric neurofunctional characteristics in major functional central nervous system disorders. The results showed that schizophrenics had more right-hemisphere impairment than affectives. They do not substantiate the hypothesis of right hemisphere-lateralized malfunctioning in functional mood disorders. Psychopharmacological treatment influences neuropsychological test performance, neuroleptics having the greatest effects. Pharmacological effects other than anticholinergic ones are responsible for the negative influence on neuropsychological test performance.

Arylsulphatase activity in the oviduct of the frog Rana esculenta. II. Progesterone-induced changes following ovariectomy and hypophysectomy

The effects of progesterone treatment on arylsulphatase activity were studied histochemically and biochemically in the frog oviduct under different experimental conditions. In ovariectomized animals, the hormone induced a large increase in enzyme activity, while in hypophysectomized ones there was a large decrease in this activity. These results indicate that the facilitatory and inhibitory effects of progesterone on arylsulphatase activity are influenced by the presence in situ of the gonad. Hypotheses are advanced to explain different effects of the progesterone treatment.

Arylsulphatase activity in the oviduct of the frog Rana esculenta. I. Oestradiol-induced changes following ovariectomy and hypophysectomy

The effects of oestradiol treatment on arylsulphatase activity in the frog oviduct are reported. Oestradiol-induced changes were also investigated in ovariectomized and hypophysectomized animals. Under all the experimental conditions, hormonal treatment causes an increase in enzyme activity. This can be observed biochemically and also histochemically on frozen sections. Hypotheses are advanced to explain fluctuations in arylsulphatase activity.

Arylsulphatase activity and cerebroside sulphates in the frog oviduct during the reproductive cycle

The presence of arylsulphatase A and cerebroside sulphates in different tracts of Rana esculenta oviduct during different phases of the reproductive cycle were investigated by histochemical and biochemical procedures. The results indicate that enzyme activity shows seasonal fluctuations connected with the phase of the sexual cycle. The concentrations of cerebroside sulphates (the natural substrates of arylsulphatase A) is related to the activity of this hydrolytic enzyme. The role of arylsulphatase A activity in regulating the substrate concentration, and particularly that of sulphatides, is discussed.

Neurofunctional assessment of lateralized hemispheric asymmetries in affective illness

Performances of 59 affective patients, 59 schizophrenics and 59 normal controls on the Quality Extinction Test (QET), which has been proven to be valuable for detecting abnormal hemisphere functioning in neurological and psychiatric patients, are presented. Frequencies of the left and right extinctions of the affective patients did not exceed those of normal controls. Compared to schizophrenics, fewer affective patients had left and right extinctions and the number of these extinctions was significantly lower in affective patients. These results would indicate that affective patients do not differ from controls relative to lateralized cerebral malfunctioning as measured by the QET. The differences between affective and schizophrenic patients' QET performances may be explained by differences in the course and chronicity of the disease.