Residency Program Directors' Views on Research Conducted During Medical School: A National Survey

PURPOSE

With the United States Medical Licensing Examination Step 1 transition to pass/fail in 2022, uncertainty exists regarding how other residency application components, including research conducted during medical school, will inform interview and ranking decisions. The authors explore program director (PD) views on medical student research, the importance of disseminating that work, and the translatable skill set of research participation.

METHOD

Surveys were distributed to all U.S. residency PDs and remained open from August to November 2021 to query the importance of research participation in assessing applicants, whether certain types of research were more valued, productivity measures that reflect meaningful research participation, and traits for which research serves as a proxy. The survey also queried whether research would be more important without a numeric Step 1 score and the importance of research vs other application components.

RESULTS

A total of 885 responses from 393 institutions were received. Ten PDs indicated that research is not considered when reviewing applicants, leaving 875 responses for analysis. Among 873 PDs (2 nonrespondents), 358 (41.0%) replied that meaningful research participation will be more important in offering interviews. A total of 164 of 304 most competitive specialties (53.9%) reported increased research importance compared with 99 of 282 competitive (35.1%) and 95 of 287 least competitive (33.1%) specialties. PDs reported that meaningful research participation demonstrated intellectual curiosity (545 [62.3%]), critical and analytical thinking skills (482 [55.1%]), and self-directed learning skills (455 [52.0%]). PDs from the most competitive specialties were significantly more likely to indicate that they value basic science research vs PDs from the least competitive specialties.

CONCLUSIONS

This study demonstrates how PDs value research in their review of applicants, what they perceive research represents in an applicant, and how these views are shifting as the Step 1 exam transitions to pass/fail.

Form Follows Function: An Investigation Into the Categorical Boundary of Surprise

The concept of basic emotions has been widely accepted in explaining human behavior. Yet, there is still no consensus on the distinctiveness of surprise. This study tried to compare the discreteness of surprise with that of other basic emotions in terms of their categorical distinctiveness. For this study, 27 undergraduates were recruited, and a new set of morphing sequences of different emotional expressions from two young Chinese posers was created. The results show that surprise is over-generalized to the perception of fear and that the categorical boundary is less discrete than for other emotional expression pairs. This blending is perhaps due to their confusion on both the perceptual and production levels. Additionally, a choice between external and internal validity when picking emotional expression stimuli is also discussed.

Running in fear: an investigation into the dimensional account of emotion in discriminating emotional expressions

Emotion can be conceptualized by the dimensional account of emotion with the dimensions of valence and arousal. There is little discussion of the difference in discriminability across the dimensions. The present study hypothesized that any pair of emotional expressions differing in the polarity of both valence and arousal dimensions would be easier to distinguish than a pair differing in only one dimension. The results indicate that the difference in the dimensions did not affect participants' reaction time. Most pairs of emotional expressions, except those involving fear, were similarly discriminative. Reaction times to pairs with a fearful expression were faster than to those without. The fast reaction time to fearful facial expressions underscores the survival value of emotions.

Solar optics-based active panel for solar energy storage and disinfection of greywater

Smart city and innovative building strategies are becoming increasingly more necessary because advancing a sustainable building system is regarded as a promising solution to overcome the depleting water and energy. However, current sustainable building systems mainly focus on energy saving and miss a holistic integration of water regeneration and energy generation. Here, we present a theoretical study of a solar optics-based active panel (SOAP) that enables both solar energy storage and photothermal disinfection of greywater simultaneously. Solar collector efficiency of energy storage and disinfection rate of greywater have been investigated. Due to the light focusing by microlens, the solar collector efficiency is enhanced from 25% to 65%, compared to that without the microlens. The simulation of greywater sterilization shows that 100% disinfection can be accomplished by our SOAP for different types of bacteria including Escherichia coli. Numerical simulation reveals that our SOAP as a lab-on-a-wall system can resolve the water and energy problem in future sustainable building systems.

Single-step separation of platelets from whole blood coupled with digital quantification by interfacial platelet cytometry (iPC)

We report the efficient single-step separation of individual platelets from unprocessed whole blood, enabling digital quantification of platelet function using interfacial platelet cytometry (iPC) on a chip. iPC is accomplished by the precision micropatterning of platelet-specific protein surfaces on solid substrates. By separating platelets from whole blood using specific binding to protein spots of a defined size, iPC implements a simple incubate-and-rinse approach, without sample preparation, that enables (1) the study of platelets in the physiological situation of interaction with a protein surface, (2) the choice of the number of platelets bound on each protein spot, from one to many, (3) control of the platelet-platelet distance, including the possibility to study noninteracting single platelets, (4) digital quantification (counting) of platelet adhesion to selected protein matrices, enabling statistical characterization of platelet subpopulations from meaningfully large numbers of single platelets, (5) the study of platelet receptor expression and spatial distribution, and (6) a detailed study of the morphology of isolated single platelets at activation levels that can be manipulated. To date, we have demonstrated 1-4 of the above list. Platelets were separated from whole blood using iPC with fibrinogen, von Willebrand factor (VWF), and anti-CD42b antibody printed "spots" ranging from a fraction of one to several platelet diameters (2-24 μm). The number of platelets captured per spot depends strongly on the protein matrix and the surface area of the spot, together with the platelet volume, morphology, and activation state. Blood samples from healthy donors, a May-Hegglin-anomaly patient, and a Glanzmann's Thrombasthenia patient were analyzed via iPC to confirm the specificity of the interaction between protein matrices and platelets. For example, the results indicate that platelets interact with fibrinogen spots only through the fibrinogen receptor (αIIbβ3) and, relevant to diagnostic applications, platelet adhesion correlates strongly with normal versus abnormal platelet function. A critical function of platelets is to adhere to regions of damage on blood vessel walls; in contrast to conventional flow cytometry, where platelets are suspended in solution, iPC enables physiologically relevant platelet bioassays based on platelet/protein-matrix interactions on surfaces. This technology should be inexpensive to implement in clinical assay format, is readily integrable into fluidic microdevices, and paves the way for high-throughput platelet assays from microliter volumes of whole blood.

Note: Characterization of electrode materials for dielectric spectroscopy

When measuring the dielectric properties of aqueous samples, the impedance of the electrode/sample interface can limit low frequency measurements. The electrode polarization problem can be reduced by increasing the effective surface area of the electrodes. In this work, impedance spectroscopy was used to characterize and compare three different electrode surfaces that can be used to mitigate this effect: platinum black, iridium oxide, and [polypyrrole/poly(styrenesulphonate)] (PPy/PSS) conducting polymer. All three materials were directly compared with a bright platinum electrode. Equivalent circuit models were used to extract the increase in the effective surface area of the electrodes: platinum black, iridium oxide and PPy/PSS increase the effective capacitance of the electrode by factors of approximately 240, 75, and 790, respectively. The practical aspects of all electrode materials are discussed. These results suggest that iridium oxide and PPy/PSS are good alternatives to the commonly used platinum black, which is prone to mechanical damage (scratches) and is potentially toxic to cells.

Pantothenate kinase-associated neurodegeneration in two Chinese children: identification of a novel PANK2 gene mutation

Pantothenate kinase-associated neurodegeneration (formerly Hallervorden-Spatz syndrome), the most prevalent form of neurodegeneration with brain iron accumulation, is a rare degenerative brain disease characterised by predominantly extrapyramidal dysfunction resulting from mutations in the PANK2 (pantothenate kinase 2) gene. Using DNA mutation analysis, the authors identified a novel missense mutation (P354L) in exon 4 of the PANK2 gene in an adolescent with classic pantothenate kinase-associated neurodegeneration. DNA-based diagnosis of pantothenate kinase-associated neurodegeneration plays a key role in determination, and can make the diagnosis more simply, directly, and economically because it obviates the need for unnecessary biochemical tests. Once pantothenate kinase-associated neurodegeneration-like symptoms are identified, mutation analysis and target screening for the family of the proband can provide efficient and accurate evidence of pantothenate kinase-associated neurodegeneration inheritance.

Spectral tuning of localised surface plasmon-polariton resonance in metallic nano-crescents

The utilisation of plasmonic effects in metallic nanostructures is gaining importance for applications in molecular sensing. Of special interest is the local field enhancement effect, which enables surface-enhanced Raman scattering and significantly boosts the sensitivity of the Raman technique. For in vivo biological research, the ability to excite the resonance of localised surface plasmon-polaritons within the biological window is often desired. A new nanostructure called the nano-crescent is introduced and exhibits strong plasmonic activities within the biological window using a novel intra-particle plasmonic coupling scheme.

Optimization of binding electrostatics: charge complementarity in the barnase-barstar protein complex

Theoretical and experimental studies have shown that the large desolvation penalty required for polar and charged groups frequently precludes their involvement in electrostatic interactions that contribute strongly to net stability in the folding or binding of proteins in aqueous solution near room temperature. We have previously developed a theoretical framework for computing optimized electrostatic interactions and illustrated use of the algorithm with simplified geometries. Given a receptor and model assumptions, the method computes the ligand-charge distribution that provides the most favorable balance of desolvation and interaction effects on binding. In this paper the method has been extended to treat complexes using actual molecular shapes. The barnase-barstar protein complex was investigated with barnase treated as a target receptor. The atomic point charges of barstar were varied to optimize the electrostatic binding free energy. Barnase and natural barstar form a tight complex (K(d) approximately 10(-14) M) with many charged and polar groups near the interface that make this a particularly relevant system for investigating the role of electrostatic effects on binding. The results show that sets of barstar charges (resulting from optimization with different constraints) can be found that give rise to relatively large predicted improvements in electrostatic binding free energy. Principles for enhancing the effect of electrostatic interactions in molecular binding in aqueous environments are discussed in light of the optima. Our findings suggest that, in general, the enhancements in electrostatic binding free energy resulting from modification of polar and charged groups can be substantial. Moreover, a recently proposed definition of electrostatic complementarity is shown to be a useful tool for examining binding interfaces. Finally, calculational results suggest that wild-type barstar is closer to being affinity optimized than is barnase for their mutual binding, consistent with the known roles of these proteins.

A linear relation between the compressibility and density of blood

By considering the blood as a mixture of ultrafiltrate and protein concentrate, the additive nature of compressibility and density from the components is utilized to deduce a linear relation between the compressibility and density for blood. This deduction also indicates that the intercept and slope of the linear relation are independent of the hematocrit, plasma protein concentration, and hemoglobin concentration of red blood cells. To verify experimentally this linear relation, saline and plasma dilutions on porcine or canine blood flowing in an extracorporeal circuit were carried out. The hematocrit of the experiments ranges from 0% to 55% and the plasma protein concentration ranges from 10 to 90 g/l. A resonance device in the circuit measured the density rhob of blood at 37 degrees C and an ultrasound system measured the sound velocity cb. The range of density is from 1,010 to 1,060 g/l and that of sound velocity is from 1,530 to 1,580 m/s. The linear relation that best fits the data of compressibility [computed as (rhob cb(2))-1] and density has a correlation coefficient of 0.9978. The linear relation is found to fit well the dependence of compressibility on density derived from the sound velocity data of human, horse, and porcine blood in the literature.

Barstar is electrostatically optimized for tight binding to barnase

We used a novel charge optimization technique to study the small ribonuclease barnase and to analyze its interaction with a natural tight binding inhibitor, the protein barstar. The approach uses a continuum model to explicitly determine the charge distributions that lead to the most favorable electrostatic contribution to binding when competing desolvation and interaction effects are included. Given its backbone fold, barstar is electrostatically optimized for tight binding to barnase when compared with mutants where residues have been substituted with one of the 20 common amino acids. Natural proteins thus appear to use optimization of electrostatic interactions as one strategy for achieving tight binding.

Computation of electrostatic complements to proteins: a case of charge stabilized binding

Recent evidence suggests that the net effect of electrostatics is generally to destabilize protein binding due to large desolvation penalties. A novel method for computing ligand-charge distributions that optimize the tradeoff between ligand desolvation penalty and favorable interactions with a binding site has been applied to a model for barnase. The result is a ligand-charge distribution with a favorable electrostatic contribution to binding due, in part, to ligand point charges whose direct interaction with the binding site is unfavorable, but which make strong intra-molecular interactions that are uncloaked on binding and thus act to lessen the ligand desolvation penalty.

Modeling the myocardial dilution curve of a pure intravascular indicator

The dispersion and dilution of contrast medium through the myocardial vasculature is examined first with a serial model comprised of arterial, capillary, and venous components in series to determine their time-concentration curves (TCC) and the myocardial dilution curve (MDC). Analysis of general characteristics shows that the first moment of the MDC, adjusted for that of the aortic TCC and mean transit time (MTT) from the aorta to the first intramyocardial artery, is one-half the MTT of the myocardial vasculature and that the ratio of the area of the MDC and aortic TCC is the fractional myocardial blood volume (MBV). The use of known coronary vascular morphometry and a set of transport functions indicates that the temporal change in MDC is primarily controlled by the MTT. An analysis of several models with heterogeneous flow distributions justifies the procedures to calculate MTT and MBV from the measured MDC. Compared with previously described models, the present model is more general and provides a physical basis for the effects of flow dispersion and heterogeneity on the characteristics of the MDC.

Assessing microvascular volume change and filtration from venous hematocrit variation of canine liver and lung

The volume increase of canine liver after 1 min of a 10 mmHg elevation in hepatic venous pressure has been reported as 251 ml/kg tissue. An analysis of the transient hematocrit variation in hepatic venous blood indicated that 16% of the volume change results from transcapillary filtration, 72% from microvascular expansion, and 12% from macrovascular expansion. In the analysis, we first used the temporal change of the liver volume to determine the time course of the filtration and microvascular and macrovascular volume change. We next deduced, for a permeable microcirculation with a microvascular hematocrit lower than the feed hematocrit (the Fahraeus effect), how the filtration and microvascular volume change (MVC) produce a hematocrit variation in the blood leaving microcirculation. By accounting for the dispersion of the blood flow, the analysis predicted a hematocrit variation in the hepatic venous blood that matched well with the measured variation over the 1-min course of experiment. A reasonable fit with the hematocrit variation of pulmonary blood also was obtained for experiment with an 8 mm/Hg increase in the arterial and venous pressure perfusing the canine left lower lung lobe. The tissue and vascular volume increase at 1 min was 149 ml/kg tissue with 4% as a result of filtration, 41% as a result of microvascular expansion, and 55% as a result of macrovascular expansion. The large MVCs from the hepatic and pulmonary circulation indicate their microcirculations function as a reservoir in controlling blood volume redistribution.

A simple and efficient treatment for fingertip injuries

We have developed a simple, cheap and efficient method of management of fingertip injuries using an occlusive dressing--the fingertip cap (Hyphecan). The results of 156 fingertip injuries treated with this method demonstrate recovery to a near normal fingertip.

Fluid restitution and blood volume redistribution in anesthetized rabbits in response to vasoactive drugs

BACKGROUND

Vasoactive drugs could alter the fluid restitution from the tissue and redistribute blood volume between the macrocirculation and microcirculation.

METHODS AND RESULTS

With bolus injections of vasoactive drugs in anesthetized rabbits, we measured the changes in blood and plasma density for the determination of the volume of restitution and redistribution. Epinephrine 3.5 micrograms/kg caused a fluid loss to the tissue, leading to a transient decrease in total blood volume by 2.30 mL/kg. Because of blood volume redistribution, the peak volume reduction was accompanied by a volume reduction of 0.81 mL/kg from the macrocirculation and 1.49 mL/kg from the microcirculation. Phenylephrine 70 micrograms/kg caused a peak reduction in total blood volume of 1.40 mL/kg (with 0.41 mL/kg from macrocirculation and 0.99 mL/kg from microcirculation). Nitroprusside 7 micrograms/kg increased the blood volume by 1.44 mL/kg (0.83 mL/kg macro and 0.61 mL/kg micro), nitroglycerin 7 micrograms/kg by 1.48 mL/kg (0.97 mL/kg macro and 0.51 mL/kg micro), and isoproterenol 7 micrograms/kg by 2.07 mL/kg (0.68 mL/kg macro and 1.39 mL/kg micro). All plasma (or blood) density changes measured for the five drugs (with epinephrine, phenylephrine, and nitroprusside done over a wide dosage range) correlated linearly with the drug-induced changes in arterial pressures.

CONCLUSIONS

These results indicate that vasoactive drugs alter total blood volume and the volume of microcirculation and macrocirculation.

Blood volume redistribution from a passive elastic permeable microcirculation due to hypovolemia

We measured the variations in blood and plasma density for a cyclic hemorrhage protocol in conscious rabbits to calculate delta Vf [the volume of fluid restituted into the circulation from the time the blood volume was at its control to that after the hemorrhage of a blood volume (delta V)] and delta Vs (the volume shift from micro- to macrocirculation over the same time interval). We found that delta Vf is 7% of delta V and delta Vs 60% of delta V. They combine to reduce the effect of hemorrhage on macrovascular volume by 67% of delta V. Based on a two-resistor circulation model, the change in microcirculatory pressure (delta Pmic) from control to hemorrhage was estimated from the measured cardiac outputs and arterial and venous pressures. The computations indicate that delta Vs (or delta Vf) is linearly related to delta Pmic. With one relation fitting all data of rabbits that were conscious, infused with hexamethonium, and anesthetized with pentobarbital sodium, we concluded that the two short-term volume redistributions are not direct neural control or local regulation, but the response of a passive, permeable microcirculation to delta Pmic. From the linear relations, we obtained 0.88 ml.mmHg-1.kg-1 as the compliance of the rabbit microcirculation and 0.21 ml.min-1.mmHg-1.kg-1 as its filtration coefficient.

A density method for determining plasma and red blood cell volume

We employed a highly sensitive density measuring system to measure the decrease in blood density and plasma density due to the infusion of a saline bolus into the rabbit's circulation. Based on a vasculature model with the Fahraeus effect, we deduced a set of equations to calculate from the density decreases the red-blood-cell volume and plasma volume of the rabbit. A value of 0.82 +/- 0.02 was obtained for Fcell, the ratio of the hematocrit calculated from the two volumes and the arterial hematocrit.

Fluid restitution and shift of blood volume in anesthetized rabbits subject to cyclic hemorrhage

We investigated the effect of a 10% cyclic blood volume change with a period of 2 or 4 min to study the short-term control of blood volume. In experiments with pentobarbital-anesthetized rabbits, the blood density variation over a 2-min cycle is 0.94 +/- 0.04 (SE) g/l, and the plasma density variation is 0.17 +/- 0.04 g/l. The plasma density variation could result from a fluid restitution from the extravascular space (with a density 1,005 g/l), with a volume equal to 14% of the withdrawn blood volume. This restitution cannot account, however, for the entire observed density change in arterial blood. Because of the Fahraeus effect in microvascular flow, a shift in blood volume from the microvasculature is another mechanism that could lead to a decrease in the density of arterial blood. An analysis of the blood and plasma density variations indicates that a blood volume (49% of the shed volume) is shifted from the micro- to macrocirculation. This volume compensation by fluid restitution and volume shift acts to minimize the effect of hemorrhage on the filling of the venous system. We found that the blood density waveform parallels the change in blood volume. When the blood volume change reverses its direction, the density change also reverses direction with a time delay less than 8 s. The blood density variations are not altered by bilateral vagotomy or its combination with hexamethonium (a sympathetic ganglionic blocker). These observations of anesthetized rabbits indicate that the short-term compensation is primarily due to the volume shift from the microcirculation and is not regulated by humoral or neural mechanisms but by local mechanisms such as autoregulation and the passive response due to changes in microvascular pressure.

Effect of hemodilution on ventilatory fluctuations of pulmonary capillary blood volume

By diluting the hematocrit (Ha) in the rabbit's circulation without changing its blood volume, we found that the ventilatory-induced fluctuation (delta rho) in the density of aortic blood and Ha (which was in the range of 8-39%) are related by this linear regression: delta rho = 0.63 g/l (-0.009 + Ha). In this hemodilution experiment, the rabbits were ventilated by an intermittent positive pressure of 6 mmHg at a frequency of 30-35 cycles/min. Based on the Fahraeus effect for capillary blood flows and the dispersion of the density indicator in the rabbit's central circulation, we computed from the fluctuation of the measured density within a ventilation cycle the fluctuation of pulmonary capillary blood volume and found it to be 4.1 +/- 0.4% of the capillary blood volume for all hematocrits. Since the same fluctuation in the airway pressure was used to induce the volumetric fluctuation, its independence of Ha indicates that the hemodilution has no effect on the viscoelasticity of pulmonary capillaries.

Respiratory effect on the blood volume of pulmonary capillaries

We measured the density variations of aortic blood from rabbits ventilated by a positive end inspiratory pressure of 6 mmHg or a negative box pressure of the same magnitude. When calculated from the density variations, the fluctuations in blood volume of the pulmonary capillaries within one cycle as induced by an intermittent positive pressure ventilation were found to be similar to the ones induced by an intermittent negative pressure ventilation. Using these volumetric fluctuations as a means to assess the transpulmonary pressure and the transmural pressure across the pulmonary capillaries, we conclude that the switching of the ventilation method did not alter the cyclic fluctuations of these pressures.

Time shift in ventilation-induced density fluctuation of arterial blood

In an artificially ventilated dog, the varying tracheal pressure causes a density fluctuation in the blood sampled from the aorta. We cross-correlated the tracheal pressure with the density to determine the time shift or delay of the latter from the former waveform for a ventilation frequency in the range of 6-30 CPM. The delay time was found to be 29% of the mean transit time (MTT) of the pulmonary vasculature and independent of the ventilation frequency. A comparison of this percentage with the reported arterial-to-capillary-to-venous fractional volumes of the lung suggested that the delay time may be the MTT time for blood flowing through the venous network of the lung and the cross-correlation may serve as an in vivo means to partition the MTT of the pulmonary vasculature at its capillaries. These results and an analysis on the deformation of the viscoelastic, pulmonary capillaries indicated that the tracheal pressure, acting primarily through the viscous part of the viscoelasticity, deforms the capillaries to produce the density fluctuation in blood outflowing from the lung.

Ventilatory changes of pulmonary capillary blood volume assessed by arterial density

By use of an improved density measuring system, we found that the gravimetric density of arterial blood of dogs fluctuates at the same frequency as the spontaneous or mechanical ventilation. Similar density fluctuations were observed in the blood leaving isolated, perfused lobes of dogs that were ventilated cyclicly. Employing an analysis that balanced the erythrocyte and plasma flows through distensible capillaries containing blood with a tube hematocrit lower than the hematocrit in large blood vessels, we derived a relationship to estimate from the density fluctuation the change in pulmonary capillary blood volume (Vc). For mechanical ventilation, the maximum change in density over one ventilation cycle increased from 0.084 +/- 0.01 to 0.47 +/- 0.05 (SE) g/l as the frequency decreased from 29 to 6 cycles/min. These density changes were estimated to be the result of an 1-16% change in Vc. A larger tidal volume for the mechanical ventilation led to a larger density fluctuation. The maximum density change of spontaneous respiration of 6 cycles/min was one-sixth of the mechanical case, indicating a much smaller change in Vc during spontaneous respiration. When the airway flow resistance was increased for spontaneous respiration, larger density fluctuations were observed.

A density method to quantify pulmonary microvascular hematocrit

We perfused the left lower lobe of a dog with autologous blood having a hematocrit Ha. When the vascular pressure perfusing the lobe was elevated, we observed a transient increase in the density of venous blood. Converting the density increase to a rise in hematocrit, we could calculate a volume (Vr) of red blood cells (RBC) over their normal outflow that was released by the lobe as a result of the elevation. We measured the weight gain of the lobe to determine the increase in pulmonary vascular volume, V' - V. We found that the ratio, Vr/Ha/(V' - V), is 0.11 +/- 0.02. To determine the implication of this ratio, we divided the lobular vasculature into an arterial, microvascular, and venous compartment. Due to the Fahraeus effect, the tube hematocrit in the microvascular compartment (Hc) is lower than that of two macrovascular compartments, Ha. An analysis on the balance of RBC and plasma flows through the lobe identified the volume Vr as (Vc' - Vc) (Ha - Hc) with Vc' - Vc being the volumetric increase of the lobular microvascular compartment. Based on the reported volumetric fractional change of microvascular compartment, we estimated that the microvascular (tube) hematocrit in pulmonary capillaries is 80% (ranging from 78 to 82%) of the hematocrit perfusing the lobe. Since the additional RBC volume (Vr) being released from the lobe cannot be accounted for by transcapillary filtration or capillary recruitment, we conclude from this analysis that the measurement of the transient density change in pulmonary outflow can be used to quantify the microvascular hematocrit of the lung.

Serum enzymes in the BB rat before and after onset of the overt diabetic syndrome

As part of a six-month prospective study of the effects of neonatal thymectomy in the spontaneously diabetic BB Wistar rat, activities of the following enzymes were determined: alkaline phosphatase (AP), lactate dehydrogenase (LDH), creatine phosphokinase (CPK), glutamic-oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT) and UDP-galactosyltransferase (UDPG). In prediabetics, AP and LDH levels were higher than in sham-operated, non-diabetic controls; however, this increase was seen in nearly all diabetes-prone BB rats, diminishing the usefulness of these changes in discerning potential diabetics from asymptomatic, diabetes-prone rats. After onset of the syndrome, there was a striking elevation of AP values in all diabetics with no similar alteration in asymptomatic, diabetes-prone rats suggesting this was a diabetes-related phenomenon. By contrast, UDPG was the only enzyme to decrease immediately following the onset of the syndrome. Both UDPG and AP levels correlated with blood glucose, the former negatively and the latter positively, suggesting a close relationship with changes occurring after onset of the syndrome. The remaining enzymes increased only in a portion of diabetics alone (GOT, GPT) or in a portion of both diabetics and asymptomatic, diabetes-prone BB rats (LDH, CPK).

Comparison of four commercial methods for the determination of fast hemoglobins

The performance of three commercial kits, based on microchromatographic techniques for the determination of glycosylated hemoglobins (fast hemoglobins) has been evaluated. All three kits showed good precision, provided the laboratory temperature remained constant. Temperature variations of even one degree C had a profound effect on the kits from Helena Laboratories and Isolab Inc., while the one from BIO-RAD Laboratories was less influenced. The use of the temperature correction tables provided by Helena Laboratories and Isolab Inc., improved the reproducibility of their results significantly. Since there is no designated reference method, an evaluation of accuracy was not possible. The absolute values for fast hemoglobins, as measured by the three microchromatographic kits, differed from each other. Also, when a series of specimens from diabetic patients and from healthy control subjects were compared, the relative ratios of the results obtained from the three kits differed from specimen to specimen. However, there was no overlap between results from diabetic and control specimens. The performance of the electrophoretic method of Corning Medical Co. was also evaluated.

Transferred pulmonary surfactant film: chemical analysis and contact angle study

The Langmuir dip plate transfer technique was adapted to isolate the interfacial film formed at the surface of lung wash. The chemical analysis of the film showed that the weight ratio of lipid to protein of this surfactant film and its content of surface active substances were higher than those of lung wash. It was found that the wettability of the surfactant film could be simulated by a Dipalmitoyl lecithin and albumin film. When the surfactant film was transferred at condensed state (one of low air-lung-wash surface tension), we found the film exhibited a low critical surface tension which indicates the dominance of the lipid in the outer most layer of the film. On the other hand, insignificant amount of lipid was found in the film transferred at expanded state (one of high surface tension) and its surface behavior was shown to be similar to that of a protein film.

Serum UDP-galactose: glycoprotein galactosyltransferase in diabetics with microangiopathy

1. Levels of serum UDP-galactose:glycoprotein galactosyltransferase in 117 unselected diabetics were compared with those in 60 non-diabetic healthy controls. 2. Enzyme activity (mean +/- 2 S.D.) of control sera was found to be 90.2 +/- 21.5 etamoles/ml/hr at 37 degrees. In 30 of the 117 diabetic sera (26%) enzyme activity was elevated (greater than mean + 2 S.D. of the controls). Sixteen of 19 (84%) patients with retinopathy, 16 of 26 (62%) patients with peripheral vasculopathy and 13 of 26 (50%) patients with neuropathy had higher levels of serum enzyme. When serum enzyme levels of groups of diabetics with retinopathy, peripheral vasculopathy and neuropathy were compared with the enzyme level in all diabetics, there was a significant difference with p values of 0.001, 0.05 and 0.05 respectively.

Temperature effect on the permeability of plasma membranes of advanced germinal cells of the rat testis

Advanced germinal cells (spermatocytes and spermatids) prepared from adult rat testes, but not other cells, released their cellular contents into the incubation medium when they were incubated at 37° at a physiological pH. Evidence was presented that the release of cellular contents was due to changes in the permeability of the plasma membranes of these cells. The hypothesis is advanced that the changes in the permeability of the plasma membranes of the advanced testicular germinal cells of the rat may be intimately associated with the cellular degeneration and cessation of spermatogenesis which occur in cryptorchid testes.

Factors controlling ketogenesis by rat liver mitochondria

Factors controlling the rates of ketogenesis by intact rat liver mitochondria have been investigated. High rates of ketone body formation were obtained with (−)-palmitoylcarnitine (20–120 μM) as substrate, but much lower rates were observed when pyruvate (0.33–1.66 mM) or (−)-acetylcarnitine (0.33–1.00 mM) was substrate. Concentrations of CoA-SH, acetyl-CoA, and long-chain acyl-CoA have been determined in mitochondria incubated with each of these substrates in the absence of metabolic inhibitors. In general, rates of ketogenesis increased as CoA-SH levels fell. Although acetyl-CoA concentrations increased in mitochondria incubated in the presence of low concentrations of (−)-palmitoylcarnitine (below 40 μM), they decreased when higher concentrations of (−)-palmitoylcarnitine were employed. This lowering of acetyl-CoA levels occurred concomitantly with an increase in concentrations of long-chain acyl-CoA and a decrease in CoA-SH levels.In soluble mitochondrial fractions obtained after sonication, CoA-SH addition inhibited acetoacetate formation. The ratio of [acetyl-CoA]/[CoA-SH] and the concentrations of CoA-SH were shown to be of greater importance in the regulation of ketogenesis than was the concentration of acetyl-CoA. Additional factors controlling rates of ketogenesis are discussed in relation to data presented. For example, the [acetyl-CoA]/[CoA-SH] ratio was considerably elevated when pyruvate or (−)-acetylcarnitine was substrate, but at such ratios the rates of ketogenesis were far lower than when (−)-palmitoylcarnitine was the substrate. It was calculated that the "apparent Km" of acetoacetyl-CoA for ketone body formation in intact rat liver mitochondria was approximately 10−9 M when (−)-palmitoylcarnitine was the substrate but it was significantly higher when (−)-acetylcarnitine and pyruvate were substrates.

Hepatic ketogenesis during development

Livers from fetal rats were shown to have lower rates of ketogenesis from acetate, acetylcarnitine, pyruvate, octanoate, and palmitate than liver preparations from adult animals. The enzymes required for ketogenesis from acetyl-CoA were demonstrated to be nonlimiting in fetal livers. The maximal ketogenic activity by disrupted mitochondria incubated with an acetyl-CoA-generating system was one-third or more of that observed in liver mitochondrial fractions prepared from adult rats.The enzymes required for fatty acid oxidation were also shown to be present in liver mitochondria from fetal rats. Although rates of ketogenesis from octanoate and palmitate were low, ketogenesis from octanoylcarnitine was over 60% of that observed in liver mitochondria from adult rats.During late fetal development and shortly after birth, the maximal hepatic ketogenic-forming activity increased rapidly, with the increase occurring completely in mitochondrial and not in cytosol fractions. The enzymes involved with ketone body formation were shown to remain within mitochondrial particles which had been stripped of their outer membranes. Levels of carnitine acetyltransferase were measured in livers from developing rats, and results were compared with previous observations on changes in activities of carnitine palmitoyltransferase.