African Ancestry-Associated Gene Expression Profiles in Triple-Negative Breast Cancer Underlie Altered Tumor Biology and Clinical Outcome in Women of African Descent

Women of sub-Saharan African descent have disproportionately higher incidence of triple-negative breast cancer (TNBC) and TNBC-specific mortality across all populations. Population studies show racial differences in TNBC biology, including higher prevalence of basal-like and quadruple-negative subtypes in African Americans (AA). However, previous investigations relied on self-reported race (SRR) of primarily U.S. populations. Due to heterogeneous genetic admixture and biological consequences of social determinants, the true association of African ancestry with TNBC biology is unclear. To address this, we conducted RNA sequencing on an international cohort of AAs, as well as West and East Africans with TNBC. Using comprehensive genetic ancestry estimation in this African-enriched cohort, we found expression of 613 genes associated with African ancestry and 2,000+ associated with regional African ancestry. A subset of African-associated genes also showed differences in normal breast tissue. Pathway enrichment and deconvolution of tumor cellular composition revealed that tumor-associated immunologic profiles are distinct in patients of African descent.

SIGNIFICANCE

Our comprehensive ancestry quantification process revealed that ancestry-associated gene expression profiles in TNBC include population-level distinctions in immunologic landscapes. These differences may explain some differences in race-group clinical outcomes. This study shows the first definitive link between African ancestry and the TNBC immunologic landscape, from an African-enriched international multiethnic cohort. See related commentary by Hamilton et al., p. 2496. This article is highlighted in the In This Issue feature, p. 2483.

Abstract P3-20-08: Does contralateral prophylactic mastectomy improve survival in triple negative breast cancer?

Background: Despite increased incidence of contralateral prophylactic mastectomy (CPM), there is insufficient evidence that it improves survival in women at average risk for breast cancer. In addition to BRCA1/2 mutation carriers, patients with estrogen-receptor negative tumors have been examined as a subgroup that may seek to benefit from CPM. In this study, we sought to investigate whether CPM improves survival in patients with triple negative breast cancer (TNBC).Study Design: Survival outcomes were evaluated for all TNBC patients from a multi-institutional database from 1999-2018 at New York Presbyterian - Weill Cornell Medical Center and Henry Ford Health System. Median follow-up time was 44.4 months.Results: 802 TNBC patients were evaluated. The median age was 57 years. 17% patients underwent CPM. Factors associated with CPM were White American race, younger age, presence of lymphovascular invasion (LVI), lack of mammography screen-detection, mastectomy surgery, postoperative adjuvant radiotherapy, and having had genetic testing. A borderline significant trend was observed in improved overall survival among patients undergoing CPM versus those not having CPM (5-year OS 95.1% vs. 85.0%; p = 0.05). Subset analysis of patients younger than 50 years of age at diagnosis demonstrated no improvement in overall survival for patients undergoing CPM versus those that declined CPM (94.3% v. 88.7%; p = 0.21). Conclusion: Our data demonstrate a trend in improved 5-year overall survival in TNBC patients undergoing CPM. However, in patients younger than 50 years at diagnosis, CPM did not confer a survival advantage.

Citation Format: Genevieve A Fasano, Solange Bayard, Yalei Chen, Jennifer Marti, Rache Simmons, Alexander Swistel, Jessica Bensenhaver, S David Nathanson, Lindsay Petersen, Erica Proctor, Melissa Davis, Lisa Newman. Does contralateral prophylactic mastectomy improve survival in triple negative breast cancer? [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-20-08.

Investigation of triple-negative breast cancer risk alleles in an International African-enriched cohort

Large-scale efforts to identify breast cancer (BC) risk alleles have historically taken place among women of European ancestry. Recently, there are new efforts to verify if these alleles increase risk in African American (AA) women as well. We investigated the effect of previously reported AA breast cancer and triple-negative breast cancer (TNBC) risk alleles in our African-enriched International Center for the Study of Breast Cancer Subtypes (ICSBCS) cohort. Using case-control, case-series and race-nested approaches, we report that the Duffy-null allele (rs2814778) is associated with TNBC risk (OR = 3.814, p = 0.001), specifically among AA individuals, after adjusting for self-indicated race and west African ancestry (OR = 3.368, p = 0.007). We have also validated the protective effect of the minor allele of the ANKLE1 missense variant rs2363956 among AA for TNBC (OR = 0.420, p = 0.005). Our results suggest that an ancestry-specific Duffy-null allele and differential prevalence of a polymorphic gene variant of ANKLE1 may play a role in TNBC breast cancer outcomes. These findings present opportunities for therapeutic potential and future studies to address race-specific differences in TNBC risk and disease outcome.

Outcome of African-American compared to White-American patients with early-stage breast cancer, stratified by phenotype

BACKGROUND

Breast cancer mortality rates are 39% higher in the African-American (AA) women compared to White-American (WA) women despite the advances in overall breast cancer screening and treatments. Several studies have undertaken to identify the factors leading to this disparity in United States with possible effects of lower socioeconomic status and underlying aggressive biology.

METHODS

A retrospective analysis was done using a prospectively maintained database of a metropolitan health system. Patients were selected based on diagnosis of early-stage breast cancer between 10/1998 and 02/2017, and included women over age of 18 with clinically node-negative disease. Patients were then stratified by phenotype confirmed by pathology and patient-identified race.

RESULTS

A total of 2,298 women were identified in the cohort with 39% AA and 61% WA women. The overall mean age at the time of diagnosis for AA women was slightly younger at 60 years compared to 62 years for WA women (p = 0.003). Follow-up time was longer for the WA women at 95 months vs. 86 months in AA women. The overall 5-year survival was analyzed for the entire cohort, with the lowest survival occurring in patients with triple-negative breast cancer (TNBC). Phenotype distribution revealed a higher incidence of TNBC in AA women compared to WA women (AA 16% vs. WA 10%; p < 0.0001). AA women also had higher incidence of HER2 positive cancers (AA 16.8% vs. WA 15.3%; p < 0.0001). WA women had a significantly higher distribution of Non-TNBC/HER2-negative phenotype (AA 55% vs. WA 65%; p < 0.0001). Furthermore, a subgroup analysis was done for a sentinel lymph node (SLN) negative cohort that showed higher rates of grade 3 tumors in AA (AA 35% vs. WA 23%; p < 0.0001); and higher rates of grade 1 and grade 2 tumors in WA (30% vs. 21% and 44% vs. 40%). Despite higher grade tumors in AA women, five-year overall survival outcomes in SLN-negative cohort did not differ between AA and WA women when stratifying based on tumor subtype.

CONCLUSION

Breast cancer survival disparities in AA and WA women with SLN-negative breast cancer are diminished when evaluated at early-stage cancers defined by SLN-negative tumors. Our evaluation suggests that when diagnosed early, phenotype does not contribute to racial survival outcomes. The lower survival rate in AA women with breast cancer may be attributed to later stage biology between the two races, or underlying socioeconomic disparities.

Evaluation of a Multidisciplinary Team Approach for Generating Survivorship Care Plan Treatment Summaries in Patients With Breast Cancer

INTRODUCTION:

The optimal structure for survivorship care plan (SCP) programs and methodology for generating treatment summaries (TSs) has not yet been defined, but the Commission on Cancer and the National Accreditation Program for Breast Centers both mandate that participating oncology programs implement SCP-TS processes for patients that have completed treatment.

METHODS:

We used the Institute for Healthcare Improvement’s Plan-Do-Study-Act model for conducting a quality improvement project evaluating two different SCP-TS programs implemented at the Henry Ford Health System/Henry Ford Cancer Institute’s Breast Oncology Program in Detroit, Michigan. System I involved TSs drafted by nonspecialist breast clinic staff; System II involved TSs vetted through a multidisciplinary breast specialist conference approach. Accuracy of basic documentation entries related to dates and components of treatment were compared for the two approaches.

RESULTS:

Seventy-one System I and 93 System II documents were reviewed. Documentation was accurate in at least 90% of documents for both systems regarding delivery of chemotherapy and/or endocrine therapy and for documenting the identity of the various members of the cancer treatment team. Both systems had notable inaccuracies in documenting type of surgery performed, but System II had fewer inaccuracies than System I (33.78% v 51.67%, respectively; P = .05). System II, compared with System I, had fewer inaccuracies in documenting date of diagnosis (9.68% v 25.35%, respectively; P = .01) and had less missing information for dose of radiation delivered (9.33% v 33.9%, respectively; P < .01).

CONCLUSION:

A multidisciplinary team approach to drafting and reviewing SCP-TS documents improved content accuracy for our program, but ongoing education regarding documentation of various surgical procedures is warranted.

Utilization of the 21-Gene Recurrence Score in a Diverse Breast Cancer Patient Population: Development of a Clinicopathologic Model to Predict High-Risk Scores and Response to Neoadjuvant Chemotherapy

INTRODUCTION

The 21-gene expression profile [Oncotype DX Recurrence Score (RS)] stratifies benefit from adjuvant chemotherapy in hormone receptor (HR)-positive, HER2/neu-negative, node-negative breast cancer. It is not routinely applied to predict neoadjuvant chemotherapy (NACT) response; data in diverse patient populations also are limited. We developed a statistical model based on standard clinicopathologic features to identify high-risk cases (RS > 30) and then evaluated ability of predicted high RS to predict for NACT downstaging.

METHODS

Primary surgery patients with Oncotype DX RS testing 2012-2016 were identified from a prospectively-maintained database. A RS predictive model was created and applied to a dataset of comparable NACT patients. Response was defined as tumor size decrease ≥ 1 cm.

RESULTS

Of 394 primary surgery patients-60.4% white American; 31.0% African American-RS distribution was similar for both groups. No single feature reliably identified high RS patients; however, a model accounting for age, HR expression, proliferative index (MIB1/Ki67), histology, and tumor size was generated, with receiver operator area under the curve 0.909. Fifty-six NACT patients were identified (25 African American). Of 21 cases with all relevant clinicopathology, 14 responded to NACT and the model generated high-risk RS in 14 (100%); conversely, of 16 cases generating high-risk RS, only 2 did not respond.

CONCLUSIONS

Predictive modelling can identify high RS patients; this model also can identify patients likely to experience primary tumor downstaging with NACT. Until this model is validated in other datasets, we recommend that Oncotype-eligible patients undergo primary surgery with decisions regarding chemotherapy made in the adjuvant setting.

Association Between Benign Breast Disease in African American and White American Women and Subsequent Triple-Negative Breast Cancer

Importance

Compared with white American (WA) women, African American (AA) women have a 2-fold higher incidence of breast cancers that are negative for estrogen receptor, progesterone receptor, and ERBB2 (triple-negative breast cancer [TNBC]). Triple-negative breast cancer, compared with non-TNBC, likely arises from different pathogenetic pathways, and benign breast disease (BBD) predicts future non-TNBC.

Objective

To determine whether AA identity remains associated with TNBC for women with a prior diagnosis of BBD.

Design, Setting, and Participants

This study is a retrospective analysis of data of a cohort of 2588 AA and 3566 WA women aged between 40 and 70 years with a biopsy-proven BBD diagnosis. The data-obtained from the Pathology Information System of Henry Ford Health System (HFHS), an integrated multihospital and multispecialty health care system headquartered in Detroit, Michigan-include specimens of biopsies performed between January 1, 1994, and December 31, 2005. Data analysis was performed from November 1, 2015, to June 15, 2016.

Main Outcomes and Measures

Subsequent breast cancer was stratified on the basis of combinations of hormone receptor and ERBB2 expression.

Results

Case management, follow-up, and outcomes received or obtained by our cohort of 2588 AA and 3566 WA patients were similar, demonstrating that HFHS delivered care equitably. Subsequent breast cancers developed in 103 (4.1%) of AA patients (mean follow-up interval of 6.8 years) and 143 (4.0%) of WA patients (mean follow-up interval of 6.1 years). More than three-quarters of subsequent breast cancers in each subset were ductal carcinoma in situ or stage I. The 10-year probability estimate for developing TNBC was 0.56% (95% CI, 0.32%-1.0%) for AA patients and 0.25% (95% CI, 0.12%-0.53%) for WA patients. Among the 66 AA patients who developed subsequent invasive breast cancer, 16 (24.2%) developed TNBC compared with 7 (7.4%) of the 94 WA patients who developed subsequent invasive breast cancers and had complete biomarker data (P = .01).

Conclusions and Relevance

This study is the largest analysis to date of TNBC in the context of racial/ethnic identity and BBD as risk factors. The study found that AA identity persisted as a significant risk factor for TNBC. This finding suggests that AA identity is associated with inherent susceptibility for TNBC pathogenetic pathways.

Comparative Analysis of Breast Cancer Phenotypes in African American, White American, and West Versus East African patients: Correlation Between African Ancestry and Triple-Negative Breast Cancer

INTRODUCTION

Triple-negative breast cancer (TNBC) is more common among African American (AA) and western sub-Saharan African breast cancer (BC) patients compared with White/Caucasian Americans (WA) and Europeans. Little is known about TNBC in east Africa.

METHODS

Invasive BC diagnosed 1998-2014 were evaluated: WA and AA patients from the Henry Ford Health System in Detroit, Michigan; Ghanaian/west Africans from the Komfo Anokye Teaching Hospital in Kumasi, Ghana; and Ethiopian/east Africans from the St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia. Histopathology and immunohistochemistry for estrogen receptor (ER), progesterone receptor (PR), and HER2/neu expression was performed in Michigan on formalin-fixed, paraffin-embedded samples from all cases.

RESULTS

A total of 234 Ghanaian (mean age 49 years), 94 Ethiopian (mean age 43 years), 272 AA (mean age 60 years), and 321 WA (mean age 62 years; p = 0.001) patients were compared. ER-negative and TNBC were more common among Ghanaian and AA compared with WA and Ethiopian cases (frequency ER-negativity 71.1 and 37.1 % vs. 19.8 and 28.6 % respectively, p < 0.0001; frequency TNBC 53.2 and 29.8 % vs. 15.5 and 15.0 %, respectively, p < 0.0001). Among patients younger than 50 years, prevalence of TNBC remained highest among Ghanaians (50.8 %) and AA (34.3 %) compared with WA and Ethiopians (approximately 16 % in each; p = 0.0002).

CONCLUSIONS

This study confirms an association between TNBC and West African ancestry; TNBC frequency among AA patients is intermediate between WA and Ghanaian/West Africans consistent with genetic admixture following the west Africa-based trans-Atlantic slave trade. TNBC frequency was low among Ethiopians/East Africans; this may reflect less shared ancestry between AA and Ethiopians.

Characterizing Breast Cancer in a Population with Increased Prevalence of Triple-Negative Breast Cancer: Androgen Receptor and ALDH1 Expression in Ghanaian Women

BACKGROUND

The androgen receptor (AR) is a commonly-expressed hormone receptor in breast cancer and may be a marker of response to targeted anti-androgen therapy, a particularly attractive option for triple-negative breast cancer (TNBC). Gene expression studies suggest that ARs may distinguish a luminal/AR TNBC subtype from stem cell-like subtypes. TNBC frequency is two to three times higher in African American and African breast cancers compared with White American and European breast cancers, yet little is known regarding TNBC subtypes in high-frequency African-ancestry populations. We evaluated ARs and the mammary stem cell marker aldehyde dehydrogenase 1 (ALDH1) among breast cancers from Ghana, Africa.

METHODS

Overall, 147 formalin-fixed, paraffin-embedded invasive breast cancers from the Komfo Anoyke Teaching Hospital in Ghana were studied at the University of Michigan, and analyzed immunohistochemically for estrogen receptor (ER), progesterone receptor (PR), HER2/neu, ALDH1, and AR expression.

RESULTS

The median age of patients was 45 years. Only 31 cases (21 %) were ER-positive, and 14 (10 %) were HER2-positive; 89 (61 %) were TNBCs. For the entire group, 44 % were AR-positive and 45 % were ALDH1-positive. ER/PR-positive tumors were more likely to be AR-positive compared with ER/PR-negative tumors (87 vs. 26 %; p < 0.0001), but there was no association between ALDH1 and AR expression. Among the TNBC cases, 45 % were ALDH1-positive and 24 % were AR-positive. ALDH1 positivity was associated with AR positivity within the subset of TNBC (36 vs. 14 %; p = 0.019).

CONCLUSION

We confirmed other studies showing a high frequency of TNBC in Africa. Surprisingly, ALDH1 was found to correlate with AR expression among TNBC, suggesting that novel TNBC subtypes may exist among populations with African ancestry.

The Notch pathway is important in maintaining the cancer stem cell population in pancreatic cancer

BACKGROUND

Pancreatic cancer stem cells (CSCs) represent a small subpopulation of pancreatic cancer cells that have the capacity to initiate and propagate tumor formation. However, the mechanisms by which pancreatic CSCs are maintained are not well understood or characterized.

METHODS

Expression of Notch receptors, ligands, and Notch signaling target genes was quantitated in the CSC and non-CSC populations from 8 primary human pancreatic xenografts. A gamma secretase inhibitor (GSI) that inhibits the Notch pathway and a shRNA targeting the Notch target gene Hes1 were used to assess the role of the Notch pathway in CSC population maintenance and pancreatic tumor growth.

RESULTS

Notch pathway components were found to be upregulated in pancreatic CSCs. Inhibition of the Notch pathway using either a gamma secretase inhibitor or Hes1 shRNA in pancreatic cancer cells reduced the percentage of CSCs and tumorsphere formation. Conversely, activation of the Notch pathway with an exogenous Notch peptide ligand increased the percentage of CSCs as well as tumorsphere formation. In vivo treatment of orthotopic pancreatic tumors in NOD/SCID mice with GSI blocked tumor growth and reduced the CSC population.

CONCLUSION

The Notch signaling pathway is important in maintaining the pancreatic CSC population and is a potential therapeutic target in pancreatic cancer.

Effect of neoadjuvant chemoradiotherapy (nCRT) on survival in patients with borderline resectable (BR) pancreatic adenocarcinoma (PDA) with acceptable peri-operative morbidity

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Background: The impact of nCRT for patients (pts) with BR PDA has been debated, with wide variation in practice. Most studies in pts undergoing nCRT have no or historic controls, rather than a direct comparison of BR pts treated in the same era. We aimed to assess the effect of nCRT on operative, pathologic, and survival endpoints in pts with BR PDA. Methods: 241 pts underwent pancreatectomy (177 without and 64 with nCRT) for PDA (2001-2011). CT scans at dx were re-reviewed by a pancreatic radiologist using a standardized template. Pts were categorized as resectable, BR, or unresectable according to 2012 NCCN criteria. BR pts (n=74) were extracted for analysis. Survival was compared using log-rank tests; pathologic features and peri-op factors were compared using Wilcoxon rank sum tests (continuous variables) or Fisher's exact test (binary variables). Results: Median follow up was 26 ±21 months. nCRT was associated with higher 1 and 3 yr OS, lower margin and node positivity, decreased pre-op CA19-9, and lower post-op pancreatic fistula (POPF), with higher operative time, vascular reconstructions, and transfusion (PRBCs). On univariate analysis, POPF negatively impacted survival (HR 2.34, 1.16-4.75, p=0.02) as did pre-op CA19-9>150 U/mL (HR 2.11, 1.16-3.87, p=0.015). Conclusions: Pts receiving nCRT for BR PDA had higher 1 and 3 yr OS, more negative margins, and fewer positive nodes, with minimal additional peri-op co-morbidity, compared with pts going directly to surgery. These data support consideration of enrolling all pts with BR PDA into a neoadjuvant program prior to resection. [Table: see text]

Bmi1 enhances tumorigenicity and cancer stem cell function in pancreatic adenocarcinoma

Background

Bmi1 is an integral component of the Polycomb Repressive Complex 1 (PRC1) and is involved in the pathogenesis of multiple cancers. It also plays a key role in the functioning of endogenous stem cells and cancer stem cells. Previous work implicated a role for cancer stem cells in the pathogenesis of pancreatic cancer. We hypothesized that Bmi1 plays an integral role in enhancing pancreatic tumorigenicity and the function of cancer stem cells in pancreatic ductal adenocarcinoma.

Methods

We measured endogenous Bmi1 levels in primary human pancreatic ductal adenocarcinomas, pancreatic intraepithelial neoplasias (PanINs) and normal pancreas by immunohistochemistry and Western blotting. The function of Bmi1 in pancreatic cancer was assessed by alteration of Bmi1 expression in several cell model systems by measuring cell proliferation, cell apoptosis, in vitro invasion, chemotherapy resistance, and in vivo growth and metastasis in an orthotopic model of pancreatic cancer. We also assessed the cancer stem cell frequency, tumorsphere formation, and in vivo growth of human pancreatic cancer xenografts after Bmi1 silencing.

Results

Bmi1 was overexpressed in human PanINs, pancreatic cancers, and in several pancreatic cancer cell lines. Overexpression of Bmi1 in MiaPaCa2 cells resulted in increased proliferation, in vitro invasion, larger in vivo tumors, more metastases, and gemcitabine resistance while opposite results were seen when Bmi1 was silenced in Panc-1 cells. Bmi1 was overexpressed in the cancer stem cell compartment of primary human pancreatic cancer xenografts. Pancreatic tumorspheres also demonstrated high levels of Bmi1. Silencing of Bmi1 inhibited secondary and tertiary tumorsphere formation, decreased primary pancreatic xenograft growth, and lowered the proportion of cancer stem cells in the xenograft tissue.

Conclusions

Our results implicate Bmi1 in the invasiveness and growth of pancreatic cancer and demonstrate its key role in the regulation of pancreatic cancer stem cells.

P2-08-06: Improved Spatial Resolution Diffusion-Weighted Imaging for Characterizing Tumors and Treatment Response in Patients with Invasive Breast Cancer

Background: Diffusion weighted magnetic resonance imaging (DWI) is a non-invasive technique that is sensitive to tissue microstructure. Previous studies have shown that DWI adds positive predictive value in diagnostic studies of breast cancer and it has been shown to predict tumor response to neoadjuvant chemotherapy. While DWI shows promise for evaluating breast cancer, the technique suffers from limitations. Specifically, image distortion is common with the echo planar sequence available for DWI on clinical scanners, and spatial resolution is lower than that of other MRI sequences. Our group has optimized a high-resolution reduced field-of-view DWI acquisition, originally developed for the spine by Saritas et al., for breast imaging. The goal of this work was to compare high resolution (hr)-DWI) to standard resolution (std)-DWI for characterizing breast tumors.

Methods: Patients undergoing neoadjuvant chemotherapy were scanned with MRI before, during and after neoadjuvant chemotherapy as part of IRB-approved studies at our institution. Nine women were scanned with both hr-DWI and std-DWI before and after one cycle of chemotherapy. Apparent diffusion coefficient (ADC) maps were calculated from hr-DWI and std-DWI data using previously described methods. One tumor region of interest (ROI) was defined on the hr-DWI slice estimated to contain the largest tumor area. This tumor ROI was then applied to the corresponding slice and location on the std-DWI and hr-DWI ADC maps. Mean tumor ADC as well as 15th, 25th, 50th, 75th, and 90th percentile ADCs were calculated for both DWI acquisitions for all subjects.

Results: The mean tumor ADC values measured prior to treatment were similar for the hr-DWI and std-DWI acquisitions, however there was a significant difference between hr- and std-DWI 15th and 25th percentile ADC values (p= 0.0495, p=0.0717) For the early treatment time point, significant differences between the two DWI acquisitions were found for: mean tumor ADC, 15th, 25th, and 50th percentiles (p=0.0302, 0.0075, 0.0212, and 0.0488, respectively), with the most significant difference found for the lowest (15th) percentile measured. Tumor hr-DWI ADCs were consistently lower than std-DWI ADCs.

Discussion: These data show that although the mean ADC values calculated from the pre-treatment hr-DWI and std-DWI are similar, the lower percentile (15th, and 25th) ADC values are significantly lower for the hr-DWI acquisition. Our results also showed larger difference in lower percentile ADC values between the two sequences after one cycle of chemotherapy. The differences in the lower percentile ADC values calculated from the hr-DWI are consistent with reduced partial voluming between viable tumor tissue, which is characterized low ADC values, and normal fibroglandular tissue. This may be particularly important for post-treatment ADC measurements where tumor size may decrease, potentially making partial volume effects more pronounced. Continuing studies are evaluating the relationship between low percentile ADC values from hr-DWI and tumor stage and response to treatment.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-08-06.

Configuration of services used by depressed older adults

As a more comprehensive service use measure, this study identifies service use configurations based on the use of 17 services. Factors associated with service use configurations are examined guided by the Andersen and Network Episode models. Self-report data at admission and at six-month follow-up were collected, along with information from medical charts among 140 older adults hospitalized for major depression. The data document service access and levels of use in three sectors of care (psychiatric, medical, and psychosocial services) and assess need, predisposing, enabling, and social network factors associated with use. Three distinct service use configurations were identified with cluster analysis: (1) home care users; (2) moderate users of outpatient mental health services; and (3) heavy users of all formal services. Rather than psychiatric needs, post-acute service use was related to: (1) concurrent physical conditions; (2) the availability of formal and informal services; and (3) financial stability. No difference in psychiatric outcomes was found by service use configuration. It is important to understand service use patterns as a measure of service use, given the co-occurring medical, psychiatric, and psychosocial conditions of older adults and corresponding needs in multiple sectors of care.

Characterization of Salmonella enterica subspecies I genovars by use of microarrays

Subspecies 1 of Salmonella enterica is responsible for almost all Salmonella infections of warm-blooded animals. Within subspecies 1 there are over 2,300 known serovars that differ in their prevalence and the diseases that they cause in different hosts. Only a few of these serovars are responsible for most Salmonella infections in humans and domestic animals. The gene contents of 79 strains from the most prevalent serovars were profiled by microarray analysis. Strains within the same serovar often differed by the presence and absence of hundreds of genes. Gene contents sometimes differed more within a serovar than between serovars. Groups of strains that share a distinct profile of gene content can be referred to as "genovars" to distinguish them from serovars. Several misassignments within the Salmonella reference B collection were detected by genovar typing and were subsequently confirmed serologically. Just as serology has proved useful for understanding the host range and pathogenic manifestations of Salmonella, genovars are likely to further define previously unrecognized specific features of Salmonella infections.

MR image-guided investigation of regional signal transducers and activators of transcription-1 activation in a rat model of focal cerebral ischemia

BACKGROUND AND PURPOSE

STAT-1 is a member of a family of proteins called signal transducers and activators of transcription (STATs), and recent studies have shown its involvement in the induction of apoptosis. There is limited information on the role of STAT-1 following stroke. In this study we use MRI measurements of cerebral perfusion and bioenergetic status to target measurements of regional STAT-1 activity.

METHODS

Rats were subjected to 60 or 90 min of middle cerebral artery occlusion with and without reperfusion. MRI maps of the apparent diffusion coefficient of water and cerebral blood flow were acquired throughout the study. After the ischemia or reperfusion period, the brain was excised and samples were analyzed by Western blots using anti-phospho-STAT1 and anti-Fas antibodies. Regions were selected for analysis according to their MRI characteristics.

RESULTS

Transcriptional factor STAT-1 was enhanced in the lesion core and, to a lesser extent, in the lesion periphery, following ischemia and reperfusion. This level of activity was greater than for ischemia alone. Western blots demonstrated STAT-1 phosphorylation on tyrosine 701 and not serine 727 after ischemia and 3 h of reperfusion. Enhanced expression of the apoptotic death receptor Fas was confirmed after ischemia followed by reperfusion.

CONCLUSIONS

This study demonstrates that focal ischemia of the rat brain can induce STAT-1 activation, particularly following a period of reperfusion. The activation occurs not only in the lesion core, but also in the lesion periphery, as identified using MRI. STAT-1 may play an important role in the induction of cell death following stroke.

How much is enough? Perspectives of care recipients and professionals on the sufficiency of in-home care

PURPOSE OF THE STUDY

This study sought to increase knowledge about the impact of rater role on the assessment of in-home supportive care. The authors compared the perspectives of care recipients and professionals on one aspect of the broad concept of quality of care in home care-the sufficiency of the amount of care provided by informal and formal caregivers.

DESIGN AND METHOD

Sufficiency of home care was assessed through concurrent elderly persons' self-report through telephone interview and nurse clinical report based on in-home interviews with the elder. Care was assessed in terms of the sufficiency of the amount of informal and formal assistance received to meet functional dependency needs. Statistical analyses compared the ratings of elder and professional.

RESULTS

Professional ratings of the sufficiency of care were significantly lower than those of the elderly care recipients. From the perspective of both care recipients and professionals, sufficiency of care was significantly related to coresidence of elder and caregiver, and to caregiver health.

IMPLICATIONS

Consistent with previous literature, rater role was found to influence the assessment of the sufficiency of in-home care. Researchers and providers should recognize that care recipient and professional ratings are not interchangeable.

Moderate hypothermia ameliorates liver energy failure after intestinal ischaemia-reperfusion in anaesthetised rats

BACKGROUND/PURPOSE

Intestinal ischaemia-reperfusion (IR) can cause liver failure. The aims of this work were to study the effects of intestinal IR on liver energy metabolism and to evaluate the effects of moderate hypothermia.

METHODS

Intestinal IR (90-minute intestinal ischaemia plus 60-minute or 240-minute reperfusion) was achieved by clamping and unclamping the superior mesenteric artery in rats. Normothermia or moderate hypothermia (30 degrees to 33 degrees C) was maintained by adjusting the environmental temperature. The ratio of hepatic inorganic phosphate to adenosine triphosphate (ATP) was monitored continuously during intestinal IR using in vivo phosphorus ((31)P) magnetic resonance spectroscopy. Phosphorus metabolites also were measured in extracts prepared from freeze-clamped liver and intestine.

RESULTS

Mortality occurred exclusively during normothermic intestinal IR. A progressive increase in the hepatic inorganic phosphate to ATP ratio after normothermic intestinal IR was observed. Moderate hypothermia delayed this effect. Analysis of liver extracts confirmed above findings. However, there was no difference in intestinal phosphocreatine or ATP between normothermic and hypothermic rats undergoing intestinal IR.

CONCLUSIONS

Intestinal IR at normothermia was associated with liver energy failure and high mortality rate. Moderate hypothermia ameliorated liver energy failure but did not attenuate intestinal energy failure after intestinal IR. Hypothermia may prove to be useful in the management of patients with intestinal IR injuries in the future.

Proton nuclear magnetic resonance spectroscopy of lactate production in isolated rat liver during cold preservation

Lactate-edited 1H NMR difference spectra have been acquired from intact rat liver tissue following flushing and preservation in ice. A peak, initially at 1.26 ppm, was seen to increase in the liver tissue with preservation time. This peak was assigned to lactate, despite the fact that its chemical shift was initially shifted by approximately -0.1 ppm relative to an externally added standard. The assignment was based on the following: (a) the peak increased over a 24-h ischemic storage period; (b) it was coupled to a signal 2.78 +/- 0.02 ppm upfield; and (c) a parallel increase in lactate was noted in perchloric acid extracts of tissue from the same liver. An additional peak, assigned to alanine, was also observed during storage and was also shifted by approximately -0.1 ppm. Inclusion of dimethyl sulfoxide, which readily permeates liver tissue, demonstrated that this chemical shift alteration was a tissue-specific effect. These results demonstrate that 1H NMR spectroscopy of intact liver tissue during hypothermic ischemia is possible, though chemical shift assignments should be made with caution.

Hypothermic perfusion preservation of liver: the role of phosphate in stimulating ATP synthesis studied by 31P NMR

Hypothermic perfusion of rat livers was investigated by 31phosphorus nuclear magnetic resonance (31P NMR) spectroscopy using a temperature-controlled module that allowed data acquisition at various time points during a 48-h period. The livers were perfused with an oxygenated lactobionate/raffinose-based solution containing adenosine and inorganic phosphate, and changes in tissue oedema were monitored by direct on-line measurements of liver weight changes. Liver tissue ATP concentrations, determined by fluorimetric assay, were low immediately after organ removal, probably reflecting metabolic stress during the removal period, and these increased slightly during the next 3 h. This was reflected by changes in the 31P NMR spectra. However, by 24 h ATP levels had increased significantly, and these were maintained for up to 48 h, suggesting a shift in the balance between energy production and consumption. When inorganic phosphate was replaced by another anion (citrate), ATP was maintained at a constant lower level during perfusion for 48 h. Tissue weight changes were similar in both groups, suggesting that volume control was not affected by the different ATP contents of the livers. By combining the temperature-controlled module with a separate perfusion circuit, NMR spectroscopy can provide a sensitive method for following energy metabolism in the same organ over long periods during hypothermic perfusion.

Resuscitation of cardiac energy metabolism in the rabbit heart by brief hypothermic reperfusion after preservation studied by 31P NMR spectroscopy

Rabbit hearts were subjected to 24-h cold ischaemic storage (at 0 degree-2 degrees C in melting ice) after initial flushing with either St Thomas' cardioplegic solution (STS) or modified lactobionate/raffinose solution (LR), and the status of phosphorylated energy metabolites was measured by 31phosphorus nuclear magnetic resonance (P NMR) spectroscopy. In both groups signals for ATP and phosphocreatine (PCr) were still detectable by 31P NMR after 24 h, and there was significantly more ATP in the LR group (P < 0.01). The hearts were then subjected to coronary reperfusion via an aortic cannula using the same storage solution (either STS or LR) at 6 degrees-8 degrees C, which was oxygenated. In both groups PCr recovered within 30 min of cold reperfusion, and by 60 min PCr was significantly higher in the LR group (P < 0.001). Also, levels of ATP were maintained at higher values during cold reperfusion i the LR group. These studies suggest two important points: (1) the general supply of phosphorylated high-energy intermediates of hearts during cold ischaemic storage is better preserved using LR, and (2) brief cold reperfusion may be used to restore energy metabolism in hearts before re-implantation.

Registration of images from sequential MR studies of the brain

For sequential studies of patients with brain tumors, the authors have designed an automated registration procedure for intra- and interexamination alignment of magnetic resonance images. This was evaluated with artificially misregistered data and data from repeat studies of six healthy volunteers and six brain tumor patients. In a subset of cases, a manual procedure based on matching of neuroanatomic landmarks was also applied for comparison. The results showed that the technique is robust and reproducible, giving an accuracy in the range of 1-2 mm, which corresponded to the spatial resolution of the images. Subject motion between imaging sequences within the same study was negligible, although adjustments (one to two section thicknesses) were required in the z direction to correlate multisection and volume images and to allow accurate image segmentation. For alignment between sequential volunteer and patient examinations, translations of up to 22 mm and rotations in the x, y, and z axes of up to 9 degrees were required. This alignment procedure may be valuable in numerous aspects of treatment planning and patient follow-up.

Discharge destinations of Medicare patients receiving discharge planning: who goes where?

This study aims to increase knowledge about factors affecting discharge destinations of Medicare patients leaving the hospital after receiving discharge planning services. Medical, social, financial, and demographic factors are tested in relation to three dispositions: home, nursing home, and rehabilitation unit. Polytomous logistic regression was used to assess the likelihood of going to one destination versus another. For both nursing home versus home and rehabilitation unit versus home, destination was a function of first medical and then financial factors, with social resources playing a lesser role in the models. The only demographic variable with a significant relationship to destination was race, with black patients less likely to enter nursing home settings.

Evaluation of cold reperfusion as an indicator of viability in stored organs: a 31P NMR study in rat liver

Rat livers were studied during hypothermic resuscitation perfusion using 31P nuclear magnetic resonance (NMR) spectroscopy as a viability index. Livers were stored for 48 h after being flushed either with a synthetic solution containing plasma-equivalent concentrations of cations, plus citrate and including gelatin polypeptides as colloid (GC solution), or with a modified lactobionate/raffinose [University of Wisconsin (UWC)] solution. After 48 h in either solution, all NMR-detectable ATP plus ADP had disappeared, inorganic phosphate had increased markedly and pH in the livers had become acidotic. During cold reperfusion, ATP was resynthesized, inorganic phosphate declined, and pH returned toward normal values. ATP recovery and decrease in tissue inorganic phosphate were significantly greater (P < 0.02 and P < 0.005, respectively) after 1 h cold reperfusion with the modified UW compared with reperfusion with the GC. 31P NMR spectroscopy was able to detect differences in the metabolic responses of livers stored in different solutions, and coupled with cold reperfusion may be a useful indicator of viability.

Control of intracellular pH in mammalian liver at hypothermia: evidence for a relationship with energy metabolism

The metabolic status of rat livers during hypothermia has been studied using 31P magnetic resonance spectroscopy. Perfusion with oxygenated buffer at 6-8 degrees C allowed maintenance of ATP, while pH increased to values in the range 7.7-7.9. In organs depleted of ATP by a short (2 h) period of cold ischemia, pH fell to 6.92 +/- 0.10. If these livers were reperfused with hypoxic buffer at hypothermia, two distinct responses were noted. In one group (responders), there was evidence of ATP resynthesis and in these organs pH returned to 7.90 +/- 0.28. In the second group (non-responders), there was no recovery of ATP synthesis and pH remained depressed at 6.97 +/- 0.07. In another group, adenine nucleotides were severely depleted by 24 h of cold ischemia, and in these livers there was again no significant recovery of ATP synthesis during hypoxic reperfusion and pH remained at 7.03 +/- 0.25. These results suggest that (a) there is an apparent relationship between energy metabolism and control of intracellular pH in the hypothermic mammalian liver, and (b) that intracellular pH may shift in liver at hypothermia to values predicted by the alpha-stat hypothesis.

Flow pattern analysis in the abdominal aorta with velocity-encoded cine MR imaging

The sites of deposition of atherosclerotic plaque on the aortic wall are considered to be influenced by secondary and retrograde flow patterns that cause regions of altered shear stress. To detect secondary flow patterns and areas of retrograde flow in the abdominal aorta, velocity-encoded cine (VEC) magnetic resonance (MR) imaging was performed at five different levels of the abdominal aorta in nine healthy volunteers. Net retrograde flow (expressed as a percentage of antegrade flow) increased from proximal to distal levels and was maximal (13.8% +/- 11.8) just distal to the origin of the renal arteries. An increase in the duration of retrograde flow over the cardiac cycle was observed from proximal to distal levels. Whereas retrograde flow was present at end systole and early diastole in each volunteer at every level, the duration and amount of retrograde flow during diastole showed high interindividual variation. Such differences suggest the possibility of variable vascular geometric risk factors in the population for the development of atherosclerotic plaque. The location of retrograde flow in the abdominal aorta demonstrated in vivo with VEC MR imaging was close to that obtained with in vitro flow visualization studies in models of the abdominal aorta.

Controllable graded cerebral ischaemia in the gerbil: studies of cerebral blood flow and energy metabolism by hydrogen clearance and 31P NMR spectroscopy

A technique for remotely controlling the degree of carotid artery occlusion in the gerbil model of cerebral ischaemia has been developed. The technique relies on manually adjustable nylon snares around the carotid arteries, in conjunction with a computer-based monitoring system, to control the degree of occlusion. This has allowed us to determine the dependence of energy metabolism (as assessed by 31P NMR spectroscopy) on blood flow in greater detail than was possible in our previous studies. Data obtained show that energy changes first appear at flows of 25-30 mL/100 g/min, while at flows below 20 mL/100 g/min there is a major derangement of energy metabolism. The model was used to determine the sensitivity of cerebral energy metabolism to reduced cerebral blood flow under normothermic conditions and in mild hypothermia (30 degrees C). Hypothermia had a protective effect in that energy metabolites were maintained at flows significantly below the normothermic threshold.

Seroprevalence survey of borreliosis in children with chronic arthritis in British Columbia, Canada

A seroprevalence survey using an indirect immunofluorescence assay (IFA) for IgG antibodies to Borrelia hermsii and Borrelia burgdorferi was conducted for varied pediatric chronic arthritis patients and a nonrheumatic control group in the province of British Columbia, Canada. Overall, a higher rate of sera with IFA titers > or = 1/256 was found for B. hermsii (36.6%) compared to B. burgdorferi (12.5%). There were no significant differences among the arthritis subgroups and controls for the distribution of IFA titers for either organism. IgG immunoblotting of selected high titered sera to either borrelia species confirmed the lack of specificity of the IFA assay. Serological tests for borreliosis should be cautiously interpreted in children with chronic arthritis.

Patient and family satisfaction with discharge plans

This study explored factors affecting patient and family satisfaction with discharge plans, an outcome of discharge planning provided by the hospital department of social work. Adequacy of discharge plans was rated by 126 patients and 130 family members within 24 hours before hospital discharge. Patient ratings of discharge plans were related to their degree of involvement in decision making, social support networks (sex and marital status), and physical condition (diagnosis and functional ability). Three types of factors were important to family members: 1) factors related to the discharge planning process, 2) the patient's discharge destination, and 3) length of patient hospital stay. Findings are discussed in terms of their implications on maximizing consumer satisfaction in the cost-conscious environment.

Cell and tissue responses of a murine tumour to phthalocyanine-mediated photodynamic therapy

Mice bearing a subcutaneously growing tumour (Colo 26) were injected intravenously with the photosensitiser chloroaluminum sulphonated phthalocyanine (5 mg/kg) 24 h prior to irradiating the tumour with laser light (675 nm; 50mW, 100 J/tumour). Energy status of the tumour, as assessed by the loss of high energy phosphates in the 31P-nuclear magnetic resonance spectra, was altered dramatically following treatment, such that the ATP fell to undetectable levels within 1 h of light irradiation. However, assessment of the clonogenic capacity of neoplastic cells isolated from dissociated tumours showed that these rapid changes in cellular metabolism were not reflected in similar rapid changes in cell viability. Reductions in clonogenic capacity, which fell to less than 0.1% of control values at 24h postirradiation, closely mirrored those resulting from the cessation of vascular perfusion. Evaluation of tumour blood flow, using the technique of hydrogen washout, showed that the treatment protocol evoked a gradual and selective reduction in flow within the tumour resulting in complete vascular stasis by approximately 5 h after treatment. The results indicate that while chloroaluminum sulphonated phthalocyanine-mediated photodynamic therapy caused early metabolic damage in neoplastic cells, loss of viability paralleled the induction of complete inhibition of vascular flow in the tumour.

Restoration of energy metabolism and resolution of oedema following profound ischaemia

Cerebral ischaemia was produced in 2 groups of gerbils by occlusion of the common carotid arteries for 30 minutes, resulting in cerebral oedema. In group 1 cerebral oedema was measured by specific gravity microgravimetry, and in group 2 brain metabolism and blood flow were measured by 31P and 1H NMR spectroscopy and hydrogen clearance respectively. In group 1 the brain water content did not return to control levels by 180 minutes of reperfusion. Energy metabolism, determined by 31P NMR spectroscopy returned to control by 12 minutes, intracellular pH (pHi) by 20 minutes, and lactate, determined by 1H NMR spectroscopy, by 50 minutes. There was a lag of about 10 minutes before lactate began to be cleared from the brain. We suggest that while pHi is low, Na+/H+ exchange will negate the Na+ extrusion driven by the Na+/K+ ATPase. When pHi approaches normal there will be a net extrusion of Na+, taking osmotic water with it, and presumably with passive washout of lactate. This may be the cause of the initial delay in lactate clearance.

The response of liver to lactobionate/raffinose (University of Wisconsin--UW) solution during hypothermic preservation: a study using 31phosphorus nuclear magnetic resonance

31P nuclear magnetic resonance spectroscopy has been used to study rat livers following flushing with the University of Wisconsin (UW) lactobionate/raffinose solution (N. Jamieson, R. Sundberg, S. Lindell, J. Southard, and F.O. Belzer, Cryobiology 24, 573-574, 1987; M. Kalayoglu, H. Sollinger, R. Stratta, A. D'Alessandro, R. Hoffman, J. Pirsch, and F. O. Belzer, Lancet 1, 617-619, 1988). These studies have revealed that despite the improved storage properties that have been reported for this solution, hepatic ATP and ADP declined at a rate similar to that seen in the more commonly used Marshall's or Collins' solutions. However, there was a significant inhibition of the developing acidosis, such that by 5 hr postflush, the intracellular pH was 7.17 +/- 0.06 (mean +/- SD, n = 5) compared to 6.90 +/- 0.06 for Marshall's solution (4 hr postflush) and 6.94 +/- 0.04 for Collins' solution (4 hr postflush). This did not appear to be due to a buffering effect of the solution, as this was found to be relatively low, but was probably due to a modification of hepatic metabolism caused by the solution itself.

31P nuclear magnetic resonance of rat pancreatic grafts

This study investigates whether phosphate metabolite concentrations and intracellular pH alter in early acute rejection of rat pancreatic allografts. In vitro biochemical assays, in vitro 31P nuclear magnetic resonance spectroscopy, and in vivo 31P NMR spectroscopy of the grafts were compared. Duct-ligated, vascularized rat pancreatic isografts and allografts were transplanted onto the infrarenal aorta of the recipients with inferior vena cava venous drainage. In order to obtain reproducible acute rejection, allografting was performed across a major histocompatibility barrier. For the in vitro experiments freeze-clamped graft extracts were prepared and analyzed for adenosine triphosphate concentration by fluorimetry, then placed in an 8.5 Tesla vertical bore magnet. 31P NMR spectra were recorded using a Bruker AM 360 spectrometer operating at 145.7 MHz for 31P. Spectra were acquired from nontransplanted controls; 3-day, 5-day, and 1-month posttransplant isografts, and 3-day and 5-day posttransplant allografts. All grafts examined were functioning satisfactorily. The ATP content of the extracts was significantly lower in the 3- and 5-day allografts than the respective isografts. Invasive in vivo 31P NMR spectra were recorded using surface coils adjacent to the grafts from functioning 5-day posttransplant isografts and allografts (i.e., 3 days prior to an expected elevation in blood sugar from acute rejection in the allografts). The ATP/inorganic phosphate ratios and pH from the in vivo spectra were significantly lower in the allografts than in the isografts. It is concluded that changes in intracellular metabolism occur early in the process of acute rejection and that 31P NMR spectroscopy may provide a means of diagnosing this before current methods.

Studies on cryoprotectant equilibration in the intact rat liver using nuclear magnetic resonance spectroscopy: a noninvasive method to assess distribution of dimethyl sulfoxide in tissues

Nuclear magnetic resonance (NMR) spectroscopy was used in the study of rat livers following flushing with a clinically used preservation solution containing either 12 or 30% (v/v) Me2SO. The extent of equilibration of Me2SO in the tissue after 10-15 min of perfusion with Me2SO and again after subsequent washout with Me2SO-free medium was assessed by 1H NMR spectroscopy. 31P NMR spectroscopy was used to follow the changes in ATP, ADP, inorganic phosphate, and tissue pH. The data show that 1H NMR spectroscopy can be used as a sensitive and rapid method of assessing the equilibration and concentration of compounds such as Me2SO, since these compounds are likely to be present at concentrations greatly in excess of other constituents of the medium and will therefore give rise to strong, easily detected signals. At the same time, 31P NMR spectroscopy can be used to monitor the metabolic status of the tissue reflected in the levels of ATP, ADP, and inorganic phosphate, as well as being a noninvasive monitor of intracellular pH. The possibility of determining the tissue pH in the presence of solutes such as Me2SO is discussed.

Acute cerebral ischaemia: concurrent changes in cerebral blood flow, energy metabolites, pH, and lactate measured with hydrogen clearance and 31P and 1H nuclear magnetic resonance spectroscopy. III. Changes following ischaemia

CBF has been measured with the hydrogen clearance technique in the two cerebral hemispheres of the gerbil under halothane anaesthesia. At the same time, intracellular pH and the concentrations of lactate and high-energy phosphates were measured in the brain using 1H and 31P nuclear magnetic resonance spectroscopy. Flow and metabolism have been followed during either a 15- or a 30-min ischaemic period (induced by bilateral carotid occlusion) and for up to 1 h of recovery. There was no significant difference between the flow characteristics of the two experimental groups. High-energy phosphate levels and pH returned to control within approximately 20 min of the end of the ischaemic period. Lactate clearance, following a 30-min occlusion, was slower than the recovery of pH. The concentration of free ADP, calculated from the creatine kinase equilibrium, was lower during the recovery phase than under control conditions.

Quantitative estimation of lactate in the brain by 1H NMR

1H NMR was used to detect lactate accumulation in the intact gerbil brain postmortem. The lactate concentration was estimated from the spectra by comparison to signals from N-acetylaspartate, creatine + phosphocreatine, and water. The effects of T2, phase modulation, and solvent suppression were taken into account. The estimated concentrations were compared to determinations performed on the same brains after extraction. The lactate concentration estimated from the intact brain spectra was between 70 and 90% of the values determined in vitro, on the extracts, depending on the concentration standard used. If N-acetylaspartate was used as the standard then the proportion of detected lactate (92%) was not significantly different from 100%.

Acute cerebral ischaemia: concurrent changes in cerebral blood flow, energy metabolites, pH, and lactate measured with hydrogen clearance and 31P and 1H nuclear magnetic resonance spectroscopy. II. Changes during ischaemia

CBF has been measured with the hydrogen clearance technique in the two cerebral hemispheres of the gerbil under halothane anesthesia. This has been correlated with changes in local pH, tissue lactate, and phosphorus energy metabolites measured in the same animals with 1H and 31P nuclear magnetic resonance spectroscopy. We demonstrate a threshold flow value for the metabolic changes associated with energy failure at a level similar to the values previously reported for electrical failure and tissue water accumulation, but higher than that associated with breakdown of extracellular potassium homeostasis.

Intracellular metabolites in rat muscle following trauma: a 31P and 1H nuclear magnetic resonance study

Hind limb skeletal muscle was studied in vivo in a rat trauma model using nuclear magnetic resonance (NMR) spectroscopy. The model used was a 25% body surface area, full-thickness burn administered under anaesthesia. Two groups of six rats were studied. Weight loss was observed in the experimental group whilst the control group continued to gain weight. Concentration ratios involving intramyocellular phosphocreatine (PCr), creatine (Cr), adenosine triphosphate (ATP), inorganic phosphate (Pi), anserine (Ans) and taurine (Tau) were measured. No change in the ratios of PCr/Pi, PCr/ATP, Ans/PCr + Cr and Tau/PCr + Cr were seen between the two groups. Intracellular pH was the same in the two groups. NMR spectroscopy in vivo gives values of Pi and PCr that differ from those obtained by conventional techniques. NMR values are probably more accurate as no degradation occurs during measurement, the measurements being repeatable and noninvasive.

Acute cerebral ischaemia: concurrent changes in cerebral blood flow, energy metabolites, pH, and lactate measured with hydrogen clearance and 31P and 1H nuclear magnetic resonance spectroscopy. I. Methodology

CBF has been measured with the hydrogen clearance technique in the two cerebral hemispheres of the gerbil under halothane anaesthesia. This has been correlated with changes in local pH, tissue lactate, and phosphorus energy metabolites measured in the same animals with 1H and 31P nuclear magnetic resonance (NMR) spectroscopy. The NMR measurements were made with two surface coils, one on each hemisphere. This article describes the experimental details and shows that in acute unilateral or bilateral forebrain ischaemia metabolic changes can be monitored by NMR with no significant interhemispheric cross talk. The metabolic effects of reperfusion are also shown. The model allows the definition of the time course of the metabolic consequences of regional ischaemia and reperfusion in individual laboratory animals.