Enteric Glia Modulate Macrophage Phenotype and Visceral Sensitivity following Inflammation

Mechanisms resulting in abdominal pain include altered neuro-immune interactions in the gastrointestinal tract, but the signaling processes that link immune activation with visceral hypersensitivity are unresolved. We hypothesized that enteric glia link the neural and immune systems of the gut and that communication between enteric glia and immune cells modulates the development of visceral hypersensitivity. To this end, we manipulated a major mechanism of glial intercellular communication that requires connexin-43 and assessed the effects on acute and chronic inflammation, visceral hypersensitivity, and immune responses. Deleting connexin-43 in glia protected against the development of visceral hypersensitivity following chronic colitis. Mechanistically, the protective effects of glial manipulation were mediated by disrupting the glial-mediated activation of macrophages through the macrophage colony-stimulating factor. Collectively, our data identified enteric glia as a critical link between gastrointestinal neural and immune systems that could be harnessed by therapies to ameliorate abdominal pain.

Abstract 090: Does Dietary Sodium Contribute to the Discordance in Blood Pressures among Monozygotic Twins?

Background: Dietary sodium (Na) and central adiposity are considered important risk factors for hypertension (HTN). Blood pressure (BP) levels are discordant among 40-50% of monozygotic (MZ) twin pairs. One prior study of MZ twins using questionnaires reported that hypertensive (HT) MZ twins differed in their intake of meat and milk. However, none of the previous studies have evaluated the impact of Na intake on BP in MZ twins.

Methods: Eighty-eight pairs of MZ twins were enrolled from Milwaukee, WI and Michigan State University Twin Registry, East Lansing, MI (age- 44 ± 9 years, 63% women, and 96% Caucasian). BPs (measured in triplicate and averaged) and anthropometrics were measured. Na intake was calculated using Block Sodium Screener. Twin pairs were considered concordant or discordant based on systolic (SBP) or diastolic BP (DBP) difference of 10 mm Hg between co-twins, off BP medications

Results: Thirty-seven twin pairs were discordant in their BP levels. Mean (± SD, mm Hg) SBP/DBPs among concordant and discordant twins were 120 ± 12 / 77 ± 9 and 131 ± 18 / 81 ± 10 respectively. Mean differences in SBP/DBP among concordant and discordant twins were 5 ± 7 / 4 ± 4 and 14 ± 8 / 10 ± 6 respectively. Discordant twins as a group had higher waist circumference (WC) compared to concordant twins (p<0.05), but with no differences in BMI or Na intake. However, among the discordant twin pairs, the co-twin with higher BPs (138 ± 18 / 85 ± 9) had higher dietary salt intakes (3900 ± 1437 vs. 3261 ± 1058 mg/d) and higher WC (105 ± 15 vs. 98 ± 18 cm) (p=0.02) compared to their co-twin with lower BPs (121 ± 16 / 77 ± 9). The average Na intake among the concordant twins was 3443 ± 1189 mg/day. Differences in Na intake among discordant co-twins remained statistically significant after adjustment for age, gender, BMI, WC, and waist-to-hip ratio.

Conclusions: Higher Na intake is associated with higher BPs among MZ twins with discordant BPs. Differences in Na intakes were significant independent of central adiposity indicating significant Na sensitivity in discordant MZ twin pairs. The effect of ~500mg less Na intake/day in resulting in lower BPs in genetically identical individuals, suggests that modest decreases in Na-intake in Na-sensitive individuals may be sufficient to see the desired effect on BP levels.

Ammonia modifies enteric neuromuscular transmission through glial γ-aminobutyric acid signaling

Impaired gut motility may contribute, at least in part, to the development of systemic hyperammonemia and systemic neurological disorders in inherited metabolic disorders, or in severe liver and renal disease. It is not known whether enteric neurotransmission regulates intestinal luminal and hence systemic ammonia levels by induced changes in motility. Here, we propose and test the hypothesis that ammonia acts through specific enteric circuits to influence gut motility. We tested our hypothesis by recording the effects of ammonia on neuromuscular transmission in tissue samples from mice, pigs, and humans and investigated specific mechanisms using novel mutant mice, selective drugs, cellular imaging, and enzyme-linked immunosorbent assays. Exogenous ammonia increased neurogenic contractions and decreased neurogenic relaxations in segments of mouse, pig, and human intestine. Enteric glial cells responded to ammonia with intracellular Ca²⁺ responses. Inhibition of glutamine synthetase and the deletion of glial connexin-43 channels in hGFAP::CreER^T2+/-/connexin43^f/f mice potentiated the effects of ammonia on neuromuscular transmission. The effects of ammonia on neuromuscular transmission were blocked by GABA_A receptor antagonists, and ammonia drove substantive GABA release as did the selective pharmacological activation of enteric glia in GFAP::hM3Dq transgenic mice. We propose a novel mechanism whereby local ammonia is operational through GABAergic glial signaling to influence enteric neuromuscular circuits that regulate intestinal motility. Therapeutic manipulation of these mechanisms may benefit a number of neurological, hepatic, and renal disorders manifesting hyperammonemia.NEW & NOTEWORTHY We propose that local circuits in the enteric nervous system sense and regulate intestinal ammonia. We show that ammonia modifies enteric neuromuscular transmission to increase motility in human, pig, and mouse intestine model systems. The mechanisms underlying the effects of ammonia on enteric neurotransmission include GABAergic pathways that are regulated by enteric glial cells. Our new data suggest that myenteric glial cells sense local ammonia and directly modify neurotransmission by releasing GABA.

Abstract P264: DNA Methylation and Differences in Blood Pressure Levels in Monozygotic Twins

Background: The development of common forms of hypertension (HTN) involves both genetic and environmental factors. Methylation changes (one of the epigenetic modifications) of DNA may play a role in the regulation of BP and development of HTN, and may result from interaction of specific genes with the environment. The current study investigates the relationship between genome-wide changes in DNA methylation in T-lymphocytes and BP level differences among monozygotic twins, who have identical DNA sequences.

Methods: In a preliminary study, we recruited 24 pairs of monozygotic twins (60% women) with a mean age of 44 ± 10 years. Zygosity was determined via self-report or participants’ responses to a standard zygosity questionnaire. BPs were measured in triplicate after 5 minutes of rest at one minute intervals and averaged. Anthropometrics measurements were obtained along with blood for isolation of T-lymphocytes. DNA from T-lymphocytes was used to perform reduced representation bisulfite sequencing (RRBS) to measure methylation levels at single-base resolution in these subjects. Average differences in systolic (SBP) and diastolic (DBP) BPs were used as continuous variables for these analyses.

Results: Mean SBP was 124 ± 15 (range (r): 97-174) mm Hg and mean DBP was 78 ± 11 (r: 49-106) mm Hg. Average differences in SBP and DBP among the co-twins (members of a twin pair) were 9 ± 10 (r: 0-40) mm Hg and 8 ± 6 (r: 0-26) mm Hg respectively. Average BMI was 29 ± 8 kg/m 2 . We observed that an average of 3063 (r: 757-7250) CpG islands were differentially methylated (DMRs) between co-twins. Among these DMRs, 10 were associated with average SBP difference and 5 were associated with average DBP difference at a significance level of p < 0.001. DMRs showing the strongest association (unadjusted p < 10 -4 ) between the co-twins were located in the transcriptional start site (TSS) of genes: CDC26 (cell division cycle protein) and NR2F6 (nuclear receptor) for average SBP difference and LEPRE1 (propyl 3 hydroxylase protein) for average DBP difference.

Conclusions: BP differences between monozygotic co-twins, which most likely result from environmental factors, appear to be associated with differences in DNA methylation in T lymphocytes.

The case for integrating low dose, beneficial responses into US EPA risk assessments

When conducting risk assessments, the US Environmental Protection Agency (EPA) does not currently consider the beneficial effects from exposure to concentrations of agents below the no observed adverse effect level (NOAEL). If such benefits were observed, and if the beneficial and toxicological mechanisms of action were identical, this would probably be represented as a ‘j–shaped’ hormetic dose–response curve. If such data are available, they should be considered when assigning uncertainty factors for safe exposure calculations. However, when such data are not readily available, as is likely the case when the mechanism of action of the benefit differs from that of toxicity, current US EPA methods appear adequate.

Skin aging: molecular pathology, dermal remodelling and the imaging revolution

Skin is a multifunctional organ but, alongside every other organ system, is subject to both intrinsic (chronological) and extrinsic (environmental) aging, resulting in a loss of functional capacity. Cutaneous aging manifests as an observable change in the external appearance of the skin, the major accelerator of the aging process being our interactions with our environment, such as chronic exposure to solar irradiation (UV, IR or visible wavelengths of light). The aim of this contribution, therefore, was to provide a review of the pathological mechanisms which may play roles in the development of extrinsic, mainly photo-, aging and to review how these molecular changes impact on the structure of the organ as a whole, resulting in loss of function. Finally, we will describe the advances which are occurring in imaging techniques which may allow further characterisation of aged skin.

Enteric glia mediate neuron death in colitis through purinergic pathways that require connexin-43 and nitric oxide

BACKGROUND AND AIMS

The concept of enteric glia as regulators of intestinal homeostasis is slowly gaining acceptance as a central concept in neurogastroenterology. Yet how glia contribute to intestinal disease is still poorly understood. Purines generated during inflammation drive enteric neuron death by activating neuronal P2X7 purine receptors (P2X7R), triggering ATP release via neuronal pannexin-1 channels that subsequently recruits intracellular calcium ([Ca²⁺]_i) responses in the surrounding enteric glia. We tested the hypothesis that the activation of enteric glia contributes to neuron death during inflammation.

METHODS

We studied neuroinflammation in vivo using the 2,4-dinitrobenzenesulfonic acid model of colitis and in situ using whole-mount preparations of human and mouse intestine. Transgenic mice with a targeted deletion of glial connexin-43 (Cx43) [GFAP∷Cre^ERT2+/-/Cx43^f/f ] were used to specifically disrupt glial signaling pathways. Mice deficient in inducible nitric oxide (NO) synthase (iNOS^-/-) were used to study NO production. Protein expression and oxidative stress were measured using immunohistochemistry and in situ Ca²⁺ and NO imaging were used to monitor glial [Ca²⁺]_i and [NO]_i.

RESULTS

Purinergic activation of enteric glia drove [Ca²⁺]_i responses and enteric neuron death through a Cx43-dependent mechanism. Neurotoxic Cx43 activity, driven by NO production from glial iNOS, was required for neuron death. Glial Cx43 opening liberated ATP and Cx43-dependent ATP release was potentiated by NO.

CONCLUSIONS

Our results show that the activation of glial cells in the context of neuroinflammation kills enteric neurons. Mediators of inflammation that include ATP and NO activate neurotoxic pathways that converge on glial Cx43 hemichannels. The glial response to inflammatory mediators might contribute to the development of motility disorders.

Absence of developmental toxicity in a canine model after infusion of a hemoglobin-based oxygen carrier: Implications for risk assessment

Bovine-derived hemoglobin-based oxygen carriers (HBOCs) have been investigated for use in humans (HBOC-201) and approved for veterinary medicine (HBOC-301). We infused pregnant beagles with HBOC-201 to test whether HBOC-induced developmental toxicity previously observed in rats would occur in a species devoid of an inverted visceral yolk sac (invVYS). Phase 1 assessed developmental toxicity of 6g/kg HBOC-201 on gestational day (GD) 21. Phase 2 investigated single infusions of 6g/kg HBOC-201 on one of GDs 21, 25, 29 or 33. Phase 3 studied multiple sequential infusions on GDs 21, 23,25,27,29, 31, and 33 at 0.52g/kg/day (3.6g/kg total dose). Mild to moderate maternal toxicity occurred in all phases. There was an unequivocal absence of developmental toxicity in all phases. Overall, our hypothesis that HBOC, which interferes with the function of the invVYS, would not affect the offspring in dogs was supported. The implications relative to human risk are discussed.

Developmental toxicity in rats of a hemoglobin-based oxygen carrier results from impeded function of the inverted visceral yolk sac

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Infusion HBOC into pregnant rats causes developmental toxicity.

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Sensitive from GD 7 to 11 when inverted yolk sac placenta (invYSP) supplies nutrition.

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Controls for protein content, oncotic properties and Hb show effects are due to Hb.

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Whole embryo culture verified HBOC interference with invYSP function.

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Humans lack invYSP and are unlikely to be affected by HBOC.

HBOC-201 is a bovine-derived, cross-linked, and stabilized hemoglobin (250 kDa) in physiological saline. Daily intravenous infusions of HBOC (1.95, 3.90, or 5.85 g/kg/day) during gestational days (GDs) 6–18 in Sprague-Dawley rats caused fetal mortality, reduced birth weight, and malformations. Subsequent single-day infusions (5.85 g/kg/day) showed that developmental toxicity was limited to GDs 7–9 when histiotrophic nutrition via the inverted visceral yolk sac (invVYS) is essential. Histiotrophic nutrition is receptor-mediated endocytosis of bulk maternal proteins and subsequent lysosomal degradation providing amino acids and other nutrients for embryonic growth. Controls for protein content, oncotic properties, and hemoglobin content indicated that toxicity was due to hemoglobin. Rat whole embryo cultures verified HBOC interference with invVYS transport capacity and resultant deficient embryonic nutrition. These mechanisms of action are not expected to impact human development based on differences in VYS morphology and function, although a complete understanding of early human embryonic nutrition is lacking.

MRI findings in autoimmune voltage-gated potassium channel complex encephalitis with seizures: one potential etiology for mesial temporal sclerosis

BACKGROUND AND PURPOSE

Autoimmune voltage-gated potassium channel complex encephalitis is a common form of autoimmune encephalitis. Patients with seizures due to this form of encephalitis commonly have medically intractable epilepsy and may require immunotherapy to control seizures. It is important that radiologists recognize imaging characteristics of this type of autoimmune encephalitis and suggest it in the differential diagnosis because this seizure etiology is likely under-recognized. Our purpose was to characterize MR imaging findings in this patient population.

MATERIALS AND METHODS

MR imaging in 42 retrospectively identified patients (22 males; median age, 56 years; age range, 8-79 years) with seizures and voltage-gated potassium channel complex autoantibody seropositivity was evaluated for mesial and extratemporal swelling and/or atrophy, T2 hyperintensity, restricted diffusion, and enhancement. Statistical analysis was performed.

RESULTS

Thirty-three of 42 patients (78.6%) demonstrated enlargement and T2 hyperintensity of mesial temporal lobe structures at some time point. Mesial temporal sclerosis was commonly identified (16/33, 48.5%) at follow-up imaging. Six of 9 patients (66.7%, P = .11) initially demonstrating hippocampal enhancement and 8/13 (61.5%, P = .013) showing hippocampal restricted diffusion progressed to mesial temporal sclerosis. Conversely, in 6 of 33 patients, abnormal imaging findings resolved.

CONCLUSIONS

Autoimmune voltage-gated potassium channel complex encephalitis is frequently manifested as enlargement, T2 hyperintensity, enhancement, and restricted diffusion of the mesial temporal lobe structures in the acute phase. Recognition of these typical imaging findings may help prompt serologic diagnosis, preventing unnecessary invasive procedures and facilitating early institution of immunotherapy. Serial MR imaging may demonstrate resolution or progression of radiologic changes, including development of changes involving the contralateral side and frequent development of mesial temporal sclerosis.

Experimental animal models of hypertension

Hypertension (HTN) and cardiovascular disease are the most common causes of death in developed countries. The use of experimental animal models of HTN has provided valuable information regarding many aspects of HTN, including etiology, pathophysiology, complications, and treatment. Because the etiology of HTN is heterogeneous, many experimental animal models have been developed to mimic the many facets of human HTN. The choice of animal model will be determined by the research question, monetary limitations, and technical expertise. The categories of models of HTN are: renovascular, renal parenchymal, pharmacologically induced, environmentally induced, and genetic. There are considerable differences between HTN in animals and humans, including differences in homeostatic mechanisms and pathophysiology; therefore, a thorough understanding of the animal models and rigorous analysis is required before extrapolating the finding in animals to humans.

The use of angiotensin-converting enzyme inhibitors in patients with acute myocardial infarction in community hospitals. Michigan State University Inter-Institutional Collaborative Heart (MICH) Study Group

BACKGROUND

Previous studies documenting underutilization of angiotensin-converting enzyme inhibitors (ACEIs) in acute myocardial infarction (AMI) have been limited to Medicare populations.

HYPOTHESIS

This study examines ACEI prescription rates and predictors in a community sample of hospitalized patients with AMI.

METHODS

The charts of 1163 community patients with AMI, prospectively identified at admission between January 1, 1994, and April 30, 1995, were reviewed.

RESULTS

Only 64 of 158 (40%) patients considered ideal candidates for ACEI prescription were discharged with a prescription for an ACEI. In a multivariate logistic regression model, prior ACEI utilization [adjusted odds ration (OR) = 3.26; 95% confidence interval (CI) = 2.05-5.20], presence of congestive heart failure (OR = 2.33; CI = 1.50-3.61) and black race (OR = 2.20; CI = 1.34-3.64) were identified as positive predictors of ACEI prescription. Conversely, lack of left ventricular ejection fraction (LVEF) measurement (OR = 0.46; CI = 0.28-0.75), LVEF > 40 ( OR = 0.27; CI = 0.18-0.40), and acute renal failure (OR = 0.08; CI = 0.01-0.44) were negative predictors. Women were also less likely to be discharged with an ACEI prescription (OR = 0.71; CI = 0.48-1.05). Furthermore, women were significantly less likely to have LVEF measured prior to discharge than were males (77 vs. 85%, p = 0.001).

CONCLUSION

This study underscores the need for improvement in the utilization of ACEI in eligible patients with AMI. It also identifies opportunities for improvement in prescription rates, especially in women.

Morphological and biochemical characterization of remodeling in aorta and vena cava of DOCA-salt hypertensive rats

Arterial remodeling occurs in response to mechanical and neurohumoral stimuli. We hypothesized that veins, which are not exposed to higher pressures in hypertension, would demonstrate less active remodeling than arteries. We assessed remodeling with two standard measures of arterial remodeling: vessel morphometry and the expression/function of matrix metalloproteinases (MMPs). Thoracic aorta and vena cava from sham normotensive and DOCA-salt hypertensive rats (110 ± 4 and 188 ± 8 mmHg systolic blood pressure, respectively) were used. Wall thickness was increased in DOCA-salt vs. sham aorta (301 ± 23 vs. 218 ± 14 μm, P < 0.05), as was medial area, but neither measure was altered in the vena cava. The aorta and vena cava expressed the gelatinases MMP-2, MMP-9, transmembrane proteinase MT1-MMP, and tissue inhibitor of metalloproteinase-2 (TIMP-2). Immunohistochemically, MMP-2 localized to smooth muscle in the aorta and densely in endothelium/smooth muscle of the vena cava. Western and zymographic analyses verified that MMP-2 was active in all vessels and less active in the vena cava than aorta. In hypertension, MMP-2 expression and activity in the aorta were increased (59.1 ± 3.7 and 74.5 ± 6.1 units in sham and DOCA, respectively, P < 0.05); similar elevations were not observed in the vena cava. MMP-9 was weakly expressed in all vessels. MT1-MMP was expressed by the aorta and vena cava and elevated in the vena cava from DOCA-salt rats. TIMP-2 expression was significantly increased in the aorta of DOCA rats compared with sham but was barely detectable in the vena cava of sham or DOCA-salt hypertensive rats. These findings suggest that large veins may not undergo vascular remodeling in DOCA-salt hypertension.

Preferential myosin heavy chain isoform B Expression may contribute to the faster velocity of contraction in veins versus arteries

Smooth muscle myosin heavy chains occur in 2 isoforms, SMA (slow) and SMB (fast). We hypothesized that the SMB isoform is predominant in the faster-contracting rat vena cava compared to thoracic aorta. We compared the time to half maximal contraction in response to a maximal concentration of endothelin-1 (ET-1; 100 nM), potassium chloride (KCl; 100 mM) and norepinephrine (NE; 10 microM). The time to half maximal contraction was shorter in the vena cava compared to aorta (aorta: ET-1 = 235.8 +/- 13.8 s, KCl = 140.0 +/- 33.3 s, NE = 19.8 +/- 2.7 s; vena cava: ET-1 = 121.8 +/- 15.6 s, KCl = 49.5 +/- 6.7 s, NE = 9.0 +/- 3.3 s). Reverse-transcription polymerase chain reaction supported the greater expression of SMB in the vena cava compared to aorta. SMB was expressed to a greater extent than SMA in the vessel wall of the vena cava. Western analysis determined that expression of SMB, relative to total smooth muscle myosin heavy chains, was 12.5 +/- 4.9-fold higher in the vena cava compared to aorta, while SMA was 4.9 +/- 1.2-fold higher in the aorta than vena cava. Thus, the SMB isoform is the predominant form expressed in rat veins, providing one possible mechanism for the faster response of veins to vasoconstrictors.

Nuclear hormone receptors in human skin

Nuclear hormone receptors are of critical importance for skin homeostasis where they modulate cellular metabolism, proliferation, differentiation, cell death, and inflammation. The cutaneous role of the glucocorticoid, androgen, and estrogen receptors was explored initially. In recent years, sequence homology comparisons have uncovered the complete superfamily of related receptors, many of which are also implicated in cutaneous homeostasis. A subgroup of these receptors acts in concert with the retinoid X receptor by heterodimerization and has been successfully targeted for dermatologic therapy; i.e., the retinoic acid receptor and the vitamin D receptor. Ongoing research is aimed at delineating the cutaneous effects of additional members of this subgroup including the peroxisome proliferator-activated receptors and the liver X receptors. The various receptors exert differential effects in skin and can be rationally chosen as drug targets for the treatment of cutaneous pathologies.

Extension of the BLOCH T(3/2) law to magnetic nanostructures: Bose-Einstein condensation

We report a newly observed phenomenon, namely, the observation of a visible anomaly in the Bloch T(3/2) law for the temperature dependence of magnetization of nanostructured ferromagnets, for which we give a thermodynamic explanation. Our interpretation extends the Bloch law by introducing the system's chemical potential and assumes a finite Bose-Einstein condensation temperature T(BE) of the magnons. Our extension involves accounting for the possibility of a magnon or magnetic entropy term, leading to a magnon chemical potential (hitherto omitted in the traditional derivation) which varies with temperature. The result is a subtle upturn of the magnetization curves of ferromagnetic nanoparticles in the 10 to 50 K temperature range. Here we show experimental data for nanomaterials and an outline of the extended theory which includes T(BE).

Changes in rates of beta-blocker use in community hospital patients with acute myocardial infarction

OBJECTIVE

To examine changes in the rate of beta-blocker (BB) use at admission, in hospital, and at discharge between 1994 and 1995 (MICH I) and 1997 (MICH II) in patients with acute myocardial infarction (AMI).

DESIGN

Comparison of two prospectively enrolled cohorts.

SETTING

Five mid-Michigan community hospitals.

PATIENTS

We studied 287 MICH I patients and 121 MICH II patients with AMI who had no contraindications to BB use from cohorts of consecutively admitted cases of AMI (814 in MICH I; 500 in MICH II).

RESULTS

Prescription of BBs to ideal patients with AMI increased in patients with previous history of myocardial infarction on arrival at the hospital (12.5% vs 36.0%; P= .01), in hospital (47.0% vs 76%; P < .01), and at discharge (34.0% vs 61.9%; P < .01). Neither race nor gender was a predictor of BB use. Younger age predicted BB prescription at discharge (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.32 to 3.23). Later study cohort was the most important predictor of BB use in hospital (OR, 3.4; 95% CI, 2.09 to 5.25).

CONCLUSION

BB use improved dramatically over the study period, but additional work is needed to improve use of BB after discharge and among elderly patients with AMI.

Role of sensory nervous system vasoactive peptides in hypertension

The goal of the present research was to elucidate the roles and mechanisms by which the sensory nervous system, through the actions of potent vasodilator neuropeptides, regulates cardiovascular function in both the normal state and in the pathophysiology of hypertension. The animal models of acquired hypertension studied were deoxycorticosterone-salt (DOC-salt), subtotal nephrectomy-salt (SN-salt), and Nomega-nitro-L-arginine methyl ester (L-NAME)-induced hypertension during pregnancy in rats. The genetic model was the spontaneously hypertensive rat (SHR). Calcitonin gene-related peptide (CGRP) and substance P (SP) are potent vasodilating neuropeptides. In the acquired models of hypertension, CGRP and SP play compensatory roles to buffer the blood pressure (BP) increase. Their synthesis and release are increased in the DOC-salt model but not in the SN-salt model. This suggests that the mechanism by which both models lower BP in SN-salt rats is by increased vascular sensitivity. CGRP functions in a similar manner in the L-NAME model. In the SHR, synthesis of CGRP and SP is decreased. This could contribute to the BP elevation in this model. The CGRP gene knockout mouse has increased baseline mean arterial pressure. The long-term synthesis and release of CGRP is increased by nerve growth factor, bradykinin, and prostaglandins and is decreased by alpha2-adrenoreceptor agonists and glucocorticoids. In several animal models, sensory nervous system vasoactive peptides play a role in chronic BP elevation. In the acquired models, they play a compensatory role. In the genetic model, their decreased levels may contribute to the elevated BP. The roles of CGRP and SP in human hypertension are yet to be clarified.

A Short-Term Screening Protocol, Using Fibrillin-1 as a Reporter Molecule, for Photoaging Repair Agents

Photoaged skin is characterized by coarse and fine wrinkles. The mechanisms of wrinkle formation are undetermined, but appear to be due to changes within the matrix of the dermis and at the dermal-epidermal junction. Previous studies have identified marked reductions in procollagens I and III, collagen VII, and the fibrillin-rich microfibrillar apparatus in this area. Topically applied all-trans retinoic acid can repair photoaged dermal matrix, but this takes at least 6 mo of treatment. In this study, we have examined the abundance and distribution of fibrillin-1 prior to, and following, 192 wk of all-trans retinoic acid treatment. We have further developed a short-term protocol to determine the utility of potential repair agents, using fibrillin-1 as the marker for outcome. Individuals with clinically assessed severe photoaging were recruited to the study (n = 8). 0.025% all-trans retinoic acid, 5% sodium lauryl sulfate (irritant control), or vehicle were applied under occlusion to photoaged extensor forearm. A fourth control area was also occluded. After 96 h, punch biopsies were taken under local anesthesia and processed for either transmission electron microscopy or snap frozen. Frozen sections were prepared for immunohistochemistry and in situ hybridization immunohistochemistry. Electron microscopy revealed aberrant elastic fibers in the papillary dermis of photoaged forearm skin, with sparse microfibrillar apparatus and interstitial collagen. After application of 0.025% all-trans retinoic acid, there was increased deposition of both these dermal matrix components, with the aberrant elastic fibers no longer apparent. Significant increases (p < 0.05) were observed at the protein and mRNA levels for fibrillin-1 following all-trans retinoic acid and sodium lauryl sulfate treatments, with all-trans retinoic acid having a significantly greater effect than irritant control (p < 0.001); however, neither application had significant effect on the abundance of collagen VII or its mRNA. Investigation of collagen I synthesis revealed no difference following treatments. To ascertain the clinical relevance of using fibrillin-1 as a marker for photoaging, facial skin was biopsied at baseline and after long-term (192 wk) topical all-trans retinoic acid treatment (n = 5). Biopsies were wax-embedded and sections prepared for immunohistochemistry for fibrillin-1. Significant increases in the abundance of the microfibrillar apparatus was observed proximal to the dermal- epidermal junction (p < 0.001) following long-term all-trans retinoic acid application. This study indicates that all-trans retinoic acid can significantly affect fibrillin-1 content in photoaged skin. Furthermore, fibrillin-1 can be used as a "reporter" molecule in short-term protocols for testing the utility of topical agents in the repair of photoaged skin.

Performance evaluation of a Marshland Upwelling System for the removal of fecal coliform bacteria from domestic wastewater

The Marshland Upwelling System (MUS), a potential alternative wastewater treatment strategy for coastal dwellings, was examined to assess its ability to remove fecal coliforms (FC) from domestic wastewater as a step towards total treatment. Wastewater was intermittently injected down a 4.6-m injection well into the surrounding salt marsh. Optimal performance was achieved at an injection flowrate of 1.9 L/min and injection frequency of 30 minutes every 3 hours. Average influent concentrations of 930,000+/-650,000 colonies/100 mL, were reduced to effluent counts of 4.6 colonies/100 mL. Coliform removal followed exponential decay versus vector distance traveled with predicted surface concentrations less than or equal to 0.1 colony/100 mL. Hydraulic performance was acceptable with no significant reductions in permeability observed. Increasing flows to 3.8 L/min produced localized hydraulic dysfunction as indicated by sudden increases in effluent bacterial counts and injection pressures. Although fecal coliform removal typically decreased with increasing injection flowrates and isolated instances of abnormally high effluent counts were observed the MUS never experienced a catastrophic failure during the 13-month evaluation period.

Activation of oral keratinocytes by mercuric chloride: relevance to dental amalgam-induced oral lichenoid reactions

BACKGROUND

Despite the benefits of mercury-containing amalgam dental fillings there are growing concerns regarding the potential adverse health effects arising from exposure to mercury released from fillings. In some individuals this process may result in a local lichenoid reaction of the oral mucosa.

OBJECTIVES

The aim of this study was to investigate the possibility that mercury salts released from amalgam fillings might act directly on oral keratinocytes to induce changes that could promote the development of such lesions.

METHODS

In vitro experiments were performed in which normal oral and cutaneous keratinocytes were cultured in the presence of mercuric chloride (HgCl2). ICAM-1 expression and the release of cytokines was determined by enzyme-linked immunosorbent assay techniques. T-cell binding to HgCl2-pretreated keratinocytes was assessed using a colorimetric method.

RESULTS

Subcytotoxic concentrations of HgCl2 induced a concentration-related increase in ICAM-1 expression and consequent T-cell binding on oral, but not cutaneous, keratinocytes. HgCl2 also stimulated the release of low levels of tumour necrosis factor-alpha and interleukin-8 (but not RANTES), and inhibited the release of interleukin-1alpha by oral keratinocytes.

CONCLUSIONS

This study provides evidence that oral keratinocytes may play an integral part in initiating the pathogenesis of amalgam-induced lichenoid reactions.

Do race and gender influence the use of invasive procedures?

OBJECTIVE

To assess the influence of race and gender influence on the use of invasive procedures in patients with acute myocardial infarction (AMI) in community hospitals.

DESIGN

Prospective, observational.

SETTING

Five mid-Michigan community hospitals.

PATIENTS

All patients (838) identified with AMI between January 1994 and April 1995 in 1 of these hospitals.

MEASUREMENTS AND MAIN RESULTS

After adjusting for age, hospital of admission, insurance type, severity of AMI, and comorbidity, using white men as the reference group, the rate of being offered cardiac catheterization (CC) was 0.88 (95% confidence interval [95% CI], 0.60 to 1.29) for white women; 0.79 (95% CI, 0.41 to 1.50) for black men; and 1.14 (95% CI, 0.53 to 2.45)for black women. Among patients who underwent CC, after also adjusting for coronary artery anatomy, the rate of being offered angioplasty, using white men as the reference group, was 1.22 (95% CI, 0.75 to 1.98) for white women; 0.61 (5% CI, 0.29 to 1.28, P =.192) for black men; and 0.40 (95% CI, 0.14 to 1.13) for black women The adjusted rate of being offered bypass surgery was 0.47 (95% CI, 0.24 to 0.89) for white women; 0.36 (95% CI, 0.12 to 1.06) for black men; and 0.37 (95% CI, 0.11 to 1.28)for black women.

CONCLUSIONS

Our study shows that white women are less likely than white men to be offered bypass surgery after AMI. Although black men and women with AMI are less likely than white men to be offered percutaneous transluminal coronary angioplasty or coronary artery bypass grafting in both unadjusted and adjusted analyses, these findings did not reach statistical significance. Our study is limited in power due to the small number of blacks in the sample.

Distribution and expression of type VI collagen in photoaged skin

BACKGROUND

Several of the characteristic clinical features of photoaged skin, including wrinkling, are thought to be dependent on changes in the dermal matrix brought about by chronic sun exposure. Such changes include reductions in collagens I, III and VII, an increase in elastotic material in the reticular dermis and a marked reduction in the microfibrillar glycoprotein fibrillin.

OBJECTIVES

To examine whether type VI collagen, a microfibrillar collagen necessary for cell-cell and cell-matrix communication, is affected by the photoageing process.

METHODS

Six healthy volunteers with moderate to severe photoageing were enrolled into the study. Immunohistochemistry and in situ hybridization histochemistry were used to examine the levels of type VI collagen in photoprotected and photoaged sites.

RESULTS

In photoprotected skin, type VI collagen was concentrated in the papillary dermis immediately below the dermal-epidermal junction, around blood vessels, hair follicles and glandular structures. The distribution of type VI collagen was unchanged in photoaged skin, although we observed an increase in the abundance of the alpha3 chain of collagen VI in the upper papillary dermis, at its junction with the dermal-epidermal junction (P < 0.05). No alterations were observed for any alpha chain at the mRNA level.

CONCLUSIONS

These studies suggest that chronic sun exposure (photoageing) has little or no effect on either the distribution, abundance or levels of expression of type VI collagen in human skin. Thus, type VI collagen, unlike other matrix components so far studied, appears to be relatively unaffected by the photoageing process.

Detection of bovine immunodeficiency virus DNA in the blood and semen of experimentally infected bulls

Five 18- to 24-month-old bulls were inoculated with either a cell suspension containing bovine immunodeficiency virus (BIV-FL112; 3 bulls) or a BIV-free cell suspension (2 bulls). Blood and semen specimens were collected once a week for 14 weeks, and seroconversion was confirmed by indirect immunofluorescent antibody (IFA) testing. The presence of BIV in blood and semen was determined by virus isolation and/or polymerase chain reaction (PCR) assays. Antibodies to BIV were detected in the 3 experimentally infected bulls as early as day post inoculation (DPI) 17, and levels peaked at DPI 37-58. BIV was isolated from the peripheral blood mononuclear cells (MNCs) of the infected bulls at DPI 9 (2 bulls) and DPI 23 (1 bull), and could be isolated from one animal up to DPI 65. PCR analysis of MNC DNA, using BIV pol gene primers, detected virus in all three of the experimentally infected bulls from DPI 9 until the termination of the experiment at DPI 98. Efforts to isolate a significant number of non-spermatozoal cells (NSC) by gradient separation from the semen of the experimentally infected bulls were unsuccessful. Two methods for the extraction of total NSC DNA from up to 2 ml of non-extended semen were employed; however, no BIV pol fragment was amplified from these DNA preparations. Additionally, 30 bulls from artificial insemination (AI) centers were evaluated for BIV infection by PCR. No amplification products were obtained from MNC DNA from the AI submissions using primer sets for both the BIV pol and env genes.

Fibrillin-rich microfibrils are reduced in photoaged skin. Distribution at the dermal-epidermal junction

Chronic sun exposure results in photoaged skin with deep coarse wrinkles and loss of elasticity. We have examined the distribution and abundance of fibrillin-rich microfibrils, key structural components of the elastic fiber network, in photoaged and photoprotected skin. Punch biopsies taken from photoaged forearm and from photoprotected hip and upper inner arm of 16 subjects with a clinical range of photoaging were examined for fibrillin-1 and fibrillin-2 expression and microfibril distribution. In situ hybridization revealed decreased fibrillin-1 mRNA but unchanged fibrillin-2 mRNA levels in severely photoaged forearm biopsies relative to photoprotected dermal sites. An immunohistochemical approach demonstrated that microfibrils at the dermal-epidermal junction were significantly reduced in moderate to severely photoaged forearm skin. Confocal microscopy revealed that the papillary dermal microfibrillar network was truncated and depleted in photoaged skin. These studies highlight that the fibrillin-rich microfibrillar network associated with the upper dermis undergoes extensive remodeling following solar irradiation. These changes may contribute to the clinical features of photoaging, such as wrinkle formation and loss of elasticity.

All-trans retinoic acid compromises desmosome expression in human epidermis

An undesirable side-effect of retinoid treatment is skin fragility. As desmosomes are important in maintaining the cohesion of epidermal keratinocytes, we investigated whether all-trans-retinoic acid (RA) compromises desmosome expression in human epidermis, thereby predisposing skin to fragility. Solutions containing 0.025% RA, 5% sodium dodecyl sulphate (SDS) as an irritant control, or vehicle alone were applied to three sites on the buttocks of normal volunteers (n = 9). Treated sites were occluded for 4 days, and biopsies taken under local anaesthesia. Cryostat sections were stained with a panel of antibodies to desmosomal proteins and visualized by immunofluorescence microscopy. Stained sections were randomized and assessed for intensity of staining. The epidermal thickness of each treated site was quantified by image analysis. Western blots of epidermal desmocollins were quantified by densitometry. RA and SDS treatments significantly, but equivalently, increased epidermal thickness compared with vehicle. Immunohistochemically, both RA and SDS were shown to reduce epidermal staining for desmoplakin, desmoglein 1, plakophilin 1 and desmocollin 3 equally compared with vehicle-treated skin (P < 0.001). RA produced a greater reduction in desmocollin 1 staining compared with SDS (P < 0.001). Similar reductions in desmocollins were found by Western blot analysis. Reduced desmocollin expression may indicate compromised desmosomal adhesion, leading to the skin fragility that results from retinoid treatment.

Context-dependent nestmate discrimination in the paper wasp, Polistes dominulus: a critical test of the optimal acceptance threshold model

e present evidence that nestmate discrimination in the eusocial paper wasp, Polistes dominulus, is context dependent. We compared aggression levels between nestmates and non-nestmates in dyads consisting of a pair of either nestmates or non-nestmates, and triads consisting of either three nestmates, three non-nestmates, or two nestmates and a non-nestmate. In 130 of the 237 total trials, a nest fragment (containing both brood and eggs) from the nest of some, all or none of the interactants was placed into the interaction arena. Polistes dominulus workers recognized and discriminated nestmates from non-nestmates, familiar from unfamiliar nest material and neighbours from non-neighbours. These findings suggest that nestmate and neighbour discrimination are context dependent: discrimination occurs when either the presence of a nestmate or a familiar nest fragment indicate the proximity of the colony. The context-dependent variation in aggression levels is best described by multiple, context-dependent shifts in an acceptance threshold. Thus this study provides the most extensive, critical support yet obtained for Reeve's (1989, American Naturalist, 133, 407-435) optimal acceptance threshold model. Copyright 1998 The Association for the Study of Animal Behaviour

Fibrillin microfibrils are reduced in skin exhibiting striae distensae

Striae distensae (striae: stretch marks) are a common disfiguring condition associated with continuous and progressive stretching of the skin--as occurs during pregnancy. The pathogenesis of striae is unknown but probably relates to changes in those structures that provide skin with its tensile strength and elasticity. Such structures are components of the extracellular matrix, including fibrillin, elastin and collagens. Using a variety of histological techniques, we assessed the distribution of these extracellular matrix components in skin affected by striae. Pregnant women were assessed for the presence of striae, and punch biopsies were obtained from lesional striae and adjacent normal skin. Biopsies were processed for electron microscopy, light microscopy and immunohistochemistry. For histological examination, 7 microns frozen sections were stained so as to identify the elastic fibre network and glycosaminoglycans. Biopsies were also examined with a panel of polyclonal antibodies against collagens I and III, and fibrillin and elastin. Ultrastructural analysis revealed alterations in the appearance of skin affected by striae compared with that of normal skin in that the dermal matrix of striae was looser and more floccular. Light microscopy revealed an increase in glycosaminoglycan content in striae. Furthermore, the number of vertical fibrillin fibres subjacent to the dermal-epidermal junction (DEJ) and elastin fibres in the papillary dermis was significantly reduced in striae compared with normal skin. The orientation of elastin and fibrillin fibres in the deep dermis showed realignment in that the fibres ran parallel to the DEJ. However, no significant alterations were observed in any other extracellular matrix components. This study identifies a reorganization and diminution of the elastic fibre network of skin affected by striae. Continuous strain on the dermal extracellular matrix, as occurs during pregnancy, may remodel the elastic fibre network in susceptible individuals and manifest clinically as striae distensae.

Myers-Briggs Type Indicator and dental school performance

The Myers-Briggs Type Indicator (MBTI) was administered to 256 dental students, representing four classes, at the University of Florida College of Dentistry. The results of this psychological instrument were then correlated with overall dental school performance based on results from the National Dental Board Examinations Part I and II (NB-I, NB-II), yearly class rank, and specific academic difficulties as measured by the Student Performance Evaluation Committee. Introverted students were found to display a significantly increased performance on NB-I (p = .038) and NB-II (p = .044). They were also found, however, to demonstrate a progressively lower class rank over the four-year period than extroverted students and were more likely to experience major academic difficulties as well. Judging and sensing individuals were found to earn a higher class rank over the four-year period than perceiving and intuitive students, respectively. Perceiving students were found to exhibit major difficulties or were placed on probation more often than judging individuals. These results may prove useful in counseling students to recognize potential problems before they commence their dental education or to anticipate and address specific weaknesses during the course of their education.

Clinical features of photodamaged human skin are associated with a reduction in collagen VII

Chronically sun-exposed or photodamaged human skin is characterized by a number of clinical features, including wrinkles. However, little is known about the molecular mechanisms that underlie these features. We investigated the hypothesis that the mechanism of wrinkle formation may involve loss of anchoring fibrils, composed mainly of collagen VII, which are important in maintaining dermal-epidermal junction integrity. Ten volunteers with moderate to severe photodamage of dorsal forearm skin were recruited to the study. Using immunohistochemistry, transmission electron microscopy and in situ hybridization, we compared collagen VII protein and mRNA content of photodamaged forearm skin with that of sun-protected hip and upper inner arm skin from the same subjects. Numbers of anchoring fibrils per linear microns of basement membrane (mean +/- SEM) were significantly lower in photodamaged skin (1.79 +/- 0.10) as compared with sun-protected hip (2.28 +/- 0.11) and upper inner arm skin (2.21 +/- 0.10) (P < 0.01), and similarly keratinocyte expression of collagen VII mRNA, quantitated as number of positively stained keratinocytes per high power field, was significantly reduced in photodamaged skin (6.3 +/- 2.5) as compared with sun-protected hip (20.0 +/- 5.6) and upper inner arm skin (17.7 +/- 4.9) (P < 0.001). Semiquantitative assessment of immunohistochemical staining for collagen VII showed a non-significant reduction in photodamaged skin as compared with sun-protected skin. We propose that reduced content of collagen VII in photodamaged skin contributes to wrinkle formation by weakening the bond between the dermis and epidermis.

The medial capsule of the human temporomandibular joint

PURPOSE

Attachments of the medial capsule of the temporomandibular joint (TMJ) to structures other than the medial fossa wall are thought to exist and to have functional significance. This study evaluated these relationships.

MATERIALS AND METHODS

The anatomic relationships between the medial capsule and other medial structures, the sphenomandibular ligament, discomalleolar ligament, and auriculotemporal nerve, were examined in 14 cadaver heads.

RESULTS

The results showed that the sphenomandibular ligament attaches separately from the medial capsule of the TMJ and therefore has no functional significance to the biomechanics of the joint. The discomalleolar ligament was found to be a continuation of the retrodiscal tissues and minimally associated with the medial capsule. The auriculotemporal nerve was not found to be in a relationship with the medial aspect of the condyle to the extent that mechanical irritation is possible during TMJ movement or disc displacement.

Muscle attachment to the lateral aspect of the articular disk of the human temporomandibular joint

OBJECTIVE

To investigate the anatomic attachments to the lateral aspect of the anterior band of the human temporomandibular joint articular disk.

MATERIAL AND METHODS

Sixteen human cadaver half-heads were dissected and examined macroscopically.

RESULTS

No direct attachment was observed between the deep masseter muscle and the temporomandibular joint articular disk. In one specimen, a small band of the anterior temporalis muscle was directly attached to the lateral aspect of the temporomandibular joint disk; whereas, on the same specimen, the attachment of the superior belly of the lateral pterygoid muscle was a comparatively large band. In another specimen, the lateral pterygoid muscle passed in an anterolateral direction.

CONCLUSIONS

The masseter muscle has no functional significance in the biomechanics of temporomandibular joint disk displacement. The anterior temporalis muscle may have functional significance when it is accompanied by an anterolaterally divergent lateral pterygoid muscle.

The hypothalamic ventromedial nucleus sends a met-enkephalin projection to the preoptic area's periventricular zone in the female rat

The female but not the male rat possesses a dense network of methionine enkephalin (m-Enk) fibers in the periventricular zone of the preoptic area (pePOA). The potential source of these fibers was determined by injection of the tracer fluorogold, FAu, into the preoptic area of adult female rats. Twenty-four hours before they were killed, the rats were administered colchicine (intraventricularly) to enable immunocytochemical visualization of m-Enk cells. Upon examination of the brains with fluorescence microscopy, double-labeled cells showing fluorogold and immunofluorescence for m-Enk were consistently observed in the preoptic area, the ventrolateral division of the ventromedial nucleus of the hypothalamus (VMHvl) and nearby medial tuberal area (MTA), the arcuate nucleus, periventricular area of the hypothalamus, perifornical area, and dorsomedial nucleus of the hypothalamus. A series of lesion and knife cut experiments using glass, Halasz, and wire knives determined that the pePOA m-Enk fibers arose from the hypothalamus, near or within the VMH. Ibotenic acid lesions further determined that the source of the m-Enk projection was the VMHvl with a possible additional contribution from the MTA.

Estrogen-receptive neurons in the anteroventral periventricular nucleus are synaptic targets of the suprachiasmatic nucleus and peri-suprachiasmatic region

The anteroventral periventricular nucleus (AVPv) in the rat preoptic area is a key site underlying control of the steroid dependent preovulatory gonadotropin surge. Estrogen and progesterone receptor-containing neurons in the preoptic/hypothalamic continuum, particularly those in the AVPv, are believed to transduce steroidal signals and, in turn convey this information to the LHRH system, which lacks steroid receptors. In addition to the influence of the gonadal steroids, the precise timing of the preovulatory gonadotropin surge is believed to be regulated by the hypothalamic suprachiasmatic nucleus (SCN). The SCN and peri-SCN neurons send efferent projections rostrally to the anterior preoptic area suggesting that circadian signals are communicated synaptically to steroid-responsive neurons in the AVPv. To test this hypothesis, ultrastructural double label immunocytochemistry was conducted to determine whether SCN efferents contact estrogen receptor-immunoreactive neurons in the AVPv. Brain sections with SCN injections of phaseolus vulgaris leucoagglutinin (PHA-L) were immunostained for estrogen receptors and PHA-L. Light and electron microscopic data show that the anterior preoptic area received robust PHA-L-immunoreactive efferents from SCN neurons and immediately adjacent subparaventricular zone. In particular, the AVPv contained abundant labeled fibers and terminal boutons. Ultrastructurally, SCN- and subparaventricular zone-derived terminals synaptically contacted the perikaryon of many estrogen receptor-immunoreactive neurons in the AVPv. The perikarya of unlabeled neurons were also contacted, but the majority of the labeled contacts were observed upon neuronal processes. These results demonstrate that estrogen responsive AVPv neurons are regulated by SCN efferents. Furthermore, the present data provide strong support to the idea of collective control of pituitary gonadotropin release by steroid sensitive and circadian signal neural pathways.

Distribution of natriuretic peptide precursor mRNAs in the rat brain

Atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and C-type natriuretic peptide (CNP) represent members of a recently discovered neuropeptide family involved in central regulation of endocrine and autonomic functions. The present study employed an in situ hybridization approach to provide the first detailed comparative mapping of ANP, BNP, and CNP mRNAs in brain. Results indicate that ANP mRNA is highly expressed in anterior olfactory nuclei, limbic cortices, dorsal endopiriform nucleus, hippocampal subfield CA1, cortical amygdaloid nuclei, medial habenula, anteroventral periventricular and arcuate nuclei, periventricular stratum, zona incerta, mammillary nuclei, inferior olive, nucleus ambiguus, and pontine paragigantocellular nuclei. CNP mRNA is expressed at highest levels in olfactory nuclei, limbic cortices, dorsal endopiriform nucleus, hippocampal subfields CA1-3, anteroventral periventricular and arcuate nuclei, and numerous brainstem regions (including the pontine, lateral reticular, solitary tract, prepositus hypoglossal, and spinal trigeminal nuclei). Positive labeling for BNP mRNA was not observed in brain. The presence of both ANP and CNP mRNA in the same regions of distinct nuclei (e.g., the anteroventral periventricular and arcuate nuclei) suggests the potential for coexpression. Overall, the present data are consistent with a prominent role for both ANP and CNP in neuroendocrine regulation and central cardiovascular integration. The extensive localization of ANP and/or CNP mRNA in olfactory nuclei, limbic cortex, hippocampus, amygdala and diencephalic limbic relays further indicate a putative role for ANP and CNP as neuromodulators of olfactory/limbic information processing.

The C-type natriuretic peptide receptor is the predominant natriuretic peptide receptor mRNA expressed in rat hypothalamus

The natriuretic peptide receptors (NPR) are membrane-bound guanylate cyclases with extracellular binding domains specific for particular members of the natriuretic peptide family. NPR-A binds atrial natriuretic peptide (ANP) with high affinity, whereas the NPR-B appears to be specific for C-type natriuretic peptide (CNP). Previous data indicating extensive overlap between localization of ANP and CNP in hypothalamic neuroendocrine circuits suggest the importance of determining whether specificity of natriuretic peptide action may be conferred via receptor type present on target cells. To address this issue, we used in situ hybridization histochemistry to localize NPR-A and NPR-B mRNA in the hypothalamus. NPR-A mRNA was not found in substantial abundance in any hypothalamic nucleus; however, detectable NPR-A signal was observed in other brain regions, including the subfornical organ and medial habenula. In contrast, NPR-B mRNA was expressed throughout the hypothalamus, including neurons of the magnocellular and parvocellular paraventricular, the arcuate, and the supraoptic nuclei. Expression was also seen in other nuclei essential to neuroendocrine control, including the median preoptic, anteroventral periventricular, tuberomammilary, ventromedial and suprachiasmatic nuclei. NPR-B mRNA was also observed in the neural lobe of the pituitary gland, suggesting expression by pituicytes. The results suggest that NPR-B is the primary natriuretic peptide receptor in hypothalamus, and by inference indicate that CNP is the primary active natriuretic peptide in neuroendocrine regulation.

Case report: transverse colon volvulus in a patient with Clostridium difficile pseudomembranous colitis

Sixty-eight cases of transverse colon volvulus have been reported in the literature. The authors report the first case of transverse colon volvulus in association with Clostridium difficile pseudomembranous colitis, with a review of the available literature. It is possible that the acute inflammation of the colonic mucosa, which occurred from the pseudomembranous colitis in this patient, contributed to the development of volvulus. Further studies are needed to explore the role of mucosal inflammation in the occurrence of volvulus.