Compatibility and stability of an admixture of multiple anaesthetic drugs for opioid-free anaesthesia.

The ability to combine and use drugs in a single infusion device may be useful in resource-limited settings. This study examined the chemical stability of an opioid-sparing mixture of ketamine, lidocaine and magnesium sulphate when combined in a single syringe. High-performance liquid chromatography and atomic absorption spectrophotometry were performed on six syringes containing the three-drug mixture. Since most opioid-sparing techniques typically rely on a 24-hour infusion regime, we tested stability at the initial admixing and 24 hours later. Stability was defined as a measured drug concentration within 10% of expected, with the absence of precipitation or pH alterations. Pharmacokinetic simulations were conducted to further show that the achieved plasma drug concentrations were well within an effective analgesic range. All mixed drug concentration measurements were within the required 10% reference limit. No obvious precipitation or interaction occurred, and pH remained stable. Drug stability was maintained for 24 hours. Pharmacokinetic simulations showed that ketamine and lidocaine were within their minimum analgesic effect concentrations. Our results show that this three-drug mixture is chemically stable for up to 24 hours after mixing, with a pharmacokinetic simulation illustrating safe, clinically useful predicted plasma concentrations when using the described admixture.

Do habitat and elevation promote hybridization during secondary contact between three genetically distinct groups of warbling vireo (Vireo gilvus)?

Following postglacial expansion, secondary contact can occur between genetically distinct lineages. These genetic lineages may be associated with specific habitat or environmental variables and therefore, their distributions in secondary contact could reflect such conditions within these areas. Here we used mtDNA, microsatellite, and morphological data to study three genetically distinct groups of warbling vireo (Vireo gilvus) and investigate the role that elevation and habitat play in their distributions. We studied two main contact zones and within each contact zone, we examined two separate transects. Across the Great Plains contact zone, we found that hybridization between eastern and western groups occurs along a habitat and elevational gradient, whereas hybridization across the Rocky Mountain contact zone was not as closely associated with habitat or elevation. Hybrids in the Great Plains contact zone were more common in transitional areas between deciduous and mixed-wood forests, and at lower elevations (<1000 m). Hybridization patterns were similar along both Great Plains transects indicating that habitat and elevation play a role in hybridization between distinct eastern and western genetic groups. The observed patterns suggest adaptation to different habitats, perhaps originating during isolation in multiple Pleistocene refugia, is facilitating hybridization in areas where habitat types overlap.

Oncolytic virus in gliomas: a review of human clinical investigations.

Gliomas remain one of the more frustrating targets for oncologic therapy. Glioma resistance to conventional therapeutics is a product of their immune-privileged milieu behind the blood-brain barrier, in addition to their suppressive effect on the immune response itself. Taking the lead from the growing success of immunotherapy for systemic cancers, such as lung cancer and melanoma, immunotherapeutics has emerged as a major player in the potential treatment of gliomas, with oncolytic viruses in particular showing significant promise as evidenced by the recent Breakthrough and Fast Tract Designations for PVSRIPO and DNX2401. This review serves as a useful and updated compendium of the completed human clinical investigations for several oncolytic viruses in the treatment of gliomas.

Specificity of a new lipid mediator produced by testicular and peritoneal macrophages on steroidogenesis.

Macrophage-derived factor (MDF) is a lipophilic factor produced by rat testicular and peritoneal macrophages that maximally stimulates testosterone production by rat Leydig cells through a steroidogenic acute regulatory protein independent mechanism. The purpose of the present study was to determine whether MDF is also produced by human macrophages, and/or if it acts on human steroidogenic cells. We also studied the tissue-specific functions of MDF by determining if it also acts on steroidogenic cells of the ovary and adrenal glands and, if so, does it require new protein synthesis. It was found that MDF was produced by human peritoneal macrophages, and was capable of stimulating human steroidogenic cells. In terms of tissue specificity, it was found that primary cultures of rat adrenocortical cells respond to MDF with increased secretion of aldosterone and corticosterone, as did rat granulosa cells by producing progesterone. MDF acted in the presence of cycloheximide, indicating that it does not require new protein synthesis. These results indicate that MDF may have significant therapeutic potential and provide a basis for future studies concerning its physiological role in humans. These results further suggest that MDF is not only involved in paracrine regulation of Leydig cells, but also has the potential for the local regulation of steroidogenesis in both granulosa and adrenal cortical cells.

Regulation of Leydig cells through a steroidogenic acute regulatory protein-independent pathway by a lipophilic factor from macrophages.

The purpose of this investigation was to study the mechanism of action of a macrophage-derived factor that stimulates steroid production by Leydig cells. This factor increased testosterone production within 30 min, and reached a half-maximal response by 6-8 h. At a maximal dose, it stimulated testosterone production 20-fold at 24 h. Its efficacy was consistently higher than that achieved with a maximal dose of human chorionic gonadotropin (hCG). However, Leydig cells treated with a maximal dose of both the macrophage-derived factor and hCG secreted the same amount of testosterone as when given a maximal dose of only the macrophage-derived factor. The macrophage-derived factor did not require new protein synthesis to stimulate testosterone production, nor did it alter the amount of steroidogenic acute regulatory protein (StAR). While the macrophage-derived factor required an active cholesterol side-chain cleavage complex system, it did not alter the capacity of this enzyme complex. Finally, the macrophage-derived factor was unable to stimulate the production of progesterone by isolated mitochondria. In summary, the macrophage-derived factor is a highly active, acute regulator of steroidogenesis that acts through a high capacity StAR-independent pathway.

FSH does not directly influence testicular macrophages.

We have previously demonstrated that conditioned medium from testicular macrophages stimulates testosterone production by Leydig cells. It was also reported that conditioned medium from macrophages treated with follicle-stimulating hormone (FSH) had an even greater amount of Leydig cell-stimulating activity than medium from untreated macrophages, indicating that this factor is under the regulation of FSH. However, most other laboratories have been unable to reproduce this effect of FSH. We have recently purified and partially characterized the stimulatory factor from macrophage-conditioned medium that stimulates Leydig cells. The purpose of the present investigation was to reinvestigate the effect of FSH by determining whether it regulates the production of this purified factor and by determining whether macrophages have mRNA for the FSH receptor. Testicular macrophages were isolated from adult rats and incubated 24 hours with human recombinant FSH (20 units/ml), ovine FSH (200 ng/ml), fetal bovine serum (2%), or dibutyryl cyclic adenosine monophosphate (1 mM). The macrophage-derived factor (MDF) was then purified from conditioned medium of the various treatment groups and added to Leydig cells. The concentration of testosterone in the Leydig cell medium was then measured after 16 hours. It was found that serum significantly stimulated production of the MDF. However, FSH had no effect on production of the MDF in the presence or absence of serum. Dibutyryl cyclic adenosine monophosphate exerted a slight inhibitory effect on production of the macrophage-derived factor. Most importantly, testicular macrophages did not express detectable levels of FSH receptor mRNA, either in vivo or in vitro, when evaluated using either in situ hybridization or northern analysis, under identical conditions that clearly demonstrated FSH receptor mRNA in Sertoli cells. We conclude that testicular macrophages are not a direct target for FSH.

Alterations in brain and pituitary beta-endorphin content in genetically epilepsy-prone rats.

We measured beta-endorphin concentrations in the anterior and neurointermediate lobes of the pituitary gland and in microdissected brain regions of moderate-seizure genetically epilepsy-prone rats (GEPR-3), severe-seizure GEPR-9s and Sprague-Dawley non-epileptic control rats. Plasma concentrations of beta-endorphin and beta-melanocyte-stimulating hormone (alpha-MSH) were also measured as indicators of pituitary POMC-peptide secretion. Concentrations of beta-endorphin in the anterior lobe of GEPR-3s were 53% higher compared to controls and 57% higher compared to GEPR-9s. There were no differences in neurointermediate lobe beta-endorphin concentrations between control and either GEPR strain. Plasma beta-endorphin concentrations were significantly lower in GEPR-9s than controls. Plasma levels of alpha-MSH did not differ between control and GEPRs. In the hypothalamus of GEPR-9s beta-endorphin concentrations in the arcuate nucleus were significantly greater than in GEPR-3s. Concentrations of beta-endorphin in the central amygdala of GEPR-9s were two- to threefold greater than in control or GEPR-3s. Beta-Endorphin concentrations in the central gray of GEPR-3s were 58% lower than control or GEPR-9s. These data suggest that anterior lobe beta-endorphin secretion is reduced in GEPR-9s. Furthermore, brain endorphinergic pathways appear to be differentially altered in GEPR-3s and GEPR-9s. Alterations in pituitary beta-endorphin secretion and brain endorphinergic systems may contribute to seizure susceptibility in GEPRs and to differences in seizure severity between GEPR-3s and GEPR-9s.

The effects of melanocortin peptides and corticosterone on habituation in the great plains toad, Bufo cognatus.

We investigated the ability of various melanocortin peptides and corticosterone to influence habituation of prey-catching behavior in the toad, Bufo cognatus. Male toads were injected with various melanocortin peptide fragments or corticosterone 30 min prior to acquisition. Adrenocorticotropin (ACTH[1-39]), ACTH[4-10], and N-acetyl ACTH[1-13] amide (alpha-MSH) significantly decreased the number of turning reactions during acquisition in relation to controls. The effects of the noncorticotropic ACTH fragments were rapid and transient, occurring within the first 20 min of acquisition. Corticosterone caused a slight but significant decrease in the number of turning reactions. Neither des-acetyl alpha-MSH nor (Nle4, D-Phe7) alpha-MSH had any effect on acquisition. ACTH[1-39] was the only peptide that delayed extinction. The ability of alpha-MSH to facilitate acquisition was not observed in the presence of the alpha-MSH antagonist U-76188E. These data suggest that the effects of ACTH on habituation are, in part, independent of effects on glucocorticoid secretion. Apparently, similar structural requirements are necessary for the behavioral effects of melanocortins in amphibians and mammals.

Diurnal variation in alpha-melanocyte-stimulating hormone content of various brain regions and plasma of the Texas toad, Bufo speciosus.

We measured the concentrations of alpha-melanocyte-stimulating hormone (alpha-MSH) in various brain regions as well as in the pituitary gland and plasma of the toad Bufo speciosus during a 24-hr light:dark cycle. There was significant diurnal variation of alpha-MSH concentrations in the hypothalamus and brainstem. In both areas alpha-MSH concentrations were highest during the scotophase. Peak alpha-MSH concentrations in the hypothalamus were observed at 21.00 and 05.00 hr, while a single peak in alpha-MSH concentrations was observed in the brainstem at 21.00 hr. In contrast, peak alpha-MSH concentrations in the plasma were observed during the photophase at 17.00 hr, when brain concentrations of alpha-MSH were low. There was no significant diurnal variation observed in the pituitary content of alpha-MSH throughout the 24-hr light:dark cycle. These data suggest that different mechanisms control hypothalamic and pituitary alpha-MSH cells in the toad during the 24-hr light:dark cycle. The fact that peak alpha-MSH concentrations were observed in the hypothalamus during the activity period of the toad is consistent with the proposed role of alpha-MSH peptides in learning and memory processes.

Glomerulosclerosis in type 2 (non-insulin-dependent) diabetes mellitus: relationship to glycaemia in the University Group Diabetes Program (UGDP).

Kidney tissue of acceptable quality was available from autopsies of 55 patients who had been followed prospectively for 3 to 15 years as participants in the University Group Diabetes Program, a study of vascular disease in Type 2 (non-insulin-dependent) diabetic patients. Slides were prepared for light microscopic reading by uniform histologic techniques, and then were randomly intermixed and coded with tissues identically prepared from matched non-diabetic subjects (morphologic controls). After independent review by three morphologists, the results were tabulated and assigned to one of four diagnostic groups: 1) typical diabetic nodular glomerulosclerosis; 2) mesangial changes suggestive of diabetes (diffuse lesion); 3) non-diabetic renal disease; 4) normal for age. Of the diabetic cases 31% (17 of 55) were found to show nodular glomerulosclerosis, and another 47% (26 of 55) showed suggestive changes; none of the morphologic control slides was read as showing nodular glomerulosclerosis, but some were judged to show suggestive mesangial (diffuse) changes. Although only 4 of the 17 diabetic patients with nodules had died of uraemia, many had hypertension, which may have contributed to their deaths from vascular disease. The patients with nodular glomerular changes also showed, on the average, the highest blood glucose levels during life. Type 2 diabetes in later life appears to be associated with a high risk for typical tissue changes of diabetic kidney damage, which may contribute significantly to morbidity and mortality and may be present before azotaemia and qualitative proteinuria have been recognized.

Ultrastructural studies of the human round window membrane.

An ultrastructural study of 14 round window membranes of seven human ears disclosed three basic layers: an outer epithelium lining the middle ear, a middle core of connective tissue, and an inner epithelium bordering the inner ear. Morphological evidence suggests that these layers participate in absorption and secretion of substances to and from the inner ear. A comparison of morphological features of round window membranes suggests that the average thickness of 70 microns does not change with advancing age. However, in the elderly, the connective tissue has a looser arrangement; there is an increase in ground substance; and elastic fibers thicken. Fibroblast nuclei become larger, rounder, and less uniform and have extensions. The ultrastructure of the "false round window membranes," with epithelial cells of the same type bounding both sides, suggests that these membranes consist of juxtaposed epithelial folds of the overlying promontory.

Ultrastructural studies of the round-window membrane of the cat.

An ultrastructural study of eight round-window membranes of four normal cats disclosed three basic layers: an outer epithelium (middle ear), a middle core of connective tissue, and an inner epithelium (inner ear). Morphologic evidence suggests that these layers participate in absorption and secretion of substances to and from the inner ear, such that the entire membrane could play a role in an inner ear "defense system." A comparison of morphologic features of round-window membranes from cats, rodents, and human beings suggests that the cat is a superior animal model for experimental studies. Cationic ferritin, placed for two hours in the round-window niche of four normal cats, was observed to traverse the round-window membrane through pinocytotic vesicles into the connective tissue layer. Evidence of exocytosis of tracer by the inner epithelial layer into the scala tympani is presented. When placed in perilymph, this same tracer was incorporated by inner epithelial cells, suggesting absorptive capabilities of the round-window membrane.

Light microscopic morphometric analysis of rat ileal mucosa. I. Component quantitation of IgA-containing immunocytes.

A light microscopic morphometric analysis of IgA-containing immunocytes within samples of ileal mucosa was performed. The following groups of rats were studied: (1) animals raised in a gnotobiotic environment (microbial reduction); (2) animals with iatrogenic self-filling intestinal blind loops (microbial proliferation); and (3) control animals (sham operation). The unlabeled antibody enzyme immunohistochemical localization technique was employed for the identification of intracellular IgA. Component quantitation involved use of a micrometer component quantitator. Numerical density of the immunocyte population was determined by component quantitation of individual and total immunocyte volumes and by application of the Floderus equation. The methodology employed provided a precise quantitative analysis of all mucosal components of normal and manipulated rat ileum. A statistically significant reduction in the volume percentage of IgA-containing immunocytes in association with both microbial reduction and microbial proliferation was observed. The volume percentage reduction of the IgA-containing immunocyte population associated with gnotobiosis may reflect decreased microbial antigenic stimulation, whereas that associated with microbial proliferation may reflect the presence of an increased population of immunocytes producing non-IgA immunoglobulins.

Light microscopic morphometric analysis of rat ileal mucosa: II. Component quantitation of Paneth cells.

A quantitative light microscopic morphometric analysis of lysozyme- and IgA-containing Paneth cells within the ileal mucosa of physiologically manipulated and control (sham operation) animals was performed. The experimental groups of rats included animals raised in a gnotobiotic environment (microbial reduction) and animals with ileal self-filling blind (microbial proliferation) and Thiry-Vella (intestinal discontinuity) loops. The unlabeled antibody enzyme immunohistochemical localization technique was employed for the identification of intracellular lysozyme and IgA. Component quantitation was performed by use of a micrometer component quantitator. Marked Paneth cell hyperplasia was noted in association with gnotobiosis and with the Thiry-Vella fistula. This observation quantitatively confirms previous subjective impressions of increased Paneth cell differentiation in association with those physiologic states. Since the neurovascular component of the Thiry-Vella fistula is intact, the normal intraluminal succus entericus would appear to be involved in modulation of Paneth cell differentiation. The recognition of Paneth cell hyperplasia in association with the Thiry-Vella fistula suggests that this may be a useful experimental model for an evaluation of the life cycle and functional characteristics of this cell population. The results also revealed that no significant change in the volume percentage of Paneth cells and a decreased volume percentage of Paneth cells containing IgA occurred in association with the self-filling blind loop. A decreased volume percentage of IgA-containing immunocytes in association with the blind loop has previously been reported. The data are most consistent with the interpretation that the Paneth cell and immunocyte response to antigenic stimulation are interrelated and that the Paneth cell population has a restricted latitude of response to microbial proliferation.

Ganglia and ganglion cells in the middle ear. Their presence in the human and the cat.

One hundred human and 100 cat temporal bones were studied for the presence of ganglia and/or ganglion cells. These structures were found at the following two main locations: (1) the promontory wall, both anterior to and below the stapes, and (2) the vertical portion of the facial nerve. In the cat, additional ganglion cells were found within the capsule of the musculus tensor tympani, proximal, medial, and lateral to muscle fibers. The consistent presence of ganglion cells in the mucoperiosteum suggests that they play important roles in the middle ear itself; their presence in the vertical portion of the facial nerve supports the concept that the parasympathetic innervation of the parotid gland is not exclusively via the ninth nerve and/or lends anatomical support to atypical facial pains.

Passage of albumin from the middle ear to the inner ear in otitis media in the chinchilla.

A study of the permeability of the middle ear-inner ear interface for macromolecules was carried out in chinchillas with open and obstructed eustachian tubes utilizing tritiated human serum albumin and immunoelectrophoresis. Tritiated albumin was placed in the round window niche area or normal animals and animals in which the eustachian tubes had been obstructed for 24 hours or 14 days. The tritiated albumin was allowed to remain in the middle ear cavity for 24 hours, Samples of middle ear effusion, perilymph, blood and cerebrospinal fluid were collected and measured for radioactivity. Radioactivity was demonstrated in the perilymph. Samples of middle ear effusions and perilymph were also studied by immunoelectrophoresis with goat antihuman albumin. Albumin placed in the round window niche of an experimental animal could be recovered unchanged in the perilymph. The results suggest a pathophysiologic explanation for the association of otitis media and sensorineural hearing loss or endolymphatic hydrops.

Otitis media with perforation of the tympanic membrane: a longitudinal experimental study.

Despite the high incidence and prevalence of otitis media, its pathogenesis is not thoroughly understood. In an effort to provide a better understanding of this disease, experimental animal models have been developed which corroborate the changes observed in humans. In this study a new factor was added: tympanic membrane perforation 1 week after Eustachian tube obstruction. Twelve cats were divided in 4 even groups, and sacrificed at 1 and 2 weeks, 1 and 3 months after perforation, and their temporal bones were studied. Findings revealed an early massive reaction of the mucoperiosteum with granulation and polypoidal tissue formation which filled a considerable portion of the middle ear cavity. Polypoidal changes involved the stapediovestibular joint, possibly explaining the cases of stapes fixation found at tympanomastoidectomy procedures for chronic otitis media. Cholesterol granulomas with the classic characteristics as described in humans were observed in all animals at 3 month periods. These were preceded by clefts in the effusions, at 1 month, containing red blood cells. These clefts were considered as probable precursors of cholesterol granuloma formation. The association of endolymphatic hydrops, round window membrane changes, and otitis media without purulent labyrinthitis was observed; however, it was felt that the paucity of animals precluded any definite conclusions.

Oval and round window changes in otitis media. Potential pathways between middle and inner ear.

A longitudinal sequential study of oval and round window changes in otitis media in an experimental animal (cat) using Eustachian tube obstruction was done. Thirty-two animals were used. In this first sequential study of the oval and round windows in otitis media, the continuum of round window membrane changes from 1 day to 6 months after obstruction revealed changes to be gradual and similar to those of the mucoperiostium. These changes are suitable for changes in permeability and suggest that this membrane is a very likely pathway from the middle to the inner ear. Bony fistulas were not observed and the oval window remained essentially unchanged in time, thus they were not considered routes into the inner ear. Other possible routes are discussed.