Evidence for a role of arginine vasotocin receptors in the gill during salinity acclimation by a euryhaline teleost fish.

The nonapeptide arginine vasotocin (AVT) regulates osmotic balance in teleost fishes, but its mechanisms of action are not fully understood. Recently, it was discovered that nonapeptide receptors in teleost fishes are differentiated into two V1a-type, several V2-type, and two isotocin (IT) receptors, but it remains unclear which receptors mediate AVT's effects on gill osmoregulation. Here, we examined the role of nonapeptide receptors in the gill of the euryhaline Amargosa pupfish (Cyprinodon nevadensis amargosae) during osmotic acclimation. Transcripts for the teleost V1a-type receptor v1a2 were upregulated over fourfold in gill 24 h after transferring pupfish from 7.5 ppt to seawater (35 ppt) or hypersaline (55 ppt) conditions and downregulated after transfer to freshwater (0.3 ppt). Gill transcripts for the nonapeptide degradation enzyme leucyl-cystinyl aminopeptidase (LNPEP) also increased in fish acclimating to 35 ppt. To test whether the effects of AVT on the gill might be mediated by a V1a-type receptor, we administered AVT or a V1-type receptor antagonist (Manning compound) intraperitoneally to pupfish before transfer to 0.4 ppt or 35 ppt. Pupfish transferred to 35 ppt exhibited elevated gill mRNA abundance for cystic fibrosis transmembrane conductance regulator (cftr), but that upregulation diminished under V1-receptor inhibition. AVT inhibited the increase in gill Na+/Cl- cotransporter 2 (ncc2) transcript abundance that occurs following transfer to hypoosmotic environments, whereas V1-type receptor antagonism increased ncc2 mRNAs even without a change in salinity. These findings indicate that AVT acts via a V1-type receptor to regulate gill Cl- transport by inhibiting Cl- uptake and facilitating Cl- secretion during seawater acclimation.

What makes a Catholic hospital "Catholic" in an age of religious-secular collaboration? The case of the Saint Marys hospital and the Mayo Clinic.

Mayo Clinic is recognized as a worldwide leader in innovative, high-quality health care. However, the Catholic mission and ideals from which this organization was formed are not widely recognized or known. From partnership with the Sisters of St. Francis in 1883, through restructuring of the Sponsorship Agreement in 1986 and current advancements, this Catholic mission remains vital today at Saint Marys Hospital. This manuscript explores the evolution and growth of sponsorship at Mayo Clinic, defined as "a collaboration between the Sisters of St. Francis and Mayo Clinic to preserve and promote key values that the founding Franciscan sisters and Mayo physicians embrace as basic to their mission, and to assure the Catholic identity of Saint Marys Hospital." Historical context will be used to frame the evolution and preservation of Catholic identity at Saint Marys Hospital; and the shift from a "sponsorship-by-governance" to a "sponsorship-by-influence" model will be highlighted. Lastly, using the externally-developed Catholic Identity Matrix (developed by Ascension Health and the University of St. Thomas, Minnesota), specific examples of Catholic identity will be explored in this joint venture of Catholic health care institution and a secular, nonprofit corporation (Mayo Clinic).

Patients who complete advance directives and what they prefer.

OBJECTIVE: To determine health care preferences expressed by patients in advance directives (ADs) and to identify characteristics of patients who completed them. PATIENTS AND METHODS: A computer-generated random sample of 500 patients was selected from the 25,865 (margin of error, +/- 4.34%) unique patients who submitted ADs to Mayo Clinic Rochester between January 1, 2004, and July 1, 2005. After excluding 24 (4.8%) patients who had submitted documents related to financial and property matters instead of ADs, we analyzed the contents of the 476 ADs and the demographic features of the patients to whom the documents belonged. RESULTS: The median (range) age of the patients at the time they signed their respective ADs was 67 (19-97) years. Of the 476 study patients, 409 (91.3%) were high school graduates; 339 (71.2%) had submitted a combined AD, which has features of a living will and a health care power of attorney; 434 (91.2%) had designated a health care agent; and most had granted the agent powers to consent for procedures (340 [78.3%]), to access information (327 [75.3%]), and to withhold and withdraw life-sustaining treatments (337 [77.6%]). Most patients expressed a desire for pain control (308 [64.7%]). For the clinical situations of dying or permanent unconsciousness, most patients explicitly expressed a preference to avoid "general life support" (371 [77.9%]) but did not explicitly address common life-sustaining treatments, including cardiopulmonary resuscitation, mechanical ventilation, hemodialysis, blood transfusion, and artificial nutrition and hydration (if they did, nearly all expressed a preference to avoid the treatments). CONCLUSION: In ADs submitted to our institution, most patients designated a health care agent and granted the agent broad decision-making powers. Although most expressed a desire to avoid "general life support" if dying or permanently unconscious, few expressed preferences regarding specific life-sustaining treatments. Patients, clinicians, and others who use ADs, and investigators contemplating research involving ADs, might find these results informative.