Constrictive versus compressive bladder outflow obstruction in men: Does it matter?

INTRODUCTION: Bladder outflow obstruction (BOO) is a urethral resistance (UR) at a level above a clinically relevant threshold. UR is currently graded in terms of the existence and severity of the BOO based on maximum flowrate and associated detrusor pressure only. However, the pressure-flow relation throughout the course of voiding includes additional information that may be relevant to identify the type of BOO. This study introduces a new method for the distinction between the provisionally called compressive and constrictive types of BOO and relates this classification to underlying patient and urodynamic differences between those BOO types. METHODS: In total, 593 high-quality urodynamic pressure-flow studies in men were included in this study. Constrictive BOO was identified if the difference Δp between the actual minimal urethral opening pressure (pmuo) and the expected pmuo according to the linearized passive urethral resistance relation (linPURR) nomogram was >25 cmH2O. Compressive BOO is identified in the complementary case where the pressure difference Δp ≤ 25 cmH2O. Differences in urodynamic parameters, patient age, and prostate size were explored. RESULTS: In 81 (13.7%) of the cases, constrictive BOO was found. In these patients, the prostate size was significantly smaller when compared to patients diagnosed with compressive BOO, while displaying a significantly lower maximum flowrate, higher detrusor pressure at maximal flowrate and more postvoid residual (PVR). CONCLUSION: This study is an initial step in the validation of additional subtyping of BOO. We found significant differences in prostate size, severity of BOO, and PVR, between patients with compressive and constrictive BOO. Subtyping of voiding-outflow dynamics may lead to more individualized management in patients with BOO.

Quantifying bladder outflow obstruction in men: A comparison of four approximation methods exploiting large data samples.

INTRODUCTION: A pressure flow study (PFS), part of the International Continence Society standard urodynamic test, is regarded gold standard for the classification and quantification of the urethral resistance (UR), expressed in the bladder outflow obstruction (BOO). For men with benign prostatic hyperplasia, the minimum urethral opening pressure (pmuo ), found at the end of the passive urethral resistance relation is considered the relevant parameter describing BOO. However, in clinical practice, direct measurements of pmuo are easily confounded by terminal dribbling. For that reason, alternative methods were developed to derive pmuo , and thereby assess BOO using the maximum urine flow rate (Qmax ) and the corresponding pressure (pdetQmax ) instead. These methods were never directly compared against a large data set. With the increasing variety of treatments becoming available more precise grading of UR may become of relevance. The current study compares four well-known methods to approximate pmuo and examines the relation between pmuo and pdetQmax . METHODS: In total, 1717 high-quality PFS of men referred with lower urinary tract symptoms between 2003 and 2020 without earlier lower urinary tract surgery were included. From these recordings, pmuo was calculated according to three one-parameter methods. In addition, a three-parameter method (3PM) was used, based on a fit through the lowest pressure flank of the pressure-flow plot. The estimated pmuo 's were compared with a precisely assessed pmuo . A difference of <10 cmH2 O between an estimate and the actual pmuo was considered accurate. A comparison between the four approximation methods and the actual pmuo was visualized using a Bland-Altman plot. The differences between the actual and the estimated slope were assessed and dependency on pmuo was analyzed. RESULTS: A total of 1717 studies were analyzed. In 55 (3.2%) PFS, 3PM analysis was impossible because all pressures after Qmax were higher than pdetQmax . The 3PM model was superior in predicting pmuo , with 75.9% of the approximations within a range of +10 or -10 cmH2 O of the actual pmuo . Moreover, pmuo according to urethral resistance A (URA) and linearized passive urethral resistance relation (linPURR) appear equally reliable. Bladder outflow obstruction index (BOOI) was significantly less accurate when compared to all others. Bland-Altman analysis showed a tendency of BOOI to overestimate pmuo in men with higher grades of UR, while URA tended to underestimate pmuo in those cases. The slope between pmuo and pdetQmax -Qmax increased with larger pmuo , as opposed to the constant relation proposed within BOOI. Although significant differences were found, the clinical relevance of those differences is not known. CONCLUSION: Of the four methods to estimate pmuo and quantify BOO, 3PM was found the most accurate and BOOI the least accurate. As 3PM is not generally available and performance in lower quality PFS is unknown, linPURR is (for now) the most physiologically accurate.

The accuracy of navigated versus freehand curettage in bone tumors: a cadaveric model study.

PURPOSE: Navigation has been suggested to guide complex benign bone tumor curettage procedures, but the contribution of navigation to the accuracy of curettage has never been quantified. We explored the accuracy of navigated curettage in a cadaveric observational pilot study, comparing navigated to freehand curettage, performed independently by an expert and a novice user. METHODS: The expert performed curettage on 20 cadaveric bones prepared with a paraffin wax mixture tumor, 10 freehand and 10 navigated. We re-used 12 bones for the novice experiments, 6 freehand and 6 navigated. Tumor and curettage cavity volumes were segmented on pre- and post-cone-beam CT scans. Accuracy was quantified using the Dice Similarity Coefficient (DSC), and with remaining tumor volume, bone curettage volume, maximal remaining width and procedure times compared between navigation and freehand groups for both users. RESULTS: There were little differences in curettage accuracy between a navigated (DSC 0.59[0.17]) and freehand (DSC 0.64[0.10]) approach for an expert user, but there were for a novice user with DSC 0.67(0.14) and 0.83(0.06), respectively. All navigated and freehand procedures had some amount of remaining tumor, generally located in a few isolated spots with means of 2.2(2.6) cm3 (mean 20% of the tumor volume) and 1.5(1.4) cm3 (18%), respectively, for the expert and more diffusely spaced with means of 5.1(2.8) cm3 (33%) and 3.0(2.2) cm3 (17%), respectively, for the novice. CONCLUSIONS: In an explorative study on 20 cadaveric bone tumor models, navigated curettage in its current setup was not more accurate than freehand curettage. The amount of remaining tumor, however, confirms that curettage could be further improved. The novice user was less accurate using navigation than freehand, which could be explained by the learning curve. Furthermore, the expert used a different surgical approach than the novice, focusing more on removing the entire tumor than sparing surrounding bone.

Feasibility study of intraoperative cone-beam CT navigation for benign bone tumour surgery.

BACKGROUND: Intraoperative cone-beam computed tomography (CBCT) offers the advantage of navigation on the current anatomical situation and the possibility to take a control scan. We assessed the feasibility of using intraoperative CBCT for navigated intralesional curettage. METHODS: Nine benign bone tumour patients were studied. Feasibility was assessed by describing the workflow and indications for navigation, scoring CBCT image quality and registration accuracy, and measuring scan and navigation set-up times. Short-term follow-up was described. RESULTS: CBCT navigation was successful in all patients. Median tumour visibility, tumour delineation, and vital structure visibility scores were good. Median registration accuracy score was very good. Median scan and verification times were 5 and 3 minutes, respectively. One patient had a tumour recurrence after 6 months. CONCLUSIONS: Intraoperative CBCT navigation is feasible and safe. Indications for use of navigation in clinical practice are closeness to vital structures, complexly shaped tumours or bone, minimally invasive surgery, and repeated surgery.

Identifying Critical Habitat for Australian Freshwater Turtles in a Large Regulated Floodplain: Implications for Environmental Water Management.

Freshwater turtles face many threats, including habitat loss and river regulation reducing occupancy and contributing to population decline. Limited knowledge of hydrological conditions required to maintain viable turtle populations in large floodplain wetlands hinders effective adaptive management of environmental water in regulated rivers. We surveyed three turtle species over 4 years across the Lower Murrumbidgee River floodplain, a large wetland complex with a long history of water resource development. Using site and floodplain metrics and generalized linear models, within a Bayesian Model Averaging framework, we quantified the main drivers affecting turtle abundance. We also used a hierarchical modeling approach, requiring large sample sizes, quantifying possible environmental effects while accounting for detection probabilities of the eastern long-necked turtle (Chelodina longicollis). The three species varied in their responses to hydrological conditions and connectivity to the main river channel. Broad-shelled turtles (Chelodina expansa) and Macquarie River turtles (Emydura macquarii macquarii) had restricted distributions, centered on frequently inundated wetlands close to the river, whereas the eastern long-necked turtles were more widely distributed, indicating an ability to exploit variable habitats. We conclude that turtle communities would benefit from long-term management strategies that maintain a spatiotemporal mosaic of hydrological conditions. More specifically, we identified characteristics of refuge habitats and stress the importance of maintaining their integrity during dry periods. Neighboring habitats can be targeted during increased water availability years to enhance feeding and dispersal opportunities for freshwater turtles.

Response of extraintestinal pathogenic Escherichia coli to human serum reveals a protective role for Rcs-regulated exopolysaccharide colanic acid.

Extraintestinal Escherichia coli (ExPEC) organisms are the leading cause of Gram-negative bacterial bloodstream infections. These bacteria adapt to survival in the bloodstream through expression of factors involved in scavenging of nutrients and resisting the killing activity of serum. In this study, the transcriptional response of a prototypic ExPEC strain (CFT073) to human serum was investigated. Resistance of CFT073 to the bactericidal properties of serum involved increased expression of envelope stress regulators, including CpxR, σE, and RcsB. Many of the upregulated genes induced by active serum were regulated by the Rcs two-component system. This system is triggered by envelope stress such as changes to cell wall integrity. RcsB-mediated serum resistance was conferred through induction of the exopolysaccharide colanic acid. Production of this exopolysaccharide may be protective while cell wall damage caused by serum components is repaired.

Vascular and thrombogenic effects of pulmonary exposure to Libby amphibole.

Exposure to Libby amphibole (LA) asbestos is associated with increased incidences of human autoimmune disease and mortality related to cardiovascular diseases. However, the systemic and vascular impacts are less well examined because of the dominance of pulmonary disease. It was postulated that regardless of the type of exposure scenario, LA exposure might produce systemic and vascular inflammogenic and thrombotic alterations in healthy and cardiovascular compromised rat models. Samples from three independent studies were examined. In the first study, male Wistar Kyoto (WKY), spontaneously hypertensive (SH), and SH heart failure (SHHF) rats were intratracheally instilled once with 0 (vehicle), 0.25, or 1 mg/rat of LA. In the second study, F344 rats were instilled with vehicle or LA at 0.5, 1.5, or 5 mg/rat. In the third study, F344 rats were instilled with the same mass concentrations of LA delivered by biweekly multiple instillations over 3 mo to simulate an episodic subchronic exposure. Complete blood count, platelet aggregation, serum cytokines, and biomarkers of systemic and aortic effects were examined. LA reduced adenosine diphosphate (ADP)-induced platelet aggregation and decreased circulating platelets in WKY (1 mg/rat) and F344 (5 mg/rat) at the 3-mo time point but did not do so in SH or SHHF rats. A decline in circulating lymphocytes with age appeared to be exacerbated by LA exposure in F344 rats but the differences were not significant. Aorta mRNA expression for biomarkers of oxidative stress (HO-1, LOX-1), inflammation (MIP-2), and thrombosis (tPA, PAI-1, vWf) were increased at baseline in SH and SHHF relative to WKY. LA exposure upregulated several of these biomarkers and also those involved in aortic contractility of WKY rats at 3 mo, suggesting thrombogenic, vasocontractile, and oxidative stress-mediated impairments. The aorta changes in F344 rats were less remarkable than changes noted in WKY following LA exposure. In conclusion, exposure to LA decreased circulating platelets and platelet coagulability while increasing the expression of oxidative stress, thrombosis, and vasoconstriction biomarkers in the aorta of healthy rats. These changes were similar to those noted at baseline in SH and SHHF rats, suggesting that LA-induced pulmonary injury might increase the risk of developing cardiovascular disease in healthy individuals.

Analgesic effect of leaf extract from Ageratina glabrata in the hot plate test

Ageratina glabrata (Kunth) R.M. King & H. Rob., Asteraceae (syn. Eupatorium glabratum Kunth) is widely distributed throughout Mexico and popularly known as "chamizo blanco" and "hierba del golpe" for its traditional use as external analgesic remedy. Though glabrata species has been chemically studied, there are no experimentally asserted reports about possible analgesic effects which can be inferred from its genus Ageratina. To fill the gap, we evaluated A. glabrata extracts in an animal model of nociception exploiting thermal stimuli. NMR and mass analyses identified a new thymol derivative, 10-benzoiloxy-6,8,9-trihydroxy-thymol isobutyrate (1), which was computationally converted into a ring-closed structure to explain interaction with the COX-2 enzyme in a ligand-receptor docking study. The resulting docked pose is in line with reported crystal complexes of COX-2 with chromene ligands. Based on the present results of dichloromethane extracts from its dried leaves, it is safe to utter that the plant possesses analgesic effects in animal tests which are mediated through inhibition of COX-2 enzyme.

Impaired interferon-gamma responses, increased interleukin-17 expression, and a tumor necrosis factor-alpha transcriptional program in invasive aspergillosis.

BACKGROUND: Invasive aspergillosis (IA) is the most common cause of death associated with fungal infection in the developed world. Historically, susceptibility to IA has been associated with prolonged neutropenia; however, IA has now become a major problem in patients on calcineurin inhibitors and allogenic hematopoietic stem cell transplant patients following engraftment. These observations suggest complex cellular mechanisms govern immunity to IA. METHODS: To characterize the key early events that govern outcome from infection with Aspergillus fumigatus, we performed a comparative immunochip microarray analysis of the pulmonary transcriptional response to IA between cyclophosphamide-treated mice and immunocompetent mice at 24 h after infection. RESULTS: We demonstrate that death due to infection is associated with a failure to generate an incremental interferon-gamma response, increased levels of interleukin-5 and interleukin-17a transcript, coordinated expression of a network of tumor necrosis factor-alpha-related genes, and increased levels of tumor necrosis factor-alpha. In contrast, clearance of infection is associated with increased expression of a number genes encoding proteins involved in innate pathogen clearance, as well as apoptosis and control of inflammation. CONCLUSION: This first organ-level immune response transcriptional analysis for IA has enabled us to gain new insights into the mechanisms that govern fungal immunity in the lung.

Synthesis and biological testing of purine derivatives as potential ATP-competitive kinase inhibitors.

On the basis of ATP adenine, a series of adenine and purine derivatives was prepared and tested for their ability to inhibit a spectrum of disease-related kinases. There has been scant research investigating the potential of cosubstrate derived kinase inhibitors for other kinases than CDKs. Our inhibitor design combined the purine system from the original cosubstrate ATP and phenyl moieties in order to explore possible interactions with the different regions of the ATP binding site in several disease-related protein kinases. There have been a number of hits for the assayed substances, which led us to conclude that the spectrum of compounds may prove to be a valuable tool kit for the evaluation of bonding and selectivity patterns for a wide variety of kinases.

Destruction of wetlands and waterbird populations by dams and irrigation on the Murrumbidgee River in arid Australia.

The Lowbidgee floodplain is the Murrumbidgee River's major wetland in southeastern Australia. From more than 300,000 ha in the early 1900s, at least 76.5% was destroyed (58%) or degraded (18%) by dams (26 major storages), subsequent diversions and floodplain development. Diversions of about 2,144,000 ML year(-1) from the Murrumbidgee River come from a natural median flow of about 3,380,000 ML year(-1) providing water for Australia's capital, hydroelectricity, and 273,000 ha of irrigation. Diversions have reduced the amount of water reaching the Lowbidgee floodplain by at least 60%, from 1888 to 1998. About 97,000 ha of Lowbidgee wetland was destroyed by development of the floodplain for an irrigation area (1975-1998), including building of 394 km of channels and 2,145 km of levee banks. Over 19 years (1983-2001), waterbird numbers estimated during annual aerial surveys collapsed by 90%, from an average of 139,939 (1983-1986) to 14,170 (1998-2001). Similar declines occurred across all functional groups: piscivores (82%), herbivores (87%), ducks and small grebe species (90%), large wading birds (91%), and small wading birds (95%), indicating a similar decline in the aquatic biota that formed their food base. Numbers of species also declined significantly by 21%. The Lowbidgee floodplain is an example of the ecological consequences of water resource development. Yanga Nature Reserve, within the Lowbidgee floodplain, conserved for its floodplain vegetation communities, will lose these communities because of insufficient water. Until conservation policies adequately protect river flows to important wetland areas, examples such as the Lowbidgee will continue to occur around the world.

Use of satellite image analysis to track wetland loss on the Murrumbidgee River floodplain in arid Australia, 1975-1998.

Demonstrating the extent of wetland loss and its causes are essential for policy makers and managers. We used Landsat satellite imagery to show major wetland loss in the Lower Murrumbidgee floodplain on the Murrumbidgee River in arid Australia. Stratification of the floodplain according to hydrology, use of imagery from the same time of year and the separation of developed areas, using ancillary information were essential. There was considerable loss of floodplain area over a 23 year period (1975-1998), mainly in the Nimmie-Caira stratum (59% loss), as wetland areas were replaced by irrigation bays. There was also a significant increase in fragmentation. For floodplain areas distant from the river, flooding patterns were more difficult to identify because of infrequent flooding and primary reliance on rainfall. Landsat imagery provided a powerful tool for demonstrating long-term changes in wetland area, even in highly variable environments. Such information can demonstrate the ecological costs of water resource development on floodplains, forming a basis for policy and management of rivers.

Brief 95% O2 exposure effects on surfactant protein and mRNA in rat alveolar and bronchiolar epithelium.

In acute lung injury, a disturbed surfactant system may impair gas exchange. Previous evaluations of hyperoxia effects on surfactant proteins (SPs) followed exposures >1-2 days. To evaluate the effects of brief exposure to hyperoxia on the SP system, we exposed adult male rats to 95% O2 or air for 12, 36, and 60 h. SP-A, -B, and -C mRNAs were analyzed by Northern blot and semiquantitative in situ hybridization (ISH). SP-A and -B were analyzed in whole lung homogenates, lung lavage fluid, and fixed tissue by semiquantitative immunohistochemistry (IHC). All SP mRNAs were diminished at 12 h and rose to or exceeded control by 60 h as determined by Northern blot and ISH. These effects were seen mainly in the intensity of ISH signal per cell in both type II and bronchiolar epithelial (Clara) cells and to a lesser extent on numbers of positively labeled cells. SP-B declined to 50% of control in lavage at 12 h, but no changes in total lung SP-A and -B were seen. The number of SP-A positively labeled cells did not change, but SP-A label intensity measured by IHC in type II cells showed parallel results to Northern blots and ISH. The response of SP-A in Clara cells was similar. SP-B immunolabeling intensity rose in both type II and Clara cells throughout the exposure. SP-C ISH intensity fell at 12 h and was increased to two times control by 60 h of hyperoxia. Sharp declines in SP expression occurred by 12 h of 95% O2 and may affect local alveolar stability.

Brief exposure to 95% oxygen alters surfactant protein D and mRNA in adult rat alveolar and bronchiolar epithelium.

Surfactant protein D (SP-D), which has structural homology to C-type lectin binding regions, may play a role in host defense and has no known surfactant function. Because other surfactant proteins have been shown to be increased after prolonged periods of hyperoxia, we sought to evaluate the early effects of hyperoxia (95% O2) on expression of SP-D in the adult male rat lung. Animals were exposed to air or to 12, 36, or 60 h of 95% O2. Northern blot analysis of total lung RNA revealed marked SP-D mRNA increases at 12 h 95% O2 compared with air-exposed controls, with decreasing expression to near that of air-exposed animals by 60 h. Semiquantitative in situ RNA hybridization demonstrated parallel results, with increased numbers of labeled alveolar epithelial (AE) and bronchiolar epithelial (BE) cells at 12 h and increased intensity of labeled alveolar cells, compared with air-exposed controls. After 60 h of exposure to 95% O2, mRNA label intensity in AE and BE was decreased to levels near those seen in air-exposed animals. In contrast, Western blotting showed a decline in total lung SP-D with 95% O2 exposure, beginning at 12 h and continuing at 36 and 60 h, respectively. Semiquantitative immunohistochemistry demonstrated a decline in AE labeling parallel to the total lung Western blot results, but labeled total BE cell numbers increased (P = 0.10). Hyperoxia had differential effects on SP-D abundance in AE and BE cells, and therefore may influence the availability of SP-D to bind microbial pathogens in the airways depending on cell type and location.

Lack of beta 3-adrenergic receptor mRNA expression in adipose and other metabolic tissues in the adult human.

The beta 3-adrenergic receptor (beta 3AR) has been purported to play important roles in a number of metabolic functions, suggesting that beta 3AR agonists might be useful as antidiabetic and antiobesity therapeutic agents. However, these assertions are based entirely on extensive metabolic studies with such agonists in rodents. To clarify the role that the beta 3AR might have in humans, we sought to define the tissue distribution of the beta 3AR in adult human tissue by the use of a highly specific and sensitive approach. Northern blots of selected tissues failed to reveal any beta 3AR mRNA, suggesting little or no expression. To detect minute amounts of transcripts, we developed a reverse transcriptase-polymerase chain reaction (RT-PCR) method that uses primers to amplify a region of the beta 3AR that has little homology with the closely related beta 1- and beta 2-AR genes, and we verified the specificity of this approach using plasmids containing the cloned human beta 1-, beta 2-, and beta 3AR genes. RT-PCR performed on as little as 20 ng of total RNA from 3T3-F442A cells, which expressed beta 3AR at very low levels (approximately 20 fmol/mg of protein), provided an easily detectable signal by ethidium bromide staining and Southern blotting of electrophoresed products. RT-PCR was performed on RNA obtained from 23 different human tissues, using primers for the beta 3AR, the beta 2AR, and beta-actin, which acted as a control. Whereas beta-actin and the beta 2AR were detected in virtually all tissues, RT-PCR using beta 3AR primers gave products from 13 tissues, including skeletal muscle, lung, adipose tissue, kidney, small intestine, pancreas, spleen, and adrenal gland. An end-labeled 50-nucleotide probe identical to an internal region of the expected beta 3AR product hybridized under low stringency conditions to seven of these products. However, sequencing of these products, which were somewhat smaller in molecular size than expected, did not reveal beta 3AR DNA sequence. Given the specificity and sensitivity of our approach, we conclude that the beta 3AR is not expressed to any significant degree in the adult human tissues studied, including adipose tissue and other metabolic sites.

Long-term agonist exposure induces upregulation of beta 3-adrenergic receptor expression via multiple cAMP response elements.

During continuous stimulation by agonist, beta 1- and beta 2-adrenergic receptors (ARs) undergo processes that lead to decreases in receptor expression. This receptor down-regulation serves to limit the cellular cAMP response during chronic agonist exposure. In the recently described third subtype of the beta AR, denoted beta 3AR, we found four potential cAMP response elements in the 5' flanking region, suggesting that expression of this receptor might be positively regulated by agonists. These elements were cloned into the vector pA10CAT2, which contains a chloramphenicol acetyltransferase reporter gene, and transiently expressed in VERO cells. Three of these elements, TGACTCCA, TGAGGTCT, and CGAGGTCA (located 518, 622, and 1125 bases upstream of the beta 3AR coding block, respectively) were found to increase transcription of the chloramphenicol acetyltransferase gene in response to cAMP analogues and agents that increase intracellular cAMP. 3T3-F442A cells, when differentiated into the adipocyte phenotype by insulin, expressed beta 3AR, and nuclear runoff studies from such cells confirmed cAMP enhancement of beta 3AR mRNA transcription. In these cells, beta 3AR mRNA increased in response to exposure to the beta 3AR agonist isoproterenol and remained elevated during exposures of up to 24-30 hr. During prolonged exposure to agonist, no downregulation of beta 3AR expression in 3T3-F442A cells occurred. Indeed, beta 3AR expression increased during agonist exposure to approximately 165% of basal expression. In marked contrast, beta 1AR expression declined by approximately 70% in response to chronic agonist exposure. These studies reveal a subtype-specific prolonged transcriptional regulation of a beta AR gene by the end product of its signal transduction pathway. Thus, the beta 3AR undergoes a paradoxical increase in receptor expression during chronic agonist exposure.

Studies on tryptophan accumulation in brain during methiothepin-induced enhancement of 5-hydroxyindole synthesis.

The elevation of brain tryptophan, 5-hydroxytryptophan and 5-hydroxyindoles (serotonin + 5-hydroxyindole acetic acid) that results from a tryptophan load is potentiated by prior administration of methiothepin, a serotonin receptor antagonist. Co-administration of valine with tryptophan attenuates these effects even in animals receiving methiothepin pretreatment. Administration of methiothepin and tryptophan to rats with widespread reduction of brain 5-hydroxyindole levels resulting from raphe lesions or 5,7-dihydroxytryptamine pretreatment still enabled brain tryptophan levels to rise considerably above the sum of increases found in animals receiving one or the other. Following transection of the spinal cord, the cranial portion still exhibited enhanced uptake of tryptophan and 5-hydroxyindole synthesis following methiothepin plus tryptophan treatment, however, both these events were absent in the caudal segment. Apparently, enhanced tryptophan uptake can proceed in the presence of minimal neuronal activity; however, when nerve impulse flow is eliminated, both 5-hydroxyindole synthesis and tryptophan uptake is impaired.