Steady-state kinetics of imipramine in patients

Steady-state plasma level kinetics were studied in 76 patients given imipramine (IP) 150 to 225 mg/day for 2–5 weeks. IP was given in three divided doses at 8.00 a.m., 1.00 p.m. and 5.00 p.m. Plasma concentrations of IP and its active metabolite desipramine (DMI) were determined by quantitative in situ thin-layer chromatography. The plasma levels of IP and DMI showed pronounced flucutations throughout the day with a ratio of about 2 between highest and lowest level. Patients with steady-state levels of IP and/or DMI below 50 g/l reached this within 1 week of treatment. Patients with higher steady-state levels reached steady-state concentrations within 2–3 weeks. There were some intraindividual fluctuations in plasma levels from week to week after steady state had been reached (coefficient of variation: 10–20%). Interindividually, the steady-state levels corrected to a dose of 3.5 mg/kg per day varied considerably: IP: 6–356 g/l, DMI: 24–659 g/l and IP+DMI: 58–809 g/l. The steady-state plasma levels showed a skew distribution that became normal by logarithmic transformation. The IP/DMI ratio ranged from 0.07 to 5.5 with a median value of 0.47. Compared to data from amitriptyline treated patients the IP/DMI ratios had significantly lower median value and larger variation than the corresponding plasma level ratios of amitriptyline/nortriptyline. Several statistically significant differences in steady-state levels between age groups were found. For IP: Women aged 30–39 had lower levels than women aged 20–29, 40–49, and 50–59, and men aged 50–59 and 60–65; men aged 30–39 had lower levels than men aged 60–65. For DMI: Women aged 30–39 had lower levels than women aged 50–59.     

Mechanical coupling of supracellular stress amplification and tissue fluidization during exit from quiescence

Cellular quiescence is a state of reversible cell cycle arrest that is associated with tissue dormancy. Timely regulated entry into and exit from quiescence is important for processes such as tissue homeostasis, tissue repair, stem cell maintenance, developmental processes, and immunity. However, little is known about processes that control the mechanical adaption to cell behavior changes during the transition from quiescence to proliferation. Here, we show that quiescent human keratinocyte monolayers sustain an actinomyosin-based system that facilitates global cell sheet displacements upon serum-stimulated exit from quiescence. Mechanistically, exposure of quiescent cells to serum-borne mitogens leads to rapid amplification of preexisting contractile sites, leading to a burst in monolayer tension that subsequently drives large-scale displacements of otherwise motility-restricted monolayers. The stress level after quiescence exit correlates with the level of quiescence depth at the time of activation, and a critical stress magnitude must be reached to overcome the cell sheet displacement barrier. The study shows that static quiescent cell monolayers are mechanically poised for motility, and it identifies global stress amplification as a mechanism for overcoming motility restrictions in confined confluent cell monolayers.

Quiescence refers to a state of cell cycle arrest in which cells are retained in a standby mode, ready to re-enter the cell cycle upon activation by a given physiological stimuli. The pool of quiescent cells in the human body is typically represented by tissue-specific stem and progenitor cells, naive immune cells, fibroblasts, and epithelial cells (1, 2). In addition, certain cancer cells have the ability to evade cancer therapy by entering a dormant quiescence-like state (1, 2). Accordingly, careful regulation of entry into and exit out of quiescence is important for several physiological processes such as tissue homeostasis and repair, stem cell maintenance, immunity, reproduction, and development (1, 2).During homeostasis, the balance between quiescent and proliferating cells is controlled by constituents of the microenvironment such as soluble factors, extracellular matrix components, blood vessels, and neighboring cells. On the other hand, during episodes that require extensive tissue renewal and remodeling, for example after injury, coordinated stimulation of quiescent cells into proliferation is facilitated by increased exposure to blood-borne and cell-secreted mitogens through local inflammatory responses such as increased blood flow, increased vascular permeability (vasodilation), and immune cell recruitment (3, 4). Accordingly, a commonly used methodology for studies of quiescence in cultured mammalian cells involves consecutive treatments with serum-free and serum-containing growth medium (1).Quiescent cells are required to maintain a high level of preparedness in order to facilitate rapid activation of specialized cell functions once cell division is stimulated. In agreement with this, quiescent stem cells and naive immune cells have been shown to possess multiple epigenetic and posttranslation mechanisms that facilitate the rapid expression of linage-specific genes following stimulation of quiescence exit (2, 5–14). However, little is known about mechanical forces that facilitate adaptation to cell cycle–activated behaviors.Quiescence exit is frequently associated with activation of cell motility. For example, quiescent stem and naive immune cells migrate out of their niches in response to cell cycle activation in order to support tissue homeostasis, repopulate injured tissue, or to perform immune surveillance at distal locations (15–18). In addition, reawakening of dormant quiescent cancer cells can cause tumor relapse and formation of metastases years after remission (19). In multilayered epithelial tissue, like the skin, exit from quiescence during homeostasis is associated with lateral migration to suprabasal regions, while skin injury evokes massive reawakening of basally localized keratinocytes concomitant with activation of cell sheet displacement by collective migration to restore damaged epidermal surfaces (20–23). The strong correlation between quiescence exit and cell migration in multiple physiological settings suggests the existence of mechanisms that link quiescence exit to activation of cell motility.The dynamics of epithelial collectives is largely regulated by mechanical forces generated through cell–cell interactions as well as interactions between cells and the extracellular environment (24). Key components involved in controlling these forces are cytoskeletal components such as actinomyosin and adhesion complexes such as adherent junctions and focal adhesion complexes (25). Additional factors that have been reported to influence the dynamic behavior of epithelial monolayers include the presence of epithelial edges (24, 26), mechanical stretching or compression (27, 28), expression of the endosomal Rab5 protein (29), exposure of cells to growth factors (30–32), local changes in cell shape (33), and the ability of cells to undergo neighbor exchange (34, 35). In addition, recent studies have also identified a functional link between cell cycle progression and force fluctuation leading to dynamic behavior of cultured epithelial monolayers (36, 37).In this study, we have investigated a mechanical link between quiescence exit and activation of large-scale cell sheet displacements. Using traction force microscopy (TFM), we found that confluent cell monolayers install an actinomyosin-based system during quiescence that produces a coordinated burst of contractile forces and intercellular tension across the epithelial monolayer immediately following exposure to serum-borne mitogens. By combining experiments and theoretical modeling, we show that the amplified forces are essential for driving coordinated cell sheet displacements within otherwise motility-restricted cell monolayers. Furthermore, the magnitude of mechanical forces created during quiescence exit and the extent of cell sheet displacement correlate with quiescence depth. Our study provides evidence that quiescent keratinocyte monolayers possess mechanical preparedness for motility and establish monolayer stress amplification as a strategy for overcoming the motility barrier in confined cell sheets.     

Self-administered measurement of symphysis-fundus heights

BACKGROUND: Antenatal identification of infants small for gestational age (SGA) improves their perinatal outcome. Repeated measurement of symphysis-fundus (SF) heights performed by midwives is the most widespread screening method for detection of SGA. However, the inefficiency of this method necessitates improved practices. Earlier start and more frequent SF measurements, which could be accomplished by self-administered measurements, might improve the ability to detect deviant growth. The present study was set up to evaluate whether pregnant women can reliably perform SF measurements by themselves. METHOD: Forty healthy women with singleton and ultrasound-dated pregnancies from 2 antenatal clinics in Uppsala, Sweden, were asked to perform 4 consecutive SF measurements once every week, from 20 to 25 weeks of gestation until delivery. The self-administered SF measurements were recorded and systematically compared with midwives' SF measurements. RESULTS: Thirty-three pregnant women performed self-administered SF measurements over a 14-week period (range: 1-21). The SF curves constructed from self-administered SF measurements had the same shape as previously constructed population-based reference curves. The variance for self-administered SF measurements was higher than that of the midwives. CONCLUSIONS: Pregnant women are capable of measuring SF heights by themselves, but with higher individual variance than midwives. Repeated measurements at each occasion can compensate for the higher variance. The main advantage of self-administered SF measurements is the opportunity to follow fetal growth earlier and more frequently.     

Über Quecksilberinjektionen bei Kindern und Säuglingen

Ohne ZusammenfassungHiezu Taf. XXXVIII.     

875 Cases of bacterial meningitis: Diagnostic procedures and the impact of preadmission antibiotic therapy Part III of a three-part series

Data on the bacteriological findings, diagnostic measures and clinical course of 875 patients with bacterial meningitis are presented. Findings from the medical records and from a follow-up questionnaire survey of 667 of these cases revealed no significant difference between patients treated with antibiotics before admission (pretreated) and those who were not treated before admission (non-pretreated) with respect to clinical condition on admission, mortality and late sequelae. Pretreatment was, however, associated with a longer duration of symptoms. Apart from cases due to Neisseria meningitidis, there were no significant differences in diagnostic findings between pretreated and non-pretreated cases. In the group of pretreated meningococcal patients, however, positive blood cultures, pleiocytosis in the cerebrospinal fluid (CSF) and positive cultures from sites other than blood and CSF were less frequent than in the non-pretreated cases.     

Autoantibodies against 21-hydroxylase and side-chain cleavage enzyme in autoimmune Addison's disease are mainly immunoglobulin G1

OBJECTIVE: Immunoglobulin G (IgG) antibodies to the steroidogenic enzymes 21-hydroxylase (21OH) and side-chain cleavage enzyme (SCC) are important diagnostic markers for autoimmune Addison's disease and autoimmune polyendocrine syndromes (APS) types I and II. The characterization of autoantibody (IgG) subclasses may reveal information on how tIssue destruction takes place; therefore, IgG subtypes of anti-21OH and anti-SCC antibodies from sera of patients with Addison's disease, APS I and APS II were determined using recombinant 21OH and SCC. METHODS: SCC(51-521) and his-SCC(51-521) were expressed by pET-scc in the Escherichia coli strain BL21 Star (DE3) and inclusion bodies were purified. Full-length, human 21OH fused to an N-terminal 6x histidine affinity tag was expressed in insect cells by using the baculovirus expression system bac-to-bac. Western blots were used to investigate the IgG subtype(s) of the autoantibodies against 21OH and SCC in patients and healthy blood donors. RESULTS: All anti-SCC positive sera (n=10) contained autoantibodies of the IgG1 subclass, while four out of ten also contained IgG3. All anti-21OH positive sera (n=16) had autoantibodies exclusively against IgG1. Sera from 20 healthy subjects did not show any reactivity against 21OH or SCC. CONCLUSIONS: The finding of a predominating IgG1 response against 21OH and SCC may suggest that T helper (Th) cells of the Th1 subclass are involved in destruction of the adrenal cortex in patients with autoimmune Addison's disease.     

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth

Avulsion of permanent teeth is one of the most serious dental injuries. Prompt and correct emergency management is essential for attaining the best outcome after this injury. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. It represents the current best evidence and practice based on that literature search and expert opinions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on consensus opinions or majority decisions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. The purpose of these Guidelines is to provide clinicians with the most widely accepted and scientifically plausible approaches for the immediate or urgent care of avulsed permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.     

A NEW RIBONUCLEOTIDE REDUCTASE SYSTEM AFTER INFECTION WITH PHAGE T4

The ribonucleotide reductase system of Escherichia coli B participates in the biosynthesis of DNA by reducing ribonucleoside diphosphates to the corresponding deoxyribonucleotides. The enzyme is regulated in a complicated way by allosteric modifiers. We now find that infection of E. coli with the bacteriophage T4 results in the appearance of a new ribonucleotide reductase system which shows a somewhat different pattern of regulation.Two new proteins, provisionally called fractions A and B, were purified from the extracts of infected bacteria. The reduction of ribonucleotides by these two fractions required the addition of either dithiothreitol or TPNH and E. coli thioredoxin reductase. Mutants of T4 which lacked fraction A activity were obtained. Fraction B may be a virus-induced thioredoxin.