Plasma tumor necrosis factor and mortality in critically ill septic patients

Tumor necrosis factor (TNF) cachectin has been implicated as an important host mediator responsible for shock and multiple organ failure (MOF) observed during sepsis. Using a sensitive enzyme-linked immunosorbent assay, we measured plasma TNF levels in 43 septic patients suffering from a broad range of diseases. Measurements were taken on the day that sepsis was diagnosed. Eleven patients had detectable TNF plasma levels ranging from 10 to 100 pg/ml (TNF-positive group); in 32 patients circulating TNF could not be detected (TNF-negative group). The groups did not differ significantly as to age, underlying disease, percentage positive bacteremia and bacteriologic profile, sepsis score, and extent of MOF. Eight (73%) of 11 TNF-positive patients died from sepsis during ICU stay, vs. 11 (34%) of 32 TNF-negative patients (p less than .05). This study demonstrates that sepsis is accompanied by detectable circulating TNF in 25% of the cases, and for these patients mortality is twice that for comparable TNF-negative patients.     

Medical and financial implications of discontinuing a statewide free insulin program involving 3,720 people

In 1981 a statewide program supplying free insulin to 3,720 patients of state health clinics was discontinued. We attempted to assess whether this action had an adverse effect medically and financially on those concerned. A computer randomized sample of 351 patients (9%) was studied by personal interview and questionnaire. Information obtained focused on certain events that occurred 18 months before and after the program ceased. Measurements used to determine medical impact were number of hospitalizations, emergency room and physician visits, changes in weight and glucose levels, and episodes of ketoacidosis. Financial impact was measured by cost of hospitalization and physician visits. Our results revealed no significant changes in any of the medical parameters studied except for fasting serum glucose levels above 300 mg/dl, which occurred less frequently after the free insulin program was discontinued. There were fewer hospitalizations, more visits to physicians, and no change in number of emergency room visits after discontinuance of the free program. The overall cost saving was estimated to be +883,558 for the 18-month study period, in addition to the +550,000 the plan had been costing the state.     

Ultrastructural investigation of substance P-, leucine-enkephalin- and 5-hydroxytryptamine-like immunoreactive terminals in the area of cremaster motoneurons of the male rat

Studies were made on whether substance P-, leucine-enkephalin- and 5-hydroxytryptamine (serotonin)-like immunoreactive fibers exert a direct influence on the cremaster motoneurons of the male rat by immunocytochemistry combined with retrograde tracing at the light- and electron-microscopic levels. Horseradish peroxidase was used as a retrograde tracer. Two days after injection of horseradish peroxidase into the genitofemoral nerves, its accumulation in the cremaster motoneurons was demonstrated by the diaminobenzidine-nickel method. On immunocytochemical examination of the same sections immunoreactive end-products were detected by the peroxidase-antiperoxidase method. Two different kinds of reaction products were distinguishable at both the light- and electron-microscopical levels. The horseradish peroxidase-labeled cremaster motoneurons at the L1 and L2 levels of the spinal cord were surrounded by abundant immunoreactive terminals. Examination at the ultrastructural level showed that substance P-like immunoreactive terminals formed synaptic contacts almost exclusively with the proximal dendrites of these horseradish peroxidase-labeled cremaster motoneurons. On the other hand, in the leucine-enkephalin- and serotonin-like boutons, significant numbers of axosomatic contacts with horseradish peroxidase-labeled cells were seen although axodendritic contacts with horseradish peroxidase-labeled cells were predominant. Occasionally, leucine-enkephalin-like immunoreactive fibers with synapses on horseradish peroxidase-labeled neurons formed axoaxonic contacts with other leucine-enkephalin-like axonal terminals. Thus, substance P-, leucine-enkephalin- and serotonin-like fibers clearly regulate the function of cremaster motoneurons monosynaptically. The varied synaptic contacts of these fibers according to the neuroactive substances involved suggest different actions of these substances on the cremaster motoneurons.     

A simplified method of counting microorganisms in studying human autoflora

Formulae for the calculation of the count of microorganisms isolated from natural bacterial biocenoses of a child's body have been derived. The authors suggest a variant of simplified drip method for the computation of microorganism colonies in solid media. The described method helps cut down the nutrient media consumption at least 3-fold and is time-saving.     

Wall-thickness and midwall-radius variations in ventricular mechanics.

A fluid-fiber-collagen stress tensor is used to describe the rheology of the left ventricle of the heart. Linear theory is used to find the equilibrium solutions for the end-diastolic and end-systolic states of general axisymmetric shapes that are small perturbations of a thick-walled finite cylinder. The general problem can be studied by superposing the effects of variable midwall radius but constant wall thickness with those of variable wall thickness but constant midwall radius. A Fourier series representation is used to describe the midwall radius and thickness functions. Numerical calculations are performed to determine the deformed geometry and spatial distributions of tissue pressure, stresses, and fiber strains. The calculations proved to be highly accurate when compared to an analytical solution obtained for the special case of no fibers. The results show significant longitudinal differences when compared to results for the cylindrical geometry, with more sensitivity to variation in wall thickness than to variation in midwall radius.     

Maternal factors influencing development of embryos from mice superovulated with gonadotropins

In NMRI mice superovulation with pregnant mare serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG) increased mating rate, number of implantation sites, rate of advanced and delayed resorptions, as well as retarded sternebral ossification and cleft palate. On day 3 of gestation in preimplantation embryos, cell number and mitotic index were lower after superovulation than after spontaneous ovulation. However, when preimplantation embryos from superovulated and control females were transferred on day 3 of pregnancy to pseudopregnant recipients (10 embryos per female) no differences could be detected between the two groups of fetuses at term. The results of the embryo transfer experiments indicate that abnormal embryonic development after superovulation with gonadotropins is predominantly induced by effects of the hormone treatment on the maternal uterine environment.     

Neurologic eye signs following motorcycle accidents

A review of 96 consecutive patients who suffered neuro-ophthalmologic injuries in motorcycle accidents revealed a wide range of findings. These findings were similar to signs associated with other forms of closed-head trauma, aside from a higher incidence of trochlear nerve palsies.     

Effect of estrogen on calcium homeostasis and pituitary hormones in the growing chick

An experiment was carried out to investigate the effect of a range of estradiol (E2) doses (0.1-6.5 micrograms/g body wt/day) on vitamin D metabolism and the plasma levels of growth hormone (GH) and prolactin (PRL) in the growing chick. Doses of 0.5-0.7 microgram/g E2, which are insufficient to raise the plasma calcium level, did induce an increase in growth rate, an increase in 25-hydroxyvitamin D 1 alpha-hydroxylase (1-hydroxylase) and 24-hydroxylase activities, and an increase in plasma GH level. These parameters leveled off or fell over the dose range 1-2 micrograms/g E2 but there was evidence of a second peak in 1-hydroxylase activity at 6 micrograms/g E2. At this high dose rate, the plasma Ca level rose to 8 mM, as it does in the laying hen; 24-hydroxylase activity, growth rate, and plasma GH and plasma PRL levels all decreased. It was concluded that the dose response to estrogen in the growing chick is not linear and, in the case of 1-hydroxylase activity, may even be biphasic.     

Effect of bacterial purified antigenic fractions on natural defence mechanisms

The in vitro ability of bacterial purified antigenic fractions to interfere with the immune system has been investigated on human mononuclear cells from peripheral blood. Exposure of purified monocytes to the drug at concentrations from 1 to 1000 micrograms/ml, for different periods from 0 to 18 h, significantly increased cell-mediated cytotoxicity against TU5 target cells. Moreover, monocytes exposed for 1 to 18 h to drug concentrations from 0.1 to 1000 micrograms/ml released significant amounts of tumor necrosis factor alpha in a dose-dependent manner in the culture supernatants. The drug was also tested on natural killer (NK) cell activity; mononuclear cells exposed to antigenic fractions for different periods showed a significant increase of NK cytotoxic activity against K562 target cells after 3 and 6, but not 0 and 18 h. Active concentrations were from 1 to 100 micrograms/ml, higher and lower doses being ineffective. Bacterial purified antigenic fractions thus have some ability to interfere in vitro with mechanisms of cytolysis mediated by cells and soluble factors.