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Background: Bronchoalveolar lavage (BAL) is essential in determining the efficacy of novel therapies in alpha-1 antitrypsin deficiency (AATD). These require initial proof-of-concept demonstration that treatment administration increases alpha-1 antitrypsin (AAT) levels and/or anti-neutrophil elastase inhibitory capacity (ANEC) in the lung. Early-phase studies often encounter high interindividual variability of BAL results, primarily stemming from the inherent dilution characteristics of returned BAL fluid. A BAL protocol that minimises this variability is needed for reliable comparison of biochemical endpoints in the lung., Methods: The study population included 21 severe AATD (ZZ), 22 moderate AATD (MZ) and 23 non-AATD (MM) individuals, further categorised as healthy, unobstructed current smokers or patients with chronic obstructive pulmonary disease (COPD). An additional six ZZ individuals were receiving intravenous alpha-1 augmentation therapy. We compared common BAL correction methods-albumin, total protein and epithelial lining fluid (ELF) volume measured by urea-when reporting early-phase biochemical endpoints, AAT and ANEC., Results: BAL performed with a paediatric bronchoscope (PB) improved alveolar sampling compared with a traditional adult bronchoscope. Both uncorrected and ELF-corrected BAL demonstrated high interindividual variability regardless of lung health status. BAL total protein correction minimised interindividual variability, producing significant differences in AAT and ANEC between all genotypes, the strongest relationship with plasma AAT levels (r 2 =0.83), greatest inter-lobar concordance in AAT levels (r 2 =0.76) and strong correlation between BAL AAT and ANEC (r 2 =0.88)., Conclusions: By capitalising on the marked consistency in AAT levels between AAT genotypes, and the close relationship between plasma and lung AAT levels, we demonstrate reliable alveolar sampling that aligns closely with plasma., Competing Interests: Competing interests: NMcE: In the past 36 months, unrestricted research grant: Grifols, CSL Behring research grant in alpha-1 antitrypsin deficiency; advisory board: Intellia, Vertex, Inhibrx, Takeda, Dicerna, Centessa in the area of alpha-1 antitrypsin deficiency; speaker honorarium: CS Behring ERS; patent for development of resistant form of AAT in CHO cells., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

In chronic obstructive pulmonary disease (COPD), inflammation gives rise to protease-mediated degradation of the key extracellular matrix protein, elastin, which causes irreversible loss of pulmonary function. Intervention against proteolysis has met with limited success in COPD, due in part to our incomplete understanding of the mechanisms that underlie disease pathogenesis. Peptidyl arginine deiminase (PAD) enzymes are a known modifier of proteolytic susceptibility, but their involvement in COPD in the lungs of affected individuals is underexplored. In this study, we showed that enzyme isotypes PAD2 and PAD4 are present in primary granules of neutrophils and that cells from people with COPD release increased levels of PADs when compared with neutrophils of healthy control subjects. By examining bronchoalveolar lavage and lung tissue samples of patients with COPD or matched smoking and nonsmoking counterparts with normal lung function, we reveal that COPD presents with markedly increased airway concentrations of PADs. Ex vivo, we established citrullinated elastin in the peripheral airways of people with COPD, and in vitro, elastin citrullination significantly enhanced its proteolytic degradation by serine and matrix metalloproteinases, including neutrophil elastase and matrix metalloprotease-12, respectively. These results provide a mechanism by which neutrophil-released PADs affect lung function decline, indicating promise for the future development of PAD-based therapeutics for preserving lung function in patients with COPD., (Copyright © 2024 by The American Association of Immunologists, Inc.)

The use of gabapentin in treating dogs with behavioral disorders is not well described. To characterize behavioral effects of gabapentin, this study surveyed 50 owners whose dogs were prescribed gabapentin at a veterinary behavior-focused practice over a five-year period. Most owners (72%) reported that gabapentin was moderately or very effective at improving their dog's behavior. The majority of owners reported at least one side effect (70%), with sedation being the most common. Sedation was more likely to be seen at doses higher than 30 mg/kg. Specific dose ranges (mg/kg) did not correlate with any other reports of side effects nor effectiveness. Dogs with a diagnosis of conflict-related aggression were more likely to have owners report that gabapentin was effective at improving behavior compared to dogs with other behavioral diagnoses ( p = 0.04), while dogs diagnosed with aggression secondary to high arousal were less likely to have owners report that gabapentin was effective ( p = 0.01). Overall, reports of effect varied widely and, with the exception of sedation, did not correlate with specific mg/kg dose ranges. Results suggest that some dogs may be more sensitive or resistant to adverse and/or therapeutic effects than others and multiple dosage trials may be needed before finding the best fit.

Purpose: To provide a comprehensive guide of all implantable collamer lens (ICL) sizing nomograms and the respective preoperative diagnostic devices that are required. This guide would help clinicians in choosing the appropriate ICL size for myopic patients to optimize postoperative vault height., Methods: A literature search of peer-reviewed journals describing methods and postoperative outcomes of ICL sizing was conducted. Research articles containing ICL nomograms or formulas were identified from this search. Preoperative variables necessary for these nomograms and the required diagnostic devices to measure these parameters such as topography, biometry, or ultrasound biomicroscopy (UBM) were noted. An additional search was conducted to identify artificial intelligence (AI) or machine learning (ML)-derived nomograms., Results: Eighteen ICL sizing nomograms were identified through literature search. Five of these nomograms are available for use and require topography or biometry devices. Of these, four include the manufacturer's, optimized white-to-white (WTW), Kang, Kim, and Rocamora Nomograms. Eight of the 18 nomograms available for use require UBM. Eight of these include the Kojima, Nakamura, KS, ZZ, Dougherty, Parkhurst, Russo, and Reinstein Nomograms. Four of the 18 nomograms are ML-derived including Shen, Rocamora, Russo, and Kang Nomograms., Conclusion: ICL nomograms are a vital tool in helping clinicians select the right ICL size for myopic patients to optimize postoperative vault reducing risk of postoperative complications. Based on available diagnostic devices such as topography, biometry, or UBM clinicians can integrate specific nomograms into practice., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Moshirfar et al.)

Long-term preservation of laboratory strains of Chlamydomonas reinhardtii has historically involved either liquid nitrogen cryopreservation, which is expensive and labor intensive, or storage on agar plates, which requires frequent transfer to new plates, and which may leave samples susceptible to contamination as well as genetic drift and/or selection. The emergence of C. reinhardtii as a model organism for genetic analysis and experimental evolution has produced an increasing demand for an efficient method to cryopreserve C. reinhardtii populations. The GeneArt™ Cryopreservation Kit for Algae provides the first method for algal storage at -80°C; however, little is known about how this method affects recovery of different clones, much less polyclonal populations. Here, we compare postfreeze viability of clonal and genetically mixed samples frozen at -80°C using GeneArt™ or cryopreserved using liquid nitrogen. We find that the GeneArt™ protocol yields similar percent recoveries for some but not all clonal cultures, when compared to archiving via liquid N2. We also find that relative frequency of different strains recovered from genetically mixed populations can be significantly altered by cryopreservation. Thus, while cryopreservation using GeneArt™ is an effective means for archiving certain clonal populations, it is not universally so. Strain-specific differences in freeze-thaw tolerance complicate the storage of different clones, and may also bias the recovery of different genotypes from polyclonal populations., (© The Author(s) 2021. Published by Oxford University Press.)

Background: Sarcoidosis is occasionally seen in association with malignancy, both at the time of cancer diagnosis or during follow up., Aim: The purpose of this study is to identify patients with paraneoplastic sarcoid, their associated malignancies and disease characteristics., Methods: We identified 289 patients diagnosed histologically with sarcoidosis over a 6-year period in one centre, from 2010 to 2016. Fifty of these patients had a prior or concomitant diagnosis of cancer., Results: 17.3% of sarcoid cases had an associated malignancy. The most common malignancies were Gastrointestinal (20%), Haematological (18%), Lung (12%), Gynaecological (12%) and Head and Neck cancer (12%). 74% of sarcoid cases had pulmonary disease with sarcoid diagnostic tissue obtained most frequently via endobronchial ultrasound fine needle aspiration (68%). Most sarcoid cases (66%) were diagnosed within the first year of their malignancy diagnosis., Discussion: Careful consideration needs to be given to the possibility that potential cancer recurrences suspected on imaging studies may indeed be sarcoid reactions., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Evolutionary transitions in individuality (ETIs) occur when formerly autonomous organisms evolve to become parts of a new, 'higher-level' organism. One of the first major hurdles that must be overcome during an ETI is the emergence of Darwinian evolvability in the higher-level entity (e.g. a multicellular group), and the loss of Darwinian autonomy in the lower-level units (e.g. individual cells). Here, we examine how simple higher-level life cycles are a key innovation during an ETI, allowing this transfer of fitness to occur 'for free'. Specifically, we show how novel life cycles can arise and lead to the origin of higher-level individuals by (i) mitigating conflicts between levels of selection, (ii) engendering the expression of heritable higher-level traits and (iii) allowing selection to efficiently act on these emergent higher-level traits. Further, we compute how canonical early life cycles vary in their ability to fix beneficial mutations via mathematical modelling. Life cycles that lack a persistent lower-level stage and develop clonally are far more likely to fix 'ratcheting' mutations that limit evolutionary reversion to the pre-ETI state. By stabilizing the fragile first steps of an evolutionary transition in individuality, nascent higher-level life cycles may play a crucial role in the origin of complex life.This article is part of the themed issue 'Process and pattern in innovations from cells to societies'., (© 2017 The Author(s).)

In the absence of aqueous buffer, most enzymes retain little or no activity; however, "water-free" enzymes would have many diverse applications. Here, we describe the chemically precise immobilization of an enzyme on an engineered surface designed to support catalytic activity in air at ambient humidity. Covalent immobilization of haloalkane dehalogenase on a surface support displaying poly(sorbitol methacrylate) chains resulted in ∼40-fold increase in activity over lyophilized enzyme powders for the gas-phase dehalogenation of 1-bromopropane. The activity of the immobilized enzyme in air approaches 25% of the activity obtained in buffer for the immobilized enzyme. Poly(sorbitol methacrylate) appears to enhance activity by replacing protein-water interactions, thereby preserving the protein structure.

We report a general and facile method that permits the transfer (stacking) of multiple independently fabricated and nanoscopically thin polymeric films, each containing a distinct bioactive agent, onto soft biomedically relevant surfaces (e.g., collagen-based wound dressings). By using polyelectrolyte multilayer films (PEMs) formed from poly(allyl amine hydrochloride) and poly(acrylic acid) as representative polymeric nanofilms and micrometer-thick water-soluble poly(vinyl alcohol) sacrificial films to stack the PEMs, we demonstrate that it is possible to create stacked polymeric constructs containing multiple bioactive agents (e.g., antimicrobial and antibiofilm agents) on soft and chemically complex surfaces onto which PEMs cannot be routinely transferred by stamping. We illustrate the characteristics and merits of the approach by fabricating stacks of Ga 3+ (antibiofilm agent)- and Ag + (antimicrobial agent)-loaded PEMs as prototypical examples of agent-containing PEMs and demonstrate that the stacked PEMs incorporate precise loadings of the agents and provide flexibility in terms of tuning release rates. Specifically, we show that simultaneous release of Ga 3+ and Ag + from the stacked PEMs on collagen-based wound dressings can lead to synergistic effects on bacteria, killing and dispersing biofilms formed by Pseudomonas aeruginosa (two strains: ATCC 27853 and MPAO1) at sufficiently low loadings of agents such that cytotoxic effects on mammalian cells are avoided. The approach is general (a wide range of bioactive agents other than Ga 3+ and Ag + can be incorporated into PEMs), and the modular nature of the approach potentially allows end-user functionalization of soft biological surfaces for programmed release of multiple bioactive agents.

The persistence of bacterial biofilms in chronic wounds delays wound healing. Although Ga(3+) can inhibit or kill biofilms, precipitation as Ga(OH)3 has prevented its use as a topical wound treatment. The design of a microfilm construct comprising a polyelectrolyte film that releases noncytotoxic concentrations of Ga(3+) over 20 d and a dissolvable micrometer-thick film of polyvinylalcohol that enables facile transfer onto biomedically important surfaces is reported. By using infrared spectroscopy, it is shown that the density of free carboxylate/carboxylic acid and amine groups within the polyelectrolyte film regulates the capacity of the construct to be loaded with Ga(3+) and that the density of covalent cross-links introduced into the polyelectrolyte film (amide-bonds) controls the release rate of Ga(3+) . Following transfer onto the wound-contact surface of a biologic wound dressing, an optimized construct is demonstrated to release ≈0.7 μg cm(-2) d(-1) of Ga(3+) over 3 weeks, thus continuously replacing Ga(3+) lost to precipitation. The optimized construct inhibits formation of P. aeruginosa (two strains; ATCC 27853 and PA01) biofilms for up to 4 d and causes pre-existing biofilms to disperse. Overall, this study provides designs of polymeric constructs that permit facile modification of the wound-contacting surfaces of dressings and biomaterials to manage biofilms., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Lung cancer-associated paraneoplastic syndromes affecting the central nervous system present significant diagnostic and treatment challenges. In this case, the patient presented with personality change, cognitive impairment, complex partial seizures, ataxia, dyspraxia, and dysphasia. Shortly after admission, the patient suffered refractory generalized tonic-clonic seizures and a decreased level of consciousness and required intubation, ventilation, and admission to the ICU. He was subsequently diagnosed with paraneoplastic limbic encephalitis based on recognized criteria, including a compatible clinical picture, elevated protein content in his cerebrospinal fluid with negative cytology, a positive positron emission tomography-computed tomography scan showing a right upper lobe tumor, and the exclusion of other neuro-oncological complications. Histopathology confirmed the tissue diagnosis as squamous cell cancer. Initial immunotherapy with steroids and intravenous immunoglobulin and subsequent lobectomy and adjuvant chemotherapy were partially successful, leading to partial resolution of his cognitive impairment. This report highlights the diagnostic and therapeutic challenges of lung-related paraneoplastic syndromes. In addition, it illustrates the poor outcomes for patients and identifies squamous cell cancer as an extremely rare cause of paraneoplastic limbic encephalitis., (Copyright © 2015 by Daedalus Enterprises.)

Silver is a widely used antimicrobial agent, yet, when impregnated in macroscopic dressings, it stains wounds, can lead to tissue toxicity, and can inhibit healing. Recently, polymeric nanofilms containing silver nanoparticles were reported to exhibit antimicrobial activity at loadings and release rates of silver that are 100× lower than conventional dressings. Here, fabrication of composite microfilm constructs that provide a facile way to transfer the silver-loaded polymeric nanofilms onto wounds in vivo is reported. The construct is fabricated from a silver nanoparticle-loaded polymeric nanofilm that is laminated with a micrometer-thick-soluble film of polyvinylalcohol (PVA). When placed on a moist wound, the PVA dissolves, leaving the silver-loaded nanofilm immobilized on the wound-bed. In vitro, the immobilized nanofilms release <1 μg cm(-2) d(-1) of silver over 30 d from skin dermis and they kill 5 log10 CFUs of Staphylococcus aureus in 24 h. In mice, wounds inoculated with 10(5) CFU S. aureus presented up to 3 log10 less bacterial burden when treated with silver/nanofilms for 3 d, as compared to unmodified wounds. In uncontaminated wounds, silver/nanofilms allow normal and complete wound closure by re-epithelialization. Dissolvable microfilm constructs may overcome key limitations associated with current uses of silver in wound healing., (© 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Objective: To examine the feasibility and efficacy of a staff-delivered motivational interviewing technique on treatment, diet, medication, and fluid adherence in adult patients receiving outpatient hemodialysis., Design: A pre-post design was used for this pilot study., Sample/setting: Twenty-nine participants were recruited from a non-profit, free-standing hemodialysis clinic in the central United States., Methods: Prior to and after the three-month motivational interviewing intervention, three months of adherence data and the Health Care Climate Questionnaire (HCCQ) were collected., Results: Motivational interviewing appeared to influence dialysis attendance, frequency of shortened treatments, and phosphorous and albumin levels favorably while less favorably impacting interdialytic weight gain. Changes in the HCCQ scores were not statistically significant from pre- to post-intervention, though the trend was in the direction of improvement in autonomy support, a main component of motivational interviewing. Patients and staff found the approach acceptable., Conclusions: Motivational interviewing shows promise as an intervention to improve adherence in adults undergoing hemodialysis.

Tens of millions of people in Southeast Asia drink groundwater contaminated with naturally occurring arsenic. How arsenic is released from the sediment into the water remains poorly understood. Here, we show in laboratory experiments that phosphate-limited cells of Burkholderia fungorum mobilize ancillary arsenic from apatite. We hypothesize that arsenic mobilization is a by-product of mineral weathering for nutrient acquisition. The released arsenic does not undergo a redox transformation but appears to be solubilized from the apatite mineral lattice during weathering. Analysis of apatite from the source area in the Himalayan basin indicates the presence of elevated levels of arsenic, with an average concentration of 210 mg/kg. The rate of arsenic release is independent of the initial dissolved arsenic concentration and occurs at phosphate levels observed in Bangladesh aquifers. We also demonstrate the presence of the microbial phenotype that releases arsenic from apatite in Bangladesh aquifer sediments and groundwater. These results suggest that microbial mineral weathering for nutrient acquisition could be an important mechanism for arsenic mobilization.

Background: A patient-based outcome measure with good measurement properties is urgently needed for use in clinical trials of foot surgery., Methods: We evaluated an existing foot pain and disability questionnaire (the Manchester Foot Pain and Disability Questionnaire) for its suitability as an outcome measure in the context of hallux valgus corrective surgery. Interviews with patients led to initial changes, resulting in 20 candidate questionnaire items with five response categories each. These were tested in a prospective study of 100 patients (representing 138 foot operations) undergoing hallux valgus corrective surgery. Analysis of underlying factor structure, dimensionality, internal reliability, construct validity and responsiveness of the questionnaire items in relation to (i) SF-36 general health survey and (ii) American Orthopaedic Foot & Ankle Society (AOFAS) hallux clinical scale resulted in a final 16 item questionnaire (the 'Manchester-Oxford Foot Questionnaire' (MOXFQ)), consisting of three domains/scales: 'Walking/standing' (seven items), 'Pain' (five items) and 'Social interaction' (four items) each having good measurement properties. All three domains were unidimensional., Conclusions: The new 16-item MOXFQ has good measurement properties in the context of outcomes assessment of surgery for hallux valgus. Future studies should assess the MOXFQ in the context of surgery for other foot and ankle conditions.

29 patients underwent 30 Scandinavian Total Ankle Replacements (STAR) by a single surgeon, over a four year period (1997 to 2001). There were 12 primary osteo arthritic patients with 6 post traumatic. The mean age of these 18 patients was 73. Eleven patients had rheumatoid arthritis and these had a mean age of 58 years at the time of surgery. One patient had bilateral replacements giving a total of 30 prostheses inserted. On review dorsiflexion had increased from a mean of 7 to 11 degrees while plantar flexion from 15 to 24 degrees. The American Orthopaedic Foot and Ankle hindfoot score was 95 (maximum 100) and the Kofoed ankle score revealed 17 excellent, 5 good and 4 fair. No patients had radiological evidence of loosening. Our intermediate term result for the STAR (W. Link GmbH & Co., Hamburg, Germany) ankle replacement has yielded 90% excellent and good functional outcomes in a mixed osteo arthritic and rheumatoid population which mirrors the results of those published from Scandinavia.

Thirty patients with a mean age of 42 years and a dorsally displaced intra-articular fracture of the distal radius were treated by dorsal plating (Forte, PI and AO T plates). Twenty-eight required autogenous iliac crest bone graft. Mobilisation was started at 1-2 weeks and patients were left free by 6-8 weeks. At a minimum of 6 months (mean 11 months) functional outcomes were excellent or good in 93% according to the Gartland and Werley score and 60% according to Green and O'Briens modified score. The mean time taken to return to work was 10 weeks. At the final follow-up, three patients had intra-articular steps, two of <1mm and one of <2mm. Four patients had five major complications. One extensor tendon rupture, one reflex sympathetic dystrophy (RSD), one significant radial shortening requiring a Darrachs' procedure, one painful and incongruent distal radio-ulna joint (DRUJ) also requiring a Darrachs' and one early subluxation of the DRUJ requiring re-operation. Eleven patients had plates removed. The indications for this was either irritation of extensor tendons, restriction of movement, as part of the treatment of one of the above complications or as part of the initial treatment protocol. In these high energy injuries in the younger age group there exists no ideal solution. Internal fixation allows more predictable restoration of anatomy and early return to function.

Context: Complementary and alternative medicine (CAM) use continues to increase in the United States. Data on rural patients' use and extent of integration of CAM with conventional medicine are lacking, although this is a population often associated with use of "folk remedies" and self-care strategies., Purpose: To examine rural primary care patients' attitudes toward and use of CAM., Methods: A total of 176 surveys (70% response rate) were returned by patients at 5 geographically dispersed, rural Illinois family practice clinics to examine rural patients' use of, attitudes toward, and experiences with alternative medicine and providers., Findings: Nearly two thirds of patients reported use of alternative medicine. Therapies most often used were vitamins/megavitamins, chiropractic, relaxation, and prayer/faith healing. Rural patients with more medical problems and a higher level of education were more likely to use alternative techniques. Three fifths of the patients felt that their doctor should discuss alternative medicine and therapies with them., Conclusions: Physician understanding and communication regarding CAM may be especially important in rural areas, where access to care is more limited and where there is greater reliance on the primary care physician as a "gatekeeper" for patient health.

A method is described for continuous, nondestructive analysis of xylem-borne mineral nutrients in intact transpiring plants. The method uses the xylem-feeding insect the meadow spittlebug (Philaenus spumarius L. [Homoptera: Cercopidae]). This insect will feed from a wide range of plant species and organs. Insect excreta can be collected at all times of the day and night, and its mineral ion content can be analyzed rapidly, and without purification, by ion chromatography. The excreta will have a mineral content virtually identical to that of xylem sap. Cages suitable for containing the insects and collecting excreta from any desired location on plants in both laboratory and greenhouse are described. Even in the greenhouse, evaporation had only a minor effect on the sample ion content. Example results are presented which illustrate dynamics, over several days, in the xylem concentrations of sodium (Na(+)), potassium (K(+)), NH(4)(+), magnesium (Mg(2+)), calcium (Ca(2+)), chloride (Cl(-)), NO(3)(-), PO(4)(3-), and SO(4)(2-). These data were collected from young plants growing in pots of compost in the laboratory and from fully mature pepper (Capsicum annuum L. cv Bellboy) plants growing in hydroponics (rockwool) in the greenhouse. This method should facilitate studies of macronutrient uptake and transport in a range of plants and environments.

The relationship between ultrasonographic findings at birth and risk factors for developmental dysplasia of the hip have not been prospectively evaluated. Since implementing a routine screening programme for all new-born babies in 1989 we have collected 48 000 sets of data, including family history, birth presentation, mode of delivery and birth weight. Of the 92 babies (three per 1000 live births) with persistent ultrasonographic abnormality at 6 weeks only 20% displayed evidence of clinical instability at the original examination. Female babies without the additional risks of breech birth or positive family history were quantitatively the most significant group, accounting for 75% of cases treated. The majority of babies requiring intervention would not have been identified utilizing present criteria for selective ultrasound screening.

Interactions between P-selectin, expressed on endothelial cells and activated platelets, and its leukocyte ligand, a homodimer termed P-selectin glycoprotein ligand-1 (PSGL-1), mediate the earliest adhesive events during an inflammatory response. To investigate whether dimerization of PSGL-1 is essential for functional interactions with P-selectin, a mutant form of PSGL-1 was generated in which the conserved membrane proximal cysteine was mutated to alanine (designated C320A). Western blotting under both denaturing and native conditions of the C320A PSGL-1 mutant isolated from stably transfected cells revealed expression of only a monomeric form of PSGL-1. In contrast to cells cotransfected with alpha1-3 fucosyltransferase-VII (FucT-VII) plus PSGL-1, K562 cells expressing FucT-VII plus C320A failed to bind COS cells transfected with P-selectin in a low shear adhesion assay, or to roll on CHO cells transfected with P-selectin under conditions of physiologic flow. In addition, C320A transfectants failed to bind chimeric P-selectin fusion proteins. Both PSGL-1 and C320A were uniformly distributed on the surface of transfected K562 cells. Thus, dimerization of PSGL-1 through the single, conserved, extracellular cysteine is essential for functional recognition of P-selectin.

1. Candoxatrilat, an active neutral endopeptidase inhibitor, was released rapidly from the inactive prodrug candoxatril in vivo in mouse, rat, rabbit, dog and man. 2. Oral doses of [14C]-candoxatril were cleared rapidly, mostly by ester hydrolysis to candoxatrilat, in mouse, dog and man. A complementary intravenous study in man with [14C]-candoxatrilat showed that the active drug was virtually completely renally cleared. Neither candoxatril nor candoxatrilat underwent chiral inversion in man. 3. Systemic availability of candoxatrilat from the oral prodrug was estimated to be 88, 53, 42, 17 and 32% in mouse, rat, rabbit, dog and man respectively. Plasma clearance of candoxatril was too rapid to enable pharmacokinetic parameter calculation in mouse and rabbit; for man, the apparent oral clearance was 57.9 ml/min/kg and the elimination half-life was 0.46 h. 4. For intravenous candoxatrilat, total plasma clearance values were 32, 15, 5.5, 5.8 and 1.9 ml/min/kg for mouse, rat, rabbit, dog and man respectively. Renal clearance values were 8.7, 7.2, 2.9 and 1.7 ml/min/kg for mouse, rat, dog and man and these approximate to the respective glomerular filtration rates. Allometric scaling with respect to bodyweight across the species allowed reasonable prediction of the above two clearance parameters in man.

A biologic tissue adhesive, a two-component fibrin sealant, for the immobilization of experimentally produced osteochondral fractures of the radial head and femoral condyle was investigated in dogs. The two components of the fibrin sealant were a sealer protein solution (fibrinogen) and a thrombin solution. A fibrinolytic inhibitor (C-esterase inhibitor) was added to prevent degradation of the fibrin by proteolytic enzymes. The operation was performed in 16 joints in four dogs. Control fractures on the right side were fixed with 5-cm Kirschner wires. No external immobilization was utilized. The dogs were killed at intervals of two, four, and eight weeks. There were no complications. All fractures healed uneventfully by eight weeks. Osseous repair seemed to be stimulated by the sealant and to occur faster than in the fractures fixed with pins.

Neutrophils preexposed to high concentrations of activated complement or synthetic N-formyl methionyl peptides are inhibited in their subsequent spontaneous and chemotactic migratory responses. We have considered the possibility that a part of this nonspecific loss of migratory function may be attributable to the interaction of the leukocytes with reactive forms of oxygen deriving from the cytotaxin-induced burst of oxidative metabolic activity. For these studies we have assessed the effect of preexposure of neutrophils from patients with chronic granulomatous disease to cytotaxins on their subsequent migratory responses. We find that these responses are not altered by preexposure to either cytotaxin. Thus, there appears to be a functional relationship between deactivation and the ability of the normal neutrophil to undergo a cytotaxin-induced respiratory burst.

A retrospective study of 343 women treated with isoxsuprine and/or terbutaline for preterm labor (PTL) was performed to determine the incidence and nature of maternal morbidity which is associated with this treatment. The incidence of mild cardiovascular (CV), neurological and gastrointestinal side effects was similar with both medications. The incidence, however, of severe CV complications such as pulmonary edema and myocardial ischemia was higher among women treated with i.v. terbutaline (5.3%) than among those treated with isoxsuprine (0.8%, P less than 0.05). Patients with multiple gestations on i.v. terbutaline therapy had an exceptionally high incidence of severe CV complications (43%), while none of the twin pregnancies on i.v. isoxsuprine had such complications. Corticosteroid treatment was not associated with a significant increase of complications with either tocolytic medication. Both medications had similar success in inhibiting PTL.

Twenty adult Indian patients suffering from the spastic form of irritable colon, i.e. abdominal pain and constipation, were given trimebutine (Mebutin), 2-phenyl, 2-dimethylamino-n-butyl 3, 4, 5-trimethoxybenzoate. Patients were given treatment with 200 mg trimebutine three times daily, or placebo for 4 weeks, and then crossed over. In addition, stool transit times were assessed by the single stool transit time (SST) method of Cummings. Results showed a statistical improvement in abdominal pain and constipation with both trimebutine and placebo after 4 weeks, but only with trimebutine after 8 weeks. Single stool transit time was significantly reduced after trimebutine.

The efficacy of regular cervical examinations in detecting preterm labor, as well as possible risks, was studied for 133 preterm labor patients who had received regular cervical examinations as part of a preterm birth prevention program. When compared to all other patients experiencing preterm labor during the study period, the rates of preterm premature rupture of the membranes, chorioamnionitis, and postpartum endomyometritis were not increased. For 95 patients with preterm labor within 7 days of a routine cervical examination, labor onset was not temporally associated with the preceding examination. Preterm labor was diagnosed in 18 asymptomatic patients (18.2%) when the weekly examination revealed cervical change. Routine cervical exams, therefore, did not increase morbidity, and for some patients identified preterm labor before symptoms appeared.