Vitamin D Status and Clinical Outcomes in Acute Respiratory Distress Syndrome: A Secondary Analysis From the Assessment of Low Tidal Volume and Elevated End-Expiratory Volume to Obviate Lung Injury (ALVEOLI) Trial.

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a highly morbid condition that has limited therapeutic options. Optimal vitamin D status has been linked to immunological effects that may benefit critically ill patients. Therefore, we investigated whether admission 25-hydroxyvitamin D levels (25OHD) are associated with clinical outcomes in ARDS patients. METHODS: We performed a secondary analysis of data from a randomized, controlled trial comparing oxygenation strategies in 549 patients with ARDS (NCT00000579). Baseline 25OHD was measured in stored plasma samples. We investigated the relationship between vitamin D status and ventilator-free days (VFD) as well as 90-day survival, using linear regression and Cox proportional hazard models, respectively. Analyses were adjusted for age, race, and Acute Physiology and Chronic Health Evaluation III score. RESULTS: Baseline 25OHD was measured in 476 patients. 90% of these individuals had 25OHD <20 ng/ml and 40% had 25OHD <10 ng/ml. Patients with 25OHD <20 ng/ml were likely to be ventilated for 3 days longer than patients with levels ≥20 ng/ml (ß 3.41; 95%CI 0.42-6.39: P = 0.02). Patients with 25OHD <10 ng/ml were likely to be ventilated for 9 days longer (ß 9.27; 95%CI 7.24-11.02: P < 0.001) and to have a 34% higher risk of 90-day mortality (HR 1.34; 95% CI 1.06-1.71: P = 0.02) compared to patients with levels >10 ng/ml. CONCLUSIONS: In patients with ARDS, vitamin D status is associated with duration of mechanical ventilation and 90-day mortality. Randomized, controlled trials are warranted to determine whether vitamin D supplementation improves clinical outcomes in ARDS patients.

Evidence for divisome localization mechanisms independent of the Min system and SlmA in Escherichia coli.

Cell division in Escherichia coli starts with assembly of FtsZ protofilaments into a ring-like structure, the Z-ring. Positioning of the Z-ring at midcell is thought to be coordinated by two regulatory systems, nucleoid occlusion and the Min system. In E. coli, nucleoid occlusion is mediated by the SlmA proteins. Here, we address the question of whether there are additional positioning systems that are capable of localizing the E. coli divisome with respect to the cell center. Using quantitative fluorescence imaging we show that slow growing cells lacking functional Min and SlmA nucleoid occlusion systems continue to divide preferentially at midcell. We find that the initial Z-ring assembly occurs over the center of the nucleoid instead of nucleoid-free regions under these conditions. We determine that Z-ring formation begins shortly after the arrival of the Ter macrodomain at the nucleoid center. Removal of either the MatP, ZapB, or ZapA proteins significantly affects the accuracy and precision of Z-ring positioning relative to the nucleoid center in these cells in accordance with the idea that these proteins link the Ter macrodomain and the Z-ring. Interestingly, even in the absence of Min, SlmA, and the putative Ter macrodomain - Z-ring link, there remains a weak midcell positioning bias for the Z-ring. Our work demonstrates that additional Z-ring localization systems are present in E. coli than are known currently. In particular, we identify that the Ter macrodomain acts as a landmark for the Z-ring in the presence of MatP, ZapB and ZapA proteins.

Eruptive and functional changes in periodontal ligament fibroblast orientation in CD44 wild-type vs. knockout mice.

BACKGROUND AND OBJECTIVE: Periodontal ligament (PDL) fibroblasts establish principal fibers of the ligament during tooth eruption, and maintain these fibers during occlusion. PDL development and occlusal adaptation includes changes in the orientation of PDL fibroblasts; however, the mechanism for these changes in orientation is unclear. The objective of this study was to compare PDL fibroblast orientation in different stages corresponding with first molar eruption and occlusion in CD44 wild-type (WT) and knockout (KO) mice. MATERIAL AND METHODS: CD44 WT and KO mice were raised to six postnatal stages corresponding with first molar (M1 ) eruption (postnatal day 8, 11, 14 and 18) and occlusion (postnatal day 26 and 41). Coronal sections of the first mandibular molar (M1 ) were prepared and the orientation of fibroblasts in the cervical root region was measured. Angle measurements were compared across developmental stages and between strains using Watson-Williams F-test (oriana software) and ANCOVA. RESULTS: PDL fibroblast orientation increased significantly in CD44 WT (9-87°) and KO mice (14-93°; p ≤ 0.05) between intraosseous eruption (day 11), mucosal penetration (day 14) and preocclusal eruption (day 18); however, the PDL fibroblast orientation did not change significantly with the onset of occlusion (day 26) or continued function (day 41). Within each strain, the variance in fibroblast orientation during preocclusal eruption (day 18) was significantly higher than the variance of all other time points (p < 0.0005). CD44 WT and KO mice showed a similar pattern of PDL development and eruption with a significant difference in CD44 WT vs. KO fibroblast orientations only during early function (day 26, 92° vs 116°; p = 0.05). CONCLUSIONS: The development of PDL fibroblast orientation is highly similar between CD44 WT and KO mice. Between early (day 11) and late (day 18) eruptive stages PDL fibroblast orientation increases, corresponding with the upward movement of M1 . The PDL fibroblast orientation established in preocclusal eruption (day 18) is maintained during early (day 26) and late (day 41) stages of occlusal function, suggesting that PDL cells adapt to mechanical loads in the oral cavity before M1 occlusion.

GM-CSF Promotes Immune Response and Survival in a Mouse Model of COVID-19.

COVID-19 results in increased expression of inflammatory cytokines, but inflammation-targeting clinical trials have yielded poor to mixed results. Our studies of other disorders with an inflammatory component, including Alzheimer's disease, chemobrain, Down syndrome, normal aging, and West Nile Virus infection, showed that treatment with the 'pro-inflammatory' cytokine granulocyte-macrophage colony stimulating factor (GM-CSF) in humans or mouse models alleviated clinical, behavioral, and pathological features. We proposed that human recombinant GM-CSF (sargramostim) be repurposed to promote both the innate and adaptive immune responses in COVID-19 to reduce viral load and mortality1. Here, we report the results of a placebo-controlled study of GM-CSF in human ACE2 transgenic mice inoculated intranasally with SARS-CoV2 virus, a model of COVID-19. Infection resulted in high viral titers in lungs and brains and over 85% mortality. GM-CSF treatment beginning one day after infection increased anti-viral antibody titers, lowered mean lung viral titers proportionately (p=0.0020) and increased the odds of long-term survival by up to 5.8-fold (p=0.0358), compared to placebo. These findings suggest that, as an activator of both the innate and adaptive immune systems, GM-CSF/sargramostim may be an effective COVID-19 therapy with the potential to protect from re-infection more effectively than treatment with antiviral drugs or monoclonal antibodies.

Correlation of serum protein biomarkers with disease activity in psoriatic arthritis.

Objective: To assess the correlation of serum protein biomarkers with disease activity across different domains of psoriatic arthritis (PsA).Material and methods: A cross-sectional cohort of 45 adult patients with PsA fulfilling the classification for psoriatic arthritis (CASPAR) criteria was recruited from University of California San Diego (UCSD) Arthritis Clinics. Clinical data and serum samples were collected and serum was analyzed for protein biomarkers hypothesized to be relevant to disease activity in PsA. Correlations were evaluated for clinical disease activity measures across disease domains.Results: Biomarkers with the highest correlation to the composite indices and disease domains were SAA, IL-6, YKL-40, and ICAM-1. In addition, several biomarkers were moderately correlated with individual composite indices and/or disease domains. Low or no correlation was observed with some biomarkers, e.g. MMP-3, MMP-1, EGF, VEGF, and IL-6R. In contrast, the correlation of all biomarkers with certain disease domains was low; specifically, pain, percent body surface area of psoriasis, and patient global assessment. The multi-biomarker disease activity score (MBDA) developed for rheumatoid arthritis (RA) showed high correlations with most composite indices and some disease domains in PsA.Conclusions: These data suggest biomarker analysis can reflect disease activity across disease domains in PsA. Certain domains would likely benefit from the evaluation of additional biomarkers.

WT1 regulates the expression of the major glomerular podocyte membrane protein Podocalyxin.

The WT1 tumor suppressor gene encodes a zinc finger transcription factor expressed in differentiating glomerular podocytes. Complete inactivation of WT1 in the mouse leads to failure of mesenchymal induction and renal agenesis, an early developmental phenotype that prevents analysis of subsequent stages in glomerular differentiation [1]. In humans with Denys-Drash Syndrome, a heterozygous germline mutation in WT1 is associated with specific defects in glomeruli and an increased risk for developing Wilms Tumor [2,3]. WT1 target genes implicated in cell cycle regulation and cellular proliferation have been proposed [4], but the link between WT1 function and glomerular differentiation is unexplained. Here, we show that inducible expression of WT1 in rat embryonic kidney cell precursors leads to the induction of endogenous Podocalyxin, the major structural membrane protein of glomerular podocytes, which is implicated in the maintenance of filtration slits. Binding of WT1 to conserved elements within the Podocalyxin gene promoter results in potent transcriptional activation, and the specific expression pattern of Podocalyxin in the developing kidney mirrors that of WT1 itself. These observations support a role for WT1 in the specific activation of a glomerular differentiation program in renal precursors and provide a molecular basis for the glomerulonephropathy that is characteristic of Denys-Drash Syndrome.

Persistence of low disease activity after tumour necrosis factor inhibitor (TNFi) discontinuation in patients with psoriatic arthritis.

OBJECTIVE: To determine the duration of clinical benefit among patients with psoriatic arthritis (PsA) discontinuing tumour necrosis factor inhibitor (TNFi) therapy while in low disease activity (LDA), and to identify patient characteristics associated with prolonged clinical benefit. METHODS: We performed an observational cohort study assessing patients with PsA from the Consortium of Rheumatology Researchers of North America (CORRONA) registry who had discontinued TNFi after achieving LDA, defined as clinical disease activity index (CDAI) score ≤10 and physician's global assessment (PGA) of skin psoriasis ≤20/100. Kaplan-Meier method was used to estimate the duration of clinical benefit. RESULTS: Of the 5945 patients with PsA in CORRONA, 302 patients had discontinued TNFi (n=325) while in LDA and had follow-up data available. At time of discontinuation, mean PsA duration was 9.8 years, mean CDAI was 3.9, and mean duration of TNFi use was 1.5 years; 52.6% of patients had discontinued their first TNFi. Median time to loss of benefit was 29.2 months. 179 (55.1%) patients had persistent benefit at their previous clinic visit. An increased risk of losing clinical benefit was seen among patients with higher disease activity at discontinuation (CDAI≥3.2 vs <3.2; HR 1.43 (p=0.32)) and among smokers (HR 1.78 (p=0.027)). CONCLUSIONS: Patients with PsA who achieve LDA may maintain clinical benefit after discontinuation of TNFi therapy.

Prevalence and risk factors of chorioamnionitis in Dhaka, Bangladesh.

OBJECTIVE: To estimate the association between chorioamnionitis, maternal risk factors and birth outcomes. STUDY DESIGN: A cross-sectional study of 600 pregnant women was conducted at a maternity center in Dhaka from January to October 2011. Outcomes included histologic, microbiologic and clinical chorioamnionitis. Log-binomial models assessed the association between risk factors and histologic chorioamnionitis (HC). RESULTS: Of the 552 women with placental specimens, 70 (12.7%) were classified with HC: 46 (65.7%) with and 24 (34.3%) without fetal involvement. HC was associated with non-physician care (relative risk [RR] 2.04, 95% confidence interval [CI] 1.04 to 4.00), home slab or hanging latrine (RR 1.69, 95% CI 1.10 to 2.62), and lack of tetanus toxoid (RR 1.80, 95% CI 1.03 to 3.14). Women with fever (RR 2.30, 95% CI 1.18 to 4.50) or discolored amniotic fluid (RR 1.74, 95% CI 1.08 to 2.81) had a higher risk of HC. Microbiologic and clinical chorioamnionitis were unreliable HC measures. CONCLUSION: Prevalence of HC is high; many cases are not captured by clinical diagnosis or microbiologic cultures.

Cigarette smoking and diabetic retinopathy.

A sample of 181 diabetics with diabetic retinopathy was statistically investigated with regard to association of smoking with proliferative retinopathy. The numbers of patients with proliferative retinopathy rose with increasing tobacco consumption. In non-smokers no association existed between diabetes duration and proliferative retinopathy, but in smokers the number with proliferative retinopathy rose with increasing diabetes duration.

Combined radiocarbon and CO2 flux measurements used to determine in situ chlorinated solvent mineralization rate.

A series of combined measurements was made at the Naval Air Station North Island (NASNI) Installation Restoration Site 5, Unit 2 during July and August 2013. Combined measurements included CO2 respiration rate, CO2 radiocarbon content to estimate chlorinated hydrocarbon (CH) mineralization and a zone of influence (ZOI) model. CO2 was collected continuously over 2 two-week periods by recirculating monitoring well headspace gas through NaOH traps. A series of 12 wells in the main CH plume zone and a background well with no known historical contamination were sampled. The background well CO2 was used to determine radiocarbon content derived from respired natural organic matter. A two end-member mixing model was then used to determine the amount of CH-derived carbon present in the CO2 collected from plume region wells. The ZOI model provided an estimate for the soil volume sampled at each well. CH mineralization rates were highest upgradient and at the plume fringe for areas of high historical contamination and ranged from 0.02 to 5.6 mg CH carbon per day. Using the ZOI model volume estimates, CH-carbon removal ranged from 0.2 to 32 mg CH-carbon m(-3) per day. Because the rate estimates were based on a limited sampling (temporally), they were not further extrapolated to long-term contaminant degradation estimates. However, if the site manager or regulators required them, estimates - subject to long-term variability uncertainties - could be made using volume and rate data determined over short timescales. A more comprehensive seasonal sampling is needed to constrain long-term remediation models for the entire impacted area and identify environmental conditions related to more rapid turnover times amongst the wells.

Safe Tummy Tuck: Anatomy and Strategy to Avoid Injury to the Lateral Femoral Cutaneous Nerve During Abdominoplasty.

BACKGROUND: Abdominoplasty is one of the most common aesthetic procedures performed in the United States. While poor contour and unsatisfactory cosmetic result have been recognized, neuropathic pain from lateral femoral cutaneous nerve injury has been poorly described. We aim to improve outcomes by using an anatomical study to develop a strategy to avoid injury to the lateral femoral cutaneous nerve in abdominoplasty. METHODS: Twenty-three fresh cadaver abdomens were dissected to evaluate the course of the lateral femoral cutaneous nerve, using 2.5× loupe magnification. Measurements were taken from the nerve to the anterior superior iliac spine and from the pubic symphysis to the lateral femoral cutaneous nerve. Recordings of the relationship of the nerve to the inguinal ligament and depth at scarpa's fascia were also made. Statistical analysis was performed to find average distances with a standard deviation. RESULTS: On average, the distance from the lateral femoral cutaneous nerve to the anterior superior iliac spine was 3.62 (SD = 1.32) cm and 13.58 (SD = 2.41) cm from the pubic symphysis in line with the inguinal ligament. The lateral femoral cutaneous nerve was found at the inguinal ligament 80% of the time and 20% of the time superior to the ligament and always deep to scarpa's fascia. CONCLUSION: Abdominoplasty carries a high patient and surgeon satisfaction rate. The plastic surgeon is continuously challenged to identify ways to improve outcomes, efficiency, and morbidity. Minimal and careful dissection in the area around 4 cm of the anterior superior iliac spine in addition to preserving scarpa's fascia near the inguinal ligament may serve as key strategies to avoiding lateral femoral cutaneous nerve injury.

Structure, chromosomal location, and tissue-specific expression of the mouse opticin gene.

PURPOSE: To determine the structure, location, and tissue-specific expression of the mouse opticin gene (Optc) and to compare expression in the eye with that of Prelp, collagen II, and collagen IX. METHODS: Expressed sequence tags (ESTs) to mouse opticin were identified and the full-length sequence obtained after PCR reactions using a 15-day-postconception (dpc) whole-mouse embryo cDNA library. The mouse chromosomal localization of Optc was determined by radiation hybrid mapping and its genomic structure determined using an Optc-containing BAC clone. Tissue-specific expression of opticin, PRELP, collagen II, and collagen IX mRNAs was investigated by in situ hybridization and by dot blot hybridization for opticin. RESULTS: The Optc gene was localized to mouse chromosome 1 at 74.3 cM and consisted of seven exons spanning 10 kb. The Optc gene was less than 4 kb from the Prelp gene. In situ hybridization localized opticin mRNA exclusively to the presumptive ciliary body during development and to the nonpigmented ciliary epithelium of the adult mouse eye. Expression of Prelp was also detected in the nonpigmented ciliary epithelium of the adult eye. However, expression of collagen types II and IX was detected largely in the developing mouse eye, with type IX expression confined primarily to the presumptive ciliary body. CONCLUSIONS: The Optc, Prelp, and fibromodulin (Fmod) genes form a cluster on mouse chromosome 1. Opticin may represent a marker for ciliary body differentiation. Continued expression of opticin in the adult mouse eye suggests functions other than that of putative regulator of vitreous collagen fibrillogenesis.

Chronic histiocytic intervillositis: a placental lesion associated with recurrent reproductive loss.

Chronic (histiocytic) intervillositis (CHIV), defined for the purposes of this study as diffuse histiocytic infiltration of the intervillous space without villitis, is an idiopathic lesion seen in the chorionic sacs of some spontaneous abortion specimens and placentas. In this retrospective study, we evaluated all patients diagnosed with CHIV from 2 hospitals between 1993 and 2000, plus 1 additional patient from 1977. Histopathology, phenotype of the leukocytic infiltrate, perinatal outcome, and other associated clinical features were assessed by review of clinical records and all available pathology specimens plus immunohistochemical staining. CHIV was found in 31 of 45 specimens examined from 21 patients (23 of 31 first trimester, 3 of 5 second trimester, and 5 of 9 third trimester). Recurrence rate was 67% for patients with more than one specimen reviewed. Overall perinatal mortality rate was 77%, and only 18% of pregnancies reached 37 weeks. Eight of 19 patients with 3 or more pregnancies had recurrent spontaneous abortion (RSA); 5 with primary RSA (> or = 3 consecutive spontaneous abortions (SAB) with no living children) and 3 with secondary RSA (> or = 3 consecutive SAB with 1 or more living children). Severe intrauterine growth restriction was seen in 5 of 8 second- and third-trimester placentas with CHIV. Patients were generally not of advanced maternal age (mean, 29.8 +/- 6.2 years), and there was no obvious racial predisposition. Autoimmune or allergic phenomena were identified in 11 patients. Immunohistochemical staining of the intervillous infiltrate showed a near uniform population of monocyte-macrophages at varying stages of maturity and activation: more than 90% CD45Rb and CD68 positive, 30% to 40% MAC387 positive, less than 5% CD3 positive, and CD1a, CD20, CD30, and CD56 negative. We conclude that CHIV is an uncommon but important cause of recurrent spontaneous abortion and, in some cases, loss at later gestational ages. HUM PATHOL 31:1389-1396.

Fetoplacental histology as a predictor of karyotype: a controlled study of spontaneous first trimester abortions.

It has been suggested that inferences about fetal karyotype can be made from examination of placental and decidual histology in early, spontaneous abortions (SABs). We assessed the reproducibility and predictive value of histologic features in 75 karyotyped, first trimester SABs; 32% (24 of 75) had normal male karyotypes (46,XY) and 68% (51 of 75) were cytogenetically abnormal (29 trisomy, 12 triploidy, eight monosomy X, and two tetraploidy). Three pathologists independently assessed 17 fetal, placental, and decidual histological findings and made predictions about the karyotype (normal, abnormal, or uncertain). Good to excellent interobserver and intraobserver reproducibility (kappa > 0.58) was achieved for the identification of five histological features: villous cavitation, anucleate fetal erythrocytes, amnion, umbilical cord, and fetal tissue. When histology and karyotype were compared using Fisher's exact test, no histological feature was associated with "any abnormal karyotype," two features (anucleate, fetal erythrocytes and umbilical cord) were associated with a normal karyotype, two features (villous dysmorphism and cisterns) were associated with triploidy, and four features (villous hydrops, no umbilical cord, no fetal tissue, and no anucleate erythrocytes) were associated with trisomy. Despite these significant histological-cytogenetic associations, the positive predictive values of each of these histological features with their corresponding karyotypes were low, ranging from 0.41 to 0.73 (mean, 0.53). Our data suggest that certain histological features in first trimester SABs are associated with the SAB's karyotype and are reproducible; however, such histological features did not perform as well as diagnostic tests for predicting the likelihood of normal versus abnormal karyotype.

The relationship between age and process of care and patient tolerance of bronchoscopy.

OBJECTIVES: To determine whether patient age is associated with differences in flexible bronchoscopy technique and tolerance. DESIGN: Prospective cohort study. SETTING: University hospital system. PARTICIPANTS: One thousand three hundred fifty-eight adults, including 219 (16.1%) aged 70 and older, undergoing bronchoscopy. MEASUREMENTS: Indications, sampling procedures, medication doses, patient reports of pain, willingness to return, and adverse events associated with bronchoscopy. RESULTS: Indications for bronchoscopy varied with age, with solitary pulmonary nodule (P <.001), mass (P <.001), or lymphadenopathy (P <.001) being more common in older patients. Invasive sampling methods were used more often with increasing age, but variation in disease processes between age groups accounted for the difference in sampling method performed. Mean doses of midazolam and fentanyl given for sedation decreased with increasing age (P <.001). There was no significant difference between older and younger patients in reported very good to excellent pain control (50% of patients >/=70 vs 64% of patients <40; P =.56) or in willingness to return for repeat bronchoscopy (98% vs 92%, respectively; P =.324). Overall risk for an adverse event increased with increasing patient age (P <.01), but adverse events were uncommon and generally not severe. Hypotension and pneumothorax were rare but occurred more often in older persons (1.9% and 3.4% in patients >/=70 vs 0.5% and 0.7% in patients <40, respectively). CONCLUSION: Despite more-invasive sampling methods and less sedation during bronchoscopy, elderly patients tolerate bronchoscopy as well as younger patients. There is increased risk for adverse events with increasing age, but the absolute frequency is low, suggesting that chronological age should not be a contraindication for bronchoscopy in older persons.

Cholinergic modulation of neocortical long-term potentiation in the awake, freely moving rat.

The neocortex has proven resistant to LTP induction using standard in vitro and acute, in vivo preparations. Because the neocortex is widely thought to be involved in long-term information storage, this resistance raises questions about the validity of LTP as a memory model. Recently, we have shown that the neocortex of freely moving rats reliably supports LTP, provided that the stimulation is spaced and repeated over days. The following experiments were designed to evaluate the neuromodulatory role played by cholinergic systems in the induction of LTP in this preparation. Chronically implanted rats received either low- or high-intensity LTP-inducing tetani in combination with the administration of either a cholinergic agonist or antagonist injected systemically. Potentiation was evidenced as amplitude changes in both early and late components of the evoked field potential, the former including population spikes. The cholinergic agonist facilitated LTP induction in the late component of both high- and low-intensity groups. The cholinergic antagonist blocked LTP induction in the early component of the high-intensity group. The possibility that there are component-specific modulatory effects of cholinergic agents on the induction of neocortical LTP is discussed.

Developmental changes in glutamate receptor stimulated inositol phospholipid metabolism and 45Ca(2+)-accumulation in posthatch chicken forebrain.

In chicken forebrain the two phases of synapse development, formation and maturation, are temporally well separated. We have used this model system to determine the developmental profile of glutaminergic activation of phosphoinositidase C. Stimulation of [3H]inositol-loaded forebrain prisms by quisqualic acid (QA; 30 microM), or the metabotropic agonist 1-aminocyclopentane-trans-1,3-dicarboxylic acid (trans-ACPD; 30 microM), significantly increased [3H]inositol phosphate production. This response progressively decreased with developmental age, with the largest (approximately 3-fold) decrease occurring between 21 days and adult (> 10 weeks). In contrast, QA (30 microM) stimulated a quite distinct developmental profile for 45Ca2+ accumulation, with the response being maximal between 7 and 14 days before declining sharply to adult levels by 21-25 days. These results demonstrate that there is a major decrease in metabotropic glutamate receptor activation of phosphoinositidase C during the maturation phase of synapse development.

Thalamic amnesia: Korsakoff syndrome due to left thalamic infarction.

In order to support the concept that a lesion of the thalamus is sufficient to cause a Korsakoff syndrome, we are presenting 5 patients, all of whom developed the syndrome after sustaining a left (dominant) thalamic infarction. Two patients had pure thalamic strokes followed by a permanent Korsakoff syndrome. One of these patients was studied with neuropsychometric testing, as well as with a modern MRI scan. In 2 other patients, clinical and imaging data indicate that infarction was not limited to the thalamus. Another patient had bilateral thalamic infarcts but only a temporary Korsakoff syndrome. Neuropathological data are needed to elucidate the exact anatomical substrate of dominant thalamic Korsakoff syndrome.

Pertussis toxin inhibits noradrenaline accumulation by bovine adrenal medullary chromaffin cells.

Bovine adrenal medullary chromaffin cells maintained in tissue culture accumulated [3H]-noradrenaline by a high affinity, Na(+)-dependent, desipramine-sensitive process. The accumulation was linear with time (1-90 min) and had an apparent Km of 0.52 +/- 0.24 mumol/l and Vmax of 1.70 +/- 0.48 pmol/(10(5) cells.15 min). Pretreatment of the cells with the ADP-ribosylating agent pertussis toxin resulted in a reduction in the Vmax [0.81 +/- 0.39 pmol/(10(5)cells.15 min)] but no significant change in the apparent affinity (Km = 0.42 +/- 0.07 mumol/l). This inhibition of [3H]noradrenaline accumulation was distinct from that produced by the vesicular transport inhibitor reserpine. Pertussis toxin inhibition probably did not arise through an indirect action on the Na(+)-gradient because while, as expected, Na+,K(+)-ATPase inhibition reduced [3H]noradrenaline accumulation, pertussis toxin pretreatment always caused a further significant reduction even in the presence of maximally effective concentrations of ouabain. Stimulation of the cAMP-protein kinase A system by forskolin or 8-bromocyclic AMP also caused a reduction in [3H] noradrenaline accumulation but again pertussis toxin pretreatment always resulted in a further reduction. Thus, the data provide evidence for a pertussis toxin-sensitive element in the catecholamine accumulation process and are consistent with an action at a site directly associated with the transporter itself rather than with an indirect action via secondary processes.