Cholinergic vesicles: ability to empty and refill independently of cytoplasmic acetylcholine.

Incubation of minced mouse-forebrain tissues in lithium Krebs solution reduces the acetylcholine content of the vesicular fraction 70 percent without altering that of the cytoplasmic fraction. Depleted vesicular-bound acetylcholine can be restored with newly synthesized acetylcholine (formed from extracellular choline) independently of the cytoplasmic pool. Depletion of vesicular-bound acetylcholine does not facilitate the movement of preformed extracellular acetylcholine into vesicles.

Increased nitric oxide synthase activity and expression in the human uterine artery during pregnancy.

Evidence exists that NO plays a role in the vasodilation that occurs during pregnancy. The purpose of the present study was to determine whether the role of NO is associated with an increase in the activity and protein expression of NO synthase (NOS) in the human uterine artery. Uterine arteries were obtained from pregnant patients (P arteries) and nonpregnant patients (NP arteries). NOS activity was estimated with the L-[(3)H]-arginine-to-L-[(3)H]-citrulline conversion method and on the basis of changes in tissue levels of cGMP. Western immunoblotting and immunohistochemistry were used to assess NOS protein expression. Ca(2+)-dependent NOS activity was 8 times greater (P:<0.01) in P than in NP arteries. Although most of this pregnancy-induced increase in NOS activity was Ca(2+) dependent (64%), a considerable portion was Ca(2+) independent. Expressions of endothelial NOS (eNOS) and neuronal NOS, but not inducible NOS, were demonstrated in P and NP arteries. The eNOS was located in the endothelium and stained with a qualitative order of P arteries>NP arteries (follicular)>NP arteries (luteal). The neuronal NOS was located in the adventitia of P and NP arteries. Basal NO-dependent and bradykinin-stimulated levels of cGMP were higher (P:<0.05) in P than in NP arteries. These results indicate that an upregulation of eNOS protein expression could account for the increased NO synthesis/release in the human uterine artery during pregnancy.

Standards affecting mental health care: a review and commentary.

The author describes the increasing focus on regulation and the standards applied to the field of mental health. He discusses four distinct but overlapping types of standards: 1) clinical, 2) practitioner, 3) program and facility, and 4) payment. He emphasizes the increasing influence of legislation and judicial decisions and points out several trends in standard setting affecting mental health care. Psychiatrists and other mental health practitioners are called on to take a larger role in shaping these standards to ensure that the quality of patient care is not compromised.

Current issues in national insurance for mental health services.

The current economic crisis has again placed in jeopardy the inclusion of mental health benefits under national health insurance. The author notes that progress has been made in establishing effective peer review systems and in demonstrating that costs of mental health services are reasonable. Yet the lack of agreement on diagnosis and appropriate treatment, the inadequacy of utilization, cost, and treatment outcome data, and the absence of professional self-regulation remain causes for concern in the effort toward eventual comprehensive coverage for mental disorders.

Regulation of adrenal angiotensin receptor subtypes: a possible mechanism for sympathectomy-induced adrenal hypertrophy.

OBJECTIVE: Previous studies indicate that the adrenal gland plays a compensatory role in the maintenance of blood pressure in chemically sympathectomized rats. However, the mechanisms responsible for compensatory adrenal responses are poorly understood. This study examined the regulation of adrenal growth and type 1 A, 1 B, and type 2 angiotensin II (Ang II) receptor (AT1A, AT1B and AT2) expression in the adrenal gland induced by sympathectomy. METHODS: Five-week-old male Sprague-Dawley rats were treated with either guanethidine (50 mg/kg per day, intraperitoneally) or vehicle for 5 weeks. Norepinephrine and epinephrine levels in the atrium of the heart were measured by high-pressure liquid chromatography. Plasma renin activity was determined by radioimmunoassay. Adrenal AT1 and AT2 receptor density was determined by radioligand binding assay. Adrenal AT1A, AT1B and AT2 mRNA levels were determined by Northern blot analysis. RESULTS: Norepinephrine and epinephrine levels in the atrium of the heart were decreased 86% (P < 0.0001) and 58% (P < 0.05) by guanethidine treatment, respectively. Plasma renin activity was decreased 71% (P< 0.001) in guanethidine-treated rats compared with vehicle. In contrast, the ratio of adrenal to body weight was increased 38% in guanethidine-treated rats compared with vehicle (P< 0.001). Adrenal AT1 and AT2 receptor density was increased by guanethidine treatment (P< 0.05). Adrenal mRNA levels for AT2 (P< 0.001) and AT1A (P< 0.01), but not AT1B (P>0.05), were increased in guanethidine-treated rats compared with vehicle (P< 0.01). There were positive correlations between adrenal weight and AT2 (r = 0.9, P< 0.001) and AT1A (r = 0.6, P< 0.05) but not AT1B (r = - 0.01, P > 0.05) expression. CONCLUSIONS: Impairment of the sympathetic nervous system with guanethidine withdraws the normal stimulation of this system on the circulating renin-angiotensin system, but upregulates the expression of adrenal Ang II receptors. Increased expression of adrenal AT2 and AT1A receptors may play an important role in adaptive adrenal hypertrophy and hormonal responses to sympathectomy.

A role for nitric oxide in endotoxin-induced depletion of the peripheral catecholamine stores.

Endotoxemia is associated with increased sympathetic nerve activity and depletion of norepinephrine (NE) and epinephrine (EPI) contents in the adrenal gland and in sympathetically innervated tissues. Endotoxin (bacterial lipopolysacchride [LPS]) causes an increased production of nitric oxide (NO) by inducing nitric oxide synthase (iNOS) expression in various tissues. This increased production of NO contributes significantly to the hypotension associated with endotoxemia. At high concentrations, NO also can act as a neurotoxin. In this study we tested the hypothesis that increased production of NO is involved in depletion of catecholamine content in various tissues from rats treated with a nonlethal dose of LPS. Catecholamine content was measured by high-performance liquid chromatography with electrochemical detection (HPLC-EC) and NOS activity was measured by the 3H-I-arginine to 3H-I-citrulline conversion method. The NE content was decreased in rat adrenal gland, lung, spleen, tail artery, and aorta after LPS. The maximal decrease was at 24 h and returned to control levels at 6 days (144 h). There was no depletion of the NE content in the heart. The EPI content in the adrenal gland was greatly depleted (91%) from 12 to 72 h after LPS. LPS increased the NOS activity in all tissues examined. The time course for NOS activity showed an increase at 3 h, a further increase at 6 h, and a return to control level at 48 h after LPS. The increase in NOS activity occurred before maximal catecholamine depletion. Aminoguanidine, a relatively selective iNOS inhibitor, completely prevented NE depletion in all tissues and partially prevented adrenal EPI depletion induced by LPS. These results are consistent with the hypothesis that LPS-induced production of NO plays a role in depletion of tissue NE and EPI.

Differential effects of prolonged septicemia on isolated pulmonary arteries and veins from sheep.

Isolated third-order pulmonary arteries and veins from sheep were examined for the effects of septicemia on norepinephrine-induced contractions, nitric oxide (NO)-mediated dilation, and basal cyclic GMP levels. The groups studied were as follows: control sheep (n = 7); sheep given live Pseudomonas aeruginosa (Ps, n = 6) for 48 h; and sheep given NG-mono-methyl-L-arginine during the last 24 h of Ps infusion (Ps-L-NMMA, n = 4). The norepinephrine-induced contractions were significantly greater (p < .05) in arteries from septic (Ps and Ps-L-NMMA) sheep. Basal cyclic GMP levels were similar in all of the arteries. The norepinephrine-induced contractions were significantly depressed (p < .05) in veins from septic (Ps and Ps-L-NMMA) sheep. Basal cyclic GMP levels in veins from Ps sheep were markedly elevated (p < .01). N omega-nitro-L-arginine methyl ester (L-NAME) ex vivo decreased cyclic GMP in both arteries and veins. Removal of endothelium enhanced contractions and decreased cyclic GMP in arteries and veins only from control sheep. The results show that septicemia differently affects the pulmonary artery and vein. The enhanced vasoconstriction of the artery is due to decreased endothelium-dependent NO release; the attenuated vasoconstriction of the vein is associated with NO-mediated increased cyclic GMP levels.

Dopamine receptors: structure-activity relationship of d-tubocurarine analogues.

d-Tubocurarine (dTC) and d-tubocurine acted as antagonists of the dopamine-induced inhibition of adrenergic neurotransmission in the isolated, perfused rabbit ear artery. N-Methyl-dTC and O,O,N-trimethyl-dTC (metocurine) did not exhibit dopaminergic antagonist activity. dTC contains one tertiary (3 degrees) nitrogen and one quaternary (4 degrees) nitrogen and d-tubocurine contains two 3 degrees nitrogens; whereas, both N-methyl-dTC and O,O,N-trimethyl-dTC have two 4 degrees nitrogens. The results suggest that a dTC analogue (e.g., metocurine) which lacks a 3 degrees nitrogen should be considered for use in patients treated with dopamine.

Relaxation by calcitonin gene-related peptide may involve activation of K+ channels in the human uterine artery.

The vasodilatory role of calcitonin gene-related peptide in activating K+ channels was examined in isolated, suffused human uterine arteries. Calcitonin gene-related peptide produced a concentration-dependent relaxation of norepinephrine (1 microM)-induced contractions. Calcitonin gene-related peptide was antagonized by glybenclamide (1-100 microM), an inhibitor of ATP-sensitive K+ channels, but not by tetraethylammonium (1 mM), an inhibitor of calcium(2+)-activated K+ channels. Glybenclamide (10 microM) produced a 6.7 fold and an 11-fold shift to the right of calcitonin gene-related peptide (0.1 to 100 nM) in uterine arteries from pregnant patients (n = 3) and nonpregnant patients (n = 6), respectively. Calcitonin gene-related peptide (10 nM) less effectively (P < 0.05) relaxed contractions produced by KCl (50 mM) (29.4 +/- 1.6%) than by norepinephrine and glybenclamide (10 microM) did not reverse this relaxation (22.2 +/- 6.8%, n = 4 nonpregnant patients). Pinacidil (1 microM), an ATP-sensitive K+ channel opener, relaxed norepinephrine-induced contractions of uterine arteries. Glybenclamide (10 microM) also antagonized pinacidil. These results suggest that calcitonin gene-related peptide relaxes norepinephrine-contracted human uterine arteries, at least in part, by activation of a K+ channel, perhaps of the ATP-sensitive type.

Pregnancy: increased effect of verapamil in human uterine arteries.

The effect of verapamil on the contractile response to norepinephrine in isolated, suffused uterine arteries from pregnant and nonpregnant humans was investigated. The arteries, obtained after hysterectomy, were dissected free from surrounding tissue and arterial rings were prepared and mounted in tissue chambers filled with Krebs-bicarbonate solution. Isometric tension was recorded. There was no significant difference between arteries from pregnant patients and arteries from nonpregnant patients when maximal contractile response and sensitivity to norepinephrine were compared. At concentrations of 0.3 and 3 microM, verapamil attenuated the response to norepinephrine in uterine arteries from both pregnant and nonpregnant patients. However, verapamil was significantly more potent in blocking the response to norepinephrine in arteries from pregnant patients.

Quality assurance in the department of pediatrics. An application of quality management.

A continuous quality improvement program can provide the means through which medical organizations can guide their activities. This article illustrates how a pediatrics department in an urban medical center incorporated continuous quality improvement into the management of health services. Key elements of the Quality Assurance program included the organization and facilities in the department of pediatrics, important processes related to patient care, and outcome measures. If a structure is established that allows participation in decision-making and mutual adjustment, trained professionals can perform up to their standards and those standards of their peers. Involvement of physicians in the design of quality management programs and other administrative strategies offer an opportunity to develop a working formula for ongoing success.