Tracheostomy Tube Failure in Obstructive Sleep Apnea

In our institutions we routinely do posttracheostomy sleep studies on patients being treated for obstructive sleep apnea. We have identified several patients who failed to show objective evidence of improvement after tracheostomy. From our studies we have found that both mechanical obstruction and concomitant respiratory control dysfunction caused this failure. A unique tracheostomy tube was constructed to treat the subset of patients with internal collapse of the tracheostomy tube.     

A semiquantitative measure of immune responses against erythropoietic stem cell antigens

A semiquantitative assay was developed and used to measure the effects of immune responses against 16 independent non-H-2 antigenic loci on erythropoietic stem cells. The assay compares repopulation in genetically anemic WBB6F₁-W/W recipients that have normal immune responses, and in lethally irradiated WBB6F₁ +/+ mice whose immune responses are suppressed by the irradiation. The differences in repopulating ability between these two types of recipients measure how immune responses affect erythropoietic stem cells. Stem cell repopulating abilities for the cells with antigens specified by the Thy-1, H-1, H-24, Ly-1, H-37, and H-17 loci were affected slightly, if at all. Repopulating abilities were moderately reduced by responses against antigens specified by H-15, 16, Ea-2, and Ly-2, 3 loci, and against the differences between the B6 and B10 genotypes, although marrow of these types cured W/W recipients. A surprising result occurred for the antigen specified by the H-8 locus, in which immune responses strongly reduced repopulating abilities, although this type of marrow cell cured W/W recipients. A comparison of these results with skin graft survival times suggests that the antigens specified by the H-17 and H-24 loci are strongly immunogenic on skin but not on marrow stem cells, while those specified by the H-12 and H-8 loci are strongly immunogenic on marrow stem cells but not on skin.     

Microzooplankton and macrozooplankton glutamate dehydrogenase as indices of the relative contribution of these fractions to ammonium regeneration in the Gulf of Maine

Ammonium regeneration by micro- (35–153 µm) andmacrozooplankton (> 153 µm) was determined in the Gulfof Maine by measuring the activity of the excretory enzyme glutamatedehydrogenase (GDH) in various size fractions. GDH maxima weregenerally observed to correspond to the depth of the chlorophyllmaximum as previously reported in the Gulf of Mexico and inthe vicinity of the Nantucket Shoals. GDH activity of the microzooplanktonwas considerably lower than the macrazooplankton, suggestingthe microzooplankton made only a minor contribution (1–11%) to the total ammonium regenerated. These results were confirmedby biomass estimates made from counts of individual species.Ammonium excretion by both zooplankton fractions was estimatedto supply 5–31 % of the nitrogen requirements for primaryproduction, with an estimated 59–63% supplied by the verticaltransport of nitrate (new nitrogen) into the euphoric zone.     

β-Adrenergic receptor-coupled adenylate cyclase

Beta-adrenergic receptor-coupled adenylate cyclase is regulated by both amplification and desensitization processes. Desensitization of adenylate cyclase is divided into two major categories. Homologous desensitization is initiated by phosphorylation of the receptors by a beta-adrenergic receptor kinase. This reaction serves to functionally uncouple the receptors and trigger their sequestration away from the cell surface. These sequestered receptors can rapidly recycle to the cell surface or, with time, become down regulated, being destroyed within the cell. Dephosphorylation of the receptors is accomplished in the sequestered compartment of the cell, which may functionally regenerate the receptors and allow their return to the cell surface. In heterologous desensitization, receptor function is also regulated by phosphorylation, but in the absence of receptor sequestration or down regulation. In this case, phosphorylation serves only to functionally uncouple the receptors, that is, to impair their interactions with the guanine nucleotide regulatory protein Ns. Several protein kinases are capable of promoting this phosphorylation, including the cAMP-dependent kinase and protein kinase C. In addition to the receptor phosphorylation, heterologous desensitization is associated with modifications at the level of the nucleotide regulatory protein Ns and perhaps Ni. Adenylate cyclase systems are also subject to amplification that involves a protein kinase C-mediated phosphorylation of the catalytic unit of the enzyme. Phosphorylation of the catalytic unit enhances its catalytic activity and results in amplified stimulation by the regulatory protein Ns. Other receptor/effector systems exhibit qualitatively similar regulatory phenomena, suggesting that covalent modification (phosphorylation) may represent a general mechanism for regulating receptor function.     

Economic images and social change in the Romanian socialist transformation

Conclusion To summarize the uses of economic images in the socialist transformation, change in local and state forms both modeled changes in national class relations and sought to shape that same process. Clearly, though, state images have triumphed for the moment. Though first less than compelling when opposed to the symbolically expressed solidarity of the local community, they have since come to dominate the ideological evaluations of local workers. Simultaneously the local community witnessed a massive social transformation where such unity as it existed, however artificial, was replaced by a more atomized social structure partially eroded by the promise of material plenty.Thus, at first, state images assisted the formation of the Romanian proletariate as a class in itself. Today, however, with political stability generally assured and increased production an absolute necessity, one can observe the reformulation of class boundaries via state-promulgated differentiation as well as the erosion of working class consciousness, class for itself, under consumerist pressures.Workers' solidarity, purposefully engendered in post-war state images, was rarely achieved in the Fgra region. Since the mid-1960s the expansion of consumerist images especially prevents its formation. Over time the counterhegemonic qualities of local images are replaced by those which accept the socialist system and question only certain of its material results. Until the recent debt crisis local images have been hauntingly silent about production relations.This need not be permanent. The disaggregation of the local community, assisted by state image manipulaton, is a historical moment. The hegemony of state iconography also carries the possibility of its own dissolution. The spectra of Romania as socialist and luxurious may yet foment worker solidarity due to unfulfilled expectations. As the debt crisis deepens, dependency intensifies, and workers experience more of the rationing and shortages common of late, the legitimacy of Romania's hyper-industrialization may once again be questioned.It is in great measure through economic iconography that Romania's socialist governments have legitimized themselves. As hierarchy is elaborated and on-line production relations made stringent to address the current fiscal crisis, it is through industry, as expressed in local folk images, that such legitimacy may be undermined.David A. Kideckel is Associate Professor of Anthropology, Central Connecticut State University.     

Effects of phorbol esters on endothelial cell microfilaments: Laser scanning confocal microscopy and quantitative morphometry of dose dependent changes

Phorbol esters are known to alter microfilaments but it is not clear if the changes correspond to modulation of the phosphoinositide turnover/protein kinase C system. The novel technique of laser scanning confocal epifluorescence was used to study fiber orientation in phorbol ester treated cells. We treated endothelial cells with control agents and agents known to stimulate protein kinase C: 4 alpha-phorbol, phorbol 12-myristate 13-acetate (PMA), phorbol dibutyrate (PDB), or lipopolysaccharide. After incubation with the test agents, the endothelial cell microfilaments were stained with rhodamine pholloidin and viewed by conventional epifluorescence and by laser scanning confocal epifluorescence microscopy. The images obtained by the confocal microscopy corresponded to a thin optical section through the cells, 300 nm or more in thickness. The microfilaments extended predominantly in the plane of focus. After exposure of the cells to phorbol esters, the stress fibers became more nearly parallel in arrangement or were shortened, but remained in the plane of focus. The modification of microfilaments in response to phorbol esters was quantitated by a single blind analysis. In order to compare the morphological changes with a biochemical action of the phorbol esters, we measured phosphoinositide turnover. The dose-dependence of morphological changes was compared and contrasted to the dose-dependent effect of phorbol esters on bradykinin-stimulated phosphoinositide turnover. PMA had about the same EC50 (1-5 nM) for both biochemical and morphological processes. PDB was less potent in inducing the disruption of microfilament structure than in inhibiting phosphoinositide turnover. Lipopolysaccharide was ineffective in inducing a morphological change under these conditions. A simple activation of protein kinase C is insufficient to explain the dose-dependent effects of phorbol esters. Thus a morphometric analysis can help distinguish the potency of cytoskeleton modulators.