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protein molecules to specific receptors on the luminal membrane Therefore, the rate of endocytosis is increased in proportion to the concentration of protein in the glomerular filtrate until a maximal rate of vesicle formation, and thus the Tm for protein uptake, is reached The pinched-off intracellular vesicles resulting from endocytosis merge with lysosomes, whose enzymes degrade the protein to lowmolecular-weight fragments, mainly individual amino acids These end products then exit the cells across the basolateral membrane into the interstitial fluid, from which they gain entry to the peritubular capillaries To understand the potential problem associated with a failure to take up filtered protein, remember that Total filtered protein 5 GFR 3 concentration of protein in filtrate 5 180 L/day 3 10 mg/L 5 18 g/day If none of this protein was removed from the lumen, the entire 18 g would be lost in the urine In fact, almost all the filtered protein is taken up, so that the excretion of protein in the urine is normally only 100 mg/day The endocytic mechanism by which protein is taken up is easily saturated; however, any large increase in filtered protein resulting from increased glomerular permeability can cause the excretion of large quantities of protein Discussions of the renal handling of protein logically tend to focus on albumin because it is by far the most abundant plasma protein There are, of course, many other plasma proteins, and it should be emphasized that many of these proteins, being smaller than albumin, are more easily filtered than albumin For example, growth hormone (molecular weight 22,000 kDa) is approximately 60% filterable, and insulin is 100% filterable The total mass of these filtered hormones is insignificant; however, because even tiny levels in the plasma have important signaling functions in the body, renal filtration becomes an important influence on levels in the blood Relatively large fractions of these smaller plasma proteins are filtered and then degraded in tubular cells Accordingly, the kidneys are major sites of catabolism of many plasma proteins, specifically including polypeptide hormones Decreased rates of degradation occurring in renal disease may result in elevated plasma hormone concentrations Very small peptides, such as angiotensin II, are handled differently from larger proteins, although the end result is the same: the catabolism of the peptide and preservation of its amino acids The very small peptides are completely filterable at the renal corpuscles and are then catabolized mainly into amino acids within the proximal tubular lumen by peptidases located on the luminal surface of the plasma membrane The amino acids (as well as any di- and tripeptides generated by this process) are then reabsorbed by the same transporters that normally reabsorb filtered amino acids Finally, it should be noted that, in certain types of renal damage, proteins released from damaged tubular cells rather than filtered at the renal corpuscles may appear in the urine and provide important diagnostic information.

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We have some real productivity improvement with technicians with over three or more years experience," Dennis said The middleware, in particular, has proven to us that it works and can keep a computer accurately and reliably connected to computers in the field So now we ll have laptop PCs connected to Web sites, and our next generation of TechPlus will rely more on Web-based applications to the back office We ll use browsers on our laptops, and give technicians access to Web sites for new information and training programs they can download" The middleware will be modified to enable interaction with multiple Web sites I assume that when speed becomes a problem, we ll work on upgrades to the network But right now we re just getting our feet wet We re designing for interactions over the web sites that are still working well wirelessly with the available data rate (8 Kbps link) with less than 10 seconds delays In sum, the TechPlus system has given us an efficient competitive edge This should translate into a way to stay on top of the competition"

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This is not to say that ego is bad All good leaders have strong egos The progress of the human race has been built upon the egos of great statesmen, scientists, soldiers, industrialists, and educators Ego is belief in yourself Ego is a pride that pushes you to accept nothing less than your personal best The more we believe in ourselves, the higher our self-esteem, the more tension and anxiety we can endure on the road to achieving our goals Ego, therefore, is closely tied to performance My father had a healthy ego, and it was a vital contributor to his success In fact, it s hard to imagine a Vince Lombardi without an on-his-sleeve ego Every time he assembled his team in the locker room, you saw it Each time his team took the field, you saw it

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