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J E Saffitz

Publications and source records attributed to J E Saffitz.

At least 19 recordsLinked to original sources
PubMed1992

A personal computer based implementation of the maximum-likelihood method of analysis of electron microscope autoradiographs.

The maximum-likelihood (ML) method for the quantitative analysis of electron-microscopic autoradiographs has been shown to be substantially superior to the conventional crossfire (CF) method. It can generate reliable and accurate tracer concentration estimates with far fewer micrographs and produce valid estimates even at counts low enough to preclude the use of the crossfire method while eliminating the need for special ad hoc treatment of narrow membranous structures as well as the secondary verification of the tracer concentration estimates. Despite these significant advantages, the large computational requirements of the ML method has to date hampered its widespread use. In this paper, we present a new line-integration method that allows us to reduce the computational requirements of the ML method to a point where it becomes feasible to implement it on a small computer system of the type typically available to a laboratory user of EM autoradiography. We present the complete line-integration method for the particular case of EM autoradiography with tritium, and show how it can be adapted to other isotopes. We have constructed a software package that implements the complete maximum-likelihood method on the IBM PC class of machines using our line-integration method. Features of this software package which are of particular importance to the research community are device independence, which makes it usable with a large variety of currently available laboratory equipment, and easy portability of the software and data between different computer systems.

Algorithms↗
PubMed1992

Skeletal muscle beta-adrenoceptor distribution and responses to isoproterenol in hyperthyroidism.

To determine whether hyperthyroidism selectively increases beta-adrenergic receptor density in vessels or fibers of human skeletal muscle, we characterized beta-receptor distribution autoradiographically in muscle biopsies of 18 subjects aged 26 +/- 1 yr before and after daily administration of 100 micrograms 3,5,3'-triiodothyronine (T3) for 2 wk. To establish whether vascular and metabolic responses to beta-adrenergic stimulation are concomitantly altered, we quantified calf blood flow and plasma concentrations of glucose, lactate, glycerol, free fatty acids (FFA), insulin, and C-peptide during graded-dose isoproterenol infusion in eight of these individuals. Differences in beta-adrenergic receptor density among muscle fiber types and vascular components were highly significant (type I greater than type IIa greater than type IIb muscle fibers, P less than 0.001; and type I muscle fibers greater than resistance arterioles, P less than 0.05). Hyperthyroidism increased beta-adrenergic receptor density in all types of muscle fibers (+31-50%; P less than 0.01) but not in resistance arterioles. There was no change in calf blood flow or plasma glucose, glycerol, FFA, insulin, or C-peptide responses to isoproterenol. A rise in lactate during stages 3 and 4 of isoproterenol infusion (P less than 0.01) was observed before but not after T3 administration. Thus hyperthyroidism increases beta-adrenergic receptor density in fibers but not vessels of human skeletal muscle without increasing either metabolic or vascular responses to selective beta-adrenergic stimulation.

Adult↗
PubMed1992

Reentrant and focal mechanisms underlying ventricular tachycardia in the human heart.

BACKGROUND: To determine the mechanisms of ventricular tachycardia (VT) in humans, three-dimensional intraoperative mapping of up to 156 intramural sites was performed in 13 patients with healed myocardial infarction and refractory VT. METHODS AND RESULTS: Mapping was of sufficient density to define the mechanism of 10 VTs in eight patients. In five of 10 cases, sustained VT was initiated in the subendocardium or epicardium by intramural reentry with marked conduction delay as well as functional and anatomic block most prominent in the subendocardium and midmyocardium. The initiating beats of reentrant VT induced by programmed electrical stimulation arose in the endocardium or midmyocardium by progressive slowing of conduction leading to unidirectional block. Multiple simultaneous reentrant circuits can be present. In contrast, five of the 10 sustained VTs were initiated by a focal mechanism as defined by the absence of electrical activity between the termination of one beat and the initiation of the next despite the presence of multiple intervening intramural electrode recording sites. Comparisons of the mapping data with results of histopathological analysis of tissue demonstrated that the location of infarction as well as that of adjacent fibrotic muscle determined sites of both fixed and functional conduction block during macroreentrant VT and that slowing of conduction occurred in a direction transverse rather than longitudinal to fiber orientation. CONCLUSIONS: Both intramural reentry and a focal mechanism underlie sustained VT in patients with healed myocardial infarction.

Adult↗
PubMed1992

Induction of endothelial cell expression of the plasminogen activator inhibitor type 1 gene by thrombosis in vivo.

BACKGROUND: We have shown previously that products from activated platelets can augment synthesis of plasminogen activator inhibitor type 1 (PAI-1) in cultured endothelial and hepatoma (Hep G2) cells in vitro and increase plasma PAI-1 activity in vivo in rabbits. Accordingly, the effects of activation of platelets associated with thrombosis and thrombolysis in vivo on plasma PAI-1 activity and expression of the PAI-1 gene in endothelium, liver, and other organs were characterized. METHODS AND RESULTS: Endothelial injury giving rise to platelet-rich thrombi was induced with electrical stimulation in carotid arteries in rabbits. Clot lysis and recanalization were induced subsequently with intravenous tissue-type plasminogen activator (t-PA) and verified with Doppler flow probes. Plasma PAI-1 activity (mean +/- SD) increased from 6 +/- 2 arbitrary units (AU)/ml to 129 +/- 48 AU/ml (n = 15) within several hours after recanalization. When t-PA had failed to induce recanalization, the increase was much less (from 7 +/- 2 to 42 +/- 23 AU/ml, n = 11). To define mechanisms responsible for these changes, PAI-1 messenger RNA (mRNA) was evaluated by Northern blot analysis and localized in tissues by in situ hybridization. Strong and consistent induction of PAI-1 mRNA was evident in aorta, heart, and liver of animals subjected to thrombosis (twofold to threefold increases compared with values in controls), particularly in those in which thrombolysis had been induced (fourfold to sixfold). After thrombolysis, an intense, PAI-1 mRNA-specific signal was detected in endothelium of aorta, liver, and heart, with less intense signals in endothelium of lung, adrenals, and kidneys. CONCLUSIONS: The increases in plasma PAI-1 activity follow a preceding increase in endothelial cell expression of the PAI-1 gene as reflected by PAI-1 mRNA levels. Thus, increased synthesis of endothelial cell PAI-1 after thrombosis and thrombolysis may attenuate endogenous fibrinolysis early after coronary thrombolysis, thereby potentiating early, thrombotic reocclusion.

Animals↗
PubMed1992

Cardiac myocytes express multiple gap junction proteins.

Electrical propagation in the normal heart occurs via intercellular transfer of current at gap junctions. Alterations in intercellular coupling in the diseased heart are critical in the pathogenesis of reentrant ventricular arrhythmias. Until recently only a single gap junction protein was known to couple cardiac myocytes. We have now identified and sequenced two additional distinct gap junction proteins (connexins) expressed in the mammalian heart. The sequences differ in their predicted cytoplasmic regulatory domains. Expression of all three connexins by canine ventricular myocytes has been confirmed by Northern blotting and by immunohistochemistry with connexin-specific antisera. Immunoelectron microscopy confirmed that all three connexins are localized to myocyte gap junctions. The presence of multiple connexins in myocyte gap junctions suggests novel mechanisms for regulating cardiac electrical coupling.

Animals↗
PubMed1992

Subcellular distribution of beta 2-adrenergic receptors delineated with quantitative ultrastructural autoradiography of radioligand binding sites.

beta-Adrenergic receptors play a critical role in signal transduction in the cardiovascular system. Regulation of beta-adrenergic receptor expression depends on multiple factors, including rates of synthesis and degradation of receptor protein and trafficking of receptors between the cell surface and putative intracellular compartments. To characterize the subcellular distribution of beta-adrenergic receptors and to delineate the ultrastructure of intracellular compartments in which adrenergic receptors reside in the steady state, we studied Chinese hamster fibroblast cells transfected with the human beta 2-adrenergic receptor gene. beta 2-Adrenergic receptors of these cells were covalently labeled with the lipophilic photoactivatable antagonist [125I]iodocyanopindolol diazarine, and specific radioligand binding sites were localized at the ultrastructural level of resolution with quantitative electron microscopic autoradiography. The density of beta 2-adrenergic receptors was approximately 100-fold greater in the plasmalemma than in any other compartment. Approximately 50% of total cellular receptors were identified on the cell surface in an apparently random, nonclustered distribution and without association with clathrin-coated pits or other cell surface structural specializations. The remaining receptors were distributed among intracellular membranous compartments, including smooth vesicles, rough endoplasmic reticulum, and the Golgi apparatus, organelles presumably involved in stages of receptor synthesis, degradation, or trafficking. In the basal state, there was no association of beta 2-adrenergic receptors with coated intracellular vesicles typical of the endocytotic pathway of selected cell surface receptors that function to internalize their extracellular ligands. These results are the first to rigorously quantify the subcellular distribution of beta-adrenergic receptors and unequivocally establish the presence of a substantial pool of intracellular receptors.

Animals↗
PubMed1991

Association of calmodulin with isolated nuclei from rat hepatocytes.

Calmodulin plays an important role in regulating cell proliferation and intranuclear processes (J. Biol. Chem. 265: 18595, 1990). Therefore we studied the association of 125I-calmodulin with highly purified rat hepatocyte nuclear preparations which were characterized by marker enzymes and electron microscopy. Steady-state association of 125I-calmodulin was reached within 5 minutes. Half-maximal binding was achieved at approximately 7.1 microM. This association was partially Ca(2+)-dependent, but was not influenced by ATP, GTP or wheat germ agglutinin. Ultrastructural autoradiography showed specific association of 125I-calmodulin with peripheral and non-peripheral heterochromatin, nuclear membranes, and nucleoli. Specific binding (ratio of the grain density of 125I-calmodulin to Na125I) was greatest in the regions of the nucleoli and non-peripheral heterochromatin. The data indicate that exogenous calmodulin can associate with specific nuclear components in an energy-independent and Ca(2+)-dependent manner.

Adenosine Triphosphate↗
PubMed1991

Remodeling of ventricular conduction pathways in healed canine infarct border zones.

Remodeling of myocyte interconnections may be an important determinant of ventricular tachycardia in regions bordering healed infarcts. We used quantitative electron microscopy to characterize the distribution of gap junctions in 10 canine left ventricles 3-10 wk after coronary occlusion. In three normal canine left ventricles analyzed ultrastructurally, myocardial gap junctions were distributed anisotropically; gap junction profile length was significantly greater in the transverse than in longitudinal planes of section. In infarct border zone tissues, the normal anisotropic distribution was completely abolished and fewer gap junctions per unit intercalated disk length were observed. Analysis of individual gap junction profile length distributions revealed selective disruption of the largest gap junctions that collectively comprised only 9.6% of total junction profiles, but encompassed nearly 40% of aggregate gap junction length in the transverse plane of section. Three-dimensional reconstructions of myocyte interconnections by high resolution quantitative light microscopy of serial sections demonstrated a reduction in the number of cells connected by intercalated disks to a single myocyte from 11.2 +/- 1.0 in normal myocardium to 6.5 +/- 1.3 in border zone tissues (P less than 0.001). Connections of cells in primarily side-to-side apposition were reduced by 75%, whereas primarily end-to-end connections were reduced by only 22% (P less than 0.05). These alterations would disproportionately enhance axial resistivity in the transverse direction, potentially contributing to development of reentrant arrhythmias.

Animals↗
PubMed1991

The rapid and reversible activation of a calcium-independent plasmalogen-selective phospholipase A2 during myocardial ischemia.

Recent studies have demonstrated the existence of two members of a novel family of calcium-independent plasmalogen-selective phospholipases A2 in mammalian myocardium (Wolf, R. A., and R. W. Gross. 1985. J. Biol. Chem. 260:7295-7303; and Hazen, S. L., D. A. Ford, and R. W. Gross. 1991. J. Biol. Chem. 266:5629-5633). To examine the potential role of these calcium-independent phospholipases A2 in mediating membrane dysfunction during early myocardial ischemia, the temporal course of alterations in phospholipase A2 activity during global ischemia in Langendorf perfused rabbit hearts was quantified and compared with traditionally accepted markers of myocytic ischemic injury and anaerobic metabolism. We now report that membrane-associated calcium-independent plasmalogen-selective phospholipase A2 activity increased over 400% during 2 min of global ischemia (P less than 0.01), was near maximally activated (greater than 10-fold) after only 5 min of ischemia, and remained activated throughout the entire ischemic interval examined (2-60 min). Activation of membrane-associated plasmalogen-selective phospholipase A2 after 5 min of myocardial ischemia was rapidly reversible during reperfusion of ischemic tissue. Both the activation of phospholipase A2 and its reversibility during reperfusion were temporally correlated to alterations in myocytic anaerobic metabolism. Furthermore, activation of membrane-associated phospholipase A2 was essentially complete before electron microscopic evidence of cellular damage. Collectively, these results identify dynamic alterations in calcium-independent plasmalogen-selective phospholipase A2 activity during myocardial ischemia which precede irreversible cellular injury and demonstrate that activation of plasmalogen-selective phospholipase A2 is amongst the earliest biochemical alterations in ischemic myocardium.

Animals↗
PubMed1991

Mechanisms of impaired exercise capacity in short duration experimental hyperthyroidism.

To investigate the mechanism of reduced exercise tolerance in hyperthyroidism, we characterized cardiovascular function and determinants of skeletal muscle metabolism in 18 healthy subjects aged 26 +/- 1 yr (mean +/- SE) before and after 2 wk of daily ingestion of 100 micrograms of triiodothyronine (T3). Resting oxygen uptake, heart rate, and cardiac output increased and heart rate and cardiac output at the same submaximal exercise intensity were higher in the hyperthyroid state (P less than 0.05). However, maximal oxygen uptake decreased after T3 administration (3.08 +/- 0.17 vs. 2.94 +/- 0.19 l/min; P less than 0.001) despite increased heart rate and cardiac output at maximal exercise (P less than 0.05). Plasma lactic acid concentration at an equivalent submaximal exercise intensity was elevated 25% (P less than 0.01) and the arteriovenous oxygen difference at maximal effort was reduced (P less than 0.05) in the hyperthyroid state. These effects were associated with a 21-37% decline in activities of oxidative (P less than 0.001) and glycolytic (P less than 0.05) enzymes in skeletal muscle and a 15% decrease in type IIA muscle fiber cross-sectional area (P less than 0.05). Lean body mass was reduced (P less than 0.001) and the rates of whole body leucine oxidation and protein breakdown were enhanced (P less than 0.05). Thus, exercise tolerance is impaired in short duration hyperthyroidism because of decreased skeletal muscle mass and oxidative capacity related to accelerated protein catabolism but cardiac pump function is not reduced.

Adult↗
PubMed1991

Surveillance for rejection by echocardiographically guided endomyocardial biopsy in the infant heart transplant recipient.

Echocardiographically guided endomyocardial biopsy via percutaneous right internal jugular vein puncture has been performed 98 times in six patients 5-16 years of age at our institutions. The use of this approach was extended for rejection surveillance in seven infants transplanted at 2 weeks to 15 months of age (median, 2 months; mode, 2 weeks). A total of 35 consecutive biopsies were performed under heavy sedation in these infants (lowest weight, 3.0 kg) with the use of a 5F semirigid bioptome through a 5.0-cm 5F sheath. There was no case of entrance failure. A median of four biopsies was performed on each child (range, one to 14). Four to seven tissue pieces per biopsy were obtained using an apical four-chamber view for bioptome guidance. Ten instances of clinically suspected rejection were not confirmed by biopsy, and two cases of unsuspected rejection were found. The only complication was one instance of new mild tricuspid regurgitation in this group compared with one instance of increased tricuspid regurgitation after biopsy in the older child group. These preliminary results suggest that echocardiographically guided endomyocardial biopsy from the right internal jugular approach is a reliable and safe means for rejection surveillance in the infant and young child.

Biopsy↗
PubMed1990

Selective turnover of sarcolemmal phospholipids with lethal cardiac myocyte injury.

To delineate the biochemical mechanisms responsible for the transition from reversible to irreversible ischemic injury, we used quantitative electron microscopic autoradiography. Specific alterations of phospholipid catabolism in individual subcellular organelles of cardiac myocytes associated with simulated ischemic injury were identified. Neonatal rat cardiac myocytes were incubated with 5 nM [3H]arachidonic acid to label loci of phospholipid turnover and were exposed to 30 microM iodoacetate to produce reversible and irreversible injury. Although only minute amounts of arachidonic acid were incorporated into sarcolemmal phospholipids under control conditions, 20- and 96-fold increases were observed under conditions leading to reversible and irreversible cell injury, respectively. Increases of 5- and 28-fold in the specific radioactivity of sarcolemmal phospholipids in reversibly and irreversibly injured cells occurred in the absence of significant alterations in the specific radioactivity of other subcellular compartments, demonstrating that accelerated phospholipid catabolism was confined essentially to the sarcolemma. Selective catabolism of sarcolemmal phospholipids, known to be highly enriched in arachidonic acid, is likely to augment local accumulation of arachidonic acid, identified recently as a second messenger regulating myocardial K+ channels. Because the biochemical integrity of the sarcolemma is critical to both electrophysiological function and viability of myocytes, the observed selective alterations of sarcolemmal phospholipid metabolism appear to be pivotal determinants of lethal myocardial injury.

Animals↗
PubMed1990

Alterations of intercellular junctions induced by hypoxia in canine myocardium.

To delineate potential structural mechanisms of impaired cell coupling induced by hypoxia in canine myocardium, we characterized derangements in intercellular junctions and alterations in the space constant in strips of ventricular epimyocardium before and after selected intervals of hypoxia in vitro. Tissue samples were analyzed morphometrically with transmission and freeze-fracture electron microscopy. Space constants in control tissues averaged 1.61 +/- 0.47 mm (mean +/- SD). After 30 and 60 min of hypoxia, space constants declined by 0.24 +/- 0.22 and 0.32 +/- 0.17 mm, respectively (P less than 0.05 vs. control in each case). Impaired coupling was not reversible with reoxygenation. Focal pathological separation of intercalated disk membranes was observed after 30 min of hypoxia, but morphometric analysis demonstrated no reduction in gap junction surface density to account for uncoupling after 30 min of hypoxia. However, after 60 min of hypoxia, gap junction surface density was reduced by 45%. Quantitative analysis of freeze-fractured gap junction replicas after 30 min of hypoxia revealed a significant decrease in P-face particle diameter from 8.51 +/- 1.64 nm in control tissues to 7.25 +/- 1.33 nm (P less than 0.01) with no further change at 60 min. Thus impaired coupling at 30 min is likely related to a change in the gap junction particle. Further uncoupling after 60 min of hypoxia is likely related, in addition, to reduced gap junction surface density. These results suggest that alterations in P-face particles and gap junction surface density are important determinants of progressive cellular uncoupling induced by hypoxia.

Animals↗
PubMed1990

Autoradiographic delineation of skeletal muscle alpha 1-adrenergic receptor distribution.

We used light microscopic autoradiography to quantify the distribution of alpha 1-adrenergic receptors in vessels and muscle fibers of slow-twitch (type I), fast-twitch (types IIa and IIb), and mixed fiber muscles of the rat hindquarter. Frozen cross sections of soleus, vastus lateralis, and gastrocnemius muscles were incubated under equilibrium binding conditions with 10-200 pM [3H]prazosin with or without 10(-5) M phentolamine. Because of the low concentration of bound radioligand, specific binding could not be detected with scintillation spectrometry in whole tissue sections scraped from slides. However, quantitative autoradiographic analysis after extended intervals of emulsion exposure revealed a low but significant level of specific binding in muscle fibers. No difference in alpha 1-receptor density was observed among types I, IIa, and IIb fibers. Small blood vessels had a much greater alpha 1-receptor density than muscle fibers. Resistance arterioles (20-100 microns diam) and small arteries (100-500 microns diam) contained 5.8 +/- 0.9 and 31.6 +/- 7.6 (+/- SE) times more binding sites per unit section area, respectively, than did surrounding muscle fibers (both P less than 0.001). Ratios of specific grain densities in fibers and blood vessels did not vary with radioligand concentration, indicating that observed grain densities reflected differences in receptor concentration rather than radioligand affinity by fiber and vessel receptors. The densities of vascular alpha 1-receptors did not vary in slow- and fast-twitch muscles, but resistance arterioles were six and eight times more numerous in soleus than in gastrocnemius and vastus muscles, respectively (both P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Antagonists↗
PubMed1990

Use of single internal mammary artery grafts in older patients.

The indications for use of the internal mammary artery as a coronary bypass conduit in older patients are not clearly established. Between January 1985 and December 1988, 786 patients received single internal mammary artery grafts alone (717) or in conjunction with other procedures (69). Of these patients, 341 were 65 years of age or older (mean, 69.3 years). This group was compared with those patients less than 65 years of age (mean, 56.2 years). There were no significant differences between the two groups in the incidence of diabetes mellitus; the number of distal coronary anastomoses; left ventricular wall motion score; the frequency of isolated bypass procedures, reoperations, or emergent operations; or the durations of aortic clamping and cardiopulmonary bypass. The older group contained more women (34.9% versus 20.7%) and more patients with left main coronary artery disease (15.5% versus 9.4%) (p less than 0.01). No significant differences in the frequency of reoperation for hemorrhage, perioperative infarction, neurological deficits, requirements for intra-aortic balloon pumping, sternal wound infections, necessity for prolonged ventilatory support, or 30-day mortality (2.7% versus 3.2%) were observed. The length of postoperative hospitalization was greater in the older group (11.8 versus 10.2 days) (p = 0.02). Blinded histological examination of biopsies from 61 internal mammary artery grafts (34 patients less than 65 years, 27 patients greater than or equal to 65 years) showed no significant differences in luminal area or wall thickness. No significant degenerative changes were observed in either group. We conclude that the use of the internal mammary artery for bypass grafting in older patients is safe and may provide long-term benefit.

Age Factors↗
PubMed1989

Noninvasive detection of cardiac allograft rejection by analysis of the unipolar peak-to-peak amplitude of intramyocardial electrograms.

The use of standard electrocardiographic monitoring to detect cardiac allograft rejection has become unreliable since the advent of cyclosporine immunosuppression. Unipolar peak-to-peak amplitude analysis has been shown to be a quantitative measure of ischemic myocardial injury. This study was performed to determine if unipolar peak-to-peak amplitude analysis could accurately detect cardiac allograft rejection as determined by blinded endomyocardial biopsies. Ten adult mongrel dogs underwent heterotopic (n = 7) or orthotopic (n = 3) cardiac transplantation with placement of sutureless screw-in electrodes (Medtronic, Inc, Minneapolis, MN) on the anterior and posterior aspect of each ventricle. Postoperatively, animals were immunosuppressed for seven to ten days with cyclosporine and prednisone and then allowed to reject the transplant. Digitally processed intramyocardial electrograms were obtained daily. Endomyocardial biopsy was performed 1 week postoperatively and then at three to five day intervals for histological correlation. A unipolar peak-to-peak amplitude decline of 15% or greater occurred one to three days before the biopsy detection in 10 of 10 episodes of rejection. There were no false negatives and one false positive (although a small focal lymphocytic infiltrate was present). Thus, noninvasive unipolar peak-to-peak amplitude analysis was 100% sensitive and 90% specific in predicting and detecting cardiac allograft rejection.

Animals↗
PubMed1989

Essential fatty acid deficiency inhibits early but not late leukocyte infiltration in rabbit myocardial infarcts.

Essential fatty acid (EFA) deficiency, induced by elimination of the dietary (n-6) fatty acids, has been shown to limit inflammatory cell influx and consequent enhanced eicosanoid production in experimental glomerulonephritis and hydronephrosis. To determine whether EFA-deficiency exerts anti-inflammatory effects following left ventricular myocardial infarction (LVMI), male weanling rabbits were fed EFA-deficient diet for 3 months prior to 60 minutes of distal left circumflex coronary artery occlusion followed by reperfusion. One and 4 days later, corresponding to infiltration of cardiac tissue with polymorphonuclear (PMN) and mononuclear leukocytes respectively, infarcted hearts were buffer perfused and stimulated to produce eicosanoids with f-met-leu-phe or bradykinin. One day following LVMI, the hearts of EFA-deficient rabbits demonstrated a marked suppression of PMN infiltration and eicosanoid production relative to controls. Four days following myocardial infarction, no differences were observed in mononuclear cell invasion, collagen deposition, or eicosanoid production between EFA-deficient and normal hearts. Our data show that EFA-deficiency inhibits PMN influx and consequent enhanced eicosanoid production without affecting the later appearance of mononuclear cells, collagen deposition, or eicosanoid production. Recent studies have shown that suppression of PMN invasion limits the extent of tissue damage following LVMI. Selective inhibition of PMN infiltration is possible and may be useful in the management of acute myocardial infarction.

6-Ketoprostaglandin F1 alpha↗