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Isometric force kinetics upon rapid activation and relaxation of mouse, guinea pig and human heart muscle studied on the subcellular myofibrillar level.

The kinetics of force development and relaxation upon rapid application and removal of Ca2+ was measured in bundles of few myofibrils isolated from triton X-100 skinned left ventricular trabeculae of mice (M), guinea pigs (G) and humans (H). Upon rapidly switching from relaxing solution (pCa 7.5) to activating solution (pCa 4.5) at 10 degrees C, force rose by a single exponential with a rate constant k(act) of 5.2 s(-1) (M), 1.7 s(-1) (G) and 0.3 s(-1) (H) to a plateau of 0.14 microN/microm2 (M), 0.16 microN/microm2 (G) and 0.15 microN/microm2 (H). A rapid release followed by a rapid restretch to the original length applied during steady-state Ca2+ activation at pCa 4.5 induced an exponential force redevelopment with a rate constant k(redev) that was indistinguishable from k(act), indicating that k(act) is limited by cross-bridge turnover kinetics rather than by the Ca2+-induced activation of the regulatory system. Upon rapidly switching from pCa 4.5 to pCa 7.5, force decayed in a pronounced biphasic manner. Thus a slow initial, almost linear decay with a rate constant k(lin) of 1.8 s(-1) (M), 0.6 s(-1) (G) and 0.15 s(-1) (H) and a duration t(lin) of 0.06 s (M), 0.11 s (G) and 0.3 s (H) was followed by a rapid exponential decay with a rate constant k(rel) of 18 s(-1) (M), 11 s(-1) (G) and 4.6 s(-1) (H). The pronounced biphasic shapes of the force decays determined here for the first time in cardiac myofibrils differs from the force decays that had been reported for multicellular skinned trabeculae in which relaxation was induced by rapid removal of Ca2+ by flash photolysis of caged Ca2+ chelators. In the skinned trabeculae, no pronounced initial slow phase was observed. The force decays shown here are much more similar to those reported for single skeletal myofibrils. The kinetics of isometric relaxation of skinned trabeculae (i.e., multicellular preparations), therefore, do not reflect the kinetics of force relaxation at the cardiac myofibrillar level.

Animals↗

Rapid insulin initiation in non-insulin-dependent diabetes mellitus.

Three insulin-initiation regimens were compared in 43 severely hyperglycemic non-insulin-dependent diabetic patients: a "standard" regimen (Lente insulin once daily), a "rapid" regimen (a mixture of regular and Lente insulins twice daily), and a "rapid/intravenous" regimen (the "rapid" regimen preceded by overnight intravenous infusion of regular insulin). The mean serum glucose level fell more rapidly in both groups receiving "rapid" regimens, reaching less than 200 mg/dl in 3.0 days with the "rapid" regimen compared with 5.9 days with the "standard" regimen (p less than 0.005). Duration of hospitalization was similarly reduced (6.4 versus 9.9 days, p less than 0.0001) as was the cost of hospitalization. In contrast to the "rapid" regimens, symptomatic hypoglycemia was common and adequate glycemic control was rare with the "standard" regimen. Thus, rapid initiation of insulin therapy with 0.5 to 0.6 units/kg per day of a mixture of regular and intermediate-acting insulins given twice daily is effective, safe, and reduces the cost of hospitalization in patients with non-insulin-dependent diabetes mellitus who require insulin treatment.

Adult↗

The I-D fluorescence transient. An indicator of rapid energy distribution changes in photosynthesis.

The I-D transient in the chlorophyll fluorescence induction curve (kautsky effect) is investigated in the view of recently discovered rapid changes in energy distribution between the two photosystems (Schreiber, U. and Vidaver, W., FEBS Lett., in the press). Fluorescence induction curves differ appreciably depending on whether measured at lambda less than 690 nm, originating in pigment system II, or at lambda greater than 715 nm, which is in part from pigment system I. The differences occur as well in the rapid part of the induction curve (O-I-D-P) as in the slower P-S decay. Most significant changes in energy distribution are indicated in the region of the I-D dip, being induced by appropriate preillumination. The effect is studied by (a) comparing the individual fluorescence time courses at lambda less than 690 nm and lambda greather than 715, (b) plotting F less than 690 vs. F greater than 715 and (c) recording time courses of F less than 690/F greater than 715 ratios. In (a) the I and D characteristics are delayed at F greater than 715 relative to F less than 690, which is accompanied by periods close to I and D, where the two emissions follow inverse courses. In (b) the I-D dip corresponds to a loop. And in (c) it is shown that a rapid ratio decay, reflecting increasing excitation of System I pigments, is initiated before the I-D dip. These data indicate that the I-D transient is caused by a rapid switch of energy distribution in favor of System I and resulting stimulation of Q reoxidation via the electron transport chain. It is suggested that as with the slow fluorescence transients the rapid also can be understood as a composite of two different changes, (1) direct changes resulting from a switch in energy distribution, which are inverse for F less than 690 and F greater than 715, and (2) indirect changes due to stimulated Q reduction or Q oxidation, which are parallel for both emissions. The rapid ratio decay, correlated to I-D, persists and is even stimulated in the presence of electron transport inhibitors. This and the speed of the phenomenon make it improbable that the rapid energy distribution changes are affected by an ion flux-induced mechanism. It is proposed that the electrical field across the thylakoid membrane is involved in the energy switch mechanism.

Darkness↗

Pre-steady-state reduction kinetics of QH2:cytochrome c oxidoreductase and the Q-pool: evidence for a special quinone not in rapid equilibrium with the Q-pool.

The pre-steady-state kinetics of the reduction of the prosthetic groups of QH2:cytochrome c oxidoreductase in bovine heart submitochondrial particles were studied in relation to the kinetics of the Q-10 reduction, using duroquinol as substrate. The prosthetic groups, including semiquinone, were measured with EPR and low-temperature-diffuse reflectance spectroscopy, the samples being prepared with the rapid-freeze quench technique. For the determination of the redox state of ubiquinone in the pre-steady state the rapid chemical quench technique was used as an extension of the rapid-freeze quench technique, and Q-10 and QH2-10 were measured with reversed-phase HPLC after extraction with petroleum ether. Ubiquinone was reduced biphasically, 8% of total Q-10 (equal to 1 mol Q-10/mol cytochrome c1), being reduced within 5 ms, and the rest, the Q-pool, at a much lower rate. The initial rapid reduction of this special Q-10 was accompanied by rapid formation of Qi and rapid reduction of a large part of the cytochrome b-562. Both semiquinone formation and reduction of b-562 showed transient kinetics due to a contribution of the reaction pathway via centre o when the iron-sulphur cluster and cytochrome c1 were oxidised. The majority of the special quinol was located at centre i, probably bound, but also at centre o some bound quinol was formed. This was visible when antimycin was present, the antimycin-insensitive bound quinol being totally sensitive to myxothiazol. Myxothiazol alone accelerated the reduction of the Q-pool via centre i, but also the equilibration of cytochrome b-562 with the Q-pool. Antimycin drastically lowered the rate of reduction of the Q-pool and additionally seemed to block the rapid electron transfer from part of the Rieske iron-sulphur cluster to cytochrome c1. It is concluded that, during the pre-steady-state, cytochrome b-562 is not in equilibrium with the Q-pool and that the rate of equilibration is probably determined by the rate of dissociation of the special bound quinol from centre i.

Animals↗

Usefulness of a new rapid bedside troponin T assay in patients with chest pain.

We evaluated the usefulness of a rapid, qualitative, bedside immunoassay for cardiac-specific troponin T in patients with chest pain. A concordant result between quantitative troponin T and qualitative troponin T assay was observed in 183 (96%) tests. The sensitivity of the rapid troponin T assay for detecting acute myocardial infarction increased significantly according to the number of hours elapsed after onset of chest pain from 17% for patients presenting within 4 h to 71% for patients presenting in the time interval of greater than 8 h from onset of chest pain (P < 0.001). Specificity ranged from 83 to 93% in the three time intervals evaluated. A concordant result between CK-MB-measurement and rapid troponin T assay was observed in 159 (83%) tests. In 14/191 tests a positive rapid troponin T and a negative CK-MB assay was observed. In 9/14 (64%) cases this result was true positive for the rapid troponin T assay and in 5/14 (36%) cases false negative. As sensitivity and specificity of the rapid troponin T assay are comparable with CK-MB measurements, rapid troponin T assay is a simple and useful laboratory tool for the bedside triage in patients with chest pain.

Adult↗

An emergency department-based protocol for rapidly ruling out myocardial ischemia reduces hospital time and expense: results of a randomized study (ROMIO).

OBJECTIVES: We tested the hypothesis that an emergency department-based protocol for rapidly ruling out myocardial ischemia would reduce hospital time and expense but maintain diagnostic accuracy. BACKGROUND: Patients with a missed diagnosis of myocardial infarction have a high mortality rate; however, providing routine hospital care to low risk patients may not be time- or cost-effective. METHODS: One hundred low risk patients were entered into the study and randomized either to an emergency department-based rapid rule-out protocol (n = 50) or to routine hospital care (n = 50). Patients receiving routine care were managed by their attending physicians. The rapid protocol included serum enzyme testing at 0, 3, 6 and 9h, serial electrocardiograms with continuous ST segment monitoring and, if results were negative, a predischarge graded exercise test. Study patients were also compared with 160 historical control subjects. RESULTS: Myocardial infarction or unstable angina occurred in 6% of patients within 30 days; no diagnoses were missed. By intention to treat analysis (n = 50 in each group), the hospital stay was shorter and charges were lower with the rapid protocol than with routine care (p = 0.001). Among patients in whom ischemia was ruled out, those assigned to the rapid protocol had a shorter hospital stay (median 11.9 vs. 22.8 h, p = 0.0001) and lower initial ($893 vs $1,349, p = 0.0001) and 30-day ($898 vs. $1,522, p = 0.0001) hospital charges than did patients given routine care. In historical control subjects, the hospital stay was longer (median 34.5 h, p = 0.001 vs. either group) and charges greater (median $2,063, p = 0.001, vs rapid protocol, p = 0.02, vs. routine care group). CONCLUSIONS: In low risk patients who present to the emergency department with chest pain, the rapid protocol ruled out myocardial infarction and unstable angina more quickly and cost-effectively than did routine hospital care.

Clinical Enzyme Tests↗

Evaluation of two rapid screening assays for the detection of human immunodeficiency virus-1 infection in emergency department patients.

In order to determine the sensitivity and specificity of two rapid human immunodeficiency virus (HIV-1) assays compared with enzyme immunoassay and Western blot and to assess their potential use for routine screening in an emergency department (ED), we analyzed sera from 492 consecutive ED patients using an identity-unlinked design. Sera were analyzed for HIV-1 by standard enzyme-linked immunosorbent assay and Western blot and two rapid assays: the Abbott Testpack HIV-1 (Abbott Labs, Inc, Abbott Park, IL) and the HIV-1 Genie, (Genetic Systems, Seattle, WA). Seroprevalence of HIV-1 among 492 samples was 5.1%. Both rapid assays were easy to perform and required approximately 10 minutes per test. Sensitivity and specificity of both rapid assays were 100% and 99.8%, with positive and negative predictive values of 96.2% and 100%, respectively. It was concluded that both rapid assays showed high concordance with standard enzyme-linked immunosorbent assay and Western blot. Since the ED is often the primary care setting for many patients at risk for HIV-1, the ED may be an optimal site for routine HIV-1 screening. Rapid assay screening may provide the opportunity for timely identification of HIV-1-infected patients, allowing earlier treatment and counseling. However, ethical and practical questions regarding appropriate application of rapid HIV-1 testing in EDs still needs resolution.

Acquired Immunodeficiency Syndrome↗

Only modest resources are needed to improve treatment of hospitalised patients with chest pain or heart failure: rapid assessment is a safe and efficient strategy.

BACKGROUND: The objective of this study was to evaluate the safety and efficacy of rapid assessment using modest resources in hospitalised chest pain and heart failure patients. METHODS: We evaluated 81 patients hospitalised for chest pain or heart failure in a prospective rapid assessment group and 162 patients in a retrospective usual care group with 6 months' follow-up. Main outcome measures were length of hospital stay at index observation, number of days spent in hospital for all causes, chest pain or heart failure, and number of visits to the doctor. RESULTS: Chest pain patients: Length of hospital stay was significantly shorter in the rapid assessment group (1.3 vs. 3.7 days, P<0.0001). Days spent in hospital over 6 months were fewer in the rapid assessment group (2.9 vs. 8.8 days, P<0.005). Furthermore, the number of days spent in the hospital for chest pain or heart failure decreased (2.5 vs. 8.0 days, P<0.01). Heart failure patients: The length of hospital stay (8.7 vs. 9.7 days, P=ns) or days spent in the hospital over 6 months did not differ (25.7 vs. 23.1 days, P=ns). However, there were fewer days (10.5 vs. 16.7 days, P<0.01) spent in the hospital for chest pain or heart failure in the rapid assessment group. CONCLUSIONS: Rapid assessment of hospitalised chest pain and heart failure patients on the next working day is a safe strategy in a medium-sized hospital. In 6 months, rapid assessment effectively reduces days spent in the hospital in chest pain patients, but not in heart failure patients. It can easily be integrated into standard care using modest resources.

Aged↗

Risk factors for unintended versus intended rapid repeat pregnancies among adolescents.

PURPOSE: Whereas previous research has elucidated a number of risk factors for rapid repeat pregnancies among adolescents, we sought to assess both established and hypothetical risk factors in the context of the intendedness of the repeat pregnancy. METHODS: The study population, drawn from the 2002 National Survey of Family Growth (NSFG), consisting of women who experienced at least one pregnancy as an adolescent, were interviewed at least 24 months since that pregnancy's resolution and were aged 30 years and younger at the time of the NSFG interview. To evaluate the effect of various predictor variables on the intendedness of a rapid repeat pregnancy, we constructed a polytomous multiple logistic regression model. Outcomes are reported as ratios of odds ratios (ROR) and were calculated using women experiencing an adolescent pregnancy, but not a rapid repeat pregnancy, as the reference group. RESULTS: In the 2002 NSFG, 34% of the adolescents experiencing a rapid repeat pregnancy reported such pregnancies to be intended. Although young age (< or = 15 years) at first conception was associated with a decreased likelihood of an unintended rapid repeat pregnancy, racial/ethnic characteristics as well as characteristics of the teen's mother (educational status and young age of the teen's mother at first birth) were not associated with either intended or unintended rapid repeat pregnancies. Factors found to be associated with an increased likelihood of having an intended repeat pregnancy included an intended first pregnancy, prior poor obstetrical outcome, and having the repeat pregnancy intended by the teen's partner. Being married at the time of second conception was associated with a decreased likelihood of an unintended rapid repeat pregnancy. CONCLUSIONS: Consideration of the intendedness of repeat pregnancies among teenagers could help create more appropriate and effective family planning interventions.

Adolescent↗

Rapid and reversible induction of the longevity, anticancer and genomic effects of caloric restriction.

It is widely held that caloric restriction (CR) extends lifespan by preventing or reducing the age-related accumulation of irreversible molecular damage. In contrast, our results suggest that CR can act rapidly to begin life and health span extension, and that its rapid genomic effects are closely linked to its health effects. We found that CR begins to extend lifespan and reduce cancer as a cause of death within 8 weeks in older mice, apparently by reducing the rate of tumor growth. Further, 8 weeks of CR progressively reproduces nearly three quarters of the genomic effects of long-term CR (LTCR) in liver. Fewer of the genomic effects of LTCR are rapidly reproduced by the initiation of CR in the heart, but the changes produced are keys to cardiovascular health. Thus, the genomic effects of CR may be established more rapidly in mitotic than in postmitotic tissues. Most of the genomic effects of LTCR dissipate 8 weeks after switching to a control diet. Consistent with these results, others have shown that acute CR rapidly and reversibly reduces the short-term risk of death in Drosophila to that of LTCR treated flies. Further, in late adulthood, acute CR partially or completely reverses age-related alterations of liver, brain and heart proteins. CR also rapidly and reversibly mitigates biomarkers of aging in adult rhesus macaques and humans. These data argue that highly conserved mechanisms for the rapid and reversible enhancement of life- and health-span exist for mitotic and postmitotic tissues.

Aging↗

Nonlinearities in rapid event-related fMRI explained by stimulus scaling.

Because of well-known nonlinearities in fMRI, responses measured with rapid event-related designs are smaller than responses measured with spaced designs. Surprisingly, no study to date has tested whether rapid designs also change the pattern of responses across different stimulus conditions. Here we report the results of such a test. We measured cortical responses to a flickering checkerboard at different contrasts using rapid and spaced event-related fMRI. The relative magnitude of responses across contrast conditions differed between rapid and spaced designs. Modeling the effect of the rapid design as a scaling of stimulus strength provided a good account of the data. The data were less well fit by a model that scaled the strength of responses. A similar stimulus scaling model has explained effects of neural adaptation, which suggests that adaptation may account for the observed difference between rapid and spaced designs. In a second experiment, we changed the stimulus in ways known to reduce neural adaptation and found much smaller differences between the two designs. Stimulus scaling provides a simple way to account for nonlinearities in event-related fMRI and relate data from rapid designs to data gathered using slower presentation rates.

Adaptation, Physiological↗

Does rapid dose titration affect the hepatic safety profile of Bosentan?

RATIONALE: Bosentan, a dual endothelin receptor antagonist, has proven efficacy in pulmonary hypertension. Due to an association with hepatic dysfunction, it is typically initiated at a sub-therapeutic dose for 4 weeks before titration to a therapeutic dose. At our institution some patients have undergone rapid titration, to potentially benefit from therapy earlier. This study assesses the impact of this practice on hepatic safety. METHOD: All patients initiated on bosentan therapy before April 2005 were included. Rapidly titrated patients achieved a therapeutic dose by 3 days, whereas standard titration patients were titrated at 4 weeks. All patients were monitored with monthly liver function tests. RESULTS: 149 patients commenced bosentan, of which 55 were rapidly titrated. At baseline, the two groups were similar in age, BMI, diagnosis, 6-min walking distance, alanine aminotransferase (ALT), cardiac index and pulmonary artery pressures. The rapid group had elevated right atrial pressures (9.7 mm Hg versus 7.4 mm Hg, p = 0.016) and worse WHO functional class (p = 0.008) and included less females (31% versus 69%, p = 0.024). The incidence of hepatic dysfunction in all patients was 12.8% at 12 months. There was no statistical difference in incidence between the rapid and standard groups (4% versus 11% at 3 months, p = 0.211 and 6% versus 15% at 12 months, p = 0.219). Of all patients on bosentan, hepatic dysfunction was most significantly associated with a higher baseline ALT (p = 0.021), female sex (p = 0.003) and underlying connective tissue disease (p = 0.025). Subgroup analysis suggested these factors were not confounders when comparing rapid and standard titration. CONCLUSIONS: Rapid and standard titration of bosentan resulted in similar hepatic safety profiles. Baseline ALT, female sex and the presence of connective tissue disease increased the risk of hepatic dysfunction independent of the titration method used.

Alanine Transaminase↗

The effect of circuit type, volume delivered and "rapid release" on flow rates during manual hyperinflation.

Traditionally, manual hyperinflation has been performed using "rapid release" to promote a fast peak expiratory flow rate (PEFR) but rapid release has not been described. In addition, it has been demonstrated that different resuscitation circuits provide varying degrees of resistance to expiratory flow and it is known that a variety of circuits are used in Australia for manual hyperinflation. The aim of this study was to document current practice, the effect of rapid release, controlling inspiration, different volumes and circuit type on flow rates, and the inspiratory to expiratory flow rate (I:E) ratio during manual hyperinflation. Using a test lung model, 15 physiotherapists performed 11 trials using the Air Viva 2, a Mapleson-C and a Mapleson-F circuit, both with and without rapid release, and delivering two volumes. The order of the trials was randomised. Rapid release produced a faster PEFR irrespective of circuit type or volume delivered. The effect of rapid release, and the absolute PEFR, was less for the Air Viva 2 compared with the Mapleson circuits. Expiratory flow rate was faster for the larger volume. The theoretically optimal I:E ratio to move secretions was achieved delivering the lower target volume with the Mapleson circuits and using rapid release.

Clinical Competence↗

Hypothermic preconditioning induces rapid tolerance to focal ischemic injury in the rat.

Stressful, preconditioning stimuli can elicit rapid and delayed forms of tolerance to ischemic injury. The identification and characterization of preconditioning stimuli that are effective, but relatively benign, could enhance the clinical applicability of induced tolerance. This study examines the efficacy of brief hypothermia as a preconditioning stimulus for inducing rapid tolerance. Rats were administered hypothermic preconditioning or sham preconditioning and after an interval of 20-120 min were subjected to transient focal ischemia using a three-vessel occlusion model. The volume of cerebral infarction was measured 24 h or 7 days after ischemia. In other experiments, the depth or duration of the hypothermic stimulus was manipulated, or a protein synthesis inhibitor (anisomycin) was administered. Twenty minutes of hypothermia delivered 20 or 60 (but not 120) min prior to ischemia significantly reduces cerebral infarction. The magnitude of protection is enhanced with deeper levels of hypothermia, but is not affected by increasing the duration of the hypothermic stimulus. Treatment with a protein synthesis inhibitor does not block the induction of rapid tolerance. Hypothermic preconditioning elicits a rapid form of tolerance to focal ischemic injury. Unlike delayed tolerance induced by hypothermia, rapid tolerance is not dependent on either de novo protein synthesis or the duration of the preconditioning stimulus. These findings suggest that the mechanisms underlying rapid and delayed tolerance induced by hypothermia differ fundamentally. Brief hypothermia could provide a rapid means of inducing transient tissue protection in the context of predictable ischemic events.

Animals↗

Rapid injection of indocyanine green dye for evaluation of choroidal venous circulation.

PURPOSE: The purpose of this study was to investigate the effects of rapid intravenous administration of a small bolus of indocyanine green (ICG) dye on early phase findings of ICG angiography. METHODS: Rabbit eyes were used. Ten normal eyes, 5 eyes with occlusion of vortex veins, and 5 eyes with chorioretinal atrophy were examined by ICG angiography, and early-phase findings after a rapid injection of a small bolus of dye were compared with those obtained with an ordinary injection. RESULTS: In normal eyes, after the rapid injection it was possible to visualize some small bright fluorescent boluses in the choroidal veins from 6 to 12 seconds after injection, while with the ordinary injection they were unclear. In eyes with occlusion of vortex veins, the rapid injection resulted in visualization of the choroidal veins with delayed filling against the background, and the region of the choroidal veins with delayed filling could easily be determined. In eyes with chorioretinal atrophy, only the rapid injection clearly revealed the choroidal veins with delayed filling. CONCLUSIONS: The rapid injection made it possible to detect the choroidal veins with delayed filling that were not clearly and easily visible using an ordinary injection. Rapid injection of ICG dye is useful for a detailed examination of choroidal circulation.

Animals↗

Ten weeks of rapid ventricular pacing creates a long-term model of left ventricular dysfunction.

OBJECTIVE: Rapid ventricular pacing produces a reliable model of heart failure. Cessation after 4 weeks of rapid ventricular pacing results in rapid normalization of left ventricular function, but the left ventricle remains persistently dilated. We present novel data that show that prolonged rapid ventricular pacing (10 weeks) creates a model of chronic left ventricular dysfunction. METHODS: In 9 dogs undergoing 10 weeks of rapid ventricular pacing, left ventricular function and volumes were serially assessed by using 2-dimensional echocardiography and pressure-volume analysis for 12 weeks after cessation of pacing. RESULTS: Increased end-diastolic volume and decreased systolic and diastolic function were seen at the end of pacing. By 2 weeks of recovery from rapid ventricular pacing, end-diastolic volume and ejection fraction were partially recovered but did not improve further thereafter. Load-independent and load-sensitive indices of function obtained by pressure-volume analysis at 8 and 12 weeks of recovery confirmed a persistence of both systolic and diastolic dysfunction. In addition, left ventricular mass increased with pacing and remained elevated at 8 and 12 weeks of recovery. Four of these dogs studied at 6 months of recovery showed similar left ventricular abnormalities. CONCLUSION: Ten weeks of rapid ventricular pacing creates a long-term model of left ventricular dysfunction.

Animals↗

Rapid reperfusion causes stress failure in ischemic rat lungs.

OBJECTIVE: Rapid reperfusion may be injurious to the ischemic lung. Our aim was to confirm that slow reperfusion improves postischemic pulmonary function and to elucidate the ultrastructural changes associated with slow versus rapid reperfusion. METHODS. We used an ex vivo perfused rat lung transplant model to study the effect of slow versus rapid reperfusion on subsequent lung function and morphologic conditional. Functional assessment was performed in (1) fresh lung, slowly reperfused; (2) fresh lung, rapidly reperfused; (3) ischemic lung (4 hours at 22 degrees C), slowly reperfused; and (4) ischemic lung, rapidly reperfused. RESULTS: In group 4, the shunt fraction (P=.001), airway pressure (P=.001), and wet/dry ratio (P=.01) were significantly higher than in groups 1 through 3. Light and electron microscopy of slowly reperfused ischemic lungs (n=4) appeared normal. Rapidly reperfused ischemic lungs (n=4) demonstrated massive alveolar edema hemorrhage, and epithelial "blebbing" by light microscopy. Electron microscopy identified the blebbing as separation of the epithelial layer from an intact basement membrane by edema fluid. The epithelial layer was disrupted in numerous locations. Complete disruption of all layers of the blood-gas barrier was occasionally present. CONCLUSION: Rapid reperfusion of the ischemic lung is an important contributing factor to reperfusion lung injury resulting in mechanical stress failure of the alveolar/capillary barrier. Gradual reintroduction of blood flow to the ischemic lung improves oxygenation.

Animals↗

Rapid and genomic biological responses are mediated by different shapes of the agonist steroid hormone, 1alpha,25(OH)2vitamin D3.

The hormone 1alpha,25(OH)2vitamin D3 (1,25-D) produces biological responses via both genomic and rapid mechanisms. The genomic responses are linked to a nuclear receptor, while the rapid responses are believed to utilize other signal transduction pathways that are likely linked to a putative cell membrane receptor for 1,25-D. The natural seco-steroid, 1,25-D, is capable of facile rotation about its 6,7 single carbon bond to permit generation of a continuum of potential ligand shapes extending from the 6-s-cis (6C) to the 6-s-trans (6T). To identify the shape of the conformer(s) that can serve as agonists for the genomic and rapid responses, we synthesized two families of analogs that were locked in either the 6T or 6C conformation. We found that 6T-locked analogs were inactive or significantly less active than 1,25-D in both rapid responses (transcaltachia or the rapid stimulation of intestinal Ca2+ absorption in perfused chick intestine, stimulation of whole cell chloride currents in osteoblastic ROS 17/2.8 cells, and stimulation of phosphorylation of mitogen-activated protein kinase in promyelocytic NB4 leukemic cells) and in genomic responses (induction of osteocalcin in human MG-63 osteoblastic cells). For genomic responses, the 6C-locked analogs bound poorly to the nuclear receptor and were much less potent than 1,25-D. In contrast, the 6C-locked analogs were potent agonists of the three rapid responses studied and had activities equivalent to 1,25-D. These results demonstrate that the signal transduction pathways that support rapid and genomic responses can discriminate between different shapes of the conformationally flexible 1,25-D.

Animals↗