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Dual cardiac microdialysis to assess drug-induced changes in interstitial purine metabolites: adenosine deaminase inhibition versus adenosine kinase inhibition.

OBJECTIVE: The purpose of this study was: 1) to evaluate a dual microdialysis technique coupled with local drug administration in the regionally ischemic rabbit heart, and; 2) to assess the ischemia-induced changes in interstitial fluid (ISF) adenosine during inhibition of adenosine deaminase or adenosine kinase. METHODS: Two microdialysis probes were implanted parallel to each other and separated by 5 mm in myocardium perfused by a branch of the left coronary artery. Probes were used to sample myocardial ISF and to deliver drugs locally to the myocardium; purine metabolite concentrations in the collected dialysate were used as indices of ISF levels. Three groups of pentobarbital-anesthetized rabbits were studied. In a control group (n = 6), both probes were perfused with Krebs-Henseleit buffer. In the second and third groups, one probe was perfused with buffer, whereas the other probe was perfused with buffer containing 1 mM erythro-2-(2-hydroxy-3-nonyl)adenine (EHNA) (n = 5), an adenosine deaminase inhibitor, or 10 microM iodotubercidin (n = 9), an adenosine kinase inhibitor. All animals were exposed to 30 min of regional myocardial ischemia followed by 60 min of reperfusion. RESULTS: In the control group, similar increases in dialysate purine metabolites during ischemia were observed in both probes. Locally administered EHNA increased dialysate adenosine prior to ischemia and decreased dialysate inosine and hypoxanthine. During ischemia, the increase in dialysate adenosine in the EHNA-perfused probe was markedly augmented, while the increases in inosine and hypoxanthine were attenuated. In contrast, local infusion of iodotubercidin did not alter dialysate purine metabolites before ischemia, but there was a modest augmentation of adenosine during ischemia. These data illustrate the feasibility of dual microdialysis for assessing the effect of locally administered compounds on interstitial metabolite concentration in the regionally ischemic rabbit heart. Furthermore, adenosine deaminase inhibition has a more profound adenosine augmenting effect than adenosine kinase inhibition in the rabbit heart.

Adenine↗

Androgen supplementation in eugonadal men with osteoporosis-effects of 6 months of treatment on bone mineral density and cardiovascular risk factors.

This open, prospective therapeutic trial studied the effects of regular moderate androgen supplementation on bone mineral density in eugonadal men with established osteoporosis, and collected data on the safety of androgen therapy used in this setting. 23 men, aged 34-73 years, with vertebral crush fractures and back pain, in whom secondary causes of osteoporosis had been excluded, were treated with fortnightly intramuscular injections of 250 mg testosterone esters (Sustanon 250(R)) for 6 months. Blood pressure was recorded monthly; fasting lipids, glucose, haematocrit, plasma viscosity, and testosterone levels were measured every 3 months. Psychological effects were assessed using the Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire (GHQ), together with questioning on libido changes. Principal outcomes measured were changes in bone mineral density at the hip and spine by dual-energy X-ray absorptiometry (DEXA) over the treatment period. 21 men completed the study period. Mean bone mineral density at the lumbar spine increased from 0.799 g/cm(2) to 0.839 g/cm(2) during treatment (p < 0. 001), a rise of 5% in 6 months. Bone mineral density at the hip did not change. There were significant, favorable changes in diastolic blood pressure (-4.7 mmHg, p < 0.01), serum triglyceride levels (-0.405 mmol/L,p < 0.01), and total cholesterol (-0.27 mmol/L, p < 0.05). Adverse changes included a fall in HDL cholesterol (-0.087 mmol/L, p < 0.05) and a rise in plasma viscosity which was significant at 3 months but not at 6 months. The expected rises in hematocrit (0.434 to 0.456) and FAI (0.504 to 0.887) occurred. We conclude that testosterone supplementation significantly increased bone mineral density in this heterogeneous group of men with idiopathic primary osteoporosis, without an overall adverse effect on cardiovascular risk factors. This treatment warrants further evaluation in a randomized, controlled trial.

Absorptiometry, Photon↗

Metabolism of a 14C/3H-labeled GABAA receptor partial agonist in rat, dog and human liver microsomes: evaluation of a dual-radiolabel strategy.

The metabolism of 2-{[2-(3-fluoropyrid-2-yl)-1H-imidazol-1-yl]methyl}-1-propyl-5-cyano-1H-benzimidazole (1), a potent subtype-selective GABA(A) receptor partial agonist, was investigated in rat, dog and human liver microsomes. Due to its significant metabolic cleavage at C(8) observed in preliminary biotransformation studies with non-radiolabeled 1, both [(14)C]1 and [(3)H]1 were synthesized with respective radioisotopes placed on either side of C(8) to determine if all microsomal metabolites formed after C(8)N-dealkylation of 1 (or its core-intact metabolites) could be detected and quantified adequately. Both radiolabeled forms of 1, used separately in mono-radiolabel studies in cross-species microsomes and concomitantly in dual-radiolabel studies in rat microsomes, permitted the detection and quantification of all metabolites of 1, and a combination of radioactive and mass spectral data allowed structural elucidation of its Phase I metabolites. As expected, the sum of (14)C-only metabolites equaled that of (3)H-only metabolites in all incubations. In-line radiometric analysis worked extremely well (and was very reproducible) for quantifying either (14)C- or (3)H-compounds within separate incubations when using mono-radiolabeled 1. However, although the in-line radiodetector provided a comprehensive qualitative metabolic profile using dual-radiolabled 1, its inability to exclude completely (14)C- from (3)H-generated counts caused a degree of ambiguity pertaining to metabolite quantification. Thus, off-line liquid scintillation counting of collected dual-radiolabeled incubation LC-fractions was employed to quantify both (14)C- and (3)H-metabolites simultaneously, while in-line radiodetection was only used for qualitative analyses accompanying MS and MS/MS experiments. These studies demonstrated the analytical feasibility of using a dual-radiolabel approach for subsequent in vivo ADME studies with 1.

Animals↗

Advanced rhythm discrimination for implantable cardioverter defibrillators using electrogram vector timing and correlation.

INTRODUCTION: Discrimination of ventricular and supraventricular arrhythmias remains one of the major challenges for appropriate implantable defibrillator (ICD) therapy delivery. The electrogram vector timing and correlation (VTC) algorithm was developed for such rhythm discrimination. The VTC algorithm differentiates normally conducted supraventricular beats from abnormally conducted ventricular beats by comparing the timing and correlation of rate and shock channel electrograms. METHODS AND RESULTS: Rate and shock channel electrograms of sinus rhythm and induced arrhythmias were collected from 93 patients during ICD placement. The algorithm was developed using data from 50 patients and prospectively tested in a software model with the remaining 43 patients. A sinus rhythm reference was formed by averaging complexes of the shock channel signal aligned by the peak amplitude of the rate channel. Eight features measuring the amplitude and timing of shock channel signal characteristics were extracted from the reference for comparison. When a high-rate rhythm was detected, the VTC algorithm computed the correlation of the arrhythmia complex features with the reference. Rhythms with a sufficient number of uncorrelated beats were classified as ventricular tachycardia (VT). In a dual-chamber implementation, the VTC algorithm is integrated with ventricular and atrial rate comparison (V>A) and stability above an atrial fibrillation rate threshold. The test set consisted of 117 arrhythmias. Dual-chamber sensitivity was 100% (81/81 VT) and specificity was 97% (35/36 supraventricular tachycardia). Single-chamber analysis demonstrated 99% sensitivity and 97% specificity. CONCLUSION: The VTC algorithm demonstrated high sensitivity and specificity in discriminating between ventricular and supraventricular arrhythmias.

Aged↗

Prevalence of occupational asthma and immunologic sensitization to psyllium among health personnel in chronic care hospitals.

Psyllium is a high molecular weight laxative that can cause occupational asthma among health care workers who prepare this product for chronically ill patients. The prevalence of immunologic sensitization and occupational asthma to psyllium is unknown. We investigated the personnel of four chronic care hospitals, including two where four cases of occupational asthma had been confirmed the year preceding the trial. A questionnaire and skin prick tests with psyllium and various inhalants were administered to 193 of 248 (78%) of the workers who agreed to participate. Seventy-five subjects (39%) had a history of respiratory symptoms in normal life and/or respiratory symptoms and/or rhinoconjunctivitis after handling psyllium. Six (3%) showed skin reactivity to psyllium. Increased specific IgE antibodies were found in 20 of 162 of the sera that were tested (12%). In the second part of the study, a histamine inhalation challenge was performed on 70 of 75 (93%) of the subjects with a history suggestive of asthma and/or occupational asthma and/or skin reactivity to psyllium. Twenty (29%) had significant bronchial hyperresponsiveness. The six subjects with a history suggestive of occupational asthma (n = 3) and/or asthma (n = 6) and/or positive skin test results to psyllium (n = 6) had significant bronchial hyperresponsiveness and increased specific IgE levels. They all underwent specific inhalation challenges with psyllium in the laboratory. Four developed bronchospastic reactions (two immediate and two dual reactions). We conclude that by including the initial four cases reported in the year preceding the initiation of this trial, the prevalence of IgE sensitization to psyllium was between 5 (skin testing) and 12% (increased specific IgE levels).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Anthropometric and body composition assessment in dialysis patients.

Anthropometric and body composition assessments provide important information about the nutritional status of dialysis patients. Anthropometric measurements describe body size, fatness, and leanness in dialysis patients and have been collected in the Modification of Diet in Renal Disease (MDRD) and HEMO studies. Dialysis patients present special problems for anthropometry, including decreased functional status and increased comorbidity, that challenge nutrition assessment methodology. Recumbent anthropometric techniques are recommended and stature is estimated from knee height. Measures of weight, stature, calf circumference, arm circumference, and triceps and subscapular skinfolds have recently been reported for dialysis patients, who tend to be shorter, lighter, and have less adipose tissue than healthy persons of the same age. The HEMO study anthropometric data provide a clinical reference for assessing the nutritional status of dialysis patients. The most common body composition methods used with dialysis patients are dual energy X-ray absorptiometry (DEXA), bioelectrical impedance, total body water (TBW), and prediction equations, but they are not recommended for assessment of predialysis patients, as estimates are best obtained postdialysis. The TBW volume used in calculating the dose of dialysis has commonly been predicted from the limited, out-of-date equations of Watson, based on nonrepresentative samples. New prediction equations are available for white, black, and Mexican American children and adults. Watson's data are not representative of the TBW of U.S. men and women. The greater TBW in non-Hispanic black men and women and Mexican American women reflects the greater levels of obesity in the U.S. population.

Absorptiometry, Photon↗

Effect of BM-573 [N-terbutyl-N'-[2-(4'-methylphenylamino)-5-nitro-benzenesulfonyl]urea], a dual thromboxane synthase inhibitor and thromboxane receptor antagonist, in a porcine model of acute pulmonary embolism.

The aim of this study was to evaluate the effect of BM-573 [N-terbutyl-N'-[2-(4'-methylphenylamino)-5-nitro-benzenesulfonyl]urea], a dual thromboxane A2 synthase inhibitor and receptor antagonist, on the hemodynamic response to acute pulmonary embolism. Six anesthetized pigs were infused with placebo (placebo group) and compared with six other pigs receiving a continuous infusion of BM-573 (BM group). Pulmonary embolization with 0.3 g/kg autologous blood clots was carried out 30 min after the start of the infusion. Right ventricular pressure-volume loops were recorded using a conductance catheter, and end-systolic ventricular elastance was periodically assessed by varying right ventricular preload. Pulmonary vascular properties were studied by use of a four-element windkessel model. Hemodynamic data, including assessment of right ventricular-arterial coupling, were collected at baseline and every 30 min for 4 h. Blood samples were collected to assess gas exchange, thromboxane A2, and prostacyclin plasma levels and to evaluate platelet aggregation. Mean pulmonary arterial pressure in the placebo group increased significantly more than in the BM group, mainly because of an additional increase in pulmonary vascular resistance. Arterial and end-systolic ventricular elastances increased also more in the placebo group, whereas right ventricular efficiency decreased. BM-573 prevented both platelet aggregation induced by U-46619 (9,11-dideoxy-11alpha,9alpha-epoxymethanoprostaglandin F2alpha) or by arachidonic acid, and thromboxane A2 overproduction, whereas prostacyclin liberation was preserved. Oxygenation, however, was not significantly improved. We conclude that in this animal model of acute pulmonary embolism, infusion of BM-573 reduced pulmonary vasoconstriction. As a result, right ventricular-vascular coupling values were maintained at a maximal efficiency level.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗

Acute disruption of select steroid receptor coactivators prevents reproductive behavior in rats and unmasks genetic adaptation in knockout mice.

Estrogen (E) and progesterone exert profound influence on development and reproduction. In vitro, steroid receptor coactivators (SRCs) are nuclear proteins that interact with DNA-bound steroid receptors to potentiate their transcriptional efficiency. We examined the effects of antisense oligonucleotides to SRC-1, SRC-2, and SRC-3 on female sexual behavior and steroid receptor-mediated transcription. Rat (r) SRC-1, rSRC-2, and rSRC-3 genes were cloned. Our results reveal a significant inhibitory effect by antisense (AS) to SRC-1 and SRC-2, but not SRC-3, on hormone-induced reproductive behavior. Importantly, sexual behavior was attenuated through estrogen receptor alpha (ERalpha)-dependent, rather than progesterone receptor (PR)-dependent, transcription, as E failed to induce the synthesis of PR content in the medial basal hypothalamus, and immunoreactive PR in the ventromedial nucleus were depleted in tissue from rSRC-1-AS- and rSRC-2-AS-treated, but not rSRC-3-AS-treated, rats primed with E. Consistent with interruption of ERalpha-induced transcription, high dose of E and epidermal growth factor alone failed to induce sexual behavior in females treated with either rSRC-1-AS or SRC-2-AS. Immunoreactive SRC-1 and SRC-2, but not SRC-3, proteins were abundant in the ventromedial nucleus, thus demonstrating that the biological activities of hypothalamic steroid receptors are selectively regulated by regional distribution of specific SRCs. As SRC-1 knockout mice have only a slight loss in reproductive function, the possibility that genetic adaptation occurs during development was tested. Mouse (m) SRC-1-AS suppressed lordosis in wild-type, but not SRC-1, knockout mice, whereas mSRC-2-AS suppressed behavior in both genotypes. mSRC-3-AS had no effect in either genotype, and SRC-3 knockout mice exhibited full receptivity. Collectively, the findings clearly implicate dual regulation of ERalpha-dependent function by SRC-1 and SRC-2 in the intact female brain. In the genetic, but not acute, absence of SRC-1, up-regulation of SRC-2 serves as a critical adaptive mechanism during female development.

Adaptation, Physiological↗

Characterization of fragmented heavy-ion beams using a three-stage telescope detector: detector configuration and instrumentation.

Accelerated heavy-ion beams used in biological and medical research are often utilized in conjunction with absorbers which lead to the fragmentation of the beam. The BERKLET, initially a two-stage solid-state telescope detector, was designed to make rapid, on-line energy and linear energy transfer (LET) measurements of individual particles in a heavy-ion beam, thus allowing characterization of fragmented beams. From data collected with the BERKLET, one is able to determine a number of important parameters. These include: residual energy and LET histograms for the full beam and for the individual Z components, relative number of particles with a given Z, and dose and track average LET's for the full beam and for the individual Z's. Improvements to the BERKLET design and changes in data analysis are discussed and contrasted with the results of an earlier BERKLET configuration. The most notable improvements are the addition of a thin scintillation detector for improved LET measurement, a tenfold improvement in the dynamic range of the event discriminator, reported here as 1:2000, and dual high-and low-gain amplification of the LET signals, permitting the identification of particles with Z's ranging from 12 down to 1.

Energy Transfer↗

Reasons for escalating pacemaker implants.

Surveys of pacing practice have shown a steady increase in pacemaker implantation rates in the past 15 years, despite no major changes in United States guidelines for permanent pacing. There are no data to explain why this is occurring. In this study, records were extracted from the National Hospital Discharge Survey to investigate this. There were 3 major findings. First, age-adjusted implantation rates increased progressively over the study period from 370 per million in 1990 to 612 per million in 2002. Second, it was found that the escalating implantation rate is attributable to increasing implantation for isolated sinus node dysfunction (SND). Implantation for SND increased significantly over the study period (by 102%), whereas implantation for all other indications did not. The increasing implantation for SND is due primarily to the increasing prevalence of SND, with a lesser increase in implantation rate relative to prevalence rate. The third major finding of this study is that there has been a progressive relative and absolute increase in the dual-chamber implantation rate. In 2002, 82.8% of all initial pacemaker implantations were dual-chamber devices. Furthermore, the National Hospital Discharge Survey data indicate that the major randomized pacing trials seem to have had no impact on pacing practice in the United States. In conclusion, age-adjusted implantation rates increased progressively over the study period. This escalating implantation rate is primarily attributable to increasing implantation for SND.

Age Factors↗

Clinical value of immunohistochemically detected lymphovascular invasion in endometrioid endometrial cancer.

INTRODUCTION: Lymphovascular Invasion (LVSI) of tumour cells is marked as an important step in the process of tumour metastases and is an important prognostic factor in Endometrial Cancer (EC). Currently, the standard method for assessing LVSI is light microscopic examination of H&E stained sections. Tumour cells within lymphovascular spaces can evade detection on H&E staining if they are present in very small numbers or surrounded by a greater number of circulating cells. Dual immunostaining for epithelial and endothelial cell markers cell markers has been shown to increase detection rate of LVSI significantly. OBJECTIVES: To investigate the clinical significance of LVSI as detected by H&E (LVSI-H&E) and immunohistochemically (LVSI-IHC) in clinically stage I endometrioid EC patients. Methods. Single representative section of 90 patients with stage I endometriod EC were immunostained in accordance with established streptavidin-biotin peroxidase method using a mouse monoclonal pancytokeratin (PCK), clone AE1/AE3 and CD31 endothelial cell marker. The H&E sections and their corresponding immunostained sections were re-examined to identify LVSI. Clinical records were available on 72 patients. The following data were collected: age, race, parity, presentation, associated medical disorders (obesity, diabetes and hypertension), use of Tamoxifen or HRT, menopausal state, recurrence and survival. RESULTS: Overall, LVSI was present in 45 (50%) cases and absent in 45 (50%) cases on IHC, as compared with 17 (19%) and 73 (81%) cases, respectively, on H&E. Statistical analysis revealed significant association between LVSI-H&E and depth of myometrial invasion (P < 0.0001). The median follow-up period was 161 months (range 5-207 months). During the follow-up period, six of 14 cases with evidence of LVSI-H&E presented with recurrence as opposed to six of 58 patients with no evidence (OR = 6.26, 95%: CI = 1.3-30.6). There was a significant association between tumour recurrence rate and LVSI-H&E (P = 0.01). The 5-year recurrence-free survival was 54% for the group with H&E evidence of LVSI (95%: CI = 44-64%) compared with 89% for the group without (95%: CI = 82-97%). There was a significant difference in the recurrence-free survival between the two groups (Chi-square = 6.96, P = 0.008). In contrast, LVSI-IHC was found to be significantly associated only with high-grade tumours (P = 0.01) and survival analysis revealed no statistically significant association with recurrence or survival. CONCLUSIONS: LVSI-H&E in stage I EC remains an important predictive factor of recurrent disease and reduced disease-free interval. Immunohistochemically detected LVSI is a common event, associated with tumour grade and appears to be of no statistically significant clinical value.

Adult↗

Quantitative dual-probe microdialysis: mathematical model and analysis.

Steady-state microdialysis is a widely used technique to monitor the concentration changes and distributions of substances in tissues. To obtain more information about brain tissue properties from microdialysis, a dual-probe approach was applied to infuse and sample the radiotracer, [3H]mannitol, simultaneously both in agar gel and in the rat striatum. Because the molecules released by one probe and collected by the other must diffuse through the interstitial space, the concentration profile exhibits dynamic behavior that permits the assessment of the diffusion characteristics in the brain extracellular space and the clearance characteristics. In this paper a mathematical model for dual-probe microdialysis was developed to study brain interstitial diffusion and clearance processes. Theoretical expressions for the spatial distribution of the infused tracer in the brain extracellular space and the temporal concentration at the probe outlet were derived. A fitting program was developed using the simplex algorithm, which finds local minima of the standard deviations between experiments and theory by adjusting the relevant parameters. The theoretical curves accurately fitted the experimental data and generated realistic diffusion parameters, implying that the mathematical model is capable of predicting the interstitial diffusion behavior of [3H]mannitol and that it will be a valuable quantitative tool in dual-probe microdialysis.

Agar↗

Day hospital/crisis respite care versus inpatient care, Part II: Service utilization and costs.

OBJECTIVE: The authors compared service utilization and costs for acutely ill psychiatric patients treated in a day hospital/crisis respite program or in a hospital inpatient program. METHOD: The patients (N = 197) were randomly assigned to one of the two programs and followed for 10 months after discharge. Both programs were provided by a community mental health center (CMHC) in a poor urban community. Data were collected for developing service utilization profiles and estimates of per-unit costs of the inpatient, day hospital, and outpatient services provided by the CMHC. RESULTS: On average, the day hospital/crisis respite program cost less than inpatient hospitalization. The average saving per patient was +7,100, or roughly 20% of the total direct costs. There were no significant differences between programs in service utilization or costs during the follow-up phase. Cost savings accrued in the index episode because per-unit costs were lower for day hospital/crisis respite and the average stay was shorter. Significant differences in cost were found among patient groups with psychosis, affective disorders, and dual diagnoses; psychotic patients had the highest costs in both programs. The two programs had roughly equal direct service staff and capital costs but significantly different operating costs (day hospital/crisis respite operating costs were 51% of inpatient hospital costs). CONCLUSIONS: The programs were equally effective, but day hospital/crisis respite treatment was less expensive for some patients. Potential cost savings are higher for nonpsychotic patients. Cost differences between the programs are driven by the hospital's relatively higher overhead costs. The roughly equal expenditures for direct service staff costs in the two programs may be an important clue for understanding why these programs provided equally effective acute care.

Adult↗

Color image analysis in neuroanatomical research: application to senile plaque subtype quantification in Alzheimer's disease.

Many problems in neuroanatomy and neuropathology require the collection of large data sets and would benefit from a method that allows for rapid quantitative analysis to be carried out on a routine basis. An example is the quantification and subtype classification of the number of senile plaques in post-mortem Alzheimer's disease tissue. A method to reliably automate the analysis of plaques and their underlying subtypes would allow more rigorous and quantitative correlations to be investigated. Computer assisted image analysis of data typically utilizes gray scale images. These methods, however, are only applicable to quantification of objects labeled with a single marker. We sought to extend this type of analysis to double-labeled tissue sections so we could quantify dual labels separately based on their peroxidase color characteristics, analyze the resultant occurrence of overlap between the two labels, and classify senile plaques into discrete subtypes. We present a method for semi-automated color image analysis which allows one to identify separate labels based on histogram mapping of hue, saturation and value as well as apply overlapping feature detection algorithms. The technique is application driven, so that a trained observer can set threshold or object criteria and verify the desired results. These methods were able to yield total "amyloid load" and "dystrophic neurite load" values, generate plaque histograms based on total size, and subtype plaques into diffuse/primitive and neuritic/classical categories. By adjusting feature criteria, we were able to achieve promising agreement (Fisher's R to Z correlation of 0.94) between a human observer and the computer algorithm in the classification of plaque subtypes using three AD cases.

Algorithms↗

Sertoli cell synthesizes and secretes a protease inhibitor, alpha 2-macroglobulin.

The mechanism by which the seminiferous epithelium limits the damaging effects of proteases that are released from degenerating late spermatids does not depend upon protease inhibitors in the systemic circulation since these proteins are excluded from the seminiferous tubule by the blood-testis barrier. The purpose of this study was to identify the major protease inhibitor of the testis and determine its cellular origin. Sertoli cells, the major epithelial component of the seminiferous epithelium, release a protease inhibitor, testicular alpha 2-macroglobulin, in vitro. Immunoprecipitation using [35S]methionine and a monospecific polyclonal antibody prepared against purified testicular alpha 2-macroglobulin establishes that this protein is actively synthesized and secreted by Sertoli cells. Measurements of immunoreactive protease inhibitors in tubular and rete testis fluids collected by micropuncture suggest that alpha 2-macroglobulin rather than alpha 1-antitrypsin is the major protease inhibitor in the seminiferous tubules in vivo. The ability of alpha 2-macroglobulin to inactivate proteases and growth factors such as TGF-beta by a common mechanism suggests that this protein may have a dual function in the testis.

Amino Acid Sequence↗

Allergen challenge alters intracellular cytokine expression.

The pathophysiology of asthma is complex and engages cascades of events in the cytokine network. We, therefore, investigated the impact of bronchial allergen challenge in humans on the cytokine profile of circulating lymphocytes. Peripheral blood samples from 10 patients with allergic asthma were collected before and 24 h after allergen provocation. Patients who mounted a late-phase reaction were designated dual responders opposite to single responders. Whole blood cells were stimulated by mitogen and intracellular interleukin (IL)-4 and interferon (IFN)-gamma were detected by flow cytometry. The allergen challenge induced a decrease in IL-4+CD4+ cells in the patients (P = 0.05), and a significant decrease (P < 0.05) in IFN-gamma+CD4+ cells was noted in single, but not dual, responders. In addition, there was a significant difference (P < 0.01) with respect to the changes in the IFN-gamma+CD4+ cells comparing dual and single responders. No corresponding changes were observed in CD8+ cells. The data suggest a possible on-going traffic of IFN-gamma and IL-4+CD4+ lymphocytes into the bronchial mucosa in relation to an allergen challenge and generate the hypothesis that a difference exists between single and dual responders in this respect. Because the CD4+IFN-gamma-producing cells have the capacity to downregulate the T-helper type 2 response, a reduced capacity in this aspect might contribute to the pathophysiology in dual responders.

Adult↗

Neonatal and pediatric outcome of infants born to mothers with antiphospholipid syndrome.

OBJECTIVE: To determine any adverse outcome to infants born to mothers with Antiphospholipid Syndrome (APS). DESIGN: Case control study with retrospective data collection and prospective pediatric review. SETTING: Regional Recurrent Miscarriage Clinic based at a University Teaching Hospital. PARTICIPANTS: Infants (n = 62) of mothers with APS, compared to 124 index cases randomly selected from the delivery register, matched for gestation and sex who delivered between 1992 and 1997. RESULTS: Sixty two infants born to 55 women with APS were reviewed to study the neonatal outcome. The prematurity rate for the group was 10%, compared to 8.5% for the total hospital population over the same period of time. Twenty-one percent (21%) had birth weights less than or equal to the 10th centile, which was not statistically significant compared to matched controls. The presence of dual parameter positivity (lupus anticoagulant and anticardiolipin antibody) for APS is clearly associated with a higher incidence of growth restriction. All children were normal on neurodevelopmental and physical examination at pediatric review. CONCLUSIONS: There was a low rate of preterm delivery. Although the incidence of growth restriction of 21% is higher than expected it was not statistically significant. There were no developmental abnormalities on follow-up of these children.

Adult↗

The 1981 United States survey of cardiac pacing practices.

A survey of physicians implanting pacemakers was conducted to obtain a profile of permanent cardiac pacing practices in the United States during 1981. Questionnaires were mailed to 5,832 implanters with 765 responses (13%) received and 680 analyzed. It was estimated that there were approximately 5,600 physicians, 66% surgeons and 34% nonsurgeons, implanting pacemakers at 3,670 centers. About 118,000 new primary implants were performed, or 518 per million population. Only 17% of implantation procedures in 1981 were replacements compared with 31% in 1978. Roughly half the respondents worked in teams, most implanting from 46 to 55 pacemakers annually. The chief indications for permanent pacing were sick sinus syndrome (48%) and impairment of conduction in the atrioventricular node and His-Purkinje system (42%). Ninety-five percent of pacing leads were implanted transvenously. Seventy percent of the respondents had had experience with atrial and dual-chamber pacemakers, used largely to increase cardiac output. The use of ventricular demand (VVI) pacing decreased accordingly from 91% in 1975 to 84% in 1981. Although approximately 90% of primary pacemakers were programmable to some degree, almost half were not reprogrammed within the first 3 months after implantation and 30% were never reprogrammed. Most patients (85%) were followed up by transtelephonic electrocardiographic monitoring, 68% in conjunction with private office visits. The respondents estimated that dual-chamber pacing, accounting for 10% of implants in 1981, would increase to 37% by 1985. Early electrode malfunctions were less frequent when implantation was performed by high volume and solo implanters, and in public and community hospitals. It is concluded that periodic surveys of this type disclose important trends in the practice of cardiac pacing.

Cardiac Surgical Procedures↗