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An approach to computer-aided inhibitor design: application to cathepsin L.

We have developed an approach to search for molecules that can be used as lead compounds in designing an inhibitor for a given proteolytic enzyme when the 3D structure of a homologous protein is known. This approach is based on taking the cast of the binding pocket of the protease and comparing its dimensions with that of the dimensions of small molecules. Herein the 3D structure of papain is used to model cathepsin L using the comparative modeling technique. The cast of the binding pocket is computed using the crystal structure of papain because the structures of papain and the model of cathepsin L are found to be similar at the binding site. The dimensions of the cast of the binding site of papain are used to screen for molecules from the Cambridge Structural Database (CSD) of small molecules. Twenty molecules out of the 80,000 small molecules in the CSD are found to have dimensions that are accommodated by the papain binding pocket. Visual comparison of the shapes of the cast and the 20 screened molecules resulted in identifying brevotoxin b, a toxin isolated from the 'red tide' dinoflagellate Ptycho brevis (previously classified as Gymonodium breve), as the structure that best fits the binding pocket of papain. We tested the proteolytic activity of papain and cathepsin L in the presence of brevotoxin b and found inhibition of papain and cathepsin L with Kis of 25 microM and 0.6 microM, respectively. We also compare our method with a more elaborate method in the literature, by presenting our results on the computer search for inhibitors of the HIV-1 protease.

Binding Sites↗

Aspects of imported malaria at a district general hospital in non-endemic Kuwait, Arabian Gulf.

There is no indigenous mosquito-borne transmission of malaria in Kuwait. However, in a five year period at a district general hospital, the number of laboratory-diagnosed cases of malaria increased annually from 25 to 84, a rise of 336%. Except for two induced infections, all were imported, mainly from the Indian subcontinent. Plasmodium vivax was responsible for 87.29% of the cases; P.falciparum (12.05%), a mixed infection of P.vivax and P.falciparum (0.33%) and a case of P.ovale (0.33%) were also identified. Rapid preparation of acetone-fixed, Giemsa-stained thick blood films, a heightened awareness of the infection, examination of multiple samples of blood from patients and the general resurgence of malaria in endemic areas were some of the factors responsible for the high number of cases diagnosed. Most patients were young males and presented with clinical malaria due to P.vivax between May and October each year, an apparent seasonal peak. However, many were already resident in the country for a variable period. Patients with P.falciparum though, presented clinically within two weeks of arrival in the country. Parasite densities were calculated to monitor the progress of treatment and identify quickly any possible chloroquine-resistant P.falciparum strains. A policy of active prophylaxis is suggested to stem the tide of imported malaria.

Adolescent↗

Histological examination of surface repair tissue after successful osteotomy for osteoarthritis of the hip joint.

In this study biopsy specimens of the surface repair tissue from the weightbearing area of the hip joint were collected from 15 patients who had undergone successful valgus osteotomy, and these were examined histologically. In 6 of the 15 patients the specimens stained strongly with safranin-O in all three layers of the matrix. However, the repair tissue from another 6 patients showed strong staining only in the intermediate and deep layers, while that from 2 patients stained only in the deep layer. Specimens from 5 patients were stained for S-100 protein and positive cells were detected in all cases, demonstrating that the cells in the repair tissue were chondrocytes. However, there was no tide mark in the repair tissue and the arrangement of the cells differed from that in normal cartilage. Discontinuity of the subchondral bone was also noted. These findings make it likely that the repair tissue was of bone marrow origin.

Adult↗

Ventriculojugular shunt against the direction of blood flow. IV. Technical modifications and policy for treatment.

During evolution of the surgical procedure to implant ventriculojugular (VJ) shunts against the direction of blood flow for the treatment of hydrocephalus, various modifications were made in the shunting catheter and in the implantation technique with the aim of improving the results. Shunt implantation was difficult in infants and young children with compressible craniums and the modifications failed to improve the results. Accordingly, they were not considered suitable for this method of cerebrospinal fluid (CSF) shunting. Our present policy is to implant VJ shunts in hydrocephalic patients with rigid craniums and ventriculoperitoneal (VP) shunts in infants and young children to tide them over a period until they become suitable for VJ shunting. During the past 5 years, 110 hydrocephalic patients with rigid craniums were treated by implanting VJ shunts without need for further modifications. The shunt was revised in one patient during the early postoperative period due to CSF leakage under the scalp. There were no complications related to CSF overdrainage in any of the cases.

Cerebrospinal Fluid Shunts↗

Utilization of a mass-infusion system in the management of ruptured abdominal aortic aneurysms: an alternative application for devices employed in cardiopulmonary bypass.

To stabilize the hemodynamics before and during ruptured abdominal aortic aneurysmal repair, a mass-infusion system was developed and successfully employed in the treatment of two patients. The system consists of a combination of devices used in cardiopulmonary bypass, namely: suction, a reservoir, a heat exchanger, a bubble trap, and an intracaval large-sized venous femoral cannula for infusion. It proved extremely useful to tide the patients over hypovolemic shock before cross-clamping of the proximal aorta, preventing intraoperative hypothermia, which is known to cause multiple physiologic derangement associated with an adverse outcome. Moreover, the employment of a large-sized cannula allowed for a temporary switch from the preceding venous infusion support to the hypothermic circulatory assist with central aortic cannulation, using the caval cannula for drainage. This system provides an optional advantage for patients requiring an open proximal anastomosis.

Aneurysm, Ruptured↗

Pitfalls in acid/base experiments with conscious dogs.

Arterial pH and blood gases were measured at intervals in conscious dogs after their first human contact of the day. Blood was sampled through an indwelling catheter in the aorta without disturbing the animals. It appeared that in the first 90 min arterial PO2, oxygen saturation and haemoglobin concentration significantly declined. PCO2 and pH changed less consistently when the acid/base status of the dogs was normal, but when a non-respiratory acidosis was present there was a significant decrease in pH and a significant increase in PCO2. Arterial pH and blood gases were also measured before and after feeding the animals. It appeared that an appreciable metabolic alkalosis developed within 2 h after a meal. The "alkaline tide" was accompanied by a trend to higher values for PCO2. It is concluded that, after a period of seclusion, renewed human contact causes behavioural changes in a dog, which may result in appreciable transitory changes in arterial pH and blood gas values. Blood sampling from conscious dogs should therefore take place after a proper period of habituation; preferably, a few samples should be taken at intervals to check that a steady state has been reached. If possible, blood should be collected before feeding; in any case the relationship in time of blood sampling to feeding should be constant throughout.

Acid-Base Equilibrium↗

Trematode infections in Pirenella conica in three sites of a mangrove lagoon in Sinai.

Over a period of 11 months, eight samples of Pirenella conica were taken at each of three sites of a mangrove lagoon in Sinai. Infection with larval trematodes, especially of Heterophyidae, was highest at the site within the mangrove thicket with a breeding colony of reef herons, the supposed definitive hosts of the Heterophyidae. The lowest frequency of infection was recorded from a tide-pool on the broad sand-flats surrounding the lagoon, where there was a great variation in the abundance of snails and xiphidiocercariae were more common than heterophyid cercariae. Predation from fish or other molluscs did not appear to be an important factor at either of these two sites. In all three sites, double infections of Heterophyidae and trematodes with xiphidiocercariae as well as of Heterophyidae and Echinostomatidae occurred less frequently than theoretically expected, but there was no competitive exclusion between Echinostomatidae and xiphidiocercariae.

Animals↗

Taurine in toad brain and blood under different conditions of osmolality: an immunohistochemical study.

The concentrations of taurine in blood and brain regions of the toad Bufo boreas have been measured. Most of these values are considerably lower than those found in mammals. Using an antibody prepared against conjugated taurine, the distribution of taurine in three brain regions of the toad has been visualized. The possible osmoregulatory functions of taurine have been investigated by making toads hyper- or hypo-osmotic in vivo. Induction of hypoosmolality is accompanied by a massive taurine tide in blood plasma, but has no immediate effects upon the taurine concentrations in the brain areas studied. However, histochemical visualization indicates a marked redistribution of taurine between cellular components and extracellular space of brain tissues. This may indicate that taurine has an osmoregulatory function in brain tissue under hypo-osmotic conditions. Hyperosmolality results in no elevation of the taurine concentration in blood plasma of toads, but rather in a very gradual decline of total plasma taurine content over a prolonged time period. Histochemical studies reveal little change in frontal cortex after 1 hour but deeper staining of many neurons in optic lobe accompanied by greater staining in the extracellular fluid. By 3 hours there is a depletion of taurine from all compartments of cerebral cortex tissues. No evidence of any prolonged direct osmoregulatory role for taurine is indicated under hyperosmotic conditions. A possible indirect osmoregulatory function of taurine is discussed.

Animals↗

Multiple intracranial aneurysms: a high risk condition.

There is still a relative silence in the literature on what policy should be followed in treating multiple aneurysms. The main risks are: bleeding of a formerly asymptomatic aneurysm during the haemodynamic tides of the peri-operative period; aneurysm(s) can be hidden on angiograms and tend to be overlooked easier in case of an already revealed aneurysm; misjudgement of the ruptured one as a silent additional aneurysm, therefore left for second stage surgery. This paper, based on a material of 330 operations for multiple aneurysms, focuses on these problems. It advocates the one stage complete repair of all lesions using both options of bilateral pterional craniotomies or the contralateral approach. But it also describes those silent aneurysms which safely could be clipped later. Hazards and disadvantages concerning the more aggressive surgery proved to be less significant than the natural history of multiple aneurysms represents.

Adult↗

Construction of protocellular structures under simulated primitive earth conditions.

We have developed experimental approaches for the construction of protocellular structures under simulated primitive earth conditions and studied their formation and characteristics. Three types of envelopes; protein envelopes, lipid envelopes, and lipid-protein envelopes are considered as candidates for protocellular structures. Simple protein envelopes and lipid envelopes are presumed to have originated at an early stage of chemical evolution, interaction mutually and then evolved into more complex envelopes composed of both lipids and proteins. Three kinds of protein envelopes were constructed in situ from amino acids under simulated primitive earth conditions such as a fresh water tide pool, a warm sea, and a submarine hydrothermal vent. One protein envelope was formed from a mixture of amino acid amides at 80 degrees C using multiple hydration-dehydration cycles. Marigranules, protein envelope structures, were produced from mixtures of glycine and acidic, basic and aromatic amino acids at 105 degrees C in a modified sea medium enriched with essential transition elements. Thermostable microspheres were also formed from a mixture of glycine, alanine, valine, and aspartic acid at 250 degrees C and above. The microspheres did not form at lower temperatures and consist of silicates and peptide-like polymers containing imide bonds and amino acid residues enriched in valine. Amphiphilic proteins with molecular weights of 2000 were necessary for the formation of the protein envelopes. Stable lipid envelopes were formed from different dialkyl phospholipids and fatty acids. Large, stable, lipid-protein envelopes were formed from egg lecithin and the solubilized marigranules. Polycations such as polylysine and polyhistidine, or basic proteins such as lysozyme and cytochrome c also stabilized lipid-protein envelopes.

Amino Acids↗

Infections due to antibiotic-resistant gram-positive cocci.

Gram-positive cocci are becoming increasingly resistant to traditionally used antimicrobial agents. Staphylococcus aureus, coagulase-negative staphylococci, the enterococcus, and Streptococcus pneumoniae are the most commonly encountered of such pathogens in clinical practice. Clinicians should be keenly aware of the usual types of infections that are caused by these organisms and the importance of documenting susceptibilities of infecting strains. The basic mechanisms of resistance should be familiar to clinicians so that an inappropriate empiric regimen will not be selected (e.g., addition of a beta-lactamase inhibitor for penicillin-resistant pneumococci). Vancomycin remains the agent of choice, sometimes in combination with gentamicin and/or rifampin, for most cases of infection due to these resistant gram-positive organisms. Last, increased efforts toward prevention, such as strict adherence to infection control measures, selective use of broad-spectrum antibiotics, and increased use of pneumococcal vaccine, may be useful to help stem the rising tide of infections due to resistant gram-positive cocci.

Anti-Bacterial Agents↗

Molecular genetics of schizophrenia: past, present and future.

Schizophrenia is a severe neuropsychiatric disorder with a polygenic mode of inheritance which is also governed by non-genetic factors. Candidate genes identified on the basis of biochemical and pharmacological evidence are being tested for linkage and association studies. Neurotransmitters, especially dopamine and serotonin have been widely implicated in its etiology. Genome scan of all human chromosomes with closely spaced polymorphic markers is being used for linkage studies. The completion and availability of the first draft of Human Genome Sequence has provided a treasure-trove that can be utilized to gain insight into the so far inaccessible regions of the human genome. Significant technological advances for identification of single nucleo-tide polymorphisms (SNPs) and use of microarrays have further strengthened research methodologies for genetic analysis of complex traits. In this review, we summarize the evolution of schizophrenia genetics from the past to the present, current trends and future direction of research.

Anticipation, Genetic↗

Nutrition support in a surgical patient.

Nutrition has very important role to play during health and disease state in human beings. Neonates and younger children are more prone to develop nutritional deficiencies. They have very critical reserves and are rapidly growing. Any surgical insult leads to multiple nutritional problems. Careful planning of nutritional management in a surgical patient is mandatory. Nutritional support should start from the day when the child develops the surgical condition to withstand stress of disease and surgical procedure. In the postoperative period nutritional support should start as early as possible. Start with small amount and build up gradually till the normal enteral nutrition (EN) is tolerated. When EN is not tolerated parenteral nutrition (PN) should be considered. Parenteral nutrition on short term basis is very important to tide over the crisis due to postoperative complications. Parenteral nutrition on long term basis is required in short bowel syndrome resulting from resection of large part of the gut. During PN, enteral nutrition should be continued in small amounts in order to maintain the integrity of mucosal lining of the gut. Enteral nutrition is more physiological and can provide adequate amount of immunonutrients, minerals and vitamins.

Adjuvants, Immunologic↗

Interpersonal violence, aggression, and antisocial behaviours in the adolescents.

Violence is a growing problem among adolescents all over the world. Exposure to violence can have lasting and pervasive effects on an adolescent's mental and physical health, general well-being, and ability to become a productive adult. Research on adolescent violence in India and Southeast Asia is limited; very little is written in clinical journals. Addressing adolescent violence is currently a low priority for medical practitioners because disease, poverty, and infant maternal health pose more immediate threats to morbidity and mortality in Asia. Physicians, especially in India, have a unique opportunity to take preventative actions now, to stem the tide of morbidity and mortality from gun violence that plagues the United States. Adolescents in Asia are at greatest risk for violence exposure in their homes. Pediatricians who are proactive and educate their patients, families, and the community can help reduce or prevent morbidity and mortality resulting from violence in adolescents.

Adolescent↗

European Atlantic: the hottest oil spill hotspot worldwide.

Oil spills caused by maritime transport of petroleum products are still an important source of ocean pollution, especially in main production areas and along major transport routes. We here provide a historical and geographic analysis of the major oil spills (>700 t) since 1960. Spills were recorded from several key marine ecosystems and marine biodiversity hotspots. The past four decades have been characterized by an overall decrease in the number of accidents and tones of oil spilled in the sea, but this trend was less distinct in the European Atlantic area. Recent black tides from the Erika and Prestige vessels provided new evidence for the high risk of accidents with serious ecological impact in this area, which according to our analysis is historically the most important oil spill hotspot worldwide. The English Channel and waters around Galicia in Spain were the areas with most accidents. Maritime transport in European Atlantic waters has been predicted to continue increasing. Together with our own results this suggests that, in addition to measures for increased traffic safety, deployment of emergency capacities in the spill hotspot areas may be crucial for a sustainable conservation of sea resources and ecosystems.

Accidents, Occupational↗

Microbial resistance: lessons from the EPIC study. European Prevalence of Infection.

In 1992, a one day point prevalence study (EPIC) was conducted in European intensive care units (ICUs) to determine the prevalence of nosocomial infection among ICU patients. Of the 10,038 patients included, 45% were infected and 21% had a nosocomial ICU-acquired infection. Many of the organisms responsible for these infections were resistant to commonly used antibiotics. For example, 60% of the Staphylococcus aureus isolated were resistant to methicillin and 46% of Pseudomonas aeruginosa were resistant to gentamicin. The incidence of nosocomial infection varied between countries as did the incidence of antibiotic resistance. Mortality rates were higher in countries with higher rates of nosocomial infection and higher again in those countries with higher rates of resistant organisms. Antibiotic resistance is rising and clearly efforts to contain its development and spread are vital. Basic infection control procedures such as hand-washing must be developed and implemented, and antibiotic prescribing needs to be rationalized. The international variations in resistance rates, even within Europe, highlight the importance of being familiar with local resistance patterns when prescribing. The assistance of an infectious diseases specialist can be invaluable in providing a global overview of the local microbial milieu and of antibiotic resistance patterns. Epidemiological studies of this sort can provide useful information which can be used to stimulate debate on the reasons behind regional differences in infection and help in the development of strategies to combat the rising tide of microbial antibiotic resistance.

Adolescent↗

Characterization of rat liver microsomal and hepatocytal metabolites of brevetoxins by liquid chromatography-electrospray tandem mass spectrometry.

Brevetoxins are natural neurotoxins that are produced by "red tide" algae. This class of compounds can cause neurotoxic shellfish poisoning and other health problems. Brevetoxin-2 is the most abundant among the nine brevetoxins that have been characterized, whereas brevetoxin-1 is the most toxic. In this study, brevetoxin-1 and brevetoxin-2 were incubated with rat liver hepatocytes and rat liver microsomes, respectively. After clean-up steps were taken to remove the proteins, samples were analyzed by liquid chromatography (LC) coupled with electrospray mass spectrometry (LC-MS). After incubation of brevetoxin-1, two metabolites were found: brevetoxin-1-M1 (molecular weight = 900 Da), and brevetoxin-1-M2 (molecular weight = 884 Da). The increase in molecular weight combined with evidence from tandem mass spectrometry showing an increased tendency for loss of water molecules, along with considerations of established precedents for chemical transformations led to the conclusion that brevetoxin-1-M1 was formed by converting one double bond in the E or F ring of brevetoxin-1 into a diol. The second metabolite (brevetoxin-1-M2) is proposed to be a hydrolysis product of brevetoxin-1 involving opening of the lactone ring with the addition of a water molecule. The incubation study of the other starting compound, brevetoxin-2, found two metabolites in the LC-ES-MS selected ion chromatogram. Brevetoxin-2-M1 (molecular weight = 912 Da) gave a large [M-H]- peak at m/z 911, and its product ion mass spectrum allowed the deduction that this metabolite was the hydrolysis product of brevetoxin-2 involving conversion of the lactone to a carboxylic acid and an alcohol. The second metabolite (brevetoxin-2-M2, molecular weight = 896 Da) was deduced to have the same structure as that of brevetoxin-3 based on identical chromatographic retention times and similar mass spectra as those obtained for a brevetoxin-3 standard.

Animals↗

Idiopathic osteoarthritis: time to change paradigms?

Standard theory assumes that osteoarthritis is a catabolic disease, characterised by cartilage destruction brought about by absolute or relative overload. This theory fits the observed facts in secondary osteoarthritis, but when it is tested against the idiopathic disease, the disease profile includes many phenomena which are difficult to reconcile with the overload theory. It incorporates, for example, no adequate explanation for the prevalence patterns observed in human and primate epidemiology, the idiosyncratic distribution, the sparing of the ankle and wrist joints, the production of osteoarthritis by immobilisation, the anabolic dominance of early disease, and several pathological changes including the osteophyte, the reduplicated tide-mark, and the extra-articular contracture. The evidence better fits the concept of two different diseases with a possible, but not obligatory, final common pathway. In the case of the idiopathic disease, the unused arc hypothesis proposed 50 years ago by Harrison et al., reinforced with the concepts of synovial stasis and positive feedback, tests better against the evidence than the overload paradigm. These proposed adjuncts to the hypothesis are speculative and as yet untested. The results could be of more than academic interest. If the unused arc hypothesis turns out to be correct, idiopathic osteoarthritis should be preventable and conceivably, in its early stages, arrestable.

Cartilage, Articular↗