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The effects of intracoronary brachytherapy on the natural history of postangioplasty dissections.

OBJECTIVES: The aim of this study was to determine the natural history of postangioplasty intravascular ultrasound (IVUS)-detected dissections and to assess the influence of intracoronary beta-radiation on dissection resolution. BACKGROUND: Intracoronary radiotherapy is considered to impair exaggerated vessel healing. Conversely, excessive healing impairment may increase the risk of complications due to unhealed dissection. Alternatively, residual dissection may represent an innocent marker of adequate therapy. METHODS: Immediate postangioplasty and six-month follow-up IVUS studies of 94 patients in the IVUS substudy of the MultiVitamins and Probucol (MVP) trial and 26 nonstented patients in the Beta Energy Restenosis Trial (BERT) were analyzed for the presence or absence of dissection. RESULTS: Of the 28 patients with postangioplasty dissections in MVP, only one had evidence of residual dissection at six months (95% confidence interval [CI] for failure rate 0.2%; 20.2%). Conversely, 9 of 16 dissections had healed in BERT (95% CI for failure rate 30.6%; 79.2%) (p < 0.0002). Nevertheless, an index based on dissection arc and length demonstrated improvement in the irradiated patients. Irradiated patients with residual dissections showed significant increase in lumen area at six-months (5.10 +/- 0.98 to 7.11 +/- 2.61 mm2, p < 0.02) not noted when there was resolution of the dissection (6.03 +/- 2.38 to 6.36 +/- 3.33 mm2, p = NS). In both groups the external elastic membrane area was unchanged at follow-up. CONCLUSIONS: Resolution appears to be the natural history of IVUS-detected dissections in most cases. Significant resolution of dissection occurs following intracoronary beta-radiation as reflected in reduced dissection index at six-months in these patients, although significant impairment of vessel wall healing was noted.

Aortic Dissection↗

Endovascular brachytherapy in coronary arteries: the Rotterdam experience.

Purpose: The use of endovascular coronary brachytherapy to prevent restenosis following percutaneous transluminal coronary angioplasty (PTCA) began in April 1997 at the Department of Interventional Cardiology of the Thoraxcenter at the University Hospital of Rotterdam. This article reviews the more than 250 patients that have been treated so far.Methods and Materials: The Beta-Cath System (Novoste), a manual, hydraulic afterloader with 12 90Sr seeds, was used in the Beta Energy Restenosis Trial (BERT-1.5, n=31), for compassionate use (n=25), in the Beta-Cath System trial (n=27) and in the Beta Radiation in Europe (BRIE, n=14). Since the Beta-Cath System has been commercialized in Europe, 57 patients have been treated and registered in RENO (Registry Novoste). In the Proliferation Reduction with Vascular Energy Trial (PREVENT), 37 patients were randomized using the Guidant-Nucletron remote control afterloader with a 32P source wire and a centering catheter. Radioactive 32P coated stents have been implanted in 102 patients. In the Isostent Restenosis Intervention Study 1 (IRIS 1), 26 patients received a stent with an activity of 0.75-1.5 µCi, and in the IRIS 2 (European 32P dose response trial), 40 patients were treated with an activity of 6-12 µCi. In two consecutive pilot trials, radioactive stents with non-radioactive ends (cold-end stents) and with ends containing higher levels of activity (hot-end stents) were implanted in 21 and 17 patients, respectively.Results: In the BERT-1.5 trial, the radiation dose, prescribed at 2 mm from the source train (non-centered), was 12 Gy (10 patients), 14 Gy (10 patients) and 16 Gy (11 patients). At 6-month follow-up, 8 out of 28 (29%) patients developed restenosis. The target lesion revascularization rate (TLR) was 7 out of 30 (23%) at 6 months and 8 out of 30 (27%) at 1 year. Two patients presented with late thrombosis in the first year. For compassionate use patients, a restenosis rate (RR) of 53% was observed. In the PREVENT trial, 34 of 37 patients underwent an angiographic 6-month follow-up. The doses prescribed at 0.5 mm depth into the vessel wall were 0 Gy (8), 28 Gy (9), 35 Gy (11) and 42 Gy (8). TLR was 14% in the irradiated patients and 25% in the placebo group. One patient developed late thrombosis. In the IRIS 1 trial, 23 patients showed an RR of 17% (in-stent). In the IRIS 2 trial, in-stent restenosis was not seen in 36 patients at 6-month follow-up. However, a high RR (44%) was observed at the stent edges.Conclusions: The integration of vascular brachytherapy in the catheterization laboratory is feasible and the different treatment techniques that are used are safe. Problems, such as edge restenosis and late thrombotic occlusion, have been identified as limiting factors of this technique. Solutions have been suggested and will be tested in future trials.

Journal Article↗

Endovascular brachytherapy in coronary arteries: the Rotterdam experience.

PURPOSE: The use of endovascular coronary brachytherapy to prevent restenosis following percutaneous transluminal coronary angioplasty (PTCA) began in April 1997 at the Department of Interventional Cardiology of the Thoraxcenter at the University Hospital of Rotterdam. This article reviews the more than 250 patients that have been treated so far. METHODS AND MATERIALS: The Beta-Cath System (Novoste), a manual, hydraulic afterloader with 12 90Sr seeds, was used in the Beta Energy Restenosis Trial (BERT-1.5, n = 31), for compassionate use (n = 25), in the Beta-Cath System trial (n = 27) and in the Beta Radiation in Europe (BRIE, n = 14). Since the Beta-Cath System has been commercialized in Europe, 57 patients have been treated and registered in RENO (Registry Novoste). In the Proliferation Reduction with Vascular Energy Trial (PREVENT), 37 patients were randomized using the Guidant-Nucletron remote control afterloader with a 32P source wire and a centering catheter. Radioactive 32P coated stents have been implanted in 102 patients. In the Isostent Restenosis Intervention Study 1 (IRIS 1), 26 patients received a stent with an activity of 0.75-1.5 microCi, and in the IRIS 2 (European 32P dose response trial), 40 patients were treated with an activity of 6-12 microCi. In two consecutive pilot trials, radioactive stents with non-radioactive ends (cold-end stents) and with ends containing higher levels of activity (hot-end stents) were implanted in 21 and 17 patients, respectively. RESULTS: In the BERT-1.5 trial, the radiation dose, prescribed at 2 mm from the source train (non-centered), was 12 Gy (10 patients), 14 Gy (10 patients) and 16 Gy (11 patients). At 6-month follow-up, 8 out of 28 (29%) patients developed restenosis. The target lesion revascularization rate (TLR) was 7 out of 30 (23%) at 6 months and 8 out of 30 (27%) at 1 year. Two patients presented with late thrombosis in the first year. For compassionate use patients, a restenosis rate (RR) of 53% was observed. In the PREVENT trial, 34 of 37 patients underwent an angiographic 6-month follow-up. The doses prescribed at 0.5 mm depth into the vessel wall were 0 Gy (8), 28 Gy (9), 35 Gy (11) and 42 Gy (8). TLR was 14% in the irradiated patients and 25% in the placebo group. One patient developed late thrombosis. In the IRIS 1 trial, 23 patients showed an RR of 17% (in-stent). In the IRIS 2 trial, in-stent restenosis was not seen in 36 patients at 6-month follow-up. However, a high RR (44%) was observed at the stent edges. CONCLUSIONS: The integration of vascular brachytherapy in the catheterization laboratory is feasible and the different treatment techniques that are used are safe. Problems, such as edge restenosis and late thrombotic occlusion, have been identified as limiting factors of this technique. Solutions have been suggested and will be tested in future trials.

Angioplasty, Balloon, Coronary↗

Robert Hooke, inventor of the vacuum pump and the first altitude chamber (1671).

Robert Hooke (1635-1703), an assistant researcher to Robert Boyle (1627-1691), invented the first functional British air pump. Applying it to scientific research, Hooke operated the world's first hypobaric chamber in 1671, using it for self-experimentation. He recorded the first physiological observations in an artificial altitude-equivalent environment up to 2400 m. Though Hooke's experiment showed some methodological insufficiencies, his imaginative experimental techniques were remarkable for their time and were indicative of the lively intellectual atmosphere of the Royal Society and the significant contributions of Hooke, who was a member. Two centuries passed before the French physiologist Paul Bert (1830-1886) conducted his famous laboratory-supported investigations of high altitude physiology. Bert played a decisive role in the discovery of the causes of decompression sickness; a contribution Hooke could not make due to the technical deficiencies of the 17th century.

Altitude↗

A mathematical model of interstitial transport. I. Theory.

A generalized model is developed to describe the transport of fluid and plasma proteins or other macromolecules within the interstitium. To account for the effects of plasma protein exclusion and interstitial swelling, the interstitium is treated as a multiphase deformable porous medium. Fluid flow is assumed proportional to the gradient in fluid chemical potential and therefore depends not only on the local hydrostatic pressure but also on the local plasma protein concentrations through appropriate colloid osmotic pressure relationships. Plasma protein transport is assumed to occur by restricted convection, molecular diffusion, and convective dispersion. In a companion paper (D. G. Taylor, J. L. Bert, and B. D. Bowen, 1990, Microvasc. Res. 39, 279-306) a simplified version of the model is used to analyze steady-state fluid and plasma protein exchange within mesentery.

Animals↗

A mathematical model of interstitial transport. II. Microvascular exchange in mesentery.

A simplified version of the model of interstitial transport developed earlier (D. G. Taylor, J. L. Bert, and B. D. Bowen, 1990, Microvasc. Res. 39, 253-278) is used to investigate microvascular exchange of fluid and a single "aggregate" plasma protein species in mesenteric tissue. The interstitium is approximated by a rigid, rectangular, porous slab displaying two fluid pathways, only one of which is available to plasma proteins. The model is used to explore the effects of the interstitial plasma protein diffusivity, the tissue hydraulic conductivity, the restricted convection of plasma proteins, and the mesothelial transport characteristics on the steady-state distribution and transport of plasma proteins and flow of fluid in the tissue. The simulations predict significant convective plasma protein transport and complex fluid flow patterns within the interstitium. These flow patterns can produce local regions of high fluid and plasma protein exchange along the mesothelium which might be erroneously identified as "leaky sites."

Animals↗

Alveolar flooding: a computer simulation.

A validated computer simulation of pulmonary microvascular exchange (J.L. Bert and K.L. Pinder, Microvasc. Res., 27 (1984) 51-70) has been extended to include exchange with the air space (alveoli). Equations which hypothetically describe characteristics associated with this additional compartment and the exchange of both fluid and plasma proteins between the lung tissue and the alveolar space are presented. These are incorporated into the simulation which has been used to predict the behavior of the pulmonary microvascular exchange system including alveolar flooding. The predicted trends associated with alveolar flooding are reasonable. However, due to the lack of specific experimental or clinical findings, the simulation remains essentially unvalidated. The effect on alveolar flooding and interstitial edema of the parameters associated with the additional relationships is presented and discussed. Primarily, results for perturbations in circulatory pressure are presented. Additionally, changes in permeability characteristics are shown and discussed.

Blood Proteins↗

A model of fluid and solute exchange in the human: validation and implications.

In order to understand better the complex, dynamic behaviour of the redistribution and exchange of fluid and solutes administered to normal individuals or to those with acute hypovolemia, mathematical models are used in addition to direct experimental investigation. Initial validation of a model developed by our group involved data from animal experiments (Gyenge, C.C., Bowen, B.D., Reed, R.K. & Bert, J.L. 1999b. Am J Physiol 277 (Heart Circ Physiol 46), H1228-H1240). For a first validation involving humans, we compare the results of simulations with a wide range of different types of data from two experimental studies. These studies involved administration of normal saline or hypertonic saline with Dextran to both normal and 10% haemorrhaged subjects. We compared simulations with data including the dynamic changes in plasma and interstitial fluid volumes VPL and VIT respectively, plasma and interstitial colloid osmotic pressures PiPL and PiIT respectively, haematocrit (Hct), plasma solute concentrations and transcapillary flow rates. The model predictions were overall in very good agreement with the wide range of experimental results considered. Based on the conditions investigated, the model was also validated for humans. We used the model both to investigate mechanisms associated with the redistribution and transport of fluid and solutes administered following a mild haemorrhage and to speculate on the relationship between the timing and amount of fluid infusions and subsequent blood volume expansion.

Animals↗

HyLnc: a hybrid deep learning and feature-based approach for long non-coding RNA prediction.

Long non-coding RNAs (lncRNAs) play important roles in gene regulation, development and disease, yet accurate identification of lncRNAs from transcriptomic data remains a major computational challenge. Existing methods often rely either on handcrafted sequence features or deep learning approaches, each with their inherent limitations in capturing the full complexity of RNA sequences. In this study, we proposed HyLnc, a computational framework that integrates transformer-based contextual embeddings with biologically meaningful sequence features for improved lncRNA prediction. A custom BERT-based model was first pre-trained on a large corpus of metazoan RNA sequences using a masked language modelling strategy to learn contextual nucleotide dependencies. The model was subsequently fine-tuned on curated datasets of lncRNAs and protein-coding transcripts and 256-dimensional deep sequence embeddings were extracted. Parallelly, 348&#xa0;handcrafted features, including ORF characteristics, untranslated region (UTR) properties, nucleotide composition and Fickett scores, were computed. A multi-stage feature selection strategy was applied to identify the most informative features, resulting in optimized hybrid feature sets. Multiple machine learning classifiers were evaluated, with the RF model achieving the best performance. The proposed framework attained an accuracy of 91.30%, F1-score of 91.23% and MCC of 82.60 on an independent validation dataset, outperforming several existing lncRNA prediction tools. Thus, HyLnc demonstrates that integrating deep contextual representations with biologically interpretable features enhances lncRNA prediction. This approach provides a robust and scalable solution for large-scale transcriptome annotation and can be extended to other sequence-based prediction.

RNA, Long Noncoding↗

Microvascular exchange and interstitial volume regulation in the rat: implications of the model.

The present work uses and extends a dynamic mathematical model [J. L. Bert, B. D. Bowen, and R. K. Reed. Am. J. Physiol. 254 (Heart Circ. Physiol. 23): H384-H399, 1988] to investigate microvascular exchange and interstitial fluid volume regulation in the rat. Alternative concepts of transcapillary exchange as well as other parametric changes were incorporated into the model. In all cases, predictions resulting from these changes did not describe the available experimental information as well as the original model. A sensitivity analysis of the model showed the microvascular exchange system to be well regulated near its normal steady-state conditions through passive readjustment of the forces participating in the volume regulation. The transient rates of fluid and protein exchange were studied in order to determine the mechanisms inherent in the model that lead to fluid volume regulation during episodes of increased venous pressure and hypoproteinemia. In addition to interstitial compliance, lymph flow characteristics, and washdown of interstitial proteins, it was found that the magnitude and direction of reabsorption played an important role in the regulation process. Edema was always associated with a permanent reversal of the reabsorptive flow.

Animals↗

Transport of fluid and solutes in the body I. Formulation of a mathematical model.

A compartmental model of short-term whole body fluid, protein, and ion distribution and transport is formulated. The model comprises four compartments: a vascular and an interstitial compartment, each with an embedded cellular compartment. The present paper discusses the assumptions on which the model is based and describes the equations that make up the model. Fluid and protein transport parameters from a previously validated model as well as ionic exchange parameters from the literature or from statistical estimation [see companion paper: C. C. Gyenge, B. D. Bowen, R. K. Reed, and J. L. Bert. Am. J. Physiol. 277 (Heart Circ. Physiol. 46): H1228-H1240, 1999] are used in formulating the model. The dynamic model has the ability to simulate 1) transport across the capillary membrane of fluid, proteins, and small ions and their distribution between the vascular and interstitial compartments; 2) the changes in extracellular osmolarity; 3) the distribution and transport of water and ions associated with each of the cellular compartments; 4) the cellular transmembrane potential; and 5) the changes of volume in the four fluid compartments. The validation and testing of the proposed model against available experimental data are presented in the companion paper.

Animals↗

Transport of fluid and solutes in the body II. Model validation and implications.

A mathematical model of short-term whole body fluid, protein, and ion distribution and transport developed earlier [see companion paper: C. C. Gyenge, B. D. Bowen, R. K. Reed, and J. L. Bert. Am. J. Physiol. 277 (Heart Circ. Physiol. 46): H1215-H1227, 1999] is validated using experimental data available in the literature. The model was tested against data measured for the following three types of experimental infusions: 1) hyperosmolar saline solutions with an osmolarity in the range of 2,000-2,400 mosmol/l, 2) saline solutions with an osmolarity of approximately 270 mosmol/l and composition comparable with Ringer solution, and 3) an isosmotic NaCl solution with an osmolarity of approximately 300 mosmol/l. Good agreement between the model predictions and the experimental data was obtained with respect to the trends and magnitudes of fluid shifts between the intra- and extracellular compartments, extracellular ion and protein contents, and hematocrit values. The model is also able to yield information about inaccessible or difficult-to-measure system variables such as intracellular ion contents, cellular volumes, and fluid fluxes across the vascular capillary membrane, data that can be used to help interpret the behavior of the system.

Animals↗

Microvascular exchange during burn injury: IV. Fluid resuscitation model.

The present work is a continuation of studies concerned with mathematical modelling and simulation of microvascular fluid and protein exchange following burn injuries [Bert et al.: Circulatory Shock 28: 199-219, 1989: Bowen et al.: Circulatory Shock 28: 221-233, 1989]. The model has been extended to include the effects of different types of fluid resuscitation on the circulatory and microvascular exchange systems. The model and a statistical fitting procedure were used to find the ranges of fitting parameter values that best describe the changes in interstitial fluid volume and protein mass as well as transcapillary protein extravasation for three sets of experiments (no resuscitation, resuscitation with Ringer's or resuscitation with plasma). Typical changes in mass exchange related parameters postburn that resulted in simulation predictions which were a good fit to the experimental data include: an increase in the large pore pathway for protein of 100 times in the injured skin and 5 times in non-injured skin and skeletal muscle, an increase in fluid filtration coefficients in injured skin of 10 times and an instantaneous decrease of 50% in the area available for exchange in injured skin at the time of the burn.

Burns↗

Microvascular exchange during burn injury: III. Implications of the model.

The present work investigates the implications of the predictions of a dynamic mathematical model of microvascular exchange following a nonresuscitated burn injury in a rat (Bert et al.: Circulatory Shock 28:199-219, 1989). Transport coefficients, transmicrovascular pressures, and the resultant fluid and protein fluxes were examined in order to assess their quantitative importance to the dynamic behavior of small (10% body surface area) and large (40% body surface area) burns. Edema accumulation in the injured tissue is dependent not only on events occurring in that tissue but is influenced strongly by interaction with the plasma and the noninjured tissue compartments.

Animals↗

Normo- and hypobaric hypoxia: are there any physiological differences?

Since Bert (1878) and Barcroft (1925), studies on hypoxia are realized by lowering ambient O(2) partial pressure (PO(2)) either by barometric pressure reduction (hypobaric hypoxia HH) or by lowering the O(2) fraction (normobaric hypoxia NH). Today, a question is still debated: "are there any physiological differences between HH and NH for the same ambient PO(2)?" Since published studies are scarce and controversial, we submitted 18 subjects in a random order to a 40-min HH test and to a 40-min NH test at an ambient PO(2) equal to 120 hPa (4500 m). Cardioventilatory variables [breathing frequency (f), tidal volume (V(t)), minute ventilation (V(E)), O(2) and CO(2) end-tidal fractions or pressures (FET(O2) and FET(CO2) or PET(O2) and PET(CO2) respectively), heart rate (HR) and O(2) arterial saturation by pulse oxymetry (SpO(2))] were measured throughout the tests. At the end of the tests, arterial blood samples were taken to measure arterial blood gases [O(2) and CO(2) arterial partial pressures ( Pa(O2) and Pa(CO2)), pH and O(2) arterial saturation (SaO(2))]. Results show that during HH compared to NH, f is greater (P</=0.001), V(t) and V(E) under BTPS conditions are lower (P</=0.05), and FET(O2) and FET(CO2) are higher (P</=0.05). However, PET(O2) does not change during the last 25 min of the tests, and neither does PET(CO2) throughout the tests. HR is higher (P</=0.05) and SpO(2) lower (P</=0.05) in HH compared to NH. Arterial blood data reveal that hypoxemia, hypocapnia and blood alkalosis are greater in HH compared to NH and that SaO(2) is lower (P</=0.05). It is concluded that the physiological responses of humans submitted to an acute hypoxia at a PO(2) equal to 120 hPa differ according to the type of hypoxia. Compared to NH, HH leads to a greater hypoxemia, hypocapnia, blood alkalosis and a lower O(2) arterial saturation. These physiological differences could be the consequence of an increase in dead space ventilation, probably related to the barometric pressure reduction, and could be grouped together under the term "the specific response to hypobaric hypoxia". Knowledge of this specific response could improve the comprehension, prevention and treatment of altitude illnesses in the future.

Adult↗

From Galvani to patch clamp: the development of electrophysiology.

The development of electrophysiology is traced from the early beginnings represented by the work of the Dutch microscopist, Jan Swammerdam, in the 17th century through the first notion of an aqueous transmembrane pore as a substrate of excitability made by Luigi Galvani in late 18th century to the invention late in the 20th century of the patch-clamp technique by Erwin Neher and Bert Sakmann.

Animals↗

Spatial organisation of four enzymes from Stevia rebaudiana that are involved in steviol glycoside synthesis.

The sweet steviol glycosides found in the leaves of Stevia rebaudiana Bert. are derived from the diterpene steviol which is produced from a branch of the gibberellic acid (GA) biosynthetic pathway. An understanding of the spatial organisation of the two pathways including subcellular compartmentation provides important insight for the metabolic engineering of steviol glycosides as well as other secondary metabolites in plants. The final step of GA biosynthesis, before the branch point for steviol production, is the formation of (-)-kaurenoic acid from (-)-kaurene, catalysed by kaurene oxidase (KO). Downstream of this, the first committed step in steviol glycoside synthesis is the hydroxylation of kaurenoic acid to form steviol which is then sequentially glucosylated by a series of UDP-glucosyltransferases (UGTs) to produce the variety of steviol glycosides. The subcellular location of KO and three of the UGTs involved in steviol glycoside biosynthesis was investigated by expression of GFP fusions and cell fractionation which revealed KO to be associated with the endoplasmic reticulum and the UGTs in the cytoplasm. It has also been shown by expressing the Stevia UGTs in Arabidopsis that the pathway can be partially reconstituted by recruitment of a native Arabidopsis glucosyltransferase.

Arabidopsis↗

Modelling and simulation of an infant's whole body plethysmograph.

In this paper, we describe a computational model dedicated to building an apnoea monitoring system for newborn babies. The proposed model is based on whole body plethysmography, which involves non-invasive measurement of lung ventilation indirectly from the pressure deflections generated when a subject breathes inside a chamber of fixed volume (Bert in C R Soc Biol Paris 20:22-23, 1868). The computational model simulates thermal and environmental flow conditions occurring in the neonate chamber, especially steady state flow with heat transfer and carbon dioxide (CO2) transport during the exhalation phase. This permits the variance of all critical parameters and the analysis of their effects on the distributions of interest. The main objective is to study thermal and air quality comfort conditions under which infants can be monitored for long-term periods. The method deploys computational fluid dynamics techniques and parametric modelling which, by allowing input parameters to be modulated, represent a more efficient and flexible analytical tool than previous experimental techniques. Simulation data reveal that the largest flow rates occur in areas near the openings with slight formation of air recirculation zones; temperature distribution shows signs of stratification, with higher temperatures than the supplied air, CO2 distribution presents acceptable air quality level and predicted mean vote index affords a relatively acceptable thermal comfort level. This analytical approach can be considered as innovative, and can find a new application in clinical infant apnoea monitoring in a way that allows determination of the optimal location for placing a sensor to detect respiration activity without any contact with the infant's body, and without any risk, in contrast to available whole body plethysmography techniques previously tested in infants (Fleming et al. in J Appl Physiol 55:1924-1931, 1983).

Computer Simulation↗