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Concanamycin and indolyl pentadieneamide inhibitors of the vacuolar H+-ATPase bind with high affinity to the purified proteolipid subunit of the membrane domain.

The macrolide antibiotic concanamycin is a potent and specific inhibitor of the vacuolar H(+)-ATPase (V-ATPase), binding to the V(0) membrane domain of this eukaryotic acid pump. Although binding is known to involve the 16 kDa proteolipid subunit, contributions from other V(0) subunits are possible that could account for the apparently different inhibitor sensitivities of pump isoforms in vertebrate cells. In this study, we used a fluorescence quenching assay to directly examine the roles of V(0) subunits in inhibitor binding. Pyrene-labeled V(0) domains were affinity purified from Saccharomyces vacuolar membranes, and the 16 kDa proteolipid was subsequently extracted into chloroform and methanol and purified by size exclusion chromatography. Fluorescence from the isolated proteins was strongly quenched by nanomolar concentrations of both concanamycin and an indolyl pentadieneamide compound, indicating high-affinity binding of both natural macrolide and synthetic inhibitors. Competition studies showed that these inhibitors bind to overlapping sites on the proteolipid. Significantly, the 16 kDa proteolipid in isolation was able to bind inhibitors as strongly as V(0) did. In contrast, proteolipids carrying mutations that confer resistance to both inhibitors showed no binding. We conclude that the extracted 16 kDa proteolipid retains sufficient fold to form a high-affinity inhibitor binding site for both natural and synthetic V-ATPase inhibitors and that the proteolipid contains the major proportion of the structural determinants for inhibitor binding. The role of membrane domain subunit a in concanamycin binding and therefore in defining the inhibitor binding properties of tissue-specific V-ATPases is critically re-assessed in light of these data.

Binding Sites↗

Transient two-dimensional infrared spectroscopy: exploring the polarization dependence.

We present a general expression for the polarization dependence of transient two-dimensional IR spectroscopy (T2D-IR), a technique designed to measure 2D-IR spectra of transient species. T2D-IR is a UV pump narrowband-IR-pump broadband-IR-probe experiment of fifth order in the laser field which involves up to three different transition dipole moments. The UV pulse adds an additional degree of freedom in polarization as compared to 2D-IR spectroscopy and increases the versatility of signal manipulation and the potential structural information content of the signals. The polarization conditions leading to a maximum of structural information are discussed. Important special cases of polarization conditions are formulated. The application of polarization selectivity is demonstrated for different types of T2D-IR experiments on photo triggered metal-to-ligand charge transfer in the model system [Re(CO)(3)(dmbpy)Cl].

Journal Article↗

Mortality patterns during a war in Guinea-Bissau 1998-99: changes in risk factors?

BACKGROUND: The crude mortality rate of the whole population and the mortality of children <5 years of age are the common indicators of the severity of a complex emergency situation. However, these indicators rarely take account of differences in socioeconomic conditions and vulnerability. METHODS: We followed a population in Guinea-Bissau, which fled when fighting took place in the capital during the war in 1998-99. The population stayed close to the area of conflict and returned as soon as a cease-fire was negotiated. A peace treaty was signed after half-a-year. The following 6 months was a period of returning and re-settlement, even though two outbreaks of fighting occurred. RESULTS: In the first half-year the mortality rate was 78% [mortality ratio (MR) = 1.78; 95% CI 1.61-1.97] increased and mortality for children <5 years of age doubled (MR = 2.07; 95% CI 1.79-2.38). In the last 6 months of the war, mortality was slightly increased for children and not at all for the total population. In the first half-year, households living in better houses and having members with schooling were less affected. In the 're-settlement' period two inequalities emerged; the largest ethnic group, Pepel, continued to have high mortality when the mortality of other groups declined; likewise girls continued to have an elevated mortality whereas mortality of boys declined. CONCLUSION: Whereas specific 'free' interventions reduced social inequalities for the groups affected, for the total population health-inequalities were slightly amplified during the war. Once the population returned to their urban homes, mortality fell to pre-war levels even though some fighting continued, limited humanitarian aid was available and the pre-war infra-structure had not been re-established.

Child, Preschool↗

28-Day emergency surgical re-admission rates as a clinical indicator of performance.

With the introduction of clinical governance, the NHS Executive has identified 28-day emergency re-admission rates as a clinical indicator to be used to assess and compare performance between NHS trusts. We undertook a 3-month retrospective audit of patients identified from the trust computer as having been re-admitted as an emergency within 28 days of discharge from the general surgical division. We wanted to examine reasons for re-admission, possible errors in coding and any preventable factors in these patients subsequently re-admitted acutely.

Clinical Competence↗

Evaluation and treatment of low back pain in family practice.

Almost all working adults, more than half in any given year, experience low back pain. Although the differential diagnosis is extensive, most symptoms have biomechanical causes and resolve promptly with little intervention, although recurrence is common. History and physical examination are important in distinguishing potential causes and identifying "red flags" for more serious conditions. Diagnostic imaging should be ordered only when necessary because of the high incidence of radiologic abnormalities in asymptomatic persons. Once serious illness is ruled unlikely, first-line drug therapy with acetaminophen, a cyclo-oxygenase-2 inhibitor or a nonsteroidal anti-inflammatory drug is recommended. Short-term use of muscle relaxants may be considered, but they can be sedating. Patients should stay as active as possible. Comorbid conditions such as sleep disorders, anxiety, or depression should be treated, and psychosocial issues should be addressed. Opioids should be prescribed if other treatments have been insufficiently effective and if there is evidence of improved function with opioid treatment that outweighs adverse effects. Adjuvant antidepressants and anticonvulsants should be considered, especially in chronic or neuropathic pain. If a structural defect is identified and a diagnostic or therapeutic procedure is available, consider referral. If symptoms have not improved within 4 to 6 weeks, re-evaluation and additional diagnostic workup should be considered.

Algorithms↗

Impact of a chest-pain guideline on clinical decision-making.

OBJECTIVE: To evaluate the impact of a chest-pain guideline on clinical decision-making and medium-term outcomes of patients presenting to a hospital emergency department (ED) with non-traumatic chest pain. DESIGN: Before-and-after guideline implementation study. SETTING: Bankstown-Lidcombe Hospital, Sydney, NSW (454-bed metropolitan teaching hospital), in the six-month periods before and after guideline implementation in February 2001. PARTICIPANTS: Patients presenting to the ED with non-traumatic chest pain who had chest-pain assessment forms completed by ED doctors, comprising 422/768 (54.9%) of those presenting before and 461/691 (66.7%) after guideline implementation. MAIN OUTCOME MEASURES: Appropriateness of admission/discharge decisions compared with decision of senior cardiologist based on guideline; death, recurrent chest pain, ED re-presentation and hospital readmission in the ensuing three months. RESULTS: After guideline implementation, appropriate admission/discharge decisions increased significantly from 180/265 (68%) to 261/324 (81%) (difference, 13%; 95% CI, 6%-20%). The largest increase was for patients at moderate risk of death or acute myocardial infarction within six months, from 39/96 (38%) to 57/103 (55%) (difference, 18%; 95% CI, 4%-31%). Increases were seen for both junior doctors (interns and resident medical officers) (18%; 95% CI, 7%-30%) and senior doctors (11%; 95% CI, 2%-19%). Logistic regression showed that implementation of the guideline, seniority of assessing doctor and patient history of coronary disease were independent predictors of appropriate decisions. There was a significant decline in re-presentations to ED with recurrent chest pain in patients previously presenting with cardiac or possibly cardiac pain, from 46/201 (23%) before implementation to 32/247 (13%) after (difference, 210%; 95% CI, 217% to 23%). CONCLUSIONS: The chest-pain guideline resulted in a significant improvement in clinical decision-making in the ED and reduced re-presentations with cardiac/possibly cardiac chest pain.

Angina Pectoris↗

Electronic signatures for long-lasting storage purposes in electronic archives.

Communication and co-operation in healthcare and welfare requires certain Trusted Third Party (TTP) services describing both status and relation of communicating principals as well as their corresponding keys and attributes. Additional TTP services are needed to provide trustworthy information about dynamic issues of communication and co-operation such as time and location of processes, workflow relations, and system behaviour. Electronic signatures based on asymmetric cryptography are important means for securing the integrity of a message or file as well as for accountability purposes including non-repudication of both origin and receipt. These electronic signatures along with certified time stamps are especially important for electronic health records (EHR), electronic archives in general, and other typical purposes of a long-lasting storage. Apart from technical storage problems (e.g. lifetime of the storage devices), this paper needs to look for mechanisms of e.g. re-signing of messages, archive details, or whole archives.

Access to Information↗

Lessons learned from the hantaviruses and other hemorrhagic fever viruses.

In recent years, numerous previously known infections pathogens and their associated diseases have been recognized. Among these newly identified agents are the viruses that cause the hemorrhagic fevers, including Sin Nombre virus, the etiologic agent of the 1993 outbreak of hantavirus pulmonary syndrome in the American Southwest. Epidemiologic and laboratory investigations of the hemorrhagic fevers and their etiologic agents provide lessons that may be used collectively as a paradigm of the nature of emerging and re-emerging infectious diseases.

Bunyaviridae↗

Towards carbohydrate derivatives of the ReI(CO)3 fragment.

With the [Re(CO)(3)Br(3)](2-) ion as a precursor for the Re(I)(CO)(3) fragment, the diols (1R,2R)-cyclohexane-1,2-diol [(1R,2R)-Chxd], anhydroerythritol (AnEryt), and (1S,2S)-cyclopentane-1,2-diol [(1S,2S)-Cptd] form dinuclear monoanions in the salts (NBu(4))[(Re(2)(CO)(6){mu-(1R,2R)-ChxdH(-1)}(3)] (1), [K([18]crown-6)][Re(2)(CO)(6)(mu-OMe)(2)(mu-AnErytH(-1))] (2) and (NBu(4))[Re(2)(CO)(6){mu-(1S,2S)-CptdH(-1)}(3)] (3). The monoanionic diolato ligands in these triply bridged dirhenates(I) are monodentate. Bridging triolato ligation in the trirhenates(I) is supported by the anions of glycerol (Glyc) and methyl beta-D-ribopyranoside (Me-beta-D-Ribp), the latter binding in its (1)C(4) conformation, in (DBUH)(2)[Re(3)(CO)(9)(mu(3)-O)(mu(3)-GlycH(-3))]0.5 MeCN (4 a), (NEt(4))[Re(3)(CO)(9)(mu(3)-OMe)(mu(3)-GlycH(-3))] (4 b) and (DBUH)[Re(3)(CO)(9)(mu(3)-OMe)(mu(3)-(1)C(4)-Me-beta-D-Ribp2,3,4H(-3))] (5). The chiral sugar alcohols L-threitol (L-Thre) and D-arabitol (D-Arab) act as tetra- and pentadentate ligands, respectively, in (NEt(4))[Re(2)(CO)(6)(L-ThreH(-3))]MeCN (6) and (NEt(4))(2)(DBUH)(2)[Re(6)(CO)(18)(D-ArabH(-5))(2)] (7). Complexes 6 and 7 are free of supporting oxo or methoxo ligands and use solely the O-atom pattern of the polyol for the connection of the Re(I)(CO)(3) moieties.

Benzopyrenes↗

Reduction of intimal hyperplasia with Re-188-labeled stents in a rabbit model at 7 and 26 weeks: an experimental study.

The aim of this study was to analyze the feasibility of (188)Re-labeled stents to reduce neointimal formation in a rabbit atherosclerosis model and to test the long-term effects at 7 and 26 weeks. Fifty-nine male New Zealand White rabbits were fed a 0.5% cholesterol diet for 4 weeks before balloon angioplasty and insertion of Palmaz stents in the infrarenal aorta. The animals were sacrificed 7 and 26 weeks after stent implantation. Control stents were compared with (188)Re stents: (dose 1) 11.3 +/- 1.8 MBq; (dose 2) 37.3 +/- 4.2 MBq, and (dose 3) 80.1 +/- 7.8 MBq. Each activity group consisted of a short-term (7 weeks) and a long-term group (26 weeks), resulting in a total of eight study groups. No thrombotic occlusion was observed. The neointimal formation in the control group was 2.11 [95% confidence interval (CI): 0.68--6.52] mm(2) at 7 weeks and 2.10 (0.62--7.11) at 26 weeks. In the treatment groups, neointima reduction was detectable at 7 weeks [dose 1: 0.33 (0.09--1.22) mm(2); dose 2: 0.17 (0.05--0.57) mm(2); dose 3: 0.03 (0.01--0.13) mm(2)]. After 26 weeks, a catch-up of neointimal formation in the radioactive groups was most obvious in the low-dose group [dose 1: 0.80 (0.28--2.29) mm(2); dose 2: 0.18([0.06--0.52) mm(2); dose 3: 0.50 (0.17--1.42) mm(2)]. Compared to the long-term control group, neointimal reduction was still >60%. No induction of neointimal formation was observed at the edges of the stents. Radiation resulted in delayed re-endothelialization. (188)Re stents were capable to reduce intimal hyperplasia and did not cause thrombosis. The edge effect, which was the major limitation of (32)P stents, was not observed in (188)Re stents.

Animals↗

Intraoperative ductoscopy in women undergoing surgery for breast cancer.

BACKGROUND: Extensive intraductal disease represents an important clinical problem in the management of patients with invasive or in situ breast cancer. The purpose of this study was to determine the value of intraoperative ductoscopy for detection of intraductal neoplasia in women with breast cancer. METHODS: Intraoperative ductoscopy was performed in 54 women undergoing operation for breast cancer. A rigid gradient index microendoscope (0.7 mm) was used for all examinations. Ductoscopy findings were documented prospectively and correlated with preoperative mammography and histology of the resection specimen. RESULTS: Fifty of 54 (92%) patients were examined successfully. Ductoscopy identified intraductal lesions (ie, red patches, ductal obstruction, or microcalcifications) in 25 of 50 (50%) patients. Abnormal ductoscopic appearance was found in 19 of 23 patients with extensive intraductal disease (82%). Mammographic microcalcifications were observed in 15 of those 19 patients and in 3 patients with normal ductoscopy (78%). The combined sensitivity of both methods was 95%. Patients with an abnormal ductal appearance on ductoscopy, compared with those with a normal ductal appearance, had a greater incidence of extensive intraductal spread of cancer (76% vs 16%) and a greater incidence of positive surgical margins (44% vs 12%). CONCLUSIONS: High-resolution ductoscopy is able to detect extensive intraductal disease in a considerable number of women with breast cancer. In selected patients, a combination of both preoperative imaging and intraoperative ductoscopy may help to avoid incomplete resections and re-excisions.

Adult↗

Hydrate kinetics study in the presence of nonaqueous liquid by nuclear magnetic resonance spectroscopy and imaging.

The dynamics of methane hydrate growth and decomposition were studied by nuclear magnetic resonance (NMR) spectroscopy and imaging (MRI). Three well-known large molecule guest substances (LMGS) were used as structure H hydrate formers: 2,2-dimethylbutane (NH), methylcyclohexane (MCH), tert-butyl methyl ether (TBME). In addition, the impact of a non-hydrate former (n-heptane/nC7) was studied. The methane diffusion and hydrate growth were monitored by recording the 2H NMR spectra at 253 K and approximately 4.5 MPa for 20 h. The results revealed that methane diffuses faster in TBME and NH, slower in nC7, and slowest in MCH. The TBME system gives the fastest hydrate formation kinetics followed by NH, MCH, and nC7. The conversion of water into hydrate was also observed. The imaging study showed that TBME has a strong affinity toward ice, which is not the case for the NH and MCH systems. The degree of ice packing was also found to affect the LMGS distribution between ice particles. Highly packed ice increases the mass transfer resistance and hence limits the contact between LMGS and ice. It was also found that "temperature ramping" above the ice point improves the conversion significantly. Finally, hydrates were found to dissociate quickly within the first hour at atmospheric pressure and subsequently at a much slower rate. Methane dissolved in LMGS was also seen. The residual methane in hydrate phase and dissolved in LMGS phase explain the faster kinetics during hydrate re-formation.

Journal Article↗

Patterns and predictors of remission, response and recovery in major depression treated with fluoxetine or nortriptyline.

OBJECTIVE: The first objective of this paper was to describe the pattern of remission, response and recovery in patients with major depression who were randomised for treatment with fluoxetine ornortriptyline. The second objective was to report on the demographic and diagnostic predictors of the response and recovery in these depressed patients. METHOD: One hundred and ninety-five patients with major depression were recruited for this outpatient study. After a detailed clinical and neurobiological evaluation patients were randomized to receive either fluoxetine or nortiptyline as an initial antidepressant treatment. RESULTS: Of the 195 depressed patients randomised to treatment,154 completed an adequate 6-week trial of either fluoxetine or nortriptyline as their initial antidepressant. Of the 41 patients who did not complete an adequate trial the dropout rate was higher on those randomized to nortriptyline (p = 0.02). There was also an important interaction of drug and gender in determining dropouts in that women did not complete an adequate trial with nortriptyline and men did not complete an adequate trial with fluoxetine (p = 0.002). Of the 154 patients who completed an adequate 6-week antidepressant trial there were no significant differences in 6-week measures of depression severity or of percentage improvement. However, if we use an intention to treat analysis and dichotomise outcomes into response,remission or recovery; then recovery rates were significantly higher with fluoxetine than nortriptyline (p = 0.005). Using an intention to treat analysis fluoxetine was superior tonortriptyline in women, in those less than 25-years old, and in those with atypical depression. Independent of drug, those with chronic depressions had a poorer outcome. CONCLUSION: In this sample of depressed patients randomized tonortriptyline or fluoxetine the change in depressive symptoms over 6 weeks were comparable between fluoxetine and nortriptyline. However,when we look at the more clinically important variable of recovery then fluoxetine was superior to nortriptyline. Predictors of a poorer response to nortriptyline were gender, young age and atypical depression. The results challenge traditional beliefs that selective serotonin re-uptake inhibitors (SSRIs) and tricyclic antidepressant have comparable efficacy.

Adult↗