bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression and Regulation of the Na+‐K+‐2Cl− Cotransporter NKCC1 in the Normal and CFTR‐Deficient Murine Colon
Authors: Bachmann O. , Wüchner K. , Rossmann H. , Leipziger J. , Osikowska B. , Colledge W. H. , Ratcliff R. , Evans M. J. , Gregor M. , Seidler U.
Published: April 2003

Defective regulation and/or reduced expression of the Na+‐K+‐2Cl− cotransporter NKCC1 may contribute to the severe secretory defect that is observed in cystic fibrosis, but data concerning the expression and function of NKCC1 in cystic fibrosis transmembrane conductance regulator (CFTR)‐deficient cells are equivocal. We therefore investigated NKCC1 mRNA expression, Na+‐K+‐2Cl− cotransport activity and regulation by cAMP in crypts isolated from the proximal colon of CFTR‐containing (CFTR (+/+)) and CFTR‐deficient (CFTR (−/−)) mice. mRNA expression levels were determined by semiquantitative PCR, transport rates were measured fluorometrically in 2′,7′‐bis(carboxyethyl)‐5(6)‐carboxyfluorescein acetomethylester (BCECF)‐loaded crypts, cytoplasmic volume changes were assessed by confocal microscopy, and [Cl−]i changes were examined by N‐(ethoxycarbonylmethyl)‐6‐methoxyquinolinium bromide (MQAE) quenching. NKCC1 mRNA expression levels were not significantly reduced in CFTR (−/−) crypts compared to controls. Azosemide‐sensitive NH4+ influx (used as a measure of Na+‐K+‐2Cl− cotransport) was 2.23 ± 0.72 vs. 1.56 ± 0.16 mm min−1, and increased by 63.6 % in (+/+) and 87.3 % in (−/−) crypts upon stimulation for 5 min with forskolin. After 20 min of stimulation with forskolin, the Na+‐K+‐2Cl− cotransport rates in (−/−) and (+/+) crypts were identical. Crypt cross‐sectional area and [Cl−]i decreased only in (+/+) crypts upon stimulation. In conclusion, normal NKCC1 expression levels, somewhat reduced Na+‐K+‐2Cl− cotransport rates, but preserved activation by cAMP were found in colonic crypts from CFTR (−/−) mice, ruling out a severe dysfunction of the Na+‐K+‐2Cl− cotransporter in the CF intestine. Furthermore, these studies establish the existence of a direct, cell‐volume‐ and [Cl−]i‐independent activation of colonic NKCC1 by an increase in intracellular cAMP.
Haemoglobin Marseille-Long Island and interpretation of HbA1c: which HbA1c result is the “right answer”?
Authors: Florkowski C M , Walmsley T A , Brennan S O , George P M
Published: April 2003

A woman was screened for diabetes using glycated haemoglobin (HbA1c). Vastly different results were obtained by high performance liquid chromatography (45%), immunoassay (2.9%), and affinity chromatography (4.2%) compared with the non-diabetic range of less than 6.4%. Mass spectral studies confirmed the presence a haemoglobin variant, haemoglobin Marseille-Long Island which had confounded interpretation by all methods.
TRANSVERSE MOMENTUM DISTRIBUTION IN THE B MESONS IN THE HEAVY-QUARK LIMIT: THE WANDZURA–WILCZEK PART
Authors: KAWAMURA HIROYUKI , KODAIRA JIRO , QIAO CONG-FENG , TANAKA KAZUHIRO
Published: April 2003

In the heavy-quark limit, the valence Fock-state components in the B mesons are described by a set of two light-cone wave functions. We show that these two wave functions obey simple coupled differential equations, which are based on the equations of motion in the Heavy Quark Effective Theory (HQET), and the analytic solutions for them are obtained. The results generalize the recently obtained longitudinal-momentum distribution in the Wandzura–Wilczek approximation by including the transverse momenta. We find that the transverse momentum distribution depends on the longitudinal momentum of the constituents, and that the wave functions damp very slowly for large transverse separation between quark and antiquark.
Cholecystokinin Innervation of the Cerebral Cortex in a Reptile, the Lizard Psammodromus algirus
Authors: Guirado Salvador , Ángeles Real M. , Padial Jesús , J. Andreu Manuel , Carlos Dávila José
Published: April 2003

We used light and electron microscopic and immunohistochemical methods to map the distribution of cholecystokinin (CCK) in the cerebral cortex of a lizard, Psammodromus algirus. At light microscopy, the CCK immunoreactivity was limited to fibers and terminals densely innervating all cortical regions except for the lateral (pyriform) cortex which was very slightly immunostained. The CCK-positive terminals were almost restricted to the cell layers in every cortical region where they surrounded immunonegative cell bodies and proximal dendrites of neurons within the layer. No CCK-containing neurons were observed within the cerebral cortex. At the electron microscopic level, most positive structures were presynaptic boutons contacting cell bodies and proximal dendrites. All contacts appeared to form symmetric junctions. both the distribution and type of synaptic contacts of CCK fibers in the cerebral cortex of Psammodromus are very similar to the corresponding features in the hippocampus of mammals, although in this lizard the CCK cortical innervation, unlike that in mammals, is probably of extrinsic origin. Double HRP-retrograde labeling and CCK immunohistochemistry show that part of the CCK in the cerebral cortex of Psammodromus arises from the hypothalamic supramammillary nuclei.
Seven Retinal Specializations in the Tubular Eye of the Deep-Sea Pearleye, Scopelarchus michaelsarsi: A Case Study in Visual Optimization
Authors: P. Collin Shaun , V. Hoskins Robert , C. Partridge Julian
Published: April 2003

The deep-sea pearleye, Scopelarchus michaelsarsi (Scopelarchidae) is a mesopelagic teleost with asymmetric or tubular eyes. The main retina subtends a large dorsal binocular field, while the accessory retina subtends a restricted monocular field of lateral visual space. Ocular specializations to increase the lateral visual field include an oblique pupil and a corneal lens pad. A detailed morphological and topographic study of the photoreceptors and retinal ganglion cells reveals seven specializations: a centronasal region of the main retina with ungrouped rod-like photoreceptors overlying a retinal tapetum; a region of high ganglion cell density (area centralis of 56.1×103 cells per mm2) in the centrolateral region of the main retina; a centrotemporal region of the main retina with grouped rod-like photoreceptors; a region (area giganto cellularis) of large (32.2±5.6 μm2), alpha-like ganglion cells arranged in a regular array (nearest neighbour distance 53.5±9.3 μm with a conformity ratio of 5.8) in the temporal main retina; an accessory retina with grouped rod-like photoreceptors; a nasotemporal band of a mixture of rod- and cone-like photoreceptors restricted to the ventral accessory retina; and a retinal diverticulum comprised of a ventral region of differentiated accessory retina located medial to the optic nerve head. Retrograde labelling from the optic nerve with DiI shows that approximately 14% of the cells in the ganglion cell layer of the main retina are displaced amacrine cells at 1.5 mm eccentricity. Cryosectioning of the tubular eye confirms Matthiessen’s ratio (2.59), and calculations of the spatial resolving power suggests that the function of the area centralis (7.4 cycles per degree/8.1 minutes of arc) and the cohort of temporal alpha-like ganglion cells (0.85 cycles per degree/70.6 minutes of arc) in the main retina may be different. Low summation ratios in these various retinal zones suggests that each zone may mediate distinct visual tasks in a certain region of the visual field by optimizing sensitivity and/or resolving power.
Crustacean – Insect Relationships: The Use of Brain Characters to Derive Phylogeny amongst Segmented Invertebrates
Authors: Strausfeld Nicholas J.
Published: April 2003

Conserved neural characters identified in the brains of a variety of segmented invertebrates and outgroups have been used to reconstruct phylogenetic relationships. The analysis suggests that insects and crustaceans are sister groups and that the ‘myriapods’ are an artificial construct comprising unrelated chilopods and diplopods. Certain elements of the optic lobes and mid-brain support the notion that insects are more closely related to crustaceans than they are to any other arthropods. However, deep optic neuropils and optic chiasmata are homoplastic in insects and crustaceans. The organization of olfactory pathways suggests that insect olfactory lobes originated late, probably first appearing in orthopteroid or blattoid pterygotes. The present results are discussed with respect to recent studies on early development of arthropod nervous systems and the fossil record.
Diurnal and Nocturnal Visual Capabilities in Shorebirds as a Function of Their Feeding Strategies
Authors: Rojas L.M. , McNeil R. , Cabana T. , Lachapelle P.
Published: April 2003

Some shorebird species forage with the same feeding strategy at night and during daytime, e.g. visual pecking in the Wilson’s Plover (Charadrius wilsonia) or tactile probing in the Short-billed Dowitcher (Limnodromus griseus). The American Woodcock (Scolopax minor) uses tactile probing, by day and by night, but sometimes pecks for insects during daytime. The Black-winged Stilt (Himantopus himantopus) is a visual pecker, both by day and by night, and sometimes forages tactilely on windy (agitated water surface) moonless nights. Territorial Willets (Catoptrophorus semipalmatus) are visual peckers during daylight and on moonlight conditions but switch to tactile feeding under lower light conditions. It could be postulated that some shorebird species would switch from visual feeding during daytime to tactile foraging at night because they have poor night vision compared to species that are always sight foragers irrespective of the time of the day. This issue was examined by comparing retinal structure and function in the above species. Electroretinograms (ERGs) were obtained at different light intensities from anesthetized birds, and the retinae were processed for histological observations. Based on ERGs, retinal sensitivity, and rod:cone ratios, both plovers and stilts are well adapted for nocturnal vision. Although they have low rod density compared to that of stilts and plovers, Willets and woodcocks have a scotopic retinal sensitivity similar to that of stilts and plovers but rank midway between plovers and dowitchers for the b-wave amplitude. Dowitchers have the lowest scotopic b-wave amplitude and retinal sensitivity and appear the least well adapted for night vision. Based on photopic ERGs and cone densities, although stilts, Willets and dowitchers appear as well adapted for daytime vision, plovers occupy the last rank of all species examined. Compared to the nighttime tactile feeders and those that switch from daytime visual pecking to tactile feeding at night, nighttime sight feeders have a superior rod function and, consequently, potentially superior nocturnal visual capabilities.
A Morphological Study of the Cochlear Nuclei of the Pigeon (Columba livia)
Authors: Häusler U.H.L. , Sullivan W.E. , Soares D. , Carr C.E.
Published: April 2003

The pigeon cochlear nucleus angularis (NA) and nucleus magnocellularis (NM) were analyzed with Golgi and Nissl techniques. NA was divided into a medial NAm and NA proper, which could be subdivided further into an intermediate NAi and lateral NAl. NAm contained a mostly homogeneous population of a unique multipolar cell type with very short dendrites and large somatic spines. NA proper contained four cell types: large, medium, and small multipolars, and medium bipolar. The medium multipolar cells were most common, and resembled the multipolar cells of the mammalian ventral cochlear nucleus. NM presented a homogenous appearance with a mediolateral gradient of cell size and shape. Medially located higher best frequency NM principal cells had round cell bodies with small somatic spines and few dendrites. By comparison, laterally located low best frequency NM stellate cells had more dendrites and spindle shaped cell bodies. The similarities between the cell types of NA and the cell types in the cochlear nuclei of other amniote vertebrates may be due to homology or convergent evolution.
Seasonal Cell Proliferation in the Chemosensory Epithelium and Brain of Red-Backed Salamanders, Plethodon cinereus
Authors: Dawley Ellen M. , Fingerlin Amanda , Hwang Daniel , John Sunitha S. , Stankiewicz Corrie A.
Published: April 2003

The chemosensory epithelium of vertebrates retains the ability to produce new receptor neurons throughout life, presumably as a mechanism to replace aging or damaged receptors. We examined cell division in the main olfactory and vomeronasal epithelia of red-backed salamanders (Plethodon cinereus) because previous studies had shown that the volume of sensory epithelia changes seasonally. Cell division was compared throughout the year by injecting salamanders once with 5-bromo-2′-deoxyuridine (BrdU), which is incorporated into the DNA of cells during DNA synthesis, and sacrificing them one hour after injection. We used immunocytochemistry to locate cells that had arisen from cell division since BrdU injection and compared the number of labeled cells per area among animals. Animals collected in May had significantly more labeled nuclei than animals collected in any other month. However, proliferation rates among the other months were not significantly different and were quite low. Labeled nuclei also were found around the cerebral ventricles of salamanders collected in May, but rarely in any other month, although other tissues in the head often were heavily labeled. Cell proliferation appears to be up-regulated in the chemosensory epithelia and in the telencephalon during May, and we hypothesize that new receptors, and perhaps their interneurons in the telencephalon, are being generated in anticipation of seasonal events that are mediated by chemoreception.
Effects of Body Position on the Carbon Monoxide Diffusing Capacity in Patients with Chronic Heart Failure: Relation to Hemodynamic Changes
Authors: Faggiano Pompilio , D’Aloia Antonio , Simoni Paolo , Gualeni Anna , Foglio Katia , Ambrosino Nicolino , Giordano Amerigo
Published: April 2003

Objective: Pulmonary diffusion has been found to be reduced in patients with congestive heart failure. The effects of postural changes on the diffusing capacity had been evaluated in healthy subjects, but not in patients with heart failure. The aim of this study was to evaluate the posture-induced changes in diffusing capacity in patients with chronic heart failure and their relation to the hemodynamic profile. Methods: The pulmonary carbon monoxide diffusing capacity (DLCO) was measured in the supine position, with 20° passive head elevation, and in the sitting position, both postures maintained for 10 min, in a group of 32 male patients with mild to moderate chronic heart failure due to left ventricular systolic dysfunction (ejection fraction <35%). On a separate day, in the absence of any changes in clinical status and therapy, the hemodynamic parameters were measured by right-heart catheterization. The sequence of postures was assigned randomly. Results: The mean values of DLCO were slightly reduced and did not differ in the two positions (20.3 ± 5.7 vs. 19.4 ± 5.6 ml/min/mm Hg, 77 ± 23 vs. 75 ± 20% of predicted, respectively). The patients were then subdivided according to changes in DLCO from the supine to the sitting position: DLCO increased (+23%) in 9 patients (28%, group 1), decreased (–17.5%) in 17 patients (53%, group 2), and remained within the coefficient of reproducibility (±5%) in 6 patients (group 3). As compared with group 2, group 1 patients showed a significant increase in mean pulmonary artery pressure (+7 vs. –15%, p < 0.01) and pulmonary capillary wedge pressure (+8 vs. –22%, p < 0.005) from the supine to the sitting position, while the cardiac index showed a smaller – but not significant – decrease in group 1 (–5 vs. –12%). The percent changes in DLCO significantly correlated with changes in pulmonary capillary wedge (r = 0.54, p < 0.0005) and mean pulmonary artery (r = 0.47, p < 0.005) pressures. Conclusions: In chronic heart failure postural changes may induce different responses in diffusing capacity. To a greater extent than in healthy subjects, the most common response is a decrease in DLCO in the sitting as compared with the supine position. The DLCO changes correlate with variations in pulmonary circulation pressure, probably due to changes in pulmonary vascular recruitment and pulmonary capillary blood volume.
Use of Fish Oils Appears to Reduce Infarct Size as Estimated from Peak Creatine Kinase and Lactate Dehydrogenase Activities
Authors: Landmark Knud , Abdelnoor Michael , Urdal Petter , Kilhovd Bente , Dørum Hans-Petter , Borge Nina , Refvem Hilde
Published: April 2003

In 753 patients with acute myocardial infarction, use of fish oils (FO, n = 242) before onset of infarction seemed to reduce infarct size as estimated from peak creatine kinase (CKmax) and lactate dehydrogenase (LDmax) activities. The study had an observational exposed/nonexposed design, and both crude and adjusted effects were looked for. Crude Effects: In the restricted cohort of patients not receiving thrombolytic treatment (n = 411), FO reduced CKmax from 879 to 759 U/l (2 p = 0.030) and LDmax from 870 to 768 U/l (2 p = 0.011), respectively. More of these patients in the lowest enzyme quartiles used FO, p for linear trend was for CKmax 0.008 and for LDmax 0.06, respectively. Adjusted Effects: In patients not receiving thrombolytic treatment, FO reduced CKmax (2 p = 0.007) and LDmax (2 p = 0.005), but in patients receiving such treatment, CKmax and LDmax values increased, 2 p being 0.036 and 0.097, respectively. In patients not receiving thrombolysis, FO increased the incidence of small infarcts (the 25% quartile), odds ratio for CKmax was 1.82 (2 p = 0.018) and for LDmax 1.66 (2 p = 0.048), respectively. The results indicate that FO may reduce infarct size and the incidence of large infarcts. In addition, FO seems to enhance the effect of thrombolysis.
Lipid Peroxidation and Cardiac Troponin T Release during Routine Cardiac Surgery
Authors: Inselmann Gerhard , Köhler Katrin , Lange Volkmar , Silber Rolf , Nellessen Ulrich
Published: April 2003

Myocardial injury after cardiac surgery with cardiopulmonary bypass may be related to free oxygen radical-induced lipid peroxidation. The purpose of this study was to monitor perioperative changes of cardiac troponin t and malondialdehyde as an indicator of lipid peroxidation in patients who underwent routine cardiac operation and had no signs of perioperative myocardial infarction. Patients with thoracic surgery alone served as controls. We studied 20 patients with cardiopulmonary bypass (CPB) and 9 patients with other thoracic operations. Serum troponin t, malondialdehyde, myoglobin, creatine kinase (CK) including CK-MB isoenzyme levels were monitored before CPB, immediately after cessation of CPB, 20 and 44 h after CPB. Patients with signs of myocardial infarction before or up to 44 h after surgery were excluded. Of 20 patients with CBP, 18 patients showed a significant increase of troponin t and 16 patients had elevated malondialdehyde serum levels following CPB. Troponin t serum values were raised immediately after CPB to 0.60 ± 0.12 µg/l and increased further to 0.90 ± 0.17 µg/l after 44 h (p < 0.005, in comparison to preoperative: 0.08 ± 0.02 µg/l). Patients undergoing the other thoracic operations showed neither any detectable troponin t serum values nor significant changes of serum malondialdehyde during the observed period. In the CPB group serum malondialdehyde peaked immediately after CPB to 98 ± 9 nmol/g albumin (p < 0.005) and returned to preoperative levels (63 ± 3 nmol/g albumin) within 20 h (60 ± 3 nmol/g albumin). Individual maximal troponin t serum levels did not correlate with individual maximal serum malondialdehyde levels. The observed increase of troponin t levels had no influence on patients’ outcome followed up for 18 months. The results demonstrate that troponin t and lipid peroxidation increase during uncomplicated cardiac surgery in patients without signs of myocardial infarction. Following uncomplicated cardiac surgery, a moderate increase of cardiac troponin t may not reflect severe cardiac injury.
Pain Scoring – A Method for Assessing Acute Antianginal Therapy Comparison of the Response to Acute Sublingual Administration of an Isosorbide Dinitrate Tablet, Isosorbide Dinitrate Spray and Nitroglycerin Spray in Unstable Angina
Authors: Shotan Avraham , Brill Zohar , Matetzky Shlomi , Shachar Amir , Feigenberger Zvi , Hod Hanoch , Kaplinsky Elieser
Published: April 2003

It is difficult to assess acute therapeutic intervention therapy, particularly in patients with unstable angina. Our aim was to evaluate the feasibility of a pain-scoring method and to compare the response to sublingual administration of an isosorbide dinitrate (ISDN) tablet, ISDN spray or nitroglycerin (NTG) spray. Pain scoring was assessed by the subjective grading of the patients’ pain severity from 1 to 10. We studied 205 patients (mean age 66 ± 13 years). Pain attenuation, defined as at least 50% reduction in pain intensity, occurred in the ISDN tablet, ISDN spray and NTG spray groups after 360 ± 290, 318 ± 289 and 233 ± 271 s, respectively (p = 0.0005). In conclusion, pain scoring is a feasible and useful clinical method to assess antianginal therapy in unstable angina patients. Sublingual nitrate sprays, particularly NTG, seem to alleviate anginal pain faster than ISDN tablets in this patient population.
Effects of Antioxidant Vitamins C and E on Atherosclerosis in Lipid-Fed Rabbits
Authors: Sun Yi-Ping , Zhu Bo-Qing , Sievers Richard E. , Norkus Edward P. , Parmley William W. , Deedwania Prakash C.
Published: April 2003

Background: Antioxidant vitamins are hypothesized to help prevent atherosclerosis by blocking lipoprotein oxidation. We investigated the effects of dietary vitamins C and E on atherosclerosis in rabbits. Methods and Results: Forty New Zealand male rabbits were divided into 4 groups: 0.3% cholesterol diet with (LV) and without vitamin (LC), and 0.5% cholesterol diet with (HV) and without vitamins (HC). The treated groups consumed 137 ± 8 mg/day vitamin C and 80 ± 4 mg/day vitamin E for 10 weeks. Vitamin treatment did not significantly affect serum lipids. α-Tocopherol values were significantly higher in both serum (mg/dl) and omental fat (µg/g) among the treated rabbits (3.9 ± 0.5 and 31.6 ± 2.1 for LV, 1.7 ± 0.2 and 12.1 ± 1.9 for LC, 5.6 ± 0.8 and 51.3 ± 9.3 for HV and 1.9 ± 0.3 and 8.2 ± 0.4 for HC; p < 0.001). Vitamin treatment did not affect the percent of surface lesions in the aorta and pulmonary artery (23.8 ± 5.2 and 20.1 ± 3.3% for LV, 19.8 ± 5.6 and 23.2 ± 3.5% for LC, 28.1 ± 6.5 and 51.1 ± 4.2% for HV and 32.4 ± 5.5 and 43.7 ± 3.9% for HC, respectively; p = 0.981 and p = 0.562. Conclusions: Although significantly higher values of α-tocopherol were found in both serum and omental fat, antioxidant vitamins C and E did not demonstrate a significant protective effect on atherosclerosis in lipid-fed rabbits during the 10-week study period.
Neurohormonal Activation in the Treatment of Congestive Heart Failure: Basis for New Treatments?
Authors: Pool Peter E.
Published: April 2003

Traditionally, the pathophysiology of heart failure was viewed as a derangement in hemodynamic factors. Impairment in cardiac function resulted in decreased cardiac output and end-organ hypoperfusion triggering compensatory increases in heart rate, blood pressure and cardiac contractility. While initially beneficial, these mechanisms placed additional stress on the failing heart. Unfortunately, pharmacologic therapies that restored hemodynamic balance failed to halt disease progression. The activation of neurohormonal responses, including those of the renin-angiotensin-aldosterone system, the sympathetic nervous system and the arginine vasopressin system, has been implicated in the progression of heart disease. In acute heart failure, their effects help to restore cardiovascular homeostasis. However, the chronic stimulation of these systems eventually leads to worsening left ventricular function. Drug treatments that activate neurohormonal systems may have long-term clinically deleterious outcomes, and therefore new pharmacological therapies for cardiovascular disease must take into account the interaction between neurohormonal activation and hemodynamic factors.
Relationship between Left Atrial Function and Plasma Level of Atrial Natriuretic Peptide in Patients with Heart Disease
Authors: Takeichi Naoki , Fukuda Nobuo , Tamura Yoshiyuki , Oki Takashi , Ito Susumu
Published: April 2003

To investigate the relationship between left atrial function and secretion of atrial natriuretic peptide (ANP), we analyzed left ventricular inflow and pulmonary venous flow, left atrial dynamics, intracardiac pressures, and plasma ANP level in 92 patients with various cardiac diseases. From the apical four-chamber view, maximal left atrial volume and percent fractional change of the left atrial area during atrial systole (LA-%AC) were calculated. The ratio of peak early filling velocity to peak atrial systolic velocity (E/A) in the left ventricular inflow and the ratio of peak systolic velocity to peak diastolic velocity (S/D) in the pulmonary venous flow were measured with the pulsed Doppler method. A significant linear correlation was found between plasma ANP levels and pulmonary capillary wedge pressure. Significant linear correlations were also found between left ventricular end-diastolic pressure and both maximal left atrial volume and LA-%AC. Plasma ANP level was significantly correlated with maximal left atrial volume, LA-%AC, E/A, and S/D. A multivariate analysis revealed that only LA-%AC was significantly correlated with the plasma ANP level. These results suggest that left atrial systolic dysfunction associated with a left atrial afterload mismatch is closely related to the ANP secretion.
Peripheral Monocytosis following Acute Myocardial Infarction: Incidence and Its Possible Role as a Bedside Marker of the Extent of Cardiac Injury
Authors: Meisel Simcha R. , Pauzner Hana , Shechter Michael , Zeidan Ziad , David Daniel
Published: April 2003

Infiltration by mononuclear cells, mostly monocytes, into necrotic myocardial tissue can be detected beyond the 3rd day after the onset of infarction. These monocytes, mobilized by an unknown mechanism, initiate phagocytosis of necrotic tissue. We observed in patients having sustained an acute myocardial infarction (AMI) a significant increase in monocyte count 2–3 days following presentation, possibly representing peripheral recruitment of monocytes to the injured myocardium. To establish this observation, we prospectively documented monocyte and neutrophil counts throughout hospitalization in 186 consecutive patients (118 patients having sustained an AMI, 34 patients with angina, and 34 patients admitted for nonischemic reasons). Average monocyte count, which rose on the 2nd day and reached a peak on day 3, was significantly elevated in these patients compared with control subjects (p < 0.001). Neutrophil count exhibited a similar phase-shifted response. Peak monocyte count exceeded 800/mm3 (upper limit of normal range) in 69 (58%) of AMI patients but in only 3 of the 68 (4%) non-AMI patients, yielding a sensitivity and specificity of 58 and 95%, respectively, for the diagnosis of AMI by this criterion. A significant correlation between maximal creatine kinase (CK) representing the extent of myocardial necrosis and peak monocyte count was shown (r = 0.51, p < 0.0001). A correlation between CK and monocyte count sum of days 1–3 (r = 0.51, p < 0.001) was found in a substudy of 25 patients with AMI. Similarly, a correlation was shown with cardiac function score as evaluated by 2-dimensional echocardiography (p < 0.001 and p < 0.008 for difference between CK sum and monocyte count sum of high and low echo score groups, respectively). Hence, the peak monocyte count recorded during the immediate postinfarction period provides a bedside marker of the extent of myocardial damage that is the preponderant prognostic determinant. If validated in future studies this phenomenon may have diagnostic and prognostic implications.
Diagnosis of Acute Myocardial Infarction in Patients with Chronic Right Bundle-Branch Block Using Standard 12-Lead Electrocardiogram Compared with Dynamic Vector Cardiography
Authors: Eriksson Peter , Gunnarsson Gunnar , Dellborg Mikael
Published: April 2003

The aim of the study was to evaluate standard 12-lead electrocardiogram (ECG) criteria and to compare them with dynamic vector cardiography in patients with chronic right bundle-branch block for diagnosing acute myocardial infarction. We used standard 12-lead ECGs recorded on admission and after 12–24 h and compared them with dynamic vector cardiography with trend analysis during the first 12 h. In patients with right bundle-branch block, ST segment changes occurred in the same way as for patients with narrow QRS complexes. By adding 4 h of continuous vector cardiographic monitoring we were able to identify patients with acute myocardial infarction with a high diagnostic accuracy.
Distribution of Calcitonin Gene-Related Peptide, Atrial Natriuretic Peptide and Neuropeptide Y in the Rat Heart
Authors: Onuoha G.N. , Ritchie A. , Nicholls D.P.
Published: April 2003

Calcitonin gene-related peptide (CGRP) is a novel neuropeptide, predicted on the basis of structural analysis of the rat calcitonin gene. It is a neurotransmitter which has been suggested to take part in sensory transmission. In this study, we have examined the distribution of this peptide, α-atrial natriuretic peptide immunoreactivity (irANP) and neuropeptide Y (NPY) within different regions of the rat heart. Attempts were also made to compare the distributions of these peptides in the regions examined, through different methods of immunocytochemistry and further comparing these results with those obtained through radioimmunoassay. The distributions of the peptides in the atria were similar to results obtained with radioimmunoassay, but there were no myocytes containing irANP in the ventricles with immunocytochemistry as opposed to radioimmunoassay. While the staining obtained for irANP in the atrium was more intense in the right, CGRP and NPY nerve fibres were two to three times more abundant in the left atrium. The high local concentration of a vasoconstrictor peptide in the region of coronary vessels may suggest that it is involved in the control of vascular smooth muscle tone. The method of choice with the immunocytochemical studies was that of the susa wax technique for irANP. Caution should therefore be observed when interpreting results based only on a single staining technique.
Predictors of Death and Other Cardiac Events within 2 Years after Coronary Artery Bypass Grafting
Authors: Herlitz Johan , Brandrup-Wognsen Gunnar , Karlsson Thomas , Karlson Björn , Haglid Maria , Sjöland Helen
Published: April 2003

Results: In 1,841 patients who underwent coronary artery bypass grafting (CABG) we evaluated risk indicators for death and other cardiac events during 2 years of follow-up. Independent predictors of death were: a history of congestive heart failure, diabetes mellitus and renal dysfunction prior to CABG. Independent predictors of death, acute myocardial infarction (AMI), CABG or percutaneous transluminal coronary angioplasty (PTCA) were: a small body surface area, a history of congestive heart failure, diabetes mellitus and smoking prior to CABG. Independent predictors of death, AMI, CABG, PTCA or rehospitalization for a cardiac reason were: angina functional class, previous AMI, a history of congestive heart failure and renal dysfunction prior to CABG. Conclusion: When using various definitions of a cardiac event after CABG, various risk indicators for death or such an event can be found. Our data suggest that anamnestic information prior to CABG indicating a depressed myocardial function or severe myocardial ischemia are more important predictors of outcome than the information gained from cardioangiography.
Hyperbaric Oxygen and Thrombolysis in Myocardial Infarction: The ‘HOT MI’ Randomized Multicenter Study
Authors: Stavitsky Yuri , Shandling Adrian H. , Ellestad Myrvin H. , Hart George B. , van Natta Bruce , Messenger John C. , Strauss Michael , Dekleva Milica N. , Alexander John M. , Mattice Michael , Clarke Dick
Published: April 2003

In a previous pilot study, we demonstrated that adjunctive treatment with hyperbaric oxygen (HBO) appears to be feasible and safe in patients with acute myocardial infarction (AMI) and may result in an attenuated rise in creatine phosphokinase (CPK), more rapid resolution of pain and ST changes. This randomized multicenter trial was organized to further assess the safety and feasibility of this treatment in human subjects. Patients with an AMI treated with recombinant tissue plasminogen activator (rTPA) or streptokinase (STK), were randomized to treatment with HBO combined with either rTPA or STK, or rTPA or STK alone. An analysis included 112 patients, 66 of whom had inferior AMIs (p = NS). The remainder of the patients had anterior AMIs. The mean CPK at 12 and 24 h was reduced in the HBO patients by approximately 7.5% (p = NS). Time to pain relief was shorter in the HBO group. There were 2 deaths in the control and 1 in those treated with HBO. The left ventricle ejection fraction (LVEF) on discharge was 51.7% in the HBO group as compared to 48.4% in the controls (p = NS). The LVEF of the controls was 43.4 as compared to 47.6 for those treated, approximately 10% better (no significant difference). Treatment with HBO in combination with thrombolysis appears to be feasible and safe for patients with AMI and may result in an attenuated CPK rise, more rapid resolution of pain and improved ejection fractions. More studies are needed to assess the benefits of this treatment.
Predictors of Outcome in Patients with Implantable Cardioverter Defibrillators
Authors: Anvari Anahit , Gottsauner-Wolf Michael , Türel Zeynep , Stix Günter , Podesser Bruno , Mayer Christian , Schuster Ernst , Schmidinger Herwig
Published: April 2003

This study determined the impact of clinical characteristics on shock occurrence and survival in patients with implantable cardioverter-defibrillator (ICD). Methods and Results: During a follow-up of 27 ± 18 months, the actuarial incidence of appropriate shocks in 200 consecutive patients was 18, 36 and 72% at 1, 3, and 5 years, respectively. Coronary artery disease was the only significant predictor for shock occurrence (relative risk 1.32, p = 0.03). The actuarial incidence of total mortality was 10, 17 and 33% at 1, 3, and 5 years, respectively. The most powerful predictors for total mortality were: New York Heart Association functional class (NYHA) III (relative risk 4.8, p = 0.001) and a history of congestive cardiac failure (relative risk 3.6, p = 0.01). Conclusion: During long-term follow-up, the majority of patients receive appropriate shocks. No strong predictors for shock occurrence can be identified from the data analyzed. A history of congestive cardiac failure and the NYHA III are the most powerful predictors for total mortality. These clinical factors may provide valuable criteria to identify patients who will benefit from the implantation of ICD.
Acute Myocardial Infarction Induced by Alternating Exposure to Heat in a Sauna and Rapid Cooling in Cold Water
Authors: Imai Yukiko , Nobuoka Sachihiko , Nagashima Junzo , Awaya Toru , Aono Jiro , Miyake Fumihiko , Murayma Masahiro
Published: April 2003

We describe a patient with acute myocardial infarction, which was thought to result from plaque rupture or thrombosis because of coronary artery spasm. The vasospasm was most likely induced by stimulation of the α-adrenergic receptors during alternating heat exposure during sauna bathing and rapid cooling during cold water bathing. This report emphasizes the dangers of rapid cooling after sauna bathing in patients with coronary risk factors.
Soluble PECAM-1, but Not P-Selectin, Nor Osteonectin Identify Acute Myocardial Infarction in Patients Presenting with Chest Pain
Authors: Serebruany Victor L. , Murugesan Selva R. , Pothula Anitha , Semaan Husam , Gurbel Paul A.
Published: April 2003

We sought to determine plasma levels of platelet/endothelial cell adhesion molecule-1 (PECAM-1), P-selectin, and platelet-derived osteonectin, and prospectively compare these data with the discharge diagnosis in patients presenting with chest pain in a community hospital Emergency Department. Soluble antigens were measured by ELISA in 44 subjects including patients with acute myocardial infarction (AMI) (n = 13), chest pain of noncardiac origin (n = 17), and compared to those of age- and sex-matched healthy controls (n = 14). Elevated soluble PECAM-1 (64.5 ± 18.3 ng/ml, p = 0.019), but not P-selectin (149.5 ± 49.8 ng/ml, p = NS), nor osteonectin (549.5 ± 159.1 ng/ml, p = NS), occurred in the AMI group as compared to patients with noncardiac chest pain (46.2 ± 7.5 ng/ml, 118.2 ± 40.1 ng/ml, and 619.4 ± 74.4 ng/ml, respectively). Increased plasma PECAM-1 may serve as a useful marker in the early detection of patients with AMI. Larger studies will be necessary to confirm the utility of soluble PECAM-1 in identifying AMI among patients presenting with chest pain.
Platelet Reactivity and Streptokinase Resistance following Antecedent Streptokinase Therapy for Myocardial Infarction
Authors: Gorog Diana A. , Ahmed Nabeel , Davies Graham J.
Published: April 2003

Aims: To assess the efficacy of second-time administration of streptokinase (SK). First-time thrombolysis with SK in myocardial infarction (MI) is established but the efficacy of subsequent SK is unknown. Methods and Results: Platelet reactivity to shear stress, spontaneous and SK-induced thrombolysis were measured in vitro in 28 patients who had received SK for MI and compared to 15 controls. SK antibody (Ab) titres were inversely related to time from MI. Platelet reactivity was greatly enhanced in patients (p < 0.0001). Spontaneous thrombolysis in patients was poor and in 17 failed to occur. In contrast, thrombolysis occurred in all but 1 control. In patients platelet reactivity was strongly related to thrombolytic activity (r = –0.516; p = 0.0029). SK in vitro was at least 4 times more effective in controls than in patients. Conclusion: The chances of achieving patency with second administration of SK are poor. Ab titre is not a reliable predictor of resistance.
The Alcoholic Cardiomyopathies – Genuine and Pseudo
Authors: Constant Jules
Published: April 2003

Two types of genuine alcoholic cardiomyopathies can produce congestive heart failure, an acute fulminate hyperkinetic type with high cardiac output and a hypokinetic type with a low cardiac output, both of which respond to thiamine. When the chronic alcoholic develops a dilated cardiomyopathy with congestive heart failure without a history of significant malnutrition, then they do not respond to thiamine. This may be explained by a study in which mice given a myotropic virus plus alcohol developed more frequent and severe viral cardiomyopathies than those not fed alcohol. This suggests that a chronic dilated cardiomyopathy in an alcoholic may not be the direct result of the alcohol but secondary to a viral myocarditis. This suggests that the preferred terminology for a dilated cardiomyopathy in an alcoholic who does not respond to thiamine and good nutrition should simply be a dilated cardiomyopathy in an alcoholic. We should assume that the cardiomyopathy is possibly of viral etiology.
Assessment of Chronic Heart Failure Using Gas Exchange: Which Variable and When to Correct for Body Mass
Authors: Davey Patrick , Clark Andrew , Coats Andrew
Published: April 2003

We investigated whether correction for body mass is appropriate when using variables derived from gas exchange measurements in the assessment of chronic heart failure. Patients with heart failure were studied either on a bicycle ergometer (22 subjects) or on a treadmill (28 subjects). For bicycle exercise testing either peak VO2 or peak VCO2 uncorrected for body mass reflected exercise capacity. However, for treadmill exercise, body mass correction was necessary to relate exercise capacity to peak VO2 or peak VCO2. Mass correction is therefore appropriate for treadmill but not for bicycle exercise.
Role of Myocardial Ischemia and Left Ventricular Wall Motion Abnormalities as Contributory Factors in the Genesis of Exercise-Induced ST-Segment Elevation in Q-Wave Myocardial Infarction
Authors: Macieira-Coelho Eduardo , Garcia-Alves Mário , Dionisio Isabel , Cantinho Guilhermina , Da Costa Brás B. , Gouveia António
Published: April 2003

In patients with a previous myocardial infarction, controversy exists regarding the significance of postexercise ST-segment elevation in the infarct-related leads. Although usually admitted to be a sign of left ventricular dysfunction or myocardial aneurysm, other studies however have related this finding to transient myocardial ischemia and to the presence of jeopardized but viable myocardium in the infarct area. The aim of the present study was to assess the significance of postexercise ST-segment elevation in Q-wave leads as a marker of transmural ischemia or left ventricular dysfunction in 36 consecutive patients, 16 with exercise-induced ST-segment elevation in infarct-related leads. Patients were evaluated by treadmill exercise testing, coronary angiography and ventriculography, thallium-201 tomographic scintigraphy and radionuclide ventriculography within 3 months of the first myocardial infarction. Sixteen patients (group I) had exercise-induced ST segment elevation and 20 (group II) postexercise inversion, no change or pseudonormalization of the T wave in infarct-related leads. The study showed no difference in infarct-related artery, vessel disease or luminal diameter stenosis in groups I and II. The overall agreement between ST shifts and myocardial perfusion in the infarct area was 30.56% with a κ coefficient of –0.33 (p = NS). The overall agreement between ST shifts and wall motion abnormalities was 69.44% with a κ coefficient of 0.39 (p < 0.01), stress-induced ST-segment elevation being associated with severe wall contractile disorders in 85% of the patients. In conclusion stress-induced ST-segment elevation in Q wave leads, although not a marker of wall motion abnormalities, is associated with akinesia or dyskinesia of the left ventricular wall.
Serum Levels of Circulating Adhesion Molecules after Coronary Angioplasty
Authors: Inoue Teruo , Hoshi Kazuhiro , Yaguchi Isao , Iwasaki Yoichi , Takayanagi Kan , Morooka Shigenori
Published: April 2003

The activation of platelets, leukocytes, and vascular endothelial cells mediated by cell adhesion molecules may play a role in the mechanism of restenosis, which is still a significant complication after coronary angioplasty. We observed serial changes in the circulating soluble forms of adhesion molecules in 25 patients with coronary artery disease who underwent coronary angioplasty for a single lesion of the left anterior descending artery. Serum levels of sICAM-1 (p < 0.05) and sP-selectin (p < 0.05) were significantly increased immediately after angioplasty in the coronary sinus blood samples. These increases continued during the 48-hour observation period, and the maximum increase was seen 48 h after angioplasty for sICAM-1 (p < 0.01) and 24 h after angioplasty for sP-selectin (p < 0.01). The level of sL-selectin increased 24 h (p < 0.01) and 48 h (p < 0.001) after angioplasty. These changes were not observed in the peripheral blood samples. The sE-selectin level did not change after angioplasty. A multiple regression analysis showed that the late loss index obtained from quantitative angiographic (QCA) analysis was correlated with the changes in sICAM-1 (r = 0.31, p < 0.05), sL-selectin (r = 0.28, p < 0.05), and sP-selectin (r = 0.26, p < 0.05) 48 h after angioplasty in the coronary sinus blood samples, but was not correlated with procedural variables, other QCA variables, or the change in the sL-selectin level. The measurements of these adhesion molecule levels may help to evaluate traumatic vessel wall injury and inflammation at the intervention site after coronary angioplasty.
Thrombolytic Therapy with Streptokinase and Tissue Plasminogen Activator in a Patient with Suspected Acute Myocardial Infarction: A Decision Analysis
Authors: Hiatt Mark D.
Published: April 2003

Two commonly used thrombolytic agents are streptokinase (SK) and tissue plasminogen activator (t-PA), which have different impacts on the incidence of mortality and thrombolysis-related acute intracranial hemorrhage. A decision-analytic model was developed to compare the use of SK and t-PA in the treatment of a patient with suspected acute myocardial infarction (AMI). The outcome was health-related quality of life as quantified in a measure of utility from the patient’s point of view. The model included three outcome states: death, nonfatal yet disabling stroke, and survival with no disabling stroke. The utility for disabling stroke was determined relative to the reference states of no disabling stroke (1.00) and death (0.00) by means of the time trade-off estimation technique. Probabilities were derived from the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Artery trial, which revealed that although administering t-PA results in a lower percentage of deaths compared to SK, it may lead to a higher percentage of strokes. A decision tree was constructed to model the options and outcomes. The tree was analyzed by standard decision analytic techniques using SMLTREE software, and the stability of the results was examined as values of parameters were varied systematically in a sensitivity analysis. In the baseline analysis, SK yielded 0.9235, whereas t-PA yielded 0.9329. The sensitivity analysis revealed that if the probability of a disabling stroke attributable to t-PA were greater than 2.08%, SK would yield the higher expected utility. This threshold value, however, was much greater than the probability established in major trials. The administration of t-PA leads to a slightly better outcome than does the administration of SK in a patient with suspected AMI.
Long-Term Survival after Development of Acute Myocardial Infarction Has Improved after a More Widespread Use of Thrombolysis and Aspirin
Authors: Herlitz Johan , Abrahamsson Putte , Dellborg Mikael , Karlson Björn W. , Karlsson Thomas , Lindqvist Jonny
Published: April 2003

We describe the mortality during the subsequent 5 years after development of acute myocardial infarction prior to and after the introduction of a more widespread use of thrombolytic agents and aspirin in the community of Göteborg. During period I, 4% received thrombolysis as compared with 32% during period II (p < 0.0001). The corresponding figures for prescription of aspirin at discharge were 14 and 84%, respectively (p < 0.0001). The overall 5-year mortality was 48% during period I and 46% during period II (p = 0.09). However, the age-adjusted mortality during period II was significantly reduced (risk ratio 0.86; 95% confidence interval 0.78–0.95; p = 0.004). There was no significant interaction between improvement in survival and sex or any other parameter reflecting patients’ clinical history.