The P300 component of the auditory evoked potential in the posttraumatic vegetative state

The dynamic studies of P300 component of the acoustic evoked potential were conducted in 12 patients in posttraumatic state of the autonomic system. The amplitude and time parameters of P300 were analyzed, its spatial distribution over the cortex, and features of generation. The obtained results were compared with the normative data. Significant changes in P300 in comparison with the normal characteristics were revealed in patients with the absence of conscious mental activity. These changes were maximally expressed when the state of patients was irreversible. In case of patients' outcome from the studied state the amplitude-temporal and topographic response characteristics tended to normalization but did not reach it completely. The obtained results allow us to consider the P300 component as one of the most informative indices in consciousness recovery after severe brain injury.     

Synthesis of latices with hydrophobic cores and poly(vinyl acetate) shells. 2. Use of poly(vinyl acetate) seeds

A strategy is explored for synthesizing latex particles with polystyrene cores and poly(vinyl acetate) shells. The seed particles are poly(vinyl acetate), which theory indicates should be immune to secondary particle formation when a second-stage seeded emulsion polymerization with styrene is carried out. The objective is to form a single hydrophobic core by inversion of the second and first stages. While this morphology is favoured thermodynamically, conditions need to be optimized so that it is kinetically achievable: many attempts to implement this using straightforward synthetic procedures result in either no core (acorn morphology) or multiple polystyrene cores. A series of experiments enables this goal to be implemented by ensuring sufficiently fast diffusion of the first-stage hydrophilic polymer (using chain-transfer agent to reduce the molecular weight and, more importantly, the degree of branching of the parent poly(vinyl acetate) seed polymer), an initiator which minimized grafting between the first- and second-stage polymers, and modifying the seed poly(vinyl acetate) to increase its hydrophilicity.     

Vascular protection with newer antihypertensive agents

ROLE OF CALCIUM: Alterations in the structure and function of small arteries may contribute to elevated blood pressure in patients with essential hypertension and the cardiovascular complications of this disease. Angiotensin II, endothelin 1, and other peptides, as well as catecholamines, may contribute to the altered structure and function of small arteries, in part through their effects on intracellular calcium. Intracellular calcium is implicated in signal transduction pathways that result in smooth muscle cell growth and contraction and in the release of endothelium-dependent agents involved in the regulation of vascular function. VASCULAR EFFECTS OF NEWER ANTIHYPERTENSIVE AGENTS: The newer antihypertensive agents that affect intracellular calcium pathways either directly or indirectly, such as calcium antagonists or angiotensin converting enzyme (ACE) inhibitors, may exert vascular protective effects, partly by regressing vascular remodeling and by correcting endothelial dysfunction. A double-blind trial comparing the effects of the ACE inhibitor cilazapril and the beta-blocker atenolol on media: lumen ratio of small gluteal subcutaneous arteries, which was significantly higher in hypertensive patients before treatment than in normotensive subjects, was corrected after treatment with cilazapril. In contrast, no improvement was seen in the media: lumen ratio of small arteries in the patients receiving atenolol, even after 2 years of treatment. In another study, treatment with the intrinsically long-acting calcium antagonist amlodipine resulted in a reduction in forearm minimal vascular resistance. Patients treated with amlodipine also showed normalized responses of forearm blood flow to nitric oxide synthase inhibition. Furthermore, patients treated with a slow-release formulation of nifedipine exhibited normal media: lumen ratio of small arteries and normal endothelium-dependent relaxation. CONCLUSIONS: These findings appear very promising; however, it remains to be demonstrated whether the apparently beneficial effects of treatment with long-acting calcium antagonists and ACE inhibitors will lead to reductions in the cardiovascular morbidity and mortality associated with hypertension.     

Combined oral positive inotropic and beta-blocker therapy for treatment of refractory class IV heart failure

OBJECTIVES: We sought to assess the effects of combined oral positive inotropic and beta-blocker therapy in patients with severe heart failure. BACKGROUND: Patients with severe, class IV heart failure who receive standard medical therapy exhibit a 1-year mortality rate >50%. Moreover, such patients generally do not tolerate beta-blockade, a promising new therapy for chronic heart failure. Positive inotropes, including phosphodiesterase inhibitors, are associated with increased mortality when administered over the long term in these patients. The addition of a beta-blocker to positive inotropic therapy might attenuate this adverse effect, although long-term oral inotropic therapy might serve as a bridge to beta-blockade. METHODS: Thirty patients with severe heart failure (left ventricular ejection fraction [LVEF] 17.2+/-1.2%, cardiac index 1.6+/-0.1 liter/min per m2) were treated with the combination of oral enoximone (a phosphodiesterase inhibitor) and oral metoprolol at two institutions. Enoximone was given at a dose of < or = 1 mg/kg body weight three times a day. After clinical stabilization, metoprolol was initiated at 6.25 mg twice a day and slowly titrated up to a target dose of 100 to 200 mg/day. RESULTS: Ninety-six percent of the patients tolerated enoximone, whereas 80% tolerated the addition of metoprolol. The mean duration of combination therapy was 9.4+/-1.8 months. The mean length of follow-up was 20.9+/-3.9 months. Of the 23 patients receiving the combination therapy, 48% were weaned off enoximone over the long term. The LVEF increased significantly, from 17.7+/-1.6% to 27.6+/-3.4% (p=0.01), whereas the New York Heart Association functional class improved from 4+/-0 to 2.8+/-0.1 (p=0.0001). The number of hospital admissions tended to decrease during therapy (p=0.06). The estimated probability of survival at 1 year was 81+/-9%. Heart transplantation was performed successfully in nine patients (30%). CONCLUSIONS: Combination therapy with a positive inotrope and a beta-blocker appears to be useful in the treatment of severe, class IV heart failure. It may be used as a palliative measure when transplantation is not an option or as a bridge to heart transplantation. Further study of this form of combined therapy is warranted.     

Root stimulation studies in the evaluation of patients with motor neuron disease

Nerve root stimulation may be employed in patients with motor neuron disease (MND) to rule out motor neuropathy with conduction block. The diagnostic utility of these studies is unknown, in part because the range of amplitude changes across nerve root segments in patients with active neuronal degeneration has not been well studied. We reviewed root stimulation studies in 32 patients (59 nerves) with MND and found segmental amplitude reduction from 0 to 45%, a range similar to values reported for normal subjects; there was no suggestion of conduction block based on our usual criteria.     

ETA and ETB receptors on vascular smooth muscle cells from mesenteric vessels of spontaneously hypertensive rats

1. To investigate the contribution of ETA and ETB receptors, calcium responses to the ETB agonist, IRL-1620, to endothelin-1 (ET-1) and to the ETA antagonist, BQ-123, were examined in primary cultured unpassaged vascular smooth muscle cells (VSMC) from mesenteric vessels of 3, 9 and 17 week old spontaneously hypertensive rats (SHR), Wistar and Wistar-Kyoto (WKY) rats using Fura-2 methodology. 2. IRL-1620 (10(-7) mol/L) and ET-1 (10(-9) mol/L) increased [Ca2+]i in all strains and ages. Responses to ET-1 and IRL-1620 were blunted in 17 week SHR. BQ-123 significantly reduced ET-1-stimulated [Ca2+]i. In endothelium-denuded mesenteric vessels, ET-1 and IRL-1620 induced significant [Ca2+]i responses. 3. Binding of ET-1 was significantly lower in mesenteric artery membranes from 17 week SHR compared to controls. 4. Thus, ETA and ETB receptors are present in rat mesenteric VSMC. In adult SHR, a reduced density of ET receptors results in decreased responses to IRL-1620 and to ET-1.     

The activity of the high-affinity K+ uptake system Kdp sensitizes cells of Escherichia coli to methylglyoxal

Expression of the Kdp system sensitizes cells to methylglyoxal (MG) whether this electrophile is added externally or is synthesized endogenously. The basis of this enhanced sensitivity is the maintenance of a higher cytoplasmic pH (pHi) in cells expressing Kdp. In such cells, MG elicits rapid cytoplasmic acidification via KefB and KefC, but the steady-state pHi attained is still too high to confer protection Lowering pHi further by incubation with acetate increases the sensitivity of cells to MG.