Relation among stenosis severity, myocardial blood flow, and flow reserve in patients with coronary artery disease

BACKGROUND: Coronary arteriography is considered the "gold standard" for evaluating the severity of a coronary stenosis. Because the resistance to blood flow through a stenotic lesion depends on a number of lesion characteristics, the physiological significance of coronary lesions of intermediate severity is often difficult to determine from angiography alone. This study of patients with coronary artery disease seeks to determine the relation between myocardial blood flow and flow reserve measured by positron emission tomography (PET) and the percent area stenosis on quantitative coronary arteriography. METHODS AND RESULTS: We studied 28 subjects: 18 patients with coronary artery disease (66 +/- 8 years) and 10 age-matched healthy volunteers (64 +/- 13 years) with dynamic N-13 ammonia PET imaging at rest and after dipyridamole (0.56 mg/kg). The percent cross-sectional area stenosis was quantified on the coronary arteriograms as described by Brown et al. In the 18 patients, a total of 41 non-infarct-related coronary vessels were analyzed. Myocardial blood flows in normal regions of patients with coronary artery disease were not different than those in healthy volunteers, both at rest and after dipyridamole. As a result, the myocardial flow reserve was also similar in both groups (2.4 +/- 0.4 versus 2.6 +/- 0.7, respectively; P = NS). Quantitative PET estimates of hyperemic blood flow (r = .81, P < .00001), flow reserve (r = .78, P < .00001), and an index of the "minimal coronary resistance" (r = .78, P < .00001) were inversely and nonlinearly correlated with the percent area stenosis on angiography. Of note, PET estimates of myocardial flow reserve successfully differentiated coronary lesions of intermediate severity (50% to 70% and 70% to 90%; 2.4 +/- 0.4 versus 1.8 +/- 0.5, respectively; P = .04). CONCLUSIONS: In patients with coronary artery disease, non-invasive measurements of myocardial blood flow and flow reserve by PET are inversely and nonlinearly related to stenosis severity as defined by quantitative angiography. Importantly, coronary lesions of intermediate severity have a differential flow reserve that decreases as stenosis increases that can be detected noninvasively by PET, thus allowing better definition of the functional importance of known coronary stenosis.     

Obliterative angiopathy of placental stem villi (author''s transl)]

Fixed retinae of chick embryos and chicks of the first week after hatching were fractured and examined with the scanning electron microscope. The matrix cells of the retina proliferate up to the beginning of the second week. The migrating cells are oriented in cell cords. This columnar organizaion prevails up to the development of the plexiform layers formed as a consequence of the outgrowth of the dendritic and axonal cell processes. Special attention was paid to the differentiation of the ganglion, bipolar and receptor cells, and the radial fibers (Müller cells). Two main morphological patterns are significant for the organization of the retina during neurogenesis: a)the cell to cell contacts of migrating cells and b)the spatial arrangement of Müller cells which could provide guidelines for migration of neuronal elements.     

Fractionation of Crotalus durissus cumanensis venom by gel filtration

Serum lipid levels were determined in 30 children with kwashiorkor and in 30 healthy children of comparable age. The serum concentrations of unesterified and esterified cholesterol, albumin and the cholesterol esterifying activity (CEA) were also measured in children with kwashiorkor before treatment and after recovery. All serum lipid fractions were significantly lower in kwashiorkor than in the normal children. After treatment and recovery, serum lipid levels were comparable to those observed in normal children. There was also a significant increase in serum cholesterol esterifying activity (CEA) following recovery from kwashiorkor.     

Physical properties and chemical compositions of cytoplasmic and mitochondrial malate dehydrogenase from Physarum polycephalum

The malate dehydrogenase isoenzymes from Physarum polycephalum have been purified to homogeneity as confirmed by gel filtration chromatography, polyacrylamide gel disc electrophoresis and analytical ultracentrifugation. Certain physical and chemical parameters of the malate dehydrogenase isoenzymes reported here include sedimentation, molecular weight and subunit molecular weight. Most unique of the differences between the isoenzymes were the widely separate isoelectric points of 9.83 for mitochondrial malate dehydrogenase and 6.14 for the supernatant malate dehydrogenase. The amino acid analyses of each form were done revealing the isoenzymes were unquestionably unique proteins differing in the content of ten amino acids.     

Neuromuscular blocking effects of aminoglycoside antibiotics on fast- and slow-contracting muscles of the cat

The neuromuscular-blocking effects of neomycin, streptomycin, and gentamicin were examined in fast- and slow-twitch muscles of pentobarbital-anesthetized cats. These antibiotics were more effective in reducing indirectly stimulated contractions of the gastrocnemius muscle than of the ipsilateral soleus muscle in adult cats. Respiratory-depressant effects of these antibiotics were more closely associated temporally with effects on soleus than on gastrocnemius twitch. Neomycin was a more potent neuromuscular blocking agent in kittens greater than 7 weeks old than in kittens less than 6 weeks old. Calcium ions were more effective in antagonizing the effects of neomycin on gastrocnemius than on soleus twitch; however, neostigmine was more effective in antagonizing the effects of neomycin on soleus than on gastrocnemius twitch. These data indicate a difference in responsiveness of fast- and slow-twitch muscles (fast greater than slow) to the neuromuscular-blocking effects of aminoglycoside antibiotics, and suggest that this may be related to a difference in the predominance of pre- and postjunctional inhibitory actions of these agents in the 2 muscle types.     

The use of stable sulfur isotope labelling to elucidate sulfur metabolism by Clostridium pasteurianum

Seven babies with 100 cm or less remaining small bowel have been evaluated for evidence of gastric hyperacidity and/or hypergastrinemia. Two babies were also studied after feeding. No patient demonstrated hyperacidity or hypergastrinemia. This infant data is discussed in regards to reported contradictory data in adult studies.     

Salt-dependent renal effects of an angiotensin II antagonist in healthy subjects

This study was designed to evaluate in healthy volunteers the renal hemodynamic and tubular effects of the orally active angiotensin II receptor antagonist losartan (DuP 753 or MK 954). Losartan or a placebo was administered to 23 subjects maintained on a high-sodium (200 mmol/d) or a low-sodium (50 mmol/d) diet in a randomized, double-blind, crossover study. The two 6-day diet periods were separated by a 5-day washout period. On day 6, the subjects were water loaded, and blood pressure, renal hemodynamics, and urinary electrolyte excretion were measured for 6 hours after a single 100-mg oral dose of losartan (n = 16) or placebo (n = 7). Losartan induced no significant changes in blood pressure, glomerular filtration rate, or renal blood flow in these water-loaded subjects, whatever the sodium diet. In subjects on a low-salt diet, losartan markedly increased urinary sodium excretion from 115 +/- 9 to 207 +/- 21 mumol/min (P < .05). The fractional excretion of endogenous lithium was unchanged, suggesting no effect of losartan on the early proximal tubule in our experimental conditions. Losartan also increased urine flow rate (from 10.5 +/- 0.4 to 13.1 +/- 0.6 mL/min, P < .05); urinary potassium excretion (from 117 +/- 6.9 to 155 +/- 11 mumol/min); and the excretion of chloride, magnesium, calcium, and phosphate. In subjects on a high-salt diet, similar effects of losartan were observed, but the changes induced by the angiotensin II antagonist did not reach statistical significance. In addition, losartan demonstrated significant uricosuric properties with both sodium diets.(ABSTRACT TRUNCATED AT 250 WORDS)     

A Comparison of Residual Stress Development in Inertia Friction Welded Fine Grain and Coarse Grain Nickel-Base Superalloy

The effect of the base material microstructure on the development of residual stresses across the weld line in inertia friction welds (IFWs) of high-strength nickel-base superalloy RR1000 was studied using neutron diffraction. A comparison was carried out between tubular IFW specimens generated from RR1000 heat treated below (fine grain (FG) structure) and above (coarse grain (CG) structure) the γ′-solvus. Residual stresses were mapped in the as-welded (AW) condition and, after a postweld heat treatment (PWHT), optimized for maximum alloy strength. The highest tensile stresses were generally found in the hoop direction at the weld line near the inner diameter of the tubular-shaped specimens. A comparison between the residual stresses generated in FG and CG RR1000 suggests that the starting microstructure has little influence on the maximum residual stresses generated in the weld even though different levels of energy must be input to achieve a successful weld in each case. The residual stresses in the postweld heat treated samples were about 35 pct less than for the AW condition. Despite the fact that the high-temperature properties of the two parent microstructures are different, no significant differences in terms of stress relief were found between the FG and CG RR1000 IFWs. Since the actual weld microstructures of FG and CG RR1000 inertia welds are very similar, the results suggest that it is the weld microstructure and its associated high-temperature properties rather than the parent material that affects the overall weld stress distribution and its subsequent stress relief.     

T20 measurements for 1H(d

When cytochrome b5 is added to large unilamellar vesicles (LUVs) of 1-palmitoyl-2-oleoylphosphatidylcholine (POPC), it binds predominantly in a 'loose,' or transferable form. Prolonged incubation of 30 degrees C leads to insertion in the physiological 'tight,' nontransferable form, with a halftime for the loose --> tight conversion of approx. 9 days. In this study, the effect of cholesterol on the rate of tight insertion was determined. Tight binding was assayed by depleting the LUVs of loose cytochrome b5 with an excess of SUV acceptors and then separating the liposome populations by gel-filtration or velocity sedimentation. Incorporation of cholesterol into the LUVs was found to markedly increase the rate of tight insertion, even though cholesterol decreases the equilibrium binding constant and saturation level of protein binding. The effect is not a continuously increasing function of cholesterol content, but attains a maximum at 20-25% mol%, where the rate enhancement is approx. 10-fold over baseline. At higher cholesterol levels, the rate decreases, returning to baseline at 40 mol% cholesterol. These observations are highly unusual in that cholesterol generally decreases the membrane binding affinity and the permeability of solutes, and does so as a monotonic function of cholesterol concentration (above the liquid-crystalline phase transition of the phospholipids). It is suggested that tight insertion is enhanced by lipid-protein packing mismatches and by bilayer fluidity; the former increases monotonically with increasing cholesterol whereas the latter decreases monotonically. At 20-25 mol% cholesterol the optimum balance of these physical properties is obtained for tight insertion.