Microembolizatoins during heart surgery under extracorporeal circulation

OBJECTIVE: By means of transcranial Doppler sonography (TCD), microembolic signals (MES) representing embolic events can be registered during cardiac surgery and extracorporeal circulation in a considerable number of patients. We conducted the present study to determine the neuro-psychiatric consequences of MES. METHODS: 25 patients scheduled for elective aorto-coronary bypass grafting (ACBG; n = 10) or aortic valve replacement (AVR; n = 15) were studied pre- and postoperatively with neuropsychiatric testing. Results were related to the number of MES noted intraoperatively. In addition, we registered the intraoperative changes of middle cerebral artery blood flow velocity, mean arterial pressure, arterial blood gases, haemoglobin and haematocrit. Statistics included t-test, two-way analysis of variance, Mann-Whitney-U-test and Spearman correlation with p < 0.05 considered significant. RESULTS: Regarding demographic data and intraoperative parameters, both study groups (ACBG vs. AVR) were comparable except for age. AVR patients showed significantly more MES than those undergoing ACBG (p < 0.012) which was most pronounced in the late state of surgery (aortic clamp off; p < 0.0003). However, MES counts did not correlate with neuropsychiatric test results. CONCLUSIONS: In contrast to recent reports, we were unable to show a deterioration of postoperative neuropsychiatric state related to high intraoperative MES count in our patients. Future TCD studies should focus on the differentiation between gaseous emboli and particles even in the clinical setting, as the latter may well play a major role for the development of cerebral dysfunction following cardiac surgery and extracorporeal circulation.     

31P magnetic resonance spectroscopy in the frontal lobe of major depressed patients

Most research with 31P-magnetic resonance spectroscopy (31P-MRS) in affective disorders has been done in the field of bipolar disturbances. Reduced frontal and temporal lobe phosphomonoester (PME) concentrations were measured in the euthymic state, whereas increased values were found in the depressed state. In bipolar-II patients reduced phosphocreatine (PCr) concentrations were reported in the euthymic, depressed, and manic state. The aim of the present study was to explore whether PME and PCr were also altered in the frontal lobe of major depressed, unipolar patients. Therefore, we used 31P-MRS to investigate the relative phospholipid and high-energy phosphate concentrations in the frontal lobe of 14 unipolar patients, mostly medicated, and 8 age-matched controls. We found increased PME and decreased ATP values. Other 31P-MRS parameters were not different in both groups. Phosphomonoester percentages correlated negatively with the degree of depression. Thus, the main alterations found in bipolar depressed patients could also be demonstrated in unipolar depressed patients. The results are discussed with regard to disturbed phospholipid and intracellular high-energy phosphate metabolism in depressed patients.     

The effects of triethanolamine myristate, a fatty acid salt, on the bioavailability of riboflavin in dogs

A study in dogs was performed in which a physiologic approach to delaying gastric emptying was examined. Triethanolamine myristate (a fatty acid salt) was used to delay gastric emptying in hopes of increasing the bioavailability of riboflavin. A bilayer tablet consisting of triethanolamine myristate and riboflavin resulted in an absolute bioavailability of 2-3 times greater than the bioavailability of riboflavin alone. Increases in bioavailability although to a lesser extent, were also seen with the 30 min pretreatment with triethanolamine myristate. The results suggest that it was possible to delay gastric emptying.     

Reduced HIV-1 infectability of CD4+ lymphocytes from exposed-uninfected individuals: association with low expression of CCR5 and high production of beta-chemokines

Escherichia coli leader peptidase, an integral membrane protein, is responsible for the cleavage of the signal sequence of many exported proteins. Recent studies suggest that it is a novel serine protease that utilizes a serine-lysine catalytic dyad. In an effort to further understand the mechanism of this enzyme, an internally quenched fluorescent peptide substrate incorporating the leader peptidase cleavage site of maltose binding protein signal peptide, Y(NO2)-F-S-A-S-A-L-A-K-I-K(Abz) (anthraniloyl), was designed and synthesized. In the intact peptide, the fluorescence of the anthraniloyl group is quenched by the 3-nitrotyrosine. This quenched fluorescence is liberated upon cleavage of the peptide by the leader peptidase, resulting in increased fluorescence that could then be monitored fluorometrically. The designed substrate can be cleaved effectively by E. coli leader peptidase as detected by both HPLC and fluorescent spectroscopy. Mass spectra of cleavage products demonstrated that the cleavage occurs at the predicted site (A-K). The cleavage of the peptide substrate has a linear dependence on the enzyme concentration (0.1 to 1.9 microM) and the kcat/K(m) was calculated to be 71.1 M-1 s-1. These data are comparable with the unmodified peptide substrate. This report represents the first direct continuous assay based on fluorescence resonance energy transfer for E. coli leader peptidase.     

Inhibition of hemopoiesis in vitro by neuroblastoma-derived gangliosides

Hemopoiesis is disturbed in bone marrow-involving cancers like leukemia and neuroblastoma. Shedding of gangliosides by tumor cells may contribute to this tumor-induced bone marrow suppression. We studied in vitro the inhibitory effects of murine neuroblastoma cells (Neuro-2a and C1300) and their gangliosides on hemopoiesis using normal murine hemopoietic progenitor colony-forming assays. Transwell cultured neuroblastoma cells showed a dose-dependent inhibition on hemopoiesis, indicating that a soluble factor was responsible for this effect. Furthermore, the supernatant of Neuro-2a cultured cells inhibited hemopoietic proliferation and differentiation. To determine whether the inhibitory effect was indeed due to shed gangliosides and not, for instance, caused by cytokines, the effect of DL-threo-1 -phenyl-2-decanoylamino-3-morpholino-1-propanol (DL-PDMP) on Neuro-2a cells was studied. DL-PDMP is a potent inhibitor of glucosylceramide synthase, resulting in inhibition of the synthesis and shedding of gangliosides. The initially observed inhibitory effect of supernatant of Neuro-2a cells was abrogated by culturing these cells for 3 days in the presence of 10 microM DL-PDMP. Moreover, gangliosides isolated from Neuro-2a cell membranes inhibited hemopoietic growth. To determine whether the described phenomena in vitro are a reflection of bone marrow suppression occurring in vivo, gangliosides isolated from plasma of neuroblastoma patients were tested for their effects on human hemopoietic progenitor colony-forming assays. These human neuroblastoma-derived gangliosides inhibited normal erythropoiesis (colony-forming unit-erythroid/burst-forming unit-erythroid) and myelopoiesis (colony-forming unit-granulocyte/macrophage) to a higher extent compared with gangliosides isolated from control plasma. Altogether these results suggest that gangliosides shed by neuroblastoma cells inhibit hemopoiesis and may contribute to the observed bone marrow depression in neuroblastoma patients.     

Micromechanical models for the Brownian motion of hair cell stereocilia

Brownian motion of the hairs (stereocilia) of amphibian hair cells has been shown in experiments to be in the range of some nm. Our models of the Brownian motion of coupled harmonic oscillators with mechanical properties of stereocilia lead to similar displacements. Computer simulation shows that stochastic fluctuations enhance the encoding of low level acoustic signals. Stochastic resonance lowers the detection threshold of auditory signals to amplitudes one order of magnitude lower than that of the Brownian motion.     

Noniatrogenic esophageal trauma

Few guidelines are available with which to facilitate treatment in patients with noniatrogenic injuries of the esophagus. Early diagnosis and proper management are essential if a good outcome is to be expected. In an effort to define better the treatment of patients with penetrating and blunt injuries of the esophagus, we report our recent 5-year experience at an urban trauma center. From July 1988 to June 1993, nineteen patients with esophageal perforations from penetrating (18) and blunt (1) trauma were identified by our trauma registry. There was no mortality in this group of patients and morbidity was mostly due to associated injuries. Eleven cervical esophageal injuries were repaired. One cervical injury was treated by stopping oral intake and giving intravenous antibiotics. The neck was not drained in 10 of the surgical cases. In 1 patient a tracheoesophageal fistula developed, which later was repaired with a pectoralis muscle flap. Seven perforations were identified in the thoracic (2) and abdominal (5) portions of the esophagus. All were due to gunshot wounds. In 4 cases, a fundal wrap was used to reinforce the repairs. Postoperative contrast studies confirmed that all repairs were intact. We conclude that penetrating and blunt tears of the esophagus can be repaired safely with minimal mortality. Morbidity is usually from associated injuries such as to the spinal cord and trachea. When identified early, cervical esophageal injuries do not need to be drained routinely.     

Disruption of mesectodermal lineages by temporal misexpression of the Drosophila POU-domain transcription factor, drifter

The horizontal and vertical considerations that must be taken into account during the diagnosis and subsequent treatment of the dentally and skeletally compromised patient are discussed. The treatment planning and treatment of a difficult malocclusion that required comprehensive orthodontics with surgical intervention are presented.