Neurotrophin 3 is a mitogen for cultured neural crest cells

Neurotrophin 3 (NT-3) promotes the survival and induces neurite outgrowth from a subset of neural crest (NC) and placode-derived neurons. We now report that this growth factor regulates the proliferation of cultured NC progenitor cells grown in a serum-free defined medium. In cultures of somites containing NC cells at migratory stages, NT-3 promotes a 2- to 8.4-fold increase in the number of NC cells incorporating [3H]thymidine into nuclei and a 1.8- to 4.8-fold increase in NC cell number compared to controls without added factor. NT-3 also promoted, to a lesser extent, the proliferation of NC cells in homogeneous cultures established from NC clusters. In addition to its effect on NC cells, NT-3 was mitogenic to somite cells in the mixed NC/somite cultures. These data demonstrate that NT-3 can act directly on the NC cells. They also indicate that the response of NC cells to NT-3 may be modulated by the presence of somitic cells. We suggest that NT-3 may be one of the central nervous system-derived factors that mediate NC cell proliferation in vivo.

Electrosurgery in arthroscopy

Electrosurgery using high-frequency (HF) technique in arthroscopic operations has been used routinely in our hospital for 8 years. Main indications are meniscal resections, lateral release, plica cutting, and arthrolysis. The main instrument is a hook, which is insulated up to the tip and also cuts meniscal tissue. The cutting effect depends on the strength of the electrical current, the configuration of the hook-knife, and the cutting speed. The advantages of the electric knife over mechanical instruments are the ability to cut in all directions without resistance and easy manipulation within narrow joint spaces. Also, the necrotic depth of the meniscal cartilage is not excessive. Follow-up studies in 940 cases greater than 1 year after arthroscopic meniscal surgery did not show any significant difference in the results with or without use of the electric knife.

New protocols for DNA sequencing with dye terminators

We have developed a new two-step protocol for Taq cycle sequencing using the ABI dye terminators. First, linear PCR is used to extend a single sequencing primer in the absence of dye terminators. This nested set of polynucleotides as well as the original primer then serve as starting points for the cycled termination reactions. Using this method it is easily possible to generate dye terminator raw data with much improved signal intensity beyond 400 to 500 bp. We also present a quick and convenient method to remove excess of dye terminators by gel filtration using 24 mini columns fixed in a block of perspex.

Repair of tetralogy of Fallot in infancy. Effect of pulmonary artery size on outcome

The possible influence of small pulmonary artery size on the results following complete repair of tetralogy of Fallot has not been investigated in patients less than 1 year of age. We, therefore, reviewed our recent experience with infant repair to assess this. Between January 87 and October 90, repair was performed in 58 infants less than 1 year old (median, 6 months) with tetralogy of Fallot and pulmonary stenosis (n = 53) or pulmonary atresia without important aortopulmonary collaterals (n = 5). The McGoon ratio (diameter of the right pulmonary artery at the prebranching point plus that of the left divided by the diameter of the aorta at the diaphragm) by cineangiography (n = 48) was between 1.2 and 1.5 in 15 patients, 1.6 and 2.0 in 20, and greater than 2.0 in 13. Transannular patching was performed in 19 of the patients with pulmonary stenosis (36%). Muscle resection was avoided in 29 infants and was minimal in the remaining 29. A weak correlation, with considerable scatter, was found between the McGoon ratio and postrepair right ventricular/left ventricular pressure measured in the operating room (r = 0.4), and the relations were similar to those previously reported for children. Right ventricular/left ventricular pressure was 0.55 +/- 0.03 in infants with McGoon ratios of 1.2-1.5, 0.46 +/- 0.03 with ratios of 1.6-2.0, and 0.47 +/- 0.03 with ratios greater than 2.0 (p = 0.01). There were no hospital deaths, and the 3-year survivorship was 94%. Two infants underwent successful reoperation for residual right ventricular outflow tract obstruction. All other patients are free of significant hemodynamic residua.(ABSTRACT TRUNCATED AT 250 WORDS)

Neurotrophin-5: a novel neurotrophic factor that activates trk and trkB

In vertebrates, the formation and maintenance of neuronal connections are subject to regulation by multiple target-derived, diffusible (neurotrophic) factors. Here we describe the identification and characterization of a novel neurotrophic factor designated neurotrophin-5 (NT-5). NT-5 is structurally related to nerve growth factor and is expressed in embryonic as well as adult tissues. Recombinant NT-5 promotes the survival of peripheral sensory and sympathetic neurons and induces differentiation of the pheochromocytoma cell line PC12. NT-5 activates two trk-related tyrosine kinase receptors and shares these receptors with other neurotrophins. Activation of multiple receptors may permit a single neurotrophin to control target innervation by distinct neuronal populations. Receptor sharing could enable neurotrophic factors emanating from distinct targets to cooperate in regulating neurons with multiple connections.

[Transesophageal echocardiography during coronary bypass surgery]

The early diagnosis of intraoperative myocardial ischemia is important because such ischemia can lead to myocardial infarction. Clinical effectiveness of transesophageal echocardiography (TEE) was evaluated for detecting intraoperative myocardial ischemia and for observing the recovery of cardial motion at the end of cardiopulmonary bypass (CPB) in 20 patients who had undergone CABG. After endotracheal intubation, the TEE transducer was introduced into the esophagus to obtain a short axis cross-sectional view of the left ventricle at the level of the papillary muscles. Global LV function was assessed by measuring end-diastolic and end-systolic areas, which were calculated automatically, and the fractional area change (FAC). Regional endocardial wall motion was also analyzed by subdivision into four anatomical segments. The mean FACs were 48% after intubation, 47% after skin incision and 48% after sternotomy. Thereafter it increased significantly to 59% 30 minutes after CPB and 56% at the end of the operation. Thus, global LV function was improved significantly by revascularization. TEE could detect myocardial ischemia more sensitively than ECG. In 9 patients, FAC decreased significantly and new regional wall motion abnormality (RWMA) appeared around the time of sternotomy, but no ECG changes were detected. In another 7 patients, new RWMAs were detected without either a decrease in the FAC or ECG changes. It was found that myocardial ischemia took place more frequently before the initiation of CPB than expected. The recovery of left ventricular wall motion from cardioplegic arrest was able to be monitored visually during the period of weaning from CPB and the TEE could facilitated prompt and exact judgement of weaning from CPB.(ABSTRACT TRUNCATED AT 250 WORDS)

PCR walking from microdissection clone M54 identifies three exons from the human gene for the neural cell adhesion molecule L1 (CAM-L1)

Microdissection has proved to be a powerful tool in the construction of libraries from specific chromosome segments (11) which are poorly covered by existing RFLP markers. Microclones also represent starting points for finding genes of interest. However, their length (100 to 200 bp) can make their use as probes problematic and identifying them as coding sequence is difficult. We report here that microclones can be extended in vitro by a modified version of our original PCR walking method (10) which utilises oligo-cassettes and the solid phase biotin/streptavidin separation system. We have extended the microclone M54, derived by dissection from Xq27.2 to proximal Xq28 (12), in both directions for approximately 700 bp. Direct sequencing of these products revealed that M54 was located within an intron of the human gene encoding the neural cell adhesion molecule L1 (CAM-L1) which has been recently mapped to Xq28 (13). The extension of M54 also identified three exons of this gene. This information allowed subsequent amplification of a 2.4 kb cDNA molecule from fetal human brain mRNA which encodes most of human CAM-L1. Sequencing of this cDNA revealed a high degree of sequence conservation with the mouse homologue (14). This is the first description of extension of a human derived microclone by PCR mediated walking within total human genomic DNA. These results show that anonymous DNA sequences may be extended into coding or any sequence.

Primary structure and biological activity of human brain-derived neurotrophic factor

Brain-derived neurotrophic factor (BDNF) is a 27-kDa basic protein of noncovalently linked 13.5-kD subunits related to nerve growth factor and is produced by the central nervous system (CNS). BDNF has been shown to promote the survival of neurons located in or directly connected with the CNS and is likely to function in adjusting the cell number within neuronal populations to the need of this projection field. Here we describe the primary structure of a human BDNF cDNA, the biological activities of pure recombinant human BDNF, and the tissue distribution of rat BDNF. BDNF mRNA can be found in some peripheral tissues as well as in the CNS, and recombinant human BDNF is a potent neurotrophic factor for primary peripheral sensory neurons.

Intermediate-term effectiveness of balloon valvuloplasty for congenital aortic stenosis. A prospective follow-up study

BACKGROUND

Percutaneous balloon valvuloplasty has proven to be acutely effective in the treatment of congenital valvar aortic stenosis; however, the intermediate- and long-term effectiveness of the procedure remain to be documented.

METHODS AND RESULTS

To assess the intermediate-term effectiveness of balloon valvuloplasty, repeat catheterization was performed in 27 of 30 children 1.7 +/- 0.1 years after balloon valvuloplasty for congenital aortic stenosis (AS). In 33 children the peak AS gradient was reduced acutely by 55% from 77 +/- 4 to 35 +/- 3 mm Hg (p less than 0.001), and left ventricular systolic pressure was reduced from 176 +/- 4 to 138 +/- 4 mm Hg (p less than 0.001). Despite a technically adequate valvuloplasty procedure, three patients had inadequate relief of obstruction and required complex surgical intervention. Twenty-seven of the 30 patients available for late reevaluation (90%) enrolled in the follow-up study. The peak AS gradient remained significantly reduced compared with that present before valvuloplasty (29 +/- 3 versus 77 +/- 4 mm Hg, p less than 0.001). Furthermore, there was no difference in peak AS gradient at follow-up compared with that immediately after valvuloplasty. The greatest increase in gradient at reevaluation was 14 mm Hg. Twenty of 27 patients (74%) had no change in the degree of aortic insufficiency at follow-up compared with that present before valvuloplasty. At follow-up, 16 patients had no aortic insufficiency at all, and only two had moderate-to-severe (3-4+) insufficiency. Femoral artery injury was documented in four patients, three of whom were under 12 months of age at valvuloplasty.

CONCLUSIONS

Balloon aortic valvuloplasty provides safe and effective intermediate-term gradient relief without early restenosis in children and adolescents with congenital AS.

Characterization of Cobblestone mitral valve interstitial cells

Mitral valve interstitial cells (MVICs) are important in the structure and function of the valve. In a cell culture system that used explants to harvest MVICs, we found that after several passages, some of the cultures at confluence formed a monolayer of cobblestone-shaped cells (CB type). The rest of the cultures were, however, different, consisting of elongated cells (EL type) that formed overlapping orthogonal patterns. When compared with the MVICs-EL, cells from cultures of MVICs-CB were less adherent to a plastic substratum initially than were MVICs-EL and were more sensitive to trypsinization following culture for 3 to 7 days. Ultrastructurally, the cultures of MVICs-CB showed prominent Golgi's complexes and endoplasmic reticulum and fewer microfilaments when compared with those of MVICs-EL. Most strikingly, the CB cells contained much less alpha-smooth-muscle cell actin compared with that of EL cells. The MVICs-CB were not endothelial cells as they did not show the characteristic dense peripheral band that was present in endothelial cells in a confluent monolayer and showed only trace amounts of fluorescence when incubated with 1,1-dioctadecyl 1-3,3,3,3 tetramethyl-indocarbocyanine-percholate (Dil-)--acetylated low-density lipoprotein compared with large amounts of fluorescence with endothelial cells. Cells that were morphologically similar to MVICs-CB were present in the in vivo valve as well and also formed small islands of cells even in the primary cultures that grew out of the explant. The findings supported the hypothesis that MVICs-CB represent a distinct phenotype of the MVICs that is different from that of the MVICs-EL and is not that of either endothelial or medial smooth-muscle cells.

Chromosomal mapping of brain-derived neurotrophic factor and neurotrophin-3 genes in man and mouse

Brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NTF3) are two new members of the nerve growth factor gene family, which play important roles in the development and maintenance of the vertebrate nervous system. Here we describe the assignments of the BDNF and NTF3 gene loci to human and mouse chromosomes and discuss the evolutionary relationship of human chromosomes 11 and 12. BDNF has been mapped to human chromosome 11p15.5-p11.2 and to mouse chromosome 2, and NTF3 to human chromosome 12p and mouse chromosome 6.

Transesophageal echocardiographic monitoring during coronary artery bypass surgery

To demonstrate serial changes of left ventricular (LV) function during coronary artery bypass grafting surgery, transesophageal echocardiography (TEE) was used in 17 patients. The cross-sectional image of the left ventricle at the level of the papillary muscles was monitored, and was analyzed immediately in the operating room using a computer-assisted cine-memory function. Global LV function was evaluated by measuring LV end-diastolic and end-systolic area and computing the fractional area change (FAC). Segmental wall motion abnormalities (SWMA) were graded according to a scoring system. During the operative procedure before sternal closure, 5 patients showed SWMA with a simultaneous decrease in FAC to under 40%, and 9 patients showed SWMA without FAC depression. Two-thirds of new SWMA improved after myocardial revascularization. All 17 patients showed a change of interventricular septal movement at the end of the operation. FAC improved from a mean value (+/- SD) after intubation of 47.6 +/- 10.7% to a mean value after revascularization of 58.5 +/- 13.0% (p less than 0.05) and to a mean value at the end of the operation of 55.9 +/- 12.2% (p less than 0.05). Thus: 1) global and regional LV function improved immediately after myocardial revascularization with administration of inotropic agents; 2) a significant change of interventricular septal movement occurred after sternal closure; and 3) intraoperative TEE monitoring is a safe, simple, and effective method for evaluating LV global and regional function.

Acute hemodynamic effects of captopril in children with a congestive or restrictive cardiomyopathy

The acute hemodynamic effects of captopril were evaluated at cardiac catheterization in 16 children (age, 0.3-18 years) with cardiomyopathy. Twelve children had congestive cardiomyopathy, whereas four had restrictive cardiomyopathy. Hemodynamic measurements were obtained 30 and 60 minutes after the oral administration of captopril (0.5 mg/kg). Blood pressures were measured in the aorta, pulmonary artery, right atrium, and pulmonary capillary wedge position; cardiac outputs were measured by the thermodilution technique. Hemodynamic data could not be obtained after the administration of captopril in one child with congestive cardiomyopathy because of an immediate, severe hypotensive response. In 11 of 12 children with congestive cardiomyopathy, cardiac index increased by 22%, from 2.3 to 2.8 l/min/m2 (p less than 0.05), and stroke volume increased by 22%, from 23 to 28 ml/m2 (p less than 0.05). Systemic vascular resistance decreased from 32 to 21 units.m2 (p less than 0.01), but the mean aortic pressure did not change significantly. In contrast, four children with restrictive cardiomyopathy had no change in cardiac output after captopril, but there was a trend toward significant arterial hypotension (mean aortic pressure decreased from 78 to 59 mm Hg). Thus, captopril acutely reduced systemic vascular resistance and increased both cardiac output and stroke volume in children with congestive cardiomyopathy. In children with restrictive cardiomyopathy, however, captopril did not affect cardiac output, but it did decrease aortic pressure. These data indicate that captopril may benefit children with a congestive cardiomyopathy but that captopril probably should not be used in children with restrictive disease.

Formulation, nutritive value and sensory evaluation of a new weaning food based on sweet corn (Nutrimaiz) dehydrated pulp

The objective of the present work was to develop a formulation for complementary infant and child feeding employing linear programing as a mathematical model for optimization. High lysine/high tryptophan sweet corn pulp in the dehydrated form was used as the main ingredient. The restrictions imposed on the model were nutrient requirements, adequate protein/energy ratio and minimum cost. The formula derived by the computer (FC) matched the amino acid requirements, the protein/energy ratio (NDPCal%) and was rated high in laboratory tests in terms of sensory qualities. The cost determined for this formula was competitive in relation to commercial products used for the same purpose. Formula A, which contained 5% more sweet corn pulp and 10% less whole powdered milk, did not differ in nutritional, sensorial and functional properties from the formula FC and was chosen for the field acceptability trial because of its lower cost. Formula A had protein efficiency ratio and Biological Value similar to casein for the rat but protein digestibility and net protein utilization were statistically lower (p less than 0.05) for formula A than for casein. Acceptability tested on children who were 8-18 months of age ranged from 80-90%, average value 87%.

Longitudinal results after first-stage palliation for hypoplastic left heart syndrome

To evaluate the results of palliative surgery for hypoplastic left heart syndrome, we reviewed the records of 57 infants who underwent first-stage reconstruction at our institution between July 1983 and April 1989. Of the 57 infants, 12 (21%) are long-term survivors and 45 (79%) have died. Thirty-one infants died within the first 30 days after surgery. Twenty-six of the 31 early deaths occurred within the first 24 hours after surgery. Causes of early mortality were low cardiac output (23), sepsis (two), sudden death (two), pulmonary vein atresia (three), and cardiac transplant (one). Late death occurred in 14 infants due to sepsis (three), sudden death (four), and death at reoperation (seven - three after Fontan procedure, three after shunt replacement, and one after transplant). Of the 31 patients who survived more than 24 hours, the complications noted by echocardiography and confirmed by catheterization when reoperation was indicated were significant arch obstruction (13%), branch pulmonary artery stenosis (23%), small atrial septal defect (16%), inadequate shunt (26%), neoaortic regurgitation (13%), tricuspid regurgitation (13%), ventricular dysfunction (29%), thrombus (6%), and superior vena cava obstruction (3%). Of the 31 patients who survived more than 24 hours, 16 additional palliative surgical procedures were performed in eight patients. These procedures included arch reconstruction (four), additional shunt (four), Glenn shunt (three), atrial septectomy (two), coarctation balloon angioplasty (two), and pulmonary artery reconstruction and reshunting (one). Of the 12 long-term survivors, four have had a successful Fontan procedure, one has had a transplant, and seven are awaiting a second-stage procedure. Thus, 69% of all deaths occurred within the first 30 days of surgery, and 58% of all deaths occurred within the first 24 hours due to cardiovascular collapse.(ABSTRACT TRUNCATED AT 250 WORDS)

Vaccine protection of rhesus macaques against simian immunodeficiency virus infection

Rhesus macaques (Macaca mulatta) immunized with an inactivated whole SIVmac vaccine and muramyl dipeptide (MDP), incomplete Freund's adjuvant (IFA), or aqueous suspension were challenged intravenously with 0.1 TCID50 of cell-free SIVmac. Whereas virus was readily recovered from the peripheral blood lymphocytes of 10 of 10 nonvaccinated controls following this challenge dose, virus was not recovered from the three animals that received the vaccine with MDP nor from one of two animals that received the vaccine with IFA and one of three animals that received the aqueous vaccine. The animals that were protected against challenge were those that had detectable SIV antibody response to the envelop, both the outer glycoprotein (gp120) and the truncated transmembrane glycoprotein (gp31). Protected monkeys tended to have higher titers of syncytial inhibition antibody prior to challenge. An anamnestic response after challenge was observed only in the vaccinated monkeys that became infected. Vaccinated animals that became challenge-infected tended to live longer than infected controls. These results confirm those at two other primate centers and indicate that killed whole SIV vaccines can protect against low challenge doses of SIV and prevent early death in those monkeys that do become infected. The mechanism of this protection remains undetermined. This finding adds optimism to the possibility of an eventual AIDS vaccine.

Widespread expression of BDNF but not NT3 by target areas of basal forebrain cholinergic neurons

Brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT3) are homologs of the well-known neurotrophic factor nerve growth factor. The three members of this family display distinct patterns of target specificity. To examine the distribution in brain of messenger RNA for these molecules, in situ hybridization was performed. Cells hybridizing intensely to antisense BDNF probe were located throughout the major targets of the rat basal forebrain cholinergic system, that is, the hippocampus, amygdala, and neocortex. Strongly hybridizing cells were also observed in structures associated with the olfactory system. The distribution of NT3 mRNA in forebrain was much more limited. Within the hippocampus, labeled cells were restricted to CA2, the most medial portion of CA1, and the dentate gyrus. In human hippocampus, cells expressing BDNF mRNA are distributed in a fashion similar to that observed in the rat. These findings point to both basal forebrain cholinergic cells and olfactory pathways as potential central targets for BDNF.

Shone's anomaly: operative results and late outcome

Shone's anomaly, a congenital cardiac malformation, consists of multiple levels of left heart obstruction including supravalvar mitral ring, parachute mitral valve, subaortic stenosis, and coarctation. The prognosis for patients with Shone's anomaly is poor. To assess operative results and late outcome, we reviewed the records of 30 consecutive patients seen with Shone's anomaly at our institution between 1966 and 1989. Anatomical diagnoses in these patients were supravalvar mitral ring (22 patients), mitral valve abnormalities including parachute mitral valve, fused chordae, or single papillary muscle (26 patients), subaortic gradients (26 patients), and coarctation (29 patients). Nineteen patients had all four lesions. Other common defects were bicuspid aortic valve (19 patients) and ventricular septal defect (20). Two patients were treated medically. The other 28 patients required 84 operative procedures with 18 patients undergoing more than one procedure. Operations included coarctation repair (28 patients), mitral valve repair or replacement (11), ventricular septal defect closure (8), subaortic resection (8), and complex left ventricular outflow tract reconstruction or bypass (4). Age at first operation ranged from 7 days to 7 years (median age, 3 months). There were no operative deaths at the first operation. However, mortality rose to 24% (4/17) after the second operation. All operative deaths were secondary to severe mitral valve disease. The survivors have been followed from 1 to 16 years (mean follow-up, 6 +/- 1 years). There were no late or sudden deaths. Morbidity has included stroke (1), gastrointestinal bleeding (2), permanent heart block (1), and persistent congestive heart failure (6).(ABSTRACT TRUNCATED AT 250 WORDS)

Genomic walking and sequencing by oligo-cassette mediated polymerase chain reaction

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Primary structure and biological activity of a novel human neurotrophic factor

During development, each tissue receives and maintains a number of specific neuronal projections that are adequate to sustain its function. The mechanism by which this intricate process occurs is not well understood, but it has been proposed that diffusible neurotrophic factors derived from the target tissue may be involved. Here we describe the identification of a novel human protein that is important for the growth, differentiation, and survival of primary sympathetic and placode-derived sensory neurons. This polypeptide, designated neuronotrophin-3, has a broad tissue distribution and is structurally related to both nerve growth factor and brain-derived neurotrophic factor. Its unique range of trophic and differentiation-inducing activities suggests that it is likely to play a wide role in defining the fate and function of nerve cells during development.