Headache as a surrogate marker of the molecular mechanisms implicated in progressing stroke

The mechanism for headache in patients with acute ischaemic stroke are not completely understood. We analysed the relationship between headache and the early worsening of neurological symptoms in patients with acute ischaemic stroke, and we studied the possible biochemical mechanisms implicated. Headache at the onset of ischaemic stroke predicted progression with a sensitivity, specificity, and positive predictive value of 56%, 99%, and 98%, respectively. CSF concentrations of glutamate, Interleukin-6, and NO-m were significantly greater in patients with progressing stroke than in patients with nonprogressing stroke, and these biochemical markers were also significantly higher in patients with headache than in those without headache. Results of this study suggest that headache at the onset of ischaemic stroke is an independent predictor of neurological worsening and we hypothesize that headache might be a surrogate marker of the molecular mechanisms involved in neurological worsening after acute stroke.

[Nasolacrimal stent: modifications to Ho-Young Song's technique]

PURPOSE

To introduce modifications to Song's technique in the treatment of nasolacrimal occlusion by means of a polyuretane stent.

MATERIAL AND METHOD

Thirty five polyuretane stents were placed under fluoroscopic guidance in 32 patients diagnosed with total and partial nasolacrimal occlusion.

CONCLUSION

Technical success rate was 90%. Sixteen right and nineteen left nasolacrimal systems were probed. The introduction of a guidewire through the lower punctum, the use of a Ritleng guide, a Crawford hook and ocular protectors are modifications of Song's procedure that may help in successfully performing this technique in a fast and easy way.

Effects of several flavonoids on the growth of B16F10 and SK-MEL-1 melanoma cell lines: relationship between structure and activity

Although flavonoids seem to be capable of acting at all stages of the carcinogenic process, little information is available on their action in melanoma cell lines. The aim of this study was to assess the response of B16F10 and SK-MEL-1 melanoma cell lines to treatment with six different flavonoids after 24 and 72 h of exposure and to relate the response to their structure. We then compared the findings with those for melphalan treatment. When cultures were treated for 24 h, only slight inhibition at the highest concentrations (25 and 50 microM) of tangeretin and luteolin were observed, whereas melphalan caused a dose-related inhibition of growth at all concentrations. Quercetin, hesperetin, 7,3'-dimethylhesperetin and eriodictyol did not produce any effect at 24 h on B16F10 or SK-MEL-1 cells, results which point to the low toxicity of flavonoids. After 72 h of exposure culture growth was inhibited by 7,3'-dimethylhesperetin at 50 microM, but lower concentrations had no effect. Tangeretin was the most effective of the flavonoids in inhibiting B16F10 and SK-MEL-1 cell growth, showing a clear dose-response curve after 72 h. These results suggest that the absence of the C2-C3 double bond on hydroxylated flavonoids results in a loss of effect on both the cell lines, while the higher activity of tangeretin compared with 7,3'-dimethylhesperetin suggests that the presence of at least three adjacent methoxyl groups confers a more potent antiproliferative effect.

[Guidelines for action and diagnosis in atherothrombosis in Spain: ADA Study (Action and Diagnosis in Atherothrombosis)]

OBJECTIVE

The ADA Study was designed to know the usual action guidelines in Spain for the diagnosis and treatment in a cohort of patients who had a recent atherothrombotic event.

PATIENTS AND METHODS

Cross-sectional, observational, multicenter epidemiologic study (294 hospitals) with a total of 3,512 patients enrolled. Patients had had an atherothrombotic event in the coronary or cerebral vascular territory in the previous month or were diagnosed of symptomatic peripheral arterial disease within the last 3 months. A total of 237 investigators (155 cardiologists, 113 neurologists, and 79 vascular surgeons) participated in the study.

RESULTS

54.9% of patients in the study had a previous atherothrombotic event. Of these, 63.1% were on antithrombotic therapy; after the second episode, 2.6% of patients were on no preventive therapy. A great disparity and an excessive number of diagnostic tests was found to confirm the diagnosis of the current atherothrombotic event, which is in contrast with a small percentage of patients who had exams performed to confirm or rule out the atherothrombotic involvement in other vascular territories.

CONCLUSIONS

An appropriate protocol should be established for the diagnosis and therapy of patients with the likelihood of having clinical manifestations due to an ahterothrombotic event.

New concept regarding chest pain due to hypoxia of the internal mammary arteries in more than 1,600 operated patients with cerebral thoracic neurovascular syndrome (CTNVS)

In this article we describe the role of compression of the vertebral, subclavian, internal mammary, internal carotid arteries, brachial plexus and coiling and kinking of the vertebral and basilar arteries, the faulty irrigation of blood supply and oxygen of the cerebellum and basal ganglia and other areas of the brain followed by metabolic processes. Among the effects are: a decrease in the secretion of dopamine at the level of the putamen, which produces the symptoms of symptomatic Parkinson's disease, chorea due to chronic transitory faulty blood supply and oxygen to the caudate nucleus, ballism by hypoxia at the level of sub-thalamic and thalamus nuclei and athetosis in the lenticular nucleus. This compression is caused by hypertrophy of the anterior scalenus muscles and the cervical ribs at the level of the vertebrae C6-C7; by the sternocleidomastoid at the level of the cervical atlas, by the pectoralis minor muscles and coiling and kinking of the vertebral, basilar and the internal carotid arteries. The decreased blood supply to the cerebellum and basal ganglia is the cause of the cerebral thoracic neuro vascular syndrome (CTNVS) and its neurological complications, among which are ipsilateral paralysis, symptomatic Parkinson's disease, functional Alzheimer's disease multiple sclerosis and others. We are presently engaged in genetic studies to widen our understanding of these illness.

[Spanish doctoral dissertations on anesthesiology and the scientific publications of their authors]

OBJECTIVES

To determine whether obtaining a doctorate is a factor that promotes the research careers of the authors. To analyze the dissemination of Spanish doctoral theses in anesthesiology by looking at the publications they generate.

MATERIAL AND METHODS

The TESEO data base was searched for theses on anesthesiology written between 1976 and June 2001. The Medline database was then searched for publications related to each author's thesis. The search identified papers related to each thesis as well as those in which the thesis director was a coauthor.

RESULTS

Two hundred twenty-eight theses (9.12 theses/year) were found. Twenty-four authors were not anesthesiologists. The universities of Barcelona (28), Valencia (24), Navarra (23), Autónoma de Barcelona (21), Complutense de Madrid (18) and Cádiz (18) accounted for most of the theses read. The doctoral degree recipients also co-authored 1,833 publications, as the first authors of 649 articles, of which 216 (33.3%) were published before the corresponding thesis was read. Only 127 articles were related to theses. Ninety-seven authors (42.5%) published no article as first author and 22 (9.6%) accomplished no publication as co-author. The thesis director was listed in 154 of the 228 theses in the TESEO database. In this subgroup, 39 doctoral thesis authors published 58 related articles, with the director included among the co-authors in 41 of them.

CONCLUSION

Spain produces few doctoral theses on anesthesiology. Most writers of doctoral theses do not publish the results in journals with international readerships. These findings call into question the efficacy of the doctoral thesis as a factor that promotes research.

Molecular signatures of brain injury after intracerebral hemorrhage

BACKGROUND

The mechanisms of cellular death in the tissue surrounding an intracerebral hemorrhage (ICH) are not defined.

OBJECTIVE

To investigate the relationship of markers of excitotoxicity and inflammation to brain injury after ICH.

METHODS

A total of 124 consecutive patients with spontaneous ICH admitted within 24 hours of stroke onset were prospectively investigated. The volumes of the initial ICH, peripheral edema on days 3 to 4, and the residual cavity at 3 months were measured on CT scan. Glutamate, cytokines, and adhesion molecules were measured in blood samples obtained on admission. Stroke severity and neurologic outcome were evaluated with the Canadian Stroke Scale.

RESULTS

Poor neurologic outcome at 3 months (Canadian Stroke Scale < 7) was observed in 53 patients (43%). Stroke severity and glutamate concentrations (by each increment of 10 micromol/L, odds ratio 1.23; 95% CI 1.09 to 1.41), but not the initial volume of ICH, were independent predictors of poor outcome. In the multiple linear regression analyses, tumor necrosis factor-alpha concentration was correlated (r = 0.83, p < 0.0001) with the volume of perihematoma edema, and glutamate concentrations were correlated (r = 0.78, p < 0.0001) with the volume of the residual cavity. These same results were observed when lobar (n = 58) and deep (n = 66) ICH were analyzed separately.

CONCLUSIONS

High plasma levels of proinflammatory molecules within 24 hours of intracerebral hemorrhage onset are correlated with the magnitude of the subsequent perihematoma brain edema, whereas poor neurologic outcome and the volume of the residual cavity are related to increased plasma glutamate concentrations.

Helicobacter pylori stimulates pepsinogen secretion from isolated human peptic cells

BACKGROUND

Different acid and peptic related gastroduodenal diseases are associated with both increased gastric secretion and Helicobacter pylori infection. Patients with H pylori associated gastritis or duodenal ulcer have increased serum pepsinogen levels which decrease after eradication. The mechanisms of H pylori induced gastric mucosal damage are not completely understood.

AIM

To determine the effects of H pylori on pepsinogen secretion from isolated human peptic cells.

METHODS

Dispersed human peptic cells were prepared from endoscopically obtained biopsy specimens after collagenase digestion, mechanical disruption, and density gradient centrifugation. H pylori was obtained from gastric biopsies (antrum and body), and cultured in non-selective and selective media. Isolates of H pylori were used at different concentrations (1 - 20 x 10(6) colony forming units (cfu)).

RESULTS

H pylori (10(6) - 2 x 10(7) cfu) increased basal pepsinogen secretion in a concentration dependent manner. This stimulus was not observed with Escherichia coli. The increased secretion was in addition to that observed with 0.1 mM histamine and 0.1 mM dibutyryl-cyclic adenosine monophosphate. However, H pylori did not affect either carbamylcholine (0.1-10 microM) or cholecystokinin (1 microM) stimulated pepsinogen secretion. Addition of the nitric oxide synthase inhibitor N(w)-monomethyl-L-arginine (1 mM) inhibited H pylori induced cGMP generation and pepsinogen secretion, which were also reduced in the absence of extracellular calcium. H pylori induced pepsinogen secretion was not affected by the absence/presence of the cagA gene.

CONCLUSIONS

H pylori increases pepsinogen secretion from human peptic cells through a calcium and nitric oxide mediated intracellular pathway. This effect is independent of the H pylori virulent cagA gene, and may be a mechanism of H pylori induced gastric mucosal damage.

Measurement of inclusive antiprotons from Au+Au collisions at square root of s(NN) = 130 GeV

We report the first measurement of inclusive antiproton production at midrapidity in Au+Au collisions at square root of s(NN) = 130 GeV by the STAR experiment at RHIC. The antiproton transverse mass distributions in the measured transverse momentum range of 0.25<p( perpendicular)<0.95 GeV/c are found to fall less steeply for more central collisions. The extrapolated antiproton rapidity density is found to scale approximately with the negative hadron multiplicity density.

d Macro and (3)He macro production in square root of s(NN) = 130 GeV Au+Au collisions

The first measurements of light antinucleus production in Au+Au collisions at the Relativistic Heavy-Ion Collider are reported. The observed production rates for d macro and (3)He macro are much larger than in lower energy nucleus-nucleus collisions. A coalescence model analysis of the yields indicates that there is little or no increase in the antinucleon freeze-out volume compared to collisions at CERN SPS energy. These analyses also indicate that the (3)He macro freeze-out volume is smaller than the d macro freeze-out volume.

Epidemiology of chronic daily headache

Daily or near-daily headache is a widespread problem in clinical practice. The general term of chronic daily headache (CDH) encompasses those primary headaches presenting more than 15 days per month and lasting more than 4 hours per day. CDH includes transformed migraine (TM), chronic tension-type headache (CTTH), new daily persistent headache (NDPH), and hemicrania continua (HC). Around 40% of patients attending a specialized headache clinic meet CDH diagnostic criteria, of which 80% are women. In these clinics about 60% of patients suffer from TM, 20% from CTTH, and 20% meet NDPH criteria. Most, some 80%, overuse symptomatic medications. One should be very cautious on extrapolating these numbers to the general population. CDH prevalence in the general population seems to be around 4% to 5% (up to 8% to 9% for women). Regarding the prevalence of CDH subtypes, NDPH is rare (0.1%), whereas the prevalence of TM (1.5% to 2%) and CTTH (2.5% to 3%) is clearly higher. In contrast to data from specialized clinics, only around a quarter of CDH subjects in the general population overuse analgesics; the prevalence of CDH subjects with analgesic overuse being 1.1% to 1.9% of the general population. Most of these patients with analgesic overuse are TM patients.

[Remifentanil or propofol for sedation in subarachnoid anesthesia. Effects on ventilation, hemodynamic stability and bispectral index]

OBJECTIVES

To compare depth of sedation, hemodynamic and respiratory effects, and bispectral index (BIS) in surgical patients under subarachnoid anesthesia with intravenous perfusion of 1 mg/kg/h of propofol or 3 microgram/kg/h of remifentanil or placebo.

PATIENTS AND METHOD

Fifty-one elective surgery patients were randomly assigned to one of 3 groups: propofol (n = 17), remifentanil (n = 17) or placebo (n = 17). We monitored ECG, blood pressure (BP), respiratory frequency (RF), oxygen saturation by pulse oximetry (SpO2), nasal end tidal carbon dioxide pressure (PETCO2), BIS and sedation on the Observer's Assessment of Alertness/Sedation scale (OAA/S). Five minutes after starting subarachnoid anesthesia, we initiated the assigned intravenous perfusion. Measurement of hemodynamic variables, BIS, PETCO2, RF and OAA/S score occurred at baseline, every 5 minutes during surgery and after withdrawal of sedation at intervals until recovery of baseline values.

RESULTS

Patient data and SpO2 were similar in the 3 groups. PETCO2, FR and OAA/S did not change significantly from baseline in the placebo group but were significantly different in the other groups. BIS was significantly lower in the propofol group than in either the remifentanil or the control group. Times to recovery were similar in the two sedation groups. Slight complications were observed in 35.3% patients in the propofol group, 53.3% in the remifentanil group and 7.7% in the placebo group; complications were mainly nausea, pruritus and hypoventilation in the remifentanil group and venous pain in the propofol group.

CONCLUSIONS

The sedation regimens used were safe and adequate. Propofol is associated with fewer complications than remifentanil.

T7 displayed peptides as targets for selecting peptide specific scFvs from M13 scFv display libraries

M13 scFv display libraries are frontline research tools due to the rapidity in which target binding scFv can be obtained. Simple modifications of the standard affinity selection and amplification protocol allow for multiple targets to be panned simultaneously. Target peptide or protein production can become the rate-limiting step in a high throughput approach to antibody selection. To overcome this obstacle and to save both time and money, we have displayed the target peptides on T7 phage particles. In this paper we demonstrate that these particles can be used directly to select peptide specific scFv. We have discovered that the selection is most efficient when a linker separates the display from the T7 coat protein and when a continuous subtraction is employed. We have used antibodies selected in this fashion to characterize target proteins in cell lysates, immuno-precipitations and immuno-histochemistry.

Neuroprotective effect of aspirin by inhibition of glutamate release after permanent focal cerebral ischaemia in rats

Aspirin reduces the size of infarcts after ischaemic stroke. Although this fact has been attributed to its anti-platelet actions, direct neuroprotective effects have also been reported. We have recently demonstrated that aspirin is neuroprotective by inhibiting glutamate release in 'in vitro' models of brain ischaemia, via an increase in ATP production. The present study was designed to determine whether the inhibition of glutamate release induced by aspirin might be protective in a whole-animal model of permanent focal brain ischaemia. Focal brain ischaemia was produced in male adult Fischer rats by occluding both the common carotid and middle cerebral arteries. Central and serum glutamate levels were determined at fixed intervals after occlusion. The animals were then killed and infarct volume was measured. Aspirin (30 mg/kg i.p. administered 2 h before the occlusion) produced a significant reduction in infarct volume, an effect that correlated with the inhibition caused by aspirin on ischaemia-induced increase in brain and serum glutamate concentrations after the onset of the ischaemia. Aspirin also inhibited ischaemia-induced decrease in brain ATP levels. Our present findings show a novel mechanism for the neuroprotective effects of aspirin, which takes place at concentrations in the anti-aggregant-analgesic range, useful in the management of patients with risk of ischaemic events.

Liver transplantation in a case of steatohepatitis and subacute hepatic failure after biliopancreatic diversion for morbid obesity

BACKGROUND

Biliopancreatic diversion (BPD) was designed to avoid the serious complications of jejunoileal bypass (steatohepatitis and hepatic failure). Although this is today considered a safe and effective procedure, a few reports of patients who developed steatohepatitis and subsequently died in hepatic failure exist.

METHODS

We report a morbidity obese patient who developed subacute hepatitis resulting in hepatic failure 1 year after BPD.

RESULTS

Because of irreversible liver failure the decision to perform a liver transplantation was made. The patient underwent emergency liver transplant and lengthening of the common limb. The course of liver transplantation and the patient's recovery were uneventful.

CONCLUSION

Severe liver disease may rarely follow BPD. Liver transplantation and lengthening of the common bowel may be performed to treat these patients.

Multiplicity distribution and spectra of negatively charged hadrons in Au+Au collisions at square root of (sNN) = 130 GeV

The minimum-bias multiplicity distribution and the transverse momentum and pseudorapidity distributions for central collisions have been measured for negative hadrons ( h(-)) in Au+Au interactions at square root of ([s(NN)]) = 130 GeV. The multiplicity density at midrapidity for the 5% most central interactions is dN(h(-))/d(eta)/(eta = 0) = 280+/-1(stat)+/-20(syst), an increase per participant of 38% relative to pp collisions at the same energy. The mean transverse momentum is 0.508+/-0.012 GeV/c and is larger than in central Pb+Pb collisions at lower energies. The scaling of the h(-) yield per participant is a strong function of p( perpendicular). The pseudorapidity distribution is almost constant within /eta/<1.

Pion Interferometry of square root of (s(NN)) =130 GeV Au + Au collisions at RHIC

Two-pion correlation functions in Au+Au collisions at square root of [s(NN)] = 130 GeV have been measured by the STAR (solenoidal tracker at RHIC) detector. The source size extracted by fitting the correlations grows with event multiplicity and decreases with transverse momentum. Anomalously large sizes or emission durations, which have been suggested as signals of quark-gluon plasma formation and rehadronization, are not observed. The Hanbury Brown-Twiss parameters display a weak energy dependence over a broad range in square root of [s(NN)].

Predictors of deteriorating cerebral infarct: role of inflammatory mechanisms. Would its early treatment be useful?

The development of neurological deterioration in the hours following the stroke onset occurs in somewhat more than 1 in 3 cerebral infarcts and is associated with an increase in morbidity and mortality. This early deterioration (0--48/72 h) entails the conversion of the ischemic penumbra area in an irreversible lesion, a process that is mediated as much by hemodynamic changes in the local cerebral circulation as by biochemical mechanisms. Late neurological deterioration (3--7 days) is more frequently associated with systemic causes. Knowledge of the various clinical, biochemical and imaging markers associated with neurological deterioration is consequently of fundamental importance. For their repercussion in clinical practice, we classify these predictors of deteriorating cerebral infarct into nonmodifiable, modifiable and possibly modifiable. The reduction in cerebral blood flow in a particular cerebral zone causes very early cerebral damage as a consequence of a significant liberation of neuroexcitatory amino acids, followed by an excessive entry of calcium into the interior of cells; this process causes lipid peroxidation, disintegration of the cellular membranes, nuclear destruction and neuronal death. Moreover, ischemia and posterior reperfusion induce an inflammatory response leading to further cellular destruction. It is therefore conceivable that therapeutic interventions aimed at decreasing proinflammatory cytokines and cell adhesion molecules might result in better outcome in this population.