Results of revascularization in patients with severe left ventricular dysfunction

BACKGROUND

In patients with coronary artery disease and poor ventricular function (ejection fraction, < 20%), bypass grafting remains a surgical challenge. This study evaluates experience with isolated revascularization in such patients.

METHODS AND RESULTS

In 79 consecutive patients (69 men, 10 women; average age, 59 +/- 9 years), preoperative ejection fraction was 18 +/- 5%. Indications for surgery were congestive heart failure (CHF) in 5 of 79 patients (6%), CHF and angina in 19 (24%), angina in 41 (52%), ventricular arrhythmias (VAs) in 8 (10%), and critical anatomy in 6 (8%). Some patients had prior VAs (23 of 79; 29%) or mitral regurgitation (18; 23%) and required emergent surgery (25; 32%). At surgery, temperature mapping ensured adequate distribution of antegrade cold cardioplegia, with 3.6 +/- 0.7 grafts per patient, including left internal mammary artery graft in 60 of 79 (76%) and endarterectomy in 14 (18%). Hospital mortality was 3.8%. Perioperative support included intra-aortic balloon pump in 18 of 79 (23%) and drugs for VAs in 28 (35%). Morbidity included myocardial infarction in 2 of 79 (2.5%) and stroke in 2 (2.5%). During follow-up, there were 19 late deaths. Actuarial survival was 94%, 82%, and 68% at 1, 2, and 5 years, respectively, and was similar in patients with severe angina, CHF, mitral regurgitation, or VAs. Freedom from sudden death was 100%, 98%, and 91% at 1, 2, and 5 years, respectively. Among survivors, angina improved in 84% and heart failure improved in 26%.

CONCLUSIONS

These data support bypass graft surgery in patients with severe LV dysfunction. With careful cardioplegic techniques, hospital mortality was low (3.8%). Long-term survival is encouraging, with good relief of symptoms in most patients. Perioperative VAs are frequent but respond to medical treatment, with only 23% of patients discharged on antiarrhythmic drugs. Five-year freedom from sudden death is 91%, with only 3 late sudden deaths in this series.

Postinfarction ventricular septal rupture: repair by endocardial patch with infarct exclusion

A novel operative technique for postinfarction ventricular septal defect has been used in 44 consecutive patients. The operation consists of excluding rather than excising the infarcted septum and ventricular walls. This is accomplished by performance of a left ventriculotomy through the infarcted muscle and securing a glutaraldehyde-fixed bovine pericardium patch to the endocardium of the left ventricle all around the infarcted myocardium. The ventriculotomy is simply closed over the pericardial patch. There were 21 men and 23 women whose mean age was 69 +/- 7 years. Twenty-nine patients were in cardiogenic shock at the time of operation. All patients had Doppler echocardiography and coronary angiography before operation. All but two patients were operated on during the acute phase of the myocardial infarction. There were six operative deaths. Postoperative complications included renal failure in 10 patients and respiratory failure in 18. Severe right ventricular dysfunction was the only independent predictor of operative mortality. Patients have been followed up for a mean of 40 +/- 34 months. There have been six late deaths and three of these were because of cardiac problems. The actuarial survival at 6 years was 66% +/- 7%. Only one patient had a small residual ventricular septal defect. Late postoperative assessment of ventricular function by echocardiography revealed that most patients had normal or mild impairment of right ventricular function and mild or moderate impairment of left ventricular function. Repair of acute postinfarction ventricular septal defect by endocardial patch with infarct exclusion of the left ventricule probably avoids additional damage to the right ventricle, remodels the acutely infarcted left ventricle, and enhances survival.

PU.1 (Spi-1) and C/EBP alpha regulate expression of the granulocyte-macrophage colony-stimulating factor receptor alpha gene

Growth factor receptors play an important role in hematopoiesis. In order to further understand the mechanisms directing the expression of these key regulators of hematopoiesis, we initiated a study investigating the transcription factors activating the expression of the granulocyte-macrophage colony-stimulating factor (GM-CSF) receptor alpha gene. Here, we demonstrate that the human GM-CSF receptor alpha promoter directs reporter gene activity in a tissue-specific fashion in myelomonocytic cells, which correlates with its expression pattern as analyzed by reverse transcription PCR. The GM-CSF receptor alpha promoter contains an important functional site between positions -53 and -41 as identified by deletion analysis of reporter constructs. We show that the myeloid and B cell transcription factor PU.1 binds specifically to this site. Furthermore, we demonstrate that a CCAAT site located upstream of the PU.1 site between positions -70 and -54 is involved in positive-negative regulation of the GM-CSF receptor alpha promoter activity. C/EBP alpha is the major CCAAT/enhancer-binding protein (C/EBP) form binding to this site in nuclear extracts of U937 cells. Point mutations of either the PU.1 site or the C/EBP site that abolish the binding of the respective factors result in a significant decrease of GM-CSF receptor alpha promoter activity in myelomonocytic cells only. Furthermore, we demonstrate that in myeloid and B cell extracts, PU.1 forms a novel, specific, more slowly migrating complex (PU-SF) when binding the GM-CSF receptor alpha promoter PU.1 site. This is the first demonstration of a specific interaction with PU.1 on a myeloid PU.1 binding site. The novel complex is distinct from that described previously as binding to B cell enhancer sites and can be formed by addition of PU.1 to extracts from certain nonmyeloid cell types which do not express PU.1, including T cells and epithelial cells, but not from erythroid cells. Furthermore, we demonstrate that the PU-SF complex binds to PU.1 sites found on a number of myeloid promoters, and its formation requires an intact PU.1 site adjacent to a single-stranded region. Expression of PU.1 in nonmyeloid cells can activate the GM-CSF receptor alpha promoter. Deletion of the amino-terminal region of PU.1 results in a failure to form the PU-SF complex and in a concomitant loss of transactivation, suggesting that formation of the PU-SF complex is of functional importance for the activity of the GM-CSF receptor alpha promoter. Finally, we demonstrate that C/EBP alpha can also active the GM-CSF receptor alpha promoter in nonmyeloid cells. These results suggest that PU.1 and C/EBP alpha direct the cell-type-specific expression of GM-CSF receptor alpha, further establish the role of PU.1 as a key regulator of hematopoiesis, and point to C/EBP alpha as an additional important factor in this process.

Left ventricular function after mitral valve surgery

This study examined the effects of various operative procedures on the mitral valve of patients with mitral regurgitation due to degenerative disease of the mitral valve. A randomized clinical trial on the type of annuloplasty ring used at surgery revealed that early postoperative left ventricular systolic function was better in patients who had a flexible ring than in patients who had a rigid ring. Two years after surgery there were no differences between these groups and most patients were found to have fairly normal left ventricular function. The long term results of mitral valve repair in 184 patients revealed a 10-year actuarial survival of 86% +/- 6%. A randomized trial on the effect of preservation of chordae tendineae during mitral valve replacement revealed that the beneficial effect of this procedure on left ventricular function is a lasting one; five years after surgery patients who had mitral valve replacement with preservation of the chordae tendineae have better exercise capacity, and better left ventricular systolic function and performance. The long term results of mitral valve replacement in 154 patients revealed a 10-year actuarial survival of 69% +/- 5%. Logistic regression analysis indicated that age greater than 65 years and complete excision of the native mitral valve were predictors of late mortality. Of those patients, 70 had had chordal preservation during surgery and 84 did not. These two subgroups were remarkably similar preoperatively, but the 10-year actuarial survival was 80% +/- 6% for patients who had chordal preservation and 63% +/- 6% for those who did not. The mitral valve should be repaired whenever possible; if replacement is necessary it should be performed with preservation of the chordae tendineae.

An intron facilitates activation of the calspermin gene by the testis-specific transcription factor CREM tau

Calspermin is a high affinity Ca2+/calmodulin binding protein that is found only in postmeiotic male germ cells. Our previous studies have shown that the calspermin transcript is produced by utilization of a testis-specific promoter located within an intron of the calmodulin kinase IV gene. This promoter contains two cAMP response element-like motifs that bind the testis-specific transcription factor CREM tau. This interaction is required for transcriptional activation. Here we describe a novel regulatory element, the 111-base pair first intron of the calspermin gene, which is also required for enhancement of transcription by CREM tau via the cAMP response element motifs. Deletion or inversion of this intron results in loss of CREM tau-mediated stimulation of transcription. However, CREM tau stimulates calspermin promoter activity when the intron is moved upstream of the promoter but only when inserted in the proper orientation. Footprint, linker scanning, and deletion analyses were used to identify regulatory elements in the intron. We suggest that the intron functions as an orientation-dependent but position-independent regulatory element to activate the calspermin promoter by facilitating the stimulatory effect of CREM tau on transcription.

The Hancock II bioprosthesis at ten years

The Hancock II bioprosthesis was used for heart valve replacement in 843 patients from 1982 to 1993. Aortic valve replacement (AVR) was performed in 536 patients, mitral valve replacement (MVR) in 250, and aortic and mitral valve replacement (DVR) in 57. The mean age was 64 +/- 12 years. Before operation, 80% of the patients were in New York Heart Association functional class III or IV; approximately one-third of the patients had coronary artery disease, and 60 patients had ascending aorta aneurysm. There were 47 operative deaths (AVR, 4%; MVR, 7%; DVR, 10%) and 147 late deaths. Follow-up was complete in 98.6% of the patients and extended from 3 to 140 months (mean, 59 months). At the last follow-up, 84% of the patients were in New York Heart Association class I or II. The actuarial survival at 10 years was 63% +/- 4% for AVR, 55% +/- 5% for MVR, and 53% +/- 9% for DVR. At the end of 10 years, the freedom from thromboembolic complications was 80% +/- 4% for AVR, 88% +/- 3% for MVR, and 86% +/- 5% for DVR; the freedom from endocarditis was 95% +/- 2% for AVR, 96% +/- 1% for MVR, and 87% +/- 5% for DVR; the freedom from primary tissue failure was 92% +/- 3% for AVR, 81% +/- 6% for MVR, and 65% +/- 16% for DVR; and the freedom from reoperation was 89% +/- 2% for AVR, 81% +/- 6% for MVR, and 61% +/- 15% for DVR. The durability of this bioprosthetic valve was affected by the patient's age and by the position where it was implanted. The clinical results of the Hancock II bioprosthesis at 10 years are comparable to those of other current porcine and pericardial valves.

In vitro reaction of macrophages to metal ions from dental biomaterials

OBJECTIVES

This study was conducted to 1) measure the sensitivity of human and mouse macrophages to metal ions which are released from dental biomaterials, 2) compare these sensitivities with those of other cell types in the oral cavity, and 3) determine if metal ions alter the metabolism and synthetic processes of these cells at lower concentrations than are required to lyse the cells. This information will help define the biological risks associated with the release of metal ions into the oral cavity.

METHODS

Macrophages were exposed to a range of concentrations of Ag1+, Au3+, Cu2+, Hg2+, Ni2+, Pd2+, Pt4+, and Zn2+ for 24 h in cell culture. The concentrations which caused a 50% decrease in succinic dehydrogenase (SDH) activity, protein production, and lactate dehydrogenase (LDH) release were measured and compared with these values for fibroblasts and osteoblasts.

RESULTS

Most metal ions caused alteration in SDH activity and protein production at lower concentrations than were required to induce LDH release. There were exceptions to this trend, and the differences were not always statistically significant. Furthermore, although the macrophages sometimes had statistically different sensitivities to metal ions than fibroblasts or osteoblasts, these differences were less than one order of magnitude. Macrophage response to the metal ions was highly dependent on the metal ion and the species of macrophage.

SIGNIFICANCE

Macrophages react adversely to metal ions at similar concentrations as other cell types found in the oral cavity. Furthermore, the concentrations which affect cell metabolism and protein production are generally lower than those which lyse the cells. Thus, non-lethal concentrations of metal ions may alter the secretion of protein inflammatory mediators such as cytokines which direct the inflammatory response in tissues.

Follow up of patients after valvular surgery: mail vs. telephone

A study was undertaken to compare the results of patient follow up done by mail and by telephone. Using valve follow up questionnaires recently received by mail, 100 patients were randomly selected from this group for further follow up by telephone. Interviews were conducted while blinded to the mail response. Patients were questioned as to their functional status (NYHA), improvement as a result of surgery (IMP), incidence of reoperation (REOP) or bacterial endocarditis (SBE) and thromboembolic complications (TE). They were also asked whether they would prefer future follow up by mail or telephone. Analysis using the kappa coefficient and McNemar's test revealed a difference (p < 0.001) in NYHA when comparing mail and telephone responses but no difference in either IMP or TE. There was no incidence of REOP or SBE. Sixty-six percent of patients had no preference in type of future follow up and of the remaining 33%, two-thirds preferred to be contacted by phone. It appears that NYHA is significantly overestimated by the patient whereas the two methods of follow up are comparable when assessing IMP and TE. It should be noted, however, that patients seem to have difficulty in identifying the occurrence of TE and in differentiating between stroke and TIA.

The Role of Pea Chloroplast [alpha]-Glucosidase in Transitory Starch Degradation

Pea chloroplastic [alpha]-glucosidase (EC 3.2.1.20) involved in transitory starch degradation was purified to apparent homogeneity by ion exchange, reactive dye, hydroxylapatite, hydrophobic interaction, and gel filtration column chromatography. The native molecular mass and the subunit molecular mass were about 49.1 and 24.4 kD, respectively, suggesting that the enzyme is a homodimer. The enzyme had a Km of 7.18 mM for maltose. The enzyme's maximal activity at pH 7.0 and stability at pH 6.5 are compatible with the diurnal oscillations of the chloroplastic stromal pH and transitory starch accumulation. This pH modulation of the [alpha]-glucosidase's activity and stability is the only mechanism known to regulate starch degradative enzymes in leaves. Although the enzyme was specific for the [alpha]-D-glucose in the nonreducing end as the glycon, the aglycon moieties could be composed of a variety of groups. However, the hydrolysis rate was greatly influenced by the aglycon residues. Also, the enzyme could hydrolyze glucans in which carbon 1 of the glycon was linked to different carbon positions of the penultimate glucose residue. The ability of the [alpha]-glucosidase to hydrolyze [alpha]-1,2- and [alpha]-1,3-glucosidic bonds may be vital if these bonds exist in starch granules because they would be barriers to other starch degradative enzymes. This purified pea chloroplastic [alpha]-glucosidase was demonstrated to initiate attacks on native transitory chloroplastic starch granules.

[Protective effect of total flavonoids of radix Astragali on mammalian cell damage caused by hydroxyl radical]

The protective effect of total flavonoids of Radix Astragali (TFA) on V79 cell damage caused by H2O2-Fe2+ system has been studied. The results show that total flavonoids of Radix Astragali inhibit lipid peroxides and increase SOD activity. It has also been found that TFA has different protective effect against various damages of V79 cells caused by hydroxyl radical.

[The human fetal development time table of the major limb bones-ultrasonic bone age]

B-ultrasonic technique was used to examine 297 Chinese fetuses in normal pregnancy woman of completed week age from 12 to 38 weeks. The lengths of the major limb bones were measured and statistical analysis showed that the positive linear correlation between the development of fetuses' limb bones and the completed fetal age is significant.

Aberrant cell cycle inhibition pattern in human colon carcinoma cell lines after exposure to 5-fluorouracil

In this report, we describe the use of two human colon carcinoma cell lines, HCT-8 and HT-29, as potential models to study DNA- and RNA-directed cytotoxicity due to 5-fluorouracil (FUra) exposure by flow microfluorimetric analysis of DNA cell content. The sensitivity of the HT-29 line (EC50 = 0.9 microM) to FUra was somewhat greater than that of the HCT-8 line (EC50 = 4 microM), but each presented a dramatically different DNA histogram after exposure to FUra. In HCT-8, an unexpected and nearly complete disappearance of cells in S-phase occurred, whereas in HT-29 the expected accumulation of cells at the G1-S border was observed. The absence of HCT-8 cells in S-phase also occurred as a result of two RNA polymerase inhibitors: actinomycin D and dichloro-D-ribofuranosylbenzimidazole. However, an accumulation of cells in S-phase was observed in the presence of 5-fluorodeoxyuridine. These results suggest that in the HCT-8 cell line, FUra predominantly causes an RNA-related toxicity. By comparison, the rate of formation of 5-fluorodeoxyuridine monophosphate, the increased dUMP pool size, and low thymidylate synthase activity in the HT-29 line are consistent with its greater susceptibility to DNA-directed toxicity. Further evidence was seen in the prevention of FUra cytotoxicity by thymidine in HT-29, but not in HCT-8 cells. Similarly, Leucovorin synergized the action of FUra in HT-29 but not in HCT-8. Enzymatic correlates supporting these observations are seen in the greater activity of uridine kinase than thymidine kinase (20:1) in HCT-8 cells compared with that in HT-29 cells (4:1).

Identification and characterization of a functional promoter region in the human eosinophil IL-5 receptor alpha subunit gene

The molecular basis for the commitment of multipotential myeloid progenitors to the eosinophil lineage, and the transcriptional mechanisms by which eosinophil-specific genes are subsequently expressed and regulated during eosinophil development are currently unknown. Interleukin-5 (IL-5) is a T cell and mast cell-derived cytokine with actions restricted to the eosinophil and closely related basophil lineages in humans. The high affinity receptor for IL-5 (IL-5R) is composed of an alpha subunit (IL-5R alpha) expressed by the eosinophil lineage, that associates with a beta c subunit shared with the receptors for IL-3 and granulocyte-macrophage colony stimulating factor (GM-CSF). As a prerequisite to studies of the transcriptional regulation of the IL-5R alpha subunit gene, we used three different methods, including primer extension, RNase protection, and 5'-RACE to precisely map the transcriptional start site to a position 15 base pairs (bp) upstream of the 5' end of the published sequence of IL-5R alpha exon 1. To initially identify the IL-5R alpha promoter, 3.5 kilobases (kb) and 561 bp of the 5' sequence flanking the transcriptional start site were subcloned into the promoterless pXP2-luciferase vector. Transient transfection of these constructs into an eosinophil-committed HL-60 subline, clone HL-60-C15, induced the expression of approximately 240-fold greater luciferase activity than the promoterless vector, identifying a strong functionally active promoter region within the 561 bp of sequence proximal to the transcriptional start site and with activity equivalent to pXP2 constructs containing the entire 3.5 kb of upstream sequence. To more precisely localize the cis-acting regulatory elements in this region important for promoter activity, a series of 5' deletion mutants of the 561-bp region were generated in the pXP2-luciferase vector. Deletion of the region between bp -432 and -398 reduced promoter activity by more than 80% in the HL-60-C15 cell line. Further analyses of the activity of the IL-5R alpha promoter constructs in various other eosinophil, myeloid, and non-myeloid cell lines indicated that the promoter was relatively myeloid and eosinophil lineage-specific in its expression. Consensus sequences for known transcription factor binding sites were not present in the 34-bp region of the promoter required for maximal activity, suggesting unique myeloid- and possibly eosinophil-specific regulatory elements.(ABSTRACT TRUNCATED AT 400 WORDS)

Effect of renal denervation on elevation of blood pressure in cold-exposed rats

The objective of this experiment was to determine whether bilateral renal denervation (RD) prevents the elevation of blood pressure and cardiac hypertrophy characteristically induced by chronic exposure to cold. Four groups (nine male rats each) were used. The kidneys of two groups were bilaterally denervated, while the remaining two groups were sham operated. Systolic blood pressures of the four groups, measured indirectly from the tail, did not differ significantly during the control period and following RD. At this time, 1 RD and 1 sham-operated group was exposed to cold (5 degrees C, 41 degrees F). The remaining RD and sham-operated groups were kept at 25 degrees C. Blood pressure of the cold-exposed, sham-operated group increased significantly during the 1st week of cold exposure (125 +/- 2 mmHg; 1 mmHg = 133.3 Pa), and rose to 139 +/- 4 mmHg by the 5th week, whereas the blood pressure of the RD group exposed to cold remained at the control level (116 +/- 2 mmHg). Both RD and sham-operated cold-exposed groups developed cardiac hypertrophy with significantly increased resting heart rates compared with controls kept at 25 degrees C. Plasma renin activities and renal norepinephrine content of kidneys of both RD groups at 7 weeks after RD were significantly less than those of sham-operated controls, confirming that renal nerves had been severed. Thus, RD prevented the elevation of blood pressure induced by chronic exposure to cold but had no significant effect on cardiac hypertrophy.

Calspermin gene transcription is regulated by two cyclic AMP response elements contained in an alternative promoter in the calmodulin kinase IV gene

The transcript for the high-affinity Ca2+/calmodulin-binding protein calspermin is generated from the gene encoding Ca2+/calmodulin-dependent protein kinase IV only in postmeiotic germ cells during spermatogenesis. We demonstrate that this testis-specific calspermin transcript can be produced in heterologous cells by utilization of a promoter located in an intron of the calmodulin (CaM) kinase IV gene. Critical motifs within this promoter are two cyclic AMP response element (CRE)-like sequences located about -70 and -50 bp upstream of the transcriptional initiation site. Both CRE motifs are footprinted by the authentic testis-specific transcriptional activator CREM tau or by CREM tau present in adult testis nuclear extract. Whereas a 2.1-kb DNA fragment containing the calspermin promoter is inactive when transfected into NIH 3T3 cells, activity can be restored by cotransfection of CREM tau and protein kinase A or CaM kinase IV but not CaM kinase II alpha. Restoration of activity is greatly reduced by mutation of the two CRE motifs. Since CRE-like motifs have been identified in many genes uniquely expressed in postmeiotic germ cells, which contain abundant CREM tau protein, we suggest that CREM tau may function as one transcription factor responsible for the expression of postmeiotic germ cell-specific genes.

Effect of chronic treatment with prazosin and L-arginine on the elevation of blood pressure during cold exposure

Chronic exposure to cold (5 degrees C) is well known to increase both tyrosine hydroxylase (TH) activity in brown adipose tissue and systemic blood pressure. The effect of chronic dietary administration of the alpha-adrenergic antagonist, prazosin, and the amino acid, L-arginine, on both the elevation of blood pressure during exposure to cold and on TH activity and expression of TH mRNA in the adrenal glands of rats was studied. As observed previously, chronic exposure to cold increased systolic blood pressure significantly and induced cardiac hypertrophy. Chronic dietary treatment with prazosin (8 mg/kg food) and arginine (20 g/kg food) returned blood pressure to control levels, did not affect body weight significantly, but failed to prevent cardiac hypertrophy. Both prazosin and L-arginine reduced the drinking response to administration of angiotensin II. Treatment with arginine and prazosin was accompanied by a significant increase in the urinary outputs of dopamine and L-DOPA. The 3 cold-treated groups (control, L-arginine and prazosin) had increases in plasma T3 and decreases in plasma T4 and plasma renin activity. Plasma concentrations of epinephrine and norepinephrine were increased significantly in the L-arginine-treated group. TH mRNA and TH activity in the adrenal glands were increased in the 3 cold-treated groups and these measures were correlated directly and significantly with plasma norepinephrine and epinephrine concentrations. Although both prazosin and arginine prevented the cold-induced elevation of blood pressure, they did not prevent the increase in TH mRNA, TH activity or epinephrine in plasma. The protective effect of arginine and prazosin in cold-induced hypertension may be related both to their reduction in plasma renin activity and to a reduced responsiveness to angiotensin II, as well as to their abilities to increase the secretion of dopamine.

Aortic valve replacement with a stentless porcine aortic valve. A six-year experience

A stentless porcine aortic valve was used for aortic valve replacement in 123 patients from 1987 to 1993. The mean age of 86 men and 37 women was 61 +/- 12 years. Most patients had aortic stenosis; one-third had coronary artery disease and six had mitral valve disease. The stentless valve was secured in the subcoronary position by the same technique used for a freehand aortic valve homograft. The size of valve was based largely on the diameter of the sinotubular junction of the aortic root. The mean valve size was 26.5 mm (range 19 to 29 mm) and 87% were 25 mm or larger. Two operative deaths occurred, one the result of myocardial infarction and the other the result of infective endocarditis. Patients have been followed up from 3 to 77 months, mean 22 months. Three late deaths, none related to the valve, have occurred. The actuarial survival at 6 years was 91% +/- 4%. Four transient cerebral ischemic events have occurred, but two patients had extracranial cerebrovascular disease. One patient had endocarditis late in the postoperative period and required reoperation. All patients had Doppler echocardiographic studies before discharge from the hospital, 3 to 6 months later and annually. Only 15 patients have aortic insufficiency, trivial in 6 and mild in 9. The peak and mean systolic gradients decreased significantly during the first 3 to 6 months after implantation (p < 0.001), and the effective valve areas increased significantly during this time interval (p < 0.001). This improvement in valve hemodynamics is believed to be due to remodeling of the aortic root and regression of left ventricular hypertrophy. The results of aortic valve replacement with this stentless bioprosthesis have been excellent and justify its continued use in older patients.

Late hemodynamic effects of the preserved papillary muscles during mitral valve replacement

BACKGROUND

The late hemodynamic effects of preserving the papillary muscles during mitral valve replacement have not been evaluated.

METHODS AND RESULTS

Sixteen patients who had chronic mitral regurgitation due to myxomatous degeneration were randomized to preservation (Pres group, n = 8) or no preservation (No Pres group, n = 8) of the chordae tendineae and papillary muscles during mitral valve replacement. Rest and exercise nuclear ventriculograms were performed early (3 months) and late (5 years) after surgery. Early after surgery, the No Pres group had lower ejection fractions and stroke work indexes (P < .05 by repeated-measures [rm] ANOVA) than the Pres group did at similar end-diastolic volume indexes. The No Pres group had similar cardiac indexes after exercise because heart rate increased (P < .005 by rm ANOVA). Late after surgery, ejection fraction was greater at similar end-diastolic volume indexes (P < .005 by rm ANCOVA), and preload recruitable stroke work indexes (P < .001 by rm ANCOVA) were better in the Pres group.

CONCLUSIONS

Preserving chordal attachments enhanced the late hemodynamic recovery after mitral valve replacement for mitral regurgitation.

Are patients receiving amiodarone at increased risk for cardiac operations?

Amiodarone therapy has been implicated as a risk factor for cardiothoracic surgical procedures. In patients undergoing map-guided surgical procedures for the treatment of ventricular tachycardia, we compared the perioperative course of those receiving long-term amiodarone therapy (n = 36) versus that in those not receiving the drug (n = 31). The two groups were similar with respect to age, sex, presenting symptoms, functional class, extent of coronary artery disease, presence of a ventricular aneurysm, technique of ventricular tachycardia ablation, cross-clamp or pump time, the number of vessels grafted, the operative fluid balance, and a need for intraaortic balloon pump or inotropic agent support. In 5 patients receiving amiodarone, epinephrine was required to maintain a normal systemic vascular resistance and adequate arterial pressure. Postoperatively, 6 patients (17%) on amiodarone therapy suffered acute respiratory failure. In spite of aggressive therapy, 3 of these patients died. Only 1 patient not receiving amiodarone died of a stroke. We conclude that amiodarone therapy in patients undergoing open heart operations is associated with an increased risk of severe pulmonary complications (p = 0.03 by Fisher's exact test). Amiodarone therapy should be withheld in patients with ventricular tachycardia until they have been assessed as candidates for possible surgical intervention.

[Construction of human glioma cDNA library]

Total RNA from a human glioma was extracted by acid guanidinium-thiocyanate-chloroform one step method, and poly(A+)RNA was separated by affinity chromatography on oligo (dT) cellulose. The cDNA was synthesized by using poly (A+) RNA as template, the length of cDNA being 0.2-5 kb. The glioma cDNA inserts could be cloned into lambda gt11 vector, the resulting recombinant DNA was packaged in vitro. The cDNA library of 1.12 x 10(5) pfu/ml was obtained, and the cloning efficiency was 4.8 x 10(3)/ng cDNA. This library might contribute an important basis to study of the structure and function of human glioma genes.

Molecular structure and enzymatic function of lycopene cyclase from the cyanobacterium Synechococcus sp strain PCC7942

A gene encoding the enzyme lycopene cyclase in the cyanobacterium Synechococcus sp strain PCC7942 was mapped by genetic complementation, cloned, and sequenced. This gene, which we have named crtL, was expressed in strains of Escherichia coli that were genetically engineered to accumulate the carotenoid precursors lycopene, neurosporene, and zeta-carotene. The crtL gene product converts the acyclic hydrocarbon lycopene into the bicyclic beta-carotene, an essential component of the photosynthetic apparatus in oxygen-evolving organisms and a source of vitamin A in human and animal nutrition. The enzyme also converts neurosporene to the monocyclic beta-zeacarotene but does not cyclize zeta-carotene, indicating that desaturation of the 7-8 or 7'-8' carbon-carbon bond is required for cyclization. The bleaching herbicide 2-(4-methylphenoxy)triethylamine hydrochloride (MPTA) effectively inhibits both cyclization reactions. A mutation that confers resistance to MPTA in Synechococcus sp PCC7942 was identified as a point mutation in the promoter region of crtL. The deduced amino acid sequence of lycopene cyclase specifies a polypeptide of 411 amino acids with a molecular weight of 46,125 and a pI of 6.0. An amino acid sequence motif indicative of FAD utilization is located at the N terminus of the polypeptide. DNA gel blot hybridization analysis indicated a single copy of crtL in Synechococcus sp PCC7942. Other than the FAD binding motif, the predicted amino acid sequence of the cyanobacterial lycopene cyclase bears little resemblance to the two known lycopene cyclase enzymes from nonphotosynthetic bacteria. Preliminary results from DNA gel blot hybridization experiments suggest that, like two earlier genes in the pathway, the Synechococcus gene encoding lycopene cyclase is homologous to plant and algal genes encoding this enzyme.

Functional characterization of the promoter for the gene encoding human eosinophil peroxidase

The molecular basis for commitment of progenitors to the eosinophil lineage and mechanisms by which eosinophil-specific genes are expressed and regulated during differentiation is unknown. Expression of eosinophil peroxidase (EPO) is restricted to the eosinophil lineage. To understand the mechanisms involved in transcriptional regulation of EPO gene expression, we clone the region of the EPO gene upstream of the transcriptional start site and analyzed the cis-acting elements required for EPO promoter activity in an eosinophil-inducible leukemic cell line, HL-60-C15. The 5'-flanking region of the EPO gene containing 1.5 kilobases of sequence upstream of the transcriptional start site was subcloned into the promoterless pXP2-luciferase vector. The EPO-pXP2 construct and 5' deletion mutants were electroporated into HL-60-C15 cells and luciferase reporter activity assessed. The -1.5-kilobase EPO-pXP2 promoter construct reproducibly expressed > 120-fold more luciferase activity than did promoterless pXP2, and a 12-fold (90%) decrease in promoter activity was obtained when sequences between -122 and -45 base pairs (bp) were deleted. The specificity of the EPO promoter for the eosinophil lineage was analyzed by transfecting the EPO-pXP2 constructs and deletion mutants into HL-60-C15 cells and the parental HL-60 line; EPO promoter activity was 8-10-fold less in the HL-60 parental line, suggesting lineage specific elements in the -122 to -45 bp region. To further characterize regulatory sequences important for promoter activity, we performed linker-scanning analysis on the -122 to -45 bp region and identified a number of positively and negatively acting elements in the promoter. DNase I footprinting was performed with HL-60-C15, HL-60, and HeLa nuclear extracts to identify nuclear proteins that may bind to the functional elements; these experiments identified three protected regions of the EPO promoter which correspond to the functional segments defined by linker-scanning analysis and which contain consensus, potential binding sites for Egr-1, H4TF-1, PuF, CTCF, UBP-1, and GaEII transcription factors. Further study of EPO promoter regulation should elucidate unique transcriptional features of eosinophil gene regulation in granulocyte development.

Trends in elastomeric impression materials

In the past three years more addition silicones have been supplied as hydrophilic materials and heavier viscosities have been provided in automatic mixing cartridges. Also, a polyether is now supplied in an automatic mixing system. There has been an increase in the number of products available as monophase or single viscosity systems. Both addition silicones and polyethers are available as bite registration materials.

Down syndrome phenotypes: the consequences of chromosomal imbalance

Down syndrome (DS) is a major cause of mental retardation and congenital heart disease. Besides a characteristic set of facial and physical features, DS is associated with congenital anomalies of the gastrointestinal tract, an increased risk of leukemia, immune system defects, and an Alzheimer-like dementia. Moreover, DS is a model for the study of human aneuploidy. Although usually caused by the presence of an extra chromosome 21, subsets of the phenotypic features of DS may be caused by the duplication of small regions of the chromosome. The physical map of chromosome 21 allows the molecular definition of the regions duplicated in these rare cases of partial trisomy. As a first step in identifying the genes responsible for individual DS features and their pathophysiology, a panel of cell lines derived from 16 such individuals has been established and the molecular break points have been determined using fluorescence in situ hybridization and Southern blot dosage analysis of 32 markers unique to human chromosome 21. Combining this information with detailed clinical evaluations of these patients, we have now constructed a "phenotypic map" that includes 25 features and assigns regions of 2-20 megabases as likely to contain the genes responsible. This study provides evidence for a significant contribution of genes outside the D21S55 region to the DS phenotypes, including the facies, microcephaly, short stature, hypotonia, abnormal dermatoglyphics, and mental retardation. This strongly suggests DS is a contiguous gene syndrome and augurs against a single DS chromosomal region responsible for most of the DS phenotypic features.

Effect of cell line on in vitro metal ion cytotoxicity

OBJECTIVES

The choice of cell line for in vitro biological tests which assess the cytotoxicity of dental materials remains controversial, yet this issue is important because these tests are widely used to rate the biocompatibility of new and existing materials, and many different cell lines are commonly used. The purpose of the current study was to quantify the responses of four cell lines (Balb/c 3T3, L929, ROS 17/2.8 and WI-38) to 14 metal ions which are released from dental materials, and relate these responses to the metabolic activity and population doubling times of these cells.

METHODS

Succinic dehydrogenase (SDH) activity was used to monitor metabolic activity and cytotoxic response.

RESULTS

The cell lines responded differently to most metal ions. In general, the Balb/c 3T3 line was the most sensitive, and the WI-38 line was the least sensitive. However, there were many exceptions depending on the metal ion. The passage number of the cells also affected the cytotoxic response. It was concluded that the cytotoxicity of materials which release metal ions will be significantly different depending on which cell line is selected and its passage number.

SIGNIFICANCE

Based on the findings that cell lines ranked the toxicities of the metal ions similarly, it seems reasonable to use these types of in vitro tests to rank the cytotoxicities of materials. However, if these types of tests are used to predict in vivo cytotoxicity, care should be taken to choose conditions and cells which are relevant.

Bidirectional transcription from the human immunoglobulin VH6 gene promoter

The human immunoglobulin (Ig) heavy chain VH6 gene promoter contains an imperfect octamer (AgGCAAAT) and is not dependent on the Ig heavy chain enhancer for activity; reporter constructs containing this promoter are very active in non-B cells. In experiments designed to characterize regions upstream of the transcriptional start site that are important for promoter function, we produced a series of deletion constructs, including one containing sequences between -74 and -146. Surprisingly, this fragment had promoter activity in both orientations. Inspection of the VH6 promoter sequence indicated that there was a possible TATA box in the proper orientation upstream of the imperfect octamer. The -74 to -146 fragment functioned as a promoter in the reverse orientation in three B cell lines and in non-B (HeLa) cells, with a much higher level of activity seen in the HeLa cells. To determine if the promoter could work in both directions simultaneously, reporter genes were positioned up- and downstream of a VH6 promoter fragment. Reporter gene activity was found for both genes in B cells and HeLa cells. Using a reverse transcriptase-polymerase chain reaction procedure (RT-PCR), we found a transcript corresponding to sequences upstream of the VH6 promoter in RNA from both the lymphoblastoid cell line ML-1, which actively transcribes the VH6 promoter, and the REH cell line, which does not. No transcripts were found in the KB epithelial cell line. Two or three mRNA 5' ends were found that mapped between -137 to -143 from the authentic VH6 transcription site, 31-37 nucleotides upstream of the putative TATA box. Inspection of the sequence upstream of the VH6 promoter demonstrated the presence of an open reading frame capable of coding for 96 amino acids. The VH6 promoter represents the second Ig promoter with bidirectional activity.

Analysis of the imperfect octamer-containing human immunoglobulin VH6 gene promoter

The octamer sequence ATGCAAAT is highly conserved in the promoter of immunoglobulin heavy and light chain genes and is one of the sequence motifs involved in the control of transcription of these genes. The promoter region of an human immunoglobulin heavy chain variable gene, the sole member of the VH6 gene family, was found to differ from other VH gene promoters: it contains neither the conserved octamer motif nor a heptamer sequence, and generally bears little resemblance to other VH gene transcriptional control regions. An imperfect octamer sequence with a single nucleotide substitution (AgGCAAAT) is located 108 bp upstream of the ATG translation start site, and 81 bp upstream of the transcription initiation site. We sought to determine which sequence elements within the VH6 promoter were responsible for transcription initiation by creating progressive deletions of a 1 kb fragment from this region and testing their ability to function as promoter elements in B and non-B cells (HeLa). The minimum fragment required for full promoter function was 110 bp, but a fragment with only 65 bp retained 30-50% activity in B cells. Similar levels of transcription were seen when the -146 bp promoter containing two point mutations in the imperfect octamer was tested. Mutation of a possible pyrimidine box sequence located downstream of the TATA box was shown to have only a minor effect (10-30%) on transcription when three nucleotides were changed. Surprisingly, CAT activity was not B cell-specific, as all constructs had virtually the same activity in several B cell lines and in HeLa cells. Removal of the TATA box led to a 50% reduction in CAT activity, and the region upstream of the TATA box functioned as a promoter in both orientations. The transcriptional activity of the VH6 promoter was virtually enhancer independent: only a minor increase was observed when the immunoglobulin or SV40 enhancer was added to the promoter construct. Electrophoretic mobility shift assays of transcription factor binding to the region around the imperfect octamer indicated that binding was weak when nuclear extracts from either B cells or HeLa cells were used. The amount of complex shifted was increased by mutating the imperfect octamer to a perfect one. Chimeras produced between the VH6 promoter and a B cell-specific promoter from a member of the human VH2 gene family demonstrated that the lack of tissue specificity was due to the absence of a repressor of non-B cell transcription in the VH6 promoter. These results indicate that the VH6 promoter is relatively simple, requiring little more than the TATA element and the imperfect octamer, and transcription from this promoter lacks B cell specificity and is not dependent on the enhancer element.

Solute absorption from the airways of the isolated rat lung. IV. Mechanisms of absorption of fluorophore-labeled poly-alpha,beta-[N(2-hydroxyethyl)-DL-aspartamide]

The pulmonary absorption kinetics of a single molecular weight distribution (MWD) of fluorophore-labeled poly-alpha,beta-[N(2-hydroxyethyl)-DL-aspartamide] (F-PHEA), a hydrophilic and biocompatible synthetic polypeptide, were studied in the isolated, perfused rat lung (iprl) as functions of administered polymer concentration, dose, vehicle, and presence and absence of fluorophore. The MWD was characterized before and after absorption by measurement of weight- and number-averaged molecular weights (Mw and Mn, respectively) using high-performance gel-permeation chromatography. Values for Mw and Mn were 8.6 and 5.3 kD before, and 6.7 and 4.7 kD after, absorption into the perfusate; there was no significant metabolism and the MWD of the absorbed polymer was independent of both dose and sampling time over a 3-hr period. F-PHEA failed to show any evidence of aggregation in solution or changes in dose distribution within the airways as functions of increasing polymer concentration and dose. A concentration ranging study indicated the presence of a saturable, carrier-mediated transport process for F-PHEA with a maximum absorption rate, Vmax, of approximately 180 micrograms or 0.027 mumol/hr. Coadministration of fluorophore-free PHEA was capable of depressing the absorption of F-PHEA. The transport process for F-PHEA appeared to have a molecular weight limit of about 7 kD for this hydrophilic polymer.

[A study on P21(ras) in human lung cancer and body fluid of cancer patients]

The McAb of anti-P21(ras) has been used to screen 9 cases of human lung cancer tissues, 18 cases of samples and 2 cases of hydrothorax samples of lung cancer patients by means of PAGE-immunoblots. The expression of ras gene was found in 8 cases of human lung cancer among which the expression of 4 cases was higher than that of normal control. P21(ras) has not been detected in serum and hydrothorax samples of cancer patients. The present study indicated that there was P21(ras) in human lung cancer and normal control and the expression level of ras gene in lung cancer was related to the differentiation of cancer.

Texture analysis of ultrasonic images of the prostate by means of co-occurrence matrices

As speckle on ultrasonic B-scan may reveal information relative to tissue structure, the present work attempts to discriminate the various prostatic tissues (normal tissue, benign prostatic hypertrophy and cancer) by means of texture analysis. We select regions of interest by their homogeneous appearance. A pre-processing stage is required to obtain stationary samples. The method used measures the second-order statistics, namely co-occurrence matrices. Fairly good tissue signatures have been obtained with parameters derived from these matrices. Of 37 images processed, 78 percent of the samples were classified with success, which is a high score considering that the images cannot be discriminated visually. However, while such results are obtained when wide regions of interest are investigated (64 x 64 pixels), they are not as good with smaller sample sizes, i.e., when the pathological area is very small.

Late results of mitral valve repair for mitral regurgitation due to degenerative disease

From June 1981 to August 1992, 184 patients with mitral regurgitation due to degenerative disease underwent mitral valve repair. The mean age was 57 years, and 74% were men. One-third of the patients were in atrial fibrillation, and 71% were in New York Heart Association classes III and IV. The mitral regurgitation was due to prolapse of the posterior leaflet in 97 patients (53%), prolapse of the anterior leaflet in 42 (23%), and prolapse of both leaflets in 45 (24%). The degree of myxomatous changes was assessed intraoperatively as mild in 125 patients (68%), moderate in 27 (15%), and severe in 32 (17%). Mitral valve repair was accomplished largely by techniques described by Carpentier. Ring annuloplasty was performed in 160 patients (66 with Carpentier ring and 94 with Duran ring). There was one operative death, and 5 patients experienced life-threatening complications. Patients were followed up from 5 to 132 months (mean, 41 months). The actuarial survival at 8 years was 88% +/- 4%. The freedom from stroke at 8 years was 94% +/- 2%, and the freedom from transient ischemic attacks was 86% +/- 6%. Age greater than 60 years was the only factor associated with higher risk of thromboembolic complications by logistic regression analysis. The actuarial freedom from reoperation at 8 years was 95% +/- 2%. Advanced myxomatous changes in the leaflets of the mitral valve was the only significant factor associated with a higher risk of reoperation. Most patients were in New York Heart Association class I at the last follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

[A study on the transcriptional expression of oncogenes in human primary brain tumors]

The c-myc, L-myc, N-myc, Ha-ras, c-fos, and v-erbB oncogenes were used as probes to detect the total RNA of 5 cases of normal human brain tissues and 29 cases of brain tumor tissues by RNA dot hybridization analysis. The results showed that the increasing expressions of cerbB and c-fos were the highest, being 88.2% and 82.4%, respectively, the next was c-myc with an increased expression of 46.1%; the increasing expressions of L-myc (29.3%) and N-myc (31.6%) were observed in a few samples only. There was no significant difference of Ha-ras gene expression between normal brain and brain tumor. In addition, we observed the increasing expression of more than one oncogene in one sample. These results suggest that c-erbB and c-fos oncogenes may play an important role in the pathogenesis of human primary brain tumors, and that multiple genetic changes are implicated in genesis of human brain tumors.

[The appliance of image analysis in the diagnosis of oral Lichen Planus and it's malignant change]

After the Feulgen dying,if the normal oral mucous,oral Lichen planus as well as the pathological cut sheets with atypical dysplasia and malignant change in defferent degrees,use the image analysis technique to measure the morphologic parameters of the nucleus(including nuclear surface area,perimeter maximum nuclear diameter,minimum nulear diameter,equivalent circle diameter,morphological factor) and the amount of DNA,5CER acts as an indes of distinguishing malignancy or benignancy,the value of 5CER in malignant is more than 10% and in benignant is less than 10%.The result of the analysis from the optical microscope differs from the optical microscope differs form the image analysis.There are so many personal factors in the qualitative analysis by optical microscope that it because quite imperative to research for a new diagnosing way.The synchronization of quantitative analysis and qualitative analysis can correct the personal errors in qualitative analysis.It will be very useful for directing the clinical practice and the judgment of prognosis.

Clinical and hemodynamic assessment of the Hancock II bioprosthesis

The Hancock II bioprosthesis was used for heart valve replacement in 614 patients from 1982 to 1990. Aortic valve replacement (AVR) was performed in 376 patients, mitral valve replacement (MVR) in 195, and aortic and mitral valve replacement (DVR) in 43. The mean age was 62.7 years, and 78% of all patients were in New York Heart Association functional class III or IV before operation. Coronary artery bypass graft was necessary in 232 patients and replacement of ascending aorta in 55. There were 31 operative deaths (AVR, 4%; MVR, 6%; DVR, 9%). Follow-up was complete in 98.5% of the patients and extended from 12 to 103 months, with a mean of 49 months. At the last follow-up, 85% of the patients were in New York Heart Association class I or II. The actuarial survival at 8 years was 79% +/- 3% for AVR, 68% +/- 4% for MVR, and 65% +/- 10% for DVR. The freedom from stroke at 8 years was 93% +/- 2% for AVR, 83% +/- 5% for MVR, and 90% +/- 5% for DVR. At the end of 8 years 96% +/- 1% of all patients were free from endocarditis, 92% +/- 1% were free from primary tissue failure, and 89% +/- 3% were free from reoperation. The actuarial freedom from valve-related death at 8 years was 98% +/- 1% for AVR, 86% +/- 5% for MVR, and 91% +/- 6% for DVR. Hemodynamic assessment was obtained by Doppler echocardiography in all operative survivors and demonstrated satisfactorily effective valve orifices and transvalvular gradients. The clinical results obtained with the Hancock II bioprosthesis have been gratifying, particularly in the aortic position. This bioprosthesis is our biological valve of choice.

Influence of medicinal herbs on phagocytosis by bovine neutrophils

Twenty-six herbal preparations made from 24 medicinal herbs, categorized as antipyretics in Chinese materia medica, were tested in vitro to determine their effects upon phagocytosis of 32P-labelled Staphylococcus aureus by neutrophils isolated from bovine blood and milk. The percentage of phagocytosis was determined after incubating (1 hour at 37 degrees C) 1.25 x 10(7) neutrophils, 1 x 10(8) 32P-labelled S. aureus and 10% skimmed milk with herbal solutions. Concentrations of herbal preparations tested were 100%, 10% and 1% (v/v). When compared with PBSS (0.01 M phosphate buffered saline solution) controls, most of the herbs at high concentrations inhibited phagocytosis while at lower concentrations phagocytosis was increased. All 26 herbal preparations significantly increased blood neutrophil activity at their proper concentrations. The most active herbs in promoting blood neutrophil phagocytosis were observed for Herba verbenae, Flos chrysanthemi, Flos lonicerae, Radix sophorae flavescentis, Herba houttuyniae, Radix isatidis, Herba patriniae, Berberini sulfatis at the lowest concentration and for Folium hibisci at the high concentration with the increased percentage of more than 40.0% in comparison with PBSS control. Of the 19 herbal preparations tested with milk neutrophils, 18 herbs greatly increased phagocytosis at suitable concentrations. The most active preparations in stimulating milk neutrophil functions included Folium hibisci, Flos chrysanthemi, Radix bupleuri, Radix stellariae, Herba houttuyniae, Herba senecionis scandentis, Caulis lonicerae and Flos lonicerae which increased phagocytosis by over 35.0%.

[Biochemical and immunological characterization of desmosomal proteins]

Desmosmoes were dissolved by incubation at 100 degrees C for 30 minutes in lysis buffer containing 9.5 M urea. SDS-PAGE revealed seven high molecular weight (> 67 kd) bands and some keratins. Seven of these were considered to be major bands. Bands 1 and 2 with M(r) values of 250 kd and 215 kd, called desmoplakins I and II. Polypeptide bands 3, 4a 4b, 5 and 6 had M(r) values of 165kd, 130kd, 115kd, 83kd and 75kd, respectively. 2-2.5mg of Desmoplakin I was obtained by a preparative electrophoresis; the purity reached 93.1%. The isoelectric pH range was between 6.8 and 7.2, and the amino acid compositions displayed a relatively high content of glycine. It was found that McAb Desmoplakin I recognized specifically the 250kd antigenic band by immunoblotting.

[The construction of rich genomic library of bovine Y chromosome]

According to the fundamentals of DNA renatured kinetics, we made a study in which genomic DNA from male cattle was completely digested with Sau 3A, while female DNA was sheared to an average size of 500 bp fragments. The Y derived DNA sequence rich library of bovine has been contracted with pUC19 plasmid as vector and JM109 as host bacteria by reassociation of male and female DNA. Male and female DNA probes, were used. The result of colony hybridization showed that out of 1000 recombinants analysed, 6 were found to be stronger signal with male probe. Analysis of Pvu' I digested DNA fragment revealed that most of the inserts were in the 90-300 bp.

The effect of warm heart surgery on postoperative bleeding

The effects of normothermic systemic perfusion (35 degrees to 37 degrees C; n = 73) were compared with those of moderately hypothermic systemic perfusion (25 degrees to 29 degrees C; n = 73) with respect to blood loss, transfusion requirements, and platelet levels in 146 patients undergoing isolated, primary coronary artery bypass grafting. In addition, most patients were given an antifibrinolytic medication during operation as follows: tranexamic acid (10 gm intravenously; n = 63), epsilon-aminocaproic acid (15 gm intravenously; n = 63), or no drug as a control. (n = 20). Normothermic patients tended to bleed less at 24 hours (warm, 864 +/- 42 ml and cold, 918 +/- 68 ml), but these differences were not statistically significant. Patients receiving either tranexamic acid or epsilon-aminocaproic acid, regardless of perfusion temperature, bled less after 6, 12, and 24 hours than did cold control patients (p less than 0.05). Warm control patients also bled less than did cold control patients after 6 or 12 hours (p less than 0.05), and neither drug further reduced blood loss in these patients. Circulating platelet levels were better preserved in patients receiving either tranexamic acid or epsilon-aminocaproic acid and in patients with warm perfusion and no drug than in cold control patients. Normothermic systemic perfusion, tranexamic acid, and epsilon-aminocaproic acid each reduced postoperative blood loss and preserved platelets.

[Effects of insulin on expression of oncogenes in CWE mouse brain]

By RNA dot blot hybridization, we observed the expression of c-myc, c-fos, Ha-ras and erbB genes in normal brain of CWE mouse after the injection of insulin. Transcription of the c-myc and c-fos genes is greatly increased, which peaks approximately 2 h after insulin stimulation, decreases in 6 h and returns to the initial levels within 48 h. The alteration in Ha-ras transcription appears more complex; its expression decreases first but increases subsequently. We also detected the expression of erbB gene which decreases after the injection of insulin. The results suggest that c-myc, c-fos, Ha-ras and erbB might be directly involved in growth control. Their protein products might play a role in intracellular signal transduction.

Enzyme-based bilayer conducting polymer electrodes consisting of polymetallophthalocyanines and polypyrrole-glucose oxidase thin films

Bilayer conducting polymer electrodes, which consist of a polymetallophthalocyanine (PMePc) and polypyrrole incorporating glucose oxidase (PPy-GOx), were prepared on the glassy-carbon electrode by the successive electrochemical deposition of two different polymers. The bilayer film electrodes showed catalytic behavior, which included an enhanced amperometric response current with the substrate and a significantly shifted oxidation potential (approximately 700 mV) of the response current. The bilayer electrodes also showed a fast response time and good stability with the substrate. A bilayer microelectrode, which was prepared by using both PCuPc and PPy-GOx polymer films, also showed a good amperometric response with the substrate.

[The expression of oncogenes in the development of human brain]

Seven oncogenes (c-myc, L-myc, N-myc, v-erbB, c-fos, Ha-ras and mos) were used as the probe to detect the total RNA of every part (cerebellum, temporal folium, frontal folium and occipital folium) in human brain from 2 cases of 6 mon fetus and the total RNA in fetal development (4 mon, 5 mon, 6 mon, 7 mon, and newborn) of human brain tissue by RNA dot hybridization analysis. The results showed that most oncogenes were expressed at high level in cerebellum and occipital folium of 6 mon fetus and at low level in temporal folium; there was similar expression of c-myc, L-myc and N-myc in fetal development of human brain tissue, and the highest level was in the 5 mon fetal brain. There was no expression of erbB gene in normal human brain. The high level expression of Ha-ras and c-fos genes was in the middle and later stages of fetal development. These results suggested that c-myc, L-myc, N-myc, erbB, Ha-ras, c-fos and mos genes might play an important role in the fetal development of human brain.

[Effects of stimulation of renal afferent nerve on renal excretion of water, sodium and potassium]

The present study was designed to investigate the effect of stimulation of the renal afferent nerve (RAN) on renal excretory function and its mechanism. In pentobarbital-anesthetized, sino-aortic denervated and vagotomized (SAD+VD) cats, stimulation of the RAN caused a significant rise in arterial pressure. In the denervated kidney urine volume (Vu) and sodium excretion (UNa V) were greatly increased, no changes in potassium excretion (UK V) and glomerular filtration rate (GFR) were observed. In the innervated kidney, UNa V was greatly increased, but Vu, UK V and GFR were not different from those observed during the control period. When arterial pressure was held constant at the control level, stimulation of the RNA reduced the Vu, UK V of both the innervated and denervated kidneys and GFR in the innervated but not in the denervated kidney. Transection of spinal cord at C7 level did not abolish the changes in Vu, UNa V, and UK V in the innervated kidney, but completely eliminated the changes in the excretory function in the denervated kidney. These data suggest that when arterial pressure is controlled, stimulation of the RAN causes a decrease in Vu, UNa V, UK V in SAD+VD cats and that these responses in the innervated kidney can be performed at the spinal level.

Operative risks and long-term results of operation for left ventricular aneurysm

A review of 336 consecutive patients who underwent repair of left ventricular aneurysm from 1978 to 1989 disclosed that partial resection of the aneurysm and conventional closure of the ventriculotomy was performed in 281 patients, inverted T closure in 17, and endocardial patch in 38. These two latter techniques were developed in an attempt to restore normal left ventricular geometry. The operative mortality was 6.8% (23 patients). A stepwise logistic regression analysis of various preopeative clinical, hemodynamic, and angiographic variables revealed that left ventricular ejection fraction of 0.20 or less, age greater than 60 years, previous myocardial revascularization, lack of angina, and New York Heart Association functional class IV were independent predictors of operative mortality. The technique of repair was not a predictor of outcome, but when patients with poor left ventricular function were analyzed separately, the operative mortality was reduced from 12.5% to 6.5% when newer techniques were employed. Patients were followed up during a mean of 6.3 years. There have been 51 late deaths, 45 cardiac. Cox regression analysis indicated that poor left ventricular function and left main coronary artery stenosis were the only two predictors of late mortality. The actuarial survival at 10 years was 63% +/- 4%. Most patients (88%) are in New York Heart Association class I or II. These data indicate excellent long-term results after repair of left ventricular aneurysm. Newer techniques of repair are valuable in patients with poor left ventricular function.