Specific proteolysis of the NR2 subunit at multiple sites by calpain

The NMDA subtype of glutamate receptor plays an important role in the molecular mechanisms of learning, memory and excitotoxicity. NMDA receptors are highly permeable to calcium, which can lead to the activation of the calcium-dependent protease, calpain. In the present study, the ability of calpain to modulate NMDA receptor function through direct proteolytic digestion of the individual NMDA receptor subunits was examined. HEK293t cells were cotransfected with the NR1a/2A, NR1a/2B or NR1a/2C receptor combinations. Cellular homogenates of these receptor combinations were prepared and digested by purified calpain I in vitro. All three NR2 subunits could be proteolyzed by calpain I while no actin or NR1a cleavage was observed. Based on immunoblot analysis, calpain cleavage of NR2A, NR2B and NR2C subunits was limited to their C-terminal region. In vitro calpain digestion of fusion protein constructs containing the C-terminal region of NR2A yielded two cleavage sites at amino acids 1279 and 1330. Although it has been suggested that calpain cleavage of the NMDA receptor may act as a negative feedback mechanism, the current findings demonstrated that calpain cleavage did not alter [(125)I]MK801 binding and that receptors truncated to the identified cleavage sites had peak intracellular calcium levels, (45)Ca uptake rates and basal electrophysiological properties similar to wild type.

Affective reactivity of language symptoms, startle responding, and inhibition in schizophrenia

The speech of some schizophrenia patients becomes markedly more disordered when negative affect is aroused. The authors tested associations between affective reactivity of speech and responsiveness and inhibition on an acoustic startle task in a sample of 27 outpatients. Patients whose language was reactive to negative affect showed significantly higher initial startle amplitudes than those whose language was not reactive. However, they also showed greater habituation to repeated startle stimuli over trials, even after differences in initial amplitudes were controlled statistically. These findings suggest that affective reactivity of speech is associated with higher initial startle responsiveness but also with greater habituation and, conversely, that patients who are relatively nonreactive to excitatory affective and sensory stimuli are also less reactive to inhibitory input.

Zinc-induced augmentation of excitatory synaptic currents and glutamate receptor responses in hippocampal CA3 neurons

Zinc is found throughout the CNS at synapses co-localized with glutamate in presynaptic terminals. In particular, dentate granule cells' (DGC) mossy fiber (MF) axons contain especially high concentrations of zinc co-localized with glutamate within vesicles. To study possible physiological roles of zinc, visualized slice-patch techniques were used to voltage-clamp rat CA3 pyramidal neurons, and miniature excitatory postsynaptic currents (mEPSCs) were isolated. Bath-applied zinc (200 microM) enhanced median mEPSC peak amplitudes to 153.0% of controls, without affecting mEPSC kinetics. To characterize this augmentation further, rapid agonist application was performed on perisomatic outside-out patches to coapply zinc with glutamate extremely rapidly for brief (1 ms) durations, thereby emulating release kinetics of these substances at excitatory synapses. When zinc was coapplied with glutamate, zinc augmented peak glutamate currents (mean +/- SE, 116.6 +/- 2.8% and 143.8 +/- 9.8% of controls at 50 and 200 microM zinc, respectively). This zinc-induced potentiation was concentration dependent, and pharmacological isolation of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor-mediated currents (AMPAR currents) gave results similar to those observed with glutamate application (mean, 115.0 +/- 5.4% and 132.5 +/- 9.1% of controls at 50 and 200 microM zinc, respectively). Inclusion of the AMPAR desensitization blocker cyclothiazide in the control solution, however, abolished zinc-induced augmentation of glutamate-evoked currents, suggesting that zinc may potentiate AMPAR currents by inhibiting AMPAR desensitization. Based on the results of the present study, we hypothesize that zinc is a powerful modulator of both excitatory synaptic transmission and glutamate-evoked currents at physiologically relevant concentrations. This modulatory role played by zinc may be a significant factor in enhancing excitatory neurotransmission and could significantly regulate function at the mossy fiber-CA3 synapse.

Affective reactivity of language symptoms, startle responding, and inhibition in schizophrenia

The speech of some schizophrenia patients becomes markedly more disordered when negative affect is aroused. The authors tested associations between affective reactivity of speech and responsiveness and inhibition on an acoustic startle task in a sample of 27 outpatients. Patients whose language was reactive to negative affect showed significantly higher initial startle amplitudes than those whose language was not reactive. However, they also showed greater habituation to repeated startle stimuli over trials, even after differences in initial amplitudes were controlled statistically. These findings suggest that affective reactivity of speech is associated with higher initial startle responsiveness but also with greater habituation and, conversely, that patients who are relatively nonreactive to excitatory affective and sensory stimuli are also less reactive to inhibitory input.

Protracted postnatal development of inhibitory synaptic transmission in rat hippocampal area CA1 neurons

In the CNS, inhibitory synaptic function undergoes profound transformation during early postnatal development. This is due to variations in the subunit composition of subsynaptic GABA(A) receptors (GABA(A)Rs) at differing developmental stages as well as other factors. These include changes in the driving force for chloride-mediated conductances as well as the quantity and/or cleft lifetime of released neurotransmitter. The present study was undertaken to investigate the nature and time course of developmental maturation of GABAergic synaptic function in hippocampal CA1 pyramidal neurons. In neonatal [postnatal day (P) 1-7] and immature (P8-14) CA1 neurons, miniature inhibitory postsynaptic currents (mIPSCs) were significantly larger, were less frequent, and had slower kinetics compared with mIPSCs recorded in more mature neurons. Adult mIPSC kinetics were achieved by the third postnatal week in CA1 neurons. However, despite this apparent maturation of mIPSC kinetics, significant differences in modulation of mIPSCs by allosteric agonists in adolescent (P15-21) neurons were still evident. Diazepam (1-300 nM) and zolpidem (200 nM) increased the amplitude of mIPSCs in adolescent but not adult neurons. Both drugs increased mIPSC decay times equally at both ages. These differential agonist effects on mIPSC amplitude suggest that in adolescent CA1 neurons, inhibitory synapses operate differently than adult synapses and function as if subsynaptic receptors are not fully occupied by quantal release of GABA. Rapid agonist application experiments on perisomatic patches pulled from adolescent neurons provided additional support for this hypothesis. In GABA(A)R currents recorded in these patches, benzodiazepine amplitude augmentation effects were evident only when nonsaturating GABA concentrations were applied. Furthermore nonstationary noise analysis of mIPSCs in P15-21 neurons revealed that zolpidem-induced mIPSC augmentation was not due to an increase in single-channel conductance of subsynaptic GABA(A)Rs but rather to an increase in the number of open channels responding to a single GABA quantum, further supporting the hypothesis that synaptic receptors may not be saturated during synaptic function in adolescent neurons. These data demonstrate that inhibitory synaptic transmission undergoes a markedly protracted postnatal maturation in rat CA1 pyramidal neurons. In the first two postnatal weeks, mIPSCs are large in amplitude, are slow, and occur infrequently. By the third postnatal week, mIPSCs have matured kinetically but retain distinct responses to modulatory drugs, possibly reflecting continued immaturity in synaptic structure and function persisting through adolescence.

Equating health status measures with item response theory: illustrations with functional status items

BACKGROUND

More than 75 instruments have been developed to measure functional status. These measures differ in number of items, type of rating scale, and item difficulty. Such variations render it impossible to compare data across different measures. One way to overcome such test dependency is test equating, which relates scores from different measures to a common metric.

OBJECTIVE

We developed a bank of physical functioning items and equated them using item response theory.

DESIGN

We used a common-item equating design and a self-administered survey of functional status.

SUBJECTS

Individuals > or = 65 years of age who had > or = 1 ambulatory visit across a 3-month sampling frame to a Veterans Administration Medical Center or its affiliated university medical center.

RESULTS

The dressing items were the most discriminating, followed by bathing, toileting, mobility, cooking/eating, and household and community activities. The 5 most discriminating items were to put underclothes on, manage clothes after toileting, move between rooms, take pants/slacks off, and get into bed. Most of the items were located on the easier end of the ability continuum. Only 6 would classify as being very difficult.

CONCLUSIONS

We used item response theory to equate and calibrate a large number of activities of daily living on the same scale; by doing so, we were able to better understand the structure and order of domain-specific items to each other, as well as the interrelations among items across the ability continuum.

Polymer solutions as a pseudostationary phase for capillary electrochromatographic separation of DNA diastereomers

The solutions of linear polymers traditionally used for DNA separation have been employed for the capillary electrophoresis (CE) of diastereomers of chemically modified DNA. The selectivity of diastereomeric separation of the phosphorothioate (PS) and 2'-O-methylated (2-OMe) PS oligonucleotides depends on the nature of the polymer additive in the CE background electrolyte. The selectivity of separation for different polymers increases in the line: linear polyacrylamide < polyethylene glycol < polyvinyl pyrrolidone. The separation of oligomer diastereomers was shown to be primarily based on the hydrophobic interaction with the polymer network that acts as a pseudostationary phase. While lowering the temperature resulted in improved separation, the addition of organic modifiers such as formamide, methanol or acetonitrile counteracts the solute adsorption on the polymer network, and decreases the selectivity of DNA diastereoseparation. The effect of molecular mass and concentration of the polymer on the separation selectivity was investigated.

Review: history of the amyloid fibril

Rudolph Virchow, in 1854, introduced and popularized the term amyloid to denote a macroscopic tissue abnormality that exhibited a positive iodine staining reaction. Subsequent light microscopic studies with polarizing optics demonstrated the inherent birefringence of amyloid deposits, a property that increased intensely after staining with Congo red dye. In 1959, electron microscopic examination of ultrathin sections of amyloidotic tissues revealed the presence of fibrils, indeterminate in length and, invariably, 80 to 100 A in width. Using the criteria of Congophilia and fibrillar morphology, 20 or more biochemically distinct forms of amyloid have been identified throughout the animal kingdom; each is specifically associated with a unique clinical syndrome. Fibrils, also 80 to 100 A in width, have been isolated from tissue homogenates using differential sedimentation or solubility. X-ray diffraction analysis revealed the fibrils to be ordered in the beta pleated sheet conformation, with the direction of the polypeptide backbone perpendicular to the fibril axis (cross beta structure). Because of the similar dimensions and tinctorial properties of the fibrils extracted from amyloid-laden tissues and amyloid fibrils in tissue sections, they have been assumed to be identical. However, the spatial relationship of proteoglycans and amyloid P component (AP), common to all forms of amyloid, to the putative protein only fibrils in tissues, has been unclear. Recently, it has been suggested that, in situ, amyloid fibrils are composed of proteoglycans and AP as well as amyloid proteins and thus resemble connective tissue microfibrils. Chemical and physical definition of the fibrils in tissues will be needed to relate the in vitro properties of amyloid protein fibrils to the pathogenesis of amyloid fibril formation in vivo.

Long-lasting increase in cellular excitability associated with the priming of LTP induction in rat hippocampus

The mechanisms underlying the facilitation (priming) of long-term potentiation (LTP) by prior activation of metabotropic glutamate receptors (mGluRs) were investigated in area CA1 of rat hippocampal slices. In particular, we focused on whether a long-lasting increase in postsynaptic excitability could account for the facilitated LTP. Administration of the mGluR agonist 1S, 3R-aminocyclopentanedicarboxylic acid (ACPD) produced rapid decreases in the amplitude of both the slow spike afterhyperpolarization (AHP(slow)) and spike frequency adaptation recorded intracellularly from CA1 pyramidal cells. These changes persisted after drug washout, showing only a slow decay over 20 min. ACPD also caused a leftward shift of the field EPSP-population spike relation and an overall increase in population spike amplitude, but this effect was not as persistent as the intracellularly measured alterations in cell excitability. ACPD-treated cells showed increased spike discharges during LTP-inducing tetanic stimulation, and the amplitude of the AHP(slow) was negatively correlated with the degree of initial LTP induction. The beta-adrenergic agonist isoproterenol also caused excitability changes as recorded intracellularly, whereas in extracellular experiments it weakly primed the induction but not the persistence of LTP. ACPD primed both LTP measures. Isoproterenol administration during the tetanus occluded the priming effect of ACPD on initial LTP induction but not its effect on LTP persistence. We conclude that the persistent excitability changes elicited by ACPD contributes to the priming of LTP induction but that other ACPD-triggered mechanisms must account for the facilitated persistence of LTP in the priming paradigm.

A double dissociation within the hippocampus of dopamine D1/D5 receptor and beta-adrenergic receptor contributions to the persistence of long-term potentiation

We compared the effects of the D1/D5 receptor antagonist SCH-23390 with the beta-adrenergic receptor antagonist propranolol on the persistence of long-term potentiation in the CA1 and dentate gyrus subregions of the hippocampus. In slices, SCH-23390 but not propranolol reduced the persistence of long-term potentiation in area CA1 without affecting its induction. The drugs exerted reverse effects in the dentate gyrus, although in this case the induction of long-term potentiation was also affected by propranolol. The lack of effect of SCH-23390 on the induction and maintenance of long-term potentiation in the dentate gyrus was confirmed in awake animals. The drug also had little or no effect on the expression of inducible transcription factors. In area CA1 of awake animals, SCH-23390 blocked persistence of long-term potentiation beyond 3 h, confirming the results in slices. To rule out a differential release of catecholamines induced by our stimulation protocols between brain areas, we compared the effects of the D1/D5 agonist SKF-38393 with the beta-adrenergic agonist isoproterenol on the persistence of a weakly induced, decremental long-term potentiation in CA1 slices. SKF-38393 but not isoproterenol promoted greater persistence of long-term potentiation over a 2-h period. In contrast, isoproterenol but not SKF-38392 facilitated the induction of long-term potentiation. These data demonstrate that there is a double dissociation of the catecholamine modulation of long-term potentiation between CA1 and the dentate gyrus, suggesting that long-term potentiation in these brain areas may be differentially consolidated according to the animal's behavioural state.

Ancient mantle in a modern arc: osmium isotopes in izu-bonin-mariana forearc peridotites

Mantle peridotites drilled from the Izu-Bonin-Mariana forearc have unradiogenic 187Os/188Os ratios (0.1193 to 0.1273), which give Proterozoic model ages of 820 to 1230 million years ago. If these peridotites are residues from magmatism during the initiation of subduction 40 to 48 million years ago, then the mantle that melted was much more depleted in incompatible elements than the source of mid-ocean ridge basalts (MORB). This result indicates that osmium isotopes record information about ancient melting events in the convecting upper mantle not recorded by incompatible lithophile isotope tracers. Subduction zones may be a graveyard for ancient depleted mantle material, and portions of the convecting upper mantle may be less radiogenic in osmium isotopes than previously recognized.

Study of phosphorothioate-modified oligonucleotide resistance to 3'-exonuclease using capillary electrophoresis

The effect of phosphorothioate (PS) internucleotide linkages on the stability of phosphodiester oligodeoxyribonucleotides (ODNs) was investigated using 25-mer ODNs containing single or multiple PS backbone modifications. The in vitro stability of the oligomers was measured both in 3'-exonuclease solution and in plasma. For the separation of ODNs, capillary electrophoresis with a replaceable polymer separation matrix was used. As expected, DNA fragments with PS linkages at the 3'-end were found to be more resistant to 3'-exonuclease hydrolysis. Also increasing exonuclease resistance was the non-specific adsorption of phosphorothioate ODNs to enzyme.

Postmenopausal estrogen replacement therapy and the risk of developing systemic lupus erythematosus or discoid lupus

OBJECTIVE

There is evidence that estrogens play a role in the etiology of systemic lupus erythematosus (SLE), but this has not yet been shown for discoid lupus. We examined the association of postmenopausal estrogen use with the development of SLE and discoid lupus.

METHODS

We did a case-control evaluation, using the UK based General Practice Research Database. We analyzed 41 cases with SLE, 34 cases with discoid lupus, and 295 age, sex and practice matched controls, and estimated relative risk estimates (odds ratios) in relation to estrogen exposure duration as well as total cumulative dose and estrogen type (alone or combined with progestogens).

RESULTS

While short term estrogen exposure was not associated with increased risk, the risk of developing SLE (adjusted OR 2.8; 95% CI 0.9-9.0) or discoid lupus (adjusted OR 2.8; 95% CI 1.0-8.3) was significantly increased among current users who were exposed for 2 or more years. The adjusted RR estimate comparing longer term estrogen users and nonusers for all cases (SLE and discoid lupus combined) was 2.8 (95% CI 1.3-5.8; p < 0.01). A difference was found between longterm users of estrogens alone (OR 5.3; 95% CI 1.5-18.6) and those who used estrogens combined with progestogens (OR 2.0; 95% CI 0.8-5.0), compared to nonusers.

CONCLUSION

Our findings suggest that longer term use of postmenopausal estrogens plays a role in the etiology of both SLE and discoid lupus. There is a suggestion that progestogens may reduce the effect of estrogens on these autoimmune disorders.

Priming of long-term potentiation induced by activation of metabotropic glutamate receptors coupled to phospholipase C

Activation of metabotropic glutamate receptors (mGluRs) with 1-aminocyclopentane-1S,3R-dicarboxylic acid 20 min prior to tetanus facilitates, or "primes," subsequent induction of long-term potentiation (LTP; Cohen and Abraham, J Neurophysiol 1996;76:953-962). In the present study, we investigated the receptor specificity and associated second messenger pathways involved in the mGluR priming effect by using field potentials recorded from area CA1 of rat hippocampal slices. In controls, mild theta-burst or high-frequency (100 Hz) stimulation induced 16% and 21% LTP, respectively. A 10-min application of the group I mGluR agonist 3,5-dihydroxyphenylglycine (DHPG) caused a transient depression of synaptic responses but a significant enhancement of subsequent LTP for both tetanus protocols (45% and 41% LTP, respectively). Maximal LTP, induced by stronger tetanization protocols, was not enhanced by DHPG, nor was mild LTP facilitated by post-tetanic application of DHPG. Priming with agonists selective for group II or III mGluRs had no effect on LTP. The mGluR antagonists L-2-amino-3-phosphonopropionic acid and 1-aminoindan-1,5-dicarboxylic acid inhibited the LTP facilitatory effect of DHPG but not the transient response depression, whereas alpha-methyl-4-carboxyphenylglycine produced the opposite effects. Priming with N-methyl-D-aspartate or alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid did not facilitate LTP induction. Prior activation of muscarinic acetylcholine receptors produced at best a weak priming effect. Inhibition of phospholipase C by U-73122 completely abolished the priming of LTP by DHPG. We conclude that mGluR priming of LTP results from biochemical cascades triggered by activation of phospholipase C coupled to group I mGluRs.

Impact of 3'-exonuclease stereoselectivity on the kinetics of phosphorothioate oligonucleotide metabolism

For the enzymatic digestion of a 25-mer phosphorothioate (PS) oligonucleotide, the reaction kinetics was previously determined to be the sum of two parallel processes: a fast and a very slow phase of digestion suggesting a two-exponential model. A characteristic metabolite profile was observed both in vitro and in vivo. This behavior is shown to be the result of the stereoselective cleavage of chiral R-configuration and S-configuration PS internucleotide linkages by 3'-exonucleases. The stereoselective nature of 3'-exonuclease action was analyzed by reverse-phase HPLC. The separation of eight diastereomers of the tetramer TTCT (5'-3') was used to follow the stereoselective course of exonuclease hydrolysis of PS internucleotide linkages. Degradation of the 25-mer parent compound having a 3' S-terminal internucleotide linkage was calculated to be more than 300 times slower than an analog with a 3'-terminal R-configuration. These results support an approach for protecting antisense oligonucleotides based on the chirality of only the 3'-end internucleotide linkage.

Ca2+-induced Ca2+ release mediates a slow post-spike hyperpolarization in rabbit vagal afferent neurons

The relation between Ca2+-induced Ca2+ release (CICR) elicited by action potentials (APs) and a Ca2+-dependent slow post-spike hyperpolarization (AHPslow) in acutely dissociated adult rabbit nodose neurons was studied using microfluorimetric calcium measurements in conjunction with standard intracellular current- and voltage-clamp recording techniques. The magnitude of the AP-induced transient increase in [Ca2+]i (DeltaCat) was used to monitor CICR. There was a close correlation between the magnitude of the DeltaCat and the AHPslow current over the range of 1-16 APs (r = 0.985). Functional CICR blockers, ryanodine (10 muM), thapsigargin (100 nM), 2,5-di(t-butyl)hydroquinone (10 muM) or cyclopiazonic acid (10 muM), selectively reduced the peak amplitude of the AHPslow >/=91%. In five neurons, simultaneous recordings of the DeltaCat and the AHPslow revealed that both responses were blocked in parallel. These findings indicate that CICR is necessary for the generation of the AHPslow in rabbit nodose neurons. The DeltaCat rises and decays significantly faster than the AHPslow. This temporal disparity suggests that activation of the AHPslow by Ca2+ may require additional signal transduction steps.

Method for phosphorothioate antisense DNA sequencing by capillary electrophoresis with UV detection

The progress of antisense DNA therapy demands development of reliable and convenient methods for sequencing short single-stranded oligonucleotides. A method of phosphorothioate antisense DNA sequencing analysis using UV detection coupled to capillary electrophoresis (CE) has been developed based on a modified chain termination sequencing method. The proposed method reduces the sequencing cost since it uses affordable CE-UV instrumentation and requires no labeling with minimal sample processing before analysis. Cycle sequencing with ThermoSequenase generates quantities of sequencing products that are readily detectable by UV. Discrimination of undesired components from sequencing products in the reaction mixture, previously accomplished by fluorescent or radioactive labeling, is now achieved by bringing concentrations of undesired components below the UV detection range which yields a 'clean', well defined sequence. UV detection coupled with CE offers additional conveniences for sequencing since it can be accomplished with commercially available CE-UV equipment and is readily amenable to automation.

Kinetics of phosphorothioate oligonucleotide metabolism in biological fluids

The in vitro stability and metabolism of GEM[91, a 25mer phosphorothioate antisense oligonucleotide complementary to the gag mRNA region of HIV-1, was investigated using capillary electrophoresis (CE). The in vitro degradation of the parent compound at 37 degrees C was followed over the course of 120 h in human plasma. A CE method using laser-induced fluorescence detection was able to detect 5'-end intact metabolites including the parent compound extracted from biological fluids. Because the primary metabolic pathway is believed to be via 3'-exonuclease activity, the results of this study were compared with the stability of the compound in a solution containing 3'-exonuclease. The numerical solution of sequential first-order reactions was used to obtain kinetic parameters. Exonuclease digestion of the parent compound, as measured using an automated CE-UV instrument, yielded striking similarities between the two in vitro systems as well as between in vitro and in vivo systems.

Lipid peroxidation, antioxidant status and troponin-T following cardiopulmonary bypass. A comparison between intermittent crossclamp with fibrillation and crystalloid cardioplegia

OBJECTIVE

Intermittent crossclamp with fibrillation affords equivalent myocardial protection to cold crystalloid cardioplegia in patients undergoing elective coronary artery surgery. This study is a direct comparison between the two techniques with regards to free radical activity.

METHODS

The study design was part of a prospective randomised trial. We studied 24 consecutive patients with ejection fraction of 30% or greater undergoing elective coronary artery surgery. Patients were randomised into two groups. In group 1 (n = 13) the myocardium was protected by intermittent aortic cross clamping with fibrillation and group 2 (n = 11) by antegrade cold crystalloid cardioplegia. The determinants of free radical activity were serial peripheral venous samples for lipid peroxidation and plasma antioxidant status (before and at 1, 6, 24 and 72 h after the end of cardiopulmonary bypass). The determinant of the efficacy of myocardial protection was serial peripheral venous samples of cardiac troponin-T taken at the same time intervals.

RESULTS

The groups were similar with respect to age, sex distribution, preoperative ventricular function, left main stem disease, number of grafts and bypass times. Lipid peroxidation measurements at the 1 h time point were higher than preoperative values (7.24 +/- 1.19 vs. 4.48 +/- 0.69 and 9.36 +/- 1.46 vs. 4.98 +/- 1.02 (mean +/- S.E) in groups 1 and 2, respectively (units in mmol/l) thereafter values decreased to near preoperative values by 72 h. There was no significant difference between the groups (P = 0.42). Total plasma antioxidant status values at the 1 h time point were lower than the preoperative values for all patients (1.33 +/- 0.07 vs. 1.63 +/- 0.06 and 1.42 +/- 0.07 vs. 1.63 +/- 0.05 (mean +/- standard error) in groups 1 and 2, respectively, (units in mmol/l) and thereafter at the subsequent time points increased but never attained their preoperative value. There was no statistically significant difference between the two groups (P = 0.59). Troponin-T measurements showed no significant difference between the two groups at all time points (P = 0.2217).

CONCLUSIONS

This study shows that lipid peroxidation is initially elevated and the defence mechanisms against oxygen free radicals-antioxidant status'-are depressed following cardiopulmonary bypass. The degree of oxygen free radical activity produced during ischaemia and reperfusion was similar in both types of myocardial protection employed in this study.

Minimally invasive coronary revascularization through parasternal incisions without cardiopulmonary bypass

BACKGROUND

We report the results of minimally invasive coronary revascularization without cardiopulmonary bypass through miniparasternal incisions.

METHODS

This procedure was performed in 40 patients with disease in the left anterior descending, first diagonal, and right coronary arteries. After a 5- to 7-cm left vertical parasternal incision and removal of two costal cartilages, the left internal mammary artery was harvested up to the 2nd rib. The left anterior descending artery was occluded by means of two polydioxanone monofilament sutures. The anastomosis was performed with one 7-0 Prolene suture while the heart was beating. In 4 cases the left internal mammary artery was used as a sequential graft to the left anterior descending artery and the first diagonal artery. In 14 cases the right coronary artery was grafted with the right internal mammary artery through a right parasternal incision. Postoperatively, 95% of the patients underwent angiographic assessment of the anastomoses.

RESULTS

We performed 52 anastomoses (34 to the left anterior descending artery, 4 to the first diagonal artery, and 14 to the right coronary artery). The mortality was 0% and the morbidity included postoperative bleeding (5%), acute renal failure (2.5%), atrial fibrillation (2.5%), and wound infection (5%). No patient had ventricular arrhythmias or circulatory problems during or after the operation. Two patients (5%) with right internal mammary artery-to-right coronary artery grafting had graft failure that required a redo operation.

CONCLUSIONS

Small vertical parasternal incisions may be an alternative approach for single and multiple coronary revascularization, with a low incidence of intraoperative cardiac complications. The application of this approach to the right coronary artery, however, carries additional technical difficulties, and careful patient selection may be required to achieve optimal results.

National survey of endodontists and selected patient samples: infectious diseases and attitudes toward infection control

A survey was conducted of 591 patients from endodontic practices located in six large municipalities in the United States. A comparison was made between the self-reported incidence of transmissible diseases from patients medical histories to national statistics for the incidence of hepatitis B, herpes, tuberculosis, and HIV/AIDS. A national survey of 422 endodontists was also conducted. This survey was used to determine the beliefs and attitudes of practicing endodontists toward infection control techniques and infectious diseases. Compared with previous surveys, a trend toward increasing use of the hepatitis B vaccine, gloves, and greater acceptance of medically compromised patients was found.