Angiogenesis in transmyocardial laser revascularization. A nonspecific response to injury

BACKGROUND

The mechanism of action of transmyocardial laser revascularization (TMR) is poorly understood. TMR has been shown to stimulate angiogenesis in porcine and canine myocardium.

METHODS AND RESULTS

We examined the possibility that angiogenesis also occurs in ovine myocardium and that it is a nonspecific tissue injury response. Five Dorset sheep underwent creation of transmyocardial channels of equal diameter in both the apical and basal regions of the left ventricle through the use of both CO2 laser in 1 region and a power drill in the alternate region of the same heart. All channels were closed at 4 weeks. Histology showed channel remnants composed of granulation tissue, fibrosis, and new vessels (NV). These changes were not distinguishable on the basis of the method of channel creation. The average diameter of the channels was similar (laser, 630 +/- 180 microns; drill, 750 +/- 280 microns) (P = NS). NV with smooth muscle media were seen within the channel remnant and immediately surrounding this region using Verhoeff-Van Gieson (elastic) stain. The densities of the NV within the channel remnants were similar (laser, 1.87 +/- 1.05 NV/high-power field [hpf]; drill, 1.92 +/- 1.09 NV/hpf; P = NS), and both were significantly greater than the density of vessels in remote regions, > 5 mm from the channel center (remote laser area, 0.09 +/- 0.28 NV/hpf; remote drill area, 0.04 +/- 0.21 NV/hpf; P = NS for remote areas, P < 0.001 for laser versus remote laser, P < 0.001 for drill versus remote drill area).

CONCLUSIONS

These findings demonstrate that the CO2 laser stimulates angiogenesis in normal ovine myocardium and suggest that this response represents a nonspecific reaction to tissue injury.

Transmyocardial laser revascularization fails to prevent left ventricular functional deterioration and aneurysm formation after acute myocardial infarction in sheep

OBJECTIVE

Transmyocardial laser revascularization is an investigational technique for revascularizing ischemic myocardium in patients with inoperable coronary arterial disease. This study tests the hypothesis that laser revascularization prevents left ventricular functional deterioration and aneurysm formation after acute anteroapical myocardial infarction.

METHODS

An ultrasonic ascending aortic flow probe and snares around the distal left anterior descending and second diagonal coronary arteries were placed in 26 Dorsett hybrid sheep. Ten to 14 days later, snared arteries were occluded to produce an anteroapical infarction of 23% of left ventricular mass. Before infarction 14 animals had 34 +/- 4 transmyocardial perforations in the area of the anticipated infarction made with a carbon dioxide laser. Twelve animals served as controls. Hemodynamic measurements and transdiaphragmatic quantitative echocardiograms were obtained before, immediately after, and 2, 5, and 8 weeks after infarction. Eighteen sheep completed the protocol.

RESULTS

All animals had large anteroapical left ventricular aneurysms with massive ventricular enlargement. Immediately after infarction the anterior wall became thinner and dyskinetic in all sheep. At 8 weeks aneurysmal size and shape were indistinguishable between groups. Two days after infarction, laser holes were filled with fibrin. At 5 and 8 weeks the infarct consisted of dense collagen, fibroblasts, scattered calcifications, myocyte fragments, neutrophils, macrophages, and no laser holes. There were no significant differences at any time between groups for cardiac pressures or output, ventricular volumes, ejection fraction, stroke work, and the stroke work-left ventricular end-diastolic pressure index.

CONCLUSION

Transmyocardial laser perforations do not revascularize acute myocardial infarction in sheep.

Physiology and biochemistry of the pseudobranch: an unanswered question?

The structure and function of the pseudobranch has long interested scientists, but its overall role has remained a mystery. Previous studies have attributed respiratory, endocrine, osmoregulatory and sensory roles to the pseudobranch, and the present review concentrates on new findings. Perfusion experiments on the pseudobranch of the rainbow trout (Oncorhynchus mykiss) using both erythrocyte suspensions and Ringer solution have shown that this organ is able to generate values for the respiratory quotient (RQ) greater than 1.0. The release of carbon dioxide into the perfusate was found to be largely independent of flow between perfusion rates of 120-190 microl/min and could be inhibited by acetazolamide (10(-5) M), indicating a role for carbonic anhydrase. Noradrenaline (10(-5) M) had no effect on oxygen consumption or carbon dioxide release of the pseudobranch. The rate of carbon dioxide release was also dependent on the pH of the pre-pseudobranch perfusate, carbon dioxide release being reduced at lower perfusate pH values. Based on the glucose balance of the isolated saline-perfused rainbow trout pseudobranch and on the enzyme profiles for the rainbow trout, cod, swordfish and deep-water grenadier pseudobranch, it is suggested that the pentose phosphate shunt might be a source of carbon dioxide, yielding the high RQ values found for this organ. Most evidence now available indicates that the pseudobranch is integrally linked with the choroid rete and the supply of oxygen to the retina of the fish eye.

Ecophysiological adaptations to dry thermal environments measured in two unrestrained Namibian scorpions, Parabuthus villosus (Buthidae) and Opisthophthalmus flavescens (Scorpionidae)

The daily changes in body temperature experienced by Parabuthus villosus (Buthidae), a scorpion found on the gravel plains around Gobabeb, Namibia, and by Opisthophthalmus flavescens (Scorpionidae), a dune-dwelling species from the same area, were measured under similar field conditions. Thermocouples implanted under the segments of the mesosoma measured maximum temperatures as high as 43 degrees C in the shade. Air temperatures reached a maximum of 33 degrees C during the daytime and a minimum of 12 degrees C at night. Very low metabolic rates compared with those of other nonsedentary invertebrates were recorded in both species; oxygen consumption ranged from 8 microL g-1 h-1 at 16 degrees C to 115 microL g-1 h-1 at 40 degrees C. A pulsed Doppler system was used to measure heart rate in situ in free-moving scorpions. At night, heart rate declined to about 4 beats min-1 in resting undisturbed scorpions. During daylight excursions and while scorpions hunted for food, heart rates as high as 180 beats min-1 were observed. Heart rate was linearly correlated with temperature in P. villosus, with a slope of 2.37 (Q10 = 2.18), but in O. flavescens only a limited correlation was observed, with a slope of 1.18 (Q10 = 1.69). In O. flavescens, heart rate showed hysteresis as body temperature rose during daylight and then decreased during the late afternoon and evening; the reverse was observed in P. villosus. In both species, haemocyanin-oxygen affinity was independent of temperature, with a higher oxygen affinity and a larger pH sensitivity in O. flavescens. The Q10's of oxygen consumption and heart rate are quite different in O. flavescens but not as different in P. villosus. Although changes in the cardiovascular system, such as stroke volume, may also play a role in meeting increased oxygen demand, the features of the haemocyanin oxygen transport system, such as the absence of temperature sensitivity and a marked pH sensitivity, can also influence the maintenance of VO2 under temperature stress. The differences in the normal thermal habitats of the two species may be used to explain the distinctions between the evolved physiological responses to temperature increase shown by the two species.

Autogenously lined skeletal muscle ventricles in circulation. Up to nine months' experience

Skeletal muscle ventricles were constructed in fifteen dogs. After a delay period of 4 weeks the skeletal muscle ventricles were connected to the descending thoracic aorta with a polytetrafluoroethylene bifurcation graft (Gore-Tex bifurcation graft, W.L. Gore & Associates, Inc., Elkton, Md.). The aorta was ligated between the two limbs of the graft so that there was obligatory blood flow through the skeletal muscle ventricle. Nine skeletal muscle ventricles were lined with autogenously derived tissue, either pleura or pericardium, whereas six had no specific lining other than an induced fibrous reaction. The skeletal muscle ventricles were activated to contract during cardiac diastole. Aortic diastolic counterpulsation was achieved in all dogs, with ten surviving from 1 week to beyond 9 months. Thrombus eventually developed in all but three of the skeletal muscle ventricles, but no dog had clinical evidence of thromboemboli. The three thrombus-free skeletal muscle ventricles were lined with pleura, including the animal surviving beyond 9 months. These results indicate that canine skeletal muscle can provide aortic diastolic counterpulsation for 9 months without clinically apparent thromboembolic complications.

Skeletal muscle bioenergetics during frequency-dependent fatigue

The bioenergetic correlates of skeletal muscle fatigue were assessed in vivo with phosphorus-31 nuclear magnetic resonance (31P-NMR) spectroscopy. After surgical construction of latissimus dorsi muscle ventricles, seven beagles underwent 31P-NMR spectroscopy during 12-min exercise protocols at 25- and 85-Hz stimulation frequencies and during both isovolumetric and dynamic contractions. Exercise at 85 Hz was associated with significantly greater fatigue than exercise at 25 Hz. At both frequencies, the onset of exercise was associated with a marked increase in inorganic phosphate (Pi) and a decrease in phosphocreatine (PCr). As the muscle fatigued at 85 Hz but not at 25 Hz, the phosphorus spectra returned to near baseline with a decrease in Pi and increase in PCr. For a given amount of force generated, the Pi-to-PCr ratio was higher for dynamic contractions than for isovolumetric contractions. This study indicates that high-frequency fatigue is unlikely to result from the direct effects of high-energy phosphate metabolism and that contractions producing external work consume more metabolic energy than equally forceful isometric contractions.

Reversible hexadimethrine-induced alterations in glomerular structure and permeability

Female Munich-Wistar rats received hexadimethrine (HDM) i.v. until the onset of proteinuria (PEAK)--a period of not more than 30 min. There were four experimental groups: C (control), H (HDM only), HH (HDM and heparin), and HHD (identical to HH but with dextran clearances measured). Rats in groups HH and HHD received a heparin bolus after the PEAK period, whereas rats in group H did not. HDM led to dramatic increases in both albumin and IgG excretion. Glomerular filtration rate and renal plasma flow rate were reduced by 30 to 50% after HDM infusion. Neutral dextran clearances for radii greater than 30 A were elevated during the PEAK period, and, concurrently, there was extensive intraglomerular microthrombosis, obliteration of foot processes, and disruption of filtration slit diaphragms. One hour later, glomerular filtration rate, renal plasma flow rate, dextran clearances, and proteinuria returned to baseline in groups HH and HHD but not in group H. Recovery in heparin-treated rats was associated with reversal of HDM-associated morphological alterations. Membrane pore-size parameters calculated from the dextran clearances indicate that HDM leads to a detect in glomerular size-selectivity. The facts that maximal albuminuria tended to precede maximal excretion of IgG and that increases in albumin excretion were proportionately greater than those of dextran or IgG suggest that HDM also leads to a time-dependent defect in glomerular charge-selectivity.

Performance of skeletal muscle ventricles: effects of ventricular chamber size

Skeletal muscle ventricles were constructed in 12 dogs. In one group of dogs (n = 7) the skeletal muscle ventricles were constructed around a 17 ml Teflon mandrel, and in the other group (n = 5) a 45 ml mandrel was used. Use of the larger mandrel resulted in an increase in compliance and greater stroke work over the physiologic range of preloads and afterloads. With the larger mandrel, stroke work consistently exceeded normal canine stroke work at physiologic filling pressures.

Respiratory pigments: interactions between oxygen and carbon dioxide transport

Oxygen and carbon dioxide are transported in vertebrates and invertebrates by a wide range of respiratory pigments. These respiratory gases are not transported independently of one another, and this review considers the influence of carbon dioxide on oxygen transport and vice versa. A specific effect of carbon dioxide or bicarbonate, decreasing oxygen affinity, is found in many haemoglobins, but the effect is often reduced in the presence of organic phosphates. Clear experimental data are available for mammalian haemoglobins but in birds and lower vertebrates more data are required to verify the presence and magnitude of the CO2 effect. In erythrocruorins and haemocyanins CO2 increases O2 affinity, whereas in haemerythrins, as in haemoglobin, CO2 again decreases oxygen affinity. Much of our knowledge of invertebrate respiratory pigments is based, however, on data from one or two species. A specific effect of CO2 on O2 affinity has also often been found only at high CO2 partial pressures, which may be outside the physiological range for these species. More in vivo experimental data on CO2 values are required for these species, and further studies on other species may help to explain this discrepancy. The interaction of O2 and CO2 transport is mainly through the Haldane effect, i.e., deoxygenated blood having a greater capacity for CO2 than oxygenated blood. This is due directly to the formation of carbamino groups (carbamate) and also to the fact that deoxygenated blood binds relatively more protons than oxygenated blood. This forms the basis for the linkage between the Bohr and Haldane effects. In some species in which the Bohr coefficient is below −1.0, an akalosis in the tissues may be induced. Large Haldane effects may be particularly effective in promoting CO2 unloading when the partial pressure difference of CO2 between arterial and venous blood is small. Carbamate formation may account for 10–20% of the CO2 transported in mammals, but its role in lower vertebrates and invertebrates has only recently been considered. Carbon dioxide transport is modulated by those factors that influence O2 affinity as these in turn influence the Haldane effect.

Functional right-heart replacement with skeletal muscle ventricles

Skeletal muscle ventricles were constructed from the latissimus dorsi in seven dogs. All skeletal muscle ventricles underwent a vascular delay period followed by 4-7 weeks of electrical preconditioning. In group 1 (n = 5), the skeletal muscle ventricle was used to replace native right-heart function. Venous return from the superior and inferior venae cavae was directed to the skeletal muscle ventricle with outflow directed to the pulmonary artery. In group 2 (n = 2), the skeletal muscle ventricle was used for partial bypass of the right heart. In both groups, right-heart bypass was continued for as long as 8 hours. In group 1 after 4 hours of continuous complete right-heart bypass, stroke work was 163 +/- 63% of canine right ventricular stroke work. Skeletal muscle ventricle output was 1.14 +/- 0.02 l/min, central venous pressure was 13 +/- 1.5 mm Hg, and systemic systolic blood pressure was 95 +/- 9 mm Hg. Skeletal muscle ventricles are capable of performing the work of the right heart with near-physiological filling pressures.

Skeletal muscle ventricles: improved performance at physiologic preloads

We attempted to construct skeletal muscle ventricles (SMVs) so that they would develop optimal stroke work at physiologic preloads of 5 to 15 mm Hg. Thirty-one SMVs were constructed in mongrel dogs. The effects of electrical preconditioning with 2 Hz continuous and 25 Hz burst patterns were evaluated, as well as the application of passive stretch to the muscle fibers during preconditioning. We evaluated the stroke work developed by these SMVs at afterloads of 30 mm Hg and 80 mm Hg in vivo, using a mock circulation device. During mock circulation studies, the SMVs were stimulated via the thoracodorsal nerve with either a 25 Hz or 85 Hz burst pattern. SMVs with 2 Hz preconditioning developed significantly higher stroke work than SMVs with 25 Hz preconditioning under all conditions of afterload, preload, and stimulation frequency (p less than or equal to 0.001). Under these conditions, for the 2 Hz preconditioned SMVs, passive stretch during preconditioning resulted in a further significant increase in developed stroke work (p less than 0.05). For these SMVs, with an 85 Hz stimulation frequency, stroke work averaged 410% of canine RV stroke work, and 59% of canine LV stroke work at physiologic preloads and afterloads.

Antirheumatic agents: CNS toxicity and its avoidance

Altered drug metabolism, polypharmacy, multiple diseases, and errors in self-medication are all factors seen in the elderly which increase the risk for side effects from antirheumatic drug therapy. The geriatric presentation of central nervous system (CNS) toxicity, which is common yet frequently overlooked, is reviewed as it pertains to various drugs commonly used to treat rheumatic disease. Practical advice on avoiding common pitfalls in antirheumatic prescribing is offered.

Long-term neurostimulation of skeletal muscle: its potential for a tether-free biologic cardiac assist device

Skeletal muscle has a tremendous capacity to adapt. This adaptive phenomenon is seen perhaps to the greatest extent when skeletal muscle is subjected to chronic low frequency stimulation via the motor nerve. There is a decrease in glycolytic enzymes and an increase in oxidative enzymes, as well as a change in the contractile proteins and an increase in the mitochondrial volume fraction of the muscle fiber. These adaptive changes result in a muscle that is considerably more fatigue-resistant. Specifically herein, we report on a pneumatic aortic counterpulsator device powered by skeletal muscle. These muscle pumps functioned continuously and pumped blood effectively in tether-free animals for several weeks.

Acute, fatal illness in cattle exposed to boron fertilizer

Twenty-six cows died after accidental exposure to boron fertilizer. Cows developed diarrhea, weakness, ataxia, signs of depression, and died, usually within a few hours. Seizure-like behavior was noticed in 2 cows, and 2 were suspected of aborting. High boron concentrations in tissues from affected cows confirmed ingestion of an appreciable amount of boron fertilizer. In an attempt to confirm the diagnosis of boron poisoning, boron fertilizer was administered to goats. A kid goat given 3.6 g of fertilizer/kg of body weight developed clinical signs similar to those seen in the cattle. Boron compounds such as sodium borate and boric acid have been considered generally nontoxic, and reports of livestock toxicosis are uncommon. This case report suggests that these compounds may be palatable under certain circumstances leading to ingestion of toxic quantities.

Skeletal muscle ventricles as a potential right heart assist or substitute

Skeletal muscle ventricles (SMV) were constructed from canine latissimus dorsi muscle and chronically stimulated to pump fluid within a totally implantable mock circulation device. They were stimulated to contract at either 95/min (N = 7) or 54/min (N = 4). The preload was chronically maintained at 20 mmHg. After 1 month of continuous pumping the SMV were capable of generating a stroke work of 0.134 X 10(6) ergs and power output of 0.021 watts, representing 61% and 42% of the stroke work and power output of the native canine right ventricle, respectively.

Physiological adaptations of the intertidal rockpool teleost Blennius pholis L., to aerial exposure

Gas exchange, metabolism, ventilation, circulation and acid-base balance in water and air were investigated in Blennius pholis. The rates of gas exchange in water and air were similar with the RQ remaining around 0.8. Aerial gas exchange was equally divided between the head/gills and the tail region. Ventilatory adaptations involved a reduction in rate in air and the mode of ventilation changed from flow-through to tidal, with closed opercula. A transient bradycardia developed on transition to air before heart frequency (fH) returned to aquatic levels. During aerial exposure PvCO2 rose only by 1 Torr with a concomitant decrease in pH of 0.19 pH-units. At the same time a metabolic acidosis was observed which could not be fully accounted for by the formation of lactic acid in the blood, although tissue lactate levels did not change significantly. No histological evidence was found for the presence of carbonic anhydrase in the epithelial cells of the skin or the oesophagus to aid aerial CO2 excretion. Inhibition of CA activity by addition of methazolamide to blood, however, caused PvCO2 to rise by 3 Torr and pHv to decrease by 0.4 pH unit. It is concluded that B. pholis is physiologically well adapted to aerial exposure through adjustments in ventilation and circulation and that erythrocytic carbonic anhydrase plays a major role in CO2 transfer.

Heteroporous model of glomerular size selectivity: application to normal and nephrotic humans

A heteroporous model of the glomerular filtration barrier was developed and used to interpret dextransieving data in healthy volunteers (normal controls), in patients with nephrotic range proteinuria (grouped as grades I-III, according to severity), and in a group of previously nephrotic patients whose proteinuria was in remission ("resolved controls"). Several hypothetical pore-size distributions were compared in terms of their ability to describe the selective increases in the fractional clearance of large dextrans observed with increasing severity of proteinuria. The most successful model examined was based on the assumption that the major portion of the capillary wall functions as an isoporous membrane, but that a small fraction of the filtrate passes through pores that are unable to discriminate among dextrans of different sizes. The value of the membrane parameter that reflects the relative importance of the nonselective pores was found to increase in parallel with the fractional clearance of immunoglobulin G; it increased progressively in going from normal controls to resolved controls to grades I-III nephrotics. The observed patterns of protein excretion could not, however, be explained entirely by a loss of glomerular size selectivity. Variations in membrane selectivity on the basis of molecular charge and/or molecular configuration are also likely to have been important.

Oxygen binding in blood of Xenopus laevis (Amphibia) and evidence against Root effect

Blood oxygen binding was examined in the amphibian, Xenopus laevis, with the particular aim of determining whether the O2 capacity is diminished when blood pH is lowered, which is known as the Root effect in blood of some fishes. Hemoglobin-bound O2 concentration, [O2Hb], was determined by the Lex-O2-Con technique, and both total hemoglobin, [Hb]tot, and Met-hemoglobin, [MetHb], contents were measured spectrophotometrically. From these measurements were calculated the oxygen capacity, O2cap, and the content of active hemoglobin, [Hb]act, i.e. the difference between [Hb]tot and [MetHb]. The main finding was the independence of the ratio of O2cap/[Hb]act on pH, when differences between samples in [Hb]tot and the presence of MetHb, which was particularly pronounced at low pH, where properly accounted for. It is concluded that the Root effect does not exist in blood of the amphibian Xenopus laevis.