Acute coronary syndromes complicating the first infusion of rituximab

The aim of this study was to describe the occurrence of acute coronary syndromes in 3 cases of rituximab infusions. We reviewed the records of 3 patients with lymphoproliferative disorders who experienced acute coronary syndromes associated with their initial infusion of rituximab. All 3 patients received rituximab according to a standardized institutional rate schedule, and all received pre-medication with acetaminophen and diphenhydramine. The median age of patients was 61 years. One patient had known atherosclerotic heart disease, and 2 patients had risk factors for coronary artery disease. All patients had varying degrees of evidenced high tumor burden, including lymphocytosis, elevated lactate dehydrogenase values, bulky tumor masses, and bone marrow involvement by lymphoma. All 3 patients experienced fairly typical chest pain syndromes and experienced elevations of cardiac enzymes consistent with myocardial ischemia. One patient died of an arrhythmia that deteriorated into asystole, and 2 patients recovered and underwent coronary angiography. Acute coronary syndromes can be associated with the infusion of rituximab. Patients with a history of previous coronary artery disease or risk factors for coronary artery disease should be observed closely for signs of myocardial ischemia, particularly during the initial infusion. The occurrence of symptoms that could be ascribed to an acute coronary syndrome should always be taken seriously during the first rituximab infusion and investigated aggressively. Patients should be aware that this is a rare, albeit serious, complication of treatment with rituximab.

Scaling up collaborative TB-HIV activities in Latin America

TB-HIV collaborative activities are one of the cornerstones of TB control in the Stop TB strategy. Since 2003, most countries in Latin America and the Caribbean have been gradually implementing TB-HIV collaborative activities; however, limited information is currently available on the degree of implementation. This study is therefore aimed at describing to what degree TB-HIV collaborative activities are being implemented in 17 countries selected for the study. These countries were asked to complete a semi-structured questionnaire. An analysis of this questionnaire revealed that the challenges for TB-HIV collaboration lie in the fields of human resources, surveillance and HIV testing of TB patients.

Calcium/calmodulin-dependent protein kinase II supports morphine antinociceptive tolerance by phosphorylation of glycosylated phosducin-like protein

The long isoform of the phosducin-like protein (PhLPl) is widely expressed in the brain and it is thought to influence G-protein signalling by regulating the activity of Gbetagamma dimers. We show that in the mature nervous system, PhLPl exists as both a 38kDa non-glycosylated isoform and as glycosylated isoforms of about 45, 100 and 150kDa. Additionally, neural PhLPl is subject to serine phosphorylation, which augments upon the activation of Mu-opioid receptors (MORs), as does its association with Gbetagamma subunits and 14-3-3 proteins. While the intracerebroventricular (icv) administration of morphine to mice rapidly reduced the association of MORs with G proteins, it increased the serine phosphorylation of these receptors. Moreover, activated Ca2+/calmodulin-dependent protein kinase II (CaMKII) accumulated in the MOR environment and phosphorylated PhLPl was seen to co-precipitate with these opioid receptors. Opioid-induced phosphorylation of PhLPl was impaired by inhibiting the activity of CaMKII and, in these circumstances, the association of PhLPl with Gbetagamma dimers and 14-3-3 proteins was diminished. Furthermore, these events were coupled with the recovery of G protein regulation by the MORs, while there was a decrease in serine phosphorylation of these receptors and morphine antinociceptive tolerance diminished. It seems that CaMKII phosphorylation of PhLPl stabilizes the PhLPl.Gbetagamma complex by promoting its binding to 14-3-3 proteins. When this complex fails to bind to 14-3-3 proteins, the association of PhLPl with Gbetagamma is probably disrupted by GalphaGDP subunits and the MORs recover control on G proteins.

Naphthyl piperazines with dual activity as 5-HT1D antagonists and 5-HT reuptake inhibitors

SAR around a known molecule with dual 5-HT(1D) antagonist and 5-HT(transporter) inhibitory activity has led to the discovery of molecules with improved dual activity and reduced cross-reactivity toward other aminergic receptors (5-HT(1B), alpha(1), and D(2)).

Reductive Cleavage of Tetrahydrofuryl Sulfur-Substituted Oxiranes: Application to the Formal Synthesis of Kumausyne and Kumausallene

[reactions: see text] Readily available sulfinyl and sulfonyl tetrahydrofuran methanol derivatives have been transformed efficiently into a variety of substituted tetrahydrofuryl alcohols by treatment with (PhSe)2 in the presence of an excess of NaBH4. Alternatively, oxirane cleavage with MgI2 produces the related ketones, amenable to stereocontrolled reduction. This reductive cleavage methodology has been applied to short formal syntheses of trans-Kumausyne and Kumausallene.

Dipeptides as effective prodrugs of the unnatural amino acid (+)-2-aminobicyclo[3.1.0]hexane-2,6-dicarboxylic acid (LY354740), a selective group II metabotropic glutamate receptor agonist

(+)-2-Aminobicyclo[3.1.0]hexane-2,6-dicarboxylic acid (1), also known as LY354740, is a highly potent and selective agonist for group II metabotropic glutamate receptors (mGlu receptors 2 and 3) tested in clinical trials. It has been shown to block anxiety in the fear-potentiated startle model. Its relatively low bioavailability in different animal species drove the need for an effective prodrug form that would produce a therapeutic response at lower doses for the treatment of anxiety disorders. We have investigated the increase of intestinal absorption of this compound by targeting the human peptide transporter hPepT1 for active transport of di- and tripeptides derived from 1. We have found that oral administration of an N dipeptide derivative of 1 (12a) in rats shows up to an 8-fold increase in drug absorption and a 300-fold increase in potency in the fear-potentiated startle model in rats when compared with the parent drug 1.

Highly Diastereoselective Diels-Alder Reactions with Enantiopure Sulfinyl-Substituted 1-Hydroxymethyldienes

Enantiopure hydroxy-2- and -3-sulfinyldienes undergo highly selective Diels-Alder cycloadditions with various dienophiles controlled by the chiral sulfur atom. The related hydroxy-2-sulfonyldienes display complementary pi-facial selectivity.

RGS-Rz and RGS9-2 proteins control mu-opioid receptor desensitisation in CNS: the role of activated Galphaz subunits

Two consecutive i.c.v. administrations of analgesic doses of mu-opioid receptor agonists lead to a profound desensitisation of the latter receptors; a third dose produced less than 20% of the effect obtained with the first administration. Desensitisation was still effective 24h later. Impairing the activity of Galphaz but not Galphai2 subunits prevented tolerance developing after the administration of three consecutive doses of morphine. Further, the i.c.v. injection of Galphai2 subunits potentiated morphine analgesia and abolished acute tolerance, whereas i.c.v.-administered Galphaz subunits produced a rapid and robust loss of the response to morphine. The RGSZ1 and RGSZ2 proteins selectively deactivate GalphazGTP subunits, and their knockdown increased the effects produced by the first dose of morphine. However, impairing their activity also accelerated tachyphylaxis following successive doses of morphine, and facilitated the development of acute morphine tolerance. In contrast, inhibiting the RGS9-2 proteins, which bind to GalphaoGTP and GalphaiGTP but only weakly deactivates them, preserved the effects of consecutive morphine doses and abolished the generation of acute tolerance. Therefore, desensitisation of mu-opioid receptors can be achieved by reducing the responsiveness of post-receptor elements (via the possible action of activated Galphaz subunits) and/or by depleting the pool of receptor-regulated G proteins that agonists need to propagate their effects, e.g., through the activity of RGS9-2 proteins.

Resveratrol treatment controls microbial flora, prolongs shelf life, and preserves nutritional quality of fruit

Resveratrol is known as a grapevine secondary metabolite with fungicide activity. Its exogenous application on harvested grapes resulted in the reduction of microbial flora growth, and consequently, prolonged shelf life, without affecting the nutritional quality of the fruit. Resveratrol treatment also resulted in being effective on fruit that normally does not accumulate such metabolites as, for example, tomatoes, apples, avocado pears, and peppers. As a result, all treated fruits maintained their post-harvest quality and health longer than the untreated ones. This study demonstrates the potential use of resveratrol as a natural pesticide to reduce post-harvest fungi development on a broad spectrum of fruit types.

Le travail musculaire excentrique : intérêts dans la prise en charge thérapeutique du sportif

OBJECTIVES

To review the research on the effects and indications of eccentric muscular contraction in the athlete.

METHODS

We searched the Medline database using the key words eccentric and negative work for reports of eccentric muscular contraction published from 1993 to 2004.

RESULTS

The physiologic features of eccentric contraction remain unknown but significantly differ from concentric contraction. Eccentric contraction has a specific effect: during sports practice, it permits the muscular and tendinous complex to support strain and strengthens the muscular action of articular stabilization. But eccentric contraction produces injuries: delayed-onset muscle soreness, and muscle rupture and tendinous injuries such as luxation, rupture, and tendinitis.

CONCLUSION

Treatment and prevention must have controlled protocols. In therapy, eccentric contraction must be realized at progressive speeds and resistances. Prevention of tendinous injury necessitates quantifying eccentric activity during training.

[Pancoast syndrome and endobronchial tumor infiltration as the first manifestation of Hodgkin lymphoma]

The most common cause of Pancoast syndrome is bronchogenic carcinoma. Other less common causes are solid tumor metastases, other chest tumors, infections, and hematologic neoplasms. Pancoast syndrome due to lymphoma is very rare, and cases described in the literature are essentially associated with non-Hodgkin lymphomas. In a review of the literature we found a single case of Pancoast syndrome secondary to a Hodgkin lymphoma; however, the syndrome manifested during recurrence of disease in that patient. We report a case of nodular sclerosis Hodgkin lymphoma which first manifested clinically as Pancoast syndrome and which was initially diagnosed by bronchial biopsy.

Sulfur-Directed Synthesis of Enantiopure Hydroxy 2-Sulfinyl Butadienes

The treatment of sulfinyl chlorohydrins with KO-t-Bu in THF generates epoxy vinyl sulfoxides that undergo an efficient base-induced rearrangement to generate enantiopure hydroxy 2-sulfinyl dienes. This novel process takes place with high chemo- and stereoselectivity. The chirality at sulfur effectively controls the geometry of the trisubstituted alkene.

Nucleophilic Epoxidation of α‘-Hydroxy Dienyl Sulfoxides

A novel route to enantiopure densely functionalized epoxy sulfinyl tetrahydrofurans, based on the unexpected and highly stereoselective remote nucleophilic epoxidation of hydroxy 1-sulfinyl butadienes with t-BuOOK, followed by ring closure and subsequent epoxidation of the resulting sulfinyl dihydrofurans, is described. Alternatively, the treatment of these dienes with m-CPBA followed by acid-catalyzed cyclization gives rise to related sulfonyl dihydrofurans in high yields but with low selectivity. The stereochemical outcome of the nucleophilic epoxidation of these substrates has also been studied.