Interaction-induced adiabatic cooling and antiferromagnetism of cold fermions in optical lattices

We propose an interaction-induced cooling mechanism for two-component cold fermions in an optical lattice. It is based on an increase of the spin entropy upon localization, an analogue of the Pomeranchuk effect in liquid helium 3. We discuss its application to the experimental realization of the antiferromagnetic phase. We illustrate our arguments with dynamical mean-field theory calculations.

Estradiol, testosterone, dehydroepiandrosterone and androstenedione: novel derivatives and enantiomers. Interactions with rat liver microsomal cytochrome P450 and antioxidant/radical scavenger activities in vitro

Interactions of 27 steroids, among them 17 derivatives such as ethers, sulfates and amidosulfonates derived from 17 beta- and 17 alpha-estradiol, from testosterone and alpha- and beta-dihydrotesosterone and from dehydroepiandrosterone with rat liver microsomal cytochromes P450 (P450) were investigated in vitro by assessing binding to P450 and effects on P450 mediated monooxygenase functions as measured by different model reactions: ethoxyresorufin O-deethylation (EROD), ethoxycoumarin O-deethylation (ECOD) and ethylmorphine N-demethylation (EMND). With the exception of 17 alpha-estradiol-3-dimethylamidosulfonate, estrone, its -3-methylether and -3-amidosulfonate and testosterone, all other steroids displayed type I or reverse type I binding to P450. All steroids inhibited EROD activity in micromolar concentrations. An additional strong inhibition of ECOD and EMND activities was only demonstrated for the androgens and progestins. Estriol, estrone and mestranol displayed less inhibitory actions on the model reactions than estradiol. No major differences in comparison to the parent compounds were noted with the other derivatives. The only exceptions were 17 beta-(8,9-dehydro-14 alpha,15 alpha-methylene)estradiol, which displayed stronger effects than estradiol, and dehydroepiandrosterone-3-sulfate, which was less effective than dehydroepiandrosterone. Possible antioxidant properties of the steroids were examined by the stimulated lipid peroxidation (LPO), H2O2 production, and lucigenin (LC) and luminol (LM) amplified chemiluminescence (CL) using rat liver microsomes. Additionally, the influence on rat whole blood chemiluminescence (WB-CL) was assessed. All the estrogens, but not their methylethers and amidosulfonates inhibited LPO in micromolar concentrations. The effects on the other oxidase model reactions or on WB-CL were less distinct. Only ethinylestradiol and 17 beta-(8,9-dehydro-14 alpha,15 alpha-methylene)estradiol displayed a strong inhibitory action on all model reactions. With the exception of dehydroepiandrosterone-3-sulfate, which in general had only weak effects, the androgen and progestin derivatives, in contrast, strongly decreased H2O2 formation and LM- and LC-CL, but were mostly ineffective on LPO and WB-CL.

p53 levels, cell cycle kinetics and radiosensitivity in two SV40 transformed Wi38VA13 fibroblast strains

BACKGROUND

The tumor suppressor protein p53 which can mediate an ionizing radiation-induced G1 arrest in mammalian cells, forms complexes with SV40 large T antigen (L-T-Ag). We have analyzed the p53 levels, the capability to undergo a G1 arrest and the radiosensitivity of two SV40 transformed fibroblast strains differing in their large T antigen expression.

MATERIAL AND METHODS

One of the two strains (VA13F) is the commercially available form of Wi38VA13, the other (VA13E) arose spontaneously from the original one in our laboratory. Their p53 levels were measured by means of flow cytometry (FCM) and Western blot (WB) with two p53 antibodies (Ab-3, clone PAb240; Ab-6, clone DO-1; both Oncogene Science). Cell cycle distributions were determined flow cytometrically after BrdU labeling at regular time intervals after exposure to 250 kV X-rays. Radiosensitivity was assessed in a clonogenicity assay.

RESULTS

The p53 levels of the two strains corresponded to their large T antigen expression, presumably due to complex formation between the two proteins. The strain with a high p53 level did not show a G1 arrest and had a relatively high radiosensitivity, whereas the strain with a low p53 level showed a significant G1 arrest and a lower radiosensitivity.

CONCLUSION

These results suggest that 1. complex formation between the large T antigen and p53 reduces the latter's functionality; 2. in these two strains the G1 arrest is one of the factors determining radiosensitivity.

Structure of an archaeal homolog of the eukaryotic RNA polymerase II RPB4/RPB7 complex

The eukaryotic subunits RPB4 and RPB7 form a heterodimer that reversibly associates with the RNA polymerase II core and constitute the only two components of the enzyme for which no structural information is available. We have determined the crystal structure of the complex between the Methanococcus jannaschii subunits E and F, the archaeal homologs of RPB7 and RPB4. Subunit E has an elongated two-domain structure and contains two potential RNA binding motifs, while the smaller F subunit wraps around one side of subunit E, at the interface between the two domains. We propose a model for the interaction between RPB4/RPB7 and the core RNA polymerase in which the RNA binding face of RPB7 is positioned to interact with the nascent RNA transcript.

Transforming growth factor-beta 1 inhibition of macrophage activation is mediated via Smad3

Activated macrophages are critical cellular participants in inflammatory disease states. Transforming growth factor (TGF)-beta1 is a growth factor with pleiotropic effects including inhibition of immune cell activation. Although the pathway of gene activation by TGF-beta1 via Smad proteins has recently been elucidated, suppression of gene expression by TGF-beta1 remains poorly understood. We found that of Smad1-Smad7, Smad3 alone was able to inhibit expression of markers of macrophage activation (inducible nitric-oxide synthase and matrix metalloproteinase-12) following lipopolysaccharide treatment in gene reporter assays. Transient and constitutive overexpression of a dominant negative Smad3 opposed the inhibitory effect of TGF-beta1. Domain swapping experiments suggest that both the Smad MH-1 and MH-2 domains are required for inhibition. Mutation of a critical amino acid residue required for DNA binding in the MH-1 of Smad3 (R74A) resulted in the loss of inhibition. Transient overexpression of p300, an interactor of the Smad MH-2 domain, partially alleviated the inhibition by TGF-beta1/Smad3, suggesting that inhibition of gene expression may be due to increased competition for limiting amounts of this coactivator. Our results have implications for the understanding of gene suppression by TGF-beta1 and for the regulation of activated macrophages by TGF-beta1.

Archaeal RNA polymerase subunits F and P are bona fide homologs of eukaryotic RPB4 and RPB12

The archaeal and eukaryotic evolutionary domains diverged from each other approximately 2 billion years ago, but many of the core components of their transcriptional and translational machineries still display a readily recognizable degree of similarity in their primary structures. The F and P subunits present in archaeal RNA polymerases were only recently identified in a purified archaeal RNA polymerase preparation and, on the basis of localized sequence homologies, tentatively identified as archaeal versions of the eukaryotic RPB4 and RPB12 RNA polymerase subunits, respectively. We prepared recombinant versions of the F and P subunits from Methanococcus jannaschii and used them in in vitro and in vivo protein interaction assays to demonstrate that they interact with other archaeal subunits in a manner predicted from their eukaryotic counterparts. The overall structural conservation of the M. jannaschii F subunit, although not readily recognizable on the primary amino acid sequence level, is sufficiently high to allow the formation of an archaeal-human F-RPB7 hybrid complex.

Transforming growth factor-beta 1 inhibits cytokine-mediated induction of human metalloelastase in macrophages

Matrix metalloproteinases (MMP) have been identified in vulnerable areas of atherosclerotic plaques and may contribute to plaque instability through extracellular matrix degradation. Human metalloelastase (MMP-12) is a macrophage-specific MMP with broad substrate specificity and is capable of degrading proteins found in the extracellular matrix of atheromas. Despite its potential importance, little is known about the regulation of MMP-12 expression in the context of atherosclerosis. In this study, we report that in human peripheral blood-derived macrophages, MMP-12 mRNA was markedly up-regulated by several pro-atherosclerotic cytokines and growth factors including interleukin-1beta, tumor necrosis factor-alpha, macrophage colony-stimulating factor, vascular endothelial growth factor, and platelet-derived growth factor-BB. In contrast, the pleiotropic anti-inflammatory growth factor transforming growth factor-beta1 (TGF-beta1) inhibited cytokine-mediated induction of MMP-12 mRNA, protein, and enzymatic activity. Analyses of MMP-12 promoter through transient transfections and electrophoretic mobility shift assays indicated that both its induction by cytokines and its inhibition by TGF-beta1 depended on signaling through an AP-1 site at -81 base pairs. Moreover, the inhibitory effect of TGF-beta1 on MMP-12 was dependent on Smad3. Taken together, MMP-12 is induced by several factors implicated in atherosclerosis. The inhibition of MMP-12 expression by TGF-beta1 suggests that TGF-beta1, acting via Smad3, may promote plaque stability.

Reproducibility of neointima quantification with motorized intravascular ultrasound pullback in stented coronary arteries

BACKGROUND

Intravascular ultrasound (IVUS) imaging has shown excellent reproducibility immediately after coronary stent implantation. However, the variability of measurements in lesions late after stent implantation, when neointima formation is present, has not been studied. Neointimal tissue is generally low echogenic and thus difficult to quantify. We therefore sought to analyze the reproducibility of morphometric measurements late after stent implantation.

METHODS AND RESULTS

Fifty consecutive patients were investigated 6 months after Palmaz-Schatz stent implantation (motorized catheter pullback 0.5 mm/s). Two experienced investigators independently identified the stent area, lumen area, and neointimal area at different sites within the stent. Planimetric measurements were performed with commercially available software. Correlation coefficient and mean difference for corresponding measurements were calculated for the intraobserver and interobserver comparisons. Variability for the intraobserver and interobserver comparisons was similar. Observer agreement regarding the presence of neointimal hyperplasia was as high as 71% (interobserver comparison 62%). The mean difference for neointima area was 0.06 +/- 1.5 mm(2) (-0.6 +/- 1.5 mm(2)); mean differences for lumen area were 0.02 +/- 0.19 mm(2) (0.03 +/- 0.17 mm(2)) and for stent area 0.01 +/- 0.09 mm(2) (-0.02 +/- 0.12 mm(2)) (values for interobserver comparison are given in parentheses). Correlation between measurements was high for all structures: correlation coefficients were 0.66 (0.69) for neointima, 0.94 (0.95) for lumen, and 0.95 (0. 91) for stent area.

CONCLUSIONS

Morphometric measurements of IVUS investigations with motorized IVUS pullback late after stent placement show good reproducibility. Intraobserver variability and interobserver variability are low. Differences for corresponding measurements were more pronounced for neointima area. Motorized catheter pullback guarantees high reliability of IVUS measurements and should be used routinely for clinical IVUS studies.

Predictors of reduced coronary flow reserve in heart transplant recipients without angiographically significant coronary artery disease

BACKGROUND

Determination of coronary flow reserve (CFR) is increasingly used to assess the functional significance of cardiac allograft vasculopathy. Although the relation between CFR and angiographically defined vasculopathy has been studied extensively, little is known about other factors determining CFR in heart transplant recipients without significant lesions by coronary angiography.

METHODS

Sixty consecutive patients were studied 0.5 to 148 months after heart transplantation with intracoronary Doppler and intravascular ultrasound. An endothelium-independent CFR< or =2.5 was defined as abnormal. Stepwise logistic regression analysis was used to identify factors (demographic data of donor and recipient, lipid profile, epicardial vessel morphology by intravascular ultrasound, left ventricular hypertrophy, acute rejection episodes, and hemodynamics) potentially associated with a reduced CFR.

RESULTS

Only the presence of left ventricular hypertrophy (48% vs. 14%, P=0.007 and P=0.023, bivariate and multivariate analysis, respectively) and higher donor ages (41+/-12 vs. 29+/-11 years, P=0.002 and P=0.013, bivariate and multivariate analysis, respectively) showed an independent association with an abnormal flow reserve. CFR in patients with left ventricular hypertrophy was reduced due to higher baseline flow velocities (27+/-11 vs. 20+/-6 cm/sec, P=0.004). Furthermore, resting flow velocity increased as a function of donor age (r=0.264, P=0.047), while hyperemic flow velocity was not different. Other patient characteristics and hemodynamics did not affect CFR.

CONCLUSION

The presence of left ventricular hypertrophy and higher donor ages independently contribute to a reduced CFR in patients after heart transplantation. This reduction in CFR is due to elevated baseline flow velocities rather than to a change in hyperemic flow velocities. These findings should be taken into account for the interpretation of reduced CFR values obtained by intracoronary Doppler in heart transplant recipients without angiographically overt coronary lesions.

IVUS analysis of the acute and long-term stent result using motorized pullback: intraobserver and interobserver variability

Intravascular ultrasound imaging has become an established method for analysis of intra-coronary stents. We analyzed the reproducibility of morphometric measurements immediately and late after stent implantation and the variability in the selection of predefined sites during motorized catheter pullback. Fifty consecutive patients were investigated immediately and 6 months after Palmaz-Schatz stent implantation (motorized catheter pullback 0.5 mm/sec; 2.9 Fr; 30-MHz transducer). Two experienced investigators independently identified the proximal and distal reference, stent inlet, stent outlet, and the minimal in-stent area in each imaging run. The longitudinal distance between corresponding measurement sites was calculated. Lumen, stent, and vessel area were assessed by planimetry, mean difference was calculated. Long-term reproducibility was analyzed by comparison of measurements made at predefined sites within the stent, immediately and late after implantation. Observer agreement in identification of predefined measurement sites was high. Longitudinal distance between corresponding measurement sites was low and pronounced for the minimal in-stent lumen area. Variabilities for the intra- and interobserver comparison were similar. Values for interobserver comparison were given in brackets. Acute after stent implantation, the variability for the reference proximal was 4.9% (0.4%), distal -1.0% (-4.2%), minimal in-stent lumen -0.5% (1.3%). At follow-up, variability for the reference proximal was -11.0% (-2.2%), distal -1.0% (-2.3%), minimal in-stent lumen 1.9% (6.1%). Long-term reproducibility for the proximal stent inlet was 2.7% (observer 1) and -0.4% (observer 2), for the distal stent outlet 1.3% (observer 1), -3.0% (observer 2), respectively. IVUS investigations with motorized IVUS pullback in stented coronary segments show a low intra- and interobserver variability, both immediately and late after stent implantation. Absolute and relative area differences are low. Long-term reproducibility of measurements within predefined stent sites was high. Motorized catheter pullback guarantees high reliability of IVUS measurements and should be routinely used for clinical IVUS studies.

Successful treatment of coronary artery perforation during angioplasty using a new membrane-coated stent

We report a case of successful treatment of coronary artery perforation and cardiac tamponade, which developed during percutaneous transluminal coronary angioplasty, with a PTFE-coated stent. Intravascular ultrasound was first used to overcome the shortcomings of conventional angiography and overlapping of a conventional stent was not as effective as coated-stent placement in sealing a further leakage. Thus, PTFE-coated stents may be an effective alternative to emergency surgery or autologous venous covered stenting and should be considered when coronary artery perforation occurs.

Quantitative changes in reference segments during IVUS-guided stent implantation: impact on the criteria for optimal stent expansion

Intravascular ultrasound is an established method to optimize stent implantation. Stent expansion is estimated from the relation between minimal in-stent cross-sectional area and reference lumen area. We analyzed the periprocedural lumen increment in the reference segments and its impact on intravascular ultrasound (IVUS) criteria for optimized stenting. Seventy-five consecutive patients were studied with a 2.9 Fr, 30-MHz system and motorized pullback (0.5 mm/sec). Lumen area was measured by planimetry; absolute and relative differences in area (delta area) were calculated. Lumen area increment for reference segments proximal and distal to the stent was 6.4% +/- 10.3% and 6.1% +/- 10.8%; 49/75 patients fulfilled all IVUS criteria for optimal stent expansion at the final IVUS assessment, and 10/75 patients met all the IVUS criteria in relation to the first measurement of reference lumen area, but not in relation to the final measurement of reference lumen area. During high-pressure dilatation within the stent, reference lumen increment is visible. If reference lumen planimetry is not repeated after additional high-pressure balloon inflation, the final relative stent expansion may be overestimated.

Tissue plasminogen activator binds to human vascular smooth muscle cells by a novel mechanism. Evidence for a reciprocal linkage between inhibition of catalytic activity and cellular binding

Human vascular smooth muscle cells (VSMC) bind tissue plasminogen activator (tPA) specifically, saturably, and with relatively high affinity (K(d) 25 nM), and this binding potentiates the activation of cell-associated plasminogen (Ellis, V., and Whawell, S. A. (1997) Blood 90, 2312-2322). We have observed that this binding can be efficiently competed by DFP-inactivated tPA and S478A-tPA but not by tPA inactivated with H-D-Phe-Pro-Arg-chloromethyl ketone (PPACK). VSMC-bound tPA also exhibited a markedly reduced inhibition by PPACK, displaying biphasic kinetics with second-order rate constants of 7. 5 x 10(3) M(-1) s(-1) and 0.48 x 10(3) M(-1) s(-1), compared with 7. 2 x 10(3) M(-1) s(-1) in the solution phase. By contrast, tPA binding to fibrin was competed equally well by all forms of tPA, and its inhibition was unaltered. These effects were shown to extend to the physiological tPA inhibitor, plasminogen activator inhibitor 1. tPA.plasminogen activator inhibitor 1 complex did not compete tPA binding to VSMC, and the inhibition of bound tPA was reduced by 30-fold. The behavior of the various forms of tPA bound to VSMC correlated with conformational changes in tPA detected by CD spectroscopy. These data suggest that tPA binds to its specific high affinity site on VSMC by a novel mechanism involving the serine protease domain of tPA and distinct from its binding to fibrin. Furthermore, reciprocally linked conformational changes in tPA appear to have functionally significant effects on both the interaction of tPA with its VSMC binding site and the susceptibility of bound tPA to inhibition.

Assembly of urokinase receptor-mediated plasminogen activation complexes involves direct, non-active-site interactions between urokinase and plasminogen

The binding of the zymogenic form of urokinase-type plasminogen activator (pro-uPA) to its specific cellular receptor, uPAR, leads to a large potentiation of plasmin generation. This is dependent on the concurrent cellular binding of plasminogen, and is completely abrogated by the plasminogen lysine-binding site ligand, 6-aminohexanoic acid. Previous data have provided circumstantial evidence for the formation of specific complexes to mediate the kinetically favorable reciprocal interactions between the protease and zymogen components [Ellis, V., and Dano, K. (1993) J. Biol. Chem. 268, 4806-4813]. To further investigate the formation of these putative complexes, we have studied the effect of various lysine-binding site ligands on the binding and activation of plasminogen on U937 cells. Lysine-binding site ligands resembling internal lysine residues, such as Nalpha-acetyl-L-lysine methyl ester, were found to specifically inhibit uPAR-mediated cell-surface plasminogen activation at concentrations up to 40-fold lower than those inhibiting the cellular binding of 125I-labeled plasminogen (IC50s 300 microM vs 8.5 mM). By contrast, 6-aminohexanoic acid, resembling a C-terminal lysine residue, did not display this disparity (IC50s 25 vs 30 microM). These lysine analogues were also found to compete a non-active-site interaction between uPA and plasminogen, detected by surface plasmon resonance (Kd 50 nM), at concentrations correlating with their effect on cell-surface plasminogen activation, suggesting that this interaction is part of the kinetic mechanism. Consistent with this, synthetic peptides corresponding to the sequence uPA149-158 (GQKTLRPRFK) and uPA149-157 (GQKTLRPRF) specifically abolished the amplification of cell-surface plasminogen activation. These data demonstrate that a novel non-active-site interaction between uPA and plasminogen is necessary for the assembly and efficiency of cell-surface plasminogen activation complexes.

Impact of target lesion calcification on coronary stent expansion after rotational atherectomy

BACKGROUND

Calcified lesions carry the risk of suboptimal stent expansion. The purpose of this study was to investigate the impact of target lesion calcification on intracoronary ultrasound (ICUS) guided stent expansion after rotational atherectomy.

METHODS

Stent expansion was assessed by ICUS in 39 patients with the aid of the proximal stent/proximal reference lumen, the minimal stent/mean reference lumen, and the minimal stent/minor reference lumen ratios as well as the symmetry index. Thirty-nine stent implantations in uncalcified lesions served for comparison.

RESULTS

Relative stent expansion ranged between 76.3% +/- 6.7% and 98.4% +/- 16.4%. Categorization according to an ICUS-derived arc of superficial lesion calcium of <180 degrees (average 102 +/- 74 degrees) or >180 degrees (average 248 +/- 71 degrees) revealed decreased stent symmetry in calcified lesions >180 degrees compared with the control group (P <.05). Despite a trend toward less expansion with increasing calcium load, no significant differences of the lumen area ratios between the study groups was present.

CONCLUSION

Rotational atherectomy before ICUS-guided stent implantation enables adequate stent expansion even in significant superficial target lesion calcification.

Epicardial intimal thickening in transplant coronary artery disease and resistance vessel response to adenosine: a combined intravascular ultrasound and Doppler study

BACKGROUND

Transplant coronary artery disease is the major factor limiting long-term survival after cardiac transplantation. Both intravascular ultrasound imaging (IVUS) and intracoronary flow studies have been used to assess the morphologic and functional importance of the disease. However, the impact of epicardial intimal thickening, as quantitated by IVUS, on the resistance vessel response to adenosine has not been explored.

METHODS AND RESULTS

Seventy-six coronary arteries without angiographically overt coronary disease (diameter stenosis visually, < or =50%) were studied with both IVUS and intracoronary Doppler in 54 patients 0.5 to 127 months after transplantation. Mean intimal index and mean lumen cross-sectional area (CSA) were determined by IVUS, and the average was obtained for every coronary artery. Coronary flow average peak velocity (APV) was obtained by Doppler before and after administration of 16 microg adenosine to calculate coronary flow velocity reserve (CFVR) and coronary vascular resistance index (CVRI). The hyperemic pressure-flow velocity ratio (hyperemic mean aortic pressure/hyperemic APV) as an index of minimal coronary resistance was further derived. The intimal index (mean, 20.0+/-10%) did not correlate with either CFVR (mean, 2.9+/-0.7, r=.12) or CVRI (mean, 0.33+/-0.1, r=.16). However, a significant correlation between the intimal index and the hyperemic pressure-flow velocity ratio (mean, 1.52+/-0.47 mm Hg/cm/s, r=.74, P<.0001) was found. The hyperemic pressure-flow velocity ratio was not influenced by the presence or absence of left ventricular hypertrophy or a mild acute rejection period (International Society for Heart and Lung Transplantation grades IA and IB).

CONCLUSIONS

This study shows that in patients without angiographically overt coronary disease, the degree of epicardial intimal thickening as quantified by IVUS did not predict the adenosine vasodilator response, when determined by commonly used parameters such as CFVR and CVRI. The hyperemic pressure-flow velocity ratio best reflected the functional significance of transplant coronary artery disease.

One balloon approach for optimized Palmaz-Schatz stent implantation: the MUSCAT trial

BACKGROUND

After stent deployment, larger balloons are frequently needed to optimize stent expansion according to angiographic and intravascular ultrasound (IVUS) criteria. The objective of this trial was to assess the feasibility and safety of a single-balloon approach for predilation, stent implantation, and optimization with a differential-compliant balloon allowing for focal overexpansion. We also evaluated the achieved degree of stent expansion according to IVUS criteria.

METHODS AND RESULTS

Forty-seven consecutive patients with 50 lesions received single or multiple Palmaz-Schatz coronary stents. The final angiographic diameter stenosis was -2.6 +/- 12.6% (reference diameter, 2.89 +/- 0.44 mm), and the residual lumen area stenosis (IVUS) was 13.0 +/- 12.3% (reference area 10.8 +/- 3.0 mm2). This result was achieved in two steps (first angiographic, then IVUS-guided stent optimization). The balloon inflation pressure increased from 13.1 +/- 3.0 bar at step 1 to 16.1 +/- 3.0 bar at step 2, which resulted in a balloon to artery ratio of 0.97 +/- 0.12 and 1.10 +/- 0.15, respectively, at the low-compliant peripheral balloon segments. The more compliant central balloon segments showed a balloon to artery ratio of 1.09 +/- 0.17 and 1.28 +/- 0.17, respectively. The primary success rate for stent deployment was 94%. Acute complications included two type A and one type B dissection without clinical sequelae.

CONCLUSIONS

The single-balloon approach for stenting is feasible and safe. The acute result is comparable to that of other studies with IVUS-guided stent optimization, the primary success rate, however, is slightly lower with the presently available catheter.

Coronary aneurysm after bailout stent implantation: diagnosis of a false lumen with intravascular ultrasound

This case report describes the intravascular ultrasound (IVUS) evaluation of a coronary artery aneurysm, developed in a stented segment within 6 mo after bailout stenting. Analysis of the IVUS images provides in vivo insights in the vessel-remodeling process after mechanical injury. The proximal entrance of the false lumen could be clearly visualized as well as the relationship between the stent struts, neolumen, and vessel wall. The discussion is focused on the options for management of such patients.

Coronary aneurysm after bailout stent implantation: diagnosis of a false lumen with intravascular ultrasound

This case report describes the intravascular ultrasound (IVUS) evaluation of a coronary artery aneurysm, developed in a stented segment within 6 mo after bailout stenting. Analysis of the IVUS images provides in vivo insights in the vessel-remodeling process after mechanical injury. The proximal entrance of the false lumen could be clearly visualized as well as the relationship between the stent struts, neolumen, and vessel wall. The discussion is focused on the options for management of such patients.

Serial follow-up after optimized ultrasound-guided deployment of Palmaz-Schatz stents. In-stent neointimal proliferation without significant reference segment response

BACKGROUND

The effects of ultrasound-guided high-pressure stenting on late stent and reference segment dimensions are unknown. In this study, we report about angiographic and ultrasound measurements to assess the amount and distribution of neointimal ingrowth within the stent and the changes of plaque burden and dimensions within the reference segments.

METHODS AND RESULTS

Sixty-eight consecutive patients with 72 lesions received single or multiple Palmaz-Schatz coronary stents with a standardized protocol for stent optimization under ultrasound guidance. The residual angiographic diameter stenosis was 3 +/- 12% (reference diameter, 3.16 +/- 0.61 mm). At follow-up 4.8 +/- 2.5 months later, angiography revealed a diameter stenosis of 27 +/- 21% with a restenosis rate of 15.3% (confidence interval: 7.8% to 25.6%). Lumen renarrowing within the stent was exclusively due to neointimal ingrowth; no stent compression was observed. The neointima covered 20 +/- 20% of the stent area and was more pronounced in the midportion of the stent. Volumetric assessment performed in 26 patients resulted in 13 +/- 14% or 65 +/- 28% of the stent volume occupied by neointimal ingrowth in patients without or with restenosis, respectively. Vessel remodeling had an impact on lumen dimensions only at reference sites but not within the stent. Plaque burden of 46 +/- 11% and 48 +/- 11% at the proximal and distal reference sites, respectively, did not show a relevant progression during the follow-up.

CONCLUSIONS

Serial ultrasound analyses did not show any evidence of stent compression or relevant vessel remodeling. Restenosis was solely due to neointimal ingrowth. Despite a considerable plaque burden within the reference segments, there was no relevant progression of the disease adjacent to the stent.

Coronary plaque morphologic characteristics early and late after heart transplantation: in vivo analysis with intravascular ultrasonography

To characterize plaque morphologic characteristics of transplant coronary artery disease early and late after cardiac transplantation, 72 patients were studied with intravascular ultrasonography during routine coronary angiography (group 1, 25 patients < or = 2 months after surgery; group 2, 47 patients > or = 12 months after surgery). Both groups had comparable baseline characteristics. Three hundred fifty-one segments were imaged in 127 coronary arteries (4.9 +/- 1.8 segments per patient). By intravascular ultrasonography, relevant intimal thickening (> 0.3 mm) was found in the majority of patients (68% for group 1 and 72% for group 2). Angiography detected abnormal findings in only 16% and 32% for groups 1 and 2, respectively. Mean intimal index was higher in patients late after transplantation (27% +/- 12% vs 17% +/- 12%, respectively; p < 0.01). Maximal and mean plaque thickness were comparable in both groups, whereas a higher mean plaque circumference was found in group 2 (278 +/- 66 degrees vs 211 +/- 75 degrees, respectively; p < 0.002). The lesions were more eccentric in patients early after transplantation (mean eccentricity index 95% +/- 7% vs 77% +/- 15%, respectively; p < 0.0001). Diffuse, concentric intimal thickening was not a common pattern. Maximal plaque thickness correlated with donor age (r = 0.50, p < 0.0001). Coronary lesions were frequent even early after transplantation, with predominantly eccentric plaque morphologic characteristics indicative of preexisting atherosclerosis. Later after transplantation, a more homogeneous plaque distribution was seen, partly with diffuse concentic intimal thickening. Late transplant coronary artery disease appears to be a combination of preexisting native and acquired immune-mediated coronary artery disease.

Effect of respiratory syncytial virus-antibody complexes on cytokine (IL-8, IL-6, TNF-alpha) release and respiratory burst in human granulocytes

The release of interleukin-8 (IL-8), IL-6, and tumour necrosis factor-alpha (TNF-alpha) from human polymorphonuclear granulocytes (PMN) after exposure to infectious respiratory syncytial virus (RSV) particles was investigated. Our data showed that PMN secreted IL-8 and IL-6 in a time- and RSV-dose-dependent manner. During the RSV exposure, TNF-alpha was not detected in the cell supernatant of PMN. Similar amounts of IL-8 were secreted after either incubation with infectious or UV-inactivated RSV particles. Obviously, PMN bind and phagocytose the viral particles, which leads to the secretion of cytokines. The increased IL-8 secretion was accompanied with an enhanced cytoplasmic IL-8 mRNA steady state level, as shown by Northern blot analysis. The IL-8 secretion pattern from PMN was also studied after its interaction with RSV--antibody complexes. Non-neutralizing monoclonal antibodies (mAb) directed to the RSV fusion protein and glycoprotein were used to generate immune complexes. Only the mAb directed to the RSV fusion protein enhanced the IL-8 release from PMN significantly. In addition, the chemiluminescence response from PMN was analysed after exposure of the cells to RSV particles, RSV-mAb complexes, Ca-ionophore A23187 or N-formyl-methionyl-leucyl-phenylalanine (FMLP). The phagocytosis of RSV inhibited the oxygen radical production induced by the Ca-ionophore A23187 or FMLP. Only RSV-anti-fusion protein mAb complexes generated a chemiluminescence response from PMN. Thus, PMN play an important role in the control of RSV infection.

[Objective assessment of disorders of visual perception following unilateral vestibular loss. Studies of the so-called Dandy symptom]

Visual ability and compensatory eye movements during defined vertical oscillation were investigated in 20 patients with unilateral lesions of labyrinthine function and in 20 normal subjects. Oscillation frequencies were performed at the rate of 1 to 1.5 Hz with an amplitude of 5 cm, comparative to head locomotions of a running person. In synchronism with this, the visual function was tested with Landolt rings. Patients complaining of subjective visual disturbance during walking and running, also presented a measurable blur of vision under test conditions. In addition, eye movements were recorded and classified into three types. However, these eye movements showed no relation to gaze function. Our results suggest that the otolith-ocular reflex may participate in adjusting the vertical eye position during vertical stimulations at low frequencies. The effect of visual disturbances in patients with labyrinthine lesions is explained by the "efference-copy" initially described by von Holst. The efference-copy is responsible for the neutralisation of provoked retinal perceptions.

[Ergometric dose-effect study of bunitrolol (Stresson) in patients with coronary heart disease (author's transl)]

20 patients with coronary heart disease and ergometrically provocable stenocardias and electrocardiographic signs of ischemia were tested ergometrically with two different dosages (5 mg:20 mg) of the beta-blocking agent bunitrolol (Stresson) in a double-blind-test. The results obtained are in accordance with literature: The greater the ergometric stress the more effective is Stresson and vice versa. For treatment of coronary heart disease can be considered: Low dosage of Stresson in patients with stenocardias and hypoxias in high-grade exercise, high dosage of Stresson in patients with stenocardias or ischemias in low-grade exercise or rest.

Is propylene glycol an inert substance?

The effect of 30 day administration of undiluted propylene glycol (1,2-propanediol, PG) on plasma and liver lipids was studied in adult male Sprague-Dawley rats. When compared with the control group no significant difference was observed in plasma concentration of total phospholipids, cholesterol, triglycerides and free fatty acids, and in liver concentration of phospholipids, triglycerides and gangliosides. Liver total cholesterol was moderately, but significantly, increased.

The influence of design on the transmission of torque across knee prostheses

Knee prostheses of eight different designs were tested experimentally to determine the axial torque necessary to rotate the tibial component relative to the femoral component with the prosthesis positioned at or near full extension. The results represent transmitted torque as a function of axial rotation. For six designs, the transmitted torque was 11.3 newton-meters (100 inch-pounds) or greater at 6 degrees of rotation, with an axial load of 1556.8 newtons (350 pounds). These prostheses either had close conformation between femoral and tibial components, or were mechanically linked. In these prostheses, the geometry of the articulating surfaces was the primary determinant of torque. For the other two types, under similar loading conditions the transmitted torques were 2.5 newton-meters (twenty-two inch-pounds) at 6 degrees of rotation. These prostheses were designed to allow greater freedom for rotation, and hence for them the primary determinant of torque was friction between the articulating surfaces. The predictive value of this torque characteristic relative to the incidence of loosening will have to be determined by comparison with clinical experience.

Effect of tilorone hydrochloride on hepatic disposition of sulphobromophthalein (BSP) in the rat

1. Biliary excretion of sulphobromophthalein (BSP) was studied in male rats after oral administration of tilorone HCl, an anti-viral and anti-tumour agent. 2. The stimulation of bile flow by BSP was decreased 1 h after tilorone administration; this decrease was no longer apparent 24 h later but a fall of basal bile flow was noted at that time. No changes in bile flow were observed 7 days after this single dose. 3. Repeated dosing with tilorone produced a dose-dependent increase in hepatic concentration of unchanged and metabolized tilorone. This was associated with a dose-dependent decrease of bile formation and BSP excretion. Bile acid excretion was depressed as well. 4. BSP metabolism was not significantly affected by tilorone administration.

Herbert total knee prosthesis: combined laboratory and clinical assessment

We tested the Herbert knee prosthesis, which was designed to restore intrinsic stability with limited degrees of freedom for rotation to severely damaged or deformed knees, in a knee simulator. These tests indicated a tendency for the prosthesis to fracture through the medial femoral housing after cycling for the equivalent of one to three years of normal use. In a clinical series of thirty-five knees treated with the prosthesis, there were five failures similar to those produced by laboratory testing. On the basis of this combined study, the Herbert prosthesis appears to have design characteristics that seriously limit its usefulness for long-term knee replacement. Testing in a knee simulator in this case appeared to be a valid predictor of clinical failure.