Determination of volume-dependent respiratory system mechanics in mechanically ventilated patients using the new SLICE method

In patients mechanically ventilated for severe respiratory failure, respiratory system mechanics are non-linear, i.e., volume-dependent. We present a new computer-based multipoint method for simultaneously determining volume-dependent dynamic compliance and resistance. Our method is based on continuously determined tracheal pressure (Ptrach). Tidal volume is subdivided into six volume slices of equal size. One compliance value (intrinsic PEEP considered) and one resistance value are determined for each volume slice by applying of the least-squares-fit (LSF) analysis based on the linear RC-model; we therefore call this the SLICE method. The method gives the course of dynamic compliance and resistance within the tidal volume. The method was evaluated using physical models of the respiratory system with linear and non-linear passive mechanical properties. The relative error of the method is smaller than ±5%. The method needs no special ventilatory pattern. Using data from 14 patients mechanically ventilated for adult respiratory distress syndrome (ARDS) we found a very good correspondence between the measured end-inspiratory airway pressure (Paw,Ie) and the end-inspiratory alveolar pressure (Palv,Ie) calculated from the dynamic compliance values determined with the SLICE method (Palv,Ie = 1.02 * Paw,Ie + 0.097; r2 = 0.977). The SLICE method allows continuous monitoring of non-linear pulmonary mechanics on a breath-by-breath basis at the bedside.

The use of Salvinia auriculata as a bioindicator in aquatic ecosystems: biomass and structure dependent on the cadmium concentration

This study shows, in a multiple-level approach, the responses of Salvinia auriculata to Cd pollution in aquatic ecosystems. S. auriculata ramets were cultivated in nutrient solution and subjected to five treatments with Cd for ten days. At the end of the experiment, the number of new ramets and the dry biomass were determined. For ultrastructural observations, the leaves of S. auriculata were analyzed using a scanning electron microscope and transmission electron microscope. At the end of the experiment, the plants exposed to Cd showed damage in the leaves including necrosis and chlorosis, stomate deformations and damaged trichomes. We observed a decrease in the number of new ramets and dry biomass of S. auriculata following the increase in Cd concentration in the solution. At the ultrastructural level, leaves exposed to Cd presented chloroplast deformations and deterioration in the cell wall. All the symptoms of toxicity were directly proportionate to the concentration of Cd in the solution. The results suggests that S. auriculata shows good potential for use as a bioindicator and it can be used in the biomonitoring of aquatic ecosystems contaminated by Cd.

Array-CGH analysis in patients with syndromic and non-syndromic XY gonadal dysgenesis: evaluation of array CGH as diagnostic tool and search for new candidate loci

BACKGROUND

XY gonadal dysgenesis (XY-GD) is a heterogeneous disorder characterized by failure of testicular development despite a normal male karyotype. Non-syndromic and syndromic forms can be delineated. Currently, only a minority of cases can be explained by gene mutations.

METHODS

The aim of this study was to detect microdeletions and duplications by using high-resolution Agilent oligonucleotide arrays in a cohort of 87 patients with syndromic or non-syndromic 46,XY-GD.

RESULTS

In 26 patients, we identified gains or losses in regions including genes involved in XY-GD (DMRT1, SOX9, DAX1) or in regions, which have not been described as polymorphic copy number variants (CNVs).

CONCLUSIONS

This study shows that array comparative genomic hybridization (CGH) analysis is a useful tool for the molecular diagnosis of XY-GD as well as for the identification of potential candidate genes involved in male sexual development.

Soy protein isolate reduces hepatosteatosis in yellow Avy/a mice without altering coat color phenotype

Agouti (A(vy)/a) mice fed an AIN-93G diet containing the soy isoflavone genistein (GEN) prior to and during pregnancy were reported to shift coat color and body composition phenotypes from obese-yellow towards lean pseudoagouti, suggesting epigenetic programming. Human consumption of purified GEN is rare and soy protein is the primary source of GEN. Virgin a/a female and A(vy)/a male mice were fed AIN-93G diets made with casein (CAS) or soy protein isolate (SPI) (the same approximate GEN levels as in the above mentioned study) for 2 wks prior to mating. A(vy)/a offspring were weaned to the same diets and studied at age 75 d. Coat color distribution did not differ among diets, but SPI-fed, obese A(vy)/a offspring had lower hepatosteatosis (P < 0.05) and increased (P < 0.05) expression of CYP4a 14, a PPARalpha-regulated gene compared to CAS controls. Similarly, weanling male Sprague-Dawley (SD) rats fed SPI had elevated hepatic Acyl Co-A Oxidase (ACO) mRNA levels and increased in vitro binding of PPARalpha to the PPRE promoter response element. In another hepatosteatosis model, adult SD rats fed a high fat/cholesterol diet, SPI reduced (P < 0.05) steatosis. Thus, 1) consumption of diets made with SPI partially protected against hepatosteatosis in yellow mice and in SD rats, and this may involve induction of PPARalpha-regulated genes; and 2) the lifetime (in utero, neonatal and adult) exposure to dietary soy protein did not result in a shift in coat color phenotype of A(vy)/a mice. These findings, when compared with those of previously published studies of A(vy)/a mice, lead us to conclude that: 1) the effects of purified GEN differ from those of SPI when GEN equivalents are closely matched; 2) SPI does not epigenetically regulate the agouti locus to shift the coat color phenotype in the same fashion as GEN alone; and 3) SPI may be beneficial in management of non-alcoholic fatty liver disease.

Detection of a significant association between mutations in the ACVRL1 gene and hepatic involvement in German patients with hereditary haemorrhagic telangiectasia

Hereditary haemorrhagic telangiectasia (HHT) is a heterogeneous multisystemic dysplasia of the vascular tissue. This autosomal dominant inherited disorder shows a wide variation in its phenotypic expression. Between 8 and 78% of the HHT patients show arteriovenous malformations of the liver. The molecular basis for hepatic manifestation is still unknown. Two genes are known to play a major role in the development of HHT: activin A receptor type II-like 1 gene (ACVRL1) and ENG. Previously, we and others showed that hepatic involvement is associated with mutations in the ACVRL1 gene, but rarely caused by ENG mutations. Here, we report about the sequencing analysis of a new cohort of 18 adult HHT patients. In these patients, we identified eight novel (four in ACVRL1 and four in ENG) and eight already known mutations. Statistical analysis of our entire data revealed significant differences in the distribution of ACVRL1 and ENG mutations among HHT patients with and without liver involvement (p = 0.0016). The positive predictive value for type 2 HHT (ACVRL1 positive) patients to develop liver disease until the age of 52 years is 68.4%. We conclude that molecular genetic testing of HHT patients is important for prognosis with respect to liver disease.

Location and type of mutation in the LIS1 gene do not predict phenotypic severity

BACKGROUND

Lissencephaly is a neuronal migration disorder leading to absent or reduced gyration and a broadened but poorly organized cortex. The most common form of lissencephaly is isolated, referred as classic or type 1 lissencephaly. Type 1 lissencephaly is mostly associated with a heterozygous deletion of the entire LIS1 gene, whereas intragenic heterozygous LIS1 mutations or hemizygous DCX mutations in males are less common.

METHODS

Eighteen unrelated patients with type 1 lissencephaly were clinically and genetically assessed. In addition, patients with subcortical band heterotopia (n = 1) or lissencephaly with cerebellar hypoplasia (n = 2) were included.

RESULTS

Fourteen new and seven previously described LIS1 mutations were identified. We observed nine truncating mutations (nonsense, n = 2; frameshift, n = 7), six splice site mutations, five missense mutations, and one in-frame deletion. Somatic mosaicism was assumed in three patients with partial subcortical band heterotopia in the occipital-parietal lobes or mild pachygyria. We report three mutations in exon 11, including a frameshift which extends the LIS1 protein, leading to type 1 lissencephaly and illustrating the functional importance of the WD domains at the C terminus. Furthermore, we present two patients with novel LIS1 mutations in exon 10 associated with lissencephaly with cerebellar hypoplasia type a.

CONCLUSION

In contrast to previous reports, our data suggest that neither type nor position of intragenic mutations in the LIS1 gene allows an unambiguous prediction of the phenotypic severity. Furthermore, patients presenting with mild cerebral malformations such as subcortical band heterotopia or cerebellar hypoplasia should be considered for genetic analysis of the LIS1 gene.

P-selectin glycoprotein ligand-1 (PSGL-1) is up-regulated on leucocytes from patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterized by a dysregulated recruitment of circulating leucocytes into the lung which is associated with the onset and progress of the disease. P-selectin glycoprotein ligand-1 (PSGL-1) is expressed on leucocytes and plays an essential role in primary leucocyte-endothelial cell adhesive contacts. The present study investigated if PSGL-1 is up-regulated on leucocytes of COPD patients. Peripheral blood samples were collected from COPD patients as well as controls (smoking, nonsmoking volunteers) and subjected to analysis of PSGL-1 expression on leucocytes, i.e. neutrophils, eosinophils, monocytes and lymphocytes by flow cytometry. No significant difference was observed between healthy nonsmoking and healthy smoking control subjects. In contrast, PSGL-1 expression was found to be significantly increased on the surface of all four leucocyte populations in COPD patients compared to both control groups. The finding that PSGL-1 surface expression is up-regulated on leucocytes of COPD patients as compared to leucocytes of controls suggests PSGL-1 as a potential target for anti-inflammatory treatment.

Physiochemical properties, safety and pharmacokinetics of bimosiamose disodium after intravenous administration

OBJECTIVE

Bimosiamose is a novel synthetic panselectin antagonist being developed for the treatment of acute and chronic inflammatory disorders. Therefore, we have studied the pharmacokinetics and tolerability and determined the pharmacokinetically relevant physicochemical characteristics of bimosiamose.

METHOD

A randomized, double-blind, placebo-controlled dose-escalation trial in healthy male subjects has been carried out. The subjects received intravenous infusions of 0.5-30 mg/kg bimosiamose disodium.

RESULTS AND CONCLUSIONS

The maximum plasma concentration (Cmax) was 675 +/- 11 microg/ml with a tmax of 0.36 +/- 0.13 h (mean +/- SD). The elimination half-life t1/2 was 4.1 +/- 1.0 h, and the AUC(o-inf) was 1,360 +/- 393 h microg/ml after the 30 mg/kg dose. The clearance and the apparent volume of distribution decreased with increasing dose to 22 +/- 6 ml/kg/h and 40 +/- 13 ml/kg/h at the highest dose, respectively, and the mean residence time increased to 1.8 +/- 0.35 h. Bimosiamose was safe and well-tolerated.