Encoded combinatorial chemistry: synthesis and screening of a library of highly functionalized pyrrolidines

The application of a new encoding technology for drug discovery is described. A combinatorial library of mercaptoacyl pyrrolidines has been prepared on a beaded polymeric support. Each polymer bead carries one library constituent in association with an oligomeric "tag," the structure of which is a record of the specific reagents from which that library member was prepared. After the ligands were solubilized, an array of such beads was screened for angiotensin-converting enzyme inhibitory activity, and the structures of active pyrrolidines were deduced by analysis of the associated tags at sub-picomole levels. Several extremely potent enzyme inhibitors were identified, many from multiple beads. The most potent inhibitor was found to have a Ki of 160 pM, approximately 3-fold more active than captopril in the same assay. Direct comparison with iterative deconvolution shows that the encoded screening strategy is a much more efficient means for extracting information from such compound collections, producing more data on a larger number of active structures.

Synthesis and protein kinase C inhibitory activities of acyclic balanol analogs that are highly selective for protein kinase C over protein kinase A

A series of balanol analogs in which the perhydroazepine ring and the p-hydroxybenzamide moiety were combined into an acyclic linked unit have been prepared and evaluated for their inhibitory properties against the serine/threonine kinase PKC. Several low-micromolar to low-nanomolar inhibitors of the alpha, beta I, beta II, gamma, delta, epsilon and eta PKC isozymes were prepared. In general, these acyclic balanol analogs were found to be highly selective for PKC over the serine/threonine kinase PKA. The type and number of atoms linking the benzophenone ester to the p-hydroxyphenyl group necessary for optimal PKC inhibition were investigated. The most potent compounds contained a three-carbon linker in which the carboxamide moiety of balanol had been replaced by a methylene group. The effect of placing substituents on the three-carbon chain was also investigated. The preferred compounds contained either a 2-benzenesulfonamido (6b) or a 1-methyl (21b) substituent. The preferred compounds 6b and 21b were tested against a panel of serine/threonine kinases and found to be highly selective for PKC. The more active enantiomer of 6b, (S)-12b, was 3-10-fold more active than the R-enantiomer against the PKC isozymes. The effect of making the analogs more rigid by making the three-carbon chain part of a five-membered ring, but with retention of the methylene replacement for the carboxamide moiety, led to potent PKC inhibitors including anti-substituted pyrrolidine analog 35b and the most potent PKC inhibitor in the series, anti-substituted cyclopentane analog 29b. The anti cyclopentane analog 29b, was a low-micromolar inhibitor of the PMA-induced superoxide burst in neutrophils, and its carboxylic ester was a high-nanomolar inhibitor of neutrophils. Finally esterification of 21b, (S)-12b, and 35b turned these potent PKC inhibitors into low-micromolar inhibitors of neutrophils.

Predictive value of prosthetic valve area index for early and late clinical results after valve replacement with the St Jude Medical valve prosthesis

BACKGROUND

Previous studies indicate that a minimal prosthetic valve area index (VAI) of > or = 0.9 cm2/m2 for aortic and > or = 1.3 cm2/m2 for mitral valves minimizes postoperative pressure gradients.

METHODS AND RESULTS

To determine VAI as an independent risk factor for postoperative events, 607 isolated aortic valve replacement (AVR) and 482 isolated mitral valve replacement (MVR) operations with the St Jude Medical valve were studied. End points included hospital deaths, NYHA functional class, late death and late valve-related death, major thromboembolism, anticoagulant-related hemorrhage, and reoperation. VAI was calculated from the ratio of prosthetic valve area to body surface area for each patient, and a range and mean were obtained for each valve size. Follow-up ranged from 1 to 120 months, totaled 2964 patient-years, and was 98% complete. Mean and range of VAI (cm2/m2) were 1.31 (0.74 to 2.86) in the aortic and 2.5 (1.4 to 6.32) in the mitral group. There were 33 AVR (5.4%) and 38 MVR (7.9%) hospital deaths. VAI was not a risk factor for NYHA class, early death, late death, or other postoperative events. The actuarial survival rates, 84% for AVR and 80% for MVR at 5 years, were not affected by VAI.

CONCLUSIONS

Within the ranges measured, VAI did not influence the end points of the study.

Management of retrohepatic venous injuries with atrial caval shunts

Retrohepatic inferior vena caval injuries resulting from blunt or penetrating abdominal trauma are rare but devastating events that remain formidable challenges to even the most experienced Level I trauma center team members. Prepackaged atrial caval shunts have improved emergency medical treatments, and prior planning and coordination by perioperative nurses allow for rapid response by surgical team members. These efforts provide an optimal level of care required to increase patient survival. This article provides a general overview of abdominal trauma and retrohepatic inferior vena caval injuries and a proactive plan to meet the needs of patients with these injuries.

Versatile approach to encoding combinatorial organic syntheses using chemically robust secondary amine tags

Encoded combinatorial organic synthesis has recently emerged as a powerful tool for the discovery of biologically active compounds from complex chemical libraries. This report describes a new encoding methodology that uses chemically robust secondary amines as tags. These amines are incorporated into an N-[(dialkylcarbamoyl)methyl]glycine-coding oligomer through simple chemistry that is compatible with a wide range of polymer-supported transformations useful in combinatorial synthesis. In the decoding process acidic hydrolysis of the tagging polymer regenerates the secondary amines, which after dansylation are resolved and detected at sub-picomole levels by reversed-phase HPLC. The versatility of this strategy is demonstrated here by encoded syntheses of members of several representative heterocyclic compound classes, including beta-lactams, 4-thiazolidinones, and pyrrolidines.

Comparison of low-pressure versus standard-pressure fixation Carpentier-Edwards bioprosthesis

Intermediate-phase clinical results of 51 low-pressure (LP) and 234 standard-pressure (SP) fixation porcine Carpentier-Edwards (CE) valves implanted between 1977 and 1991 were compared for valve-related events. Group similarities included New York Heart Association functional class, ejection fraction, and sex. Patients with SP valves were younger (mean age, 58 versus 68 years; p = 0.0001). There were 20 in-hospital deaths (8.6%) in the SP valve group and 5 (9.8%) in the LP valve group (p = 0.79). Follow-up was 99%, with a mean of 104 months in the SP valve group versus 55 months in the SP valve group (p = 0.0001). The actuarial survival rate was 48.2% and 22.3% at 10 and 15 years, respectively, in the SP valve group and 34.1% at 10 years in the LP valve group (p = 0.42). Freedom from events at 5, 10, and 15 years in the SP valve group and at 5 years in the LP valve group was as follows: for late valve-related events, 86.3%, 51.4% and 20.2%, respectively, in the SP valve group versus 85% in the LP valve group (p = 0.44); for valve-related death, 96.4%, 93.6%, and 87.3% in the SP valve group versus 100% in the LP valve group (p = 0.20); for structural valve failure, 96%, 68%, and 35% in the SP valve group versus 100% in the LP valve group (p = 0.09); and for reoperation, 95%, 61%, and 30% in the SP valve group versus 92% in the LP valve group (p = 0.82). In conclusion, this study revealed no significant statistical difference between LP and SP valves. In the LP valve group, structural valve failure/valve-related death was not observed, perhaps indicating a more favorable result. Absolute verification of this trend awaits long-term follow-up.

Energy cost of wearing chemical protective clothing during progressive treadmill walking

While chemical protective (CP) clothing is known to adversely affect physical performance, few data exist regarding the physiological response of wearing US military CP clothing during incremental, dynamic exercise. To quantify the effects of CP clothing on energy cost and to test the hypothesis that the mask contributes little to this effect, oxygen uptake (VO2) and ventilation (VE) were determined in 14 male soldiers who walked on a treadmill at 1.56 m.s-1 for 20 min each at 0, 5, and 10% grades in three clothing conditions: BDU (battledress uniform only), MASK (BDU + M-17 protective mask), and CP clothing (MASK + overgarment, gloves and boots). In BDU's, exercise intensities expressed as %VO2max were 29, 42, and 59% at the three grades, respectively. VO2 was significantly (p < 0.01) greater at all grades (range 13 to 18%) in CP clothing compared to BDU. However, no differences in VO2 were seen between BDU and MASK at any level of exercise. VE was significantly higher at the two highest grades in CP clothing compared to BDU but when expressed relative to VO2 (VE/VO2) was significantly lower at 0% and 5% grades but not at 10%. In the MASK condition, VE was significantly lower at the 10% grade and VE/VO2 was significantly lower at all grades compared to BDU. The results show that despite the mask induced hypoventilation, VO2 is unaffected at exercise intensities up to 60% of VO2max.(ABSTRACT TRUNCATED AT 250 WORDS)

Social facilitation and inhibition of emotional expression and communication

Does the presence of others facilitate or inhibit emotional expression? Female "senders" (n = 45) viewed 12 emotionally loaded slides either alone or with another sender while responses were secretly videotaped. In Study 1, 14 "receivers" guessed the type of slide viewed by dyads more accurately (eta = .366). In Study 2, 42 receivers viewed 10 senders with friends, 10 with strangers, and 10 alone. One dyad member was covered so that only 1 sender was visible. Analysis revealed significant effects of condition (alone, friend, or stranger; eta = .456), slide type (sexual, scenic, unpleasant, or unusual; eta = .325), and the Condition x Slide Type interaction (eta = .350). Strangers had overall inhibitory effects on communication accuracy, whereas friends had facilitative effects on some slides and inhibitory effects on others. Thus, both social facilitation and inhibition of expression occurred on the basis of the emotional stimulus and personal relationship involved.

Social facilitation and inhibition of emotional expression and communication

Does the presence of others facilitate or inhibit emotional expression? Female "senders" (n = 45) viewed 12 emotionally loaded slides either alone or with another sender while responses were secretly videotaped. In Study 1, 14 "receivers" guessed the type of slide viewed by dyads more accurately (eta = .366). In Study 2, 42 receivers viewed 10 senders with friends, 10 with strangers, and 10 alone. One dyad member was covered so that only 1 sender was visible. Analysis revealed significant effects of condition (alone, friend, or stranger; eta = .456), slide type (sexual, scenic, unpleasant, or unusual; eta = .325), and the Condition x Slide Type interaction (eta = .350). Strangers had overall inhibitory effects on communication accuracy, whereas friends had facilitative effects on some slides and inhibitory effects on others. Thus, both social facilitation and inhibition of expression occurred on the basis of the emotional stimulus and personal relationship involved.

Pulse voltammetry at microcylinder electrodes

Microcylindrical electrodes are easier to construct and maintain than microdisk electrodes. In the normal-pulse mode, ranges of time parameters and electrode sizes can be found such that depletion of reactant is unimportant and the response to the analysis pulse is predicted by theory for planar conditions. Similarly, ranges of parameters are found for reverse-pulse voltammetry such that the potential-dependent response can be treated as a sequence of individual double-pulse responses. Cylindrical diffusion and convection act to replenish reactant quickly near the electrode and thus permit overall experiment times in the range of seconds. For square-wave voltammetry the shape and position of the net current response are independent of the extent of cylindrical diffusion.

A rapid method for standardization of the gated radionuclide left ventricular ejection fraction

Radionuclide ventriculography has become the standard method for serially evaluating left ventricular ejection fraction (EF). The "gold standard" for evaluating EF is the contrast ventriculogram, which uses mathematical models to arrive at the volumes used to calculate EF. These models are subject to possible error. This paper reports the standardization of volume measurements of a digital angiographic camera system using a series of cardiac phantoms and the correlation of measurement of the EF of a series of patients whose EF was determined by digital angiography and radionuclide ventriculography.

Five cases of Thermopsis poisoning

Various Thermopsis species are found in the foothills and plains of the Rocky Mountains. There are no reported cases of human ingestion to Thermopsis reported in the literature. We report 5 cases of ingestion of seeds or flowers where the primary symptoms were nausea, vomiting and headache of several hours duration. As few as 6 seeds produced symptoms. The common names used by parents when calling the poison center could have easily lead to misidentification and a careful history and subsequent professional identification were required to ascertain the actual plant involved.

Fibroblast stimulation in schistosomiasis. VII. Egg granulomas secrete factors that stimulate collagen and fibronectin synthesis

Tissue fibrosis in schistosomiasis is largely responsible for the important morbidity that results from infection with the trematode worms, Schistosoma. Neither the migrating larval forms (cercariae) nor the intravascular adult worms appear to incite pathological responses that are important in chronic schistosomiasis. On the other hand, eggs deposited in tissue incite chronic granulomatous inflammatory responses that are the hallmark of infection and precede the onset of adjacent tissue fibrosis. We previously reported that products of the egg granulomas can stimulate a number of relevant responses in fibroblast cultures that in vivo would be expected to promote tissue fibrosis. We report here that the granulomas secrete factors that in vitro can stimulate collagen and fibronectin synthesis in fibroblasts. We determined that activity stimulating collagen synthesis is congruent to 10 Kd (gel filtration) with a pI of congruent to 5.5 (isoelectric focusing); additional activity is also detected in some other fractions (congruent to Kd; pI approximately 7.0). In contrast, the activity stimulating fibronectin synthesis was congruent to 22 Kd with a pI of 5.5. Activity was also present in fractions of 50 Kd with pI of approximately 7.5. Fibroblasts grown in granuloma supernatant-containing medium contained greater steady-state levels of specific mRNA coding for type I procollagen and fibronectin compared with cells cultured in unsupplemented medium. These observations support the hypothesis that biologically active molecules secreted by granuloma cells are instrumental in the initiation of tissue fibrosis in schistosomiasis.

Fibroblast stimulation in schistosomiasis. VII. Egg granulomas secrete factors that stimulate collagen and fibronectin synthesis

Tissue fibrosis in schistosomiasis is largely responsible for the important morbidity that results from infection with the trematode worms, Schistosoma. Neither the migrating larval forms (cercariae) nor the intravascular adult worms appear to incite pathological responses that are important in chronic schistosomiasis. On the other hand, eggs deposited in tissue incite chronic granulomatous inflammatory responses that are the hallmark of infection and precede the onset of adjacent tissue fibrosis. We previously reported that products of the egg granulomas can stimulate a number of relevant responses in fibroblast cultures that in vivo would be expected to promote tissue fibrosis. We report here that the granulomas secrete factors that in vitro can stimulate collagen and fibronectin synthesis in fibroblasts. We determined that activity stimulating collagen synthesis is congruent to 10 Kd (gel filtration) with a pI of congruent to 5.5 (isoelectric focusing); additional activity is also detected in some other fractions (congruent to Kd; pI approximately 7.0). In contrast, the activity stimulating fibronectin synthesis was congruent to 22 Kd with a pI of 5.5. Activity was also present in fractions of 50 Kd with pI of approximately 7.5. Fibroblasts grown in granuloma supernatant-containing medium contained greater steady-state levels of specific mRNA coding for type I procollagen and fibronectin compared with cells cultured in unsupplemented medium. These observations support the hypothesis that biologically active molecules secreted by granuloma cells are instrumental in the initiation of tissue fibrosis in schistosomiasis.

Comparative anaerobic power of men and women

The purpose of this study was to determine the differences in anaerobic power (AnP) between men and women and the contribution of anthropometric variables in accounting for these differences. There were 18 female and 19 male subjects who performed the 30-s Wingate test where power outputs in watts are expressed as mean power (MP, the mean for 30 s) and peak power (PP, the highest 5-s interval). Thigh volume (TV), lean body mass (LBM) and body weight (BW) were used as anthropometric variables. Absolute AnP of men was 35% and 40% higher (p less than 0.001) than that of women for PP and MP, respectively. These differences decreased to 10% and 17% for PP and MP when expressed relative to kg LBM. Anthropometric variables explained less than 50% of the variation in PP and MP for men, while in women, TV accounted for 66% and 71% of the variation in PP and MP, respectively. When the data were combined, TV, BW, and LBM explained 48%, 74%, and 79% of variation in MP and 53%, 71%, and 76% in PP, respectively. These data show that gender differences in indices of AnP are similar to those reported for muscular strength and aerobic power. Additionally, a larger portion of the between gender variation compared to the within gender variation in AnP can be accounted for by anthropometric variables.

Oral intake of phosphorus can determine the serum concentration of 1,25-dihydroxyvitamin D by determining its production rate in humans

Changes in the oral intake of phosphorus could induce the reported changes in the serum concentration of 1,25-dihydroxyvitamin D (1,25-(OH)2D) by inducing changes in its production rate (PR) or metabolic clearance rate (MCR), or both. To investigate these possibilities, we employed the constant infusion equilibrium technique to measure the PR and MCR of 1,25-(OH)2D in six healthy men in whom the oral intake of phosphorus was initially maintained at 1,500 mg/70 kg body weight per d for 9 d, then restricted to 500 mg/d (coupled with oral administration of aluminum hydroxide) for 10 d, and then supplemented to 3,000 mg/d for 10 d. With phosphorus restriction, the serum concentration of 1,25-(OH)2D increased by 80% from a mean of 38 +/- 3 to 68 +/- 6 pg/ml, P less than 0.001; the PR increased from 1.8 +/- 0.2 to 3.8 +/- 0.6 micrograms/d, P less than 0.005; the MCR did not change significantly. The fasting serum concentration of phosphorus decreased from 3.5 +/- 0.2 to 2.6 +/- 0.2 mg/dl, P less than 0.01. With phosphorus supplementation, the serum concentration of 1,25-(OH)2D decreased abruptly, reaching a nadir within 2 to 4 d; after 10 d of supplementation, the mean concentration of 27 +/- 4 pg/ml was lower by 29%, P less than 0.01, than the value measured when phosphorus intake was normal. The PR decreased to 1.3 +/- 0.2 micrograms/d, P less than 0.05; the MCR did not change significantly. The fasting serum concentration of phosphorus increased significantly, but only initially. These data demonstrate that in healthy men, reductions and increases in the oral intake of phosphorus can induce rapidly occurring, large, inverse, and persisting changes in the serum concentration of 1,25-(OH)2D. Changes in the PR of 1,25-(OH)2D account entirely for the phosphorus-induced changes in serum concentration of this hormone.

Maximal power outputs during the Wingate anaerobic test

The purpose of this study was to determine the resistance loads which elicit maximal values of power output (PO) during performance of the Wingate test (WT). Nineteen male subjects (mean age, 25.1 yrs; mean VO2 max, 3.52 l/min) performed multiple WTs in a random order at resistances ranging from 3.23 to 6.76 joules/pedal rev/kg BW. Tests were carried out on a Monark cycle ergometer modified to permit instantaneous application of resistance. Revolutions were determined by a computer interfaced frequency counter. The mean resistances eliciting the highest peak power (PP) and mean power (MP) outputs were 5.65 and 5.53 joules/pedal rev/kg BW, respectively (average of 5.59 joules/pedal rev/kg BW). Both PP and MP were significantly higher (15.5% and 13.0%, respectively) using a resistance load of 5.59 compared to the Wingate setting of 4.41 joules/pedal rev/kg BW. The test-retest reliability for PP and MP ranged between 0.91 and 0.93 at both resistance loads. Body weight and thigh volume did not significantly estimate the individual resistances eliciting maximal POs. The data suggest that resistance be assigned according to the subjects BW but consideration be given to increasing the resistance from that presently used in various laboratories.