Structure and expression of human fibroblast growth factor-10

We isolated the cDNA encoding a novel member of the human fibroblast growth factor (FGF) family from the lung. The cDNA encodes a protein of 208 amino acids with high sequence homology (95.6%) to rat FGF-10, indicating that the protein is human FGF-10. Human FGF-10 as well as rat FGF-10 has a hydrophobic amino terminus ( approximately 40 amino acids), which may serve as a signal sequence. The apparent evolutionary relationships of human FGFs indicate that FGF-10 is closest to FGF-7. Chromosomal localization of the human FGF-10 gene was examined by in situ hybridization. The gene was found to map to the 5p12-p13 region. Human FGF-10 (amino acids 40 to 208 with a methionine residue at the amino terminus) was produced in Escherichia coli and purified from the cell lysate. Recombinant human FGF-10 (approximately 19 kDa) showed mitogenic activity for fetal rat keratinizing epidermal cells, but essentially no activity for NIH/3T3 cells, fibroblasts. The specificity of mitogenic activity of FGF-10 is similar to that of FGF-7 but distinct from that of bFGF. In structure and biological activity, FGF-10 is similar to FGF-7.

Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri

OBJECTIVES

To determine whether intra-abdominal pressure (as estimated from urinary bladder pressure) is elevated in patients with central obesity (as measured by sagittal abdominal diameter) and pseudotumor cerebri and whether this increased intra-abdominal pressure is associated with increased pleural pressure and cardiac filling pressure, implying a resistance to venous return from the brain.

DESIGN

Nonrandomized, prospective.

SETTING

University hospital, operating room.

MAIN OUTCOME MEASUREMENTS

Intracranial pressure, urinary bladder pressure, sagittal abdominal diameter, transesophageal pleural pressure, central venous pressure, pulmonary artery pressure, and pulmonary artery occlusion pressure.

SUBJECTS

Six women with pseudotumor cerebri (one with CSF leak, one with lumboperitoneal shunt).

RESULTS

Urinary bladder pressure (22 +/- 3 cm H2O) and sagittal abdominal diameter (29 +/- 3 cm) were significantly elevated in these patients with elevated intracranial pressure (293 +/- 80 mm H2O) compared with a previously reported group of nonobese control patients. The transesophageal pleural pressure (15 +/- 10 mm Hg), central venous pressure (20 +/- 6 mm Hg), mean pulmonary artery pressure (31 +/- 6 mm Hg), and pulmonary artery occlusion pressure (21 +/- 7 mm Hg) were all markedly elevated compared with published normal values and with previous data from obese patients without pseudotumor cerebri.

CONCLUSIONS

These data support the hypothesis that central obesity raises intra-abdominal pressure, which increases pleural pressure and cardiac filling pressure, which impede venous return from the brain, leading to increased intracranial venous pressure and increased intracranial pressure associated with pseudotumor cerebri.

Heavy fluorocarbon liquids for a phase-conjugated stimulated Brillouin scattering mirror

Heavy fluorocarbon liquids were found to be an ideal medium for high-power stimulated Brillouin scattering experiments. Fluorinert FC-75 gives high reflectivity, near 98%, and excellent fidelity in phase conjugation of 14-J, 18-ns optical pulses. The complete removal of microparticle impurities was found to be essential for avoiding laser damage in a high-energy operation. A method of purification based on ultrafiltration has been developed.

High-aspect-ratio line focus for an x-ray laser by a deformable mirror

A high-aspect-ratio line focus is required on a plane target in x-ray laser experiments for obtaining a high gain-length product. Inherent wave-front aberrations in line-focusing optics, which consist of a cylindrical lens and a spherical lens, are discussed with respect to beam diameter. The nonuniformity of the linewidth that is due to the aberrations is also calculated by the ABCD matrix method. A deformable mirror of a continuous plate type with a diameter of 185 mm provides an adequate wave-front distribution for compensating for the wave-front aberration. The wave-front control by the deformable mirror realizes a fine linewidth of 25 microm and 18.2 mm long, corresponding to the aspect ratio of 728. The linewidth is three times the diffraction limit. The intensity distribution along the line focus is also improved.

Frequency modulation controlled by cross-phase modulation in optical fiber

We have generated a frequency-modulated laser beam by use of cross-phase modulation between orthogonally polarized beams in a polarization-preserving optical fiber. This frequency modulation is based on the temporal intensity beating of the drive beam that is caused by another beam that has a slightly different wavelength. Moreover, we have demonstrated generation of a special frequency-modulated laser beam with temporally changing modulation frequency by use of cross-phase modulation in conjugation with self-phase modulation.

Pulmonary vascular resistance and right ventricular function in morbid obesity in relation to gastric bypass surgery

STUDY OBJECTIVE

To investigate right ventricular function (RVF) during gastric bypass surgery in morbidly obese patients. To study the influence of obstructive sleep apnea syndrome on hemodynamics and RVF as a preoperative evaluation in morbidly obese patients.

DESIGN

Prospective study.

SETTING

Surgical patients at a university hospital.

PATIENTS

14 morbidly obese patients undergoing gastric bypass surgery.

INTERVENTIONS

Hemodynamic changes and RVF were investigated using a thermodilution ejection fraction volumetric catheter and the REF-1 computer.

MEASUREMENTS AND MAIN RESULTS

Hemodynamic parameters and RVF were measured: (1) before induction of anesthesia, awake, (2) after induction of anesthesia, (3) after opening the abdomen, and (4) after closing the abdomen. Esophageal pressure was measured in the midesophagus after induction of anesthesia with a camino catheter and its device. Morbidly obese patients with obstructive sleep apnea syndrome had significantly lower PaO2, higher PaCO2, and higher pulmonary artery (PA) pressure and pulmonary vascular resistance (PVR) compared with patients without sleep apnea (p < 0.05). However, there were no significant differences in heart rate, mean blood pressure, pulmonary capillary wedge pressure (PCWP), right ventricular ejection fraction (RVEF), and right ventricular end-diastolic volume. During gastric bypass procedure, PA pressure, PCWP, and PVR decreased significantly after opening the abdomen (p < 0.05). There were no significant changes in RVEF and cardiac index during gastric bypass procedure.

CONCLUSION

The presence of chronic hypoxemia and hypercarbia in our morbidly obese patients with obstructive sleep apnea syndrome while awake, causes significant increases in PA pressure and PVR. We also demonstrated that RVEF did not change significantly during gastric bypass procedure despite significant decreases in PA pressure, PCWP, and PVR after opening the abdomen. This decrease in PA pressure and PVR may be caused by decreases in pleural pressure reflected by a concomitant decrease in esophageal pressure.

Shack Hartmann wave-front measurement with a large F-number plastic microlens array

A new plastic microlens array, consisting of 900 lenslets, has been developed for the Shack Hartmann wave-front sensor.The individual lens is 300 µm × 300µm and has a focal length of 10 mm, which provides the same focal size, 60 µm in diameter, with a constant peak intensity. One can improve thewave-front measurement accuracy by reducing the spot centroiding error by averaging a few frame memories of an image processor. A deformable mirror for testing the wave-front sensor gives anappropriate defocus and astigmatism, and the laser wave front is measured with a Shack Hartmann wave-front sensor. The measurement accuracy and reproducibility of our wave-front sensor are better than λ/20 and λ/50 (λ = 632.8 nm),respectively, in rms.

1988: unilateral high-frequency jet ventilation during one-lung ventilation for thoracotomy. Updated in 1995

One-lung ventilation is indicated during thoracic operations for bronchopleural fistula, pulmonary abscess, and pulmonary hemorrhage in spite of the possibility of the development of severe hypoxemia. To evaluate methods for improving oxygen transport during one-lung ventilation, we applied high-frequency jet ventilation (HFJV) and continuous positive airway pressure (CPAP) to the nondependent lung following deflation to atmospheric pressure in each procedure, and measured the effects on cardiac output and arterial oxygenation. In each case, the dependent lung was ventilated with conventional intermittent positive pressure ventilation (IPPV). Eight patients were studied during posterolateral thoracotomy using double-lumen endobronchial tubes. HFJV or CPAP to the nondependent lung improved arterial oxygenation significantly during both closed and open stages of the surgical procedures (p < 0.008). When the chest was open, HFJV maintained satisfactory cardiac output, whereas CPAP usually decreased cardiac output (p < 0.008). There were no significant differences in mean partial pressure of arterial carbon dioxide between HFJV, CPAP, and deflation to atmospheric pressure. In conclusion, HFJV to the nondependent lung provides not only satisfactory oxygenation but also good cardiac output, thereby maintaining better oxygen transport than CPAP or deflation to atmospheric pressure, while the dependent lung is ventilated with IPPV during one-lung ventilation for thoracotomy.

Selective inhibition of the 12-lipoxygenase pathway of arachidonic acid metabolism by L-arginine or sodium nitroprusside in intact human platelets

L-arginine (1-100 microM) or sodium nitroprusside (1-100 microM) caused a concentration dependent decrease in the metabolism of exogenously added arachidonic acid via the 12-lipoxygenase pathway in intact human platelets, as determined by the use of an HPLC assay. NG-monomethyl-L-arginine, but not the D-isomer of this compound, diminished the inhibitory effect of L-arginine. The D isomer of arginine had no effect. The cyclooxygenase pathway was much less susceptible to these effects. This study indicated that nitric oxide formed in intact human platelets selectively inhibited 12-lipoxygenase over that of cyclooxygenase and suggests that such inhibition may be an important regulatory mechanism.

Efficient laser-diode-pumped neodymium-doped calcium-niobium-gallium-garnet laser

Efficient lasing of Nd:Ca (Nb, Ga)(2-x) Ga(3)-garnet (CNGG) disordered crystal pumped by a laser diode was demonstrated. In the end-pumped cw lasing experiment with a single-stripe diode, a slope efficiency of 24.2% and a maximum optical conversion efficiency of 19.3% were obtained. It was shown that the dependence of cw output power on the pump wavelength is insensitive compared with Nd:YAG because of the broad pump absorption bandwidth of Nd:CNGG. From the diode-bar-pumped experiment, it was confirmed that Nd:CNGG is a promising material for diode-bar pumping to obtain high average power with good beam quality, because of its advantages of a broader pump absorption band compared with that of Nd:YAG and the higher thermal conductivity compared with Nd-doped glasses.

Assessment of right ventricular diastolic filling in patients with coronary artery disease

To assess right ventricular (RV) diastolic filling in coronary artery disease (CAD), with special reference to the involved lesions of the coronary arteries and left ventricular (LV) systolic function, gated radionuclide ventriculography was performed at rest in 106 patients with single-vessel CAD. Based on the site of coronary arterial involvement, patients were classified into three groups: left anterior descending CAD, right CAD, and left circumflex CAD. Patients in each group were further subdivided according to normal or decreased LV ejection fraction, resulting in six groups. Seventeen normal subjects were examined as a control group. Time-activity and its first-derivative curves were computed for the right and left ventricles. RV systolic function was normally preserved in all six groups, even when LV systolic function was damaged severely. The ratio of peak RV filling rate to peak RV ejection rate was significantly decreased in all six groups compared with that in control subjects, indicating that RV filling was impaired in patients with CAD. The ratio was below the lower limit of normal in 14 (23%) of 62 patients with normal LV systolic function and in 13 (30%) of 44 patients with impaired LV systolic function. None of the control subjects showed a decreased ratio of peak RV filling rate to peak RV ejection rate. Thus, in patients with CAD, RV filling is impaired, which may be independent of the site of coronary arterial involvement and of the LV or RV systolic function.

[Antinuclear antibody measurement as a screening test for sterile and infertile women with immunological abnormality]

The efficacy of examining antinuclear antibody (ANA) was investigated as a screening test detecting subclinical immune disorders in infertility and sterility. ANA was measured in 116 unexplained infertile or sterile patients. The ANA positive rate was 43.5% in group A (habitual abortion, n = 23), 38.1% in group B (consecutive miscarriages, n = 21), 30.0% in group C (one miscarriage, n = 10), 16.7% in group D (one or more deliveries n = 12) 22.0% in group E (primary sterility, n = 50), and 22.4% in the control group (n = 54). The positive rate for all the infertile patients (group A+B) was 40.9% and significantly higher than that in for the control group (p < 0.05). Ten patients with positive ANA had 12 deliveries and 20 patients with negative ANA had 23 deliveries. The frequency of preeclampsia in the patients with positive ANA was higher than in those with negative ANA (41.7% versus 4.3%, p < 0.05). A higher incidence of premature deliveries was recognized in the patients with positive ANA than in those with negative ANA (41.7% versus 8.7%, p < 0.1). Average birth weight (> 35 week) for patients with and without positive ANA was 2,976g (n = 8) and 3,122g (n = 19) respectively. The former tends to be smaller than the latter (p < 0.1).

Exercise-induced silent myocardial ischemia in single vessel coronary artery disease associated with Q wave infarction. Assessment by thallium 201 single-photon emission computed tomography

PURPOSE

To examine the relationship between the symptom of ischemia and the amount of abnormally perfused myocardium, coronary arteriography and exercise and redistribution thallium 201 single-photon emission computed tomography (SPECT) were analyzed.

MATERIALS AND METHODS

The study group consisted of 153 patients with single-vessel coronary artery disease; 53 patients had no pathologic Q waves (group 1) and 100 patients had pathologic Q waves consistent with the area supplied by the diseased vessel (group 2). Twenty normal subjects were used as control subjects. The apical, mid, and basal left ventricular levels of the short-axis view and apical portion of the long-axis view were divided into 20 segments, and segmental images were scored blindly on a 0 (normal) to 4 (severely reduced uptake) scale. The redistribution score was defined as the thallium 201 defect score of exercise subtracted from that of the redistribution image and was used as a measure of the amount of ischemic myocardium.

RESULTS

The redistribution score in 20 control subjects was 0.20 +/- 2.06, and the upper limit of normal redistribution score was defined as mean + 2 x SD (4.32). In group 1, 40 of 53 patients had a redistribution score above the normal range. In group 2, 34 of 100 patients had a redistribution score above the normal range. Of 40 patients in group 1, angina during exercise was observed in 22 patients (55 percent). Twenty-two patients who had angina had a redistribution score of 15.2 +/- 6.7, while those who did not have angina had a score of 13.7 +/- 5.2 (p = NS). Of 34 patients in group 2, angina was observed in 10 patients (29 percent) during exercise. Ten patients with angina had a redistribution score of 10.1 +/- 4.4, and those without angina had a score of 9.9 +/- 3.4 (p = NS).

CONCLUSION

Thus, the incidence of silent ischemia without the Q wave infarct zone was found to be higher than that within the ischemic zone without Q wave. Patients with silent and symptomatic ischemia during exercise have similar amounts of ischemic myocardium demonstrated by tomographic thallium 201 imaging; this was found in patients who had Q wave infarction and in those who did not.

[Acute cardiac tamponade in nonpenetrating injury of proximal aorta: report of a case]

A 21-year-old male admitted to the emergency room with multiple traumatic injuries and shock. Although a chest X-ray showed normal in size of cardiac shadow, echocardiography confirmed cardiac tamponade. A median sternotomy was performed and the pericardial space was evacuated of 600 ml of blood and blood clots. Minor bleeding was identified in the proximal aorta, and complete hemostasis was achieved with manual compression and fibrin glue sealing. One month follow-up showed no pseudoaneurysm formation.

The effects of amrinone and calcium chloride on pulmonary vasculature and biventricular function in ethchlorvynol-induced lung injury in sheep

The effects of amrinone and CaCl2 on pulmonary vasculature and biventricular function in sheep with acute lung injury (ALI) were studied. Seven sheep were ventilated with a tidal volume of 10-12 ml.kg-1 with end-tidal CO2 of 40 +/- 5 mmHg (5.3 +/- 0.7 kPa) after acute lung injury was induced with up to 30 mg kg-1 of ethchlorvynol (ECV). Biventricular function and hemodynamic profiles were estimated with a rapid computerized thermodilution method and modified pulmonary artery catheters after acute lung injury, following a loading dose (1 mg kg-1) and maintenance dose (5 micrograms kg-1 min-1) of amrinone and after a bolus dose of CaCl2 (20 mg kg-1). ECV successfully induced acute lung damage in sheep, causing significant increases in pulmonary artery pressure (PAP) and pulmonary vascular resistance index (PVRI). Amrinone reversed the unfavorable changes induced by ECV, significantly reducing PAP, PVRI and left ventricular end-diastolic volume (LVEDV). CaCl2, however, reversed the effect of amrinone and increased PAP, PVRI, and LVEDV but decreased left ventricular ejection fraction.

De-acclimatization process of rats acclimatized to high altitude hypoxia

The de-acclimatization process in rats acclimatized to high altitude hypoxia was analyzed according to the changes in the activities of hepatic enzymes. The activities of tryptophan 2,3-dioxygenase and tyrosine aminotransferase in the liver of non-acclimatized rats were increased, whereas those of acclimatized rats were decreased after exposure to a simulated altitude of 8,000 m. When the acclimatized rats were kept under normoxic conditions for 8 days and over, the suppression of enzyme induction was nullified, and both enzymes were induced by exposure to the simulated 8,000 m altitude. De-acclimatization of rats acclimatized to hypoxia can be completed in 8-11 days.

Platelet activating factor in culture media as an indicator of human embryonic development after in-vitro fertilization

Although human chorionic gonadotrophin can detect trophoblast after implantation of the conceptus, there is a need to detect the conceptus before implantation. We have investigated whether human embryo-derived platelet activating factor is formed during embryonic development after in-vitro fertilization. A total of 99 ova from 12 patients were cultured and the 54 media were analysed. Platelet activating factor was also measured by radioimmunoassay after extraction. Fertilization increased the amount of platelet activating factor 4-fold over non-fertilized ova to a level of 4 ng/ml. This increase was also dependent on the degree of embryonic development with a maximum level of platelet activating factor of 7 ng/ml at the 2-cell stage. The follicular inducing agent used to treat the patient also had an effect on platelet activating factor; buserelin treatment gave embryos with a higher level than did clomiphene citrate treatment. These results indicate that platelet activating factor may have a role in embryonic development before implantation and may serve as a useful marker for fertilization and the developmental stage of the embryo.

Hemodynamic and respiratory effects of transtracheal high-frequency jet ventilation during difficult intubation

STUDY OBJECTIVE

To evaluate the hemodynamic and respiratory effects of percutaneous transtracheal high-frequency jet ventilation (HFJV) during difficult intubation using fiberoptic bronchoscopy under general anesthesia.

DESIGN

Prospective study.

SETTING

Surgical patients scheduled for general anesthesia at the Medical College of Virginia Hospital.

PATIENTS

Eight patients with known difficult airways. Three patients had deformed facial structures. One patient had temporomandibular joint impairment. Four patients had tumors of the oral cavity with deformed upper airways.

INTERVENTIONS

A 13-gauge cricothyroidotomy jet ventilation cannula was inserted percutaneously under local anesthesia. Anesthesia was induced with etomidate 0.2 to 0.3 mg/kg, alfentanil 15 to 20 micrograms/kg, and vecuronium 0.1 mg/kg. HFJV was started with 100% oxygen at 30 to 35 pounds per square inch of driving pressure, 100 cycles per minute, and an inspiratory/expiratory ratio of 25%. Thoracic electrical bioimpedance was used to measure cardiac index (CI) and ejection fraction (EF).

MEASUREMENTS AND MAIN RESULTS

Mean arterial pressure (MAP), heart rate (HR), CI, and EF were measured before induction of anesthesia; after 1 minute of HFJV, 5 minutes of HFJV, and 10 minutes of HFJV; and during positive pressure ventilation following fiberoptic intubation. Arterial blood gas samples were obtained before induction of anesthesia and after 10 minutes of HFJV. HR decreased significantly after 5 minutes of HFJV, after 10 minutes of HFJV, and after intubation (p less than 0.05). MAP decreased significantly after 10 minutes of HFJV compared with the preinduction value (mean, 97 to 71 mmHg; p less than 0.01). Although EF increased significantly following intubation, from 46% to 59%, there were no significant changes in CI. Arterial oxygen tension increased from 85 to 240 mmHg (p less than 0.05). Arterial carbon dioxide tension also increased, from 39 to 42 mmHg (p less than 0.05).

CONCLUSIONS

Transtracheal HFJV under general anesthesia with etomidate, alfentanil, and vecuronium provided satisfactory hemodynamic conditions and pulmonary gas exchange. Percutaneous transtracheal HFJV can be used safely to manage patients with a difficult airway under general anesthesia using fiberoptic bronchoscopy.

[Reliability of the exercise ECG in detecting silent ischemia in patients with prior myocardial infarction]

To assess the reliability of the exercise ECG in detecting silent ischemia, ECG results were compared with those of stress-redistribution thallium-201 single-photon emission computed tomography (SPECT) in 116 patients with prior myocardial infarction and in 20 normal subjects used as a control. The LV was divided into 20 segmental images, which were scored blindly on a 5-point scale. The redistribution score was defined as thallium defect score of exercise subtracted by that of redistribution image and was used as a measure of amount of ischemic but viable myocardium. The upper limit of normal redistribution score (= 4.32) was defined as mean +2 standard deviations derived from 20 normal subjects. Of 116 patients, 47 had the redistribution score above the normal range. Twenty-five (53%) of the 47 patients showed positive ECG response. Fourteen (20%) of the 69 patients, who had the normal redistribution score, showed positive ECG response. Thus, the ECG response had a sensitivity of 53% and a specificity of 80% in detecting transient ischemia. Furthermore, the 116 patients were subdivided into 4 groups according to the presence or absence of chest pain and ECG change during exercise. Fourteen patients showed both chest pain and ECG change and all these patients had the redistribution score above the normal range. Twenty-five patients showed ECG change without chest pain and 11 (44%) of the 25 patients had the abnormal redistribution. Three (43%) of 7 patients who showed chest pain without ECG change had the abnormal redistribution score. Of 70 patients who had neither chest pain nor ECG change, 19 (27%) had the redistribution score above the normal range. Thus, limitations exist in detecting silent ischemia by ECG in patients with a prior myocardial infarction, because the ECG response to the exercise test may have a low degree of sensitivity and a high degree of false positive and false negative results in detecting silent ischemia.

On kynureninase activity

1) In Mg-deficient rats, kynureninase activity is decreased. 2) p-Hydroxyphenylpyruvate inhibits kynureninase activity. 3) -SH groups in the apoenzyme of kynureninase play a very important role in the enzymatic reaction. 4) 3-Hydroxykynurenine may be a very important regulative metabolite in the 3-hydroxykynurenine----xanthurenic acid pathway.

Acclimatization to hypoxia modulates the tryptophan 2,3-dioxygenase activity in rats exposed to simulated high altitude

1. Exposure of rats to an 8000 m altitude increased the hepatic tryptophan 2,3-dioxygenase (EC 1.13.1.12) activity. 2. Acclimatization to hypoxia by a repeated exposure to an altitude of 5000 m induced a marked decrease in liver tryptophan dioxygenase activity after the rats were subjected to an 8000 m altitude, but a pre-exposure to 4000 m altitude showed no effect on the enzyme activity. 3. Plasma tryptophan was rapidly decreased by exposure to 8000 m altitude to the same extent in the acclimatized and non-acclimatized rats. 4. Plasma tryptophan may be utilized as the substrate for tryptophan dioxygenase in liver of the non-acclimatized rats under highly hypoxic conditions; however, acclimatized rats can reserve tryptophan as the substrate for the alternative metabolism other than the degradation pathway in liver.

Inhibition in mice of experimental metastasis of B16 melanoma by the synthetic lipid A-subunit analogue GLA-60

Antimetastatic effects of the monosaccharic lipid A-subunit analogue GLA-60 against B16-F10 melanomas were investigated. Intravenous injection of 10 micrograms GLA-60 one day or two days before transplantation of 10(5) melanoma cells resulted in a significant decrease in the number of melanoma colonies metastasized into the lung. Intramuscular injection was also effective. Oral administration as well as intraperitoneal and subcutaneous administrations of 100 micrograms GLA-60 were also effective in preventing metastasis of the melanoma. However, these prophylactic effects of GLA-60 on the metastasis were diminished in mice which had been pre-treated with anti-asialo GM1 serum; on the other hand, prophylaxis was not affected in mice pre-treated with anti-Mac 1 antibody. These results suggest that asialo GM1 positive cells, probably natural killer cells, but not macrophages, participate as effector cells in depressing metastasis of the melanoma cells into the lung. In addition, GLA-60 also showed therapeutic potency in depressing metastasis, under a defined condition. The antimetastatic effect of GLA-60 was compared with other immunomodulators.

Non-specific protective activity of synthetic lipid A-subunit analogs against microbial infections is influenced by their 2-N- and 3-O-linked acyl substituents in the D-glucosamine backbone

Non-specific protective activities against vaccinia virus (VV) and Pseudomonas aeruginosa infections as well as interferon (IFN)-inducing, natural killer (NK) cell and macrophage activation activities of chemically synthesized lipid A-subunit analogs were investigated. The analogs are 4-O-phosphono-D-glucosamine derivatives carrying different 2-N- and 3-O-linked acyl substituents such as (R)-3-tetradecanoyloxytetradecanoyl (C14-O-(C14)), (R)-3-hydroxytetradecanoyl (C14-OH) and tetradecanoyl (C14) groups. Compounds GLA-59 and GLA-60, which possess C14-OH and C14-O-(C14) groups as their acyl substituents, showed stronger IFN-inducing and anti-vaccinia virus activities than GLA-27 and GLA-68, which possess a C14 group instead of the C14-OH group in GLA-59 and GLA-60, although NK cell activation activity was similarly high in all of these compounds. In protective activity against P. aeruginosa infection and macrophage activation activity, GLA-60 and GLA-68, which carry a C14-O-(C14) group at the 3-O-position, expressed higher activities than GLA-27 and GLA-59, which carry the acyloxyacyl group at the 2-N-position. These results indicate that the acyl substituent (whether the counterpart of the C14-O-(C14) group is a C14 or a C14-OH group) and the binding position of the acyloxyacyl group at the 2-N- or the 3-O-position strongly influence the manifestation of antimicrobial and immunomodulating activities in different ways depending on the activity. Among the compounds, GLA-60 satisfied the structure requirements for protection against both VV and P. aeruginosa infections. This compound is a hopeful immunomodulator for prevention against broad microbial infections.

Inhibition of FKBP rotamase activity by immunosuppressant FK506: twisted amide surrogate

The immunosuppressive agents cyclosporin A and FK506 inhibit the transcription of early T cell activation genes. The binding proteins for cyclosporin A and FK506, cyclophilin and FKBP, respectively, are peptidyl-prolyl-cis-trans isomerases, or rotamases. One proposed mechanism for rotamase catalysis by cyclophilin involves a tetrahedral adduct of an amide carbonyl and an enzyme-bound nucleophile. The potent FKBP rotamase inhibitor FK506 has a highly electrophilic carbonyl that is adjacent to an acyl-pipicolinyl (homoprolyl) amide bond. Such a functional group would be expected to form a stabilized, enzyme-bound tetrahedral adduct. Spectroscopic and chemical evidence reveals that the drug interacts noncovalently with its receptor, suggesting that the alpha-keto amid of FK506 serves as a surrogate for the twisted amide of a bound peptide substrate.

Coronary artery spasm during cardiac angiography

Unexpected occurrence of coronary artery spasm is sometimes observed during cardiac catheterization. We report here two cases of coronary artery spasm with hypotension and urticaria subsequent to administration of contrast material. The etiology of coronary artery spasm is discussed.

Enhancement of nonspecific resistance to microbial infections of synthetic lipid A-subunit analogues of GLA-27 modified at the C1 position of the glucosamine backbone

The C1 position of lipid A-subunit analogue GLA-27, 4-O-phosphono-D-glucosamine carrying N-3-tetradecanoyloxytetradecanoyl(C14-O-(C14)) and 3-O-tetradecanoyl (C14) groups, was S-acetylated, thiolated or phosphorylated. Enhancement of nonspecific resistance to Pseudomonas aeruginosa and vaccinia virus infections of these chemically modified compounds were investigated. Thiolation augmented the nonspecific resistance to P. aeruginosa infection. Protective activity against vaccinia virus infection was reduced by all the chemical modifications. NK cell activity was found not to be effected by S-acetylation, but to be decreased slightly by thiolation or phosphorylation. IFN-inducing activity was reduced remarkably by thiolation or S-acetylation, or completely diminished by phosphorylation, compared with that of GLA-27.

Right ventricular function and high-frequency positive-pressure ventilation during coronary artery bypass grafting

The hemodynamic and respiratory consequences of two modes of ventilation, conventional intermittent positive-pressure ventilation with a frequency of 10 cycles/min and high-frequency positive-pressure ventilation at 70 cycles/min were investigated before and after cardiopulmonary bypass in 6 patients having coronary artery bypass grafting. All patients were adequately ventilated with each mode. During prebypass and postbypass periods, the group with high-frequency ventilation had significantly lower peak airway pressures (p = 0.0001) and mean airway pressure (p less than 0.05). There were, however, no significant differences in right ventricular performance or pulmonary vascular resistance between the two modes of ventilation. No significant differences in other cardiovascular and respiratory variables were noted. High-frequency positive-pressure ventilation, with the advantage of quieter operating conditions and improved surgical access, can be safely applied when meticulous operation or hemostasis is required or during dissection of the internal mammary artery.

Enhancement of nonspecific resistance to bacterial infections and tumor regressions by treatment with synthetic lipid A-subunit analogs. Critical role of N- and 3-O-linked acyl groups in 4-O-phosphono-D-glucosamine derivatives

Enhancement of nonspecific resistance against Pseudomonas aeruginosa infection and regression of growth of Meth A fibrosarcoma by chemically synthesized lipid A-subunit analogs, 4-O-phosphono-D-glucosamine derivatives carrying 3-O- and N-linked acyl groups, were investigated. Compounds carrying an (R)-3-hydroxytetradecanoyl (C14-OH) group at the 2-N-position with (R)-3-tetradecanoyloxytetradecanoyl [C14-O-(C14)] or (R)-3-dodecanoyloxytetradecanoyl [C14-O-(C12)] groups at the 3-O-position, termed GLA-60 or GLA-63, respectively, showed strong activity about one-tenth that of natural lipid A. The protective activity of compounds carrying an (R)-3-hexadecanoyloxytetradecanyl group instead of a C14-O-(C14) or C14-O-(C12) group was very weak. GLA-59 carrying the same acyl components as those of GLA-60 but with reversed binding sites showed significant but not so strong protective activity. The activity of compounds possessing a tetradecanoyl group instead of a C14-OH group in GLA-60 or GLA-63 was weaker than that of GLA-60 or GLA-63. Intravenous or intratumoral administration of GLA-59, GLA-60 and GLA-63 induced significant regression of Meth A fibrosarcoma in terms of tumor size, tumor weight and number of cured mice. The activity of GLA-59 was almost equivalent to that of GLA-60. None of the tested compounds exhibited significant pyrogenicity at a dose of 10 micrograms/kg in rabbits.

Unilateral high-frequency jet ventilation during one-lung ventilation for thoracotomy

One-lung ventilation is indicated during thoracic operations for bronchopleural fistula, pulmonary abscess, and pulmonary hemorrhage in spite of the possibility of the development of severe hypoxemia. To evaluate methods for improving oxygen transport during one-lung ventilation, we applied high-frequency jet ventilation (HFJV) and continuous positive airway pressure (CPAP) to the nondependent lung following deflation to atmospheric pressure in each procedure, and measured the effects on cardiac output and arterial oxygenation. In each case, the dependent lung was ventilated with conventional intermittent positive pressure ventilation (IPPV). Eight patients were studied during posterolateral thoracotomy using double-lumen endobronchial tubes. HFJV or CPAP to the nondependent lung improved arterial oxygenation significantly during both closed and open stages of the surgical procedures (p less than 0.008). When the chest was open, HFJV maintained satisfactory cardiac output, whereas CPAP usually decreased cardiac output (p less than 0.008). There were no significant differences in mean partial pressure of arterial carbon dioxide between HFJV, CPAP, and deflation to atmospheric pressure. In conclusion, HFJV to the nondependent lung provides not only satisfactory oxygenation but also good cardiac output, thereby maintaining better oxygen transport than CPAP or deflation to atmospheric pressure, while the dependent lung is ventilated with IPPV during one-lung ventilation for thoracotomy.

Enhancement of nonspecific resistance to viral infection by chemically synthesized lipid A-subunit analogs with different backbone structures and acyl groups

Protection against vaccinia virus infection and induction of interferon (IFN) were investigated in Propionibacterium acnes-primed mice following treatment with chemically synthesized lipid A-subunit derivatives. The antiviral activity was based on the reduction of numbers of tail lesions in mice injected intravenously with the test compounds 1 day before virus infection. GLA-27, a 4-O-phosphono-D-glucosamine carrying 3-O-tetradecanoyl (C14) and N-3-tetradecanoyloxytetradecanoyl [C14-O-(C14)] groups, offered significant antiviral activity. Chemical modifications at the C1 position of GLA-27, e.g. phosphorylation, replacement of OH by an SH, did not cause a significant change in antiviral activity. GLA-57 carrying an N-3-dodecanoyloxytetradecanoyl group showed stronger activity than GLA-27, but GLA-58 carrying an N-3-hexadecanoyloxytetradecanoyl group did not exhibit significant activity. GLA-59 carrying 3-O-3-hydroxytetradecanoyl and N-C14-O-(C14) groups was more active than GLA-27 and GLA-57. GLA-60 possessing the same fatty acid substituents as GLA-59 but in the reversed order was the most active of all compounds tested. This suggests that the nature and position of the acyl substituents are important for achieving the antiviral effects. The (R) isomers of GLA-59 and GLA-60 possessed stronger IFN-inducing activity than the (S) isomers, but no significant difference in antiviral activity was seen between the isomers.

Antitumor and antimicrobial activities of lipid A-subunit analogue GLA-27

Activities for enhancing nonspecific host resistance against microbial infections and growth inhibition against tumors by a lipid A-subunit analogue GLA-27 were investigated. GLA-27, a 4-O-phosphono-D-glucosamine derivative with 2-N-3-tetradecanoyloxytetradecanoyl and 3-O-tetradecanoyl group, inhibited significantly the growth of solid-type tumors RL male 1 lymphoma and Meth A fibrosarcoma. In the case of RL male 1 lymphoma, 2.5 micrograms of GLA-27 was needed to exhibit the activity, while for Meth A fibrosarcoma, 250 micrograms of GLA-27 was needed. On the other hand, tail lesions induced by intravenous inoculation with vaccinia virus were effectively suppressed in mice injected with 1 microgram of GLA-27 1 day before the viral injection. The antiviral activity of GLA-27 was 100 times higher than that of MDP by ED50. GLA-27 also showed nonspecific protective activity against Pseudomonas aeruginosa infection at a dose of 30 micrograms/mouse, although the activity was far less than that induced by lipid A. GLA-27 did not exhibit toxic activities such as pyrogenicity and Shwartzman reaction.

A method of rapid-sequence induction using high-dose narcotics with vecuronium or vecuronium and pancuronium in patients with coronary artery disease

A method of rapid-sequence induction was studied in 18 patients undergoing coronary artery bypass grafting (CABG) to assess the adequacy of relaxation for endotracheal intubation without resulting in major changes in heart rate (HR). Ten patients received vercuronium, 0.2 mg/kg (V); and eight patients received vecuronium, 0.1 mg/kg, and pancuronium, 0.1 mg/kg (V + P). All patients then received fentanyl, 50 to 70 microg/kg, or sufentanil, 5 to 7 microg/kg, followed 60 seconds later by intubation. Patients were assessed for ulnar and mandibular nerve response to train-of-four (TOF) and tetanic (T) stimulation at 60 seconds; presence or absence of coughing or bucking; degree of vocal cord relaxation (1=none, 2=some, 3=complete relaxation); ability to intubate at 60 seconds; and changes in HR. At the time of intubation, 17 patients had four twitches to TOF and a positive response to T stimulation of the ulnar nerve, while all 18 patients had zero or one twitch to TOF and only four had a positive response to T stimulation of the mandibular nerve (P < .0001 for T and TOF, ulnar v mandibular). Coughing and bucking were not observed in any patient. Vocal cord position was "3" in 14 patients and "2" in four patients. All patients were intubated without difficulty. The mean change in HR was -4.1 beats/min for patients receiving V and +16.4 beats/min for those receiving V + P (P < .002 for change in HR), with two V + P patients developing tachycardia. It is concluded that the onset of neuromuscular blockade is more rapid in the distribution of the mandibular nerve than at the ulnar nerve; mandibular nerve stimulation is a better predictor of adequate intubating conditions; good intubating conditions can be attained with either V or V + P; and, rapid-sequence induction with V is safe from a cardiac standpoint as measured by changes in HR, but the addition of pancuronium is unnecessary.

Importance of fatty acid substituents of chemically synthesized lipid A-subunit analogs in the expression of immunopharmacological activity

The immunopharmacological activities of chemically synthesized lipid A-subunit analogs, 4-O-phosphono-D-glucosamine derivatives carrying different N- and 3-O-linked acyl groups, were investigated. None of the synthetic compounds tested exhibited any detectable pyrogenicity at a dose of 10 micrograms/kg. Weaker lethal toxicity in galactosamine-sensitized mice was detected at 1 microgram per mouse for all the synthetic compounds except GLA-58. Among (RS) stereoisomers of 4-O-phosphono-D-glucosamine derivatives carrying a 3-O-tetradecanoyl (C14) group with different N-linked acyloxyacyl groups, i.e., 3-dodecanoyloxytetradecanoyl [C14-O-(C12)], 3-tetradecanoyloxytetradecanoyl [C14-O-(C14)], and 3-hexadecanoyloxytetradecanoyl [C14-O-(C16)] groups (termed GLA-57, GLA-27, and GLA-58, respectively), GLA-27 exhibited significant colony-stimulating factor-inducing and tumor necrosis factor-inducing activities, mitogenicity, polyclonal B-cell activation activity, macrophage activation, and adjuvanticity. The activities of GLA-57, which had an N-linked C14-O-(C12) group, were equivalent to or somewhat weaker than those of GLA-27 with a C14-O-(C14) group. Significant immunopharmacological activities were not observed for GLA-58, carrying a C14-O-(C16) group bound to the amino group. GLA-59, carrying 3-O-linked 3-hydroxytetradecanoyl (C14OH) and N-linked C14-O-(C14) groups, showed much higher activities than GLA-27, GLA-60, a compound which possesses the same fatty acid substituents as GLA-59 but with reversed binding sites, showed the strongest B-cell activation and adjuvant activities among the synthetic compounds. Among stereoisomers of GLA-59 and GLA-60 composed of fatty acid substituents with the (RR) and (SS) configuration, compounds with the (RR) configuration elicited stronger activities than the (SS) stereoisomers. The importance of fatty acid substituents, including stereospecificity for the expression of immunopharmacological activities of 4-O-phosphono-D-glucosamine derivatives, was demonstrated.

Antiviral and immunomodulating activities of chemically synthesized lipid A-subunit analogues GLA-27 and GLA-60

Biological and antiviral activities of chemically synthesized lipid A-subunit analogues, GLA-27 and GLA-60, were investigated with respect to defense mechanisms such as macrophage and natural killer (NK) cell activation and interferon (IFN)-inducing activity. GLA-27, a 4-O-phosphono-D-glucosamine derivative carrying 3-O-tetradecanoyl (C14) and 2-N-3-tetradecanoyloxytetradecanoyl (C14-O-(C14] group, and GLA-60, a similar analogue carrying 3-O-linked C14-O-(C14) and 2-N-linked 3-hydroxytetradecanoyl (C14-OH) groups, strongly inhibited the formation of pox tail lesions and the growth of vaccinia virus at the tail lesion sites in infected mice. The antiviral activity of GLA-60 was about 1000-fold higher than that of muramyldipeptide (MDP), a representative immunomodulator. GLA-27 and GLA-60 had stronger immunomodulating activity than MDP in macrophage activation, NK cell activation and IFN-inducing activity, although it was weaker than natural lipid A. Toxic manifestations such as pyrogenicity, local Schwartzman reaction and lethality were far less pronounced for GLA-27 and GLA-60 than for natural lipid A.

Immunopharmacological activities of chemically synthesized lipid A-subunit analogue GLA-27 combined with muramyl dipeptide via spacers of different carbon chain length

A lipid A-subunit analogue GLA-27, a 4-O-phosphono-D-glucosamine derivative carrying 3-O-tetradecanoyl and N-3-tetradecanoyloxytetradecanoyl groups, exhibited significant biological activities but no detectable pyrogenicity or local Shwarzman activity. In order to synthesize compounds combining GLA-27 with muramyl dipeptide (MDP), the OH group at the C6 position of GLA-27 was first succinylated. A compound which combined a succinylated GLA-27 (GLA-101) with 1-deoxy N-acetyl-muramyl-L-alanyl-D-isoglutamine methyl ester (1-deoxy MDP) via spacers of different carbon chain lengths of 5, 11 and 15, termed GLA-105, GLA-106 and GLA-107, respectively, and their biological activities were investigated. Intraperitoneal administration of combined preparations with spacers, GLA-105 and GLA-107, induced much higher phagocytic activity in peritoneal macrophages than GLA-27, GLA-101 and 1-deoxy MDP. The activity of GLA-106 did not increase by the combination. In induction of natural killer (NK) activity in peritoneal cells, GLA-105 and GLA-107 were significantly more active than 1-deoxy MDP but only comparable with GLA-27. GLA-101 showed stronger NK activity than GLA-27. The activity of GLA-106 was stronger than 1-deoxy MDP but weaker than GLA-27, GLA-105 and GLA-107. Mitogenic, interferon-inducing and tumor necrosis factor-inducing activities decreased by combining GLA-101 with 1-deoxy MDP. GLA-101, GLA-105 and GLA-107 strongly inhibited the formation of lesions on the tail of mice infected with Vaccinia virus. The activity was almost equivalent to that of GLA-27.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary collateral vessels in patients with previous myocardial infarction

To assess the degree of collateral vessels after myocardial infarction, coronary angiograms, left ventriculograms, and exercise thallium-201 myocardial scintigrams of 36 patients with previous myocardial infarction were reviewed. All 36 patients had total occlusion of infarct-related coronary artery and no more than 70% stenosis in other coronary arteries. In 19 of 36 patients with transient reduction of thallium-201 uptake in the infarcted area during exercise (Group A), good collaterals were observed in 10 patients, intermediate collaterals in 7 patients, and poor collaterals in 2 patients. In 17 of 36 patients without transient reduction of thallium-201 uptake in the infarcted area during exercise (Group B), good collaterals were seen in 2 patients, intermediate collaterals in 7 patients, and poor collaterals in 8 patients (p less than 0.025). Left ventricular contractions in the infarcted area were normal or hypokinetic in 10 patients and akinetic or dyskinetic in 9 patients in Group A. In Group B, 1 patient had hypokinetic contraction and 16 patients had akinetic or dyskinetic contraction (p less than 0.005). Thus, patients with transient reduction of thallium-201 uptake in the infarcted area during exercise had well developed collaterals and preserved left ventricular contraction, compared to those in patients without transient reduction of thallium-201 uptake in the infarcted area during exercise. These results suggest that the presence of viable myocardium in the infarcted area might be related to the degree of collateral vessels.

Studies on the monoexponential nature of the left ventricular pressure fall during isovolumic relaxation period in the diseased heart

Our recent clinical studies on the negative dP/dt upstroke pattern suggested that the left ventricular pressure (LVP) deviated from the exponential curve during isovolumic relaxation period (IRP) in diseased hearts. To examine this further two types of monoexponential curve fitting were done in various heart diseases (normal (N): 8, angina pectoris (AP): 8, myocardial infarction (MI): 13, hypertrophic cardiomyopathy (HCM): 10, dilated cardiomyopathy (DCM): 8). LVP was measured by a Millar's catheter-tip transducer, and four types of time constant (T1-T4) were derived: T1 was calculated by an exponential curve fitting e-t/T1 + B (B is constant), T2 by the ratio Pm/peak (-) dP/dt (Pm is LVP at peak (-) dP/dt), T3 by the best exponential curve fit e-t/T3 + B + C (C is constant), and T4 by the ratio (Pm-C)/peak (-) dP/dt. If the exponential curve fitting was reasonable, the relation between T1 and T2, or T3 and T4, should be on the line of identity. The result was as follows: T2 = 1.4 T1 - 6.1 (r = 0.84) and T4 = 1.1 T3 - 10.7 (r = 0.94). Additionally, C (mmHg) in MI (-26 +/- 15), HCM (-36 +/- 19) and DCM (-32 +/- 20) were lower (p less than 0.05) than in N (-13 +/- 7). These findings suggest that the LVP during IRP could deviate from the monoexponential curve and that careful attention should be given to calculate the time constant in diseased hearts.

Effect of stereospecificity of chemically synthesized lipid A-subunit analogues GLA-27 and GLA-40 on the expression of immunopharmacological activities

Tumor necrosis factor (TNF)-inducing, mitogenic, polyclonal B cell activation (PBA), macrophage activation and antiviral activities of chemically synthesized lipid A-subunit analogues, GLA-27 and GLA-40, were investigated. The structure of GLA-27 comprises 4-O-phosphono-D-glucosamine carrying tetradecanoyl and 3-tetradecanoyloxytetradecanoyl [C14-O-(C14)] groups as the 3-O- and 2-N-acyl substituents, respectively. GLA-40 is a 1-deoxy compound of GLA-27. The activities of stereoisomers, (R) and (S) forms at the C3 position of the C14-O-(C14) group, of both compounds were also investigated. TNF-inducing activity of the (S) isomers of GLA-27 and GLA-40 was stronger than that of the (R) isomers while the (R) isomers exhibited stronger mitogenic and PBA activities than the (S) isomers. With respect to macrophage activation such as phagocytosis, acid phosphatase and N-acetyl-beta-D-glucosaminidase activity as cellular lysosomal enzymes and cytostasis, peritoneal macrophages obtained from mice administered i.p. with test samples showed significant activities. Among stereoisomers of GLA-27, the (R) isomer exhibited somewhat stronger phagocytic and lysosomal enzyme activities than those of the (S) isomer while there was no appreciable difference in the activities between the isomers of GLA-40. Significant cytostasis-inducing activity was observed in stereoisomers tested. All of the isomers showed remarkable antiviral activity against vaccinia virus.

[Giant left ventricular thrombi in the hypereosinophilic syndrome: report of two cases]

This is a report of two cases of the hypereosinophilic syndrome with an unusual apical filling defect suggestive of an intraventricular mass. Case 1 (45-year-old man): This patient had marked eosinophilia, congestive heart failure, and murmurs of aortic and mitral regurgitation. A subcutaneous cervical mass revealed histologic features of angiolymphoid hyperplasia with eosinophilia (so-called Kimura's disease). Left ventriculography confirmed mitral regurgitation with extensive obliteration of the left ventricular cavity. It was suspected that an extensive ventricular mural thrombus was superimposed on a thickened endocardium. Right ventricular endomyocardial biopsy showed focal regions of fibrosis in the myocardium, and infiltration of eosinophils were identified. Case 2 (70-year-old man): This patient had marked eosinophilia and congestive heart failure. Left and right angiography showed apical filling defects suggestive of intraventricular mass. Right ventricular endomyocardial biopsy showed focal areas of fibrosis, and infiltration of eosinophils were observed. Diagnosis of Löffler's endocarditis was made. It is suggested that the spectrum of ventricular abnormalities in these patients results from endomyocardial fibrosis of varying severity, and that eosinophilia may play a leading role or may associate with the genesis of the disease in these two cases.