Reduced factor VII and factor VIII levels and prolonged thrombin-generation times during a healthy diet in middle-aged women with mild to moderate cardiovascular disease risk

BACKGROUND

No experimental study has investigated the effect of whole-diet therapies on a wide range of hemostatic parameters, and their relationship with metabolic and inflammatory markers. Such information was sought in middle-aged women with moderate cardiovascular disease (CVD) risk subjected to an integrated healthy diet.

METHODS

Forty-nine premenopausal women were screened for C-reactive protein levels > or =1 mg L(-1) and at least one additional CVD risk factor. Sixteen women (age: 43-54 years) were selected and received a 12-week diet (four phases) integrating National Cholesterol Education Program-Adult Treatment Panel-III recommendations with components of a Mediterranean-style diet.

RESULTS

We observed a reduction in body mass index (BMI) (P = 0.001), waist circumference (P = 0.005), total (P = 0.011) and low-density lipoprotein (LDL) cholesterol levels (P = 0.035). Antigen levels of coagulation factor (F)VII (P = 0.003) and FVIII (P = 0.005) were clearly reduced by dietary intervention, which also appeared to decrease circulating tissue factor but not fibrinogen and von Willebrand factor (VWF) antigen levels. Levels of FVIII and tumor necrosis factor-alpha, among the inflammation markers, showed the highest correlation, particularly before the intervention (r = 0.55, P = 0.032). Only this cytokine influenced FVIII variation over time, thus highlighting new relations between coagulation and cellular components of inflammation. The functional effect of diet on coagulation was indicated by markedly prolonged thrombin generation initiation and propagation times (lag time, P = 0.002; time to peak, P = 0.005).

CONCLUSIONS

The changes observed in coagulation initiation and amplification phases, body composition and lipid profile could translate into a remarkable decrease in the risk for cardiovascular disease. Our observations suggest novel relationships between coagulation and inflammatory components.

Vitamin K-induced modification of coagulation phenotype in VKORC1 homozygous deficiency

BACKGROUND

Combined vitamin K-dependent clotting factor (VKCF) deficiency type 2 (VKCFD2) is a rare bleeding disorder caused by mutated vitamin K 2,3-epoxide reductase complex subunit 1 (VKORC1) gene.

METHODS AND RESULTS

An Italian patient with moderate to severe bleeding tendency was genotyped, and found to be homozygous for the unique VKORC1 mutation (Arg98Trp) so far detected in VKCFD2. The activity levels of VKCFs were differentially reduced, and inversely related to the previously estimated affinity of procoagulant factor propeptides for the gamma-carboxylase. The normal (factor IX) or reduced antigen levels (other VKCFs) produced a gradient in specific activities. Vitamin K supplementations resulted in reproducible, fast and sustained normalization of PT and APTT. At 24 h the activity/antigen ratios of VKCFs were close to normal, and activity levels were completely (factor VII and IX), virtually (prothrombin, factor X and protein C) or partially (protein S) restored. Thrombin generation assays showed a markedly shortened lag time. The time to peak observed at low tissue factor concentration, potentially mimicking the physiological trigger and able to highlight the effect of reduced protein S levels, was shorter than that in pooled normal plasma. At 72 h the thrombin generation times were normal, and the decrease in activity of procoagulant VKCFs was inversely related to their half-life in plasma. The improved coagulation phenotype permitted the uneventful clinical course after invasive diagnostic procedures.

CONCLUSIONS

Modification of coagulation phenotypes in VKCFD2 after vitamin K supplementation was clinically beneficial, and provided valuable patterns of factor specific biosynthesis, half-life and decay.

Guillain-Barré syndrome after varicella zoster virus infections. A case report

The case of a 13 year-old patient affected by Guillain-Barré syndrome developed after varicella zoster virus infection is reported. Cerebrospinal fluid examination and motor and sensory conduction velocity were consistent with GBS. Antibodies against gangliosides GM1 were present; it is likely that some of these may play an important role in the pathogenesis of syndrome after varicella infection. The therapy was carried out with increasing high-doses of immunoglobulins, with full clinical recovery.

A simple extraction procedure for efficient routine detection of pathogenic bacteria in plant material by polymerase chain reaction

A simple and rapid method for extracting DNA from plants based on the use of an extraction buffer and precipitation with isopropanol was assayed to see its usefulness in detecting pathogenic bacteria in plant material. The method was compared with a phenol-chloroform standard procedure obtaining higher sensitivity levels of detection. The protocol developed was efficient for detecting a Gram-positive bacterium, Clavibacter michiganensis subsp. sepedonicus and several Gram-negative pathogenic bacteria (Ralstonia solanacearum, Erwinia amylovora, Xanthomonas axonopodis pv. citri) with a sensitivity of 10(2)-10(3) cfu/ml in spiked samples. It was also efficient to specifically identify such bacteria in naturally infected plant material. This procedure is proposed as a routine tool for detection of plant pathogenic bacteria, as well as in environmental microbiology and biotechnology studies.

The unidirectional valve is the best method to determine maximal inspiratory pressure during weaning

OBJECTIVES

Although maximal inspiratory pressure (MIP) is used as an index of inspiratory muscular strength, there is no consensus on how to measure it. We compared, during weaning from mechanical ventilation, two methods of measurement to determine which shows the greater values (MIPbest) and is more reproducible. One method measured MIP when negative pressure was maintained for at least 1 s after a forceful expiration, and the other method measured MIP with a unidirectional expiratory valve (MIPuni).

DESIGN

The study had a crossover design, and patients randomly performed three measurements of each method (t1). The procedure was repeated by the same observer after 20 min (t2). The maximal value in each method was considered.

SETTING

ICU, Hospital A.C. Camargo, São Paulo, Brazil.

PATIENTS

Fifty-four consecutive patients undergoing short-term mechanical ventilation who became eligible for the study when their physicians decided to restore spontaneous breathing.

RESULTS

MIPbest values were arrived at using MIPuni 75% of the time either in tl or t2. MIPuni yielded a higher average of MIPbest values in t1 and t2 (p < 0.0001). The effort-to-effort coefficient of variation of one method compared with the other during t1 and t2 was similar (p > 0.2 for t1; p > 0.8 for t2). Also, when comparing tl and t2, the coefficients of variation were similar for each method (p > 0.62).

CONCLUSIONS

Because MIPuni displayed the maximal values, it is the best method for estimating MIP in patients undergoing short-term mechanical ventilation. The reproducibility of consecutive measurements was similar between the methods, even after a short period of time.

A foodborne outbreak of Salmonella enteritidis vehicled by duck and hen eggs in southern Italy

A foodborne outbreak of Salmonella enteritidis PT4 is described. This microrganism was detected in a home-made dessert, in the duck and hen eggs used for its preparation and in faecal samples of six persons involved in the outbreak. PCR ribotyping revealed that all the strains shared a profile of S. enteritidis never previously identified in southern Italy and quite different from that of the strains simultaneously isolated in the same geographic area. The possible identification of a clonal variant of S. enteritidis PT4 host-adapted to duck is hypothesized.

Comparative analysis of isolated human bronchi contraction and biosynthesis of cysteinyl leukotrienes using a direct 5-lipoxygenase inhibitor

Quantitation of cysteinyl leukotriene production and smooth muscle contraction upon immunological challenge of isolated human bronchi was evaluated. Analysis of picomole amounts of leukotriene C4, D4, and E4 was achieved using HPLC separation and enzyme immunoassay quantitative determination. The aim of the study was to correlate the contraction of airway smooth muscle and cysteinyl leukotriene production with and without 5-lipoxygenase inhibition. In human isolated bronchial tissue treated with indomethacin and pyrilamine to make their contractile responses leukotriene dependent only, the novel 5-lipoxygenase inhibitor 5,6-Dihydroxy-2-(N,N-Dimethylhydrazino)-1,2,3,4-tetrahydro-naph talene bromide (CHF 1909) caused a concentration-dependent inhibition of the immunologically induced contraction, showing an IC50 value of 13 +/- 2.2 microM (mean +/- CV). At the concentration of 30 microM, this compound caused more than 90% inhibition of the maximal bronchoconstriction in vitro, and inhibited cysteinyl leukotriene production by 90% as well. Contemporary measurement of immunologically induced contraction and production of cysteinyl leukotrienes in isolated human bronchi provided a direct correlation between smooth muscle contraction and synthesis of leukotriene C4, D4, and E4.

Comparison of tailored and empiric scan delays for CT angiography of the abdomen

OBJECTIVE

Scan delays for CT angiography of the abdomen are currently individualized by matching a scan delay to the transit time of a test bolus of IV contrast material to the abdominal aorta. We sought to determine whether this procedure improves the extent and uniformity of aortic enhancement when compared with the use of a standard scan delay that is determined empirically.

SUBJECTS AND METHODS

CT angiography of the upper abdomen (either the entire abdominal aorta or the aorta spanning the length of both kidneys for dedicated renal studies) was obtained in 48 patients who were considered to have normal cardiac function as determined by their referring physicians. Patients were randomized to undergo CT angiography that used either a standard scan delay of 20 or 22 sec (group 1, n = 26) or a tailored scan delay (group 2, n = 22), all other imaging parameters being identical. Tailored delays were determined by measuring contrast transit time to the abdominal aorta with software from the SmartPrep system. For each patient, aortic attenuation was measured at three different anatomic levels, and a lower threshold of 160 H was considered optimal. The number of attenuation values above this threshold, the mean attenuation, and the attenuation changes for each unit length along the abdominal aorta were then compared for the two groups of patients.

RESULTS

Fifty-eight (74%) of 78 aortic attenuation values in group 1 and 55 (88%) of 69 in group 2 were above 160 H. Mean attenuation values were 192.2 H +/- 8.1 (+/-SE) in group 1 and 199.2 H +/- 10.1 in group 2. These values and the attenuation changes for each unit length along the abdominal aorta-3.7 H/cm +/- 1.7 for group 1 and 2.2 H/cm +/- 2.0 for group 2- were not significantly different.

CONCLUSION

Tailoring the scan delay for CT angiography of the abdomen in patients considered to have normal cardiac function requires additional IV contrast agent, time, and patient imaging and does not improve the extent or uniformity of aortic enhancement over that obtained with a standard, empiric scan delay.

Inhibition of parathyroid hormone-stimulated resorption in cultured fetal rat long bones by the main metabolites of ipriflavone

Ipriflavone is an isoflavone derivative used in the prevention and treatment of postmenopausal and senile osteoporosis in humans. To assess the potential contribution of the main in vivo ipriflavone metabolites (M1, M2, M3, and M5) on the pharmacological properties of the drug, we investigated their effect on osteoclastic resorption induced by the well-known stimulator of bone resorption bovine parathyroid hormone fragment 1-34 (bPTH 1-34). The study was carried out using fetal rat long bones in stationary cultures. The amount of osteoclastic resorption was determined by assaying for 5 days the release from bones in the media of previously incorporated 45Ca. All metabolites were effective at inhibiting osteoclastic resorption. Maximal potency was shown by M3, characterized by a significant effect at 10 microM (P < 0.01) and by an IC50 value of 17 microM. M2 was about threefold less potent than M3 (IC50 = 46 microM). M1 and M5 were the least active compounds with an IC50 value of 117 and 200 microM, respectively. The present evidence indicates that metabolites of ipriflavone, in particular M3 and M2, inhibit bPTH 1-34-induced bone resorption in fetal rat long bones. Accordingly, they may play an important role in the pharmacological effects of the drug.

The involvement of the release of nitric oxide in the pharmacological activity of the new furoxan derivative CHF 2363

1. The mechanism of action and the pharmacological effects of the new furoxan derivative, CHF 2363 (4-ethoxy-3-phenylsulphonylfuroxan), were investigated. 2. Pre-incubation of CHF 2363 with human platelet-rich plasma produced a concentration-dependent inhibition of the platelet aggregation induced by collagen, adenosine diphosphate (ADP) and platelet activating factor (PAF). The test compound was about 5 times more potent than sodium nitroprusside. 3-Isobutyl-1-methyl-xanthine (IBMX) potentiated the antiaggregating effect of CHF 2363. 3. CHF 2363 was a potent inhibitor of rubbed endothelium rabbit aortic ring contraction induced by noradrenaline. Comparison of IC50 values showed that CHF 2363 was as potent as glyceryl trinitrate (GTN). 4. Increasing concentrations of CHF 2363 elevated platelet guanosine 3':5'-cyclic monophosphate (cyclic GMP) levels. Adenosine 3':5'-cyclic monophosphate (cyclic AMP) levels were unaffected. 5. Oxyhaemoglobin reduced all the pharmacological actions of the test compound. Moreover, CHF 2363 concentration-dependently released nitric oxide (NO) in platelet-rich plasma. The NO release was correlated to its ability to increase platelet cyclic GMP levels. 6. After exposure of rat aortic strips to supramaximal concentrations of GTN (550 microM), the vasorelaxant activity of CHF 2363 did not change, although that of GTN decreased about 55 fold. 7. It has been concluded that the new furoxan derivative CHF 2363 exerts a potent antiaggregating and vasorelaxant activity via NO release and increase of cyclic GMP levels. No in vitro cross tolerance between GTN and CHF 2363 was observed.

Evaluation of cytogenetic effects of a naturally occurring non-ice-nucleation Pseudomonas fluorescens strain in Chinese hamster ovary (CHO) cells

One of the main methods for eliminating ice-nucleation-active (INA+) bacteria the micro-organisms responsible for frost injuries to plants at mild freezing temperatures, is the use, as competitors, of other naturally occurring non-nucleating strains (non-INA). In the present article we investigated the cytogenetic effects of a naturally occurring non-INA strain of Pseudomonas fluorescens (MS 1640 R3), evaluating the induction of chromosomal aberrations and sister chromatid exchanges (SCEs) in Chinese hamster ovary (CHO) cells in the absence and presence of rat S9 metabolism. The results obtained did not show any increase in either chromosomal aberrations or SCEs, both in the absence and presence of rat S9 metabolism when used as i) intact bacteria cells, ii) sonicated bacteria (i.e., potential endotoxins), or iii) metabolic bacterial products (i.e., potential exotoxins) released in the growth medium.

CHF 2206, a new potent vasodilating and antiaggregating drug as potential nitric oxide donor

The effects of the new 3,4-disubstituted furoxan, CHF 2206, on vascular tone, platelet aggregation and platelet cyclic 3',5'-guanosine monophosphate (cGMP) levels were investigated. The compound was a potent inhibitor of rabbit aortic ring contraction induced by norepinephrine, the stable prostaglandin F2 alpha analogue, U-46619, and KCl; this activity was independent of endothelium integrity. When pre-incubated with platelet-rich plasma, CHF 2206 potently reduced in a dose-dependent manner the aggregation induced by the threshold aggregating concentration of collagen, ADP or platelet activating factor (PAF). In the same experimental conditions, the test compound increased the platelet cGMP levels and this rise was clearly associated with the inhibition of platelet aggregation. Moreover, 3-isobutyl-1-methyl-xanthine (IBMX) 5 microM potentiated the antiaggregating activity of CHF 2206. These results indicate that the increase in cGMP plays a key role in the CHF 2206-elicited responses. Oxyhemoglobin reduced all the pharmacological actions of the test compound. This evidence, along with the capacity of CHF 2206 to cause inorganic nitrite production in the presence of platelet-rich plasma, strongly suggests that nitric oxide (NO) may be a common reactive intermediate responsible for the effects induced by the drug. In conclusion, the furoxan derivative CHF 2206 exerts a potent antiaggregating and vasodilating activity with a pharmacological profile similar to the one described for NO-donating pro-drugs.

Modulation of arachidonic acid metabolism by orally administered morniflumate in man

Unlike other classic NSAIDs, some fenamates given at therapeutic concentrations, have been shown to inhibit, both in vitro and in vivo, the 5-lipoxygenase pathway of arachidonic acid cascade as well as the synthesis of cyclooxygenase products. This dual inhibitory property might represent an improvement in anti-inflammatory therapy. The aim of this work was to characterize the effect of morniflumate, administered at therapeutic dosages to normal human volunteers, on leukotriene B4 (LTB4) and thromboxane (TXB2) synthesis, both in purified PMNs and in whole blood. PMNs, isolated two hours after a single oral administration of morniflumate and at steady-state condition, fully retain their capacity to release LTB4 and TXB2. Since intracellular concentrations of the drug were undetectable, in spite of its elevated concentrations in platelet poor plasma, the results obtained using PMNs suggest a drug loss during the cells purification procedure. In whole blood experiments, morniflumate reduced blood LTB4 synthesis induced by Ca-ionophore A23187 Bx approximately 50%, both after single dose and at steady state; the degree of inhibition showed a pattern similar to the plasma levels of the bioactive metabolite of morniflumate (M1). The inhibition of serum TXB2 levels was higher than 85%. Hence, morniflumate is capable of reducing arachidonic acid metabolism acting both on cyclooxygenase and 5-lipoxygenase. This characteristic might provide a better approach in anti-inflammatory therapy.

Effects of hyaluronic acid fractions in the rabbit eye

Two fractions of hyaluronic acid with different molecular weight (Ial, molecular weight 500,000-730,000 and Healon, molecular weight 750,000) were injected intracamerally or intravitreously in the rabbit eye. Although the fraction with higher molecular weight caused an increase in intraocular pressure, no change of this parameter was found after administration of the fraction with the lower molecular weight. Furthermore, various inflammatory reactions in ocular tissues were observed during slit-lamp biomicroscopy after administration of Healon but not of Ial. No inflammatory reaction was found after subchronic instillation of the compounds.

Neurotensin-induced miosis: the role of dopaminergic pathways

In this study we investigated the role that dopaminergic pathways play in the miotic effect exerted by neurotensin after intracameral administration. Neurotensin was injected into the anterior chamber (AC) at a dose of 30 micrograms to 4 groups of albino rabbits which had previously undergone the following treatment: a) desmethylimipramine IM and, after 30 min, 6-hydroxydopamine IV 7 days prior to the neurotensin administration; b) haloperidol IM for 15 days; c) haloperidol AC 10 minutes before the neurotensin administration. Our data confirm previous observations regarding the miotic activity of neurotensin and suggest that the dopaminergic system plays an important role in the miotic effect of neurotensin.