[Arterial rigidity, a marker of cardiovascular diseases]

Rigidity of the arterial wall is a generally accepted marker of cardiovascular diseases. Many studies are designed to investigate arterial rigidity in patients with arterial hypertension, coronary heart disease, and diabetes mellitus. The authors consider pathophysiological mechanisms underlying the enhancement of vascular rigidlity and the respective contributing fiactors, such as extensibility compressibility elasticity modulus, pulse wave propagation velocity, and augmentation index. The main methods for measuring arterial rigidity are described with special reference to non-invasive techniques and fbctors responsible for this condition. Possibilities for medicamental modification of main arteries are discussed

Stiff-person syndrome (SPS) and anti-GAD-related CNS degenerations: protean additions to the autoimmune central neuropathies

Stiff Person Syndrome (SPS) is a rare autoimmune neurological disease attributable to autoantibodies to glutamic acid decarboxylase (anti-GAD) more usually associated with the islet beta cell destruction of autoimmune type 1 diabetes (T1D). SPS is characterized by interference in neurons with the synthesis/activity of the inhibitory neurotransmitter gamma amino butyric acid (GABA) resulting in the prototypic progressive spasmodic muscular rigidity of SPS, or diverse neurological syndromes, cerebellar ataxia, intractable epilepsy, myoclonus and several others. Remarkably, a single autoantibody, anti-GAD, can be common to widely different disease expressions, i.e. T1D and SPS. One explanation for these data is the differences in epitope engagement between the anti-GAD reactivity in SPS and T1D: in both diseases, anti-GAD antibody reactivity is predominantly to a conformational epitope region in the PLP- and C-terminal domains of the 65 kDa isoform but, additionally in SPS, there is reactivity to conformational epitope(s) on GAD67, and short linear epitopes in the C-terminal region and at the N-terminus of GAD65. Another explanation for disease expressions in SPS includes ready access of anti-GAD to antigen sites due to immune responsiveness within the CNS itself according to intrathecal anti-GAD-specific B cells and autoantibody. Closer study of the mysterious stiff-person syndrome should enhance the understanding of this disease itself, and autoimmunity in general.

Generalized tetanus in a Labrador retriever

A 10-week-old, intact female, Labrador retriever was presented for progressive extensor rigidity, facial swelling, and difficulty in walking. Generalized tetanus was diagnosed and treated successfully.

Dopa-responsive infantile hypokinetic rigid syndrome due to dominant guanosine triphosphate cyclohydrolase 1 deficiency

We report on a GTP cyclohydrolase 1 mutation-confirmed heterozygous case presenting with an infantile hypokinetic rigid syndrome and delay in attainment of motor milestones starting from the first year of life. He had a family history of dopa-responsive dystonia-parkinsonism. CSF neopterin, biopterin and HVA values were decreased. Molecular study of GCH-1 gene showed the Q89X mutation in exon 1. Treatment with l-dopa resulted in a complete remission of symptoms.

Acoustic Changes Related to Laryngeal Examination with a Rigid Telescope

The influence on voice quality of the insertion of endoscopic equipment with tongue anchoring and head position requirements during endoscopic evaluation has not been fully investigated. The present study attempted to examine the influence of: (1) the presence of a rigid endoscope and tongue anchoring, and (2) the angle of position technique (70-degree and 90-degree) on participants' vocal output during sustained production of the vowel /i/. Five acoustic measurements including fundamental frequency (F0) values, percent jitter values, relative average perturbation of F0 shimmer, and noise-to-harmonic ratios were used to represent participants' voice quality. Results indicated that F0 values were significantly influenced by the angle of sitting position, while percent jitter values, relative average perturbation of F0, shimmer, and noise- to-harmonic ratios were affected by the presence of a rigid endoscope and tongue anchoring.

Muscle stiffness and strength and their relation to hand function in children with hemiplegic cerebral palsy

This study compared the passive stiffness of wrist flexors and the strength of wrist flexors and extensors in three different wrist positions (30 degrees of flexion, neutral, and 30 degrees of extension) between children with cerebral palsy (CP) and typically developing (TD) comparison children. It also examined associations between these characteristics and manual function in children with CP. Eleven children with spastic hemiplegic CP (six females, five males; mean age 8y 5mo [SD 1y 8mo], range 6-11y) and 11 TD children, matched for age and sex, took part in this study. Passive stiffness of muscles was measured as the torque/angle relation during passive motion. Isometric strength tests were performed and the time needed to complete three tasks based on the Jebsen-Taylor Hand Function Test was recorded. Flexor stiffness was higher in the group with CP. Strength of flexors and extensors in the group with CP was lower with the wrist extended. No difference among test positions was found in the TD group. Moderate correlations were observed between manual function and variables related to strength and stiffness of wrist muscles in the group with CP. Children with CP showed muscle alterations coherent with the use of the wrist in flexion. Intervention on these characteristics could have a positive impact on manual function.

Substrate rigidity and force define form through tyrosine phosphatase and kinase pathways

Cell forces define cell morphology, alterations in which are caused by tyrosine kinase and phosphatase mutations, which implies a causal linkage. Recent studies have shown that phosphotyrosine signaling is involved in force sensing for cells on flat surfaces. Early force-dependent activation of Src family kinases by phosphatases or cytoskeleton stretch leads to the activation of downstream signaling. In addition, force generation by cells depends on a feedback mechanism between matrix rigidity or force generation and myosin contractility. Components of the force-sensing pathway are linked to the integrin-cytoskeleton complex at sites of force application and serve as scaffolds for signaling processes. Thus, early events in force detection are mechanically induced cytoskeletal changes that result in biochemical signals to mechanoresponsive pathways that then regulate cell form.

Estimation of early postmortem intervals by a multiple regression analysis using rectal temperature and non-temperature based postmortem changes

Five general methods based on rectal temperature and a multiple regression analysis using rectal temperature and non-temperature based postmortem changes were applied to 212 postmortem cases of within 24h postmortem (PM) intervals. Non-temperature based postmortem changes of rigidity, hypostasis and corneal turbidity were numerically categorized and used with rectal temperatures as four statistical variables in the multiple regression analysis. The correlation coefficient values between true and calculated postmortem intervals were 0.78-0.82 in the five general methods based on rectal temperature. The multiple regression analysis produced a multiple correlation coefficient value of 0.89 and according to the error ranges of the PM intervals, 72% of the cases were estimated within the error of +/-1.0 h and 92% within +/-5.0 h. Although assessments of non-temperature based PM changes are mostly subjective and have a wide variation, the present study demonstrated a usefulness of non-temperature based PM changes in the estimation of PM intervals.

Apparent life-threatening events in infants: high risk in the out-of-hospital environment

STUDY OBJECTIVE

The purpose of this study is to define the prevalence and significance of apparent life-threatening events among infants in the out-of-hospital setting.

METHODS

This was a retrospective, cohort, outcome study of infants for whom a caregiver activated the emergency medical services (EMS) system. For purposes of the study, an apparent life-threatening event was defined as an episode of apnea, skin color change, or change in muscle tone. Study data characteristics included initial physical appearance, work of breathing, circulation skin signs, pulse rate, respiratory rate, and overall concern for the chief complaint as interpreted by EMS personnel.

RESULTS

Sixty (7.5%) of 804 infants encountered by EMS during the study period met our criteria for apparent life-threatening event. Mean age was 3.1+/-3.3 months, and 55% were boys. Of the infants with apparent life-threatening event, 50 (83.3%) infants appeared to be in no distress, 8 (13.3%) infants were in mild distress, and 2 (3.3%) infants were in moderate distress. General physical appearance, work of breathing, circulatory signs, respiratory rate, and pulse rate were not clinically abnormal in the study group as a whole. Critical conditions associated with apparent life-threatening event included pneumonia or bronchiolitis (12%), seizure (8%), sepsis (7%), intracranial hemorrhage (3%), bacterial meningitis (2%), dehydration (2%), and severe anemia (2%). Limitations of the study included retrospective design and inability to follow up study patients beyond hospital discharge.

CONCLUSION

An apparent life-threatening event in an infant can present without signs of acute illness and is commonly encountered in the EMS setting. It is often associated with significant medical conditions, and EMS personnel should be aware of the clinical importance of an apparent life-threatening event. Infants meeting criteria for an apparent life-threatening event should receive a timely and thorough medical evaluation.

Mechanical factors of cardiovascular risk in systemic arterial hypertension. A new sign of arterial rigidity

ANTECEDENT: By means of sphygmokinetocardiography (SKCG) we developed and arterial rigidity index (ARI) which measure the pulse wave aortic carotid reflexion time over the left ventricular ejection time (LVET). This index, together with the pulse wave velocity (PWV) and the pulse pressure (PP) are indicators of arterial stiffness. In this paper we measured these index in 27 systemic artery hypertension. Cases (group A, GA), with and without left ventricular hypertrophy (subgroups: A1 SGA1, n = 13, and A2, SGA2, n = 14), respectively, and 28 normotensive cases (group B, GB).

PROTOCOL

In two occasions: after 3 minutes of sitting position (SP) and after 3 minute of logging in an upright position (UP), blood pressure, ARI, PP, PWV (aortic-hand finger distance/aorto-hand finger pulse time) and R-IV interval (electrocardiographic R wave-left early ventricular kinetocardiography deflexion) were measured.

RESULTS

Demography was similar in GA and GB. Systolic, diastolic and pulse pressure were significantly higher in GA vs GB. LVET (ms) was lower in GA vs GB in SP (268 +/- 42 vs 274 +/- 40, p < 0.001, respectively) and higher postexercise UP (280 +/- 42 vs 244 +/- 46, p < 0.001). PWV m/s were higher in SP in GA vs GB (9.8 +/- 2.8 vs 7.4 +/- 1.2, p < 0.001, respectively) and in UP (10.1 +/- 1.9 vs 7.9 +/- 9, p < 0.001, respectively). ARI was lower in UP in GA vs GB (0.48 +/- 0.3 vs 0.80 +/- 0.3, p < 0.003). Correlation index of PP vs SBP, vs DBP and vs PWV were significant in SP and in UP. Height had a significant correlation vs ARI in SP and UP (r = 0.60, p < 0.01, and r = 0.42, p < 0.05, respectively).

CONCLUSION

PWV is increased in GA vs GB patients. The ARI index is lower in GA vs GB cases in post exercise. PWV and PP showed a statistical significant correlation; height vs ARI had also a significant correlation: SKCG is a new method, that uses a not commercially instrument, which should have clinical application.

Rigor-force producing cross-bridges in skeletal muscle fibers activated by a substoichiometric amount of ATP

Isometric skinned muscle fibers were activated by the photogeneration of a substoichiometric amount of ATP and their cross-bridge configurations examined during the development of the rigor force by x-ray diffraction and electron microscopy. By the photogeneration of approximately 100 microM ATP, approximately 2/3 of the concentration of the myosin heads in a muscle fiber, muscle fibers originally in the rigor state showed a transient drop of the force and then produced a long-lasting rigor force (approximately 50% of the maximal active force), which gradually recovered to the original force level with a time constant of approximately 4 s. Associated with the photoactivation, muscle fibers revealed small but distinct changes in the equatorial x-ray diffraction that run ahead of the development of force. After reaching a plateau of force, long-lasting intensity changes in the x-ray diffraction pattern developed in parallel with the force decline. Two-dimensional x-ray diffraction patterns and electron micrographs of the sectioned muscle fibers taken during the period of 1-1.9 s after the photoactivation were basically similar to those from rigor preparations but also contained features characteristic of fully activated fibers. In photoactivated muscle fibers, some cross-bridges bound photogenerated ATP and underwent an ATP hydrolysis cycle whereas a significant population of the cross-bridges remained attached to the thin actin filaments with no available ATP to bind. Analysis of the results obtained indicates that, during the ATP hydrolysis reaction, the cross-bridges detached from actin filaments and reattached either to the same original actin monomers or to neighboring actin monomers. The latter cross-bridges contribute to produce the rigor force by interacting with the actin filaments, first producing the active force and then being locked in a noncycling state(s), transforming their configuration on the actin filaments to stably sustain the produced force as a passive rigor force.