The mechanism of blood pressure variability. Study in patients with fixed ventricular pacemaker rhythm

BACKGROUND

Several studies have shown that heart rate variability plays an anti-oscillatory role in the regulation of blood pressure variability in humans. We tested whether systolic blood pressure variability in patients with a fixed ventricular pacemaker rhythm differs from that in patients with sinus rhythm.

METHODS AND RESULTS

In 18 patients with a fixed ventricular pacemaker rhythm and in ten age-matched patients with sinus rhythm the systolic blood pressure oscillation and the low and high-frequency spectral components of systolic blood pressure were studied in the resting supine position during spontaneous breathing and during forced deep ventilation of 6 cycles.min-1. Patients with a pacemaker had a higher amplitude of systolic blood pressure oscillation than control subjects during spontaneous breathing (13.5 +/- 2.0 mmHg vs 6.4 +/- 1.6 mmHg, P = 0.035), and a slight but not significant difference also persisted during forced deep ventilation 19.0 +/- 2.3 mmHg vs 15.0 +/- 2.3 mmHg, P = 0.18). The increment in systolic blood pressure fluctuation from spontaneous breathing to forced deep ventilation was less marked in the pacemaker group than in the control subjects (40% vs 130%, P = 0.43). Although all the systolic blood pressure spectral components of the pacemaker patients were higher during both spontaneous breathing and forced deep ventilation, the differences between the two groups did not reach statistical significance.

CONCLUSIONS

Our observations in patients with a fixed ventricular pacemaker rhythm suggest that the mechanical effects on the intrathoracic vessels and the consecutive stroke volume changes are responsible for respiration-related systolic blood pressure oscillation and reflex systolic blood pressure changes.

Corticosterone-induced insulin resistance is not associated with alterations of insulin receptor number and kinase activity in chicken kidney

Chicken renal insulin receptors have been recently characterized; their number and kinase activities vary in response to altered nutritional status. In the present study, the effect of chronic corticosterone treatment was examined in 5-week-old chickens. The development of an insulin resistance following corticosterone was suggested after 1 and 2 weeks of treatment by a significant increases in plasma insulin levels (1.63 +/- 0.13 vs 0.56 +/- 0.14 ng insulin/ml in controls) and in renal cytosolic phosphoenolpyruvate carboxykinase activity (17.2 +/- 0.8 vs 13.7 +/- 0.7 nm/mn/mg tissue in controls). No significant changes were present at the level of insulin receptor number and kinase activity. Therefore, in kidney and, as previously observed, in muscles, corticosterone can induce insulin resistance at postreceptor steps in the cascade of events leading to insulin action.

[Comparative evaluation of clinical and ultrasonographic screening of hip dislocation in Breton and Languedoc populations]

BACKGROUND

Congenital dislocation of the hip varies greatly in incidence among different regions. This work is aimed at comparing results of clinical investigation and ultrasonography of the hip in Languedoc-Roussillon and Brittany.

POPULATION AND METHODS

Two thousand eight hundred and twelve and 2,809 neonates admitted to Nîmes and Vannes hospitals respectively, were enrolled in a prospective study. Clinical examinations were made according to the protocol established by the "Groupe d' études en orthopédie pédiatrique". Ultrasound investigations were performed in every risk case.

RESULTS

No dislocation occurred in the 4946 neonates without risk factors. In the 675 neonates with risk factors, 213 ultrasonographic examinations were abnormal, more frequently in the Brittany group (P < 0.001); nine dislocations were observed. A familial history of hip dysplasia (P < 0.001) and the addition of two risk factors (P < 0.001) were more frequent in Brittany. One hundred and six cases required treatment, more frequently in Brittany (P < 0.001).

CONCLUSIONS

Some clinical risk factors and delayed ossification or hip dysplasia at ultrasound examination are significantly more frequent in Brittany. Clinical examination with selective ultrasonography is a reliable method, allowing early diagnosis and treatment of delayed dislocations.

Preferential binding of insulin-like growth factors to a binding protein rather than to receptors on chicken hepatoma cell (LMH) membranes

[125I]IGF-I binding to chicken hepatoma cell (LMH) membranes was displaced by unlabelled IGF-I or IGF-II, but not by insulin. Cross-linking revealed specific binding sites of 128 and 28-31 kDa, which following solubilization could be separated by wheat germ agglutinin (WGA) chromatography. [125I]IGF-I binding to the WGA eluate (128 kDa) could be displaced by insulin although with a 30-fold lower potency than IGF-I. Binding to the WGA flow-through (28-31 kDa) was not inhibited by insulin. This suggested that IGF binding to LMH was due mainly to membrane bound IGFBP rather than to type 1 IGF receptors. A reverse proportion was observed in normal chicken liver. A predominant 28 kDa IGFBP was synthesized and secreted by LMH cells, together with an unusual 60 kDa IGF binding entity which only bound [125I]IGF-II (with weak affinity). This process was not affected by the presence or absence of glucose, dexamethasone, glucagon, insulin or IGF-I.

Altered phospholipid fatty acid content and metabolism in heart cell cultures from newborn spontaneously hypertensive rats

Genetic hypertension has been proposed to be associated with impaired lipid metabolism. To investigate whether lipid metabolism is altered in young rats of the spontaneously hypertensive Okamoto strain (SHR), we have compared the phospholipid fatty acid content and metabolism in cultured heart myocytes and fibroblasts from SHR and normotensive Wistar-Kyoto (WKY) newborn rats. The phospholipid-bound fatty acid profile and metabolism were altered in SHR cardiomyocytes and unchanged in SHR fibroblasts. In SHR myocytes, the fatty acid composition of the phospholipid fraction was modified, with a lowered proportion of linoleic (P < .05) and eicosapentaenoic acid (P < .001), resulting in a decreased polyunsaturated to saturated fatty acid ratio (1.16 +/- 0.08 in SHR v 1.44 +/- 0.08 in WKY, P < .02). The metabolism of radioactive arachidonate (C20:4) and linoleate (C18:2) also differed between SHR and WKY myocytes. Their release was increased (P < .004 and .05 for C20:4 and C18:2, respectively). The labeled phospholipid species also differed between the two strains, suggesting an altered phospholipid turnover in SHR. This study demonstrates modifications of phospholipid fatty acid profile and metabolism in spontaneously contractile cardiac cells from newborn prehypertensive SHR, in the absence of neural, hormonal, and hemodynamic influences.

Characterization of insulin receptors in chicken kidneys: effect of nutritional status

In chickens, the kidneys actively contribute to gluconeogenesis. A cytosolic form of phosphoenolpyruvate carboxykinase (PEPCK) is present in this tissue but is absent in liver. Cytosolic renal PEPCK is nutritionally and hormonally controlled which indicates a likely contribution of insulin in the control of this enzyme (and other renal functions). The present studies characterize renal insulin receptors in the chicken. The effects of the following nutritional conditions were examined: fed, 48 hr fasted, and 24 hr refed following a 48-hr fast. PEPCK activity was increased by the 48-hr fast and returned to normal after refeeding. Specific binding of 125I-insulin to renal membranes was time-, temperature-, and protein-dependent. Unlabeled insulin was more potent than IGF-1 in inhibiting 125I-insulin binding; the ratio of potencies for insulin and IGF-1, however, was dependent upon the nutritional state. Insulin binding was significantly higher (P < 0.05) following 48 hr fasting and lower (P < 0.05) following refeeding compared to ad libitum feeding. Receptor affinity was similar irrespective of the nutritional state. Solubilized and wheat germ agglutinin purified renal insulin receptors were devoid of ATPase activity in contrast to hepatic receptors. The sizes of alpha- and beta-subunits of renal receptors were similar to those of hepatic receptors: 135 and 95 kDa, respectively. Insulin-stimulated autophosphorylation of the beta-subunit was decreased, although not significantly, by prolonged fasting. Phosphorylation of artificial substrate: poly(Glu-Tyr) 4:1 was significantly decreased by the 48-hr fast at high insulin concentrations (10 and 100 nM). Kinase activities of renal insulin receptors from fed or refed chickens were very similar. In conclusion, typical insulin receptors are present in chicken kidneys. These receptors exhibit a regulation at the level of their number and kinase activity in a fashion similar to that found for hepatic receptors. The present results suggest a role for insulin in chicken renal function.

Evolution of cellular and humoral response against Tuberculin and antigen 85 complex during intravesical treatment with BCG of superficial bladder cancer

Prophylactic treatment with Bacillus Calmette-Guerin (BCG) is an established and effective therapy of bladder cancer. The antitumor effect of BCG seems to be largely related to cellular immunological mechanisms, although its precise mode of action is unknown. Antitumor response of BCG seems to be initiated by the attachment of BCG to bladder wall via Fibronectin (FN). The cellular immune response against Tuberculin PPD and the major secreted BCG antigen (Fibronectin-binding AG 85 complex) has been tested in a control group of 20 untreated bladder tumor patients and before and after 6 weekly intravesical BCG instillations in a group of 20 superficial bladder tumor patients. A major increase in the lymphoproliferative response against PPD and AG 85 was observed in respectively 66% and 57% of the treated patients. In contrast, no detectable antibody response (IgA, IgM, IgG) was observed against AG 85 complex after BCG treatment. On the other hand, antibodies against Tuberculin increased in 13 of 20 patients. This study seems to demonstrate a specific cellular immune activation against AG 85 Fibronectin-binding complex during BCG treatment of superficial bladder tumors. Humoral response against the AG 85 is not activated after BCG treatment. Further studies are needed to elucidate the role of AG 85 in the cellular intravesical penetration of BCG. Presence or absence of cellular response against this antigen could be of clinical value.

Intraventricular cerebral neuroblastoma. Analysis of subtypes and comparison with hemispheric neuroblastoma

Two cases of intraventricular neuroblastomas were compared with cases of intraventricular and hemispheric neuroblastomas that have been reported in the published literature. The following order of tumor subtypes was found in patients with increasing age: hemispheric neuroblastoma, intraventricular undifferentiated neuroblastoma, intraventricular differentiated neuroblastoma, and intraventricular neurocytoma; for patients with intraventricular neuroblastomas, this was also the order of increasing cellular maturation and survival. Neuronal morphologic or epitope differentiation was associated with a longer survival time than lack of differentiation by Kaplan-Meier product-limit estimates and with a better survival rate (chi 2) for intraventricular tumors but not for hemispheric tumors. Pathologic distinction of a neurocytoma was confirmed with immunostaining or ultrastructural studies that suggested that a neurocytoma is a matured neuroblastoma of a granule-cell (interneuron) phenotype. Differences among neuroblastoma groups bolster previous suggestions that intraventricular tumors arise differently than do cases of hemispheric tumors and follow a more benign course when neuronal differentiation is present.

[Immunoscintigraphy results in the comparison of ocular with cutaneous melanoma]

For several years, immunoscintigraphy (IS) using a 99mTc-labeled monoclonal antibody for tumor localization has been used as an additional tool in the diagnosis of malignant melanoma. The aim of our study was to verify previously published data with respect to our own patients and to correlate immunoscintigraphic results with histological findings. In particular, we wanted to compare the outcome of IS in ocular melanoma with that in cutaneous melanoma. We examined 28 patients (15 females, 13 males, average age 64 years) with clinically suspected ocular melanoma. IS was performed using the monoclonal antibody 225.28S (Tecnemab-K-1, Fa. Sorin/Solco), and images were obtained in a standard fashion (planar) as well as with the SPECT technique. In 16 patients, the tumor was examined afterwards histologically. The control group consisted of 102 patients with histologically proven metastasizing cutaneous melanoma who were investigated by IS in an identical fashion. In contrast to the literature published so far, we demonstrated a positive IS reaction in only 42% (and 56% in histologically proven cases, respectively) in our patients with ocular melanoma, while in patients with cutaneous melanoma, we found a sensitivity of more than 80%. In the 3 patients who turned out not to have ocular melanoma, we found one false-positive reaction (subretinal hemorrhage). No correlation was found between the various histological features of ocular melanoma and the immunoscintigraphic results. We conclude that IS using the antibody 25.28S is of limited value in patients with ocular melanoma and should only be recommended in selected cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Human t(4;11)(q21;q23) acute lymphoblastic leukemia in mice with severe combined immunodeficiency

Mice with severe combined immunodeficiency (SCID) were injected intravenously with primary bone marrow blasts from 12 children with newly diagnosed t(4;11)(q21;q23) acute lymphoblastic leukemia (ALL). Blasts from eight patients caused overt disseminated leukemia, whereas blasts from the other four patients produced occult leukemia that was detectable only by the polymerase chain reaction (PCR) technique. Only one patient among eight whose blasts caused disseminated leukemia in SCID mice remains alive and disease-free at 48.4 months postdiagnosis. In contrast, three of the other four patients whose blasts did not cause overt leukemia in SCID mice remain alive and disease-free at 6.1, 23.6, and 35.9 months, respectively. Thus, the occurrence of overt leukemia in SCID mice may be a predictor of patients' disease-free survival. The described SCID mouse model system may prove useful for designing more effective treatment strategies against therapy-refractory t(4;11) ALL.

Auditory M100 component 1: relationship to Heschl's gyri

This study was designed to localize the neuroanatomic generator of the 100 ms latency magnetic auditory evoked field (EF) component (M100) activated by an unattended tone pip. Magnetic EFs in response to 25 ms duration, 90 dB, 1 kHz tone pips were recorded from both hemispheres of nine normal adults, five males and four females, using a seven-channel second-order gradiometer. The source of the M100 was estimated, with confidence intervals, by a least squares based inverse solution algorithm. Magnetic resonance (MR) images of the brain were acquired with a 1.5 T system using a standard head coil. The superior temporal gyri (STG) were manually segmented from 1.7 mm thick coronal images, and the superior surfaces were then rendered from the 3-D volume data. Translation and rotation matrices were identified to locate the magnetoencephalography (MEG) determined sources within the reconstructed STGs. This population of 18 STGs in 9 individuals demonstrated two transverse gyri in 4 of 9 left hemispheres, and 5 of 9 right hemispheres. All 9 left hemisphere M100 sources were in or included Heschl's gyrus(i) in the confidence intervals. Seven of the 9 included Heschl's gyrus(i) on the right: the remaining two, both males, had sources slightly anterior to Heschl's gyrus(i). We conclude that all M100 source location estimates were compatible with an auditory koniocortex source in or adjacent to Heschl's gyri.

Childhood acute myeloid leukemia in mice with severe combined immunodeficiency

Primary bone marrow blasts from 4 children with t(8;21) acute myeloid leukemia (AML), 6 children with inv(16) AML, and 2 children with t(9;11) AML were injected intravenously or transplanted under the kidney capsule of sublethally irradiated mice with severe combined immunodeficiency (SCID). Leukemic cells from all AML patients infiltrated the SCID mouse thymus, suggesting that the thymic microenvironment supports the survival and growth of human AML blasts. Blasts from 1 of 4 t(8;21) AML patients and 4 of 6 inv(16) AML patients caused histopathologically detectable disseminated leukemia. Blasts from the remaining patients produced disseminated occult leukemia that was only detected by polymerase chain reaction. Occurrence of histopathologically detectable disseminated leukemia was dependent on intravenous injection of leukemic cells; none of the mice challenged with an inoculum transplanted under the kidney capsule developed overt leukemia. No obvious association was noted between occurrence of leukemia in SCID mice and clinical or laboratory features presented by patients, including age, sex, or leukocyte count at diagnosis. To our knowledge, this study is the first to show that leukemic blasts from children with newly diagnosed AML, especially inv(16) AML, can cause disseminated human leukemia in SCID mice without exogenous cytokine support. The SCID mouse model system may prove particularly useful for designing more effective treatment strategies against childhood AML.

[Continuous non-invasive blood pressure monitoring in the diagnosis of pacemaker syndrome]

The drop in blood pressure coinciding with the atrioventricular dyssynchrony plays an important role in the genesis of pacemaker syndrome. The diagnosis is often based on continuous blood pressure recording. Formerly the continuous blood pressure monitoring could only be performed by invasive methods. The authors demonstrate the feasibility of a new non invasive continuous blood pressure recorder, the Finapres 2300, by presenting illustrative case reports. The authors recommend more widespread use of non invasive haemodynamic monitoring for the diagnosis of pacemaker syndrome.

[Alcohol and health--friend or foe?]

BACKGROUND

The association of alcohol with a number of diseases, accidents, traffic and word injuries, psychoses, degenerative nervous processes and some organ malignities is known and has been proved. An exception is formed by population studies providing evidence of a reduced risk of development of ischaemic heart disease, incl. mortality from the latter. Our population has a high beer consumption: In the West Bohemian region the consumption is 180-200 l of beer per head per year. We were concerned with the problem of the influence of this consumption on the prevalence of IHD, myocardial infarction and some tumours and the general mortality of middle-aged men.

METHODS AND RESULTS

The investigation started in 1976 comprised 3758 men aged 40-50 years. On account of manifest disease 171 subjects were eliminated and in the general evaluation after 12 years another 192 subjects could not be included. The final analysis was made in 3395 men, mean age 44.6 +/- 3.6 years, BMI 27.0 +/- 3.2, mean systolic pressure 133.1 +/- 18 mm Hg (17.74 +/- 2.4 kPa), mean diastolic pressure 83.2 +/- 10.7 mm Hg (11.0 +/- 1.5 kPa) and mean serum cholesterol values 5.69 +/- 0.99 mmol/l. A BMI above 29 was recorded in a total of 835 men (23.6%), systolic pressure above 160 mm Hg (21.23 kPa) in 302 men, diastolic pressure higher than 90 mm Hg (11.98 kPa) in 1004 (28.4%); serum cholesterol above 6.7 mmol/l was recorded in 491 (13.9%) of the examined subjects, regular smoking was admitted by 1915 (54.1%) and regular alcohol intake by 1815 (51.3%) of the investigated subjects. The mean follow-up period was 10.73 years. For statistical analysis multiple logistic regression was used and the relative risk expressed as the "odds ratio" (OR) standardized for a number of variables known to influence in a comprehensive way selected final indicators. Approximately 50% of the men were smokers and consumed alcohol. Regular alcohol intake was associated with a significantly lower risk (odds ratio 0.87). The significant difference was, however, not found when the data were standardized for age, blood pressure, family-history and leisure activities. Separate assessment of the relative risk of alcohol for fatal and non-fatal acute myocardial infarction and for the total mortality rate revealed the following risks (expressed as OR and 95% confidence limit in parentheses: OR for fatal infarction = 0.85 (0.44-1.64), not significant), OR for non-fatal infarction = 0.84 (0.60-1.17) and OR for the general mortality = 0.89 (0.68-1.17): both the latter values are at the borderline of statistical significance (p = 0.05-0.1). When smokers drink regularly, they have a significantly lower risk of non-fatal infarctions (but not fatal infarctions!). This effect is not found in non-smokers. The relative risk for the development of tumours in smokers-drinkers is insignificantly elevated, OR = 1.55 (0.89-2.75). The largest number of malignities was lung cancer. Regular smokers who drink alcohol have a treble risk of developing lung cancer, as compared with abstainers: OR = 2.96 (1.07-8.23) a statistically significant increase.

CONCLUSIONS

From the investigation it is apparent that regular alcohol intake reduces the rate of all coronaries in middle-aged men, but this protective effect applies only to non-fatal myocardial infarctions, in particular in smokers. No effect on the general mortality was proved. However, there was evidence of a positive association between alcohol intake and lung cancer. Alcohol potentiates (3x) the relative risk of development of lung cancer in smokers.

Enhancer point mutation results in a homeotic transformation in Drosophila

In Drosophila, the misexpression or altered activity of genes from the bithorax complex results in homeotic transformations. One of these genes, abd-A, normally specifies the identity of the second through fourth abdominal segments (A2 to A4). In the dominant Hyperabdominal mutations (Hab), portions of the third thoracic segment (T3) are transformed toward A2 as the result of ectopic abd-A expression. Sequence analysis and deoxyribonuclease I footprinting demonstrate that the misexpression of abd-A in two independent Hab mutations results from the same single base change in a binding site for the gap gene Krüppel protein. These results establish that the spatial limits of the homeotic genes are directly regulated by gap gene products.

Transient expression of the recombinant chick brain P2y1 purinoceptor and localization of the corresponding mRNA

Extracellular ATP acts at specific cell surface purinoceptors to elicit a wide range of physiological responses. We have recently isolated a cDNA for a G-protein-coupled P2 purinoceptor (P2y1) from chick brain. It has been defined as a P2Y-like purinoceptor by the rank order of potency of P2 purinoceptor ligands, determined electrophysiologically in the Xenopus oocyte expression system. Here, we examine the ligand selectivity of this recombinant receptor, expressed transiently in COS-7 cells. The regional distribution of the P2y1 purinoceptor transcript within the one-day-post-hatch chick brain was also determined. It is widely expressed in the cerebellum and telencephalon and in specific nuclei of the mesencephalon and diencephalon, suggesting a neuronal localization of the P21 purinoceptor.

[3H]dynorphin1-8 binding sites in frog (Rana esculenta) brain membranes

Opioid binding sites specific for [3H]dynorphin1-8 were characterized in the particulate membrane fraction of frog (Rana esculenta) brain. The degradation of the radioligand during the assay was prevented by the use of a broad spectrum of peptidase inhibitors. The binding of [3H]dynorphin1-8 to frog brain membranes was stereoselective, reversible, saturable, and displaceable by a series of opioid ligands including dynorphin1-13, bremazocine, levorphanol and naloxone. The specific binding of [3H]dynorphin1-8 can be significantly inhibited by Na+ ions and/or guanine nucleotides confirming the agonist property of the ligand in vitro. A single set of high affinity opioid binding sites with a Kd approximately 7.5 nM is present in the membranes. The maximum density of binding sites (Bmax approximately 1.1 pmol [3H]dynorphin1-8 per mg protein) was considerably higher than such sites in guinea-pig brain. In addition, comparison with binding of tritiated opioid peptides selective for the mu- and delta-types of opioid receptor showed that in the frog brain most of the sites labelled by [3H]dynorphin1-8 are kappa-sites and that this is a rich source of such sites.

Auditory sensory gating, hippocampal volume, and catecholamine metabolism in schizophrenics and their siblings

Schizophrenia may result from the concerted action of several pathophysiological factors. This pilot study compared the distribution of measurements of three such putative factors in 11 schizophrenics and their siblings: a neurophysiological deficit in auditory sensory gating, diminished hippocampal volume, and increased catecholamine metabolism. Abnormal auditory sensory gating was found in all schizophrenics in the 11 families studied and in 8 of their 20 siblings. Compared with the schizophrenics, the clinically unaffected siblings with abnormal auditory gating had larger hippocampal volume. There was no similar difference for the siblings with normal gating. The siblings with abnormal auditory gating also had lower homovanillic acid levels than the other siblings. The data suggest that a familial neuronal deficit, identified by diminished sensory gating, may be a necessary, but not sufficient factor in the pathogenesis of schizophrenia. Individuals with this deficit are generally clinically unaffected, except for schizophrenics, who also have other abnormalities, such as diminished hippocampal volume and increased catecholamine metabolism.

Cases from the aerospace medicine resident teaching file. Case #59. A case of "unbearable" gremlinenteritis

A flight surgeon presents with severe diarrhea of sudden onset. The unusual cause could be traced to sorbitol, a common sweetener that is widely available and could easily affect many aviators. The symptoms are exacerbated in the aerospace environment and close investigation of the dietary history may be the only clue to this elusive diagnosis.