Isolation of plaice (Pleuronectes platessa) alpha1-microglobulin: conservation of structure and chromophore

A cDNA coding for plaice (Pleuronectes platessa) alpha1-microglobulin (Leaver et al., 1994, Comp. Biochem. Physiol. 108B, 275-281) was expressed and purified from baculovirus-infected insect cells. Specific monoclonal antibodies were then prepared and used to isolate the protein from plaice liver and serum. Mature 28.5 kDa alpha1-microglobulin was found in both liver and serum. The protein consisted of an 184 amino acid peptide with a complex N-glycan in position Asn123, one intrachain disulfide bridge and a yellow-brown chromophore. Physicochemical characterization indicated a globular shape with a frictional ratio of 1.37, electrophoretic charge-heterogeneity and antiparallel beta-sheet structure. A smaller, incompletely glycosylated, yellow-brown alpha1-microglobulin as well as a 45 kDa precursor protein were also found in liver. The chromophore was found to be linked to alpha1-microglobulin intracellularly. Recombinant plaice alpha1-microglobulin isolated from insect cells had the same N-terminal sequence, globular shape and yellow-brown color as mature alpha1-microglobulin, but carried a smaller, fucosylated, non-sialylated N-glycan in the Asn123 position. The concentration of alpha1-microglobulin in plaice serum was 20 mg/l and it was found both as a 28.5 kDa component and as high molecular weight components. Thus, the size, shape, charge and color of plaice alpha1-microglobulin were similar to mammalian alpha1-microglobulin, indicating a high degree of structural conservation between fish and human alpha1-microglobulin. The monoclonal antibodies against plaice alpha1-microglobulin cross-reacted with human alpha1-microglobulin, emphasizing the structural similarity.

Amplitude variation in static-charge-sensitive bed signal increased in obstructive airways disease

The relationship between oesophageal pressure variation and amplitude variation in the static-charge-sensitive bed (SCSB) ballistocardiogram suggests that changes in intrathoracic pressure can be detected using the SCSB method. We investigated whether amplitude variation in the static-charge-sensitive bed ballistocardiogram (SAV) is related to severity of airway obstruction in patients with asthma and chronic obstructive pulmonary disease. The ability of SAV to detect an increase in airway obstruction induced by histamine challenge was also tested. Twenty-six patients suffering from asthma and 12 patients with chronic obstructive pulmonary disease (COPD) were enrolled in the study. SAV, amplitude from the SCSB ballistocardiogram, respiratory amplitude from the SCSB respiratory wave form and heart rate from the electrocardiogram (ECG) were computed using analysing software (Biorec, Helsinki, Finland) during a 7-min supine rest. SAV was related to forced expiratory volume in one second (FEV1) immediately after signal recording. Asthma patients participated in a standardized histamine challenge test to reveal the effect of acute bronchoconstriction on SAV. An inverse relationship existed between baseline FEV1 and SAV in asthma and COPD. In the histamine inhalation test, FEV1 fell by 0.7 +/- 0.3 l or 26% +/- 11% (P < 0.0001) and SAV increased by 12% +/- 5% (P < 0.0001) in 12 asthma patients. The fall in FEV1 induced by histamine followed regularly and correlated significantly with the rise in SAV (n = 24, r = -0.58, P = 0.002). Changes in respiratory amplitude or heart rate did not explain changes in SAV. SAV may not separate the upper airway obstruction from the bronchial obstruction but it is related to severity of airway obstruction. The clinically significant increase in airway obstruction induced by histamine inhalation increases amplitude variation in SCSB.

Effects of polyamine synthesis inhibition on polyamines, growth and mechanical properties in hypertrophic rat urinary bladder

The polyamines putrescine, spermidine and spermine, are ubiquitous intracellular metabolites associated with growth and protein synthesis. In this study effects of polyamine synthesis inhibition on bladder growth, polyamine levels and mechanical properties were investigated in rat urinary bladder subjected to partial outflow obstruction that causes bladder hypertrophy. The S-adenosyl methionine decarboxylase inhibitor CGP-48664 (5 and 20 mg kg-1) was administered alone or in combination with the ornithine decarboxylase inhibitor DFMO (500 mg kg-1), starting one day before creation of partial outflow obstruction and then daily for 7 days. The bladder muscle level of putrescine was increased 38 times and that of spermine reduced by 4 times while spermidine was unchanged after treatment with CGP-48664 (20 mg kg-1). The increase in putrescine was abolished in animals receiving CGP-48664 in combination with DFMO. Treatment with polyamine synthesis inhibitors could not prevent or reduce the hypertrophy of the bladder as judged by bladder wet weight and protein contents. The effects on polyamine quantities were not associated with changes in Ca(2+)-force relationship or in agonist and electrically stimulated force. In summary, treatment of rats with polyamine synthesis inhibitors resulted in changes in polyamine levels in the growing urinary bladder but did not affect growth or mechanical properties.

Perinatal mortality and route of delivery in term breech presentations

OBJECTIVE

To compare intrapartum related infant mortality in term (> 34 weeks) breech presentations in relation to vaginal delivery or delivery by caesarean section.

DESIGN

Register based nationwide study.

SETTING

Sweden from 1991 to 1992.

PARTICIPANTS

6542 singleton fetuses born in the breech presentation.

MAIN OUTCOME MEASURES

Intrapartum and early neonatal deaths, stillbirths and congenital malformations, low Apgar score < 7 at 5 min, mode of delivery.

RESULTS

After exclusion of antepartum stillbirths and congenital malformation, the intrapartum and early neonatal mortality rate was 2/2248 (0.09%) in the group delivered vaginally and 2/4029 (0.05%) in the group delivered by caesarean section. The relative risk was 1.81 (95% CI 0.26-12.84). Thus the difference was not statistically significant. This result was further supported after reviewing individual cases.

CONCLUSIONS

The intrapartum related mortality in the group delivered vaginally was low and the result could not verify an increased mortality in term breech presentations delivered vaginally compared with those delivered by caesarean section.

Reactivity of skin blood flow and heart rate to external thermal stimulation in anencephaly

Oscillations of skin blood flow and heart rate can be synchronised using external rhythmic thermal stimulation in healthy adults and infants. We examined the effect of thermal stimulation on the cutaneous circulation and heart rate of an anencephalic neonate using cutaneous laser Doppler flowmetry and ECG monitoring. The results suggest that synchronisation of SBF and HR to thermal stimulation can also be induced in an anencephalic newborn.

The association between diabetic nephropathy and autonomic nerve function in type 1 diabetic patients

Diabetic cardiovascular autonomic neuropathy increases the risk of deterioration in renal function and is associated with increased mortality in patients with renal failure. Type 1 diabetic patients with long diabetes duration, matched for age (38 +/- 9 years) and diabetes duration (28 +/- 8 years) were studied regarding the association between cardiovascular autonomic nerve function and different degrees of diabetic nephropathy. Eighteen patients were normo- (< 30 mg/l), six micro- (30-300 mg/l), and 13 macroalbuminuric (> 300 mg/l) based on urinary albumin concentrations in three separate morning samples. They were compared with 33 control subjects with similar age. Autonomic nerve function was evaluated by measuring the response of heart rate to deep breathing and active standing. Beat-to-beat finger artery blood pressure (Finapres) was tested during active standing. During deep breathing both change in heart rate (17 +/- 11, 9 +/- 7 and 4 +/- 3 beats/min) and ratio between expiratory and inspiratory R-R intervals (1.32 +/- 0.24, 1.14 +/- 0.15 and 1.05 +/- 0.04) decreased from normo- over micro- to macroalbuminuria (p < 0.05 vs normoalbuminuric and control subjects [17 +/- 5 beats/min and 1.28 +/- 0.10, respectively]). Similar results were obtained during active standing with respect to change in systolic arterial blood pressure (3 +/- 8, 2 +/- 13 and -6 +/- 11 mmHg; p < 0.05 vs control subjects [8 +/- 11 mmHg]). However, the response of diastolic arterial blood pressure or mean heart rate to standing up did not differ between any of the groups. The ratio of maximum to minimum R-R interval during the dynamic response of heart rate to active standing decreased with the degree of nephropathy (1.27 +/- 0.17, 1.11 +/- 0.11 and 1.05 +/- 0.06) with significantly higher values in patients with normo- compared with patients with macroalbuminuria (p < 0.05). All patients groups had significantly lower values than control subjects (1.46 +/- 0.22, p < 0.05). The overshoot of the blood pressure after an initial fall during active standing decreased with the degree of diabetic nephropathy. In conclusion, type 1 diabetic patients with long duration of diabetes have signs of cardiovascular autonomic neuropathy, the severity of which is related to the degree of nephropathy.

Inhibition of calcium entry preserves contractility of arterial smooth muscle in culture

The addition of the growth stimulator fetal calf serum (FCS, 10%) to rings of rat tail artery causes an increase in [Ca2+]i, accompanied by contraction. This response was inhibited by the calcium entry blocker verapamil (1 microM). To investigate the effect of Ca2+ entry blockade on growth and contractility, rings of rat tail artery were cultured for 4 days in medium with or without FCS and then mounted for tension registration and stimulated with noradrenaline (NA) or high-K+ solution. In cultured rings growth was quantitated by [3H]-thymidine incorporation and increase in protein contents. FCS in the medium stimulated DNA synthesis by about 2-fold and increased protein contents by about 70%. The growth-stimulated cultured rings developed less force than freshly prepared rings (2.2 +/- 0.3 vs. 8.3 +/- 1.0 mN/mm). The addition of 1 microM verapamil to the medium during culture increased maximal NA-evoked force to 5.0 +/- 0.4 mN/mm but had no effect on the increases in DNA synthesis and protein contents. Force developed by growth-arrested rings, cultured in the absence of FCS, was not different from that of freshly prepared rings (7.2 +/- 0.6 mM/mm). Verapamil did not affect maximal force in these rings. Similar responses were seen when contraction was elicited by high-K+ solution. We conclude that verapamil, present during culture, preserves contractility of arterial smooth muscle, and that this effect is not parallel to inhibition of growth.

Artery blood pressure oscillation after active standing up: an indicator of sympathetic function in diabetic patients

Dynamic artery blood pressure (Finapres) response to active standing up, normally consisting of initial rise, fall and recovery above the baseline (overshoot), was compared with the early steady-state artery blood pressure level to measure sympathetic vasomotor function in healthy subjects (n = 23, age 35 +/- 9 years; mean +/-SD) and in type I diabetic patients without autonomic neuropathy (AN) (group 1: n = 18, 38 +/- 13 years), with AN but no cardiovascular drugs (group 2a: n = 7, 44 +/- 11 years) and with both AN and cardiovascular drugs (group 2b: n = 10, 47 +/- 7 years). Systolic and diastolic overshoot were similar in the control (15 +/- 13/15 +/- 11 mmHg) and group 1 subjects. Systolic overshoot disappeared in 57% of patients in group 2a (-1 +/- 9 mmHg; P < 0.03), whereas artery blood pressure still overshot in diastole (8 +/- 7 mmHg; NS). Systolic overshoot disappeared in all patients in group 2b (-22 +/- 22 mmHg; P < 0.0006) and diastolic overshoot disappeared in 60% of these patients (-6 +/- 16 mmHg; P = 0.0006). Systolic early steady-state level was not lower in group 2a than in group 1 (NS), but it was impaired in group 2b (P < 0.006), in which six diabetic patients had a pathological response beyond the age-related reference values. There was a strong association between the overshoot and steady-state levels (P for chi 2 < 0.001, n = 58). Overshoot of the control subjects and patients in group 2b correlated to their respective steady-state blood pressure levels (r > or = 0.76; P < or = 0.001). In conclusion, baroreceptor reflex-dependent overshoot of the artery blood pressure after active standing up diminishes with the development of AN and it is associated with the early steady-state level of the artery blood pressure.

The effects of midazolam and ephedrine on post-exercise autonomic chronotropic control of the heart in normal subjects

Benzodiazepines may induce hypotension by inhibiting the pressor response. Ephedrine has adrenergic effects on the circulation. After exercise, changes in cardiovascular control impair orthostatic tolerance. The impaired pressure response can be compensated for by chronotropic control of the heart. We studied the effect of midazolam and ephedrine on post-exercise cardiac autonomic chronotropic control in six 21-year-old female volunteers, who received single doses of 15 mg midazolam, 50 mg ephedrine, or placebo orally according to a placebo-controlled, double-blind, crossover design. After exercise, the subjects assumed the supine position for rest, then a -10 degrees head-down position followed by a 70 degrees head-up position. Power spectral analysis of heart rate variability for 7 min and steady-state brachial arterial blood pressure were measured in each position. After administration of midazolam, three subjects had an abnormal fall in their arterial blood pressure (with one presyncope) as a response to head-up tilt. Changes in heart rate variability exceeded those seen during placebo treatment (p < 0.01) and involved oscillations, suggesting activation of both sympathetic and parasympathetic dynamics. After ephedrine administration, arterial blood pressure increased during head-down tilt, but parasympathetic dynamics to the heart were dampened. Head-up tilt induced increased sympathetic stimulation of the heart and a sympathicotonic cardiovascular response (p < 0.01). In conclusion, midazolam induced unexpectedly great changes in dynamic cardiac control during cardiovascular stimulation. Ephedrine increased tonic sympathetic activity and stabilized the neural circulatory control of the heart by immobilizing dynamic parasympathetic activation.

Reactivity of skin blood flow and heart rate to thermal stimulation in infants during the first postnatal days and after a two-month follow-up

The reactivity of skin blood flow and heart rate to periodic thermal stimulation was studied in 10 term small-for-gestational age (SGA) infants, in 9 preterm and 8 term normal-sized infants during the first two postnatal months. During the first postnatal days, the increase in thermally stimulated skin blood flow oscillations was absent in SGA infants but was clearly present in both preterm (p < 0.01) and term (p < 0.01) normal-sized infants. The responsiveness of SGA infants improved during the follow-up (p < 0.05). The response of the periodic heart rate variability of SGA and preterm infants was inferior to term normal-sized infants until the age of 2 months. The cardiovascular responsiveness of growth-retarded infants seems abnormal during the first days of life, and may impair their ability to meet stress, e.g. changes of ambient temperature.

Bovine alpha 1-microglobulin/bikunin. Isolation and characterization of liver cDNA and urinary alpha 1-microglobulin

cDNA coding for alpha 1-microglobulin, an immunoregulatory plasmaprotein, was isolated from bovine liver. The sequence of a total of 1258 nucleotides revealed an open reading frame of 352 amino acids. This included alpha 1-microglobulin, 182 amino acids, and bikunin, the light chain of the plasmaprotein inter-alpha-inhibitor, 147 amino acids. The two proteins were connected by a basic tetrapeptide, R-A-R-R, which conforms to the consensus sequence recognized by endoproteolytic cleavage enzymes. The deduced amino acid sequence showed a high degree of identity with alpha 1-microglobulin and bikunin sequences from other species, and the alpha 1-microglobulin part displayed sequence motifs typical for members of the lipocalin protein superfamily. A single alpha 1-microglobulin/bikunin mRNA with a size of around 1300 nt was found in bovine liver. The mature alpha 1-microglobulin protein was isolated from bovine urine, and partly characterized. It was found to be a globular molecule with an apparent molecular weight of 23,300, containing one N-linked and at least on O-linked oligosaccharide, one intra-chain disulfide bridge and an electrophoretic heterogeniety with a pI-value of 4.1-5.2.

Static-charge-sensitive bed ballistocardiography in cardiovascular monitoring

We evaluated the autonomic influence on balistocardiograms recorded by a static-charge-sensitive bed for cardiovascular monitoring in nine healthy males (20-44 years) and its clinical use in 11 patients who underwent coronary bypass surgery (51-59 years). The ballistocardiogram displayed a distorted low amplitude from the empty beating heart during bypass surgery, impaired by a reduced effective transmural filling pressure of the heart, and returned to its pre-bypass level when the preload to the heart and its pumping was restored. Submaximal dynamic exercise and isoprenaline caused the heart rate to rise to 90-114 beats min-1, and increased the ballistocardiographic amplitude threefold, while at the same time shortening the interval between the R-wave of the electrocardiogram and the peak of the ballistocardiographic waveform (P < 0.01). In contrast, atropine accelerated the heart rate to 96 beats min-1, but did not significantly change the amplitude or temporal pattern of the ballistocardiogram. Thus, the ballistocardiogram reflects sympathetic and parasympathetic influence on the contractility of the myocardium and the effect of cardiac filling (e.g. during bypass surgery).

Skin blood flow oscillations respond more effectively to rhythmic thermal stimulation than to continuous or periodic breathing in newborn infants

Effect of continuous (n = 30) and periodic (n = 5) breathing on forehead skin blood flow (SBF) oscillations was studied in healthy 3-day-old preterm and term infants. Femoral SBF was measured in 10 of the term infants during continuous breathing. Respiratory and SBF signals were analysed by power spectrum during the control period. The signal analysis was repeated during rhythmic thermal stimulation which was applied to the skin of each infant in order to synchronise spontaneous SBF oscillations. During the control period, the forehead and femoral SBF of all the studied infants oscillated at frequencies corresponding to the frequency of regular continuous breathing. External thermal stimulation decreased these high-frequency oscillations of forehead SBF in both preterm and term infants. Oscillations in femoral SBF of term infants remained unchanged. During periodic breathing, the spontaneous forehead SBF oscillation was synchronised to the frequency of respiratory amplitude variation. Despite periodic breathing, thermal stimulation was able to resynchronise the SBF oscillation to the stimulation frequency in 4/5 infants. Forehead SBF oscillates at the frequency of both continuous and periodic breathing in preterm as well as in term infants on postnatal day 3. Rhythmic thermal stimulation synchronises SBF and affects SBF more effectively than continuous or periodic breathing. These results suggest functional neural control of cutaneous vasculature at birth.

Beat-to-beat agreement of non-invasive finger artery and invasive radial artery blood pressure in hypertensive patients taking cardiovascular medication

The aim of this study was to investigate and quantify the agreement between simultaneous and ipsilateral non-invasive finger artery blood pressure (Finapres) and intra-arterial radial blood pressure among 13 volunteer hypertensive patients, aged 36-71 years and taking cardiovascular medication, during steady-state fluctuation of arterial blood pressure and during an increase in blood pressure induced by static exercise. Eight patients were being treated with beta-blocking agents, eight with calcium antagonists, four with angiotensin-converting enzyme inhibitors, four with diuretics and one with prazosin in combination therapy. Their auscultatory brachial artery blood pressures ranged in systole from 142 to 206 mmHg and in diastole from 88 to 120 mmHg during the treatment. The mean systolic finger artery blood pressure deviated by -14 +/- 5 mmHg (P = 0.02, mean value +/- SEM) and the diastolic finger artery blood pressure deviated by 0.6 +/- 3 mmHg (P = 0.70) from the corresponding radial artery pressure. The maximal beat-to-beat difference between systolic and diastolic finger and radial artery pressure, respectively, showed that a range of less than 10 mmHg in the steady state after individual adjustment for bias. In general, neither systolic nor diastolic differences between the methods exceeded the limits of +/- 10 mmHg, and the bias did not significantly increase (P > or = 0.12) during a 10-mmHg increase in arterial blood pressure caused by static exercise. Among three subjects, an increase in bias and poorer agreement was associated with atrial fibrillation and steplike changes in the Finapres output after autocalibration. The results support usage of the Finapres technique to measure beat-to-beat changes of peripheral arterial blood pressure in hypertensive patients taking cardiovascular medication, with a feasible agreement with beat-to-beat radial artery blood pressure.

Cardiovascular functional disorder and distress among patients with thoracic outlet syndrome

Cardiovascular functional stability of 11 women with thoracic outlet syndrome (TOS; mean age 34.5) and nine female controls (mean age 35.1) was studied using an orthostatic test, a deep breathing test, Valsalva manoeuvre and hand-grip test. The heart rate at rest was significantly higher in TOS patients. The TOS group showed significant accentuation in T wave vacillation in the orthostatic test. The rise in diastolic blood pressure of the TOS group during a hand-grip test was significantly less than that of the control group. TOS patients experienced significantly more distress according to the modified somatic perception questionnaire (MSPQ) than the control group. Pain was correlated with the score of MSPQ, the resting heart rate and increase in diastolic blood pressure in a hand-grip test. The results suggest that TOS patients' symptoms often reflect a wider disturbance than merely anatomical compression in the thoracic outlet. It seems possible that sympathetic tone is higher in TOS patients than in controls. In addition to possible operative treatment, it may be necessary to provide psychological help, relaxation and endurance training.

Post-prandial effects in reactivity of forehead and mid-femoral skin blood flow and heart rate in neonates

The effect of post-prandial period on the cutaneous vascular reactivity was studied in twelve full-term infants on their 3rd postnatal day. The differences in vasomotor reactions between the forehead and femoral skin were also investigated. Two 10-min control registrations about 30 and 90 min after feeding were followed by a registration of equal duration during thermal stimulation of the skin. The lower extremity of each infant was stimulated by warm and cool air currents (5 cycles/min) to induce periodic vasomotor changes. The fast Fourier transform was used to compute variability spectra for the recorded skin blood flow, heart rate and respiratory wave form signals. The skin blood flow became synchronised to the thermal stimulation in both skin regions. Neither the spontaneous nor synchronised oscillations of the skin blood flow differed significantly between femoral skin and forehead. The post-prandial time did not have any influence on this synchronisation. Heart rate variability was synchronised to the periodicity of thermal stimulation more 1.5 h after feeding than 0.5 h after feeding. Respiration was not affected. The results show that increasing post-prandial time has no influence on the synchronised oscillations of skin blood flow. However, it potentiates reactivity of heart rate to perturbations in the peripheral vasculature.

Heart rate and cardiac arrhythmia during high-Gz flight

Twenty-four pilots (age 20-32 years) were monitored with a Holter monitor during 26 hours including a high-Gz flight in order to evaluate heart rate (HR) and cardiac rhythm. Flight experience did not predict the mean in-flight HR (range 69-121 beats/minute), which decreased with increasing age and correlated to the maximum HR during sleep. We recorded maximally 27 ventricular and 97 supraventricular ectopic beats, 10 junctional rhythms, 5 gray-out, 1 vestibular symptom, and 1 instance of numbness of the feet during the flight. No causal relationship between HR, cardiac arrhythmia, or symptoms was found. Adaptation to in-flight +Gz stress takes place without significant arrhythmia and at a submaximal age-related HR.

Interaction between streptococcal protein Arp and different molecular forms of human immunoglobulin A

Protein Arp, the IgA-binding protein of the group A Streptococcus, has affinity for the Fc-part of IgA. The binding between protein Arp and several different molecular forms of human IgA was characterized. It was found that protein Arp bound with higher affinity to uncomplexed forms of IgA than to complexed forms (secretory IgA, alpha 1-antitrypsin-IgA and alpha 1-microglobulin-IgA). Thus, the affinity constant was 2.0-5.9 x 10(8) M-1 for the binding to monomeric, dimeric, trimeric, and quadrimeric IgA, and 4.5-5.0 x 10(7) M-1 for binding to the complexed forms. Among the uncomplexed IgA-molecules, the affinity constant was in the same range for J chain-containing forms (dimeric, trimeric and quadrimeric IgA) as for forms without J chain (monomeric and a particular quadrimeric IgA devoid of J chain). Western blotting demonstrated that protein Arp bound exclusively to the alpha-chain of all IgA-forms. Several lines of evidence pointed to a localization of the binding site to the C alpha 3-domain. First, protein Arp did not bind to three N-terminal alpha-chain fragments which lacked a region corresponding to the C alpha 3-domain, including that form a four-chain myeloma IgA, naturally occurring in plasma. Second, the binding to dimeric and tri/quadrimeric IgA was partially blocked by an added secretory component, which has been suggested to bind to the C alpha 2- and C alpha 3-domains of the alpha-chain. Finally, alpha 1-antitrypsin and alpha 1-microglobulin, in the weakly binding IgA-complexes, have been shown to be linked to the C alpha 3-domain via the penultimate amino acid residue of the alpha-chain peptide, supporting the hypothesis of a localization of the binding site of protein Arp to the C alpha 3-domain.

Circadian variation in peripheral blood flow in relation to core temperature at rest

The aim of the present study was to examine the circadian variation in skin blood flow and its relationship to the rhythm of rectal temperature. Eight young men were confined to continuous bed rest for 24 h in a thermoneutral environment. Rectal temperature, oxygen consumption, and peripheral blood flow (laser-Doppler flowmetry and plethysmography) were measured at intervals of 2 h, except at 2400 hours and 0600 hours. According to the cosinor-method, the mean rectal temperature displayed a statistically significant circadian variation with a minimum at 0400 hours. A significant circadian rhythm was also observed in total finger blood flow, finger laser-Doppler flow, and forearm laser-Doppler flow, but not in total forearm blood flow and forehead laser-Doppler flow. The rhythms of rectal temperature and extremity skin blood flow were phased differently, i.e. the decrease in rectal temperature was preceded by an increase in extremity skin blood flow with an average of 4-h time difference. The results would support the idea that circadian rhythm of core temperature is, at least in part, regulated by variation in extremity skin blood flow.

Cardiovascular functional disorder in primary fibromyalgia: a noninvasive study in 17 young men

Cardiovascular functional stability was studied in 17 young men (20-year-old conscripts) with the symptoms of primary fibromyalgia (PF). They were compared to 20 medical students of the same age. The subjects underwent an orthostatic test, deep breathing test, Valsalva maneuver, and a handgrip test. They were evaluated by an autoanamnestic questionnaire on vegetative symptoms and laboratory tests on blood chemistry. The heart rate of the PF group after 8 min of active standing was 32 +/- 15 beats/min greater than at supine rest. The corresponding figure for the controls was 23 +/- 7 beats/min (p = 0.001). Twelve conscripts with PF (71%) presented sympathicotonic cardiovascular reaction on the orthostatic test (p < 0.001). Four of these sympathicotonic conscripts and two other conscripts (total 35%) had an abnormal high index of dystonic symptoms (p = 0.01). The results suggest that young men with symptoms of PF have not only cardiovascular dystonic symptoms but also increased sympathetic nervous reactivity of the cardiovascular system.

Protein Arp and protein H from group A streptococci. Ig binding and dimerization are regulated by temperature

Cell surface proteins that bind to the Fc part of Ig are expressed by many strains of group A streptococci, an important human pathogen. Two such bacterial strains, AP4 and AP1, were shown to bind IgA and IgG, respectively, in a temperature-dependent manner. The binding of radiolabeled Ig to the bacterial cells was lower at 37 degrees C than at 22 and 4 degrees C. Similarly, protein Arp, the IgA-binding protein isolated from strain AP4, and protein H, the IgG-binding protein isolated from strain AP1, displayed a strong Ig-binding at 22 degrees C and lower temperatures, and virtually no binding at all at 37 degrees C. The effect was reversible: lowering of the temperature restored the binding and vice versa. A gradual shift between binding and nonbinding took place between 27 and 37 degrees C. Gel chromatography and velocity sedimentation centrifugation showed that protein Arp and protein H appeared as noncovalently associated dimers at 10 and 22 degrees C, and as monomers at 37 degrees C. These results strongly suggest that the dimerization of protein Arp and protein H, rather than the low temperature itself, yielded the strong Ig-binding of the proteins at 10 and 22 degrees C. Indeed, after covalent cross-linking of the dimers at 10 degrees C by incubation with low concentrations of glutaraldehyde, full Ig-binding was achieved even at 37 degrees C. A carboxyl-terminal proteolytic fragment of protein Arp, which completely lacked the IgA-binding capacity at any temperature, showed the same temperature-dependent dimerization as intact protein Arp, suggesting that the Ig-binding part of the protein is not required for dimerization. The implications of these results for the function of Ig-binding group A streptococcal proteins, and their role in the host-parasite relationship are discussed.

Protein Arp and protein H from group A streptococci. Ig binding and dimerization are regulated by temperature

Cell surface proteins that bind to the Fc part of Ig are expressed by many strains of group A streptococci, an important human pathogen. Two such bacterial strains, AP4 and AP1, were shown to bind IgA and IgG, respectively, in a temperature-dependent manner. The binding of radiolabeled Ig to the bacterial cells was lower at 37 degrees C than at 22 and 4 degrees C. Similarly, protein Arp, the IgA-binding protein isolated from strain AP4, and protein H, the IgG-binding protein isolated from strain AP1, displayed a strong Ig-binding at 22 degrees C and lower temperatures, and virtually no binding at all at 37 degrees C. The effect was reversible: lowering of the temperature restored the binding and vice versa. A gradual shift between binding and nonbinding took place between 27 and 37 degrees C. Gel chromatography and velocity sedimentation centrifugation showed that protein Arp and protein H appeared as noncovalently associated dimers at 10 and 22 degrees C, and as monomers at 37 degrees C. These results strongly suggest that the dimerization of protein Arp and protein H, rather than the low temperature itself, yielded the strong Ig-binding of the proteins at 10 and 22 degrees C. Indeed, after covalent cross-linking of the dimers at 10 degrees C by incubation with low concentrations of glutaraldehyde, full Ig-binding was achieved even at 37 degrees C. A carboxyl-terminal proteolytic fragment of protein Arp, which completely lacked the IgA-binding capacity at any temperature, showed the same temperature-dependent dimerization as intact protein Arp, suggesting that the Ig-binding part of the protein is not required for dimerization. The implications of these results for the function of Ig-binding group A streptococcal proteins, and their role in the host-parasite relationship are discussed.

Exercise alters the pharmacokinetics of midazolam

Six healthy volunteers received 15 mg midazolam, 50 mg ephedrine, or placebo orally before a 50-minute aerobic treadmill exercise and in a control session. Plasma drug concentrations for pharmacokinetic calculations were estimated from samples drawn up to 24 hours after drug intake. Heart rate, blood pressure, critical flicker fusion test, Maddox wing test, and visual analog scales relating to mood and feelings of tiredness were included in the sessions as pharmacodynamic measures. These tests were made at 35, 55, and 75 minutes and at 2, 2 1/2, 3 1/2, and 5 hours after drug intake. Exercise impaired the absorption of midazolam and counteracted the midazolam-induced decrement in flicker fusion threshold. Whether the effect on flicker fusion was caused mainly by the pharmacokinetic changes or by a general alerting effect of exercise cannot be verified by this experiment. The kinetics of ephedrine was not affected by exercise, but exercise enhanced the tachycardic response to ephedrine and abolished its pressor effect.

Rat α1-microglobulin: co-expression in liver with the light chain of inter-α-trypsin inhibitor

A 1162 bp rat liver cDNA clone encoding the immunoregulatory plasma protein alpha 1-microglobulin was isolated and sequenced. The open reading frame encoded a 349 amino acid polyprotein, including alpha 1-microglobulin, 182 amino acids, and bikunin, the light chain of the plasma protein inter-alpha-trypsin inhibitor, 145 amino acids. The alpha 1-microglobulin/bikunin mRNA was found only in the liver when different tissues were examined. Free alpha 1-microglobulin and a polyprotein, containing both alpha 1-microglobulin and inter-alpha-trypsin inhibitor epitopes, were found in the microsomal fraction from rat liver homogenates.

Clinical testing of thermally stimulated cardiovascular oscillations in man

STUDY OBJECTIVE

The study assessed the physiological validity of an automatic thermal stimulation method to induce synchronised oscillations in the neural cardiovascular control system.

DESIGN

Automatic alternating rhythmic warm and cool immersion of different skin areas of 18 males was done at different frequencies and water temperatures. The neurally mediated responses to the periodic thermal stimulation were measured from skin blood flow and heart rate and compared to those of a sham stimulation. Respiration was monitored for control purposes. The reproducibility of the stimulation and responses was examined.

SUBJECTS

18 young males volunteered for the study.

MEASUREMENTS AND MAIN RESULTS

The water bath method produced reproducible thermal stimulation and responses of skin blood flow and heart rate. Rhythmic thermal stimulation at 0.013-0.096 Hz synchronised the oscillations of the forearm skin blood flow when the thermal stimulus amplitude exceeded 10 degrees C. The increase in the stimulus amplitude or enlargement of the stimulus area did not further increase the oscillatory response of skin blood flow. Sham stimulation or mean temperature of the periodic thermal stimulation in the range 23-33 degrees C did not influence the oscillations of skin blood flow. Local cooling of the stimulated lower legs attenuated the response of skin blood flow. Both thermal stimulation and sham stimulation affected heart rate, but no stable synchronisation of the periodic heart rate variability was found at supine rest. Thermal stimulation of the sitting subjects' forearm instead of legs increased the synchronisation of the periodic heart rate variability.

CONCLUSIONS

The response of skin blood flow agreed with the theory of the thermal entrainment. In a supine man, both thermal stimulation and non-specific central nervous influences induced significant and reproducible interactions with periodic heart rate variability and respiration.

Binding properties of protein Arp, a bacterial IgA-receptor

A cell surface receptor that binds to the Fc region of IgA is expressed by certain strains of group A streptococci. The physico-chemical properties and binding characteristics of this receptor, called protein Arp, were studied. Like bacterial receptors that bind IgG, protein Arp has an elongated shape and no disulfide bonds. The affinity constant of protein Arp for three different molecular forms of IgA was determined, and was found to be more than ten-fold higher for serum IgA than for two complexed forms of IgA: secretory IgA and IgA bound to alpha 1-microglobulin. Cleavage of protein Arp with CNBr resulted in a peptide corresponding to the region located outside the cell wall, except for the N-terminal 52 amino acids. This CNBr-fragment did not bind IgA, which strongly suggests that the IgA-binding region of protein Arp is located in the N-terminal part of the molecule. In addition to the binding of IgA, protein Arp also binds to IgG weakly. The pH-dependence of these two types of binding is different, with maximal binding of IgA at neutral pH (5-7) and maximal binding of IgG at acidic pH (3-5). Both for IgA and IgG, protein Arp shows strong specificity for immunoglobulins of human origin.

Effect of posture on spontaneous and thermally stimulated cardiovascular oscillations

STUDY OBJECTIVE

The aim of the study was to investigate the effect of posture on thermally stimulated cardiovascular oscillations.

DESIGN

The effect of increased gravitational stress (rising from sitting to standing position) on the thermally stimulated cardiovascular oscillations was measured in young male volunteers. Extensive cardiovascular function data were obtained using a cardiovascular investigation protocol.

SUBJECTS

The volunteers were five fit young men, aged 20-21 years. EXPERIMENTS AND MAIN RESULTS: Cardiovascular changes from sitting to standing indicated increased sympathetic and decreased parasympathetic influence on heart and skin blood vessels; mean heart rate increased, beat to beat heart rate variability diminished, high frequency periodic heart rate variability decreased, low frequency heart rate oscillations and ratio of low frequency to high frequency heart rate variability increased, mean skin blood flow and oscillations of skin blood flow decreased (all p less than 0.05). Thermal skin stimulation at 0.01-0.10 Hz frequency increased both sitting and standing 0.10 Hz periodic heart rate variability (p less than 0.05), and 0.10 Hz thermal stimulation entrained the heart rate oscillations in sitting and standing subjects (p less than 0.05). In contrast, skin blood flow oscillations in sitting subjects decreased, while in standing subjects it increased during 0.10 Hz thermal stimulation compared to the corresponding prestimulus values (p less than 0.04).

CONCLUSIONS

On the basis of previous physiological experiments, these results suggest coupling between thermoregulatory and 0.10 Hz reflex activities.

Seasonal variability of exercise-induced asthma especially outdoors. Effect of birch pollen allergy

A study was made to determine whether natural allergenic exposure modulates exercise-induced asthma. Eighteen asthmatic men, ten non-allergic and eight allergic to birch pollen, underwent heart rate-monitored outdoor exercise tests during both the cold winter season and in the spring, the birch pollen season. The mean fall in FEV1 after the outdoor exercise test increased in the allergic group from 17 +/- 3% in the winter to 27 +/- 6% in the spring, while it decreased in the non-allergic group from 31 +/- 6% to 22 +/- 4%, respectively (P less than 0.01). Initial FEV1 and FCV values remained unchanged in both groups. The non-specific airway responsiveness to histamine did not change significantly in birch pollen allergic or non-allergic subjects during the spring, when compared with the winter values. We conclude that the exercise-induced asthma is aggravated in the birch pollen allergic asthmatics during the pollen season, when compared to the non-birch pollen allergic asthmatics, in whom the exercise-induced bronchoconstriction is attenuated as expected, because of the warmer and more humid weather in the spring.

A non-invasive method for testing neural circulatory control in man

Exaggerated cardiovascular responsiveness is common in young men and may cause non-specific symptoms and poor performance. Conventional autonomic function tests are not clinically useful. We have therefore designed a thermal entrainment method to evaluate sympathetic and parasympathetic cardiovascular function in subjects with dystonic symptoms and orthostatic intolerance. Oscillations of thermal gradient in the skin were produced by standardised periodic stimulation of the lower part of the arm with warm and cool water. Vasomotor activity of the skin induced oscillations of arterial blood pressure which were thought to be regulated by sympathetic and parasympathetic heart rate control and by oscillation of the sympathetically controlled peripheral vascular resistance. We tested the method in subjects with cardiovascular symptoms (n = 7) and controls (n = 7). At supine rest, the frequency response of the heart rate variability to the thermal stimulation at frequencies of 0.01, 0.02, 0.03 and 0.1 Hz was significantly different (p = 0.008) between symptomatic subjects and controls. The gain of the heart rate control was increased to 0.03 Hz [-1.3(SEM 0.5) dB v -3.8(0.8) dB, p = 0.068] and decreased at 0.1 Hz [-3.9(1.1) dB v -1.5(0.6) dB, p = 0.076] in the test group compared to the control group. At stimulus frequencies of less than 0.03 Hz the individual overall heart rate variability of the subjects with symptoms stayed below the mean control value, at 60(6) ms v 79(15) ms, p = 0.16. The cutaneous temperature oscillations at the site of stimulation, frequency response of the oscillations of the skin blood flow and respiration to the thermal stimulation, and mean heart rate were similar in the both groups. The results show that this thermal entrainment method quantifies the increased sympathetic and decreased parasympathetic cardiac control of subjects with dystonic symptoms.

Unchanged bronchial reactivity after killed influenza virus vaccine in adult asthmatics

Polyvalent killed influenza virus vaccine or saline was administered subcutaneously to 27 asthmatics to investigate the effect of influenza vaccine on respiratory function and on airway responsiveness to inhaled histamine. The patients were adults with mild to moderate asthma. Airway resistance (Raw) and intrathoracic gas volume (ITGV) were measured immediately before and 2, 3 and 21 days after vaccine or saline injection. Raw and ITGV values were used to calculate specific airway conductance (SGaw). Bronchial reactivity was expressed as the provocative dose of histamine diphosphate producing a decrease of 40% in SGaw (PD40). Fourteen (87%) of 16 asthmatics who received killed virus vaccine displayed a significant rise in serum antibody level as measured by single radial haemolysis in gel test. No significant alterations in mean Raw, ITGV and SGaw values were observed after viral vaccination. The median PD40 values for histamine also remained unchanged. However, an increased bronchial reactivity was observed in some patients after administration of virus vaccine or saline. Subclinical natural infection or allergen exposure cannot be excluded as possible causes of the increased airway reactivity in these patients. The side-effects of vaccination were minimal and no more harmful than those produced by saline injection. We conclude that the killed influenza virus vaccine used is effective in boosting serum antibody levels and is suitable for adult asthmatics when prophylactic immunisation is indicated.

Reactivity of autonomic nervous control of heart rate in diabetes mellitus and juvenile rheumatoid arthritis

Autonomic cardiac control of children with diabetes mellitus (DM, n = 12), juvenile rheumatoid arthritis (JRA, n = 12) and healthy controls (n = 12) was studied by a procedure consisting of a deep breathing test and an intermittent tilting test. Frequency selective entrainment of HR could be produced by tilting and deep breathing. No statistically significant intergroup differences were detected in the patterns of average heart rate (HR), overall or beat-to-beat heart rate variability (HRV) or HRV spectra. The DM group had an 8% higher HR and a limited short-term HRV response in relation to HR throughout the whole test procedure compared to controls. This increased HR causes an extra load to the cardiovascular system. We conclude that in spite of elevated HR and changed short-term chronotropic HR control in DM no features of autonomic failure could be detected in children with JRA.

Patterns of QT/QS2 ratio in vasomotorically labile young men

The QT/QS2 ratio in seven 21-year-old men with a history of vasomotor lability was measured when they were resting supine and during orthostatic, Valsalva and diving reflex tests. The vasolability was characterized by an abnormal sympathicotonic heart rate (HR) response to the orthostatic test and vacillating inferoapical T waves in the ECG. The results of the vasolabile subjects were compared to those of seven fit control subjects of the same age. In spite of equal HR's in both groups the vasolabile subjects' QT/Q2 ratio constantly exceeded 1.00 during the whole test protocol and it was higher than of the controls (P = 0.04). The reversed QT/QS2 relationship in the test subjects seemed to be due both to a prolongation of the QT time and a shortening of the QS2 time. This difference prevailed throughout although the reaction pattern to autonomic stimulations was equal in both groups. We considered an inadequate neural control of the heart, possibly with metabolic and haemodynamic interactions, responsible for the prolongation of the electrical systole in relation to the electromechanical systole in the heart of the vasomotorically labile subjects.

Heart rate variability, cardiac mechanics, and subjectively evaluated stress during simulator flight

The effects of a simulator flight task on the heart rate variation (HRV) and hemodynamic variables were studied in nine pilots with instrument flight ratings. An electrocardiogram (ECG), phonocardiogram (PCG), and impedance cardiogram (ICG) were recorded continuously during three successive flights. Indices of HRV, power spectra, and autocorrelograms were computed from the R-R interval signal. Stroke volume (SV), cardiac output (CO), and systolic time intervals (STI) were determined by means of the ECG, PCG, and ICG. A scaling method for a subjective evaluation of tiredness, effort, and success during the flight was used. The repeats of the flight task decreased the heart rate (HR), CO, and cardiac index (CI). The different phases of the flight altered the HR (mean 97 min-1, S.E.M. 4 min-1), total HRV (RMSM) (mean 33 ms, S.E.M. 5 ms), and the periodic HRV. Subjectively, the pilots felt only moderate stress. The subjectively evaluated tiredness was significantly associated with the STI. Moderate informative stress in the flight simulator affected the chronotropic parameters of the heart. The inotropic state of the heart was not affected by the different phases of the flight but possibly by the diminishing sympathetic drive with accommodation during the repeats.

Impact of thermal vasomotor control on the heart rate variability of newborn infants

The reactivity of the periodic heart rate variability (HRV) to the thermal vasomotor control was studied during quiet sleep in a total of 20 neonates which were classified in 5 groups according to their maturity. Thermal stimulation on the peripheral skin was applied by an air blower at the rates of 5, 2.5 and 1.5 cycles/min. The oscillation of successive R-R intervals of the ECG was determined by a hybrid computer technique during thermal stimulations and compared to spontaneous HRV activity. The indices of the HRV and the total power of the periodic HRV remained unchanged during thermal stimulations. The response of the periodic HRV was selective at the spectral band corresponding to the frequency of stimulation. It was maximal at 5 cycles/min. The relative response was highly significant (P less than 0.001) and it increased with increasing maturity. The state of SGA (small for gestational age) seemed to decrease the vasomotor response of the HRV. The results suggested that the thermal vasomotor control was functional already in small preterm infants and it tended to increase with increasing maturity as does the autonomic cardiac control in general.