Transient decreases in Bispectral Index without associated changes in the level of consciousness during photic stimulation in an epileptic patient

This case report describes a patient with a history of epileptic seizures who showed unusual decreases in the Bispectral Index (BIS) attributable to the induction of abnormal slow electroencephalographic (EEG) waves by photic stimulation, without any associated decrease in his level of consciousness. After starting anticonvulsive therapy, photic stimulation no longer induced abnormal EEG activity nor decreased BIS values. These findings suggest that BIS values may not accurately reflect a patient's actual level of consciousness in the presence of epilepsy-related abnormal EEG activity and that the BIS monitor may be able to track such EEG changes.

Relationship Between Real-Time Monitoring of the Graft Motility and Mucosal Histology in Swine Intestinal Transplantation

We studied the correlation between the motility and the mucosal histology of the small bowel seeking to detect rejection in an early stage by real-time monitoring using a swine model. Intestinal transplantation (ITx) was performed orthotopically using FK506 immunosuppression. The distal about 20 cm segment of the allograft was exteriorized as a Thiry-Vella stoma for biopsies. Strain gauge (SG) force transducers were attached to the graft for real-time monitoring of graft motility. Pigs without ITx were used as controls (group 1). Rejection was classified into four groups by histologic findings: nonrejection (group 2), mild rejection (group 3), moderate rejection (group 4), and severe rejection (group 5). Migrating motor complex (MMC) phase III was analyzed for the following parameters: duration, amplitude, interval, motility index, velocity, and frequency of propagation. In group 2, all parameters were almost the same as those for group 1. In contrast, groups 4 and 5 showed most parameters significantly lower than those in group 1. In group 3, the contractility of the MMC was not significantly altered, but the frequency of the propagation was decreased significantly. In conclusion, graft motility detected by a real-time SG method correlated with the grade of mucosal histology. This method is useful to detect rejection at an early stage by examining the frequency of MMC propagation.

Variable Very-High-Energy Gamma-Ray Emission from the Microquasar LS I +61 303

Microquasars are binary star systems with relativistic radio-emitting jets. They are potential sources of cosmic rays and can be used to elucidate the physics of relativistic jets. We report the detection of variable gamma-ray emission above 100 gigaelectron volts from the microquasar LS I 61 + 303. Six orbital cycles were recorded. Several detections occur at a similar orbital phase, which suggests that the emission is periodic. The strongest gamma-ray emission is not observed when the two stars are closest to one another, implying a strong orbital modulation of the emission or absorption processes.

Cerebral ischaemia during cardiac surgery in children detected by combined monitoring of BIS and near-infrared spectroscopy

BACKGROUND

Children frequently suffer transient cerebral ischaemia during cardiac surgery. We measured cerebral ischaemia in children during cardiac surgery by combining two methods of monitoring.

METHODS

We studied 65 children aged between 5 months and 17 yr having surgery to correct non-cyanotic heart disease using hypothermic cardiopulmonary bypass (CPB). During surgery, we measured the Bispectral Index (BIS) and regional cerebral haemoglobin oxygen saturation (SrO2) with near-infrared spectroscopy (NIRS). Cerebral ischaemia was diagnosed if both SrO2 and BIS decreased abruptly when acute hypotension occurred. In each patient, the relationship between SrO2 and arterial blood pressure (AP) was indicated by a plot of mean SrO2 against simultaneous mean AP.

RESULTS

We noted 72 episodes of cerebral ischaemia in 38 patients. Sixty-three ischaemic events were during CPB. Cerebral ischaemia was less frequent in older patients. Cerebral ischaemia was more common and more frequent in children under 4 yr old. Haematocrit during CPB was lower and SrO2 was more dependent on AP in children under 4 yr.

CONCLUSIONS

Children less than 4 yr of age are more likely to have cerebral ischaemia caused by hypotension during cardiac surgery. Ineffective cerebral autoregulation and haemodilution during CPB may be responsible.

Detection of cerebral hypoperfusion with bispectral index during paediatric cardiac surgery

BACKGROUND

The bispectral index (BIS) may indicate changes in cerebral activity when the cerebral circulation is affected by acute hypotension.

METHODS

We measured BIS and cerebral haemoglobin saturation (Sr(O(2))) by near-infrared spectroscopy in 10 children undergoing cardiac surgery.

RESULTS

We noted 14 episodes of simultaneous decreases in Sr(O(2)) and BIS during acute hypotension in five children. An acute decrease in BIS, which coincided with a decrease in Sr(O(2)) suggesting a reduction in cerebral blood flow, was associated with acute slowing of the raw EEG waveforms.

CONCLUSIONS

Our findings suggest that an acute decrease in BIS during acute hypotension indicates cerebral hypoperfusion, and that cerebral hypoperfusion caused by hypotension may occur frequently during paediatric cardiac surgery.

Lack of association between the hKCa3 gene and Japanese schizophrenia patients

Several researchers have suggested an association between large numbers of CAG repeats in the hKCa3 gene and schizophrenia. However, these reports remain inconclusive and require further investigation. We tried to replicate these results in 112 Japanese schizophrenia patients and 102 control subjects of highly matched age and sex by applying an allele dichotomization model. No association was found. The overall distributions of allele frequencies were not significantly different between schizophrenic patients and normal control subjects. In addition, we tested the association between the size of the CAG repeats and the scores on three dimensions (positive and negative symptoms, and disorganization), but no significant results were obtained. Our results do not support the involvement of the hKCa3 gene in schizophrenia, at least in the Japanese population.

[Evaluation of nursing notes based on the nursing process]

This is a retrospective study that analyzed the nursing notations in a Specialized Unit which develops the care to the patient based on Nursing Process. The data were collected through two promptuaries utilizing instrument constructed for this purpose. Aspects which valuate appearance and content were considered in the analysis. The nursing assistant was distinguished in the results considering the bigger number of extensive and not very specific notations, and in the registrations achieved by the nurse, it was observed a bigger number of legible and objective notations. By expressing the Nursing work, greater investments must be made to become more objective and full the nursing notations.

Rational design, discovery, and synthesis of a novel series of potent growth hormone secretagogues

In the joint experimental and computational efforts reported here to obtain novel chemical entities as growth hormone secretagogues (GHSs), a small database of peptides and non-peptides known to have GHS activity was used to generate and assess a 3D pharmacophore for this activity. This pharmacophore was obtained using a systematic and efficient procedure, "DistComp", developed in our laboratory. The 3D pharmacophore identified was then used to search 3D databases to explore chemical structures that could be novel GHSs. A number of these were chosen for synthesis and assessment of their ability to release growth hormone (GH) from rat pituitary cells. Among the compounds tested, those with a benzothiazepin scaffold were discovered with micromolar activity. To facilitate lead optimization, a second program, a site-dependent fragment QSAR procedure was developed. This program calculates a library of chemical and physical properties of "fragments" or chemical components in a known pharmacophore and determines which, if any, of these properties are important for the observed activity. The combined use of the 3D pharmacophore and the results of the site-dependent fragment QSAR analysis led to the discovery and synthesis of a novel series of potent GHSs, a number of which had nanomolar in vitro activity.

Sample preparation with fiber-in-tube solid-phase microextraction for capillary electrophoretic separation of tricyclic antidepressant drugs in human urine

Solid-phase microextraction (SPME) is a solvent-free sample preparation technique using a thin coating attached to the surface of a fused silica-fiber as the extraction medium, which has been successfully applied to the analysis of a wide variety of compounds by coupling to gas chromatography (GC). In recent years, in-tube SPME using GC capillary column as the extraction medium has also been developed and coupled with liquid chromatography (LC) for the preconcentration of nonvolatile compounds. In this study, an on-line interface between the fiber-in-tube SPME and capillary electrophoresis (CE) has been developed, and the preconcentration and separation of four tricyclic antidepressant (TCA) drugs, amitriptyline, imipramine, nortriptyline, and desipramine, were performed with the hyphenated system. Under the optimized condition, a better extraction performance than conventional in-tube SPME was obtained, even the length of the extraction medium was much shorter. The results clearly indicated that the fiber was working effectively as an extraction medium. For the separation of these four TCAs, capillary electrophoretic separation with beta-cyclodextrin as the buffer additive has been employed and the application of the developed system to the analysis of complex sample mixtures in a biological matrix is also demonstrated.

[Telangiectatic focal nodular hyperplasia: a case report]

Focal nodular hyperplasia(FNH) is a benign tumor-like lesion of the liver. The telangiectatic type is an atypical histologic variant of FNH, and descriptions of its radiologic findings are rare. We report a case of telangiectatic FNH. A 26-20 mm round lesion was found in the lateral segment of the liver. Although this lesion appeared similar to cavernous hemangioma with rapid intratumoral contrast material enhancement on cross-sectional images, its signal intensity decreased on T2-weighted imaging after the administration of superparamagnetic iron oxide(SPIO), and its appearance differed from that of cavernous hemangioma.

Lactate levels in cirrhotic patients undergoing liver resection

BACKGROUND/AIMS

The role of lactate in liver ischemia-reperfusion injury in cirrhosis has not been clarified.

METHODOLOGY

One hundred patients with hepatocellular carcinoma who underwent partial liver resection under Pringle's maneuver were included in this study. Blood lactate was measured before the operation, three times during the surgery and on the first postoperative day to calculate its rate of accumulation or elimination. Aminotransferase levels were also recorded perioperatively. We calculated the rate of lactate accumulation during the pre-ischemic and ischemic phases and the elimination rate during the post-ischemic phase, and examined the correlation between these results and the clinical findings.

RESULTS

The rate of lactate accumulation during the pre-ischemic and ischemic phases was correlated with the preoperative indocyanine green retention rate (P = 0.04 and P = 0.004, respectively). The indocyanine green retention rate tended to be correlated with the rate of lactate elimination during the post-ischemic phase (P = 0.06).

CONCLUSIONS

The blood lactate profile might be a reliable indicator of liver function during the perioperative period in cirrhotic patients who undergo liver resection with Pringle's maneuver.

Influence of ethanol on metabolism of methamphetamine in rats including hair analysis

To investigate possible influences of ethanol (EtOH) on metabolism of methamphetamine (MA), dark agouti (DA) rats were assigned to 3 groups including EtOH mono-dosing group, MA mono-dosing group and combined dosing group of EtOH and MA. Following successive administration of respective drugs, time-course changes of plasma and urine levels of EtOH and its metabolites, as well as alterations of plasma, urine, hair levels of the MA and its metabolites, were monitored. Preliminary hydrolysis of the glucuronate conjugates was required because parahydroxymethamphetamine (p-OHMA) and parahydroxyamphetamine (p-OHAP) were promptly conjugated with glucuronic acid in the body. When compared with EtOH group, the maximum plasma concentration of EtOH occurred with some delay in EtOH + MA group, suggesting possibility of some delay of its metabolism. MA concentrations in EtOH + MA group were slightly higher until 6 hours after administration when EtOH was detectable in the blood whereas concentrations of amphetamine (AP) in EtOH + MA group were less, on the contrary. Concentrations of p-OHMA and p-OHAP were obviously less in EtOH + MA group. These findings indicate that N-demethylation and parahydroxylation of aromatic ring of MA would be inhibited in the presence of EtOH. Concentrations of MA and AP in hair were higher in EtOH + MA group. Not only difference in AUC but also possible increase in uptake of the drugs into hair could likely account for this phenomenon.

Lactate is correlated with the indocyanine green elimination rate in liver resection for cirrhotic patients

The role of lactate in liver ischemia-reperfusion injury in cirrhosis has not been clarified. Fifty patients with hepatocellular carcinoma who underwent partial liver resection under Pringle's maneuver were included in this study. We performed the indocyanine green clearance test before the operation and three times during the surgery to calculate its elimination rate. Blood lactate and base excess were measured at the corresponding times. Systolic and diastolic systemic arterial pressure, heart rate, cardiac index, and esophageal temperature were monitored. Aminotransferase levels were recorded the day before the operation, 1 h after the operation, and on the first and third postoperative days. We calculated the increase or decrease in lactate levels during the preischemic, ischemic, and postischemic phases, and examined the correlation between these results and the changes in indocyanine green elimination rate and some clinical factors. The lactate levels increased before reperfusion and began to decrease after reperfusion. The lactate increase and decrease during the ischemic and postischemic phases correlated with the change in indocyanine green elimination rate (P < 0.0001 and P = 0.02 for the respective phases). The lactate increase during the preischemic phase correlated with the duration of the preischemic phase (P < 0.0001). In cirrhotic patients who undergo liver resection with Pringle's maneuver and who do not show postoperative liver failure, the blood lactate profile might be a reliable indicator of liver metabolic capacity during surgery.

IMPLICATIONS

In cirrhotic patients who underwent liver resection with Pringle's maneuver, the lactate increase and decrease during the ischemic and postischemic phases correlated with the change in the indocyanine green elimination rate. The blood lactate profile might be a reliable indicator of liver metabolic capacity during surgery.

Crystal structures of the transposon Tn5-carried bleomycin resistance determinant uncomplexed and complexed with bleomycin

The transposon Tn5 carries a gene designated ble that confers resistance to bleomycin (Bm). In this study, we determined the x-ray crystal structures of the ble gene product, designated BLMT, uncomplexed and complexed with Bm at 1.7 and 2.5 A resolution, respectively. The structure of BLMT is a dimer with two Bm-binding pockets composed of two large concavities and two long grooves. This crystal structure of BLMT complexed with Bm gives a precise mode for binding of the antibiotic to BLMT. The conformational change of BLMT generated by binding to Bm occurs at a beta-turn composed of the residues from Gln(97) to Thr(102). Crystallographic analysis of Bm bound to BLMT shows that two thiazolium rings of the bithiazole moiety are in the trans conformation. The axial ligand, which binds a metal ion, seems to be the primary amine in the beta-aminoalanine moiety. This report, which is the first with regard to the x-ray crystal structure of Bm, shows that the bithiazole moiety of Bm is far from the metal-binding domain. That is, Bm complexed with BLMT takes a more extended form than the drug complexed with DNA.

[Analysis of expectations on the nurse's leadership in the light of Grid's theories]

Based on the understanding that leadership is a fundamental resource for nurses in health institutions, the aim of the authors was to analyze, under the light of Blake & Mouton's Grid Theories, the expectations of the Nursing team regarding nurse's leadership. The analysis was based on four investigations performed in different contexts of Brazilian Nursing and data were collected through the application of the "Grid & Leadership in Nursing Instrument" developed by Trevizan. Results show that the subjects prefer the Grid style 9.9. The authors discuss the results and emphasize the need for the development of leadership in Nursing.

SADS: A new component of Fas-DISC is the accelerator for cell death signaling and is downregulated in patients with colon carcinoma

Fas is the death receptor, transducing cell death signaling upon stimulation by Fas ligand. During Fas-initiated cell death signaling, the formation of Fas-death inducing signaling complex (Fas-DISC) is the first step. Here we have identified a new component of Fas-DISC which we call 'small-accelerator for death signaling' (SADS). SADS cDNA encodes a 150 amino acid polypeptide (Mr = 16,700). During Fas-mediated cell death, SADS enhances the interaction of Fas-death domain-interactive factors (FADD) and procaspase-8, and deletion mutant analysis has identified FADD- and caspase-8-interactive domains in SADS. Inhibition or removal of SADS delays Fas-mediated cell death. In addition, we demonstrate the deletion or mutation of SADS in patients with colon carcinoma and that exogenous SADS expression in human colon carcinoma SW480 cells that lack SADS leads to re-acquisition of Fas-mediated cell death. Here, we propose that SADS is one of the cell death-associated factors and enhances Fas-DISC formation, especially FADD and procaspase-8 recruitment.

Cell death induction by CTL: perforin/granzyme B system dominantly acts for cell death induction in human hepatocellular carcinoma cells

Cell death induction by cytotoxic T lymphocytes (CTLs) is an important thesis for the understanding of tumor immunotherapy. In the current study we investigated the molecular machinery of CTL-induced cell death in human hepatocellular carcinoma cell lines (HCC lines). CTLs prepared from human peripheral blood induced cell death in all tested HCC lines. As the CTL-induced death system, the effectiveness of Fas ligand/Fas and/or Perforin/Granzyme B systems has been suggested, whereas cell death induction by CTLs was shown independently on Fas expression in the current study. Using various tetrapeptide inhibitors for caspase and its associated factor, we additionally demonstrated that inhibitors for caspase 3 (Ac-DEVD-CHO) and caspase 8/granzyme B (Ac-IETD-CHO) suppressed CTL-induced cell death, but an inhibitor for Fas-activated serine proteinase, which acts for the caspase 3 activator, did not, suggesting that CTL-induced cell death was initiated by the Perforin/Granzyme B system, rather than the Fas ligand/Fas system. On the basis of our current results, we report here that the Perforin/Granzyme B system acts dominantly for the cell death induction of HCC lines.

Hepatocyte growth factor promotes cell survival from fas-mediated cell death in hepatocellular carcinoma cells via Akt activation and Fas-death-inducing signaling complex suppression

The Akt/PI-3 kinase pathway is a system essential for cell survival. In the current study, we showed that hepatocyte growth factor (HGF) activates the Akt/PI-3 kinase pathway to suppress Fas-mediated cell death in human hepatocellular carcinoma (HCC; 3 lines; SK-Hep1, HLE, and Chang Liver cell lines), hepatoblastoma (1 line; HepG2), and embryonic hepatocyte (1 line; WRL). Five tested cell lines showed the resistance to Fas-mediated cell death by the pretreatment of HGF. This HGF-induced cell survival was suppressed by wortmannin (Akt/PI-3 kinase pathway inhibitor), suggesting an involvement of Akt. When cells were pretreated with HGF, Fas-mediated cell death was suppressed, followed by Akt phosphorylation at Ser473. Fas-death-inducing signaling complex (DISC) formation, especially FADD and caspase 8 interaction, was suppressed by HGF and the suppression of the Akt/PI-3 kinase pathway by transient expression of PTEN, resulting in acquisition of Fas-DISC formation and Fas-mediated cell death in HGF-treated cells. We suggest that HGF promotes cell survival in hepatocyte-derived cell lines (HCC, hepatoblastoma, and embryonic hepatocyte) from Fas-mediated cell death via Fas-DISC suppression as a result of Akt activation.