Detection of silent myocardial ischemia in diabetes mellitus

The prevalence of silent myocardial ischemia and its relation to autonomic dysfunction and pain threshold was studied in 58 men with diabetes mellitus and without cardiac symptoms. All patients underwent 48-hour ambulatory electrocardiographic monitoring and exercise testing after assessment of their autonomic function and pain threshold. Silent myocardial ischemia, defined as greater than or equal to 1 mm of ST-segment depression on either exercise testing or ambulatory electrocardiographic monitoring, was corroborated by exercise-induced reversible defect(s) on tomographic thallium scintigraphy. Autonomic function was assessed by heart rate response to: (1) Valsalva maneuver, (2) deep breathing, and (3) upright posture, as well as by diastolic blood pressure response to sustained handgrip and systolic blood pressure response to upright posture. Autonomic dysfunction was defined as greater than or equal to 2 abnormal responses. Pain threshold measurements were performed using electrical cutaneous stimulation of both forearms. Of the 58 diabetic patients, 21 were found to have autonomic dysfunction (36%). Silent myocardial ischemia was detected in 10 patients (17%), and was significantly more frequent in patients with than without autonomic dysfunction (38 vs 5%, p = 0.003). There was no difference in the electrical pain threshold or tolerance in subjects with and without silent myocardial ischemia. It is concluded that silent myocardial ischemia in asymptomatic diabetic men occurs frequently and in association with autonomic dysfunction, suggesting that diabetic neuropathy may be implicated in the mechanism of silent myocardial ischemia.

Extracellular matrix and androgen receptor expression associated with spontaneous transformation of rat prostate fibroblasts

Spontaneous transformation in continuous culture of the androgen-sensitive rat prostate fibroblast cell line, NbF-1, resulted in an aggressively tumorigenic nonmetastatic phenotype that coincided with few gross chromosome abnormalities. This study identified transformation-associated alterations in extracellular matrix and androgen receptor expression in the NbF-1 cell line. Substantial levels of procollagens I, III, and IV and fibronectin mRNAs were detected in nontumorigenic NbF-1 cells. Laminin B1 and B2 mRNAs were also detectable, but at lower levels. Expression of all six extracellular matrix mRNAs was nonuniformly lower in tumorigenic NbF-1 cells. This decrease in expression was greatest for alpha 2 procollagen IV mRNA, which was reduced 17-fold. Proteoglycans and glycosaminoglycans synthesized by the NbF-1 cultures were also characterized. The NbF-1 cell line expressed chondroitin sulfate proteoglycans predominantly, and expression was reduced 5- to 10-fold in tumorigenic cultures. In contrast to the extensive alterations in the extracellular matrix, measurement of high-affinity androgen binding and androgen receptor mRNA levels showed substantial expression of androgen receptors in both NbF-1 cultures. Cultures of early and late passage NbF-1 cells demonstrated a mitogenic response to dihydrotestosterone. These data indicate (a) that alterations in expression of extracellular matrix components may represent early markers for tumorigenic transformation in prostatic mesenchymal cells and (b) that these changes can occur without disrupting androgen receptor expression and androgen sensitivity.

Ultrastructural studies of unstable angina in living man

Nineteen patients with refractory unstable angina who were undergoing aortocoronary bypass were studied to assess the extent of platelet aggregation present in the microvasculature. Ultrastructural findings on the morphology of cardiac muscle and microvasculature were correlated with the findings on coronary angiograms and thallium scans. There were no significant correlations. The presence of platelet aggregates was identified in four biopsies, two of which had thrombus by angiographic criteria. Biopsy in areas with thallium defects revealed an increased prevalence of white blood cells without acute myocardial infarction. This study confirms the presence of platelet aggregates in patients with unstable angina, albeit at a reduced frequency when compared with autopsy studies.

Prognosis in medically stabilized unstable angina: early Holter ST-segment monitoring compared with predischarge exercise thallium tomography

OBJECTIVE

To assess the relative value of invasive and noninvasive predictors of outcome in patients after unstable angina.

DESIGN

Cohort of 54 patients with unstable angina who had 6-month follow-up after stabilization on medical therapy.

SETTING

University-based hospital, tertiary referral center.

PATIENTS

Consecutive patients with unstable angina whose symptoms resolved while receiving medical therapy.

MEASUREMENTS AND MAIN RESULTS

We prospectively compared 24-hour Holter ST-segment monitoring at admission, quantitative exercise thallium tomography, and cardiac catheterization 5 +/- 2 days after admission and analyzed their value for predicting a cardiac event in patients with unstable angina within 6 months. When patients with a favorable outcome (n = 40) were compared with patients with an unfavorable outcome (n = 11) no statistical difference was found in duration of ST shift of 1 mm or more on Holter monitoring (51 +/- 119 min compared with 37 +/- 43 min), exercise duration by the standard Bruce protocol (8.0 +/- 3.6 min compared with 7.9 +/- 3.1 min), exercise-induced ST depression (0.6 +/- 0.9 mm compared with 1.0 +/- 1.0 mm), and contrast left ventricular ejection fraction (70% +/- 10% compared with 69% +/- 15%). Patients with a favorable outcome were distinguished from those with an unfavorable outcome by a higher maximum rate-pressure product (24 x 10(3) +/- 6 x 10(3) compared with 18 x 10(3) +/- 7 x 10(3), P = 0.0025), smaller size of the reversible scintigraphic perfusion defect expressed as a percentage of total myocardium imaged (6% +/- 11% compared with 17% +/- 18%, P = 0.05) and a smaller number of vessels with stenosis of 50% or more (1.1 +/- 1.2 compared with 2.1 +/- 1.0, P = 0.01). On multiple logistic regression analysis, a history of previous myocardial infarction was the most powerful predictor of outcome. In patients without myocardial infarction, reversible exercise thallium perfusion defect size was the only predictor.

CONCLUSION

After stabilization of an episode of unstable angina, quantitative tomographic exercise thallium scintigraphy has greater value for risk stratification than Holter ST-segment monitoring, particularly in patients who have not had a previous infarction.

Regulation of gene expression in rat prostate by androgen and beta-adrenergic receptor pathways

Denervation of rat ventral prostate has been accomplished by excising prostatic tissue fragments and implanting them under the renal capsules of intact syngeneic rats. This resulted in a substantial reduction of expression of a major organ-specific secretory protein, prostatic binding protein (PBP). The depressed level of PBP and its subunits and mRNAs could be restored, however, to as much as 80% of control levels by the administration of a pharmacological dose of exogenous androgen, testosterone propionate (TP), and/or a beta-adrenergic agonist, isoproterenol (ISO). Furthermore, compared to ascorbate-treated controls, TP and ISO increased the synthesis of total cellular protein and PBP by the prostatic renal implants. TP and/or ISO also remodelled the luminal epithelial structure and elevated secretory functions. ISO alone had no effect, however, in castrated animals, indicating that androgen plays a dominant role in the restoration of tissue PBP content. Concomitant to increased PBP content and remodelling of prostatic histomorphology, androgen was also found to raise the depressed levels of beta 2-adrenergic and androgen receptors in the prostatic isografts maintained in intact hosts. In contrast, although an established rat prostatic epithelial cell line (NbE-1) contains high affinity androgen receptor, androgen failed to restore beta-adrenergic receptor as well as PBP content in this cultured cell line. These results, taken together, suggest that a tight coupling between androgen receptor and beta 2-adrenergic receptor pathways may be a prerequisite for PBP expression and functional differentiation in the rat ventral prostate gland.

Fibroblast-mediated acceleration of human epithelial tumor growth in vivo

Transformed fibroblasts coinoculated with epithelial cells accelerated the growth and shortened the latency period of human epithelial tumors in athymic mice. Addition of NbF-1 fibroblasts caused epithelial tumors to grow from five marginally tumorigenic or "nontumorigenic" (nontumor-forming) human tumor cell lines or strains: PC-3 (prostate), WH (bladder), MDA-436 (breast), and cells derived from the ascites fluids of patients with metastatic renal pelvic or prostate cancers. Evidence for the human and epithelial nature of these experimental tumors was provided by histologic, immunohistochemical, Southern and dot-blot hybridization, and cytogenetic analyses. Transformed fibroblasts induced predominantly carcinosarcomas, whereas nontumorigenic fibroblasts (NIH 3T3) and lethally irradiated transformed fibroblasts induced exclusively carcinomas. The fibroblast-epithelial interaction appears to occur bidirectionally and does not result from cell fusion. Because coculture experiments in vitro did not demonstrate an increased cell proliferation, it appears that undefined host factors can influence tumor growth. This tumor model may be useful in drug-screening programs and in mechanistic studies of factors regulating human tumor growth and progression.

Aberrant expression of epidermal growth factor receptor and HER-2 (erbB-2) messenger RNAs in human renal cancers

Amplification, rearrangement, or overexpression of the gene for the epidermal growth factor receptor (EGFR) occurs in certain types of human neoplasia. We investigated EGFR gene structure and measured EGFR mRNA levels in human renal tumor biopsies. Seventeen renal tumors [13 renal cell carcinomas (RCCs), two Wilms' tumors, one oncocytoma, and one metastatic ganglioneuroblastoma] and their corresponding normal kidney tissues were examined for EGFR gene structural integrity by Southern blot hybridization. Twelve of these tumors (including 11 RCCs) were examined for EGFR mRNA expression levels by RNA blot hybridization. The EGFR gene was rearranged in one of 13 (8%) of the RCC specimens examined and was highly amplified in the ganglioneuroblastoma. The overall frequency of EGFR gene structure alterations in this series of renal tumors was 12%. Nine of 11 RCC specimens (82%) exhibited markedly elevated EGFR mRNA levels (approximately 2- to 6-fold). In contrast, expression of the EGFR-related protooncogene HER-2 (erbB-2) was found to be decreased in 11 RCCs and one Wilms' tumor; HER-2 gene structure, however, appeared normal in all specimens. These results indicate that overexpression of EGFR mRNA, probably due to changes in gene regulation, and underexpression of HER-2 mRNA are characteristic features of human RCC.

New etiology for intestinal uptake of thallium-201

A patient with both rest and exercise thallium images for unstable angina demonstrated marked large intestinal uptake of thallium. However, the thallium uptake in the large intestine was noted only after exercise. The only change in the patient status between the two studies was the administration of verapamil. Thus, verapamil administration has been demonstrated to be a new cause for gut uptake of thallium.

Intracoronary thrombus and complex morphology in unstable angina. Relation to timing of angiography and in-hospital cardiac events

In 78 consecutive patients with unstable angina, we performed coronary angiography randomized to either the first day of presentation or later during the hospital admission to assess the frequency of intracoronary thrombus and complex coronary morphology relative to the time of symptomatic presentation and the impact of these angiographic features on outcome. Early angiography (17 +/- 6 hours) was performed in 42 patients and late angiography in 36 patients (5.7 +/- 2.1 days). Twelve patients randomized to late angiography required urgent cardiac catheterization 3.9 +/- 2.2 days after admission. Coronary thrombi were present in 43% (18 of 42) of early angiography patients and in 38% (14 of 36) of late angiography patients (p = NS). Only 21% (five of 24) late elective angiography patients had coronary thrombi, but 75% (nine of 12) of late urgent angiography patients had thrombi (p less than 0.05 vs. both early and late elective angiography patients). There was no difference in the frequency of complex coronary morphology among patients randomized to early angiography (42%, or 15 of 36), late urgent angiography (42%, or five of 12), and late elective angiography (38%, or nine of 24). Cardiac events (death, myocardial infarction, and urgent revascularization) were more frequent in the patients with coronary thrombus (73%, or 23 of 32), complex coronary morphology (55%, or 16 of 29), and multiple-vessel disease (58%, or 29 of 50) than in the patients without these angiographic features (17%, or eight of 46; 31%, or 15 of 49; and 7%, or two of 28, respectively; all p less than 0.05). Multiple regression analysis demonstrated that coronary thrombus was the best angiographic predictor of cardiac events. Thus, angiographic detection of intracoronary thrombi varies according to the temporal relation between angiography and chest pain at rest.

ST segment shift in unstable angina: pathophysiology and association with coronary anatomy and hospital outcome

The significance of ST segment shift with respect to coronary anatomy and hospital outcome was evaluated in 135 patients with unstable angina. ST shift was evident in 44% of patients on admission electrocardiogram (ECG) and in 66% on Holter monitor ECG. During hospitalization, 7% of patients had myocardial infarction, 4% died and 34% had urgent coronary revascularization. By comparing patients with and without ST shift on admission ECG, an unfavorable outcome was found in 55% versus 25% (p less than 0.005), multivessel disease in 77% versus 63% (p less than 0.05) and left main coronary artery stenosis in 22% versus 7% (p less than 0.025). When patients with and without ST shift on Holter monitor ECG were compared, an unfavorable outcome was found in 48% versus 20% (p less than 0.005), multivessel disease in 76% versus 54% (p less than 0.01) and left main coronary stenosis in 18% versus 4% (p less than 0.05). The duration of ST shift was also greater in patients with 1) unfavorable outcome (129 +/- 136 versus 52 +/- 111 min, p less than 0.01); 2) multivessel disease (98 +/- 129 versus 36 +/- 90 min, p less than 0.01); and 3) left main stenosis (150 +/- 147 versus 67 +/- 114 min, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Tissue plasminogen activator: Toronto (TPAT) placebo-controlled randomized trial in acute myocardial infarction

The efficacy and safety of recombinant tissue plasminogen activator (rt-PA) administered on a dosing per weight basis was evaluated in a randomized, placebo-controlled, double-blind trial in 115 patients with acute myocardial infarction. The principal outcomes were global and regional left ventricular function in the distribution of the qualifying myocardial infarction, determined 9 days after the onset of symptoms. Global and regional ejection fraction values were significantly better for patients treated with rt-PA than for placebo-treated patients (the differences were 5.8 +/- 2.7% units [p = 0.017] and 7.1 +/- 3.1% units [p = 0.012], respectively). This benefit was also evident from visual assessment of left ventricular segmental wall motion. After adjustment for differences in important prognostic variables at baseline, the estimates of treatment effect were 4.0 +/- 2.4% units (p = 0.048) for global and 4.3 +/- 2.6% units (p = 0.047) for regional ejection fraction. Early patency of the infarct-related vessel was demonstrable in 7 (29%) of 24 placebo-treated patients and 18 (78%) of 23 rt-PA-treated patients, whereas 15 (56%) of 27 patients in the placebo group and 23 (72%) of 32 in the rt-PA group had a patent infarct-related vessel at hospital day 9. There was no significant difference in irreversible or reversible defect size as assessed by thallium scintigraphy on day 7.(ABSTRACT TRUNCATED AT 250 WORDS)

Regulation of the S100 protein and GFAP genes is mediated by two common mechanisms in RT4 neuro-glial cell lines

RT4-AC cells express both neuronal and glial properties and undergo cell-type conversion in culture to three distinct derivatives, described as either neuronal-like or glial-like. A coordinate induction of glial fibrillary acidic protein (GFAP) and S100 protein and GFAP gene expression is coordinately induced by cAMP. In addition, for the first time we provide direct evidence that the ability to express both the S100 and GFAP genes is conserved with cell-type conversion to the glial derivative cell types, but is coordinately lost with conversion to the neuronal derivative cell types. These results make it highly likely that the GFAP and S100 genes are regulated by two common mechanisms in RT4-AC cells: (1) cAMP-mediated control of gene expression; and (2) a mechanism that allows these two genes to be coordinately expressed or not expressed as a consequence of cell-type conversion.

Changes in jugular venous flow velocity after coronary artery bypass grafting

The factors underlying postoperative jugular venous flow velocity and pulse contour changes were studied in 25 patients undergoing coronary artery bypass grafting. Before operation, all patients had normal right-sided cardiac hemodynamics, normal jugular pulse contours and normal jugular venous flow velocity patterns, i.e., systolic flow (SF) velocity greater than diastolic flow (DF) velocity. After operation, jugular venous flow velocity was abnormal in 24 patients (SF = DF in 14 and SF less than DF in 10). Neither the right-sided cardiac pressures after the operation nor any of the perioperative factors examined had any bearing on these flow alterations. Postoperative right ventricular ejection fraction was normal in all 5 patients with SF greater than DF and SF = DF flow patterns (mean +/- standard error of the mean 48 +/- 3%). It was significantly depressed in all 6 patients with SF less than DF flow pattern (34 +/- 1%, 2p less than 0.001). These findings suggest that the right atrium behaves as a conduit rather than a capacitance chamber. However, the postoperative abnormal flow pattern of SF less than DF as opposed to SF = DF indicates the additional presence of right ventricular dysfunction. The implications of these observations for the clinical assessment of right ventricular function in the postoperative patients are discussed.

Role of resting thallium201 perfusion in predicting coronary anatomy, left ventricular wall motion, and hospital outcome in unstable angina pectoris

We performed quantitative thallium scintigraphy in 66 unstable angina patients, 5.6 +/- 5.1 hours after rest pain, to predict coronary anatomy, left ventricular wall motion, and hospital outcome. Thallium defects and/or washout abnormalities were present in 5 of 10 (50%) patients with coronary stenoses less than 50%, 27 of 33 (82%) patients with coronary stenosis greater than or equal to 50% and no history of previous myocardial infarction, and in 23 of 23 patients (100%) with histories of previous infarction. Defects were uncommon in the territory of vessels with less than 50% (13 of 61, 21%), but significantly more common in the territory of vessels with greater than or equal to 50% stenosis (57 of 137, 42%), p less than 0.005. With the addition of washout abnormalities to defect analysis, sensitivity for detection of coronary stenoses improved to 67% (92 of 137), p less than or equal to 0.005, but specificity fell to 59% (36 of 61), p less than 0.01. Segmental wall motion abnormalities were less common in segments with normal perfusion (21%) or in those with washout abnormalities alone (19%), than in segments with thallium defects (45%, p less than 0.005). Defects in patients with previous infarction were common in both segments, with normal (26 of 66, 40%) or abnormal (24 of 45, 53%) wall motion. Eleven of 18 patients with in-hospital cardiac events, but no history of myocardial infarction, had resting thallium defects, whereas only 8 of 25 patients without cardiac event had thallium defect (p = 0.056).(ABSTRACT TRUNCATED AT 250 WORDS)

Usefulness of exercise electrocardiography and thallium scintigraphy in unstable angina pectoris in predicting the extent and severity of coronary artery disease

The safety and efficacy of exercise electrocardiography and thallium scintigraphy early in the course of unstable angina pectoris were assessed 4.6 +/- 1.6 days after admission in 67 patients with unstable angina that stabilized after medical therapy. Coronary arteriography was performed in all patients 5.4 +/- 2.4 days after admission. There was no difference in clinical, exercise or scintigraphic variables between patients with stenoses less than 50% and patients with 1-vessel coronary artery disease (CAD) defined as a diameter stenosis greater than or equal to 50%. Patients with 3-vessel CAD had a significantly shorter exercise duration than patients with less than 50%-diameter narrowing (5.5 +/- 2.2 vs 8.3 +/- 3.3 minutes, respectively), lower exercise heart rate (119 +/- 20 vs 149 +/- 22 beats/min) and systolic blood pressure (156 +/- 29 vs 166 +/- 33 mm Hg), more frequent chest pain (76 vs 20%) and more pronounced ST depression (-1.48 +/- 1.37 vs -0.33 +/- 0.72 mm). In addition, thallium defect size on exercise was greater in the patients with 2-vessel CAD (159 +/- 132 degrees) and 3-vessel CAD (255 +/- 132 degrees) than in patients with no CAD (28 +/- 319 degrees) or 1-vessel CAD (73 +/- 78 degrees), p greater than or equal to 0.05. Multiple regression analysis demonstrated that thallium defect size was the best predictor of extent of CAD, with exercise heart rate and presence of chest pain during exercise also predictive of extent of CAD.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiographic morphology in unstable angina pectoris

Complex morphology occurs frequently in unstable angina; however, its relation to symptomatic presentation, timing of angiography and hospital outcome has not been investigated. Accordingly, coronary angiography was performed 5 +/- 2 days after qualifying rest pain in 101 consecutive patients presenting with acute coronary insufficiency (n = 67) or crescendo angina (n = 34). Significant coronary artery disease was defined as any greater than or equal to 50% stenosis, and complex morphology as any stenosis with irregularity, overhang or thrombus. Eight of the 67 patients presenting with acute coronary insufficiency later proved to have a myocardial infarction as the qualifying event (creatine kinase twice normal with elevation of MB fraction). There were no myocardial infarctions in the crescendo angina group. Complex morphology occurred in 61% of patients. Thrombus alone occurred in 27% of patients with unstable angina without myocardial infarction, with similar frequencies between the 2 clinical groups. In contrast, intraluminal thrombi were identified in 78% of patients with acute coronary insufficiency who later proved to have a myocardial infarction as the qualifying event. The need for urgent catheterization (less than 48 hours) prompted by recurrent symptoms was associated with the angiographic findings of intraluminal thrombus (46%) and complex morphology (83%). The presence of complex morphology and intracoronary thrombus was associated with a higher incidence of in-hospital cardiac events, i.e., revascularization, myocardial infarction and death, independent of the incidence of multivessel disease.

Induction and segregation of glial intermediate filament expression in the RT4 family of peripheral nervous system cell lines

We have found glial fibrillary acidic protein (GFAP), the major component of astrocyte intermediate filaments, to be expressed in cell lines of the RT4 peripheral neurotumor family. The RT4 family is a "stem-cell-like" cell line, RT4-AC, that spontaneously undergoes differentiation in culture to three derivative cell types. This process, termed cell-type conversion, results in a segregation among the derivative cell types of parental cell phenotypes that have been described as neuronal-like or glial-like. We have identified a 50-kDa GFAP-immunoreactive cytoskeletal protein and GFAP mRNA in continuous RT4-AC and RT4-D (glial-type derivative) cell lines, but not in two presumptive neuronal-type cell lines. This result suggests that GFAP gene expression is coordinately coupled with the expression of other glial properties during cell-type conversion. In addition, the RT4-AC and RT4-D sublines were found to significantly express GFAP only at high cell densities and not during logarithmic growth and to express GFAP precociously during morphological differentiation following treatment with 1 mM N6, O2'-dibutyryladenosine 3',5'-cyclic monophosphate. These observations closely reflect reports of glial filament expression in astrocyte cultures, suggesting that a common regulatory mechanism is employed by central and peripheral nervous system glia.

Effects of subsidising bus travel on the occurrence of road traffic casualties

Between 1975 and 1 April 1986, public transport by bus in the metropolitan county of South Yorkshire, England, was increasingly subsidised. Trends in road traffic accident casualties between 1974 and 1983 in all the six provincial English metropolitan counties have been compared in order to examine the possible effect of this unique subsidy on the incidence of road traffic accident casualties. During that period the total number of casualties in South Yorkshire did not change significantly compared to the other metropolitan counties. However, the proportion of all casualties in South Yorkshire who were bus occupants did increase relative to other metropolitan counties, indicating either an increase in the amount of bus travel or a decrease in travel by other modes. There was a large increase in bus patronage in South Yorkshire relative to the other metropolitan counties, and the conclusion is that it is the transport policy in South Yorkshire which resulted in an actual increase in distances travelled by bus. Since bus is the safest form of road travel, it is concluded that the public transport subsidy in South Yorkshire has benefited the health of the local population by providing the social amenity of additional travel at the least additional health cost.

Quantitative analysis of stress thallium-201 myocardial scintigrams: a multicenter trial

Previously we validated a method for quantification of 201TI myocardial stress distribution and washout in which the patient's stress and washout circumferential profiles are compared with observed normal limits. The present study reports the results of a multicenter trial in which this method, utilizing normal limits from our institution, was employed to evaluate the presence, location, and extent of coronary artery disease (CAD). The normal limits utilized were generated from 49 patients having a low likelihood of CAD. The study population included 157 patients from four centers in the United States and Canada as well as a comparative prospective population from Cedars-Sinai Medical Center (CSMC) of 51 patients with CAD, 30 patients with normal coronary arteriograms, and 30 additional low-likelihood normals. The results in the combined centers regarding overall detection of CAD revealed a sensitivity of 84% and a frequency of test normality in the patients with low likelihood of CAD of 88%, compared to a sensitivity of 82% and true normalcy rate of 83% obtained in the prospective CSMC population. The sensitivity for detecting disease increased according to the extent of angiographic CAD in both the multicenter sites and the prospective CSMC group. Regarding localization of disease, similar sensitivities and specificities for detecting disease in individual coronary arteries were found in the multicenter sites and the prospective CSMC population. The results indicate that our method for quantifying 201TI stress-redistribution scintigrams utilizing standard normal limits can be applied at other institutions using a variety of scintillation cameras with similar accuracy to that currently obtained at our institution.

Lipoprotein lipase and hepatic lipase deficiencies associated with impaired chylomicron clearance in D-(+) galactosamine hepatitis

D-(+) galactosamine (GaIN) produces a reversible from of hepatic injury in the rat, accompanied by alterations in morphology and composition of plasma lipoproteins in the fasting state. Lipoprotein lipase (LPL) and hepatic lipase (HL) activities were measured in fasting control and GaIN rats 24 hr after GaIN injection and initiation of fasting. Significant (p less than 0.001) deficiencies of both enzymes were noted in GaIN animals as compared to controls with LPL activity decreasing to 37.6% and HL activity to 23.2% of control values in GaIN animals. Serial enzyme determinations performed in both GaIN and control animals after gastric fat loading revealed an early persistent HL deficiency (p less than 0.025) at 9 hr after GaIN injection and initiation of fasting which persisted after the fat loading at 15 hr, and a later appearing LPL deficiency (p less than 0.025) was noted at 24 hr after GaIN injection and at 9 hr after fat loading. Serial compositional studies of plasma lipoproteins in pooled specimens after a gastric fat load revealed a marked chylomicronemia in GaIN animals compared to controls which reached a maximum at 12 hr after fat loading. A slight increase in VLDL (very low density lipoprotein) triglyceride and total cholesterol (CH) and a late-appearing (16 hr after fat loading) LDL (low density lipoprotein) CH peak, consisting mostly of unesterified CH, were also noted in GaIN rats as compared to control animals. These data demonstrate a defect in chylomicron (CM) catabolism in GaIN hepatopathy in the rat which is probably secondary to the observed severe LPL and HL deficiencies, although other factors such as activator deficiency, plasma inhibitory substances, and a defective CM particle may be important.

Comparison of upright and supine bicycle exercise in the detection and evaluation of extent of coronary artery disease by equilibrium radionuclide ventriculography

Upright and supine multiple gated cardiac blood pool scintigraphy was performed at rest and during maximum exercise in 37 patients, 15 with normal coronary arteriograms, 12 with coronary artery disease (CAD) without myocardial infarction (MI), and 10 with CAD and previous MI. Heart rate and systolic blood pressure were similar during upright and supine exercise in normal patients, but were significantly lower during supine exercise in both CAD groups. Left ventricular (LV) ejection fraction (EF), right ventricular (RV) EF, and LV segmental wall motion were similar in the upright and supine positions at rest or during maximum exercise within each group and showed high concordance of exercise responses. Although LV end-diastolic volume increased in all three groups during upright exercise and in both CAD groups when exercised supine, it did not change during supine exercise in patients without CAD. The fall of LV end-systolic volume in normals was greater during supine exercise than during upright exercise. LV end-systolic volume rose in the CAD patients in both positions. Therefore, although LVEF, RVEF, and LV segmental wall motion responses are similar in the upright and supine positions, LV end-systolic and LV end-diastolic volume changes are not. For detecting and evaluating CAD, the two different positions of exercise appear to have similar diagnostic content.

Improvement in global and segmental left ventricular function after coronary bypass surgery

Ventricular function was assessed at rest and during exercise by multiple gated cardiac blood pool scintigraphy before and after coronary artery bypass surgery in 21 patients. Resting left and right ventricular ejection fraction and segmental wall motion were unchanged by surgery. However, the postoperative exercise response of left ventricular ejection fraction (-1 +/- 12% vs 6 +/- 9%) and segmental wall motion score (medium -2.7 [range -8 to 2] vs -0.4 [range -6 to 2]) were significantly improved (p less than 0.05). The normal right ventricular ejection fraction exercise response was maintained after surgery. Previous myocardial infarction in 15 patients did not attenuate the observed improvement in ventricular function. In addition, normal postoperative left ventricular ejection fraction response to exercise was associated with symptomatic improvement. In three of six patients a normal preoperative left ventricular ejection fraction response to exercise was not maintained. Therefore, global and regional left ventricular reserve is improved by coronary bypass surgery and this improvement is not affected by previous myocardial infarction.

Improved assessment of inferior segmental wall motion by the addition of a 70-degree left anterior oblique view in multiple gated equilibrium scintigraphy

Conventional anterior and 45-degree left anterior oblique (LAO) views are limited in the evaluation of inferior segmental wall motion by multiple gated equilibrium cardiac blood pool scintigraphy. This study evaluated the addition of a 70-degree LAO view by comparing scintigraphic and contrast ventriculography in 25 patients, of whom 17 demonstrated abnormal inferior wall motion. Abnormal inferior wall motion was correctly identified in only 10 of 17 patients in the anterior view, but in 16 of 17 patients in the 70-degree LAO view. The number of assessable inferior segments was improved from 58% in the anterior view to 98% in the 70-degree LAO view. When the inferior segments could be visualized in the anterior view, inferior wall motion was accurately assessed. The addition of the 70-degree LAO view aids in the multiple gated equilibrium scintigraphic detection of inferior wall motion abnormalities with a minor loss in specificity.

Randomness, redundancy and repair: roles and relevance to biological aging

In this paper, some of the key findings of the last decade will briefly be surveyed and, where possible, be related to two separate computer simulation models which have been designed to determine the validity of certain widely accepted dogmas and to define the limits and restrictions imposed by attrition of or ambiguity of information retrieval from information storage systems. It is known: (1) that the idealized rectangular survival curve in an "ideal" environment is an extrapolation that is inconsistent with reasonable primary assumptions; (2) that loss of redundant copies of functional "housekeeping" genes may well be a dominant contributor to human senescence; and (3) that redundancy, particularly of informational storage, not only confers greater stability on an organism in dealing with stochastic or programmed age changes, but that it also provides a means through which a more optimized use of informational storage space may be attained.

Progesterone-binding components of chick oviduct: partial purification and characterization of a calcium-activated protease which hydrolyzes the progesterone receptor

A calcium (Ca2+)-activated protease has been purified from laying hen oviducts. This enzyme can catalyze the limited proteolysis of the native chick oviduct progesterone receptor subunits, A and B, to smaller hormone-binding fragments. The protocol used has resulted in a 2000-fold purification of the enzyme in 40% yield from hen oviduct postmitochondrial supernatant fractions. This resulted in an active, purified protease preparation which can be used as an analytical tool for studying receptor protein structure. Characterization of the purified enzyme has shown that it is activated by Ca2+ (0.5-1 mM), has a molecular weight of 113 000, and has a sedimentation value of 6 S. No effect of calmodulin (Ca2+-dependent regulator) could be shown on the enzymatic activity of the protease. The enzyme has a Km of 1.04 x 10(-8) M for the receptor protein substrate. The protease is inactivated by sulfhydryl attacking reagents and thus can be classified as a sulfhydryl protease. This protease exhibits remarkable similarities to the "receptor transforming factor (RTF)", a Ca2+-activated protease which performs a limited proteolysis on the calf uterine estrogen receptor [Puca, G. A., Nola, E., Sica, V., & Bresciani, F. (1977) J. Biol. Chem. 252, 1358].

Propranolol withdrawal in angina pectoris: a prospective study

In a prospective study, 100 consecutive patients (mean age 51.3 years) with angina pectoris had propranolol abruptly discontinued 24 to 144 hours (mean 39.0 hours) prior to elective coronary arteriography. The mean duration of therapy was 8.2 months and the mean daily propranolol dose was 216.1 mg. New York Heart Association Class II, III and IV symptoms were present in 30, 41, and 29 patients and one, two, or three coronary arteries were more than 50 per cent narrowed in 37, 29, and 34 cases, respectively. Three patients experienced minor increases in chest pain and two suffered non-transmural myocardial infarctions prior to the time of scheduled cessation of therapy. The same number of minor and major complications occurred in the post-withdrawal period. All four patients who developed non-transmural myocardial infarction in this study had pre-existing Class IV symptoms. The course of the remaining 90 patients was uneventful. These findings do not support the concept of a rebound propranolol withdrawal reaction.

Alpha-adrenoceptor-mediated coronary artery spasm

Selective coronary arteriography performed on a 41-year-old woman with angina pectoris demonstrated proximal stenosis of the right and left main coronary arteries that was unaffected by nitrate therapy. To exclude coronary artery spasm, the study was repeated, and a striking increase in the narrowing of the right coronary artery was observed. This 90% stenosis was virtually abolished by pretreatment with intravenously given phentolamine hydrochloride. Prolonged alpha-adrenoceptor blockade with phenoxybenzamine hydrochloride improved the patient's exercise tolerance and postexercise electrocardiographic abnormalities when compared to therapy in matched controls given placebo. These observations suggest that alpha-adrenoceptor-mediated coronary artery spasm may mimic organic lesions at coronary arteriography and may be a factor in the pathogenesis of angina pectoris in some patients.