Inhibition of leukocyte leukotriene B4 production by an olive oil-derived phenol identified by mass-spectrometry

We have evaluated the effects of hydroxytyrosol (HT), a potent antioxidant present in olive oil, on the formation of arachidonic acid 5-lipoxygenase metabolites by leukocytes in vitro. HT, a simple phenolic compound, extracted from first-pressure oil, was isolated by HPLC and characterized by gas chromatography/mass spectrometry. HT inhibited in a dose-related manner the production of leukotriene B4 (LTB4) by calcium ionophore-stimulated leukocytes. As expected, similar inhibition was observed for omega-oxidized metabolites of LTB4, namely 20-hydroxy and 20-carboxy-LTB4. The results disclose a new biological activity of olive oil-derived phenols on leukocyte eicosanoid production.

Additional approaches to DNA typing of skeletal remains: the search for "missing" persons killed during the last dictatorship in Argentina

DNA typing techniques are among the most advanced tools for human identification and can contribute to the identification of poorly preserved skeletal remains. Ten thousand people are thought to have been killed during the last dictatorship in Argentina (1976-1983) and there are few official records on the identity of the victims or the location of burials. A mass grave containing 340 skeletons was excavated using archeological methods. A small number of individuals was identified by traditional forensic methods and one family group by mitochondrial DNA (mtDNA) analysis. Due to the lack of antemortem physical information on many of the victims, the application of molecular methods is imperative to speed up the identification process. We have tested two molecular screening methods, Y chromosome-specific short tandem repeats (DYS19, DYS385, DYS389 I, DYS389 II, DYS390, DYS391, DYS392, DYS393) and amplification of autosomal microsatellites using nested primers. These methods can complement solely matrilineal mtDNA sequence data in the identification of "missing" persons.

Early and late results of ascending aorta surgery: risk factors for early and late outcome

This study was designed to evaluate risk factors for in-hospital mortality and midterm survival in patients undergoing ascending aorta surgery at a single institution during an 11-year period. Between 1984 and 1994 a total of 158 patients underwent an ascending aorta procedure at our institution. Their mean age was 59.6 +/- 12.3; 115 (73%) were male, 33 (21%) had a history of congestive heart failure, 61 (39%) had an acute type A dissection, 21 (13%) underwent redo operations, and 55 (35%) were operated on an emergency basis. In-hospital mortality was 9.7% (10/103) for elective procedures and 36.4% (20/55) for emergency operations (p < 0.0001). Multivariable stepwise logistic regression analysis identified the cardiopulmonary bypass time [odds ratio (OR) = 1.01/min, p = 0.0021], emergency operation (OR = 2.27, p = 0.0022), arch replacement (OR = 2.71, p = 0.0067), and the need of femoral vein cannulation at intervention (OR = 1.89, p = 0.0375) as independent predictors of in-hospital death. When this kind of analysis was performed, evaluating only the variables known before surgery, acute type A dissection (OR = 2.21, p = 0.0009) and preoperative NYHA class (OR = 1.88 per class, p = 0.0290) were independent risk factors for in-hospital death. Follow-up ranged from 10 to 126 months (median 42 months), with Kaplan-Meier survivals of 69 +/- 4%, and 60 +/- 5% at 5 and 7 years, respectively; survival rates for hospital survivors were 85 +/- 4% and 67 +/- 7% at 5 and 7 years, respectively. Cox regression analysis has identified arch replacement [relative risk (RR) = 2.48, p < 0.0001], perioperative myocardial infarction (RR = 2.44, p = 0.0003), preoperative NYHA class (RR = 1.97 per class, p = 0.0009), acute type A aortic dissection (RR = 1.44, p = 0.0238), the need of femoral vein cannulation at intervention (RR = 1.55, p = 0.0332), and redo operation (RR = 1.44, p = 0.0851) as independent predictors of reduced survival at follow-up. When this kind of analysis was performed on hospital survivors only, postoperative tracheostomy (p = 0.0003, RR = 3.42), reexploration for bleeding (p = 0.0003, RR = 3.77), and the occurrence of postoperative ventricular arrhythmias (p = 0.0007, RR = 2.45) emerged as risk factors. Multiple factors affect the early and late outcome after ascending aorta surgery; our data suggest that the preoperative clinical status of the patients and the priority of surgery and aortic dissection are the main determinants of the early results; on the other hand, the early postoperative course is the main determinant of the late outcome of hospital survivors.

[Cellular viability and immune response in homologous cryopreserved cardiac valves]

BACKGROUND

Long-term durability of homograft valves is related to cellular viability and immunological compatibility. In this paper, we carry out a critical update of the relationship between cellular viability and immunology of cryopreserved homograft valves.

BIOLOGICAL ISSUE

In the first section, we review the theoretical background of the superior durability of cryopreserved valves with high cellular viability, with respect to the "fresh" antibiotic-stored valves, with lower viability rates. Afterwards, a brief review of the principal factors influencing the homograft valve viability rate during harvesting, preparation, sterilization and cryopreservation phases, is performed.

CELLULAR VIABILITY

In the second paragraph, we analyze the problem of cellular viability in cryopreserved valves, both for matrix cells--fibroblast--and for endothelium. In particular, we report the current methods of quantifications of viability and more recent biological researches. Correlations between biological and clinical data are also discussed.

IMMUNOLOGICAL ISSUE

Finally, the immunological issue and its relationships with cellular viability is analyzed, with particular regard to experimental evidence and clinical implications. Moreover, we have described the recent hypothesis on the influence of cryopreservation on the antigenicity of tissues, and the laboratory researches on the long-term antibody response in humans after homograft valve implantation.

Transcellular metabolism of leukotriene A4 by rabbit blood cells: lack of relevant LTC4-synthase activity in rabbit platelets

The objective of this study was to determine the transcellular metabolism of leukotriene A4 by rabbit blood cells. mixed peripheral blood leukocyte preparations with and without platelets in a ratio of 1:40 were challenged with the Ca(2+)-ionophore A23187. 5-Lipoxygenase metabolites production was assessed by RP-HPLC coupled with diode-array UV detection. In light of the observation that leukotriene C4 production in leukocyte-platelet coincubation was the same as with leukocytes alone, mixed coincubation of human and rabbit blood cells was tested. Rabbit leukocytes with human platelets resulted in a significant increase of leukotriene C4 production, while no changes were observed in human leukocytes with or without rabbit platelets. In agreement with these results, intact rabbit platelets or rabbit platelet lysates, unlike human platelets, were not able to convert synthetic leukotriene A4 free acid to leukotriene C4. These data provide evidence that rabbit leukocytes are able to make a significant amount of leukotriene A4 available for transcellular metabolism, while rabbit platelets, unlike human platelets, lack leukotriene C4-synthase activity.

Simultaneous determination of ITF 296 and two metabolites in plasma by a validated HPLC method

A simple and sensitive HPLC validated method was developed for the simultaneous determination of ITF 296 (a new orally active nitrate) and its metabolites ITF 1124 and ITF 1577 in biological samples. Quantitation was performed by peak height ratios between the three compounds and the internal standard (ITF 1721). Detection limit of the method was 0.005 microgram/ml using 1 ml of plasma. The results indicated that the method is reproducible, accurate, precise, sensitive and specific for the measurement of the three compounds in plasma samples. Those characteristics allowed us to conclude that the method is suitable for analysing samples obtained after administration of ITF 296 to humans at therapeutic dosage and to animals for formulation studies.

Pharmacological modulation of human platelet leukotriene C4-synthase

The aim of this study was to test if human platelet leukotriene C4-synthase (LTC4-S) is pharmacologically different from cloned and expressed LTC4-S and, in light of the significant homologies between 5-lipoxygenase activating protein (FLAP) and LTC4-S, if different potencies of leukotriene synthesis inhibitors acting through binding with FLAP (FLAP inhibitors) reflect in different potencies as LTC4-S inhibitors. Leukotriene C4 (LTC4) synthesis by washed human platelets supplemented with synthetic leukotriene A4 (LTA4) was studied in the absence and presence of two different, structurally unrelated FLAP inhibitors (MK-886 and BAY-X1005) as well as a direct 5-lipoxygenase inhibitor (zileuton). LTC4 production was analyzed by RP-HPLC coupled to diode array detection. We report that human platelet LTC4-S was inhibited by MK-886 and BAY-X1005 (IC50 of 4.7 microM and 91.2 microM, respectively), but not by zileuton (inactive up to 300 microM); all 3 compounds were able to inhibit 5-lipoxygenase metabolite biosynthesis in intact human polymorphonuclear leukocytes (IC50 of 0.044 microM, 0.85 microM, and 1.5 microM, respectively). Platelet LTC4-S does not appear pharmacologically different from expression cloned LTC4-S. LTC4-S inhibition by FLAP inhibitors is in agreement with the significant homology reported for expression-cloned LTC4-S with FLAP, Furthermore, functional homology of the binding sites for inhibitors on LTC4-S and FLAP is suggested by the conservation of the relative potencies of MK-886 and BAY-X1005 vs FLAP-dependent 5-lipoxygenase activity and LTC4-S inhibition: MK-886 was 19.3-fold more potent than BAY-X1005 as FLAP inhibitor and 19.6-fold more potent than BAY-X1005 as LTC4-S inhibitor.

Effects of warm ischemia on valve endothelium

BACKGROUND

This study investigates the time-dependent resistance of the endothelium of porcine aortic and pulmonary valves to different periods of warm ischemia (WIT).

METHODS

Twenty-five 9-month-old swine were divided after death into five groups of WIT (0, 6, 12, 24, and 36 hours). Aortic and pulmonary valves were removed and a total of 15 aortic and 15 pulmonary valve specimens were obtained for each WIT interval. Valves were then examined for (1) their viability rate by the trypan blue dye exclusion method at light microscopy (percent of viability compared with 0 hours of WIT); (2) ultrastructural signs of irreversible or reversible ischemic damage by transmission electron microscopy (cell disruption, dilation of endoplasmic reticulum, cytoplasmic edema, nuclear and mitochondrial changes); (3) endothelial function by pharmacologic evaluation of both the endothelial-releasing capacity of prostacyclin and the endothelial-dependent dynamic responses to relaxing (acetylcholine from 1 x 10(-10) mol/L to 1 x 10(-4) mol/L) in aortic and pulmonary valve segments precontracted with norepinephrine (1 x 10(-6) mol/L) and contracting (NG-monomethyl-L-arginine, 1 x 10(-4) mol/L) drugs.

RESULTS

Our results showed an endothelial progressive time-dependent ischemic injury, which reached significance after 12 hours of exposure. Viability and functional data indicated that 6 hours of WIT only provoked slight endothelial damage (p > 0.05 respect to time 0 hours), with signs at transmission electron microscopy consistent with a reversible injury. At 12 hours of exposure, we observed a significant reduction (p < 0.05) with respect to time 0 of the viability rate of prostacyclin production and of the endothelium-dependent dynamic responses to acetylcholine and NG-monomethyl-L-arginine. These functional impairments, although significant, were not consistent, however, with a complete loss of viability. Transmission electron microscopic observations confirmed the appearance of signs of irreversible injury; nevertheless, some elements were found to be well preserved or presented reversible damage. After 24 hours of WIT, ultrastructural and functional data were consistent with a dramatic decrease compared with controls in endothelial viability and functions (p < 0.01). Finally, after 36 hours of WIT, there was a subtotal loss of viability, of functions (p < 0.001) and, at transmission electron microscopic observations, of the endothelial layer of the valves.

CONCLUSIONS

Our data show that the endothelial cells are resistant to short periods of WIT (up to 6 hours), and suggest that these cells can endure longer exposures, up to 12 hours of warm ischemia. Periods of 24 and 36 hours of WIT provoke progressive irreversible damage.

Endothelial cells as target for antiphospholipid antibodies. Human polyclonal and monoclonal anti-beta 2-glycoprotein I antibodies react in vitro with endothelial cells through adherent beta 2-glycoprotein I and induce endothelial activation

OBJECTIVE

To investigate the ability of human anti-beta 2-glycoprotein I (anti-beta 2 GPI) antibodies to recognize the cofactor adherent on endothelial cells (EC) and to modulate endothelial functions.

METHODS

Six human affinity-purified polyclonal anti-beta 2 GPI IgG and 2 IgM monoclonal antibodies (MAb) were obtained from patients with the antiphospholipid syndrome. The antibodies were tested for their ability to 1) bind to endothelial monolayers through the adherent beta 2 GPI and 2) modulate endothelial adhesion molecule expression and interleukin-6 (IL-6) and 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) secretion.

RESULTS

The affinity-purified IgG and the MAb with anti-beta 2 GPI activity, but not the respective controls, displayed EC binding, which declined on cells incubated in serum-free medium and was restored in a dose-dependent manner by exogenous human beta 2 GPI. After EC binding, both polyclonal and monoclonal antibodies up-regulated adhesion molecule expression. Anti-beta 2 GPI MAb also significantly increased IL-6 and 6-keto-PGF1 alpha secretion.

CONCLUSION

These findings support the hypothesis that anti-beta 2 GPI antibodies bind and activate EC through the adherent cofactor beta 2 GPI, likely leading to a procoagulant state.

Treatment of childhood Hodgkin's disease with COPP or COPP-ABV (hybrid) without radiotherapy in Nicaragua

BACKGROUND

Childhood Hodgkin's disease (HD) in low-income countries has been reported to have distinct presenting features, including a high prevalence of the mixed cellularity subtype, which also seems to be associated with poorer prognosis. Further investigations are needed to evaluate these issues. Another controversial aspect of childhood HD is the use of radiotherapy (RT) in its treatment and the growing concern about its serious adverse side effects. In this paper, data on the diagnosis and outcome of children treated without RT in a low-income country (Nicaragua) are reported.

PATIENTS AND METHODS

Forty-eight consecutive children aged 0-15 years, diagnosed at 'La Mascota' Hospital of Managua (Nicaragua) from January 1990 to October 1995. entered this study. Follow-up was updated in May 1996. Clinical and histopathological staging was performed according to Ann Arbor and Rye criteria, respectively. Treatment consisted of COPP (six cycles) for stages I or IIA, or COPP-ABV hybrid): eight cycles for stages IIB or III, and ID cycles for stage IV. Total cumulative doses of adriamycin and bleomycin in this protocol are, respectively, 200 and 80 mg:sqm for stages II B or III and 250 and 100 mg/sqm for stage IV.

RESULTS

The median age of the 48 patients at diagnosis was seven years, and the mean age was 7.9 years (range 3-15 years). Clinical stages were IA in 5, IIA in 9, IIB in 6, IIIA in 5, IIIB in 14, and IVB in 9. Histopathologically, 25 cases presented with mixed cellularity, 15 with nodular sclerosis, 5 with lymphocytic predominance and 3 with lymphocytic depletion. Four patients did not proceed with treatment and were lost to follow-up. Two patients (stages IIIB and IVB), who never achieved complete remission (CR) during treatment, presented progressive disease at the end of the scheduled chemotherapy. The remaining 42 patients were in complete remission at the end of chemotherapy. Following discontinuation of therapy, one patient (stage IA) was lost to follow-up and two patients with stage IIIB, who were in CR after the second chemotherapy cycle, relapsed 20 and 9 months following the diagnosis. EFS at three years is 100% for the 25 patients with stages I, II, IIIA and 74.9% for the 23 patients with stages IIIB or IV.

CONCLUSION

The presenting features found in these patients are similar to those reported from other low-income countries. In our experience, however, the high prevalence of the mixed cellularity subtype was not associated with poorer prognosis. Satisfactory results have been achieved in patients with stages I, II or IIIA HD using COPP or COPP-ABV (hybrid) regimens without RT. The treatment was also well tolerated and can thus be recommended for these patients in low-income countries, where RT facilities may be scarce or unavailable. The use of more aggressive treatment schedules and/or RT on involved fields in front-line treatment may, however, be needed for the more advanced stages IIIB or IV. Large studies with adequate follow-up are needed to evaluate whether, if RT is omitted, higher cumulative doses of more toxic drugs are required and thus compare the long-term toxic effects of different treatment modalities.

HPLC determination of ITF 188 and its metabolite ITF 1078 in urine after intranasal administration of new heparin salt ITF 1300 to dogs

Heparin salt ITF 1300 in which low molecular weight heparin is salified with a new counterion, di-[3-(N,N-dibutylamino)]propyl carbonate (ITF 188), was selected for the pharmacological development. A specific, sensitive and reproducible HPLC method for the determination of ITF 188 and its alcoholic metabolite ITF 1078 in urine was developed. The method was employed for the study of urinary excretion of the counterion after intranasal administration of ITF 1300 to dogs. The total amount of ITF 188 and ITF 1078 found in urine within 72 hours after the nasal instillation of ITF 1300 accounts for about 5% of the administered dose.

Cyclooxygenase-2 and synthesis of PGE2 in human bronchial smooth-muscle cells

The purpose of this study was to determine the mechanism of enhanced prostaglandin synthesis in cultured human bronchial smooth-muscle cells challenged with interleukin-1 beta (IL-1 beta). Cells were incubated with IL-1 beta (10 to 50 U/ml) for 0 to 24 h. Prostaglandin E2 (PGE2) production was evaluated through the conversion of exogenous (14C)-arachidonic acid and specific enzyme immunoassay of endogenous products. IL-1 beta enhanced PGE2 formation in a concentration- and time-dependent manner, reaching its peak at 6 to 8 h and fading at 18 to 24 h. Immunoblot analysis showed that the inducible cyclooxygenase enzyme (COX-2) was expressed only in IL-1 beta treated cells, whereas the constitutive isoform of cyclooxygenase (COX-1) remained unaltered. COX-2 expression and PGE2 formation were inhibited by dexamethasone (2 microM), cycloheximide (10 microM), and IL-1-receptor antagonist (IL-1 ra) (250 ng/ml), independently. PGE2 synthesis was significantly reduced by compound SC-58125, a specific COX-2 inhibitor. The close parallelism between the kinetics of COX-2 protein expression and PGE2 accumulation, as well as the constitutive nature of COX-1 isoform, indicate that IL-1 beta-driven PGE2 formation in human bronchial smooth-muscle cells is mediated by de novo expression of COX-2 enzyme.

Nitric oxide modulation of transcellular biosynthesis of cys-leukotrienes in rabbit leukocyte-perfused heart

1. We have studied the role of nitric oxide (NO) in the regulation of the transcellular biosynthesis of sulphidopeptide leukotrienes (cys-LT) generated upon neutrophil-vascular wall interactions and their functional consequences, in the spontaneously beating, cell-perfused, heart of the rabbit. 2. Hearts were perfused under recirculating conditions (50 ml) with 5 x 10(6) purified human neutrophils (PMNL), and challenged with 0.5 microM A-23187 for 30 min. Coronary perfusion pressure (CPP) and left-ventricular end-diastolic pressure (LVEDP) were monitored. Cys-LT formation was measured by reversed phase high performance liquid chromatography (h.p.l.c.) and u.v. spectral analysis. Myeloperoxidase (MPO) enzyme activity, assayed in aliquots of the recirculating buffer, was used as a marker of PMNL, adhesion to the coronary endothelium. 3. Basal CPP and LVEDP values averaged 45 +/- 1.4 mmHg and 5 +/- 0.1 mmHg, respectively; A-23187 triggered an increase in CPP (134 +/- 9 mmHg, at 30 min) which was significantly attenuated by pretreatment with L-arginine, 100 microM (90 +/- 3 mmHg, at 30 min). Pretreatment with NG-monomethyl-L-arginine, 10 microM (L-NMMA), induced a marked increase in CPP (290 +/- 40 mmHg, at 20 min) and in LVEDP (47 +/- 16 mmHg), so pronounced that it caused cardiac arrest in systole in 5 out of 6 hearts and these were prevented by L-arginine, 100 microM, (CPP 115 +/- 10 mmHg, LVEDP 6 +/- 1.1 mmHg, at 30 min). 4. The increase in CPP was accompanied by the release of cys-LT in the circulating buffer, which was reduced significantly by L-arginine. Pretreatment with L-NMMA, caused a marked rise in cys-LT concentrations which was prevented by L-arginine. 5. Neither L-arginine nor L-NMMA affected directly the A-23187-induced arachidonic acid (AA) metabolism in isolated PMNL alone. 6. Pretreatment with L-NMMA caused a prompt drop in myeloperoxidase (MPO), activity, suggesting rapid adhesion of PMNL to the coronary wall; this effect was significantly blunted by L-arginine. 7. This study suggests that NO provides cardioprotection in an organ model of transcellular metabolism of cys-LT by preventing PMNL adhesion to the coronary intima.

Surgery of descending thoracic aortic aneurysms with centrifugal pump support

Fifty-five patients with descending thoracic aortic aneurysms were operated upon between October 1987 and October 1994. All patients were supported by a centrifugal pump during operation. The mean(s.d.) duration of cross-clamping was 39(13) min. In order to evaluate the efficacy of the centrifugal pump, haemodynamic and metabolic measurements were made on four occasions (before cross-clamping, immediately after cross-clamping and before cross-clamp removal) and again after cross-clamp removal. The haemodynamic data remained stable throughout the procedure: central venous pressure (15(4.6) versus 16(4.8) versus 16(4.6) versus 15(4.6) mmHg; P = n.s.), pulmonary artery pressure (25(6.2) versus 24(5.1) versus 22(5.3) versus 23(4.4) mmHg; P = n.s.), radial systolic pressure (119(19.9) versus 116(25.2) versus 111(25.9) versus 111(20.7) mmHg; P = n.s.) and heart rate (75(12.6) versus 77(14) versus 76(15.6) versus 78(16) beats/min; P = n.s.). The acid-base status deteriorated slowly during surgery. Values before and after cross-clamping were: pH (7.42 (0.04) versus 7.37(0.06); P < 0.05), base excess (-0.67(2.20) versus -3.70(2.50); P < 0.05) and bicarbonates (24(8.9) versus 20(1.9); P < 0.05). The cerebrospinal fluid pressure remained constant: 20(5.7) versus 19(5.9) versus 18(5) versus 19(5) mmHg; P = n.s. Renal function, measured before, and at 1, 3 and 7 days after the operation also remained stable (creatinine: 1.1(0.4) versus 1.2(0.4) versus 1.2(0.4) versus 1.2(0.4); P = n.s.; blood urea nitrogen: 46(18.7) versus 46(18.6) versus 51(24.9) versus 55(27.9); P = n.s.). Step-wise multiple linear regression comparing cerebrospinal fluid pressure against haemodynamic and metabolic data showed that during aortic cross-clamping there was a significant relationship between central venous pressure (P < 0.0013) and arterial pH (P < 0.0148), while before and after cross-clamping multivariate analysis showed a relationship only between central venous pressure and cerebrospinal fluid pressure (P < 0.0035). The results confirm that centrifugal pump support is effective in stabilizing haemodynamics and protecting the kidney during thoracoabdominal aneurysm repair.

Activation of human B-MYB by cyclins

B-MYB expression is associated with cell proliferation and recent studies have suggested that it promotes the S phase of mammalian cells. Based on its homology to the transcription factors c-MYB and A-MYB, B-MYB is thought to be involved in transcriptional regulation; however, its activity is not detectable in several cell lines. It was postulated that B-MYB function may depend on the presence of a cofactor, and recent studies suggested that B-MYB is phosphorylated specifically during S phase in murine fibroblasts. In this report we provide evidence that the product of the human B-myb gene can be activated in vivo by coexpression with cyclin A or cyclin E. Transfection studies showed that B-MYB was a weak transcriptional activator in SAOS-2 cells and was unable to promote their proliferation. In contrast, overexpression of both B-MYB and cyclin A or cyclin E caused a drastic increase in the number of SAOS-2 cells in S phase. Also, overexpression of cyclin A and cyclin E in SAOS-2 cells enhanced the ability of B-MYB, but not c-MYB, to transactivate various promoters, including the cdc2 promoter, the HIV-1-LTR, and the simian virus 40 minimal promoter. A direct role for cyclin-dependent activation of B-MYB was demonstrated using an in vitro transcription assay. These observations suggest that one mechanism by which cyclin A and E may promote the S phase is through modification and activation of B-MYB.

The retinoblastoma family member p107 binds to B-MYB and suppresses its autoregulatory activity

It was recently reported that B-MYB can overcome p107-induced growth arrest. Here we show that B-MYB autoregulation of its own transcription is specifically suppressed by p107 and transient transfection assays with p107 deletion constructs determined that the carboxyl terminus of the protein, containing the major pocket region, was associated with inhibition of B-MYB-dependent transactivation. Consistent with these results, co-immunoprecipitation studies showed that p107 interacted in vivo with B-MYB through its pocket and carboxyl terminus domain. Thus, B-MYB-dependent promotion of cell proliferation and gene transactivation might be specifically repressed by the growth suppressor p107 through direct interaction with B-MYB.

Physico-chemical parameters of nitrate esters. A contribution to the choice of a candidate for preclinical development

Physico-chemical parameters of new nitrate esters were carried out in order to contribute to the choice of a drug candidate for preclinical development. Thermal analysis (DSC), wettability and solubility of the compounds were investigated in this study.

Myocardial revascularization procedures on multisegment diseased left anterior descending artery: endarterectomy or multiple sequential anastomoses (jumping)?

Complete revascularization is the primary goal in coronary surgery because of its superior long term results. However, in some patients the extent of the coronary artery disease is such that the usual coronary bypass technique may not allow to perform a complete myocardial surgical revascularization and, consequently, a satisfactory myocardial perfusion: so complementary revascularization techniques may become mandatory, especially when the diseased vessel is LAD or its branches. As a consequence, alternative procedures should be undertaken: coronary endarterectomy (EA) and multiple sequential anastomoses on a single vessel (jump), which guidelines are actually somehow controversial. Between January, 1989, and May, 1992, 53 patients underwent a myocardial revascularization procedure on LAD system unsuitable for single distal bypass; of them 35 (66%) underwent coronary endarterectomy, while in 18 (34%) multiple sequential anastomoses (jumping) were performed on the same vessel. About preoperative variables, average NYHA class (2.7 jump vs 2.1 EA group, p < 0.05), the history of more than 1 myocardial infarction (22.2% jump vs 2.9% EA, p < 0.04) and the presence of preoperative nitrates e.v (33.3% vs 8.6%, p < 0.04) were statistically higher in the jump group, suggesting a more unstable clinical status, while other clinical echocardiographic and catheterization features were not statistically different. For what operative and postoperative features are concerned, the number of anastomoses performed was statistically higher in the jump group, as exasperated (3.8 vs 2.7, p < 0.002) while perfusion (138 vs 141 min) and crossclamp time (103 vs 106 min) were similar. Furthermore we found a statistically lower incidence of perioperative myocardial infarction (0% jump is 22.8% EA group, p < 0.04); the postperfusion inotropic drugs requirement (22.2% vs 37.1%), the need of an intraaortic counterpulsation (0% vs 2.9%) and the in-hospital mortality (0% vs 5.7%) were lower in the jumping group too, also if they didn't reach statistical significance. Our experience suggest, also with the limits imposed by a retrospective case review and by a low number of cases reported, that myocardial revascularization of a multisegment diseased LAD system may be safely performed with the jumping technique with a low incidence of postoperative complications: it should be the first choice technique when conventional revascularization procedures are not enough to achieve complete myocardial revascularization. We advocate the use of EA technique only in that cases characterized by a diffuse atherosclerotic core and a well delimited plane of dissection, associated to a very poor runoff, which really excludes any chance to multiple anastomoses.

Consequences of transcellular biosynthesis of leukotriene C4 on organ function

Formation of eicosanoids is a special mode of cell communication whereby production of eicosanoids by mixed cell populations differs from that expected from each individual cell. Transcellular biosynthesis of leukotriene C4 occurs via transfer of the reactive intermediate leukotriene A4 from neutrophils to vicinal acceptor cells devoid of 5-lipoxygenase activity such as platelets or vascular cells. Evidence for the in vivo relevance of transcellular eicosanoid metabolism results from experiments using the isolated beating rabbit heart perfused with activated neutrophils. The resultant leukotriene C4 synthesis is timely related to the pressor response of the coronary arteries and inflammatory damage of the heart by edema formation and neutrophil infiltration into the organ. Blockade of leukotriene C4 synthesis by 5-lipoxygenase inhibitors or leukotriene C4 actions by respective receptor antagonists facilitated significant protective effects. Further confirmation of the potential role of LTC4 in myocardial ischemia comes from in vivo studies in the rabbit.

Bone marrow transplantation for refractory Langerhans' cell histiocytosis

Langerhans' cell histiocytosis (LCH) is an uncommon disorder of childhood, formerly referred to histiocytosis X. A significant proportion of children with disseminated disease may undergo progression to a fatal outcome despite chemotherapy with single or multiple agents. Only six cases of LCH treated with BMT have been reported in the literature, including two cases of autologous BMT. Of them, only one was less than 14 years of age. We describe a 4-year-old child whose disseminated, refractory Langerhans' cell histiocytosis was not controlled by front-line monotherapy with etoposide, nor by rescue treatment with combined chemotherapy (vinblastine and etoposide) and immunotherapy (steroids and cyclosporine). Due to the high risk of fatal progressive disease, he underwent bone marrow transplantation from his HLA-identical sister who was heterozigous for beta-thalassemia. On day 24 after transplantation marrow reconstitution was evident, with WBC count 2.3 x 10(9)/L, neutrophil count > 0.5 x 10(9)/L, and platelet count 72 x 10(9)/L. Engraftment was demonstrated by PCR DNA analysis. The patient was discharged on day 25. After transplantation he experienced fever for 11 days and developed signs of grade I cutaneous and intestinal graft-versus-host disease, that was treated with methylprednisolone from days 11 to day 68 (1 mg/kg/day for 18 days, then tapered). He became transfusion independent on day 24; the hemoglobin value was 7.5 g/dL on day 54 and has remained > 10 g/dL since day 200. Features of heterozygous beta-thalassemia have been evident since then. Bone marrow aspirate was normal on days 25 and 94. At the time of this writing he remains in excellent condition, disease and treatment free, 25 months after transplantation. Although limited, current experience suggests that bone marrow transplantation has the potential to cure refractory Langerhans' cell histiocytosis.

Release of leukotriene A4 versus leukotriene B4 from human polymorphonuclear leukocytes

The reactive intermediate formed by 5-lipoxygenase metabolism of arachidonic acid, leukotriene A4, is known to be released from cells and subsequently taken up by other cells for biochemical processing. The objective of this study was to determine the relative amount of leukotriene A4 synthesized by human polymorphonuclear leukocytes (PMNL) that is available for transcellular biosynthetic processes. This was accomplished by diluting cell suspensions and measuring the relative amounts of enzymatic versus nonenzymatic leukotriene A4-derived metabolites after challenge with the Ca2+ ionophore A23187. Nonenzymatic leukotriene A4-derived metabolites were used as a quantitative index of the amount of leukotriene A4 released into the extracellular milieu. The results obtained demonstrated that in human PMNL, the relative amounts of nonenzymatic versus enzymatic leukotriene A4-derived metabolites increased with decreasing cell concentrations. After a 20-fold dilution of PMNL in cell preparations, a doubling in the amount of nonenzymatic leukotriene A4-derived metabolites was observed following challenge (from 53.9 +/- 1.3 to 110.4 +/- 8.9 pmol/10(6) PMNL, p < 0.01). Reduction of possible cell-cell interactions by dilution suggested that over 50% of leukotriene A4 synthesized is released from the PMNL. These data provide evidence that, in human PMNL preparations, transfer of leukotriene A4 to neighboring PMNL is taking place, resulting in additional formation of leukotriene B4 and its omega-oxidized metabolites 20-hydroxy- and 20-carboxy-leukotriene B4. Neutrophil reuptake of extracellular leukotriene A4 leads to an underestimation of the fraction of leukotriene A4 that is in fact available for transcellular metabolism when tight cell-cell interactions occur, such as during PMNL adhesion to the microvascular endothelium and diapedesis.

Leukotriene A4, and not leukotriene B4, is the main 5-lipoxygenase metabolite released by bovine leukocytes

The production of leukotriene A4 (LTA4)-derived metabolites, analysed by RP-HPLC, was studied in purified bovine polymorphonuclear leukocyte (PMNL) preparations and in PMNL-platelet coincubations after challenge with the calcium ionophore A23187. The results obtained show that in bovine PMNL LTB4 represents the main LTA4 metabolite. When washed platelets were added to PMNL, LTC4 was the main enzymatic metabolite observed, indicating a substantial transfer of PMNL-derived LTA4 to platelets. The synthesis of LTC4 was accompanied by a significant decrease in LTB4, suggesting that a quota of the LTB4 synthesized in PMNL preparations is the result of transcellular metabolism of released LTA4 by neighbouring PMNL. Reduction of PMNL-PMNL interactions through dilution of cell incubates allowed us to estimate that most of the leukotriene A4 synthesized by PMNL is indeed released from the cell. LTA4, and not LTB4, represents the main 5-lipoxygenase metabolite released by bovine PMNL.

Apoptotic response to oncogenic stimuli: cooperative and antagonistic interactions between c-myb and the growth suppressor p53

c-myb, a protooncogene prevalently expressed in the hematopoietic tissue, is a transcription factor that contains a DNA-binding domain and an acidic domain and is able to transactivate specific viral and cellular genes. In this report, we show that c-myb can stimulate apoptosis in both the murine promyelocytic 32D and the human osteosarcoma SAOS2 cell lines when coexpressed with p53. Apoptosis is accompanied by increased transactivation of the cell death-associated BAX gene. This effect is c-myb specific, because B-myb is not able to cooperate with p53 in the induction of BAX transcription and apoptosis. Immunoprecipitation studies and gel shift analysis indicate that c-myb does not directly interact with the BAX promoter or the p53 protein but, rather, cooperates through an indirect mechanism. Consistent with the existence of a functional link between c-myb and p53, we also observed that c-myb represses p53-induced activation of the WAF-1 promoter and induces proliferation of SAOS2 cells growth arrested by p53. These results might contribute to the elucidation of the mechanisms underlying p53-dependent pathways of oncogene-induced apoptosis and provide a further example of DNA-binding independent myb activity.

Vasoconstriction to polymorphonuclear leukocytes in the isolated, perfused rabbit heart: inhibition by prostacyclin mimetics

Perfusion of the isolated rabbit heart with 5 x 10(6) human polymorphonuclear leukocytes (PMNL), under recirculating conditions (50 ml) and challenge with A-23187 (0.5 mu M) increased coronary perfusion pressure (CPP) sixfold, accompanied by increased levels of sulfidopeptide leukotrienes (CY-SLT), which had previously shown to correlate linearly with the increase in CPP. Pretreatment (20 min) of isolated rabbit hearts with the prostacyclin (PGI(2)) analogue iloprost (3 nM) resulted in significant protection against the increase in CPP and in almost complete inhibition of 5-lipoxygenase (5-LO) product synthesis. Similarly, pretreatment of isolated rabbit heart with defibrotide (200 mu g/ml), a polydeoxyribonucleotide derivative known to inhibit PMNL activation and enhance PGI(2) production by heart endothelial cells, produced significant protection against the increase in CPP and almost complete inhibition of 5-LO product synthesis. Neither iloprost nor defibrotide affected the A-23187-induced arachidonic acid (AA) metabolism in isolated PMNL alone. Inhibition of rabbit cyclooxygenase by intravenous (i.v.) administration of lysine-acetylsalicylate (60 mg/kg) 2 h before the animals were killed significantly reduced the protection provided by defibrotide, with a parallel fivefold increase in sulfidopeptide LT levels, returning to values in the range observed in control hearts. Control of endogenous modulators of leukocyte-vascular wall interactions such as PGI(2) results in significant changes in sulfidopeptide LT production in an organ model of transcellular metabolism of LT A(4), suggesting a novel mechanism of action for cardioprotective drugs in myocardial ischemia.

B-myb promotes S phase and is a downstream target of the negative regulator p107 in human cells

The retinoblastoma protein family has been implicated in growth control and modulation of the activity of genes involved in cell proliferation, such as B-myb. Recent evidence indicates that the product of the B-myb gene is necessary for the growth and survival of several human and murine cell lines. Upon overexpression, B-myb induces deregulated cell growth of certain cell lines. Here we show that B-myb overexpression is able to induce DNA synthesis in p107 growth-arrested human osteosarcoma cells (SAOS2). p107 might exert its growth-suppressive activity by regulating B-myb gene transcription. Indeed, p107 down-modulated B-myb promoter activity and drastically decreased E2F-mediated transactivation. Finally, B-myb was able to stimulate DNA synthesis of both stably and transiently transfected human glioblastoma cells (T98G). Altogether, these data provide definitive evidence that the human B-myb protein is involved in growth control of human cells, and that p107 has a significant role in regulating B-myb gene activity.

Nasal neutrophilia and release of myeloperoxidase induced by nasal challenge with platelet activating factor: different degrees of responsiveness in atopic and nonatopic subjects

BACKGROUND

Nasal challenge with platelet activating factor (PAF) is able to induce local neutrophilia, with a different degree of responsiveness in atopic subjects and in nonatopic subjects. We investigated whether nasal accumulation of neutrophils induced by PAF is accompanied by the release of neutrophil-derived mediators.

METHODS

Nasal lavages were performed before and after challenge with PAF (500 nmol), lyso-PAF (500 nmol), and saline solution in 10 patients with allergic rhinitis and 10 normal subjects to evaluate changes in neutrophil counts and the release of myeloperoxidase (MPO) and immunoreactive leukotriene B4.

RESULTS

PAF caused neutrophilia, which appeared after 30 minutes in atopic subjects and after 3 hours in nonatopic subjects. Furthermore, when compared with saline insufflation, PAF caused a significant release of MPO in the nasal lavage fluids collected 30 minutes, 3 hours, and 24 hours after challenge in atopic subjects and 3 hours after challenge in nonatopic subjects, with higher values in the former than in the latter. Neutrophil counts correlated with MPO levels in the nasal lavages collected after PAF challenge. A lower degree of neutrophilia was found 3 hours after stimulation with lyso-PAF in both groups of subjects, with a marginal release of MPO in atopic subjects only. No significant increase of immunoreactive leukotriene B4 levels in nasal lavages was found after challenge with either PAF or lyso-PAF.

CONCLUSION

These results indicate that PAF-induced neutrophilia in the nose is accompanied by the release of MPO, which appears earlier and is more marked in atopic subjects than in nonatopic subjects.

[Evaluation of the effectiveness of arterial hypertension control in a primary health unit]

The present study is part of a performance evaluation of the Aging Health Care Program carried out at a Primary Health Care Clinic. Activities for Arterial Hypertension (AH), control oriented according to a risk assessment, in conformity with Ministry of Health norms, are included in the Program mentioned. The effectiveness of the reduction of blood pressure (BP) levels in hypertensive individuals subjected to programmatic activities for disease control, in an attempt to identify conditions association with that reduction, is evaluated. Of the 396 patients with AH registered under the Program between 01/01/92 and 06/30/93, 250 cases were included for this evaluation. These patients had, in addition to high blood pressure levels (BP > or = 160/95 mm Hg) on the first attendances at the health center (before registration in the programme), at least two medical consultations during program follow-up. The differences in blood pressure levels between measurements taken during consultations before the beginning of attendance at the program and those taken on the first attendances to the programme were analysed according to initial blood pressure level, age, sex, registering diagnosis and absences during the program follow-up. Reductions of > or = 5 mm Hg diastolic blood pressure (DBP) and/or > or = 10 mm Hg in systolic blood pressure (SBP) were obtained in 197 (78.8%) patients. The mean reduction was 8.8 mm Hg (sd = 11.4) for DBP and 17.7 mm Hg (sd = 18.6) for SBP. Results of several epidemiological studies allow the inference that a decrease in the mortality risk from Cardiovascular Disease can be achieved in a significant proportion of the individuals registered in the program. Blood pressure normalization according to program norms occurred in 111 (44.4%) individuals. Multiple linear regression analysis demonstrated that initial blood pressure and percentages of absenteeism during the follow-up were independently associated with the reductions in SBP and DBP. Age was independently associated only with the reductions in SBP. Participation of age and percentage of absenteeism during follow-up thus reveal that the final result of the programmed work is also a result of the different ways people take care of their own health.

[Heart surgery, cardiopulmonary bypass and inflammatory response. I. Changes in hemostasis and complement]

The use of cardiopulmonary bypass for surgical cardiac procedures is characterized by a whole-body inflammatory reaction due to the contact of blood through nonendothelialized surfaces; this stimulates the organism to recognize the cardiopulmonary bypass system as "nonself" and to activate specific (immune) and nonspecific (inflammatory) responses. These responses are then related with postoperative damage to many body systems, like pulmonary, renal or brain dysfunction, excessive bleeding and postoperative sepsis. In this paper, present knowledge on untoward responses of the patient to the use of cardiopulmonary bypass in cardiac surgery is reviewed and discussed, particularly focusing on the perturbation of the hemostasis and of the complement activation system.

Role of right gastroepiploic artery in myocardial revascularization with arterial grafts

Between July 1990 and December 1992. 112 patients underwent myocardial revascularization with arterial grafts in the Department of Cardiac Surgery, University of Milan. Monovascular patients were excluded from the study. The right gastroepiploic artery was used in 44 patients (39.3%); mean age was 54.3 years and reoperation rate 18.2%. Of the 44 patients, previous myocardial infarction had occurred in 25 (57%). Emergency operation was performed in one case (2%). Mean left ventricular shortening fraction was 36% and mean ejection fraction 58.6%. Coronary artery disease was bivascular in 10 patients (23%) and trivascular in 34 (77%). The arterial revascularization in patients with gastroepiploic artery was performed using a left internal thoracic artery graft in all 44 patients; the right internal thoracic artery was used in 18 (41%) and the inferior epigastric artery in two (4%). The sites of gastroepiploic artery grafting were 55% posterior descending, 16% right coronary artery, 11% posterolateral branch, 14% circumflex and in 4% posterior descending and posterolateral as sequential graft. No patient died; postoperative myocardial infarction rate was 4%. No complications related to gastroepiploic artery utilization were noted. Forty-three (98%) of the gastroepiploic artery group underwent graft reinvestigation: the arteries were correctly visualized in 41 patients (95%) and were patent in 39 cases and stenotic in two. A mid-term postoperative stress test (mean 17.4 months) was performed in 91% of patients. Normal limits were found in 37 patients (92.5%) and an abnormal stress test result in three (7.5%). The contemporary follow-up showed no deaths or myocardial infarctions. Three patients (7%) had recurrent angina. The role of gastroepiploic artery in arterial revascularization has become fundamental, especially, it is believed, for the posterior or posterolateral left ventricular wall. The present data show the patients to be clinically and functionally well 1 year after operation.

Morphological and functional changes of coronary vasculature caused by transcellular biosynthesis of sulfidopeptide leukotrienes in isolated heart of rabbit

Morphological and functional modifications occurring in Langendorff rabbit heart preparations perfused with purified human leukocytes (PMNL), as an organ model of sulfidopeptide-leukotrienes (sLT) transcellular biosynthesis, were studied. Coronary perfusion pressure (CPP), monitored as an index of coronary vasospasm, increased by 295% after challenge with the Ca(2+)-ionophore A-23187 (0.5 micromol/L) for 30', accompanied by a significant formation of sLT. Increase in CPP was prevented by PMNL pretreatment with the 5-lipoxygenase inhibitor MK-886 (1 micromol/L) or by heart pretreatment with LTD4-receptor antagonist SKF 104353, indicating a pivotal role of PMNL-derived 5-lipoxygenase (5-LO) products in the observed functional modifications. Similar effects were obtained using granulocyte macrophage-colony stimulating factor-primed PMNL challenged with the tripeptide n-formyl-methionyl-leucyl-phenylalanine. Scanning electron microscopy (SEM) of coronary arteries showed craters on the vessel luminal surface, PMNL adhering to endothelial cells (EC), increased number of microvilli on EC, presence of nonviable, desquamating, fusiform EC. SEM and transmission electron microscopy of myocardial microvessels, showed presence of perivascular and intermuscle edema, presence of activated PMNL and decreased number of patent microvessels. These morphological alterations were significantly blunted by MK-886 or SKF 104353. These data provide evidence of close interaction between PMNL and myocardial EC, resulting in enhanced sLT formation via transcellular biosynthesis, originating from transfer of PMNL-derived LTA4 to EC. These potent proinflammatory autacoids are responsible for coronary vasospasm and the morphological alternations observed.

Retention of endothelium-dependent properties in human mammary arteries after cryopreservation

BACKGROUND

We investigated the effects of cryopreservation and antibiotic treatment on endothelium-dependent vasomotor properties of human internal mammary arteries (IMAs).

METHODS

Sixty IMA specimens from routine coronary artery bypass grafting procedures were randomly assigned to six groups. Group I (controls) were immediately tested after harvest. Remaining groups were prepared according to a stepwise design: group II, 6 hours of warm ischemia; group III, 6 hours of warm ischemia + 24 hours at 4 degrees C (without antibiotics); group IV, 6 hours of warm ischemia + 24 hours of 4 degrees C antibiotic disinfection; group V, 6 hours of warm ischemia + 24 hours at 4 degrees C (without antibiotics) + cryopreservation; and group VI, 6 hours of warm ischemia + 24 hours of 4 degrees C disinfection+cryopreservation. The IMA specimens were cut into rings and the tension of vascular smooth muscle was recorded. The IMA rings were contracted with norepinephrine (3 x 10(-6) mol/L) and tested with cumulative concentrations of acetylcholine (from 1 x 10(-9) to 1 x 10(-5) mol/L), contracted with endothelin-1 (from 1 x 10(-11) to 1 x 10(-6) mol/L), and contracted with the nitric oxide-synthase inhibitor NG-monomethyl-L-arginine (1 x 10(-4) mol/L). Rings were also tested for their capacity to generate 6-keto-prostaglandin F1 (the stable metabolite of prostacyclin), and endothelial cell viability rate was finally evaluated with the trypan blue dye exclusion method.

RESULTS

Our results show that a complete cryopreservation protocol does not significantly modify (p > 0.05) the relaxant activity to acetylcholine in norepinephrine-precontracted IMA rings (controls; 90.2% +/- 4.2% vs group VI, 77.1% +/- 6.2%) or the vasoconstrictor response induced by endothelin-1 (controls, 62.6% +/- 2.8% versus group VI, 73.7% +/- 4.8%) and NG-monomethyl-L-arginine (controls, 22.4% +/- 1.5% versus group VI, 18.9% +/- 1.9%). Furthermore, IMA cryopreservation does not significantly modify (p > 0.05) the endothelial release of prostacyclin either in basal conditions (-20% versus controls) or during pharmacologic intervention with acetylcholine (-18% versus controls), endothelin-1 (-17% versus controls), and NG-monomethyl-L-arginine (-18% versus controls).

CONCLUSIONS

We conclude that the IMA endothelial function does not seem significantly injured by any of the current steps of disinfection and cryopreservation.

Inhaled PGE2 prevents aspirin-induced bronchoconstriction and urinary LTE4 excretion in aspirin-sensitive asthma

Bronchial overproduction of leukotrienes and inhibition of prostaglandin synthesis are involved in the pathogenesis of aspirin-induced asthma. We investigated whether inhaled prostaglandin E2 (PGE2) attenuates the response to bronchial challenge with lysine acetylsalicylate (LASA) and the associated increase in urinary leukotriene E4 (u-LTE4) in seven aspirin-sensitive subjects with asthma. Each subject performed two challenges with a single dose of LASA that caused a decrease in FEV1 of 20% or more in a preliminary test, immediately after inhaling 100 micrograms PGE2 in 4 ml saline or placebo, according to a randomized double-blind protocol. FEV1 was recorded at 30-min intervals for 4 h. u-LTE4 was measured by combined high-performance liquid chromatography enzyme immunoassay at 2-h intervals. After placebo, LASA caused an obstructive reaction in all patients, with a maximum decrease in FEV1 of 35 +/- 5% with respect to baseline. u-LTE4 rose from 911 +/- 261 picograms (pg)/mg creatinine at baseline to a maximum value of 2249 +/- 748 after challenge. Inhaled PGE2 provided almost complete protection in all patients. Baseline u-LTE4 was 883 +/- 243 pg/mg creatinine and did not change significantly during the test, reaching a maximum value of 864 +/- 290 (p < 0.05 versus placebo). These results confirm that PGE2 is highly effective in preventing aspirin-induced asthma and suggest that this effect is mediated by inhibition of sulfidopeptide leukotriene production.

Prevalence of eating disorders in Italy: a survey on a sample of 16-year-old female students

BACKGROUND

To date, the number of epidemiological studies on eating disorders (ED) in Italy and in other Mediterranean countries is still limited. This study evaluated the eating attitudes and the prevalence of eating disorders in a sample of 359 16-year-old Italian schoolgirls.

METHODS

The study followed a two-stage procedure consisting in a first screening stage followed by clinical interviews. A third stage consisting in a case register study and a 1-year followup confirmed the importance of evaluating subjects who chose not to participate in the survey.

RESULTS

Prevalence rates found in our sample are consistent with those of other prevalence studies conducted on adolescent girls: 0% for anorexia nervosa, 0.5% for bulimia nervosa and 3.7% for ED not otherwise specified. Also some important features associated with the presence of an ED appeared to be present in Italian female students, as in Anglo-Saxon populations: the tendency towards denial that led to an overrepresentation of ED among nonrespondents, and the ascertainment that just a small proportion of people seeks help for ED. The Italian sample reported higher scores on eating attitudes test compared to Anglo-Saxon samples.

CONCLUSIONS

No evidence of different rates of ED was found in our Italian sample in comparison with non-Mediterranean samples. The importance of using a two-stage design and a third control stage in prevalence studies is emphasized by our findings.

Myocardial protection by the leukotriene synthesis inhibitor BAY X1005: importance of transcellular biosynthesis of cysteinyl-leukotrienes

Perfusion of the isolated rabbit heart with 5 x 10(6) human polymorphonuclear leukocytes, under recirculating conditions (50 ml), and challenge with A-23187 (0.5 microM) caused an increase in coronary perfusion pressure (from a prechallenge value of 46 +/- 1.1 to 176.2 +/- 29.7 mm Hg, 30 min after challenge, n = 6-4), which was linearly correlated (P < .006) with formation of cysteinyl leukotrienes (29.7 +/- 7.3 pmol/ml, 30 min after challenge). Pretreatment with the leukotriene synthesis inhibitor BAY X1005 (1 microM) (n = 6) resulted in significant protection against the increase in coronary perfusion pressure (76.7 +/- 12.8 mm Hg, 30 min after challenge) and in almost complete inhibition of sulfidopeptide leukotriene synthesis (3.2 +/- 1.7 pmol/ml, 30 min after challenge). In in vivo experiments, ligation of the left anterior descending coronary artery in the rabbit (n = 10) resulted in acute myocardial infarction marked by a mortality rate of 60% compared with sham-operated animals (n = 10). Intravenous treatment of the rabbits with BAY X1005 (10 mg/kg/h, for 2 h) (n = 10) markedly reduced the mortality rate (20%), protected the rabbits against the marked electrocardiogram derangement and abolished the significant increase in plasma creatine phosphokinase activity and cardiac tissue myeloperoxidase activity induced by coronary artery ligation. BAY X1005 exerts a significant cardioprotection and suggests that specific leukotriene synthesis inhibitors may lead to innovative therapy in myocardial ischemia.

Inhibition of erythro-myeloid differentiation by constitutive expression of a DNA binding-deficient c-myb mutant: implication for c-myb function

The c-myb proto-oncogene encodes a nuclear protein involved in the regulation of cell proliferation, differentiation, and development. Myb protein contains a DNA binding and a transactivating domain thought to mediate its biologic properties. The DNA binding domain consists of three repeats (R1, R2, and R3), each containing a highly conserved motif of tryptophan residues. A c-myb mutant (DR1-myb) lacking the last 46 amino acids of R1 and 23 amino terminal residues of R2, a region homologous to the ADA-2 yeast transcriptional adaptor, lost DNA binding ability, but remained able to transactivate the human heat-shock promoter. Transfection of murine 32D and murine erythroleukemia (MEL) cell lines with DR1-myb caused inhibition of cellular differentiation induced by granulocyte colony-stimulating factor (G-CSF) and dimethyl sulfoxide (DMSO), respectively. A second c-myb mutant (D-ADA2-myb) lacking the first 23 amino acids of R2, also lost DNA binding and transactivation activity, but did not inhibit DMSO-induced differentiation of MEL transfected cells. These findings suggest that deletion of R1 activates a DNA binding-independent mechanism of c-myb function, which may involve interaction of Myb with cellular factors.

Descending thoracic aorta aneurysmectomy: left-left centrifugal pump versus simple clamping technique

Forty-six patients who had had an elective repair of a descending thoracic aortic aneurysm were reviewed, in order to investigate the efficacy of support by a centrifugal pump on distal organ perfusion and spinal cord protection during cross-clamping of the thoracic aorta. Two concurrent groups were analysed: 36 patients (78%) were supported by left atriofemoral arterial bypass with a centrifugal pump and 10 (22%) had no distal circulatory support. No patient was fully heparinized. The demographic data and preoperative characteristics of the groups, including location and type of aneurysm, were similar. The mean(s.d.) duration of cross-clamping was 37.8 (16) min in the centrifugal pump group and 42.3(21) min in the simple clamping group. Preoperative haemodynamic and laboratory data were similar in both groups. During cross-clamping, parameters of pH and blood urea varied but were better in the centrifugal pump group; changes from pre-intervention to early aortic cross-clamping time were not significant (pH, P < 0.0006; bases, P < 0.0003). Differences in creatinine values were caused mainly by the change from pre-intervention to the first postoperative day (P < 0.03); this continued throughout the hospital stay. The cerebrospinal fluid pressure measurement indicated a significant difference in time change (P < 0.0001) and mean level over time (P < 0.0002): levels were significantly lower in the centrifugal pump group throughout aortic cross-clamping. Three patients in the simple clamping group and none in the centrifugal pump group (P < 0.02) required cerebrospinal fluid drainage.(ABSTRACT TRUNCATED AT 250 WORDS)

Mass disasters: rapid molecular screening of human remains by means of short tandem repeats typing

Human remains identification represents a challenging situation and constitutes a difficult task associated with mass disasters. The only highly efficient means for individual and family group reconstruction is that based on DNA typing. On July 18, 1994 an explosion destroyed the A.M.I.A. (Argentine Israeli Association). Over 100 people died; however, the exact number of victims is still being investigated. Our Service received over 70 remains to be characterized by DNA typing in order to determine the number of victims and to try to reconstruct the family groups to which they belonged. DNA was extracted by a cetyltrimethylammonium bromide (CTAB) based protocol, a rapid molecular screening of all samples was carried out by multiplex STR amplifications including HUMTH01, HUMFABP, HUMHPRTB, HUMRENA4, HUMVWA, HUMFES/FPS and Y27H39LR. Samples with identical genotypes were HaeIII-digested. Southern blotted and probed with YNH-24 (D2S44). PH-30 (D4S139). LH-1 (D5S110) and MS-1 (D1S7) for variable number of tandem repeats (VNTR) evaluation. The minisatellite variant repeat (MVR) approach was used in those cases in which band or profile shift were detected in Southern blot assays. Kinship between victims and putative relatives was initially evaluated by comparison of short tandem repeat (STR) profiles and then confirmed by VNTR with the above probes. The high identification efficiency attained in this case is, in part, supported by a previous experience, the DNA-based molecular characterization of human remains caused by the explosion of the Israeli Embassy in Buenos Aires, March 1992.

"Thinning-down phenomenon" and vasomotor adaptability of the inferior epigastric artery graft

We report a case of diffuse thinning of an inferior epigastric artery early after its implantation as a coronary free graft. This phenomenon showed reversibility at the 20-month angiographic follow-up in response to progression of the proximal lesion in the recipient coronary artery. Graft vasodilation in response to atrial pacing and nitroglycerin infusion at late angiography confirmed the vasomotor adaptability of this arterial conduit.

Requirement of b-myb function for survival and differentiative potential of human neuroblastoma cells

The B-myb gene belongs to a family of transcription factors that also includes A-myb and c-myb. B-myb is expressed in many cell types including human neuroblastoma cells. Here we demonstrate that B-myb expression is down-regulated during retinoic acid-induced neural and glial differentiation of neuroblastoma cells. This modulation is an early event, is maintained at late times of induction, and is in part regulated at the transcriptional level. Constitutive expression of B-myb prevents retinoic acid-induced neural differentiation as reflected by morphological features and the expression of (or lack of) biochemical markers associated with the undifferentiated phenotype. Furthermore, the expression of antisense B-myb transcripts does not allow the rescue of viable cells, suggesting an important role for B-myb in the survival of neuroblastoma cells. These results indicate that B-myb plays a functional role in the differentiative potential of neuroblastoma cells, raising the possibility that this gene is one of the nuclear regulators in the cascade of events leading to cellular differentiation.

Aortic arch surgery: pros and cons of selective cerebral perfusion. A multivariable analysis for cerebral injury during hypothermic circulatory arrest

Thirty-five consecutive patients with aortic arch aneurysm who required surgical reconstruction were operated on with the aid of extracorporeal circulation between February 1985 and December 1993. Nineteen patients (54.3%) were treated with hypothermic circulatory arrest (HCA) (Group A) and 16 (45.7%) (Group B) with HCA and selective cerebral perfusion (SCP) through the carotid arteries. Preoperative characteristics didn't show any significant differences between the two groups: mean age was 58.7 +/- 12 vs 62.1 +/- 7, p = ns, male sex 73.6% vs 75%, p = ns; atherosclerotic aneurysms were 57.8% vs 43.7%, p = ns; Type A dissections 42.2% vs 56.3%, p = ns and emergency operation were 68.4% vs 43.7%, p = ns in Groups A and B respectively. For SCP, blood was infused initially at a rate of 200-300 ml/min, maintaining the 30-40% of cerebral blood flow in normothermia, successively, with the aid of transcranial Doppler sonography (TDS) SCP-flow was improved to 500-1000 ml/min. The MHz pulsed TDS was used to measure the middle cerebral artery flow velocity in deep hypothermia before the arrest, in order to adjust the SCP flow during the HCA. In all patients we used open aortic anastomosis; in two cases an extraanatomical ascending-descending aorta was required, and in other two the "elephant trunk" technique was used in case of combined aortic arch and descending aneurysms. The HCA times were similar in the two groups 47.5 +/- 22 vs 47.7 +/- 78, p = ns. Early deaths occurred in 5 patients of the Group A (26.3%) and in 3 patients of the group B (18.7%), p = ns.(ABSTRACT TRUNCATED AT 250 WORDS)

New antianginal nitro esters with reduced hypotensive activity. Synthesis and pharmacological evaluation of 3-[(nitrooxy)alkyl]-2H-1,3-benzoxazin-4(3H)-ones

New nitro ester 3-[(nitrooxy)alkyl]-2H-1,3-benzoxazin-4(3H)-ones show marked inhibitory activity against ischemia-induced electrocardiographic changes, with only limited systemic hemodynamic effects, and are reported in the present study. These new nitro vasodilators are potent inhibitors of the electrocardiographic T-wave and S-T segment elevation induced by intravenous or intracoronary administration of Arg-vasopressin or methacholine in the anesthetized rat. The most active compounds are up to 300- and 600-fold more potent than glyceryl trinitrate or Nicorandil, respectively. These nitro esters relax in a concentration-dependent manner the isolated rabbit aorta, at higher concentrations (2-40-fold) than glyceryl trinitrate, and reduce the mean arterial blood pressure at doses 7-300-fold higher than those required by glyceryl trinitrate to exert a similar hypotensive effect. Remarkably, these compounds retain their anti-ischemic and hemodynamic profile after oral (po) administration. These new nitro ester derivatives, endowed with a marked antianginal activity, which is not associated with concurrent and pronounced falls in systemic blood pressure, represent the leads of a new class of selective nitrovasodilators having a preferential action on large coronary vessels, which could be clinically relevant in the treatment of coronary artery diseases.

The effect of "high dose" aprotinin and other factors on bleeding and revisions for bleeding in adult coronary and valve operations: an analysis of 2190 patients during a five-year period (1987-1991)

We retrospectively evaluated risk factors for postoperative bleeding and for revisions due to bleeding in 2190 adult coronary and valve patients who underwent surgery at our hospital during the 5-year period from 1987 to 1991. During this period 889 (40.6%) patients were given "high dose" aprotinin. Their mean age was 59.3 +/- 8.8 years, 1636 (74.7%) were males, 200 (9.1%) underwent surgery on an emergency basis and 72 patients (3.3%) underwent redo-operations. The patients were divided into four groups according to the type of surgery: all patients pooled together (2190), coronary artery surgery patients (1384, 63.2%, group I), valve surgery patients (706, 32.2%, group II) and combined (coronary plus valve) surgery patients (100, 4.6%, group III). Stepwise logistic regression analysis, performed to assess the risk factors for revisions due to bleeding showed aprotinin treatment to be the sole protective factor in all patients, group I and group II. In group III only the use of a hollow fiber membrane oxygenator proved a protective factor. Risk factors for revisions for bleeding were found to be aortic cross-clamp time in all patients, group I and group II. Use of the internal thoracic artery (ITA) was significant in group I patients and age at operation in group II. Multiple stepwise linear regression analysis, performed to evaluate the effect of various risk factors on cumulative postoperative blood loss in all patients, confirmed aprotinin as the only factor capable of reducing blood loss, while aortic cross-clamp time, coronary surgery and male gender showed a positive linear relation with postoperative bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)

Composite valve graft replacement of the ascending aorta and the aortic valve by a modified button technique: the influence of aortic pathology on early mortality and late survival

The risk factors for in-hospital mortality and mid-term survival in patients undergoing composite graft replacement of the aortic root with reimplant or coronary arteries by a modified button technique were evaluated with special emphasis on the underlying aortic pathology. Between 1985 and 1993 74 patients underwent replacement of the ascending aorta and the aortic valve following a modified button technique. The patients were divided into three groups according to aortic pathology: annuloaortic ectasia (43.58%), type A dissection (18.24%), and miscellaneous (13.18%). In-hospital mortality rates were 4.7%, 33.3% and 23.1%, respectively (P = 0.011). Univariate analysis showed that aortic pathology, NYHA class, emergency operation, redo operation, acute aortic dissection, preoperative cardiogenic shock, preoperative cardiac tamponade, longer cardiopulmonary bypass (CPB) and aortic cross-clamp times, and the need of femoral vein or femoral artery cannulation at intervention had univariate influence on in-hospital mortality. Multivariable stepwise logistic regression analysis identified CPB time odds ratio (OR) = 1.021/min, P = 0.007), the need of femoral vein cannulation at intervention (OR= 4.85, P = 0.008) and preoperative cardiac tamponade (OR = 3.11, P = 0.07) as independent predictors of in-hospital death. Follow-up ranged from 1 to 98 months (mean 39 +/- 30 months) with an actuarial survival rate of 75 +/- 9%, 52 +/- 13% and 67 +/- 14% at 5 years in annuloaortic ectasia, type A dissection, and miscellaneous patients, respectively (P = 0.18); when survival was evaluated in hospital survivors only, Kaplan-Meier survival rates were 77 +/- 9%, 79 +/- 14% and 89 +/- 10% at 5 years (P = 0.87). Comparing survival of annuloaortic ectasia patients (5-year survival 75 +/- 9%) versus survival of all other patients pooled together (5-year survival 55 +/- 11%), there was a statistically significant difference (P < 0.05); such a difference was no longer significant when comparing hospital survivors alone (5-year survival rate 77 +/- 9% annuloaortic ectasia patients vs 79 +/- 12% all other patients P = 0.61). Although aortic root replacement carries higher in-hospital mortality in some high-risk subgroups of patients, mid-term survival seems to be less affected by aortic pathology; high-risk patients are expected to have an out-hospital outcome comparable to the low-risk ones.

Ectopic thyroid tissue in the ventricular outflow tract: embryologic implications

The case of a 66-year-old female patient with a tumor located in the right ventricular outflow tract is reported. Histologic examination of an intraoperative biopsy revealed that the tumor was an intracardiac ectopic thyroid. We performed conservative surgery with partial resection of the mass. After 5 years, the patient is asymptomatic and leading a normal life. The authors examine the relation between the embryologic development of the primitive heart and the thyroid primordium and suggest the hypothesis of ectopic thyroid location in the right- or left-ventricular outflow tract.