Glucose, insulin and potassium for heart protection during cardiac surgery

BACKGROUND

Coronary artery bypass grafting with hypothermic cardiac arrest and cardiopulmonary bypass (CPB) is associated with myocardial injury. Our study investigated whether an infusion of glucose, insulin and potassium (GIK) during elective coronary artery bypass surgery decreases myocardial cell death.

METHODS

We measured cardiac troponin I (cTnI), a myofibrillar structural protein, which is a sensitive and specific indicator of myocytic injury. With ethics committee approval, 42 patients were enrolled into a randomized, prospective, double-blinded study. In the GIK group, 500 ml of 50% dextrose solution containing 100 IU insulin and potassium 80 mmol was infused at the rate of 0.75 ml kg(-1) h(-1). Patients in the non-GIK group received 5% dextrose solution at the same rate. Arterial blood samples were taken before induction of anaesthesia, after removal of the aortic clamp and 6 and 12 h after CPB.

RESULTS

In both groups there was an increase in cTnI concentration (P<0.05), which was greatest about 6 h after CPB. At no time did the cTnI concentration differ between the two groups.

CONCLUSION

The results suggest that GIK does not decrease the irreversible myocardial damage associated with routine coronary artery bypass surgery.

Efficacy of hair-sampling techniques for the detection of medium-sized terrestrial mammals. I. A comparison between hair-funnels, hair-tubes and indirect signs

We compared the efficacy of two different designs of hair-tube for detecting medium-sized, terrestrial marsupials in a range of forest types in south-east New South Wales. The two designs compared were a large-diameter PVC pipe (large hair-tube) and a tapered hair-funnel. In addition, the relative abundance of forage-diggings of the same marsupials was estimated simultaneously in order to provide an independent assessment of their distribution within the same study area. Only two hair-tubes out of 620 contained hair that could be attributed to the target fauna, both from the long-nosed bandicoot (Perameles nasuta). This was despite the widespread occurrence of forage-diggings at all of the 31 transects that were surveyed. Only two species of mammal, the agile antechinus (Antechinus agilis) and the bush rat (Rattus fuscipes), were detected in sufficient quantity to enable statistical analysis comparing the efficacy of the two hair-tube types. For R. fuscipes the large hair-tube was significantly more effective than the hair-funnel. Conversely, the hair-funnel was significantly more effective in detecting A. agilis than the large hair-tube. Our results suggest that both designs of hair-tube, in their current form, are ineffective for surveying for medium-sized terrestrial marsupials. We see three important issues regarding hair-tube design and implementation that require more attention before this technique can be considered an effective surveying tool: hair-tube morphology, the material used to capture hair, and bait type.

Acamprosate is neuroprotective against glutamate-induced excitotoxicity when enhanced by ethanol withdrawal in neocortical cultures of fetal rat brain

BACKGROUND

Acamprosate reduces relapse, and the drug may interact with glutamate transmission and with glutamate/NMDA receptors. Because these systems are implicated in excess calcium entry leading to alcohol withdrawal-induced neurotoxicity, we evaluated the effects of acamprosate on these parameters in neuronal cultures.

METHODS

Primary cultures of neocortical neurons from fetal Sprague-Dawley rats were maintained either in normal medium or in medium containing 100 mM ethanol for 4 days. After this time, cultures were challenged with glutamate for 10 min and then returned to medium (all in the absence of ethanol). 45Ca2+ uptake was measured during the challenge, and glutamate-induced toxicity was assessed after 20 hr. The effects of acamprosate present during the glutamate challenge were measured on both parameters.

RESULTS

In controls, acamprosate did not significantly affect glutamate-induced neurotoxicity but produced a significant inhibition of calcium entry. The NMDA receptor antagonists dizocilpine and d-amino-phosphonovalerate (D-APV) inhibited both glutamate neurotoxicity and calcium entry. In cultures previously exposed to ethanol, glutamate-induced neurotoxicity and calcium entry were both significantly enhanced. Dizocilpine reduced both these parameters to unstimulated control values, and D-APV reduced both calcium entry and neurotoxicity with the same relation that we obtained in control cultures. In the ethanol-withdrawn cultures, acamprosate reduced both the enhanced glutamate-induced calcium entry and the enhanced neurotoxicity in a concentration-dependent manner. Acamprosate also significantly reduced calcium entry caused by 80 mM K+ in control and ethanol-exposed cultures.

CONCLUSIONS

Acamprosate had protective effects against glutamate-induced neurotoxicity only in ethanol-withdrawn cultures. The neuroprotective effects of the drug did not correlate with its effects on calcium entry, making it unlikely that acamprosate directly affects NMDA receptors via the glutamate binding site or the receptor-operated calcium channel. The results are, however, compatible with other inhibitory effects on NMDA receptor function.

Mitochondrial cytochrome oxidase immunolabeling in aged human temporal bones

Presbycusis, an age-related hearing loss, is accompanied by histopathological cochlear changes including variable amounts of degeneration of the auditory receptors, neurons and the stria vascularis. The causes of degeneration are unknown, although acoustic trauma and exposure to ototoxic agents are certainly contributors to the cellular degeneration. Acquired mitochondrial DNA defects are postulated as important determinants of aging in neuromuscular tissues. The cochlear neurons are highly metabolic and are, therefore, likely to be affected by mitochondrial DNA defects. Sequence analysis has demonstrated a significant number of acquired mutations in the cytochrome oxidase gene in the neurons from aged human cochleas. The current study used immunohistochemical labeling of cytochrome oxidase in the neuronal cell bodies in archival celloidin sections to evaluate relationships among label density, hearing loss, number of neurons and mitochondrial DNA changes within individual cochleas. Label density was less in many aged temporal bones, but not all. There was no relationship among any other variables. It is concluded that while there may be a decrease in the amount of cytochrome oxidase expression in aged spiral ganglion cell bodies, there are many other factors that contribute to hearing loss and cellular degeneration.

Formulations of single or multiple H. pylori antigens with DC Chol adjuvant induce protection by the systemic route in mice. Optimal prophylactic combinations are different from therapeutic ones

The ability to induce a protective response against Helicobacter pylori infection has been investigated by systemic immunization of mice with urease formulated with the cationic lipid DC Chol. This compound acts both as a formulating agent and as an adjuvant and induces a balanced Th1/Th2 response shown to be more effective for protection in our previous studies. Urease-DC Chol induced a significant protection in prophylaxis but not in therapeutic immunization. The protection level was between 1.5 and 2 log reduction of bacterial density measured by quantitative culture compared to unimmunized-infected mice. In parallel, the protective efficacy of other H. pylori antigens formulated in a similar way and administered with DC Chol was tested. These antigens were tested alone or in combination in prophylactic and therapeutic regimens. Some combinations of antigens induced a better prophylactic or therapeutic activity than urease alone (0.5-1.5 log further reduction in prophylaxis and therapy respectively, P<0.05). The combinations that induced the best protection were different in prophylaxis and therapy. In conclusion, DC Chol provides a convenient and efficient method to formulate different antigens even when they are present in non-compatible buffers initially. Moreover, the results obtained in protection against H. pylori with such formulations should lead the way to future clinical trials.

Formulations of single or multiple H. pylori antigens with DC Chol adjuvant induce protection by the systemic route in mice. Optimal prophylactic combinations are different from therapeutic ones

The ability to induce a protective response against Helicobacter pylori infection has been investigated by systemic immunization of mice with urease formulated with the cationic lipid DC Chol. This compound acts both as a formulating agent and as an adjuvant and induces a balanced Th1/Th2 response shown to be more effective for protection in our previous studies. Urease-DC Chol induced a significant protection in prophylaxis but not in therapeutic immunization. The protection level was between 1.5 and 2 log reduction of bacterial density measured by quantitative culture compared to unimmunized-infected mice. In parallel, the protective efficacy of other H. pylori antigens formulated in a similar way and administered with DC Chol was tested. These antigens were tested alone or in combination in prophylactic and therapeutic regimens. Some combinations of antigens induced a better prophylactic or therapeutic activity than urease alone (0.5-1.5 log further reduction in prophylaxis and therapy respectively, P<0.05). The combinations that induced the best protection were different in prophylaxis and therapy. In conclusion, DC Chol provides a convenient and efficient method to formulate different antigens even when they are present in non-compatible buffers initially. Moreover, the results obtained in protection against H. pylori with such formulations should lead the way to future clinical trials.

Storybook-based communication intervention for girls with Rett syndrome and their mothers

PURPOSE

Storybook reading provides a natural language learning context in which to support early symbolic communication. In this study, we explored the impact of (1) resting hand splints, (2) light tech augmentative communication systems such as voice-output devices and symbols, and (3) very basic parent training on the symbolic communication and labelling behaviours of six girls with Rett syndrome.

METHOD

Mothers and daughters were videotaped as they read familiar and unfamiliar storybooks in their homes.

RESULTS

Group and individual data collected from the six girls indicated that they became more active and successful participants in the interactions during storybook reading. The girls employed a wider range of communication modes and increased the frequency of their labelling. Familiar storybook reading encouraged greater symbolic communication than unfamiliar storybooks in half the girls.

CONCLUSION

This study suggests that motivated parents may not require expensive technologies or lengthy training in order to enhance their children's early communication and participation in storybook reading.

The impact of antidepressants on sleep and anxiety: a comparative study of fluoxetine and dothiepin using the Leeds Sleep Evaluation Questionnaire

Fluoxetine (20 mg) was compared to dothiepin (150 mg) in a multicentre, prospective, double blind, randomised clinical trial involving 125 patients with major depression treated for an initial phase of 6 weeks and then followed up for a further 6 months. There was no difference in the efficacy of the two drugs based on the results of established rating scales (MADRS, HAM-D, BPRS). The impact of both drugs on sleep measured using the Leeds Sleep Evaluation Questionnaire showed no significant differences between treatments, however drowsiness and disturbed sleep were reported more frequently as side effects with dothiepin. Symptoms of anxiety responded equally well to both treatments. The short term and long term tolerability of dothiepin was inferior to that of fluoxetine. The place of dothiepin in treatment should be reassessed in the light of its anticholinergic adverse event profile, particularly in the elderly. Copyright 2000 John Wiley & Sons, Ltd.

Conventional physiotherapy and treadmill re-training for higher-level gait disorders in cerebrovascular disease

OBJECTIVES

to compare the therapeutic effects of two approaches to gait re-training--a schedule of conventional physiotherapy and treadmill re-training--in patients with higher-level gait disorders associated with cerebral multiinfarct states.

DESIGN

single-blind crossover study involving a 4-week baseline period, 4 weeks of treadmill re-training and 4 weeks of conventional physiotherapy.

SETTING

a large teaching hospital.

SUBJECTS

patients with cerebral multi-infarct states who met the criteria for higher-level gait disorders. Computed tomographic brain scans showed at least one large vessel infarct, basal ganglia and white matter lacunes or extensive leukoaraiosis.

INTERVENTIONS

a schedule of treadmill re-training and a specific schedule of physiotherapy containing 31 interventions in three treatment modules: (i) for gait ignition failure and turning; (ii) to improve postural alignment and enhance balance reactions; and (iii) for other components of cerebral multi-infarct state disordered gait.

MAIN OUTCOME MEASURES

spatial and temporal gait measures and activity of daily living assessments.

RESULTS

we recruited 18 patients, mean (SD) age 79.1 (6.8) years. Patients walked an average of 7.9 (5.5) km on the treadmill and had an average of 6.7 (3.2) h of physiotherapy. There were clinically moderate but highly statistically significant (P < 0.001) improvements in the following indices: time taken to complete the sit-to-stand test; time taken to walk 10 m; number of steps over 10 m; walking velocity; right and left step lengths; and time taken to complete the 'S' test. There were no differences in the results obtained in each limb of the study.

CONCLUSION

there is no difference between the effects of conventional physiotherapy and treadmill re-training on the gait of patients with higher-level gait disorders associated with cerebral multi-infarct states. However, the improvements seen during the treatment period suggest that there is scope to improve the gait of this group of frail, elderly patients.

'Infront outback' goes national

The National Rural Health Alliance, the Toowoomba Hospital Foundation and the Cunningham Centre have agreed to merge the two biennial conferences for rural and remote health that have been running in alternate years since 1991. This means that in March 2001, the National Rural Health Conference will, for the first time, incorporate 'Infront Outback', the Australian Rural and Remote Health Scientific Conference. There will, therefore, be one major biennial rural heath conference, dealing coherently with health scientific research and policy development. The recommendations to governments and national bodies that result should be even stronger and more highly regarded than has been the case to date.

An actuarial procedure for assessing risk with juvenile sex offenders

Assessments of juvenile sexual offenders that are intended to aid in dispositional decisions occur at a multitude of decision points within the juvenile justice system. Despite the ubiquity of decisions that include considerations of risk, relatively little empirical work has been done on the development and validation of a risk assessment procedure for these young offenders. In this article, we discuss our initial efforts in developing and validating an actuarial risk assessment protocol for juvenile sex offenders using a sample of 96 adolescents that had been admitted, treated, and discharged from the Joseph J. Peters Institute. We conclude with a critical discussion of problems associated with evaluating risk in this population, and of deficiencies and revision requirements in the present protocol.

Progress in Arabidopsis genome sequencing and functional genomics

Arabidopsis thaliana has a relatively small genome of approximately 130 Mb containing about 10% repetitive DNA. Genome sequencing studies reveal a gene-rich genome, predicted to contain approximately 25000 genes spaced on average every 4.5 kb. Between 10 to 20% of the predicted genes occur as clusters of related genes, indicating that local sequence duplication and subsequent divergence generates a significant proportion of gene families. In addition to gene families, repetitive sequences comprise individual and small clusters of two to three retroelements and other classes of smaller repeats. The clustering of highly repetitive elements is a striking feature of the A. thaliana genome emerging from sequence and other analyses.

Unequal representation of the temporal and nasal retina in an anomalous projection to the lateral thalamus

Study of an anomalously regenerated, nontopographically organized retinal projection in the frog olfactory cortex revealed that the temporal retina is the main source of this projection, suggesting the existence of specific temporal fiber-directed attractant or trophic influences. In the present study, we examined the organization of an anomalous retinal projection that forms in the frog thalamus after ablation of the optic tectum. The projections from different sectors of the retina were studied by means of the anterograde transport of biotinylated dextran-amine (BDA) delivered to incisions made across the nerve fiber layer in frogs surviving ablation of the contralateral tectal hemisphere for 13-46 weeks. The projections from nasal retinal sectors were always lightly constructed in the aberrant terminal field, whereas their projections to the lateral geniculate complex remained reasonably strong. In contrast, the projections from temporal retinal sectors, though also weak initially, in time became robust and filled the aberrant field over most of its extent. The specific amplification of the temporal fiber projection now observed in two foreign targets provides further evidence for the existence of target-based, attractant/trophic molecules with functional specificity for temporal retinal fibers. That such agents can exist or be inducible in a foreign area would suggest that they belong to a family of molecules having natural biological activity in normal development or regeneration. However, the possibility that the augmented role of the temporal retina in these projections is a result of experience-based plasticity is also discussed.

Genetic definition and sequence analysis of Arabidopsis centromeres

High-precision genetic mapping was used to define the regions that contain centromere functions on each natural chromosome in Arabidopsis thaliana. These regions exhibited dramatic recombinational repression and contained complex DNA surrounding large arrays of 180-base pair repeats. Unexpectedly, the DNA within the centromeres was not merely structural but also encoded several expressed genes. The regions flanking the centromeres were densely populated by repetitive elements yet experienced normal levels of recombination. The genetically defined centromeres were well conserved among Arabidopsis ecotypes but displayed limited sequence homology between different chromosomes, excluding repetitive DNA. This investigation provides a platform for dissecting the role of individual sequences in centromeres in higher eukaryotes.

Sequence and analysis of chromosome 4 of the plant Arabidopsis thaliana

The higher plant Arabidopsis thaliana (Arabidopsis) is an important model for identifying plant genes and determining their function. To assist biological investigations and to define chromosome structure, a coordinated effort to sequence the Arabidopsis genome was initiated in late 1996. Here we report one of the first milestones of this project, the sequence of chromosome 4. Analysis of 17.38 megabases of unique sequence, representing about 17% of the genome, reveals 3,744 protein coding genes, 81 transfer RNAs and numerous repeat elements. Heterochromatic regions surrounding the putative centromere, which has not yet been completely sequenced, are characterized by an increased frequency of a variety of repeats, new repeats, reduced recombination, lowered gene density and lowered gene expression. Roughly 60% of the predicted protein-coding genes have been functionally characterized on the basis of their homology to known genes. Many genes encode predicted proteins that are homologous to human and Caenorhabditis elegans proteins.

Is functional upregulation of the 5-HT2B receptor in deoxycorticosterone acetate salt-treated rats blood pressure dependent?

This study tests the hypothesis that the functional upregulation of the arterial 5-hydroxytryptamine (5-HT)2B receptor in arteries of deoxycorticosterone acetate (DOCA)-salt hypertensive rats depends on the development of high blood pressure. Wistar-Furth and Wistar rats were given sham or DOCA-salt treatment (200 mg/kg DOCA, SC; 1.0% NaCl and 0.2% KCI in drinking water). Systolic blood pressures (4 week; mm Hg) were: Wistar Sham (120+/-3), Wistar DOCA (176+/-6), Wistar-Furth Sham (112+/-3) and Wistar-Furth DOCA (136+/-4). Isolated mesenteric arteries from Wistar DOCA and Wistar-Furth DOCA rats displayed a three- to fivefold leftward shift in contraction to 5-HT that was insensitive to blockade by the 5-HT2A receptor antagonist ketanserin (10 nM) and a significantly increased maximal contraction to the 5-HT2B receptor agonist BW723C86 [Wistar DOCA = 90+/-17% phenylephrine contraction; Wistar Sham = 1+/-1%; Wistar-Furth DOCA = 33+/-8%; Wistar-Furth Sham = 0%]. Arteries from Sprague-Dawley rats receiving salt or DOCA alone displayed similar systolic blood pressures (151+/-11 mm Hg and 144+/-5 mm Hg, respectively), but only tissues from rats receiving DOCA displayed an increased contraction to BW723C86 (DOCA alone = 60.7+/-16% vs. sham = 13+/-5.3%). These data suggest that upregulation of the arterial 5-HT2B receptor is largely independent of an increase in blood pressure.