Neonatal transport in Texas

The critically ill newborn requires specialized care, which is generally provided in neonatal intensive care units (NICUs). We surveyed all identifiable NICUs in the state of Texas to study deficiencies in the current system. Despite the existence of many neonatal transport teams, little or nothing has been done to coordinate similar efforts at different programs or to organize programs into sharing the responsibility of transport among the less served areas of Texas. The lack of adequate reimbursement may be a limiting factor in the organization and regionalization of neonatal transport. We urge further efforts toward coordination and regionalization of transport with an examination of reimbursement policies to allow teams to share equally the responsibility of neonatal transport in Texas.

Possible involvement of a chloride conductance in the transient outward current of whole-cell voltage-clamped ferret ventricular myocytes

The transient outward current was studied, using the whole-cell patch-clamp technique, in isolated ventricular cells from the ferret heart. In the presence of 4-aminopyridine and cadmium chloride which respectively blocked the Ca-insensitive and the Ca-dependent outward currents, a residual transient outward current was observed in about 30% of the cells tested. This current was suppressed in external hypochloride solution, completely inhibited by SITS (3 mM) and reversed at the equilibrium potential for chloride ions. This suggests the presence of a chloride permeability which could contribute to the repolarization phase of the cardiac action potential.

The correlation between the increase in slow outward current and in contraction induced by caffeine, ryanodine, and rapid cooling in voltage-clamped frog muscle fibers

The effects of caffeine, ryanodine, and rapid cooling were tested on the depolarization-induced contraction and the apamin-insensitive slow outward current (Iso) of voltage-clamped (double mannitol gap) single frog muscle fibers. Subthreshold caffeine concentrations (0.5-2 mM) induced a monotonic increase in contractile and Iso amplitude. Whatever the concentration, the increase in contraction was roughly twice the one in current. Similar results were obtained upon rapid cooling (20-4 degrees C) in the presence of 0.5 mM caffeine. In the absence of external Na+ (choline-substituted) 10(-5) M ryanodine induced a delayed increase (approximately 30 min) in contraction and in current, shortly before the development of a drastic and irreversible contracture. Here again, the increase in contraction was twice that in current. In the presence of 5 mM tetraethylammonium (TEA) and (or) 25 nM charybdotoxin, 2 mM caffeine still induced a strong facilitating effect on contraction but the parallel increase in current was strongly reduced. The linear relationship between the increase in current and contractile amplitude has a slope approximately 0.5 (whatever the drug used to increase contractility); it is approximately 0.1 in the presence of TEA and (or) charybdotoxin. In conclusion, provided the changes in contractile amplitude are caused by parallel changes in depolarization-induced sarcoplasmic reticulum Ca2+ release, about 50% of the apamin-insensitive Iso is controlled by internal Ca2+ release. The main part of this current corresponds to the TEA- and charybdotoxin-sensitive component of Iso.

Muscular strength and bone density with weight training in middle-aged women

Previous research has demonstrated positive correlations between bone mass and both physical activity and muscular strength. There is a paucity of information describing the specific type of exercise which most benefits the human skeleton. The effects of a 1 yr weight training program on 18 middle-aged women participating in an endurance dance program (E + W) compared with 17 other women in the endurance dance program only (E) and with 19 sedentary controls (C) were studied by measuring muscular strength and bone mineral density (BMD). Eighteen women in the E + W group demonstrated increases in all strength measurements, whereas the E and C groups either had smaller increases or had declined. A significant group x test interaction term, indicating that groups responded differently over time, was observed for nondominant isokinetic elbow flexion measured through the range of motion at a constant velocity of 60 degrees.s-1 (P less than 0.05), nondominant isokinetic elbow extension at 180 degrees.s-1 (P less than 0.01), and nondominant isokinetic elbow flexion at 180 degrees.s-1 (P less than 0.05). BMD did not change significantly except that a significant group x test interaction term appeared for the radius ultradistal site (P less than 0.01). BMD of the humerus and femoral Ward's triangle increased nonsignificantly in both E and E + W over the year. This weight training program increased muscular strength but did not increase measured bone mass.

The direct depressant effect of LCB29 (idrocilamide) on mechanical tension of rat soleus muscle fibers

The effect of LCB29 was tested on twitch characteristics, tetanic tension, and K+ and voltage-clamp contractures of rat soleus muscle fibers. In concentrations ranging from 10(-6) to 5 x 10(-4) M, LCB29 simultaneously inhibited the twitch amplitude, the maximum rate of tension development, and the maximum rate of relaxation. In concentrations ranging from 10(-5) to 10(-4) M, tetanic tension (100 Hz, 1 s) was inhibited by the same amount. The effect of 5 x 10(-5) M LCB29 was studied on K+ contractures and contractures induced, under voltage-clamp conditions, by long-lasting depolarizations. Its effect was significantly stronger than those on twitch and tetanic tension. In addition, LCB29 had a dual effect on strength--duration curves for mechanical threshold. It increased both the rheobasic potential and the steepness of the curve. It is concluded that LCB29 exerts a direct myorelaxant effect on rat soleus muscle; two sites of action are probably involved.

Phenytoin preferentially inhibits L-type calcium currents in whole-cell patch-clamped cardiac and skeletal muscle cells

The effect of the anticonvulsant diphenylhydantoin (phenytoin) was tested on the inward calcium currents of whole-cell patch-clamped cells from rat and human muscles and from frog atrium. A concentration of 10 microM phenytoin was required to obtain a threshold inhibitory effect and, even with high concentrations (100 microM), the inhibition was not complete. In skeletal muscle (rat and human cells in culture), phenytoin (30 microM) exerted a more potent effect on the high-threshold calcium current (ICa,L inhibition: 53 +/- 6% mean +/- SDn-1) rather than on the low-threshold one (ICa,T inhibition: 16 +/- 10%). Similar results were obtained on dissociated frog atrial cells. These data are to be contrasted with those previously reported on neuronal cells, where specific inhibition of ICa,T was reported. Thus, the action of phenytoin appears to be different in muscle and nerve so that phenytoin does not appear to be a specific inhibitor of ICa,T.

Calcium currents in normal and dystrophic human skeletal muscle cells in culture

Human muscle cells obtained from biopsy specimens were grown in a primary culture system and electrophysiologically studied. Whole cell patch-clamp recordings revealed the presence of two types of calcium currents: (i) a low-threshold (-60 mV) one (ICa, T) with fast activation and inactivation kinetics (time-to-peak: 39 ms at -30 mV); and (ii) a high-threshold (-10 mV) one (ICa,L) with slower kinetics (time-to-peak: 550 ms at 20 mV). These two types of calcium currents could be also distinguished by their pharmacological characteristics since ICa,L was sensitive to the antagonist and agonist dihydropyridine derivatives contrary to ICa,T which was completely resistant to these compounds. These functional calcium channels existed both in normal and Duchenne dystrophic (DMD) human skeletal muscle cells in culture. We discuss a possible role of these two types of calcium channels in the myoplasmic calcium accumulation observed in the Duchenne muscular dystrophy.

Propranolol metabolism by isolated hepatocytes from normal and cirrhotic rat livers: the effect of albumin

Several recent reports have shown that the hepatic uptake and subsequent elimination of some substrates is faster in the presence of albumin than in its absence, as if some of the substrate bound to albumin was also available for uptake. In the present study, we examined the effect of albumin on the clearance of propranolol by isolated rat hepatocyte suspensions. The clearance of total drug decreased progressively as albumin concentration increased. There was also a progressive decrease in the free fraction of propranolol and the net result was an increase in the clearance of unbound drug (+50% at 40 g/L albumin). This increase was not due to an oncotic pressure effect of albumin, nor to the presence of fatty acids bound to albumin. The clearance of propranolol by isolated hepatocytes from cirrhotic rats was decreased compared with controls (-50%), and albumin also increased propranolol free clearance, albeit to a lesser extent than in control animals. Our results indicate that albumin facilitates the elimination of propranolol by hepatocytes, possibly because of surface-mediated catalysis of the albumin-propranolol complexes.

The depressing effect of tetracaine and ryanodine on the slow outward current correlated with that of contraction in voltage-clamped frog muscle fibres

The effects of tetracaine (10-50 microM) and ryanodine (0.1-10 microM) were tested on the slow outward K+ current (Iso) and the mechanical tension of isolated frog muscle fibres in a voltage-clamp device (double mannitol-gap) connected to a mechanoelectric transducer. In the concentration range tested, both drugs induced a simultaneous inhibition of tension and current. In all cases the effect on tension was twice that on current. The tetracaine-induced current and tension blocks were fully reversible and dose-dependent. In contrast the ryanodine effects on current and tension were not reversible and did not exhibit a dose dependence except for the delay before the onset of the response, which was shortened when the concentration was raised. Linear regression analysis of the time-dependent and dose-dependent effects of both drugs indicated a strong correlation between the decreases in tension and current. It is concluded that the slow outward current is partly under the control of the Ca2+ release from sarcoplasmic reticulum during contraction.

The blockade of excitation/contraction coupling by nifedipine in patch-clamped rat skeletal muscle cells in culture

The effects of the dihydropyridine derivative, nifedipine, well known as a blocker of calcium channels, were tested on cultured rat myoballs. Membrane currents and contractions were simultaneously recorded by means of the patch-clamp technique and a photoelectric transducing method. High concentrations of nifedipine (5 microM) inhibited the contractile responses and inward calcium current (ICa) elicited by long depolarizations. In the absence of ICa (1.5 mM cadmium in the bath), nifedipine inhibited both the ICa-independent contractile component and the outward current, supposed to depend on the intracellular calcium released during contraction. At low concentrations (0.5 microM) the blocking effects of nifedipine could be strongly enhanced by shifting the membrane potential towards less negative values (-60 mV) for 50 s prior to the test pulse. A blocking effect of nifedipine, at a usually ineffective concentration (0.1 microM), could also be observed when long-lasting (3 min) prepulses to 0 mV were applied from a reference membrane potential of -60 mV. This effect could be relieved by long-lasting cell hyperpolarizations (-90 mV). The blocking effects of nifedipine unrelated to ICa could be interpreted as an action on a molecule (voltage sensor) in the T-tubule membrane involved in the excitation/contraction coupling process and as a preferential binding of the dihydropyridine derivative on the inactivated form of this molecule, favored by the weak negative potentials or long-lasting depolarizations. The results provide data in favor of the existence of strong similarities between the calcium channels and voltage sensors since their operation was inhibited in a voltage-dependent manner by nifedipine.

An efficient isolation procedure of Ca-tolerant ventricular myocytes from ferret heart for applications in electrophysiological studies

A simple procedure which provides a large yield of isolated ferret ventricular myocytes is described. The enzymatic dissociation was performed by perfusion of the whole heart with the "Langendorff method" at 37 degrees C, without an incubation period. Special attention was given to the period of perfusion with Ca-free or low-calcium containing solutions and to the proportion of both collagenase and elastase used. The viability and calcium tolerance of the isolated cells were tested by ultrastructural and electrophysiological studies. Photo-microscopy showed that 60 to 80% of the isolated cells had an elongated shape (18 microns in diameter, 150 microns in length) and did not beat spontaneously in normal Tyrode solution. The morphological and ultrastructural integrity of these cells was shown in SEM by their smooth surface with regularly spaced T-tubule openings and in TEM by the regular distribution of the transverse tubular system, mitochondrium and sarcomeres. Using the whole-cell patch-clamp technique, they had a resting membrane potential of -72 mV, two types ("Purkinje like" and "ventricular like") of action potentials could be elicited and they were correctly affected by well-known modulators of calcium channels. This technique was successfully applied to the rat heart and could be used for heart dissociation of small mammals. It can simultaneously provide isolated cells of different regions of the heart and can be easily and routinely used by any investigator.

The depressant effects of some amiloride analogues on the slow outward K+ current and contraction of voltage-clamped frog muscle fibres

The effects of 4 derivatives of amiloride, which are known to block the Na+/H+ antiporter, were studied on the slow outward current (Iso) and on tension development of voltage-clamped single muscle fibres of the frog Rana ridibunda. Each compound tested induced a strong depressant effect on tension and Iso in a voltage-, time- and dose-dependent (10(-8) to 10(-5) M) manner at physiological pH. The effects exhibited a strong pH dependence (the greater the pH in the range between 6.6 and 8.0, the greater the depressant action). This seems to exclude the involvement of the Na+/H+ antiport and alterations of surface membrane charges as mediators. The current block was not observed after the release of calcium from the sarcoplasmic reticulum was blocked with 75 microM tetracaine. It is concluded that the primary effect of the 4 compounds used was to inhibit the internal release of Ca2+ from the sarcoplasmic reticulum, and that this inhibition blocked the Ca2+-dependent slow outward current.

Are Ba2+ and Sr2+ ions transported by the Na+-Ca2+ exchanger in frog atrial cells?

Ba2+ and Sr2+ ions are widely used to replace Ca2+ ions for the study of Ca2+ channel currents in electrophysiological experiments. Using the double sucrose gap technique, we investigated the effects of Sr2+ and Ba2+ ions on the Na+ Ca2+ exchange activity in frog atrial fibres where it is the major relaxation mechanism. With either Sr2+ or Ba2+ ions instead of Ca2+ in the extracellular bath, Na-free contractures reversibly developed but with different kinetics. Voltage clamp experiments showed that the tonic tension recorded in the presence of Sr2+ or Ba2+ was markedly increased following the addition of monensin, a Na+ ionophore known to increase the intracellular Na+ activity. In Na-free solutions (Li-substituted), it was possible to induce contractures by substituting Sr2+ or Ba2+ ions for extracellular Ca2+. These contractures could be relaxed by reintroducing Na+ or Ca2+ ions in the extracellular medium. Taken together, these results suggest that Sr2+ and Ba2+ ions can interact with the Na+-Ca2+ exchange mechanism and potentially participate not only in Na+-cation but also in Ca2+-cation exchanges on either side of the sarcolemmal membrane.

Genetic switching in the flagellar gene hierarchy of Caulobacter requires negative as well as positive regulation of transcription

Caulobacter crescentus flagellar (fla, flb, or flg) genes are periodically expressed in the cell cycle and they are organized in a regulatory hierarchy. We have analyzed the genetic interactions required for fla gene expression by determining the effect of mutations in 30 known fla genes on transcription from four operons in the hook gene cluster. These results show that the flaO (transcription unit III) and flbF (transcription unit IV) operons are located at or near the top of the hierarchy. They also reveal an extensive network of negative transcriptional controls that are superimposed on the positive regulatory cascade described previously. The strong negative autoregulation observed for the flaN (transcription unit I), flbG (transcription unit II), and flaO (transcription unit III) promoters provides one possible mechanism for turning off fla gene expression at the end of the respective synthetic periods. We suggest that these positive and negative transcriptional interactions are components of genetic switches that determine the sequence in which fla genes are turned on and off in the C. crescentus cell cycle.

[Mechanisms of excitation-contraction coupling and calcium liberation in striated muscles of vertebrates]

In vertebrate skeletal muscle, the main part of excitation-contraction coupling occurs at the level of the triad, where membranes of T-system and of junctional SR are facing each other. From place to place, the junctional gap is bridged by "feet" structures which include the SR Ca2+ channel. Half of them are closely apposed to tubular intramembranous structures assumed to be DHP-sensitive voltage-sensors which are similar to tubular Ca2+ channels and act by controlling Ca2+ release from SR. During a twitch, the release of Ca2+ activator from SR is controlled both by voltage-sensors via the feet structures and by a tubular Na+ current via a Na+-induced Ca2+ release mechanism. During long-duration mechanical responses, additional mechanisms are involved: a Ca2+-induced Ca2+ release which can be activated by ICa; the release of Ca2+ from membrane, controlled by the operation of a Na+/Ca2+ exchanger and/or new arrangements of surface membrane charges. An IP3-mediated Ca2+ release could be involved too. All these mechanisms can be regulated by intracellular biochemical or ionic processes.

The slow inward calcium current is responsible for a part of the contraction of patch-clamped rat myoballs

The slow inward calcium current and the contractile response were simultaneously recorded in voltage clamped (whole cell patch clamp recording) rat myoballs in primary culture. The shape of the contraction(T)/potential(V) relationship and the application of the inorganic calcium channel blocker cadmium (1.5 mM), which suppresses a part of the contractile activity, demonstrate the existence of two components of contraction. One of them is related to the slow calcium current.

A new porcine bioprosthesis: design rationale and early clinical experience

The Medtronic Intact valve is a third-generation porcine bioprosthesis produced using a leaflet fixation process which imposes virtually zero hydrostatic pressure. This fixation method provides optimal preservation of the original leaflet structure and integrity and should result in an improvement in durability compared to conventional preservation techniques. The biomechanical basis for this hypothesis is presented along with early experience with 118 patients (125 valves). There have been no complications related to primary valve failure and the incidence of other valve related events is acceptable.

Tension activation and relaxation in frog atrial fibres. Evidence for direct effects of divalent cations (Ca2+, Sr2+, Ba2+) on contractile proteins and Na-Ca exchange

The effect of alkali-earth cations (Ca2+, Sr2+, Ba2+) on the excitation-contraction coupling events of the frog atrial fibres were studied using a double mannitol gap voltage clamp technique coupled with a mechano-electric transducer. Photoremoval of the suppressive effect of nifedipine on the calcium channels allowed to obtain rapid transient Ca2+, Sr2+ or Ba2+ ions current jumps. The effect on the amplitude of the associated contraction was proportional to the current jumps. These results together with the correlation established between the estimated increase in the internal concentration of divalent cations and the amplitude of the phasic tension suggest that the essential source of divalent cations for activation of contraction is the extracellular space. Also Ba2+ ions reduced the tonic tension and strongly slowed the relaxation of the phasic component whereas Sr2+ exhibited smaller effects. Sr2+ ions could be more efficient than Ba2+ ions in substituting for Ca2+ ions in the Na+-Ca2+ exchange mechanism known to regulate these two mechanical events. The conclusions are that the order of effectiveness of these ions (Ca2+ greater than Sr2+ greater than Ba2+) is the same with regard to transarcolemmal exchange for Na+ ions, presumed uptake by a "second relaxing system", activation of contraction, and inactivation of the slow inward current.

Antamanide antagonizes the phalloidin-induced negative inotropic effect and blocks voltage dependently the fast outward K+ current in voltage-clamped frog muscle fibres

The effects of antamanide (10(-14)-10(-5) M) and N-acetyl-secophalloidin (10(-7)-5 X 10(-3) M) a neutral non-toxic derivative of phalloidin, were tested on voltage-clamped single frog muscle fibres. Antamanide protected muscle fibres against the negative inotropic effect of phalloidin but blocked the fast potassium permeability in the same concentration range and the same voltage-dependent manner as did phalloidin. N-Acetyl-secophalloidin exhibited a strongly attenuated blocking effect on K+ permeability in a 1,000-fold higher concentration range than phalloidin. Neither antamanide nor N-acetyl-secophalloidin affected the contractile properties. These results suggest the existence in the frog muscle membrane of a receptor with two sites for phalloidin and antamanide which acts on potassium conductance.

Stimulation frequency and external ionic composition control the repriming of caffeine-induced contractures in frog skeletal muscle

The effect of stimulation rate and of external ionic composition on the repriming period of contractures induced by 6 mM caffeine was tested on isolated skeletal muscle fibres of the frog (Rana ridibunda). The repriming period, which was 11.2 +/- 0.1 min (mean +/- SEM, n = 9) on quiescent fibres, was shortened in fibres stimulated at a frequency ranging from 3 to 12 min-1 (optimal rate, 8 min-1; full repriming 5.7 +/- 0.2 min; n = 10). A 10-fold increase in the extracellular calcium concentration shortened the repriming period on both stimulated and quiescent fibres, whereas decreasing external calcium (1/10) delayed it. In a Na+-free solution (Li+ substituted) the repriming period of stimulated fibres was markedly delayed (14 min), whereas quiescent fibres never recover more than 10% of their ability to develop subsequent caffeine contractures. In contrast, with a 35% Na solution, the repriming period was greatly shortened (stimulated, 5.4 +/- 0.2 min, n = 7; quiescent, 6.2 +/- 0.5 min, n = 8). It is concluded that repriming depends on three mechanisms that seem to refill a calcium store and trigger recovery: the slow inward calcium current, a Na+-Ca2+ exchange, and perhaps a passive Ca2 influx.

Bay K 8644 enhances slow inward and outward currents in voltage-clamped frog skeletal muscle fibres

In isolated frog skeletal muscle fibre slow inward calcium current and slow outward potassium current were recorded by means of a double mannitol-gap device. Bay K 8644, the so-called Ca-channel activator, shifted the activation threshold of the slow inward calcium current (recorded in Cl-free, Ca-rich solution), towards negative potential by 15 mV. It increased the peak current amplitude in a dose-dependent manner (from 10(-11) to 10(-7) M; EC50 approximately equal to 10(-9) M). Apamin, the bee venom toxin which is known to specifically block a class of calcium-dependent potassium channels, failed to block the slow inward calcium current and slowed down its declining phase. This effect exhibited a potential dependence: the more the membrane was depolarized, the more the current decay was slowed down. Bay K 8644 (10(-7) M) transiently decreased the slow outward potassium current, which then progressively increased to stabilize at 135% of the control value. This effect seemed to be more pronounced at potentials above the reversal potential for inward ICa. The results suggest that the increase of the slow outward current is due to a direct action of Bay K 8644 on the slow K channel, rather than an indirect action via potentiation of slow inward calcium current. Moreover, results obtained with apamin indicated that the slow outward potassium current is unlikely to flow through Ca-channels.