A comparison of thoracic and lumbar epidural techniques for post-thoracoabdominal esophagectomy analgesia

PURPOSE

To compare thoracic epidural analgesia (TEA) using a bupivacaine/fentanyl mixture and lumbar epidural analgesia (LEA) with morphine, in respect to the time to extubation and the quality of post-operative analgesia, in patients having thoracoabdominal esophagectomy.

METHODS

Twenty two patients scheduled for elective thoracoabdominal esophagectomy were randomized to TEA or LEA. Postoperatively, the TEA group received Patient Controlled Epidural Analgesia (PCEA) with bupivacaine 0.125% and 5 microg x ml(BI) fentanyl, and the LEA group received PCEA with 0.2 microg x ml(BI) morphine. A blinded observer assessed criteria for tracheal extubation and the time of tracheal extubation was recorded. Early extubation was defined as tracheal extubation within four hours postoperatively. Visual analogue pain scores at rest (Static Visual Analogue Pain Scores, SVAPS) and with movement (Dynamic Visual Analogue Pain Scores, DVAPS) were recorded at 1, 6, 12, 18 and 24 hr post-extubation. Failure of the epidural protocol (FEP) was defined as a request for additional analgesia.

RESULTS

Tracheal extubation was achieved in 70% of the LEA and 100% of the TEA at four hours postoperatively (P=NS). However, the TEA group achieved earlier extubation times when assessed with log rank testing (P = 0.01). By six hours post-extubation FEP had occurred in 50% of the LEA group but in none of the TEA group (P = 0.01). Mean SVAPS and DVAPS were lower in the TEA than in the LEA group at all measured times (P < 0.01).

CONCLUSION

This study has demonstrated superior pain control in patients undergoing thoraco-abdominal esophagectomy treated with TEA than with LEA, particularly for pain with movement. Tracheal extubation occurred earlier in the TEA group, but this difference was not significant at four hours postoperatively.

Voicing judgements by chinchillas trained with a reward paradigm

Experiments were performed to replicate and extend previous findings of similar categorization of voiced/voiceless consonant-vowel (CV) syllables by humans and chinchillas. A reward paradigm was applied to the question of how stimulus range affects the voice-onset-time (VOT) corresponding to the voiced/voiceless category boundary. Each of four adult chinchillas and four human subjects identified synthetic CV syllables as voiced (/ba/, /da/, /ga/) or voiceless (/pa/, /ta/, /ka/) using voiceless standards of either 80 or 120 ms. In both humans and animals, extending the VOT range from 80 to 120 ms shifted category boundaries to longer VOTs, but to a different extent across listeners. Control experiments suggested that listeners were attending to different phonetic cues in a manner that depended on the listener, rather than on species. The results are interpreted in terms of similar contextual effects and use of multiple phonetic cues to voicing in humans and animals.

Developmental changes in nicotinic receptor mRNAs and responses to nicotine in the suprachiasmatic nucleus and other brain regions

Our previous studies demonstrated that nicotine induces c-fos expression in the suprachiasmatic nucleus (SCN) of the rat during a narrow developmental window occurring in the perinatal period. We have extended these observations by showing that c-fos cannot be induced in the adult SCN by nicotine even during the subjective night, when phase shifts do occur. In contrast to the SCN, significant induction of c-fos and NGFI-A was observed in the medial habenula and paraventricular nucleus at all circadian times. In the fetal rat SCN we show that NGFI-A and junB are also induced by nicotine, but not c-jun. To investigate whether changes in nicotinic acetylcholine receptor (nAChR) expression in the SCN may underlie this change in sensitivity during the perinatal period, we examined nAChR mRNAs across this developmental period. By Northern analyses, alpha2, alpha3 and alpha4 subunit mRNAs are relatively abundant in the fetal SCN but decline substantially in the adult. alpha7 mRNA increases substantially while beta2 mRNA is relatively abundant throughout development. We also examine expression in the whole mouse brain beginning at embryonic day 11. Many mRNA sizes for nAChR subunits in both the rat and mouse are characterized here for the first time by Northern analyses and some show very large changes in expression across development. In particular, a small 1.4 kb alpha2-related mRNA is highly expressed during early development, perhaps indicating an important novel function for this subunit.

The glutamate induced phase shift in the SCN slice: a two pulse study

The short-term dynamics of resetting the circadian 'clock' was assessed by a double-pulse paradigm in vitro. On day 1, single and double 1 h 'pulses' of 1 mM l-glutamate were applied to the rat suprachiamastic nuclei (SCN). On days 2 and 3, single unit activity (SUA) was recorded and time-of-peak SUA was used as a phase marker of the circadian rhythm. The time-of-peak in untreated slices at 'Zeitgeber' time (ZT; hours after lights-on) 6, was used to evaluate effects of glutamate on phase. In accordance with published data, a single glutamate pulse at ZT 14 resulted in a 3 h delay of peak SUA on days 2 and 3. A 2nd pulse, given 3 h after a 1st pulse, resulted in two distinct peaks on day 2: a 1st at ZT 7 and a 2nd at ZT 12, i. e., a 6 h phase delay and hence twice the delay obtained after a single pulse. On day 3, no peak in SUA was observed which indicates that a new steady state was not reached on day 2. The bimodal distribution of SUA on day 2 corroborates other findings which suggest that the SCN comprises two distinct neuronal populations with circadian firing patterns that are normally coupled but, possibly due to different sensitivities to glutamate, can desynchronize. The additive phase-shifting effect of two consecutive glutamate pulses suggests that, at least for one sub-population of SCN neurons, the phase shift is completed within 3 h.

Unilateral lung volume reduction in preparation for contralateral pneumonectomy

A case of staged trans-sternal unilateral lung volume reduction (LVR) on the right followed by contralateral pneumonectomy for a locally advanced left lung malignancy is presented. The predicted symptomatic and functional benefit offered by LVR was felt to be necessary before the removal of the left lung. The patient, a 50-year-old male, with a history of chronic air flow limitation secondary to bullous emphysema, underwent a left pneumonectomy six weeks following a right LVR procedure for poor pulmonary function secondary to generalized emphysema. On admission, forced expiratory volume in 1 s (FEV1) was 1.37 L, 47% of predicted with an FEV1/forced vital capacity of 56%. Five weeks after the unilateral LVR, the patient's FEV1 was 1.85 L, and one year postdischarge from hospital, FEV1 was 0.9 L. One year after discharge, the patient did not require oxygen support, and was active and free of malignant disease.

Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury

OBJECTIVES

To assess the prognostic value of summary measures of secondary physiological insult in addition to baseline clinical variables for patients with traumatic brain injury.

METHODS

A series of 110 patients with traumatic brain injury had data on intracranial pressure (ICP), arterial blood pressure (ABP), cerebral perfusion pressure (CPP), arterial O2 saturation (SaO2), temperature in degrees C (Temp), and heart rate in beats/min (HRT) monitored and recorded every minute. Secondary insults were defined according to the Edinburgh University secondary insult grading system. The prognostic value of summary measures of these secondary insults was assessed by adding them to a prognostic model for survival at 1 year after controlling for baseline clinical variables using a previously validated model.

RESULTS

Of the eight secondary insults measured, only ICP added significantly to the prediction of survival in the first 72 hours after injury. The particular type of summary measure did not seem to influence the results. After the addition of ICP to the model, none of the other secondary insult measures could improve the predictive power of the model significantly.

CONCLUSIONS

Early intracranial hypertension is confirmed as a sign of poor prognosis in patients with traumatic brain injury, even after controlling for baseline clinical variables. The value or otherwise of treating such secondary insults, however, can only be definitively established in the context of prospective randomised controlled trials. The specific pathophysiological evolution of secondary insults is still the subject of much research, and a clear understanding will be necessary before the development of specific treatments is feasible.

Predicting survival using simple clinical variables: a case study in traumatic brain injury

OBJECTIVES

Prediction of patient outcome can be useful as an aid to clinical decision making, to explore possible biological mechanisms, and as part of the clinical audit process. Many studies have constructed predictive models for survival after traumatic brain injury, but these have often used expensive, time consuming, or highly specialised measurements. The aim of this study was to develop a simple easy to use model involving only variables which are rapidly and easily clinically achievable in routine practice.

METHODS

All consecutive patients admitted to a regional trauma centre with moderate or severe head injury were enrolled in the study. Basic demographic, injury, and CT characteristics were recorded. Patient survival at 1 year was used to construct a simple predictive model which was then validated on a very similar patient group.

RESULTS

372 patients were included in the study, of whom 365 (98%) were followed up for survival at 1 year. Multiple logistic regression resulted in a model containing age (p<0.001), Glasgow coma scale score (p<0.001), injury severity score (p<0.001), pupil reactivity (p=0.004), and presence of haematoma on CT (p=0.004) as independently significant predictors of survival. The model was validated on an independent set of 520 patients, showing good discrimination and adequate calibration, but with a tendency to be pessimistic about very severely injured patients. It is presented as an easy to use nomogram.

CONCLUSIONS

All five variables have previously been shown to be related to survival. All variables in the model are clinically simple and easy to measure rapidly in a centre with access to 24 hour CT, resulting in a model that is both well validated and clinically useful.

Lung volume reduction for emphysema and the Canadian Lung Volume Reduction Surgery (CLVR) Project

OBJECTIVE

To review the literature on the surgical treatment of emphysema and to present preliminary results from a pilot study of lung volume reduction (LVR) surgery.

DESIGN

Case series of consecutive patients referred for LVR surgery. Outcomes were quality of life, pulmonary function and exercise capacity.

SETTING

Two university-affiliated hospitals in Ontario.

POPULATION STUDIED

Patients between the ages of 40 and 75 years with emphysema who had severe airflow limitation, hyperinflation of the lungs and impaired quality of life.

INTERVENTION

Bilateral reductions with multiple wedge resections of the lung using a linear stapling device with bovine pericardial buttressing were completed via a median sternotomy.

MAIN RESULTS

Of 50 patients referred, 24 underwent LVR surgery. Mean age of the cohort was 63 years. Operative 30-day or in hospital mortality was 8%. Two other patients (8%) died from respiratory failure after LVR within the first year. Postoperative complications included prolonged air leaks (six of 24), tracheobronchitis (five of 24), mechanical ventilation (four of 24) and pneumonia (three of 24). Mean length of stay was 18 days (median 12 days). At one year, there was a sustained decrease in total lung capacity from 133% to 123% predicted. There were improvements in forced expiratory volume in 1 s, from 22% of predicted preoperatively to 32% postoperatively, and in 6 min walk performance, from 345 to 381 m. Improvements were also noted in the quality of life assessments.

CONCLUSIONS

Preliminary results suggest that LVR surgery is feasible and may improve the patient's quality of life, pulmonary function and exercise capacity. A randomized clinical trial comparing LVR plus the best medical management with the best medical management alone is currently underway to determine the effectiveness of LVR.

Delayed intracranial hypertension: relationship to leukocyte count

OBJECTIVE

Secondary intracranial hypertension has been linked to leukocytosis. We examined our data bank containing physiologic recordings and outcome data of severely head injured patients to investigate the relationship between delayed increases in intracranial pressure (ICP), defined as occurring after a 12-hr period of normal ICP values, and leukocytosis.

DESIGN

A retrospective study of observational data.

SETTING

Regional neurosurgical unit and intensive care unit.

PATIENTS

Sixty-four patients suffered increased ICP >20 mm Hg. Thirty-five patients fulfilled selection criteria for delayed increases in ICP (group 1). Twenty-nine patients with increased ICP with no preceding or intervening periods of normal ICP were selected as a comparison group (group 2).

MEASUREMENTS AND MAIN RESULTS

Comparison of 12-month outcome revealed that 11% of group 1 patients died, with 49% remaining severely disabled, in contrast to group 2, where 35% of patients died and 14% were left severely disabled (p = .021). The pattern of outcome was independent of monitoring time, or injury severity. Regression modeling was performed for prediction of delayed increase in ICP. Of 46 patients with an initial increase then decrease in leukocyte count in the first 48 hrs, 65% experienced delayed increases in ICP, as compared with 18% of the 11 patients without this pattern p = .01 1).

CONCLUSIONS

Patients with delayed increases have a significantly different pattern of outcome. Change in leukocyte count from admission to day 2 is a significant predictor of such a delayed increase.

Cost-effectiveness of statins

Currently, 6 hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are marketed in the United States (US). Given the wide variation in the prices and efficacy of statins, formal cost-effectiveness analysis may improve drug selection decisions. To assess the cost-effectiveness of statin therapy in primary and secondary prevention of coronary heart disease, we developed a model of the costs and consequences of lipid-regulating therapy and estimated the incremental cost-effectiveness of 5 statins (atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin) at usual starting doses versus no therapy. Drug effects on serum lipids were assessed using data approved by the US Food and Drug Administration for product labeling. Annual risks of coronary event occurrence were estimated using Framingham Heart Study coronary risk equations developed for use in this model. Current estimates of direct medical costs of coronary heart disease were used to assign costs to health states and acute coronary events. Main outcome measurements were net cost (statin therapy minus savings in coronary heart disease treatment), gain in life expectancy, and cost per life-year saved. The maximum gain in life expectancy was achieved with atorvastatin, which also had a lower net cost than lovastatin, pravastatin, and simvastatin. Compared with fluvastatin, atorvastatin's greater effectiveness is attained at a lower cost per life-year saved. The cost-effectiveness of HMG-CoA reductase inhibition in primary and secondary prevention of coronary heart disease has been improved with the introduction of atorvastatin.

Brain TXA(2) and PGI(2) levels after head injury with secondary insults

OBJECTIVE: The brain TXA(2) and PGI(2) levels in a new rodent model of impact acceleration diffuse brain injury alone and with hypotention and hyperthermia in combination were observed to look into the relationship between TXA(2), PGI(2) levels and different types of head injury. METHODS: Thirty-two SD rats were randomized into sham, head injury alone, secondary insult alone and head injury with secondary insult groups. At 4 hours after injury or experiment, all the rats were decapitated and their brains were sampled for radioimmunoassay (RIA) measurement. RESULTS: Compared with that of sham group there were no changes in TXA(2) and PGI(2) levels in injury alone group while there was a significant augmentation in PGI(2) level in insult alone group. Both TXA(2) and PGI(2) level in injury with secondary insult group increased significantly in comparison with that of sham at 4 hours postimpact. CONCLUSIONS: PGI(2) providing energy and precursors to the injured tissue and producing some vasoactive arachidonic products, especially TXA(2), is closely connected to the severity of brain damage.

The SCN is comprised of a population of coupled oscillators

The circadian clock in the suprachiasmatic nucleus (SCN) of the mammalian hypothalamus exhibits two necessary properties: (1) a mechanism for the generation of autonomous circadian rhythms in individual pacemaker cells, and (2) a means to synchronize the autonomous pacemaker cells. A variety of potential components of the endogenous pacemaker, including ion channels, second messengers, transcriptional factors, and the protein targets of kinases and transcription factors are reviewed. Similarly, reverse transmitter transport, extracellular ion fluxes, small membrane-diffusible molecules, glial regulation, and neural adhesion molecules are considered as possible synchronizing factors. Provisional criteria are suggested for empirical distinction of endogenous pacemaker versus synchronizing mechanisms.

Historical prospective cohort study of the recurrence of pain after discontinuation of treatment with danazol or a gonadotropin-releasing hormone agonist

OBJECTIVE

To determine the duration of time to the recurrence of pain attributable to endometriosis after the discontinuation of treatment with danazol or a GnRH agonist (GnRH-a) in patients who have had a satisfactory response to the treatment.

DESIGN

Retrospective study.

SETTING

Nine academic medical centers in three countries.

PATIENT(S)

Three hundred twenty-seven women with diagnosed and staged endometriosis who were treated with at least 6 months of danazol or a GnRH-a and who experienced significant pain relief with therapy.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Duration of pain relief after completion of treatment as determined by a patient-initiated report of pain recurrence or increase in pain severity requiring intervention.

RESULT(S)

The median time to the recurrence of pain was 6.1 months for patients treated with danazol and 5.2 months for patients treated with a GnRH-a.

CONCLUSION(S)

Although there was a lack of uniformity in treatment effects across sites, the analyses have taken into account major covariant effects. The time to the recurrence of endometriosis-associated pain after danazol treatment was slightly longer than that after GnRH-a treatment.

Acute pulmonary hemorrhage in infants associated with exposure to Stachybotrys atra and other fungi

BACKGROUND

A geographic cluster of 10 cases of pulmonary hemorrhage and hemosiderosis in infants occurred in Cleveland, Ohio, between January 1993 and December 1994.

STUDY DESIGN

This community-based case-control study tested the hypothesis that the 10 infants with pulmonary hemorrhage and hemosiderosis were more likely to live in homes where Stachybotrys atra was present than were 30 age- and ZIP code-matched control infants. We investigated the infants' home environments using bioaerosol sampling methods, with specific attention to S atra. Air and surface samples were collected from the room where the infant was reported to have spent the most time.

RESULTS

Mean colony counts for all fungi averaged 29 227 colony-forming units (CFU)/m3 in homes of patients and 707 CFU/m3 in homes of controls. The mean concentration of S atra in the air was 43 CFU/m3 in homes of patients and 4 CFU/m3 in homes of controls. Viable S atra was detected in filter cassette samples of the air in the homes of 5 of 9 patients and 4 of 27 controls. The matched odds ratio for a change of 10 units in the mean concentration of S atra in the air was 9.83 (95% confidence interval, 1.08-3 X 10(6)). The mean concentration of S atra on surfaces was 20 X 10(6) CFU/g and 0.007 x 10(6) CFU/g in homes of patients and controls, respectively.

CONCLUSION

Infants with pulmonary hemorrhage and hemosiderosis were more likely than controls to live in homes with toxigenic S atra and other fungi in the indoor air.

Safety and efficacy of intracameral injections of unpreserved lidocaine to reduce intraocular sensation

PURPOSE

To determine the safety and efficacy of intracameral injections of unpreserved lidocaine to reduce intraocular sensation.

SETTING

Carolina Eye Associates, Southern Pines, North Carolina, USA.

METHODS

In this prospective study, 100 patients having phacoemulsification under topical anesthesia were randomly assigned to receive an intracameral injection of unpreserved lidocaine (0.5 cc of a 1% unpreserved solution) or balanced salt solution.

RESULTS

Ninety-three patients completed the study. There were no significant between-group differences in cell density parameters or Kowa laser flare-cell meter measurements. Seventy-eight percent of lidocaine patients and 56% of controls reported no sensation (P = .048, Fisher's exact test).

CONCLUSION

Intracameral injections of unpreserved lidocaine safely and effectively reduced intraocular sensation during phacoemulsification.

Glutathione S-transferase-placental form expression and proliferation of hepatocytes in fumonisin B1-treated male and female Sprague-Dawley rats

Fumonisin B1 (FB1), a mycotoxin produced by a common corn contaminant Fusarium moniliforme and a hepatocarcinogen in rats, has been previously suggested to act as a poor initiator, but a better promoter of gamma-glutamyltranspeptidase (GGT)-positive rat liver preneoplastic lesions. Using glutathione S-transferase-placental form (GSTP) as a more sensitive marker of initiation, we have further evaluated the initiating capacity of various doses of purified FB1 administered (a) intraperitoneally (i.p.) to male Sprague-Dawley (SD) rats for 4 days and (b) orally (PO) to male and female SD rats for 11 days. Compared to their respective controls, significant increases in GSTP-positive hepatocytes were observed in male rats administered FB1 i.p. at 10 mg/kg body weight/day for 4 days, as well as in male and female rats treated with 35 and 75 mg/kg body weight/day FB1 p.o. for 11 days. The percentage section area of liver occupied by GSTP-positive mini-foci comprising of three to 12 cells was increased significantly in male rats given 10 mg/kg FB1 i.p., or in p.o.-treated males and females with 75 mg/kg FB1. Both i.p. and p.o. FB1 treatments resulted in dose-related enhanced hepatocyte proliferation as measured by proliferating cell nuclear antigen (PCNA) labeling with significant increases in the number of PCNA-positive nuclei at the same i.p. and p.o. dose levels where the number of GSTP-positive cells were elevated. In all studies, enhanced PCNA and GSTP expression occurred at FB1 doses which, based on serum biochemical and histopathological data previously reported from our laboratory, were shown to be hepatotoxic. Therefore, our data suggest that in a manner similar to known genotoxic carcinogens, FB1 has the capacity to initiate GSTP-positive hepatocytes with their subsequent development into GSTP mini-foci at exposure levels that induce enhanced hepatocyte proliferation in response to liver toxicity. In SD rats, this occurs as early as within 4 days of i.p. treatment or 11 days of p.o. treatment.

Isolation of a New Fumonisin from Fusarium moniliforme Grown in Liquid Culture

A new fumonisin, iso-fumonisin B1 (iso-FB1, 1), has been isolated from liquid cultures of the fungus Fusarium moniliforme (Sheldon) NRRL 13616. On the basis of its spectroscopic data, its structure has been determined to differ from that of fumonisin B1 only in the presence of a hydroxyl function at C-4 instead of C-5.

Counting antigen-specific CD8 T cells: a reevaluation of bystander activation during viral infection

Viral infections induce extensive T cell proliferation in vivo, but the specificity of the majority of the responding T cells has not been defined. To address this issue we used tetramers of MHC class I molecules containing viral peptides to directly visualize antigen-specific CD8 T cells during acute LCMV infection of mice. Based on tetramer binding and two sensitive assays measuring interferon-gamma production at the single-cell level, we found that 50%-70% of the activated CD8 T cells were LCMV specific [2 x 10(7) virus-specific cells/spleen]. Following viral clearance, antigen-specific CD8 T cell numbers dropped to 10(6) per spleen and were maintained at this level for the life of the mouse. Upon rechallenge with LCMV, there was rapid expansion of memory T cells, but after infection with the heterologous vaccinia virus there was no detectable change in the numbers of LCMV-specific memory CTL. Therefore, much of the CD8 T cell expansion seen during viral infection represents antigen-specific cells and warrants a revision of our current thinking on the size of the antiviral response.

Nicotine and nicotinic receptors in the circadian system

Considerable data support a role for cholinergic influences on the circadian system. The extent to which these influences are mediated by nicotinic acetylcholine receptors (nAChRs) has been controversial, as have the specific actions of nicotine and acetylcholine in the suprachiasmatic nucleus (SCN) of the hypothalamus. In this article we review the existing literature and present new data supporting an important role for nAChRs in both the developing and adult SCN. Specifically, we present data showing that nicotine is capable of causing phase shifts in the circadian rhythms of rats. Like light and carbachol, nicotine appears to cause phase delays in the early subjective night and phase advances in the late subjective night. In the isolated SCN slice, however, only phase advances are seen, and, surprisingly, nicotine appears to cause the inhibition rather than the excitation of neurons. Among nAChR subunit mRNAs, alpha 7 appears to be the most abundant subunit in the adult SCN, whereas in the perinatal period, the more typical nAChRs with higher affinity for nicotine predominate in the SCN. This developmental change in subunit expression may explain the dramatic sensitivity of the perinatal SCN to nicotine that we have previously observed. The effects of nicotine on the SCN may contribute to alterations caused by nicotine in other physiological systems. These effects might also contribute to the dependence properties of nicotine through influences on arousal.

Quantitative measures reflect degeneration, but not regeneration, in the deafness mouse organ of Corti

The deafness mouse (dn/dn) is a well known model of hereditary deafness uncomplicated by behavioral and motor disturbances. The organ of Corti in this mouse develops a normal complement of sensory and supporting cell structures, yet animals homozygous for this gene never demonstrate any hearing capacity. They are profoundly deaf from birth. Soon after development, the organ of Corti rapidly degenerates, most sensory cells having vanished by 50 days of age. Published observations have suggested that apical regions of the organ of Corti may regenerate some supporting cell structures by 90 days of age. We have quantified changes in organ of Corti structure from 15 to 130 days of age using several different measures. Measures of peak height and total cross-sectional area. as well as a subjective rating scale, all demonstrate consistent degenerative changes during this time period. No evidence for regeneration of supporting or sensory cell structures is noted, although a surprising degree of variability is present in all regions of the organ of Corti which may account for previous claims.

The aged suprachiasmatic nucleus is phase-shifted by cAMP in vitro

The cyclic adenosine monophosphate (cAMP) analog, 8-bromo-cAMP, phase advanced circadian neuronal rhythms in both aged and adult rat suprachiasmatic nuclei (SCN) by approximately 2 h in vitro. Rhythm amplitude was 20% lower in aged compared to adult SCN. The diminished efficacy of serotonergic agonists to phase shift behavioral rhythms of aged animals may be due to decrements in signal transduction mechanisms proximal to cAMP.

Comparative study of continuous extrapleural intercostal nerve block and lumbar epidural morphine in post-thoracotomy pain

OBJECTIVES

To compare the efficacy of continuous extrapleural intercostal nerve block with bupivacaine 0.5% in 1:200,000 epinephrine and continuous lumbar epidural block with morphine in controlling post-thoracotomy pain and to measure serum bupivacaine concentrations during extrapleural infusion.

DESIGN

A prospective, randomized, controlled trial.

SETTING

St. Joseph's Hospital, Hamilton, Ont., a tertiary care teaching centre.

PATIENTS

Sixty-one patients booked for elective thoracotomy were randomized by scaled envelope to two groups.

INTERVENTIONS

Group A received a continuous extrapleural intercostal nerve block with bupivacaine 0.5% in 1:200,000 epinephrine as a bolus of 0.3 mL/kg followed by an infusion of 0.1 mL/kg every hour for 72 hours. Group B received a continuous lumbar epidural block with morphine as a bolus of 70 g/kg followed by an infusion of 7 g/kg every hour for 72 hours.

MAIN OUTCOME MEASURES

Pain was assessed by a linear visual analogue scale (VAS) pain score. The cumulative amount of "rescue" intravenous morphine used, and serum bupivacaine concentrations were measured as secondary outcomes.

RESULTS

Pain control was the same in both groups as assessed by linear VAS score (p = 0.33). The cumulative dose of intravenous morphine for supplemental analgesia was statistically significant between the groups: group A patients used more morphine than group B (p < 0.05). Accumulation of serum bupivacaine was present with no clinical toxicity.

CONCLUSIONS

There is no significant difference in the degree of post-thoracotomy pain control measured by the VAS score when analgesia is provided by continuous extrapleural intercostal nerve block with bupivacaine 0.5% in 1:200,000 epinephrine or lumbar epidural block with morphine. Larger amounts of rescue analgesia were used by patients in the continuous extrapleural group with bupivacaine than those in the continuous lumbar epidural block with morphine. Serum bupivacaine concentrations rise without clinical toxicity.

Localization of perlecan (or a perlecan-related macromolecule) to isolated microglia in vitro and to microglia/macrophages following infusion of beta-amyloid protein into rodent hippocampus

The origin of the heparan sulfate proteoglycan (PG), perlecan, in beta-amyloid protein (A beta)-containing amyloid deposits in Alzheimer's disease (AD) brain is not known. In the present investigation we used indirect immunofluorescence, SDS-PAGE, and Western blotting with a specific perlecan core protein antibody to identify possible cell candidates of perlecan production in both primary cell cultures and in a rat infusion model. Double and triple-labeled indirect immunofluorescence was performed on dissociated primary rat septal cultures using antibodies for specific identification of cell types and for perlecan core protein. In mixed cultures of both embryonic day 18 (containing neurons and glia) and postnatal day 2-3 (devoid of neurons), microglia identified by labeling with OX-42 or anti-ED1 were the only cell type also double labeled with an affinity-purified polyclonal antibody against perlecan core protein. Similar immunolabeling of microglia with the anti-perlecan antibody was also observed in purified cultures of post-natal rat microglia. Analyses of PGs from cultured postnatal rat microglia by Western blotting using a polyclonal antibody against perlecan core protein revealed an approximately 400 kDa band in cell layer, which was intensified following heparitinase/heparinase digestion, suggestive of perlecan core protein. Other lower Mr bands were also found implicating either degradation of the 400 kDa core protein or the presence of separate and distinct gene products immunologically related to perlecan. Reverse transcription followed by polymerase chain reaction using human perlecan domain I specific primers demonstrated perlecan mRNA in cultured human microglia derived from postmortem normal aged and AD brain. Following a 1-week continuous infusion of A beta (1-40) into rodent hippocampus, immunoperoxidase immunocytochemistry and double-labeled immunofluorescent studies revealed perlecan accumulation primarily localized to microglia/macrophages within the A beta infusion site. These studies have identified microglia/macrophages as one potential source of perlecan (or a perlecan-related macromolecule) which may be important for the ongoing accumulation of both perlecan and A beta in the amyloid deposits of AD.

Effects of fumonisin B1 on the immune system of sprague-dawley rats following a 14-day oral (gavage) exposure

The effects of fumonisin B1 (FB1) on the immune system of Sprague-Dawley rats were investigated. Groups of male and female rats (10 rats/group) were gavaged daily for 14 days with doses of 0, 5, 15, and 25 mg/kg body wt/day and the primary (IgM) response to sheep red blood cells expressed as plaque-forming cell numbers/10(6) spleen mononuclear leukocytes (PFC/10(6) splenocytes) and PFC/spleen was determined. There was a significant dose-related linear trend toward decreased PFC/10(6) splenocytes (p = 0.003) and PFC/spleen cells (p = 0.001) in the male rats. Body weights, expressed as a percentage of the control, were significantly reduced (p = 0.002) in the male rats administered 15 and 25 mg/kg doses. The PFC numbers in female rats were not affected significantly by treatment (p > 0.05). For the remaining immunotoxicity studies, groups of male rats (10 rats/group) were gavaged with FB1 doses of 0, 1, 5, and 15 mg/kg body wt/day for 14 days. There was a weakly significant dose-related trend toward increased numbers of serum immunoglobulin class G (p = 0.04). Also a significant dose-related increase (p = 0.013) in Listeria monocytogenes numbers was observed in the spleen at 24 hr postinfection. Treatment did not have a significant effect on organ weights, hematology, mitogen-induced lymphocyte transformation, calcium mobilization, the numbers of leukocytes and T-lymphocyte subsets, the natural killer cell activity, and phagocytosis (p >/= 0. 05). These observations suggested that FB1 may have indirect consequences for human health and warrant further investigations.

Philopatry of male marine turtles inferred from mitochondrial DNA markers

Recent studies of mitochondrial DNA (mtDNA) variation among marine turtle populations are consistent with the hypothesis that females return to beaches in their natal region to nest as adults. In contrast, less is known about breeding migrations of male marine turtles and whether they too are philopatric to natal regions. Studies of geographic structuring of restriction fragment and microsatellite polymorphisms at anonymous nuclear loci in green turtle (Chelonia mydas) populations indicate that nuclear gene flow is higher than estimates from mtDNA analyses. Regional populations from the northern and southern Great Barrier Reef were distinct for mtDNA but indistinguishable at nuclear loci, whereas the Gulf of Carpentaria (northern Australia) population was distinct for both types of marker. To assess whether this result was due to reduced philopatry of males across the Great Barrier Reef, we determined the mtDNA haplotypes of breeding males at courtship areas for comparison with breeding females from the same three locations. We used a PCR-restriction fragment length polymorphism approach to determine control region haplotypes and designed mismatch primers for the identification of specific haplotypes. The mtDNA haplotype frequencies were not significantly different between males and females at any of the three areas and estimates of Fst among the regions were similar for males and females (Fst = 0.78 and 0.73, respectively). We conclude that breeding males, like females, are philopatric to courtship areas within their natal region. Nuclear gene flow between populations is most likely occurring through matings during migrations of both males and females through nonnatal courtship areas.

Effects of alfentanil on cerebral haemodynamics in an experimental model of traumatic brain injury

Alfentanil is reported to increase intracranial pressure (ICP) after neurotrauma. A direct cerebral vasodilator effect has been postulated. We studied 17 Sprague-Dawley rats allocated to one of three groups. Animals were anaesthetized and their lungs ventilated, and arterial pressure, ICP and/or regional cerebral blood flow (CBF) measurements were undertaken. Group 1 (n = 6) received a severe closed head injury while group 2 (n = 5) received no injury. ICP and mean arterial pressure (MAP) were measured before, during and after rapid infusion of alfentanil 250, 500 and 750 micrograms kg-1. CBF was measured by hydrogen clearance before rapid infusions and at 30-min intervals after starting a subsequent slow infusion of alfentanil 500 micrograms kg-1 h-1. Group 3 (n = 6) underwent CBF measurement only, for comparison with those of groups 1 and 2. They received an injury but no alfentanil. ICP or MAP values did not differ significantly between groups 1 and 2. Rapid i.v. doses of alfentanil produced increases in ICP and reductions in MAP. ICP changes were consistent with a drug effect (P < 0.001) but were small. Reductions in MAP were significant (P < 0.05) and preceded changes in ICP. CBF values were similar and unaffected by slow alfentanil infusion in groups 1 and 2, and did not differ significantly between groups 1 and 3. We conclude that alfentanil did not appear to exert a direct effect on the cerebral circulation. Changes in ICP after rapid infusion were secondary to reductions in SAP. Slow infusion did not cause such changes.

Effect of surgical experience on results of esophagectomy for esophageal carcinoma

BACKGROUND

Esophagectomy for esophageal cancer is associated with substantial operative morbidity and mortality. The effect of surgical experience on results of esophagectomy has received little attention in the medical literature.

METHODS

A retrospective review of esophagectomies for cancer was done.

RESULTS

Seventy-four patients underwent esophagectomy by 20 different surgeons. Three surgeons performed 6 or more esophagectomies per year ("frequent" surgeons), whereas the other 17 surgeons performed 5 or fewer esophagectomies per year ("occasional" surgeons). Forty-two patients were operated on by frequent surgeons. There were 3 (7%) anastomotic leaks and no deaths. In 32 patients operated on by occasional surgeons, there were 7 (22%) anastomotic leaks and 7 (22%) operative deaths. The anastomotic leak rates were not significantly different (P < .07), but frequent surgeons had a significantly lower operative mortality (P < .0014).

CONCLUSIONS

Esophagectomy for esophageal cancer should be performed by experienced esophageal surgeons with sufficient yearly volume of procedures to maintain competence.

Electrokinetic Behavior of Fluoride Salts as Explained from Water Structure Considerations

Unlike the other silver halides, silver fluoride is positively charged in its saturated solution as determined by nonequilibrium electrophoresis measurements. In the absence of surface hydrolysis reactions, other fluoride salts (LiF, CaF2 , and MgF2 ) also are positively charged in their saturated solutions. Furthermore, the electrokinetic behavior of these fluoride salts is rather insensitive to the fluoride ion activity in neutral or acidic solutions, and reversal of the sign of the surface charge by fluoride addition is not possible. Based on FTIR transmission spectra to describe the water structure of ionic solutions, in situ FTIR/internal reflection spectroscopy (FTIR/IRS) has been used to spectroscopically characterize interfacial water at fluoride salt surfaces. The experimental spectra were examined by consideration of the O-H stretching region (3000-3800 cm-1 ) associated with the vibrational spectra of interfacial water. These results reveal a unique hydration state for fluorides and explain the anomalous electrokinetic behavior of fluoride salts such as LiF, CaF2 , and MgF2 , which show an unexpected insensitivity to the fluoride ion concentration in solution. It appears that this insensitivity is due to the formation of strong hydrogen bonding of the fluoride ions with water molecules. This hydration state prevents the accommodation of excess fluoride ions at surface lattice sites and accounts for the observed electrokinetic behavior.

Effect of surgical experience on results of esophagectomy for esophageal carcinoma

BACKGROUND

Esophagectomy for esophageal cancer is associated with substantial operative morbidity and mortality. The effect of surgical experience on results of esophagectomy has received little attention in the medical literature.

METHODS

A retrospective review of esophagectomies for cancer was done.

RESULTS

Seventy-four patients underwent esophagectomy by 20 different surgeons. Three surgeons performed 6 or more esophagectomies per year ("frequent" surgeons), whereas the other 17 surgeons performed 5 or fewer esophagectomies per year ("occasional" surgeons). Forty-two patients were operated on by frequent surgeons. There were 3 (7%) anastomotic leaks and no deaths. In 32 patients operated on by occasional surgeons, there were 7 (22%) anastomotic leaks and 7 (22%) operative deaths. The anastomotic leak rates were not significantly different (P < .07), but frequent surgeons had a significantly lower operative mortality (P < .0014).

CONCLUSIONS

Esophagectomy for esophageal cancer should be performed by experienced esophageal surgeons with sufficient yearly volume of procedures to maintain competence.

Head Blight Gradients Caused by Gibberella zeae from Area Sources of Inoculum in Wheat Field Plots

ABSTRACT The spread of Fusarium head blight of wheat from a small area inoculum source was examined in wheat plots (100, 625, or 2,500 m(2)) inoculated in the center with Gibberella zeae-colonized corn kernels or macro-conidia sprayed on heads at anthesis. With the first inoculation method, disease foci were produced from ascospores released from perithecia formed on inoculated kernels. With the second inoculation method, disease foci were produced by macroconidia directly applied to the heads. Some plots were misted during anthesis. Plots were divided into grids, and disease incidence on spikelets and seeds was assessed at the grid intersections. Isopath contour maps were constructed using an interpolation procedure based on a weighted least squares method. Disease gradients were constructed from the isopath contours in the direction parallel to average nightly wind vectors using an exponential model. This study was conducted over a 3-year period at two sites: one in Quebec and one in Ontario. Both inoculation methods resulted in a discrete, primary focus of head blight in each plot, with one or two smaller secondary foci in some plots. The highest incidence of disease on spikelets or seed was commonly displaced somewhat from the inoculum source, usually downwind. The gradient slopes of seed and spikelet infection ranged from -0.10 to -0.43 m(1) in plots with ascospore inoculum and from -0.48 to -0.79 m(1) in plots inoculated with macroconidia. Seed infection declined to 10% of the maximum within 5 to 22 m from the focal center in asco-spore-inoculated plots, and within 5 m in a macroconidia-inoculated plot. Gradients were usually steeper upwind compared with downwind of the inoculum source. In misted plots, incidence of disease was higher and more diffuse than in nonirrigated plots. Based on gradients and dispersal patterns, disease foci in plots inoculated with G. zeae-colonized corn kernels probably arose from airborne ascospores rather than from splash-borne macroconidia and were the result of infection events that occurred over a short period of time. Comparison of conidial- and ascospore-derived disease gradients indicated a lack of secondary infection, confirming that Fusarium head blight is primarily a monocyclic disease.

Absence of a synergistic effect between fumonisin B1 and N-nitrosomethylbenzylamine in the induction of oesophageal papillomas in the rat

Fumonisins and N-nitrosamines (NNO) are suggested risk factors in the development of human oesophageal cancer; exposure to both occurs in high risk populations in Africa and People's Republic of China. The hypothesis that the two would interact in oesophageal carcinogenesis was therefore tested by treating male rats with the known oesophageal carcinogen N-methylbenzylnitrosamine (NMBA), and fumonisin B1 (FB1). The treatment groups were: Group 1, NMBA (2.5 mg/kg) intraperitoneally twice per week from week 2 to 4 inclusive; Group 2, as for group 1 but in addition FB1 (5 mg/kg) daily from weeks 1 to 5 inclusive by gavage; Group 3, FB1 (5 mg/kg) alone daily from weeks 1 to 5 inclusive by gavage, and Group 4, vehicle treatment from week 1 to 5 inclusive. Two of 12 animals in group 1 developed oesophageal papillomas and a further two had oesophageal dysplasia. Data were similar in group 2, animals receiving both NMBA and FB1, with one of 12 animals having papillomas and three of 12 with dysplasia. Sphingolipid biosynthesis was affected in the kidney and slightly in the liver after fumonisin treatment but not in the oesophagus or lung as determined by sphinganine:sphingosine ratios in urine and tissues. These data show that there is no synergistic interaction between NMBA and FB1 in the rat oesophagus when the two compounds are administered together. It is nevertheless important to examine other experimental models and treatment protocols which may be more relevant to the human situation and also to pursue epidemiological investigations of the role of fumonisins in oesophageal cancer.

The use of ergosterol to measure exposure to fungal propagules in indoor air

This report concerns the development of a method for the measurement of ergosterol in indoor air as a determinant of fungal exposure. Ergosterol was determined in spores of 11 species of Aspergillus, Penicillium, and Cladosporium selected from the most common molds in 400 homes in Ontario. Spore ergosterol content was about 1 microgram/mg, which is the range reported for mycelia, and varied by about 25% for the species tested. Ergosterol was determined in bedroom air samples taken in the winter in homes in southern Ontario. The median ergosterol value corresponded to a total concentration of fungal spores on the order of 10 to 10(2) per m3, in the range for other studies where total and viable propagules were determined by other methods. The sampling of air for ergosterol is a robust method for assessing fungal biomass in air, but provides no information on the species present.

Measurement of Interaction Forces between Silica and alpha-Alumina by Atomic Force Microscopy

Interaction forces between a silica sphere and an alpha-alumina substrate at various pH values were measured by atomic force microscopy (AFM). As expected, at pH values of 10.8 and 10.2 when the surfaces are similarly charged, a repulsive force was observed. On the other hand, at pH values of 5.5, 6.4, and 8.6 when the surfaces are oppositely charged, attractive forces were observed. Experimental force vs separation distance curves were found to be in good agreement with theoretical predictions based on electrostatic and van der Waals interactions. Interestingly, when the force/radius values at a particular separation distance were plotted against pH, the transition from an attractive to a repulsive force occurred at pH 9.3, which is very close to the point of zero charge (pzc) of alpha-alumina as determined from electrophoresis experiments. These results suggest that AFM force measurements can be used to estimate the pzc of materials. This method may be of particular significance for soluble salt minerals where conventional electrophoretic measurements are not possible at high ionic strengths. Finally, results from transmittance studies further confirmed the interaction between silica and alpha alumina particles in suspensions at various pH values as would be expected based on the results from atomic force microscopy measurements.

The CBFbeta subunit is essential for CBFalpha2 (AML1) function in vivo

The CBFbeta subunit is the non-DNA-binding subunit of the heterodimeric core-binding factor (CBF). CBFbeta associates with DNA-binding CBFalpha subunits and increases their affinity for DNA. Genes encoding the CBFbeta subunit (CBFB) and one of the CBFalpha subunits (CBFA2, otherwise known as AML1) are the most frequent targets of chromosomal translocations in acute leukemias in humans. We and others previously demonstrated that homozygous disruption of the mouse Cbfa2 (AML1) gene results in embryonic lethality at midgestation due to hemorrhaging in the central nervous system and blocks fetal liver hematopoiesis. Here we demonstrate that homozygous mutation of the Cbfb gene results in the same phenotype. Our results demonstrate that the CBFbeta subunit is required for CBFalpha2 function in vivo.

Monitoring weight drop velocity and foam stiffness as an aid to quality control of a rodent model of impact acceleration neurotrauma

Since the publication by Marmarou of a new rodent model of head injury, an increasing number of centres are adopting the model for use in a variety of paradigms. We report on two simple methods we have applied which allows us to monitor weight drop velocity and foam stiffness, both of which are critical factors for producing repeatable closed head injury with this model. We hope the application of these methods will assist in the standardisation of this model between centres.

New insights into the mammalian circadian clock

The focus of this review is recent studies of the mammalian circadian pacemaker in the suprachiasmatic nucleus (SCN) of the hypothalamus. The anatomy of the SCN and its major afferents from the retina, raphe, and intergeniculate leaflet (IGL) of the thalamus are considered, with a special emphasis on the effects of afferent interaction on the circadian timekeeping system. What is known of the endogenous clock mechanism is reviewed in comparison with known molecular circadian mechanisms in other species. Efferents of the SCN are also discussed with a view toward understanding how circadian information is transmitted to the rest of the central nervous system. Where possible, anatomical, electrophysiological, neuropharmacological, molecular, and behavioral data are integrated in an attempt to illuminate the mechanisms of circadian timekeeping.

Surgical neurology and clinical neurosciences in Edinburgh, Scotland

Surgical neurology in Edinburgh started > 70 years ago with Norman Dott, after his apprenticeship with Harvey Cushing. It continued under the chairmanship of John Gillingham, until 1980, and then Douglas Miller, who merged the Departments of Surgical Neurology and Medical Neurology to form the Department of Clinical Neurosciences in 1986. Particular strengths of the Edinburgh program have been the management of intracranial aneurysms, stereotactic and functional neurosurgery, the management of head and spinal injury and stroke, and neuro-oncology.

Inhibition of HIV-1 infectivity by low molecular weight heparin. Results of in vitro studies and a pilot clinical trial in patients with advanced AIDS

Several sulfated polysaccharides have been shown to have anti-HIV activity in vitro. However, many of these compounds are not suited for use in vivo because they present an increased risk of bleeding or cannot be administered chronically. We tested the anti-HIV effects of low molecular weight heparin (LMW-heparin) (Enoxaparin) in vitro using a model system of HIV infectivity because LMW-heparin can be given to patients on a long-term basis with little risk. In vitro, LMW-heparin was shown to inhibit HIV-1 production from a T cell lymphoma line (H9) and phytohemagglutinin-stimulated lymphoblasts. Inhibition of infectivity was dose dependent at concentrations achievable in vivo. We then performed a pilot clinical trial in 13 patients with advanced AIDS of 6 months of chronic, self-administered Enoxaparin given in standard prophylactic doses. CD4 counts appeared to stabilize or increase in most patients during the first 3 months of treatment, then remained stable or declined after 6 months. There was no appreciable change in serum p24 levels. There was no evidence of drug toxicity and no bleeding episodes. These findings demonstrate that a commercially available, relatively non-toxic form of LMW-heparin is a potent inhibitor of HIV-1 production in cultured cells and that it is feasible to treat patients with AIDS with LMW-heparin on a long-term basis. Definitive clinical trials of LMW-heparins and related compounds as experimental anti-viral agents in patients with HIV infection are indicated.

The influence of temperature, phylogeny, and lung structure on the lipid composition of reptilian pulmonary surfactant

The lungs of all air-breathing vertebrates contain a form of pulmonary surfactant that lines the alveolar air-water interface where it modifies the interfacial surface tension. These pulmonary surfactants all consist of varying amounts of phospholipids (saturated and unsaturated) and cholesterol. The extent of variation between vertebrate groups and between species within a vertebrate group has been attributed to differences in factors such as phylogeny, body temperature, habitat, and lung structure. The influence of these factors on amphibian surfactant composition and function has been studied, but the reptiles, which comprise a polyphyletic group of vertebrates, have never been critically examined. The surfactant lipid composition from species belonging to the three groups of reptiles, the Archosauria (crocodiles), Lepidosauria (snakes and lizards), and Anapsida (turtles), has been determined. New data is presented in conjunction with already published data to create an evolutionary framework that concentrates particularly on the influence of phylogeny, body temperature, and lung structure on the composition of the surfactant lipids. Large amounts of pulmonary surfactant were found in all species of reptiles. All species lavaged at 23 degrees C (except C. atrox) demonstrated DSP/PL ratios of 23-33%. Animals with multicameral lungs exhibited an elevated CHOL/DSP ratio compared with species with unicameral lungs. In all groups, phosphatidylcholine (PC) was the dominant (60-80%) phospholipid. Phosphatidylserine and phosphatidylinositol (PS/PI) and sphingomyelin (S) represented the other phospholipids, while phosphatidylglycerol (PG), lysophosphatidylcholine (LPC), and phosphatidylethanolamine (PE) were occasionally observed. In two species of lizards (C. nuchalis and P. vitticeps), the saturated fatty acid, palmitic acid (16:0), was the dominant tail group on the phospholipids. Oleic acid (18:1) was the dominant monounsaturated fatty acid, whereas polyunsaturates comprised about a fifth of the total fatty acid profile. Short-term (4 h) changes in temperature did not affect the relative proportions of the fatty acids in either species. Comparison of the current data with previously published literature suggests that phylogeny and habitat do not significantly influence surfactant lipid composition, but body temperature and to a lesser extent lung structure are important determinants of reptilian surfactant lipid composition.

Prostate-specific antigen expression is regulated by an upstream enhancer

Prostate cancer can be detected using assays for blood-borne prostate-specific antigen (PSA), which is the clinically most useful diagnostic marker of malignant disease. This paper characterizes the 5 -flanking prostate-specific enhancer which controls expression of the human PSA gene This enhancer, located between -5824 and -3738, is androgen-responsive and requires a promoter for activity. Inductions of 12-100-fold activity occur at 1 nM concentrations of the testosterone analog R1881. The enhancer demonstrated tissue specificity as judged by transfections of several human cell lines. Electrophoretic mobility shift assays comparing nuclear extracts from breast cancer cells MCF-7, and prostate cancer cells LNCaP, showed three regions of prostate-specific binding. These three regions are -4168 to -4797 (region I), -4710 to 4479 (region II), and -4168 to -3801 (region III). Region III contained a putative androgen response element at -4136 that markedly affected activity if mutated. These data suggest that prostate-specific gene expression may involve interaction of prostate-specific proteins or protein complexes with the enhancer in addition to binding of the androgen receptor to androgen response elements.

Ocular motor dysfunction in HIV-1-infected subjects: a quantitative oculographic analysis

We recorded eye and head movements in 13 human immunodeficiency virus type-1 (HIV-1)-infected patients with CD4 counts of less than or equal to 500 cells/mm3 using magnetic search coil oculography. Horizontal and vertical saccades, smooth pursuit, and vestibular smooth eye movements were recorded, as were horizontal antisaccades and vestibular memory-guided saccades. Rightward and leftward and upward and downward responses were analyzed separately. Compared to normal control subjects, HIV-1--infected patients performed the antisaccade test poorly, making the initial antisaccade in the correct direction (away from the target) in only 33% of trials. The mean final gaze position achieved during the vestibular memory-guided saccade task was less accurate for HIV-1-infected patients than for control subjects, and this correlated with inaccuracies on the antisaccade task. Horizontal saccades, horizontal and vertical smooth pursuit, and vestibular smooth eye movements were quantitatively normal. However, smooth pursuit showed directional asymmetries, vertically more than horizontally; horizontal and vertical unpredictable saccades were more inaccurate than predictable saccades; and vertical saccade latencies were prolonged. In patients with HIV-1 infection, abnormalities in vertical eye movements and relative asymmetries in smooth pursuit gains, both horizontally and vertically, are more sensitive and consistent indicators of CNS dysfunction than are horizontal eye movement abnormalities or measurements of absolute smooth pursuit gain and phase.

Disposition of 14C-derived residues in tissues of pigs fed radiolabelled fumonisin B1

The uptake and distribution of radioactive material-derived residues were determined in tissues of growing pigs consuming 14C-labelled fumonisin B1 (FB1) in the diet. Animals were fed 3.0 mg (3.0 microCi) 14C-FB1/kg feed from days 1-12, followed by 2.0 mg (2.0 microCi) 14C-FB1/kg feed during days 13-24, followed by a 9-day withdrawal period where pigs received clean feed only. Of the tissues analysed, residues were found to accumulate only in liver and kidney. Radioactivity was detected at the first sampling time (day 3), and continued to increase until the 14C-toxin was removed from the diet. Peak tissue levels (dpm/g tissue +/- SD, N = 2) in liver and kidney were 347 +/- 28 and 146 +/- 14, respectively, on day 24, which were equivalent to about 160 and 65 ng FB1 and/or metabolites per g tissue, respectively. Once pigs were placed on clean feed, tissue levels declined rapidly; down to approximately 35% of peak levels after 3 days, and only marginally above detection limits (approximately 25 dpm/g) after 9 days. Delayed recovery of the radioactive material consumed indicated a persistence within the body of FB1-derived residues, which could be eliminated only upon removal of the contaminated diet.

NMR structural studies of fumonisin B1 and related compounds from Fusarium moniliforme

Fumonisin B1 (FB1) is the primary mycotoxin produced by Fusarium moniliforme and appears to be responsible for the varied toxigenic effects associated with ingestion of this mold, particularly that of the inhibition of sphingolipid biosynthesis. Understanding the structure and biosynthesis of fumonisins is a key factor in determining structure/activity relationships. To this end, Nuclear Magnetic Resonance (NMR) methods have been used to identify various derivatives of FB1, both naturally occurring and synthetic. With accurate chemical shift assignments, NMR may be used to determine the level of impurities in toxicological grade FB1 preparations. Specifically enriched FB1 was prepared from F. moniliforme cultures using 13C-enriched acetate as well as several 13C-enriched amino acids. 13C NMR analysis indicates that the biosynthesis of fumonisins involves the addition of methionine-derived methyl functions, glutamate-derived tricarballylic ester functions and alanine to an 18 carbon hydrocarbon backbone that is likely polyketide in origin. With the goal of obtaining a crystalline compound for the determination of absolute configuration, several derivatives of FB1 have been prepared, and NMR analysis used to determine the relative and absolute configuration of the 10 stereocenters present in this molecule.

Biological fate of fumonisin B1 in food-producing animals

The presence of mycotoxins in grains and feedstuffs causes not only animal health problems, but also a valid concern about the transmission of potentially toxic residues into animal-derived products intended for human consumption. In a series of studies at Agriculture and Agri-Food Canada, we investigated the biological fate of fumonisin B1 (FB1) in several food-producing animals (grower pigs, laying hens, dairy cattle), as well as monitored various parameters for evidence of toxicity in these species. In several experiments involving either single-dose protocols (iv, po) or longer-term feeding trials, the pharmacokinetic profiles of FB1 (purity > 95%) in these species were determined, including tissue accumulation and transmission of residues. Toxicological (and economical) implications such as performance (feed consumption, growth), productivity, and carcass quality were also measured when appropriate.