Fission yeast Skp1 is required for spindle morphology and nuclear membrane segregation at anaphase

Skp1 is a core component of the Skp1-Cullin-1-F-box ubiquitin ligase. Here, we show a novel role for fission yeast Skp1 in mitotic progression. Temperature-sensitive skp1-A7 mutants enter mitosis, but fail to execute anaphase. Time-lapse imaging shows that spindles in this mutant form intranuclear arch-like structures, which eventually collapse abruptly. The two spindle poles are also seen to move backward to the cell centre rather than towards the cell ends. These abnormal phenotypes appear to stem from defects in nuclear membrane segregation. Our results show that Skp1 is required for coordinated structural alterations of mitotic spindles and nuclear membranes.

Ein Vergleich des Arndt®-Bronchusblockers mit einem Doppellumentubus im Rahmen robotergestützter Eingriffe in der Herzchirurgie

OBJECTIVE

In this prospective, randomised study a double lumen tube (DLT) or an Arndt bronchial blocker (BB) was used for one lung ventilation (OLV). Intraoperative oxygenation, ventilation, haemodynamics, and ease of placement were compared.

METHODS

In 32 patients undergoing robotic harvesting of the left internal thoracic artery (ITA) a left-sided DLT or a BB controlled by bronchoscopy was used for OLV of the right lung. In 2 patients randomised for DLT, a single lumen tube and BB was used for difficult visualisation of the larynx. These 2 patients were excluded from the study.

RESULTS

Correct placement of DLT (8.8 +/- 5.4 min, 87.5 % of the patients) as well as BB (6.5 +/- 4.0 min; n. s.; 100 % of the patients) was achieved rapidly. The Cormack-Lehane score for visualisation of the larynx was 2, 1 - 3 (median, range) in group DLT and 3, 1 - 4 (median, range) in group BB (p < 0.05). OLV lasted for 93 +/- 29 min in group DLT and 88 +/- 34 min in group BB (n. s.). Satisfactory conditions for harvesting ITA were achieved in all patients of both groups. There was no difference in any haemodynamic parameter at any time between the two groups. Mean pulmonary arterial pressure and pulmonary vascular resistance were increased without significant differences between the two groups during thoracoscopy for robotic preparation of left ITA. During OLV, index of paO (2)/FiO (2) was significantly (p < 0.05) lower in DLT patients compared to BB patients. Time to extubation did not differ between the two groups (DLT 14.3 +/- 4.6 h; BB 11.8 +/- 3.8 h).

CONCLUSION

OLV in patients undergoing robotic cardiac surgery was safely achieved either by BB or by left-sided DLT. Positioning of the BB was easier than that of a DLT when intubation was difficult and tube exchange at the end of surgery is avoided. Therefore, we prefer a BB in patients undergoing robotic harvesting of left ITA.

Molecular interactions of fission yeast Skp1 and its role in the DNA damage checkpoint

Skp1 is a central component of the E3 ubiquitin ligase SCF (Skp1-Cullin-1-F-box). It forms an adapter bridge between Cullin-1 and the substrate-determining component, the F-box protein. In order to establish the role of Skp1, a temperature sensitive (ts) screen was carried out using mutagenic PCR (polymerase chain reaction) and 9 independent ts mutants were isolated. Mapping the mutated residues on the 3-D structure of human Skp1 suggested that the mutants would be compromised in binding to F-box proteins but not Cullin-1 (Pcu1). In order to assess the binding properties of ts Skp1, 12 F-box proteins and Pcu1 were epitope-tagged, and co-immunoprecipitation performed. This systematic analysis showed that ts Skp1 retains binding to Pcu1. However, binding to three specific F-box proteins, essential Pof1, Pof3 involved in maintaining genome integrity, and nonessential Pof10, was reduced. skp1ts cells exhibit a G2 cell cycle delay, which is attributable to activation of the DNA damage checkpoint. Intriguingly, contrary to pof3 mutants, in which this checkpoint is required for survival, checkpoint abrogation in skp1(ts) suppresses a G2 delay and furthermore almost rescues the ts phenotype. The activation mechanism of the DNA damage checkpoint therefore differs between pof3Delta and skp1(ts), implicating a novel role for Skp1 in the checkpoint-signalling cascade.

[Is levosimendan an inoprotective drug in patients with acute coronary syndrome undergoing surgical revascularization?]

Levosimendan, is a new calcium sensitiser with 2 major effects. First, levosimendan acts as a positive inotropic agent by binding calcium dependently to cardiac troponin C. Second, levosimendan activates adenosine triphosphate-regulated potassium (K (ATP)) channels. Thus it has vasodilatory properties and cardioprotective effects at a dose enhancing myocardial contractility. These unique properties of levosimendan might be of great advantage in patients with myocardial ischemia simultaneously requiring inotropic support. The concept of perioperative inoprotection is presented in 6 patients with acute ischemia undergoing emergent cardiac surgery.

Impact of atrio-biventricular pacing to poor left-ventricular function after CABG

AIMS

The relation between acute postoperative management of epicardial pacing and haemodynamic status in patients with poor left-ventricular function after coronary artery bypass grafting (CABG) demonstrates the importance of synchronous ventricular activation and contraction during the vulnerable early postoperative period.

METHODS

in 22 patients (mean age - 69.3 +/- 5.4 years) with poor left-ventricular function (ejection fraction 29.8 +/- 4.8), we compared the postoperative haemodynamic parameters between atrio-biventricular, atrio-monoventricular and atrial pacing 3 - 24 hours after elective coronary artery revascularisation. Temporary epicardial pacing electrodes were placed on the right atrium and the paraseptal region of the left and right ventricle. The ventricular pacing modus was confirmed by surface electrocardiogram (EGG). We used overdrive rate pacing.

RESULTS

In patients with left bundle branch block, atrio-left-ventricular and atrio-biventricular pacing increased cardiac index and decreased wedge pressure. Atrial pacing and atrio-right-ventricular pacing decreased cardiac index. In contrast, atrio-right-ventricular and atrio-biventricular pacing increased cardiac index in patients with right bundle brunch block.

CONCLUSION

Atrio-biventricular pacing increased cardiac index and decreased wedge pressure compared with AAI pacing. In patients with wall-motion abnormalities and impaired cardiac conduction, a site-specific pacing therapy can help to optimize postoperative haemodynamics and reduce the application of inotropic substances.

Baclofen-mediated gastro-oesophageal acid reflux control in patients with established reflux disease

AIM

To explore the effect of baclofen on oesophageal acid exposure in patients with gastro-oesophageal reflux disease.

METHODS AND MATERIALS

Twenty patients with established reflux disease were included in this double-blind, randomized, crossover study. Baclofen, 40 mg, or placebo was given as a single dose with a washout period of 4 weeks. Symptoms were assessed by a visual analogue scale. Oesophageal pH was registered for 12 h and analysed for the whole period and for the 0-4-h, 4-8-h, 8-12-h and 2-h post-prandial periods.

RESULTS

Baclofen significantly reduced the number of reflux episodes during the 0-4-h (7.9 vs. 16.5, P < 0.0001; post-prandially: 6.0 vs. 11.2, P < 0.0001) and 0-12-h (46.5 vs. 73, P=0.0001; post-prandially: 18.8 vs. 29.3, P < 0.0001) periods. The fraction of time with pH < 4 was significantly lowered during the 0-4-h period (9.3 vs. 15.6, P=0.0019; post-prandially: 16.1 vs. 23.5, P=0.0083). Similar results were also obtained in patients with a hiatus hernia (n=13). Belching was significantly reduced (32 vs. 69 episodes, P < 0.01).

CONCLUSIONS

A single oral dose of 40 mg baclofen significantly reduced both the number of reflux episodes and the fraction of time with pH < 4, an effect primarily found during the first 4 h after dosing.

Survival and quality of life after a long-term intensive care stay

OBJECTIVE

The growing number of high-risk patients in cardiac surgery unavoidably leads to more complications, and therefore to a prolonged stay in an intensive care unit (ICU). The aim of our investigation was to elaborate on the fate of patents after long-term ICU treatment.

METHODS

Out of 5055 patients, 232 had to be treated for longer than 5 days in ICU. These 232 patients were analyzed for in-hospital mortality and followed up for quality of life. The Barthel mobility index and geriatric depression scale by Sheikh and Yesavage were used to evaluate physical ability and mood disturbances. Follow-up time was 82 months, and could be completed for 99 % of the patents.

RESULTS

In-hospital mortality was 34.6 %, with the majority of cases being coronary artery bypass grafting procedures (59.9 %). Average stay in ICU was 12.0 days for the survivors and 17 days for non-survivors. During follow-up time (6 - 82 months), another 56 patients (23 %) died. Survivors (n = 98) were predominantly in NYHA classes l-ll (83 %) with a Barthel index of more than 80, representing adequate mobilization during daily life in 78 % of the patients. Results according to the geriatric depression scale were normal in the vast majority of patients (91 %) with severe or life threatening depressions in only 6 patients (8 %).

CONCLUSION

Long-term treatment of critically ill patients is admittedly burdened with high in-hospital and follow-up mortality. However, the excellent physical and psychological recovery of survivors unequivocally supports the employment of all technical and personnel resources within modern intensive care medicine.

Fission yeast F-box protein Pof3 is required for genome integrity and telomere function

The Skp1-Cullin-1/Cdc53-F-box protein (SCF) ubiquitin ligase plays an important role in various biological processes. In this enzyme complex, a variety of F-box proteins act as receptors that recruit substrates. We have identified a fission yeast gene encoding a novel F-box protein Pof3, which contains, in addition to the F-box, a tetratricopeptide repeat motif in its N terminus and a leucine-rich-repeat motif in the C terminus, two ubiquitous protein-protein interaction domains. Pof3 forms a complex with Skp1 and Pcu1 (fission yeast cullin-1), suggesting that Pof3 functions as an adaptor for specific substrates. In the absence of Pof3, cells exhibit a number of phenotypes reminiscent of genome integrity defects. These include G2 cell cycle delay, hypersensitivity to UV, appearance of lagging chromosomes, and a high rate of chromosome loss. pof3 deletion strains are viable because the DNA damage checkpoint is continuously activated in the mutant, and this leads to G2 cell cycle delay, thereby preventing the mutant from committing lethal mitosis. Pof3 localizes to the nucleus during the cell cycle. Molecular analysis reveals that in this mutant the telomere is substantially shortened and furthermore transcriptional silencing at the telomere is alleviated. The results highlight a role of the SCF(Pof3) ubiquitin ligase in genome integrity via maintaining chromatin structures.

Control of transient lower oesophageal sphincter relaxations and reflux by the GABA(B) agonist baclofen in patients with gastro-oesophageal reflux disease

BACKGROUND AND AIMS

Transient lower oesophageal sphincter relaxations (TLOSRs) are the major cause of gastro-oesophageal reflux in normal subjects and in most patients with reflux disease. The gamma aminobutyric acid (GABA) receptor type B agonist, baclofen, is a potent inhibitor of TLOSRs in normal subjects. The aim of this study was to investigate the effect of baclofen on TLOSRs and postprandial gastro-oesophageal reflux in patients with reflux disease.

METHODS

In 20 patients with reflux disease, oesophageal motility and pH were measured, with patients in the sitting position, for three hours after a 3000 kJ mixed nutrient meal. On separate days at least one week apart, 40 mg oral baclofen or placebo was given 90 minutes before the meal.

RESULTS

Baclofen reduced the rate of TLOSRs by 40% from 15 (13.8-18.3) to 9 (5.8-13.3) per three hours (p<0.0002) and increased basal lower oesophageal sphincter pressure. Baclofen also significantly reduced the rate of reflux episodes by 43% from 7.0 (4.0-12.0) to 4.0 (1.5-9) per three hours (median (interquartile range); p<0.02). However, baclofen had no effect on oesophageal acid exposure (baclofen 4.9% (1.7-12.4) v placebo 5.0% (2.7-15.5)).

CONCLUSIONS

In patients with reflux disease, the GABA(B) agonist baclofen significantly inhibits gastro-oesophageal reflux episodes by inhibition of TLOSRs. These findings suggest that GABA(B) agonists may be useful as therapeutic agents for the management of reflux disease.

Effects of antagonism of NMDA receptors on transient lower esophageal sphincter relaxations in the dog

Transient lower esophageal sphincter relaxation is the major cause of gastroesophageal reflux. Mechanisms underlying transient lower esophageal sphincter relaxation are poorly understood although gastric mechanosensitive vagal afferent pathways play a central role. Glutamate is a key transmitter of vagal afferents acting partly on NMDA receptors. The aim of this work was to study the effects on transient lower esophageal sphincter relaxation in awake dogs (n=5) of the competitive NMDA receptor antagonist cis-4-phosphonomethyl-2-piperidine carboxylic acid (CGS 19755; 0.3 and 3 mg/kg i.v., the high dose was given at two separate occasions to each dog). Transient lower esophageal sphincter relaxations were evoked by intragastric infusion of a liquid meal followed by air insufflation and were scored during a 45-min period. Neither dose produced any significant effect on the group average number of transient lower esophageal sphincter relaxations. Synchronous contractions of the esophagus were commonly seen during transient lower esophageal sphincter relaxation and CGS 19755 at both doses greatly reduced their occurrence. The findings indicate that NMDA receptor antagonism selectively inhibits the esophageal component of transient lower esophageal sphincter relaxation although the rate of transient lower esophageal sphincter relaxations is not consistently affected.

[Is measuring the depth of anesthesia sensible? An overview on the currently available monitoring systems]

Without any doubt there is an increasing need for accurately measuring depth of anesthesia - from the viewpoint of the anesthesiologist and also of the patient. The ideal monitoring should fulfill the following criteria: It should be applicable for any type of anesthesia (intravenous as well as inhalative anesthesia); the monitor must have an extremely high sensitivity (each patient being awake must be recognized by the device).If the monitor does not have a high sensitivity, the monitor itself might lead to an increasing number of patients being awake during anaesthesia, because the anesthesiologist might rely on the monitor and does not deepen anesthesia while the patient is awake. Specificity is not as important as sensitivity. As incidence of interoperative awareness is low, one must monitor more than 750 patients to recognize only one patient who is awake. Finally, the monitoring device must be economic. If costs are considerably increased by measuring depth of anesthesia in today's climate of cost consciousness, the monitoring has to be restricted to special high risk groups of patients. If monitoring depth of anesthesia will become simple, safe, and economic, each anesthesia should be monitored for its depth, as today each patient needs pulseoxymetry. We try to give an orientation about the available devices for monitoring depth of anesthesia. Since the introduction of BIS interest in measuring depth of anesthesia is growing very dynamically. Due to the dynamic growth we hope that we were able to present an actual and complete overview about the monitoring systems for measuring depth of anesthesia. Until today no monitoring system has proven to fulfill the mentioned criteria. Monitoring of the depth of anesthesia will be based on any processing of the spontaneous EEG or its evoked potentials. Which type of monitoring, entropy, BIS, PSI, or MLAEP will be used in clinical routine will be shown in the future. All available monitors are no predictors, whether depth of anesthesia is sufficient for the next painful surgical stimulus. They can only monitor the anesthetic state at the time of measurement. There is no "golden number" predicting absolutely safely that the patient is in adequate anesthesia. The anesthetist must consider any technique for monitoring of the depth of anesthesia as an additional help in improving care for his patient.

Target-controlled infusion or manually controlled infusion of propofol in high-risk patients with severely reduced left ventricular function

OBJECTIVE

To compare hemodynamics, time to extubation, and costs of target-controlled infusion (TCI) with manually controlled infusion (MCI) of propofol in high-risk cardiac surgery patients.

DESIGN

Prospective, randomized.

SETTING

Major community university-affiliated hospital.

PARTICIPANTS

Twenty patients undergoing first-time implantation of a cardioverter-defibrillator with severely reduced left ventricular function (left ventricular ejection fraction <30%).

INTERVENTIONS

Anesthesia was performed using remifentanil, 0.2 to 0.3 microg/kg/min, and propofol. Propofol was used as TCI (plasma target concentration, 2 to 3 microg x mL; n = 10) or MCI (2.5 to 3.5 mg/kg/hr; n = 10).

MEASUREMENTS AND MAIN RESULTS

Hemodynamics were measured at 6 data points: T1, before anesthesia; T2, after intubation; T3, after skin incision; T4, after first defibrillation; T5, after third defibrillation; and T6, after extubation. There were no significant hemodynamic differences between the 2 groups. Dobutamine was required to maintain cardiac index >2 L/min/m(2) in significantly more patients of the TCI group than of the MCI group. Mean dose of propofol was higher in the TCI patients (6.0 +/- 1.0 mg/kg/hr) than in the MCI patients (3.0 +/- 0.4 mg/kg/hr) (p < 0.05), whereas doses of remifentanil did not differ. Time to extubation was significantly shorter in the MCI (11.9 +/- 2.4 min) versus the TCI group (15.6 +/- 6.8 min). Costs were significantly lower in MCI patients (34.73 dollars) than in TCI patients (44.76 dollars).

CONCLUSIONS

In patients with severely reduced left ventricular function, TCI and MCI of propofol in combination with remifentanil showed similar hemodynamics. TCI patients needed inotropic support more often than MCI-treated patients. Although extubation time was longer in TCI patients and costs were higher, both anesthesia techniques can be recommended for early extubation after implantation of a cardioverter-defibrillator.

Influence of a new hydroxyethylstarch preparation (HES 130/0.4) on coagulation in cardiac surgical patients

OBJECTIVE

To compare volume therapy with HES 130/0.4, a new hydroxyethylstarch (HES) solution with a gelatin-based fluid replacement strategy.

DESIGN

Prospective, randomized, safety study.

SETTING

Urban, university-affiliated hospital (single institution).

PARTICIPANTS

Forty-two patients undergoing elective cardiac surgery.

INTERVENTIONS

Patients were prospectively randomized into 2 groups: In group 1 (n = 21), gelatin was given perioperatively for volume support until the 1st postoperative day to keep the central venous pressure (CVP) between 10 and 14 mmHg; in group 2 (n = 21) HES 130/0.4 was administered using the same protocol as in group 1.

MEASUREMENTS AND MAIN RESULTS

Standard coagulation variables and modified thromboelastography (TEG) were used. Using different activators for extrinsic and intrinsic activation and heparin inactivation by heparinase, the onset of coagulation (coagulation time), kinetics of clot formation (clot formation time), and maximum clot firmness were measured. Measurements were performed after induction of anesthesia (T0), at the end of surgery (T1), 4 hours after surgery (T2), and on the morning of the 1st postoperative day (T3). A total of 3310 +/- 810 mL of gelatin and 3070 +/- 570 mL of HES 130/0.4 were used in the 2 groups during the study period. The 2 groups did not differ with regard to postoperative bleeding or in use of packed red blood cells or fresh frozen plasma. Standard coagulation variables were similar between the 2 groups. All TEG variables were within the normal range at baseline. Coagulation time and clot formation time data were significantly elevated after surgery and in the intensive care unit, without showing specific differences between the 2 volume replacement groups. Intrinsic TEG and heparinase TEG clot formation times remained significantly higher until the end of the study period. No differences were seen between HES-treated and gelatin-treated patients.

CONCLUSIONS

Volume replacement with the new HES preparation was as safe as gelatin-based volume replacement with regard to coagulation in cardiac surgical patients. HES 130/0.4 is an alternative plasma substitute to treat volume deficits.

Long-term behaviour and cross-correlation water quality analysis of the River Elbe, Germany

This study analyses weekly data samples from the river Elbe at Magdeburg between 1984 and 1996 to investigate the changes in metabolism and water quality in the river Elbe since the German reunification in 1990. Modelling water quality variables by autoregressive component models and ARIMA models reveals the improvement of water quality due to the reduction of waste water emissions since 1990. The models are used to determine the long-term and seasonal behaviour of important water quality variables. Organic and heavy metal pollution parameters showed a significant decrease since 1990, however, no significant change of chlorophyll-a as a measure for primary production could be found. A new procedure for testing the significance of a sample correlation coefficient is discussed, which is able to detect spurious sample correlation coefficients without making use of time-consuming prewhitening. The cross-correlation analysis is applied to hydrophysical, biological, and chemical water quality variables of the river Elbe since 1984. Special emphasis is laid on the detection of spurious sample correlation coefficients.

Influence of prophylactic use of pentoxifylline on postoperative organ function in elderly cardiac surgery patients

OBJECTIVE

To study the effects of pretreatment with pentoxifylline before cardiac surgery on postoperative organ function in elderly patients (>80 yrs) undergoing cardiac surgery.

DESIGN

Prospective, randomized, placebo-controlled study.

SETTING

Two-day clinical investigation in an intensive care unit of a university-affiliated hospital.

PATIENTS

Forty elderly patients (age >80 yrs) undergoing first-time elective aortocoronary bypass grafting.

INTERVENTIONS

In 20 patients, pentoxifylline (loading bolus of 300 mg followed by a continuous infusion of 1.5 mg.kg-1.hr-1 until the second postoperative day) was given after induction of anesthesia; another 20 patients received saline solution as placebo.

MEASUREMENTS AND MAIN RESULTS

Concentrations of soluble adhesion molecules (soluble E-selectin, soluble vascular cell adhesion molecule-1, and soluble intercellular adhesion molecules) were measured to assess endothelial function. Liver function was evaluated by monoethylglycinexylidide test and by measuring alpha-glutathione S-transferase plasma concentrations. Renal function was assessed by measuring serum creatinine and urine concentrations of alpha-1-microglobulin. Splanchnic perfusion was assessed by monitoring intramucosal pH by using continuous tonometry. All measurements were performed before pentoxifylline infusion (T0), at the end of surgery (T1), 5 hrs after surgery (T2), and at the morning of the first (T3) and second (T4) postoperative day. Postoperative concentrations of all measured soluble adhesion molecules were significantly higher in the nontreated controls than in the pentoxifylline-treated patients. Monoethylglycinexylidide serum concentrations were significantly lower and abnormal (<50 ng/mL) postoperatively only in the untreated control patients. alpha-Glutathione S-transferase increased in both groups with a significantly higher increase in the control group (from 3.2 +/- 1.2 to 24.1 +/- 4.2 ng/mL) than in the pentoxifylline-treated patients (from 3.8 +/- 1.9 to 11.5 +/- 2.1 ng/mL). Serum creatinine was unchanged in both groups, whereas alpha-1-microglobulin increased significantly more in the control group than in the pentoxifylline-treated group. Intramucosal pH remained almost unchanged in the pentoxifylline patients (>7.35) but decreased significantly in the control group (5 hrs after surgery, intramucosal pH 7.29 +/- 0.13).

CONCLUSIONS

Pretreatment of patients aged >80 yrs undergoing cardiac surgery with pentoxifylline attenuated deterioration of endothelial, renal, and liver function as seen in an untreated control group. Splanchnic perfusion also appears to be improved in the pentoxifylline-treated group. Whether pretreatment with pentoxifylline will improve outcome in this patient population remains to be elucidated.

Chromosome evolution in the genus Poecilimon (Orthoptera, Tettigonioidea, Phaneropteridae)

Cytotaxonomic analysis of 20 species and subspecies of the genus Poecilimon using C-banding pattern, chiasma frequency, and morphometric characteristics of the chromosomes were described. Using a cladistic analysis the chromosome data provided a basis to produce a phylogenetic tree which was compared with a tree based on morphological characters and DNA sequence data. There are important differences in the grouping of data sets to species obtained on the basis of morphology/DNA analyses and that based on chromosomes. The explanation of the differences between C-banding patterns and taxonomic proximity is probably that the C-banding pattern changes quickly as the result of the high degree of variation of constitutive heterochromatin.

Prophylactic use of pentoxifylline on inflammation in elderly cardiac surgery patients

BACKGROUND

Inflammation plays a pivotal role in the pathogenesis of organ injury after cardiopulmonary bypass (CPB). Elderly patients appear to be especially prone to develop general inflammation. Use of pentoxifylline (PTX) before surgery may be a promising approach to minimize the negative effects of CPB in these patients.

METHODS

In a prospective, randomized study, patients more than 80 years old undergoing aortocoronary artery bypass grafting received either PTX (n = 15) after induction of anesthesia (initial bolus of 300 mg followed by a continuous infusion of 1.5 mg.kg(-1).h(-1) during the next 2 days) or saline as placebo (control group; n = 15). Polymorphonuclear neutrophil (PMN) elastase, C-reactive protein (CRP), and interleukins (IL-6, IL-8, IL-10) were measured from arterial blood samples before surgery (T0), at the end of surgery (T1), 5 hours after surgery (T2), and at the morning of the first (T3) and second (T4) postoperative day.

RESULTS

Postoperatively, PTX-treated patients less often needed catecholamines and were extubated earlier than the control patients (p < 0.05). On the intensive care unit, cardiac index inceased more in the PTX-treated (from 1.95 +/- 0.3 to 3.26 +/- 0.4 L.min(-1).m(-2)) than in the control patients (from 1.89 +/- 0.2 to 2.78 +/- 0.3 L.min(-1).m(-2)). Increase in CRP and PMN-elastase was significantly higher in the untreated control than in the PTX patients. After CPB, IL-6, IL-8, and IL-10 increased in both groups showing a significantly higher increase in the untreated control patients (IL-8 control: from 11.3 +/- 2.6 to 154.4 +/- 57 pg/mL [T1]); IL-8 PTX: from 10.9 +/- 2.7 to 71.8 +/- 23 pg/mL [T1]).

CONCLUSIONS

In elderly cardiac surgery patients, use of PTX before surgery and continued after CPB resulted in less inflammatory response than in an untreated control group. The value of attenuating the inflammatory process by PTX on outcome in this patient population needs to be evaluated in further controlled studies.

The spike of S phase cyclin Cig2 expression at the G1-S border in fission yeast requires both APC and SCF ubiquitin ligases

We describe a novel set of oscillation mechanisms for the fission yeast S phase cyclin Cig2, which contains an authentic destruction box and is destroyed at anaphase via the APC/cyclosome (APC/C). Unlike the mitotic cyclin Cdc13, however, Cig2 mRNA and protein peak at the G1/S boundary and decline to low levels in G2 and M phases. We show here that SCF(Pop1, Pop2) plays a role in transcriptional periodicity, as pop mutations result in constitutive cig2(+) transcripts. The instability of Cig2 during G2 and M is independent of either the APC/C or Pop1/Pop2, but requires Skp1, a core component of SCF. These data indicate that the APC/C and SCF control Cig2 levels differentially at different stages of the cell cycle.

Electroencephalogram bispectral index predicts hemodynamic and arousal reactions during induction of anesthesia in patients undergoing cardiac surgery

OBJECTIVE

To evaluate hemodynamic and clinical responses to induction of anesthesia and intubation at 3 different values of the electroencephalogram bispectral index (BIS).

DESIGN

Prospective randomized trial.

SETTING

University-affiliated hospital.

PARTICIPANTS

Forty-five patients undergoing elective coronary artery bypass graft surgery.

INTERVENTIONS

Patients were assigned to 3 groups (n = 15 for each group). Anesthesia was induced with midazolam, sufentanil, and pancuronium. In each group, sufentanil was titrated to a BIS value of 60, 50, or 40 before intubation. Mean arterial blood pressure, heart rate, incidence of coughing, tearing, and need for fluid replacement or injections of norepinephrine were recorded before intubation as well as immediately and 1 and 2 minutes after intubation.

MEASUREMENTS AND MAIN RESULTS

Thirteen patients intubated at a BIS value of 60 coughed and 14 experienced tearing after intubation, whereas no patient of the other groups showed signs of arousal. Mean arterial blood pressure remained stable in the BIS 60 and 50 groups, whereas in the BIS 40 group it decreased significantly to lower values before and after intubation. Patients in the BIS 40 group needed significantly more fluid replacement and injections of norepinephrine compared with the other groups. No significant changes in heart rate were detected.

CONCLUSIONS

Electroencephalogram BIS predicts hemodynamic and arousal reaction resulting from induction of anesthesia and endotracheal intubation. BIS value should be kept at 50 before intubation to ensure safe hemodynamic conditions during induction of anesthesia in cardiac surgical patients.