Establishing the cut-off concentration for the detection of etorphine in horse urine

An 125I radioimmunoassay to determine the pattern of urinary excretion of etorphine (a semisynthetic opiate agonist) after its administration to horses is described. Three thoroughbred horses were each given 5, 15, 30 and 100 micrograms of etorphine intramuscularly. Urine was collected for up to 72 after administration. The maximum etorphine concentration after administration of a dose of 5 micrograms was 711 pg ml-1 (concentrations were greater than 100 pg ml-1 after 23 h in all three horses); a 15 micrograms gave 2661 pg ml-1 (levels remained above 100 pg ml-1 for more than 44 h in each horse); a 30 micrograms dose gave a maximum of 3344 pg ml-1 (levels were above 100 pg ml-1 for 24, 72 and 72 h); and 100 micrograms gave in excess of 10,000 pg ml-1 (levels were greater than 300 pg ml-1 for up to 70 h). Forty-eight urine samples from horses not given etorphine all had levels of etorphine less than 100 pg ml-1. There was no increase in apparent etorphine concentrations after hydrolysis of samples with beta-glucuronidase and aryl sulfatase. The half-lives of etorphine equivalents (calculated with a mono-exponential equation after the 100 micrograms dose) in the urine of the three horses were 569, 803 and 821 min, respectively. We conclude that radioimmunoassay can provide a useful first line screening procedure for the assessment of etorphine use in racing horses.

Aspiration of free blood from the peritoneal cavity does not mandate immediate laparotomy

The objective was to establish the relationship between the aspiration of free blood (+ASP) versus diagnostic peritoneal lavage (DPL), abdominal injury severity, hemodynamic instability, and the need for immediate operative intervention. We prospectively compared the significance of +ASP to +DPL in our level I trauma center. Consecutive patients received sequential needle tap, catheter aspiration (ASP), and DPL. If gross blood was withdrawn during the tap or ASP, it was returned to the peritoneal cavity before completing the DPL. The DPL was considered positive if there were > 100,000 RBCs for blunt injuries or anterior abdominal stab wounds, or > 10,000 RBCs for other penetrating injuries. During a 12-month period, 566 patients fulfilled the study criteria; they were 50 per cent blunt and 50 per cent penetrating trauma. There were 70 patients with both +ASP/+DPL, 30 with -ASP/+DPL and 4 with +ASP but -DPL. Exploratory laparotomy was performed on these 104 patients (18.4%), 22 of which were considered nontherapeutic. The ATI was statistically higher in the +ASP patients (14.9 +/- 12.9 versus 8.5 +/- 8.2, P < 0.05) but was not clinically different. Overall injury severity and hemodynamic stability were not different in the two groups. The sensitivity of DPL at detecting intra-abdominal injury was higher than the ASP group (98% versus 72%), but the specificities were equal (98%). Because +ASP patients are not more critically injured or unstable than +DPL patients, and because DPL is more accurate in detecting the need for operative intervention, aspiration should be abandoned as part of the DPL procedure in patients with abdominal trauma.

Prenatal cocaine produces dose-dependent suppression of prolactin and growth hormone in neonatal rats

Pregnant Long-Evans hooded rats were dosed with 5, 10, 20, or 40 mg/kg/d cocaine from GD7 through GD20; pairfed/vehicle-injected, and uninjected controls were included. At birth, representative pups from each litter were killed by decapitation and serum assayed for prolactin and growth hormone via radioimmunoassay. Prolactin levels were significantly reduced on P1 in offspring which had been dosed prenatally with 20 or 40 mg/kg/d, while growth hormone levels were significantly lower than control levels in the 5 and 10 mg/kg/d animals. Pairfed/vehicle controls did not differ from uninjected controls on levels of either hormone. These endocrine changes associated with cocaine dosing may affect subsequent development of the organism.

BEAUTY: an enhanced BLAST-based search tool that integrates multiple biological information resources into sequence similarity search results

BEAUTY (BLAST enhanced alignment utility) is an enhanced version of the NCBI's BLAST data base search tool that facilitates identification of the functions of matched sequences. We have created new data bases of conserved regions and functional domains for protein sequences in NCBI's Entrez data base, and BEAUTY allows this information to be incorporated directly into BLAST search results. A Conserved Regions Data Base, containing the locations of conserved regions within Entrez protein sequences, was constructed by (1) clustering the entire data base into families, (2) aligning each family using our PIMA multiple sequence alignment program, and (3) scanning the multiple alignments to locate the conserved regions within each aligned sequence. A separate Annotated Domains Data Base was constructed by extracting the locations of all annotated domains and sites from sequences represented in the Entrez, PROSITE, BLOCKS, and PRINTS data bases. BEAUTY performs a BLAST search of those Entrez sequences with conserved regions and/or annotated domains. BEAUTY then uses the information from the Conserved Regions and Annotated Domains data bases to generate, for each matched sequence, a schematic display that allows one to directly compare the relative locations of (1) the conserved regions, (2) annotated domains and sites, and (3) the locally aligned regions matched in the BLAST search. In addition, BEAUTY search results include World-Wide Web hypertext links to a number of external data bases that provide a variety of additional types of information on the function of matched sequences. This convenient integration of protein families, conserved regions, annotated domains, alignment displays, and World-Wide Web resources greatly enhances the biological informativeness of sequence similarity searches. BEAUTY searches can be performed remotely on our system using the "BCM Search Launcher" World-Wide Web pages (URL is < http:/ /gc.bcm.tmc.edu:8088/ search-launcher/launcher.html > ).

Behavioral and developmental changes associated with prenatal opiate receptor blockade

Pregnant Long-Evans hooded rats were dosed with 1, 5, or 10 mg/kg per day naloxone from gestational day 7 (GD7) through GD20. The control groups included both uninjected animals and injected animals pairfed to the 10-mg dose animals. At birth, all litters were culled to four males and four females, and fostered to undosed surrogate dams. Prenatal naloxone exposure produced changes in body weight development, pain sensitivity, and motor behavior in the offspring. Five and 10 mg/kg naloxone increased adult body weights in females only, as did the pairfeeding condition. The 10 mg/kg naloxone altered pain sensitivity (in males only) as measured by the tail flick test. Animals in the 1 mg/kg dose condition habituated more rapidly than uninjected (UN) subjects in the open field, and showed less activity than UNs as they matured. Bar pressing rates were reduced in the 10 mg/kg dose males in a visual discrimination task, while 10 mg/kg males and females showed reduced bar pressing rates on differential reinforcement of low rates of responding (DRL). These findings confirm that prenatal exposure to naloxone alters some aspects of neurobehavioral development in the rat, and are consistent with the hypothesis that 1 mg/kg prenatally may increase opiate function in offspring, while 10 mg/kg prenatally may decrease opiate functioning in the offspring.

Transport-induced stress responses in fed and fasted donkeys

Plasma endocrine and metabolic responses to transport for 30 minutes and four hours were investigated in six fed donkeys. In the unstressed animals there was a pulsatile secretion of cortisol at two-hour intervals, from minima of 51.4 +/- 17.6 nmol litre-1 to maxima of 160.0 +/- 11.0 nmol litre-1, but during transport this pulsatility was lost and the animals' stress response was characterised by steady high concentrations of 110 to 220 nmol litre-1. The cortisol concentration decreased after the journey and remained at a minimum until the restoration of pulsatile secretion 8.5 to 10.5 hours later. The transport-induced adrenocortical response did not produce any significant changes in the plasma concentrations of triglycerides, cholesterol, glucose, total protein, albumin, globulin or urea. The donkeys' responses to transport for four hours were also investigated after they had been deprived of food for one or three days. Food deprivation alone increased plasma cortisol and triglyceride concentrations, and decreased glucose and insulin concentrations, and transport consistently, and feeding after the journey sometimes, accentuated their adrenocortical function; the changes in cortisol concentrations as a result of the journey tended to be lower than in the fed animals. Transport had no effect upon the triglyceride response to either period of fasting. Hyperglycaemia was induced by transport in four of the six donkeys fasted for one day and in all of them after three days of fasting.

Identification of new members of a carbohydrate kinase-encoding gene family

In a sequence database search using the human glycerol kinase-encoding sequence (HUMGLYKINB) as a query, we identified six previously unidentified carbohydrate kinase sequences. Five of the six newly identified sequences appear to be known types of carbohydrate kinases, four are glycerol kinases and one is a gluconokinase. The sixth newly identified sequence, the Caenorhabditis elegans gene, CER08D7.7-CEF59B2.1, shows similarity to the family of carbohydrate kinases including other glycerol kinases, xylulokinases, gluconokinases, ribulokinases, rhamnulokinases, and fucokinases. A phylogenetic comparison of this newly identified Caenorhabditis elegans gene with the other members of the carbohydrate kinase family demonstrated that this sequence cannot be assigned to one of the known classes of carbohydrate kinases.

Outcome in an urban pediatric trauma system with unified prehospital emergency medical services care

HYPOTHESIS

Pediatric mortality is predicted by age, presence of head trauma, head trauma with a low Glasgow Coma Scale (GCS) score, a low Pediatric Trauma Score (PTS), and transport directly to a pediatric trauma center.

POPULATION

Studied were 1,429 patients younger than 16 years old admitted to or declared dead on arrival (DOA) in a pediatric trauma center from January through October, 1988. The trauma system, which served 3-million persons, included six pediatric trauma centers.

METHODS

Data were obtained by a retrospective review of summary statistics provided to the Chicago Department of Health by the pediatric trauma centers.

RESULTS

Overall mortality was 4.8% (68 of 1429); 32 of the patients who died (47.1%) were DOA. The in-hospital mortality rate was 2.6%. Head injury was the principal diagnosis in 46.2% of admissions and was a factor in 72.2% of hospital deaths. The mortality rate was 20.3% in children with a GCS < or = 10 and 0.4% when the GCS was > 10 (odds ratio [OR] = 67.0, 95% CI = 15.0-417.4). When the PTS was < or = 5, mortality was 25.6%; with a PTS > 5, the mortality was 0.2% (OR = 420.7, 95% CI = 99.3-2,520). Although transfers to a pediatric trauma center accounted for 73.6% of admissions, direct field triage to a pediatric trauma center was associated with a 3.2 times greater mortality risk (95% CI = 1.58-6.59). Mortality rates were equal for all age groups. Pediatric trauma center volume did not influence mortality rates.

CONCLUSIONS

Head injury and death occur in all age groups, suggesting the need for broad prevention strategies. Specific GCS and PTS values that predict mortality can be used in emergency medical services (EMS) triage protocols. Although the high proportion of transfers mandates systemwide transfer protocols, the lower mortality in these patients suggests appropriate EMS field triage. These factors should be considered as states develop pediatric trauma systems.

Identification of a eukaryotic-like protein kinase gene in Archaebacteria

Primary sequence patterns based on known conserved sites in eukaryotic protein kinases were used to search for eukaryotic-like protein kinase sequences in a six-frame translation of the bacterial subsection of GenBank. This search identified a previously unrecognized eukaryotic-like protein kinase gene in three related methanogenic archaebacteria, Methanococcus vannielii, M. voltae, and M. thermolithotrophicus. The proposed coding sequences are located in orthologous open reading frames (ORFs): ORF547, ORF294, and ORF114, respectively. The C-terminus of the ORFs contains 9 of the 11 subdomains characteristically conserved within the eukaryotic protein kinase catalytic domain. The N-terminus of the ORFs is similar to a putative glycoprotease in Pasteurella haemolytica and its homologue in Escherichia coli, the orfX gene. This is the first report of a eukaryotic-like protein kinase sequence observed in Archaebacteria.

Further comments on the measurement of carotid stenosis from angiograms. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group

BACKGROUND AND PURPOSE

Three different methods for estimating the percentage of reduction in the diameter of the internal carotid artery (ie, stenosis) have been proposed in the literature. Further comparisons of the methods were carried out with the intent of recommending a current standard for determining the percentage of stenosis from angiograms.

METHODS

Angiograms from 112 patients were obtained. For each angiogram, stenosis was estimated in the manner of the European Carotid Surgery Trial (ECST method), the North American Symptomatic Carotid Endarterectomy Trial (NASCET method), and by a method using the common carotid artery lumen diameter (CC method).

RESULTS

Although there is much discrepancy among the estimates of stenosis arising from the three different methods for any particular patient, it is possible to predict (on average) the percentage of stenosis from one method to another. The relationship between the NASCET and CC methods is linear, with a mean ratio of distal internal carotid artery to common carotid diameter of 0.62 (SD of 0.11). The variability in the diameter of the common carotid artery lumen stabilizes only beyond 2.5 common carotid diameter units (approximately 20 to 30 mm by conventional angiography) proximal to the bifurcation. Unexpectedly, the relationships between both the ECST and NASCET methods and ECST and CC methods were parabolic (P < .001). The reasons underlying these departures from linearity are uncertain.

CONCLUSIONS

The comparability of our results with those reported in the literature regarding the CC and NASCET methods provides further evidence of the reproducibility of methods measuring anatomic features that can be visualized on an angiogram. Disease of the internal carotid artery is one of the important causes of ischemic symptoms. Measuring the narrowest portion of the internal artery relative to the normal portion of the same artery, well beyond the bulb, is a logical method. Moreover, benefits of carotid endarterectomy for patients with 70% to 99% stenosis as determined by the NASCET method have been well established in a clinical trial. Converting from the NASCET method to the CC method, given that the CC method is neither superior nor easier to calculate, is not recommended.

Mutational trends in V3 loop protein sequences observed in different genetic lineages of human immunodeficiency virus type 1

Highly variable international human immunodeficiency virus type 1 envelope sequences can be assigned to six major clades, or phylogenetically defined subtypes, designated A through F. These subtypes are approximately equidistant in terms of evolutionary distance measured by nucleotide sequences. This radiation from a common ancestral sequence may have been in step with the spread of the pandemic. In this study, V3 loop protein sequence relationships within these major clades are analyzed to determine how the different lineages might be evolving with respect to this biologically important domain. The V3 loop has been shown to influence viral phenotype and to elicit both humoral and cellular immune responses. To identify patterns in V3 loop amino acid evolution, we cluster the sequences by a phenetic principle which evaluates protein similarities on the basis of amino acid identities and similarities irrespective of evolutionary relationships. When phenetic clustering patterns are superimposed upon phylogenetic subtype classifications, two interesting mutational trends are revealed. First, a set of identical, or highly similar, V3 loop protein sequences can be identified within two otherwise dissimilar genetic subtypes, A and C. Second, the D subtype sequences are found to possess the most radically divergent set of V3 loop sequences. These and other patterns characteristic of the V3 loop reflect the acquisition of specific biological properties during the apparently recent evolution of the human immunodeficiency virus type 1 lineages.

Transport stress delays the oestradiol-induced LH surge by a non-opioidergic mechanism in the early postpartum ewe

The present study was designed to investigate whether transport, a mild environmental stressor, could affect the oestradiol-induced LH surge in postpartum ewes and, if so, the mechanism involved. Welsh Mountain ewes, with lambs removed at parturition (day 0) and hand-milked 12 and 48 h later, were given 50 micrograms oestradiol benzoate intramuscularly at various times postpartum. Blood samples were taken via an indwelling jugular venous catheter every 2 h from 8 to 24 h after oestradiol injection. All results are given as means +/- S.D. On day 1 oestradiol was unable to induce an LH surge in any ewe. Transport (10-14 h after oestradiol) delayed the onset of the oestradiol-induced LH surge on day 14 (17.5 +/- 1.7 vs 14.4 +/- 2.0 h, n = 5 each; P < 0.05), but not on day 28 (14.9 +/- 2.0 vs 14.0 +/- 2.4 h, n = 5 out of 7). Transport had no effect on the amplitude of the surge on either day. Naloxone treatment (1 mg/kg per 2 h) was unable to prevent the delay caused by transport (18.0 +/- 1.1 vs 17.5 +/- 1.7 h, n = 8 each), and did not affect the amplitude of the surge (28.4 +/- 5.3 vs 28.1 +/- 2.3 ng/ml, n = 8 each).(ABSTRACT TRUNCATED AT 250 WORDS)

Turbine flow sensor for volume-flow rate verification in MR

A turbine flow sensor for MR flow experiments has been evaluated using reference volume-flow rate measurements obtained using an electromagnetic (EM) flow meter measurements and simultaneous phase contrast (PC) MR acquisitions. After calibration, the device was found to have accuracy (compared with the EM flow meter), linearity, and precision of better than +/- 1%, +/- 3.5%, 3.5%, respectively, in constant flow mode (0 to 30 ml s-1). The frequency response of the flow sensor was flat (within +/- 10%) up to 13.9 Hz. Volume-flow rate measurements on constant and simulated physiologic flow waveforms were in close agreement with both the electromagnetic (EM) flow meter and the gated MR PC estimates.

Acute aortic occlusion. A 40-year experience

OBJECTIVE

To review a large experience with acute aortic occlusion (AAO) to better define the cause, clinical presentation, treatment, prognostic variables, and outcome.

DESIGN

Retrospective review of 46 consecutive patients with AAO during a 40-year period.

SETTING

A large urban tertiary care referral center in Detroit, Mich.

PATIENTS

Adult patients with arteriographic and/or operative confirmation of acute occlusion of the abdominal aorta plus signs and symptoms of acute ischemia.

INTERVENTION

Operative and nonoperative treatment of AAO.

MAIN OUTCOME MEASURES

Mortality, morbidity, and long-term survival. Other variables measured included cause, risk factors, and effects of duration and severity of ischemia and treatment methods on outcome.

RESULTS

Two primary causes were identified--embolism (65%) and thrombosis (35%). Heart disease and female gender were risk factors for embolism, while smoking and diabetes were risk factors for thrombosis. Severity of ischemia on presentation correlated better with outcome than duration of ischemia. The hospital mortality rate was 35% and morbidity, 74%, with no difference between the two groups. Recurrent arterial embolism occurred in 43% of patients with embolic AAO. Seventy-two percent of AAO survivors were alive 5 years after therapy.

CONCLUSIONS

Acute aortic occlusion remains a serious vascular surgical emergency with significant morbidity and mortality, even when recognized promptly and treated appropriately. Nevertheless, survivors have a reasonable long-term outcome. Permanent anticoagulation is suggested in patients with embolic AAO to minimize a high incidence of recurrent arterial embolism.

Opioids and suckling in relation to inhibition of oestradiol-induced LH secretion in postpartum ewes

The effects of time postpartum and suckling status on the oestradiol-induced LH surge in ewes and some of the possible mechanisms involved were investigated. Lambs were removed from nonsuckled ewes at parturition (day 0) and the ewes hand-milked 12 and 48 h later to prevent discomfort. Nonsuckled ewes on day 1, 7, 14 or 28, and suckled ewes on day 7 or 28 postpartum were injected i.m. with 50 micrograms oestradiol benzoate (hour 0). A further eight suckled ewes were given oestradiol on day 1 (as above), and four were also given naloxone (1 mg kg-1 h-1) from 10 until 14 h after administration of oestradiol benzoate. There was no LH surge in response to oestradiol on day 1. In nonsuckled ewes the onset of the LH surge was significantly (P < 0.05) delayed when oestradiol was administered on day 7 (17.4 +/- 1.5 h), compared with when it was injected on days 14 and 28 postpartum (14.4 +/- 1.7 and 14.0 +/- 1.4 h). The LH surge was also delayed (P < 0.05) when oestradiol was administered on day 7 (18.0 +/- 2.8 h) in suckled ewes. There was no difference in the duration or amplitude of the LH surge with time postpartum in nonsuckled ewes. Suckling significantly (P < 0.05) reduced the amplitude of the LH surge on both day 7 (21.0 +/- 2.4 versus 26.4 +/- 2.3 ng ml-1) and day 28 (23.6 +/- 3.2 versus 28.8 +/- 2.9 ng ml-1), but had no effect on the onset or duration of the surge.(ABSTRACT TRUNCATED AT 250 WORDS)

Response of male eye-spotted bud moth,Spilonota ocellana (Lepidoptera: Tortricidae), to different pheromone blends in north America and The Netherlands

Response of male eye-spotted bud moth,Spilonota ocellana (Denis and Schiffermüller), to different ratios of synthetic sex pheromone components, (Z)-8-tetradecenyl acetate (Z8-14:OAc) and (Z)-8-tetradecenyl alcohol (Z8-14:OH), were compared in four North American locations and in one location in The Netherlands. In British Columbia, Nova Scotia, Michigan, and The Netherlands, a 99:1 blend ofZ8-14:OAc andZ8-14:OH captured significantly more maleS. ocellana thanZ8-14:OAc alone or binary blends containing 10-50%Z8-14:OH. In Ontario, where population sizes were low compared to the other four locations, trends in trap catches were similar, and there was no indication that maleS. ocellana responded differently to the tested pheromone blends. A 99:1 blend ofZ8-14:OAc andZ8-14:OH should be most effective in pheromone-based control programs ofS. ocellana in North America and in The Netherlands. Our results confirm earlier studies that a 99:1 blend ofZ8-14:OAc andZ8-14:OH captures significantly more maleS. ocellana thanZ8-14:OAc alone. However, our finding that a 99:1 blend ofZ8-14:OAc andZ8-14:OH is significantly more attractive than binary blends containing 10-50%Z8-14:OH differs from previous findings in Germany and Switzerland.

Behavioral sensitivity of rats to extremely-low-frequency magnetic fields

Work in our laboratory has revealed autonomic and/or behavioral sensitivity of mice, rats, and a domestic fowl to extremely-low-frequency (ELF) or nominally static magnetic (B) fields at flux densities between 250 and 1700 microT (rms). To extend our work, an automated exposure and data-acquisition system was used with the technique of conditional suppression to assess behavioral sensitivity to time-varying B fields. Each of five rats was exposed aperiodically to a B field during 3 min warning periods that terminated in a brief electric shock. The difference between rates of lever pressing during B-field warning periods and rates during immediately antecedent, 3 min control periods was analyzed at frequencies of 7, 16, 30, 60, and 65.1 Hz. To produce equivalent induced voltages in the rat at each frequency, graded flux densities were established that ranged from 1900 microT at 7 Hz to 200 microT at 65.1 Hz. Analysis of differences in lever-pressing rates revealed that in a given session of testing the rats would increasingly suppress responding when exposed to a B field, but this trend was independent of frequency. This experiment provides evidence of behavioral sensitivity by a mammal to an ELF magnetic field.

Neoadjuvant cisplatin, methotrexate and vinblastine for muscle-invasive bladder cancer: long-term followup

A total of 26 patients with locally advanced bladder cancer received chemotherapy consisting of cisplatin, methotrexate and vinblastine. Radical cystectomy was performed in 24 of 26 patients (92%) receiving neoadjuvant therapy, with a pathological complete response in 6 (23%) and pathological partial response in 1 (4%) for an overall response rate of 35% (95% confidence limits 17 to 56%). The overall median survival time is currently undefined. Of the patients 15 (58%) are alive with a median followup of 48.6 months. Response rates from this neoadjuvant chemotherapy appear to be similar to those reported with methotrexate, vinblastine, doxorubicin and cisplatin, and may represent a therapeutically equivalent regimen but neither may be curative in the majority of the patients.

Repair of pararenal abdominal aortic aneurysms. An analysis of operative management

OBJECTIVE

To analyze different operative approaches for repair of pararenal abdominal aortic aneurysm, to define factors associated with perioperative morbidity, particularly renal insufficiency, and to compare the results of pararenal abdominal aortic aneurysm repair with standard infrarenal repair.

DESIGN

Case series review of all patients undergoing repair of nonruptured pararenal abdominal aortic aneurysms over 7 consecutive years at a tertiary care teaching hospital.

PATIENTS

Fifty-three consecutive patients with nonruptured atherosclerotic pararenal abdominal aortic aneurysms undergoing operative repair. A comparison group of 65 patients randomly selected from a pool of 384 patients undergoing concurrent infrarenal abdominal aortic aneurysm repair.

MAIN OUTCOME MEASURES

Operative morbidity and mortality, postoperative renal insufficiency, estimated blood loss, perioperative blood and fluid requirements, and length of hospital stay.

RESULTS

Postoperative renal insufficiency was more likely when concomitant renal revascularization was performed (P = .007) or when any major intraoperative complication occurred (P = .008). Retroperitoneal abdominal aortic aneurysm repair was associated with lower estimated blood loss (P = .05) and less fluid requirement within the first 24 hours following operation than transperitoneal repair (P = .03). No differences in outcome measures were identified with regard to site of proximal aortic clamping (supraceliac vs suprarenal). Pararenal abdominal aortic aneurysms were larger and their repair was associated with greater estimated blood loss (P = .007), intraoperative blood replacement (P < .001), and a longer hospital stay (P = .02) than infrarenal abdominal aortic aneurysms.

CONCLUSIONS

Pararenal abdominal aortic aneurysm repair is a technically challenging operation associated with significant morbidity. A retroperitoneal approach facilitates repair. The site of proximal aortic cross-clamping should be dictated by technical factors and not by any perceived outcome advantages.

Functional capacity in heart failure. Comparison of methods for assessment and their relation to other indexes of heart failure. The V-HeFT VA Cooperative Studies Group

BACKGROUND

Left ventricular (LV) dysfunction plays a primary role in the pathogenesis of congestive heart failure and correlates with prognosis, but a strong quantitative relation between exercise performance and indexes of LV function has not been demonstrated. We examined the relation between LV ejection fraction at rest, oxygen consumption at peak exercise (VO2), patient and physician assessments of clinical severity, and other clinical attributes in 804 patients with moderate heart failure.

METHODS AND RESULTS

Ejection fraction correlated weakly with VO2, and mean ejection fraction was related to severity of symptoms. There was a statistical association between the patient's self-assessed quality of life questionnaire score and the physician-assigned New York Heart Association (NYHA) functional class; NYHA class was statistically associated with exercise performance. To identify other factors that might influence exercise capacity, comparisons of clinical attributes were made between patients grouped by VO2 within each stratum of LV function. Exercise performance was inversely related to plasma norepinephrine levels within the ejection fraction < 25% stratum. The percentage of patients reaching their anaerobic threshold was not different between groups, yet the peak heart rate increased with VO2 within all strata. Elevated venous pressure and cardiomegaly were inversely related to exercise performance.

CONCLUSIONS

Clinical scales based on physician and patient assessment of symptoms were statistically associated with exercise capacity but do not accurately predict individual exercise performance. The strong association of heart rate response to exercise performance suggests that the variability of the chronotropic response to exercise contributes to differences in exercise capacity among patients with a similar degree of LV dysfunction.

Transmission-blocking antibodies recognize microfilarial chitinase in brugian lymphatic filariasis

Brugia malayi is a parasitic nematode that causes lymphatic filariasis in humans. The monoclonal antibody MF1, which mediates clearance of peripheral microfilaremia in a gerbil infection model, recognizes two stage-specific proteins, p70 and p75, in B. malayi microfilariae. cDNA coding for the MF1 antigen was sequenced, and the predicted protein sequence shows significant similarities to chitinases from bacteria and yeast. When microfilarial extracts and purified preparations of the MF1 antigen were tested for chitinase activity, strong bands of chitin-degrading activity comigrated in SDS/PAGE with p70 and p75 and showed a reduction-dependent mobility shift characteristic of the MF1 antigen. Thus, the MF1 antigen is microfilarial chitinase, which may function to degrade chitin-containing structures in the microfilaria or in its mosquito vector during parasite development and transmission.

Pattern-induced multi-sequence alignment (PIMA) algorithm employing secondary structure-dependent gap penalties for use in comparative protein modelling

A multiple sequence alignment algorithm is described that uses a dynamic programming-based pattern construction method to align a set of homologous sequences based on their common pattern of conserved sequence elements. This pattern-induced multi-sequence alignment (PIMA) algorithm can employ secondary-structure dependent gap penalties for use in comparative modelling of new sequences when the three-dimensional structure of one or more members of the same family is known. We show that the use of secondary structure information can significantly improve the accuracy of aligning structure boundaries in a set of homologous sequences even when the structure of only one member of the family is known.

Left flank retroperitoneal exposure: a technical aid to complex aortic reconstruction

Over the last 5 years an extended left flank retroperitoneal approach was used in 85 of 531 (16%) aortic reconstructions deemed technically complex. Abdominal aortic aneurysm repair was performed in 70 patients (82%), bypass of aortoiliac occlusive disease was performed in 11 (13%), and aortic endarterectomy for mesenteric and/or renovascular disease was performed in 4 (5%). Indications for use of this approach included a "hostile" abdomen (43 patients), juxta/suprarenal abdominal aortic aneurysm (35), large (greater than 10 cm) abdominal aortic aneurysm (12), extreme obesity (10), associated renal and/or visceral artery stenosis requiring endarterectomy (9), inflammatory abdominal aortic aneurysm (2), and horseshoe kidney (2). Suprarenal or supraceliac aortic clamping, averaging 31 minutes, was required in 43 patients (50%). Postoperative recovery was rapid (average length of stay, 10.2 days), and morbidity was minimal despite the complex nature of these reconstructions. The perioperative mortality rate in elective operations was 1.2%. This approach facilitated proximal abdominal aortic exposure and anastomosis, especially in large, pararenal aneurysms or in situations unfavorable to a transabdominal approach. Whereas a left flank retroperitoneal approach can be used in most aortic reconstructions, it seems especially suited to those that pose significant technical challenges.