Effects of chronic beta-adrenergic blockade on hemodynamic and metabolic responses to endurance training

To study the influence of chronic propranolol therapy on hemodynamic and metabolic adaptations associated with endurance training, five dogs given 250 mg X d-1 propranolol therapy (P) and five control dogs (NP) were endurance trained for 7 wk using a continuously increasing treadmill workload. The P group was also evaluated pre- and post-training off the drug (P-OD) to separate drug and training effects. Training lowered mean heart rate score (HR) to a standardized multistage dog treadmill test in the NP and P-OD (P less than 0.05) and had no effect on the HR of the P group while on propranolol. At a fixed submaximal workload there were also slight reductions in cardiac output in the P group which were more pronounced (P less than 0.10) following training, and a corresponding increase in a-vDO2. Pre- and post-training metabolic studies were performed at rest, during a fixed submaximal workload, and following 30 min of recovery. During exercise, blood glucose levels were significantly lower in the P group both before and after training. While NP showed no significant change in high-density lipoprotein bound cholesterol after training, the P-OD group demonstrated a significant fall in high-density lipoprotein bound cholesterol after training (P less than 0.05). These data indicate that endurance exercise training done in the presence of chronic beta-adrenergic blockade produces training-induced hemodynamic adaptations to exercise, but beta-blockade inhibits the changes in serum lipids and lipoprotein fractions normally seen in response to an exercise conditioning program.

The relationship between vessel wall injury and venous thrombosis: an experimental study

The relative importance of stasis, vessel wall damage and hypercoagulability in the pathogenesis of venous thrombosis remains disputed. While the combination of local vascular stasis and systemic hypercoagulability can be shown to produce experimental thrombi within a few minutes, it has been claimed that vessel wall damage is also a necessary component of venous thrombogenesis. In this experimental study, mechanical crushing of the jugular veins produced patchy areas of denuded endothelium, with underlying vessel wall oedema, as seen by ultrastructural examination. While the exposed subendothelium became covered with activated platelets following restored blood flow, there was no fibrin formation after 5 min. When blood flow was restored for 60 min following the crush injury, white cells could be seen adhering to and migrating through the vessel wall, although there was still no visible fibrin. The addition of venous stasis for 20 min did not lead to the formation of stasis thrombi in association with the damaged areas. The present experiments demonstrate that, far from there being subtle endothelial damage contributing to acute venous thrombosis, even readily demonstrable damage is a poor stimulus to fibrin formation at local sites of vessel wall injury.

A comparison of heparin potency estimates obtained by activated partial thromboplastin time and british pharmacopoeial assays

Heparin samples from five manufacturers were assayed by the revised British Pharmacopoeia (BP) heparin assay and the results compared with those obtained using the activated partial thromboplastin time (APTT) assay. The United States Pharmacopoeia (USP) reference heparin preparation and the 4th International Standard (IS) for heparin were also assayed by the two methods relative to the 3rd IS. The results obtained by the revised BP assay were in close agreement with those obtained by the APTT assay for all the heparins that were tested. The assays revealed that there is at least a 10% discrepancy between the International Unit for heparin and the USP unit.

Venous thrombogenesis

The various factors that may be responsible for converting fluid blood into stasis thrombi in the deep veins of the legs are reviewed in relation to some recent experimental data. While stasis promotes the passage of white blood cells through the vascular endothelium, such emigration does not by itself lead to subsequent thrombus formation. Similarly, mechanical crushing of the vein, with exposure of the subendothelium, is not associated with fibrin deposition, and appears to be a relatively poor thrombogenic stimulus. In contrast, trace amounts of an activated clotting factor, combined with local stasis, produce venous thrombi within minutes.

A collaborative study designed to establish the 4th International Standard for Heparin

An international collaborative study, in which 22 laboratories participated, was carried out to establish a replacement for the International Standard for Heparin. A total of 248 assays were analyzed, including APTT, thrombin inhibition and anti-Xa assays, as well as pharmacopoeial assays. Overall, there was less than 5% difference in the mean potency estimates of the candidate preparations, by all assay methods. The freeze-dried preparation 82/502 demonstrated the closest parallelism by bioassay to the existing standard and was established by WHO as the 4th International Standard for Heparin, with an assigned unitage of 1780 i.u. per ampoule.

Cyclohexanone extraction: an improvement in the thiobarbituric acid method for the determination of nonenzymatic glycosylation of hair and epidermal keratin

Colorimetric techniques such as the thiobarbituric acid assay are widely used for the determination of nonenzymatic glycosylation of proteins. One of the major problems associated with this technique is the high nonspecific background absorbance which, due to its variability, results in loss of sensitivity. This report describes a method of removing the nonspecific absorbance by extracting the final chromogen into cyclohexanone. Using this method for the determination of nonenzymatic glycosylation of hair and epidermal keratin, at least 90% of the background absorbance is removed, increasing the sensitivity of the technique. This allows more effective discrimination of the level of glycolsylation of proteins from control and diabetic patients, by reducing the degree of overlap. The requirement for individual borohydride reduced samples is also avoided, thus simplifying the technique. Cyclohexanone extraction provides a simple addition to the standard thiobarbituric acid technique with significant improvement in results.

Myocardial morphology and blood flow distribution in chronic volume-overload hypertrophy in dogs

In this study we investigated myocardial structural alterations and regional myocardial blood flow in chronic volume-overload induced left ventricular hypertrophy in the dog. Moderate hypertrophy (28%) was produced by inserting a shunt between the left subclavian artery and the left atrial appendage in 7 dogs (LVH), while a sham operation was performed on 5 control dogs (C). At a paced heart rate of 100 beats/min there were no differences in blood-flow distribution to the subendocardium (ENDO) mid-myocardium (MYO) or subepicardium (EPI) or in ENDO/EPI ratios between the two groups of dogs. Following adenosine-induced coronary vasodilatation (1 mg/kg/min), there was a relative shift in blood flow away from the ENDO in the LVH dogs so that the ENDO/EPI ratio was reduced. Analysis of the microvascular bed and myocyte cross-sectional area in the same three regions of interest revealed a significant reduction in capillary density in the ENDO region of the hypertrophied hearts when compared to controls (LVH = 2463 +/- 10, C = 2773 +/- 75 caps/mm2) and a corresponding increase in myocardial cell cross-sectional area (LVH = 262 +/- 10, C = 233 +/- 36 microns 2). The reduction in capillary density in LVH may be explained on the basis of increased muscle growth without appropriate capillary proliferation indicating an inadequate neovascular response to this form of overload. The results also indicate that blood-flow distribution abnormalities may not be detected at resting flow with moderate LVH produced by volume overload.

High and low affinity heparin compared with unfractionated heparin as antithrombotic drugs

A preparation of heparin was separated by affinity chromatography into two fractions: one of high ( HAH ) and the other of low (LAH) affinity to antithrombin III. These two fractions were compared with unfractionated heparin ( UFH ) by in vitro assay and their ability to impair experimental stasis thrombosis was also examined. Although the in vitro activity of HAH was double that of UFH , HAH was less effective than UFH as an antithrombotic drug; LAH was virtually inactive, both in vitro and in vivo. A mixture of 30 micrograms/kg of HAH and 50 micrograms/kg of LAH was as effective in preventing thrombosis as 80 micrograms/kg of UFH , and was more effective than 40 micrograms/kg of HAH alone, demonstrating that LAH potentiates the action of HAH in vivo.

Low-affinity heparin potentiates the action of high-affinity heparin oligosaccharides

Previous studies have shown that high-affinity (HA) heparin oligosaccharides, with molecular weights of 3,000-5,000, were less effective than unfractionated heparin in preventing serum-induced venous thrombosis in rabbits, using a Wessler stasis model. In the present study, a larger high-affinity fragment (M.Wt. 6,000-6,500) was also found to be less effective than unfractionated heparin as an antithrombotic agent. However, addition of 80 micrograms/kg low affinity (LA) heparin to 80 micrograms/kg of this HA fragment significantly potentiated its antithrombotic activity, and the antithrombotic action of the mixture was equivalent to that of unfractionated heparin. Significant potentiation of antithrombotic activity was also observed on the addition of LA heparin to a HA decasaccharide (M.Wt. 3,000-3,500) with anticoagulant activity only against Factor Xa. The LA heparin content of low molecular weight heparin fractions appears to be an important determinant of their antithrombotic activity.

Standardization of Factor VIII-IV. Establishment of the 3rd International Standard for Factor VIII: C concentrate

An international collaborative study was carried out to establish a replacement for the current (2nd) international standard for Factor VIII:C, concentrate. Twenty-six laboratories took part, of which 17 performed one-stage assays, three performed two-stage assays and six used both methods. The proposed new standard, an intermediate purity concentrate, was assayed against the current standard, against a high-purity concentrate and against an International Reference Plasma, coded 80/511, previously calibrated against fresh normal plasma. Assays of the proposed new standard against the current standard gave a mean potency of 3.89 iu/ampoule, with good agreement between laboratories and between one-stage and two-stage assays. There was also no difference between assay methods in the comparison of high-purity and intermediate purity concentrates. In the comparison of the proposed standard with the plasma reference preparation, the overall mean potency was 4.03 iu/ampoule, but there were substantial differences between laboratories, and the two-stage method gave significantly higher results than the one stage method. Of the technical variables in the one-stage method, only the activation time with one reagent appeared to have any influence on the results of this comparison of concentrate against plasma. Accelerated degradation studies showed that the proposed standard is very stable. With the agreement of the participants, the material, in ampoules coded 80/556, has been established by the World Health Organization as the 3rd International Standard for Factor VIII:C, Concentrate, with an assigned potency of 3.9 iu/ampoule.

Standardization of Factor VIII-III. Establishment of a stable reference plasma for Factor VIII-related activities

An international collaborative study has been carried out to establish a reference plasma for Factor VIII-related activities. The freeze-dried reference plasma, coded 80/511, was assayed against fresh normal plasma, local standards and another freeze-dried plasma. There was good agreement between laboratories for the comparison of the two freeze-dried plasmas, but wide variation in the comparison of plasma 80/511 with fresh normal plasma and local standards, indicating the differences in Factor VIII content of local pooled plasmas. There were no significant differences between the one-stage and two-stage assays of VIII:C, or between electroimmunoassay (EIA) and immuno-radiometric (IRMA) assays of VIII:Ag. However, in VIII R:RCoF (ristocetin co-factor) assays, the aggregometry methods gave lower values than the macroscopic and counting methods for the comparison of freeze-dried against fresh normal plasmas. From the combined results of assays against each laboratory's fresh normal plasma, potencies were assigned to plasma 80/511 as follows: VIII:C 0.73 VIIIR:Ag 0.87 International Units VIIIR:RCoF 0.80 per ampoule VIIIC:Ag 0.95. Results from accelerated degradation studies indicated that losses of each VIII-related activity in plasma 80/511, when stored at -20 degrees C, should be less than 0.01% per year, indicating its suitability to serve as a long-term reference preparation. Plasma 80/511 has been established by the WHO Expert Committee on Biological Standardization as the 1st International Reference Preparation for Factor VIII-Related Activities in Plasma.

The effect of stasis on the venous endothelium: an ultrastructural study

In carefully dissected neck veins, no evidence was found of platelet adherence to the vessel wall or leucocyte migration. However, 30-60 min of total stasis led to polymorphonuclear leucocytes sticking to the endothelium and their subsequent migration. This migration across the vessel wall resulted from stasis and not the trauma of dissection. Adherence and migration of leucocytes did not cause gross endothelial cell damage or desquamation within the observed period of stasis and there was no associated platelet adherence following restoration of blood flow. Thus leucocyte migration does not impair the non-thrombogenicity of the endothelium in acute experiments.

Influence of a meal on skin temperatures estimated from quantitative IR-thermography

In young men at 25 degrees C, quantitative IR-thermography showed that fasting values of skin temperatures over suspected areas of brown adipose tissue (BAT) were higher than where no BAT is thought to occur. However, at 30 min and again at 60-90 min after a meal of 2.5 MJ, the magnitude of the increase in skin temperature was similar in areas with or without suspected BAT. In conclusion, either thermography was unable to detect the activation of BAT, or the meal did not stimulate heat production in the sites of suspected BAT.

Effects of training on cardiorespiratory function in the horse

The effects of 5- and 10-wk treadmill exercise training on cardiorespiratory function were evaluated in the horse. Cardiac output (Q), heart rate (HR), and stroke volume (SV), as well as left ventricular (LVP), aortic (AoP), and mean right atrial (RAP) pressures and the peak first time derivative of LVP (LV dP/dtmax), were measured at rest and at five different levels of exercise up to 90% of initial predicted maximal HR (HRmax). Oxygen uptake (VO2) and respiratory exchange ratio (R) were also obtained under the same conditions. At rest, although HR was no different after training, LV dP/dtmax was lower at 10 wk (2,369 +/- 502 vs. 1,615 +/- 302 mmHg/s). At the different measured work loads during exercise, Q and VO2 remained unchanged with training, whereas there were consistent trends toward lower LVP, AoP, and LV dP/dtmax and significant reductions in HR and R (both P less than 0.05). In contrast, SV and mean RAP were elevated (P less than 0.05) during exercise after the 10-wk training program. Although the observed changes in cardiorespiratory function in response to a training program in the horse are generally similar to those reported for other species, our data also suggest a training-induced increase in venous pressures during exercise as measured by elevated mean RAP values.

The stability of factor VIII in heparinized plasma

We studied the stability for 24 hr of factor VIII:C and factor VIII C:Ag in plasma collected in citrate, EDTA or heparin, and confirmed the previously reported two-phase decay of factor VIII:C in plasma when calcium ions have been chelated. We observed that plasma factor VIII:C is remarkably stable at 22 degrees C (+/- 2 degrees) when normal calcium ion concentrations are maintained. The loss of activity of factor VIII:C between one and 24 hr after blood collection was on average only 0.5% per hr for heparinized plasma. There was also an apparent loss of factor VIII C:Ag in plasma where calcium ions had been removed, compared with factor VIII C:Ag in heparinized plasma. However, a comparison of one-site and two-site assays suggested that calcium chelating agents may lead to factor VIII C:Ag levels being under-estimated when one-site fluid-phase assays are employed. To confirm the action of calcium ions in maintaining factor VIII:C stability, we carried out a series of experiments where calcium chloride was added four hr after blood collection to plasma anticoagulated by a mixture of citrate plus heparin; we observed total recovery of factor VIII:C activity within four hr. The stability of factor VIII:C, even at room temperature, in the presence of physiological calcium ion concentrations has implications for manufacturers of factor VIII concentrates and cryoprecipitates.

Parathyroidectomy in chronic renal failure

Parathyroidectomy was carried out in 26 patients over a 14-year period. Excellent results were obtained in patients with severe hyperparathyroidism. Vascular calcification, hypercalcaemia and pruritus did not justify surgery unless associated with unequivocal hyperparathyroidism. 13 patients required intravenous calcium infusion for up to 2 weeks to control post-operative hypocalcaemia. Calcium requirements could be predicted from the pre-operative plasma alkaline phosphatase level. Following operation continued treatment with vitamin D was necessary to prevent hypocalcaemia. Hyperparathyroidism recurred in 1 patient after 8 years and 4 patients developed osteomalacia. Since parathyroid hormone may have toxic effects other than those on bone, maintenance of normal levels should be a long-term objective in the treatment of patients with chronic renal failure. Where large parathyroid glands are present, surgical reduction in gland mass is a logical prelude to long-term suppression of parathyroid hormone with vitamin D and phosphate-binding agents.

Carotid plaques and retinal emboli: a clinical, angiographic and morphological study

The angiographic criteria for the significance of a carotid lesion and the contribution of embolic versus haemodynamic factors in stroke pathogenesis are currently unresolved. This study evaluated correlations between the clinical features, presence of retinal emboli, angiographic appearance of the carotid bifurcation and morphology of the surgically excised plaque in 32 consecutive patients with symptomatic carotid lesions. Retinal emboli were found in 22% of patients, including some without a history of amaurosis fugax. The carotid plaques were complicated by ulceration, intraplaque haemorrhage and/or intraluminal debris in 91% of cases. The degree of carotid stenosis seen at operation correlated well with the angiographic estimate. Plaque complications could not be accurately predicted angiographically, however. The high frequency of plaque complications, and the presence of retinal emboli, suggested that embolisation was the likely pathogenetic mechanism of stroke in most of these patients.