Zebrafish brain atlases: a collective effort for a tiny vertebrate brain

In the past two decades, digital brain atlases have emerged as essential tools for sharing and integrating complex neuroscience datasets. Concurrently, the larval zebrafish has become a prominent vertebrate model offering a strategic compromise for brain size, complexity, transparency, optogenetic access, and behavior. We provide a brief overview of digital atlases recently developed for the larval zebrafish brain, intersecting neuroanatomical information, gene expression patterns, and connectivity. These atlases are becoming pivotal by centralizing large datasets while supporting the generation of circuit hypotheses as functional measurements can be registered into an atlas' standard coordinate system to interrogate its structural database. As challenges persist in mapping neural circuits and incorporating functional measurements into zebrafish atlases, we emphasize the importance of collaborative efforts and standardized protocols to expand these resources to crack the complex codes of neuronal activity guiding behavior in this tiny vertebrate brain.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Translocation of CaMKII to dendritic microtubules supports the plasticity of local synapses

Synaptic plasticity correlates with the local dendritic translocation of CaMKII in a Ca²⁺- and microtubule-dependent manner.

The processing of excitatory synaptic inputs involves compartmentalized dendritic Ca²⁺ oscillations. The downstream signaling evoked by these local Ca²⁺ transients and their impact on local synaptic development and remodeling are unknown. Ca²⁺/calmodulin-dependent protein kinase II (CaMKII) is an important decoder of Ca²⁺ signals and mediator of synaptic plasticity. In addition to its known accumulation at spines, we observed with live imaging the dynamic recruitment of CaMKII to dendritic subdomains adjacent to activated synapses in cultured hippocampal neurons. This localized and transient enrichment of CaMKII to dendritic sites coincided spatially and temporally with dendritic Ca²⁺ transients. We show that it involved an interaction with microtubular elements, required activation of the kinase, and led to localized dendritic CaMKII autophosphorylation. This process was accompanied by the adjacent remodeling of spines and synaptic AMPA receptor insertion. Replacement of endogenous CaMKII with a mutant that cannot translocate within dendrites lessened this activity-dependent synaptic plasticity. Thus, CaMKII could decode compartmental dendritic Ca²⁺ transients to support remodeling of local synapses.

Significant alterations of biodistribution and immune responses in Balb/c mice administered with adenovirus targeted to CD40(+) cells

CD40 ligation has been shown to promote antigen-presenting functions of dendritic cells, which express CD40 receptor. Here we reported significantly altered biodistribution and immune responses with the use of CD40-targeted adenovirus. Compared with unmodified adenovirus 5, the CD40-targeted adenovirus following intravenous administration (i.v.) resulted in increased transgene expressions in the lung and thymus, which normally do not take up significant amounts of adenovirus. Intradermal injection saw modified adenovirus being mainly processed in local draining lymph nodes and skin. Following intranasal administration (i.n.), neither unmodified nor targeted viruses were found to be in the liver or spleen, which predominantly took up the virus following i.v. administration. However, inadvertent infection of the brain was found with unmodified adenoviruses, with the second highest gene expression among 14 tissues examined. Importantly, such undesirable effects were largely ablated with the use of targeted vector. Moreover, the targeted adenovirus elicited more sustained antigen-specific cellular immune responses (up to 17-fold) at later time points (30 days post boosting), but also significantly hampered humoral responses irrespective of administration routes. Additional data suggest the skewed immune responses induced by the targeted adenoviruses were not due to the identity of the transgene but more likely a combination of overall transgene load and CD40 stimulation.

Mycoplasmosis in evening and pine grosbeaks with conjunctivitis in Quebec

An outbreak of conjunctivitis affected evening grosbeaks (Coccothraustes vespertinus) and pine grosbeaks (Pinicola enucleator) in Quebec (Canada) during the winter 1998-99. One to 30% of the individuals from these two species were sick at 13 feeding stations. Sick birds were thin and had unilateral or bilateral catarrhal and lymphoplasmacytic conjunctivitis and rhinitis, and mucopurulent infra-orbital sinusitis. Mycoplasmal organisms were isolated in cultures in an affected evening grosbeak and identified as Mycoplasma gallisepticum by direct immunofluorescence. Random amplified polymorphic DNA (RAPD) fingerprinting of this isolate resulted in a banding pattern that was identical to patterns of M. gallisepticum isolates made from similar lesions in house finches (Carpodacus mexicanus) and American gold finches (Carduelis tristis) throughout eastern North America. Mycoplasma gallisepticum was identified by polymerase chain reaction in another evening grosbeak and a pine grosbeak. These observations suggest that the same strain of M. gallisepticum is the likely etiology for the observed disease in evening and pine grosbeaks in Canada and represent an extension of the host-species range for the ongoing epidemic of M. gallisepticum conjunctivitis in eastern North America.

A single center experience with the freestyle bioprosthesis: midterm results at the Québec Heart Institute

Stentless bioprostheses show excellent early hemodynamic performance. However, longevity still remains unknown. This study reports midterm follow-up in 419 patients in which a Freestyle bioprosthesis (Medtronic Heart Valves, Minneapolis, MN) was inserted between January 1993 and January 2000 at the Quebec Heart Institute (Ste-Foy, Québec, Canada). Mean age at implantation was 68.0 +/- 8.2 years. Implantation was subcoronary in 81.9% of the patients, as a root replacement in 16.5%, and as a root inclusion in 1.7%. Mortality at 30 days was 6.2% for the whole cohort (2.8% for isolated subcoronary aortic valve replacement). Female gender, root implantation, valve sizes 19 to 21 mm, previous surgery, a history of stroke and diabetes were identified as predictors of 30-day mortality. Actuarial freedom from all death causes was 81.5% at 7 years; freedom from valve-related deaths 97.0%, and freedom from cardiac deaths 92.7%. Freedom from thromboembolic events was 86.1% at 7 years (55.1% of events were < 30 days). Freedom from endocarditis and hemorrhagic complications were respectively 98.5% and 95.6% at 7 years. Six patients required reoperations for valve explantation: 2 for endocarditis, 2 for structural dysfunction, and 2 for nonstructural dysfunction. Incidence of moderate or severe valve insufficiency at annual echocardiographic follow-up was: discharge: 0.6%; year 1: 0.7%; year 2: 1.3%; year 3: 3.3%; year 4: 3.7%; year 5: 2.6%; year 6: 0%. At 6 years after implantation, mean transvalvular gradient and effective valve orifice area were comparable to the year 1 values. This single center experience with the Medtronic Freestyle prosthesis shows preserved hemodynamic performance and low valve-related complications at midterm.

Midterm follow-up of unstented biological valves

We have used the stentless aortic biosprosthesis for aortic valve replacement during the last 10 years. Since 1988, 647 stentless aortic prosthesis were implanted: 384 unstented heterografts, 176 Ross procedures, and 87 homografts. Patients up to age 50 were offered the Ross procedure, those between the ages of 50 and 60 a homograft, and patients 60 years old and older received heterografts. All patients were evaluated at our clinic. An echocardiogram was obtained before discharge from the hospital, at 3 to 6 months postoperatively, and yearly thereafter. Gradients, regurgitation, and effective orifice area were recorded at each visit. The patient was also evaluated clinically. Early mortality rate was 5.4%, 1.7%, and 5.8% for heterograft, autograft, and homograft, respectively. The mean gradient for the unstented porcine valve was 7.6 mm Hg at 3 to 6 month but 5 mm Hg or less for the homografts or autografts. Unstented valves are relatively new but they showed superior hemodynamic performance compared with either mechanical or biological stented valves. Anticoagulation is not mandatory, which should decrease the number of complications. They are the replacement of choice for young and old patients with a small aortic root and are the best alternative to the natural valve.

Usefulness of the indexed effective orifice area at rest in predicting an increase in gradient during maximum exercise in patients with a bioprosthesis in the aortic valve position

This study examines the hemodynamic behavior of aortic bioprosthetic valves during maximum exercise. Nineteen patients with a normally functioning stented bioprosthetic valve and preserved left ventricular function were submitted to maximum ramp bicycle exercise. In 14 of the 19 patients, valve effective orifice area and mean gradient were measured at rest and during exercise using Doppler echocardiography. At peak exercise (mean maximal workload 118 +/- 53 W), the cardiac index increased by 122 +/- 34% (+3.18 +/- 0.71 L/min/ m2, p <0.001), whereas mean gradient increased by 94 +/- 49% (+12 +/- 8 mm Hg, p <0.001), and effective orifice area by 9 +/- 13% (+0.15 +/- 0.22 cm2, p = 0.02). A strong correlation was found between the increase in mean gradient during maximum exercise and the valve area at rest indexed for body surface area (r = 0.84, p <0.0001). Due to the increase in valve area, the increase in gradient was less (-9 +/- 7 mm Hg, -41 +/- 33%, p = 0.0006) than theoretically predicted assuming a fixed valve area. These results suggest that the effective orifice area of the bioprostheses has the capacity to increase during exercise; therefore, limiting the increase in gradient. The relation found between the indexed effective orifice area at rest and the increase in gradient during exercise should be useful in predicting the hemodynamic behavior of a stented bioprosthesis during exercise.

Transcriptional interferences at the Hoxa4/Hoxa5 locus: importance of correct Hoxa5 expression for the proper specification of the axial skeleton

We have previously described a Hoxa5 mutant mouse line in which specification of axial identity is perturbed and viability is markedly reduced. In the present study, we assay the Hoxa5 mutation in different genetic backgrounds and carry out a complete analysis of skeletal transformations. Although Hoxa5 is expressed over a large domain during embryogenesis, homeotic transformations of the axial skeleton are confined between cervical vertebra C3 and thoracic vertebra T2, which corresponds to the specific expression domain of the major Hoxa5 transcript. Loss of Hoxa5 function also affects the formation of the acromion in the appendicular skeleton. Disruption of the adjacent Hoxa4 gene leads to similar homeotic transformations of the cervicothoracic vertebrae. To discriminate the respective role of each gene, we generated transheterozygous animals carrying inactivated Hoxa4 and Hoxa5 alleles on different chromosomes. Compound heterozygous mutants exhibit homeotic transformations in the cervicothoracic transition region more reminiscent to those observed in Hoxa5 homozygous mutants. Although the Hoxa5 mutation does not significantly affect Hoxa4 expression, the pattern of Hoxa5 expression is impaired in cis by the Hoxa4 mutation, specifically in the cervicothoracic region of the prevertebral column. The expression of Hoxa5 in this particular domain is also perturbed by the Hoxa5 mutation itself, raising the possibility of regional autoregulation. Altogether, these results demonstrate the crucial role of Hoxa5 in the specification of the cervical and upper thoracic region of the skeleton and establish the importance of its correct expression for the proper patterning of the embryo.

Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbidity and mortality after aortic valve replacement with a bioprosthetic heart valve

BACKGROUND AND AIMS OF THE STUDY

Previous studies have shown that the effective orifice area of an aortic prosthetic valve may be too small in relation to the patient's body surface area, resulting in abnormally high gradients. The consequences of this condition, termed prosthesis-patient mismatch, have not been fully studied. The study objective was to determine if the condition has a detrimental effect on symptomatic and hemodynamic status, morbidity and mortality of patients undergoing aortic valve replacement.

METHODS

A cohort of 392 patients was prospectively followed for up to seven years after implantation of a Medtronic Intact bioprosthesis. Doppler echocardiography was performed annually in 72 patients. Based on previous studies, presence of mismatch was defined as an indexed valve area < or = 0.85 cm2/m2.

RESULTS

Mismatch was associated with less postoperative improvement of NYHA functional class (p < 0.009) independently of other predictors, such as age and preoperative functional class, but had no significant impact on patient survival (mismatch: 75 +/- 4%, no mismatch: 79 +/- 3%; p = 0.59) and valve-related morbidity up to seven years. Cardiac index was similar in patients with and without mismatch up to three years after operation but decreased significantly thereafter only in patients with mismatch (-0.54 +/- 0.32 versus -0.17 +/- 0.49 l/min/m2; p = 0.04). Likewise, the mean transprosthetic gradient, which was higher at one year after operation in patients with mismatch (22 +/- 8 versus 15 +/- 7 mmHg), increased significantly (+6 +/- 6 versus +1 +/- 1 mmHg; p = 0.008) only in this group during follow up.

CONCLUSIONS

Patients with mismatch have less symptomatic improvement and worse hemodynamics that continue to deteriorate with time. However, medium-term prognosis (up to seven years) is relatively good. Further studies are necessary to determine the longer-term effects of mismatch on morbidity and mortality.

Early postnatal lethality in Hoxa-5 mutant mice is attributable to respiratory tract defects

To uncover roles for the Hoxa-5 gene during embryogenesis, we have focused on identifying structural and functional defects in organ systems underlying the perinatal lethality in Hoxa-5 homozygous mutants. Analysis of the mutant phenotype shows that Hoxa-5 is essential for normal organogenesis and function of the respiratory tract. In homozygous newborn mutants, improper tracheal and lung morphogenesis can lead to tracheal occlusion, and to respiratory distress associated with a marked decrease in the production of surfactant proteins. Collectively, these defects likely underlie the pronounced mortality of homozygous mutant pups. Furthermore, the loss of Hoxa-5 function results in altered TTF-1, HNF-3 beta, and N-myc gene expression in the pulmonary epithelium. Since expression of Hoxa-5 is confined to the mesenchymal component of the developing trachea and lung, the effects observed in epithelial cells may result from a disruption of normal epithelial-mesenchymal interactions.

Maximizing the benefits of thrombolytic therapy for acute myocardial infarction

Thrombolytic therapy is a huge advance in the management of acute myocardial infarction (AMI). The results of large clinical trials over the past 9 years have unequivocally demonstrated its benefit: of every 1000 patients treated 30 will be saved, at a cost of two cases of nonfatal cerebral hemorrhage and seven of noncerebral major hemorrhage. The concurrent use of acetylsalicylic acid increases the benefit of thrombolytic therapy. Sales figures for thrombolytic agents indicate that their use in Canada is less than optimal and lags behind that in several European countries. Major educational efforts are needed to promote awareness of the efficacy of thrombolytic therapy and of optimal approaches for maximizing its potential benefit for patients with AMI.

Surgical treatment of left main coronary aneurysm

Aneurysms of the coronary arteries occur in 0.3% to 4.9% of angiograms. Only 13 cases of left main artery (LMA) aneurysms have been reported. Of these, three were treated by ligation of the aneurysm and coronary revascularization; the others by revascularisation alone. We report the case of a 56 years old man presenting with unstable angina and previous history of myocardial infarction. Coronary angiography confirmed three vessels disease and the presence of an aneurysm of the LMA extending to the proximal part of the left anterior descending artery (LAD). The patient was treated with ligation of the aneurysm and total myocardial revascularization. The clinical and radiological features are reviewed, and the surgical options considered.

Specification of axial identity in the mouse: role of the Hoxa-5 (Hox1.3) gene

Numerous lines of study have suggested that the Hox genes, encoding putative transcription factors, are key genes in the establishment of the body plan of the mammalian embryo. To examine the role of Hoxa-5 (Hox1.3) gene during development, we have used targeted mutagenesis in embryonic stem cells to produce a strain of mice carrying a disrupted Hoxa-5 allele. The viability of homozygous mutant mice is markedly reduced, with 50% of the mutant animals dying at birth or shortly thereafter. Analysis of the skeleton of Hoxa-5 mutants reveals a number of homeotic transformations restricted to the cervical and thoracic regions. Of these, one of the most frequent morphological abnormalities is the posterior transformation of the seventh cervical vertebra into the likeness of a thoracic vertebra complete with a pair of ribs. These results demonstrate that the Hoxa-5 gene has an important role in the establishment of the skeleton during development and contributes to the process whereby the axial structures are determined.

Behavioral responses elicited by intraperitoneal neurotensin in guinea pigs

The potential behavioral responses to single intraperitoneal (IP) injection of neurotensin (NT) were examined in conscious, freely moving guinea pigs. Most animals injected with NT solvent (i.e., controls) or NT solution with low NT concentration (i.e., 5.4 nM) exhibited little or no particular behavioral reaction. On the other hand, 50 to 75% of the animals given IP injection of NT with 54, 540, or 5400 nM of NT exhibited motor responses characterized by a transient episode of clonic body jerks. Vocalization responses were observed in less than 25% of the animals given IP NT. Animal pretreatment with morphine reduced the incidence of motor and vocalization responses. The results were interpreted as an indication that IP injection of moderately concentrated NT solution (i.e., greater than or equal to 54 nM) is probably a weak noxious stimulus in conscious guinea pigs.

Haemodynamic and abdominal motor reflexes elicited by neurotensin in anaesthetized guinea-pigs

1. Single intraperitoneal (i.p.) injections of neurotensin (NT) (0.14- 140 nmol kg-1) in anaesthetized guinea-pigs were found to trigger transient abdominal wall contractions (TAWC) accompanied by relatively sustained increases of systemic blood pressure (BP) and heart rate (HR). The modification of the latter NT effects by various drugs and surgical manipulations was examined to obtain some insight into the nature of, and possible relationship between, these responses. 2. The abdominal motor response (i.e. TAWC) to i.p. NT (14 nmol kg-1) was inhibited by prior i.v. injection of the guinea-pigs with pancuronium (0.27 mumol kg-1), morphine (1.5 and 15 mumol kg-1), clonidine (0.34 mumol kg-1), by concomitant i.p. injection of procaine 2% w/v, or by acute spinalization. It was potentiated by naloxone (2.8 and 28 mumol kg-1), but not affected by i.v. injection of autonomic drugs (i.e. pentolinium, prazosin, yohimbine and atropine), by capsaicin desensitization, or by acute bilateral cervical vagotomy. In spinalized animals a sustained abdominal wall contraction (SAWC) was unmasked, which was resistant to i.v. morphine, clonidine or baclofen but suppressed by i.v. pancuronium or i.p. lignocaine 2% w/v. 3. Haemodynamic responses to i.p. NT were not affected by i.v. pancuronium, morphine, naloxone, atropine, or by vagotomy. They were inhibited by i.v. pentolinium or clonidine (BP, HR), i.v. prazosin (BP), i.p. procaine 2% w/v (BP, HR), capsaicin desensitization or acute spinalization (BP, HR). Yohimbine (i.v.) potentiated BP and HR increases caused by i.p. NT.4. These results suggest that: (1) the haemodynamic and TAWC responses to i.p. NT in this animal model, are two independent, neurally-mediated reflexes which are likely to originate from the abdominal cavity and require a functionally intact spinal cord for their full expression; (2) the neural pathways subserving both types of responses appear to be different from each other. The nature and time-response characteristics of the reflexes caused by i.p. NT, raise the possibility that i.p. NT is a noxious stimulus, at least in guinea-pigs.

Mechanism of the pressor response to intraperitoneal injection of bradykinin in guinea pigs

Single intraperitoneal (IP) injection of bradykinin (BK) in anesthetized guinea pigs caused concentration-related pressor effects and slight, not significant tachycardia. Intravenous injections of BK in the same animal model evoked hypotension and a marked tachycardia. IP injection of des-Arg9-BK, a selective B1 receptor agonist, caused no changes of blood pressure or heart rate. The pressor response to IP BK was reduced by concomitant IP injection of lidocaine or of D-Arg[Hyp3,D-Phe7,Leu8]BK, a B2 receptor antagonist. It was also inhibited by acute animal pretreatment with sympatholytic drugs, by chronic animal exposure to capsaicin, or acute spinalization, but it was not affected by atropine, propranolol, indomethacin, [Leu8]des-Arg9-BK, a B1 receptor antagonist, or by acute cervical vagotomy. These results suggest that pressor responses to IP BK in anesthetized guinea pigs are reflex in nature, involving abdominal, capsaicin-sensitive, nonvagal visceral afferents, efferent components of the sympathetic nervous system and possibly supraspinal centers, and likely to be mediated by B2 receptors of kinins presumably located on abdominal visceral afferents.

Effect of initial blood pressure level on cardiovascular reflexes caused by intraperitoneal neurotensin

The reflex changes of systemic blood pressure (BP) and heart rate (HR) induced by intraperitoneal (IP) injections of neurotensin-containing solutions (NTCS) were measured in anesthetized guinea pigs whose BP was raised up by intravenous (IV) infusions of either angiotensin II (ATII) or noradrenaline (NA), and compared to those observed in control animals (i.e., saline-infused guinea pigs with low initial BP level). The amplitudes of reflex pressor and tachycardic responses to IP NTCS were either not affected or reduced in animals whose BP was raised with ATII or NA. However, no hypotensive effect was observed, following IP NTCS, in any of the animals tested. The results indicate that high initial BP levels tend to attenuate the reflex increases of BP and HR caused by IP NTCS, the level of inhibition being largely determined by the type of vasopressor agent utilized to raise up the BP. They also suggest that the initial BP level is unlikely to be an important factor in determining whether the activation of capsaicin-sensitive visceral afferents will produce hypotensive or hypertensive effects in this animal model.

Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiography

Doppler echocardiographic evaluation of aortic valve prostheses is based on the use of variables heretofore validated mostly for native valves. Accordingly, this study examined the validity and relative usefulness of the Doppler valve gradient and area measurements in 31 patients (mean age 69 +/- 10 years) 20 +/- 4 months after implantation of a given type of aortic bioprosthesis ranging in size from 19 to 29 mm. Valve area data obtained with both the standard and simplified continuity equations were compared with known in vitro prosthetic valve area measurements and an excellent correlation was obtained between the standard and simplified continuity equations (r = 0.98, SEE +/- 0.07 cm2, p less than 0.0005) and between in vivo and known in vitro prosthetic valve areas (r = 0.86, SEE +/- 0.16 cm2, p less than 0.0005). Peak gradient ranged from 10.8 to 75.0 mm Hg (mean 35 +/- 16) and mean gradient from 7.6 to 43.7 mm Hg (mean 20.5 +/- 9.5). The correlations between prosthetic valve gradient and in vivo area were r = -0.53, SEE +/- 14 mm Hg and r = -0.49, SEE +/- 8.63 mm Hg for peak and mean gradient, respectively. These relations were improved by indexing valve area by body surface area. The best correlations were obtained between indexed valve area and a quadratic function of the gradient (r = -0.72, SEE +/- 11.72 mm Hg and r = -0.70, SEE +/- 7.28 mm Hg for peak and mean gradient, respectively), reflecting a curvilinear relation.(ABSTRACT TRUNCATED AT 250 WORDS)

Further observations on the mechanism of the cardiovascular reflexes caused by exposure of the peritoneum to neurotensin

Intraperitoneal (IP) injections of either 1, 3 or 9 ml of neurotensin-containing solutions (NTCS) with 5.4, 54, 540 or 5400 nM of neurotensin (NT) were found to cause concentration-dependent, but volume-independent, increases of blood pressure (BP) and heart rate (HR) in anesthetized, close-abdomen guinea pigs. The duration of both effects varied between 15 to 30 min depending both on the NT concentration and volume of NTCS utilized. Indirect evidence suggested that NT inactivation within the peritoneal cavity contributed to shorten the duration of NT effects. Animal pretreatment with a ganglion blocker, adrenoceptor antagonists, clonidine or capsaicin, reduced the BP and HR increases caused by IP injection of NTCS whereas both effects were either unaffected or slightly potentiated by animal pretreatment with atropine, morphine or captopril. Addition of a local anesthetic to NTCS inhibited the hemodynamic effects of NT whereas acute bilateral cervical vagotomy was without significant effect. These results suggest that NT has the ability to trigger cardiovascular reflexes following its IP injection in guinea pigs. The activation of peritoneal, sympathetic, capsaicin-sensitive primary afferents appears to be at the basis of these reflexes, the amplitudes of which seem poorly related to the volume of NTCS utilized (at least within the range of volume examined).

Validation and applications of mitral prosthetic valvular areas calculated by Doppler echocardiography

Doppler echocardiography is used in the noninvasive evaluation of mitral valve prostheses using parameters heretofore validated primarily for native valves. Accordingly, this study was designed to examine the validity and relative usefulness of valve gradient and area measurements in a group of 26 patients (17 women, 9 men, mean age 62 +/- 8 years), 19 +/- 4 months after implantation of different sizes (25 to 31 mm) of a given type of bioprosthesis. Areas obtained with both the continuity equation, using stroke volume measured in the left ventricular outflow tract, and the pressure half-time method are compared to known prosthetic areas derived from an in vitro hydraulic model. Areas calculated by the continuity equation correlate well with in vitro areas (r = 0.82, standard error of the y estimate = 0.1 cm2, p less than 0.001), and are within the range of predicted in vitro values in 92% of cases. Areas derived by the pressure half-time method do not correlate with in vitro areas (r = 0.15, p greater than 0.3) or continuity equation areas (r = 0.23, p greater than 0.2), and are above the range of predicted values in 69% of cases. Correlations are also found between continuity equation areas and the peak and mean valvular gradients (r = 0.59, p less than 0.005 and r = -0.63, p less than 0.0005, respectively). Taking the effect of cardiac output on gradients into account results in projected relations between indexed prosthetic areas and the pressure gradients at rest and during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

An antigen located in the kinetochore region in metaphase and on polar microtubule ends in the midbody region in anaphase, characterised using a monoclonal antibody

We describe a new component of the kinetochore region of Chinese hamster ovary cells, which was characterised using a monoclonal antibody (mAb). This antigen was localised on the kinetochore regions of purified metaphase chromosomes, but in anaphase it was instead located on the polar microtubules in the midbody region, where they terminate in the stembody. It was not detectable in prophase or interphase cells by immunofluorescence, but was present in the interphase nucleus as shown by immunoblotting after SDS-polyacrylamide gel electrophoresis. The mAb recognised two polypeptides of Mr 140,000 and 155,000. The localisation of this antigen in metaphase on the kinetochore region, where the plus ends of the kinetochore microtubules are temporarily stabilised when they attach, and later in the stembody and midbody where the plus ends of the polar microtubules are stabilised in anaphase and telophase, suggests that it could play a role in stabilising the plus ends of microtubules and thus in the control of microtubule dynamics during mitosis.

Capsaicin-sensitive primary afferents are involved in the hypotensive effect of neurotensin in ganglion-blocked guinea pigs

The mechanism of the blood pressure (BP)-lowering effect of neurotensin (NT) in the anesthetized, ganglion-blocked guinea pigs was further examined using animals in which the basal BP was artificially raised by an IV infusion of noradrenaline (NA) to overcome the BP-lowering effect of the anesthesia as well as of the ganglion blocker. The animals were also vagotomized and given atropine at the beginning of the experiments to prevent potential baroreceptor-mediated vagal reflexes and/or activation of muscarinic receptors by endogenous acetylcholine. Under these experimental conditions, the IV bolus injections of NT as well as of capsaicin (a reference drug) produced dose-dependent hypotensive effects and variable levels of tachycardia. Omitting the ganglion blocker from the animal drug regimen attenuated but did not abolish the BP-lowering effect of NT and of capsaicin. Neither the hypotensive nor the tachycardic effects of NT and of capsaicin in ganglion-blocked guinea pigs were affected by prior animal treatment with propranolol (a beta adrenoceptor blocker), antihistaminics (mepyramine, cimetidine) or indomethacin (a cyclooxygenase inhibitor). Morphine was found to slightly reduced the hypotensive effect of NT without altering its slight tachycardic effect. Both the hypotensive and tachycardic effects of NT and of capsaicin, in contrast to those elicited by substance P (SP) and calcitonin gene-related peptide (CGRP), were inhibited in ganglion-blocked guinea pigs pretreated four days previously with capsaicin.(ABSTRACT TRUNCATED AT 250 WORDS)

Local application of neurotensin to abdominal organs triggers cardiovascular reflexes in guinea pigs: possible mechanisms

Intraabdominal (IAB) injections or topical application of neurotensin (NT) to the serosal surface of the ileum or stomach evoked dose-dependent increases of blood pressure and of heart rate in anesthetized guinea pigs. These effects were markedly reduced by prior animal treatment with a ganglion blocker, alpha and beta adrenoceptor blockers, as well as by exposure of the abdominal organs to lidocaine, a local anesthetic. The blood pressure and heart rate responses to IAB injections or topical application of NT to the ileum or stomach were both inhibited by animal pretreatment with capsaicin. Cervical vagotomy or atropine pretreatment did not prevent or alter the cardiovascular responses to IAB injections of NT. These results suggest the presence in some organs and/or tissues of the abdominal cavity of sympathetic, capsaicin-sensitive sensory nerve fibers which, upon stimulation by NT, produce reflex increases of blood pressure and of heart rate.

A new porcine bioprosthesis: design rationale and early clinical experience

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

Compartmentation of glucose 6-phosphate in hepatocytes

Rat hepatocytes were incubated with 14C-labelled hexoses, and the specific radioactivities of glucose 6-phosphate, glucose 1-phosphate and fructose 6-phosphate were determined. (1) When suspensions of freshly isolated hepatocytes were incubated with [14C]glucose, the specific radioactivities of glucose 1-phosphate and fructose 6-phosphate were severalfold higher than that of glucose 6-phosphate. The ratios of the specific radioactivities decreased with time of incubation. These relationships were also found when incubations were carried out with primary cultures of rat hepatocytes or with crude homogenates of hepatocytes, but not with isolated nuclei. (2) When cells were incubated with [14C]fructose, the ratios of the specific radioactivities were higher than with [14C]glucose, and also decreased with time. (3) Paired incubations were carried out with a mixture of galactose and fructose, with one or other sugar being labelled with 14C. The specific radioactivity of glucose released into the medium was greater than that of glucose 6-phosphate when fructose was labelled, but not when galactose was labelled. Furthermore, glucose 6-phosphate and glucose in the medium differed with regard to the distribution of 14C between C-1 and C-6. These results are interpreted as evidence that glucose 6-phosphate in hepatocytes does not exist as a homogeneous pool, but that subcompartments exist which are associated with glucose phosphorylation, gluconeogenesis and glycogenolysis.

Concentrations of fusidic acid, cloxacillin, and cefamandole in sera and atrial appendages of patients undergoing cardiac surgery

The concentrations of cefamandole, cloxacillin and fusicid acid were measured in the serum and heart tissue of 100 recipients of these drugs before cardiac surgery. During cardiopulmonary bypass, mean (+/- standard deviation) peak concentrations in serum of all patients were 63.0 +/- 34.0 micrograms of cefamandole per ml, 30.8 +/- 17.7 micrograms of cloxacillin per ml, and 32.4 +/- 10.8 micrograms of fusidic acid per ml. Mean (+/- standard deviation) concentrations in atrial appendages taken 1 h (+/- 15 min) after infusion were 21.3 +/- 11.0 micrograms of cefamandole per g, 23.8 +/- 17.3 micrograms of cloxacillin per g, and 10.7 +/- 4.2 micrograms of fusidic acid per g. No cloxacillin could be detected in 5 of 39 heart specimens. Mean tissue-to-serum ratios at 1 h for cefamandole, cloxacillin, and fusidic acid were respectively 0.35, 0.73, and 0.33. Fusidic acid, a drug which is highly effective in vitro against both methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis, was detectable in heart tissue in concentrations which were 12 times higher than the MICs of this agent against these resistant microorganisms.

Transaxillary pleurectomy for treatment of spontaneous pneumothorax

In the 16-year period 1962 to 1978, 409 transaxillary apical pleurectomies were carried out for definitive treatment of spontaneous pneumothorax in 362 patients. Surgical indications included recurrence (336), bilaterality of the disease (23), persistent air leak (22), and nonexpansion of the lung (10). There was 1 operative death (unsuspected brain tumor), and 3 patients required reexploration for clot removal. The average postoperative period of hospitalization was 6 days. Three hundred ten patients (86% of all patients) were contacted for follow-up 1 to 16 years after operation (average, 4.5 years). There were two documented episodes of recurrent ipsilateral pneumothorax (0.6%). Postoperative pulmonary function studies were done in 40 patients (unilateral, 29; bilateral, 11) 2 to 5 years after operation. The results indicate that there are no significant abnormalities compared with predicted values.

Value of a cinefluoroscopic assessment of the Lillehei-Kaster prosthetic heart valves

In order to assess the functioning of the pivoting disc of the Lillehei-Kaster prosthetic valve, a cinefluoroscopic technique using multiple angulations was developed. The disc was detected in 240 (99%) of the 242 valves studied (126 aortic, 107 mitral, and nine tricuspid valves). The maximal-opening angle of the disc was measured in 75% of the aortic but only 20% of the mitral valve prostheses in the 182 valve studies in which this was attempted. Prosthetic dysfunctions were suspected clinically in three aortic and three tricuspid valves and confirmed with the cinefluoroscopic technique. This cinefluoroscopic approach constitutes a rapid, noninvasive, and sensitive evaluation of the function of the Lillehei-Kaster prosthetic valve in the aortic position.

[Prevention and chronicity in community psychiatry.]

The author poses the problem of the chronic mental patient in 1977 in light of the commu-nity approach. During the 1950's the discovery of penicillin, the phenothiazines and the anti-depressants; the notion of institutional dementia as well as the rapid growth of physical health costs, formed the basis for a needed reform which took the guise of community psychiatry. The latter created many hopes (eg. the possible elimination of the asylum, the potential for preventive effects). In fact community mental health programs did produce a decrease in the hospitalized psychiatric population, a higher quality of hospital services, a change in the laws relating to the mentally ill, and an improvement in treatment, personnel competence as well as a stability in real health costs. But the 1970's brought disillusionment. The rate of psychotic disorder remains unchanged, the cost-benefit of the program is less than had been anticipated and, in addition, the community approach has transplanted the asylum to the city thus creating a new immigrant - the psychotic individual. Citing this failure, the author argues for a psychiatry focussed on research into the makeup of the internal psychotic dynamic and its treatment.

Mediastinopleuroscopy: a new approach to the diagnosis of intrathoracic diseases

With the advent of modern therapy, it has become essential to obtain a tissue diagnosis in all cases of pulmonary and mediastinal disease. Since it is often necessary to resort to thoracotomy as a final step in making such a diagnosis, we have sought a procedure that is simpler while capable of providing the same information. Through a standard cervical mediastinoscopy incision, the mediastinum is first explored; if the diagnosis is not obtained, the mediastinal pleura is digitally opened and lung or pleural biopsies are taken. In the course of 1,100 mediastinoscopies since 1969, 275 pleuroscopies have been done. We were able to obtain a tissue diagnosis in 102 (78%) of 131 patients with bronchogenic carcinoma, in 92 (91%) of 102 with benign pulmonary disease, and in all 20 (100%) with pleural disease.