Effects of therapeutic ultrasound on the endothelial function of patients with type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is characterized by endothelial dysfunction that causes micro- and macrovascular complications. Low intensity therapeutic ultrasound (LITUS) may improve endothelial function, but its effects have not been investigated in these patients. The aim of our study was to compare the effects of pulsed (PUT) and continuous (CUT) waveforms of LITUS on the endothelium-dependent vasodilation of T2DM patients. The present randomized crossover trial had a sample of twenty-three patients (7 men) diagnosed with T2DM, 55.6 (±9.1) years old, with a body mass index of 28.6 (±3.3) kg/m2. All patients were randomized and submitted to different waveforms (Placebo, CUT, and PUT) of LITUS and the arterial endothelial function was evaluated. The LITUS of 1 MHz was applied in pulsed (PUT: 20% duty cycle, 0.08 W/cm2 SATA), continuous (CUT: 0.4 W/cm2 SPTA), and Placebo (equipment off) types of waves during 5 min on the brachial artery. Endothelial function was evaluated using the flow-mediated dilation (FMD) technique. PUT (mean difference 2.08%, 95% confidence interval 0.65 to 3.51) and CUT (mean difference 2.32%, 95% confidence interval 0.89 to 3.74) increased the %FMD compared to Placebo. In the effect size analysis, PUT (d=0.65) and CUT (d=0.65) waveforms presented moderate effects in the %FMD compared to Placebo. The vasodilator effect was similar in the different types of waves. Pulsed and continuous waveforms of LITUS of 1 MHz improved the arterial endothelial function in T2DM patients.

Effects of photobiomodulation therapy (PBMT) over endothelial function in healthy individuals: a preliminary crossover clinical trial

Photobiomodulation therapy (PBMT) causes stimulatory effects that raise cell metabolism. The study aimed to evaluate the effects of PBMT on the endothelial function of healthy individuals. It was a controlled, randomized, crossover, triple-blind trial with 22 healthy volunteers (female: 77.3%), aged 25.45 years which were randomly divided into three groups. PBMT with gallium-aluminum-arsenide (GaAlAs) diode laser (810 nm, continuous-wave mode, 1000 mW, 0.28 cm²) was applied over the radial and ulnar artery regions in two parallel spots: group 1-30 J (n = 22, 107 J/cm²) per spot; group 2-60 J (n = 22, 214 J/cm²) per spot; and group 3-placebo (n = 22, sham). The endothelial function was measured before and immediately after PBMT by the flow-mediated dilation technique (%FMD) with high-resolution ultrasound. Statistical analysis was made with ANOVA for repeated measures, the effect size was measured by Cohen's d, and results are presented as mean and standard error (or 95% confidence intervals). A p-value < 0.05 was considered statistically significant. The %FMD increases 10.4% with 60 J (mean difference = 0.496 mm, 95% CI = 0.42 to 0.57, p < 0.001), 7.3% with 30 J (mean difference = 0.518 mm, 95% CI = 0.44 to 0.59, p < 0.001), and 4.7% with placebo (mean difference = 0.560 mm, 95% CI = 0.48 to 0.63, p < 0.001). We found a small effect size (p = 0.702; d de Cohen = 0.24) without statistical difference between interventions. PBMT with the energy density of 60 J and 30 J did not improve endothelial function.Trial registration number: NCT03252184 (01/09/2017).

The effects of exercise on circulating endocannabinoid levels-a protocol for a systematic review and meta-analysis

BACKGROUND

Increased circulating endocannabinoids levels are typically associated with aerobic exercise. This phenomenon is associated with a "runner's high," a state of euphoria and well-being experienced after a long exercise. We will provide in this review a transparent and standardized methodology following the PRISMA-P and Cochrane Handbook for Systematic Reviews of Interventions for conducting a systematic review and meta-analysis for synthesizing the available evidence about the effects of physical activity on the circulating levels of AEA and 2-AG endocannabinoids in healthy subjects.

METHODS

A multi-disciplinary team with basic and clinical expertise in exercise science developed this protocol. PubMed, EMBASE, Web of Science, CINAHL, SPORTDiscus, and Scopus will be the databases. A health sciences librarian was consulted in the development of the research. Search strategies will combine MeSH terms and free text words, including "exercise," "exercise, physical," "exercise training," "physical activity," "endocannabinoids," "2-arachidonoyl-glycerol," "glyceryl 2-arachidonate," "2-AG," "anandamide," "AEA," "n-arachidonoylethanolamide," "adult," "young adult," and "middle-aged." We will select experimental or quasi-experimental studies published through December 2021. The selection of studies, data extraction, assessment of the risk of bias, and the quality of evidence will be carried out in a paired and independent manner, and the consistency will be assessed using the statistics of Cohen Kappa. Methodological quality will be assessed using the Revised Cochrane risk of bias tool for randomized trials (RoB 2) and the Risk Of Bias In Nonrandomized Studies of Interventions (ROBINS-I) risk tool. We will use the Grading of Recommendations Assessment, Development, and Evaluation to assess the quality of the evidence, χ² and I² tests for heterogeneity, funnel plots, and the Egger test for publication bias. A meta-analysis for each data comparison will be performed whenever possible to determine the effect of physical activity on endocannabinoids' circulating levels.

DISCUSSION

This systematic review and meta-analysis will provide an overview of the evidence about physical activity over AEA and 2-AG endocannabinoids, including comparability of variables between studies, critical interpretation of results, and use of accurate statistical techniques. The endocannabinoid is molecules by which muscles communicate with other tissues and organs, mediating the beneficial effects of exercise on health and performance, including increased glucose uptake, improved insulin action, and mitochondrial biogenesis. They are essential to exercise. Thus, this study will review the acute effect of physical exercise on circulating levels of endocannabinoids in healthy individuals. The results of this study will potentially be transferred to doctors, health professionals, and legislators to guide their decision making, as well as will improve future research.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020202886 .

Intensity-dependent effect of pulsed and continuous therapeutic ultrasound on endothelial function: a randomised crossover clinical trial

Background/Aims

The aim of this study was to evaluate the effects of different intensities and waveforms of therapeutic ultrasound on endothelial function in typically healthy participants.

Methods

A total of 15 participants were evaluated over 2 consecutive days. Different intensities of continuous and pulsed (20% duty cycle) 1-MHz ultrasound were applied to the brachial artery for 5 minutes each. Endothelial function was measured using flow-mediated dilation technique before and immediately after ultrasound was applied.

Results

Compared to baseline values, endothelium-dependent vasodilation increased with both continuous (2.8%) and pulsed (1.6%) ultrasound at an intensity of 0.4 W/cm2SPTA. At 1.2 W/cm2SPTA, endothelium-dependent vasodilation was 4.1% above baseline for pulsed and 5.3% above baseline for continuous waveforms. There was no additional increase in vasodilation at intensities above 1.2 W/cm2SPTA. The percentage of endothelium-dependent vasodilation was similar for the all of the different waveforms studied.

Conclusions

Both continuous and pulsed ultrasound waveforms promote endothelium-dependent vasodilation. There was a dose-dependent increase in vasodilation at intensities from 0.4 W/cm2SPTA to 1.2 W/cm2SPTA. Pulsed is more efficient than continuous ultrasound because it produces the same effect on endothelium-dependent vasodilation while employing 20% of the energy applied with continuous ultrasound.

Effects of aerobic exercise using cycle ergometry on balance and functional capacity in post-stroke patients: a systematic review and meta-analysis of randomised clinical trials

BACKGROUND

Previous studies have shown that aerobic exercise with cycle ergometer improves motor control.

PURPOSE

The objective of this systematic review and meta-analysis are to evaluate evidence about the effects of aerobic exercise with cycle ergometer on the balance of post-stroke patients, evaluated by the Berg Balance Scale (BBS), and functional capacity, evaluated by the maximal oxygen intake and six-minute walk test (6MWT).

METHODS

The research was conducted on MEDLINE, LILACS, Cochrane Library, EMBASE, Physiotherapy Evidence Database, and Google Scholar until March 2018 (CRD42015020146). Two independent reviewers performed the article selection, data extraction, and methodological quality assessment. The main outcome was balance assessed by the Berg scale and the secondary outcome was functional capacity of the maximal oxygen intake and the 6MWT. Meta-analysis was conducted using a random-effects method, and mean pre-post intervention difference with a 95% confidence interval (95%CI).

RESULTS

The review included 5 papers and a total of 258 patients. It was observed that the cycle ergometer did not improve balance in this population (0.03 [-0.57 to 0.64] p = 0.91) or functional capacity in maximal oxygen intake (2.40 [-0.24 to 5.04] p = 0.07) and 6MWT (-40.49 [-131.70 to 50.72] p = 0.38).

CONCLUSIONS

The cycle ergometer aerobic exercise did not seem to improve balance or functional capacity in post-stroke patients.IMPLICATIONS FOR REHABILITATIONAerobic exercise with cycle ergometer does not improve balance in patients after chronic stroke, but the results for functional capacity are more promising.Beneficial changes in functional capacity can be seen after 12-4 weeks of training, and are dependent on the initial level of physical fitness of each individual.The use of the cycle-ergometer to improve balance and functional capacity was not superior when compared to conventional physiotherapy; therefore, a combination of therapeutic modalities would be ideal for rehabilitation and post-stroke patients.

MALE ADULT RAT SPERM PARAMETERS AFTER SKELETAL MUSCLE INJURY

ABSTRACT Introduction: Skeletal muscle injuries stimulate a systemic inflammatory response which may interfere in species reproduction. Objective: To evaluate the effects caused by skeletal muscle injuries on the inflammatory response and sperm parameters of male adult rats. Methods: The sample group was composed of 30 Wistar rats distributed evenly across control and injury groups. Muscle injury was induced by bruising, caused by the release of a 200 g weight from a height of 30 cm onto the gastrocnemius muscle. Blood (CBC and damage/muscle inflammation markers), muscle (oxidative stress) and gonad (sperm parameters) samples were collected 72h after the injury. Results: The muscle injury increased monocytes, creatine kinase, C-reactive protein, reactive oxygen species (ROS) concentration and lipid peroxidation. In contrast, the injury reduced antioxidant capacity against peroxyl radicals (ACAP), membrane integrity (36%) and sperm acrosome (33%). Membrane integrity and acrosome (p<0.05) correlate directly with ACAP (ρ=0.602; ρ=0.513 respectively) and inversely with monocytes (ρ=-0.703; ρ=-0.635, respectively), creatine kinase (ρ=-0.450; ρ=-0.603), C-reactive protein (ρ=-0.511; ρ=-0.703) and parameters of oxidative stress (ROS ρ=-0.703; ρ=-0.635; lipid peroxidation ρ=-0.494; ρ=-0.559). Conclusion: The acute systemic inflammatory response arising from skeletal muscle injury interferes in the male reproductive cell organelles (membrane and acrosome). Level of Evidence V; Experimental study.

Effects of transcutaneous electrical nerve stimulation alone or as additional therapy on chronic post-stroke spasticity: systematic review and meta-analysis of randomized controlled trials

Purpose: To evaluate the effects and to compare transcutaneous electrical nerve stimulation protocols, alone or as additional therapy in chronic post-stroke spasticity through a systematic review and meta-analysis of randomized clinical trials.Methods: Search was conducted in MEDLINE, Cochrane Library, EMBASE and Physiotherapy Evidence Database through November 2017 (CRD42015020146). Two independent reviewers performed articles selection, data extraction and methodological quality assessment using the Cochrane Collaboration's risk of bias tool. The main outcome was spasticity assessed with Modified Ashworth Scale or other valid scale. Meta-analysis was conducted using random effects method, and pooled-effect results are mean difference with 95% confidence interval.Results: Of 6506 articles identified, 10 studies with 360 subjects were included in the review. Transcutaneous electrical nerve stimulation alone or as additional therapy is superior to placebo TENS to reduce post-stroke spasticity assessed with Modified Ashworth Scale (-0.52 [-0.74 to -0.30] p < 0.0001, 6 studies), especially in lower limbs (-0.58 [-0.82 to -0.34] p < 0.0001, 5 studies), which is in accordance with the studies that used other scales. Low frequency TENS showed a slightly larger improvement than high-frequency, but without significant difference between subgroups. Most studies present low or unclear risk of bias.Conclusion: Transcutaneous electrical nerve stimulation can provide additional reduction in chronic post-stroke spasticity, mainly as additional therapy to physical interventions. Studies with better methodological quality and larger sample are needed to increase evidence power.Implications for RehabilitationTranscutaneous electrical nerve stimulation as additional treatment to physical interventions can lead to additional reduction in chronic post-stroke spasticity.High and low frequency transcutaneous electrical nerve stimulation showed similar results, with a smaller numerical superiority of low frequency TENS.More studies are needed to substantiate the best protocol of transcutaneous electrical nerve stimulation to the treatment of spasticity.

Effects of High-Intensity Inspiratory Muscle Training Associated with Aerobic Exercise in Patients Undergoing CABG: Randomized Clinical Trial

OBJECTIVE

Evaluate the interaction between high-intensity inspiratory muscle training (IMT) and aerobic exercise on physical capacity, respiratory muscle strength, peripheral muscle strength, and quality of life of patients who underwent coronary artery bypass grafting (CABG).

METHODS

Twenty-four patients underwent CABG were randomized into two groups. During 36 sessions, one group received IMT associated with aerobic exercise and the other group received only aerobic exercise. Primary outcome was the distance in the six-minute walk distance (6MWD) test. Secondary outcomes included respiratory muscle strength, peripheral muscle strength, and quality of life. Measures were taken at the baseline, at the 12th session, the 24th session, and 36th session.

RESULTS

Baseline characteristics were similar between the groups. There was no statistically significant difference between the two groups in any outcome [6MWD - P=0.935; peak oxygen consumption (PeakVO2) - P=0.853; maximal inspiratory pressure (MIP) - P=0.243; maximal expiratory pressure (MEP) - P=0.268; sitting-rising test (SRT) - P=0.212], but there was interaction in MIP (P=0.000) and all outcomes improved in the two groups (6MWD - P=0.000; PeakVO2 - P=0.000; MIP - P=0.000; MEP - P=0.000; SRT - P=0.000).

CONCLUSION

There was an improvement of all outcomes in both groups, but IMT was not able to provide additional benefits. The use of this combination should be used with caution to not generate higher costs in the rehabilitation process of these patients.

Comparison of the effects of 1MHz and 3MHz therapeutic ultrasound on endothelium-dependent vasodilation of humans: a randomised clinical trial

OBJECTIVE

To compare the effects of different waveforms of 1MHz and 3MHz therapeutic ultrasound on endothelial function in healthy subjects.

DESIGN

Randomised placebo-controlled, crossover study with concealed allocation and assessor blinding.

SETTING

Imaging Centre of the University Hospital.

PARTICIPANTS

Thirty volunteers aged between 18 and 35 years were divided into two homogeneous groups (1MHz and 3MHz).

INTERVENTIONS

Continuous (CUT; 0.4W/cm^2SATA), pulsed (PUT; 20% duty cycle, 0.08W/cm^2SATA) and placebo waveforms (equipment off) of ultrasound (1MHz and 3MHz) were randomized and applied over the brachial artery for 5minutes.

MAIN OUTCOME MEASURES

Endothelial function was evaluated using the flow-mediated dilation (FMD) technique.

RESULTS

Both 1MHz [CUT: mean difference 4%, 95% confidence interval (CI) 2 to 6%, P<0.001; PUT: mean difference 4%, 95% CI 2 to 6%, P<0.001] and 3MHz (CUT: mean difference 4%, 95% CI 2 to 6%, P<0.001; PUT: mean difference 4%, 95% CI 2 to 6%, P<0.001) of therapeutic ultrasound increased %FMD by approximately 4% compared with the placebo waveforms. The endothelium-dependent vasodilator responses were the same for both types of waves and frequencies. No differences in baseline diameter, hyperaemic flow, and nitroglycerin-mediated diameter and vasodilation were observed between groups.

CONCLUSION

Both CUT and PUT ultrasound waveforms improved endothelial function. The 1MHz and 3MHz frequencies of therapeutic ultrasound led to similar improvement in endothelial function in healthy volunteers. Clinical trial registration number RBR-4z5z3t.

Effects of Different Therapeutic Ultrasound Waveforms on Endothelial Function in Healthy Volunteers: A Randomized Clinical Trial

The purpose of this study was to determine the effects of different therapeutic 1-MHz ultrasound waveforms on endothelial function before and after cyclooxygenase (COX) inhibition. Forty-two healthy volunteers aged 27.2 ± 3.8 y underwent interventions and an evaluation for endothelial function (n = 15; with COX inhibition, n = 15; duration of the vasodilator effect, n = 12) by technique flow-mediated dilation. Continuous ultrasound therapy (0.4 W/cm(2 SATA)), pulsed ultrasound therapy (20% duty cycle, 0.08 W/cm(2 SATA)) or placebo (equipment power off) was randomly applied over the brachial artery for 5 min. COX inhibition (aspirin) was carried out 30 min before treatments. In relation to the placebo, flow-mediated dilation increased by 4.8% using continuous ultrasound and by 3.4% using pulsed ultrasound. After COX, flow-mediated dilation was enhanced by 2.1% by continuous ultrasound and 2.6% by pulsed ultrasound. This vasodilation persisted for 20 min. Continuous and pulsed therapeutic 1-MHz ultrasound waveforms improved endothelial function in humans, which provided them with anti-inflammatory vascular effects.

EFEITOS DO TREINAMENTO FÍSICO NO ENDOTÉLIO APÓS CIRURGIA DE REVASCULARIZAÇÃO

Introdução A cirurgia de revascularização do miocárdio (CRM) é uma das mais frequentes cirurgias realizadas em todo o mundo, muitos estudos vêm relatando os benefícios do treinamento físico para a melhora da capacidade funcional, porém há poucos estudos sobre os efeitos na função endotelial vascular. Objetivo Analisar os efeitos do treinamento físico sobre a função endotelial vascular em pacientes submetidos à CRM, isoladamente na fase tardia da reabilitação após seis meses de programa de reabilitação cardíaca (PCR). Métodos Foram incluídos pacientes que haviam sido submetidos à CRM no período máximo de um ano após a cirurgia. O PRC foi empregado durante seis meses consecutivos, com três sessões semanais. Todos os pacientes realizaram exames laboratoriais, teste de força muscular de uma repetição máxima (1-RM) para os membros superiores e inferiores, teste de caminhada de 6 min (TC6M) e avaliação da função endotelial através da técnica de vasodilatação mediada pelo fluxo. Resultados Onze pacientes iniciaram o PRC, porém nove pacientes o completaram. A média de idade foi de 66 anos (50 a 82 anos) e o sexo masculino foi predominante (55,6%). Houve mudanças significativas nos exames laboratoriais bioquímicos: aumento do colesterol total (Basal: 162 ± 31mg/dL vs. 195 ± 39mg/dL; P=0,012) e diminuição da hemoglobina glicada (Basal: 6,74 ± 1,64% vs. 6,26 ± 1,62%; P=0,028). A força muscular aumentou significativamente nos membros superiores e inferiores (P=0,030 e P=0,038, respectivamente); no TC6M observou-se um aumento significativo de 20% na distância percorrida (P=0,020) após seis meses consecutivos de treinamento e houve uma melhora na vasodilatação mediada pelo fluxo (Basal: 6,35 ± 3,92% vs. 6 meses: 9,90 ± 4,19%; P=0,026). Conclusão O treinamento combinado realizado em seis meses ajudou a melhorar a função endotelial e a capacidade funcional de pacientes sedentários que foram submetidos à CRM na fase tardia da reabilitação.

A GIS model-based screening of potential contamination of soil and water by pyrethroids in Europe

The paper presents a geographic information system (GIS) model-based approach for analysis of potential contamination of soil and water by pyrethroids for the European continent. Pyrethroids are widely used pesticides and their chemical and toxicological characteristics suggest there may be concerns about human health and ecosystems, although so far there is no strong evidence indicating actual risk. However, little monitoring has been conducted and limited experimental information is available. We perform an assessment exercise that demonstrates how accessible information and GIS-based modeling allow to estimate the spatial distribution of chemical concentrations and fluxes at a screening level. The assessment highlights potential hot spots and the main environmental transport pathways, in a quick and simple way. By combining information on pesticide use, crop distribution and landscape and climate parameters we identify potential problem areas to help focusing monitoring campaigns. The approach presented here is simple and fast, and can be applied to virtually all pesticide classes used over a large domain, and is therefore suitable for the screening of large quantities of chemicals, of which the majority has not undergone any systematic environmental monitoring program. The method has been tested through benchmarking with other well-established models. However, further research is needed to evaluate it against experimental observations.

Toward using delta13C of ecosystem respiration to monitor canopy physiology in complex terrain

In 2005 and 2006, air samples were collected at the base of a Douglas-fir watershed to monitor seasonal changes in the delta13CO2 of ecosystem respiration (delta13C(ER)). The goals of this study were to determine whether variations in delta13C(ER) correlated with environmental variables and could be used to predict expected variations in canopy-average stomatal conductance (Gs). Changes in delta13C(ER) correlated weakly with changes in vapor pressure deficit (VPD) measured 0 and 3-7 days earlier and significantly with soil matric potential (psi(m)) (P value <0.02) measured on the same day. Midday G (s) was estimated using sapflow measurements (heat-dissipation method) at four plots located at different elevations within the watershed. Values of midday Gs from 0 and 3-7 days earlier were correlated with delta13C(ER), with the 5-day lag being significant (P value <0.05). To examine direct relationships between delta13C(ER) and recent Gs, we used models relating isotope discrimination to stomatal conductance and photosynthetic capacity at the leaf level to estimate values of stomatal conductance ("Gs-I") that would be expected if respired CO2 were derived entirely from recent photosynthate. We compared these values with estimates of Gs using direct measurement of transpiration at multiple locations in the watershed. Considering that the approach based on isotopes considers only the effect of photosynthetic discrimination on delta13C(ER), the magnitude and range in the two values were surprisingly similar. We conclude that: (1) delta13C(ER) is sensitive to variations in weather, and (2) delta13C(ER) potentially could be used to directly monitor average, basin-wide variations in Gs in complex terrain if further research improves understanding of how delta13C(ER) is influenced by post-assimilation fractionation processes.

Indications for predismissal testing with arrhythmia-induction in patients receiving an implantable cardioverter defibrillator

Arrhythmia induction during implantation of cardioverter defibrillators (ICD) is a standard procedure. However, controversy exists regarding the need for routine arrhythmia induction before discharge from hospital (pre-hospital discharge (PHD) test). In order to reduce the number of tests we identified risk factors that predict relevant ICD malfunction.

METHODS AND RESULTS

965 patients receiving a first device implantation (n=724) or device/system replacement (n=241) between 1998 and 2004 were analysed. During implantation 176 (18%) complications (intraoperative undersensing of induced arrhythmias, unsuccessful arrhythmia-therapy or low DFT safety margin) occurred. Frequent (>4 times) intraoperative lead repositioning due to low sensing values was present in 44 patients (5%). 9% of the patients with first ICD implantation, 21% with device replacement and 27% with system replacement developed complications during PHD testing with arrhythmia induction. Intraoperative complications, although corrected during implantation, were independent risk factors for malfunction during PHD testing (p<0.05). Additional predictors for malfunction were intraoperative lead repositioning (>4 times) and a history of both VF and VT (p<0.05). Patients without intraoperative complications rarely developed malfunction during PHD testing (3.7% first device, 6.25% system replacement). Only in patients undergoing device replacement was a higher risk for failure (13%) evident. No risk factors could be identified for these subgroups.

CONCLUSION

Routine arrhythmia induction during PHD is recommended in ICD patients with intraoperative complications, although corrected during implantation, as well as frequent intraoperatives lead repositioning. Patients undergoing device/system replacement uncomplicated implantation are not generally at low risk for device failure.

Age-dependent variations of human PMNL elastase activity as a function of pH, ionic strength and calcium concentration

Human leukocyte elastase (HLE) has been implicated in the pathomechanism of various diseases, such as emphysema and atherosclerosis. The incidence of these diseases is increasing with aging. Therefore, it can be supposed that the HLE activity is changing with aging according to the well known age-related physiological alterations. Thus, the effects of pH, NaCl and calcium concentrations on HLE activity, separated from polymorphonculear leucocytes (PMNLs) of healthy, young (<35 years) and elderly (>75 years) subjects, were studied by measuring the activity with synthetic substrate and with bovine and human atherosclerotic and non-atherosclerotic aortic elastin. From our results, it may be concluded, that the elastolytic activity of HLE separated from PMNLs of elderly subjects is more sensitive to ionic strength, to pH and to the calcium concentration of the medium, than the HLE activity of young subjects. The elastolytic activity of HLE, of both young and old subjects, increases dramatically on atherosclerotic aortic elastin in the presence of calcium. These findings might explain, at least partly, the increased incidence of atherosclerosis with aging.

Laserevozierte Potentiale: der diagnostische Zugang zur Hinterwurzel

Functional diagnostics of the dorsal root are especially effective via nociceptive fibers on account of less intersegmental overlap compared to large-diameter fibers of the mechanoreceptive afferents. Laser-evoked potentials (LEP) are induced by short, painful heat stimuli. The aim of this work was to describe changes of the LEP in cases of dorsal root damage. The recorded LEP changes will be discussed with regard to their prognostic value as well as pathophysiologic aspects of dorsal root damage. Dorsal root function was tested in 21 patients suffering from clinically proven radiculopathy in one of the segments L4 to S1. Mechanosensibility and thermosensibility were clinically investigated. LEP were induced by slightly painful stimuli (80 on the affected and 80 on the contralateral unaffected dermatome). The LEP were evaluated by amplitude of the averaged electroencephalogram (EEG). In addition, a subjective pain rating was recorded after each stimulus. Investigation of dorsal root function by LEP in patients with radiculopathy yields two typical changes of the amplitude. On the one hand, there were significant reductions of amplitude, and on the other hand, a complete loss of LEP was found. LEP changes allow a graduation of patients who show no obvious differences in their clinical appearance. Which mechanisms are responsible as concerns deafferentiation and neuropathy of the dorsal root fibers are discussed. With regard to the LEP changes, a prognostic relevance in patients with dorsal root affections is likely. This question will be addressed in a prospective study soon.

[The elastin-laminin receptor]

Elastin is a major component of the extracellular matrix. Elastin peptides derived from its degradation are present in human sera. Elastin peptides induce on fibroblasts, phagocytic cells, lymphocytes, smooth muscle cells and endothelial cells, a variety of biological effects mediated by the elastin-laminin receptor which has been demonstrated to be present on the membrane of these cells. The transduction pathway of the ELR receptor involves the activation of phospholipase C (PLC) by a pertussis toxin sensitive G-protein. PLC induces the production of inositol trisphosphate (IP3) leading to the increase of the intracellular free calcium on one hand, and of diacylglycerol (DAG) which stimulates the translocation to the membrane of PKC leading to the phosphorylation of members of the MAPK family, such as p42/p44 MAPK. Considering the multiple biological effects of ELR the elucidation of the complexity of the signaling pathways will help to better modulate it, mainly in pathological situations such as atherosclerosis.

Age-related alterations in the signal transduction pathways of the elastin-laminin receptor

With aging we assist to alterations in the vascular structure and function. One important factor in these vascular wall changes is the degradation of the elastin fibre major protein: elastin. Elastin peptides derived from the degradation are present in human sera. Elastin peptides induce on fibroblasts, phagocytic cells, lymphocytes, smooth muscle cells and endothelial cells, a variety of biological effects mediated by the elastin-laminin receptor which has been demonstrated to be present on the membrane of these cells. The transduction pathway of the ELR receptor involves the activation of phospholipase C (PLC) by a pertussis toxin sensitive G-protein. PLC induces the production of inositol trisphosphate (IP3) leading to the increase of the intracellular free calcium on one hand, and of diacylglycerol (DAG) which stimulates the translocation to the membrane of PKC leading to the phosphorylation of members of the MAPK family, such as p42/p44 MAPK. A progressive age dependent uncoupling of the elastin-laminin receptor occurs impairing its transduction pathway and which results in alteration of the calcium signaling and loss in calcium homeostasis of the cells. These alterations in the signal transduction of the elastin-laminin receptor result in modified activities of parenchymal and phagocytic cells with aging, such as free radical production and elastase release. Thus, these age-related alterations in the elastin-laminin receptor signal transduction may be involved in the atherogenesis.

Relevance of element content of bark for the distribution of epiphytic lichens in a montane spruce forest affected by forest dieback

Element content in the bark on Norway spruce (Picea abies) was measured in a montane forest heavily affected by forest dieback and compared to that in a nearby intact stand. Bark contained less S, K, Fe, Mn, Pb, Cu, and H+ and more N, Ca, Mg, and Zn in the dieback-affected stand than in the intact one. Diversity of epiphytic lichen vegetation was higher in the dieback-affected stand than in the intact one. Cover of the foliose lichen Hypogymnia physodes was negatively correlated with Mn and Cu content of bark. Cover of the extremely acidophytic species Lecanora conizaeoides decreased with increasing Mg and increased with increasing Cu content of bark. The measurements support the hypothesis that chemical site factors are decisive for the high lichen diversity in dieback-affected montane spruce forests.

Effect of omental angiogenic lipid factor on revascularization of autotransplanted spleen in dogs

Since the turn of the century, studies have been carried out showing that the omentum contains a factor which enhances revascularization of ischemic tissues. This study was conducted for a period of 3 months and was designed to evaluate the effect of an omental lipid fraction on neovascularization of autotransplanted spleen chips in dogs. Twelve dogs underwent splenectomy and autotransplantation of 5 splenic chips into an omental pouch. In 4 dogs, the splenic chips were immersed in omental angiogenic lipid factor (OAF), while on another 4 dogs, an intramuscular injection of 4 cm3 of OAF was given each day for 7 days postoperatively. A further 4 dogs were not given any of the above treatments (control group). Serial angiographies and histologic examinations demonstrated better neovascularization and regeneration of the transplanted spleen in the dogs from the immersion plus injection group. These data suggest that the omental lipid fraction contains a factor which induces a better regeneration of splenic transplants.

Effect of gamma-hydroxybutyrate on pain, fatigue, and the alpha sleep anomaly in patients with fibromyalgia. Preliminary report

OBJECTIVE

To evaluate the effects of using a gamma-hydroxybutyrate (GHB) administered in divided doses at night in 11 patients previously diagnosed with fibromyalgia (FM).

METHODS

Subjects completed daily diaries assessing their pain and fatigue levels and slept in the sleep laboratory before and one month after initiating GHB treatment. Polysomnographic recordings were evaluated for sleep stages, sleep efficiency and the presence of the alpha anomaly in non-REM sleep.

RESULTS

There was a significant improvement in both fatigue and pain, with an increase in slow wave sleep and a decrease in the severity of the alpha anomaly.

CONCLUSION

Further controlled studies are needed to characterize the clinical improvement and the polysomnographic changes we observed.

Protection of the renal artery in nephron-sparing surgery. II. Arterial contractility investigations

It has been well known that reperfusion following ischaemia may cause functional and structural damage to not only the organ involved but also the blood vessels supplying that organ. As in organ-sparing renal surgery it is inevitable to clamp the renal artery for some time, it is expected that reperfusion, following the removing of clamping, causes structural changes in the vessel wall which may result in a decrease in arterial function. In our model experiments on animals, the left renal arteries were atraumatically clamped for 30, 45 and 60 minutes. Simultaneously with clamping, perfusion regional renal venous cooling was applied to some of the animals, together with nephrotomy. In some cases cooling was performed in combination with antioxidant treatment. On the 3rd postoperative day renal arteries from both sides were removed, the right, intact ones serving as control. Noradrenaline dose effect curves characterizing vessel contractility were determined to demonstrate functional changes. It was established that cooling the renal artery for only 30 minutes was enough to rule out the damage due to ischaemia-reperfusion. If clamping lasted for 45 minutes, venous cooling of the kidney in combination with antioxidant treatment was necessary to spare arterial function. Clamping for 60 minutes resulted in irreversible/permanent decrease in contractility even if hypothermia and antioxidant treatment were given simultaneously.

Caring for children and adults on a specialty unit

The nursing care system in a university hospital was modified to accommodate children on an organ transplant unit. System components for ensuring high-quality care for patients of all ages are identified and described. Primary nursing, a Pediatric Nursing Practice Council, Child Family Life and the support of the health care team are incorporated to successfully care for adults and children on this specialty unit.

Investigation of microcirculatory changes in the duodenum of dogs caused by surgical suture materials

Surgical suture materials play an important role in the safe performance of surgical interventions. In our experiments we made an attempt to investigate what microcirculatory changes result from pulling the thread through the wall of the duodenum in Lembert stitches by including 3 kinds of absorbable and non-absorbable suture materials each (Catgut, Dexon, PDS, Silk, Ethibond, Ethilon). Research is still in the pre-experimental stage. In the long run, we hope to enrich the description of these suture materials by some new details. It could help prevent suture insufficiency, facilitate wound healing and thus, improved surgical safety.

Bright Spots, Structure, and Magmatism in Southern Tibet from INDEPTH Seismic Reflection Profiling

INDEPTH seismic reflection profiling shows that the decollement beneath which Indian lithosphere underthrusts the Himalaya extends at least 225 kilometers north of the Himalayan deformation front to a depth of approximately 50 kilometers. Prominent reflections appear at depths of 15 to 18 kilometers near where the decollement reflector apparently terminates. These reflections extend north of the Zangbo suture to the Damxung graben of the Tibet Plateau. Some of these reflections have locally anomalous amplitudes (bright spots) and coincident negative polarities implying that they are produced by fluids in the crust. The presence of geothermal activity and high heat flow in the regions of these reflections and the tectonic setting suggest that the bright spots mark granitic magmas derived by partial melting of the tectonically thickened crust.

Partially Molten Middle Crust Beneath Southern Tibet: Synthesis of Project INDEPTH Results

INDEPTH geophysical and geological observations imply that a partially molten midcrustal layer exists beneath southern Tibet. This partially molten layer has been produced by crustal thickening and behaves as a fluid on the time scale of Himalayan deformation. It is confined on the south by the structurally imbricated Indian crust underlying the Tethyan and High Himalaya and is underlain, apparently, by a stiff Indian mantle lid. The results suggest that during Neogene time the underthrusting Indian crust has acted as a plunger, displacing the molten middle crust to the north while at the same time contributing to this layer by melting and ductile flow. Viewed broadly, the Neogene evolution of the Himalaya is essentially a record of the southward extrusion of the partially molten middle crust underlying southern Tibet.

The Louisiana State University Comprehensive Epilepsy Program: procedures and outcomes

The first comprehensive epilepsy surgery center in Louisiana was established in 1990 at the Louisiana State University Medical Center in New Orleans by the Departments of Neurology and Neurosurgery. The center performs a wide variety of diagnostic tests essential for the medical and surgical treatment of epilepsy including EEG and video monitoring, quantitative hippocampal MRI volumetry, ictal SPECT brain scanning, intracranial evoked potential and subdural stimulation functional mapping, neuropsychological evaluations, and intracarotid amobarbital (Wada) language and memory localization. Surgical interventions include (1) the placement of subdural strip and grid electrodes, depth electrodes, and foramen ovale electrodes, (2) temporal lobectomies, and (3) frontal, temporal, parietal, and occipital lobe resections. From August 1990 through October 1995 41 patients with medically intractable seizures underwent neurosurgical procedures for epilepsy. Thirty-five patients had resective surgery, while six had only intracranial monitoring by subdural or intracerebral electrodes. The surgical outcomes thus far compare favorably with those of other established centers in North America.

Effect of glucagon and somatostatin on pancreatic secretion in dogs

The authors investigated the effects of glucagon and a somatostatin preparation (Stilamin) on the secretion volume and on the secreted and absorbed enzyme levels of the pancreas. Four groups of dogs with an artificial pancreatic fistula were given a single intravenous injection of glucagon (group I, n = 8), intravenous drip-infusion of glucagon (group II, n = 8), intravenous drip-infusion of somatostatin (group III, n = 10) and intravenous drip-infusion of the carrier fluid, physiological sodium-chloride (control, group IV, n = 5), respectively. Pancreatic juices were collected and volume, pH, bicarbonate, amilase, lipase, trypsin and protein contents were determined. Serum amilase and lipase levels before and at the termination of the experiment were also measured. Intravenous drip-infusion of both Glucagon and Stilamin decreased pancreatic secretion, Stilamin being more effective than Glucagon. On the other hand, a single i.v. injection of Glucagon resulted in an increased secretion. The authors suggest that based on the observed inhibitory effect on pancreatic secretion, both glucagon and somatostatin could be used to reduce postoperative complications of pancreatic operations in the clinical practice.

Laparoscopic implantation of temporary electrodes for bladder stimulation in dogs

Five female mongrel dogs were used in an acute animal experiment. Under general anesthesia two monopolar wire electrodes armed with needles on either side were implanted into the bladder wall, the leads of both electrodes were then pulled through the abdominal wall. Filling of the bladder and intravesical pressure measurement were achieved through a suprapublic percutaneous cystostomy. Electrostimulation was carried out using the XEJ-2 experimental electroejaculator (biphasic pulses, pulse width 2.5 msec, approximately 70 mAmp, 50 Hz). The pressure changes within the bladder following electrostimulation were recorded, the effect of stimulation was observed endoscopically. Electrostimulation of the bladder wall resulted in micturition in all cases, showing an initial pressure peak at the commencement of electrostimulation followed by a decrease after onset of evacuation. We believe that laparoscopic implantation of temporary wire electrodes followed by percutaneous electrostimulation may open up new possibilities for bladder rehabilitation as well as for diagnostic investigations into the contractile capabilities of the bladder.

Social initiations by autistic children to adults and other children

Social initiations made by autistic and verbal-matched retarded children were recorded in two naturalistic situations. Frequencies of initiation to adults did not differ between groups, but the retarded children initiated much more frequently to peers. Most interactions for both groups were positive, but the autistic children engaged in more ritualized, and the retarded children more playful, initiations. The autistic children monitored the social environment more when forced into proximity with peers, whereas the retarded children initiated more in the unstructured situation. Autistic initiation to peers was unrelated to severity of autism, but was related to cognitive skills, including vocabulary and comprehension of affect, whereas retarded children's initiations were unrelated to cognitive level. Results are discussed in terms of the differences between adults and children as social stimuli, prerequisite skills for initiation to peers, and the relationship between social cognition and social behavior. It is suggested that autistic and retarded children differ in the quantity of their initiations to peers, and the quality of their initiations to adults, and that initiations to peers may be a particularly useful index of social development in autistic children. Results confirm the need of autistic children for highly structured social environments, and suggest an important role for the remediation of specific cognitive skills such as comprehension of others' affects.

Effects of synthesized elastin peptides on human leukocytes

It is well demonstrated that various peptides derived from elastin are biologically active. The hexapeptide (Val-Gly-Val-Ala-Pro-Gly; VI) as well as elastin peptides were demonstrated to be chemotactic for fibroblasts, while kappa-elastin had marked biological effects on human PMNLs. The aim of our present work was to synthesize various elastin peptides and compare their action to that of kappa-elastin and this hexapeptide. The results indicate that the hexapeptide (Val-Gly-Val-Ala-Pro-Gly) and the two other synthesized hexapeptides (Pro-Gly-Val-Gly-Val-Ala; III and Val-Gly-Val-Gly-Val-Ala; IV) had very similar and specific effects on intracellular free calcium metabolism, on superoxide anion production and elastase release. The other peptides had no effects on these parameters, except a tripeptide (Val-Gly-Val; V) on superoxide anion production. Moreover, the effect of the hexapeptides (III and VI) could be abolished by Pertussis toxin preincubation. All peptides had very similar stimulating effects on H2O2 production and myeloperoxidase release. We conclude that most probably the peptide size and conformation, as well as peptide composition play a role in the biological effects of these peptides, through specific receptors on PMNLs surface.

Transmembrane signaling changes with aging

Altered immune response and transmembrane signaling with aging has previously been demonstrated. The aim of the present study was to characterize PMNLs and lymphocyte G proteins and to determine whether their relative amounts are altered with aging. First we studied the effects of FMLP on PMNLs IP3 formation. It was found that in any group of elderly the PMNLs IP3 formation was significantly decreased compared to that of young subjects. In FMLP receptor binding affinity no measurable difference exists in either low- or high-affinity FMLP receptors. The autoradiogram of 32P-ADP-ribosylated proteins by CT in lymphocytes of young individuals showed a major polypeptide of 40 kDa, and two much less prevalent components of 52 and 45 kDa. In contrast, in lymphocytes of elderly subjects the major polypeptide was 45 kDa, and the two others were very weakly labeled. In PMNLs, CT labeled the 45-kDa band quite strongly, mainly in the elderly, and the 52- and 40-kDa bands were very weakly labeled, mainly in young subjects. When PT was used, no age-related pattern changes could be demonstrated, while differences could be observed between the two types of cells.

Sera and leukocyte elastase-type protease and antiprotease activity in healthy and atherosclerotic subjects of various ages

Serum and granulocyte elastase-type protease activities were determined simultaneously with their main plasma proteinase inhibitors such as alpha-1-antitrypsin and alpha-2-macroglobulin in healthy control and atherosclerotic (ATS) subjects. The age-related associations of these parameters were also investigated. Serum elastase-type protease activity increased, but not statistically significantly, with aging in both control and ATS subjects. The enhancement of elastase-type protease activity in sera of ATS patients was significantly (p less than .02) greater than control subjects only in the case of the elderly. The granulocytes' elastase activity was significantly greater in granulocytes derived from both middle-aged and elderly ATS patients (p less than .03 and p less than .06) compared to age-matched control subjects. Alpha-1-antitrypsin was not significantly lower, whereas alpha-2-macroglobulin was significantly lower in sera of ATS subjects compared to age-matched control subjects (p less than .01). The conclusion is that increased elastase-type activity and decreased antiproteinase activity should be considered as potential factors in atherosclerotic arterial wall damage. The similarity of the results in the elderly and the ATS subjects suggest that atherosclerosis is an early aging process.

Human aortic elastin from normal individuals and atherosclerotic patients: lipid and cation contents; susceptibility to elastolysis

Aortic elastins, isolated from 30 humans of different ages, were purified by alkaline extraction, and separated into two groups depending on the presence of atherosclerotic plaques and calcification (grades 0 and 1). It was confirmed that the severity of atherosclerosis increases significantly with age (P less than 0.001) and elastin content decreases with atherosclerosis (P less than 0.001). The hydrolysis of the aortic elastins using pancreatic porcine elastase (PPE) was studied. It was observed that increased elastolytic activities are connected with severity of atherosclerosis (P less than 0.001) and both Vm and Km apparent kinetic parameters are affected (P less than 0.001). Correlation tests have shown that enzymatic hydrolysis is significantly modified by cholesterol (P less than 0.05), calcium (P less than 0.001) and magnesium concentrations (P less than 0.01) but only cholesterol changes significantly Vm and Km parameters.

[Determination of cyclamate in complex matrix using HPLC after column derivatization with 4-fluoro-7-nitrobenzofurazan]

A method for the analysis of cyclamate in complex foodstuffs has been developed. This method is applicable in strongly coloured and protein-rich foodstuffs. The quantitative determination depends on oxidation of cyclamate to cyclohexylamine and derivatisation with 4-fluoro-7-nitrobenzofuran (NBD-F). The derivatives are analysed by HPLC on a C18: reversed-phase column, their minimal stability being 12 h. There are two possible methods of detection: (a) absorbance at 485 nm and (b) fluorescence with excitation at 485 nm and emission at 530 nm. The detection limit of cyclamate is 5 mg/kg foodstuff, with fluorescence detection 0.4 mg/kg. The recoveries are in the range of 88% to 104%.

O-specific polysaccharides of Hafnia alvei lipopolysaccharides isolated from two serologically related strains: ATCC 13337 and 1187. A serological and structural study using chemical methods, gas chromatography/mass spectrometry and NMR spectroscopy at 500 MHz

The O-specific polysaccharides of Hafnia alvei ATCC 13337 standard strain and 1187 strain have been isolated and characterized. By means of 1H-NMR spectroscopy, methylation analysis and periodate oxidation, the repeating unit of the polysaccharides could be allocated the respective structures. (formula; see text) where Acyl = D-3-hydroxybutyryl, and 3-O-acetylation was to about 66%. The structural similarity of the polysaccharides was confirmed in the serological study; their epitopes were determined and the importance of various structural elements for the serological specificity was discussed.