Attenuation of blood flow pulsatility along the Atlas slope: a physiologic property of the distal vertebral artery?

BACKGROUND AND PURPOSE

Physiologic and pathologic arterial tortuosity may attenuate blood flow pulsatility. The aim of this prospective study was to assess a potential effect of the curved V3 segment (Atlas slope) of the vertebral artery on arterial flow pulsatility. The pulsatility index and resistance index were used to assess blood flow pulsatility.

MATERIALS AND METHODS

Twenty-one healthy volunteers (17 men, 4 women; mean age, 32 years) were examined with a 3T MR imaging system. Blood velocities were measured at 2 locations below (I and II) and at 1 location above the V3 segment (III) of the vertebral artery by using a high-resolution 2D-phase-contrast sequence with multidirectional velocity-encoding.

RESULTS

Pulsatility and resistance indices decreased along all measurement locations from proximal to distal. The pulsatility index decreased significantly from location II to III and from I to II. However, the decrease was more pronounced along the Atlas slope than in the straight-vessel section below. The decrease of the resistance index was highly significant along the Atlas slope (location II to III). The decrease from location I to II was small and not significant.

CONCLUSIONS

The pronounced decrease in pulsatility and resistance indices along the interindividually uniformly bent V3 segment compared with a straight segment of the vertebral artery indicates a physiologic attenuating effect of the Atlas slope on arterial flow pulsatility. A similar effect has been described for the carotid siphon. A physiologic reduction of pulsatility in brain-supplying arteries would be in accordance with several recent publications reporting a correlation of increased arterial flow pulsatility with leukoencephalopathy and lacunar stroke.

[Neuroradiological focus on stroke imaging]

Stroke is heterogenous in its symptoms, which are also caused by various pathologies. Clinically the causing mechanism (bleeding or ischemia) of a new onset of neurological deficits can not reliably be distinguished. However, ischemia is four times more frequent than a bleeding causing neurological symptoms. Modern imaging technologies (computed assisted tomography or magnetic resonace imaging) and interventional techniques are a mainstay in diagnostics and management of acute onset of neurological symptoms. They can reliably distinguish between bleeding and stroke, especially taking newest technologies, such as perfusion studies and angiographies, into account. Neuroradiology with its interventional options has nowadays furthermore become an important tool in strokes and offers a local maneuver to retrieve the clotting pathology and even opens the therapeutic window for a delayed start of the therapy since symptom's onset beyong the conventional 4.5 hours window. Also risks of a therapy and which therapy option should be used can immediately be assessed.

Impairment of prostate cancer cell growth by a selective and reversible lysine-specific demethylase 1 inhibitor

Post-translational modifications of histones by chromatin modifying enzymes regulate chromatin structure and gene expression. As deregulation of histone modifications contributes to cancer progression, inhibition of chromatin modifying enzymes such as histone demethylases is an attractive therapeutic strategy to impair cancer growth. Lysine-specific demethylase 1 (LSD1) removes mono- and dimethyl marks from lysine 4 or 9 of histone H3. LSD1 in association with the androgen receptor (AR) controls androgen-dependent gene expression and prostate tumor cell proliferation, thus highlighting LSD1 as a drug target. By combining protein structure similarity clustering and in vitro screening, we identified Namoline, a γ-pyrone, as a novel, selective and reversible LSD1 inhibitor. Namoline blocks LSD1 demethylase activity in vitro and in vivo. Inhibition of LSD1 by Namoline leads to silencing of AR-regulated gene expression and severely impairs androgen-dependent proliferation in vitro and in vivo. Thus, Namoline is a novel promising starting compound for the development of therapeutics to treat androgen-dependent prostate cancer.

Charting, navigating, and populating natural product chemical space for drug discovery

Natural products are a heterogeneous group of compounds with diverse, yet particular molecular properties compared to synthetic compounds and drugs. All relevant analyses show that natural products indeed occupy parts of chemical space not explored by available screening collections while at the same time largely adhering to the rule-of-five. This renders them a valuable, unique, and necessary component of screening libraries used in drug discovery. With ChemGPS-NP on the Web and Scaffold Hunter two tools are available to the scientific community to guide exploration of biologically relevant NP chemical space in a focused and targeted fashion with a view to guide novel synthesis approaches. Several of the examples given illustrate the possibility of bridging the gap between computational methods and compound library synthesis and the possibility of integrating cheminformatics and chemical space analyses with synthetic chemistry and biochemistry to successfully explore chemical space for the identification of novel small molecule modulators of protein function.The examples also illustrate the synergistic potential of the chemical space concept and modern chemical synthesis for biomedical research and drug discovery. Chemical space analysis can map under explored biologically relevant parts of chemical space and identify the structure types occupying these parts. Modern synthetic methodology can then be applied to efficiently fill this “virtual space” with real compounds.From a cheminformatics perspective, there is a clear demand for open-source and easy to use tools that can be readily applied by educated nonspecialist chemists and biologists in their daily research. This will include further development of Scaffold Hunter, ChemGPS-NP, and related approaches on the Web. Such a “cheminformatics toolbox” would enable chemists and biologists to mine their own data in an intuitive and highly interactive process and without the need for specialized computer science and cheminformatics expertise. We anticipate that it may be a viable, if not necessary, step for research initiatives based on large high-throughput screening campaigns,in particular in the pharmaceutical industry, to make the most out of the recent advances in computational tools in order to leverage and take full advantage of the large data sets generated and available in house. There are “holes” in these data sets that can and should be identified and explored by chemistry and biology.

Psoromic acid is a selective and covalent Rab-prenylation inhibitor targeting autoinhibited RabGGTase

Post-translational attachment of geranylgeranyl isoprenoids to Rab GTPases, the key organizers of intracellular vesicular transport, is essential for their function. Rab geranylgeranyl transferase (RabGGTase) is responsible for prenylation of Rab proteins. Recently, RabGGTase inhibitors have been proposed to be potential therapeutics for treatment of cancer and osteoporosis. However, the development of RabGGTase selective inhibitors is complicated by its structural and functional similarity to other protein prenyltransferases. Herein we report identification of the natural product psoromic acid (PA) that potently and selectively inhibits RabGGTase with an IC(50) of 1.3 μM. Structure-activity relationship analysis suggested a minimal structure involving the depsidone core with a 3-hydroxyl and 4-aldehyde motif for binding to RabGGTase. Analysis of the crystal structure of the RabGGTase:PA complex revealed that PA forms largely hydrophobic interactions with the isoprenoid binding site of RabGGTase and that it attaches covalently to the N-terminus of the α subunit. We found that in contrast to other protein prenyltransferases, RabGGTase is autoinhibited through N-terminal (α)His2 coordination with the catalytic zinc ion. Mutation of (α)His dramatically enhances the reaction rate, indicating that the activity of RabGGTase is likely regulated in vivo. The covalent binding of PA to the N-terminus of the RabGGTase α subunit seems to potentiate its interaction with the active site and explains the selectivity of PA for RabGGTase. Therefore, psoromic acid provides a new starting point for the development of selective RabGGTase inhibitors.

[Implementation of the laryngeal tube for prehospital airway management: training of 1,069 emergency physicians and paramedics]

OBJECTIVE

The European Resuscitation Council recommends that only rescuers experienced and well-trained in airway management should perform endotracheal intubation. Less trained rescuers should use alternative airway devices instead. Therefore, a concept to train almost 1,100 emergency physicians (EP) and emergency medical technicians (EMT) in prehospital airway management using the disposable laryngeal tube suction (LTS-D) is presented.

METHODS

In five operational areas of emergency medicine services in Germany and Switzerland all EPs and EMTs were trained in the use of the LTS-D by means of a standardized curriculum in the years 2006 and 2007. The main focus of the training was on different insertion techniques and LTS-D use in children and infants. Subsequently, all prehospital LTS-D applications from 2008 to 2010'were prospectively recorded.

RESULTS

None of the 762 participating EMTs and less than 20% of the EPs had previous clinical experience with the LTS-D. After the theoretical (practical) part of the training, the participants self-assessed their personal familiarity in using the LTS-D with a median value of 8 (8) and a range of 2-10 (range 1-10) of 10 points (1: worst, 10: best). Within the 3-year follow-up period the LTS-D was used in 303 prehospital cases of which 296 were successfully managed with the device. During the first year the LTS-D was used as primary airway in more than half of the cases, i.e. without previous attempts of endotracheal intubation. In the following years such cases decreased to 40% without reaching statistical significance. However, the mean number of intubation attempts which failed before the LTS-D was used as a rescue device decreased significantly during the study period (2008: 2.2 ± 0.3; 2009: 1.6 ± 0.4; 2010: 1.7 ± 0.3).

CONCLUSION

A standardized training concept enabled almost 1,100 rescuers to be trained in the use of an alternative airway device and to successfully implement the LTS-D into the prehospital airway management algorithm. Because the LTS-D recently became an accepted alternative to endotracheal intubation in difficult airway scenarios, the number of intubation attempts before considering an alternative airway device is steadily decreasing.

Dampening of blood-flow pulsatility along the carotid siphon: does form follow function?

BACKGROUND AND PURPOSE

The tortuous distal part of the ICA may have an attenuating effect on pulsatile arterial flow. We investigated local arterial blood flow patterns in the ICA proximal and distal to the carotid siphon to detect quantitative waveform changes.

MATERIALS AND METHODS

Arterial flow patterns were analyzed by using flow-sensitized 4D PC MR imaging (time-resolved 3D PCMR) at 3T in 17 healthy volunteers. Time-resolved blood flow velocities were extracted from the source data at the C4 and C7 segments of the ICA. PI, RI, and PA were calculated by using time-resolved flow volume. A linear mixed-effects model was applied to compare values at C4 and C7. Furthermore, 3D blood flow visualization was performed for all 34 ICAs.

RESULTS

PI, RI, and PA were significantly lower at the distal C7 segment compared with the proximal C4 segment of the ICA (P < .0001). Helical flow patterns were observed in 5 ICAs of 4 subjects.

CONCLUSIONS

Arterial flow patterns showed a significant reduction in PI, RI, and PA when compared distal to proximal to the carotid siphon. The observed attenuation of flow pulsatility is most likely related to the contorted shape of the distal ICA and may bear a protective effect for downstream cerebral vasculature.

Evaporation and condensation of SiO and SiO2 studied by infrared spectroscopy

Physical evaporation of SiO and SiO(2) under ultra-high vacuum conditions was monitored in situ with infrared spectroscopy at frequencies between 450 cm(-1) and 5000 cm(-1). The measured vibrational spectra of the condensed films are identical in both cases, for SiO and SiO(2) evaporation, and can be described with four Brendel oscillators located at 380 cm(-1), 713 cm(-1), 982 cm(-1), and 1101 cm(-1), corresponding to typical vibration modes in SiO.

Interactive exploration of chemical space with Scaffold Hunter

We describe Scaffold Hunter, a highly interactive computer-based tool for navigation in chemical space that fosters intuitive recognition of complex structural relationships associated with bioactivity. The program reads compound structures and bioactivity data, generates compound scaffolds, correlates them in a hierarchical tree-like arrangement, and annotates them with bioactivity. Brachiation along tree branches from structurally complex to simple scaffolds allows identification of new ligand types. We provide proof of concept for pyruvate kinase.

Bioactivity-guided mapping and navigation of chemical space

The structure- and chemistry-based hierarchical organization of library scaffolds in tree-like arrangements provides a valid, intuitive means to map and navigate chemical space. We demonstrate that scaffold trees built using bioactivity as the key selection criterion for structural simplification during tree construction allow efficient and intuitive mapping, visualization and navigation of the chemical space defined by a given library, which in turn allows correlation of this chemical space with the investigated bioactivity and further compound design. Brachiation along the branches of such trees from structurally complex to simple scaffolds with retained yet varying bioactivity is feasible at high frequency for the five major pharmaceutically relevant target classes and allows for the identification of new inhibitor types for a given target. We provide proof of principle by identifying new active scaffolds for 5-lipoxygenase and the estrogen receptor ERalpha.

Impact of stent design on intra-aneurysmal flow. A computer simulation study

SUMMARY

In addition to providing a skeleton for vessel reconstruction, stent implantation as used for cerebral aneurysm treatment can induce flow redirection, thus reducing vortical flow velocities within the aneurysm cavity. Further, stent characteristics such as strut size, porosity and cell shape influence the changes in intra-aneurysmal flow by analog simulations. The purpose of this computer simulation study was to visualize the flow pattern over the entire neck area of a side wall aneurysm while changing the stent parameters. A 3-D computer model aneurysm was constructed to have a parent artery of 5 mm diameter and an aneurysm of 10 mm diameter. The distance between the midline of main artery and center point of the aneurysm was 6.8 mm, providing a neck length of 5 mm, a width of 3.6 mm, and a neck area of 14 mm 2. The simulations were carried out with a Finite Element Method based flow simulation package. The incompressible Navier-Stokes equation was solved for a steady flow with a mean speed of 290 mm/s, steady viscosity of 3.83 cp, and density of 1.0 g/cm3. Two parallel stent struts (dimensions: 100 mum m 100 mum m 2.0 mm) were introduced into the plane of the aneurysm neck. The fraction of the aneurysm neck cross-section occupied by the stent was 2.83% in all cases. The velocity distribution through the neck of the aneurysm was calculated for three different choices of separation between the struts for each of two orientations of the struts (parallel and perpendicular) relative to the vessel axis. The flow pattern in the aneurysm was composed of an inflow zone at the distal neck and of an outflow zone at the proximal neck. The placement of stent struts at the aneurysm neck resulted in a decrease in the mean speed in the aneurysm. The degree of reduction and the distribution of flow through the neck did depend on the orientation of the stent struts. The struts, when placed parallel or perpendicular to the parent vessel axis affected the mean speed through the aneurysm neck differently.

ATP competitive inhibitors of D-alanine-D-alanine ligase based on protein kinase inhibitor scaffolds

D-Alanine-D-alanine ligase (DDl) is an essential enzyme in bacterial cell wall biosynthesis and an important target for developing new antibiotics. Here, we describe a new approach to identify new inhibitor scaffolds for DDl based on similarity in the ATP binding region of different kinases and DDl. After an initial screening of several protein kinase inhibitors, we found that the Brutons's tyrosine kinase inhibitor LFM-A13, an analog of the Leflunomide metabolite A771726, inhibits DDl with a K(i) of 185 microM. A series of malononitrilamide and salicylamide derivatives of LFM-A13 has been synthesized to confirm the validity of this scaffold as an inhibitor of DDl.

The scaffold tree--visualization of the scaffold universe by hierarchical scaffold classification

A hierarchical classification of chemical scaffolds (molecular framework, which is obtained by pruning all terminal side chains) has been introduced. The molecular frameworks form the leaf nodes in the hierarchy trees. By an iterative removal of rings, scaffolds forming the higher levels in the hierarchy tree are obtained. Prioritization rules ensure that less characteristic, peripheral rings are removed first. All scaffolds in the hierarchy tree are well-defined chemical entities making the classification chemically intuitive. The classification is deterministic, data-set-independent, and scales linearly with the number of compounds included in the data set. The application of the classification is demonstrated on two data sets extracted from the PubChem database, namely, pyruvate kinase binders and a collection of pesticides. The examples shown demonstrate that the classification procedure handles robustly synthetic structures and natural products.

In vivo assessment and visualization of intracranial arterial hemodynamics with flow-sensitized 4D MR imaging at 3T

SUMMARY

We evaluated electrocardiogram-synchronized flow-sensitized 4-dimensional MR imaging at 3T in combination with advanced 3D visualization strategies to ascertain its feasibility for the assessment of local intracranial blood-flow patterns in vivo. In large arteries of healthy volunteers, the temporal and spatial evolution of blood flow was successfully visualized and revealed--for example, a helical flow pattern in the carotid siphon. In a patient with steno-occlusive neurovascular disease, stagnant and retrograde flow patterns were readily visible.

Charting biologically relevant chemical space: a structural classification of natural products (SCONP)

The identification of small molecules that fall within the biologically relevant subfraction of vast chemical space is of utmost importance to chemical biology and medicinal chemistry research. The prerequirement of biological relevance to be met by such molecules is fulfilled by natural product-derived compound collections. We report a structural classification of natural products (SCONP) as organizing principle for charting the known chemical space explored by nature. SCONP arranges the scaffolds of the natural products in a tree-like fashion and provides a viable analysis- and hypothesis-generating tool for the design of natural product-derived compound collections. The validity of the approach is demonstrated in the development of a previously undescribed class of selective and potent inhibitors of 11beta-hydroxysteroid dehydrogenase type 1 with activity in cells guided by SCONP and protein structure similarity clustering. 11beta-hydroxysteroid dehydrogenase type 1 is a target in the development of new therapies for the treatment of diabetes, the metabolic syndrome, and obesity.

Traumatic vertical atlantoaxial dislocation

We present a case of traumatic vertical atlantoaxial dislocation of 16 millimetres with a fatal outcome. We hypothesize that this extremely rare traumatic vertical atlantoaxial dislocation results from insufficiency of the C1/C2 facet capsules after rupture of the tectorial membrane and the alar ligaments.

Eczema herpeticatum

Patients affected by atopic dermatitis tend to develop viral infections. Probably the most feared complication of atopic dermatitis is eczema herpeticum, a disseminated infection with herpes simplex virus. A monomorphic eruption of dome-shaped blisters, pustules and erosions in the eczematous skin lesions along with severe systemic illness leads to the diagnosis. The clinical diagnosis may be confirmed by polymerase chain reaction, viral culture, electron microscopy with negative staining, Tzanck test, immunofluorescence tests or serology. While intravenous acyclovir is still regarded as standard treatment of eczema herpeticum, several recently-developed antiviral drugs provide therapeutic options.

ADC mapping of the aging frontal lobes in mild cognitive impairment

Normal aging, leukoaraiosis (LA) and vascular disease particularly involve the human frontal lobes. We decided to investigate a population of elderly patients referred for neuroimaging because of progressive minor cognitive deficits but no dementia. They underwent conventional Magnetic resonance imaging (MRI) using axial T1 and T2-weighted imaging as well as coronal FLAIR sequences in addition to the axial diffusion-weighted MRI. MRI allowed us to differentiate patients with leukoaraïosis (LA+) from those without it (LA-) and mapping of the apparent diffusion coefficient (ADC) to investigate local tissular water motion. We observed an increase in the ADC in all investigated patients with increasing age (r=0.326, p=0.002). This increase was observed in both patients groups (LA+ and LA-). In addition, the LA+ group had significant higher ADC values than the LA- group after controlling for age (p<0.0001).

Multiplex RT-PCR detection of four aphid-borne strawberry viruses in Fragaria spp. in combination with a plant mRNA specific internal control

The principal aphid-borne viruses infecting Strawberry (Fragaria spp.) Strawberry crinkle virus (SCV), Strawberry mild yellow edge virus (SMYEV), Strawberry mottle virus (SMoV) and Strawberry vein banding virus (SVBV) can cause serious crop losses. In this paper, a multiplex reverse transcriptase polymerase chain reaction (RT-PCR) method is described for the simultaneous detection of all four viruses in combination with a plant mRNA specific internal control which can be used as an indicator of the effectiveness of the extraction and RT-PCR. In total, 18 strawberry isolates infected naturally were analysed by this method. Every combination of RNA virus was able to be detected and a full complement of all four viruses were found together in three isolates, all taken from wild strawberry (Fragaria chiloensis (L.) Duch.) in Chile. The upper detection limit for the four viruses was at an extract dilution of 1/200. The broad applicability of the RNA specific internal control primers-which produced a PCR fragment of the expected size in 25 of 27 plant species tested-combined with improvements, made in extraction methods described provides potentially a standard method for comparable RT-PCR analyses in a wide variety of plant species.