Chemogenetic ON and OFF switches for RNA virus replication

Therapeutic application of RNA viruses as oncolytic agents or gene vectors requires a tight control of virus activity if toxicity is a concern. Here we present a regulator switch for RNA viruses using a conditional protease approach, in which the function of at least one viral protein essential for transcription and replication is linked to autocatalytical, exogenous human immunodeficiency virus (HIV) protease activity. Virus activity can be en- or disabled by various HIV protease inhibitors. Incorporating the HIV protease dimer in the genome of vesicular stomatitis virus (VSV) into the open reading frame of either the P- or L-protein resulted in an ON switch. Here, virus activity depends on co-application of protease inhibitor in a dose-dependent manner. Conversely, an N-terminal VSV polymerase tag with the HIV protease dimer constitutes an OFF switch, as application of protease inhibitor stops virus activity. This technology may also be applicable to other potentially therapeutic RNA viruses.

ALIGNed on adherence: subanalysis of adherence in immune-mediated inflammatory diseases in the DACH region of the global ALIGN study

Background

Non‐adherence to medication is a challenging problem in daily clinical practice.

Objective

To assess reasons for non‐adherence in patients with chronic immune‐mediated inflammatory diseases (IMIDs) in a direct comparison including evaluation of treatment necessity and concerns.

Methods

ALIGN was a non‐interventional, multicountry, multicentre, self‐administered, cross‐sectional, epidemiologic survey study. Here, we investigate the German, Austrian and Swiss (DACH) cohort. Six hundred thirty‐one patients with different IMIDs (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, plaque psoriasis, Crohn's disease and ulcerative colitis) under systemic therapies were evaluated concerning adherence, beliefs of necessity and concerns towards treatment in patients with IMIDs.

Results

The DACH cohort had significantly different levels of adherence depending on the IMID (P < 0.05) and the type of therapy (P < 0.05). Based on the significant influence of concerns on treatment adherence (P < 0.05) and the high belief of treatment necessity, patients could be classified in four attitudinal segments, which were unequally distributed throughout various IMIDs. High concerns had a significant influence on non‐adherence, whereas necessity did not. Older age, female sex, TNFi mono‐, conventional combination and TNFi combination therapy are positively associated with adherence.

Conclusions

In the DACH region, patients are less concerned about medication and believe in the necessity of treatment. Therefore, we suggest adapting the communication in the various patient groups.

Reduction in alkaline phosphatase is associated with longer survival in primary sclerosing cholangitis, independent of dominant stenosis

BACKGROUND

Alkaline phosphatase (ALP) is an important serum marker in primary sclerosing cholangitis (PSC). Patients with obstruction of the large bile ducts due to dominant strictures (DS) are a special, clinically important phenotype.

AIM

To determine the impact of ALP reduction on liver transplantation-free survival in PSC patients with DS.

METHODS

Prospective cohort study in 215 PSC patients. We performed subgroup analysis for patients without DS (no DS, n = 84), DS at first presentation (DS early, n = 72) and development of DS during the course of the study (DS late, n = 59). We evaluated two scores of ALP reduction. ALP reduction 1 was defined as ALP normalisation, 50% reduction compared with baseline values, or reduction below 1.5 times of upper limit of normal (ULN) within 6 months. ALP reduction 2 was defined as ALP reduction below 1.5 times of ULN within 12 months.

RESULTS

Of the patients, 59.5% reached an ALP reduction 1 and 56.7% according to ALP reduction 2. Achievement of each score was associated with longer transplantation-free survival in all three groups (ALP reduction 1: no DS P = 0.001; DS early P < 0.001; DS late P = 0.022; ALP reduction 2: no DS P = 0.014; DS early P = 0.001; DS late P = 0.002). Cox-regression analysis revealed each score as an independent predictor for improved transplantation-free survival (ALP reduction 1 and 2 P < 0.001 each). We further analysed previously published scores of ALP improvement in PSC showing also improved survival in patients with ALP normalisation or a reduction below 1.5 times of ULN (P = 0.003, P = 0.001, respectively), whereas the score determined by 40% reduction did not show significant differences in survival (P = 0.55).

CONCLUSIONS

Reduction in alkaline phosphatase values within the first year is associated with improved transplantation-free survival in patients with primary sclerosing cholangitis independent of the presence of dominant strictures. Alkaline phosphatase might be an adequate surrogate marker for outcome assessment in clinical studies both for patients with and without dominant strictures.

Multi-time scale perspective in analyzing cardiovascular data

Cardiovascular dynamic and variability data are commonly used in experimental protocols involving cognitive challenge. Usually, the analysis is based on a sometimes more and sometimes less well motivated single specific time resolution ranging from a few seconds to several minutes. The present paper aimed at investigating in detail the impact of different time resolutions of the cardiovascular data on the interpretation of effects. We compared three template tasks involving varying types of challenge, in order to provide a case study of specific effects and combinations of effects over different time frames and using different time resolutions. Averaged values of hemodynamic variables across an entire protocol confirmed typical findings regarding the effects of mental challenge and social observation. However, the hemodynamic response also incorporates transient variations in variables reflecting important features of the control system response. The fine-grained analysis of the transient behavior of hemodynamic variables demonstrates that information that is important for interpreting effects may be lost when only average values over the entire protocol are used as a representative of the system response. The study provides useful indications of how cardiovascular measures may be fruitfully used in experiments involving cognitive demands, allowing inferences on the physiological processes underlying the responses.

Post-exercise decrease of plasma hyaluronan: increased clearance or diminished production?

The exercise-induced increase and post-exercise decrease of plasma hyaluronan concentration were studied in human subjects. Six well trained men performed incremental exercise until exhaustion (MAX), intensive (submaximal, SUB) and extensive exercise (moderate, MOD) on a bicycle ergometer, defined as work at 100, 77 and 50% of maximal oxygen consumption. Hyaluronan was analyzed using a high-sensitivity, proteoglycan-dependent time-resolved immunoassay and hemoglobin, hematocrit and plasma protein levels were assessed using standard laboratory procedures. Compared to resting control levels, the plasma hyaluronan concentration (pHA) increased (p < 0.05) by 76% (65.0 +/- 6.1 vs. 37.0 +/- 1.0 microg/l) during 15 min MAX, by 44% (56.4 +/- 2.6 vs. 39.2 +/- 3.8 microg/l) during 30 min SUB and by 27% (46.3 +/- 7.8 vs. 36.4 +/- 4.3 microg/l) during 90 min MOD. The increase with time averaged 4.03%.min(-1) during MAX, 1.35%.min(-1) during SUB and 0.35%.min during MOD. After exercise (15 and 30 min), pHA decreased by 43% below resting levels after MAX (p < 0.05) and by 36% after SUB, respectively. In conclusion, pHA steadily rose with time during physical exertion, with a non-linear increase of concentration/time slope with exercise intensity; second, the magnitude of the post-exercise pHA decrease was proportional to the exercise-induced pHA increase, suggesting elevated hyaluronan clearance with rising plasma levels after physical exertion.

Is there "cardiovascular drift" during and after simulated orthostasis in humans?

This study investigates the time course of hemodynamic variables during and after simulated orthostasis (lower body suction at 55mmHg for 30 mins: LBNP-55). Individual strategies of blood pressure defense could be observed; LBNP-55 increased heart rate and reduced stroke volume, but was non-hypotensive. During 20 minutes post-LBNP, heart rate was decreased as well as stroke volume index below pre-LBNP values. The reduced cardiac index together with unchanged mean arterial pressure gave a highly significant increase of peripheral resistance after LBNP. The validity of stroke volume results under the experimental conditions given needs to be clarified.

Permanent depression of plasma cGMP during long-term space flight

The purpose of this study was to investigate plasma concentrations of cyclic guanosine monophosphate (cGMP) and atrial natriuretic peptide (ANP) during and after real and simulated space flight. Venous blood was obtained 3 min after the beginning and 2 min after the lower body negative pressure maneuver in two cosmonauts preflight (supine), inflight, and postflight (supine) and in five other subjects before, at the end, and 4 days after a 5-day head-down tilt (-6 degrees) bed rest. In cosmonaut 1 (10 days in space), plasma cGMP fell from preflight 4.3 to 1.4 nM on flight day 6, and was 3.0 nM on the fourth day after landing. In cosmonaut 2 (438 days in space), it fell from preflight 4.9 to 0.5 nM on on flight day 3, and stayed <0.1 nM with 5, 9, and 14 months in space, as well as on the fourth day after landing. Three months after the flight his plasma cGMP was back to normal (6.3 nM). Cosmonaut 2 also displayed relatively low inflight ANP values but returned to preflight level immediately after landing. In a ground-based simulation on five other persons, supine plasma cGMP was reduced by an average of 30% within 5 days of 6 degrees head-down tilt bed rest. The data consistently demonstrate lowered plasma cGMP with real and simulated weightlessness, and a complete disappearance of cGMP from plasma during, and shortly after long-duration space flight.

Cardiovascular and hormonal changes with different angles of head-up tilt in men

The purpose of this study was to assess the endocrine status, thoracic impedance, blood concentration, and hemodynamic dose-responses using different angles of passive head-up tilt (HUT) ranging from 12 degrees to 70 degrees in the same subjects. Measurements were performed during 20 min supine position (pre-HUT), 30 min upright (HUT12, HUT30, HUT53, or HUT70), and 20 min supine (post-HUT); subjects 70 min in the supine position only (HUT0) served as resting controls. Norepinephrine increased above resting control values by 19, 44, 80, and 102%; epinephrine by 30, 41, 64, and 68%; aldosterone by 29, 62, 139, and 165%; plasma renin activity n. s., 41, 91, and 89%; vasopressin n.s., 27, 47, and 59%; thoracic bioimpedance n. s., 8, 13, and 16%; heart rate n. s., 5, 26, and 45%, and mean arterial pressure n. s., 5, 7, and 10%; at min 27 of HUT12, HUT30, HUT53, and HUT70, respectively. Pulse pressure decreased with HUT53 and HUT70 by 4 and 10%. Hematocrit increased by 0.2, 1.7, 6.3, and 7.2%, respectively. Blood density increased by 2.3 and 3.0 g/l, plasma density by 1.7 and 1.8 g/l with HUT53 and HUT70. After finishing HUT, heart rate fell to values which stayed below pre-HUT, and also below resting control levels for > or = 5 min ("post-orthostatic bradycardia") even after the lowest orthostatic load (HUT12). Thoracic impedance and arterial pressure remained increased after terminating HUT30, HUT53, and HUT70. In conclusion, passive orthostatic loading of different extent produces specific dose-responses of different magnitude in the endocrine system, blood composition, thoracic impedance, and hemodynamic variables. The heart rate is depressed even after HUT12, while arterial blood pressure and thoracic impedance exceed pre-stimulus levels after greater head-up tilt, indicating altered cardiovascular response after passive orthostasis.

Prospective value of perfusion and X-ray attenuation imaging with single-photon emission and transmission computed tomography in acute cerebral ischemia

BACKGROUND AND PURPOSE

The aim of the present study was to test the hypothesis that perfusion single-photon emission computed tomography (SPECT), carried out in addition to transmission computed tomography (TCT), improves the predictive value of brain imaging within the therapeutically relevant time window after acute cerebral ischemia.

METHODS

Using TCT and [(99m)Tc]ethyl cysteinate dimer (ECD)-SPECT within 6 hours after symptom onset, we examined 108 patients (44 women, 64 men; mean age 65+/-13 years) with acute ischemic stroke attributed to the territory of the middle cerebral artery (MCA). In each case, 3 experts prospectively evaluated the early SPECT and TCT images. We correlated these ratings with follow-up TCT findings for the final infarction as well as with clinical outcome (Scandinavian Stroke Scale, Barthel Index, Modified Rankin Scale) after 30 and 90 days.

RESULTS

Severe activity deficits on SPECT, not caused by local atrophy on TCT, were the best predictors (positive predictive value [PPV ]94%, 95% CI 89% to 99%; negative predictive value [NPV] 90%, 95% CI 78% to 100%; P<0.001) for evolving cerebral infarction. Complete MCA infarctions were predicted with significantly higher accuracy with early SPECT (area under receiver operating characteristic curve [AUC] index 0.91) compared with early TCT (AUC index 0.77) and clinical parameters (AUC index 0.73, P<0.05). Logistic regression analysis revealed 1 independent predictor for completed MCA territory infarction: SPECT activity deficits in the corresponding areas (PPV 88%, 95% CI 65% to 100%; NPV 96%, 95% CI 92% to 100%; P<0.001). Furthermore, death after stroke was optimally predicted by [(99m)Tc]ECD-SPECT. Clinical outcome up to 90 days after the stroke event best correlated with the degree of activity deficits in early SPECT (r=0.53, P<0.001).

CONCLUSIONS

[(99m)Tc]ECD brain perfusion SPECT that completes TCT definitely improves the predictive value of brain imaging after acute cerebral ischemia. Thus, the combined imaging of brain edema and of cerebral perfusion early after stroke is recommended for clinical use.

Plasma sodium-osmotic dissociation and hormonal interaction with drinking-induced hypervolemia at 2800 m altitude

PURPOSE

To study hormonal factors that may account for the dissociation between beverage-induced plasma sodium p[Na+] and osmotic p[Osm] concentrations that appear to refute the high theoretical correlation between p[Na+] and p[Osm].

METHODS

Ten men (24 +/- SD 3 yr of age) sat reclining (head up) for 12 h in a chamber (21-23 degrees C dry bulb, 25-33% relative humidity) at 2800 m (9184 ft, 539 mm Hg) altitude (ALT), and at 321 m (1053 ft, 732 mm Hg) on the ground (GND). During 1000-1030 hours they consumed 3 fluids (12 ml x kg(-1),X = 948 ml x d(-1)) with large differences in sodium and osmotic contents: AstroAde (AA) with 185 mEq x L(-1) Na+ and 283 mOsm x kg(-1), Performance 1 (Shaklee) (P1) with 22 mEq x L(-1) Na+ and 365 mOsm kg(-1), or H2O at ALT; and only H2O on the GND.

RESULTS

After drinking: plasma volume (PV) increased at 1200 hours by 8.3% (p < 0.05) with AA but was not significantly (NS) changed in the other sessions (Xdelta = +0.9%, range -0.9 to 2.8%); p[Na+] and p[Osm] were unchanged. Urinary rates and free-water clearances were attenuated with AA and P1 vs. those with H2O. Correlations between and among p[Na+] and p[Osm] suggest that the pNa+ ion is more tightly controlled than pOsm; and that there was no clear hormonal response that could account for this dissociation from theoretical considerations.

CONCLUSIONS

There is significant dissociation between plasma sodium and osmotic concentrations after fluid intake. Induction and maintenance of hypervolemia requires increased (near isotonic) drink Na+ osmols rather than increased non-ionic osmols.

[Cardiovascular and humoral adaptation with passive orthostasis in men]

The aim of our study was to quantitate, in the same test subjects, hormonal, thoracic bioimpedance, blood composition, and hemodynamic dose-responses during different angles of passive orthostatic loading (head-up tilt, HUT) ranging from 12 degrees to 70 degrees. Measurements were performed with 20 min supine (pre-HUT), 30 min upright (HUT-12 degrees, HUT-30 degrees, HUT-53 degrees, or HUT-70 degrees), and 20 min supine (post-HUT); or supine only (HUT-0 degree, rest control). Norepinephrine increased above rest control by 19, 44, 80 and 102%; epinephrine 30, 41, 64, and 68%; aldosterone 29, 62, 139, and 165%; plasma renin activity n. s., 41, 91, and 89%; vasopressin n. s., 27, 47, and 59%; thoracic bioimpedance n. s., 8, 13, and 16%; heart rate n. s., 5, 26, and 45%, and mean arterial pressure n. s., 5, 7, and 10%; respectively, at min 27 of HUT-12 degrees, -30 degrees, -53 degrees, and -70 degrees. Pulse pressure narrowed with HUT-53 degrees and -70 degrees by 4 and 10%. Hematocrit increased 0.2, 1.7, 6.3, and 7.2%, respectively. Blood density increased by 2.3 and 3.0 g/l, plasma density by 1.7 and 1.8 g/l with HUT-53 degrees and -70 degrees. After finishing HUT, heart rate fell to values which stayed below pre-HUT, and also below rest control levels for > or = 5 min ("post-orthostatic bradycardia") even after the lowest orthostatic load (HUT-12 degrees). Thoracic bioimpedance and arterial blood pressure stayed increased after finishing HUT-30 degrees, -53 degrees, and -70 degrees. In summary, passive orthostasis of different degree produces specific dose-responses of different magnitude within endocrine, blood concentration, thoracic bioimpedance, and hemodynamic variables. Heart rate is depressed even after HUT-12 degrees, while arterial blood pressure and thoracic bioimpedance exceed pre-stimulus levels after HUT of higher degree, indicating altered cardiovascular state after passive orthostasis.

Cardiovascular and humoral readjustment after different levels of head-up tilt in humans

PURPOSE

To get a more complete picture of cardiovascular regulation after postural changes, this investigation directly monitored volume-related, hemodynamic, and endocrine variables during and after 30 min of passive head-up tilt (HUT) of various degrees. It was hypothesized that the return of variables to pre-tilt control level is of system-specific duration and different from what is found after lower body negative pressure (LBNP).

DESIGN

We tested 7 persons on 5 different days using, in random order, no (HUT0) or different intensity (12 degrees , 30 degrees , 53 degrees , and 70 degrees ) of passive orthostasis (HUT12, HUT30, HUT53, HUT70). Data were collected before (supine), during, and after (supine) HUT and compared with synchronous data from HUT0.

RESULTS

There was graded alteration with the sine of tilt angle for all hormones and directly volume-related variables. The effects of HUT70 were of the same magnitude as previously documented by others. After HUT, hemodynamic variables and catecholamines returned to control levels most rapidly. Heart rate depression, as observed in a companion LBNP study in the same subjects, did not occur. Vasopressin, PRA, plasma volume and Z0 returned to nominal values more slowly. Plasma aldosterone was still elevated 50 min after reassuming supine posture.

CONCLUSION

Besides specific dose-responses within hemodynamic, volume-dependent, and hormonal variables after orthostatic loading of different degree, the return to control levels after HUT occurs with distinctly different time-courses, which are not identical with those seen after LBNP-simulated orthostasis.

Potential of rheopheresis for the treatment of acute ischemic stroke when initiated between 6 and 12 hours

Improvement of hemorheology is one of the most important approaches in the treatment of acute ischemic stroke. We investigated the influence of extracorporal rheopheresis (ER) on cerebral blood flow in patients with acute ischemic stroke and evaluated its therapeutic effect. Thirty-three patients (rheopheresis group, 17; control group, 16; mean age 64 +/- 10 years) with acute ischemic stroke were included in our prospective randomized trial. The first treatment was started within 12 h after onset of symptoms, and treatment was repeated 3 times at an interval of 24 h. Hemorheological parameters were measured before and after each session. The cerebral blood flow was analyzed using 99mTc-ECD-SPECT. The functional and neurological outcomes were determined by follow-up investigations after 3 months. The hemorheological parameters were significantly different between the rheopheresis group (18% decrease of plasma viscosity, 55% decrease of red blood cell aggregation) and the control group (no decrease of both parameters). The single photon emission computed tomography (SPECT) analysis showed early reperfusion in 35% of the patients treated with rheopheresis and in 37% of the control group (NS). There were no differences in the neurological outcomes between the 2 groups. Extracorporal rheopheresis is practicable and safe. It rapidly and consistently improved the hemorheological parameters. Although this did not impact on cerebral perfusion or clinical outcome in patients with acute ischemic stroke in this report, we propose that ER deserves to be further evaluated by initiating the first treatment within 6 h post-insult.

Mechanical ventilation in patients with hemispheric ischemic stroke

OBJECTIVE

Whether stroke patients should be ventilated mechanically is still a contentious issue, because their outcome is very poor. We wanted to investigate how often mechanical ventilation is indicated in patients with hemispheric ischemic stroke as well as the outcome of these patients and the factors by which outcome is influenced.

DESIGN

Prospective case series.

SETTING

University hospital, neurocritical care unit.

SUBJECTS

Subjects were 218 patients who met the following inclusion criteria: age 18-85 yrs, acute hemispheric ischemic infarction, clinical examination, and computed tomography within 6 hrs after the onset of symptoms.

INTERVENTIONS

Mechanical ventilation was instituted with one or more of the following conditions: deterioration of consciousness with the inability to protect the airway; PaO2 of <60; P(CO2) of >60 mm Hg; breath rate of >40 breaths/min; and left heart insufficiency with definitive or impending pulmonary edema.

MEASUREMENTS AND MAIN RESULTS

Mechanical ventilation was indicated for 52 (24%) of the 218 patients: in 47 (90%) patients because of deterioration of consciousness, and in five (10%) patients because of heart insufficiency and/or pneumonia. In a logistic regression model, the history of hypertension and a size of infarction exceeding two thirds of the middle cerebral artery territory were independent variables for the application of mechanical ventilation. After 3 months, 42 (81%) of these 52 patients had died. The most common cause of death was fatal midbrain herniation caused by complete middle cerebral artery infarction. Patients who survived had a good-to-fair outcome.

CONCLUSIONS

New therapeutic strategies (e.g., hemicraniectomy) must be developed to reduce mortality and improve the outcome for this subgroup of ischemic stroke patients. Mechanical ventilation is and will remain a crucial element within such new concepts.

Orthostatic stimuli rapidly change plasma adrenomedullin in humans

The aim of this study was to evaluate the effect of orthostasis on the time course of plasma adrenomedullin concentration. On 5 different days, normotensive subjects were randomized to undergo for 30 minutes either 12 degrees, 30 degrees, 53 degrees, or 70 degrees passive head-up tilt or to remain supine. Venous blood was collected from each subject in the supine position before tilting, at 3 and 27 minutes during tilting, and at 2 and 50 minutes after orthostasis. Plasma adrenomedullin increased significantly with tilt of >/=30 degrees in a stimulus-dependent manner. Approximately half of the increase seen at 27 minutes occurred during the first 2 minutes of upright positioning; the maximum effect with 70 degrees tilt was +70%. Elevations in norepinephrine, epinephrine, aldosterone, plasma renin activity, vasopressin, heart rate, and mean arterial pressure were also significant. Hematocrit, blood density, plasma density, and plasma volume loss rose (P<0.05) at 53 degrees and 70 degrees tilt. Our results indicate that adrenomedullin may play an important role in stabilization of hemodynamics during passive orthostasis. In conclusion, plasma adrenomedullin rapidly increases with orthostatic challenge in a stimulus-dependent manner and also swiftly returns to baseline levels after the subject resumes the supine position.

Extracorporeal rheopheresis in the treatment of acute ischemic stroke: A randomized pilot study

BACKGROUND AND PURPOSE

Extracorporeal rheopheresis is a safe method to optimize hemorheology. Our aim was to determine whether treatment with extracorporeal rheopheresis in patients with acute ischemic hemispheric stroke improves cerebral perfusion as assessed with serial 99mTc-ethyl-cysteinate-dimer single-photon emission CT (99mTc-ECD SPECT). We also investigated how clinical outcome is associated with treatment and imaging results.

METHODS

Thirty-three patients (mean age, 64+/-10 years) with acute ischemic hemispheric stroke were included in a prospective, randomized, parallel group pilot study. First treatment with or without extracorporeal rheopheresis took place within 12 hours after the onset of symptoms and was repeated 3 times at intervals of 24 hours. Hemorheological parameters were measured before and after each session. Each patient underwent 99mTc-ECD SPECT immediately before treatment, 6 to 8 hours after treatment, and after 5 days. A semiquantitative SPECT graded scale was used to measure depth and extent of activity deficits and thus to quantify the perfusion deficit.

RESULTS

Seventeen patients were actively treated with extracorporeal rheopheresis, and 16 patients did not receive extracorporeal rheopheresis. After 3 months, no differences were found in the functional or neurological outcome. Despite a rapid, sustained decrease of plasma viscosity and erythrocyte aggregation in the rheopheresis group, there was no significant difference in the SPECT graded scale after therapy between the 2 groups. Patients with early reperfusion (decrease in the SPECT graded scale >25% 6 to 8 hours after therapy compared with the baseline examination) experienced a better functional outcome (Modified Rankin Scale) after 3 months compared with patients without reperfusion (P=0.04).

CONCLUSIONS

Since quantitative flow mapping and clinical follow-up did not reveal any differences between patients who were treated with extracorporeal rheopheresis and controls, it appears very unlikely that extracorporeal rheopheresis enhances reperfusion after acute cerebral ischemia.

Endocrine status and LBNP-induced hormone changes during a 438-day spaceflight: a case study

We investigated basal levels and lower body negative pressure (LBNP)-induced changes of volume regulating (PRA, aldosterone, AVP, ANP99-126) and other stress-sensitive hormones (catecholamines, cortisol, ACTH) in venous plasma from one cosmonaut before (-45 d), during (3, 170, 287, 430 d) and after (+4, +90 d) a record-breaking long-term (438 d) spaceflight. Blood was taken at the beginning and immediately after ending LBNP (-15/-30/-35 mm Hg for 15/15/10 min, respectively) preflight supine, inflight, and postflight supine. PRA, aldosterone, and vasopressin levels stayed within normal boundaries during the entire flight and after landing. Catecholamines exceeded reference limits (epinephrine > 140 pg x ml(-1), norepinephrine >1000 pg x ml(-1) 5 and 9 mo inflight, and 4 d postflight. ANP and cGMP were lower inflight (p<0.04) than pre- or postflight. Cortisol and ACTH were not consistently altered. LBNP-induced hormonal changes were not different (p>0.05) in microgravity and 1-G. Based on data from one cosmonaut, we conclude that long-term spaceflight up to 430 d duration appeared to lower plasma ANP and cGMP during flight and occasionally elevate catecholamine levels, without significantly altering LBNP-induced relative hormone changes as compared with those observed on the ground.

Plasma hyaluronan concentration: no circadian rhythm but large effect of food intake in humans

This study was designed to determine if a circadian rhythm in plasma hyaluronan concentration [HA] exists in the absence of physical activity, and if plasma [HA] is associated with feeding in human subjects. Five persons were studied under standardized conditions, blood samples being taken between 0600 and 2200 hours at 30-min intervals. Any orthostatic challenge and muscle activity was abolished by immobilization by a 6 degrees head-down bed-rest, and the effect of a quasi-continuous ingestion of energy compared a normal, three-portion diet of equivalent energy content or to fasting. Reproducibility of HA profiles on two consecutive half-days was also studied. A highly sensitive immunoassay was used to determine plasma [HA]. The data indicated that without physical activity and without food ingestion, [HA] was unchanged and displayed no diurnal rhythm. In addition, we observed that [HA] increased after the first food intake, peaking after 60 min, and concluded from our results that without ingestion of a larger meal, and sessions of postural or muscle activity, no circadian plasma [HA] rhythm exists.

Sodium chloride-citrate beverages attenuate hypovolemia in men resting 12 h at 2800 m altitude

BACKGROUND

The mechanism for reduction and restoration of total body water and plasma volume (PV) during initial exposure to acute altitude (ALT) is not clear but may involve involuntary dehydration; i.e., delayed voluntary fluid intake.

METHOD

Ten men (24 +/- SD 3 yr, 180.8 +/- 8.1 cm height, 78.8 +/- 12.8 kg weight, 1.99 +/- 0.19 m2 surface area, and 12.2 +/- 4.0% body fat) were in a semi-reclining position for 12 h in a chamber at 2800 m (539 mmHg) ALT or at 321 m (732 mmHg; ground). They ate a controlled breakfast (450 kcal + 3 ml x kg(-1) H2O) on the ground, and lunch and dinner at ALT (or on the ground) for a total daily intake of 2850 kcal (14% PRO, 67% CHO, 16% fat, 2.6g NaCl). At hour 10 they consumed fluid-electrolyte beverages or water (12 ml x kg(-1), 948 ml x d(-1)) in 4 sessions at weekly intervals. Beverage compositions were: a) 185 mEq x L(-1) Na+, 283 mOsm x kg(-1); b) 21.6 mEq x L(-1) Na+, 365 mOsm x kg(-1); c) water at ALT; and d) water on the ground.

RESULTS

After 10 h at ALT % deltaPV (Hb-Hct) decreased (p < 0.05) by: a) 9.0 +/- SE 1.5%; b) 6.2 +/- 1.7%; c) 7.4 +/- 2.2%; and d) by 9.0 +/- 2.4%, respectively. After drinking from 1000-1030 h, PV at 1200 h changed by: a) +8.3 +/- SE 2.0% (p < 0.05); b) +2.8 +/- 2.7% (NS); c) -0.9 +/- 1.5% (NS); and d) by +0.8 +/- 3.5% (NS), respectively. The similar ground-induced hypovolemia suggests a response to confinement rather than an ALT effect and involuntary dehydration does not appear to be implicated.

CONCLUSION

The significant increase in PV after consuming the (a) NaCl-NaCitrate beverage indicates that drink ionic composition appears to be more important than its osmolality for restoring PV in these conditions. Practical considerations: Because this hypovolemia was probably due to the confinement rather that reduced ambient pressure, appropriate countermeasures could be consumption of isotonic beverages, elastic stockings, leg exercise, and leg elevation.

An ultrasensitive, nonisotopic immunoassay for hyaluronan using the streptavidin-biotin system

A time-resolved fluoroimmunoassay for measuring hyaluronan concentrations in plasma and several biological fluids is described. The solid-phase immunoassay is based on the competition between aggregation of hyaluronan with the cartilage proteoglycan monomer, followed by binding of a monoclonal antibody to keratan sulfate of the proteoglycan and a biotinylated anti-mouse IgG. Fluorescence can be measured by a time-resolved fluorometer after binding of Eu(3+)-labelled streptavidin to the biotinylated IgG. The assay is precise and correlates well (r = 0.986) with the only established radioimmunoassay known. The results show that it is essential to perform a blank run without addition of proteoglycan, as endogenous proteoglycan disturbs the measurement and causes underestimation of plasma hyaluronan. The distinguishing feature of this assay is its extreme sensitivity (< 0.24 microgram/l of plasma). The mean analytical recovery after serial dilutions and addition was 100.3 and 101.3%, the within-assay and between-assay coefficients of variation were 3.67% and 7.02%, respectively.

Cardiovascular changes during and after different LBNP levels in men

BACKGROUND

This study quantifies hemodynamic and thoracic impedance (TI) changes with four levels of lower body negative pressure (LBNP) from -15 to -65 mm Hg in seven healthy men in supine position 20 min before (pre-LBNP), 30 min during, and 20 min after suction (post-LBNP) as well as without suction (LBNP-0, rest control).

RESULTS

LBNP > 15 mm Hg increased basic TI by up to 2.2 omega (+9.5%). TI-computed stroke volume index (SVI) continuously decreased with time up to -12%, -28%, -36%, and -40% at the end of LBNP-15, -35, -55, and -65. TI-computed cardiac index decreased most (-14%) at LBNP-15 and -35, resulting in a 19% increase of calculated total peripheral resistance index at those intensities. Mean arterial pressure (MAP) did not change in any systematic way with lower LBNP levels, but increased +4.7% and +7.4% at the end of LBNP-55 and -65, respectively. Heart rate remained unchanged at LBNP-15, but continuously increased to reach +22%, +42%, and +55% at the end of LBNP-35, -55, and -65. After finishing LBNP, heart rate fell to values below both pre-LBNP and rest control for > or = 5 min (post-LBNP bradycardia). SVI transiently returned to, and MAP increased above, pre-LBNP levels after suction.

CONCLUSION

In conclusion, different levels of lower body subatmospheric pressure produced quantitatively different time course and dose-response patterns and remained non-hypotensive up to -65 mm Hg suction. Further, heart rate was depressed after LBNP, while arterial BP and TI-computed total peripheral resistance exceeded pre-stimulus levels, indicating an altered cardiovascular state after 30 min of simulated orthostasis.