A systematic review and meta-analysis of human population studies on the association between exposure to toxic environmental chemicals and left ventricular dysfunction (LVD)

BACKGROUND

Exposure to environmental chemicals has been associated with an elevated risk of heart failure (HF). However, the impact on early markers of HF, such as left ventricular dysfunction (LVD), remains limited.

OBJECTIVE

To establish a foundation of evidence regarding early HF markers and their association with environmental pollutants, a systematic review and meta-analysis was conducted.

METHODS

The search, conducted on October 13th, 2023, encompassed PubMed, Embase, and Web of Science without filters, focusing on observational studies reporting myocardial geometrical, structural, or functional alterations in individuals without a history of heart disease. This included the general adult population, workers, young people, and the elderly. The risk of bias was assessed using the ROBINS-I tool at both study and item levels.

RESULTS

The systematic review included 17 studies involving 43.358 individuals exposed to air pollution and 2038 exposed to heavy metals. Approximately 41% of the effect measures of associations reported significant abnormalities in myocardial structure or function. The metanalyses by pollutants categories indicated positive associations between LV systolic and diastolic abnormalities and exposure to PM2.5 [-0.069 (-0.104, -0.033); -0.044 (-0.062, -0.025)] and PM10 [-0.055 (-0.087, -0.022); -0.030 (-0.050, -0.010)] and NO2 [-0.042 (-0.071, -0.013); -0.021 (-0.037, -0.004)], as well as positive associations between lead exposure and LV systolic abnormalities [-0.033 (-0.051, -0.016)].

CONCLUSIONS

Existing evidence shows that specific early markers of HF may be associated with exposure to chemical pollutants. It is recommended to include such endpoints in new longitudinal and case-control studies to confirm further risk associations. These studies should consider co-exposures, account for vulnerable groups, and identify cardiotoxic compounds that may require regulation. When examining the link between myocardial abnormalities and environmental exposure, it is also advisable to explore the supportive use of Adverse Outcome Pathway (AOP) approaches to confirm a causal relationship.

Green hospital pharmacy: A sustainable approach to the medication use process in a tertiary hospital

BACKGROUND

Sustainable management of healthcare waste has a positive impact on the global environment. In order to reduce it, the sustainable practice of the pharmacotherapeutic process in all its stages is essential.

OBJECTIVE

To analyze the sustainability strategies proposed by the pharmacy service to reduce drug waste derived from the pharmacotherapeutic process.

SECONDARY OBJECTIVES

to analyze the stage of the pharmacotherapeutic process and the number and type of drugs involved.

METHODS

The study was carried out in a tertiary level hospital. To coordinate the proposals, a referent pharmacist from every pharmacy department area was selected. Four stages of the process were evaluated (procurement, validation, dispensing and compounding), patients concerned were classified as outpatients or inpatients, and drugs potentially involved were analyzed by the administration route: into oral or parenteral.

RESULTS

28 ideas were proposed, which could affect more than 1200 drugs. 39.3% would affect the validation process, 17.9% the procurement management, 17.9% dispensing and 7.1% the compounding. Implementation feasibility and acceptability of these proposals were evaluated. Those with the greatest potential were: limiting the duration of treatments when possible, favoring the implementation of computer prescription order entry, favoring the use of the oral route over the parenteral route, and implementing computers in the preparation areas to avoid the use of paper guides.

DISCUSSION

In our study, many ideas have been proposed by hospital pharmacists to improve the sustainability of the medication use process. When assessing these proposals by impact and feasibility, according to our results, shorten as much as possible the duration of treatments, computerization of the medication use process and oral administration over intravenous should be prioritized in order to reduce environmental impact.

Artificial intelligence algorithms for the recognition of Brugada type 1 pattern on standard 12-leads ECG

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This research project is funded by Tuscany Region

Background/Introduction

Electrocardiograms (ECGs) are rapidly moving from analog to digital versions. Consequently, a series of automatic analyses of standard 12-lead ECGs are attracting interest for their ability to support clinicians in the automatic recognition of specific features associated with different cardiac diseases [2]. Artificial Intelligence applications and Machine Learning (ML) algorithms have gained much attention in the last years for their ability to figure out patterns from data independently, without being explicitly taught rules. Peculiar features define the ECGs of patients with Brugada Syndrome (BrS); however, ambiguities still exist for the correct diagnosis of BrS and discrimination with respect to other pathologies.

Purpose

The BrAID (Brugada syndrome and Artificial Intelligence applications to Diagnosis) project aims to develop an innovative system for diagnosing Type 1 BrS based on ECG pattern recognition through the application of ML algorithms. In this work, an application of Echo State Networks (ESN), a type of Recurrent Neural Network (RNN), for the diagnosis of BrS from ECG is presented.

Methods

After approval from the Local Ethical Committees, 12-lead ECGs were obtained in patients enrolled in 5 Centers diagnosed with typical spontaneous Type 1 pattern (coved) (group A, 81 patients). Baseline ECG was also collected in patients undergoing the ajmaline test, classified as positive (group B, 37 patients) or negative (group C, 14 patients) according to test results. 174 patients with no clinical and familial history of arrhythmias were considered controls (group D). Data were collected from 4 beats extracted from the ECGs as input to the ESN. The datasets obtained in the different groups were used for the ESN model’s training and assessment (testing) through a double cross-validation approach.

Results

As shown in Table 1, the performances using three leads (V1, V2, V3) or V2 only were compared.

The algorithm performance was assessed in all the datasets (group A+B+C+D) and in spontaneous BrS (group A) and controls (group D). A good accuracy (79.21%) was seen when the three leads were considered for groups A and D only; the best test set accuracy (80.20%) was obtained in the case in which V2 only was used as input in all the datasets.

Conclusion(s)

In this work, a novel system for diagnosing Type 1 BrS using an ESN approach was developed. Our preliminary results show that this ML model is able to detect ECG patterns associated with Type 1 BrS with good and comparable accuracy both when three leads (79.21% ) or V2 only (80.20%) were analyzed. The future availability of larger datasets could improve the model performance, increasing the ESN potentialities as a clinical support system tool to be used in everyday clinical practice.

Table 1. The accuracy, specificity, and sensitivity reported for each dataset group are obtained through double cross-validation.

Initial Dynamic Susceptibility of Maghemite Nanoparticles Dispersed in Surface-Treated Polymeric Template

Magnetic nanocomposites based on maghemite nanoparticles supported (ex situ route) on styrene- divinilbenzene (Sty-DVB) copolymer templates were produced and characterized for their structure and morphology. The as-produced nanocomposites were further chemically-treated with different oxidant agents and surface-coated with stearic acid. X-ray diffraction and transmission electron microscopy data show that the incorporated nanoparticles are preserved despite the aggressive chemical treatments employed. From the dynamical susceptibility measurements performed on the nanocomposites, the values of the saturation magnetization (76 emu/g) and the effective magnetic anisotropy (1.7 × 10⁴ J/m³) were obtained, in excellent agreement with the values reported in the literature for maghemite. This finding strongly supports the preservation of the magnetic properties of the supported nanosized maghemite throughout the entire samples' processing.

The BrAID study protocol: integration of machine learning and transcriptomics for brugada syndrome recognition

BACKGROUND

Type 1 Brugada syndrome (BrS) is a hereditary arrhythmogenic disease showing peculiar electrocardiographic (ECG) patterns, characterized by ST-segment elevation in the right precordial leads, and risk of Sudden Cardiac Death (SCD). Furthermore, although various ECG patterns are described in the literature, different individual ECG may show high-grade variability, making the diagnosis problematic. The study aims to develop an innovative system for an accurate diagnosis of Type 1 BrS based on ECG pattern recognition by Machine Learning (ML) models and blood markers analysis trough transcriptomic techniques.

METHODS

The study is structured in 3 parts: (a) a retrospective study, with the first cohort of 300 anonymized ECG obtained in already diagnosed Type 1 BrS (75 spontaneous, 150 suspected) and 75 from control patients, which will be processed by ML analysis for pattern recognition; (b) a prospective study, with a cohort of 11 patients with spontaneous Type 1 BrS, 11 with drug-induced Type 1 BrS, 11 suspected BrS but negative to Na + channel blockers administration, and 11 controls, enrolled for ECG ML analysis and blood collection for transcriptomics and microvesicles analysis; (c) a validation study, with the third cohort of 100 patients (35 spontaneous and 35 drug-induced BrS, 30 controls) for ML algorithm and biomarkers testing.

DISCUSSION

The BrAID system will help clinicians improve the diagnosis of Type 1 BrS by using multiple information, reducing the time between ECG recording and final diagnosis, integrating clinical, biochemical and ECG information thus favoring a more effective use of available resources. Trial registration Clinical Trial.gov, NCT04641585. Registered 17 November 2020, https://clinicaltrials.gov/ct2/show/NCT04641585.

Connexin 26 Expression in Mammalian Cardiomyocytes

Connexins are a family of membrane-spanning proteins named according to their molecular weight. They are known to form membrane channels mediating cell-cell communication, which play an essential role in the propagation of electrical activity in the heart. Cx26 has been described in a number of tissues but not in the heart, and its mutations are frequently associated with deafness and skin diseases. The aim of this study was to assess the possible Cx26 expression in heart tissues of different mammalian species and to demonstrate its localization at level of cardiomyocytes. Samples of pig, human and rat heart and H9c2 cells were used for our research. Immunohistochemical and molecular biology techniques were employed to test the expression of Cx26. Interestingly, this connexin was found in cardiomyocytes, at level of clusters scattered over the cell cytoplasm but not at level of the intercalated discs where the other cardiac connexins are usually located. Furthermore, the expression of Cx26 in H9c2 myoblast cells increased when they were differentiated into cardiac-like phenotype. To our knowledge, the expression of Cx26 in pig, human and rat has been demonstrated for the first time in the present paper.

Synthesis, characterization and applications of maghemite beads functionalized with rabbit antibodies

Magnetic nanoparticles (NPs) have attracted great attention owing to their applications in the biomedical field. In the present work, maghemite (γFe₂O₃) NPs of 6.5 nm were prepared using a sonochemical method and used to prepare magnetic beads through silanization with 3-aminopropyltrimethoxysilane (APTS). Subsequently, amino groups in the resulting APTS-γFe₂O₃ beads were converted to carboxylic acid (CARB-γFe₂O₃) through the succinic anhydride reaction, as confirmed by transmission electron microscopy (TEM), Fourier transform infrared spectroscopy and dynamic light scattering (DLS) measurements. The size of these beads was measured as 12 nm and their hydrodynamic diameter as 490 nm, using TEM analysis and DLS, respectively. The CARB-γFe₂O₃ beads were further functionalized by immobilizing rabbit antibodies on their surfaces; the immobilization was confirmed by flow cytometry and ionic strength. The samples were further characterized by Mössbauer spectroscopy and DC magnetization measurements. Studies on magnetic relaxivities showed that magnetic beads present great potential for application in MR imaging.

Mechanisms of resistance to three mite growth inhibitors of Tetranychus urticae in hops

Mite growth inhibitors (MGIs), such as etoxazole and hexythiazox, are valuable IPM tools for Tetranychus urticae control in hops due to their unique mode of action and selectivity. Hence, it is necessary to standardize bioassay methods to evaluate the efficacy of MGIs, monitor resistance, and identify mechanisms underlying MGI resistance in the field. Here, we developed a three-tiered approach for evaluating ovicidal toxicity of MGIs to T. urticae, which simulated different MGI exposure scenarios in the field. The most effective bioassay method was direct exposure of T. urticae eggs to MGIs. With this method, four field-collected T. urticae populations showed low-to-moderate resistance to MGIs. Cross-resistance among MGIs and from MGIs to bifenazate and bifenthrin was detected. Besides target site insensitivity, enhanced cytochrome P450 and esterase activities also contribute to the MGI resistance in hop yard-collected T. urticae populations. Low-to-moderate MGI resistance in T. urticae populations may be mediated by multiple mechanisms. Positive selection pressure on the I1017F mutation is moderate in field-collected T. urticae populations. Further studies are required to identify metabolic detoxification genes that confer resistance to MGIs for precise resistance monitoring.

A mitochondrial HSP70 (HSPA9B) is linked to miltefosine resistance and stress response in Leishmania donovani

Background

Protozoan parasites of the genus Leishmania are responsible for leishmaniasis, a neglected tropical disease affecting millions worldwide. Visceral leishmaniasis (VL), caused by Leishmania donovani, is the most severe form of leishmaniasis with high rates of mortality if left untreated. Current treatments include pentavalent antimonials and amphotericin B. However, high toxicity and emergence of resistance hinder the success of these options. Miltefosine (HePC) is the first oral treatment available for leishmaniasis. While treatment with HePC has proven effective, higher tolerance to the drug has been observed, and experimental resistance is easily developed in an in vitro environment. Several studies, including ours, have revealed that HePC resistance has a multi-factorial origin and this work aims to shed light on this complex mechanism.

Methods

2D-DIGE quantitative proteomics comparing the soluble proteomes of sensitive and HePC resistant L. donovani lines identified a protein of interest tentatively involved in drug resistance. To test this link, we employed a gain-of-function approach followed by mutagenesis analysis. Functional studies were complemented with flow cytometry to measure HePC incorporation and cell death.

Results

We identified a mitochondrial HSP70 (HSPA9B) downregulated in HePC-resistant L. donovani promastigotes. The overexpression of HSPA9B in WT lines confers an increased sensitivity to HePC, regardless of whether the expression is ectopic or integrative. Moreover, the increased sensitivity to HePC is specific to the HSPA9B overexpression since dominant negative mutant lines were able to restore HePC susceptibility to WT values. Interestingly, the augmented susceptibility to HePC did not correlate with an increased HePC uptake. Leishmania donovani promastigotes overexpressing HSPA9B were subjected to different environmental stimuli. Our data suggest that HSPA9B is capable of protecting cells from stressful conditions such as low pH and high temperature. This phenotype was further corroborated in axenic amastigotes overexpressing HSPA9B.

Conclusions

The results from this study provide evidence to support the involvement of a mitochondrial HSP70 (HSPA9B) in experimental HePC resistance, a mechanism that is not yet fully understood, and reveal potential fundamental roles of HSPA9B in the biology of Leishmania. Overall, our findings are relevant for current and future antileishmanial chemotherapy strategies.

Electronic supplementary material

The online version of this article (doi:10.1186/s13071-016-1904-8) contains supplementary material, which is available to authorized users.

Bleomycin in the setting of lung fibrosis induction: From biological mechanisms to counteractions

Bleomycin (BLM) is a drug used to treat different types of neoplasms. BLM's most severe adverse effect is lung toxicity, which induces remodeling of lung architecture and loss of pulmonary function, rapidly leading to death. While its clinical role as an anticancer agent is limited, its use in experimental settings is widespread since BLM is one of the most widely used drugs for inducing lung fibrosis in animals, due to its ability to provoke a histologic lung pattern similar to that described in patients undergoing chemotherapy. This pattern is characterized by patchy parenchymal inflammation, epithelial cell injury with reactive hyperplasia, epithelial-mesenchymal transition, activation and differentiation of fibroblasts to myofibroblasts, basement membrane and alveolar epithelium injuries. Several studies have demonstrated that BLM damage is mediated by DNA strand scission producing single- or double-strand breaks that lead to increased production of free radicals. Up to now, the mechanisms involved in the development of pulmonary fibrosis have not been fully understood; several studies have analyzed various potential biological molecular factors, such as transforming growth factor beta 1, tumor necrosis factor alpha, components of the extracellular matrix, chaperones, interleukins and chemokines. The aim of this paper is to review the specific characteristics of BLM-induced lung fibrosis in different animal models and to summarize modalities and timing of in vivo drug administration. Understanding the mechanisms of BLM-induced lung fibrosis and of commonly used therapies for counteracting fibrosis provides an opportunity for translating potential molecular targets from animal models to the clinical arena.

Dipyridamole-induced C-type natriuretic peptide mRNA overexpression in a minipig model of pacing-induced left ventricular dysfunction

Dipyridamole (DP) restores ischemic tissue blood flow stimulating angiogenesis in eNOS-dependent pathways. C-type natriuretic peptide (CNP) is expected to mimic the migration-stimulatory effect of NO via a cGMP-dependent mechanism. Aim of this study was to assess the role of concomitant treatment with DP on CNP levels in blood and myocardial tissue of minipigs with left ventricular dysfunction (LVD) induced by pacing at 200bpm in the right ventricular apex. Minipigs with DP therapy (DP+, n=4) or placebo (DP-, n=4) and controls (C-SHAM, n=4) underwent 2D-EchoDoppler examination and blood collection before and after 4 weeks of pacing, when cardiac tissue was collected. Histological/immunohistochemical analyses were performed. CNP levels were determined by radioimmunoassay; cardiac CNP, BNP, natriuretic receptors expression by Real-Time PCR. After pacing, cardiac parameters resulted less impaired in DP+ compared to DP-. Histological sections presented normal morphology while the arteriolar density resulted: C-SHAM: 9.0±1.2; DP-: 4.9±0.3; DP+: 6.5±0.6number/mm(2); C-SHAM vs DP- and DP+ p=0.004, p=0.04, respectively. CNP mRNA resulted lower in DP- compared to C-SHAM and DP+ as well as NPR-B (p=0.011, DP- vs DP+). Both NPR-A/NPR-C mRNA expressions were significantly (p<0.001) lower both in DP- and DP+ compared to C-SHAM. BNP mRNA was higher in LVD. CNP plasma levels showed a similar trend with respect to gene expression (C-SHAM: 30.5±15; DP-: 18.6±5.5; DP+: 21.2±4.7pg/ml). These data suggest that DP may serve as a preconditioning agent to increase the protective CNP-mediated endocrine response in LVD. This response, mediated by its specific receptor NPR-B, may offer new insights into molecular targets for treatment of LVD.

Synthesis, characterization and magnetic properties of polymer-Fe3O4 nanocomposite

The chemical stability of magnetic particles is of great importance for their applications in medicine and biotechnology. The most challenging problem in physics of disordered systems of magnetic nanoparticles is the investigation of their dynamic properties. The chemical coprecipitation process was used to synthesize spherical magnetite nanoparticles of 14 nm. The as-prepared magnetite nanoparticles have been aged in the matrix. Magnetic properties and aging effect were studied by Mössbauer spectroscopy at temperatures ranging from 77 to 300 K, and X-ray diffraction. At room temperature, the Mössbauer spectrum showed superparamagnetic behavior of the particles, while well-defined sextets were observed at 77K, indicating a blocked regime. The superparamagnetic magnetite nanoparticles can be used as microbead biosensors.

Photoacoustic spectroscopy study of Blepharocalyx salicifolius (Kunt) O. Berg

Photoacoustic spectroscopy (PAS) has revolutionized the fields of biological, environmental, and agricultural sciences. It is a very simple, sensitive, and non-destructive technique that allows the determination of optical properties of bio-samples. The in vivo chlorophylls of the leaf have a recorded maximum absorption peak at 675 nm as against 665 nm of the in vitro chlorophylls. The intensity of purple pigmentation in leaves of Blepharocalyx salicifolius (Kunt) O. Berg, is inversely correlated to the soil moisture levels, leaf water content and leaf water potentials. The applicability of PAS to biological samples was discussed. It allows the validation of existing emission models which are important for atmospheric process. A portable device for photoacoustic spectroscopy of plants and other photosynthetic tissues, cells and organelles is provided. Further, there is provided a method to measure photosynthesis of such tissues, cells and organelles.

Photoacoustic investigation of maghemite-based nanocomposite

Photoacoustic spectroscopy was used to investigate magnetic nanocomposites incorporating nanosized maghemite particles into styrene-divinylbenzene copolymer template. Typical photoacoustic features were observed in bands C, S and L in the wavelength region of 300-1000 nm. The relative intensity of band-C scaled with the nominal concentration of nanosized maghemite incorporated into the polymeric template whereas the lowest relative intensity of band-S was found in the sample in which the template polymerization took place in the presence of the highest polar-like reaction medium. X-ray diffraction and transmission electron microscopy were used to characterize the magnetic nanosized phase as maghemite, with average particle diameter of 6.9 nm (sample Est34), 7.0 nm (sample H30), and 7.9 nm (sample Em15).

Similar patterns of myocardial metabolism and perfusion in patients with type 2 diabetes and heart disease of ischaemic and non-ischaemic origin

AIMS/HYPOTHESIS

Type 2 diabetes and insulin resistance are often associated with the co-occurrence of coronary atherosclerosis and cardiac dysfunction. The aim of this study was to define the independent relationships between left ventricular dysfunction or ischaemia and patterns of myocardial perfusion and metabolism in type 2 diabetes.

METHODS

Twenty-four type 2 diabetic patients--12 with coronary artery disease (CAD) and preserved left ventricular function and 12 with non-ischaemic heart failure (HF)--were enrolled in a cross-sectional study. Positron emission tomography (PET) was used to assess myocardial blood flow (MBF) at rest, after pharmacological stress and under euglycaemic hyperinsulinaemia. Insulin-mediated myocardial glucose disposal was determined with 2-deoxy-2-[(18)F]fluoroglucose PET.

RESULTS

There was no difference in myocardial glucose uptake (MGU) between the healthy myocardium of CAD patients and the dysfunctional myocardium of HF patients. MGU was strongly influenced by levels of systemic insulin resistance in both groups (CAD, r = 0.85, p = 0.005; HF, r = 0.77, p = 0.01). In HF patients, there was an inverse association between MGU and the coronary flow reserve (r = -0.434, p = 0.0115). A similar relationship was observed in non-ischaemic segments of CAD patients. Hyperinsulinaemia increased MBF to a similar extent in the non-ischaemic myocardial of CAD and HF patients.

CONCLUSIONS/INTERPRETATION

In type 2 diabetes, similar metabolic and perfusion patterns can be detected in the non-ischaemic regions of CAD patients with normal cardiac function and in the dysfunctional non-ischaemic myocardium of HF patients. This suggests that insulin resistance, rather than diagnosis of ischaemia or left ventricular dysfunction, affects the metabolism and perfusion features of patients with type 2 diabetes.

West Nile Virus in the New World: trends in the spread and proliferation of West Nile Virus in the Western Hemisphere

The observed patterns and variations in the ecology, epidemiology, distribution and prevalence of the West Nile Virus (WNV) in different areas of the Western Hemisphere make this pathogen of particular importance as a model for understanding the potential risk factors associated with emerging pathogens worldwide, particularly those involving zoonotic pathogens whose epidemiology involves the potential for vertical transmission in arthropod vector species, and horizontal and vertical transmission within and among vertebrate host species. Record numbers of human WNV cases were recorded in Canada during 2007, with >50% more cases than documented in any previous year. Although overall numbers of human infections recorded in the United States were not exceptionally high during 2007 relative to epidemic levels reported in 2002 and 2003, the state of Oklahoma reported that the highest-ever number of human WNV cases and the numbers of human cases recorded in Canada were 50% higher than previous record levels recorded in 2003. The record and near-record numbers of human WNV infections recorded in several regions of North America during 2007 have important implications for the future management and surveillance of WNV vectors and reservoirs in North America. The spatiotemporal distribution of WNV infections in humans and animals recorded during 2007 in North America and South America have important implications for the surveillance and management of public health threats from WNV in the Western Hemisphere. Serological surveys conducted in areas of intense WNV transmission in the United States have reported low prevalence of antibodies to WNV in human s populations, indicating that additional epidemic outbreaks of human disease from WNV can be expected in the future.

Segregation of the classical transmitters norepinephrine and acetylcholine and the neuropeptide Y in sympathetic neurons: modulation by ciliary neurotrophic factor or prolonged growth in culture

Recent evidence has demonstrated that cotransmission from mammalian neurons is not uniquely achieved by costorage and corelease of transmitters and cotransmitters from single varicosities, but also by the concurrent release of mediators segregated in separate synapses of individual neurons. An important question to be addressed is whether neurons show defined patterns of segregation or whether this is a plastic feature. We addressed this question by exploring the segregation pattern of the classical sympathetic transmitters norepinephrine (NE) and acetylcholine (ACh) and the cotransmitter neuropeptide Y (NPY) in sympathetic ganglionic neurons cocultured with cardiac myocytes. Using antibodies against NPY and the vesicular NE and ACh transporters VMAT2 and vesicular acetylcholine transporter (VAChT), we investigated the effect of ciliary neurotrophic factor (CNTF) or long (three weeks) culture periods on the segregation of VMAT2, VAChT, and NPY to separate varicosities. We found that although ganglionic neurons showed cell body coexpression of all the markers examined after three days, VMAT2 was segregated from VAChT in 43% of the VAChT-positive varicosities. In contrast, VMAT2 was only segregated from NPY in 16.3% of the NPY-positive varicosities. Cotransmitter segregation and VAChT expression was potentiated by both CNTF and longer times in culture. We also found two types of varicosities: one was smaller and located further from neuronal somata, and the other was larger, proximal to neuronal somata and had a higher level of segregation. These data demonstrate segregation of classical transmitters in sympathetic neurons and plasticity of neurotransmitter segregation. Finally, we discuss a possible functional correlate of segregation in sympathetic neurons.

[Factors influencing the distribution of nests of the Argentine ant Linepithema humile Mayr (hymenoptera: formicidae), in a foothills ecosystem of the central zone of Chile]

The purpose of this research was to demonstrate the dependant relationship between the Argentine ant Linepithema humile Mayr, plant coverage, and human settlements. A method was designed in order to sample the presence of the Argentine ant and other ant species that may had influenced L. humile distribution, under different types of vegetation and percentages of plant coverage, taking in consideration the distance from human settlements. Eight sample stations were established. Four of these stations were found on a dwelling home and the other four were found on similar areas, but far from human settlements. Three transects were established from the center of each sampling station (Tt1, shrublike vegetation, Tt2, herblike vegetation and Tt3, no vegetation). Transects were compound by 10 m side quadrants. A negative correlation was found between nest number of L. humile and human settlement distance, therefore nests were not found at distances higher than 80 m, in all studied areas. There was a positive and significant correlation between nest number of L. humile and plant coverage percentage, regardless the type of vegetation found. The same trend was found for other ant species studied in the area. Finally, it was proved that the distribution of L. humile nests is not influenced by other ant species.

Segregation of met-enkephalin from vesicular acetylcholine transporter and choline acetyltransferase in sympathetic preganglionic varicosities mostly lacking synaptophysin and synaptotagmin

Sympathetic preganglionic neurons (SPN) coexpress the acetylcholine (ACh)-synthesizing enzyme choline acetyltransferase and different peptides in their cell bodies, but can express them independently in separate varicosities, indicating that SPN segregate transmitters to different synapses. Consequently, there are populations of preganglionic varicosities (peptidergic and noncholinergic) that store peptides but not ACh. We studied in the cell bodies and axon processes of the rat SPN the expression and the proportional coexpression of the vesicular ACh transporter-like immunoreactivity (VAChT), a specific marker of cholinergic synaptic vesicles or ChAT-like immunoreactivity (ChAT), and the peptide methionine enkephalin-like immunoreactivity (mENK), and confirmed the presence of a population of SPN peptidergic, noncholinergic varicosities. We characterized these varicosities by exploring the occurrence of synaptophysin-like immunoreactivity (Syn), a marker of small clear vesicles, and synaptotagmin-like immunoreactivity (Syt), a preferential marker of large dense core vesicles. We found that (i) VAChT and mENK, like ChAT-mENK, were coexpressed in only 59% of the mENK-containing varicosities, although they colocalized in the SPN cell bodies; and (ii) almost 60% of the population of mENK-containing varicosities did not express Syn or Syt, and over 80% of the mENK-containing varicosities negative for VAChT also lacked Syn. These data prove that SPN segregate mENK from VAChT and ChAT, and show that most of the subset of mENKergic varicosities negative for VAChT also does not express Syn, suggesting the presence of a different vesicular pattern in these sympathetic preganglionic varicosities.

Contrast echocardiography in the diagnosis of myocardial stunning

The identification of viable myocardium within dysfunctional myocardium has important clinical implications. By using a microvascular tracer, myocardial contrast echocardiography may have the potential for prediction of myocardial viability in the acute and subacute phases of myocardial infarction. In the case presented, the normal myocardial perfusion observed after intravenous injection of the contrast agent, combined with severe wall motion abnormality following prolonged chest pain, suggested myocardial stunning. This was confirmed by normal coronary angiography and by restoration of normal left ventricular function at 1-month follow-up echocardiography.

Differential contribution of extracellular and intracellular calcium sources to basal transmission and long-term potentiation in the sympathetic ganglion of the rat

Calcium involved in basal ganglionic transmission and long-term potentiation (LTP) can arise either by influx from the extracellular medium or release from intracellular stores. No attempts have yet been made to concurrently explore the contributions of extracellular and intracellular Ca2+ to basal ganglionic transmission or LTP. Here, we investigate this subject using the superior cervical ganglion of the rat. To explore the extracellular Ca2+ contribution, we evaluated basal transmission and LTP at different extracellular Ca2+ concentrations. To assess intracellular Ca2+ release, we explored the contribution of the calcium-induced calcium release process by overactivation or blockade of ryanodine-sensitive Ca2+ receptor channel with caffeine, and also by blocking either IP3R with Xestospongin C or the sarco(endo)plasmic reticulum Ca2+-ATPase pump with thapsigargin. Extracellular Ca2+ affected ganglionic basal transmission and LTP to different extents. While 25% of the physiological Ca2+ concentration supported 80% of basal transmission, 50% of normal Ca2+ was required to achieve 80% of LTP. Notably, disruption of intracellular Ca2+ release by all the drugs tested apparently did not affect basal ganglionic transmission but impaired LTP. We conclude that basal transmission requires only a small level of Ca2+ entry, while LTP expression not only requires more Ca2+ entry but is also dependent on Ca2+ release from intracellular stores.

Choline acetyl transferase and neuropeptide immunoreactivities are colocalized in somata, but preferentially localized in distinct axon fibers and boutons of cat sympathetic preganglionic neurons

Cholinergic sympathetic preganglionic neurons (SPN) coexpress the biosynthetic enzyme for acetylcholine, choline acetyl-transferase (ChAT), and neuropeptides such as enkephalin (ENK) in their cell bodies. However, it is not clear whether they also coexpress ChAT and neuropeptides in axon fibers and boutons. To explore coexpression of ChAT and neuropeptides in somata and axon processes of SPN, we investigated, using immunohistochemistry, retrograde labeling, confocal analysis, and tridimensional reconstruction, whether ChAT and the peptides neurotensin, methionine-ENK, somatostatin, calcitonin gene-related peptide, and vasoactive intestinal peptide colocalize in somata, axons fibers, and boutons of cat SPN. Practically, complete colocalization for these peptides and ChAT was observed in SPN somata. Conversely, in most instances we observed independent localization of immunoreactivity (IR) for ChAT and the peptides in axon fibers and boutons. The minor colocalization between ChAT- and peptide-IR in preganglionic fibers could correspond to a sequential axonal transport of ChAT and peptides, since we observed coexistence of these transmitters after blocking axonal transport. Contrary to Dale's principle, our results suggest that SPN can synthesize ChAT and peptides in their cell bodies and route them to distinct axon boutons or terminals in sympathetic ganglia. Presence of axon boutons containing either ChAT or neuropeptides lead us to suggest a new neurochemical pattern of cotransmission in sympathetic ganglia based on the concurrent release of transmitters and cotransmitters from distinct presynaptic boutons, rather than in the corelease of these mediators from the same axon process. The possibility that cellular segregation could be transient and depend on functional requirements is considered.

Cleaner production and methodological proposal of eco-efficiency measurement in a Mexican petrochemical complex

Abstract In the frame of the Petróleos Mexicanos Institutional Program for Sustainable Development, processes were evaluated in the manufacture operation of the petrochemical industry, with the purpose of reducing their ecological fingerprint. Thirteen cleaner production opportunities were registered in six process plants: ethylene oxide and glycols, acetaldehyde, ethylene, high density polyethylene, polypropylene switch and acrylonitrile, and 45 recommendations in the waste water treatment plant. Morelos is the second most important petrochemical complex in the Mexican and Latin American petrochemical industry. A tool was developed to obtain eco-efficiency indicators in operation processes, and as a result, potential savings were obtained based on best performance, as well as the integrated distribution of Sankey diagrams. Likewise, a mechanism of calculation to obtain economic savings based on the reduction of residues during the whole productive process is proposed. These improvement opportunities and recommendations will result in economic and environmental benefits minimising the use of water, efficient use of energy, raw materials and reducing residues from source, generating less environmental impacts during the process.

Experimental infection of coho salmon Oncorhynchus kisutch by exposure of skin, gills and intestine with Piscirickettsia salmonis

Piscirickettsiosis pathogenesis was examined using some tissues as entry portals of Piscirickettsia salmonis in coho salmon. Juvenile fish, weighing approximately 8.4 g, were used in this trial. Inocula were prepared using the strain SLGO-95 of P. salmonis. The micro-organism was cultured in the CHSE-214 cell line as described by Fryer et al. (1990) and doses containing 10(4.7) and 10(3.7) TCID50 were prepared. Each dose was used to infect the fish via skin, gills and intestine. Skin and gills were exposed by calibrated drops, and the intestine by an intubation through the anal opening. Some fish were injected intraperitoneally with the same P. salmonis doses, as positive virulence controls. Sham-inoculated fish for each of the tested routes were also included as negative controls. Piscirickettsiosis was experimentally reproduced with all the inoculation methods. Cumulative mortalities and survival analyses showed that the most effective entry portal was skin followed by intestinal intubation and finally by gill infection.

Sonographic detection of fluid collections and postoperative morbidity following Cesarean section and hysterectomy

OBJECTIVES

To evaluate the clinical significance of sonographically detected fluid collections following Cesarean section and hysterectomy, and to identify risk factors associated with their formation.

METHODS

This was a prospective study including 280 women, 145 of whom had undergone a Cesarean section and 135 of whom had undergone abdominal or vaginal hysterectomy. Ultrasound examinations were carried out on all women on day 4 after surgery to assess the presence of abdominal wall or pelvic fluid collections. The sonographers were unaware of the clinical course before the examination and were not involved in any clinical decision-making. Ultrasound findings were correlated with clinical data and postoperative morbidity.

RESULTS

A fluid collection was found in 69 (48%) women after Cesarean section, and in 59 (44%) women who had undergone hysterectomy. No risk factors for the development of fluid collections after Cesarean section or hysterectomy were identified. The risk of developing febrile morbidity was not related to the presence, location or size of fluid collections.

CONCLUSIONS

Postoperative fluid collections are common after Cesarean section and hysterectomy. As fluid collections detected by sonography were not associated with postoperative morbidity, this finding is unlikely to be useful in the workup for postoperative fever.

Contribution of different calcium channels to long-term potentiation in superior cervical ganglion of the rat

We explored the contribution of different calcium channel types to the long-term potentiation (LTP) of superior cervical ganglion of the rat. Right after a conditioning train of 40 Hz for 5 s, the maximum amplitude of the postsynaptic response (maximum potentiation) increased 5.6+/-0.5-fold. Potentiation decreased to 20% of its initial value within the following 70.0+/-8.0 min (LTP decay time). The contribution of P/Q-, N- and L-type calcium channels to LTP was studied by blocking their activity with synthetic funnel-web spider toxin (10 or 100 microM), omega-conotoxin GVIA (5 microM) or nifedipine (10 microM), respectively. The three blockers reduced the amplitude of the postsynaptic compound action potential before the conditioning train. After the train, all of the toxins reduced the LTP decay time and the integral of the amplitude versus time curve, defined as the LTP extent. In addition, all three blockers increased the maximum potentiation. Our results demonstrate that different calcium channel types contribute to ganglionic LTP. These effects may be by coupling excitation-secretion from different types of synaptic vesicles.

Differences in the Effects of Simulated Sea Aerosol on Water Relations, Salt Content, and Leaf Ultrastructure of Rock-Rose Plants

White-leaf rock-rose (Cistus albidus L.) and Montpellier rock-rose (C. monspeliensis L.) plants were sprayed 2 to 3 min per day over a 7-d period, in an unheated plastic greenhouse, with different aqueous solutions containing deionized water alone (control); an anionic surfactant (sodium dodecylbenzenesulfonate 82.5%, 50 mg L(-1)) (S1); a solution simulating the composition of sea aerosol (S2); and a solution simulating sea aerosol with anionic surfactant (S3). White-leaf rock-rose was more sensitive to sea aerosol, showing greater leaf damage and markedly decreased growth, and the presence of surfactant enhanced the phytotoxic effect leading to greater increases in mortality. Montpellier rock-rose did not appear to be more adversely affected when surfactant was used in combination with sea aerosol, and manifested slight or less severe symptoms than white-leaf rock-rose. There was a significant increase in leaf turgor potential in the plants treated with both sea aerosol treatments by osmotic adjustment effect. The decrease in photosynthesis level seems to be due to both stomatal and nonstomatal factors. The results of microscopical analysis of Montpellier rock-rose plants show that sea aerosol treatment caused alterations in the chloroplast structure, reducing the starch grain and swelling the thylakoid membranes. The results of this study indicated that Montpellier rock-rose was more tolerant to sea aerosol than white-leaf rock-rose, showing a lower reduction in plant growth and less leaf damage, probably because of its ability to compartmentalize the toxic ions at the intracellular level.

Contrasting physiological responses of dwarf sea-lavender and marguerite to simulated sea aerosol deposition

Plants of two wild native species from littoral areas, marguerite [Argyranthemum coronopifolium (Willd.) C.J. Humphries] and dwarf sea-lavender [Limonium pectinatum (Aiton) O. Kuntze], grown in an unheated plastic greenhouse, were sprayed 2 to 3 min per day over a 7-d period with different aqueous solutions containing (i) an anionic surfactant (S1); (ii) a solution simulating the composition of sea aerosol (S2); (iii) a solution simulating sea aerosol with anionic surfactant (S3), and (iv) deionized water alone (control). The plant resistance to sea aerosol and the ability to recover from treatments were studied. By the end of the spraying period, marguerite showed a significant reduction in growth compared with control. However, most of the growth parameters were significantly unaffected in dwarf sea-lavender when plants were treated with sea aerosol containing surfactant. Measurements of water relations variables in marguerite showed a slight decrease in leaf turgor potential after spraying with sea aerosol containing surfactant. The surfactant enhanced the foliar absorption of salt in marguerite plants, inducing reductions in leaf stomatal conductance and causing such damage in the photosynthetic apparatus that the level of net photosynthesis decreased and had not recovered by the end of the experiment. The treatments had no effect on leaf stomatal conductance and photosynthesis rate in dwarf sea-lavender plants. The response of the species studied to sea aerosol was related to the degree of salinity tolerance. Although both species are wild native plants from littoral areas, marguerite is not salt tolerant and was the most sensitive to the sea aerosol treatments, while dwarf sea-lavender, a halophyte species, was more efficient at decreasing the toxic salt content of the tissues as its growth and ornamental characteristics were not affected.

Prevention of inclusion body hepatitis/hydropericardium syndrome in progeny chickens by vaccination of breeders with fowl adenovirus and chicken anemia virus

The hypothesis that an effective protection of progeny chickens against inclusion body hepatitis/hydropericardium syndrome (IBH/HP) can be achieved by dual vaccination of breeders with fowl adenovirus (FAV) serotype 4 and chicken anemia virus (CAV) was tested. Thus, 17-wk-old brown leghorn pullet groups were vaccinated by different schemes including single FAV (inactivated), single CAV (attenuated), FAV and CAV dually, or were not vaccinated (controls). Subsequent progenies of these breeders were challenged with the virulent strains FAV-341 and CAV-10343 following three strategies: 1) FAV-341 intramuscularly (i.m.) at day 10 of age (only FAV-vaccinated and control progenies); 2) FAV + CAV i.m. simultaneously at day 10 of age (all progenies); 3) CAV i.m. at day 1 and FAV orally at day 10 of age (all progenies). The induction of IBH/HP in these progenies was evaluated throughout a 10-day period. Both breeder groups vaccinated against FAV and those vaccinated against CAV increased virus neutralizing specific antibodies. Challenge strategy 1 showed 26.6% mortality in control progeny chickens and 13.3% in the progeny of FAV-vaccinated breeders. Presence of lesions in the liver of these groups showed no significant differences (P > 0.05), suggesting a discreet protective effect of the vaccine. Challenge strategy 2 showed 29.4% mortality in controls and 94% of chickens showed hepatic inclusion bodies (HIB). Single CAV vaccination of breeders did not demonstrate a beneficial effect, with both mortality and liver lesions resembling the nonvaccinated controls. FAV vaccination of breeders significantly reduced both mortality (7.4%) and liver lesions (26% HIB) (P < 0.05), providing protection against this challenge strategy. Dual vaccination of breeders with FAV and CAV proved to be necessary to achieve maximum protection of the progeny (no mortality and 7% HIB). Challenge strategy 3 produced no mortality but consistent liver damage in controls (96% HIB). In this case, both CAV and FAV + CAV-vaccinated breeders showed best protection results in terms of liver histopathology (8% and 0% HIB, respectively). FAV vaccination alone produced 24% HIB, similar to challenge strategy 2, demonstrating a lower protective effect.

A nested polymerase chain reaction (Ln-PCR) for diagnosing and monitoring Leishmania infantum infection in patients co-infected with human immunodeficiency virus

We investigated a Leishmania-specific nested polymerase chain reaction (Ln-PCR) for the diagnosis and treatment monitoring of L. infantum infections in patients co-infected with human immunodeficiency virus (HIV). Peripheral blood and bone marrow samples from 89 HIV patients in Spain suspected of having leishmaniasis were examined by different diagnostic techniques (Ln-PCR, microscopy, NNN culture and indirect fluorescent antibody test). The sensitivity of Ln-PCR compared with microscopy and culture of bone marrow was 95.45% using blood and 100% when using bone marrow. 38 of these patients with confirmed leishmaniasis were entered in a chemotherapy trial (reported elsewhere), and samples from them were collected before treatment, one month after treatment ended and during follow-up (1-20 months), and examined similarly. Ln-PCR was shown to be a good method for testing efficacy of treatment and for predicting relapses after treatment (relapses were predicted on average 5 months earlier than when using classical diagnostic techniques). We suggest that Ln-PCR (especially using peripheral blood) should be the technique of choice for diagnosis, monitoring the success of treatment, and predicting relapses in patients with HIV and suspected or confirmed L. infantum infection.

Molecular epidemiology of Leishmania infantum on the island of Majorca: a comparison of phenotypic and genotypic tools

In the Mediterranean basin, Leishmania infantum is the causative agent of both visceral and cutaneous leishmaniasis, and is an important opportunistic parasite in patients infected with human immunodeficiency virus (HIV). The commonest method used to study the variability of Leishmania spp. is isoenzyme analysis. In addition to this, we employed 3 assays based on the polymerase chain reaction (PCR): random amplified polymorphic deoxyribonucleic acid (RAPD), intergenic region typing (IRT), based on the amplification of ribosomal ribonucleic acid internal transcribed spacers and restriction fragment length polymorphism (PCR-RFLP). We used 54 L. infantum stocks isolated from HIV co-infected patients, 38 isolated from dogs, 3 isolated from immunocompetent patients and 3 isolated from 1826 sand files in the island of Majorca (Spain), a closed ecological niche. Zymodemes MON-1 (70%), MON-24 (11%) and MON-34 (18%) were found among the human isolates, and MON-1 (95%) and MON-108 (5%) among those from dogs. RAPD and IRT could not discriminate among the strains as they all gave the same pattern, even when different zymodemes were examined. In contrast, PCR-RFLP was able to distinguish the strains and, furthermore, a dendrogram (unweighted pair group method with arithmetic average [UPGMA]) was constructed from the genetic distances derived from RFLP data. The Leishmania isolates from HIV-infected subjects formed a single cluster, supporting the existence of an artificial anthroponotic cycle previously proposed by our group, in which syringes have been substituted for sand flies, and in which certain clones have been spread among intravenous drug users. This contrasts with the clusters representing a zoonotic cycle, involving dogs, sand flies and both immunocompetent and immunocompromised humans.

Leishmania in discarded syringes from intravenous drug users

Needle sharing by intravenous drug users (IVDUs) has been proposed as providing an alternative, artificial, and anthroponotic cycle for leishmania transmission. We looked for parasites in syringes discarded by IVDUs using two different PCR techniques. Leishmania spp were detected in 65 (52%) of 125 syringes collected in southern Madrid, Spain, in 1998, and in 52 (34%) of 154 collected in southwestern Madrid in 2000-01. We found shared restriction fragment length polymorphisms in 12 of 65 positive samples tested, suggesting that syringe sharing can indeed promote the spread of leishmania clones among IVDUs.

Regio- and stereoselectivity of captodative olefins in 1,3-dipolar cycloadditions. A DFT/HSAB theory rationale for the observed regiochemistry of nitrones

Captodative olefins 1-acetylvinyl carboxylates proved to be highly regioselective dipolarophiles in 1,3-dipolar cycloadditon to propionitrile oxide, arylphenylnitrile imines, diazoalkanes, and nitrones to yield the corresponding 5-substituted heterocycles. The addition of the latter was also stereoselective, being slightly susceptible to steric demand of the carboxylate substituent in the olefin. All atempts to cleave the isoxazolidine N-O bond under reductive conditions failed, providing diverse products with side-group reduction. FMO theory was unsuccessful to explain the regioselectivity observed with nitrones, since the opposite orientation was predicted. The recently formulated DFT/HSAB theoretical model was able to rationalize this regioselectivity, identifying the nucleophilic and electrophilic atoms involved in the process via calculation of interaction energies, suggesting the specific direction of the electronic process at each of the reaction sites.

Analgesic and anti-inflammatory effects of Mangifera indica L. extract (Vimang)

Vimang is an aqueous extract of Mangifera indica used in Cuba to improve the quality of life in patients suffering from elevated stress. To assess its possible analgesic and antiinflammatory effects, the results of a standard extract evaluation are presented. Analgesia was determined using acetic acid-induced abdominal constriction and formalin-induced licking. Antiinflammatory effects were evaluated using carrageenan- and formalin-induced oedema. Vimang (50-1000 mg/kg, p.o.) exhibited a potent and dose-dependent antinociceptive effect against acetic acid test in mice. The mean potency (DE(50)) was 54.5 mg/kg and the maximal inhibition attained was 94.4%. Vimang (20-1000 mg/kg, p.o.) dose-dependently inhibited the second phase of formalin-induced pain but not the first phase. The DE(50) of the second phase was 8.4 mg/kg and the maximal inhibition was 99.5%, being more potent than indomethacin at doses of 20 mg/kg. Vimang (20-1000 mg/kg, p.o.) significantly inhibited oedema formation (p < 0.01 or p < 0.05) of both carrageenan- and formalin-induced oedema in rat, guinea-pigs and mice (maximal inhibitions: 39.5, 45.0 and 48.6, respectively). The inhibitions were similar to those produced by indomethacin and sodium naproxen, p.o. The different polyphenols found in Vimang could account for the antinociceptive and antiinflammatory actions reported here for the first time for M. indica bark aqueous extract.

Molecular tracking of infections by Leishmania infantum

Leishmania infantum is a major opportunistic parasite in patients with acquired immune deficiency syndrome and is very variable in these subjects. Isoenzyme characterization is not able to explain this variability, since half of the stocks isolated from patients co-infected with human immunodeficiency virus and Leishmania belong to zymodeme MON-1. Amplification of L. infantum minicircles by the polymerase chain reaction (PCR) and digestion of the amplified product to reveal restriction fragment length polymorphisms (RFLP) has proved very useful in distinguishing between relapses and reinfections in co-infected, treated patients. We have confirmed the existence of a leishmaniasis outbreak among intravenous drug users in north-east Spain, previously detected by isoenzymatic analysis. We have documented persistence of the same strain of Leishmania in 2 treated co-infected patients throughout several years, regardless of the theoretical rapid evolution ascribed to kinetoplast deoxyribonucleic acid minicircle sequences. We suggest using this PCR-RFLP technique to detect reinfections in treated co-infected subjects.

Vertical induction of the inclusion body hepatitis/hydropericardium syndrome with fowl adenovirus and chicken anemia virus

The hypothesis that fowl adenovirus (FAV) and chicken anemia virus (CAV), transmitted vertically and simultaneously, induce the inclusion body hepatitis (IBH)/hydropericardium (HP) syndrome in progeny chickens was tested. Thus, 35-wk-old light brown layer breeders, showing absence of antibodies against FAV and variable titers against CAV, were intramuscularly singly infected with the FAV serotype 4 isolate 341 or dually infected with CAV (isolate 10343) and FAV. All hens (groups A [FAV alone], B [FAV + CAV], and C [noninfected]) were clinically healthy throughout the experimental period. Both infectious viruses FAV and CAV were isolated from progenies obtained as early as 5 days after infection of their breeders. Hematocrit, serum proteins, and aspartate-aminotransferase values showed a few statistical differences between the progeny groups. Most of these differences were detected in the progeny chickens of group B. However, almost all values met reference values for the species. The pathologic findings showed that progeny chickens obtained from both singly and dually infected breeders developed macroscopic and histopathologic changes of IBH/HP. The pathologic findings shown by progeny chickens of group A (FAV) were not expected because neither synergism nor prior immunodepression by CAV was concurrent. Chickens of group B (CAV + FAV) also developed IBH/HP. Although not many differences in the evaluated parameters between groups A and B were statistically significant, most pathologic findings of group B indicated a more severe manifestation of the disease. However, because FAV alone did reproduce the syndrome, the results shown by group B would not allow a definitive confirmation of the hypothesis that the association of FAV and CAV is necessary for the successful induction of the IBH/HP syndrome in chickens when transmitted vertically.

Contrast echocardiography for myocardial perfusion imaging using intravenous agents: progress and promises

AIMS

This article is a convenient overview to assist the interested echocardiographist towards acquiring his own experience in the field of myocardial perfusion imaging using intravenous contrast agents. This goal is now pursued in many centres, since contrast echo holds the advantages of cardiac ultrasound (non-invasiveness, high spatial and temporal resolution, wide availability, use of non-ionizing radiation), and because a variety of transpulmonary agents-together with a spectrum of imaging modalities-are becoming available.

METHODS AND RESULTS

Many technical considerations need to be addressed for optimal myocardial perfusion imaging: characteristics of the contrast medium (air-filled or perfluorocarbon filled and/or encapsulated agents), modality of administration (bolus injection or continuous infusion) and interaction between microbubbles and ultrasound (dependency on power output). Moreover, intermittent harmonic imaging, intermittent harmonic power Doppler, pulse inversion and amplitude modulation imaging have all been developed to enhance microbubble detection over myocardial tissue. These new acquisition modalities also yield specific artifacts impacting on myocardial perfusion assessment. Finally, acute myocardial infarction and chronic ischaemic heart disease (at baseline and during stress) are the most studied clinical models for perfusion imaging with contrast echo, and are reviewed in this article.

CONCLUSION

Perfusion imaging with intravenous contrast agents has never been as close to widespread clinical use as it is today, but many methodological issues remain unsettled before the wish of the contrast echocardiographist comes true: that is, a cheap, user-friendly and widely available technology that would disclose new information in echocardiography.

Clinical experience with SonoVue in myocardial perfusion imaging

Ultrasound-enhancing agents have the potential to evaluate myocardial perfusion, adding a new dimension to echocardiography. This article summarizes the clinical studies involving SonoVue, a new intravenous ultrasound contrast agent, in assessing myocardial perfusion. Safe and well tolerated, SonoVue coupled with echocardiography has the capability to identify perfusion abnormalities, as confirmed by scintigraphic imaging. While the optimal modalities for ultrasound perfusion assessment are not yet determined, numerous technical advances have been introduced: continuous infusion or slow intravenous administration of the agent, harmonic intermittent imaging, pulse inversion, background subtraction, color coding, and others. SonoVue is a promising new agent in the booming field of myocardial contrast echocardiography.

Human umbilical vein endothelial cells express multiple prolactin isoforms

Members of the prolactin (PRL) hormonal family have direct effects on endothelial cell proliferation, migration and tube formation. Moreover, isoforms of PRL may function as autocrine regulators of endothelial cells. Bovine brain capillary endothelial cells (BBCEC) express the PRL gene, while anti-PRL antibodies inhibit BBCEC proliferation. Here, we show the expression of the PRL gene into various PRL isoforms in endothelial cells from the human umbilical vein. Reverse transcription-polymerase chain reaction of total RNA from human umbilical vein endothelial cells (HUVEC) detected the full-length PRL mRNA as well as a 100 bp smaller PRL transcript similar to the one previously reported in BBCEC. HUVEC were positive to PRL immunocytochemistry. In addition, various PRL immunoreactive proteins were detected in HUVEC extracts and HUVEC conditioned media by metabolic labelling immunoprecipitation analysis. These PRL immunorelated proteins had apparent molecular masses of 60, 23, 21, 16 and 14 kDa. In contrast to previous findings in BBCEC, HUVEC conditioned media contained very little PRL bioactivity as determined by the selective bioassay of Nb2 cell proliferation. Moreover, some polyclonal or monoclonal antibodies directed against PRL stimulated HUVEC proliferation, in contrast to the inhibitory effect seen in BBCEC. The present findings extend the previous observations about the expression of PRL gene in endothelial cells from bovine brain capillaries to human cells of the umbilical vein, implicating that endothelium from different types of vessels and species share the expression of PRL gene but may differ in the putative autocrine role of the PRL isoforms expressed.

Age dependency of myocardial structure: a quantitative two-dimensional echocardiographic study in a normal population

Histological changes of the myocardium occur with aging due to an increase in collagen content, hypertrophy of fibers, and patchy fibrosis. Quantitative analysis of conventional echocardiographic images provides an in vivo assessment of myocardial structure by the evaluation of the gray level distribution; with this technique, a relation between myocardial fibrosis and pathological ultrasonic response has been documented. The aim of this study was to evaluate the relation between ultrasonically assessed myocardial structure and age in a normal population. Seventy-eight subjects (47 men; mean age, 51 years; age range, 23-87 years) without apparent cardiovascular and systemic disease underwent conventional two-dimensional echocardiographic examinations. Still frames at end-diastole from apical four-chamber view were digitized and converted in matrices of 256 x 256 pixels. First-order statistical analysis was performed to describe a region of interest in the interventricular septum. The following parameters were studied: mean (gray level amplitude), standard deviation (overall contrast), uniformity (tonal organization), and entropy (tendency of gray levels to be spread). Myocardial structure was assessed in 75 of 78 subjects, divided into three groups: I, age 23-40 years; II, age 41-65 years; and III, > 65 years. Significant differences for all the parameters were found between the age groups. Age correlated directly with mean and entropy (r = 0.77 and 0.69, respectively) and inversely with uniformity (r = 0.70). Our results suggest that quantitative echocardiography can reveal age-related changes in myocardial structure that are characterized by a greater echogenicity and loss in tonal organization, possibly due to increased collagen content within the fibers.

[Estimation of the neurologic demand in a health care area of Madrid, Spain (area 11, University Hospital, 12 of October)]

OBJECTIVES

To analyse the demand for neurologic care and the neurological resources in a health district.

PATIENTS AND METHODS

Demographic, medical care aspects, neurologic care demands and neurological resources of the health district 11 of Madrid (University Hospital "12 de Octubre"), referred to 1996, were reviewed.

RESULTS

The rate of aging (17%) and the consulting rates in the National Health System (86%) versus private care were high in this health district. The neurologic care demands were 17.5-18.1 and 36 consultations respectively per 1,000 inhabitants/year. There were 2 patient-care neurologists and 3.7 neurologic beds per 100,000 inhabitants.

CONCLUSIONS

The neurologic care was considered high and with a tendency to increase. The available neurological resources were judged to be insufficient.

Safety of ergotamine-ergic pharmacologic stress echocardiography for vasospasm testing in the echo lab: 14 year experience on 478 tests in 464 patients

BACKGROUND

The safety of ergonovine/ergometrine stress testing for coronary vasospasm when performed outside the cath lab has vigorously been questioned. The aim of this study was to assess the value of ergonovine/ergometrine stress testing performed in the echo lab.

METHODS

We retrospectively reviewed the data prospectively collected in the echo lab of the Institute of Clinical Physiology of Pisa (Italy) from January 1, 1985, to October 1, 1998, on 478 tests performed on 464 patients with either ergonovine or ergometrine stress echo testing. By selection, all patients had history of chest pain, consistent with vasospastic angina, negative or ambiguous exercise stress testing, and normal or near normal resting left ventricular function. Ergonovine or ergometrine maleate was injected up to a total cumulative dosage of 0.35 mg, under continuous 12 lead ECG and two-dimensional echo monitoring.

RESULTS

There were no death, myocardial infarction, ventricular fibrillation or III degree atrioventricular block. One patient had non-sustained ventricular tachycardia associated with transient ST segment elevation 30 min after the test. Two patients had II degree atrioventricular block, associated with positive echocardiography test and promptly reversed by nitrate administration. Transient regional myocardial dysfunction occurred in 74 patients (15%). Limiting ischemia-independent side effects were present in 13 patients (3%): hypotension in 1, arterial hypertension in 5, nonsustained ventricular tachycardia in 2, and nausea/vomiting in 5. The overall feasibility was 97%.

CONCLUSIONS

Pharmacological stress echocardiography with either ergonovine or ergometrine is highly feasible and can be safely performed in the echo lab in properly selected patients in whom coronary vasospasm is suspected. It is often the only way to document coronary vasospasm otherwise missed by conventional noninvasive stress test and even by coronary angiography.

Release-depletion and receptor-mediated neuronal internalization of endogenous neurotensin in the stellate ganglion of the cat

The release and depletion of neurotensin in sympathetic preganglionic axon terminals and internalization in principal ganglion cells were investigated in the cat stellate ganglion by means of combined immunohistochemical staining, image analysis and confocal microscopy. Neurotensin stored in preganglionic boutons was released by 40 or 5 Hz electrical stimulation of preganglionic nerves, being depleted to 7.4 and 19.2% of control levels by continuous stimulation lasting 20 or 160 min (both stimuli delivered 48,000 pulses). Once released, neurotensin was internalized by the principal ganglion cells as evidenced by a ring of bright spot-like granules in the perinuclear region indicating the sites of intracellular neurotensin accumulation. Neurotensin internalization was time-dependent, thus, different content was found when the time between the end of stimulation and start of perfusion was varied. The onset of neurotensin internalization appeared in the first minutes, intracellular accumulation was evident at 20 min, maximal internalization occurred at 120 min and, 24 h later internalized neurotensin content had faded. Internalization was partially blocked by the nonpeptide neurotensin antagonist SR48692. These data provide evidence of presynaptic neurotensin release and depletion by electrical stimulation with varied frequencies. They also provide evidence for in situ receptor-mediated internalization of endogenously released neurotensin, raising the possibility that internalization may represent, in addition to some kind of turnover dynamics, an important part of the mechanisms of neuropeptide signaling.

Effects of some natural extracts on the acetylcholine release at the mouse neuromuscular junction

Natural extracts have been proved to be useful in different human pathological conditions. The scientific consideration of the therapeutic potential of plant extracts is still inappropriate due to the lack of both pharmacological and epidemiological basic studies. Here, we started from an electrophysiological point of view, a study on the effects of two extracts on the acetylcholine (ACh) release at the neuromuscular junction. The extracts purified from Sugar cane (policosanol) and Psidium guajava (quercetin) have been submitted to this study. The wide epidemiology of these agents suggests therapeutic potentials not yet well outlined at the basic level. Our data demonstrate some interactions in the modulation of the ACh release at the mouse neuro-muscular junction, which are well correlated with the suggested molecular mechanisms. Policosanol enhances to a small extent either the spontaneous or the evoked ACh release. Furthermore, an increase of the rate of the conformational change induced at the nicotinic receptor-channel complex by ACh is also observed. Quercetin induced a reduction of the ACh evoked release. The possibility that this effect could be ascribed to some interaction with presynaptic calcium channel is noteworthy. The results are discussed in terms of a possible interference with acetylcholinesterase by policosanol and of a presynaptic molecular action of quercetin modulating the cytosolic calcium concentration.

Effects of low ozone-oxygen concentrations on the acetylcholine release at the mouse neuromuscular junction

The use of a mixture of low concentrations of ozone (O3) with oxygen (O2) have been proved to be useful in different human pathological conditions. Owing to a lack of both pharmacological and epidemiological basic studies, the scientific consideration of this therapeutic potential is still inappropriate. Here, we started, from an electrophysiological point of view, a study on the possible effects of low O3 doses on the acetylcholine (ACh) release at the neuromuscular junction. Indeed, some experimental conditions indicate a positive effect either in maintaining cytosolic calcium (Ca2+) homeostasis or in increasing the efficacy of the intracellular antioxidant systems. Furthermore, a positive action on the kinetics of some antioxidant enzymes must be taken into account as a possible molecular mechanism in the regulation of the function of cellular homeostasis. Our data demonstrate a reduction of evoked ACh release in the mouse neuromuscular junction. O3 affects neither the spontaneous ACh release nor the kinetics of the ACh-receptor-channel complex. The results are compatible with a reduction of intracellular Ca2+ and proved a molecular action of O3.

Impaired sympathetic response before intradialytic hypotension: a study based on spectral analysis of heart rate and pressure variability

The purpose of this study was to evaluate the autonomic response to standard haemodialysis and the changes associated with the onset of intradialytic hypotension in 12 normotensive patients with uraemia. Power spectra of R-R interval and of blood pressure fluctuations were obtained during a standard dialysis session and estimated in the low-frequency (LF, 30-150 mHz) and high-frequency (HF, 150-400 mHz) range. The absolute power of the LF component of blood pressure variations and the LF/HF ratio of R-R interval were assumed as indexes of sympathetic activity. Standard haemodialysis induced hypotension in six patients (unstable) while a minor pressure decline was present in the other six (stable). Normalized blood volume before dialysis and percentage volume reduction were similar in the two groups. Tachycardia in response to pressure and volume decrease was more pronounced in stable than in unstable patients, as evidenced by a higher slope of the relation between R-R interval and systolic blood pressure (7.9 versus 0.9 ms/mmHg, P<0.01). Sympathetic tone was enhanced during early dialysis in all patients (+2+/-1 for R-R LF/HF ratio, +2.4+/-0.6 mmHg2 and +7.2+/-2 mmHg2 for absolute LF power of diastolic and of systolic blood pressure respectively, P<0.05), compared with baseline predialysis values. During late dialysis, unstable patients showed an impairment of sympathetic activation which preceded hypotension and was maximal during the crisis (-2.9+/-1.4 for R-R LF/HF ratio, -2.7+/-1.4 mmHg2 and -8.6+/-4.0 mmHg2 for absolute LF power of diastolic and of systolic blood pressure respectively, P<0.05). On the contrary, stable patients showed constantly elevated indexes (+3.7+/-1.4 for R-R LF/HF ratio, +5.9+/-2.7 mmHg2 and +13.3+/-6.2 mmHg2 for LF of diastolic and of systolic blood pressure, P<0.05). Values returned to predialysis levels after the end of the dialysis session in all patients. We conclude that standard haemodialysis activates a marked and reversible sympathetic response in both stable and unstable uraemic patients. However, in unstable patients, such activation is impaired in late dialysis, therefore contributing to the onset of the hypotensive crisis.