Re-designing the substrate binding pocket of laccase for enhanced oxidation of sinapic acid

Iterative saturation mutagenesis was performed over six residues delimiting the substrate binding pocket of a high redox potential chimeric laccase with the aim of enhancing its activity over sinapic acid, a lignin-related phenol of industrial interest.

The Bonfils fiberscope: a clinical evaluation of its learning curve and efficacy in difficult airway management

BACKGROUND

This study evaluated the use of the Bonfils fiberscope by analyzing its learning curve, efficacy and safety during airway management.

METHODS

This was a prospective observational study where five anesthetists, with differing levels of experience, were asked to use the Bonfils rigid fiberscope (Karl Storz) for a six-month period. They used the scope when performing endotracheal intubations in patients undergoing general anesthesia. The patients were excluded if various clinical indicators predicted that they might be difficult to intubate. The patient's head was kept in the neutral position to simulate the intubation of a trauma patient. Direct laryngoscopy with a Macintosh blade was performed to assign a Cormack and Lehane grade prior to attempting laryngoscopy with the Bonfils fiberscope. After intubating the patient with the Bonfils fiberscope, intubation time and any complications or failures noted after the procedure were recorded.

RESULTS

The study included 216 patients, three of which were failed intubations. No complications occurred during the study period. The median intubation time was 21.4 s. The learning curve improved significantly after 20 intubations (P<0.05) and was affected by the operator's experience and aptitude with endoscopic viewing. Seventeen patients were deemed to have "unpredicted" difficult airways: 15 subjects with a Cormack grade 3 (6.9%) and two subjects with a Cormack 4 (0.9%). Median time to intubation in subjects with a Cormack <3 was 16 s (95% CI=10-29 s), and in subjects with a Cormack ≥3, it was 15 s (CI 95%=15-18 s) with P=0.703.

CONCLUSION

The Bonfils fiberscope is an efficient, easy to use and safe device for endotracheal intubation.

Influence of patients' representations and beliefs about diabetes and its treatment on their adherence to therapy

Research in the last 25 years has shown that diabetic patients' adhesion to medical advice is a multi-factor phenomenon. Most recent research has focused on a patient-centred approach, on the representations that the patient has with respect to medicine, health and disease (with particular regard to the perceived self-efficiency in managing the disease, trust in conventional medicine, treatment, drugs, etc) and on the level of agreement between the patient's representations and those of the health care provider. These representations can potentially act as barriers/facilitators on patients' adhesion to treatment; the best adherence can only be obtained if the real needs of the patient are met, matching therapy with his/her representations and expectations, and acknowledging the constraints that everyday life puts on the individual. The indication is therefore to avoid exclusively considering the physical burdens of the disease, while ignoring the personal and social significance of the experience that the patient is having. It will take time for this to become routine in health care, since it requires a complex change from a traditional, bio-medical approach to an integrated bio-psycho-social approach. The aim of this review is to show how those disease representations of diabetes, and the treatment having considerable impact on patients' adhesion, are being considered in recent literature, and how this nonetheless still constitutes a little explored aspect in medical consultation and research.

Personality variables and compliance with insulin therapy in Type 2 diabetic subjects

Forty-five diabetic patients were studied to evaluate adaptation and coping strategies. The authors have also analysed personality traits mainly to study different behaviour in compliance conduct. The results revealed an important psychological dimension made up of difficulties in accepting insulin immediately, in fear of addiction and doubts about the therapy. On the basis of these results the sample was then divided into two subgroups, which were then tested and compared with the Adjective Check List. The subgroup that showed more fear, insecurity and initial resistance towards insulin therapy appeared to be more rigid and seemingly conforming. These people also revealed personality aspects compatible with the presence of passive-aggressive and avoidant traits.

Nutritional assessment in head injured patients through the study of rapid turnover visceral proteins

BACKGROUND & AIMS

Nutritional monitoring of rapid turnover visceral protein is important in the recognition of malnutrition in patients admitted to the Intensive Care Unit (ICU). We studied prealbumin and retinol-binding protein in patients who received three different kinds of artificial nutrition in order to evaluate the appropriateness of artificial nutrition.

METHODS

45 consecutive head injury patients received enteral (Group A), parenteral (Group B) or both enteral and parenteral nutrition (Group C) at random. We considered these parameters: prealbumin, retinol binding protein and nitrogen balance before (T1), after 3 (T2), 7 (T3) and 11 (T4) days after the beginning of study. Statistical analysis was performed with Kruskal-Wallis test and Bonferroni's t -test.

RESULTS

Plasma prealbumin and Retinol binding protein (RBP) showed an increasing of basal values during the study period in all groups (<< 0.0001) and more significantly in group A (Enteral nutrition P < 0. 001 vs Total parenteral nutrition (TPN) and Enteral P<< 0.01 vs Enteral and parenteral nutrition).

CONCLUSION

Data obtained in the present study indicate that a laboratory is essential for monitoring nutritional assessment and for checking the appropriateness of nutritional therapy. We found prealbumin to be the most sensitive measure and found it to be the test of choice for early assessment and intervention.

Histidine 179 mutants of GTP cyclohydrolase I catalyze the formation of 2-amino-5-formylamino-6-ribofuranosylamino-4(3H)-pyrimidinone triphosphate

GTP cyclohydrolase I catalyzes the conversion of GTP to dihydroneopterin triphosphate. The replacement of histidine 179 by other amino acids affords mutant enzymes that do not catalyze the formation of dihydroneopterin triphosphate. However, some of these mutant proteins catalyze the conversion of GTP to 2-amino-5-formylamino-6-ribofuranosylamino-4(3H)-pyrimidinone 5'-triphosphate as shown by multinuclear NMR analysis. The equilibrium constant for the reversible conversion of GTP to the ring-opened derivative is approximately 0.1. The wild-type enzyme converts the formylamino pyrimidine derivative to dihydroneopterin triphosphate; the rate is similar to that observed with GTP as substrate. The data support the conclusion that the formylamino pyrimidine derivative is an intermediate in the overall reaction catalyzed by GTP cyclohydrolase I.

[The psychological evaluation of patients with severe heart failure awaiting a heart transplant]

Because of the limitations resulting from the severity of heart failure, patients in the waiting list for cardiac transplantation often show a worsening in their social life. They usually present with psychological problems caused by symptoms, medical or surgical therapies and consequences on their own work. We have devised and utilized an experimental psychodiagnostic protocol to study the psychological characteristics of a sample of patients with heart failure (NYHA functional class III and IV) candidate to heart transplantation. Our study was particularly aimed at investigating the quality of life and the psychological mechanisms of adaptation. Findings show a strong attempt of denying the discomfort deriving from the disease and the expectation for transplant. Patients seem to have an adequate reaction to the illness and, otherwise, they feel anxiety and trouble that make very fragile their psychological adaptation. This behaviour is probably correlated with symptoms and the clinical history of heart failure, and does not match with a visible state of well-being that can be detected with a superficial analysis. Nevertheless patients have a good availability in receiving a psychological support from the whole medical staff (physicians, nurses): this suggests that the benefits deriving from a contemporary medical and psychological therapy are able to prevent the appearance of clear psychiatric symptoms. Additional studies involving larger samples of selected populations are needed to confirm the results of the present investigation.

[The influence of psychological factors on the patient's management of diabetes. Critical survey of psychodynamic models on personal management of diabetes]

The authors have examined the currently accepted methods to face a chronic disease like diabetes. The person affected by this illness should learn to accept his/her limits and find a new identity. The aim of technical and scientific medicine is to teach the patient how to cope with the disease. However, in spite of the progress of the scientific research in this field, diabetes remains a poorly treated disease. A review of the literature shows that there is a deep interaction between diabetes and psychological states. Psychological disorders like depression and anxiety might be associated with the origin of diabetes and can affect its course. It seems that emotional factors have a more important role than education in diabetes care. The psychological aspect becomes even more important during adolescence, as the chronic illness can affect the normal development of the teen-ager who will deny it to protect himself. If the patient does not collaborate, his behaviour may be unconsciously aggressive and destructive. Some patients can use diabetes as a tool to act out aggressive feelings against themselves or the environment. Diabetes bad management becomes then the expression of their destructive narcissism which prevents them from finding a new identity. The collaboration of medical and psychological operators should help these patients to find a new identity which includes diabetes as an integrating part of their personality and enables them to cope with it under the guidance of the diabetes team.

Blood contamination of amniotic fluid after amniocentesis in relation to placental location

The aim of the present study was to evaluate blood contamination of the amniotic fluid collected in 20 patients undergoing a second amniocentesis performed 2 weeks after a first procedure that had failed due to Pseudomonas aeruginosa contamination of the cell cultures. Red blood cell and haemoglobin concentrations in the amniotic fluid were significantly higher in patients who had undergone a transplacental procedure compared with patients in whom the placenta was not traversed with the needle. For both groups, blood contamination of the amniotic fluid was significantly higher compared with a control group of 20 patients undergoing amniocentesis for the first time. Significant blood contamination of the amniotic fluid after amniocentesis occurs in every instance if evaluated at a "second-look' procedure; the blood contamination is higher when an anterior placenta is traversed with the needle. The clinical significance of these findings needs to be further evaluated.

Transplacental amniocentesis: is it really a higher-risk procedure?

The aim of this study was to compare transplacental with non-transplacental amniocentesis in terms of related complications. Between January 1991 and December 1992, 4564 genetic amniocenteses were performed in 4527 patients (4491 singleton, 35 twin, and one triplet pregnancy) at 15-16 weeks of gestation. All the procedures were ultrasound-guided and performed by the same operator. In 1487 cases, an anterior placenta was traversed with the needle, whereas in 3077 cases, the needle was inserted directly into the amniotic cavity without traversing the placenta. After the exclusion of patients in whom amniotic cell culture failed or in whom an abnormal karyotype was obtained, and of patients lost to follow-up, a total of 4454 patients (98 per cent) were followed for 30 days after amniocentesis. Two spontaneous abortions occurred after a transplacental procedure, and five after a nontransplacental procedure (P = not significant). There were no episodes of amniotic fluid leakage in the first group, whereas 16 ruptures of the membranes that resolved spontaneously occurred in the second group (P < 0.01). Our data suggest that transplacental amniocentesis carries a similar abortive risk to and a lower risk of transient rupture of the membranes than non-transplacental amniocentesis and may therefore be preferred at the gestational period examined (15-16 weeks). However, the risk of feto-maternal haemorrhage, which is reported to be higher for a transplacental procedure, must be considered in the case of an anterior placenta.

[Recurrent organic abdominal pain. Psychosocial investigation]

This study has produced the following results. All the children with RAP show an excessive excitability and timidness, a strong insecurity and apprehension towards the society. The majority of the children show a strong dependence upon their relatives, they are not able to place themselves, as active subjects, in the present trality and to make plans for their future life (absence of interests and/or programmes about their autorealization). These children have a psychological maturity not corresponding to the physical one, even if there is no real strongly marked mental insufficiency. About 50% of the subjects have difficult relations with their siblings, friends and teachers, unlike the group examined (infact these difficulties are not seen).

Absorption, distribution, metabolism and excretion of 2-[2-thiophenecarboxythio]-N-[dihydro-2-(3H)-thiophenone-3-yl]-propiona mide in the rat

2-[2-Thiophenecarboxythio]-N-[dihydro-2-(3H)-thiophenone-3-y l]- propionamide (MR 889) was administered orally to rats in order to investigate its pharmacokinetics. 1-2 h after the administration, MR 889 was detected as unchanged compound in plasma only in traces whereas some catabolites, i.e. 2-thiophene carboxylic acid and its glycinate were detected with a tmax of 2 h. The thiolic component of MR 889 induced an evident and sustained increase of total sulfhydryl groups in plasma (tmax 2 h), tissues and urine. Relevant concentrations of 2-thiophene carboxylic acid were found in small intestine and gastric wall followed by liver, lungs and kidneys. The thiolic component also increased, mainly in liver and lungs followed by small intestine and gastric wall. Homocysteine thiolactone S-methyl thiolactamide was identified as a minor metabolite of MR 889.

Moclobemide compared with second-generation antidepressants in elderly people

Two multicentre studies are described here; the first compared moclobemide with mianserin and the second with maprotiline, both in elderly patients with a DSM-III diagnosis of major depressive episode. In the first study, 80 eligible patients were randomized to either moclobemide 300-500 mg or mianserin 75-125 mg per day for 4 weeks. Mean reduction in Hamilton Rating Scale for Depression (HRSD) score was 52% in both groups. The overall assessment of efficacy was good or very good for 60% of the patients, and tolerance was considered good or very good for 85% of the patients in both groups; no significant differences between the 2 treatments were seen. The second study comprised 39 hospitalized patients randomized to either moclobemide 150-300 mg daily or maprotiline 75-150 mg daily for 6 weeks. At the end of treatment, HRSD scores declined 85% in both groups compared with baseline. The overall assessment of efficacy was over 90% good or very good in both groups. Tolerance was rated good or very good for 80% of moclobemide and 75% of maprotiline patients; none of these results differed significantly between the groups, indicating that moclobemide is as effective in elderly patients as the 2 second-generation antidepressants. In view of the safety of moclobemide, it should be considered first-line therapy for depression in elderly people.

Ovarian development of the female child and adolescent: I. Morphology

Ovarian morphology of 180 randomly selected females, aged 8-21, was investigated, utilizing standard sector scanning ultrasound techniques, at -1 year (1 year before menarche), year 0 (menarche) and years +1 to +8 (1-8 years postmenarche). According to strict morphologic criteria, seven ovarian patterns were recognized which varied in dominance with age in reference to menarche. Prior to menarche a multifollicular ovarian pattern (Type 1) dominates which after menarche is substituted by a predominantly active ovarian pattern (Type 5). Approximately 20% of postmenarcheal females do not develop this active pattern. In a relatively persistent percentage of females a microcystic (Type 2) ovarian pattern was recognized throughout all postmenarcheal years, suggestive of a normal transitional pattern from Type 1 to Type 5 ovaries. In contrast, multicystic (Type 3), hyperthecosis (Type 4), polycystic ("Mickey Mouse") (Type 6) and silent (Type 7) ovaries appear to represent abnormal ovarian developments. Based on percentage distributions, it is tempting to speculate that multicystic (Type 3) and/or hyperthecosis (Type 4) ovaries represent precursor ovaries to Type 6 (polycystic) ovaries. Confirmation of this hypothesis would have major clinical importance for the early diagnosis of the polycystic ovarian syndrome.

[Trans-1-(4-phenylcyclohexyl)ethylamine derivatives with antidepressant activity. II]

Some derivatives of trans-1-(4-phenylcyclohexyl)ethylamine (A) with a substituent at position 4 of the phenyl group were prepared and tested for antireserpine activity on the CNS. All compounds showed reduced activity compared with that of (A) except the amino derivative (II) which proved more active but at the same time showed increased toxicity and other adverse effects on the CNS.

[Pyrrolidone and piperidone derivatives with antihistaminic and antianaphylactic activities. Synthesis and pharmacological study]

The preparation of several derivatives to oxatomide (A), with the benzimidazolinone moiety replaced by another heterocyclic residue is described. In some cases changes to the basic chain of (A) were also considered. All the new compounds were evaluated as antihistaminics (H1) and antianaphylactics. The derivatives where the heterocyclic moiety was an unsubstituted or phenylsubstituted 2-pyrrolidone or 2-piperidone residue showed antihistaminic and antianaphylactic activities similar to those of oxatomide while modification of the basic side chain with elimination of the benzhydryl group, gave a complete loss of activity. The pharmacological screening was completed by the evaluation of the barbiturate induced sleep prolongation and of acute toxicity.

The sonographic picture of endometrium in spontaneous and induced cycles

Ultrasonic volume evaluation of the endometrium was performed on 19 spontaneously ovulating and 48 ovulation-induced women and correlated to E2 and P values in peripheral blood. No statistical correlations were obtained between either hormone level and any of the sonographically obtained parameters except for E2 levels in reference to the anteroposterior diameter of the endometrium in stimulated cycles (R = 0.29; P less than 0.05). It is concluded that the sonographic evaluation of the endometrium does not contribute to the evaluation of either spontaneous or induced cycles.

[Methionine derivatives with liver protecting activity]

Some methionine derivatives with the amine group acylated with an aliphatic group bearing a free, esterified or etherified thiol group in the omega position were prepared and tested for protection against CCl4, paracetamol, ethyl alcohol and ethionine intoxication. Acid (XIV) (MG 28013) (Table I) and some of its alkyl derivatives (XVIII) (MG 28228) and (XIX) (MG 28226) proved to have significant activity in these tests. A more in-depth study on MG 28226 however indicated a slight intolerance when subacute toxicity was examined (90 gg).

A new method for the measurement of pre-ejection period in the human fetus

The pre-ejection period (PEP) of the cardiac cycle was measured in the human fetus using pulse Doppler in association with transabdominal ECG. The technique permitted the exact localization of the aortic valve, a good recording of its opening and the exact measurement of PEP. Between 32 and 42 weeks of pregnancy there is a strong correlation between PEP and gestational age. This new method seems to be an easy and reliable tool for measuring the PEP during intrauterine life.

[New derivatives of clofibrate and probucol. Preliminary study of their hypolipemic activity]

The preparation is reported of compounds with a free or esterified hydroxyisobutyric acid grouping characteristic of clofibrate, on various supporting molecules related to clofibrate itself or to probucol. Some compounds showed clear hypolipemic activity and for one compound (MG 6893) the effect was not accompanied by hepatomegalia.

[Synthesis and pharmacologic study of new esters of naproxen with derivatives of N-oxyethylpiperazine]

The preparation of naproxen esters with N,N'-dioxyethylpiperazine and derivatives of N-oxyethylpiperazine with various substituents on the nitrogen is described. Study of analgesic-antiinflammatory properties in comparison with a reference compounds has shown that in most of the new compounds analgesic activity (phenylquinone) is preserved whereas antiinflammatory activity (carrageenin) is generally reduced. The diester with N,N'-dioxyethylpiperazine (MG 28136) proved most interesting, showing clear pharmacological activity and very low toxicity.

[N-acylated derivatives of cyclohexylaniline with potential antiallergic and analgesic-antiinflammatory activity]

Some N-acylated derivatives of cyclohexylaniline were prepared. These can be considered as derived from oxarbazol (A), a carbazolic structure with antiallergic activity, by breaking the bond between carbon atom 4a and 4b. In the new molecule the following groups were introduced: benzoic acid, salicylic acid, acetylsalicylic acid and tetrazol. The synthesized compounds were studied for analgesic, antiedema and antiallergic activity. Some showed analgesic action (phenylquinone) comparable with that of naproxen. Antiinflammatory activity was slight and antiallergic activity nonexistent.

Fetal ossification centers as predictors of gestational age in normal and abnormal pregnancies

The main fetal ossification centers appear ultrasonically as egg-shaped echo-rich areas. The calcaneal and talar ossification centers are seen at the level of the tarsus osseus, and the distal femoral epiphyseal and proximal tibial epiphyseal ossification centers are found at the level of the knee. Examination of 312 normal pregnancies between 20 and 40 weeks of gestation showed that the calcaneal ossification center was detectable for 24 weeks of gestation, the talar ossification center from 26 weeks, and the distal femoral epiphyseal and proximal tibial epiphyseal ossification centers, from 32 and 36 weeks, respectively. Corresponding figures found for 36 pregnancies showing intrauterine growth retardation (IUGR), examined between 34 and 40 weeks of gestation, were similar for the calcaneal and talar ossification centers but showed delays in the development of the epiphyseal ossification centers, which were particularly striking in cases of symmetrical IUGR. The amniotic fluid lecithin/sphingomyelin ratio was also evaluated in 51 normal pregnancies between 31 and 38 weeks of gestation and was found to be greater than or equal to 2 in every case where the distal femoral epiphyseal ossification center was greater than or equal to 6 mm in diameter. Evaluation of fetal ossification centers may be another useful means to evaluate gestational age in late pregnancy

[Heterocyclic compounds with potential anti-inflammatory activity containing a 4-aminophenylalkanoic acid residue. V. Derivatives of 2,4-dihydro-3H-pyrazole-3-one]

The synthesis and pharmacological study of some derivatives of 2,4-dihydro-3H-pyrazol-3-one of general formula (I) are described. The compound in which R = C6H5 and R' = CH3 [2-(4- carboxymethylphenyl )-4-phenyl-5-methyl-2,4- dihydropyrazol -3-one] (MG 18949) proved to have antipyretic activity equal to that of ibuprofen and aminopyrine.

Nutritional studies on maltitol. Part 2: Effect on lipid metabolism and fatty acid composition of different rat tissues

This study has been designed to investigate the possible metabolic consequences of maltitol feeding (replacing 1/3 of the dietary carbohydrates) on the fatty acid composition in various body compartments of the rat. The detailed biochemical analysis of the lipid composition rules out the possible interference of this disaccharide on the lipid metabolism, at least with the dosage and duration of treatment used in the experiment.

[Derivatives of 4-phenylcyclohexylethylamine with antidepressive activity]

Several new derivatives of trans-1-(4-phenylcyclohexyl)-ethylamine (M.G. 6669) have been synthesized with various substituents at the alpha-carbon and/or at the amine nitrogen atom. All compounds were evaluated for a potential antidepressant activity taking M.G. 6669 as reference. They turned out to be less active than the reference substance. Pharmacological evaluation of M.G. 6669 itself was broadened during this work. The good antidepressant properties of this compound were confirmed, accompanied however by some toxic phenomena.

[Heterocyclic compounds containing the residue of a 4-aminophenylalkanoic acid with potential anti-inflammatory activity. IV. Derivatives of 2-phenyl-2H-indazole]

Numerous derivatives of 2-phenyl-2H-indazole were prepared. The compounds were of general formula I: where R is an acid, neutral or basic radical and R1, R2, R3 represent various functional groups, hydrogen atom or chlorine. The compounds were examined for analgesic-antiinflammatory properties and in some cases as inhibitors of platelets aggregation. Among the compounds where R is an alkanoic acid residue, the only compound showing interesting activity was M.G. 18755 [R = CH(CH3) COOH; R1, R2, R3 = H] and its lysine salt (M.G. 18334), which in various tests showed activity greater than that of ibuprofen. The homologous butyric derivative (M.G. 18860) showed a good anti-aggregatin activity.

[Heterocyclic compounds containing a 4-aminophenylalkanoic acid group with potential antiinflammatory activity. II. 2-Substituted morpholine derivatives]

Derivatives of 4-aminophenylalkanoic acids where the amino groups is part of a 3-morpholinone or a 2-morpholine ring, substituted in position 2 with a methyl, phenyl, 2-thienyl or (2-cyclohexyl)phenoxymethyl residue are described. Pharmacological evaluation aimed at evidencing analgesic and anti-inflammatory activity gave no noteworthy results.

[2-(2-Thienyl)morpholines with CNS activity]

The synthesis and pharmacological investigation of 2-(2-thienyl)morpholine and some of its derivatives substituted on the nitrogen are described. The non-substituted compound showed interesting antidepressive properties with a pharmacological profile similar to that of imipramine.

[Cyclohexylphenoxymorpholines with antidepressive activity]

A report is given of the synthesis and pharmacological investigation of some cyclohexylphenoxymethylmorpholines of general formula: Formula: (see text). The compound in which R = H and bearing the cyclohexyl group at the ortho position showed a pharmacological profile typical of drugs with antidepressant activity and was studied in detail in comparison with viloxazine and imipramine.

[Synthesis and pharmacological study of orciprenaline and salbutamol derivatives]

The effect of replacing the basic aliphatic residue of orciprenaline [(A); R = isopropylamino] and salbutamol [(B); R = tert.butylamino] with: a) a heterocyclic amine; b) a basic residue containing a phenylcyclohexane radical had been studied. The synthesis of the compounds is outlined. They were tested in vitro for relaxation of histamine-induced spasm of tracheal chains and on the isolated Langendorff heart, and in vivo according to the Konzett and Rössler technique and for their action on the cardiovascular system. In all tests the new derivataives were less active than the reference substances; the only exception was (A) where R = 4-phenylpiperidine (M.G. 6604), which was almost as active as orciprenaline in the Konzett and Rössler test, had one third of its activity on isolated trachea and showed absolutely no influence on heart rate in vitro or in vivo. Its effect was not inhibited by beta-blocking agents; it therefore showed an antihistaminic profile.