Angiography alone versus angiography plus intracoronary imaging to guide emergency percutaneous coronary intervention: outcomes from a single-centre retrospective analysis

Funding Acknowledgements

Type of funding sources: None.

Background

There is emerging evidence showing improvement in clinical outcomes with optical coherence tomography (OCT) and intravascular ultrasound (IVUS)-guided elective percutaneous coronary intervention (PCI). Yet data supporting their use in emergency setting are still conflicting.

Purpose

We aim to compare the immediate angiographic outcomes, short and long-term clinical outcomes in patients undergoing emergency PCI with intracoronary imaging to those with angiography guidance only.

Methods

We included 426 patients from May 2012 to December 2020 who presented with ST-elevation myocardial infarction (STEMI) and underwent emergency PCI within 24 hours of hospital admission. Intracoronary imaging was used in 196 of them to guide PCI. Immediate angiographic outcomes in terms of TIMI flow grade (TFG), myocardial blush grade (MBG) and corrected TIMI frame count (CTFC) are compared. Clinical outcomes including major adverse cardiac events (MACE), target vessel revascularization (TVR), hospitalization for heart failure and all-cause mortality were also compared.

Results

196 patients (46%) underwent intracoronary imaging-guided PCI. Use of imaging was associated with a higher post procedural CTFC (27.0 vs. 25.8, p=0.11), yet it failed to reach statistical significance. Comparing with angiography-guided PCI, imaging-guided PCI was associated with significantly larger proportion of high CTFC post procedure (slow coronary flow) (OR, 0.62; 95% CI: 0.38-1.0, P=0.05), and this result was consistent after adjustment of variables (adjusted OR, 0.57; 95% CI 0.34-0.98, P=0.04). Subjective measures of TIMI flow grade and MBG, however, were not different between the 2 groups. In the subgroup of patients with high Syntax score and American Heart Association (AHA)/American College of Cardiology (ACC) type C culprit lesion morphology, imaging guided PCI was associated with significantly worse post procedural MBG (OR, 0.36; 95% CI 0.17-0.78, P=0.01 vs. OR, 0.40; 95% CI 0.18-0.94, P=0.04), and the results were consistent after adjusting for variables. In the subgroup of patients with high Syntax score, imaging guided PCI was associated with significantly worse post procedural TIMI flow grade (adjusted OR, 0.35; 95% CI 0.12-0.95, P=0.05) and a trend towards higher CTFC (adjusted OR, 0.26; 95% CI: 0.06-0.94, P=0.05) after adjusting for variables. The cumulative incidences of all clinical outcome measures were not significantly different between the 2 groups before and after adjusting for confounders.

Conclusions

Imaging-guided PCI was not associated with improved angiographic or clinical outcomes in patients with STEMI who underwent emergency PCI. Use of intracoronary imaging in emergency PCI may associate with worse immediate angiographic outcomes.

Pulmonary pressure-to-longitudinal strain ratio by echocardiography: a rapid surrogate to magnetic resonance for right ventricular failure assessment

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): United Christian Hospital Ruttonjee and Tang Siu Kin Hospitals

Background

Better risk stratification in pulmonary hypertension (PH) by echocardiography (echo) to detect ventricular vascular uncoupling may act as gate-keeper for downstream management, such as MRI and expensive therapies. Studies showed modest correlation found between RV peak global longitudinal strain (RVGLS), which is afterload dependent, and right ventricular ejection fraction (RVEF)

Purpose

To test the accuracy and optimal cut-off of echo derived mean PA pressure-to-RVGLS ratio against MRI detected severe RV dysfunction (defined as RVEF< 35%), RV dilatation (defined as RVEDVi >87ml), and correlate native T1-values (nT1)

Method

Strain analyses by echo and volumetric assessment by 1.5 tesla MRI were performed in all patients. Contoured MRI short axis images provided RVEF. In a subgroup of pulmonary arterial hypertension (PAH), right heart catheterization and MRI non-contrast native T1 mapping were performed (Figure 1). Using previous study data, to identify a difference of 1.8 pressure-to-strain ratio between mild and severe PH with a variance  of 2.2 , power of 80% and a significance level of 0.05, a total of 11 participants per group were needed

Result

Thirty-one PH patients (13 female, age 60 ± 14y, 13 had PAH) were recruited prospectively. Strong correlation was demonstrated between the mean PA pressure-to-RVGLS ratio to MRI derived RVEF (r = 0.80, p < 0.01), and to catheterization derived pulmonary vascular resistance and indexed cardiac output (r = -0.80, p= 0.001; r= -0.75, p = 0.003 respectively). The cut-off value of -2.5 had best accuracy in ROC analyses (Table 1)

In PAH patients, this ratio correlated with global nT1 at basal short-axis level (r= -0.91, p = 0.004), but not at the mid short-axis level. Their basal posterior interventricular insertion regions had significantly higher nT1 than those of age-matched normal controls at the same region on the same scanner (1256 ± 217 ms vs. 932 ± 25 ms, p = 0.04)

Conclusion

In terms of detection of severe right ventricular dysfunction by echocardiography, mean PA pressure-to-RVGLS ratio performed better than RVGLS alone, and a ratio cutoff of -2.5 predicts MRI determined ventricular vascular uncoupling in pulmonary hypertension

Table 1 Echo detect MRI AUC standard error 95% CI sens (%) spec (%) p Mean PA pressure -to-RVGLS ratio RVEF < 35% 0.86 0.073 0.71-1.00 72 83 0.007 RVEDVi > 87ml 0.81 0.081 0.65-0.97 83 70 0.004 RVGLS RVEF < 35% 0.76 0.100 0.57-0.96 60 83 0.048 RVEDVi > 87ml 0.73 0.090 0.55-0.91 67 70 0.032 PA pulmonary artery; RVGLS: RV global longitudinal strain; RVEDVi: indexed RV end-diastolic volume Abstract Figure 1

Electroencephalography and delirium in the postoperative period

Delirium commonly manifests in the postoperative period as a clinical syndrome resulting from acute brain dysfunction or encephalopathy. Delirium is characterized by acute and often fluctuating changes in attention and cognition. Emergence delirium typically presents and resolves within minutes to hours after termination of general anaesthesia. Postoperative delirium hours to days after an invasive procedure can herald poor outcomes. Easily recognized when patients are hyperactive or agitated, delirium often evades diagnosis as it most frequently presents with hypoactivity and somnolence. EEG offers objective measurements to complement clinical assessment of this complex fluctuating disorder. Although EEG features of delirium in the postoperative period remain incompletely characterized, a shift of EEG power into low frequencies is a typical finding shared among encephalopathies that manifest with delirium. In aggregate, existing data suggest that serial or continuous EEG in the postoperative period facilitates monitoring of delirium development and severity and assists in detecting epileptic aetiologies. Future studies are needed to clarify the precise EEG features that can reliably predict or diagnose delirium in the postoperative period, and to provide mechanistic insights into this pathologically diverse neurological disorder.

Induction of muscle weakness by local inflammation: an experimental animal model

OBJECTIVE AND DESIGN

The objective of this study was to characterize the response of skeletal muscle to a localized inflammation induced by the inflammatory agent casein.

METHODS

An inflammatory agent, casein, was injected into the right hindlimb and saline was injected into the left hindlimb of normal adult mice, once daily for six consecutive days. Inflammatory response was monitored by immunohistochemical labeling of leukocytes. Muscle protein levels were determined by electrophoresis and muscle function was determined by isometric force measurements.

RESULTS

Local inflammation was induced by casein in association with the accumulation of extensive neutrophils and macrophages in the soleus muscle. This local inflammation resulted in a shift in myosin heavy chain (MHC) isoform expression and a significant reduction in total MHC concentration in the soleus. Maximal twitch and tetanic forces were significantly reduced in the inflamed soleus. Contractile function in soleus was fully restored after two weeks of recovery, along with the restoration of protein concentration and the disappearance of inflammatory cells.

CONCLUSION

This study establishes a unique and robust model in which mechanisms of local inflammation induced muscle protein degradation, reduction of contractile force, and subsequent recovery from this condition can be further studied.

Localized inflammation in peripheral tissue signals the CNS for sickness response in the absence of interleukin-1 and cyclooxygenase-2 in the blood and brain

The CNS can be activated by both local and systemic inflammation, resulting in the manifestation of sickness symptoms. The pathways by which the CNS is activated under these two conditions, however, may differ. In this study, we injected casein into the peritoneal cavity (i.p.) or into an s.c. air pouch of mice to induce restricted local inflammation. Both routes of casein injection caused fever and reduced locomotor activity. These responses were not accompanied by the statistically significant induction of the inflammatory cytokine interleukin-1 (IL-1) in the blood and brain. Further, these responses were produced without the induction of brain cyclooxygenase-2 (COX-2), which has been implicated as an obligatory step in systemic inflammation-induced activation of the CNS. Induction of IL-1, interleukin-6 (IL-6), and COX-2, however, was found consistently at the sites of casein injection. The local inflammation-induced febrile and locomotor activity responses were blunted in animals deficient in functional Toll-like receptor 4 (TLR4), type I interleukin-1 receptor (IL-1R1), IL-6, or COX-2. Therefore, the observed febrile and locomotor activity effects appear to require local, but not central, IL-1, IL-6, and COX-2. These findings suggest that local inflammation can activate the CNS via pathways distinguishable from those mediating systemic inflammation-induced CNS activation.

Phenotypic measurements and various indices of lean and fat tissue development in barrows and gilts of two genetic lines from twenty to one hundred twenty-five kilograms of body weight1,2

Two genetic lines with different lean gains were evaluated for various body measurements and indices of lean tissue in barrows and gilts from 20 to 125 kg of BW. One genetic line was identified as the low-lean line [280 g of fat-free lean (FFL)/d], and the second line was the high-lean line (375 FFL gained/d). The experiment was conducted as a completely randomized design using a 2 x 2 x 5 factorial arrangement of treatments in 6 replicates (n = 120 pigs). The 2 genetic lines and sexes were provided ad libitum access to cornsoybean mixtures that met or exceeded their required amino acid requirements for their respective lean gain potentials. Six pigs of each sex and genetic line were slaughtered initially and at 25-kg of BW intervals to 125 kg of BW. Pigs slaughtered were measured for height, width, and length using metal calipers. Backfat and LM area were measured using real-time ultrasound, with backfat depth also measured using A-mode ultrasound technology. Longissimus muscle area and back-fat thickness at the 10th rib were measured on the chilled carcass. Data was analyzed using the MIXED procedure of SAS, with the animal as the experimental unit. Shoulders (P < 0.05) and lumbars (P < 0.05) were wider in the low-lean genetic line and in barrows. Gilts and the high-lean genetic line had less backfat and greater LM areas than the low-lean genetic line. As BW increased, there was a greater increase in FFL tissue and lower backfat depths in the high-lean vs. the low-lean genetic line. This resulted in a greater divergence of measurement values as BW increased. Femur weight, length, and cortical wall thickness were greater in the high-lean genetic line, but the differences were not significant. The high-lean genetic line had a greater (P < 0.01) organic matrix content in the femur and less ash, resulting in a lower percentage of bone ash (P < 0.01). The results indicate that differences occurred phenotypically between pigs having more muscle (wider hams) or more fat (wider shoulder and lumbar). As BW increased, the high-lean pigs had an increase in lean tissue, particularly after 75 kg of BW, and less backfat and less bone mineralization, whereas the low-lean line pigs had increased backfat and greater bone mineralization. Real-time ultrasound measurements using various formulas to estimate lean tissue produced values close to those determined from carcass measurements at 100 and 125 kg of BW.

Tissue weights and body composition of two genetic lines of barrows and gilts from twenty to one hundred twenty-five kilograms of body weight1,2

Barrows and gilts of 2 genetic lines with differing lean gain potentials (high-lean = 375 g of fat-free lean/d; low-lean = 280 g of fat-free lean/d) were used to determine tissue and organ weights and compositions from 20 to 125 kg of BW. The experiment was a 2 (genetic line) x 2 (sex) x 5 (BW) factorial arrangement of treatments in a completely randomized design conducted with 2 groups of pigs in 6 replicates (n = 120 pigs). Six pigs from each sex and genetic line were slaughtered at 20 kg of BW and at 25 kg of BW intervals to 125 kg of BW. At slaughter, the internal tissues and organs were weighed. Loin and ham muscles were dissected from the carcass and trimmed of skin and external fat, and the ham was deboned. Residuals from the loin and ham were combined with the remaining carcass. Body components were ground, and their compositions were determined. The results demonstrated that tissue weights increased (P < 0.01) as BW increased. Loin and ham muscle weights increased but at a greater rate in the high-lean line and in gilts resulting in genetic line x BW and sex x BW interactions (P < 0.01). Liver and heart expressed on a BW or a percentage of empty BW basis increased at a greater rate in the high-lean line resulting in a genetic line x BW interaction (P < 0.01). Liver and intestinal tract weights were heavier in barrows than in gilts, significant only at 45 (P < 0.05), 75 (P < 0.01), and 100 (P < 0.05) kg of BW. Loin and ham muscles from the high-lean genetic line and gilts had greater (P < 0.01) water, protein, and ash contents compared with the low-lean genetic line and barrows resulting in genetic line x BW and sex x BW interactions (P < 0.01). The remaining carcass (minus loin and ham muscles) had greater (P < 0.01) amounts of water and protein, and less (P < 0.01) fat in the high-lean genetic line and gilts. The high-lean genetic line and gilts had more total body water, protein, and ash, but less body fat, with these differences diverging as BW increased, resulting in a genetic line x BW interaction (P < 0.01). The results indicated that liver and heart weights were greater in high-lean pigs, reflecting the greater amino acid metabolism, whereas the liver and intestinal tract weights were greater in barrow than gilts, reflecting their greater feed intakes and metabolism of total nutrients consumed.

Peripheral injection of lipopolysaccharide prevents brain recruitment of leukocytes induced by central injection of interleukin-1

I.c.v. injection of interleukin-1beta induces infiltration of leukocytes into the brain. I.p. injection of bacterial endotoxin lipopolysaccharide induces the expression of interleukin-1 in the CNS without causing the entry of leukocytes into the brain. This suggests that during systemic inflammation trafficking of potentially damaging leukocytes into the CNS is inhibited. In this study, we investigated the effects of peripheral injection of lipopolysaccharide on brain leukocyte recruitment induced by i.c.v.-interleukin-1 in mice. I.c.v.-interleukin-1 induced widespread infiltration of leukocytes into the brain 16 h after the injection. Pretreatment with i.p.-lipopolysaccharide 2 h before the i.c.v. interleukin-1 injection completely blocked interleukin-1-induced leukocyte infiltration, whereas i.p.-LPS only attenuated the effect of interleukin-1 if it was given 12 h before i.c.v. interleukin-1 injection. I.p.-lipopolysaccharide given 24 h before i.c.v. interleukin-1 injection did not alter interleukin-1 induced leukocyte infiltration. I.c.v.-interleukin-1 induced expression of p- and e-selectins in brain vasculatures prior to the appearance of leukocytes in the brain parenchyma. Induction of p- and e-selectin was inhibited by the pretreatment of i.p.-lipopolysaccharide 2 h, but not 24 h, before i.c.v.-interleukin-1 injection. I.c.v.-interleukin-1-induced leukocyte infiltration was diminished in both e- and p- selectin knockout animals. These results suggest that systemic inflammation actively inhibits recruitment of leukocytes by CNS. Inhibition of the expression of p- and e-selectins is a mechanism by which peripheral inflammation regulate CNS leukocyte recruitment.

DEVELOPMENTAL ASPECTS AND FACTORS INFLUENCING THE SYNTHESIS AND STATUS OF ASCORBIC ACID IN THE PIG

Ascorbic acid synthesis in the pig occurs at mid-pregnancy, but activity of the enzyme l-gulono-gamma-lactone oxidase (GLO) declines thereafter during gestation and remains low when the pig nurses the sow. During late gestation the ascorbic acid concentration in the fetus increases, but serum and liver ascorbic acid concentration in the sow declines without affecting the dam's liver GLO activity. It is presumed that as gestation progresses an increased amount of maternal ascorbic acid is transferred to the fetus and to the mammary gland. Colostrum and milk are rich sources of the vitamin and supply the nursing pig with ascorbic acid. The available data suggest that high amounts of ascorbic acid appear to suppress liver GLO activity in the pig. Upon weaning, when exogenous vitamin C is generally not provided, liver GLO activity and serum ascorbic acid increases. During the initial periods postweaning, some reports have indicated growth benefits of supplemental vitamin C. Body tissues differ in their concentrations of ascorbic acid, but tissues of high metabolic need generally have greater concentrations. The corpus luteum in the female, the testis in the male, and the adrenal glands in all pigs contain greater concentrations of the vitamin. Knockout genes preventing ascorbic acid synthesis in pigs have demonstrated poor skeletal and collagen formation and poor antioxidant protection. Under periods of stress ascorbic acid declines in the adrenal, but the pig rapidly recovers to its resting state once the stressor agent is removed. Although there are periods when supplemental vitamin C has been shown to promote pig performance (e.g., during high environmental stress and early postweaning), supplemental vitamin C has not been shown to routinely enhance pig performance.

Pre-exercise oral creatine ingestion does not improve prolonged intermittent sprint exercise in humans

BACKGROUND

This investigation determined whether pre-exercise oral Cr ingestion could enhance prolonged intermittent sprint exercise performance.

METHODS

EXPERIMENTAL DESIGN

a randomised, double-blind crossover design was employed.

SETTING

testing was performed at the Western Australian Institute of Sport and participants were monitored and treated by both scientific and medical personnel.

PARTICIPANTS

eight active, but not well-trained males with a background in multiple-sprint based sports acted as subjects for this investigation.

INTERVENTIONS

subjects ingested either 15 g Cr.H2O or placebo 120 min and 60 min prior to the start of an 80-min maximal sprint cycling task (10 sets of multiple 6-sec sprints with varying active recoveries). Subjects were retested 14 days later, being required to ingest the alternate supplement and repeat the exercise test.

MEASURES

performance variables (work done and peak power) were obtained throughout the exercise challenge. Muscle biopsies (vastus lateralis) were raised to a peak of 2348+/-223 micromol x l(-1) prior to the commencement of exercise after Cr ingestion. There were no significant changes in any cycling performance parameters following Cr ingestion, although blood La- was significantly lower (p<0.05) than placebo at all time points during were taken preexercise as well as immediately and 3 min post-exercise in order to determine concentrations of ATP, PCr, Cr, La- and glycogen. Venous blood was drawn prior to and on four occasions during the exercise test, and analysed for Cr, NH3+, La- and pH.

RESULTS

Serum Cr concentrations exercise, and plasma NH3+ accumulation was also significantly reduced (p<0.05) in the Cr condition, but only in the second half of the 80-min exercise test. Muscle ATP and TCr levels as well as postexercise PCr replenishment were unaffected following Cr administration.

CONCLUSIONS

The data suggest that although the pre-exercise ingestion of a large Cr dose was shown to have some impact on blood borne metabolites, it does not improve maximal prolonged intermittent sprint exercise performance, possibly due to an insufficient time allowed for uptake of serum Cr by skeletal muscle to occur. Therefore, this form of loading does not provide an alternative method of Cr supplementation to the traditional five-day supplementation regimes established by previous research.

Evaluating the antioxidant status of weanling pigs fed dietary vitamins A and E

Two experiments evaluated the relationship of vitamin E (source and level) and vitamin A (level) on the apparent absorption and retention of both vitamins in weaned pigs. Both experiments used a combined total of 460 crossbred pigs ([Yorkshire x Landrace] x Duroc), housed in elevated 1.2- x 1.2-m crates containing five pigs per pen. Experiment 1 was a 2 x 2 x 2 factorial arrangement of treatments in a randomized complete block design conducted in seven replicates. Levels of vitamin A (2,200 or 13,200 IU/kg), vitamin E (15 or 90 IU/kg), and two vitamin E sources (D-alpha-tocopheryl acetate [D-TAc] or DL-alpha-tocopheryl acetate [DL-TAc]) were evaluated over a 35-d period. Vitamin A or E levels and the two vitamin E sources did not affect pig performances to 20 kg BW. Serum retinol and alpha-tocopherol concentrations increased (P < 0.01) as the dietary level of each vitamin increased. Serum alpha-tocopherol declined as dietary vitamin E level increased when vitamin A level increased resulting in an interaction (P < 0.05). Serum alpha-tocopherol concentrations were higher (P < 0.05) at 35-d postweaning when D-TAc was the vitamin E source. Experiment 2 was a 3 x 2 factorial arrangement of treatments conducted in six replicates. Three levels of vitamin A (2,200, 13,200, or 26,400 IU/ kg) and two sources of vitamin E (D-TAc or DL-TAc) each provided at 40 IU/kg diet were evaluated over a 35-d period. Pig performances to 35-d postweaning were not affected by the dietary variables. Serum alpha-tocopherol (P < 0.01) and retinol (P < 0.05) concentrations increased as their respective vitamin level increased. Serum (P < 0.05) and liver (P < 0.01) alpha-tocopherol concentrations both declined as dietary vitamin A levels increased resulting in interaction responses. Serum alpha-tocopherol concentration was higher (P < 0.05) at 35-d postweaning when d-TAc was the vitamin E source. Dietary vitamin E sources had no effect on serum or liver retinol concentrations. These results demonstrated that both supplemental vitamin A and vitamin E increased in the blood as their dietary levels increased. However, as dietary vitamin A level increased, serum and liver alpha-tocopherol concentrations declined, suggesting a reduced absorption and retention of alpha-tocopherol when weaned pigs were fed high dietary vitamin A levels.

Effect of Vitamin C and E supplementation on biochemical and ultrastructural indices of muscle damage after a 21 km run

This study investigated whether 4 weeks of daily supplementation with 500 or 1000 mg of Vitamin C and 500 or 1000 IU of Vitamin E could modify biochemical and ultrastructural indices of muscle damage following a 21 km run. Fifteen experienced male distance runners were divided into two groups (vitamin or placebo) and received supplementation for four weeks before completing the first 21 km run in as fast a time as possible. A four-week "washout" period followed before the subjects crossed over and received the alternate supplement for the next four weeks. They then completed a second 21 km run. Before, immediately after and 24 h after each run venous blood samples were taken and analysed for serum creatine kinase, myoglobin, malondialdehyde and vitamin C and E (before-samples only) concentrations. A subgroup of six subjects also had muscle biopsy (gastrocnemius) samples taken 24 h before and 24 h after each 21 km run, which were later analysed by electron microscopy. The two dosages of supplementation produced similar results, so a single vitamin group was formed for further analysis of results. Significant increases (p < 0.05) in creatine kinase and myoglobin, but not in malondialdehyde, were found post-run in both groups. However, no significant differences were found between the vitamin and placebo groups for creatine kinase, myoglobin and malondialdehyde concentrations recorded after the 21 km runs. A qualitative ultrastructural examination of pre-run muscle samples revealed changes consistent with endurance training, but little further change was seen after the 21 km run in either the vitamin or placebo groups. It was concluded that vitamin C and E supplementation (500 or 1000 mg or IU per day) for four weeks does not reduce either biochemical or ultrastructural indices of muscle damage in experienced runners after a half marathon.

Synthesis of a new hollandite-type manganese oxide with framework and interstitial Cr(III)

Hollandite with Cr(III) in both tunnel and framework sites has been prepared hydrothermally from layered manganese oxide precursors.

Liver L-gulonolactone oxidase activity and tissue ascorbic acid concentrations in nursing pigs and the effect of various weaning ages

In Experiment 1, we evaluated liver L-gulono-gamma-lactone oxidase (GLO) activity and tissue concentration of ascorbic acid in young pigs from birth to weaning (14 d) and through a 28-d postweaning period; in Experiment 2, we evaluated the effect of three weaning ages on these measurements. Sow colostrum and milk collected in both experiments demonstrated a linear decline (P < 0.01) in ascorbic acid concentration as lactation progressed. In Experiment 1, three pigs were killed at 0, 3, 7, 14, 21, 28, 35 and 42 d of age for determining liver GLO activity and serum and tissue ascorbic acid. Liver GLO activity decreased by 80% from 0 to 3 d of age and remained low until d 14 (weaning). After weaning, liver GLO activity increased linearly (P < 0.01). Tissue ascorbic acid concentrations decreased during the nursing period and again after weaning, but then increased to 42 d of age (P < 0.01). In Experiment 2, pigs were weaned at 10, 17 or 24 d of age. Three pigs from each group were killed at weaning and at each week postweaning until 38 d of age. Liver GLO activity was low during the nursing period but increased linearly (P < 0.01) for each group during the subsequent postweaning period. Pig serum and tissue ascorbic acid concentrations increased postweaning in each group. These results suggest that a factor in sow's milk, possibly ascorbic acid, suppressed liver GLO activity of nursing pigs but upon weaning, liver GLO activity of pigs increased in a linear manner (P < 0.01).

Ascorbic acid synthesis in fetal and neonatal pigs and in pregnant and postpartum sows

The ontogeny of ascorbic acid synthesis and its concentration in fetal pigs from mid- to late gestation, and the effect of birth order and premature or normal delivery ages were evaluated. In Experiment 1, fetal pigs were collected from three sows at 60, 80, 100, 107 and 111 d of development. Liver L-gulono-gamma-lactone oxidase (GLO) activity and ascorbic acid concentration were measured. High liver GLO activity in fetal liver occurred at 60 d but declined as pregnancy advanced (P < 0.01), whereas ascorbic acid concentration increased (P < 0.01). Experiment 2 evaluated ascorbic acid synthesis and concentration in neonates born early (1st and 2nd) or late (7th and 8th) in the birthing sequence, or when born 2 d prematurely vs. the normal delivery age. Pigs born early in the birthing sequence (P < 0.01) and those born at the natural delivery age (P < 0.05) had higher liver ascorbic acid concentrations, but liver GLO activity did not differ among groups. Sows were killed at each period; liver GLO activity was constant during gestation but increased postpartum (P < 0.01). Liver ascorbic acid concentration was constant during gestation, except for a decline during late gestation, and increased postpartum (P < 0.05). These results suggest that more ascorbic acid was transferred from the dam to the fetuses as pregnancy advanced, possibly suppressing fetal GLO activity. Thus, fetal liver GLO activity was the primary source of ascorbic acid during early fetal development, but more fetal ascorbic acid was transferred from the dam during later pregnancy.

Effect of creatine loading on long-term sprint exercise performance and metabolism

PURPOSE

This study examined whether creatine (Cr) supplementation could enhance long-term repeated-sprint exercise performance of approximately 80 min in duration.

METHODS

Fourteen active, but not well-trained, male subjects initially performed 10 sets of either 5 or 6 x 6 s maximal bike sprints, with varying recoveries (24, 54, or 84 s between sprints) over a period of 80 min. Work done (kJ) and peak power (W) were recorded for each sprint, and venous blood was collected preexercise and on four occasions during the exercise challenge. Muscle biopsies (vastus lateralis) were obtained preexercise as well as 0 min and 3 min postexercise. Subjects were then administered either 20 g.d-1 Cr.H2O (N = 7) or placebo (N = 7) for 5 d. Urine samples were collected for each 24 h of the supplementation period. Subjects were then retested using the same procedures as in test 1.

RESULTS

Total work done increased significantly (P < 0.05) from 251.7 +/- 18.4 kJ presupplementation to 266.9 +/- 19.3 kJ (6% increase) after Cr ingestion. No change was observed for the placebo group (254.0 +/- 10.4 kJ to 252.3 +/- 9.3 kJ). Work done also improved significantly (P < 0.05) during 6 x 6 s sets with 54-s and 84-s recoveries and approached significance (P = 0.052) in 5 x 6 s sets with 24-s recovery in the Cr condition. Peak power was significantly increased (P < 0.05) in all types of exercise sets after Cr loading. No differences were observed for any performance variables in the placebo group. Resting muscle Cr and PCr concentrations were significantly elevated (P < 0.05) after 5 d of Cr supplementation (Cr: 48.9%; PCr: 12.5%). Phosphocreatine levels were also significantly higher (P < 0.05) immediately and 3 min after the completion of exercise in the Cr condition.

CONCLUSION

The results of this study indicate that Cr ingestion (20 g.day-1 x 5 d) improved exercise performance during 80 min of repeated-sprint exercise, possibly due to an increased TCr store and improved PCr replenishment rate.

Carbohydrate-deficient transferrin as a marker of change in alcohol intake in men drinking 20 to 60 g of alcohol per day

We evaluated carbohydrate-deficient transferrin (CDT) and gamma-glutamyltranspeptidase (gamma-GT) as markers of alcohol intake and change in alcohol intake in white Australian men aged 20 to 63 years who regularly drank 20 to 60 g of alcohol/day (2 to 6 standard drinks), either as weekend (n = 14) or daily drinkers (n = 41). After 4 weeks of familiarization on usual alcohol intake, men were provided with low alcohol beer (24 x 375 ml cans, 0.9%, v/v, two-weekly), and, for 4 weeks, consumed as much or as little as they wished with no additional alcohol permitted. In an alternate 4-week period, the same amount of full-strength beer (4.9%, v/v) was provided, whereas subjects continued their usual amount and pattern of alcohol consumption. The order of experimental conditions was randomized. Retrospective 7-day diaries documented weekly alcohol intake during 4 weeks of familiarization and 8 weeks of intervention. Mean alcohol intake was 345 g/week of alcohol (SD 97) during familiarization. During the last 4 weeks of intervention (study weeks 8 to 12), mean alcohol intake either increased by 360 g/week (SD 138) with the switch from low to high alcohol or decreased by 328 g/week (SD 120) with the reverse. During familiarization (study weeks 1 to 4), alcohol intake was significantly related independently (R2 = 0.21) to mean corpuscular volume (p = 0.008) and uric acid (p = 0.003), but not to gamma-GT (p = 0.22) nor CDT (p = 0.94). Change in alcohol intake was predicted independently (R2 = 0.60) by change in CDT (p < 0.0001) and gamma-GT (p = 0.0003), but not by change in uric acid or mean corpuscular volume. A 10% change in CDT gave 70% sensitivity and 80% specificity to detect a change of at least 2 standard drinks/day; respective values were 68% and 0 for 10% change in gamma-GT. Results were not related to drinking pattern, smoking, age, or weight. CDT, particularly when used as a continuous variable, may have a place in monitoring alcohol consumption, even in men whose alcohol intake is in the 20 to 60 g/day range.

Biochemical and ultrastructural indices of muscle damage after a twenty-one kilometre run

Increased serum concentrations of intracellular proteins are generally accepted as good indicators of muscle damage. The mechanism of this damage is, however, poorly understood. Twenty male runners completed a 21 km run in as fast a time as possible. Blood samples were obtained from each subject just prior to, immediately after, and 24 hr after the run. Samples were analysed for haemoglobin, haematocrit, creatine kinase (CK), myoglobin (Mb) and malondialdehyde (MDA) concentrations and corrected for percentage change in plasma volume (PV). Percutaneous muscle biopsies were taken from the lateral gastrocnemius muscle of 6 of the subjects 24 hr before and 24 hr after the run and examined by electron microscopy. Mb levels in the serum increased significantly (p < 0.001) immediately post-exercise, while CK levels increased significantly (p < 0.001) at 24 hours post-exercise. The PV corrected serum MDA levels were very close (p = 0.06) to a significant increase immediately post-exercise. Ultrastructural examination of pre-exercise samples revealed evidence of muscle changes consistent with endurance exercise training, but no further damage was evident at 24 hr post-exercise. It is thus suggested that the increased serum levels of CK and Mb after the 21 km run may be a result of free radical induced cell membrane damage and increased permeability, as evidenced by elevated serum MDA levels, and not due to mechanical muscle damage.

Cardiac troponin I should replace CKMB for the diagnosis of acute myocardial infarction

Cardiac troponin I (cTnI) has been reported to be a highly specific marker for cardiac injury. We investigated the performance of this assay in patients admitted to a coronary care unit for suspected acute myocardial infarction (AMI), patients with extensive skeletal muscle damage, marathon runners and as a routine diagnostic test over a four week period. cTnI proved to be as sensitive a marker for AMI as creatine kinase/MB isoenzyme (CKMB) in patients admitted to the coronary care unit. In 10 patients with a proven AMI, the cTnI remained elevated from 69 to 183 h with a median time of 127 h. Cardiac troponin I had superior specificity to CKMB in patients with skeletal muscle damage. It was very useful in these patients to confirm or exclude concurrent myocardial damage. In routine diagnostic use, cTnI had greater efficiency than CKMB to classify patients as having an AMI. Consequently cTnI should replace CKMB as a marker for AMI.

Detection of Chlamydia trachomatis and Neisseria gonorrhoeae by ligase chain reaction-based assays with clinical specimens from various sites: implications for diagnostic testing and screening

Ligase chain reaction (LCR)-based tests for the diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae infections in men and women attending a sexually transmitted disease clinic were evaluated. LCR testing of urethral swab and urine specimens from men and cervical swab and urine specimens from women was compared with culture of male urethral swabs and female cervical and urethral swabs, respectively. An expanded "gold standard" was defined as a positive culture or at least one specimen confirmed to be positive by LCR testing. The prevalence of C. trachomatis infection as detected by cell culture was 7.0% among 614 men and 5.0% among 602 women. By LCR, these values increased to 11.4 and 9.9% with urethral swabs and urine, respectively, for men and 9.6 and 9.1% with cervical swabs and urine, respectively, for women. Relative to the expanded gold standard, the sensitivity of cell culture with male urethral swabs or female cervical swabs was 57.3 and 45.5%, respectively, compared with corresponding values of 93.3 and 87.9% for LCR. The sensitivity of LCR with urine specimens was 77.3 and 78.8% for men and women, respectively. The prevalence of N. gonorrhoeae infection as detected by culture was 5.9% among 220 men and 2.9% among 383 women. The corresponding values were 8.2 and 5.5%, respectively, by LCR testing of swabs. Prevalence values by LCR testing of urine were 7.3% for men and 2.9% for women. The sensitivity of culture was 72.2% for men and 50.0% for women. The sensitivities of LCR were 100% with male urethral swabs, 95.4% with female cervical swabs, 88.9% with male urine, and 50.0% with female urine. These results indicate that the LCR-based assays represent a major improvement in C. trachomatis and N. gonorrhoeae diagnostics. The sensitivity of testing of urethral or cervical swabs by LCR was markedly greater than that by culture. The sensitivity of testing female or male urine specimens was equal to or greater than that of culturing cervical or urethral specimens. LCR testing of urine specimens may prove useful for screening for C. trachomatis.

Ligase chain reaction for detection of Neisseria gonorrhoeae in urogenital swabs

The ligase chain reaction (LCR) is an in vitro nucleic acid amplification technique that exponentially amplifies targeted DNA sequences. In a multicenter study, we evaluated the use of a 4-h LCR-based assay for the diagnosis of Neisseria gonorrhoeae infection of the cervix and male urethra. The LCR results were compared with those of culture for N. gonorrhoeae by using selective media. This assay amplifies target sequences within the N. gonorrhoeae opacity gene. Discordant LCR-positive and culture-negative specimens were further evaluated by testing by another LCR assay which used N. gonorrhoeae-specific pilin probe sets. A total of 1,539 female endocervical specimens and 808 male urethral swab specimens were evaluated in the study. An expanded "gold standard" was defined to include all culture-positive as well as culture-negative, confirmed LCR-positive specimens. After resolution of discrepant samples, the sensitivities of the N. gonorrhoeae LCR assays for the female and male specimens were 97.3 and 98.5%, respectively, with specificities of 99.6 and 99.8%, respectively. Resolved culture sensitivities were 83.9 and 96.5% for the female and male specimens, respectively. The LCR assay for gonorrhea is a rapid, highly sensitive nonculture method for detecting gonococcal infection of the cervix and male urethra.

Tyrosine phosphorylation during synapse formation between identified leech neurons

1. We have examined whether tyrosine phosphorylation is required for synapse formation between identified neurons from the central nervous system of the leech in culture. 2. Within a few hours of contact with the cell body of the serotonergic Retzius neuron (R cell), the soma of the postsynaptic pressure-sensitive neuron (P cell), but not the R cell, could be labelled intracellularly with an antibody against phosphotyrosine residues. The labelling seemed specific for P cells contacted by R cells, as it was greatly reduced in pairs of either R or P cells and in single cells. Genistein (20 microM) and lavendustin A (10 microM), selective inhibitors of tyrosine kinases, blocked the labelling of contacted P cells, whereas their ineffective analogues (genistein and lavendustin B) had no effect on labelling. 3. R cell contact also induced the loss of an extrasynaptic, depolarizing response (due to modulation of cation channels) to serotonin (5-HT) in the P cell within a few days of juxtaposing cell bodies and within an hour of contact with growth cones. Treatment of the neurons with the tyrosine kinase inhibitors (but not the ineffective analogues) prevented the loss of the depolarizing response and of single cation channel modulation by 5-HT. 4. R cells formed inhibitory, Cl(-)-dependent synapses with P cells. Synapse formation was prevented by the tyrosine kinase inhibitors but not by their ineffective analogues. These compounds had no obvious effect on neurite outgrowth or cell adhesion. We conclude that tyrosine phosphorylation is a signal during the formation of this synapse.

Evaluation of ligase chain reaction for use with urine for identification of Neisseria gonorrhoeae in females attending a sexually transmitted disease clinic

The high sensitivity of nucleic acid amplification tests such as ligase chain reaction (LCR) has the potential to simplify specimen collection for the microbiologic diagnosis of gonorrhea. We screened first-void urine specimens from 283 women attending a Birmingham, Ala., sexually transmitted disease (STD) clinic by using LCR and compared the results to those of cervical and urethral cultures for gonorrhea diagnosis. Fifty-three (18.7%) women had positive cervical cultures for gonorrhea, and 41 of the 53 (77%) also had positive urethral cultures. One additional patient had only a positive urethral culture (the cervical gonorrhea culture was negative). LCR testing of urine specimens for gonorrhea yielded positive results for 51 of 54 (94.4%) women with positive cervical or urethral cultures. Of 229 women with both urethral and cervical cultures negative for gonorrhea, 2 (0.8%) had positive urine LCR results as well. To resolve the discrepancies between urine LCR and culture results, LCR tests of simultaneously collected urethral and cervical swab specimens and LCR tests of the same urine specimens using different nucleotide primers were conducted. After evaluation of five discrepant results, the sensitivity, specificity, positive predictive value, and negative predictive value of LCR for the detection of gonorrhea in urine specimens were 94.6%, 100%, 100%, and 98.7%, respectively. We conclude that urine LCR testing for Neisseria gonorrhoeae is a practical alternative to culture for the detection of gonorrhea in women. Urine testing for STD diagnosis has the potential to simplify and expand the opportunities for STD screening and surveillance of women.

Deletion detection in the dystrophin gene by multiplex gap ligase chain reaction and immunochromatographic strip technology

The purpose of this study is to demonstrate the value of a multiplex amplification and readout system. The validation was done using as a model system the detection of deletions in nine possible dystrophin exons: 4, 8, 12, 17, 19, 44, 45, 48, and 51. The amplification system was gap ligase chain reaction, adapted to amplify selected regions of multiple exons simultaneously. The amplified products were read out with an immunochromatographic methodology, adapted from that used in the Abbott product line commercialized under the name Test Pack Plus. In each amplification, the beta-globin gene was incorporated and served as a procedural control. The complete process takes < 3 hr from DNA sample to result. The procedure is therefore rapid and simple, as well as being potentially very cost effective. The combination of these two technologies is shown to be a useful tool for the determination of deletions in the nine exons of the dystrophin gene. The results of a 100-patient sample study showed concordance with cDNA and PCR in current use. Equivalent performance at two sites was shown.

Selection of transmitter responses at sites of neurite contact during synapse formation between identified leech neurons

1. Pressure sensitive (P) neurons of the leech Hirudo medicinalis show both an inhibitory, Cl(-)-dependent response and a depolarizing, cationic response to pipette application of serotonin (5-HT). Serotonergic Retzius (R) neurons in culture reform inhibitory, Cl(-)-dependent synapses with P neurons but fail to elicit the extrasynaptic, depolarizing response to 5-HT. We have examined the localization of the selection of 5-HT responses by testing the sensitivity of P cell growth cones and neurites to 5-HT application. 2. As measured by intracellular recording at the P cell soma, synaptic release of 5-HT from R cell processes activated only the Cl(-)-dependent response in P cell neurites. Focal application of 5-HT from a micropipette depolarized uncontacted P cell growth cones and neurites. In contrast, processes from the same P cells that were contacted by R cells were rarely depolarized by 5-HT application unless the application pipette was moved along the neurites away from the sites of contact. 3. The channels underlying the depolarizing response to 5-HT were identified in patch clamp recordings from P cell growth cones. These cation channels showed rare, brief openings in the absence of 5-HT. Application of 5-HT in the bath (outside the patch pipette) increased channel activity in uncontacted P cell growth cones but not in growth cones of the same P cells contacted by R cells. 4. We conclude that the selection of transmitter responses during synapse formation was localized to discrete sites of contact between the synaptic partners.

One-step competitive immunochromatographic assay for semiquantitative determination of lipoprotein(a) in plasma

Numerous studies have associated high concentrations of lipoprotein(a) [Lp(a)] with atherosclerosis. We developed a rapid, one-step competitive immunochromatographic assay to measure Lp(a) in plasma. The assay is performed on a nitrocellulose membrane strip and the result is determined by a visual readout of rust-colored colloidal selenium. The assay is based on the principle that Lp(a) in the sample will compete with Lp(a)-coated colloidal selenium for binding to the anti-Lp(a) monoclonal antibody immobilized on the assay strip in the format of four ladder bars. The number of capture bars that appear as a result of the formation of colloidal selenium color is proportional to the concentration of the Lp(a) protein in the samples. The strip assay semiquantitatively measures Lp(a) concentrations ranging from 0 to 180 mg/L of Lp(a) protein in serum, plasma, or fingerstick whole-blood samples. This assay appears very useful for quick identification of individuals with above-normal concentrations of plasma Lp(a) protein (> 70 mg/L), and has potential for monitoring a patient's response to treatment with Lp(a)-lowering drugs.

One-step competitive immunochromatographic assay for semiquantitative determination of lipoprotein(a) in plasma

Numerous studies have associated high concentrations of lipoprotein(a) [Lp(a)] with atherosclerosis. We developed a rapid, one-step competitive immunochromatographic assay to measure Lp(a) in plasma. The assay is performed on a nitrocellulose membrane strip and the result is determined by a visual readout of rust-colored colloidal selenium. The assay is based on the principle that Lp(a) in the sample will compete with Lp(a)-coated colloidal selenium for binding to the anti-Lp(a) monoclonal antibody immobilized on the assay strip in the format of four ladder bars. The number of capture bars that appear as a result of the formation of colloidal selenium color is proportional to the concentration of the Lp(a) protein in the samples. The strip assay semiquantitatively measures Lp(a) concentrations ranging from 0 to 180 mg/L of Lp(a) protein in serum, plasma, or fingerstick whole-blood samples. This assay appears very useful for quick identification of individuals with above-normal concentrations of plasma Lp(a) protein (&gt; 70 mg/L), and has potential for monitoring a patient's response to treatment with Lp(a)-lowering drugs.

Transferrin index: an alternative method for calculating the iron saturation of transferrin

We surveyed 140 clinical chemistry laboratories in Australia to establish which laboratory methods they used to determine serum iron status: 125 measured serum iron (Fe), 85 measured transferrin (TRF), 47 measured total iron-binding capacity (TIBC), and 14 measured both TRF and TIBC. Of the 55 laboratories routinely reporting TRF saturation (TS), 16 calculated TS directly as (Fe/TIBC) x 100, and 9 used [Fe/(TRF x 2)] x 100. Thirty laboratories measured TRF and converted it to an equivalent TIBC concentration; the derived TIBC was then used to calculate TS. We measured iron, TIBC, and TRF concentrations in 94 control subjects, 59 patients with alcoholic liver disease (ALD), and 20 with proven genetic hemochromatosis (GH). TS was compared with a transferrin index (TI = Fe/TRF) to determine whether both methods were sensitive for GH screening and which method gave the fewest false-positive results with discrimination limits of > 55% and > 1.0, respectively. All GH patients were detected by both TS and TI at these limits. One control subject had a TI > 1.0, whereas three control subjects had a TS > 55%. Nine patients with ALD had a TI > 1.0 and 11 ALD patients had a TS > 55%. Some iron-overload patients had lower than expected TS values compared with TI, possibly because of ferritin interference in the TIBC assay. Also, the precision of the TRF assay was better than that of the TIBC assay: CVs of 1.85-3.68% vs 6.17%. We therefore recommend that calculated TI replace TS in screening for iron overload.

Transferrin Index: An Alternative Method for Calculating the Iron Saturation of Transferrin

We surveyed 140 clinical chemistry laboratories in Australia to establish which laboratory methods they used to determine serum iron status: 125 measured serum iron (Fe), 85 measured transferrin (TRF), 47 measured total iron-binding capacity (TIBC), and 14 measured both TRF and TIBC. Of the 55 laboratories routinely reporting TRF saturation (TS), 16 calculated TS directly as (Fe/TIBC) x 100, and 9 used [Fe/(TRF x 2)] x 100. Thirty laboratories measured TRF and converted it to an equivalent TIBC concentration; the derived TIBC was then used to calculate TS. We measured iron, TIBC, and TRF concentrations in 94 control subjects, 59 patients with alcoholic liver disease (ALD), and 20 with proven genetic hemochromatosis (GH). TS was compared with a transferrin index (TI = Fe/TRF) to determine whether both methods were sensitive for GH screening and which method gave the fewest false-positive results with discrimination limits of &gt; 55% and &gt; 1.0, respectively. All GH patients were detected by both TS and TI at these limits. One control subject had a TI &gt; 1.0, whereas three control subjects had a TS &gt; 55%. Nine patients with ALD had a TI &gt; 1.0 and 11 ALD patients had a TS &gt; 55%. Some iron-overload patients had lower than expected TS values compared with TI, possibly because of ferritin interference in the TIBC assay. Also, the precision of the TRF assay was better than that of the TIBC assay: CVs of 1.85-3.68% vs 6.17%. We therefore recommend that calculated TI replace TS in screening for iron overload.

Exercise parameters for the prediction of post-training increase in exercise tolerance in patient with stable angina pectoris

Twenty cases with effort angina underwent exercise training for a mean follow-up period of 38 weeks. Various parameters were investigated to clarify whether or not such parameters can be used to predict an increase in exercise tolerance of patients with effort angina. The increase of exercise tolerance after training was found to be related to a reduction of the myocardial oxygen demand at a given external work load. The maximal heart rate (max HR) the maximal systolic blood pressure (max SBP) and the maximal rate-pressure product (max RPP) could not predict the post-training increase in exercise tolerance. Before training, the maximal oxygen intake (VO2max) was found to be lower, and the HR/VO2max and the SBP/VO2max were higher in the group (11 patients) which showed a good response to the exercise program (effective group) than those in the group (9 patients) which did not (unchanged group). Before training, the HR/VO2max and the SBP/VO2max in the effective group were also higher than those of 96 healthy adults. On the other hand, the HR/VO2max and the SBP/VO2max in the unchanged group were not different from those of the healthy adults throughout the training. It is useful to compare the values of the HR/VO2max and the SBP/VO2max of patients with effort angina to those of healthy adults for the prediction of post-training increase in exercise tolerance.