Association of hepatic steatosis with subclinical cardiac dysfunction in asymptomatic people with type 2 diabetes

Introduction

Non-alcoholic fatty liver disease is highly prevalent among people with type 2 diabetes (T2D) and is an emerging risk factor for heart failure with preserved ejection fraction (HFpEF). Whether excess liver adiposity is simply a marker of the coexisting adverse cardiometabolic risk profile or independently contributes to the development of HFpEF is unclear.

Purpose

To assess the association between liver fat fraction and subclinical cardiac dysfunction in adults with T2D.

Methods

Prospective cross-sectional study. Two-hundred and thirty-eight adults with T2D (mean age 63±7 years, 62% males, HbA1c 7.2±1.5%, diabetes duration 10±8 years) with no signs, symptoms, or evidence of cardiovascular disease and 40 age-, sex-, and ethnicity-matched non-diabetic controls (mean age 61±8 years, 63% males, HbA1c 5.2±1.2%) underwent comprehensive phenotyping with echocardiography and multiparametric cardiac MRI including adenosine stress and rest perfusion. Volumetric liver fat fraction (VLFF) was measured using a histologically validated, proprietary MRI technique blinded to all participant details. Inter-study reproducibility was assessed in participants (n=28) who underwent a repeat MRI within two weeks. Linear regression analysis was performed to assess any independent associations between VLFF and identified markers of subclinical cardiac dysfunction in subjects with T2D.

Results

People with T2D had evidence of concentric left ventricular (LV) remodelling (higher LV mass/volume), extracellular matrix expansion (higher ECV fraction), both systolic and diastolic dysfunction (lower global longitudinal systolic strain and E/A ratio, respectively), and coronary microvascular dysfunction (lower myocardial perfusion reserve) (Table 1). VLFF demonstrated excellent inter-study reproducibility with an intra-class correlation coefficient (ICC) of 0.988 (0.974–0.994). T2Ds had higher VLFF compared to controls [7.5 (3.8–13.7)% vs 2.9 (1.7–4.7)%, p<0.001]. In multivariable regression analysis adjusting for age, sex, ethnicity, body mass index, ambulatory systolic blood pressure, HbA1c, and low-density lipoprotein, VLFF (β=−0.161, p=0.027) was independently associated with E/A, but not other imaging measures of subclinical cardiac dysfunction.

Conclusion

Liver fat fraction is elevated in people with T2D and is independently associated with early LV diastolic dysfunction. These results add to the growing evidence that ectopic fat plays an important role in the pathogenesis of HFpEF and may be a potential target for intervention.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health Research (NIHR) United Kingdom through a Research Professorship award (RP-2017-08-ST2-007).British Heart Foundation through a Clinical Research Training Fellowship (FS/16/47/32190).

Retraction Note to: miR-200 Regulates Epithelial-Mesenchymal Transition in Anaplastic Thyroid Cancer via EGF/EGFR Signaling

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

The role of regulatory T cells during Plasmodium chabaudi chabaudi AS infection in BALB/c mice

An inappropriate immune response to parasite infection is one of the primary drivers of malaria pathogenesis. Regulatory T cells (Tregs), an important subset of CD4(+) T cells, can maintain self-tolerance and prevent autoimmune diseases. However, there is little consensus about their role in malaria pathogenesis. In this study, we transiently depleted Tregs (CD25(+) T cells) using an anti-CD25 mAb (7D4 clone) at different time points following Plasmodium chabaudi chabaudi AS infection in BALB/c mice and investigated the effect of depletion of Tregs in this model. In control mice, Tregs proliferated significantly and their suppressive function was enhanced after infection. IL-10 was increased drastically during infection. Depletion of Tregs at various time points can lead to divergent outcomes. When Tregs were depleted prior to or during the early phase of infection, most mice survived and had a robust Th1 immune response. In contrast, when Tregs were depleted close to peak parasitemia, all mice died as a result of inflammation. Taken together, these data suggest that in P. c. chabaudi AS-infected BALB/c mice, Tregs inhibit the Th1 response and macrophage activation, leading to increased parasite load; however, they also control inflammation-mediated pathology by secreting high levels of IL-10.

[Correlation between urinary sediment spectra and pathological patterns of renal biopsies]

OBJECTIVE

To investigate the clinical value of urinary sediment analysis, a non-invasive diagnostic means, in the evaluation of pathological patterns of renal diseases.

METHODS

A total of 1 140 pairs of matched renal biopsies and fresh fasting morning urine specimens were collected from hospitalized patients in Peking University First Hospital. Their urinary sediments were examined with phase-contrast microscopy; the 24 h urine proteins were measured. Based on urinary sediment features combined with urine protein amount, the spectra of the urine sediments were classified into four types, Type I: hematuria-dominant, with multiple cells and casts; Type II: proteinuria-dominant, with hyaline or fine-granular casts but scanty cells; Type III: renal tubular epithelial cell(RTEC)-dominant, minor proteinuria; Type IV: non-specificurine sediments,minor proteinuria. According to the pathological lesions detected in renal biopsies, the renal diseases were classified into three patterns: proliferative glomerulopathy(P-GP), non-proliferative glomerulopathy (NP-GP) and tubulointerstitial nephropathy(TIN). The urinary sediment spectra of different pathological patterns and the correlation between urinary sediment types and pathological patterns were analyzed. Statistical analyses were performed using kappa test, and χ(2) test, and significance was accepted at P<0.05.

RESULTS

(1) Of the 840 cases of matched urine samples and renal biopsies, 419 cases were diagnosed with P-GP; 375 cases with NP-GP; 46 cases with TIN respectively. (2) The spectra of urine sediments were associated with pathological patterns of the renal biopsies, and 84.0% of the patients with P-GP manifested type I urine sediments; 93.1% of the patients with NP-GP had type II urine sediments; 67.4% of the patients with TIN had type III urine sediments. (3) The correlation between the urinary sediment types and renal pathological patterns was validated in an additional 300 matched samples. The positive predictive values of urinary sediment spectra in predicting renal pathological lesions were 84.8% for typeI to P-GP, 86.0% for type II to NP-GP and 73.7% for type III to TIN, respectively.

CONCLUSION

As a non-invasive diagnostic means, the urinary sediment analysis is valuable in the evaluation of pathological patterns of renal diseases.

A comparative study of the iron status of patients with oesophageal adenocarcinoma to determine suitability for a clinical trial of iron chelation therapy

INTRODUCTION

The incidence of oesophageal adenocarcinoma (OAC) is rising dramatically and overall survival remains extremely poor. Iron has been shown to potentiate tumourigenesis in OAC, and iron chelation therapy demonstrates promise in vivo as an adjunct to neoadjuvant and palliative chemotherapy. OAC, however, has traditionally been associated with iron deficiency anaemia. The aim of this study was therefore to formally quantify the iron status of OAC patients in order to guide the design of future clinical trials involving iron chelation therapy.

METHODS

Demographic and cancer specific data were collected prospectively from all patients presenting with OAC and gastric adenocarcinoma (GAC). Patients had haemoglobin, serum iron, serum ferritin and serum transferrin receptor (sTfR) levels measured to assess systemic iron status. In addition, the sTfR/log ferritin (sTfR-F) index was calculated.

RESULTS

Average haemoglobin, serum iron, serum ferritin, sTfR and sTfR-F index values for all patients presenting with OAC were within normal sex specific reference ranges. No statistical difference in iron status was observed between OAC patients presenting with resectable and advanced OAC. Patients with OAC are relatively iron replete compared with those presenting with GAC. Iron parameters were not significantly altered by standard neoadjuvant chemotherapy.

CONCLUSIONS

Patients presenting with resectable or advanced OAC could be considered as candidates for a clinical trial of iron chelation therapy as an addition to standard neoadjuvant or palliative treatments.

Low expression of Mfn2 is associated with mitochondrial damage and apoptosis in the placental villi of early unexplained miscarriage

INTRODUCTION

Early miscarriage is the most common complication of pregnancy and in many cases the etiology is not clearly understood. We aim to profile the expression of Mfn2 and mitochondrial damage in villous tissues, in order to determine the underlying mechanism of unexplained miscarriage.

METHODS

We investigated placental villous samples of 30 women with early unexplained miscarriage (miscarriage group) and 30 women with normal pregnancy (control group). Immunohistochemistry and western blotting were used to detect the Mfn2 expression. We observed trophoblastic cell apoptosis with TUNEL and analyzed Bcl-2 and Bax levels by western blotting. Transmission electron microscopy was used to analyze mitochondrial morphology and phosphomolybdic acid colorimetric method was used to measure the ATP content of all villous samples.

RESULTS

Mfn2 staining showed extra-nuclear localization in the trophoblastic cells. Compared with the control group, the levels of Mfn2 and Bcl-2 were markedly decreased (P < 0.01), while both the levels of Bax protein and apoptosis index (AI) were increased in the miscarriage group (P < 0.01). Mfn2 levels positively correlated with Bcl-2, but negatively correlated with Bax. Moreover, compared to the control group (33.8 ± 6.5 μmol/g), ATP levels in the miscarriage group were significantly decreased (15.8 ± 4.8 μmol/g). In addition, obvious impairment of mitochondrial function was observed in trophoblastic cells from the unexplained miscarriage group.

CONCLUSION

Mitochondrial morphologic and functional changes were observed in trophoblastic cells, and in relation with apoptosis, may be correlated with low levels of Mfn2. Deficient expression of Mfn2 in trophoblastic cells could be an important cause of early miscarriage.

Homocysteine levels and cognitive function scores measured with MMSE and BCAT of middle-aged and elderly subjects in Tianjin City

OBJECTIVE

China is proceeding into the aging society. There are near 6 million elderly suffering senile dementia,while cognitive impairment is an important clinical feature in dementia. The factors involved in cognitive dysfunction in the middle-aged and the elderly persons were investigated.

DESIGN

Cross-sectional study.

SETTING

Community dwellers and nursing home residents in Tianjin, China.

SUBJECTS

Total of 662 subjects(284 men and 378 women) aged 55-93.

METHODS

A designed questionnaire was used to collect their demographic data, information of disease and medication, and life style. Mini-mental state examination (MMSE) and Basic Cognitive Aptitude Tests (BCAT) software were applied to evaluate their cognitive function. Serum total homocysteine (tHcy) level was quantified by enzyme conversion method. A multiple linear stepwise regression analysis was applied to find the influencing factors of cognitive function.

RESULTS

The average serum tHcy concentrations was 15.95±7.29 μmol/L, while the prevalence of hyperhomocysteinemia (HHE) was 45.4%. The average serum tHcy level and prevalence of HHE were higher in men than those in women after ruling out the age differences. The mean MMSE and BCAT scores were 26.74±2.71 and 50.26±18.84 respectively. The BCAT score was negatively correlated with age and positively correlated with education. Multiple linear stepwise regression equations showed that the P value was less than 0.001, the BCAT regression equation showed that the R2=0.453. Serum tHcy concentration was negatively correlated with total scores of BCAT, digit copy, Chinese character comparison, mental arithmetic, Chinese character rotation and recall answer of mental arithmetic test. Total scores of BCAT were negatively correlated with education, inhabitancy, serum tHcy concentration and age. In addition, Chinese character rotation was correlated with tea consumption. Remembrance and recognition of dual words and nonsense figures was correlated with income level.

CONCLUSIONS

Hyperhomocysteinemia is associated with cognitive impairment in the middle-aged and the elderly persons in Tianjin. The BCAT scores could well represent the detailed cognitive function in elderly and negatively correlate with age, but positively correlated with education level. Serum tHcy concentration was negatively correlated with total BCAT scores.

Comparison of Water Displacement and WinRHIZO Software for Plant Root Parameter Assessment

Water-displacement and WinRHIZO root-scanning methods were compared for efficacy of root damage assessment. Results from both methods were similar and a highly significant relationship was found between the two methods in trial one (r² = 0.9968, P < 0.0001) and trial two (r² = 0.9988, P < 0.0001). Both protocols provide consistent root volume measurements; however, water displacement is preferred as an economical method if a quick evaluation of a large amount of roots is essential. For a more detailed root morphological and architectural analysis, WinRHIZO root scanning provides additional information about several root parameters that cannot be measured by simple water displacement.

Bone marrow-derived B cells preserve ventricular function after acute myocardial infarction

OBJECTIVES

In view of evidence that mature cells play a role in modulating the stem cell niche and thereby stem cell potential and proliferation, we hypothesized that a mature bone marrow (BM) mononuclear cell (MNC) infusion subfraction may have particular potency in promoting hematopoietic or resident stem cell-induced cardiac repair post-infarction.

BACKGROUND

Treatment of acute myocardial infarction (MI) with BM MNC infusion has shown promise for improving patient outcomes. However, clinical data are conflicting, and demonstrate modest improvements. BM MNCs consist of different subpopulations including stem cells, progenitors, and differentiated leukocytes.

METHODS

Stem cells (c-kit+) and subsets of mature cells including myeloid lineage, B and T-cells were isolated from bone marrow harvested from isogeneic donor rats. Recipient rats had baseline echocardiography then coronary artery ligation; 1 x 10(6) cells (enriched subpopulations or combinations of subpopulations of BM MNC) or saline was injected into ischemic and ischemic border zones. Cell subpopulations were either injected fresh or after overnight culture. After 2 weeks, animals underwent follow-up echocardiography. Cardiac tissue was assayed for cardiomyocyte proliferation and apoptosis.

RESULTS

Fractional ventricular diameter shortening was significantly improved compared with saline (38 +/- 3.2%) when B cells alone were injected fresh (44 +/- 3.0%, p = 0.035), or after overnight culture (51 +/- 2.9%, p < 0.001), or after culture with c-kit+ cells (44 +/- 2.4%, p = 0.062). B cells reduced apoptosis at 48 h after injection compared with control cells (5.7 +/- 1.2% vs. 12.6 +/- 2.0%, p = 0.005).

CONCLUSIONS

Intramyocardial injection of B cells into early post-ischemic myocardium preserved cardiac function by cardiomyocyte salvage. Other BM MNC subtypes were either ineffective or suppressed cardioprotection conferred by an enriched B cell population.

Safety of intramyocardial injection of autologous bone marrow cells to treat myocardial ischemia in pigs

OBJECTIVE

The purpose of this study is to determine the potential adverse consequences of intracardiac injections of bone marrow mononuclear cells (BMCs) to facilitate the revascularization of ischemic myocardium.

BACKGROUND

Bone marrow mononuclear cells are used to treat heart failure, though there are few studies that evaluated the safety of BMC transplantation for chronic myocardial ischemia.

METHODS

The pigs received coronary ameroid constrictors to induce chronic myocardial ischemia and left ventricular dysfunction. At 4 weeks, autologous BMCs were injected intramyocardially by Boston Scientific Stiletto catheter with low-dose (10(7) cells) or high-dose BMC (10(8)). Control animals received saline. Blood samples were collected for hematological and chemical indices, including cardiac enzyme levels at regular time intervals postinfarction. At 7 weeks, animals underwent electrophysiological study to evaluate the arrhythmic potential of transplanted BMC, followed by necropsy and histopathology.

RESULTS

No mortalities were associated with intramyocardial delivery of BMC or saline. At Day 0, the total creatine phosphokinase (CPK) was in the normal range in all groups. All groups had significant elevations in CPK after ameroid placement, with no significant differences between groups. At 7 weeks, CPK in all groups had returned to pretreatment levels. Electrophysiological assessment revealed that one control animal had an inducible arrhythmia. No arrhythmias were induced in low- or high-dose BMC-treated pigs. There were no histopathological changes associated with BMC injection.

CONCLUSION

This study showed, in a clinically relevant large-animal model, that catheter-based intramyocardial injection of autologous BMC into ischemic myocardium is safe.

Characterization of primitive marrow CD34+ cells that persist after a sublethal dose of total body irradiation

Knowledge of the molecular events that occur during hematopoietic stem/progenitor cell (HSPC) development is vital to our understanding of blood cell production. To study the functional groups of genes characteristic of HSPCs we isolated a subpopulation of CD34+ bone marrow (BM) cells from nonhuman primates that persisted in vivo after a sublethal dose of total body irradiation (TBI). CD34+ cells isolated during the phase of maximal hematopoietic suppression show a transcriptional profile characteristic of metabolically inactive cells, with strong coordinate downregulation of a large number of genes required for protein production and processing. Consistent with this profile, these CD34+ cells were not able to generate hematopoietic colonies. Transcriptional profiling of these CD34+ cells in conjunction with a pathway analysis method reveals several classes of functionally related genes that are upregulated in comparison to the CD34+ cells obtained prior to TBI. These families included genes known to be associated with self-renewal and maintenance of HSPCs (including bone morphogenetic proteins), resistance to apoptosis (Bcl-2) as well as genes characteristic of a variety of nonhematopoietic tissues (gamma-aminobutyric acid/glycine receptor, complement receptor C1qRp). In contrast, during the period of hematopoietic recovery, the CD34+ cells expressed higher level of genes encoding factors regulating maturation and differentiation of HSPCs. Our data indicate that the primitive BM CD34+ cell population that persists after radiation possesses a transcriptional profile suggestive of pluripotency.

Studies of the route of administration and role of conditioning with radiation on unrelated allogeneic mismatched mesenchymal stem cell engraftment in a nonhuman primate model

OBJECTIVE

The aim of this study was to examine the effects of the route of administration [intrabone marrow (IBM) vs intravenous (IV)] and the role of conditioning with irradiation in optimizing mesenchymal stem cell (MSC) transplantation.

MATERIALS AND METHODS

To determine if irradiation resulted in depletion of colony-forming unit fibroblasts (CFU-F), which might favor the engraftment of donor MSC, the number of CFU-Fs was assayed from animals receiving either hemibody irradiation (HBI) or total body irradiation (TBI).

RESULTS

TBI resulted in a marked reduction of CFU-F numbers that spontaneously resolved, whereas animals receiving HBI did not experience depletion of CFU-F. Animals receiving MSC grafts by the IV route had higher numbers of marrow CFU-F. MSC were transduced using retroviral vectors encoding the neomycin resistance gene (Neo(R)) and a second gene encoding either the human soluble tumor necrosis factor receptor (hsTNFRII) or beta-galactosidase (beta-Gal). MSCs were administered by either the IV or IBM route to animals receiving HBI. The Neo(R) transgene was detectable in hematopoietic tissues of all animals and nonhematopoietic tissues in a single animal. Evidence of transgene expression was documented by detection of beta-Gal(+) cells in BM smears and transiently elevated serum levels of hsTNFRII.

CONCLUSION

These studies indicate that 1) MSC possess the ability to engraft and persist in an unrelated mismatched allogeneic hosts; 2) 250-cGy HBI did not favor engraftment of MSC; 3) the IBM route was not more effective than the IV route in delivering MSC grafts; and 4) transplanted MSC preferentially localized to the marrow rather than nonhematopoietic tissues.

Comparative study of stromal cell lines derived from embryonic, fetal, and postnatal mouse blood-forming tissues

OBJECTIVE

To better understand the differentiation of stromal cells of the hematopoietic microenvironment, we set out to characterize stromal cells from the different developmental sites of hematopoiesis in the mouse (30 bone marrow, 7 spleen, 3 embryonic and 15 fetal liver, 6 yolk sac, and 6 aorta-gonad-mesonephros lines) for expression of 22 cytoskeletal, membrane, and extracellular matrix proteins.

MATERIALS AND METHODS

Western blotting, immunofluorescence, and flow cytometry were used. Statistical methods included principal components analysis and analysis of variance.

RESULTS

Stromal cells from 11 dpc mouse embryos express mesenchymal and vascular smooth muscle cell (VSMC) markers. Principal components analysis on the 70 stromal cell lines isolated from different anatomic sites and developmental stages allows classification of stromal lines along a mesenchymal to VSMC differentiation pathway. Stromal cells do not express endothelial and hematopoietic differentiation membrane antigens, but they do express integrin alpha(5), alpha(6), and beta(1) subunits, vascular cell adhesion molecule-1, CD44, stem cell antigen-1, Thy-1, CD34, and endoglin. The intensity of expression of certain markers differs between lines according to the anatomic site of origin.

CONCLUSIONS

This study indicates that stromal cells, whatever their anatomic site of origin, follow a VSMC differentiation pathway, suggesting a blood-forming tissue-specific differentiation of mesenchymal stem cells. Differential quantitative expression of distinct sets of markers appears to be correlated with the anatomic sites of origin of the stromal cells.

A new complex variant t(4;15;17) in acute promyelocytic leukemia: fluorescence in situ hybridization confirmation and literature review

We report a 37-year-old male with acute promyelocytic leukemia (APL) harboring a complex translocation (4;15;17). Karyotypic analysis with R-banding of bone marrow cells revealed 46,XY,t(4;15;17)(q21;q22;q21). Fluorescence in situ hybridization analysis using painting probes for chromosomes 4, 15 and 17 and reverse transcriptase polymerase chain reaction analysis revealed three derivative chromosomes: der(4)t(4;15)(q21;q22), der(15)t(4;15;17)(q21;q22;q21), and del(17)(q21q22). This is the third report of such a translocation and the first confirmed by molecular methods. Considering reported similar cases, it is possible that 4q21 is a nonrandom breakpoint in APL with complex translocations and the gene involved in 4q21 should be investigated.

[The implications of the biological indices examination of bone marrow cells in myelodysplastic syndromes]

OBJECTIVE

To explore the biological characteristics of the hematopoietic cells in myelodysplastic syndromes(MDS) and the relationship between the biological indices and the disease progressing.

METHODS

R banding technique for karyotype analysis, in vitro semi-solid culture for CFU-GM growth patterns, flow cytometry after monoclonal antibody labeling for proliferation cell nuclear antigen (PCNA) expression, flow cytometry after in vitro bromodeoxyuridine (BrdU) incorporation for cell cycle kinetics analysis, and X-linked HUMARA gene polymorphism assay for hematopoiesis clonality analysis were carried out in 37 MDS patients.

RESULTS

1. Cytogenetic abnormalities were detected in 31% of the MDS patients and AML transformation occurred in 2 of 9 with normal and 3 of 5 with abnormal chromosomal karyotypes. 2. The mean CFU-GM colony yield was decreased and cluster yield increased in the MDS patients. Disease progression in 6 of 9 with more CFU-GM cluster yields, while only 1 of 9 with either normal or no CFU-GM yields transformed into AML. 3. Percentages of PCNA-positive BMMNCs were significantly higher in MDS patients than in normal control (44.22% vs 26.82%, P < 0.01). RAEB/RAEB-t subtypes had significantly higher PCNA-positive cells (P < 0.01). 4. The mean BrdU labeling index of MDS marrow cells was lower (5.07%), the mean DNA synthesis time (Ts) and potential doubling time(Tpot) of MDS patients were longer than that of normal control (p < 0.01), and the increased Ts and T pot were related to the disease progression. 5. Monoclonal pattern of BMMNCs was detected in 5 of 7 heterozygous female RA patients and the other 2 were polyclonal hematopoiesis. All 3 RAEB and 1 MDS/AML were monoclonal hematopoiesis.

CONCLUSION

With disease progressing and bone marrow blasts increasing, the biological nature of the hamatopoetic cells in MDS exhibited a tendency to transformation as follows: hematopoiesis converting into clonal, in vitro CFU-GM growth pattern approaching leukemic, PCNA expression increasing, and cell cycle prolonging.

On the reduction of spontaneous and glutamate-driven spinocerebellar and spinoreticular tract neuronal activity during active sleep

The present study was performed to provide evidence that dynamic neural processes underlie the reduction in dorsal spinocerebellar tract and spinoreticular tract neuron activity that occurs during active sleep. To ascertain the effect of local inhibition on the spontaneous and glutamate-evoked spike discharge of sensory tract neurons, preliminary control tests were performed during the state of quiet wakefulness, where GABA or glycine was co-administered in a sustained fashion during pulsatile release of glutamate to dorsal spinocerebellar tract (n=3) or spinoreticular tract (n=2) neurons. Co-administration of GABA or glycine also resulted in a significant marked suppression of spontaneous spike activity and glutamate-evoked responses of these cells. Extracellular recording experiments combined with juxtacellular application of glutamate were then performed on 20 antidromically identified dorsal spinocerebellar tract and spinoreticular tract neurons in the chronic intact cat as a function of sleep and wakefulness. The glutamate-evoked activity of a group of 10 sensory tract neurons (seven dorsal spinocerebellar tract, three spinoreticular tract), which exhibited a significant decrease in their spontaneous spike activity during active sleep, was examined. Glutamate-evoked activity in these cells was significantly attenuated during active sleep compared with wakefulness. In contrast, the glutamate-evoked activity of a second group of eight sensory tract neurons (four dorsal spinocerebellar tract, four spinoreticular tract), which exhibited a significant increase in their spontaneous spike activity during active sleep, was not significantly altered in a state-dependent manner. These data indicate that, during natural active sleep, a dynamic neural process is engaged onto certain dorsal spinocerebellar tract and spinoreticular tract neurons, which in turn dampens sensory throughput to higher brain centers.

Spontaneous spike activity of spinoreticular tract neurons during sleep and wakefulness

Sleep mentation studies infer that pain sensation in humans may be reduced during active REM sleep. However, to provide a mechanistic explanation for this phenomenon, few, if any neurophysiological studies have been performed at the lumbar level from neurons comprising classical pain pathways during sleep and wakefulness. The spinoreticular tract is one such classical pathway that has been implicated in the rostral transmission of nociceptive information. The present study was performed to determine if the activity of spinoreticular tract (SRT) neurons is dependent upon behavioral state. Accordingly, extracellular recording techniques were used to monitor the activity of identified SRT neurons in unanesthetized chronic cats during sleep and wakefulness. The ongoing spike activity of SRT neurons was found to be relatively uniform when the states of quiet wakefulness and quiet sleep were compared. However, during active sleep, the majority of the SRT neurons sampled underwent a sustained reduction in spike activity. Marked facilitation of SRT cell activity occurred in a few instances. These data provide the first unitary evidence supporting earlier evoked potential, psychophysical and clinical studies that ascending sensory information in a classical pain pathway is regulated in a state-dependent fashion.

Patient-controlled analgesia with tramadol versus tramadol plus lysine acetyl salicylate

By using a patient-controlled analgesia (PCA) delivery system, we compared the clinical advantages and disadvantages of PCA with tramadol and PCA with a mixture of tramadol plus lysine acetyl salicylate (a soluble aspirin). Fifty adult patients who had undergone major orthopedic surgeries were enrolled into a prospective, randomized, and double-blinded study. The general anesthesia was performed in a standard manner. At the beginning of wound closure, an equal volume dose of either tramadol 2.5 mg/kg (Group 1) or tramadol 1.25 mg/kg + lysine acetyl salicylate 12.5 mg/kg mixture (Group 2) was administered slowly IV. These solutions were continued postoperatively for IV PCA. Pain control, patient satisfaction, vital signs, and adverse effects were assessed for 48 h. Visual Analog Scale </=3 could be achieved with either group. Total tramadol consumption was significantly less in Group 2 than in Group 1 (614 +/- 259 mg vs 923 +/- 354 mg) (P: < 0.05). Patients in Group 2 were more alert (P: < 0.05). Blood loss from the surgical drain was similar, 865 +/- 275 mL (Group 1) vs 702 +/- 345 mL (Group 2). We conclude that aspirin can be used as an effective and safe adjuvant to tramadol for PCA after orthopedic surgery.

IMPLICATIONS

Injectable aspirin can be used as an effective and safe adjuvant to tramadol for patient-controlled analgesia (PCA) in orthopedic patients. The tramadol requirement is therefore reduced. This combination supports the concept that drugs other than opioids can be used for PCA.

Patient-controlled analgesia with morphine plus lysine acetyl salicylate

Using a patient-controlled analgesia (PCA) delivery system, we evaluated the clinical advantages and disadvantages of morphine PCA compared with morphine plus lysine acetyl salicylate (LAS), a soluble aspirin. After major orthopedic surgery, 50 adult patients were enrolled in a prospective, randomized, and double-blinded study. When a patient in the recovery room complained of pain, an initial dose of morphine or the morphine/LAS mixture was titrated to achieve analgesia of visual analog score < or = 3 in 30 min. An equivalent volume PCA dose of either morphine 1 mg/mL or morphine 0.5 mg + LAS 90 mg/mL was used with a lockout interval of 10 min. Pain score, patient satisfaction, vital signs, and adverse effects were observed for 48 h. Adequate analgesia (visual analog scale score < or = 3) was achieved with either drug. Morphine consumption in the morphine/LAS group was significantly less than in morphine group (13.9 vs 18.4 mg in 24 h and 24.3 vs 32.4 mg in 48 h). Significantly more sedation was evident with the morphine group (P < 0.05). We conclude that injectable LAS can be used as an effective and safe adjuvant to morphine for PCA. This combination reduces dose requirements of morphine and hence some of its adverse effects.

IMPLICATIONS

Injectable aspirin could be used as an effective and safe adjuvant to morphine for patient-controlled analgesia. This combination reduces the dose requirement of morphine and therefore some of the morphine-related untoward effects.

Hemoglobin New York associated with alpha-thalassemia

A Chinese family is described in which 6 members possess both the beta-chain hemoglobin variant Hb New York and alpha-thalassemia trait. The frequency of this combination may be greater than hitherto realized because Hb New York may easily be missed on routine hemoglobin electrophoresis.