Nucleotides regulate NaCl transport in mIMCD-K2 cells via P2X and P2Y purinergic receptors

Extracellular nucleotides regulate NaCl transport in some epithelia. However, the effects of nucleotide agonists on NaCl transport in the renal inner medullary collecting duct (IMCD) are not known. The objective of this study was to determine whether ATP and related nucleotides regulate NaCl transport across mouse IMCD cell line (mIMCD-K2) epithelial monolayers and, if so, via what purinergic receptor subtypes. ATP and UTP inhibited Na(+) absorption [measured via Na(+) short-circuit current (I(Na)(sc))] and stimulated Cl(-) secretion [measured via Cl(-) short-circuit current (I(Cl)(sc))]. Using selective P2 agonists, we report that P2X and P2Y purinoceptors regulate I(Na)(sc) and I(Cl)(sc). By RT-PCR, two P2X receptor channels (P2X(3), P2X(4)) and two P2Y G protein-coupled receptors (P2Y(1), P2Y(2)) were identified. Functional localization of P2 purinoceptors suggest that I(Cl)(sc) is stimulated by apical membrane-resident P2Y purinoceptors and P2X receptor channels, whereas I(Na)(sc) is inhibited by apical membrane-resident P2Y purinoceptors and P2X receptor channels. Together, we conclude that nucleotide agonists inhibit I(Na)(sc) across mIMCD-K2 monolayers through interactions with P2X and P2Y purinoceptors expressed on the apical plasma membrane, whereas extracellular nucleotides stimulate I(Cl)(sc) through interactions with P2X and P2Y purinoceptors expressed on the apical plasma membrane.

Epithelial P2X purinergic receptor channel expression and function

P2X purinergic receptor (P2XR) channels bind ATP and mediate Ca(2+) influx--2 signals that stimulate secretory Cl(-) transport across epithelia. We tested the hypotheses that P2XR channels are expressed by epithelia and that P2XRs transduce extracellular ATP signals into stimulation of Cl(-) transport across epithelia. Electrophysiological data and mRNA analysis of human and mouse pulmonary epithelia and other epithelial cells indicate that multiple P2XRs are broadly expressed in these tissues and that they are active on both apical and basolateral surfaces. Because P2X-selective agonists bind multiple P2XR subtypes, and because P2X agonists stimulate Cl(-) transport across nasal mucosa of cystic fibrosis (CF) patients as well as across non-CF nasal mucosa, P2XRs may provide novel targets for extracellular nucleotide therapy of CF.

Operative management of Haglund's deformity in the nonathlete: a retrospective study

Haglund's deformity, or "pump bump," is a common cause of posterior heel pain. Management of the condition usually consists of nonoperative therapy. This study presents a retrospective study of 65 cases (53 patients), with symptomatic Haglund's deformity in nonathletes (13 male and 40 female), who presented during a 4-year period (1989-1994). Sixty-five percent (39 heels) of these patients failed to respond to nonoperative therapy for an average of 62 weeks, (range, 4-260 weeks). This group of patients went on to operative treatment. Surgical management consisted of excision of the posterior calcaneal tuberosity through a medial longitudinal incision with debridement, reattachment of the Achilles tendon using bone anchors, and 4 weeks of postoperative immobilization. Thirty-nine patients (74%) were contacted for follow-up. The average follow-up period for these patients was 155 weeks, (range, 92-335 weeks). There were 50% excellent results, 47% good results, 3% fair results (1 patient), and no poor results. The Maryland Foot Score for operated heels was an average of 67/100 preoperative and an average of 92/100 postoperative. On unoperated heels the score was an average of 81/100 at first evaluation and an average of 86/100 at final evaluation. Complications included one recurrence of painful prominence, one wound infection, and one incisional neuroma. The outcome of these cases demonstrated that in those patients who fail nonoperative treatment, surgical treatment of Haglund's deformity produces a predictably good surgical result when performed using the technique described.

Bioluminescence detection of ATP release mechanisms in epithelia

Autocrine and paracrine release of and extracellular signaling by ATP is a ubiquitous cell biological and physiological process. Despite this knowledge, the mechanisms and physiological roles of cellular ATP release are unknown. We tested the hypothesis that epithelia release ATP under basal and stimulated conditions by using a newly designed and highly sensitive assay for bioluminescence detection of ATP released from polarized epithelial monolayers. This bioluminescence assay measures ATP released from cystic fibrosis (CF) and non-CF human epithelial monolayers in a reduced serum medium through catalysis of the luciferase-luciferin reaction, yielding a photon of light collected by a luminometer. This novel assay measures ATP released into the apical or basolateral medium surrounding epithelia. Of relevance to CF, CF epithelia fail to release ATP across the apical membrane under basal conditions. Moreover, hypotonicity is an extracellular signal that stimulates ATP release into both compartments of non-CF epithelia in a reversible manner; the response to hypotonicity is also lost in CF epithelia. The bioluminescence detection assay for ATP released from epithelia and other cells will be useful in the study of extracellular nucleotide signaling in physiological and pathophysiological paradigms. Taken together, these results suggest that extracellular ATP may be a constant regulator of epithelial cell function under basal conditions and an autocrine regulator of cell volume under hypotonic conditions, two functions that may be lost in CF and contribute to CF pathophysiology.

Reference centile charts for measures of disease activity, functional impairment, and metrology in ankylosing spondylitis

OBJECTIVE

To construct reference centile charts for validated measures of disease activity, functional impairment, and metrology (the Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI], and Bath Ankylosing Spondylitis Metrology Index [BASMI]) in a population of patients with AS, and to explore the potential application of these charts in patient care and clinical research.

METHODS

We collected BASDAI and BASFI data on 2,979 patients with AS from the Royal National Hospital for Rheumatic Diseases (RNHRD) database and BASMI data on 393 patients at RNHRD. Data on age, sex, and duration of AS were also obtained. Centile charts were constructed for the BASDAI, BASFI, and BASMI in both males and females, with duration of AS as the time-dependant variable. Where necessary, BASDAI, BASFI, and BASMI raw scores were transformed to ensure that the indices were normally distributed over the range of disease duration, and allowance was made for change in variability of the indices.

RESULTS

Linear models were fitted to the mean and standard deviations of BASDAI, BASFI, and BASMI scores in males and females as a function of disease duration. A standard deviation score plot confirmed goodness of fit of the models, and fitted centiles were derived. Charts showing the 5th, 10th, 25th, 50th, 75th, 90th, and 95th centiles were constructed. The charts confirmed that AS remains active after 40 years' duration (mean BASDAI score 2.22 and 2.99 in males and females, respectively). The charts also demonstrated that females have greater disease activity and more functional impairment than males, despite better metrology.

CONCLUSION

The use of centile reference charts for disease activity, functional impairment, and metrology in AS will allow physicians and patients to interpret index scores relative to a reference population and will provide the opportunity to assess change over time and response to therapeutic interventions, to improve definition of disease status, and to enhance patients' involvement in their care.

Scleromyxoedema associated with synovitis and myopathy

Scleromyxoedema is a rare skin disease characterized by the deposition of hyaluronic acid in the papillary dermis and often associated with the presence of a monoclonal para protein. Patients with this disorder may also have systemic manifestations. A case of a patient with biopsy proven scleromyxoedema who, in addition to the skin changes had a steroid responsive myopathy and polysynovitis is presented.

Developing guidelines for local use: algorithms for cost-efficient outpatient management of cardiovascular disorders in a VA Medical Center

Local use of practice guidelines requires paying close attention to the concerns of the patient within the framework of society, to the professional and educational needs of the provider, and to the realities of cost. One Veterans Affairs facility took the challenge of balancing these factors and developed their own algorithms for three cardiovascular disorders.

Interventricular septal rupture complicating acute myocardial infarction: from pathophysiologic features to the role of invasive and noninvasive diagnostic modalities in current management

Rupture of the interventricular septum is a serious complication of acute myocardial infarction, accounting for 5% of deaths due to acute infarction. The septal perforation most frequently occurs during the first week after the infarction. The majority of these patients present with at least two-vessel coronary artery disease, and most cases have a total occlusion of the infarct-related artery. The degree of associated right ventricular damage is clinically important. Unpredictable hemodynamic deterioration can rapidly develop in 80% of the patients, and mortality with medical therapy alone exceeds 90%. Because the preoperative hemodynamic status of these patients appears to be a major determinant for survival, accurate diagnosis, urgent management, and early operative correction are necessary to avoid a catastrophic clinical outcome. Traditionally, diagnostic procedures included first, the insertion of a pulmonary artery catheter for recording of pressures, sequential oximetry, and calculation of the shunt's magnitude and the cardiac output followed by left ventriculography and coronary arteriography for angiographic demonstration of the shunt and the coronary anatomy. Currently, optimal utilization of color flow Doppler and two-dimensional and transesophageal echocardiography offers a significant clinical advantage and can be used to shorten the time spent on diagnosis, evaluation, and management prior to the urgent surgical repair. The elimination of time-consuming diagnostic tests can contribute to further improvement in the survival rate.

Segmental systolic responses to brief ischemia and reperfusion in the hypertrophied canine left ventricle

OBJECTIVES AND BACKGROUND

Left ventricular hypertrophy is associated with increased mortality, increased myocardial infarct size and an increased incidence of sudden death. Although reperfusion after ischemia has been shown to result in decreased infarct size and recovery of systolic thickening, it is unknown how left ventricular hypertrophy might influence recovery of regional systolic thickening after ischemia and reperfusion. We hypothesized that left ventricular hypertrophy might attenuate or abolish the functional response to reperfusion.

METHODS

Three groups of chronically instrumented, conscious dogs (dogs with left ventricular hypertrophy and hypertension; dogs with left ventricular hypertrophy and reduced blood pressure and a control group without hypertrophy and with normal blood pressure) underwent 15 min of ischemia and 24 h of reperfusion. Segmental systolic thickening was measured by sonomicrometers and myocardial segments were grouped by percent of control segmental systolic thickening retained at 15 min of ischemia (class 1 greater than or equal to 67%, class 2 from 0% to 66%, class 3 less than 0% control systolic thickening). The recovery of each class of segment was measured serially during reperfusion. Hemodynamic variables and regional myocardial blood flow were also measured.

RESULTS

There were no differences among groups in recovery of segmental systolic thickening for class 1 segments. Systolic thickening in class 2 (hypokinetic) segments was significantly depressed (p less than 0.05 compared with control value) in the group with left ventricular hypertrophy and reduced blood pressure (but not in the group with hypertrophy and hypertension) during early reperfusion; systolic thickening in class 3 (dyskinetic) segments showed a similar trend in the group with hypertrophy and reduced pressure.

CONCLUSIONS

Although left ventricular hypertrophy with hypertension did not attenuate the contractile response to reperfusion, hypertrophy with reduced blood pressure was associated with significantly greater depression of segmental systolic thickening early during reperfusion.

Genetic control of flocculation inEscherichia coli

Escherichia coli cells form flocs or aggregates by overproducing type 1 pili. When the pil operon is placed under the control of a tac or lac promoter-operator sequence, the bacterial cells can be induced to form flocs by adding isopropyl-beta-D-thiogalactopyranoside to the culture medium. This phenomenon of genetically induced flocculation can aid in the downstream of biological products. This paper describes the construction of two artificially controlled plasmids which cause cell flocculation. Cell aggregates 50 microns in mean diameter were obtained 1 h after the cells were induced.

Aortic valve morphology influences regurgitant volume in aortic regurgitation: in vitro evaluation

STUDY OBJECTIVE

According to the Gorlin hydraulic orifice equation, aortic regurgitation volume can be determined by the regurgitant orifice cross sectional area, diastolic filling period, mean pressure gradient between the aorta and left ventricle, and a constant relating the coefficients of contraction (Cc) and velocity (Cv). This study was performed to determine whether variation in aortic valve morphology affects regurgitant flow volume, Cc and Cv.

DESIGN

Four aortic valve templates, modelled after circular, rheumatic, degenerative, and bicuspid lesions, were constructed with equal orifice cross sectional areas in two sizes, 0.2 and 0.7 cm2. These valves were studied in vitro in a flow model of aortic regurgitation, wherein aortic pressure was regulated by varying the height of a column of fluid. Flow, pressure, and velocity were measured, and the coefficient Cc and Cv were calculated from standard equations.

MEASUREMENTS AND MAIN RESULTS

Regurgitant volume was assessed at diastolic filling periods of 0.5 and 1.0 s and averaged 15% greater for bicuspid and degenerative as compared to circular or rheumatic valve shapes (p = 0.0001). This difference was accentuated at the shorter diastolic filling time and higher pressure gradient, such that bicuspid lesions allowed 29% more regurgitant flow across the 0.2 cm2 orifice at fluid height of 120 cm over 0.5 s. This difference in regurgitant volume between valve shapes was due to an increased Cc for the bicuspid and degenerative valve shapes, suggesting that they are more efficient orifices than rheumatic or circular valve shapes.

CONCLUSIONS

Aortic valve morphology influences regurgitant volume in aortic regurgitation. Specifically, degenerative and bicuspid orifice shapes have a higher contraction coefficient and allow more regurgitant flow than rheumatic or circular orifices at a given driving pressure and diastolic filling time.

Potentiation of reperfusion-associated ventricular fibrillation by left ventricular hypertrophy

Important electrophysiological alterations that may predispose hearts to arrhythmias have been described for hypertrophied myocytes, and hypertrophy coupled with ischemia has been associated with an increased incidence of sudden death; however, an influence of hypertrophy on reperfusion arrhythmias has not been previously described. We hypothesized that reperfusion-associated arrhythmias would be potentiated by left ventricular hypertrophy. After induction of renovascular hypertension, 37 awake, unsedated dogs (17 with left ventricular hypertrophy and 20 without hypertrophy) underwent 15 minutes of coronary artery occlusion and reperfusion. All dogs were pretreated with lidocaine bolus injections and with lidocaine by continuous infusion during coronary occlusion and reperfusion. Reperfusion-associated ventricular fibrillation occurred in seven of 17 dogs with left ventricular hypertrophy versus one of 18 dogs without hypertrophy (p less than or equal to 0.05). The presence of hypertension was not significantly associated with an increased incidence of reflow ventricular arrhythmias. Neither QT interval nor area-at-risk was different between the dogs with and without reperfusion ventricular fibrillation; however, increased heart rate just before reperfusion did correlate with an increased incidence of ventricular fibrillation at reperfusion. Thus, 1) left ventricular hypertrophy was associated with a significantly increased incidence of reperfusion-induced ventricular fibrillation after 15 minutes of ischemia, 2) this increased incidence was independent of the presence of hypertension, and 3) lidocaine protected control and hypertrophied hearts against ventricular fibrillation during ischemia but was ineffective in protecting hypertrophied hearts against reperfusion-induced ventricular fibrillation.

Aortic valve morphology: an important in vitro determinant of proximal regurgitant jet width by Doppler color flow mapping

In vitro and in vivo studies suggest that proximal aortic regurgitant jet width on Doppler color flow mapping predicts severity of aortic regurgitation. The influence of aortic valve morphology on proximal regurgitant jet width has not been studied. Despite equal cross-sectional area, differences in aortic valve morphology may influence regurgitant jet width and thus estimates of severity of aortic regurgitation. Aortic valve simulations representing degenerative, rheumatic and bicuspid valves as well as a circle in two cross-sectional areas (0.2 cm2 and 0.7 cm2) were placed in a flow model using two gradients (50 and 100 mm Hg) to produce simulated aortic regurgitant jets. Flow maps were obtained from parasternal and apical positions with color gain, frames per second, low velocity reject and depth held constant. The mean of three regurgitant jet widths for each shape, size and gradient were compared by three factor analysis of variance. Aortic valve morphology significantly affected regurgitant jet width in both parasternal and apical views (p = 0.0001 by analysis of variance) with bicuspid shapes producing regurgitant jet widths significantly different from all other shapes. Valve area also consistently significantly influenced proximal regurgitant jet width (p = 0.0001) in both views. Initial pressure gradient was less important. It is concluded that in an in vitro flow model aortic valve morphology introduces significant variability in the measurement of proximal regurgitant jet widths independent of orifice cross-sectional area. Estimates of severity of aortic regurgitation may therefore be influenced considerably by aortic valve morphology.

Entrainment onset in a pacemaker model of reentrant ventricular tachycardia: insight into localization of critical elements of a reentrant circuit

We investigated entrainment in a pacemaker model of reentrant ventricular tachycardia (VT) created in the intact dog heart using a VAT pacemaker with both electrodes on the ventricular epicardium. This produced an incessant wide QRS tachycardia originating from the pacing site with a cycle length equal to the conduction time between the sensing and pacing site plus the pacemaker AV delay. The conduction time between entrainment sites and the critical elements of the reentrant pathway (sensing and pacing sites) was determined by pacing at a comparable cycle length during sinus rhythm. Entrainment was achieved in 12 tachycardias with pacing at 1-4 sites at cycle lengths 10-100 msec shorter than tachycardia and confirmed by constant QRS fusion, progressive QRS fusion, and coupling of the first nonpaced QRS or intracardiac electrogram at the entraining cycle length. By least squares regression, the timing of entrainment onset (first reset of pacing or sensing site electrogram) measured by the prematurity of the local electrogram at the entraining site was highly correlated to the shortest conduction time between the entraining site and the circuit (F value of 84.7 and R = 0.752 [P less than 0.001]). Therefore, the timing of entrainment onset maybe useful in predicting the conduction time from the entraining site to critical elements of a reentrant circuit and may assist in localization of the reentrant pathway.

Differential enhancement of postischemic segmental systolic thickening by diltiazem

Prolonged depression of segmental systolic thickening after brief coronary artery occlusion may result principally from events during reperfusion rather than during the ischemic interval. Thus, cellular calcium overload at reperfusion may be a mediator of contractile dysfunction after brief ischemia, and reduction of calcium entry by diltiazem, a calcium channel antagonist, may enhance recovery of systolic thickening after brief periods of ischemia. Thirteen awake unsedated dogs instrumented with hemodynamic catheters, left anterior descending coronary artery occluders and five to six pairs of intramyocardial sonomicrometers underwent two 15 min coronary artery occlusions with 24 h reperfusion. The order of infusion of diltiazem (15 micrograms/kg per min) or saline solution was alternated. Systolic thickening, hemodynamic variables and regional myocardial blood flow were measured serially over 24 h. Despite equally severe ischemic dysfunction during coronary occlusion, diltiazem-treated segments with systolic thinning during ischemia recovered control segmental thickening significantly earlier than saline solution-treated segments (at 30 versus 180 min of reperfusion). Blood pressure was mildly decreased during diltiazem treatment; therefore, a second group of 10 dogs underwent a similar occlusion and reflow period during infusion of nitroprusside to lower mean arterial pressure equivalently. Decreases in blood pressure in this group resulted in some improvement in segmental systolic function; however, this did not reach statistical significance at any time. Regional myocardial blood flows were similar in the saline solution- and diltiazem-treated groups during ischemia and reflow. Thus, it is concluded that 1) diltiazem infusion significantly enhanced recovery of segmental systolic thickening after 15 min of ischemia and 24 h of reperfusion; 2) the enhancement in segmental systolic function could not entirely be attributed to decreased mean arterial pressure; 3) improvement in postischemic segmental ventricular function was seen only in those segments with systolic thinning during ischemia; thus, segments with the most severe ischemic dysfunction benefited most; and 4) there were no important differences in regional myocardial blood flow during ischemia and reperfusion between saline- and diltiazem-treated animals.