Venoplasty can be performed safely and successfully in patients with subtotal and total venous occlusion needing additional transvenous electrodes

Funding Acknowledgements

Type of funding sources: None.

Introduction

Lead failure, but also upgrade procedures from pacemaker to implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy (CRT) can be hampered by venous obstruction occurring in 10-25% of patients with prior transvenous electrodes. A relatively underused technique to overcome venous obstruction are lead percutaneous venous dilation procedures (venoplasty).

Purpose

We aimed to identify the feasibility of venoplasty procedures in two Dutch tertiary referral centers.

Methods

84 consecutive patients where venoplasty was attempted were included in the study and baseline parameters as well as procedural characteristics and complications were recorded. 42% of patients needed replacement of a defective electrode and 58% an upgrade to CRT or from pacemaker to ICD. Venous stenosis was defined as significant (70-90%), subocclusive (90-99%) and occlusive (100%) and the region was divided into three segments: subclavian vein, brachiocephalic vein and junction to the vena cava superior.

Results

The study included 30 pacemaker and 54 ICD patients, 68±12 years old, 80% were male. Body mass index was 26±3, left ventricular ejection fraction 32±12% and eGFR 63±24ml/min/1,73m2. At the time of the procedure, 2,1±0,8 electrodes were present and 1,2±0,2 electrodes were implanted, in 15% atrial, 52% RV and 52% LV electrodes. The procedures took 123±58 minutes and fluoroscopy dose was 5334±5390µGy/m2. There were 79 total occlusions of any segments and in addition, 51 subocclusive lesions needing venoplasty (table). 8 procedures were unsuccessful (9%), mostly due to failure to pass the occlusion. 3 patients (4%) had pocket hematoma not needing reintervention and one patient (1%) needed lead repositioning due to dislocation. There was no damage to any existing lead during the procedures. 89% of patients had a successful procedure without a complication needing reintervention.

Conclusions

Venoplasty is safe in subocclusive and occlusive venous stenosis and can be performed with high success using modern material potentially avoiding lead extraction or contralateral tunneling procedures.

Impact of the ESC 2021 guidelines on cardiac pacing and cardiac resynchronization therapy left bundle branch block definition on CRT patient selection and survival

Funding Acknowledgements

Type of funding sources: None.

Background

The recently published ESC 2021 guidelines on cardiac pacing and cardiac resynchronization therapy (CRT) underwent significant changes compared to the ESC 2013 guidelines regarding the definition of left bundle branch block (LBBB) by adding notching or slurring in 2 adjacent leads as a prerequisite. The level of recommendation for CRT depends on diagnosing LBBB or non-LBBB. These changes may have a significant impact on patient selection for CRT, as fewer patients may be diagnosed with LBBB and may therefore get a lower level of recommendation for CRT.

Purpose

In this study we investigated the impact of these changes in LBBB definition on patient selection and heart transplantation/left ventricular assist device (LVAD) free survival.

Methods

A large multicenter CRT database, consisting of consecutive patients implanted with a CRT device between 2001 and 2015 in 3 university hospitals in the Netherlands, was used for this study. Patient selection, device implantation, lead positioning and follow-up were according to then prevailing guidelines and local protocols. For this study, patients were selected with baseline sinus rhythm, QRS duration >130ms, and without right ventricular pacing. Patients were stratified according to ESC 2013 and ESC 2021 guideline definitions on LBBB.

Results

The current analyses included 1.202 CRT patients. 66% of patients were male with an age of 66±11 years. Heart failure etiology was ischemic in 49% of patients with baseline left ventricular ejection fraction of 25% and baseline NYHA class II-III in 93% of patients. There is a considerable difference in LBBB diagnoses when stratifying patients according to ESC 2013 and ESC 2021 guideline definitions as especially the number of LBBB patients is reduced from 80.9% to 31.6% (Figure 1). Heart transplantation/LVAD free survival analyses when stratifying according to ESC 2013 LBBB definition showed significant separation of the curves (p<0.0001) (Figure 2). Furthermore, there was a significant difference between the wide (QRS>150ms) LBBB and wide non-LBBB subgroup concerning heart transplantation/LVAD free survival (p<0.0001). In contrast, there was no significant separation of the curves when stratifying according to ESC 2021 LBBB definition (Figure 2).

Conclusion

The changes made in LBBB definition in the ESC 2021 CRT guidelines lead to a difference in stratification of LBBB and non-LBBB. The ESC 2013 LBBB definition, however, seems to be better in predicting heart transplantation/LVAD free survival after CRT.

Gradually increasing impedance in patients with pacemakers and implantable defibrillators: a watchful waiting strategy

Funding Acknowledgements

Type of funding sources: None.

Introduction

Pacing impedance measurements are important in the surveillance of pacemaker and implantable cardioverter/defibrillator (ICD) devices. Whereas sudden changes in impedances can reflect lead fracture or isolation defects, gradually increasing impedances are thought to occur because of calcifications at the endomyocardial interface. In many cases, these leads are replaced prophylactically but this has not been studied systematically.

Purpose

We aimed to identify the outcome of right ventricular (RV) electrodes with high impedances that were left active in this single center study.

Methods

All patients in the electronic patient database were screened for impedances >1200Ohms. 41,201 individual recordings led to 207 individual patients. 161 patients were excluded from the analysis due to sudden impedance increase, temporarily high impedances or wrong entry. Of the remaining 46 patients, baseline characteristics as well as pacing impedance, sensing values, pacing thresholds, and shock impedance in case of ICDs were recorded.

Results

There were 17 pacemaker and 29 ICD patients, 68 ± 15 years old, 70% were male. Glomerular filtration rate at baseline was 81 ± 22 ml/min/1.73m2. Baseline RV impedance was 597 ± 123Ohms. During follow-up impedances increased to 1875 ± 682Ohms (p < 0,001). Pacing thresholds increased from 0,6 ± 0,4V to 3,0 ± 1,9V (p < 0,001). Sensing remained stable. The median time from implant to  impedance rise >1000Ohms was 5,5 (3,4-7)years and median follow-up thereafter 2,4 years (1,2-4,2). During follow-up, no intervention was performed for 33 leads (72%). No events occurred. 13 leads (28%) were replaced , 9 prophylactically (mostly because of ICD advisory leads), 3 because of high pacing thresholds and high percentage pacing and one lead because of noise oversensing, probably unrelated as it occurred 7 years after impedance increase.

Conclusions

A watchful waiting strategy appears to be a safe option for patients with ICDs and pacemakers with low percentage pacing. As impedance increase cannot be used for surveillance for imminent lead fracture, other means such as short interval counts and non-sustained oversensing have to be employed and should be combined with remote monitoring.

A protocol for manual segmentation of medial temporal lobe subregions in 7 Tesla MRI

Recent advances in MRI and increasing knowledge on the characterization and anatomical variability of medial temporal lobe (MTL) anatomy have paved the way for more specific subdivisions of the MTL in humans. In addition, recent studies suggest that early changes in many neurodegenerative and neuropsychiatric diseases are better detected in smaller subregions of the MTL rather than with whole structure analyses. Here, we developed a new protocol using 7 Tesla (T) MRI incorporating novel anatomical findings for the manual segmentation of entorhinal cortex (ErC), perirhinal cortex (PrC; divided into area 35 and 36), parahippocampal cortex (PhC), and hippocampus; which includes the subfields subiculum (Sub), CA1, CA2, as well as CA3 and dentate gyrus (DG) which are separated by the endfolial pathway covering most of the long axis of the hippocampus. We provide detailed instructions alongside slice-by-slice segmentations to ease learning for the untrained but also more experienced raters. Twenty-two subjects were scanned (19-32 yrs, mean age = 26 years, 12 females) with a turbo spin echo (TSE) T2-weighted MRI sequence with high-resolution oblique coronal slices oriented orthogonal to the long axis of the hippocampus (in-plane resolution 0.44 × 0.44 mm2) and 1.0 mm slice thickness. The scans were manually delineated by two experienced raters, to assess intra- and inter-rater reliability. The Dice Similarity Index (DSI) was above 0.78 for all regions and the Intraclass Correlation Coefficients (ICC) were between 0.76 to 0.99 both for intra- and inter-rater reliability. In conclusion, this study presents a fine-grained and comprehensive segmentation protocol for MTL structures at 7 T MRI that closely follows recent knowledge from anatomical studies. More specific subdivisions (e.g. area 35 and 36 in PrC, and the separation of DG and CA3) may pave the way for more precise delineations thereby enabling the detection of early volumetric changes in dementia and neuropsychiatric diseases.

Genomewide single nucleotide polymorphism discovery in Atlantic salmon (Salmo salar): validation in wild and farmed American and European populations

A considerable number of single nucleotide polymorphisms (SNPs) are required to elucidate genotype-phenotype associations and determine the molecular basis of important traits. In this work, we carried out de novo SNP discovery accounting for both genome duplication and genetic variation from American and European salmon populations. A total of 9 736 473 nonredundant SNPs were identified across a set of 20 fish by whole-genome sequencing. After applying six bioinformatic filtering steps, 200 K SNPs were selected to develop an Affymetrix Axiom(®) myDesign Custom Array. This array was used to genotype 480 fish representing wild and farmed salmon from Europe, North America and Chile. A total of 159 099 (79.6%) SNPs were validated as high quality based on clustering properties. A total of 151 509 validated SNPs showed a unique position in the genome. When comparing these SNPs against 238 572 markers currently available in two other Atlantic salmon arrays, only 4.6% of the SNP overlapped with the panel developed in this study. This novel high-density SNP panel will be very useful for the dissection of economically and ecologically relevant traits, enhancing breeding programmes through genomic selection as well as supporting genetic studies in both wild and farmed populations of Atlantic salmon using high-resolution genomewide information.

Augmentation of venous, arterial and microvascular blood supply in the leg by isometric neuromuscular stimulation via the peroneal nerve

BACKGROUND

Deep vein thrombosis (DVT) is the formation of a blood clot within the deep veins. During periods of sitting, blood flow is decreased and this contributes to an increased risk of DVT. Trials have shown that 5% to 10% of passengers undertaking long-haul flights develop asymptomatic calf DVT.

AIM

To investigate the safety and efficacy of a novel neuromuscular device that augments peripheral blood flow.

METHODS

Thirty healthy volunteers were assessed while seated. Each subject had one leg connected to the stimulator and the other leg immobile acting as control. Fifteen sequential electrical stimulations were applied for 5 min each followed by a 10 min recovery phase. The following noninvasive measurements were performed before, during and after the stimulation programs: photoplethysmography, strain gauge plethysmography, laser Doppler fluxmetry, transcutaneous oxygen tension, pulse oximetry, superficial femoral vein blood flow and vessel diameter (ultrasound); discomfort questionnaires were also administered.

RESULTS

During neuromuscular stimulation, significant increases in blood volume flow and velocity and skin capillary blood flow were found; transdermal skin oxygen levels were maintained. No changes were observed in heart rate, blood pressure, oxygen saturation or femoral vein vessel diameter.

CONCLUSIONS

Using a newly developed device, electrical nerve stimulation of the lower leg significantly increased blood flow; the device in the present study is, therefore, a promising tool for the development of a novel DVT prevention device. Because this method of electrical nerve stimulation is virtually pain free, the present study has significant implications for the prevention of DVT in hospitals, outpatient settings and community care settings, as well as in preventing travel-related thrombosis.

Real-time in vivo imaging of retinal cell apoptosis after laser exposure

PURPOSE

To investigate whether the detection of apoptosing retinal cells (DARC) could detect cells undergoing apoptosis in a laser model of retinal damage.

METHODS

Laser lesions were placed, with the use of a frequency-doubled Nd:YAG laser, on the retina in 34 eyes of anesthetized Dark Agouti rats. Lesion size and laser-induced retinal elevation were analyzed using in vivo reflectance imaging. Development of retinal cell apoptosis was assessed using intravitreal fluorescence-labeled annexin 5 in vivo with DARC technology from baseline until 90 minutes after laser application. Histologic analysis of retinal flat mounts and cross-sections was performed.

RESULTS

The lateral and anteroposterior depth extension of the zone of laser damage was significantly larger for higher exposure settings. A strong diffuse signal, concentrated at the outer retina, was seen with DARC for low exposures (<300 ms and <300 mW). In comparison, higher exposures (>300 ms and >300 mW) resulted in detectable hyperfluorescent spots, mainly at the level of the inner retinal layers. Dose-dependent effects on spot density and positive correlation of spot density between lesion size (P < 0.0001) and retinal elevation (P < 0.0001) were demonstrated. Histology confirmed the presence of apoptosing retinal cells in the inner nuclear and the ganglion cell layers.

CONCLUSIONS

This is the first time that DARC has been used to determine apoptotic effects in the inner nuclear layer. The ability to monitor changes spatially and temporally in vivo promises to be a major advance in the real-time assessment of retinal diseases and treatment effects.

Assessment of rat and mouse RGC apoptosis imaging in vivo with different scanning laser ophthalmoscopes

PURPOSE

We have recently described a novel way of imaging apoptosing retinal ganglion cells in vivo in the rat. This study investigated if this technique could be used in the mouse, and whether the Heidelberg Retina Angiograph II (HRAII) was appropriate.

METHODS

Retinal ganglion cell (RGC) death was induced by intravitreal injections in rat and mouse eyes using staurosporine. Fluorescent-labeled apoptosing cells were detected by imaging with both the HRAII and a prototype Zeiss confocal scanning laser ophthalmoscope (cSLO). Averaged in vivo images were analyzed and results compared with histologic analysis.

RESULTS

Fluorescent points (FPs) used as a measure of RGC apoptosis in vivo were detected in the mouse eye but only with the HRAII and not the Zeiss cSLO. The HRAII was able to detect 62% more FPs in rat than the Zeiss cSLO. Both cSLOs showed peak FP counts at the 5- to 10-microm range in rat and mouse. Maximal FP counts were detected in the superior and superior temporal regions in the rat, with no obvious pattern of distribution in the mouse. The HRAII was found to have more FP correspondence with histologically identified apoptosing RGCs.

CONCLUSIONS

To our knowledge, this is the first demonstration of visualized apoptosing RGC in vivo in a mouse. The improved image quality achieved with the HRAII compared with the Zeiss cSLO was validated by histology. This together with its enhanced maneuverability and the fact that it is already commercially available make the HRAII a potential tool for the early detection and diagnosis of glaucomatous disease in patients.

Targeting amyloid-beta in glaucoma treatment

The development of the devastating neurodegenerative condition, Alzheimer's disease, is strongly associated with amyloid-beta (Abeta) deposition, neuronal apoptosis, and cell loss. Here, we provide evidence that implicates these same mechanisms in the retinal disease glaucoma, a major cause of irreversible blindness worldwide, previously associated simply with the effects of intraocular pressure. We show that Abeta colocalizes with apoptotic retinal ganglion cells (RGC) in experimental glaucoma and induces significant RGC apoptosis in vivo in a dose- and time-dependent manner. We demonstrate that targeting different components of the Abeta formation and aggregation pathway can effectively reduce glaucomatous RGC apoptosis in vivo, and finally, that combining treatments (triple therapy) is more effective than monotherapy. Our work suggests that targeting the Abeta pathway provides a therapeutic avenue in glaucoma management. Furthermore, our work demonstrates that the combination of agents affecting multiple stages in the Abeta pathway may be the most effective strategy in Abeta-related diseases.

The gut flagellate community of the termite Neotermes cubanus with special reference to Staurojoenina and Trichocovina hrdyi nov. gen. nov. sp

At least seven species of flagellates have been found to inhabit the paunch of the termite Neotermes cubanus. Staurojoenina sp. is the largest species, measuring 100-150mum in length. Three small parabasalids belong to the genera Tritrichomonas, Metadevescovina, and Foaina. A fourth small type is described as Trichocovina hrdyi nov. gen. nov. sp.; the combination of features in this flagellate, such as the presence of a costa, undulating membrane and spiralled dictyosome, does not fit to any known genus. The two oxymonad species do not possess a rostellum. One belongs to the family Polymastigidae; it has one unattached flagellum and three partially attached flagella. The second is a member of the family Pyrsonymphidae, but this one possesses ring-like surface structures, one free flagellum and three spirally attached flagella. It is the first report of a pyrsonymphid in a kalotermitid termite.

Assessment of neuroprotective effects of glutamate modulation on glaucoma-related retinal ganglion cell apoptosis in vivo

PURPOSE

To assess the neuroprotective effects of different glutamate modulation strategies, with a nonselective (MK801) and a selective (ifenprodil) NMDA receptor antagonist and a metabotropic glutamate receptor agonist (mGluR Group II, LY354740), in glaucoma-related in vivo rat models of retinal ganglion cell (RGC) apoptosis.

METHODS

RGC apoptosis was induced in Dark Agouti (DA) rats by staurosporine (SSP) treatment. Single agents MK801, ifenprodil, or LY354740, or MK801 and LY354740 combined, were administrated intravitreally at different doses. Eyes were imaged in vivo using a recently established technique and the results confirmed histologically. The most effective combined therapy regimen of MK801 and LY354740 was then assessed in a chronic ocular hypertension (OHT) rat model with application at 0, 1, and 2 weeks after OHT surgery and the effects assessed as described before.

RESULTS

All strategies of glutamate modulation reduced SSP-induced-RGC apoptosis compared with the control, in a dose-dependent manner: MK801 (R2= 0.8863), ifenprodil (R2= 0.4587), and LY354740 (R2= 0.9094), with EC50s of 0.074, 0.0138, and 19 nanomoles, respectively. The most effective combination dose of MK801 and LY354740 was 0.06 and 20 nanomoles (P < 0.05), respectively, and the optimal timing of the therapy was 0 weeks after OHT surgery (P < 0.05).

CONCLUSIONS

This novel SSP model was validated as a useful tool for screening neuroprotective strategies in vivo. Group II mGluR modulation may be a useful treatment for RGC death. Combination therapy optimized to limit neurotoxic effects of MK801 may be an effective neuroprotective approach in retinal degenerative disease. Furthermore, treatments that minimize secondary RGC degeneration may be most useful in glaucoma.

Symbionts of the gut flagellate Staurojoenina sp. from Neotermes cubanus represent a novel, termite-associated lineage of Bacteroidales: description of ‘Candidatus Vestibaculum illigatum’

The symbioses between cellulose-degrading flagellates and bacteria are one of the most fascinating phenomena in the complex micro-ecosystem found in the hindgut of lower termites. However, little is known about the identity of the symbionts. One example is the epibiotic bacteria colonizing the surface of hypermastigote protists of the genusStaurojoenina. By using scanning electron microscopy, it was shown that the whole surface ofStaurojoeninasp. from the termiteNeotermes cubanusis densely covered with long rod-shaped bacteria of uniform size and morphology. PCR amplification of 16S rRNA genes from isolated protozoa and subsequent cloning yielded a uniform collection of clones with virtually identical sequences. Phylogenetic analysis placed them as a new lineage among theBacteroidales, only distantly related to other uncultivated bacteria in the hindgut of other termites, including an epibiont of the flagellateMixotricha paradoxa. The closest cultivated relative wasTannerella forsythensis(<85 % sequence identity). Fluorescencein situhybridization with a newly designed clone-specific oligonucleotide probe confirmed that these sequences belong to the rod-shaped epibionts ofStaurojoeninasp. Transmission electron microscopy confirmed the presence of a Gram-negative cell wall and revealed special attachment sites for the symbionts on the cell envelope of the flagellate host. Based on the isolated phylogenetic position and the specific association with the surface ofStaurojoeninasp., we propose to classify this new taxon ofBacteroidalesunder the provisional name ‘CandidatusVestibaculum illigatum’.

Inferring traits from behaviors versus behaviors from traits: the induction-deduction asymmetry

It is argued that inductive inferences from behaviors to traits are performed more frequently than deductive inferences from traits to behaviors-a phenomenon referred to as the induction-deduction asymmetry. Two experiments are reported in which behavior-to-trait inferences and trait-to-behavior inferences were compared within the same paradigm: Participants learned a series of descriptions of a target person, half of which were presented in trait form, half in behavior form. A subsequent recognition task was constructed so that some of the items (traits and behaviors) had actually been seen, some were entirely new, and some were new but had been implied by the information given. The 2 experiments provide clear evidence for the hypothesis that traits implied by a behavior are more frequently misidentified as already seen than behaviors implied by a trait. Response-time data in Experiment 2 further suggest that inferences from behaviors to traits are made on-line, whereas inferences from traits to behaviors appear to be memory based.

Cardiac and skeletal muscle adaptations to voluntary wheel running in the mouse

In this paper, we describe the effects of voluntary cage wheel exercise on mouse cardiac and skeletal muscle. Inbred male C57/Bl6 mice (age 6-8 wk; n = 12) [corrected] ran an average of 4.3 h/24 h, for an average distance of 6.8 km/24 h, and at an average speed of 26.4 m/min. A significant increase in the ratio of heart mass to body mass (mg/g) was evident after 2 wk of voluntary exercise, and cardiac atrial natriuretic factor and brain natriuretic peptide mRNA levels were significantly increased in the ventricles after 4 wk of voluntary exercise. A significant increase in the percentage of fibers expressing myosin heavy chain (MHC) IIa was observed in both the gastrocnemius and the tibialis anterior (TA) by 2 wk, and a significant decrease in the percentage of fibers expressing IIb MHC was evident in both muscles after 4 wk of voluntary exercise. The TA muscle showed a greater increase in the percentage of IIa MHC-expressing fibers than did the gastrocnemius muscle (40 and 20%, respectively, compared with 10% for nonexercised). Finally, the number of oxidative fibers as revealed by NADH-tetrazolium reductase histochemical staining was increased in the TA but not the gastrocnemius after 4 wk of voluntary exercise. All results are relative to age-matched mice housed without access to running wheels. Together these data demonstrate that voluntary exercise in mice results in cardiac and skeletal muscle adaptations consistent with endurance exercise.

Animal models of hypertrophic cardiomyopathy

Familial hypertrophic cardiomyopathy (FHC) is an autosomal-dominant disease that is both clinically and genetically heterogeneous. Disease-causing mutations have been found in eight genes encoding structural components of the thick and thin filament systems of the cardiac myocyte; it has therefore been coined a disease of the sarcomere. How each mutation leads to the diverse clinical phenotypes is still obscure, and research in this area is very active. Many approaches have been used to characterize the pathogenesis of the disease. Biochemical characterization of mutant alleles expressed in vitro has shed some insight into the functional deficits of several mutant alleles of myosin heavy chain, troponin-T, and alpha-tropomyosin. Transgenic animal models for FHC have been created to gain further insight into the pathogenesis of this disease. Most of these models have been made in mice; however, recently a transgenic rabbit model has been created. In addition, there are several natural-occurring forms of FHC in animals that will be interesting to explore. The discovery of additional responsible genes and the elucidation of the molecular mechanisms of pathogenesis through the use of animal models promise improved and early diagnosis and the potential for developing specific, mutation-, or mechanism-based therapeutics.

[Significance of calcium detection with electron-beam tomography in coronary disease]

PURPOSE

Coronary calcium is a powerful indicator of arteriosclerosis and can be detected very precisely with electron beam tomography. The method can be applied in patients with known coronary artery disease or in asymptomatic patients at risk of arteriosclerotic disease.

METHODS

The standard protocol of EBT consists of 30 to 40 slices of 3-mm thickness with a scan time of 100 ms, no overlap. No contrast medium is needed. The total scan can be performed within one breathhold. The calcium score is calculated as described by Agatston. Radiation exposure amounts to 0.8 mSv per total screen. We used spiral CT with and without ECG trigger as an alternative.

RESULTS

At the University of Munich we performed an EBT scan of the heart in 1100 patients within the last year. In 567 patients coronary angiography was performed also (+/- 3 days). Confirming previous reports in the literature, we found a correlation of the calcium score with the age and gender of the patients. Severe coronary artery disease (stenoses > or = 75%) was associated with significantly more calcium than less severe CAD. The calcium score did not discriminate between one-, two- and three-vessel disease. The site of calcification does not correlate with the localization of stenoses. Thirty-three percent of the patients with significant coronary artery disease showed a normal age-adjusted calcium score; a total of 8.1% of patients with severe stenoses did not reveal any coronary calcification (score = 0). With asymptomatic patients there are only a few studies available. Soft plaques cannot be detected with EBT, but in most patients soft plaques occur together with hard plaques. Our results show that spiral CT of the newest generation may also be used for calcium screening. There was an excellent correlation of the calcium scores of EBT and spiral CT at all levels of calcification.

DISCUSSION

Coronary calcium is a sensitive marker of coronary artery disease. In the clinical setting EBT is indicated in patients with known coronary artery disease (to evaluate prognosis), in patients who are unable to perform a stress test, and in patients with atypical chest pain. However, lack of calcification may be associated with severe stenoses in a minority of patients. The clinical value in asymptomatic patients needs to be defined: randomized studies are necessary. We see a possible indication in patients with known risk factors, in whom primary preventive strategies could be performed more selectively and cost-effectively.

Expression of the plasma membrane Ca2+-ATPase in myogenic cells

To study the physiological function of the plasma membrane calmodulin-dependent calcium ATPase (PMCA) in intact cells, L6 myogenic cell lines stably overexpressing the human PMCA isoform 4CI (= human PMCA isoform 4b) were generated. Several independent L6 clones and controls stably transfected with the empty expression vector were analyzed in detail. The resting cytosolic calcium level in hPMCA4CI-overexpressing muscle cells (measured by the Fura-2 method) was significantly reduced by 20-30% compared with controls. This was shown in a cytosolic window of 1322 single cells (p < 0.01). Furthermore, the differentiation process of these cells was remarkably accelerated compared with control myoblasts and parental nontransfected L6 cells as assessed by multinucleated myotube formation and creatine phosphokinase activity elevation. After 4 and 6 days of differentiation, PMCA-overexpressing L6 cells from four independent clones displayed a 3- and 4-fold higher creatine phosphokinase activity compared with controls (n = 5, p < 0.02). These results may extend the concept of the function of the PMCA from simple prevention of calcium overload to an active involvement in intracellular calcium regulation with potentially important consequences for cellular functions.

Lack of evidence of areas of slow conduction early after radiofrequency current application at porcine atrial myocardium

Electrophysiological sequelae after creation of atrial myocardial lesions by radiofrequency current (RFC) application have not been studied in vitro. During general anesthesia, a steerable 6 French electrode catheter, equipped with a thermistor at the 4-mm tip electrode, was positioned at the lateral atrial aspect of the tricuspid valve annulus in 5 piglets (German Landrace, mean body weight 12.5 kg). Temperature-guided (75 degrees C) RFC (500 kHz) was delivered over 30 seconds. Forty-eight hours later, the hearts were removed and placed in ice-cold Turner's solution. The right atria were dissected, and the RFC lesions with surrounding tissue were cut out and transferred to an organ bath according to Steiert. Preparations were superfused with Turner's solution at 37 degrees C. Pacing of the viable tissue at the border of the preparations was accomplished at a cycle length of 500 ms. Whole atrial preparations were impaled (76 to 150 impalements per specimen) with KCl capillary microelectrodes containing 3 MKCl. In the surrounding viable tissue of the five preparations, mean maximum diastolic transmembrane potential ranged from -61.3 to -63.7 mV, mean action potential duration at 90% repolarization ranged from 135.2 to 156.1 ms, and mean maximum upstroke velocity of phase 0 of the action potential was between 104.7 and 112.9 V/sec. Statistical analysis revealed no significant differences among all 3 variables. No intracellular action potential was recorded from the surface of all 5 lesions. The surrounding tissue was sharply demarcated, with unaltered transmembrane action potential characteristics in the vicinity of the lesions. Areas of slow conduction were not observed. Lack of evidence of areas of slow conduction after RFC application to the atrial myocardium may imply that this technique is safe regarding occurrence of atrial tachyarrhythmias.

Opposite effects of alcuronium on agonist and on antagonist binding to muscarinic receptors

Alcuronium is known to retard allosterically the dissociation of [3H]N-methylscopolamine from muscarinic M2 receptors, thereby augmenting the binding of this antagonist. Functionally, alcuronium behaves as a weak antimuscarinic agent and induces in combination with N-methylscopolamine an overadditive antimuscarinic action with oxotremorine-M as the agonist. The effect of alcuronium on the binding of [3H]oxotremorine-M was studied in porcine heart homogenates. Agonist binding was concentration dependently inhibited with a Ki = 0.48 +/- 0.03 microM (means +/- S.D., n = 3). Under identical conditions [3H]N-methylscopolamine binding was elevated. Alcuronium, 100 microM, which nearly prevented the dissociation of [3H]N-methylscopolamine, retarded the rate of dissociation of [3H]oxotremorine-M only by a factor of two. These findings support the notion that the overadditive antimuscarinic action of alcuronium in conjunction with N-methylscopolamine is based on a shift by alcuronium of the interplay between agonist and antagonist in favour of the antagonist.

Hormonal induction of an immediate-early gene response in myogenic cell lines--a paradigm for heart growth

Cardiac hypertrophy is characterized by growth of myocardial cells without proliferation. Many endo- paracrine stimuli such as angiotensin II, endothelin, alpha 1-adrenergic agonists, and insulin have been shown to be able to induce cardiac hypertrophy either in vivo or in vitro. We have used the myoblast model of differentiation and proliferation to determine nuclear signal transduction mechanisms in muscle and (by analogy) cardiac growth. The first nuclear event known to occur when a growth stimulus acts upon a cell is induction of a family of immediate-early genes. Our group focused on the role of one of these genes, the early growth response gene-1 (Egr-1). We have shown that this gene is induced in isolated adult cardiac myocytes in the presence of endothelin. An anti-sense oligonucleotide complementary to the first six codons of the Egr-1 mRNA abolishes the stimulation of protein synthesis induced by endothelin. In the present study we further characterized paracrine growth stimuli in the myogenic cell line Sol8, which was used as a paradigm to further investigate mechanisms of paracrine growth induction. We demonstrated that a variety of candidate endo- paracrine stimuli for the induction of cardiac hypertrophy induced the Egr-1 messenger RNA in the myogenic cell line Sol8. Among these are endothelin, insulin, basic fibroblast growth factor, and platelet-derived growth factor BB (PDGF BB). We conclude: (1) In analogy to the myocardium, these growth factors act upon myoblasts. (2) This line appears to be a suitable model for the molecular characterization of Egr-1 target genes.

Linguistic intergroup bias: differential expectancies or in-group protection?

The linguistic intergroup bias describes the tendency to communicate positive in-group and negative out-group behaviors more abstractly than negative in-group and positive out-group behaviors. This article investigated whether this bias is driven by differential expectancies or by in-group protective motives. In Experiment 1, northern and southern Italian participants (N = 151) described positive and negative behaviors of northern or southern protagonists that were either congruent or incongruent with stereotypic expectancies. Regardless of valence, expectancy-congruent behaviors were described more abstractly than incongruent ones. Experiment 2 (N = 40) showed that language is used in an equally biased fashion for individuals as previously demonstrated for groups. Experiment 3 (N = 192) induced expectancies experimentally and found greater abstraction for expectancy-congruent behaviors regardless of valence. All experiments confirmed the differential expectancy approach.

Potentiation by alcuronium of the antimuscarinic effect of N-methylscopolamine in guinea pig left atria

Alcuronium is known to stabilize allosterically the binding of the muscarinic antagonist N-methylscopolamine to muscarinic M2 receptors and thus to elevate the equilibrium binding of N-methylscopolamine in homogenized cardiac tissue. In order to check for a functional consequence of this effect, the action of alcuronium alone and in combination with N-methylscopolamine was determined in contracting guinea pig left auricles with oxotremorine-M as the negative inotropic agonist. For sake of comparison, the allosteric modulator W84 = hexane-1,6-bis(dimethyl-3'- phthalimidopropyl-ammonium bromide) was included. Alcuronium displayed a weak antimuscarinic action (pA2 = 5.7). In conjunction with 10(-7) M N-methylscopolamine, alcuronium (> or = 10(-6) M) induced a more pronounced antimuscarinic effect than expected for a combination of competitive antagonists. The extent of overadditivity with combinations of W84 and 10(-7) M N-methylscopolamine was smaller. In conclusion, alcuronium potentiates the antimuscarinic effect of N-methylscopolamine in contracting cardiac preparations with high effectivity.

Linguistic intergroup bias: differential expectancies or in-group protection?

The linguistic intergroup bias describes the tendency to communicate positive in-group and negative out-group behaviors more abstractly than negative in-group and positive out-group behaviors. This article investigated whether this bias is driven by differential expectancies or by in-group protective motives. In Experiment 1, northern and southern Italian participants (N = 151) described positive and negative behaviors of northern or southern protagonists that were either congruent or incongruent with stereotypic expectancies. Regardless of valence, expectancy-congruent behaviors were described more abstractly than incongruent ones. Experiment 2 (N = 40) showed that language is used in an equally biased fashion for individuals as previously demonstrated for groups. Experiment 3 (N = 192) induced expectancies experimentally and found greater abstraction for expectancy-congruent behaviors regardless of valence. All experiments confirmed the differential expectancy approach.

Mitogenic signals control translation of the early growth response gene-1 in myogenic cells

Muscle is a major site of expression of the early growth response gene-1 (Egr-1). To investigate its role in muscle proliferation and/or differentiation we studied the effect of a variety of growth factors on cultured mouse muscle Sol8 cells. Three groups of responses could be distinguished: 1. AII, endothelin, phenylephrine, and PMA induced Egr-1 mRNA accumulation, but the message remained untranslated. These factors induced neither differentiation nor proliferation. 2. Insulin induced differentiation. It stimulated Egr-1 mRNA accumulation, but no translation into the Egr-1 protein was seen. 3. bFGF, PDGF BB, and FCS strongly induced DNA- and protein synthesis (i.e. proliferation) and Egr-1 mRNA accumulation. Only under these conditions was the message translated into protein. We conclude: 1. AII, endothelin, phenylephrine, and PMA elicit a nuclear response in Sol8 muscle cells which may lead to reprogramming of genes unrelated to differentiation or proliferation. 2. Differentiation induces a translational block of the Egr-1 mRNA which is only relieved by mitotic stimuli. 3. These results strongly suggest a pivotal role of Egr-1 in muscle proliferation and define translational control as a new mechanism of Egr-1 regulation.

Use of positron emission tomography with fluorodeoxyglucose in patients with extracranial head and neck cancers

BACKGROUND

The purpose of this study was to evaluate the utility of positron emission tomography- (PET) 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) imaging in extracranial head and neck cancers.

METHODS

Sixty patients with biopsy-proven cancers were studied using PET-FDG. Thirty-four patients were studied before therapy (staging), of which 15 patients received primary radiotherapy and serial PET-FDG imaging (monitoring). Seven patients with advanced disease had laser excision (monitoring), and 19 patients were evaluated for recurrent disease (recurrence).

RESULTS

Four patients had unknown primary lesions. PET-FDG imaging located the primary tumor in two of four patients, and magnetic resonance imaging (MRI) in none of four. In the remaining patients (staging), PET-FDG imaging detected the primary tumor in 29 of 30 patients, and MRI in 23 of 30. In the staging group, PET-FDG imaging identified the presence or absence of lymph node involvement in 32 of 34 patients, and MRI in 31 of 34. PET-FDG imaging was helpful in evaluating tumor response to radiation therapy or laser excision. Ten patients evaluated for recurrent disease had biopsy-confirmed recurrences, and 7 had no recurrence. PET-FDG imaging results were positive for primary tumor recurrence in 9 of 10 patients, and MRI results were positive in 6 of 10. MRI results were negative for lymph node disease in one of these patients with recurrent primary tumor where PET-FDG imaging and biopsy demonstrated nodal involvement. PET-FDG results were negative for recurrent disease in seven of seven patients, and MRI results were negative for recurrent disease in in four of seven.

CONCLUSION

In this series, the authors found that PET-FDG is a useful diagnostic modality for evaluating the patient with an unknown primary, monitoring response to therapy, and in detecting recurrent tumors.

Immediate-early gene induction by repetitive mechanical but not electrical activity in adult rat cardiomyocytes

Mechanical factors are thought to play an important role in the induction of myocardial hypertrophy. Yet, it is not known whether active contraction induces genes that probably represent initial steps in the hypertrophic response in the adult myocardium--and if so, whether the mechanical or the electrical component of the twitch governs this response. We therefore investigated whether electrical stimulation of contraction was able to induce the immediate-early genes (IEGs) egr-1 and c-fos in adult rat cardiomyocytes. Cyclical contraction led to an increase in egr-1 and c-fos mRNA levels within 30 min. Full inhibition of contraction during electrostimulation by the Ca(2+)-desensitizer 2,3-butanedione monoxime (BDM) totally blocked this IEG-response without altering membrane potential. These data suggest that in adult myocardium, the mechanical rather than the electrical activity is responsible for the IEG-response during active twitch.

Hyperosmotic stress induces immediate-early gene expression in ventricular adult cardiomyocytes

Mammalian cells possessing osmosensors have long been described in brain and kidney. The genetic basis of the response to hyperosmotic stress has been well characterized in prokaryotes. In contrast, the genetic response of eukaryotic cells is poorly understood. Therefore we investigated the effect of hypertonic NaCl and sucrose solutions on the transcriptional activation of the immediate-early genes (IEGs) egr-1 and c-fos in isolated ventricular adult rat cardiomyocytes. We observed that even small increases in osmolarity to 315 +/- 5 mosmol/l and 370 +/- 8 mosmol/l by hypertonic NaCl solution resulted in dose-dependent induction of egr-1 (4-and 5-fold) and c-fos (3-and 4-fold), respectively. Hypertonic sucrose solution had the same effect on egr-1 and c-fos mRNA levels while increased sucrose concentration under isotonic conditions had no effect. Cardiomyocytes exposed to hypertonic media did not significantly shrink as shown by a cell length measurement. We conclude that isolated adult cardiomyocytes possess an osmoreceptor mechanism which is able to sense even slight changes in osmolarity and to translate these into a transcriptional response of the myocardial IEG program.

Language use in intergroup contexts: the linguistic intergroup bias

Three experiments examine how the type of language used to describe in-group and out-group behaviors contributes to the transmission and persistence of social stereotypes. Two experiments tested the hypothesis that people encode and communicate desirable in-group and undesirable out-group behaviors more abstractly than undesirable in-group and desirable out-group behaviors. Experiment 1 provided strong support for this hypothesis using a fixed-response scale format controlling for the level of abstractness developed from Semin and Fiedler's (1988a) linguistic category model. Experiment 2 yielded the same results with a free-response format. Experiment 3 demonstrated the important role that abstract versus concrete communication plays in the perpetuation of stereotypes. The implications of these findings and the use of the linguistic category model are discussed for the examination of the self-perpetuating cycle of stereotypes in communication processes.

Language use in intergroup contexts: The linguistic intergroup bias

Three experiments examine how the type of language used to describe in-group and out-group behaviors contributes to the transmission and persistence of social stereotypes. Two experiments tested the hypothesis that people encode and communicate desirable in-group and undesirable out-group behaviors more abstractly than undesirable in-group and desirable out-group behaviors. Experiment 1 provided strong support for this hypothesis using a fixed-response scale format controlling for the level of abstractness developed from Semin and Fiedler's (1988a) linguistic category model. Experiment 2 yielded the same results with a free-response format. Experiment 3 demonstrated the important role that abstract versus concrete communication plays in the perpetuation of stereotypes. The implications of these findings and the use of the linguistic category model are discussed for the examination of the self-perpetuating cycle of stereotypes in communication processes.