Validity and reliability of VO2-max testing in persons with Parkinson's disease

INTRODUCTION

Direct whole body assessment of maximal oxygen consumption (VO₂-max test) is considered the gold standard when assessing cardiorespiratory fitness (VO₂-max) in healthy people. VO₂-max is also an important health and performance indicator for persons with Parkinson's disease (pwPD) and is often used when prescribing exercise and evaluating aerobic exercise interventions. However, no study has examined the content validity of the VO₂-max test in pwPD as well as the test-retest reliability (i.e., day-to-day variation) in both the ON and OFF medication state. Therefore, the present study investigated the content validity and test-retest reliability of the VO₂-max test in pwPD both ON and OFF medication.

METHODS

Twenty pwPD completed four VO₂-max tests (two tests ON and two tests OFF medication), in a randomized order, separated by four to sixteen days. The first tests ON and OFF medication were used to assess content validity based on attainment of five pre-defined end-criteria (one primary and four secondary). Reliability was examined by intraclass correlation coefficients (ICC) and the day-to-day variation of the two ON and OFF medication tests.

RESULTS

In pwPD, 50% and 60% attained the primary end-criterion ON and OFF medication, respectively. A higher proportion (i.e., 70-90%) attained the secondary end-criteria both ON and OFF medication with no difference between medication states. Day-to-day variations were 1.2 and 1.8 ml O₂/kg/min, while ICC_2.1 were 0.97 (95%-CI: 0.92; 0.99) and 0.96 (95%-CI: 0.90; 0.98) ON and OFF medication, respectively.

CONCLUSION

The VO₂-max test has an acceptable content validity and excellent day-to-day reliability ON and OFF medication in pwPD.

Nitrite transport into pig erythrocytes and its potential biological role

AIM

To study nitrite transport and its oxygenation dependency in pig erythrocytes, as this is fundamental to the possible participation of nitrite in blood flow regulation via its reduction to nitric oxide by deoxygenated haemoglobin (Hb).

METHODS

Pig red blood cells (RBCs) were tonometer-equilibrated to physiological pCO2 in oxygenated and deoxygenated states. Nitrite was added and the kinetics of NO2- influx and methaemoglobin (metHb) formation were assessed at variable temperature and haematocrit.

RESULTS

Nitrite quickly permeated and equilibrated across the membrane, and then continued to enter RBCs as a consequence of its intracellular removal (via reactions with Hb to form nitrate and metHb in oxygenated cells, and NO and metHb in deoxygenated cells). The membrane permeation as such showed little oxygenation dependency, but as metHb formation was significantly higher in oxygenated than deoxygenated RBCs, nitrite transport tended to be largest into oxygenated RBCs. This contrasts with a preferential permeation of deoxygenated RBCs in some fish species. Nitrite transport showed low temperature sensitivity but was speeded up at low haematocrit via more rapid intracellular nitrite removal (metHb formation). Nitrite influx was not affected by inhibitors of facilitated diffusion (DIDS, phloretin and PCMB) and may occur via conductive transport. Extracellular pH was stable during nitrite transport.

CONCLUSION

Nitrite extensively permeates both oxygenated and deoxygenated pig RBCs, which may enable a dual function of nitrite entry: viz. conversion to NO at low pO2 to promote blood flow and detoxification to non-toxic nitrate at inappropriate high nitrite levels.

Perfusion of the isolated trout heart coronary circulation with red blood cells: effects of oxygen supply and nitrite on coronary flow and myocardial oxygen consumption

A method for perfusion of the isolated trout heart coronary circulation with red blood cells (RBCs) was developed. The method was used to analyse the influence of RBC perfusion on myocardial O2 supply and O2 consumption and to test the hypothesis that nitrite is converted to vasoactive nitric oxide in the RBC-perfused coronary circulation. Perfusion with RBCs significantly increased myocardial O2 supply and O2 consumption by increasing the incoming O2concentration and the O2 extraction. Coronary flow did not differ between RBC perfusion and saline perfusion, but RBC perfusion established a strong linear increase in myocardial O2 consumption with coronary flow. Nitric oxide was measured in the atrial effluent of the preparation. Perfusion with saline under hypoxic conditions was associated with NO production. The nitric oxide synthase inhibitor L-NA obliterated this NO production and significantly decreased coronary flow, showing that the NO was vasoactive and probably of endothelial origin. RBC perfusion at low PO2 similarly caused an L-NA-inhibitable NO production. The change in NO production upon subsequent nitrite addition, by contrast, was not inhibited by L-NA. Nitrite entered trout erythrocytes independent of degree of oxygenation, but the O2 saturation of RBCs showed a major decrease in the coronary circulation, and[NO2-] decreased while methaemoglobin rose, suggesting that deoxyHb-mediated reduction of nitrite to NO may have occurred. However,other possibilities (e.g. NO2-→NO conversion in myocardial cells) cannot be excluded. The NO formation associated with nitrite had no effect on coronary flow, possibly because NO was produced after the resistance vessels.

Bicarbonate secretion plays a role in chloride and water absorption of the European flounder intestine

Experiments performed on isolated intestinal segments from the marine teleost fish, the European flounder (Platichthys flesus), revealed that the intestinal epithelium is capable of secondary active HCO3(-) secretion in the order of 0.2-0.3 micromol x cm(-2) x h(-1) against apparent electrochemical gradient. The HCO3(-) secretion occurs via anion exchange, is dependent on mucosal Cl(-), results in very high mucosal HCO3(-) concentrations, and contributes significantly to Cl(-) and fluid absorption. This present study was conducted under in vivo-like conditions, with mucosal saline resembling intestinal fluids in vivo. These conditions result in a transepithelial potential of -16.2 mV (serosal side negative), which is very different from the -2.2 mV observed under symmetrical conditions. Under these conditions, we found a significant part of the HCO3(-) secretion is fueled by endogenous epithelial CO2 hydration mediated by carbonic anhydrase because acetazolamide (10(-4) M) was found to inhibit HCO3(-) secretion and removal of serosal CO(2) was found not to influence HCO3(-) secretion. Reversal of the epithelial electrochemical gradient for Cl(-) (removal of serosal Cl(-)) and elevation of serosal HCO3(-) resulted in enhanced HCO3(-) secretion and enhanced Cl(-) and fluid absorption. Cl(-) absorption via an anion exchange system appears to partly drive fluid absorption across the intestine in the absence of net Na(+) absorption.

Red blood cell pH, the Bohr effect, and other oxygenation-linked phenomena in blood O2 and CO2 transport

The discovery of the S-shaped O2 equilibrium curve and the Bohr effect in 1904 stimulated a fertile and continued research into respiratory functions of blood and allosteric mechanisms in haemoglobin (Hb). The Bohr effect (influence of pH/CO2 on Hb O2 affinity) and the reciprocal Haldane effect (influence of HbO2 saturation on H+/CO2 binding) originate in the Hb oxy-deoxy conformational change and allosteric interactions between O2 and H+/CO2 binding sites. In steady state, H+ is passively distributed across the vertebrate red blood cell (RBC) membrane, and intracellular pH (pHi) changes are related to changes in extracellular pH, Hb-O2 saturation and RBC organic phosphate content. As the Hb molecule shifts between the oxy and deoxy conformation in arterial-venous gas transport, it delivers O2 and takes up CO2 and H+ in tissue capillaries (elegantly aided by the Bohr effect). Concomitantly, the RBC may sense local O2 demand via the degree of Hb deoxygenation and release vasodilatory agents to match local blood flow with requirements. Three recent hypotheses suggest (1) release of NO from S-nitroso-Hb upon deoxygenation, (2) reduction of nitrite to vasoactive NO by deoxy haems, and (3) release of ATP. Inside RBCs, carbonic anhydrase (CA) provides fast hydration of metabolic CO2 and ensures that the Bohr shift occurs during capillary transit. The formed H+ is bound to Hb (Haldane effect) while HCO3- is shifted to plasma via the anion exchanger (AE1). The magnitude of the oxylabile H+ binding shows characteristic differences among vertebrates. Alternative strategies for CO2 transport include direct HCO3- binding to deoxyHb in crocodilians, and high intracellular free [HCO3-] (due to high pHi) in lampreys. At the RBC membrane, CA, AE1 and other proteins may associate into what appears to be an integrated gas exchange metabolon. Oxygenation-linked binding of Hb to the membrane may regulate glycolysis in mammals and perhaps also oxygen-sensitive ion transport involved in RBC volume and pHi regulation. Blood O2 transport shows several adaptive changes during exposure to environmental hypoxia. The Bohr effect is involved via the respiratory alkalosis induced by hyperventilation, and also via the pHi change that results from modulation of RBC organic phosphate content. In teleost fish, beta-adrenergic activation of Na+/H+ exchange rapidly elevates pHi and O2 affinity, particularly under low O2 conditions.

Influence of hyperosmotic shrinkage and beta-adrenergic stimulation on red blood cell volume regulation and oxygen binding properties in rainbow trout and carp

Whole blood from rainbow trout and carp was subjected to hyperosmotic shock and subsequent beta-adrenergic stimulation (isoprenaline) at different oxygen tension ( PO(2)) and carbon dioxide tension ( PCO(2)) levels with the aim to evaluate changes in red blood cell (RBC) volume, pH and ion concentrations and their ultimate effect on blood O(2) transport characteristics. Hyperosmolality (addition of NaCl) induced RBC shrinkage, which was followed by a regulatory volume increase (RVI) that was larger at low than at high PO(2)and more complete in carp than in trout. Carp RBC showed practically full volume recovery within 140 min at low PO(2)and partial recovery at high PO(2), whereas RVI was partial under all PO(2)and PCO(2)conditions in trout. The RVI increased intracellular [Na(+)], water content, and, in carp, also pH (pHi), suggesting activation of Na(+)/H(+) exchange. In trout RBCs, activation of RVI was rapid but succeeded by deactivation. In carp RBCs, activation of Na(+) influx was slower but it continued, allowing full volume recovery. Shrinkage of the RBCs was associated with only minor decreases in blood oxygen saturation and oxygen affinity in both species. Thus, the oxygen affinity decrease expected on the basis of the increased concentration of intracellular haemoglobin and organic phosphates was small, and it appeared to some extent countered during RVI by an oxygen affinity increase via increased pHi. Addition of isoprenaline increased RBC volume and pHi and increased Hb oxygen saturation. The beta-adrenergic response was stronger at low compared to high PO(2) and at high compared to low PCO(2). The PO(2) dependency was largest in carp, whereas the PCO(2) (pH) dependency was more expressed in trout. The adrenergic response of trout RBCs was similar under isoosmotic and hyperosmotic conditions. In carp RBCs, the response was absent at high PO(2) under isoosmotic conditions, but interestingly it could be induced under hyperosmotic conditions. The data suggest that the RBC shrinkage occurring in fish moving from freshwater to seawater has minimal impact on blood O(2) binding properties.

Adrenergic receptors, Na+/H+ exchange and volume regulation in lungfish erythrocytes

Aestivation in African and South American lungfish (Protopterus and Lepidosiren, respectively) is associated with elevations of extracellular osmolarity. Osmotic shrinkage of Protopterus red blood cells (RBCs) caused a small but significant stimulation of the Na influx that was amiloride-sensitive. suggesting involvement of the Na+/H+ exchanger (NHE). The associated in vitro regulatory volume increase was insignificant within a time frame of 120 min, but the shrinkage-activated Na+ influx may be sufficient for slow regulatory volume increase during aestivation in vivo. Osmotic swelling of the RBCs induced an incomplete regulatory volume decrease that was statistically significant after 180 min. The RBCs of Protopterus were very large (mean cellular volume of 6939 +/- 294 microm3) and possessed 23,066 +/- 7,326 beta-adrenoceptors cell(-1) with a Kd value of 6.1 +/- 3.2 nM. The number of receptors per unit surface area of lungfish RBCs was calculated to be twice that of trout RBCs and 70% that of cod RBCs. There was, however, no adrenergic stimulation of the NHE in either Protopterus or Lepidosiren. Acidification of the extracellular medium also failed to activate the NHE.

Vacuolar-type H(+)-ATPase and Na+, K(+)-ATPase expression in gills of Atlantic salmon (Salmo salar) during isolated and combined exposure to hyperoxia and hypercapnia in fresh water

Changes in branchial vacuolar-type H(+)-ATPase B-subunit mRNA and Na+, K(+)-ATPase alpha- and beta-subunit mRNA and ATP hydrolytic activity were examined in smolting Atlantic salmon exposed to hyperoxic and/or hypercapnic fresh water. Pre-smolts, smolts, and post-smolts were exposed for 1 to 4 days to hyperoxia (100% O2) and/or hypercapnia (2% CO2). Exposure to hypercapnic water for 4 days consistently decreased gill vacuolar-type H(+)-ATPase B-subunit mRNA levels. Salmon exposed to hyperoxia had either decreased or unchanged levels of gill B-subunit mRNA. Combined hyperoxia + hypercapnia decreased B-subunit mRNA levels, although not to the same degree as hypercapnic treatment alone. Hyperoxia generally increased Na+, K(+)-ATPase alpha- and beta-subunit mRNA levels, whereas hypercapnia reduced mRNA levels in presmolts (beta) and smolts (alpha and beta). Despite these changes in mRNA levels, whole tissue Na+, K(+)-ATPase activity was generally unaffected by the experimental treatments. We suggest that the reduced expression of branchial vacuolar-type H(+)-ATPase B-subunit mRNA observed during internal hypercapnic acidosis may lead to reduction of functional V-type H(+)-ATPase abundance as a compensatory response in order to minimise intracellular HCO3- formation in epithelial cells.

Intestinal iron uptake in the European flounder (Platichthys flesus)

Iron is an essential element because it is a key constituent of the metalloproteins involved in cellular respiration and oxygen transport. There is no known regulated excretory mechanism for iron, and homeostasis is tightly controlled via its uptake from the diet. This study assessed in vivo intestinal iron uptake and in vitro iron absorption in a marine teleost, the European flounder Platichthys flesus. Ferric iron, in the form 59FeCl3, was reduced to Fe2+ by ascorbate, and the bioavailability of Fe3+ and Fe2+ were compared. In vivo Fe2+ uptake was significantly greater than Fe3+ uptake and was reduced by the iron chelator desferrioxamine. Fe2+ was also more bioavailable than Fe3+ in in vitro studies that assessed the temporal pattern and concentration-dependency of iron absorption. The posterior region, when compared with the anterior and mid regions of the intestine, was the preferential site for Fe2+ uptake in vivo. In vitro iron absorption was upregulated in the posterior intestine in response to prior haemoglobin depletion of the fish, and the transport showed a Q10 value of 1.94. Iron absorption in the other segments of the intestine did not correlate with haematocrit, and Q10 values were lower. Manipulation of the luminal pH had no effect on in vitro iron absorption. The present study demonstrates that a marine teleost absorbs Fe2+ preferentially in the posterior intestine. This occurs in spite of extremely high luminal bicarbonate concentrations recorded in vivo, which may be expected to reduce the bioavailability of divalent cations as a result of the precipitation as carbonates (e.g. FeCO3).

Effects of temperature and oxygen availability on circulating catecholamines in the toad Bufo marinus

The release of catecholamines during hypoxia has received limited attention in amphibians and the adrenergic regulation of cardio-pulmonary functions is, therefore, not well understood at the organismic level. To describe the changes in plasma catecholamine concentrations, we exposed toads (Bufo marinus) to different levels of hypoxia at two temperatures (15 and 25 degrees C). In addition, blood oxygen binding properties were determined in vitro at 15 and 25 degrees C at two different pH values. Hypoxia elicited a significant increase in plasma catecholamines (adrenaline and noradrenaline) at both temperatures, in spite of a respiratory alkalosis. At 15 degrees C, the increase was from 2.6+/-1.0 in normoxia to 4.8+/-1.4 ng ml(-1) at an inspired oxygen fraction of 0.05. At 25 degrees C, the hypoxic release of catecholamines was significantly higher (maximum levels of 44.8+/-11.6 ng ml(-1)). Plasma noradrenaline concentration was elevated at the most severe hypoxic levels, suggestive of an adrenal release. The arterial oxygen threshold for catecholamine release were approximately 1.0 mmol O(2) l(-1) blood or a PaO(2) of 30 mmHg. The P(50) values at 15 degrees C were 23.5+/-0.7 and 28.9+/-1.0 mmHg at pH 7.98+/-0.01 and 7.62+/-0.02, respectively, and increased to 36.5+/-0.6 and 43.0+/-1.1 mmHg at pH 8.04+/-0.04 and 7.67+/-0.05, respectively, at 25 degrees C. The oxygen equilibrium curves were linear when transformed to Hill-plots and Hills n (the haemoglobin subunit co-operativity) ranged between 2.24 and 2.75. The in vitro blood O(2) binding properties corresponded well with in vivo data.

Hydrogen ion binding properties of tuna haemoglobins

Tunas are very active fish with a high aerobic capacity, but they also regularly perform burst swimming with massive production of lactic acid. The present study examines whether H(+) buffering by tuna haemoglobin (Hb) is elevated to cope with metabolic acidoses (by analogy with the high buffer capacity of tuna white musculature) or whether the Hb-H(+) binding properties resemble other teleosts that have low buffer values and high Haldane effects. H(+) titration of oxygenated and deoxygenated composite Hb from yellowfin tuna, skipjack tuna and bigeye tuna in 0.1 M KCl revealed low Hb-specific buffer values in all three tunas. Values at physiological pH were comparable to those reported in less active species such as carp and eel. The fixed acid Haldane effect was large (maximal uptakes of close to 4 mol H(+) per mol Hb tetramer upon deoxygenation). Thus, the Hb-H(+) binding properties of very active tuna species correspond to other teleosts. Low Hb buffer values may be a pre-requisite for the regulation of red blood cell pH via Na(+)/H(+) exchange. Approximately nine "neutral" groups were titratable in tuna Hbs, suggesting that two alpha-amino groups and seven histidine residues are titrated within each tetramer.

Comparative Analysis of Autoxidation of Haemoglobin

Autoxidation of oxyhaemoglobin (oxyHb) to methaemoglobin was measured at different temperatures in haemoglobin solutions from Atlantic hagfish, river lamprey, common carp, yellowfin tuna and pig. The aims were to evaluate the impact of the absent distal histidine in hagfish haemoglobin, the importance of oxyHb being either monomeric (hagfish and lamprey) or tetrameric (carp, tuna and pig) and to gain information on the temperature-sensitivity of autoxidation. The rate of autoxidation was lower in hagfish than in carp, yellowfin tuna and lamprey haemoglobins at any given temperature. Substitution of the distal histidine residue (His E7) with glutamine in hagfish haemoglobin was therefore not associated with an accelerated autoxidation, as might be expected on the basis of the normal protective role of His E7. Glutamine may have similar qualities to histidine and be involved in the low susceptibility to autoxidation. The low oxidation rate of hagfish haemoglobin, together with an oxidation rate of lamprey haemoglobin that did not differ from that of carp and yellowfin tuna haemoglobins, also revealed that autoxidation was not accelerated in the monomeric oxyhaemoglobins. Pig haemoglobin was oxidised more slowly than fish haemoglobins, demonstrating that fish haemoglobins are more sensitive to autoxidation than mammalian haemoglobins. The rate of autoxidation of hagfish haemoglobin was, however, only significantly greater than that of pig haemoglobin at high temperatures. Autoxidation was accelerated by rising temperature in all haemoglobins. Arrhenius plots of carp and yellowfin tuna haemoglobin revealed a break at 25°C, reflecting a lower temperature-sensitivity between 5 and 25°C than between 25 and 40°C.

Acute and chronic influence of temperature on red blood cell anion exchange

Unidirectional (36)Cl(−) efflux via the red blood cell anion exchanger was measured under Cl(−) self-exchange conditions (i.e. no net flow of anions) in rainbow trout Oncorhynchus mykiss and red-eared freshwater turtle Trachemys scripta to examine the effects of acute temperature changes and acclimation temperature on this process. We also evaluated the possible adaptation of anion exchange to different temperature regimes by including our previously published data on other animals. An acute temperature increase caused a significant increase in the rate constant (k) for unidirectional Cl(−) efflux in rainbow trout and freshwater turtle. After 3 weeks of temperature acclimation, 5 degrees C-acclimated rainbow trout showed only marginally higher Cl(−) transport rates than 15 degrees C-acclimated trout when compared at the same temperature. Apparent activation energies for red blood cell Cl(−) exchange in trout and turtle were lower than values reported in endothermic animals. The Q(10) for red blood cell anion exchange was 2.0 in trout and 2.3 in turtle, values close to those for CO(2) excretion, suggesting that, in ectothermic animals, the temperature sensitivity of band-3-mediated anion exchange matches the temperature sensitivity of CO(2) transport (where red blood cell Cl(−)/HCO(3)(−) exchange is a rate-limiting step). In endotherms, such as man and chicken, Q(10) values for red blood cell anion exchange are considerably higher but are no obstacle to CO(2) transport, because body temperature is normally kept constant at values at which anion exchange rates are high. When compared at constant temperature, red blood cell Cl(−) permeability shows large differences among species (trout, carp, eel, cod, turtle, alligator, chicken and man). Cl(−) permeabilities are, however, remarkable similar when compared at preferred body temperatures, suggesting an appropriate evolutionary adaptation of red blood cell anion exchange function to the different thermal niches occupied by animals.

Anion uptake and acid-base and ionic effects during isolated and combined exposure to hypercapnia and nitrite in the freshwater crayfish, Astacus astacus

Nitrite influx into crayfish showed saturation kinetics, supporting a carrier-mediated uptake. Addition of 4,4'-diisothiocyanatostilbene-2,2'-disulfonate (DIDS: at 10(-5), 10(-4) and 10(-3) M) and bumetanide (at 10(-5) M and 10(-4) M) to the ambient water did not significantly affect nitrite influx. Rather than suggesting that neither Cl-/HCO3- exchange nor K+/Na+/2Cl- cotransport were involved in the transport, this may reflect that the gill cuticle has a low permeability to the pharmacological agents, or that the sensitivity of the transport mechanism to the inhibitors is low. Nitrite accumulation in the haemolymph was significantly decreased during hypercapnic conditions compared to normocapnic conditions. This supports the idea that an acid-base regulatory decrease in Cl-(influx)/HCO3- (efflux) induced by hypercapnia should decrease NO2- uptake if NO2- and Cl- share this uptake route. The respiratory acidosis caused by exposure to hypercapnia alone was partially compensated by HCO3- accumulation in the haemolymph. Combined exposure to hypercapnia and nitrite improved pH recovery, mainly by augmenting the [HCO3-] increase, but also by decreasing haemolymph PCO2. Exposure to nitrite in normocapnic water induced an initial increase in haemolymph [HCO3-] and later also a decrease in PCO2. Thus, the improved acid-base compensation during combined hypercapnia and nitrite exposure was an amplification of this nitrite-induced response. Haemolymph base excess rose much more than haemolymph [Ca], suggesting that transfer of acid-base equivalents between animal and water was more important than H+ buffering by exoskeletal CaCO3 in mediating the increase in haemolymph [HCO3-].

Uptake and effects of nitrite in the marine teleost fish Platichthys flesus

The route of NO(2)(-) uptake and subsequent physiological effects were examined in the marine teleost, European flounder (Platichthys flesus), during exposure to 1 mM ambient NO(2)(-) for up to 11 days. Drinking of seawater resulted in a similar nitrite concentration in the anterior part of the intestine as in the ambient water. The NO(2)(-) concentration decreased along the gastro-intestinal tract, suggesting NO(2)(-) uptake across the intestinal epithelium. Comparison of NO(2)(-) uptake in fish that drank NO(2)(-)-contaminated seawater with fish that did not (i.e. had the intestine perfused with a NO(2)(-)-free saline during NO(2)(-) exposure) revealed that the intestinal route contributed some 66% of whole-body NO(2)(-) uptake. Plasma [NO(2)(-)] stayed below the ambient level. It reached a maximum of 0.35-0.4 mM on days 3-6 and then declined to 0.2 mM on day 11. The physiological effects of NO(2)(-) exposure were relatively minor compared with those reported in freshwater fish. Blood methemoglobin levels increased from approximately 4% in non-exposed fish to a maximum of 18% of total hemoglobin in exposed fish. An extracellular hyperkalemia was observed from day 3 of NO(2)(-) exposure, with a maximal increase in plasma K(+) concentrations of 38%. No mortality occurred during the 11 days of NO(2)(-) exposure. The lack of mortality can be related to the relatively low NO(2)(-) accumulation in the plasma and the relatively minor physiological disturbances.

Effects of feeding on metabolism, gas transport, and acid-base balance in the bullfrog Rana catesbeiana

Massive feeding in ectothermic vertebrates causes changes in metabolism and acid-base and respiratory parameters. Most investigations have focused on only one aspect of these complex changes, and different species have been used, making comparison among studies difficult. The purpose of the present study was, therefore, to provide an integrative study of the multiple physiological changes taking place after feeding. Bullfrogs (Rana catesbeiana) partly submerged in water were fed meals (mice or rats) amounting to approximately (1)/(10) of their body weight. Oxygen consumption increased and peaked at a value three times the predigestive level 72-96 h after feeding. Arterial PO(2) decreased slightly during digestion, whereas hemoglobin-bound oxygen saturation was unaffected. Yet, arterial blood oxygen content was pronouncedly elevated because of a 60% increase in hematocrit, which appeared mediated via release of red blood cells from the spleen. Gastric acid secretion was associated with a 60% increase in plasma HCO3(-) concentration ([HCO3(-)]) 48 h after feeding. Arterial pH only increased from 7.86 to 7.94, because the metabolic alkalosis was countered by an increase in PCO(2) from 10.8 to 13.7 mm Hg. Feeding also induced a small intracellular alkalosis in the sartorius muscle. Arterial pH and HCO3(-) returned to control values 96-120 h after feeding. There was no sign of anaerobic energy production during digestion as plasma and tissue lactate levels remained low and intracellular ATP concentration stayed high. However, phosphocreatine was reduced in the sartorius muscle and ventricle 48 h after feeding.

Respiratory consequences of feeding in the snake Python molorus

Snakes can ingest large meals and exhibit marked increases in metabolic rate during digestion. Because postprandial oxygen consumption in some snakes may surpass that attained during exercise, studies of digestion offers an alternative avenue to understand the cardio-respiratory responses to elevated metabolic rate in reptiles. The effects of feeding on metabolic rate, arterial oxygen levels, and arterial acid-base status in the snake Python molorus are described. Four snakes (180-250 g) were cannulated in the dorsal aorta and blood samples were obtained during 72 h following ingestion of a meal (rat pups) exceeding 20% of body weight. Oxygen consumption increased from a fasting value of 1.71 +/- 0.08 to 5.54 +/- 0.42 ml kg-1 min-1 at 48 h following feeding, and the respiratory gas exchange ratio increased from 0.67 +/- 0.02 to a maximum of 0.92 +/- 0.03 at 32 h. Plasma lactate was always less than 0.5 mM, so the postprandial increase in metabolic rate was met by aerobic respiration. In fasting animals, arterial PO2 was 66 +/- 4 mmHg and haemoglobin-O2 saturation was 92 +/- 3%; similar values were recorded during digestion, but haematocrit decreased from 15.8 +/- 1.0 to 9.8 +/- 0.8 due to repeated blood sampling. Plasma [HCO3-] increased from a fasting level of 19.3 +/- 0.8 to 25.8 +/- 1.0 mmol l-1 at 24 h after feeding. However, because arterial PCO2 increased from 21.1 +/- 0.5 to 27.9 +/- 1.4 mmHg, there was no significant change in arterial pH from the fasting value of 7.52 +/- 0.01. Acid-base status returned to pre-feeding levels at 72 h following feeding. The increased arterial PCO2 is most likely explained by a reduction in ventilation relative to metabolism, but we predict that lung PO2 does not decrease below 115 mmHg. Although ingestion of large meals is associated with large metabolic changes in pythons, the attendant changes in blood gases are relatively small. In particular, the small changes in plasma [HCO3-] and stable pH show that pythons respond very differently to digestion than alligators where very large alkaline tides have been observed. It is unclear why pythons and alligators differ in the magnitude of their responses, but given these interspecific differences it seems worthwhile to describe arterial blood gases during digestion in other species of ectothermic vertebrates.

NO2- uptake and HCO3- excretion in the intestine of the European flounder (Platichthys flesus)

Ion transport across isolated intestinal segments from the European flounder (Platichthys flesus) was studied with the primary aim of evaluating the mechanisms of nitrite (NO2-) uptake and HCO3- excretion. A double-radiolabelling technique was applied to monitor unidirectional Cl- and Na+ influx. Furthermore, net fluxes of NO2-, HCO3-, Cl-, Na+ and water were recorded. NO2- uptake was inhibited by mucosal application of bumetanide (10(−)4 mol l-1) but not DIDS (10(−)3 mol l-1), suggesting that NO2- is transported across the intestine via the Na+/K+/2Cl- cotransporter rather than via a Cl-/HCO3- exchanger. In addition to transport via the Na+/K+/2Cl- cotransporter, NO2- uptake may also occur through the Na+/Cl- cotransporter and by conductive transport. NO2- and Cl- influx rates seemed to reflect their mucosal concentrations, and NO2- did not influence unidirectional influx or net flux of Cl-. HCO3- efflux was significantly reduced in the presence of 10(−)3 mol l-1 DIDS in the mucosal solution. This may indicate the presence of an apical Cl-/HCO3- exchanger in the intestinal epithelium, which would not comply with the current model of HCO3- excretion in the intestine of marine teleost fish. An alternative model of HCO3- excretion across the intestinal epithelium is proposed.

Haemoglobin H+ equilibria in lamprey (Lampetra fluviatilis) and hagfish (Myxine glutinosa)

Agnathans, comprising lamprey and hagfish species, have been reported to be practically devoid of HCO3-/Cl- exchange across the red blood cell membrane. This suggests that the capacity of their haemoglobin (Hb) to remove H+ is essential for obtaining a high CO2-carrying capacity in the blood. Hydrogen ion titrations were performed on oxygenated and deoxygenated composite Hbs from river lamprey and from Atlantic hagfish at 15 degrees C and an ionic strength of 0.1 (0.1 mol l-1 KCl). Lamprey Hb was characterised by very low buffer values when the degree of oxygenation was constant, whereas the fixed-acid Haldane effect was large (uptake of approximately 0.9 H+ per monomer upon deoxygenation). Hagfish Hb, in contrast, had large buffer values and a moderate fixed-acid Haldane effect. In deoxygenated Hb, the low buffer values in lamprey correlated with the presence of only 1–1.5 titratable ‘neutral’ groups (normally histidines and α -amino groups) per monomer, whereas there were 4–5 titratable ‘neutral’ groups per monomer in hagfish. The large differences in Hb/H+ equilibria between the two species reflect the early evolutionary divergence between lampreys and hagfish. With respect to CO2 transport, the special Hb/H+ equilibria and the high red blood cell pH in lamprey ensure a high concentration of free HCO3- inside the red cells in venous blood, which compensates for the absence of a shift of HCO3- to the plasma. The Hb/H+ equilibria in hagfish are less effective in ensuring a high CO2-carrying capacity given the virtual absence of a red blood cell HCO3-/Cl- exchange, and other adaptations may be involved.

Influence of body temperature on the development of fatigue during prolonged exercise in the heat

We investigated whether fatigue during prolonged exercise in uncompensable hot environments occurred at the same critical level of hyperthermia when the initial value and the rate of increase in body temperature are altered. To examine the effect of initial body temperature [esophageal temperature (Tes) = 35.9 +/- 0.2, 37.4 +/- 0. 1, or 38.2 +/- 0.1 (SE) degrees C induced by 30 min of water immersion], seven cyclists (maximal O2 uptake = 5.1 +/- 0.1 l/min) performed three randomly assigned bouts of cycle ergometer exercise (60% maximal O2 uptake) in the heat (40 degrees C) until volitional exhaustion. To determine the influence of rate of heat storage (0.10 vs. 0.05 degrees C/min induced by a water-perfused jacket), four cyclists performed two additional exercise bouts, starting with Tes of 37.0 degrees C. Despite different initial temperatures, all subjects fatigued at an identical level of hyperthermia (Tes = 40. 1-40.2 degrees C, muscle temperature = 40.7-40.9 degrees C, skin temperature = 37.0-37.2 degrees C) and cardiovascular strain (heart rate = 196-198 beats/min, cardiac output = 19.9-20.8 l/min). Time to exhaustion was inversely related to the initial body temperature: 63 +/- 3, 46 +/- 3, and 28 +/- 2 min with initial Tes of approximately 36, 37, and 38 degrees C, respectively (all P < 0.05). Similarly, with different rates of heat storage, all subjects reached exhaustion at similar Tes and muscle temperature (40.1-40.3 and 40. 7-40.9 degrees C, respectively), but with significantly different skin temperature (38.4 +/- 0.4 vs. 35.6 +/- 0.2 degrees C during high vs. low rate of heat storage, respectively, P < 0.05). Time to exhaustion was significantly shorter at the high than at the lower rate of heat storage (31 +/- 4 vs. 56 +/- 11 min, respectively, P < 0.05). Increases in heart rate and reductions in stroke volume paralleled the rise in core temperature (36-40 degrees C), with skin blood flow plateauing at Tes of approximately 38 degrees C. These results demonstrate that high internal body temperature per se causes fatigue in trained subjects during prolonged exercise in uncompensable hot environments. Furthermore, time to exhaustion in hot environments is inversely related to the initial temperature and directly related to the rate of heat storage.

Copper exposure impairs intra- and extracellular acid-base regulation during hypercapnia in the fresh water rainbow trout (Oncorhynchus mykiss)

In order to evaluate the impact of water-borne copper on acid-base regulation in fresh water rainbow trout, chronically cannulated fish were exposed to copper (0.6 mg 1(-1)), hypercapnia (water PCO2 of 6 mmHg) or a combination of copper and hypercapnia, while a fourth untreated group served as the control. Blood samples obtained at 0 h, 4 h and 24 h were analysed for acid-base status, ion concentrations and respiratory parameters. Tissue samples from caudal skeletal muscle, liver and gill filaments were examined for intracellular acid-base status, ion- and water contents, and copper concentration. Exposure to copper alone elicited a small extracellular metabolic alkalosis, no changes in arterial PO2, and a minor decrease in plasma ion concentrations. Hypercapnia alone increased arterial PCO2 from approximately 2 mmHg to 7.2 mmHg, but the extracellular respiratory acidosis present at 4 h was almost completely compensated at 24 h due to an increase in plasma bicarbonate concentration [HCO3-] from 8.1 mM to 24.4 mM. Combined exposure to hypercapnia and copper resulted in a slightly larger acidosis at 4 h, and the fish failed to restore extracellular pH at 24 h, because plasma [HCO3-] only increased to 16.3 mM. Fish exposed to hypercapnia and copper also showed a delayed recovery of intracellular pH in skeletal muscle, compared to fish exposure to hypercapnia only. Thus, copper exposure impaired both extracellular and intracellular acid-base regulation during hypercapnia. When seen in connection with only minor effects of copper on osmoregulatory and respiratory parameters, the reduced ability to regulate acid-base suggests that acid-base regulation may be one of the most copper-sensitive branchial functions.

Interaction between haemoglobin and synthetic peptides of the N-terminal cytoplasmic fragment of trout band 3 (AE1) protein

Two acidic peptides corresponding to the first 10 and 20 amino acid residues of the N-terminal, cytoplasmic fragment of rainbow trout band 3 (AE1) protein were synthesised in order to study their interaction with trout and human haemoglobin (Hb). The peptides did not influence the oxygen affinity of the main anodic trout Hb component (Hb IV) when tested at surplus peptide concentration ([peptide]/[Hb4]=16), at high and low ionic strength and at pH values ranging from 6.5 to 7.6. With human Hb, however, the 20-mer peptide markedly decreased the oxygen affinity and increased the Bohr effect. These data suggest that the trout band 3 peptide binds preferentially to the deoxy (T) conformation of human Hb, probably at the organic phosphate binding site in the central cavity between the beta-chains, which is known to be the binding site for the acidic N terminus of human band 3. In trout Hb IV, the presence of negatively charged Asp at position NA2 of the beta-chains (in contrast to positive or neutral residues in mammalian Hb) may weaken any interaction with the highly negatively charged peptides.

Carbon dioxide transport in alligator blood and its erythrocyte permeability to anions and water

Deoxygenation of alligator red blood cells (RBCs) caused binding of two HCO3- equivalents per hemoglobin (Hb) tetramer at physiological pH. At lowered pH, some HCO3- binding also occurred to oxygenated Hb. The erythrocytic total CO2 content was large, and Hb-bound HCO3-, free HCO3-, and carbamate contributed about equally in deoxygenated cells. The nonbicarbonate buffer values of RBCs and Hb were high, and the Hb showed a significant fixed acid Haldane effect. Binding of HCO3- on deoxygenation occurred without a change in RBC intracellular pH, revealing equivalence between oxylabile HCO3- and H+ binding. Erythrocyte volume, plasma pH, and plasma HCO3- concentration also varied little with the degree of oxygenation. Diffusional water permeability was higher in oxygenated than deoxygenated RBCs. The RBCs have rapid band 3-mediated Cl- and HCO3- transport, which was not affected by degree of oxygenation, but net fluxes of Cl- and HCO3- via the anion exchanger are small during blood circulation at rest. Most of the CO2 taken up into the blood as it flows through tissue capillaries is carried within the erythrocytes as Hb-bound HCO3- until CO2 is excreted when blood flows through pulmonary capillaries.

Effects of exhausting exercise and catecholamines on K+ balance, acid-base status and blood respiratory properties in carp

The potential role of adrenergic mechanisms in the recovery of potassium balance and acid-base status following 5 min of exhausting exercise was studied in carp. The extracellular metabolic H+ load after exercise matched the lactate load, suggesting similar release rates of H+ and lactate from white muscle. Blockage of alpha-adrenoceptors by phentolamine or beta-adrenoceptors by propranolol neither influenced absolute magnitudes nor recovery kinetics of extracellular H+ and lactate loads. The arterial oxygen tension increased following exercise, but blood oxygen transport was not improved via a red cell beta-adrenergic response or modulation of the red cell nucleoside triphosphate content. Exercise induced an increase in extracellular [K+] which was corrected within 30-60 min of recovery. The recovery of K+ balance was not influenced by blockage of adrenergic receptors. Red cell [K+] changed only insignificantly following exercise, whereby a possible function of the red cells as a temporary depository for K+ during the extracellular hyperkalaemia could not be established. The minimal influence of catecholamines on the measured parameters during recovery from exercise was supported by an absence of change in these parameters upon adrenaline injection in resting carp.

Acid-base regulation in tadpoles of Rana catesbeiana exposed to environmental hypercapnia

Tadpoles of Rana catesbeiana were exposed to different levels of environmental hypercapnia. The acid-base regulatory response differed from that in adult amphibians in showing a high degree of pH compensation in the extracellular fluid (65-85%) and complete compensation in the intracellular fluid (tail muscle and liver) within 24 h. Hypercapnia induced a massive transfer of HCO3- equivalents and Ca2+ from the tadpoles to the environment, which lasted some 4-6 h. Bicarbonate accumulated in the body fluids came mainly from internal buffer sources (probably CaCO3 in lime sacs and/or skin deposits). It is suggested that the large bicarbonate efflux from the animal is a consequence of the dissolution of CaCO3 stores and the delayed adjustment of bicarbonate-retaining mechanisms. Re-exposure of tadpoles to hypercapnia after 1-3 weeks of normocapnic recovery only affected transepithelial fluxes of acid-base equivalents marginally, suggesting that mobilisable CaCO3 stores were depleted during the first exposure to hypercapnia and that they were not refilled. The CaCO3 stores may normally be mobilised during the slowly developing internal hypercapnia that occurs during metamorphosis.

[Penile vein surgery. A follow-up study of erectile dysfunction of presumed venous origin]

Forty patients who underwent penile venous surgery (PVS) because of suspected veno-occlusive dysfunction, were evaluated approximately 15 months (median) postoperatively as to their sexual capability. Although 47.5% were able to obtain penile rigidity, this was sufficient for intercourse in only 35%. Short-term subjective improvement was noted in 55% as opposed to long-term improvement in 35%. Analysis for predictive factors was negative. In conclusion, the indication for PVS should be reconsidered, as an insufficient theoretical concept might explain the low long-term success rate.

Cardiac activity, ventilation rate and acid-base regulation in rainbow trout exposed to hypoxia and combined hypoxia and hypercapnia

A computerised system for non-invasive monitoring of heart and ventilation rates and the time intervals between heart beats and between breaths was developed and used to investigate cardio-respiratory changes in rainbow trout exposed to hypoxia and to combined hypoxia and hypercapnia. Upon exposure to hypoxia and hypoxia-hypercapnia the arterial O2 tension decreased from about 90 mmHg to about 30 mmHg. Acid-base changes were small in hypoxia whereas exposure to combined hypoxia-hypercapnia caused a large extracellular respiratory acidosis. This acidosis was completely compensated within 24h by accumulation of bicarbonate in plasma to concentrations twice the normoxic values. The ventilation rate was increased to higher values in hypoxic-hypercapnic trout than in hypoxic trout. In contrast to previous reports, the heart rate increased in hypoxia. On top of the tachycardia response to hypoxia, the heart rate was governed by circadian rhythms, with higher heart rates during the day than during the night. The time interval between heart beats varied considerably in normoxic fish. Hypoxia strongly reduced this variability, which may originate in a reduced cholinergic tone to the heart. The width of the frequency distribution of the time intervals between breaths was not affected by hypoxia. The degree of cardio-respiratory synchronization was low in both normoxic and in hypoxic and hypoxic-hypercapnic trout.

Influence of nucleoside triphosphates, inorganic salts, NADH, catecholamines, and oxygen saturation on nitrite-induced oxidation of rainbow trout haemoglobin

Oxidation of rainbow trout haemoglobin (Hb) by nitrite proceeded via an initial lag phase followed by autocatalysis when the O2 saturation of the Hb was high. At low O2 saturations, the rate of methaemoglobin (metHb) formation was strongly reduced and autocatalysis was absent. Addition of adenosine triphosphate and guanosine triphosphate to oxyHb lowered the haemoglobin O2 affinity and O2 saturation and slowed down nitrite-induced metHb formation in a dose-dependent manner, the effect of GTP being larger than that of ATP. Reduced nicotinamide adenine dinucleotide (NADH) and the catecholamines adrenaline and noradrenaline did not affect O2 saturation in oxyHb solutions but significantly slowed down nitrite-induced metHb formation. Inorganic salts (NaCl, KCl, NaNO3) impeded the oxidation of oxyHb by nitrite in a manner that was dependent on salt concentration but independent of the type of salt. The mechanisms and physiological implication of the effects are discussed.

Inhibition of adrenergic proton extrusion in rainbow trout red cells by nitrite-induced methaemoglobinaemia

The effects of nitrite-induced methaemoglobinaemia on adrenergic proton extrusion from rainbow trout red blood cells were studied using the pH-stat method. In control conditions adrenergic proton extrusion was completely inhibited by amiloride and was greater in deoxygenated than in oxygenated erythrocytes. Nitrite-induced methaemoglobinaemia was associated with a pronounced reduction in the catecholamine-stimulated proton efflux from both deoxygenated and oxygenated erythrocytes. In deoxygenated erythrocytes the initial proton efflux upon catecholamine stimulation decreased by 60-70%, while the percentage of methaemoglobin in the red cells increased from the control level of 1-3% to 20%. In oxygenated erythrocytes the decrease was 30% at the same methaemoglobin percentage range. It is suggested that the pronounced influence of nitrite-induced methaemoglobinaemia on adrenergic proton efflux results from an inhibition of the red cell sodium/proton exchanger by the R-like haemoglobin conformations.

Increased working capacity with hyperoxia in humans

The purpose of the study was to examine the influence of oxygen-breathing on maximal oxygen uptake (VO2max) and submaximal endurance performance. Six young women and five men rode a cycle-ergometer while breathing compressed air (normoxia, NOX) or a 55% O2 in N2 mixture (hyperoxia, HOX). The VO2max increased significantly by 12% (P less than 0.01) with HOX in the women but not in the men (+4%; nonsignificant). Maximal heart rate was also increased with HOX in the women but not in the men. Endurance time during work to exhaustion at 80% of normoxic VO2max was 41% longer in HOX than in NOX (P less than 0.025) with no significant difference between the men and the women. The variation among individuals was large. The oxygen uptake and respiratory quotient were not different in the two endurance tests, but pulmonary ventilation (VE) and blood lactate concentration were lower in HOX than in NOX, especially during the latter part of the task. Plasma base deficit (BDpl) increased initially by 3.5 mmol.l-1 during HOX and then stabilized. In NOX, a continuous increase was seen and the change was more than twice as large. Relative to BDpl, VE was higher in HOX than in NOX indicating a more efficient ventilatory compensation of the metabolic acidosis. The reduced ventilatory demand and lower metabolic acidosis in HOX in combination with lower relative exercise intensity may have contributed to the longer time to exhaustion. However, the pattern of individual variation suggested that other mechanisms were also involved.

Interrelationships between red cell nucleoside triphosphate content, and blood pH, O2-tension and haemoglobin concentration in the carp, Cyprinus carpio

As a starting point for investigations of possible control factors for the nucleoside triphosphate content in carp red cells, we utilized the natural variability in blood physico-chemical parameters to test for interrelationships. By application of two-variable regression analysis, the red cell NTP content was found to be significantly correlated with arterial PO 2 and pH as well as with the blood haemoglobin (Hb) concentration. These correlations show a rise in red cell NTP content with falling pH as well as with falling Hb concentration, whereas a decrease in PO 2 was associated with a decrease in the content of NTP, particularly at low PO 2 values. Evaluation based on multiple regression analysis suggested that only PO 2 and pH significantly affected the red cell NTP content, and that the influence of changes in Hb concentration could be accounted for by naturally occurring simultaneous changes in PO 2 and pH. The multifactorial control of red cell nucleoside triphosphates is discussed in relation to the role of still unknown factors.

External negative thigh pressure. Effect upon blood flow and pressure in the foot in patients with occlusive arterial disease

We studied the effect of external application of 35-45 mmHg negative pressure around the thigh on toe blood pressure and skin blood flow in nine patients with occlusion of the superficial femoral artery and rest pain/severe intermittent claudication. The systolic toe blood pressure increased from 32 (range 5-70) mmHg before treatment to 57 (42-75) mmHg (p less than 0.05) during negative thigh pressure and 44 (range 10-88) mmHg after treatment. In addition, the gain in toe blood pressure tended to be greater the lower the pre-test toe pressure was, correlation coefficient r = 0.52 (p greater than 0.05). Relative skin blood flow, measured in the first toe interstice by the 133Xe wash-out method, increased by 304 (range 86-767) percent (p less than 0.05) during the test period compared to the mean wash-out rate obtained before and following the test period. Heart rate, systemic blood pressure, skin temperature, serum protein and haematocrit measured during each phase of the study were similar. We conclude that 35-45 mmHg negative pressure around the thigh in patients with occlusion of the superficial femoral artery induce increased blood perfusion in the foot, possibly due to changes in collateral arterial resistance in the thigh.

Non-invasive blood pressure monitoring during head-up tilt using the Penaz principle

Continuous blood pressure measurement by a non-invasive means is of clinical utility in many situations where changes in cardiovascular hemodynamics and blood volume distribution are likely to occur. We have compared blood pressure measurements using the Penaz principle (Finapres, Ohmeda) to an intra-arterial catheter system during head-up tilt (reverse Trendelenburg's position) which models central hypovolemia. Twelve healthy volunteers were raised to a 60 degree head-up tilt position for 60 min or until presyncope occurred. Seven subjects developed presyncopal symptoms at a mean time of 38 +/- 6 min with blood pressure measured by the Penaz principle falling from 140 +/- 8/72 +/- 4 to 82 +/- 10/54 +/- 6 mmHg (18.7 +/- 1.1/9.6 +/- 0.5 to 10.9 +/- 1.3/7.2 +/- 0.8 kPa) (P less than 0.01), at which point they were returned to a horizontal position with an immediate rise in blood pressure. During the maximal drop in blood pressure, heart rate decreased from 82 +/- 7 to 45 +/- 5 (P less than 0.01). Overall, the non-invasive system had a correlation coefficient of 0.98 as compared to the intra-arterial method and ECG for blood pressure and heart rate in all 12 subjects during rest, tilt, and recovery. We conclude that the Penaz principle apparatus is a useful monitor of symptomatic hypotension during central hypovolemia.

Heart rate and arterial blood pressure at the onset of static exercise in man with complete neural blockade

1. We tested the 'muscle-heart reflex' hypothesis for the immediate increases in heart rate and blood pressure at the onset of static exercise in man by performing complete blockade of afferent nerves from the working muscles. Brief (5 s) maximal static hand-grip contractions were performed without performing a Valsalva-like manoeuvre and with no increase in central venous pressure both before and after combined axillary and radial blockade with lidocaine. Muscle strength was reduced to near zero. The effectiveness of the afferent neural blockade was evaluated by recording the heart rate and blood pressure responses and rating the perceived pain during a cold pressor test of the blocked and contralateral unblocked hand. 2. The cold pressor test increased blood pressure but had no effect on heart rate. Afferent neural blockade eliminated the increase in blood pressure and the perceived pain associated with the cold pressor test. Maximal hand-grip contractions resulted in immediate and similar increases in heart rate and blood pressure before and after afferent neural blockade of the arm. 3. The results of this study suggest that the immediate increases in heart rate and blood pressure at the onset of static exercise in man occur when the 'muscle-heart reflex' is inoperable.

[Continuous non-invasive measurement of blood pressure]

Automatic continuous non-invasive measurement of blood pressure using the Penaz' principle (Finapres) was compared with the blood pressure records using a sphygmomanometer during anaesthesia in 29 patients without significant arteriosclerosis. There were no significant differences between values recorded using the two methods. Furthermore, the changes recorded in systolic, diastolic and mean arterial pressures were not significantly different. Also, the pulse recorded with the Penaz' principle corresponded to the heart rate recorded from ECG. Automatic continuous non-invasive measurement of blood pressure using the Penaz' principle offers a valuable aid for monitoring patients during anaesthesia.

[Ergotism in migraine. Peripheral vascular complications in 14 patients with migraine]

The general occurrence of subclinical ergotism with reduced peripheral systolic blood pressures in patients taking ergotaminepreparations regularly for migraine and the frequent occurrence of milder symptoms indicates that severe ischaemia of the extremities is not as rare a complication as would appear from the few case reports published. The 14 cases reported here constitute the largest series published of migraine patients with acute ergotism. The patients, all women, were admitted to a vascular department over a period of 14 years. They suffered from severe ischaemia of one or more extremities after consumption of varying doses of ergotamine tartrate. Ten patients had previously exhibited symptoms of acute or chronic ergotism, but only eight were admitted with this diagnosis. Liver enzyme tests were abnormal in five out of six patients examined, while three patients had ECG signs of myocardial ischaemia, regressing during treatment. At the beginning of the period, hyperbaric oxygen at 3 ATAB was the standard treatment. Since 1980, the treatment of choice has been continous i.v. nitroglycerine infusion for 24 hours. Nine patients experienced prolonged postischaemic symptoms; one patient required a forefoot amputation and four patients had permanent ischaemic muscular damage. Increased bioavailability of ergotamine due to hepatic vasospasm is suggested as a cause of sudden reduced tolerance to ergotamine. Peripheral systolic pressures and liver function tests should be controlled in patients taking ergotamine regularly. Subclinical ergotism over a prolonged period may facilitate development of occlusive peripheral vascular disease.

Hydrogen ion equilibria in fish haemoglobins

H+ titration studies on oxygenated and deoxygenated haemoglobins from carp, rainbow trout, spiny dogfish and pig are reported, and compared with Hb-H+ equilibria in other species and structural information deduced from amino acid sequences. The buffer values of oxygenated and deoxygenated teleost haemoglobins are low in comparison with elasmobranch and mammalian haemoglobins. This correlates with a much lower content of histidine residues and alpha-amino groups in teleost haemoglobins, than that in elasmobranch, dipnoan, amphibian, reptilian, avian and mammalian haemoglobins. The low total histidine content in teleost haemoglobins is paralleled by a reduced number of titratable histidine residues compared with that in mammals. An inverse relationship is observed between the magnitude of buffer values and the magnitude of fixed-acid Haldane effects. The largest Haldane effect and smallest buffer values are seen in carp, followed by trout, whereas the smallest Haldane effect and largest buffer values are seen in dogfish. The H+ equilibria of pig haemoglobin are intermediate between those of teleost and elasmobranch haemoglobins.

Effect of electrode temperature on orthostatic changes in forefoot transcutaneous oxygen tension (tc-PO2)

The influence of increasing the temperature of the transcutaneous oxygen tension (tc-PO2) electrode from 37 to 45 degrees C on the orthostatic changes in tc-PO2 was studied in six normal subjects. The tc-PO2 electrode was mounted on the forefoot. The blood pressure of the forefoot was changed by elevating and lowering the forefoot in relation to heart level. At all electrode temperatures tc-PO2 decreased about 35% when the forefoot was elevated. At electrode temperatures between 41 and 45 degrees C tc-PO2 increased about 20% when the electrode was lowered below heart level. This indicates a passive vascular bed in the heated tissue under the electrode. However, at 37 degrees C tc-PO2 decreased about 40% when the forefoot was lowered. This indicates that the local vasoconstrictor response to increased venous transmural pressure is preserved when the tissue under the electrode is heated to 37 degrees C only. The study suggest that tc-PO2 monitoring at 37 degrees C may be used for continuous, non-invasive monitoring of the local vasoconstrictor response, and thus of arteriolar contractility and intact sympathetic innervation.

Red-cell pH in tench. Interacting effects of cellular nucleoside triphosphates, Hb-oxygenation and extracellular pH

Experimental adjustments of red-cell pH (pHi) by varying red-cell nucleoside triphosphate (NTP) content, blood oxygenation state and extracellular pH (pHe) demonstrated a tight interdependence of these variables in their influence upon pHi. The increase in pHi with deoxygenation (delta pHi (d--o] is large, but becomes strongly reduced when the NTP content is decreased and when pHe falls. Lowering of red-cell NTP increases pHi, notably at high pHe, but this NTP dependence of pHi (delta pHi/delta(NTP/Hb] is much smaller in deoxygenated than in oxygenated blood. The pHe dependence of pHi (delta pHi/delta pHe) increases upon reduction of red-cell NTP content and upon deoxygenation. The results are consistent with the view that pHi is governed by Donnan-like distribution of protons across the red-cell membrane, and show that a pronounced red-cell swelling accompanies increases in the distribution ratio [H+]e/[H+]i. The data are interpreted in terms of changes in the red-cell non-permeable charge as induced by NTP and its linkage with the haemoglobin proton equilibria.

Effects of nitrite exposure on blood respiratory properties, acid-base and electrolyte regulation in the carp (Cyprinus carpio)

Adult carp were subjected to 1 mM environmental nitrite for 48 h and nitrite uptake and changes in blood respiratory properties, extracellular electrolyte composition and acid-base status were examined. A constant influx of nitrite caused an accumulation of NO2- in plasma to 5.4 mM in 48 h. The fraction of methaemoglobin rose with plasma [NO2-] to 83%, and the arterial oxygen content decreased to extremely low values. Arterial PO2 increased as a compensation to this O2-shortage, whereas the O2 saturation of the functional (unoxidized) haemoglobin decreased, revealing a reduction in its O2 affinity. Blood haematocrit decreased as a result of red cell shrinkage, which caused very high red cell haemoglobin (Hb) concentrations. The erythrocytic nucleoside triphosphate (NTP) concentration showed a parallel increase whereby NTP/Hb, as well as the relative contributions of ATP and GTP to NTP, remained unchanged. Plasma [Cl-] declined by 15 mM in 48 h, offsetting the plasma [NO2-] increase, minor changes in plasma [HCO3-] and a considerable increase in plasma [lactate]. Arterial pH and [HCO3-] rose slightly during the first 24 h of nitrite exposure, but returned to control values at 48 h. The rise in plasma [lactate] was not reflected in an extracellular metabolic acidosis. Plasma [K+] increased by 94% in 48 h, revealing an uncompensated extracellular hyperkalemia, whereas plasma [Na+] decreased, and plasma [Ca++] was unchanged. Plasma osmolality remained essentially constant.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of teleost hemoglobin by Adair and Monod-Wyman-Changeux models. Effects of nucleoside triphosphates and pH on oxygenation of tench hemoglobin

The allosteric effects of the erythrocytic nucleoside triphosphates (NTP) and of proton concentrations were investigated by precise measurement of Hb-O2 equilibria of tench hemoglobin (including extreme, high and low saturation ranges) and analysed in terms of the MWC two state model and the Adair four step oxygenation theory. At low concentrations (NTP/Hb ratio = 1.0, and pH greater than 7.3) ATP, GTP and protons decrease Hb-O2 affinity by increasing the allosteric constant L and reducing KT, the association constant of the deoxy, tense state of the Hb, without significantly affecting that (KR) of the oxy state, increasing the free energy of cooperativity (delta G). High concentrations of these effectors, however, also reduce KR. The greater sensitivity of the half-saturation O2 tension (P50) of the Hb to GTP than to ATP at the same concentration, correlates with greater effects of GTP on both KT and KR. The pH and NTP dependence of the four Adair association constants and the calculated fractional populations of Hb molecules in different stages of oxygenation show that the autochthonous NTP effectors and protons stabilize the T structure and postpone the T----R transition basic to cooperativity in fish Hb. The possible implications of the findings for aquatic respiration are discussed.

Influences of exercise-stress and adrenaline upon intra- and extracellular acid-base status, electrolyte composition and respiratory properties of blood in tench (Tinca tinca) at different seasons

Exercise-stress in tench resulted in severe acidosis in both the red cells and the extracellular fluid in vivo. These coincident pH decreases conformed to the in vitro pHi-pHe relationship for tench blood in the oxygenated state. The extracellular acidosis was primarily respiratory in winter and metabolic in spring and summer. This was due to more effective buffering of metabolic protons in winter by an elevation in [HCO3-] levels, rather than to differences in the lactic- and carbonic acid loads. A good correspondence was found between buffered metabolic protons and increases in [lactate]. There was no evidence for beta-adrenergic red cell swelling and associated red cell pH changes in tench both after exercise and adrenaline infusion. Arterial O2 transport was, however, improved in exercise by pronounced increases in PO2. This increase was not of adrenergic origin, as adrenaline alone caused a decrease in arterial PO2. Large increases in plasma potassium concentration and small elevations of chloride and calcium levels occurred in exercise. Hematocrit and blood [Hb] also increased, probably due to an adrenergic release of erythrocytes from the spleen, but these increases were small and appeared unimportant for blood O2 transport. Seasonal differences were found in exercise-induced changes in [lactate], in the magnitude of electrolyte and PO2 changes, as well as in resting values for pHe, pHi, [HCO3-], [Cl-] and [Ca++]. The origin and importance of these are discussed.

Thermodynamic analysis of precisely measured oxygen equilibria of tench (Tinca tinca) hemoglobin and their dependence on ATP and protons

Precise oxygen equilibria including extreme, high and low saturation values were determined for hemoglobin (Hb) from the freshwater teleost Tinca tinca at three temperatures, each at two pH levels and in the presence and absence of the erythrocytic cofactor ATP, at twofold molar excess over Hb. Analysis of the data in terms of Adair's successive oxygenation theory shows that in the absence of ATP, each of the four oxygenation steps are exothermic, but that net heat release decreases as pH falls from 8.2 to 7.4. ATP greatly depresses the temperature sensitivity of oxygenation particularly at physiological erythrocytic pH, where endothermic cofactor dissociation finds expression in a reverse temperature sensitivity for binding of the 3rd oxygen molecule to the tetrameric Hb. Enthalpy (delta Hi) and entropy (delta Si) changes of oxygenation vary with oxygenation step, i, as well as with pH and ATP addition, but the variations of delta Hi are similar to those of delta Si reflecting enthalpy-entropy compensation. The data show that the cooperative effects in tench Hb can be dominated either by entropic or enthalpic contributions, depending on the experimental condition and the oxygenation step.

Pronounced influence of Hb-O2 saturation on red cell pH in tench blood in vivo and in vitro

At an extracellular pH of 7.9 the red cell pH in tench blood exhibits a nonlinear, strongly inverse relationship with Hb-O2 saturation, both when investigated in vitro and in vivo (in fish exposed to acid water with and without aluminium). The pHi difference between deoxygenated and oxygenated erythrocytes is large (i.e., 0.35 pH units), which can be accounted for by the Haldane effect and the buffering properties of the blood. The major shift in pHi occurs between 50 and 100% Hb-O2 saturation, indicating an almost full exploitation of the Haldane effect within the normal physiological range of blood O2 saturations.

Effects of exercise stress on acid-base balance and respiratory function in blood of the teleost Tinca tinca

We measured the effects of severe, short-term exercise stress on the acid-base balance, the O2 transporting properties and the cofactors for O2 binding in the blood of tench, Tinca tinca. Short-term severe exercise resulted in a drastic decrease in arterial blood pH which is attributed to a mixed respiratory and metabolic acidosis. Concomitantly arterial PO2 rose in apparent compensation for the detrimental effects of the acidosis on O2 transport by the blood.

Evidence for the presence of receptors for C3 and IgG Fc on human synovial cells

The presence of receptors for IgG Fc and fragments of C3 on primary cultures and cryostat sections of normal and rheumatoid synovial tissues was assessed. Significant proportions of large rounded cells with asteroid projections found in such cultures had receptors for both IgG Fc and fragments of C3. Moreover, Gram negative bacteria that had fixed complement, but not EAC, bound in a linear fashion on the superficial layers of synovial cryostat sections. On the basis of morphologic and histochemical criteria, the cultured cells bearing these receptors were tentatively determined to represent a subset of synovial lining cells. The possible role of such receptors on synovial lining cells in the pathogenesis of rheumatoid arthritis is discussed.