The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

BACKGROUND

The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not.

METHODS

Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not.

RESULTS

A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001].

CONCLUSIONS

The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands.

Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study

BACKGROUND

Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation.

AIM

We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project".

METHODS

We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale.

RESULTS

Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001).

CONCLUSION

This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.

The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017

Introduction

Delirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium.

Methods

The analyses were conducted employing the cross-sectional “Delirium Day” initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses.

Results

A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09–2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001].

Discussion and conclusion

Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-01950-8.

Analyzing Nonequilibrium Quantum States through Snapshots with Artificial Neural Networks

Current quantum simulation experiments are starting to explore nonequilibrium many-body dynamics in previously inaccessible regimes in terms of system sizes and timescales. Therefore, the question emerges as to which observables are best suited to study the dynamics in such quantum many-body systems. Using machine learning techniques, we investigate the dynamics and, in particular, the thermalization behavior of an interacting quantum system that undergoes a nonequilibrium phase transition from an ergodic to a many-body localized phase. We employ supervised and unsupervised training methods to distinguish nonequilibrium from equilibrium data, using the network performance as a probe for the thermalization behavior of the system. We test our methods with experimental snapshots of ultracold atoms taken with a quantum gas microscope. Our results provide a path to analyze highly entangled large-scale quantum states for system sizes where numerical calculations of conventional observables become challenging.

Sufentanil Sublingual Tablet System: from rationale of use to clinical practice

The control of post-operative pain in Italy and other western countries is still suboptimal. In recent years, the Sufentanil Sublingual Tablet System (SSTS; Zalviso; AcelRx Pharmaceuticals, Redwood City, CA, USA), which is designed for patient-controlled analgesia (PCA), has entered clinical practice. SSTS enables patients to manage moderate-to-severe acute pain during the first 72 postoperative hours directly in the hospital setting. However, the role of SSTS within the current framework of options for the management of post-operative pain needs to be better established. This paper presents the position on the use of SSTS of a multidisciplinary group of Italian Experts and provides protocols for the use of this device.

Intensive dietary intervention promoting the Mediterranean diet in people with high cardiometabolic risk: a non-randomized study

AIMS

Mediterranean diet (MD) is acknowledged to exert a number of beneficial health effects. We assessed the efficacy and the durability of a 3-month intensive dietary intervention aimed at implementing the MD on body weight and cardiometabolic risk factors in subjects at high risk.

METHODS

One hundred and sixteen subjects participated in the study (71 assigned to the intensive intervention and 45 to the conventional intervention). The intensive intervention consisted of 12 weekly group educational meetings and a free-of-charge supply of meals prepared according to the MD model. The conventional intervention consisted of an individual education session along with monthly reinforcements of nutritional messages by the general practitioner. All participants were followed up for 9 months.

RESULTS

The two groups had similar pre-intervention characteristics. After the intervention, mean body weight decreased significantly in both groups (p < 0.001). However, the intervention group lost more weight (6.8 ± 4.0 vs. 0.7 ± 1.3, p < 0.0001) and showed a greater reduction in plasma glucose, triglycerides, blood pressure and an increase in HDL cholesterol than the control group (p < 0.01-p < 0.002). In the subgroup of participants with type 2 diabetes, there was a significant reduction in HbA1c level following the intensive (p < 0.0001) but not the conventional intervention. At follow-up, weight loss still persisted in the intervention group (p < 0.0001), while it was lost in the control group. Both interventions significantly reduced blood pressure in the long term (p < 0.001). A significant reduction in daily total energy intake was observed in both groups with a greater reduction in saturated fat and a higher increase in fibre intake in the intervention than in the control group (p < 0.009 and p < 0.001, respectively).

CONCLUSIONS

A 3-month intensive dietary intervention inspired to the traditional MD produced greater and more durable weight loss and improvement in cardiometabolic risk profile than the conventional intervention.

Quality of vision: A consensus building initiative for a new ophthalmologic concept

PURPOSE

Many studies have addressed the quantification of visual acuity, and the conventional method of measuring it has so far demonstrated serious limitations. Vision testing requires new methods that can more precisely express the quality of vision as perceived by the patient.

METHODS

This study employed the Delphi method of consensus building. Concepts associated with quality of vision (QoV) were identified by a board of experts and proposed to participating specialists in two subsequent questionnaires. Upon receipt of the completed questionnaires, the replies were classified to determine the building blocks of a consensus.

RESULTS

By analyzing the replies to the two questionnaires, the authors determined the key elements of QoV on which a consensus was found among the respondents.

CONCLUSIONS

A consensus was reached on the opinion that the quantification of visual acuity by traditional means is inadequate for investigating QoV. Although visual acuity is still a basic element for testing, the experts believe that contrast sensitivity, reading speed, and microperimetry are additional parameters necessary for quantifying QoV. The use of a psychometric questionnaire on visual function could allow a better interpretation of visual impairment.

Endothelial microparticles correlate with erectile dysfunction in diabetic men

Cell-derived microparticles are supposed to be involved in endothelial dysfunction and atherogenesis. This study aimed to evaluate circulating microparticles in diabetic subjects with erectile dysfunction (ED) and their relation with endothelial dysfunction. Thirty diabetic men with ED and 20 age-matched control subjects without ED were assessed for circulating microparticles and endothelial dysfunction. Flow cytometry was used to assess microparticles by quantification of circulating endothelial (EMP, CD31(+)/CD42b(-)) and platelet (PMP, CD31(+)/CD42b(+)) microparticles in peripheral blood. Endothelium-dependent flow-mediated dilation (FMD) was evaluated in the right brachial artery after reactive hyperemia. Compared with non-diabetic subjects, diabetic men presented significantly higher numbers of EMP (P=0.001), and reduced FMD (P=0.01), with a significant inverse correlation between the number of circulating EMP and the International Index of Erectile Function (IIEF) score (r=-0.457, P=0.01). Multivariate analysis correcting for age, anthropometric indices, glucose and lipid parameters, FMD and PMP identified EMP as the only independent predictor for IIEF score (P=0.03). EMP are elevated in impotent diabetic subjects and independently involved in the pathogenesis of ED.

The leading-edge: the significance of sentence disruptions in the development of grammar

This research explored the relationship between sentence disruptions and the length and complexity of sentences spoken by children developing grammar. The study was cross-sectional in design and used samples of naturalistic, conversational interaction between 26 typically developing children (ages 2;6 to 4;0) and a primary caregiver. The active, declarative sentences produced by these children were coded for the presence of disruption, length in morphemes and words, and clausal complexity. The results showed that, for the majority of the children, disrupted sentences tended to be longer and more complex than fluent sentences. The magnitude of the differences in length and complexity was positively correlated with the children's grammatical development, as measured by the Index of Productive Syntax. It was also found that differences between the average complexity of disrupted versus fluent sentences increased with grammatical development even when sentence length was held constant. As grammatical development proceeded, disrupted sentences were more apt to be sentences on the "leading-edge" of the child's production capacity. Although these more advanced grammatical structures are part of the child's grammatical competence, the child cannot produce these sentences without an increased risk of processing difficulty. The results are congruent with proposals concerning the incremental and procedural nature of adult sentence production.

Towards a more precise model of pronoun case error: a response to Schütze

In my paper Patterns of Pronoun Case Error (Rispoli, 1998b), I documented two aspects of pronoun case errors arising out of principles of lexical retrieval that are operative during the acquisition of the word specific pronoun case paradigms of English. The two aspects were; (a) the ‘double-cell effect,’ a supercharging of the her for she error rate; and (b) the ‘antagonism’ between the stereotypic objective for nominative replacement (e.g. him for he) and the rarer nominative overextensions (e.g. he for him/his). In my response, I shall address Schütze's criticisms in both of these areas. The response begins by addressing issues surrounding the double-cell effect. It then moves to issues surrounding antagonism.

Case and agreement in English language development

This study examines the relationship between third person singular (3Psg) subject pronoun case and agreement, focusing on the hypothesis that these two grammatical subsystems develop together. This hypothesis is broken down into two separate, empirically testable hypotheses: (a) that correct subject case pronoun production and the production of agreement are correlated, and (b) that at the sentence level, correct case is dependent on the presence of agreement. Twenty-nine children between the ages of 2;6 and 4;0 were each audiotaped for approximately two hours playing and interacting with their primary caregivers. Transcribed production data showed that 3Psg masculine subject pronoun case was correlated with agreement marking, whereas 3Psg feminine subject pronoun case was not. This result suggests the influence of a retrieval factor, termed the double-cell effect, on the her for she pronoun case error. At the utterance level, pronoun case was independent of the presence of agreement. Overall, the study indicates that the relationship between case and agreement may be discernible as a general correlation, yet indiscernible at the level of sentence production.

Rethinking innateness

Review essay on: ELMAN, J., BATES, E., JOHNSON, M., KARMILOFF-SMITH, A., PARISI, D. & PLUNKETT, K. Rethinking innateness: a connectionist perspective on development. Cambridge, MA: MIT Press (1996). Pp. 447.

I believe that the field of developmental psycholinguistics suffers from two major weaknesses. The first is its impressionistic and inexact formulations. The second is its divisive polarizations. One can see the reasons for the first weakness. Developmental psycholinguistics is only about 30 years old (ignoring diary studies which preceded the linguistic and cognitive surge of the sixties). But speculation and hypothesizing on the basis of relatively little data and passing acquaintance with phenomena has reached the level of customary ‘business as usual’. We are skilful at hypothesis construction, yet we are regretfully delinquent at formulating clear tests of our hypotheses. We are fond of conjecture about causal relationships, but our empirical tests progress no further than weak forms of correlation.

With regard to our second major weakness, our knack for polarizing opinion regarding chimerical questions such as the innateness of language can also be understood. After all, are we not following the classical dialectic model of thesis, antithesis and eventual synthesis? I think this is an idealized view of ourselves. In fact, we are driven by hunch and bias far more often than we would like to admit. Following hunches may be a real sign of creativity and vitality in our thinking. However, polarization driven by biases is ultimately detrimental. At some point we must disentangle ourselves from customary dialogue and transcend our deeply rutted patterns of thought.

When I began Rethinking innateness, I had hoped that the book might help us overcome these two weaknesses. I believe that it contributes positively to the goal of increasing the precision of our hypotheses and their empirical substantiation. At the same time, I am afraid that it will have a negative impact by aggravating the degree of polarization in our field.

Patterns of pronoun case error

This paper addresses the question of whether the rate and patterns of pronoun case error are influenced by the composition of an individual pronoun's paradigm. Twenty-nine children, aged 2;6 to 4;0 were audiotaped for two 1-hour sessions, interacting with their primary caregivers engaged in free play, book reading and family album viewing. It was found that her was overextended for she at a significantly higher rate than him for he and them for they, providing evidence of a 'double-cell' effect that increases the incidence of error in the feminine pronoun. It was also found that the overextension of nominative forms (e.g. he for him), were antagonistic to the more frequently occurring type of overextension, objective for nominative (e.g. him for he). These findings indicate that the composition of a pronoun's paradigm influenced the patterns of pronoun case error observed.

Me or my: two different patterns of pronoun case errors

This paper investigates why some young children prefer to replace I with me (me-children), whereas others prefer to replace I with my (my-children). The data come from 12 children, observed monthly, from 1;0 to 3;0. It was found that the percentage of errors in which me replaced I (the me-error rate) was positively correlated with the correct production of me as an objective pronoun (the me-total). The me for I and my for I errors were antagonistic, with one of the patterns almost always dominating over the other, resulting in a clear individual difference between me-children and my-children. It was also found that the me-total during the period in which my for I replacements first emerged prefigured whether a child would become a me-child or a my-child.

Pronoun case overextensions and paradigm building

Pronoun case errors, or overextensions, like *me want it are characteristic of English child language. This paper explores a hypothesis that the morphological structure of a pronoun influences the pattern of these errors. The Language Acquisition Device (LAD) attempts to analyse English pronoun case forms into stems and affixes, but cannot because of their irregularity. Nevertheless the LAD extracts a phonetic core for each pronoun (e.g./m-/ for the 1st sg.,/h-/ for the 3rd masc. sg.). The phonetic core blocks the overextension of suppletive nominative forms like I and she. This hypothesis predicts strong differences in the frequency and types of errors between pronouns with suppletive nominatives and those without. Evidence for this hypothesis was found in a transcript database of twelve children, with data collected in one hour samples every month from 1;0 to 3;0. 20,908 pronouns were examined, 1347 of which were errors. Statistical analyses of these data provide support for this hypothesis.

Histones and DNA methylation in mammalian chromatin. Differential inhibition by histone H1

Histones (from calf thymus or from human placenta), if renatured in the presence of EDTA, caused a severe inhibition of in vitro methylation of double-stranded DNA (from Micrococcus luteus) by human placenta DNA methyltransferase. The absence of EDTA during the histone renaturation procedure abolished--at least in the 'physiological' range of the histones/DNA ratio--the inhibition. The H1 component was responsible for this inhibition, no effect being exerted by the other histones. H1 preparations were more effective if renatured in the presence of EDTA--90% inhibition being reached at a 0.3:1 (w/w) H1/DNA ratio. It seems likely that the requirement for the presence of EDTA during the renaturation process is correlated to its ability to induce a fairly stable ordered conformation of the histones, although this effect could also be shown with the 'inactive' H2a, H2b and H3 components, and was instead less evident with histone H1. The restriction to histone H1 of the ability to inhibit enzymic DNA methylation may account for the lower methylation levels present in the internucleosomal DNA of mammalian chromatin.

A possible role of chromatin and tightly-bound chromatin proteins on enzyme-catalyzed methylation of DNA

Upon extensive digestion with DNAaseI of placenta chromatin matrix, previously "stripped" from its loosely-bound components by high-salt extraction, a fraction is obtained that contains almost no endogenous DNA methylase activity but whose DNA, if still included in this whole fraction--not if it has been purified to a protein-free condition--is a good substrate for externally added enzyme. This chromatin matrix can even cause a significant stimulation of methylation of single-stranded Micrococcus luteus DNA by placental methylase. In vivo, this phenomenon may have possible counterparts in the existence of highly-methylated regions of chromatin loops that appear to be protected by tightly-bound protein components from digestion of the "stripped loops" with DNAaseI.

[Evaluation of heart rate changes in the aged. An ambulatory electrocardiography study. Arrhythmias in the aged]

The Holter examinations of 111 subjects aged more than 65 who then underwent dynamic ecg were investigated in order to assess the clinical significance of cardiac arrhythmias in geriatric age. Group A was formed of 53 patients with no clinical signs of cardiovascular diseases. Thirty-two patients with clinical evidence of ischaemic cardiopathy made up Group B and 26 with arterial hypertension formed Group C. The Holter examinations were evaluated in accordance with current guidelines, considering the basic rhythm, heart rate, pulse formation and conduction disturbances and supraventricular and ventricular hyperkinetic arrhythmias. Sinus base rhythm was present in most cases whereas atrial fibrillation was noted in a similar percentage in the three groups, whether or not cardiovascular disease was present. Supraventricular and ventricular hyperkinetic arrhythmias were extremely common in the elderly and made no discrimination between patients with ischaemic cardiopathy or hypertension and the clinically healthy; for example, ventricular tachycardia was observed in 10.6% of Group A subjects, in 7.1% of Group B and 8.6% of Group C. To conclude, the clinical significance of heart rhythm changes in the elderly remains obscure because in most subjects they are not related to the presence of cardiovascular disease.

Localization, in human placenta, of the tightly bound form of DNA methylase in the higher order of chromatin organization

In human placenta, the DNA of all subfractions of the third level of chromatin organization exhibits similar values of the methylcytosine-to-cytosine ratio. The tightly bound form of DNA methyltransferase is mostly recovered in the 'stripped loop' fraction, although, on the basis of the DNA content, the 'stripped loops' and the 'stripped matrix' appear to possess a similar amount of the enzyme. DNA methyltransferase activity is instead totally absent from the 'digested matrix', i.e., from the fraction remaining after digestion of the 'stripped matrix' with DNAase I. Upon addition of exogenous DNA methyltransferase, however, the DNA of this fraction, which is only 1% (in weight) of the total chromatin DNA and which has a length of approx. 9 kbp, can readily undergo methylation.

Do tightly-bound chromatin proteins play a role in DNA methylation?

When chromatin matrix, "stripped" from its loosely-bound components by extraction with 3 M NaCl, is extensively digested with DNAase I, a fraction is obtained, which carries no endogenous DNA methyltransferase activity but which is a good substrate for externally added enzyme. Under the same conditions, protein-free DNA isolated from this fraction can instead hardly be methylated, this different behaviour pointing to a role of DNA-tightly-bound proteins in favoring or promoting the catalytic action of the enzyme. A similar stimulation of enzymatic methylation could also be shown when, in the presence of this same fraction, single stranded Micrococcus luteus DNA was incubated with placental methyltransferase, using S-adenosylmethionine as a methyl donor. This finding can be correlated to the existence, in chromatin loops, of small regions which resist digestion by DNAase I also after high-salt removal of their loosely-bound components (presumably because of the presence of tightly-bound proteins) and whose DNA is characterized by high methylation levels and, at the same time, by high relative content of thymine.

Inactivation of de novo DNA methyltransferase activity by high concentrations of double-stranded DNA

The activity of eukaryotic DNA methyltransferase diminishes with time when the enzyme is incubated with high concentrations (200-300 micrograms/ml) of unmethylated double-stranded Micrococcus luteus DNA. Under similar conditions, single-stranded DNA induces only a limited decrease of enzyme activity. The inactivation process is apparently due to a slowly progressive interaction of the enzyme with double-stranded DNA that is independent of the presence of S-adenosyl-L-methionine. The inhibited enzyme cannot be reactivated either by high salt dissociation of the DNA-enzyme complex or by extensive digestion of the DNA. Among synthetic polydeoxyribonucleotides both poly(dG-dC).poly(dG-dC) and poly(dA-dT).poly(dA-dT), but not poly(dI-dC).poly(dI-dC), cause inactivation of DNA methyltransferase. This inactivation process may be of interest in regulating the 'de novo' activity of the enzyme.

Direct coronary vasodilator effects of intracoronary histamine administration in humans

Histamine is widely present in human tissues and can be released by immunologic and nonimmunologic reactions. Although several direct cardiovascular effects of histamine have been demonstrated in humans, little is known about the direct effects of histamine on the human coronary circulation in vivo. Therefore, we investigated the changes in coronary hemodynamics induced by bolus intracoronary administration of 4 micrograms of histamine to 11 patients with angiographically normal coronary arteries under continuous monitoring of R-R interval from the electrocardiogram, arterial pressure (AP), and coronary sinus blood flow (CBF), measured by thermodilution. Immediately after the end of the intracoronary histamine bolus, with R-R interval and AP unchanged, CBF increased from 144 +/- 20 to 238 +/- 27 ml/min (p less than 0.01) and coronary vascular resistance decreased from 0.7 +/- 0.16 to 0.42 +/- 0.1 mm Hg/ml/min (p less than 0.01). No change in coronary hemodynamics was observed after bolus intracoronary administration of physiologic saline. The effects of histamine on systemic hemodynamics consisted of a transient fall in AP and R-R interval, starting after the onset of changes in coronary hemodynamics. These data show that histamine possesses a direct coronary vasodilator effect in humans, independent of the determinants of myocardial oxygen consumption.

Substrate preferences of human placental DNA methyltransferase investigated with synthetic polydeoxynucleotides

A DNA methyltransferase partly purified from human placenta has been tested on a variety of synthetic polydeoxynucleotides. The results showed that: the enzyme is most active as a 'maintenance' or 'hemi-' methylase but also has some de novo methylating activity; the presence or absence of A or T in the substrate strand has little influence on maintenance or de novo activity, while polymers containing C but not G in the same strand are poor de novo substrates and bind poorly to the enzyme; single-stranded polymers are about as good substrates as double-stranded ones, and the effects of nucleotide composition (particularly G and mC content) on enzyme activity with single strands are similar to those with double-stranded polymers; strands in which all the cytosines are methylated bind the enzyme well. A mechanism is suggested involving two different sites on the enzyme that recognize CG and mCG, and which rationalizes the activity of eukaryotic DNA methyltransferases towards single-stranded DNA.

Effects of histamine H1-receptor stimulation on coronary hemodynamics in man

Exogenous histamine in man induces significant cardiovascular effects mediated by activation of H1 and H2-receptors present on human heart and on coronary arteries. We studied the effects of selective H1-receptor stimulation on human coronary hemodynamics in 10 patients undergoing cardiac catheterization. All patients were pretreated with cimetidine before the histamine infusion (0.5 micrograms/kg/min i.v. for 5 min). Six of these patients had normal coronary arteries and four had single vessel coronary artery disease (CAD) and vasospastic angina. During the study heart rate was held constant (100 beats/min) by coronary sinus pacing. We measured mean aortic pressure (MAP), coronary sinus blood flow (CSBF), coronary vascular resistance (CVR) and myocardial oxygen consumption (MVO2) at rest, during histamine infusion, and 10 min after the end of the infusion. During infusion, MAP decreased from 103 +/- 5 to 85 +/- 6 mmHg (p less than 0.02) and CVR from 1.00 +/- 0.16 to 0.81 +/- 0.14 mmHg/ml/min (p less than 0.05); CSBF and MVO2 did not significantly change. All parameters returned to baseline at the end of the infusion. The response was similar in patients with normal coronary arteries and in 3 patients with CAD. Only one patient with CAD developed angina with ST segment elevation in D3, reduction in CSBF and an increase in CVR. These results indicate that H1-receptor stimulation in man induces significant coronary dilatation and that histamine infusion after cimetidine pretreatment is unlikely to provoke coronary spasm in patients with vasospastic angina.

Dissociation of lipolysis from the levels of cyclic AMP in rat epididymal fat cells

Two compounds, theophylline and 8-aza-9-furfuryl-adenine (SQ 4665), were found to maximally stimulate lipolysis in preparations of rat epididymal fat cells in the absence of exogenous hormones. Cyclic AMP levels in lipocytes maximally stimulated by either agent alone were unchanged from control levels. In contrast, lipolysis stimulated by either epinephrine alone or in combination with several cyclic nucleotide phosphodiesterase inhibitors correlated well with increases in the levels of cyclic AMP observed. These results suggest the presence of a non-cyclic AMP dependent pathway for the stimulation of lipolysis in rat epididymal fat cells.