Surgical solutions for refractory J-pouch inlet obstruction

AIM

Many surgeons consider total proctectomy with ileal pouch-anal anastomosis as the treatment of choice for patients with medically refractory ulcerative colitis or ulcerative colitis with dysplasia. However, obstruction occurring at the pouch inlet or involving the afferent limb can be refractory to nonoperative or endoscopic management. Historically, these refractory obstructions have usually required resection of the pouch. There is now increasing evidence to suggest that pouch salvage surgery may be feasible in these patients.

METHODS

A retrospective review was performed of all patients of a single surgical practice who underwent a neo ileal-pouch anastomosis for J-pouch inlet obstructions between 2000 and 2017. Data collected included patient demographics, preoperative workup, intra-operative findings, type of surgical intervention and postoperative outcomes.

RESULTS

Surgical interventions were performed on eight patients with J-pouch inlet obstructions. Six patients had inlet strictures or acute angulations at the inlet, which were either bypassed or resected and primarily anastomosed. Two patients had internal hernias posterior to the mesentery, with volvulus of the pouch. At a mean follow-up of 36.5 months, all patients retained their pouches and the mean number of daily bowel movements was eight. Two major and two minor complications occurred.

DISCUSSION

J-pouch inlet obstructions may take years to develop. In patients with obstruction who are refractory to endoscopic or medical treatment, good functional results may be obtained with pouch salvage procedures. With increasing numbers of J-pouches being performed, awareness of novel surgical techniques is important.

Visceral Obesity Is Associated with Gallbladder Polyps

Background/Aims

Gallbladder polyps (GBP) are a common clinical finding and may possess malignant potential. We conducted this study to determine whether visceral obesity is a risk factor for GBP.

Methods

We retrospectively reviewed records of subjects who received both ultrasonography and computed tomography with measurements of the areas of visceral adipose tissue and total adipose tissue (TAT) on the same day as health checkups.

Results

Ninety-three of 1,615 subjects (5.8%) had GBP and were compared with 186 age- and sex-matched controls. VAT (odds ratio [OR], 2.941; 95% confidence interval [CI], 1.325 to 6.529; p=0.008 for the highest quartile vs the lowest quartile) and TAT (OR, 3.568; 95% CI, 1.625 to 7.833; p=0.002 for the highest quartile vs the lowest quartile) were independent risk factors together with hypertension (OR, 2.512; 95% CI, 1.381 to 4.569; p=0.003), diabetes mellitus (OR, 2.942; 95% CI, 1.061 to 8.158; p=0.038), hepatitis B virus positivity (OR, 3.548; 95% CI, 1.295 to 9.716; p=0.014), and a higher level of total cholesterol (OR, 2.232; 95% CI, 1.043 to 4.778; p=0.039 for <200 mg/dL vs ≥240 mg/dL). Body mass index and waist circumference were not meaningful variables.

Conclusions

Visceral obesity measured by VAT and TAT was associated with GBP irrespective of body mass index or waist circumference.

Primary mucosa-associated lymphoid tissue lymphoma of the esophagus, manifesting as a submucosal tumor

We report a case of primary mucosa-associated lymphoid tissue (MALT) lymphoma in the esophagus that manifested as a large submucosal tumor (SMT). Primary esophageal lymphoma is very rare, occurring in less than 1% of all patients with gastrointestinal lymphoma. Only a few cases of MALT lymphoma in the esophagus have been reported in the English literature. A 53-year-old man was referred to Dongguk University Ilsan Hospital (Goyang, Korea) in July 2012 for further evaluation and treatment of an esophageal SMT. Endoscopy showed a cylindrically elongated submucosal mass with normal overlying mucosa in the mid esophagus, 25-30 cm from the incisor teeth. He underwent surgery to confirm the diagnosis. Pathologic findings showed diffuse small atypical lymphoid cells which were stained with Bcl-2, CD20, but not with CD3, CD5, CD23, Bcl-6, or cyclin D1. These cells showed a positive monoclonal band for immunoglobulin heavy chain gene rearrangement. Based on the pathological, immunohistochemical, and molecular biological features, the esophageal mass was diagnosed as extranodal marginal zone B-cell lymphoma of the MALT type.

Vegetarianism as a protective factor for reflux esophagitis: a retrospective, cross-sectional study between Buddhist priests and general population

BACKGROUND/AIMS

Several risk factors for reflux esophagitis, such as smoking, alcohol consumption, obesity, and metabolic syndrome, are recognized. But vegetarianism as a protective factor for reflux esophagitis has not been reported. The aim of this study is to elucidate the protective effect of vegetarianism for reflux esophagitis.

METHODS

This is a cross-sectional study that compared the prevalence of reflux esophagitis of 148 Buddhist priests, who are obligatory vegetarians with that of age- and sex-matched controls who underwent health checkups in a health promotion center.

RESULTS

The prevalence of reflux esophagitis was higher in the control group than in the Buddhist priest group (21.6 vs 12.2 %). Weight, body mass index, waist circumference, waist-to-hip ratio, and abdominal adipose tissue area were higher and high density lipoprotein (HDL) cholesterol and total cholesterol were lower in the Buddhist priest group. The prevalence of metabolic syndrome was higher in the Buddhist priest group than the control group (30.4 vs 17.6 %). In univariate analysis, male sex (odds ratio [OR] = 3.325; 95 % confidence interval [CI], 1.659-6.666), current smoking (OR = 3.37; 95 % CI, 1.439-7.881), alcohol consumption (OR = 2.75; 95 % CI, 1.375-5.481), waist circumference (OR = 1.99; 95 % CI, 1.062-3.739), negative for Helicobacter pylori IgG antibody (OR = 1.89; 95 % CI, 1.018-3.491) and non-vegetarianism (OR = 1.99; 95 % CI, 1.062-3.739) were associated with reflux esophagitis. According to multivariate analysis, male sex (OR = 3.44; 95 % CI, 1.698-6.970), non-vegetarianism (OR = 2.08; 95 % CI, 1.086-3.974) and negative H. pylori IgG antibody (OR = 1.96; 95 % CI, 1.039-3.712) were significantly associated with reflux esophagitis.

CONCLUSIONS

A non-vegetarian diet is associated with reflux esophagitis.

Rosiglitazone inhibits Kv4.3 potassium channels by open-channel block and acceleration of closed-state inactivation

BACKGROUND AND PURPOSE

Rosiglitazone is a widely used oral hypoglycaemic agent, which improves insulin resistance in type 2 diabetes. Chronic rosiglitazone treatment is associated with a number of adverse cardiac events. The present study was designed to characterize the effects of rosiglitazone on cloned K(v)4.3 potassium channels.

EXPERIMENTAL APPROACH

The interaction of rosiglitazone with cloned K(v)4.3 channels stably expressed in Chinese hamster ovary cells was investigated using whole-cell patch-clamp techniques.

KEY RESULTS

Rosiglitazone decreased the currents carried by K(v)4.3 channels and accelerated the current inactivation, concentration-dependently, with an IC(50) of 24.5 µM. The association and dissociation rate constants for rosiglitazone were 1.22 µM(-1)·s(-1) and 31.30 s(-1) respectively. Block by rosiglitazone was voltage-dependent, increasing in the voltage range for channel activation; however, no voltage dependence was found in the voltage range required for full activation. Rosiglitazone had no effect on either the deactivation kinetics or the steady-state activation of K(v)4.3 channels. Rosiglitazone shifted the steady-state inactivation curves in the hyperpolarizing direction, concentration-dependently. The K(i) for the interaction between rosiglitazone and the inactivated state of K(v)4.3 channels was 1.49 µM, from the concentration-dependent shift in the steady-state inactivation curves. Rosiglitazone also accelerated the kinetics of the closed-state inactivation of K(v)4.3 channels. Rosiglitazone did not affect either use dependence or recovery from inactivation of K(v)4.3 currents.

CONCLUSION AND IMPLICATIONS

Our results indicate that rosiglitazone potently inhibits currents carried by K(v)4.3 channels by interacting with these channels in the open state and by accelerating the closed-state inactivation of K(v)4.3 channels.

Severe hypertriglyceridemia in diabetic ketoacidosis accompanied by acute pancreatitis: case report

We report a case of diabetic ketoacidosis (DKA) and hypertriglyceridemia (severely elevated to 15,240 mg/dL) complicated by acute pancreatitis, which was treated successfully with insulin therapy and conservative management. A 20-yr-old woman with a history of type 1 diabetes came to the emergency department 7 months after discontinuing insulin therapy. DKA, severe hypertriglyceridemia and acute pancreatitis were diagnosed, with DKA suspected of contributing to the development of the other conditions. In Korea, two cases of DKA-induced hypertriglyceridemia and 13 cases of hypertriglyceridemia-induced acute pancreatitis have been previously reported separately.

Exendin-4 induction of cyclin D1 expression in INS-1 beta-cells: involvement of cAMP-responsive element

Glucagon-like peptide-1 (GLP-1) and its analog exendin-4 (EX) have been considered as a growth factor implicated in pancreatic islet mass increase and beta-cell proliferation. This study aimed to investigate the effect of EX on cyclin D1 expression, a key regulator of the cell cycle, in the pancreatic beta-cell line INS-1. We demonstrated that EX significantly increased cyclin D1 mRNA and subsequently its protein levels. Although EX induced phosphorylation of Raf-1 and extracellular-signal-regulated kinase (ERK), both PD98059 and exogenous ERK1 had no effect on the cyclin D1 induction by EX. Instead, the cAMP-elevating agent forskolin induced cyclin D1 expression remarkably and this response was inhibited by pretreatment with H-89, a protein kinase A (PKA) inhibitor. Promoter analyses revealed that the cAMP-responsive element (CRE) site (at position -48; 5'-TAACGTCA-3') of cyclin D1 gene was required for both basal and EX-induced activation of the cyclin D1 promoter, which was confirmed by site-directed mutagenesis study. For EX to activate the cyclin D1 promoter effectively, CRE-binding protein (CREB) should be phosphorylated and bound to the putative CRE site, according to the results of electrophoretic mobility shift and chromatin immunoprecipitation assays. Lastly, a transfection assay employing constitutively active or dominant-negative CREB expression plasmids clearly demonstrated that CREB was largely involved in both basal and EX-induced cyclin D1 promoter activities. Taken together, EX-induced cyclin D1 expression is largely dependent on the cAMP/PKA signaling pathway, and EX increases the level of phosphorylated CREB and more potently trans-activates cyclin D1 gene through binding of the CREB to the putative CRE site, implicating a potential mechanism underlying beta-cell proliferation by EX.

Inhibition of the cloned delayed rectifier K+ channels, Kv1.5 and Kv3.1, by riluzole

The action of riluzole, a neuroprotective drug, on cloned delayed rectifier K+ channels (Kv1.5 and Kv3.1) was examined using the whole-cell patch-clamp technique. Riluzole reversibly inhibited Kv1.5 currents in a concentration-dependent manner with an IC50 of 39.69+/-2.37 microM. G-protein inhibitors (pertussis toxin and GDPbetaS) did not prevent this inhibition of riluzole on Kv1.5. No voltage-dependent inhibition by riluzole was found over the voltage range in which channels are fully activated. Riluzole shifted the steady-state inactivation curves of Kv1.5 in a hyperpolarizing direction in a concentration-dependent manner. It accelerated the deactivation kinetics of Kv1.5 in a concentration dependent-manner, but had no effect on the steady-state activation curve. Riluzole exhibited a use-independent inhibition of Kv1.5. The effects of riluzole on Kv3.1, the Shaw-type K+ channel were also examined. Riluzole caused a concentration-dependent inhibition of Kv3.1 currents with an IC50 of 120.98+/-9.74 microM and also shifted the steady-state inactivation curve of Kv3.1 in the hyperpolarizing direction. Thus, riluzole inhibits both Kv1.5 and Kv3.1 currents in a concentration-dependent manner and interacts directly with Kv1.5 by preferentially binding to the inactivated and to the closed states of the channel.

Site-specific localization of protein kinase C isoforms in rat pancreas

BACKGROUND

Protein kinase C (PKC), a major signal-transducing enzyme, is recognized to play an important role in the regulation of pancreatic exocrine and endocrine secretion, and yet the distribution of PKC isoforms in rat pancreas has remained unclarified.

AIM OF THE STUDY

We examined the precise localization of PKC isoforms to elucidate the role of PKC in the normal rat pancreas.

METHODS

Male Sprague-Dawley rats were used throughout the experiment. For Western blot analysis, the islet of Langerhans and the acinar tissue were separated by the collagenase digestion method. Also, the whole pancreas was taken out and immunohistochemistry performed.

RESULTS

According to Western blot analysis, PKC-alpha, -gamma, -delta, -epsilon, -zeta, and -lambda were detected in both acinar and islet cells while PKC-beta II were observed exclusively in the islet. PKC-beta I was not observed. On immunohistochemistry, the immunoreactivities of PKC isoforms were observed as follows: PKC-alpha, weakly in some endocrine cells and ductal epithelium; PKC-beta II, mainly in the islet center; PKC-gamma, in the islet, intrapancreatic ganglia and ductal epithelium; PKC-delta, in the islet periphery, weakly in some acinar cells and ductal epithelium; PKC-epsilon, strongly in the islet, acinar cell and ductal epithelium; PKC-zeta, in the islet, acinar cell and ductal epithelium; PKC-lambda in some endocrine cells and ductal epithelium.

CONCLUSION

These results suggest that the intrapancreatic site-specific existence of PKC isoforms may regulate pancreatic exocrine and endocrine functions via a PKC-mediated signal transduction.

Effect of ethanol on spontaneous phasic contractions of cat gastric smooth muscle

BACKGROUND

Ethanol is generally believed to inhibit extracellular Ca2+ influx, thereby inhibiting gastric muscle contraction. Recently, we observed that verapamil inhibited only the amplitude of spontaneous phasic contractions, whereas ethanol inhibited both amplitude and frequency. In our objective to investigate the mechanism of ethanol's inhibition of gastric motility, the involvement of various protein kinases in ethanol-inhibited spontaneous phasic contractions of the stomach muscle strips was tested.

METHODS

Circular muscle strips (2.0 x 0.2 cm) were prepared from the corpus of cat stomach in order to measure isometric contraction in a chamber filled with Krebs-Ringer solution (pH 7.4, temperature 36 degrees C) bubbled with 5% CO2 in O2.

RESULTS

Spontaneous phasic contraction was not affected by various receptor antagonists (I microM atropine, 1 microM hexamethonium, 1 microM phentolamine and 1 microM propranolol) or 1 microM tetrodotoxin. EGTA and verapamil dose-dependently inhibited only the amplitude of spontaneous phasic contractions and not the frequency. Ethanol dose-dependently inhibited both the amplitude and frequency of phasic contractions. The amplitude and frequency of spontaneous phasic contractions were significantly inhibited by protein kinase C and tyrosine kinase inhibitors. However, neither protein kinase C activator nor various phosphatase inhibitors blocked the inhibitory effect of ethanol.

CONCLUSIONS

Ethanol appears to inhibit spontaneous phasic contractions by a mechanism other than the inhibition of protein kinase C or tyrosine kinase or the inhibition of extracellular Ca2+ influx.

Clinical evaluation of defibrillation efficacy with a new single-capacitor biphasic waveform in patients undergoing implantation of an implantable cardioverter defibrillator

AIMS

Improvements in the size and shape of implantable cardioverter defibrillators (ICDs) might be obtained by using one capacitor instead of the series connection of two capacitors traditionally used in ICDs. The aim of this study was to determine whether a biphasic waveform delivered from a single 336 microF capacitor had the same defibrillation efficacy as a standard biphasic waveform.

METHODS AND RESULTS

Randomized, paired defibrillation threshold testing was acutely performed in 54 patients undergoing ICD implantation. A standard 140 microF 80% tilt biphasic waveform (two 280 microF capacitors connected in series) was compared with an experimental biphasic waveform delivered from a single 336 microF capacitor at either 60% tilt (33 patients) or 80% tilt (21 patients). All waveforms had a 60/40 phase1/phase2 duration ratio. Compared with the standard waveform, the 60% tilt experimental waveform had a lower delivered energy (6.7 +/- 2.8 vs 7.9 +/- 3.3 joules, P<0.02), lower peak voltage (218 +/- 43 vs 333 +/- 68 V, P<0.01), and a slightly longer pulse duration (13.4 +/- 1.4 vs 10.7 +/- 1.1 ms, P<0.01). Conversely, the 80% tilt experimental waveform had a higher delivered energy (9.1 +/- 3.5 vs 6.3 +/- 2.4 joules, P<0.01), a lower peak voltage (234 +/- 44 vs 302 +/- 51 V, P<0.01) and a much longer pulse duration (25.7 +/- 2.5 vs 1.13 +/- 1 ms, P<0.01).

CONCLUSION

Waveforms delivered from a large capacitance are feasible but require a lower tilt. This technique may allow smaller, thinner ICDs without jeopardizing defibrillation success.

Neoplastic transformation and tumorigenesis associated with overexpression of phospholipase D isozymes in cultured murine fibroblasts

Phospholipase D (PLD) has been suggested to play an important role in a variety of cellular functions. PLD activity has been shown to be significantly elevated in many tumours and transformed cells, suggesting the possibility that PLD might be involved in tumorigenesis. In this study, we have established stable cell lines overexpressing PLD1 and PLD2 from fibroblast cells. These cells, but not control cells, showed altered growth properties and anchorage-independent growth in soft agar. Both PLD1 and PLD2 also induced an up-regulation of the activity of matrix metalloprotease-9 as detected by zymograms. Furthermore, both PLD1 and PLD2 transformants, but not vector-transfectants, induced undifferentiated sarcoma when transplanted into nude mice. Both PLD1- and PLD2-mediated cell cycle distributions in stable cell lines revealed an increased fraction of cells in the S phase compared with control cells. Interestingly, the level of cyclin D3 protein, known as an activator of G(1) to S phase transition in the cell cycle, was aberrantly high in cells overexpressing PLD1 and PLD2 compared with control cells. These results suggest that overexpression of PLD isozymes may play an important role in neoplastic transformation.

Effects of norfluoxetine, the major metabolite of fluoxetine, on the cloned neuronal potassium channel Kv3.1

The effects of fluoxetine and its major metabolite, norfluoxetine, were studied using the patch-clamp technique on the cloned neuronal rat K(+) channel Kv3.1, expressed in Chinese hamster ovary cells. In whole-cell recordings, fluoxetine and norfluoxetine inhibited Kv3.1 currents in a reversible concentration-dependent manner, with an IC(50) value and a Hill coefficient of 13.11+/-0.91 microM and 1.33+/-0.08 for fluoxetine and 0.80+/-0.06 microM and 1.65+/-0.08 for norfluoxetine at +40 mV, respectively. In inside-out patches, norfluoxetine applied to the cytoplasmic surface inhibited Kv3.1 with an IC(50) value of 0.19+/-0.01 microM. The inhibition of Kv3.1 currents by both drugs was characterized by an acceleration in the apparent rate of current decay, without modification of the activation time course and with relatively fewer effects on peak amplitude. The degree of inhibition of Kv3.1 by norfluoxetine was voltage-dependent. The inhibition increased steeply between 0 and +30 mV, which corresponded with the voltage range for channel opening. In the voltage range positive to +30 mV, inhibition displayed a weak voltage dependence, consistent with an electrical distance delta of 0.31+/-0.05. The association (k(+1)) and dissociation (k(-1)) rate constants for norfluoxetine-induced inhibition of Kv3.1 were 21.70+/-3.39 microM(-1) s(-1) and 14.68+/-3.94 s(-1), respectively. The theoretical K(D) value derived by k(-1)/k(+1) yielded 0.68 microM. Norfluoxetine did not affect the ion selectivity of Kv3.1. The reversal potential under control conditions was about -85 mV and was not affected by norfluoxetine. Norfluoxetine slowed the deactivation time course, resulting in a tail crossover phenomenon when the tail currents, recorded in the presence and absence of norfluoxetine, were superimposed. The voltage dependence of steady-state inactivation was not changed by the drug. Norfluoxetine produced use-dependent inhibition of Kv3.1 at a frequency of 1 Hz and slowed the recovery from inactivation. It is concluded that at clinically relevant concentrations, both fluoxetine and its major metabolite norfluoxetine inhibit Kv3.1, and that norfluoxetine directly inhibits Kv3.1 as an open channel blocker.

Effects of (-)-epigallocatechin-3-gallate, the main component of green tea, on the cloned rat brain Kv1.5 potassium channels

The interaction of (-)-epigallocatechin-3-gallate (EGCG), the main component of green tea (Camellia sinensis), with rat brain Kv1.5 channels (rKv1.5) stably expressed in Chinese hamster ovary (CHO) cells was investigated using the whole-cell patch-clamp technique. EGCG inhibited rKv1.5 currents at +50 mV in a concentration-dependent manner, with an IC50 of 101.2+/-6.2 microM. Pretreatment with protein tyrosine kinase (PTK) inhibitors (10 microM genistein, 100 microM AG1296), a tyrosine phosphatase inhibitor (500 microM sodium orthovanadate), or a protein kinase C (PKC) inhibitor (10 microM chelerythrine) did not block the inhibitory effect of EGCG on rKv1.5. The inhibition of rKv1.5 by EGCG displayed voltage-independence over the full activation voltage range positive to +10 mV. EGCG had no effect on the midpoint potential or the slope factor for steady-state activation and inactivation. EGCG did not affect the ion selectivity of rKv1.5. The activation (at +50 mV) kinetics was significantly slowed by EGCG. During repolarization (at -40 mV), EGCG also slowed the deactivation of the tail currents, resulting in a crossover phenomenon. Reversal of inhibition was detected by the application of repetitive depolarizing pulses and of identical double pulses, especially during the early part of the activating pulse, in the presence of EGCG. EGCG-induced inhibition of rKv1.5 showed identical affinity between EGCG and the multiple closed states of rKv1.5. These results suggest that EGCG interacts directly with rKv1.5 channels. Furthermore, by analyzing the kinetics of the interaction between EGCG and rKv1.5, we conclude that the inhibition of rKv1.5 channels by EGCG includes at least two effects: EGCG preferentially binds to the channel in the closed state, and blocks the channel by pore occlusion while depolarization is maintained.

Expression and regulation of phospholipase D during neuronal differentiation of PC12 cells

To assess a possible role for phospholipase D (PLD) in PC12 cell signal transduction and differentiation, we have investigated the expression of PLD in PC12 cells and found that the differentiation factor, nerve growth factor (NGF) increased PLD1 protein expression and phorbol 12-myristate 13 acetate (PMA)-induced PLD activity. During neuronal differentiation, this effect showed correlation to the protein expression levels of classical protein kinase C (PKC) isozymes, PKC-alpha and -beta II, but there was no significant increase in the protein level of RhoA, another regulatory factor for PLD activation. Interestingly, PLD1 was associated with PKC-alpha or beta II, and its association gradually increased as NGF-induced neuronal differentiation progressed. PKC inhibitor, Ro-31-8220, caused a significant inhibition of neurite outgrowth and PLD activity. Furthermore, PLD1 was constitutively associated with the Shc adaptor molecule, the overexpression of which is known to induce PLD activity and to induce neurite outgrowth. Taken together, the data in this study suggests that PLD1 is closely implicated in neuronal differentiation of PC12 cells.

Effect of somatostatin on cholecystokinin-induced amylase release in rat pancreatic acini

The effect of somatostatin on cholecystokinin-induced amylase release was investigated in isolated rat pancreatic acini. Acini were isolated by enzymatic digestion and incubated in a HEPES buffered Ringer's solution with testing reagents for 30 minutes at 37 degrees C. The activity of released amylase, cAMP, and inositol phosphate formation were measured. Intracellular calcium concentration ([Ca2+]i) was also checked. Somatostatin 14 and octreotide, a somatostatin analog, inhibited CCK-stimulated amylase release in a concentration-dependent manner. The inhibitory effect of octreotide on CCK-induced amylase release was not shown when the acini were treated with 8-Br-cAMP, irrespective of the presence of IBMX. Forskolin potentiated CCK-induced amylase release and this effect was blocked by octreotide treatment; although CCK-8 (3 x 10(-11) M) failed to stimulate cAMP formation, octreotide significantly inhibited basal cAMP formation in the acini. The increase of [Ca2+]i in response to CCK was inhibited by octreotide. However, CCK-induced inositol phosphate formation was not changed by 10(-9) M octreotide. Octreotide had no effect on CCK-stimulated tyrosine phosphorylation, and tyrosine phosphatase inhibitors (NaF and Na2WO4) did not influence the effect of octreotide on CCK-induced amylase release. From these results, we conclude that octreotide inhibits CCK-induced amylase release by inhibiting basal cAMP formation and decreasing the [Ca2+]i stimulated by CCK.

Altered expression of phospholipase D1 in spontaneously hypertensive rats

To clarify the involvement of phospholipase D (PLD) in the mechanism underlying genetically-induced hypertension, we investigated the activity and expression levels of PLD in tissues taken from spontaneously hypertensive rats (SHR), and their normotensive controls, Wistar-Kyoto rats (WKY). The ADP-ribosylation factor 3 (ARF3)-dependent PLD activity and protein levels of PLD1 from SHR increased significantly in the brain and liver, but not in the heart and kidney, compared to those of WKY. The activity and expression of PLD were the same between the homogenated whole kidneys of the two strains; however, there were topographical differences in the expression and activity of PLD between the kidneys of the two strains. The activity and expression level of PLD gradually increased from the cortex to the inner medulla of WKY. The enzyme activity, and amount of PLD in the inner stripe of the outer medulla and in the inner medulla, was significantly lower in SHR than in WKY. Taken together, these results suggest that the distinctly distributed patterns of PLD in the kidney may be associated with differential signal transduction pathways that are involved in hypertension in conjunction with an increase of PLD activity in the brain and liver.

Inhibition of Kv1.3 channels by H-89 (N--[2-(p-bromocinnamylamino)ethyl]-5-isoquinolinesulfonamide) independent of protein kinase A

The effects of H-89 (N-[2-(p-bromocinnamylamino)ethyl]-5-isoquinolinesulfonamide), a potent and selective inhibitor of protein kinase A (PKA), were examined on Kv1.3 channels stably expressed in Chinese hamster ovary (CHO) cells using the patch clamp technique. In whole-cell recordings, H-89 decreased Kv1.3 currents and accelerated the decay rate of current inactivation in a concentration-dependent manner with an IC(50) value of 1.70 microM. These effects were completely reversible after washout. Intracellular infusion with PKA inhibitors, adenosine 3', 5'-cyclic phosphorothioate-Rp (Rp-cAMPS) or protein kinase A inhibitor 5-24 (PKI 5-24) had no effect on Kv1.3 currents and did not prevent the inhibitory action of H-89 on the current. H-89 applied to the cytoplasmic surface also inhibited Kv1.3 currents in excised inside-out patches. These findings suggest that H-89 inhibits Kv1.3 currents independently of PKA.

The involvement of phospholipase A(2) in ethanol-induced gastric muscle contraction

To understand the underlying mechanism of ethanol in tonic contraction, the effect of ethanol on phospholipase A(2) and phospholipase C activities and the effects of phospholipase inhibitors on ethanol-induced contraction of cat gastric smooth muscle were tested. Circular muscle strips (2.0 x 0.2 cm) obtained from the fundus of cat stomach were used to measure isometric contraction. Ethanol elicited tonic contraction and activated phospholipase A(2) activity in a dose-dependent manner. Phospholipase A(2) inhibitors, manoalide (0.1--10 microM) and oleyloxyethyl phosphorylcholine (1--10 microM), significantly inhibited ethanol-induced contraction. Furthermore, 342 mM ethanol-induced contraction was significantly inhibited by cyclooxygenase inhibitors, ibuprofen (10--100 microM) and indomethacin (10--100 microM), but not by lipoxygenase inhibitors. On the other hand, phospholipase C inhibitors had no effect on ethanol-induced contraction, indicating that phospholipase C is not involved in ethanol-induced contraction. It is suggested from the above results that ethanol-induced contraction in cat gastric smooth muscle is, in part, mediated by phospholipase A(2) and cyclooxygenase pathways.

Distributional patterns of phospholipase C isozymes in rat pancreas

Phospholipase C (PLC) isozymes are believed to play a role in regulating pancreatic exocrine and endocrine secretion. In an attempt to investigate the role of PLC, we examined the distribution patterns of PLC isozymes in the normal rat pancreas by Western blot analysis and immunohistochemistry. Western blot analysis was performed on pancreatic acinar tissues and the islet of Langerhans, which were separated from each other. PLC-beta isozymes (beta1, beta2, beta3, and beta4), delta1, and delta2 were detected in both acinar and islet cells, whereas PLC-gamma1 and gamma2 were observed only in acinar tissues. On immunohistochemistry, the immunoreactivities of PLC isozymes except for PLC-gamma1 were observed as follows: PLC-beta1, in both the exocrine and endocrine tissues; PLC-beta2, mainly in the periphery of the islet and acinar cells; PLC-beta3, in the periphery of the islet and in some ductal epithelium; PLC-beta4, through the islet of Langerhans and ductal epithelium; PLC-gamma1, not detected in pancreatic tissue; PLC-gamma2, mainly in acinar cells; PLC-delta1 and delta2, in the islet and in ductal epithelium. These results suggest that the intrapancreatic site-specific existence of PLC isozymes may modulate pancreatic exocrine and endocrine functions through a PLC-mediated signal transduction.

Involvement of cyclic GMP in nitric-oxide-induced gastric relaxation Comparison of the actions of cyclic GMP and cyclic AMP

BACKGROUND

Smooth muscle relaxation induced by various agents that increase the cellular levels of cyclic nucleotides (cAMP and cGMP) is accompanied by a decrease in intracellular Ca2+ concentration. However, little is known about the differences between the inhibitory effects of cAMP and cGMP on the contraction of smooth muscle.

OBJECTIVE

To compare the effects and underlying mechanisms of cAMP and cGMP on the inhibition of gastric smooth muscle contraction, cyclic nucleotide promoting agents, as well as cell membrane permeable cyclic nucleotides were used.

METHODS

Isometric contraction was measured from circular muscle strips prepared from the fundus of cat stomach in a cylinder-shaped chamber filled with Krebs-Ringer solution (pH 7.4, temperature 36 degrees C) bubbled with 5% CO2 in O2. The level of inositol phosphates (IPs) was measured.

RESULTS

Forskolin and sodium nitroprusside significantly inhibited acetylcholine (ACh)-induced gastric smooth muscle contraction and increased the cellular levels of cAMP and cGMP, respectively. Direct application of 8-Br-cAMP and 8-Br-cGMP also significantly inhibited ACh-induced contraction. Both verapamil and TMB-8 inhibited ACh-induced contraction. The combined inhibitory effect of verapamil and TMB-8 was significantly greater than the effect of either one, separately. Forskolin or sodium nitroprusside similarly augmented the effect of verapamil. However, the inhibitory effect of TMB-8 was augmented only by 8-Br-cGMP or sodium nitroprusside but not by 8-BrcAMP or forskolin. Forskolin and 8-Br-cAMP significantly inhibited the formation of inositol phosphates stimulated by ACh.

CONCLUSIONS

cAMP inhibits the contraction mechanism associated with intracellular Ca2+ mobilization as well as extracellular Ca2+ influx, while cGMP inhibits contraction by inhibiting the mechanism associated with extracellular Ca2+ influx.

Phospholipase C, protein kinase C, Ca(2+)/calmodulin-dependent protein kinase II, and tyrosine phosphorylation are involved in carbachol-induced phospholipase D activation in Chinese hamster ovary cells expressing muscarinic acetylcholine receptor of Caenorhabditis elegans

Recently, we have isolated a cDNA encoding a muscarinic acetylcholine receptor (mAChR) from Caenorhabditis elegans. To investigate the regulation of phospholipase D (PLD) signaling via a muscarinic receptor, we generated stable transfected Chinese hamster ovary (CHO) cells that overexpress the mAChR of C. elegans (CHO-GAR-3). Carbachol (CCh) induced inositol phosphate formation and a significantly higher Ca(2+) elevation and stimulated PLD activity through the mAChR; this was insensitive to pertussis toxin, but its activity was abolished by the phospholipase C (PLC) inhibitor U73122. Western blot analysis revealed several apparent tyrosine-phosphorylated protein bands after CCh treatment. The CCh-induced PLD activation and tyrosine phosphorylation were significantly reduced by the protein kinase C (PKC) inhibitor calphostin C and down-regulation of PKC and the tyrosine kinase inhibitor genistein. Moreover, the Ca(2+)-calmodulin-dependent protein kinase II (CaM kinase II) inhibitor KN62, in addition to chelation of extracellular or intracellular Ca(2+) by EGTA and BAPTA/AM, abolished CCh-induced PLD activation and protein tyrosine phosphorylation. Taken together, these results suggest that the PLC/PKC-PLD pathway and the CaM kinase II/tyrosine kinase-PLD pathway are involved in the activation of PLD through mAChRs of C. elegans.

Direct block by bisindolylmaleimide of rat Kv1.5 expressed in Chinese hamster ovary cells

The interaction of bisindolylmaleimide (BIM), widely used as a specific protein kinase C (PKC) inhibitor, with rat brain Kv1.5 (rKv1.5) channels stably expressed in Chinese hamster ovary cells was investigated using the whole-cell patch-clamp technique. BIM (I) and its inactive analog, BIM (V), inhibited rKv1.5 currents at +50 mV in a reversible concentration-dependent manner with an apparent K(d) value of 0.38 and 1.70 microM, respectively. BIM (I) accelerated the decay rate of inactivation of rKv1.5 currents but did not significantly modify the kinetics of current activation. Other specific PKC inhibitors, chelerythrine and PKC 19-36, had no effect on rKv1.5 and did not prevent the inhibitory effect of BIM (I). The inhibition of rKv1.5 by BIM (I) and BIM (V) was highly voltage-dependent between -30 and 0 mV (voltage range of channel opening), suggesting that both drugs interact preferentially with the open state of the channel. The additional inhibition by BIM (I) displayed a voltage dependence (delta = 0.19) in the full activation voltage range positive to 0 mV, but was not shown in BIM (V) (delta = 0). The rate constants of association and dissociation for BIM (I) were 9.63 microM(-1) s(-1) and 5.82 s(-1), respectively. BIM (I) increased the time constant of deactivation of tail currents from 26. 35 to 45.79 ms, resulting in tail crossover phenomenon. BIM (I) had no effect on the voltage dependence of steady-state inactivation. BIM (I) produced use-dependent inhibition of rKv1.5, which was consistent with the slow recovery from inactivation in the presence of drug. These results suggest that BIM (I) directly inhibits rKv1.5 channels in a phosphorylation-independent, and state-, voltage-, time-, and use-dependent manner.

Mechanism of fluoxetine block of cloned voltage-activated potassium channel Kv1.3

The effects of fluoxetine (Prozac), a widely used antidepressant drug, on Kv1.3 stably expressed in Chinese hamster ovary cells were examined using the whole-cell and excised inside-out configurations of the patch-clamp technique. In whole-cell recordings, fluoxetine accelerated the decay rate of inactivation of Kv1.3 and thus decreased the current amplitude at the end of the pulse in a concentration-dependent manner with an IC(50) value of 5.9 microM. The inhibition displayed a weak voltage dependence, increasing at more positive potentials. Neither the activation nor the steady-state inactivation curve was affected by fluoxetine. In addition, fluoxetine reduced the tail current amplitude and slowed the deactivation of the tail current, resulting in a crossover phenomenon. When applied to the internal side of the membrane in inside-out recordings, the inhibition by fluoxetine was much faster and more potent with an IC(50) value of 1.7 microM compared with whole-cell recordings. Norfluoxetine, the major metabolite of fluoxetine, also inhibited Kv1.3 in a concentration-dependent manner (IC(50) = 1.4 microM) in whole-cell recordings. To check whether the fluoxetine-induced inhibition demonstrated in cloned Kv1.3 could also be observed in native T lymphocytes, the effects of fluoxetine were investigated on human T lymphocytes. Fluoxetine also inhibited outward K(+) current in human T lymphocytes. Our results indicate that fluoxetine produced a concentration- and voltage-dependent inhibition of Kv1.3 that can be interpreted as an open channel block and that a binding site for fluoxetine is more accessible from the intracellular side.

Cell type-specific expression of the Kv3.1 gene is mediated by a negative element in the 5' untranslated region of the Kv3.1 promoter

The Kv3.1 potassium channel gene is restrictively expressed in the CNS, and its expression level is especially high in neurons that are able to follow synaptic inputs at high frequencies. To understand the transcriptional mechanisms controlling Kv3.1 expression, we have conducted a functional analysis of the Kv3.1 promoter in various cell lines of different tissue origins and in transgenic mice. Our results suggest that an upstream regulatory fragment coupled with the 5' untranslated region (UTR) is able to confer tissue-specific expression in both cell lines and in transgenic mice. Deletion analysis of the regulatory region carried out in cell lines reveals that a strong negatively acting element, uniquely residing in the 5' UTR (+350 to +158), appears able to confer cell type specificity on both the Kv3.1 promoter and the thymidine kinase promoter in transient transfection assays. A weak cell type-specific enhancer in the proximal region of the promoter (-123 to -71) also contributes to cell type-specific expression of the Kv3.1 gene.

Staurosporine directly blocks Kv1.3 channels expressed in Chinese hamster ovary cells

The effects of staurosporine (ST), a widely used protein kinase C (PKC) inhibitor, were examined on Kv1.3 channels stably expressed in Chinese hamster ovary (CHO) cells using the whole-cell and excised inside-out configurations of the patch clamp technique. In whole-cell recordings, ST, at external concentrations from 300 nM to 10 microM, accelerated the rate of inactivation of Kv1.3 currents and thereby reduced the current at the end of the depolarizing pulse in a concentration-dependent manner with an IC50 of 1.2 microM. The actions of ST were unaffected by pretreatment with another selective PKC inhibitor, chelerythrine, or by including the PKC pseudosubstrate peptide inhibitor, PKC 19-36, in the intracellular solution. Rp-cAMPS, a specific protein kinase A inhibitor, included in intracellular solution did not affect the effects of ST. Furthermore, the same effects of ST on Kv1.3 were also observed in excised inside-out patches when applied to the internal face of the membrane. These effects were completely reversible upon washing. Current-voltage relations for Kv1.3 currents at the end of voltage steps indicated that ST reduced Kv1.3 currents over a wide voltage range. The blockade exhibited a shallow voltage dependence between -10 mV and +40 mV, increasing at more positive potentials. ST had no effect on the voltage dependence of steady-state inactivation. It reduced the tail current amplitude and slowed the deactivation time course, resulting in a crossover phenomenon. These results suggest that the action of ST on Kv1.3 is independent of PKC and PKA inhibition. ST blocks the open state of Kv1.3 channels to produce an apparent acceleration of the inactivation rate.

Inhibition by fluoxetine of voltage-activated ion channels in rat PC12 cells

The effects of fluoxetine (Prozac) on voltage-activated K+, Ca2+ and Na+ channels were examined using the whole-cell configuration of the patch clamp technique in rat pheochromocytoma (PC12) cells. When applied to the external bath solution, fluoxetine (1, 10, 100 microM) decreased the peak amplitude of K+ currents. The K+ current inhibition by fluoxetine (10 microM) was voltage-independent and the fraction of current inhibition was 39.7-51.3% at all voltages tested (0 to +50 mV). Neither the activation and inactivation curves nor the reversal potential for K+ currents was significantly changed by fluoxetine. The inhibition by fluoxetine of K+ currents was use- and concentration-dependent with an IC50 of 16.0 microM. The inhibition was partially reversible upon washout of fluoxetine. The action of fluoxetine was independent of the protein kinases, because the protein kinase C or A inhibitors (H-7, staurosporine, Rp-cAMPS) did not prevent the inhibition by fluoxetine. Intracellular infusion with GDPbetaS or pretreatment with pertussis toxin did not block the inhibitory effects of fluoxetine. The inhibitory action of fluoxetine was not specific to K+ currents because it also inhibited both Ca2+ (IC50 = 13.4 microM) and Na+ (IC50 = 25.6 microM) currents in a concentration-dependent manner. Our data indicate that when applied to the external side of cells, fluoxetine inhibited voltage-activated K+, Ca2+ and Na+ currents in PC12 cells and its action on K+ currents does not appear to be mediated through protein kinases or G proteins.

Somatostatin potentiates voltage-dependent K+ and Ca2+ channel expression induced by nerve growth factor in PC12 cells

It has been proposed that neurotransmitters and neuromodulators may function as neurotrophic factors during the development of the nervous system. Somatostatin (SS) was known to increase neurite outgrowth in PC12 cells, rat pheochromocytoma cell line, and cerebellar granule cells as well as Helisoma neuron. To further investigate a neurotrophic role of SS, voltage-dependent K+ and Ca2+ channel expression was studied using whole-cell patch-clamp in PC12 cells and the effect of SS was compared to that of nerve growth factor (NGF). Cyclic AMP (cAMP) level and mitogen-activated protein (MAP) kinase phosphorylation were also studied following the treatment with SS and/or NGF. Whereas NGF (50 ng/ml) increased continually the current density of the voltage-dependent K+ channel throughout 8 days treatment, SS (1 microM) increased the K+ current density on day 2 to the peak. K+ current density was decreased thereafter and was not different on day 6 from that of undifferentiated cells. Although SS did not increase voltage-dependent Ca2+ current density, it potentiated NGF-induced increase of voltage-dependent Ca2+ channel current density as well as the K+ current density. cAMP level was decreased by NGF and/or SS treatment. An increased phosphorylation of MAP kinase induced by NGF was not changed by SS treatment. These results support functionally that SS may function as a neurotrophic factor in developing nervous system.

Randomized comparison of a 90 uF capacitor three-electrode defibrillation system with a 125 uF two-electrode defibrillation system

INTRODUCTION

A variety of factors, including the number of defibrillation electrodes and shocking capacitance, may influence the defibrillation efficacy of an implantable defibrillator system. Therefore, the purpose of this study was to compare the defibrillation energy requirement using a 125 uF two-electrode defibrillation system and a 90 uF three-electrode defibrillation system.

METHODS AND RESULTS

The defibrillation energy requirements measured with both systems were compared in 26 consecutive patients. The two-electrode system used a single transvenous lead with two defibrillation coils in conjunction with a biphasic waveform from a 125 uF capacitor. The three-electrode system used the same transvenous lead, utilized a pectoral implantable defibrillator generator shell as a third electrode, and delivered the identical biphasic waveform from a 90 uF capacitor. The two-electrode system was associated with a higher defibrillation energy requirement (10.8 +/- 5.5 J) than was the three-electrode system (8.9 +/- 6.7 J, p < 0.05), however, the leading edge voltage was not significantly different between systems (361 +/- 103 V vs. 397 +/- 123 V, P = 0.07). The two-electrode system also had a higher shocking resistance (49.0 +/- 9.0 ohms vs. 41.4 +/- 7.3 ohms, p < 0.001) and a lower peak current (7.7 +/- 2.6 A vs. 10.1 +/- 3.7 A, p < 0.001) than the three-electrode system.

CONCLUSIONS

A three-electrode defibrillation system that utilizes a dual coil transvenous lead and a subcutaneous pectoral electrode with lower capacitance is associated with a lower defibrillation energy requirement than is a dual coil defibrillation system with higher capacitance. This finding suggests that the utilization of a pectoral generator as a defibrillation electrode in conjunction with smaller capacitors is a more effective defibrillation system and may allow for additional miniaturization of implantable defibrillators.

Uterine leiomyomas reduce the efficacy of assisted reproduction cycles: results of a matched follow-up study

A matched follow-up study design was used to test the hypothesis that pregnancy rates following assisted reproduction procedures do not differ between women with or without intramural or sub-serosal uterine leiomyomas. Women undergoing their first in-vitro fertilization (IVF)-embryo transfer or zygote intra-Fallopian transfer (ZIFT) cycle between January 1993 and June 1995 were included. Cases (women with leiomyomas) were matched 1:1 with the next consecutive control (women without leiomyomas) according to age, number of embryos transferred, embryo grade, and the route of embryo transfer (uterine or Fallopian). Assisted reproduction cycles were performed in an identical manner, independent of the presence or absence of uterine leiomyomas. The main outcomes measured were clinical pregnancy and delivery rates. A total of 182 cycles was evaluated. Of the 91 assisted reproduction cycles performed in the leiomyoma group, there were 34 clinical pregnancies (37%) and 30 deliveries (33%). Of the 91 assisted reproduction cycles in the control group, there were 48 clinical pregnancies (53%) and 44 deliveries (48%). The Mantel-Haenszel estimate of relative risk indicated that the presence of a uterine leiomyoma significantly reduced the chance for a clinical pregnancy or delivery. These findings suggest that leiomyomas are associated with a reduction in the efficacy of assisted reproduction cycles.

Regulation of protein kinases in steady-state contraction of cat gastric smooth muscle

Cat gastric smooth muscle strips were used to investigate the involvement of protein kinases in the steady-state contraction induced by 1 microM acetylcholine or 20 mM KCI. The steady-state contraction induced by acetylcholine or KCl was inhibited by EGTA dose dependently. Voltage-dependent Ca2+ channel antagonists dose dependently inhibited the contractions induced by KCI as well as by acetylcholine. Inhibitory effects of voltage-dependent Ca2+ channel antagonists were significantly more prominent on KCI-induced contractions than on acetylcholine-induced contractions. The acetylcholine-induced contraction was dose dependently inhibited by 8-(N,N-diethylamino)octyl-3,4,5-trimethoxybenzoate (TMB-8, a blocker of intracellular Ca2+ release), but the KCl-induced contraction was not inhibited at all. Therefore both intracellular Ca2+ release and extracellular Ca2+ influx seem to be necessary for the acetylcholine-induced contraction, but intracellular Ca2+ release is not necessary for the KCl-induced contraction. Protein kinase C inhibitors, 10 microM 1-(5-isoquinolinylsulfonyl)-2-methyl-piperazine 2HCl (H-7) and 1 microM staurosporine, significantly inhibited the contraction induced by acetylcholine or KCl. Calmodulin antagonists, 30 microM trifluoperazine and 50 microM N-(6-aminohexyl)-5-chloro-2-naphthalenesulfonamide HCI (W-7), however, significantly inhibited the contraction induced by acetylcholine but not by KCl. A tyrosine kinase inhibitor, 50 microM genistein, did not affect the acetylcholine-induced contraction but significantly inhibited the KCl-induced contraction. These results strongly suggest that the involvement of protein kinases in regulation of the steady-state contraction may be agonist-dependent.

Stimulatory role of the dorsal motor nucleus of the vagus in gastrointestinal motility through myoelectromechanical coordination in cats

This study was undertaken to investigate the effect of stimulation of the dorsal motor nucleus of the vagus (DMV) on myoelectric activity and motility of the gastric antrum and duodenum in normal and in vagotomized cats. 37 cats were starved for 24 h and then anesthetized with alpha-chloralose (70-80 mg/kg, iv). Electrical stimulation (0.1 mA, 0.2 ms, 50 Hz) of the left DMV was performed through a stereotaxically inserted electrode in 19 of the cats. The remaining 18 cats were injected in the left DMV with a glutamate solution (1 M, 200 nl) through an inserted 3-barreled micropipette. The myoelectric activity (slow wave) and the motility of the gastric antrum (2 cm proximal to the pylorus) and duodenum (3 cm distal to the pylorus) were measured using serosal bipolar electrodes and intraluminal balloons. Both the electrical and the glutamate stimulations of the DMV markedly increased the occurrence of spike potentials on the antral and duodenal myoelectric activity; however, the stimulations significantly decreased the frequency of the antral slow wave. The stimulations also produced increases in the motility of the antrum and duodenum which corresponded to the changes in the myoelectric activity. All the changes in the myoelectric activity and the motility were not observed after the ipsilateral vagotomy. Thus, these results strongly suggest that the dorsal motor nucleus of the vagus has a stimulatory influence on antral and duodenal motility through myoelectromechanical coordination via the vagus nerve in cats.

Inhibition by nystatin of Kv1.3 channels expressed in Chinese hamster ovary cells

The patch-clamp technique was used to study the effects of nystatin on a cloned delayed rectifier potassium channel (Kv1.3) expressed in Chinese hamster ovary (CHO) cells. Kv1.3 currents recorded in the whole-cell configuration, using an intracellular solution containing nystatin, were subjected to a time- and concentration-dependent reduction in their amplitude and in the time constants of apparent inactivation. Direct application of nystatin to the cytoplasmic side of excised inside-out patches inhibited Kv1.3 currents and this inhibition was immediately reversible upon washout of the drug. In contrast, currents mediated by another delayed rectifier (Kv3.1) were not affected by this drug. The concentrations for nystatin and its structural analog, amphotericin B, required to produce half maximal inhibition (IC50) of the current were estimated to be about 3 and 60 microM, respectively. The effects of nystatin on the amplitude and inactivation of Kv1.3 currents were not voltage-dependent. In inside-out patches, tetraethylammonium (TEA) produced a rapid block of Kv1.3 currents upon the onset of a voltage pulse, while the inhibition by nystatin developed slowly. When co-applied with TEA, nystatin potentiated the extent of the TEA-dependent block, and the kinetic effect of nystatin was slowed by TEA. In summary, nystatin, a compound frequently used in perforated patch recordings to preserve intracellular dialyzable components, specifically inhibited the potassium channel Kv1.3 at concentrations well below those required for perforation. The site of this inhibition may be different from that for TEA and is readily accessible from the cytoplasmic side of the membrane.

Implantable cardioverter defibrillator lead technology: improved performance and lower defibrillation thresholds

The performance of an ICD system depends, in part, on the effectiveness with which the lead system functions. Engineering trade-offs are made during the design of a lead to optimize one or more performance characteristics: e.g., lead handling, fatigue life, size, and optimized therapy delivery. To assure low defibrillation thresholds, careful attention must be taken during the design process to prevent these trade-offs from hampering the lead's therapy effectiveness. Four basic design rules are described that capture many of the engineering concepts that will enhance a lead's efficacy: (1) minimize electrode pullback, (2) deliver current to the apex, (3) minimize energy loss in the lead, and (4) use large, efficient electrodes. These rules speak to optimizing delivery of current to the heart and efficiency of the lead and electrode interface. When the lead performs its function well, the complete ICD system of the heart, lead, and implantable pulse generator will provide optimal safety margins for device implant and an increased number of patients that can be implanted with a single-lead system.

Position of epicardial patch electrodes for implantable defibrillation significantly affects shock strength requirements

OBJECTIVE

To assess the impact of epicardial patch electrode position on internal defibrillation efficacy.

METHODS

Two mesh patch electrodes (13 cm2) were positioned on the epicardium of acute, isoflurane-anesthetized pigs (n = 7, 40-47 kg). Defibrillation efficacy was determined for three different patch positions: P1 = anterior-basal right ventricle (RV) and lateral-apical left ventricle (LV); P2 = lateral RV and lateral LV; and P3 = anterior-basal septal region and posterior-apical septal region. To quantify defibrillation efficacy, single capacitor discharge, fixed-tilt (68%) biphasic waveforms were delivered to the heart 10 seconds after initiation of ventricular fibrillation. Initial shock intensities were selected using an up/down protocol. Conversion data were used to construct sigmoidal curves relating probability of defibrillation to energy delivered, peak voltage, and peak current in each animal.

RESULTS

Mean peak voltage and current at 50% defibrillation probability were 40% higher for P2 than they were for either P1 or P3 (p < 0.05). Similarly, mean energy delivered was 75% higher for P2. In this pig model, position of epicardial patch electrodes affects defibrillation efficacy.

CONCLUSION

Apical-to-basal shock vectors (P1 and P3) yielded significantly lower defibrillation shock strength requirements than did a lateral-wall-to-lateral-wall vector (P2), which was perpendicular to the intraventricular septum. These data may help explain the disparity in defibrillation thresholds observed in the human population of patients undergoing implantable cardioverter defibrillator testing with epicardial patch electrodes.

Large capacitor defibrillation waveform reduces peak voltages without increasing energies

This study tested the hypothesis that increasing capacitance would allow a reduction in ICD size without reducing the deliverable energy. For example, the volume of a single 450 microF capacitor (390 V peak) is 1/3 less than that of two 250 microF capacitors (780 V), but it can store equivalent amounts of energy.

METHODS

Endocardial defibrillation electrodes (3.4 cm) were positioned in the RV apex and at the RA/SVC junction in six mixed-breed, isoflurane anesthetized pigs (41 +/- 3 kg). Three 17-cm ribbon wires were positioned subcutaneously on the left lateral chest (SQArray). Two CPI VENTAK ECDs were equipped to deliver 60/40 biphasic waveforms using either 125 microF (STD) or 500 microF (LD) of capacitance. A 15 shock up/down protocol was used to determine the 50% probability of success levels for each waveform in each animal. Shocks were delivered from RV(-)-->SVC + SQArray(+) in random order. Results were compared using paired Student's t-tests and are reported as mean +/- SE.

RESULTS

The 500 microF, long duration waveform reduced peak voltage 41% (374 +/- 18 V [STD] vs 219 +/- 14 V [LD], P < 0.001) and reduced peak current 38% (11.0 +/- 1.1 A [STD] vs 6.8 +/- 0.6 A [LD], P < 0.001) but did not significantly change the delivered energy (12.4 +/- 1.3 J [STD] vs 13.4 +/- 1.0 J [LD]). Durations increased from 10.0 +/- 0.2 to 17.6 +/- 0.5 msec (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Stimulatory effects of the central amygdaloid nucleus on pancreatic exocrine secretion in rats

The effects of electrical stimulation of the central (CE) and basolateral (BL) amygdaloid nuclei on pancreatic exocrine secretion were tested in urethane-anesthetized rats. Electrical stimulation (0.1 mA, 1 ms, 40 Hz) of the CE significantly increased basal and hormone (secretin+cholecystokinin-8)-infused pancreatic exocrine secretion. These increases in pancreatic secretion were abolished by bilateral vagotomy. Electrical stimulation of the BL had no significant effect on basal and hormone-infused secretion. We conclude that the CE plays a stimulatory role in pancreatic exocrine secretion via the vagus nerve but the BL does not affect pancreatic secretion.

Ovarian hyperstimulation syndrome: protocols for nursing care

One of the few life-threatening conditions encountered by the nurse caring for reproductive endocrinology and infertility patients is ovarian hyperstimulation syndrome (OHS). Having protocols for the nursing care of the patient with OHS enhances patient safety and quality of care. Model OHS protocols for outpatient and inpatient settings are presented. The collaborative nursing role in patient care also is discussed.

Effect of medial amygdaloid stimulation on pancreatic exocrine secretion in anesthetized rats

Effects of medial amygdaloid stimulation on pancreatic exocrine secretion were investigated in anesthetized rats with pyloric ligation. During intraduodenal 0.01 N HCl perfusion, the electrical stimulation of the medial amygdaloid nucleus augmented significantly the HCl-induced pancreatic secretion of water and bicarbonate output. The duodenal acidification significantly increased secretin concentration in plasma. The effects of medial amygdaloid stimulation were also tested in the rats that received a small dose of porcine secretin. Although the amount of secretin infused was not enough to increase the pancreatic exocrine secretion, the stimulation of the medial amygdaloid nucleus significantly increased flow and bicarbonate output. The augmented pancreatic secretory responses to electrical stimulation of the medial amygdaloid nucleus were abolished by bilateral truncal vagotomy. However, the medial amygdaloid stimulation was not effective in stimulating pancreatic secretion in the rats perfused with isotonic saline. From these results, it is suggested that the medial amygdaloid nucleus plays a stimulatory role in pancreatic exocrine secretion via vagus nerves and that a certain level of plasma secretin is needed for the medial amygdaloid stimulation to be effective.

Oocyte donation and in vitro fertilization: the nurse's role with ethical and legal issues

Oocyte donation has made pregnancy a realistic option for women who want to become pregnant yet are unable to produce viable, healthy eggs. This article reviews oocyte donation technology, discusses ways that donor programs can deal effectively with the legal and ethical issues involved, and describes the role of the in vitro fertilization nurse.

H1 receptor mediates inositol phosphates response to histamine in gastric smooth muscle of guinea pigs

The effect of histamine on [3H]-inositol phosphates (IPs) formation was investigated with [3H]-inositol-labeled gastric smooth-muscle cells in guinea pigs. Histamine (10(-5) M) increased the formation of [3H]-IPs in the muscle cells. The increase was significantly inhibited by pyrilamine (10(-5) M) but not by cimetidine (10(-5) M). The contractile response to histamine was also completely inhibited by pyrilamine but not by cimetidine. Phorbol ester 12-myristate 13-acetate (10 microM) significantly inhibited histamine-stimulated [3H]-IPs formation by 56%, whereas forskolin (10 microM) decreased it by 18%. This study demonstrates that the response of [3H]-IPs formation and contraction to histamine is mediated through H1 receptor, and the formation of [3H]-IPs is negatively regulated by protein kinase C in gastric smooth muscle of guinea pigs.

Comparison of concurrent pregnancy rates for in-vitro fertilization--embryo transfer, pronuclear stage embryo transfer and gamete intra-fallopian transfer

Concurrent pregnancy and implantation (sacs/embryos transferred) rates were compared for 84, 77 and 49 cases of in-vitro fertilization-embryo transfer (IVF-ET), pronuclear stage embryo transfer (PROST) and gamete intra-Fallopian transfer (GIFT), respectively. All cases reported occurred during an 18-month interval since the initiation of PROST by our programme. Leuprolide acetate was used with follicle stimulating hormone and human menopausal gonadotrophin for follicular stimulation of all but donor oocyte cases (n = 9). Clinical pregnancy (per transfer) and implantation rates were significantly higher (P less than 0.03) for PROST (52.4%, 20.2%) in comparison with IVF-ET (26.9%, 11.4%). Rates for GIFT (48.9%, 18.4%) were not significantly higher (P = 0.10, 0.14) than for IVF-ET. This was probably due to the lower number of GIFT than PROST procedures performed. The total pregnancy rate for GIFT (biochemical, ectopic and clinical combined) was significantly greater (P less than 0.05) than for IVF-ET. Pregnancy and implantation rates for PROST and GIFT were similar. These results support the use of PROST rather than IVF-ET for all cases in which the woman has one functional Fallopian tube. Furthermore, to maintain equivalent rates of pregnancy with PROST and GIFT, it is suggested that GIFT should not be used for cases of male-factor infertility without first documenting normal rates of in-vitro fertilization with PROST.

Electrical stimulation of the medial amygdala facilitates gastric acid secretion in conscious rats

One hundred and twenty-seven conscious rats prepared with chronic gastric fistula were studied to investigate the effect of stimulation of the medial amygdala on gastric acid secretion. Gastric acid output was significantly increased by electrical stimulation of the medial amygdala in normal rats and the increase in acid secretion was completely abolished by vagotomy. Vagotomized rats, with or without amygdaloid stimulation, showed comparable levels of gastric acid output which were significantly lower than in controls. These results indicate that the amygdala effect on gastric acid secretion is carried via the vagus nerve. Subcutaneous injections of high doses of histamine increased gastric acid secretion which was further increased by amygdaloid stimulation. Plasma levels of gastrin were not significantly changed by stimulation of the medial amygdala with or without vagotomy. From the above results, we concluded that in conscious rats the medial amygdala plays a significant role in stimulating gastric acid secretion, the vagus nerve is involved in this process, but it is not mediated by release of either histamine or gastrin.

The action of histamine on the isolated stomach muscle of the cat

The effect of histamine on contractile and electric activity was studied in the isolated stomach muscle strips of 138 cats. Histamine dose-dependently produced tonic and phasic contractions of the muscle preparations from the fundus and the corpus but only phasic contraction of the antral muscle preparations. The frequency of gastric slow waves (SWs) was also increased dose-dependently by histamine. The responses of muscle contractions and gastric SW frequency to histamine were completely blocked by pretreatment with pyrilamine (10(-6) M) and were significantly inhibited by atropine (10(-5) M) but not by cimetidine (10(-5) M), hexamethonium (10(-5) M), phentolamine (10(-5) M), or propranolol (10(-5) M). The inhibition by pyrilamine was competitive. Although atropine inhibited the effect of histamine significantly, it could not completely block the effect of histamine even at a high concentration (3 x 10(-5) M). It is concluded that histamine may participate in the regulation of gastric motility in the cat by acting on the H1 receptor to cause the release of acetylcholine and also other contractile substance(s).