Impact of temporary mechanical circulatory support on mortality in cardiogenic shock: an emulated target trial with a prospective, multicenter, French cohort study

Background

The field of temporary mechanical circulatory support (TMCS) has advanced in last decade justifying that TMCS is increasingly used for treatment of refractory cardiogenic shock (CS). Nevertheless, the efficacy of TMCS (extracorporeal life support (ECLS) and Impella) in CS remains controversial due to the lack of high-quality evidence. The aim of this prospective multicenter observational study simulating a randomized trial was to assess the impact of TMCS on the hospital mortality in patients with CS.

Methods

This study (ClinicalTrials.gov ID: NCT03528291) was conducted at 3 TMCS centers organized in a cardiac assistance network, one as a level 1 TMCS center (expert center), and 2 as level 2 centers (hub centers). The study was designed and led by the heart team of the expert center with input from the hub centers.

All patients admitted to an intensive care unit between July 2017 and May 2020 either directly at the TMCS centers or after transfer from a non-specialized hospital, were screened for TMCS indication provided they were admitted for CS. CS was defined according to the European Society of Cardiology criteria. Were excluded patients younger than 18 years, CS after cardiac surgery, or after cardiac arrest if it was refractory or with a no flow >3 min and/or out-of-hospital cardiac arrest with non-shockable rhythm, or CS in the context of myocardial infarction complications, massive pulmonary embolism, and if TMCS was contraindicated

TMCS indication was decided after a multidisciplinary discussion carried out by the “heart team”. Implantation of TMCS resulted from an agreement of the heart team within the first 24 hours after admission mainly based on the initial severity of the CS, or if CS was refractory to the medical treatment.

The primary outcome was in-hospital survival. A propensity score-weighted analysis was done for treatment-effect estimation. This method, which weights each patient according to their propensity score, includes all participants in the analysis.

Results

246 patients with CS were included in the study: 121 in TMCS group (72% ECLS, 14% Impella, 14% both ECLS and Impella) and 125 in control group. After adjustment by a propensity score, hospital mortality was comparable in the two groups (32% TMCS group vs 27% control group; Odds ratio with TMCS, 1.28; 95% confidence interval, 0.87 to 1.88; p=0.21). Mortality at D180 was also similar in the two group (33% vs 30% respectively; p=0.51). Thromboembolic events were significantly higher in the TCMS group (14% vs 4%; p<0.01) as well as the transfusion rate ((median (IQR); 4.0 (0.0; 9.0) vs 0.0 (0.0; 0.0); p<0.01).

Conclusion

In our study, the use of TMCS does not seem to improve hospital survival in patients with cardiogenic shock. Thus, TMCS, which are iatrogenic side effects providers, should be reserved for the most severe patient and discussed by a multidisciplinary team.

Funding Acknowledgement

Type of funding sources: None. Flow chart

The female sex pheromone of sugarcane stalk borer,Chilo auricilius identification of four components and field tests

Four pheromonal components have been detected in ovipositor washings and volatiles from female sugarcane stalk borers,Chilo auricilius Dudgeon (Lepidoptera: Pyralidae), using combined gas chromatography-electroantennography. The components have been identified as (I) (Z)-7-do-decenyl acetate, (II) (Z)-8-tridecenyl acetate, (III) (Z)-9-tetradecenyl acetate, and (IV) (Z)-10-pentadecenyl acetate by comparison of their gas chromatographic behavior with that of synthetic standards. In field tests carried out in northern India during 1982-1984, a combination of II, III, and IV in their naturally occurring ratio (8∶4∶1) was shown to provide a highly attractive synthetic source for trap use. (Z)-7-Dodecenyl acetate was found to reduce catches of maleC. auricilius, both when dispensed with the other three components and when released from dispensers surrounding a trap baited with the other three components.

Programming of adipose tissue miR-483-3p and GDF-3 expression by maternal diet in type 2 diabetes

Nutrition during early mammalian development permanently influences health of the adult, including increasing the risk of type 2 diabetes and coronary heart disease. However, the molecular mechanisms underlying such programming are poorly defined. Here we demonstrate that programmed changes in miRNA expression link early-life nutrition to long-term health. Specifically, we show that miR-483-3p is upregulated in adipose tissue from low-birth-weight adult humans and prediabetic adult rats exposed to suboptimal nutrition in early life. We demonstrate that manipulation of miR-483-3p levels in vitro substantially modulates the capacity of adipocytes to differentiate and store lipids. We show that some of these effects are mediated by translational repression of growth/differentiation factor-3, a target of miR-483-3p. We propose that increased miR-483-3p expression in vivo, programmed by early-life nutrition, limits storage of lipids in adipose tissue, causing lipotoxicity and insulin resistance and thus increasing susceptibility to metabolic disease.

Alterations in corticostriatal synaptic plasticity in mice overexpressing human alpha-synuclein

Most forms of Parkinson's disease (PD) are sporadic in nature, but some have genetic causes as first described for the alpha-synuclein gene. The alpha-synuclein protein also accumulates as insoluble aggregates in Lewy bodies in sporadic PD as well as in most inherited forms of PD. The focus of the present study is the modulation of synaptic plasticity in the corticostriatal pathway of transgenic (Tg) mice that overexpress the human alpha-synuclein protein throughout the brain (ASOTg). Paired-pulse facilitation was detected in vitro by activation of corticostriatal afferents in ASOTg mice, consistent with a presynaptic effect of elevated human alpha-synuclein. However basal synaptic transmission was unchanged in ASOTg, suggesting that human alpha-synuclein could impact paired-pulse facilitation via a presynaptic mechanism not directly related to the probability of neurotransmitter release. Mice lacking alpha-synuclein or those expressing normal and A53T human alpha-synuclein in tyrosine hydroxylase-containing neurons showed, instead, paired-pulse depression. High-frequency stimulation induced a presynaptic form of long-term depression solely in ASOTg striatum. A presynaptic, N-methyl-d-aspartate receptor-independent form of chemical long-term potentiation induced by forskolin (FSK) was enhanced in ASOTg striatum, while FSK-induced cAMP levels were reduced in ASOTg synaptoneurosome fractions. Overall the results suggest that elevated human alpha-synuclein alters presynaptic plasticity in the corticostriatal pathway, possibly reflecting a reduction in glutamate at corticostriatal synapses by modulation of adenylyl cyclase signaling pathways. ASOTg mice may recapitulate an early stage in PD during which overexpressed alpha-synuclein dampens corticostriatal synaptic transmission and reduces movement.

Proximal scaphoid rib graft arthroplasty

We prospectively reviewed 14 patients with deficiency of the proximal pole of the scaphoid who were treated by rib osteochondral replacement arthroplasty.

Improvement in wrist function occurred in all except one patient with enhanced grip strength, less pain and maintenance of wrist movement. In 13 patients wrist function was rated as good or excellent according to the modified wrist function score of Green and O’Brien. The mean pre-operative score of 54 (35 to 80) rose to 79 (50 to 90) at review at a mean of 64 months (27 to 103). Carpal alignment did not deteriorate in any patient and there were no cases of nonunion or significant complications.

This procedure can restore the mechanical integrity of the proximal pole of the scaphoid satisfactorily and maintain wrist movement while avoiding the potential complications of alternative replacement arthroplasty techniques and problems associated with vascularised grafts and salvage techniques.

Germin-like genes are expressed during somatic embryogenesis and early development of conifers

Germins and germin-like proteins (GLPs) are members of a superfamily of proteins widely distributed in plants. Their localization within the extracellular matrix and in some cases their hydrogen peroxide-producing activity suggests that these proteins are involved in cell wall metabolism during stress responses and developmental processes. Several very highly conserved conifer GLPs have been identified in somatic embryo tissues. In order to gain more knowledge on their potential involvement in the development of this particular tissue, we have characterized a new GLP gene, LmGER1 in hybrid larch. Anti-GLP immunserum and in-gel activity analyses suggested the presence of superoxide dismutase activity in apoplastic proteins from larch somatic embryos. These results could indicate a possible role for LmGER1 in this physiological process. The expression of LmGER1 has been followed during the maturation of somatic embryos and in different organs of young plantlets by homologous transformation with a promoter-gus construct. This promoter was activated in the root cap of young embryos and, later on, in the cotyledons and in the vascular procambium and xylem. Furthermore, the importance of this gene in embryo development was evaluated by transforming embryonal masses with a gene construct encoding a hairpin RNA leading to gene silencing. The potential role of LmGER1 in cross-linking of cell wall components is discussed.

ESTs from the fibre-bearing stem tissues of flax (Linum usitatissimum L.): expression analyses of sequences related to cell wall development

In order to learn more about the diversity of genes expressed during flax fibre cell wall formation, expressed sequence tags (ESTs) were obtained from a cDNA library derived from the outer fibre-bearing tissues of flax (Linum usitatissimum) stems (cv Hermes) harvested at the mid-flowering stage. After elimination of vector and unreadable sequences, 927 ESTs were grouped into 67 clusters and 754 singletons. The flax ESTs have been submitted to the dbEST and GenBank databases with the accession numbers 25939634 - 25940560 (dbEST) and CV478070 - CV478996 (GenBank). Functional analysis allowed the grouping of ESTs into 13 functional categories and revealed that 62 % of ESTs were similar to known sequences, while 12.4 % of ESTs presented no similarity to any known sequences and 25.6 % of ESTs corresponded to proteins of unknown function. The most highly expressed transcripts belonged to four functional categories: protein maturation and metabolism (31 ESTs), signalling (22 ESTs), the cell wall (21 ESTs) and photosynthesis (19 ESTs). 4.4 % (41) of the total ESTs were potentially related to cell wall formation and maturation. The most highly expressed cell wall EST (15 ESTs) corresponded to a beta-xylosidase gene--potentially involved in cell wall remodelling during growth and development. Other cell wall-related ESTs corresponded to cellulose synthase, xyloglucan endotranglucosylase/hydrolase (XTH), beta-galactosidases, and peroxidases. The expression patterns of different cell wall-related ESTs were determined at different developmental stages in flax plants grown under different field conditions. The potential roles of gene products associated with cell wall related ESTs in fibre cell wall development is discussed.

A risk-based methodology for deriving quality standards for organic contaminants in sewage sludge for use in agriculture—Conceptual Framework

This paper describes a systematic methodology (Conceptual Framework) to derive quality standards for organic (anthropogenic) contaminants in sewage sludge added to agricultural land, in the context of revision of EU Sludge Directive 86/278/EEC and the broader Soil Thematic Strategy. The overall objective is to ensure, based on a risk assessment approach, a sustainable use of sludge over a long time horizon. ILSI-Europe's Conceptual Framework is in essence consistent with the EU Technical Guidance Document (TGD) for Environmental Risk Assessment of Chemicals in the soil compartment, or US-EPA's Sewage Sludge Use and Disposal Regulations, Part 503 Standards. A 'checklist' of different exposure pathways and transfer processes for organic contaminants needs to be considered, and the most sensitive relevant toxicological endpoint and its PNEC need to be identified. The additional complexity specific to deriving Sludge Quality Standards (SQS) is that the toxicity results may need-e.g., for (indirect) human toxicity-to be related back to maximum acceptable soil exposure levels (PEC(soil)). In turn, the latter need to be back-calculated to the maximum acceptable levels in sewage sludge (PEC(sludge)) at the time of application. Finally, for a sustainable sludge use, the exposure from repeated addition and potential chemical build-up over time (e.g., 100 years) needs to be assessed. The SQS may therefore vary with the (local) sludge application regime, and/or sludge pretreatment processes.

Simian virus 40 is present in human lymphomas and normal blood

Many independent studies have demonstrated Simian virus 40 (SV40) in normal and neoplastic human tissues. Clonal integration of virus in the DNA of several thyroid and bone tumors suggests a direct role for SV40 in some cancers. However, in most cases the role of SV40 remains unclear. This study determined the presence of SV40, by amplification followed by hybridization, in 266 normal and neoplastic blood and lymphoid samples. Amplification detected SV40 in 14% of non-autoimmune deficiency syndrome (AIDS) lymphomas, 28% of AIDS related lymphoma and 16% of peripheral blood lymphocytes from non-cancerous patients. No SV40 was detected in leukemia samples. Direct Southern blotting of SV40+ samples detected no virus, consistent with less than one viral genome in ten cells. Sequence analysis of SV40 in blood and lymphoid samples found sequences distinct from laboratory strains of SV40. The presence of limited quantities of SV40 in a small proportion of both normal and neoplastic tissues is suggestive of an adventitious presence with no apparent direct role in blood and lymphoid cancers.

[Agenesis of the internal carotid artery: two cases report]

The authors report two cases of agenesis of the internal carotid artery evaluated with MR angiography allows the diagnosis of the internal carotid artery agenesis and appreciates both the supply post.

Importance of experience for older home care workers in facing up to the constraints of work

Home care workers (HCWs) are at risk from injury. A case study was undertaken in a local community health center in order (1) to identify the constraints that introduce risk into the work of HCWs, and (2) to study the strategies they apply, depending on their age, to reduce the effects of those constraints. Observation and semistructured interviews were the main sources of data. Analysis shows that HCWs aged 45 or over sometimes adopt different postures from those used by their younger colleagues. During physical care, the HCWs also carry out screening and social support tasks that are not recognized in the organization of their work. Older workers develop strategies that help them save time, refine their screening and support methods, protect themselves against accidents, and react properly in emergencies or dangerous situations. Because the changes that can be made in patients' homes are limited, the expertise of experienced HCWs is essential. The organization of work must maintain a certain flexibility to allow the workers to use their strategies.

Rb independent inhibition of cell growth by p15(INK4B)

The INK4 cyclin dependent kinase inhibitors (CDKI), such as p15(INK4B) and p16(INK4A), block cell cycle progression from G to S phase. This is mediated by inhibition of phosphorylation of proteins, including the retinoblastoma susceptibility protein (Rb), by cyclin dependent kinases. Ectopic over-expression of the p16(INK4A) CDKI can inhibit growth of cell lines depending on Rb status. Cell lines lacking Rb, with few exceptions, are resistant to growth inhibition by p16(INK4A). The effects of ectopic over-expression of p15(INK4B) in cell lines with and without wild type Rb were examined by measuring cell recovery. Proliferation was inhibited in cells lacking Rb as well as in cells with wild type Rb expression. Experiments analyzing the effectiveness of chimeric p15(INK4B)/p16(INK4A) proteins indicated that the Rb independent growth inhibition required N-terminal residues of p15(INK4B). Linker insertion mutation of p15(INK4B) showed that the inhibition was dependent on intact ankyrin structures. Double staining flow cytometry found that the growth inhibition correlated with a decrease in cells in G2/M phases of the cell cycle. These findings are consistent with Rb independent inhibition of the progression from G1 to S caused by overexpression of p15(INK4B).

[MRI symptomology in reflex sympathetic dystrophy of the foot]

PURPOSE

To describe the MRI findings of reflex sympathetic dystrophy of the foot and ankle.

METHODS

Retrospective study of 50 patients with reflex sympathetic dystrophy of the foot (5 with the cold form, and 45 with the warm form) diagnosed based on clinical and scintigraphic findings. All patients underwent MR imaging. The MRI findings were correlated with the clinical and scintigraphic findings.

RESULTS

Patients with the cold form of reflex sympathetic dystrophy had no abnormality of signal at MR imaging. All patients with the warm from of reflex sympathetic dystrophy showed periarticular marrow edema at MR, typically involving more than one bone (mean of 4). Other findings were inconstant: soft tissue edema, joint effusion, and rarely, subchondral band of low T1W signal intensity of unclear etiology.

CONCLUSION

MR imaging, including fat-suppressed T2W or STIR images and noncontrast T1W images, is helpful in patients with the warm or acute form of reflex sympathetic dystrophy of the foot. In patients with the cold form, MR imaging is helpful to exclude another underlying etiology for the symptoms and identify patients with the warm form of the process.

Two outbreaks of trichinellosis in the state of Northrhine-Westfalia, Germany, 1998

Illness or death from trichinellosis is statutorily notifiable in Germany. Between nought and ten cases were reported each year from 1987 to 1997. From November 1998 to January 1999, however, 52 cases of trichinellosis were identified by the public health

Outbreak of multiple drug-resistant tuberculosis in Lisbon: detection by restriction fragment length polymorphism analysis

SETTING

Multidrug-resistant tuberculosis (MDR-TB) mainly among human immunodeficiency virus (HIV) seropositive patients in Lisbon hospitals in 1996-1997.

OBJECTIVE

Detection of transmission of MDR-TB strains and epidemic outbreaks in several hospital units in the city of Lisbon, including a prison hospital.

DESIGN

Use of restriction fragment length polymorphism (RFLP) to fingerprint isolates of Mycobacterium tuberculosis resistant to isoniazid, rifampicin, and one other drug.

RESULTS

A total of 43 MDR-TB strains were typed. Sixty-seven per cent of the patients were HIV positive, 12% were HIV negative, and the remainder had unknown HIV status. About 88% of the isolates were grouped in three genetically similar clusters, suggesting possible recent transmission. A predominant cluster (cluster A), corresponding to 72% of the cases, was found, 45% of which came from the prison hospital. Strains from this cluster were resistant to isoniazid, rifampicin, streptomycin, and sometimes ethambutol. A retrospective epidemiological investigation was conducted with respect to all patients in cluster A, and epidemiological links were established between them.

CONCLUSION

Our results suggest recent transmission of MDR-TB, mainly in HIV-positive patients, in Lisbon hospitals. Moreover, the predominant MDR-TB clustered strains were not confined to HIV-infected individuals, as they were also isolated in some immunocompetent patients.

Characterization of a germin-like protein gene expressed in somatic and zygotic embryos of pine (Pinus caribaea Morelet)

Germin-like proteins (GLPs) ionically bound to the walls of preglobular somatic embryos of Pinus caribaea Morelet are markers of this early developmental stage. In order to reveal the physiological implications of such markers during early embryo development, we isolated a cDNA clone from somatic embryos predicted to encode a protein with sequence similarity to GLPs. PcGER1 has an open reading frame corresponding to a 220 amino acid polypeptide with a putative N-glycosylation site on Asn-69. The presence of a 24 amino acid putative signal peptide supports the hypothesis of an apoplastic location. The N-terminal 20 amino acid sequence of the predicted mature protein is identical to the amino terminal sequence of GP111, one of the extracellular pine GLPs previously identified. Southern blot hybridizations indicate that PcGER1 is probably unique in the pine genome. Transcripts homologous to PcGER1 are abundant in all embryogenic lines, absent from nonembryogenic lines, and present in quiescent zygotic embryos but not in the female gametophyte, the haploid storage tissue of conifers. Their abundance sharply decreases during germination. Isolation of gf-0.8, a genomic fragment identical to PcGER1 cDNA sequence, confirms that no introns disrupt the coding region as it has been already described for wheat gf-2.8 and gf-3.8 genomic clones. Recombinant PcGER1, produced in Escherichia coli, is recognized by antibodies raised against the GP111 N-terminal nonapeptide and the unglycosylated wheat germin monomer. The implications of GLPs in pine embryogenesis are discussed.

-The value of MRI in cerebral fat embolism-

We report two clinical cases of cerebral fat embolism, thereby demonstrating the value of MRI.

[MRI in post-traumatic cerebral fat embolism]

We report two cases of posttrauma cerebral fat embolism evaluated with MRI. Due to sensitivity, MRI is the best examination for detecting focal abnormalities of the grey or white matter. MRI helps to make the diagnosis in atypical cases and allows assessment of both extension and course of the embolism.

Preference for sex of first child among women classified as androgynous and nonandrogynous

This paper examined the relation between gender-role orientation and the preference for sex of firstborn child in 212 pregnant nulliparous women. The Bem Sex-role Inventory was used to assess gender-role orientation of participants. Analysis suggested that gender-role orientation, as measured does not effectively predict the preference for sex of firstborn child.

Perceptual defense and vigilance to perinatal stimuli

The presentation times (milliseconds on a computer screen followed by a masking grid) required for the correct identification of tachistoscopically presented perinatal stimuli were compared for 30 pregnant women and 25 perimenopausal women. Analysis indicated a differential facilitation or inhibition of perception in logical relation to subjects' closeness to pregnancy or menopause: pregnant women are quicker to identify stimuli related to pregnancy or babies but slower to recognize pictures of a pregnant woman with her father or mother. This supports the validity of measurements based on the theory of perceptual defense or vigilance.

cDNA sequence, genomic organization and differential expression of three Arabidopsis genes for germin/oxalate oxidase-like proteins

Wheat germin is a protein expressed during germination which possesses an oxalate oxidase activity. Germin-type oxalate oxidases have been extensively studied in monocotyledons (wheat and barley) where they are thought to have important functions for development, stress response and defence against pathogens. In contrast, almost nothing is known about the germin-like proteins found in dicotyledons, gymnosperms and myxomycetes. In this work, cDNA clones for three genes (ATGER1, ATGER2 and ATGER3) encoding germin-like proteins, initially characterized as expressed sequence tags (ESTs), from Arabidopsis thaliana cDNA libraries were further characterized. In addition, we isolated and sequenced a Brassica napus cDNA which was strongly homologous to the cDNA for ATGER1. Sequence analysis and secondary structure predictions of the proteins encoded by these cDNAs showed that they possess all the characteristic features of members of the germin family and of the germin/seed globulins/sucrose binding protein superfamily. Sequence comparisons and mapping demonstrated the existence of at least two different gene families in the A. thaliana genome encoding a minimum of three genes for germins. These three genes have been mapped in three different location on the Arabidopsis genome. By northern blot hybridizations we found that these genes are differentially regulated. ATGER1 was expressed during germination, like wheat germin, but also in leaves whereas ATGER2 transcripts were exclusively found in developing embryos, like wheat pseudo-germin. ATGER3 mRNAs were found in leaves and flowers and their abundance was shown to vary during the circadian cycle.

Psychosocial predictors of depressive symptomatology level in postpartum women

This study explored a multifactorial model for the prediction of the intensity of depressive symptoms in postpartum women. Data were gathered from 213 pregnant women during the second trimester of pregnancy and at 6 months postpartum. Participants were assessed according to a number of psychosocial variables. A path analysis indicated that four variables had a direct effect on postpartum depressive symptomatology level: lower occupational status, prenatal depression level, more distal stressors and a personal psychiatric history. Eight variables, which reflected past and present experiences, showed an indirect effect. The implications of these findings are discussed.

Xylose-rich polysaccharides from the primary walls of embryogenic cell line of Pinus caribaea

Embryogenic cell lines of Pinus caribaea were isolated from somatic embryogenesis from zygotic embryos. Previous studies showed that the proteins and glycoproteins were characteristic of the embryogenic state. In the present work we were seeking typical feature in the polysaccharide from the cell walls of embryogenic calli at nine days of culture. Sequential extraction with water, ammonium oxalate, dimethyl sulfoxide, sodium borohydride and 4.3 M potassium hydroxide revealed that the extracted polysaccharides contained high proportions of arabinose and significant amounts of xylose. Fractionation of the hydrosoluble polymers on DEAE cellulose afforded a xylose-rich fraction (80% xylose, 24% glucose and lower properties of fucose and mannose). Methylation analysis and 13C-NMR spectra showed that the glycan backbone consisted of beta 1 --> 4 linked xylosyl residues Similar study of the fractions extracted respectively with DMSO and 4.3 M KOH showed the presence of polydisperse glycoxylans but excluded the presence of xyloglucan in significant amount. This could be a characteristic feature of embryogenic cells walls of Pinus caribaea or could be typical of cells grown as calluses. In the various fractions obtained from DEAE cellulose chromatography of the alkaline extract the infrequent occurrence of fucoxylans beside an arabinogalactan showed again the unusual nature of the cell wall polymers of this embryogenic lines, which seems to differ greatly from those found in the primary wall of cells from suspension cultures.

Psychosocial factors related to emotional disturbances during pregnancy

This study explored a multifactorial model for the understanding of the factors related to the intensity of prenatal emotional disturbances. Data were gathered from 213 pregnant women during the second trimester of pregnancy. Participants were assessed according to a number of psychosocial variables. Two types of prenatal emotional disturbances were examined: depressive symptoms and ambivalence and fears related to maternity. A path analysis indicated that four risk factor domains had a direct effect on depressive symptom level: locus of control; interpersonal relationships; stressors; and psychiatric history. Four risk factor domains also had a direct effect on the level of ambivalence and fears: sociodemographics; depressive symptom level; interpersonal relationships; and family history. Several factors showed an indirect effect on one or both of the disturbances. These results indicate that the study of factors related to prenatal emotional disturbances benefits from a multifactorial model assessing direct and indirect effects.

Mental representations concerning the sex of the baby of pregnant nulliparous women who wished a boy or a girl

The objective was to obtain the mental representations concerning the sex of the child of 125 nulliparous third- and fourth-mo. pregnant women who wished a boy or a girl, using Kelly's Repertory Grid. Our data indicate that the grid's average of the two groups of women is significantly different from 3 (the neutral point).

Evaluation of purine nucleotide loss, lipid peroxidation and ultrastructural alterations in post-hypoxic hepatocytes

1. Hypoxic alterations in isolated rat hepatocytes were demonstrated by a 90% ATP loss during 60 min of ischaemia and temporary increases of nucleotide degradation products. 2. The oxidative stress during reoxygenation was demonstrated in these cells by a decrease in reduced glutathione (GSH) concentration (30%) and a threefold increase in lipid peroxidation products such as 4-hydroxynonenal and thiobarbituric acid-reactive substances (TBA-RSs). The tremendous GSH loss could not be balanced by the slight oxidized glutathione (GSSG) increase during reoxygenation. 3. For the first time the involvement of free radicals was directly demonstrated using electron spin resonance (ESR) spectroscopy in reoxygenated liver cells. Using the spin trap 5,5-dimethylpyrroline-1-oxide (DMPO), a carbon-centred radical and the adduct of the hydroxyl radical could be detected during early reoxygenation. 4. Morphological alteration of cells was observed, beginning during hypoxia and increasing during post-hypoxic reoxygenation. Electron microscopic findings of hypoxic and post-hypoxic cell damage included pyknosis of nuclei, spherical transformation of mitochondria and increased number of vesicles.

Immobilization of flax protoplasts in agarose and alginate beads. Correlation between ionically bound cell-wall proteins and morphogenetic response

Linum usitatissimum protoplast-derived colonies that are cultured in auxin-supplemented medium and immobilized in Ca(2+)-alginate matrix form round colonies that develop into polarized, embryo-like structures. On the other hand, protoplast-derived colonies that are immobilized in agarose do not show an organized morphogenetic response, and unique, ionically bound cell-wall protein patterns match this response. Although only slight differences in neosynthesized or total constitutive polypeptides are observed, dramatic changes in ionically bound cell-wall proteins are seen. In protoplasts grown on Ca(2+)-alginate-solidified, auxin-containing medium, several basic polypeptides were strongly induced and were found tightly bound to the cell wall. In contrast, these basic proteins were found only weakly bound to the walls of protoplasts grown on agarose-solidified, auxin-containing medium or on Ca(2+)-alginate-solidified, auxin-free medium, in which they were released into the medium. Our results suggest that plant cells can perceive and respond to the adjacent extracellular matrix, since we show that the growth of flax cells on Ca(2+)-alginate in the presence of auxin-containing medium may promote the binding of specific proteins to the walls. This establishes a direct correlation of an embryo-like morphogenesis with ionically bound cell-wall basic proteins in flax protoplasts grown on Ca(2+)-alginate-solidified, auxin-containing medium.

Mental representations of pregnant nulliparous women having no sex preference

The objective was to elicit the mental representations about the sex of the future child of 89 nulliparous pregnant women who declared having no sex preference, using the Kelly's Repertory Grid. Analyses showed that 67% of these women had no explicit and clear representation about the sex of their first child. These data suggest that these pregnant women seemed really to have no sex preference.

Chromosomal proteins HMG-14 and HMG-17 are synthesized throughout the S-phase in Burkitt's lymphoma

Here we test whether the targeting of chromosomal proteins HMG-14 and HMG-17 to transcriptionally active regions is due to coincidence of the synthesis of these proteins with the replication and assembly of active chromatin. Cells from the Burkitt's lymphoma line CA46 were synchronized with mimosine. The mRNA levels and the protein synthesis rates of HMG-14/-17 were determined at various stages during the S phase. The expression pattern of HMG-14/-17 was essentially constant throughout this phase of the cell cycle. The half-life for HMG-14/-17 protein corresponded to the doubling time of the cells. These results indicate that HMG-14/-17 are synthesized throughout S-phase and persist through the cell cycle. Targeting of HMGs to active genes is not simply due to the timing of their synthesis during S phase.

[Peak follicular estradiol (E2) levels and midluteal progesterone/E2 ratios in ongoing pregnancies and nonconception cycles after ovulation induced with gonadotropins]

We assessed the predictive value of peak follicular estradiol (E2) levels and progesterone/E2 ratios at the time of implantation (midluteal phase) in cycles resulting in pregnancies and in nonconception cycles after ovulation induced by hMG. hMG, administered to 31 consecutive patients with ovulatory dysfunction, resulted in 13 conception and 27 nonconception cycles. It was started on day 5 of the cycle and continued until at least 1 follicle was > 18 mm and E2 levels exceeded 300 pg/ml, when HCG, 100,000 IU, was administered. Baseline hormonal profile, peak follicular E2, serum E2, progesterone levels 7 days after hCG administration, and progesterone/E2 ratios were compared between ongoing pregnancies and during nonconception cycles. There was a significant difference in peak follicular E2 levels between ongoing pregnancies and nonconception cycles (means +/- SD: 1453 +/- 580 to 1176 +/- 275, pg/ml, p < 0.05). The length of follicular phase and the number of hMG ampules administered were similar in both groups. There was no difference in midluteal progesterone/E2 ratios (131 +/- 16.9 vs 124 +/- 27.5). E2 levels the day of hCG administration were higher in cycles leading to pregnancies. We conclude that mean midluteal progesterone/E2 ratios cannot be used to predict the outcome of cycles after ovulation induction with hMG.

Ophthalmology in Luanda (Angola): a hospital based report

AIMS/BACKGROUND

As part of a 4 year Spanish development aid programme, an ophthalmic hospital was set up in Luanda in 1991 for the in situ training of local ophthalmologists. Presented here are the data obtained from 4201 patients treated during the first 2 years of the project.

METHODS

Patients were referred to the institute from the emergency ward at the Luanda General Hospital, selected mainly according to the severity of their disease. The following data were collected from the clinical reports: age, sex, diagnosis (single or multiple), type of treatment (medical or surgical), acuity of the best eye at the time of diagnosis, and main disease group.

RESULTS

The main causes of blindness treated were: cataracts; glaucoma; optic nerve diseases (neuritis and atrophy); trauma; xerophthalmia; uveitis; hereditary retinal diseases (degenerative myopia, retinitis pigmentosa, albinism, and Stargardt's disease); retinal detachment; and diabetic retinopathy.

CONCLUSIONS

Sanitary resources in Angola are generally inadequate, and ophthalmic care is no exception to this. Owing to the high percentage of preventable or treatable blinding diseases in this environment, a campaign of social education should always be held along with any medical programme, in order to optimise the available resources.

Perioperative vascular flushing perfusion in acute mesenteric artery occlusion

AIM

To evaluate in animals and patients a perioperative vascular flushing perfusion with antioxidants in order to improve postischaemic condition of the bowel and hence, to prolong the warm ischaemia tolerance time.

MATERIALS

40 rats and 10 patients with acute mesenteric artery occlusion.

METHODS

Intestinal ischaemia was induced in 40 rats by clipping the superior mesenteric artery for 1 h. Thirty animals received a vascular flushing perfusion with oxygen radical scavengers (ascorbate, tocopherol or oxypurinol). Histology, ATP, ADP levels were examined in tissue biopsies and malondialdehyde, lactate dehydrogenase, alkaline phosphatase levels were measured in blood during ischaemia and 60 min after reperfusion.

RESULTS

ATP restoration was particularly improved in the oxypurinol group (ATP/ADP-ratio = 2 vs. 1.2 in the control group). Malondialdehyde increase observed after reperfusion as a marker of radical induced lipid destruction was significantly attenuated (control group 160% of base level vs. 127% in the ascorbate group, 133% in the tocopherol group, 121% in the oxypurinol group). Histological alterations during ischaemia/reperfusion were markedly less extensive in the perfusion groups than in control. The patients treated perioperatively with arterial flushing perfusion had an overall mortality of 10%.

CONCLUSION

Vascular flushing perfusion with oxygen radical scavengers prevents radical induced ischaemic damage and may prolong the warm ischaemic tolerance time of the intestine.