Fluid distribution kinetics during cardiopulmonary bypass

OBJECTIVE: The purpose of this study was to examine the isovolumetric distribution kinetics of crystalloid fluid during cardiopulmonary bypass. METHODS: Ten patients undergoing coronary artery bypass grafting participated in this prospective observational study. The blood hemoglobin and the serum albumin and sodium concentrations were measured repeatedly during the distribution of priming solution (Ringer's acetate 1470 ml and mannitol 15% 200 ml) and initial cardioplegia. The rate of crystalloid fluid distribution was calculated based on 3-min Hb changes. The preoperative blood volume was extrapolated from the marked hemodilution occurring during the onset of cardiopulmonary bypass. Clinicaltrials.gov: NCT01115166. RESULTS: The distribution half-time of Ringer's acetate averaged 8 minutes, corresponding to a transcapillary escape rate of 0.38 ml/kg/min. The intravascular albumin mass increased by 5.4% according to mass balance calculations. The preoperative blood volume, as extrapolated from the drop in hemoglobin concentration by 32% (mean) at the beginning of cardiopulmonary bypass, was 0.6-1.2 L less than that estimated by anthropometric methods (p<0.02). The mass balance of sodium indicated a translocation from the intracellular to the extracellular fluid space in 8 of the 10 patients, with a median volume of 236 ml. CONCLUSIONS: The distribution half-time of Ringer's solution during isovolumetric cardiopulmonary bypass was 8 minutes, which is the same as for crystalloid fluid infusions in healthy subjects. The intravascular albumin mass increased. Most patients were hypovolemic prior to the start of anesthesia. Intracellular edema did not occur. .

Glioma Grading Capability: Comparisons among Parameters from Dynamic Contrast-Enhanced MRI and ADC Value on DWI

OBJECTIVE: Permeability parameters from dynamic contrast-enhanced MRI (DCE-MRI) and apparent diffusion coefficient (ADC) value on diffusion-weighted imaging (DWI) can be quantitative physiologic metrics for gliomas. The transfer constant (Ktrans) has shown efficacy in grading gliomas. Volume fraction of extravascular extracellular space (ve) has been underutilized to grade gliomas. The purpose of this study was to evaluate ve in its ability to grade gliomas and to assess the correlation with other permeability parameters and ADC values. MATERIALS AND METHODS: A total of 33 patients diagnosed with pathologically-confirmed gliomas were examined by 3 T MRI including DCE-MRI and ADC map. A region of interest analyses for permeability parameters from DCE-MRI and ADC were performed on the enhancing solid portion of the tumors. Permeability parameters form DCE-MRI and ADC between low- and high-grade gliomas; the diagnostic performances of presumptive metrics and correlation among those metrics were statistically analyzed. RESULTS: High-grade gliomas showed higher Ktrans (0.050 vs. 0.010 in median value, p = 0.002) and higher ve (0.170 vs. 0.015 in median value, p = 0.001) than low-grade gliomas. Receiver operating characteristic curve analysis showed significance in both Ktrans and ve for glioma grading. However, there was no significant difference in diagnostic performance between Ktrans and ve. ADC value did not correlate with any of the permeability parameters from DCE-MRI. CONCLUSION: Extravascular extracellular space (ve) appears to be comparable with transfer constant (Ktrans) in differentiating high-grade gliomas from low-grade gliomas. ADC value does not show correlation with any permeability parameters from DCE-MRI.

Autophagic failure promotes the exocytosis and intercellular transfer of alpha-synuclein

The accumulation of abnormal protein aggregates is a major characteristic of many neurodegenerative disorders, including Parkinson's disease (PD). The intracytoplasmic deposition of alpha-synuclein aggregates and Lewy bodies, often found in PD and other alpha-synucleinopathies, is thought to be linked to inefficient cellular clearance mechanisms, such as the proteasome and autophagy/lysosome pathways. The accumulation of alpha-synuclein aggregates in neuronal cytoplasm causes numerous autonomous changes in neurons. However, it can also affect the neighboring cells through transcellular transmission of the aggregates. Indeed, a progressive spreading of Lewy pathology among brain regions has been hypothesized from autopsy studies. We tested whether inhibition of the autophagy/lysosome pathway in alpha-synuclein-expressing cells would increase the secretion of alpha-synuclein, subsequently affecting the alpha-synuclein deposition in and viability of neighboring cells. Our results demonstrated that autophagic inhibition, via both pharmacological and genetic methods, led to increased exocytosis of alpha-synuclein. In a mixed culture of alpha-synuclein-expressing donor cells with recipient cells, autophagic inhibition resulted in elevated transcellular alpha-synuclein transmission. This increase in protein transmission coincided with elevated apoptotic cell death in the recipient cells. These results suggest that the inefficient clearance of alpha-synuclein aggregates, which can be caused by reduced autophagic activity, leads to elevated alpha-synuclein exocytosis, thereby promoting alpha-synuclein deposition and cell death in neighboring neurons. This finding provides a potential link between autophagic dysfunction and the progressive spread of Lewy pathology.

A known expressed sequence tag, BM742401, is a potent lincRNA inhibiting cancer metastasis

Long intergenic non-coding RNAs (lincRNAs) have historically been ignored in cancer biology. However, thousands of lincRNAs have been identified in mammals using recently developed genomic tools, including microarray and high-throughput RNA sequencing (RNA-seq). Several of the lincRNAs identified have been well characterized for their functions in carcinogenesis. Here we performed RNA-seq experiments comparing gastric cancer with normal tissues to find differentially expressed transcripts in intergenic regions. By analyzing our own RNA-seq and public microarray data, we identified 31 transcripts, including a known expressed sequence tag, BM742401. BM742401 was downregulated in cancer, and its downregulation was associated with poor survival in gastric cancer patients. Ectopic overexpression of BM742401 inhibited metastasis-related phenotypes and decreased the concentration of extracellular MMP9. These results suggest that BM742401 is a potential lincRNA marker and therapeutic target.

Extracellular High-Mobility Group Box 1 is Increased in Patients with Behcet's Disease with Intestinal Involvement

High-mobility group box 1 (HMGB1) protein has been demonstrated to play an important role in chronic inflammatory diseases including rheumatoid arthritis, and systemic lupus erythematosus. This study investigated the association between extracellular HMGB1 expression and disease activity, and clinical features of Behcet's disease (BD). Extracellular HMGB1 expression in the sera of 42 BD patients was measured and was compared to that of 22 age- and sex-matched healthy controls. HMGB1 expression was significantly increased in BD patients compared to healthy controls (78.70 +/- 20.22 vs 10.79 +/- 1.90 ng/mL, P = 0.002). In addition, HMGB1 expression was significantly elevated in BD patients with intestinal involvement compared to those without (179.61 +/- 67.95 vs 61.89 +/- 19.81 ng/mL, P = 0.04). No significant association was observed between HMGB1 concentration and other clinical manifestations, or disease activity. It is suggested that extracellular HMGB1 may play an important role in the pathogenesis of BD.

Enfrentamiento de la hiponatremia: Más allá de la corrección del sodio. A propósito de un caso clínico / Secondary adrenal insufficiency presenting as hyponatremia: Report of one case

Hyponatremia can be a marker of an underlying disease. We report a 52 years-old male with Diabetes Mellitus who consulted for an episode of nausea and vomiting lasting four days. His baseline serum sodium was 118 mEq/L. He had no neurological deficit. Hyponatremia was initially interpreted in context of gastrointestinal fluid loss but correction with saline solution was poor. His urine sodium was 105 mEq/L and his urine osmolality was 281 mOsm/L, so an Inappropriate Secretion of Antidiuretic Hormone Syndrome was suspected. Later, we found that the patient had a two year history of fatigue, weakness, anorexia, frequent nausea, vomiting and diarrhea, loss of libido and decreased axillary and pubic hair. Thyroid-Stimulating Hormone (TSH) was normal and serum Cortisol < 1 µg/dL. A CT scan showed a sellar mass compatible with a macroadenoma. There was also a moderately high serum prolactin and low testosterone, thyroxin and growth hormone levels. The visual fi eld exami-nation showed right temporal hemianopsia. The patient was treated with steroids with a very good clinical response and serum sodium normalization. Subsequently a transsphenoidal excision of the tumor was performed and replacement of the other hormones was started. Now the patient remains asymptomatic.

New Directions in Inflammation and Immunity: The Multi-functional Role of the Extracellular RNA/RNase System.

In the mid-eighties of the last century, extracellular-proteolipid complexes have been identified in tumor patients and circulating RNA was suggested to represent a specific secretory product of cancer cells. The presence of specific types of RNA in a variety of cancer types proved to be useful in cancer diagnosis. It has been suggested that extracellular RNA and DNA are not inert molecules, but contain biological activities. Recent data have demonstrated that extracellular RNA is likely to present the up to now undefined “natural foreign surface”, serving as an initiating factor in blood coagulation in vivo. Yet, extracellular RNA seems to have even more functions. Investigations on blood-brain-barrier have shown that extracellular RNA mediates endothelial permeability. Ample success has been achieved in administrating RNase in different animal models of vascular diseases, thereby significantly delaying thrombus formation and reducing cerebral edema formation with neuroprotection in acute stroke models. Furthermore, extracellular mammalian RNA was found to decrease tumor yield in a murine model system, suggesting that extracellular RNA might trigger immune response. Finally, extracellular nucleic acids were identified as danger signals involved in innate immunity related to neutrophil-mediated bacterial killing and haemocyte activation and coagulation in the insects. Thus, a new area of research on extracellular RNA functions with promising future perspectives just started in the field of inflammation and immunity.

Optimization of extracellular xylanase production by Sclerotinia sclerotiorum S2 using factorial design.

The improvement of xylanase production by Sclerotinia sclerotiorum S2 using a liquid fermentation culture was investigated. The optimized process was divided into three basic steps: (i) evaluating xylanase inducers using different agricultural residues such as wheat bran, oat bran, orange peel and barley bran at 1% final concentration, and also filter paper. Among these, wheat bran showed the maximum activity (2.5 U/ml) at 12 days post-inoculation; (ii) for optimization, we determined the optimal concentration of inducer, the effect of phosphate anion (K2HPO4/KH2PO4) and culture aeration using a rotary shaker at 100 and 180 rpm. The optimal conditions for these three factors were determined in an experimental panel using factorial data, in which a mathematical model (Minitab software) was fitted; (iii) The optimized culture medium containing a high level of wheat bran (3%) without KH2PO4-K2HPO4 and submitted to a high agitation (180 rpm/min) increased the xylanase production from 2.5 U/ml to 4 U/ml (1.6-fold).

Secretion of adenylate kinase 1 is required for extracellular ATP synthesis in C2C12 myotubes

Extracellular ATP (exATP) has been known to be a critical ligand regulating skeletal muscle differentiation and contractibility. ExATP synthesis was greatly increased with the high level of adenylate kinase 1 (AK1) and ATP synthase beta during C2C12 myogenesis. The exATP synthesis was abolished by the knock-down of AK1 but not by that of ATP synthase beta in C2C12 myotubes, suggesting that AK1 is required for exATP synthesis in myotubes. However, membrane-bound AK1beta was not involved in exATP synthesis because its expression level was decreased during myogenesis in spite of its localization in the lipid rafts that contain various kinds of receptors and mediate cell signal transduction, cell migration, and differentiation. Interestingly, cytoplasmic AK1 was secreted from C2C12 myotubes but not from C2C12 myoblasts. Taken together all these data, we can conclude that AK1 secretion is required for the exATP generation in myotubes.

Purification and properties of an extracellular pectin lyase produced by the strain of Penicillium oxalicum in solid-state fermentation.

A pectin lyase (PNL, EC 4.2.2.10) produced extracellularly by the strain of Penicillium oxalicum in solid-state fermentation medium containing deoiled mandarin orange peel meal was purified to apparent homogeneity by a protocol that included ammonium sulfate precipitation, DEAE-Sephadex A-50 and Sephadex G-100 chromatography. The enzyme had molecular mass of 50 kD, as determined by SDS- PAGE and showed optimum pH and temperature at 8.0 and 50 degrees C respectively. It had an isoelectric point (pI) of 5.0 and showed a K(m) of 1.1 mg/ml of citrus pectin. The enzyme was strongly inhibited by Mo4+, Ag+ and Pb2+ and also by polyphenolic compounds, in particular tannic acid.

High extracellular Ca2+ alone stimulates osteoclast formation but inhibits in the presence of other osteoclastogenic factors

High ambient Ca2+ at bone resorption sites have been implicated to play an important role in the regulation of bone remodeling. The present study was performed to clarify the mode of high extracellular Ca2+ (Ca2+e)-induced modulation of osteoclastogenesis and the expression of receptor activator of nuclear factor-kB ligand (RANKL) and osteoprotegerin (OPG), thereby to define its role in osteoclast formation. Mouse bone marrow cells were cocultured with osteoblastic cells in the absence or presence of osteoclastogenic factors such as 1,25-dihydroxyvitaminD3 (1,25-(OH)2vitD3) and macrophage colony-stimulating factor/soluble RANKL. Ca2+ concentration in media (1.8 mM) was adjusted to 3, 5, 7 or 10 mM. Osteoclast formation was confirmed by the appearance of tartrate-resistant acid phosphatase (TRAP)-positive multinuclear cells and the expression of osteoclast phenotypic markers (calcitonin receptor, vitronectin receptor, cathepsin K, matrix metalloproteinase-9, carbonic anhydrase 2). High Ca2+e alone significantly stimulated osteoclast formation in a dose-dependent manner. However, in the presence of highly osteoclastogenic factors, high Ca2+e significantly inhibited osteoclastogenesis. High Ca2+e alone continuously up-regulated RANKL expression while only transiently increased OPG expression. However, in the presence of 1,25-(OH)2vitD3, high Ca2+e did not change the 1,25-(OH)2vitD3- induced RANKL expression while increased OPG expression. Taken together, these findings suggest that high Ca2+e alone increase osteoclastogenesis but inhibit in the presence of other osteoclastogenic factors. In addition, high Ca2+e-induced osteoclastogenesis may be mediated by osteoblasts via up-regulation of RANKL expression. Meanwhile up-regulated OPG might participate in the inhibitory effect of high Ca2+e on 1,25-(OH)2vitD3-induced osteoclastogenesis.

In Vivo Microdialysis Measures of Extracellular Norepinephrine in the Rat Amygdala during Sleep-wakefulness

Norepinephrine (NE)-containing locus ceruleus (LC) has been known to participate in the regulation of the sleep-wake cycle according to the differential firing rate. The aim of this study was to know the change of extracellular NE level in the rat amygdala, which are reciprocally connected with LC, during sleep-wake-fulness. Extracellular NE levels in the rat amygdala were inrestigated during different stages of the sleep-waking cycle using in vivo microdialysis and polygraphic recording. Dialysates were collected every 5 min and correlated with the results of polygraphic recording. The content of NE was measured by high-performance liquid chromatography with electrochemical detection. NE level was the highest in active waking (AW) and, when compared to AW, NE level was progressively lower in quiet waking (QW; 86%), quiet sleep (QS; 72%), and active sleep (AS or REM sleep; 61%). This result suggests that the rat amygdala also participates in the regulation of the sleep-wake cycle according to the differential NE release.

Cell swelling and ion redistribution assessed with intrinsic optical signals

Cell volume changes are associated with alterations of intrinsic optical signals (IOS). In submerged brain slices in vitro, afferent stimulation induces an increase in light transmission. As assessed by measurement of the largely membrane impermeant ion tetramethylammonium (TMA) in the extracellular space, these IOS correlate with the extent and time course of the change of the extracellular space size. They have a high signal to noise ratio and allow measurements of IOS changes in the order of a few percent. Under conditions of reduced net KCl uptake (low Cl solution) a directed spatial buffer mechanism (K syphoning) can be demonstrated in the neocortex with widening of the extracellular space in superficial layers associated with a reduced light transmission and an increase of extracellular K concentration. The nature of the IOS under pathophysiological conditions is less clear. Spreading depressions first cause an increase of light transmission, then a decrease. Such a decrease has also been observed following application of NMDA where it was associated with structural damage. Pharmacological analyses suggest that under physiological conditions changes of extracellular space size are mainly caused by astrocytic volume changes while with strong stimuli and under pathophysiological conditions also neuronal swelling occurs. With reflected light usually signals opposite to those observed with transmitted light are seen. Recording of IOS from interface slices gives very complex signals since under these conditions an increase of light transmission has been reported to be superimposed by a decrease of the signal due to mechanical lensing effects of the slice surface. Depending on the method of measurement and the exact conditions, several mechanisms may contribute to IOS. Under well defined conditions IOS are a useful supplementary tool to monitor changes of extracellular volume both in space and time

Changes in phospholipids and acetylcholinesterase during early phase of injury to spinal cord--an experimental study in rats.

Injury to spinal cord was produced in rats by the clip compression technique by placing the aneurysm clip extradurally for 30 seconds. The traumatised spinal segment and the adjoining upper segment were used for biochemical estimations. Motor function of the injured rats was evaluated using the inclined plane. Phospholipid phosphorus values were significantly decreased in the injured spinal segment at 24 hrs. AchE activity was also decreased in the traumatised segment one week after injury. Dexamethasone and verapamil reversed the changes in AchE activity at the end of one week. At the one week assessment period, aneurysm clipped rats showed a decrease in the maximum angle in the inclined plane. Dexamethasone and verapamil treated rats showed improvement in the neurologic function, neurologic recovery was better in the dexamethasone treated group.

Hemodynamic characteristics of extracellular UTP in the perfused rat liver

Uridine 5'-triphosphate (UTP) is stored in the granules of cells such as platelets and is released into the extracellular space upon cell stimulation. Extracellular UTP is known to influence many biological processes. We investigated the hemodynamic effects of UTP on the perfused rat liver and characterized its receptors. Liver perfusions were performed in a recirculation system under constant pressure (28 cmH2O). The perfusion flow and oxygen consumption rate were measured at 30 second intervals. UTP decreased the perfusion flow and the oxygen consumption rate, dose-dependently. UTP-induced changes were transient and disappeared in about 10 minutes. Suramin (P2-purinergic antagonist, 100 uM) and indomethacin (cyclooxygenase inhibitor, 20 uM) blocked UTP-induced hemodynamic changes significantly. The effects of UTP were also inhibited when Kupffer cells were damaged with treatment of gadolinium chloride (10 mg/kg iv). L-NAME (1 mM), a potent inhibitor of nitric oxide synthase, markedly enhanced and prolonged the contractile response of UTP in the hepatic vessel. These results suggest that UTP acts mainly on suramin-sensitive UTP receptors on the Kupffer cell through prostanoid synthesis. The nitric oxide systems in the endothelium seem to counteract the vasoconstrictile action of UTP in the hepatic circulation.

Relation between ischemic preconditioning and the duration of sustained ischemia

It has been reported that repetitive brief periods of ischemia and reperfusion (ischemic preconditioning, IP) cause a significant reduction in the extent of myocardial necrosis or in the incidence of reperfusion arrhythmias in rat heart. However, recent reports have stated that IP effect is diminished or lost in the canine or bovine heart if ischemia (mostly regional) is sustained for 40 min or longer. The main objective of this study is to assess whether IP provides myocardial protection in prolonged sustained ischemia under the condition of global ischemia in isolated rabbit heart. The hearts were subjected to 10-60 min sustained ischemia (SI) followed by 60 min reperfusion with (IP heart) or without IP (ISCH heart). IP was induced by 4 cycles of 5 min global ischemia and 5 min reperfusion. Left ventricular function (LVF), extent of infarction (EI) and ultrastructural changes were examined. As a whole, the LVF began to recover on reperfusion but there was no significant difference in the functional parameters. However, extracellular Ca2+ concentration was lower in the ISCH hearts (p <0.05) and the EI was significantly different between the hearts which had received 60 min SI (67% in the ISCH versus 32% in the IP heart, p <0.01). Ultrastructural changes were homogeneous in the ISCH hearts and became irreversible in accordance with increase of the duration of ischemia, while these changes were heterogeneous and restricted in the IP heart. These results suggest that IP does not attenuate the postischemic dysfunction in prolonged ischemia but it can provide an infarct size-limiting effect and delay ultrastructural changes. This cardioprotective effect may be related to calcium homeostasis.

Increased pH induces tension development in rat anococcygeus muscle by intracellular calcium release

The relationship between extracellular pH (pHe) alterations and muscle tension was studied in rat anococcygeus muscle. Increased cytosolic calcium levels induced smooth muscle contraction and increased tension. Extracellular alkalinization (pH 8.2) with 20 mM NH4Cl produced a sustained increase in tension of the same magnitude as phenylephrine (PHE)-stimulated contraction (NH4Cl = 22.0 +/- 2.8 mm; PHE = 21.7 +/- 3.1 mm). The muscle relaxed when the pH returned to pH 7.4. This increase in tension seems to be independent of extracellular calcium influx because it was not inhibited in Ca(2+)-free EGTA-PSS. Extracellular acidification with 10 mM sodium acetate, pH 6.8, produced no changes in tension or PHE-stimulated contractile response. The data suggest that pH changes lead to a release of stored intracellular calcium, with a consequent increase in tension.

Effects of extracellular sodium, quinidine, and ryanodine on slow response excitability in rabbit atrial trabeculae

1. We investigated Na(+)-Ca2+ exchange and the involvement of the sarcoplasmic reticulum in frequency-dependent slow response excitability enhancement in rabbit atrial trabeculae. 2. Slow responses were induced in a modified Tyrode solution containing high K+ and Ba2+ and conventional electrophysiological techniques were used for stimulating and recording membrane potentials. 3. Under these conditions, the frequency-dependence of slow response excitability can be demonstrated with excitability enhancement as stimulation frequency is increased (0.25 to 1.0 Hz). 4. The frequency-dependent excitability enhancement depends on external Na+, increasing in high-[Na+]o (173.8 mM) and decreasing in low-[Na+]o (103.8 mM) media. 5. Quinidine (10 microM) and ryanodine (10 microM) decrease frequency-dependent slow response excitability enhancement. 6. These results indicate that the Na(+)-Ca2+ exchange might have an important role in frequency-dependent excitability enhancement of slow responses. Moreover, we suggest that the control of internal Ca2+ by the sarcoplasmic reticulum might have an additional role in regulating the excitability enhancement process in depolarized atrial trabeculae