[Hardnekkige aanhoudende lichamelijke klachten in de huisartsenpraktijk]. / Hardnekkige aanhoudende lichamelijke klachten in de huisartsenpraktijk.

BACKGROUND: In the care of patients with persevering (‘treatment-resistant’) persistant physical symptoms (PPS), problems are common. With this study, we want to identify starting points for improvement of care, including suggestions for the role of mental health care. AIM: Using the profile for persevering PPS we will estimate the prevalence, describe characteristics of this patient group and map problems encountered in their care. METHOD: Online survey in general practitioners (GPs). RESULTS: The response rate to the survey was 12.8%. The mean estimated prevalence of persevering PPS in general practice was 0.7% (corresponding to an estimated 122,500 patients throughout the Netherlands). Many patients encountered iatrogenic harm, experience societal problems and limitations in mobility and ADL independence. Although there was a general increased use of health care in these patients, some also avoided care or were under-treated. In the persistence of symptoms, patient-related factors played a role (like insisting on further somatic diagnostic tests, lack of motivation for PPS-specific treatment), but health-care related factors, like rejection for care or a lack of regional treatment options for patients with PPS, also had a causal role. CONCLUSION: Almost every GP experiences problems in the care for patients with persevering PPS. Mental health care professionals can support the GP better, by optimizing options for consultation and referral.

Enamide-olefin ring-closing metathesis.

[reaction: see text] The first examples of ring-closing metathesis reactions of olefin-containing enamides using ruthenium-based catalysts have been demonstrated. A preliminary investigation into the scope and limitations, leading to protected five- and six-membered cyclic enamides, will be presented.

An in vitro model for acoustic overstimulation.

Although many studies have been performed on the effects of acoustic overstimulation on the inner ear, our knowledge about the cellular processes underlying reduced hearing sensitivity and auditory cell death is still limited. In order to further our understanding of cellular processes occurring in conjunction with acoustic trauma, we designed an in vitro model to study the effects of overstimulation directly on sensory hair cells isolated from the low-frequency part of the guinea pig cochlea. The isolated outer hair cells were subjected to pressure jets delivered by a glass micropipette positioned close to the cell, in order to mimic the pressure changes occurring in the intact inner ear during sound stimulation. A second micropipette coupled to a piezoresistive pressure transducer was used as a probe measuring the pressure at precise locations at and around the cell. In a previous study, we found that such stimulation gave rise to increases in the intracellular calcium concentration. The present study characterizes the stimulus, describes the computer-controlled setup used for calibration, and gives examples of different modes of overstimulation at the cellular level. The peak pressure that could be generated using the pressure jet was around 325 Pa, or 144 dB (re 20 microPa) at 140 Hz. The pressure jet elicited large mechanical vibrations of the cell bodies of isolated cells. The vibration mode of the cells often changed over time, implying that the stimulation caused changes of the cellular stiffness. However, most cells appeared quite resistant to the high intensity mechanical stimulation.

Electrical stimulation of the sacral dorsal gray commissure evokes relaxation of the external urethral sphincter in the cat.

Stimulation of the pontine micturition center (PMC) results in micturition, i.e. an immediate relaxation of the urethral sphincter and a contraction of the detrusor muscle of the bladder. The PMC generates the bladder contraction by way of a direct excitatory pathway to the parasympathetic bladder motoneurons in the sacral cord. The idea is that the PMC produces the relaxation of the urethral sphincter via direct projections to GABAergic neurons in the dorsal gray commissure (DGC), which, in turn, inhibit the urethral sphincter motoneurons. According to this hypothesis, electrical stimulation in the DGC in three cats should result in relaxation of the urethral sphincter. The results were in total agreement with this concept. During DGC stimulation a sharp decrease of the urethral pressure was found, the strength of which depended completely on the amplitude of the electrical stimulation.

Design and synthesis of an orally active GPIIb/IIIa antagonist based on a phenylpiperazine scaffold.

The design and synthesis of an orally active LMW non-peptide GPIIb/IIIa antagonist, based on a N,N'-bisphenylpiperazine scaffold, is described. The optimal compound showed a high in vitro binding potency (pIC50 = 8.7) in combination with potent oral antithrombotic activity (30-40% inhibition of thrombus growth at 0.3-3 mg/kg) with a duration of action of > 90 min. in a hamster cheek pouch model.

Solid phase synthesis of heterocycles by cyclization/cleavage methodologies.

For the solid phase preparation of various (pharmacologically important) heterocycles, cyclization/cleavage (C/C) or cyclorelease strategies proved to be superior. CC approaches take utmost advantage of the benefits of solid phase synthesis. Besides the practical benefits of solid phase reactions, cyclative release approaches are distinguished especially because of the generally found high purity of the final detached products, since only the anticipated structures cleave off the resin. Also cyclization/cleavage strategies are "traceless", as the obtained moiety after cyclization is part of the formed heterocycle. Over the last thirty years numerous approaches towards important heterocycle classes have been published. Among the successfully applied strategies are carbon-nitrogen (sulfur) bond, carbon-oxygen bond, sulfur-sulfur bond and carbon-carbon forming reactions in the final cyclorelease step.

Pressure-induced basilar membrane position shifts and the stimulus-evoked potentials in the low-frequency region of the guinea pig cochlea.

We have used the guinea pig isolated temporal bone preparation to investigate changes in the non-linear properties of the tone-evoked cochlear potentials during reversible step displacements of the basilar membrane towards either the scala tympani or the scala vestibuli. The position shifts were produced by changing the hydrostatic pressure in the scala tympani. The pressures involved were calculated from measurements of the fluid flow through the system, and the cochlear DC impedance calculated (1.5 x 10(11) kg m-4 s-1, n = 10). Confocal microscopic visualization of the organ of Corti showed that pressure increases in the scala tympani caused alterations of the position of the reticular lamina and stereocilia bundles. For low pressures, there was a sigmoidal relation between the DC pressure applied to the scala tympani (and thus the position shift of the organ of Corti) and the amplitude of the summating potential. The cochlear microphonic potential also showed a pronounced dependence on the applied pressure: pressure changes altered the amplitude of the fundamental as well as its harmonics. In addition, the sound pressure level at which the responses began to saturate was increased, implying a transition towards a linear behaviour. An increase of the phase lag of the cochlear microphonic potential was seen when the basilar membrane was shifted towards the scala vestibuli. We have also measured the intracochlear DC pressure using piezoresistive pressure transducers. The results are discussed in terms of changes in the non-linear properties of cochlear transduction. In addition, the implications of these results for the pathophysiology and diagnosis of Meniérè's disease are discussed.

Antiviral and tumor cell antiproliferative SAR studies on tetracyclic eudistomins. II.

In a search for the minimum pharmacophore of the naturally occurring tetracyclic eudistomins, five structural analogues (4-8) were evaluated for their in vitro antiviral and tumor cell antiproliferative activities. For the synthesis of these derivatives both intra- and intermolecular Pictet-Spengler reactions have been used. Opening of the beta-carboline annulated 7-membered D-ring in 6 and 7 resulted in a complete loss of activity. On the other hand, replacement of either the oxygen atom or the sulfur atom in the 7-membered ring by a methylene group in 5 and 8, respectively, is allowed. These results combined with previous SAR data underline the crucial importance of the D-ring in eudistomins as a scaffold for the correct positioning of both basic nitrogen atoms. Also bioisosteric replacement of the bicyclic indole system with a dimethoxyphenyl group, to give the isoquinoline skeleton, is allowed. The tricyclic isoquinoline derivative 4 is, so far, the most promising antiviral analogue; it combines a high potency (MIC at 100 ng/ mL (340 nM)) with high MCC/MIC ratios (ranging from 1000 to 5000 against HSV-1, HSV-2, vaccinia virus, and vesicular stomatitis virus.

Antiviral and antitumor structure-activity relationship studies on tetracyclic eudistomines.

The in vitro antiviral and antitumor activities of (-)-debromoeudistomin K (1a) and 10 structural analogues (1b-1j and 11) were evaluated. The synthesis was accomplished with an intramolecular Pictet-Spengler condensation reaction as the key step. This examination revealed some structural and stereochemical features that are important for both the antiviral and antitumor activities. The most striking points for activity are the necessity to have the correct natural stereochemistry at both C(1) and C(13b) and the presence of the C(1)-NH2 substituent. As was revealed before with naturally isolated eudistomins a substituent in the indole ring greatly influences the biological activity. The 5-OMe derivative 1h shows high potency in both antiviral and antitumor models.