Ultrasound-guided percutaneous irreversible electroporation of hepatic and abdominal tumors not eligible for surgery or thermal ablation: a western report on safety and efficacy.

PURPOSE: To report our first results on sixteen patients affected by liver and abdominal malignant tumors, unfit for surgery or thermal ablation, treated with US-guided percutaneous irreversible electroporation (IRE). METHODS: From June 2014 to December 2016, all patients meeting the inclusion criteria (malignant hepatic or abdominal tumors not eligible for resection or thermal ablation) and not meeting the exclusion criteria (heart arrhythmia, pro-hemorrhagic hematological alterations, tumor size > 8 cm, presence of a biliary metallic stent) referred to our institutions were prospectively enrolled to undergo percutaneous US-guided irreversible electroporation (IRE). Sixteen patients (age range 59-68 years, mean 63; 7 females) with 18 tumors (diameter range 1.3-7.5 cm) fulfilled the inclusion criteria and were included in the study. Data concerning efficacy (tested by a 1-week CEUS and a 4-week enhanced CT and/or enhanced MRI) and safety were recorded during a 18-month follow up. RESULTS: All patients completed a 35-50-min procedure without complications. One patient with 6 cm Klatskin tumor also underwent a second session for 1 month. A 1-week CEUS and a 4-week e-CT and/or e-MRI arterial phase contrast enhancement analysis showed an overall reduction of arterial flow with confirmation of unenhanced lesions for seven nodules. After 1-18 months of follow up, no major complications were recorded and no tumor-related death occurred. The lesions of two patients disappeared 3 and 6 months after their treatment, respectively. CONCLUSIONS: IRE is a promising ablation modality in the treatment of malignant hepatic and abdominal tumors unsuitable for resection or thermal ablation.

Morbimortalidad y costos en pacientes con y sin cobertura social que esperan la colocación de marcapasos definitivos / Morbidity, mortality and costs in patients with and without social awaiting permanent pacemaker

Los pacientes sin cobertura social que se internan en un hospital público y requieren de un marcapasos definitivo en forma no programada permanecen internados por largos períodos de tiempo en forma innecesaria y están expuestros a un mayor número de complicaciones con riesgo para la vida del paciente, generando una mala utilización de los recursos, lo que determina un aumento de los costos hospitalarios. Se estudiaron 31 pacientes que ingresaron al hospital con indicación de implante de marcapasos definitivo entre agosto/2000 hasta junio/2003 y se conformaron dos grupos: grupo sin cobertura social (GSC) n:23 y grupo con cobertura social (GCC) n:8. Los pacientes pertenecientes al GSC tuvieron una estadía casi tres veces superior al GCC (30.8 ± 20 días vs. 13.3 ± 6 días, p: 0.02. Esta diferencia estuvo principalmente relacionada con un mayor tiempo de espera de la llegada del marcapasos definitivo (23.6 ± 18 días vs. 6.6 ± 3 días, p: 0.02. Mayor número de complicaciones relacionadas con la prolongación de la estadía, incluyendo una muerte fue observada en el GSC. El costo total promedio por paciente fue dos veces superior en el GSC con respecto al GCC ($8.011 ± 4.900 vs. $3.945, p: 0.062).

Differential and age-dependent expression of hyperpolarization-activated, cyclic nucleotide-gated cation channel isoforms 1-4 suggests evolving roles in the developing rat hippocampus.

Hyperpolarization-activated cation currents (I(h)) are found in several brain regions including thalamus and hippocampus. Important functions of these currents in promoting synchronized network activity and in determining neuronal membrane properties have been progressively recognized, but the molecular underpinnings of these currents are only emerging. I(h) currents are generated by hyperpolarization-activated, cyclic nucleotide-gated cation channels (HCNs). These channel proteins are encoded by at least four HCN genes, that govern the kinetic and functional properties of the resulting channels. Because of the potential impact of I(h)-mediated coordinated neuronal activity on the maturation of the functional hippocampal network, this study focused on determining the expression of the four members of the HCN gene family throughout postnatal hippocampal development at both the regional and single cell level.The results of these experiments demonstrated that HCNs 1, 2 and 4 are differentially expressed in interneuronal and principal cell populations of the rat hippocampal formation. Expression profiles of each HCN isoform evolve during postnatal development, and patterns observed during early postnatal ages differ significantly from those in mature hippocampus. The onset of HCN expression in interneurons of the hippocampus proper precedes that in the dentate gyrus, suggesting that HCN-mediated pacing activity may be generated in hippocampal interneurons prior to those in the hilus. Taken together, these findings indicate an age-dependent spatiotemporal evolution of specific HCN expression in distinct hippocampal cell populations, and suggest that these channels serve differing and evolving functions in the maturation of coordinated hippocampal activity.

HCN2 overexpression in newborn and adult ventricular myocytes: distinct effects on gating and excitability.

Ventricular pacemaker current (I(f)) shows distinct voltage dependence as a function of age, activating outside the physiological range in normal adult ventricle, but less negatively in neonatal ventricle. However, heterologously expressed HCN2 and HCN4, the putative molecular correlates of ventricular I(f), exhibit only a modest difference in activation voltage. We therefore prepared an adenoviral construct (AdHCN2) of HCN2, the dominant ventricular isoform at either age, and used it to infect neonatal and adult rat ventricular myocytes to investigate the role of maturation on current gating. The expressed current exhibited an 18-mV difference in activation (V(1/2) -95.9+/-1.9 in adult; -77.6+/-1.6 mV in neonate), comparable to the 22-mV difference between native I(f) in adult and neonatal cultures (V(1/2) -98.7 versus -77.0 mV). This did not result from developmental differences in basal cAMP, because saturating cAMP in the pipette caused an equivalent positive shift in both preparations. In the neonate, AdHCN2 caused a significant increase in spontaneous rate compared with control (88+/-5 versus 48+/-4 bpm). In adult, where HCN2 activates more negatively, the effect was evident only during anodal excitation, requiring significantly less stimulus energy than control (2149+/-266 versus 3140+/-279 mV. ms). Thus, ventricular maturational state influences the voltage dependence of expressed HCN2, resulting in distinct physiological impact of expressed channels in neonate and adult myocytes. The full text of this article is available at http://www.circresaha.org.

Molecular mechanism of cAMP modulation of HCN pacemaker channels.

Hyperpolarization-activated cation channels of the HCN gene family contribute to spontaneous rhythmic activity in both heart and brain. All four family members contain both a core transmembrane segment domain, homologous to the S1-S6 regions of voltage-gated K+ channels, and a carboxy-terminal 120 amino-acid cyclic nucleotide-binding domain (CNBD) motif. Homologous CNBDs are responsible for the direct activation of cyclic nucleotide-gated channels and for modulation of the HERG voltage-gated K+ channel--important for visual and olfactory signalling and for cardiac repolarization, respectively. The direct binding of cyclic AMP to the cytoplasmic site on HCN channels permits the channels to open more rapidly and completely after repolarization of the action potential, thereby accelerating rhythmogenesis. However, the mechanism by which cAMP binding modulates HCN channel gating and the basis for functional differences between HCN isoforms remain unknown. Here we demonstrate by constructing truncation mutants that the CNBD inhibits activation of the core transmembrane domain. cAMP binding relieves this inhibition. Differences in activation gating and extent of cAMP modulation between the HCN1 and HCN2 isoforms result largely from differences in the efficacy of CNBD inhibition.

Molecular and functional heterogeneity of hyperpolarization-activated pacemaker channels in the mouse CNS.

The hyperpolarization-activated cation current (termed I(h), I(q), or I(f)) was recently shown to be encoded by a new family of genes, named HCN for hyperpolarization-activated cyclic nucleotide-sensitive cation nonselective. When expressed in heterologous cells, each HCN isoform generates channels with distinct activation kinetics, mirroring the range of biophysical properties of native I(h) currents recorded in different classes of neurons. To determine whether the functional diversity of I(h) currents is attributable to different patterns of HCN gene expression, we determined the mRNA distribution across different regions of the mouse CNS of the three mouse HCN genes that are prominently expressed there (mHCN1, 2 and 4). We observe distinct patterns of distribution for each of the three genes. Whereas mHCN2 shows a widespread expression throughout the CNS, the expression of mHCN1 and mHCN4 is more limited, and generally complementary. mHCN1 is primarily expressed within neurons of the neocortex, hippocampus, and cerebellar cortex, but also in selected nuclei of the brainstem. mHCN4 is most highly expressed within neurons of the medial habenula, thalamus, and olfactory bulb, but also in distinct neuronal populations of the basal ganglia. Based on a comparison of mRNA expression with an electrophysiological characterization of native I(h) currents in hippocampal and thalamic neurons, our data support the idea that the functional heterogeneity of I(h) channels is attributable, in part, to differential isoform expression. Moreover, in some neurons, specific functional roles can be proposed for I(h) channels with defined subunit composition.

The HCN gene family: molecular basis of the hyperpolarization-activated pacemaker channels.

The molecular basis of the hyperpolarization-activated cation channels that underlie the anomalous rectifying current variously termed Ih, Iq, or I(f) is discussed. On the basis of the expression patterns and biophysical properties of the newly cloned HCN ion channels, an initial attempt at defining the identity and subunit composition of channels underlying native Ih is undertaken. By comparing the sequences of HCN channels to other members of the K channel superfamily, we discuss how channel opening may be coupled to membrane hyperpolarization and to direct binding of cyclic nucleotide. Finally, we consider some of the questions in cardiovascular physiology and neurobiology that can be addressed as a result of the demonstration that Ih is encoded by the HCN gene family.

Identification of a gene encoding a hyperpolarization-activated pacemaker channel of brain.

The generation of pacemaker activity in heart and brain is mediated by hyperpolarization-activated cation channels that are directly regulated by cyclic nucleotides. We previously cloned a novel member of the voltage-gated K channel family from mouse brain (mBCNG-1) that contained a carboxy-terminal cyclic nucleotide-binding domain (Santoro et al., 1997) and hence proposed it to be a candidate gene for pacemaker channels. Heterologous expression of mBCNG-1 demonstrates that it does indeed code for a channel with properties indistinguishable from pacemaker channels in brain and similar to those in heart. Three additional mouse genes and two human genes closely related to mBCNG-1 display unique patterns of mRNA expression in different tissues, including brain and heart, demonstrating that these channels constitute a widely expressed gene family.

Interactive cloning with the SH3 domain of N-src identifies a new brain specific ion channel protein, with homology to eag and cyclic nucleotide-gated channels.

We have isolated a novel cDNA, that appears to represent a new class of ion channels, by using the yeast two-hybrid system and the SH3 domain of the neural form of Src (N-src) as a bait. The encoded polypeptide, BCNG-1, is distantly related to cyclic nucleotide-gated channels and the voltage-gated channels, Eag and H-erg. BCNG-1 is expressed exclusively in the brain, as a glycosylated protein of approximately 132 kDa. Immunohistochemical analysis indicates that BCNG-1 is preferentially expressed in specific subsets of neurons in the neocortex, hippocampus, and cerebellum, in particular pyramidal neurons and basket cells. Within individual neurons, the BCNG-1 protein is localized to either the dendrites or the axon terminals depending on the cell type. Southern blot analysis shows that several other BCNG-related sequences are present in the mouse genome, indicating the emergence of an entire subfamily of ion channel coding genes. These findings suggest the existence of a new type of ion channel, which is potentially able to modulate membrane excitability in the brain and could respond to regulation by cyclic nucleotides.

[Doppler ultrasonography of the intrarenal arteries before and after radiologic treatment in obstructive uropathy]. / Eco Doppler delle arterie intrarenali prima e dopo trattamento radiologico nell'uropatia ostruttiva.

Resistive index (RI) calculation on Doppler tracing of intrarenal arterial blood flow is a sensitive method for the early diagnosis of obstructive uropathy. However, the RI is not specific and can increase in a number of other conditions, e.g., old age, circulating endogenic factors or drugs, other nephropathies. The authors investigated RI usefulness and accuracy by measuring it both before and after the radiologic treatment of acute urinary obstruction in 21 patients, 9 of whom had chronic renal failure due to other causes, i.e., hypertension, diabetes and chronic pyelonephritis. The clinical conditions of the patients limited the feasibility of RI measurements before and after nephrostomy to 66%. In 22 kidneys in 17 patients examined before nephrostomy, the RI ranged 0.63 to 0.93 (mean: 0.80); when the obstruction was unilateral, the RI was always higher than in the contralateral kidney. In 25 kidneys in 18 patients examined after nephrostomy, the mean RI value was 0.68 (15% lower than before). Taking 0.7 as the cut-off value, RI sensitivity in detecting acute urinary obstruction was high (about 90%), while its specificity was low (about 50%); specificity increased (to about 80%) when other concomitant causes of increased intrarenal arterial resistance, e.g., other vascular or parenchymal nephropathies, were not considered. In some cases, the method was also useful in excluding the presence of recurrent obstruction after ureteral stent removal. In conclusion, Doppler US values of intrarenal arterial perfusion are indicative of acute urinary obstruction when they can be compared with those from the contralateral healthy kidney or when they can be measured, in the same patient, before and after decompressive nephrostomy. In other cases, other nephropathies and some technical limitations must be considered.

RNA-protein interactions in the nuclei of Xenopus oocytes: complex formation and processing activity on the regulatory intron of ribosomal protein gene L1.

The gene encoding ribosomal protein L1 in Xenopus laevis is known to be posttranscriptionally regulated; the third intron can be processed from the pre-mRNA in two alternative ways, resulting either in the production of L1 mRNA or in the release of a small nucleolar RNA (U16). The formation of splicing complexes was studied in vivo by oocyte microinjection. We show that spliceosome assembly is impaired on the L1 third intron and that the low efficiency of the process is due to the presence of suboptimal consensus sequences. An analysis of heterogeneous nuclear ribonucleoprotein (hnRNP) distribution was also performed, revealing a distinct site for hnRNP C binding proximal to the 5' end of the L1 third intron. Cleavage, leading to the production of the small nucleolar RNA U16, occurs in the same position, and we show that conditions under which hnRNP C binding is reduced result in an increase of the processing activity of the intron.

In vitro study of processing of the intron-encoded U16 small nucleolar RNA in Xenopus laevis.

It was recently shown that a new class of small nuclear RNAs is encoded in introns of protein-coding genes and that they originate by processing of the pre-mRNA in which they are contained. Little is known about the mechanism and the factors involved in this new type of processing. The L1 ribosomal protein gene of Xenopus laevis is a well-suited system for studying this phenomenon: several different introns encode for two small nucleolar RNAs (snoRNAs; U16 and U18). In this paper, we analyzed the in vitro processing of these snoRNAs and showed that both are released from the pre-mRNA by a common mechanism: endonucleolytic cleavages convert the pre-mRNA into a precursor snoRNA with 5' and 3' trailer sequences. Subsequently, trimming converts the pre-snoRNAs into mature molecules. Oocyte and HeLa nuclear extracts are able to process X. laevis and human substrates in a similar manner, indicating that the processing of this class of snoRNAs relies on a common and evolutionarily conserved mechanism. In addition, we found that the cleavage activity is strongly enhanced in the presence of Mn2+ ions.

Identification of the sequences responsible for the splicing phenotype of the regulatory intron of the L1 ribosomal protein gene of Xenopus laevis.

Splicing of the regulated third intron of the L1 ribosomal protein gene of Xenopus laevis has been studied in vivo by oocyte microinjection of wild-type and mutant SP6 precursor RNAs and in vitro in the heterologous HeLa nuclear extract. We show that two different phenomena combine to produce the peculiar splicing phenotype of this intron. One, which can be defined constitutive, shows the same features in the two systems and leads to the accumulation of spliced mRNA, but in very small amounts. The low efficiency of splicing is due to the presence of a noncanonical 5' splice site which acts in conjunction with sequences present in the 3' portion of the intron. The second leads to the massive conversion of the pre-mRNA into site specific truncated molecules. This has the effect of decreasing the concentration of the pre-mRNA available for splicing. We show that this aberrant cleavage activity occurs only in the in vivo oocyte system and depends on the presence of an intact U1 RNA.

Expression vectors and gene transfer.

The development of DNA cloning techniques, together with the possibility of reintroducing cloned DNA fragments into the genome of a living organism, has led to an extraordinary growth of our knowledge in molecular biology over the past twenty years. In the present paper a brief overview of the vectors and techniques used in transforming different groups of organisms is given. The importance and applications of genetic engineering for each group (yeasts, plants, Drosophila and mammals) will be discussed.

The ABF1 factor is the transcriptional activator of the L2 ribosomal protein genes in Saccharomyces cerevisiae.

The same factor, ABF1, binds to the promoters of the two gene copies (L2A and L2B) coding for the ribosomal protein L2 in Saccharomyces cerevisiae. In vitro binding experiments and in vivo functional analysis showed that the different affinities of the L2A and L2B promoters for the ABF1 factor are responsible for the differential transcriptional activities of the two gene copies. The presence of ABF1-binding sites in front of many housekeeping genes suggests a general role for ABF1 in the regulation of gene activity.

5-Aza-2'-deoxycytidine as inducer of differentiation and growth inhibition in mouse neuroblastoma cells.

We studied the effect of 5-aza-2'-deoxycytidine (5-AZA-CdR) on the differentiation of murine 41A3 neuroblastoma cells. Neuroblastoma cells treated with 0.1-1.0 microM 5-AZA-CdR underwent differentiation; markers of neuronal functions, such as acetylcholinesterase activity and growth of nerve fibers, were expressed at a higher level in the drug-treated cells than in the controls. This increased expression was accompanied by significant hypomethylation of newly synthesized DNA. A secondary event seemed to be a partial inhibition of DNA synthesis, cell proliferation and colony-forming activity. These effects were more pronounced than those caused by the related cytidine analog, 1-beta-D-arabinosil-cytosine (ARA-C). The results obtained suggest that 5-AZA-CdR may be an effective agent for the growth control of human neuroblastoma cells.

Purification of a high-affinity discoidin I-binding proteoglycan from axenic Dictyostelium discoideum growth medium.

The axenic Dictyostelium discoideum growth medium HL-5, prepared using Difco proteose peptone No. 2, contains an extremely potent inhibitor of the binding of 125I-labeled discoidin I to glutaraldehyde-fixed, cohesive D. discoideum cells. Axenic strain A3 D. discoideum cells bind or internalize the inhibitor during growth in HL-5 medium and subsequently shed or excrete it while differentiating in suspension. The inhibitor has been purified from Difco proteose peptone No. 2 by sequential gel filtration on Sepharose 4B and affinity adsorption using discoidin I-Sepharose. The inhibitor is heterogeneous in molecular weight (4 . 10(5)--2 . 10(6)), but is relatively homogeneous in density on CsCl density gradients. The size and activity of the inhibitor are resistant to periodate, reduction and maleylation, proteases, nucleases and heating in the absence or presence of sodium dodecyl sulfate. Mild alkali causes a partial reduction in activity and converts the higher molecular weight fraction of the inhibitor to a lower molecular weight. The purified inhibitor contains neutral hexose, hexosamine and amino acid in an approximate molar ratio of 4 : 3 : 2. These and other properties suggest that the inhibitor is an unusual proteoglycan. Certain well-characterized glycosaminoglycans are relatively potent inhibitors of discoidin I binding. The proteoglycan reported here is the most potent discoidin I-binding inhibitor ever identified.

Duodenoscopy and endoscopic pancreatography in patients with postive morphine prostigmine tests.

Twenty-three patients with abdominal pain and positive morphine prostigmine tests underwent duodenoscopy and endoscopic retrograde cholangiopancreatography (ERCP). Sixteen demonstrated marked or moderate ampullary stenosis. The pancreatic duct was dilated in three and stenotic in four. Ampullary stenosis was confirmed in all patients who subsequently underwent sphincteroplasty. Only six patients had pancreatitis demonstrated by appropriate laboratory studies or at surgery. Relief of pain after sphincteroplasty was complete in ten patients during follow-up.