Phytohormones: structural and functional relationship to purine nucleotides and some pharmacologic agents.

Structural components of second messenger signaling (nucleotides and associated enzyme systems) within plant and animal cells have more in common than the hormones that initiate metabolic and functional changes. Neurotransmitters and hormones of mammalian pharmacologic classes relate to purine nucleotides in respect of chemical structure and the molecular changes they initiate. This study compares the molecular structures of purine nucleotides with compounds from the abscisic acid, auxin, brassinosteroid, cytokinin, gibberellin, and jasmonate classes by means of a computational program. The results illustrate how phytohomones relate to each other through the structures of nucleotides and cyclic nucleotides. Molecular similarity within the phytohormone structures relates to synergism, antagonism and the modulation of nucleotide function that regulates germination and plant development. As with the molecular evolution of mammalian hormones, cell signaling and cross-talk within the phytohormone classes is purine nucleotide centered.

Assessing parenteral diuretic treatment of decompensated heart failure in the community.

Referrals of 46 patients with decompensated end-stage heart failure were reviewed by a community heart-failure specialist nurse as part of a pilot study to determine patient numbers suitable for parenteral diuretic treatment at home, and the appropriateness of the Mini Nutritional Assessment (MNA), Edmonton Symptom Assessment System (ESAS) and Carer's Stress Scales. Triage of patients resulted in the following care pathways: 14 (30%) received intravenous therapy, 11 (24%) received subcutaneous therapy, 9 (20%) required adjustment of medication, 8 (17%) could not be treated because of limited staffing resource, 4 (9%) met study exemption criteria. There were no adverse events following furosemide infusion. The majority of intravenous and subcutaneous treatments took 1-7 days (total 187 days). Parenteral diuretic therapy prevented admissions and reduced the severity heart failure symptoms in particular oedema. Patients and carers appreciated the service, which had a positive effect on carers stress. Of the nursing tools, the ESAS and the Carer's Stress Scales proved useful in the management of patients.

Patterns of fatigue in elderly heart failure patients measured by a quality of life scale (Minnesota living with heart failure).

BACKGROUND: Progression of fatigue in elderly heart failure patients is not well documented. AIM: To report on patterns and severity of fatigue in surviving patients (n = 112, mean age 75 years) of a 5 year heart failure programme (HFP). METHODS: Patients (n = 200 at baseline) participated in a 6 month trial of cardiac rehabilitation (CR versus standard care) followed by the same prescribed maintenance programme (Phase IV and/or independent exercise). Fatigue was rated by the MLHF questionnaire and compared to quality of life (QoL), physical and clinical measures. Patterns of fatigue are described in the whole sample. Data analysis is undertaken on sub-groups based on baseline randomisation, aetiology, gender, co-morbidity and survival. Heart failure patients (n = 29) newly diagnosed at the 5 year follow-up time point provided information on their experience of fatigue. RESULTS: At baseline and 5 years, 45% patients rated fatigue within the two highest categories of severity, whereas 10% reported no symptoms on assessment. Over 5 years, the fatigue patterns in the sample were unsustained improvement commensurate with the HFP (37%), an adverse pattern from baseline (37%), maintained improvement (18%) or no overall change (8%). Fatigue was higher in patients with joint problems and responded to the intervention. There was a significant increase (p < 0.05) in the proportion of patients with reduced haemoglobin level and severe fatigue at 5 years. Fatigue scores correlated significantly (p < 0.01) with QoL and physical measures. CONCLUSIONS: Severe fatigue progresses differently in elderly patients and is a modifiable symptom in the early phases of CR.

Relative similarity within purine nucleotide and ligand structures operating on nitric oxide synthetase, guanylyl cyclase and potassium (K ATP, BK Ca) channels.

OBJECTIVES: Purine nucleotides play a central role in signal transduction events initiated at the cell membrane. The NO-cGMP-cGK pathway, in particular, mediates events involving NOS and some classes of K(+) ion channel. The aim of this study is to investigate relative molecular similarity within the ligands binding to NOS, K(ATP), BK(Ca) channels and regulatory nucleotides. METHODS: Minimum energy conformers of the ligand structures were superimposed and fitted to L-arginine and the nucleotides of adenine and guanine using a computational program. KEY FINDINGS: Distinctive patterns were evident in the fitting of NOS isoform antagonists to L-arginine. K(ATP) channel openers and antagonists superimposed on the glycosidic linkage and imidazole ring of the purine nucleotides, and guanidinium and ribose groups of GTP in the case of glibenclamide. The fits of BK(Ca) channel openers and antagonists to cGMP were characterized by the linear dimensions of their structures; distances between terminal oxy groups in respect of dexamethasone and aldosterone. CONCLUSIONS: The findings provide structural evidence for the functional interaction between K(+) channel openers/antagonists and the regulatory nucleotides. Use of the purine nucleotide template systematizes the considerable heterogeneity evident within the structures of ligands operating on K(+) ion channels.

Multidisciplinary management of elderly patients with chronic heart failure: five year outcome measures in death and survivor groups.

BACKGROUND: The utility of multidisciplinary chronic disease evaluation measures, especially health related quality of life (HRQL), for long long-term prognostic use in elderly patients with heart failure is uncertain. AIM: To report on clinical, functional and HRQL values of deceased and surviving patients of a 6-month RCT of Cardiac Rehabilitation in addition to specialist nurse outpatient clinic at 5 years. METHODS: The original measures (walk test, Borg RPE, MLHF, EuroQol score and vas, biochemistry) were repeated for patients in a satisfactory condition. RESULTS: Five year survival was characterised by significantly better baseline values for LV dysfunction and NYHA class and 6-month values for MLHF, physical function and biochemistry measures. EuroQuol scores were worse than baseline for surviving patients at 5 years, in contrast to MLHF scores. The walk test gave the highest 5-year relative mortality risk, whereas the MLHF gave similar values to the Borg and uric acid measures. Deaths were more evident in normal weight older patients than in younger obese patients. CONCLUSION: Changes in patient measures were evident over 5 years and most differentiated between survivor and deceased groups. In comparison to the use of the MLHF and EuroQuol-vas, the EuroQuol score was limited by impairments of the ageing process.

Recurrent brief depression and personality traits in allergy, anxiety and premenstrual syndrome patients: a general practice survey.

BACKGROUND: Recurrent brief depression (RBD) is a common disorder, poorly characterised in clinical studies. Some problems associated with the diagnosis and treatment of RBD may be improved if patients are easier to identify. This study investigates the distribution of RBD and personality types within three common syndromes. MATERIAL/METHODS: A survey of adult patients in one general practice. Patients with anxiety, PMS or an allergy condition (n=1094) were screened for exclusion criteria, including depression. Of the study sample (n=384) 159 patients were interviewed. RBD patients were identified by DSM-IV criteria. The Hospital Anxiety and Depression Scale was used to categorise RBD (symptom scores of at least moderate severity) and RBD-res (milder symptoms) patients. Trait anxiety and personality dimensions were measured with the State-Trait Anxiety Inventory (STAI) and Eysencks' Personality Questionnaire (EPQ-R). RESULTS: In the syndrome groups, 40% of anxiety or PMS patients and 21% of allergy patients had a recurrent problem with brief depression, with half reporting symptoms of at least moderate severity. Patients with brief depression showed syndrome specific symptom and impairment differences for sleep, cognition, medication and suicide ideation. There were significant differences in the distribution of STAI, neuroticism (N) and extraversion (E) scores between patients in the RBD and no depression categories. In the anxiety group, high STAI or N scores, and low E scores identified all patients with RBD. CONCLUSIONS: This study reveals a substantial burden of RBD in a practice population who were not receiving treatment nor consulting for depression. Trait scores were useful markers of RBD in patients with an anxiety condition.