Heart rate and energetics of free-ranging king penguins (Aptenodytes patagonicus).

The main objective of this study was to determine heart rate (fh) and the energetic costs of specific behaviours of king penguins while ashore and while foraging at sea during their breeding period. In particular, an estimate was made of the energetic cost of diving in order to determine the proportion of dives that may exceed the calculated aerobic dive limit (cADL; estimated usable O2 stores/estimated rate of oxygen consumption during diving). An implanted data logger enabled fh and diving behaviour to be monitored from 10 free-ranging king penguins during their breeding period. Using previously determined calibration equations, it was possible to estimate rate of oxygen consumption (VO2) when the birds were ashore and during various phases of their foraging trips. Diving behaviour showed a clear diurnal pattern, with a mixture of deep (>40 m), long (>3 min) and shallow (<40 m), short (<3 min) dives from dawn to dusk and shallow, short dives at night. Heart rate during dive bouts and dive cycles (dive + post-dive interval) was 42% greater than that when the birds were ashore. During diving, fh was similar to the 'ashore' value (87+/-4 beats min(-1)), but it did decline to 76% of the value recorded from king penguins resting in water. During the first hour after a diving bout, fh was significantly higher than the average value during diving (101+/-4 beats min(-1)) and for the remainder of the dive bout. Rates of oxygen consumption estimated from these (and other) values of fh indicate that when at sea, metabolic rate (MR) was 83% greater than that when the birds were ashore [3.15 W kg(-1) (-0.71, +0.93), where the values in parentheses are the computed standard errors of the estimate], while during diving bouts and dive cycles, it was 73% greater than the 'ashore' value. Although estimated MR during the total period between dive bouts was not significantly different from that during dive bouts [5.44 W kg(-1) (-0.30, +0.32)], MR during the first hour following a dive bout was 52% greater than that during a diving bout. It is suggested that this large increase following diving (foraging) activity is, at least in part, the result of rewarming the body, which occurs at the end of a diving bout. From the measured behaviour and estimated values of VO2, it was evident that approximately 35% of the dives were in excess of the cADL. Even if VO2 during diving was assumed to be the same as when the birds were resting on water, approximately 20% of dives would exceed the cADL. As VO2 during diving is, in fact, that estimated for a complete dive cycle, it is quite feasible that VO2 during diving itself is less than that measured for birds resting in water. It is suggested that the regional hypothermia that has been recorded in this species during diving bouts may be at least a contributing factor to such hypometabolism.

Improvement of glucose metabolism in patients with type II diabetes after treatment with a hemodialysate.

Insulin resistance of skeletal muscle glucose uptake is a prominent feature of Type II diabetes (NIDDM); therefore, pharmacological intervention should aim to improve insulin sensitivity. Previous studies have shown that Actovegin, a hemodialysate of calf blood, which has been used for treatment of circulatory disorders for many years, improves glucose tolerance in NIDDM without affecting insulin levels; in vitro studies found an improvement of insulin-stimulated glucose uptake in adipocytes. This pilot study was initiated to see whether this compound augments insulin sensitivity after repeated treatment. Ten patients with NIDDM received the hemodialysate (Actovegin 2.000 pro infusions, 500 ml as daily infusions) over a period of 10 days. A hyperinsulinaemic, isoglycaemic glucose-clamp was done on day 0 and day 11; oral glucose tolerance test (oGTT) was done on day -4 and day 12. Parenteral administration of the hemodialysate markedly augmented insulin stimulated glucose disposal (glucose infusion rate and metabolic clearance rate) by more than 80% (p < 0.003 day 11 vs. day 0). Although tested 44 h after the last infusion, oGTT also improved significantly, as documented by the diminished area under the curve (AUC) for glucose, whereas the AUC for insulin remained unchanged. This is the first clinical study to show that parenteral administration of the tested hemodialysate results in a significant increase of insulin-stimulated glucose disposal in NIDDM. The exact mode of action of the hemodialysate in improving insulin sensitivity is currently not known. The hemodialysate possibly acts via a supplementation of inositol-phosphate-oligosaccharides (IPO), as in experimental studies IPOs isolated from the hemodialysate improved glucose uptake in adipocytes in an insulin-independent manner. Further studies are needed to elucidate the underlying mechanisms.

Confirmed clinical efficacy of Actovegin in elderly patients with organic brain syndrome.

A double-blind randomized clinical trial was performed comparing the therapeutic effects of Actovegin versus placebo in elderly patients with organic brain syndrome. In addition to the necessary basic internal medicine therapy, 40 geriatric patients received dialy intravenous infusions of 250 ml Actovegin 20% p.i., and 20 patients received 250 ml 0.9% saline solution as placebo over a period of four weeks. Of the patient sample, 58% were hospitalized for simple dementia (ICD-9: 290.0) and 42% due to senile dementia with depressive or paranoid symptoms (ICD-9: 290.2). Based on the Syndrome Short Test (SKT) and the Sandoz Clinical Assessment Geriatric Scale (SCAG) score, the patients suffered from mild to moderate dementia. The therapeutic effect on the total SCAG score and the Clinical Global Impression (CGI) were the primary study variables. The scores for the SCAG subscales and the SKT score served as secondary variables. The mean total SCAG score in the drug group decreased from 56.3 at the start of therapy to 36.3 points at the end of therapy, and in the placebo group the total score went from 61.2 to 52.0 (p < 0.01). The CGI showed that with Actovegin, 70% of the patients experienced "distinct improvement" or "improvement" compared to only 35% with such results in the placebo group. The SCAG subscales and the total SKT score also demonstrated the superior effects of Actovegin compared to placebo. Moreover, the therapy group treated with Actovegin showed greater improvements in social behavior and mental performance than did the placebo group.(ABSTRACT TRUNCATED AT 250 WORDS)

Fibrin-glue-coated collagen fleece in lung surgery--experimental comparison with infrared coagulation and clinical experience.

Diffuse parenchymal bleeding and major air leaks still present a challenge to the thoracic surgeon. This study was therefore designed to evaluate efficacy and handling of fibrin-glue-coated collagen fleece, to address these problems. In an experimental part defects were produced in lungs of troll pigs to compare the use of the fleece with infrared coagulation. Immediate airtightness and postoperative adhesions were evaluated. Scores were designed to evaluate quality and extension of the adhesions. In a clinical study parenchymal resection sites were sealed with fibrin-glue-coated collagen fleece in 52 patients. No patient suffered from postoperative bleeding. In three cases air leaks were still present on the third postoperative day, representing a 5.8% failure rate. 92.3% of the patients showed neither postoperative hemorrhage nor prolonged air leaks. A fixed combination of collagen fleece and fibrin glue consequently can be considered as a valuable tool in thoracic surgery.

[An epidemiologic study of the value and limits of physical therapy/exercise therapy in Fontaine stage II arterial occlusive disease]. / Eine epidemiologische Untersuchung zur Einsetzbarkeit und zu den Grenzen der physikalischen Therapie/Bewegungstherapie bei der arteriellen Verschlusskrankheit im Stadium II nach Fontaine.

Using a questionaire the members of the German Society for Angiology (DGA) were interrogated on the use of physical training for the treatment of peripheral arterial occlusive disease; from a total of n = 431 as much as n = 156 responded, i.e. making up a response of 36%. 104 of them conduct physical training either on their own or assign patients to it (67%). In most of the institutions exclusively walking/interval training (83%) or medical exercise (74%) are performed. In most cases the training is conducted by physiotherapeutists (71%). 13% of the patients are admitted exclusively to physical training, 34% undergo combined therapy, i.e. physical training and vaso-active medication. 22% receive mere medical, 31% surgical treatment. A general evaluation on the success of the different therapies applied turned out following frequency: 1. combined therapy (medical treatment/physical training); 2. surgical procedures as a therapeutic measure; 3. physical training; 4. medical treatment. A further study performed at three ambulatory centres offering physical training were to show what kind and to which extent such training is useful. In 34% of the cases (from a total of n = 201 patients with peripheral arterial occlusive disease in state II according to Fontaine) contraindications argue against the application of physical training. From a rest of 66% as much as 36% of the patients refuse to undergo physical training the reasons of which were stated with large transport distances and time problems. The remaining rest accepts the offer, although 24% attend such training only sporadically. The results show that mainly contraindications and insufficient patient compliance account for the fact that only one third of the patients attend physical training. The results are discussed and proposals are made to improve patient compliance.

[Comparison of the effectiveness of physical training with parenteral drug therapy in Fontaine stage IIb peripheral arterial occlusive disease]. / Vergleich der Effizienz des physikalischen Trainings gegenüber parenteraler medikamentöser Therapie bei peripherer arterieller Verschlusskrankheit im Stadium IIb nach Fontaine.

In an open, randomized study in patients with peripheral arterial occlusive disease in state IIb according to Fontaine the clinical efficacy and tolerability of Actovegin upon intravenous and intraarterial application was examined compared to vascular training. 30 patients were included in each of the three therapy groups. Over a period of four weeks each patient received daily therapy--except for weekends. Patients of group I received a daily intravenous infusion of 250 ml Actovegin 20% p.i. the patients in group II received this medication by the intraarterial route. The third patient group received standardized vascular training. From a total of 90 patients 73 completed the study according to the study protocol. In all three groups the therapy resulted in the improvement of pain-free and pain-limited walking distances. Upon comparison of relative changes in the intraarterial and intravenous group significant differences turned out: whereas patients in the intravenous group achieved a mean increase in pain-free walking distance of 37.8%, a mean increase in walking distance of 44.9% in the intraarterial group was observed. With respect to maximum walking distances the relative improvements amounted to a mean of 44.0% in the intravenous group, and 64.3% in the intraarterial group. After training over four weeks in the vascular-training group the patients achieved a mean increase in pain-free walking distance of 69.6% and 53.5% in pain-limited walking distance. This meant a significantly greater improvement in pain-free walking distance compared to the intravenous group; the difference compared to the intraarterial group was not significant; however the mean values indicated that the vascular-training group showed greater improvements in pain-free walking distance, and more moderate improvements in maximum walking distance than the intraarterial group. However, these results were significantly modified, if a differentiation was made in the vascular-training group between patients with high and low compliance. In the patients' rating all three therapies were described as throughout beneficial, however, less positive for the intravenous therapy, which is in accordance to the results of changes in walking-distance. The results of the present study are discussed having in mind physical therapy being limited through contraindications and insufficient patient compliance.

Influence of deproteinized hemodialysate on rest pain and walking distance in the presence of peripheral chronic arterial occlusive disease.

In a controlled and randomized single-blind study (blind observer) the clinical efficacy of intra-arterial therapy with a metabolically active deproteinized dialysate from calf blood has been tested against a vasodilating and hemorheologically active reference substance (bencyclan). Over a period of four weeks 28 patients each received 20 intra-arterial infusions of the deproteinized hemodialysate 20% for infusion. The reference group with 30 patients was treated with 250 mg bencyclan in 250 mL saline 0.9%. As for the target criteria, rest pain and consumption of analgesics, the hemodialysate treatment proved superior to the therapy with the reference substance. Both preparations induced to a small extent pain-free walking distances: hemodialysate group, 29.2 +/- 14.6 m; reference group, 25.8 +/- 18.7 m (group difference not significant).

Haemostyptic preparations on the basis of collagen alone and as fixed combination with fibrin glue.

Preparations containing collagen play a prominent role among local haemostyptic agents in surgery. Sheets of collagen are used as degradable haemostyptic tampons. Various investigations have shown better haemostasis with collagen compared to other degradable materials, although the haemostyptic effect of these collagen preparations is limited. Concerning the mechanism of haemostasis, not all the reactions stimulated, e.g. by the collagen of an injured vessel wall, may be activated by a haemostyptic tampon from collagen. This depends very much on the kind of preparation. The combined application of a sheet of collagen with fibrin glue improved local haemostasis to a great extent. Large areas of capillary bleeding can be treated successfully with this method. Despite the very good results, this method has not been applied on a broad scale. This is due to the necessary skill and experience and the relatively cumbersome preparation required at the operation site. These drawbacks have been overcome with the latest development in this field--a sheet of collagen covered with a fixed layer of the solid components of a fibrin glue (fibrinogen, thrombin and aprotinin). The performance of this new local haemostyptic agent is described with special emphasis on the results of clinical trials. Haemostasis of large areas of capillary bleeding was very efficient and safe with the new material. Moreover, bile leakage and liquor, pancreatic and aerial fistulae could be sealed without problems.

Malignant intracerebral granular cell tumor reacts positively with anti-alpha-1-antichymotrypsin and the MB2 antibody: a clue to the histogenesis of the brain granular cell?

A 50-year-old man developed a granular cell tumor (GCT) of the right hemisphere (parieto-occipital) with visual deterioration and headache. Two months after surgery the tumor relapsed with diffuse infiltration of the right hemisphere, the corpus callosum and the adjacent left hemisphere. Subsequently, radiotherapy (5000 rads) was applied. Controls two and four months after the radiotherapy did not show any signs of the tumor in the computerized tomogram (CT). Light- and electronmicroscopy showed typical type I (small) and type II (large) granular cells with irregularly rounded or oval nuclei, abundant cytoplasm and PAS positive granules. Immunohistochemistry was positive with anti-alpha-1-antichymotrypsin (ACT) and the MB2 antibody. A survey of the relevant literature is given with special emphasis on the impact of the results of immunohistochemistry on the histogenesis of the CNS granular cell. Finally, some aspects of the therapy of GCTs will be discussed.

Whose structure is it anyway?

While "structure" is a term that is widely used in psychiatric nursing practice, few nurse authors have clearly defined the concept. This article offers an operational definition of structure, and proposes a theoretical basis to the client's need for structure. A case presentation, as well as characteristics of an effective structure, are also described.

Comparison of the two purified allozymes (1B and 1A) of X-linked phosphoglycerate kinase in the mouse.

The two allelic isozymes (wild-type 1B and the electrophoretic variant 1A) of mouse X-linked phosphoglycerate kinase (PGK-1) have been purified by affinity chromatography. The following properties were determined for both forms: molecular weight, specific activity, nucleotide specificity, Km values of the four substrates, Ki of the ATP-ribosyladipoyldihydrazo-Mg complex, turnover number, activation energy, pH and ionic strength dependence, thermostability, content of free sulfhydryl groups, and antibody cross-reactivity. With the exception of specific activity and thermostability, both allozymes appear to be identical in all properties. The higher in vitro specific activity of the 1B allozyme may be due to the higher thermostability. No antigenic difference could be detected between the two allozymes.

The expression of X-linked phosphoglycerate kinase in the early mouse embryo.

During early mouse embryogenesis, the activity of X-chromosomally linked maternal and paternal phosphoglycerate kinase (PGK-1) alleles was determined using electrophoretic separation of their gene products and a sensitive fluorometric enzyme assay. In the embryos collected from females homozygous for PGK-1b mated with PGK-1a males and vice versa, the paternally derived allozyme was first detected after implantation on day 6. Expression of the maternally inherited allele was studied in embryos from females heterozygous for PGK-1b and PGK-1a. From day 1 to day 4, the embryos maintained a constant ratio of enzyme activity of PGK-1B to PGK-1A. Prior to implantation of the embryos between day 4 and day 5, the activity ratio of the two PGK-1 allelic variants changed significantly due to the first appearance of newly synthesized PGK derived from the maternally inherited allele. Our data demonstrate a temporal difference in the onset of PGK synthesis depending on whether this particular gene product is of maternal or paternal origin. Therefore, we conclude that the maternal PGK-1 locus is already activated during late preimplantation development whereas the paternally inherited gene locus remains silent at the preimplantation stage but is subsequently expressed at approximately the time of X-chromosomal inactivation.

Immunohistochemical localization of mouse testis-specific phosphoglycerate kinase (PGK-2) by monoclonal antibodies.

Monoclonal antibodies against mouse testis-specific phosphoglycerate kinase (PGK-2) were produced in order to determine immunohistochemically the onset of PGK-2 synthesis in the germinal epithelium of the mouse. PGK-2 was detected in testis sections in spermatids as early as stage 12 and in spermatozoa, but not in earlier stages of spermatogenesis nor in any somatic cells of the testis. During ontogeny, PGK-2 appears within the testis at day 30 post-partum, concomitant with spermatids entering the maturation phase. All three allelic isozymes PGK-2A, -2B, and -2C were detected equally by the monoclonal antibody in testis sections of several inbred mouse strains, each of which expresses a specific PGK-2 variant. Moreover, the monoclonal antibody against mouse PGK-2 reacted with heterologous sperm-specific PGK from rat, rabbit, and bull and, therefore, may serve as a useful immunochemical marker for mammalian spermatogenesis.

Characterization of a phosphoglycerate kinase deficiency variants not associated with hemolytic anemia.

The properties of a variant phosphoglycerate kinase (PGK) found in a large German clan were examined. The normal and variant enzymes, isolated by affinity chromatography, have the same molecular weight, specific activity, substrate affinity, and nearly identical pH-optima. Using immunoinactivation and immunodiffusion, the same specific activity for both forms was again determined. Since the enzymatic activity in older and younger erythrocytes varied only slightly, and since the specific activity of the variant was normal, the variant seems to be stable in vivo. This suggests that the decreased enzyme content is due to a decreased synthesis rate. The variant PGK described here is distinctly different from the known PGK variants and has been designated as "PGK München."