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Biomedical subjects

C Delgado

Publications and source records attributed to C Delgado.

At least 37 records · Page 2Linked to original sources

Intermittent electromechanical dissociation as an unusual sign of prosthetic valve thrombosis in a patient with prosthetic fibrous ingrowth.

We describe the echocardiographic features of an unusual hemodynamic phenomenon of intermittent electromechanical dissociation during regular sinus tachycardia in a patient with prosthetic mitral valve thrombosis. Thrombolysis with a solution of recombinant tissue-type plasminogen activator resulted in the disappearance of electromechanical dissociation and was effective in stabilizing the patient's condition. The later discovery of panus covering the valve ring after the lysis of clots confirmed surgery as the definitive treatment.

Adult↗

Methoxamine inhibits transient outward potassium current through alpha1A-adrenoceptors in rat ventricular myocytes.

alpha1-Adrenoceptor agonists are known to reduce transient outward potassium current (I(to)) in the heart. The aim of this study was to analyze the effect of methoxamine (mtx) on I(to) and to elucidate which adrenoceptor subtype was involved in this effect. We used the whole-cell configuration of the patch-clamp technique to record I(to). Our experiments confirm that mtx induces a dose-dependent decrease of I(to) that is characterized by an acceleration of time to peak (3.5 +/- 0.2 and 2.3 +/- 0.3 ms for control and mtx, respectively), and a decrease in both inactivation time constants (T(fast) was reduced from 20.8 +/-2.6 to 14.9 +/- 1.1 ms, and tau(slow) was reduced from 138 +/- 32.1 to 114 +/- 28.7 ms; n = 7). All these effects were antagonized by prazosin and the alpha1A-antagonist 5-methylurapidil but not by the irreversible alpha1B-antagonist chloroethylclonidine. These data indicate that stimulation of alpha1A-adrenoceptor subtype is involved in the methoxamine-induced reduction of I(to) in rat ventricular myocytes.

Adrenergic alpha-Agonists↗

[Cognitive deficiency in mild hypothyroidism].

OBJECTIVE: Moderate and severe primary adult hypothyroidism produces cognitive and behavioral disturbances, but the effects of mild hypothyroidism are not well established. We have tried to determine the pattern of cognitive performance and the effect of hormonal treatment in mild hypothyroidism. PATIENTS AND METHODS: 15 patients with subclinical or very mild hypothyroidism were compared with other 15 patients suffering from mild diseases without central nervous system damage, who were matched in age, sex and previous intelligence. A neuropsychological battery, including tests of global cognitive performance (Mini Mental Status Examination, WAIS), attention (reaction time), visual memory (Benton test, Rey's Figure), verbal memory (word learning), verbal fluency and executive functions (Trail Making Test), was applied. RESULTS: Hypothyroid patients had worse performance in some WAIS subtests, reaction time, verbal fluency, free recall and copy of the Rey's figure. After hormonal treatment, a significant improvement and normal performance in almost all cognitive functions were found. CONCLUSIONS: Even mild hypothyroidism produces cognitive defects, mainly in tasks with high attentional requirements, that can and should be corrected with hormonal replacement.

Adult↗

PEGylation of adenovirus with retention of infectivity and protection from neutralizing antibody in vitro and in vivo.

Replication-defective recombinant adenovirus (Ad) vectors are under development for a wide variety of gene therapy indications. A potential limiting factor associated with virus gene therapy requiring repeated treatment is the development of a humoral immune response to the vector by the host. In animal models, there is a dose-dependent rise in neutralizing antibodies after primary vector administration, which can preclude effective repeat administration. The strategy we have developed to circumvent the neutralization of adenovirus vectors by antibodies is to mask their surface by covalent attachment of the polymer polyethylene glycol (PEG). Covalent attachment of PEG to the surface of the adenovirus was achieved primarily by using activated PEG tresylmonomethoxypolyethylene glycol (TMPEG), which reacts preferentially with the epsilon-amino terminal of lysine residues. We show that the components of the capsid that elicit a neutralizing immune response, i.e., hexon, fiber, and penton base, are also the main targets for PEGylation. Several protocols for PEGylation of an adenovirus vector were evaluated with respect to retention of virus infectivity and masking from antibody neutralization. We show that covalent attachment of polymer to the surface of the adenovirus can be achieved with retention of infectivity. We show further that PEG-modified adenovirus can be protected from antibody neutralization in the lungs of mice with high antibody titers to adenovirus, suggesting that PEGylation will improve the ability to administer Ad vectors on a repeated basis.

Adenoviruses, Human↗

Atrial tamponade causing acute ischemic hepatic injury after cardiac surgery.

A patient developed late cardiac tamponade after aortic valve replacement and coronary artery bypass grafting. Nausea and dramatic elevations of serum aminotransferases were the initial clinical manifestations of cardiac tamponade. Severe acute ischemic hepatic injury secondary to isolated compression of both atrial cavities by two loculated thrombi was diagnosed.

Acute Disease↗

Expression of T-type Ca(2+) channels in ventricular cells from hypertrophied rat hearts.

In this study we examined the existence of T-type Ca(2+) current in ventricular myocytes isolated from rats with pressure-overload hypertrophy. The whole-cell clamp technique was used to record Ca(2+) currents in enzymatically dissociated ventricular cells. T- and L-type Ca(2+) currents were separated by applying voltage steps to different test potentials from a holding potential of -80 mV and -50 mV. T-type Ca(2+) current was defined as the difference between the currents from the two holding potentials. Ventricular myocytes from sham-operated rats showed only L-type Ca(2+) current (maximal density -13.9+/-1.3 pA/pF n=17), whereas ventricular myocytes isolated from rats with aortic stenosis showed both L- and T-type Ca(2+) currents. The average values of T- and L-type Ca(2+) current density were -4.8+/-0.4 pA/pF and -12.4+/-0.9 pA/pF (n=32), respectively. T-type Ca(2+) current was distinguished from L-type Ca(2+) current by its voltage dependence, its kinetics and by its strong blockade by nickel 50 microM. In conclusion, we have demonstrated that hypertrophied ventricular rat cells express T-type Ca(2+) channels and this finding strongly supports a role for this channel in regulating growth processes in cardiac tissue.

Animals↗

Frequency-dependent increase in cardiac Ca2+ current is due to reduced Ca2+ release by the sarcoplasmic reticulum.

"Ca(2+)-current facilitation" describes several features of increase in current amplitude often associated with a reduction in inactivation rate. The aim of this study was to investigate the mechanism of frequency-dependent increase in L-type Ca2+ current, I(Ca) taking advantage of recent knowledge on the control of Ca2+ current inactivation in cardiac cells. The frequency-dependent increase in I(Ca) was studied in adult rat ventricular myocytes using the whole-cell patch-clamp technique. I(Ca) was elicited by a train of 200-ms depolarizing pulses to +20 mV applied at various frequencies (0.2 up to 1.3 Hz). The increase in frequency induced a rate-dependent enhancement of I(Ca), or facilitation phenomena. In most cells, that showed two inactivation phases of I(Ca), facilitation was mainly related to slowing of the fast I(Ca) inactivation phase that occurred besides increase in peak I(Ca) amplitude. Both the decrease and slowing of the fast component of inactivation phase were attenuated on beta -adrenergic-stimulated current. Frequency-dependent I(Ca) facilitation paralleled a reduction in Ca2+ transient measured with fluo-3. After blocking sarcoplasmic reticulum-Ca2+ release by thapsigargin, the fast I(Ca) inactivation phase was reduced and facilitation was eliminated. Facilitation could not then be restored by 1 microM isoprenaline. Thus in rat ventricular myocytes, frequency-dependent facilitation of I(Ca)reflects a reduced Ca(2+)-dependent inactivation consecutive, in most part, to reduced Ca2+ load and Ca2+ release by the sarcoplasmic reticulum rather than being an intrinsic characteristic of the L-type Ca2+ channel.

Animals↗

[Pseudoaneurysm of the mitral-aortic fibrosa secondary to the partial detachment of a mechanical aortic prosthesis].

We report a patient with an iatrogenic pseudoaneurysm of the mitral-aortic intervalvular fibrosa under the level of a prosthetic aortic valve. Partial detachment of the proximal suture line of the sewing ring is the most probable etiology. This unusual pathology was well demonstrated by transesophageal echocardiography incidentally in an asymptomatic patient who died of a brain haematoma. Aspects related to the diagnosis, treatment and prognosis of this infrequent finding are discussed.

Aged↗

Right lateral transthoracic approach mimicking standard transesophageal echocardiographic views in a patient with giant left atrium.

We describe the case of a patient with long-standing severe mitral periprosthetic regurgitation and a giant left atrium. The patient was referred for surgery. On the third postoperative day, after resuture of the dehiscence of the valve sewing ring, the patient complained of dyspnea. Transthoracic ultrasound examination was performed to eliminate pleural effusion. The severe right lateral displacement of an aneurysmatic left atrial cavity contacting with the thoracic wall allowed us to obtain excellent images of the posterior cardiac anatomy by a right lateral thoracic view. The new transthoracic approach made it possible to safely assess the atrial side of the mitral prosthesis, eliminating mitral regurgitation after surgery without transesophageal echocardiographic examination.

Cardiomegaly↗

An unusual tethering of the bridging leaflets in atrioventricular septal defect producing a communication from left atrium to right ventricle.

We describe a 39-year-old woman who was diagnosed as having an unusual atrioventricular septal defect with a communication from left atrium to right ventricle. A common atrioventricular junction, with partially separated right and left atrioventricular orifices, was found at transoesophageal ultrasonic examination. Both bridging leaflets were attached to the underside of the atrial septum, which was grossly malaligned relative to the ventricular septum. The shunt was exclusively from left atrium to right ventricle because of the overriding of the left atrioventricular valve, with the left component of the inferior bridging leaflet firmly fused to the ventricular septal crest.

Adult↗

Modulation of adrenergic receptors during left ventricular hypertrophy development and after regression by captopril.

The objective of this study was to analyze adrenergic receptors during cardiac hypertrophy development, after establishment of cardiac hypertrophy and after regression of cardiac hypertrophy by an angiotensin-converting enzyme inhibitor. Left ventricular hypertrophy (LVH) was induced by abdominal aortic stenosis. After surgery, plasma norepinephrine concentrations (PNE) and left ventricular adrenergic receptors from rat hearts subjected to aortic stenosis were assessed during cardiac hypertrophy development (at 3, 7, 15, and 30 days of aortic stenosis), once cardiac hypertrophy had been established (7 and 14 weeks after the stenosis) and after regression of cardiac hypertrophy by an antihypertensive dose (200 mg/kg/day) of captopril. The presence of LVH was observed from day 7 after stenosis. PNE had significantly increased after 15 days but returned to control values 30 days after surgery. The density of alpha1-adrenoceptors was found to decrease with development of hypertrophy. Once hypertrophy had been established, 7 weeks from stenosis, PNE was not different from control; however, the density of alpha1-adrenoceptors continued to diminish, whereas PNE and the density of beta-adrenoceptors were no different from control values. Fourteen weeks after stenosis, a significant decrease in PNE was recorded, and no change in alpha1- but an increase in beta-adrenoceptors was observed. LVH was reversed by treatment with captopril; PNE was similar in control and stenosed treated animals. The density of alpha1-adrenoceptors was decreased when compared with control animals, and no change in the density of beta-adrenoceptors was observed with treatment. In conclusion, a decrease of alpha1-adrenoceptors was associated with LVH development and earlier stages of established cardiac hypertrophy. Later stages of established cardiac hypertrophy were characterized by no change in alpha1- and an increase in beta-adrenoceptors. Treatment with captopril induced LVH regression and decreased the number of alpha1-adrenoceptors without any change in beta-adrenoceptors.

Angiotensin-Converting Enzyme Inhibitors↗

[Myocardial stunning in the context of a subarachnoid hemorrhage].

Myocardial stunning has been poorly described in patients with cerebrovascular accidents. We present a patient in whom severe anteroapical wall motion abnormalities and extensive anterior ST-segment elevation developed after subarachnoid hemorrhage. Total recovery ensued within 2 days. Coronary vasospasm induced by stroke-related sympathetic surge might be the determinant factor of this cardiac event.

Aged↗

PEGylation of cytokines and other therapeutic proteins and peptides: the importance of biological optimisation of coupling techniques.

Polyethylene glycol (PEG) modification, PEGylation, is a well established technique which has the capacity to solve or ameliorate many of the problems of protein and peptide pharmaceuticals. It is one of the most important of the molecule altering structural chemistry (MASC) techniques and in many settings is enabling technology. The use of PEG as a linker molecule is also beginning to make a contribution to the production of exciting new products. We have previously reviewed the marked differences between methods of PEGylation and the surprising and dramatic impact of different coupling techniques (using different activated PEGs) on factors such as retention of bioactivity, stability and immunogenicity of the resulting PEGylated proteins and peptides. Numerous factors play a part in this variation: the presence or absence of linkers between the PEG and the target molecule; the nature and stability of the bond(s) between the PEG, linker and target; the impact of PEG attachment on surface charge; the coupling conditions; and the relative toxicity of the activated polymer and/or coproduct(s). These are not, however, the only sources of qualitative differences in PEGylated products. Our own experience whilst developing a linkerless PEGylation technique (i.e. one attaching only PEG to the target molecule), which we devised to overcome all the major problems of pre-existing PEGylation techniques, was that considerable modification of the prototype method and a process of 'biological optimisation' was required to achieve good results in terms of conservation of bioactivity. Biological optimisation has not, as far as we are aware, been systematically applied by other groups working in PEGylation. It is the term we use to describe an iterative process for examining and refining all the steps in the PEGylation process, including manufacturing the activated polymer, in order to achieve the best possible conservation of bioactivity and other beneficial features of the method. The application of this biologically optimised PEGylation technique, using tresyl monomethoxy PEG (TMPEG), to a variety of target proteins reveals, as outlined in this review, an exceptional ability to conserve biological activity of the target. This, and the benefit of adding nothing other than PEG itself (which has an excellent safety record), to the protein, as well as other manufacturing and practical advantages, makes the method ideal for the modification of cytokines and other therapeutic proteins.

Animals↗

Analytical partitioning of poly(ethylene glycol)-modified proteins.

Covalently grafting proteins with varying numbers (n) of poly(ethylene glycol) molecules (PEGs) often enhances their biomedical and industrial usefulness. Partition between the phases in aqueous polymer two-phase systems can be used to rapidly characterize polymer-protein conjugates in a manner related to various enhancements. The logarithm of the partition coefficient (K) approximates linearity over the range O<n<x. However, x varies with the nature of the conjugate (e.g., protein molecular mass) and such data analysis does not facilitate the comparison of varied conjugates. The known behavior of surface localized PEGs suggests a better correlation should exist between log K and the weight fraction of polymer in PEG-protein conjugates. Data from four independent studies involving three proteins (granulocyte-macrophage colony stimulation factor, bovine serum albumin and immunoglobulin G) has been found to support this hypothesis. Although somewhat simplistic, 'weight fraction' based analysis of partition data appears robust enough to accommodate laboratory to laboratory variation in protein, polymer and phase system type. It also facilitates comparisons between partition data involving disparate polymer-protein conjugates.

Chromatography, Gel↗

A new phospholipase A2 isoform isolated from Bothrops neuwiedii (Yarará chica) venom with novel kinetic and chromatographic properties.

A new phospholipase A2 isoform, called P-3, isolated from Bothrops neuwiedii (Yarará chica) venom, showed different chromatographic, enzymatic and cytotoxic properties compared to the previously purified isoforms P-1 and P-2 but it had a similar edema-inducing activity. In contrast to previously reported B. neuwiedii phospholipase A2 isoforms, P-3 did not interact with the oligosaccharide matrix of gel filtration columns (Superose, Superdex). Its molecular weight was 15,000 and its N-terminal 14 amino acid sequence was Asn-Leu-Val-Gln-Phe-Glu-Thr-Leu-Ile-Met-Lys-Ile-Ala-Gly. Amino acid analyse revealed the presence of an unique histidine, presumably located at the active site, because a full inhibition of enzymatic activity was observed after treatment with p-bromophenacyl bromide. The new isoform also differentiated in its surface pressure activity profile when assayed in lipid monolayers. P-3 had an optimum activity towards dilauroylphosphatidylcholine monolayers of 27 mN/m and a cut-off pressure of 30 mN/m, whereas P-1 and P-2 had an optimum of 13 mN/m with a cut-off of 22 mN/m. P-3 retained its edema-inducing activity in the absence of hydrolytic activity, suggesting that the inflammatory activity was not dependent on the enzymatic activity. Neither the enzymatic nor the edema-inducing activity was affected by heparin. The new isoform was not lethal when a single dose of 5 micrograms/g body weight was injected intraperitoneally into mice. All of the isoforms displayed cytotoxic activity in vitro on B16F10 melanoma cells evaluated by direct MTT assay, with an EC50 of 31 micrograms/ml for P-3 and of 15 micrograms/ml for P-1 and P-2. The cytotoxic activity of P-3 was inhibited by p-bromophenacyl bromide treatment of the enzyme (up to 170 micrograms/ml), whereas the same treatment on P-1 and P-2 changed their EC50 to 60 micrograms/ml. The difference observed with inhibited enzymes suggests a different mechanism for the cytotoxic action of P-3 with respect to P-1 and P-2.

Amino Acid Sequence↗

Left ventricular pseudoaneurysm with left atrium tamponade: a rare postinfarction complication.

A 65-year-old man was readmitted to the hospital with deep-vein thrombophlebitis 3 weeks after suffering a small infarction. Two days after the patient was readmitted severe symptoms of cardiac failure developed. Transthoracic echocardiographic examination showed an unusual echo-free space adjacent to the lateral wall of the left atrium. No further diagnostic information could be obtained from precordial examinations. Single-plane transesophageal echocardiography demonstrated the presence of a ruptured aneurysm in the posterolateral wall of the left ventricle and a pseudoaneurysm, which was severely compressing the left atrial cavity. On color-flow Doppler examination a tear was detected in the wall of the left ventricular aneurysm close to the posterior atrioventricular sulcus. Pericardial adhesions because of coronary artery bypass grafting performed 10 years before may have contributed to the unusual location of this left ventricular pseudoaneurysm, complicated with left atrium tamponade after myocardial infarction.

Aged↗