Biomedical subjects
Publications and source records attributed to M Rosenthal.
Persons who abuse alcohol have not been specifically targeted for education on prevention of AIDS, yet failure to address the connection between alcohol and HIV transmission may carry a heavy price.
Intact turtle brain provides a useful model for the study of anoxia and potential survival strategies, since this tissue maintains transmembrane ion gradients and ATP levels during prolonged anoxia and recovers functional activity afterwards. Since isolated tissues offer experimental advantages, the present study sought to determine effects of anoxia on the isolated turtle cerebellum and to define relationships between anoxia survival and glucose supply. In normoxia, the extracellular potassium ([K+]o) activity and evoked potentials were maintained with 5 mM glucose, but 20 mM glucose was required to maintain adenosine triphosphate (ATP) levels and prevent significant increases in [K+]o during anoxia. Inhibition of glycolysis by iodoacetic acid (IAA) during anoxia provoked large increases in [K+]o at all glucose levels. These results demonstrate the usefulness of the isolated turtle cerebellum for studies of anoxic survival since this tissue can maintain ATP levels and [K+]o during prolonged anoxia with 20 mM glucose in the artificial cerebrospinal fluid medium. They also suggest the presence of a Pasteur effect at least during the transition to a hypometabolic state.
Studies were directed toward defining relationships between brain ion transport, glycolysis, and oxidative phosphorylation. This was done by examining the relative sensitivity to hypoxemia and to iodoacetate (IAA)-induced inhibition of glycolysis in rats anesthetized with pentobarbital. Both insults had minimal effects on K+o baseline. In response to neuronal activation, IAA increased the time required for K+o clearance from maximal values to half-recovery of baseline. Hypoxemia slowed the later phase of K+o clearance, when K+o was approaching "resting" levels. Hypoxemia produced greater declines in high-energy intermediates than did IAA, which indicated that the IAA effect was not due to a greater overall insult to metabolism and suggested a direct link between ATP produced by glycolysis and ion transport activity. These data demonstrate that K+o clearance requires energy from glycolysis and oxidative phosphorylation for different phases of the recovery process and that inhibition specific to glycolysis or oxidative phosphorylation may be temporally resolved within a single stimulus.
OBJECTIVE: Human T-cell leukemia virus types I (HTLV-I) and II (HTLV-II) are closely related human retroviruses. HTLV-I has been implicated in a chronic progressive myelopathy, known as tropical spastic paraparesis (TSP) or HTLV-I-associated myelopathy (HAM). We sought to determine whether autoantibodies to brain antigens were present in the cerebrospinal fluid (CSF) of a patient with chronic progressive spastic myelopathy with evidence of both HIV-1 infection and HTLV-I/II seropositivity. DESIGN: A 54-year-old bisexual man with clinical features of HAM/TSP of over 20 years' duration was followed. METHODS: We applied discriminatory DNA amplification (polymerase chain reaction) to distinguish HTLV-I from HTLV-II and to verify co-infection with HIV-1. The patient's CSF was used to screen a human brain cDNA expression library to identify antibodies directed against brain antigens. Autoreactive bacteriophage clones were isolated and sequenced. RESULTS: The patient was found to be co-infected with both HIV-1 and HTLV-II, but not with HTLV-I. HTLV-II proviral levels in the peripheral blood remained relatively constant, despite therapy with zidovudine. Prominent oligoclonal banding of immunoglobulins was present in the patient's CSF. A single repeatedly reactive cDNA clone was identified, by screening with CSF antibody, sequenced, and found to be the human homologue of the rat insulinoma gene, rig. CONCLUSIONS: HTLV-II infection may predispose to development of a HAM/TSP-like illness. Autoimmune mechanisms, such as autoantibody formation, may play a role in pathogenesis.
OBJECTIVE: To evaluate the effects of low-power light therapy on pain and disability in elderly patients with degenerative osteoarthritis of the knee. DESIGN: Partially double-blinded, fully randomized trial comparing red, infrared, and placebo light emitters. PATIENTS: Fifty patients with degenerative osteoarthritis of both knees were randomly assigned to three treatment groups: red (15 patients), infrared (18 patients), and placebo (17 patients). Infrared and placebo emitters were double-blinded. INTERVENTIONS: Self-applied treatment to both sides of the knee for 15 minutes twice a day for 10 days. MAIN OUTCOME MEASURES: Short-Form McGill Pain Questionnaire, Present Pain Intensity, and Visual Analogue Scale for pain and Disability Index Questionnaire for disability were used. We evaluated pain and disability before and on the tenth day of therapy. The period from the end of the treatment until the patient's request to be retreated was summed up 1 year after the trial. RESULTS: Pain and disability before treatment did not show statistically significant differences between the three groups. Pain reduction in the red and infrared groups after the treatment was more than 50% in all scoring methods (P less than 0.05). There was no significant pain improvement in the placebo group. We observed significant functional improvement in red- and infrared-treated groups (p less than 0.05), but not in the placebo group. The period from the end of treatment until the patients required treatment was longer for red and infrared groups than for the placebo group (4.2 +/- 3.0, 6.1 +/- 3.2, and 0.53 +/- 0.62 months, for red, infrared, and placebo, respectively). CONCLUSIONS: Low-power light therapy is effective in relieving pain and disability in degenerative osteoarthritis of the knee.
Putative roles of glycolytic and oxidative metabolism in the removal of potassium ion from the extracellular space were examined in rat cerebral cortex. In response to direct electrical stimulation of the cerebral surface, the activity of extracellular potassium ion (Ko+) transiently increased. Inhibition of glycolysis with iodoacetate prolonged the time required for dissipation of the elevated Ko+. This slowing was most evident in the early period after stimulation, when Ko+ was relatively high. Levels of high-energy intermediates were unchanged by iodoacetate. In contrast, severe hypoxemia was without effect during the early phase of K+ removal but hypoxemia slowed the later restoration of the Ko+ baseline. These data demonstrate that the rapid removal of potassium ion from the extracellular space following intense neuronal activity is aided by the Embden-Myerhoff metabolic pathways and perhaps by direct coupling of ATP produced by glycolysis. We suggest that removal of potassium ion from the brain extracellular space depends on two ATP pools, one derived from oxidative phosphorylation, the other from glycolysis. The glycolytic ATP pool may be most involved in the early and rapid phase of potassium clearance; the oxidative ATP pool may be more associated with the second and slower phase of Ko+ clearance, and with the maintenance of the Ko+ baseline under 'resting' conditions.
In contrast to mammalian brain, which exhibits rapid degeneration during anoxia, the brains of certain species of turtles show an extraordinary capacity to survive prolonged anoxia. The decrease in energy expenditure shown by the anoxic turtle brain is likely to be a key factor for anoxic survival. The "channel arrest" hypothesis proposes that ion channels, which regulate brain electrical activity in normoxia, may be altered during anoxia in the turtle brain as a mechanism to spare energy. Goals of present research were to test this hypothesis and to determine whether down-regulation of sodium channels is a possible explanation for spike threshold shifts seen during anoxia in isolated turtle cerebellum. We report here that anoxia induced a significant (42%) decline in voltage-gated sodium channel density as determined by studies of the binding of a sodium channel ligand, [3H]brevetoxin. This study demonstrates that sodium channel densities in brain may be regulated by tissue oxygenation or by physiological events associated with anoxia. Moreover, it also suggests that downregulation of sodium channels may be a basis for changes in action potential thresholds, the electrical depression and energy conservation that provide the unique anoxic tolerance of turtle brain.
Electrical depression in the turtle brain during anoxia has been suggested as a strategy for sparing energy and promoting the extraordinary survival capacity of this tissue. The present study was aimed toward defining the changes in membrane properties during anoxia that may underlie such electrical depression. Studies were conducted in isolated cerebellum from turtle brain. Anoxia caused transmembrane potentials (TMP) to become relatively less polarized in most Purkinje cells. In no cell, however, was TMP depolarized to levels associated with the complete loss of transmembrane ion gradients produced by tissue superfusion with iodoacetate during anoxia. Sodium (and likely calcium) spike thresholds were increased, postsynaptic responses from the major afferent input pathways to Purkinje cells were depressed, and input resistance decreased significantly during anoxia. These changes likely contribute to the sparing of energy needed for ion transport and perhaps other functions that may be directly related to cell survival.
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Epirubicin (4'-epidoxorubicin), an analogue of doxorubicin (Adriamycin), has established activity in the treatment of small-cell lung cancer (SCLC) when used at doses of 75 to 120 mg/m2 in previously untreated patients. We completed a phase II study of epirubicin (85 mg/m2 given intravenously at 3-week intervals) in 20 patients with recurrent SCLC, all of whom had received prior combination chemotherapy. Of 19 patients who were assessable for response, 2 achieved a complete response and 2 a partial response, for an overall response rate of 4/19 (21%); 95% confidence interval, 8%-43%). Myelosuppression and alopecia were the most frequent toxicities; epirubicin was otherwise well tolerated, with other toxicities such as nausea and vomiting being infrequent or mild. Epirubicin at a dose of 85 mg/m2 exhibits modest single-agent activity in previously treated SCLC and is generally well tolerated. Given as a single agent or in combination with other well-tolerated drugs, epirubicin would be suitable in cases in which palliation of symptoms without undue toxicity is required in the management of previously treated SCLC.
To determine if female or male sterilization affects long-term female marital sexuality, we prospectively compared baseline data and 5 consecutive years of follow-up data from 152 tubal sterilization women, 106 vasectomy wives, and 83 women not planning sterilization. By follow-up year 5, no group of women expressed any change in satisfaction with their own sexual response; however, all groups showed a significant decrease across time in satisfaction with their sexual relationship, in coital desire, and in coital frequency. There were no group differences in overall net changes or in rates of change over the 5-year period. However, two short-term group differences were noted: a decrease in coital desire among women not planning sterilization between baseline and follow-up year 4, compared with increases for both sterilization groups, and an increase in coital frequency at the first follow-up year only in the tubal sterilization group. These data indicate that there are no detrimental effects and some short-term benefits of both sterilization procedures on female marital sexuality.
Cerebral ischemia provokes sequential changes that include EEG suppression, anoxic depolarization (AD) with maximal increases in extracellular potassium ion activity (K+o), and anoxia with maximal decreases in tissue oxygen tension (tPO2) and increases in the reduction/oxidation (redox) ratios of the mitochondrial electron transport carriers. Studies were directed toward relationships among these events during cerebral ischemia ("four-vessel occlusion model") in pentobarbital anesthetized rats. Results demonstrate that EEG suppression and anoxic depolarization do not occur as a simple function of progressive oxygen decline during cerebral ischemia. Rates of K+ elevation, tPO2 decline, and cytochrome a,a3 reduction were decreased in the immediate period following EEG suppression. Latency to EEG suppression was inversely correlated with latency to maximal cytochrome reduction. In contrast, AD was associated with increased rates of tPO2 decline and cytochrome a,a3 reduction. Latency to AD was related to latency of subsequent maximal cytochrome a,a3 reduction. These data suggest that EEG suppression spares oxygen while AD accelerates the progression to energy failure by accelerating the decline in oxygen stores in brain following global ischemia.
Insights into the etiology and pathophysiology of Parkinson's disease may derive from elucidation of the neurotoxic mechanisms of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) and its active metabolite, 1-methyl-4-phenylpyridinium (MPP+). In previous studies, MPP+ provoked oxidation of cytochrome b and K+ leakage into the extracellular space of rat striatal slices. Magnitudes of these time-dependent responses were far greater than expected had the MPP+ effects been limited to dopaminergic terminals. To determine whether cytochromes become oxidized from K(+)-induced increases in ion transport activity or from electron transport inhibition at complex I, oxygen consumption was measured because this should be increased by the former and decreased by the latter mechanism. Low MPP+ concentrations (1 microM) decreased O2 consumption (approximately 40% in 3 h) in striatal slices. This decrease was diminished by mazindol and did not occur in hippocampal slices. High toxin concentrations (100 microM) inhibited oxygen consumption to a greater extent (approximately 60%) in striatal slices; this inhibition was still greater in hippocampal slices. These results support the hypothesis that acute effects of low ("selective") MPP+ concentrations require the presence of dopaminergic terminals to trigger a sequence of destructive metabolic events but that the metabolic consequences of MPP+ spread to neighboring cells. In contrast, high MPP+ concentrations nonselectively inhibit metabolic and ion transport activity without requiring the presence of dopaminergic terminals. These results also suggest that physiological effects of "selective" MPP+ concentrations extend to nondopaminergic cells.
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OM-8980 is an immunomodulating drug which has been shown in double blind placebo controlled trials to be effective in the management of rheumatoid arthritis (RA). For this report, longterm information was collected from 32 patients (27 women, 5 men) with RA who had been treated for periods ranging from one to over 8 years with OM-8980 daily (median 5 years). Statistically significant reductions were observed in duration of morning stiffness, articular index, pain and erythrocyte sedimentation rate (ESR). An improvement or strong improvement in overall condition was noted in 23 patients. Adverse events were reported in only 3 patients and were minimal in nature. Our study demonstrates that OM-8980 is an effective longterm slow acting antirheumatic drug which has minimal adverse effects and should be considered to have a role to play in the management of RA.
Age-related changes in the capacity of the brain to survive short anoxic episodes were studied in stratum pyramidale (region CA1) of hippocampal slices from control (6-7 months) and aged (26-27 months) rats. Our primary interest was in how aging affected the ability of slices to maintain or to recover extracellular potassium ion (K+o) homeostasis and orthodromically-stimulated field potentials during and after anoxia. During anoxia, K+o homeostasis was lost faster in slices from aged rats. Following anoxia, K+o homeostasis recovered more slowly, and synaptic transmission recovered less completely, in aged slices. These studies provide what is believed to be the first demonstration that aging diminishes the capacity of brain tissue to maintain K+o during anoxia and to recover K+o homeostasis and synaptic transmission following anoxia, and support suggestions that the aged brain is more vulnerable to anoxia.
To evaluate the contribution of extracellular H+ activity toward depression of brain electrical activity during anoxia, extracellular pH (pHe) and field potentials were measured in turtle and rat olfactory bulbs with ion-selective microelectrodes. This study tests the hypothesis that unique regulation of pHe contributes to the remarkable tolerance of turtle brain to prolonged anoxia. Hypercapnea (20% CO2 ventilation) depressed olfactory bulb evoked potentials 25-30% in both rat and turtle. During anoxia, evoked potentials were completely abolished within 1 min in rat olfactory bulb but decreased to only 40% of control after 4 h in the turtle despite similar changes in brain pHe. Anoxia-induced acidification of turtle brain was exacerbated by hypercapnea and was attenuated by hypocapnea or by hypocapnea plus intravenous infusion of sodium bicarbonate. However, these manipulations of pHe during anoxia in turtle brain had little effect on depression of evoked potentials. We conclude that energy failure, rather than extracellular acidification, is the major contributor toward suppression of electrical activity in mammalian brain and that preservation of energy balance, rather than unique pH regulation, is responsible for protection of turtle brain during anoxia.
We analyzed baseline and 12-month follow-up interview data from 98 women who had volunteered to use an experimental intracervical device (ICD) and from 155 women who had been randomly assigned to two control groups, the levonorgestrel-releasing intrauterine device (LNG-IUD; N = 86) and the copper Nova-T IUD (N = 69). All participants were clinic patients in Helsinki, Finland. Initial analysis of 12-month discontinuation data indicated that a significantly higher percent of ICD users (22.4) discontinued their device than did either LNG-IUD (7.0) or Nova-T (8.7) users. However, we were no longer able to detect significant differences in discontinuation after controlling for baseline variables that assessed predisposition to be dissatisfied with contraception in general. Adjusted probabilities of discontinuing the ICD, LNG-IUD, and Nova-T were 11.8%, 6.2% and 7.9%, respectively. These data indicate that the ICD is likely to be acceptable to Helsinki clinic patients; moreover, they suggest a definite place for hormonal intrauterine devices in the contraceptive armamentarium. Most importantly, the methodology used here can be generalized to acceptability studies of other contraceptive devices and drugs undergoing Phase I and early Phase II clinical trials (in situations where randomization may not be feasible) in order to identify and control for the bias introduced by nonrandom assignment procedures.