Comment on Berry and Hachinski. Chronic whiplash syndrome as a functional disorder.
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Humans↗
Biomedical subjects
R Ferrari
Publications and source records attributed to R Ferrari.
Security concept in 'MyAngelWeb' a website for the individual patient at risk of emergency.
We describe the Security Plan for the 'MyAngelWeb' service. The different actors involved in the service are subject to different security procedures. The core of the security system is implemented at the host site by means of a DBMS and standard Information Technology tools. Hardware requirements for sustainable security are needed at the web-site construction sites. They are not needed at the emergency physician's site. At the emergency physician's site, a two-way authentication system (password and test phrase method) is implemented.
Computer Security↗
Ischaemic heart disease: clinical improvement with metabolic approach.
The term myocardial ischemia describes a condition which exists when fractional uptake of oxygen in the heart is not sufficient to maintain the rate of cellular oxidation. This leads to extremely complex situations which have extensively in recent years. A large amount of experimental research has been directed to establish the precise sequence of biochemical events leading to myocyte necrosis as such knowledge could lead to rational treatments designed to delay myocardial cell death. At the present time there is no simple answer to the question of what determines cell death and no recovery on reperfusion. Problems arise because: 1) ischemic-damage is not homogeneous and many factors may combine to cause cell death; 2) severity of biochemical changes and development of necrosis are usually associated (both the processes being dependent on the duration of ischemia) and it is impossible to establish a causal relationship; 3) the inevitability of necrosis can only be assessed by reperfusion of the ischaemic myocardium. Restoration of flow, however, might result in numerous further negative consequences, thus directly influencing the degree of recovery. From the clinical point of view, we have recently learnt that there are several potential manifestations and outcomes associated with myocardial ischaemia and reperfusion. Without doubt ventricular dysfunction (either systolic or diastolic) of the ischaemic zone is the most reliable clinical sign of ischemia, since ECG changes and symptoms are often absent. The ischaemia-induced ventricular dysfunction, at least initially, is reversible, as early reperfusion of the myocardium results in restoration of normal metabolism and contraction. In the ischaemic zone, recovery of contraction might occur instantaneously or, more frequently, with a considerable delay, thus yielding the condition recently recognised as the stunned myocardium. On the other hand, when ischemia is severe and prolonged, cell death might occur. Reperfusion at this stage is associated with the released of intracellular enzymes, disruption of cell membranes, influx of calcium, persistent reduction of contractility, and eventual necrosis of at least a portion of the tissue. This entity has been called reperfusion damage by those who believe that much of the injury is the consequence of events occurring at the moment of reperfusion rather than a result of changes occurring during the period of ischaemia. The existence of reperfusion damage, however, it has been questioned, and has been argued that, with the exception of induction of arrhythmias, it is difficult to be certain that reperfusion causes further injury. The existence of such an entity has clinical relevance, as it would imply the possibility of improving recovery with specific interventions applied at the time of reperfusion. In 1985 Rahimtoola described another possible out-come of myocardial ischemia. He demonstrated that late reperfusion (after months or even years) of an ischaemic area showing ventricular wall-motion abnormalities might restore normal metabolism and function. He was the first to introduce the term hibernating myocardium, referring to ischemic myocardium in which the myocytes remain viable but in which contraction is chronically depressed. Our data on metabolic changes occurring during ischemia followed by reperfusion which were obtained either in the isolated and perfused rabbit hearts or in CAD patient undergoing intracoronary thrombolysis or aortocoronary bypass grafting will be reviewed.
Free Radicals↗
Changes in nicotinic acetylcholine receptor subunit mRNAs and nicotinic binding in spontaneously hypertensive stroke prone rats.
We have studied nicotinic acetylcholine receptors in spontaneously hypertensive 'stroke prone' (SHsp) rats. We found a significant decrease in 125I-alpha-bungarotoxin binding and alpha7 subunit mRNA levels in cortical areas of the SHsp rats with respect to Wistar Kyoto (WKy) normotensive rats. Antihypertensive drug treatment counteracted these changes in cerebral cortex but not in hippocampus. No significant change was instead found in [3H]-epibatidine binding and alpha4 and beta2 subunit mRNA levels. SHsp rats showed decreased latency at the active avoidance test and transiently increased threshold at both hot-plate and tail-flick tests in comparison with WKy rats. None of these behavioral parameters was correlated with 125I-alpha-bungarotoxin binding in cortical areas. In conclusion, present data show a preferential impairment of alpha-bungarotoxin sensitive nAChRs in SHsp rats.
Animals↗
Serum from patients with severe heart failure downregulates eNOS and is proapoptotic: role of tumor necrosis factor-alpha.
BACKGROUND: Cytokine activation and endothelial dysfunction are typical phenomena of congestive heart failure (CHF). We tested the hypothesis that incubating human umbilical vein endothelial cells with serum from patients with CHF will downregulate endothelial constitutive nitric oxide synthase (eNOS) and induce apoptosis. METHODS AND RESULTS: We studied 21 patients with severe CHF. Levels of tumor necrosis factor-alpha (TNF-alpha) and several neuroendocrine parameters were assessed. eNOS was measured by Western Blot analysis and apoptosis by optical microscopy and flow cytometry. We observed (1) eNOS downregulation (difference versus healthy subjects at 24 hours [P<0.05] and 48 hours [P<0.001]), (2) nuclear morphological changes typical of apoptosis; and (3) a high apoptotic rate with propidium iodide (increasing from 2.1+/-0.4% to 11.3+/-1.2% at 48 hours; P<0.001 versus healthy subjects) and annexin V. An anti-human TNF-alpha antibody did not completely counteract these effects. A strong correlation existed between eNOS downregulation and apoptosis (r = -0.89; P<0.001). CONCLUSIONS: Serum from patients with severe CHF downregulates eNOS expression and increases apoptosis. High levels of TNF-alpha likely play a role, but they cannot be the only factor responsible.
Aged↗
Involvement of alpha6 nicotinic receptor subunit in nicotine-elicited locomotion, demonstrated by in vivo antisense oligonucleotide infusion.
Enhanced locomotion in a habituated environment is a well documented effect of nicotine mediated by the mesotelencephalic dopaminergic system. The nicotinic receptor subunit alpha6 is, among other subunits, strongly expressed in the dopaminergic neurons of the mesencephalon. To examine the functional role of this subunit, we inhibited its expression in vivo using antisense oligonucleotides. In vitro treatments of embryonic mesencephalic neuron cultures demonstrated that the alpha6 antisense oligonucleotides caused a marked decrease in the level of alpha6 subunit protein. In vivo, 1 week infusion of alpha6 antisense oligonucleotides by osmotic mini-pump reduced the effect of nicotine on locomotor activity in habituated environment by 70%. These data support the notion that the effects of nicotine on the dopaminergic system involve alpha6 subunit containing nAChRs.
Amino Acid Sequence↗
Psychological factors in illness.
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Disease↗
High-dose heparin impairs nitric oxide pathway and vasomotion in rats.
BACKGROUND: Platelet-activating effects have been reported with high-dose heparin in acute thrombotic disorders. Recent studies have shown that increased platelet aggregation is due to reduced nitric oxide (NO) production in endothelial cells cultured in the presence of high-dose heparin. The aim of this study was to determine whether heparin can affect the NO pathway and the regulation of the vascular tone in vivo. METHODS AND RESULTS: Anesthetized and mechanically ventilated Sprague-Dawley rats were treated with high-dose heparin. After 4 hours, the endothelial constitutive NO synthase (ecNOS) protein content in the aorta decreased (36% reduction, P<0.05), as detected by immunoblotting, and NO-dependent vascular reactivity was impaired. In fact, the increase in mean arterial blood pressure after inhibition of ecNOS with NG-nitro-L-arginine methyl ester (30 mg/kg) was smaller in heparin-treated animals than in controls (+26. 9+/-4.8 versus +48.3+/-9.1 mm Hg, P<0.05), and further infusion of the biological ecNOS substrate L-arginine (0.5 g/kg) was ineffective in reversing systemic vasoconstriction (-1% versus 28% vasodilatation, P<0.001). CONCLUSIONS: High-dose heparin can significantly affect vascular reactivity in vivo by downregulation of ecNOS protein expression.
Animals↗
Increased neurodegeneration during ageing in mice lacking high-affinity nicotine receptors.
We have examined neuroanatomical, biochemical and endocrine parameters and spatial learning in mice lacking the beta2 subunit of the nicotinic acetylcholine receptor (nAChR) during ageing. Aged beta2(-/-) mutant mice showed region-specific alterations in cortical regions, including neocortical hypotrophy, loss of hippocampal pyramidal neurons, astro- and microgliosis and elevation of serum corticosterone levels. Whereas adult mutant and control animals performed well in the Morris maze, 22- to 24-month-old beta2(-/-) mice were significantly impaired in spatial learning. These data show that beta2 subunit-containing nAChRs can contribute to both neuronal survival and maintenance of cognitive performance during ageing. beta2(-/-) mice may thus serve as one possible animal model for some of the cognitive deficits and degenerative processes which take place during physiological ageing and in Alzheimer's disease, particularly those associated with dysfunction of the cholinergic system.
Aging↗
Waddell signs in patients with chronic low back pain.
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Chronic Disease↗
Compensation of horizontal temperature and salinity gradients in the ocean mixed layer
Establishment of the temperature-salinity relationship in the ocean has concerned oceanographers for decades because of its importance for understanding ocean circulation. High-resolution measurements in the ocean mixed layer are used to show that temperature and salinity gradients on horizontal scales of 20 meters to 10 kilometers tend to compensate in their effect on density. These observations support the notion of a horizontal mixing in the mixed layer that depends on density gradient.
Journal Article↗
Whiplash: heading for a higher ground.
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Accidents, Traffic↗
Development of persistent neurologic symptoms in patients with simple neck sprain.
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Chronic Disease↗
Fibromyalgia and physical and emotional trauma: how are they related? Comment on the article by Aaron et al.
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Emotions↗
Cardioprotection: intermittent ventricular fibrillation and rapid pacing can induce preconditioning in the blood-perfused rat heart.
The aim of the study was to use the isolated blood-perfused rat heart to: (i) determine whether brief intermittent rapid pacing and ventricular fibrillation are able to mimic preconditioning by ischemia and thereby protect the isolated blood-perfused heart against ischemia-induced injury and (ii) characterize the effects of these interventions on cardiac metabolism. To this end, isolated, blood-perfused (2.4 ml/min), paced (360 beats/min) rat hearts (n = 6/group), were aerobically perfused for 20 min. Hearts were then randomized to four groups: (i) a further 16 min aerobic perfusion (UC, untreated controls), (ii) ischemic preconditioning (IP, 3 min ischemia + 3 min reperfusion followed by 5 min ischemia + 5 min reperfusion), (iii) electrically induced ventricular fibrillation (VF, 3 min fibrillation + 3 min sinus rhythm followed by 5 min fibrillation + 5 min sinus rhythm) and (iv) rapid pacing at > or = 600 beats/min (RP, 3 min rapid pacing + 3 min normal heart rate followed by 5 min rapid pacing + 5 min normal heart rate). Hearts were then subjected to 35 min of zero-flow, global ischemia (37 degrees C) and 40 min reperfusion. In parallel studies, blood samples were collected during the first 3 min of treatment and plasma taken for the analysis of noradrenaline. The hearts were then immediately frozen and assayed for high energy phosphates and noradrenaline content. Time-to-50% contracture during ischemia was 13.2 +/- 0.8 min in controls; this was reduced to 6.3 +/- 1.1 min by IP but was unaffected by VF or RP (12.4 +/- 1.1 and 12.8 +/- 1.2 min respectively). Post-ischemic left ventricular developed pressure (LVDP) in untreated controls recovered to only 19.9 +/- 8.4% of its pre-ischemic value whereas with IP, VF and RP substantial and similar improvements were observed (60.3 +/- 7.4, 56.2 +/- 5.7 and 45.3 +/- 10.3%, respectively, P < 0.01). This protection was achieved without any significant depletion of high energy phosphates during VF or RP. Noradrenaline was essentially unchanged in controls and with RP, but VF caused a loss from tissue and a large elevation in the plasma. Our results suggest that both RP and VF are as effective as brief ischemia in protecting the heart against injury during ischemia and reperfusion. In contrast to IP, this protection can be achieved without the exacerbation of ischemic contracture and without inducing ischemia during the preconditioning period.
Adenine Nucleotides↗
The role of TNF in cardiovascular disease.
There is increasing evidence that cytokines in general and tumour necrosis factor (TNF) in particular play an important role in cardiovascular disease. This is not surprising since TNF modulates both cardiac contractility and peripheral resistance, the two most important haemodynamic determinants of cardiac function. Thus, increased levels of TNF or of its soluble receptors have been implicated in the pathophysiology of ischaemia-reperfusion injury, myocarditis, cardiac allograft and, more recently, also in the progression of congestive heart failure. In this later condition, TNF could be responsible for further ventricular remodelling; down-regulation of myocardial contractility; increased rate of apoptosis of the endothelial cell and of the myocytes, alteration of the expression and function of the enzymes regulating nitric oxide production and, of course, the induction of cachexia resulting in further peripheral muscle dysfunction. The hypothesis that TNF may be involved in the progression of CHF may be of clinical relevance as anti-TNF strategies are considered for therapeutical strategies. The purposes of this article are: (1) to define the physiological aspects of TNF; (2) to outline the specific function of TNF within the heart; (3) to consider the role of TNF in CHF; and (4) to speculate on possible anti-TNF treatment.
Cardiovascular Diseases↗
The blood perfused isolated heart: characterization of the model.
We have characterized the aerobic blood-perfused isolated heart model evaluating the hemodynamics and metabolism of both the blood donor animal and the isolated organ. Anaesthesia of the blood donor with sodium pentobarbital (30 mg/kg) increases arterial concentration of non esterified fatty acids (NEFA) from 80 +/- 6 to 452 +/- 70 microM; p < 0.01. Injection of 1,000 U/kg heparin causes a second significant increase from 452 +/- 70 to 1012 +/- 104 microM; p < 0.01. Insertion of the perfusion circuit, without the isolated heart, causes a reduction in blood pressure of the blood donor and a significant increase in norepinephrine from 277 +/- 44 to 634 +/- 130 pg/ml; p < 0.05. Two hours of aerobic perfusion of the isolated heart inserted in the perfusion circuit, decreases arterial pressure of the blood donor with a concomitant increase of plasma norepinephrine from 475 +/- 150 to 841 +/- 159 pg/ml; p < 0.05. Developed pressure, oxygen consumption, glucose and NEFA uptake of the isolated heart remain constant during two hours of aerobic perfusion, NEFA being the preferred substrate. Tissue content of high energy phosphates at the end of the perfusion is high and similar to that observed "in vivo". Despite this, there is a release of lactate and CPK from the isolated heart. We conclude that: 1) the model allows accurate measurement of hemodynamics and metabolism of both the isolated heart and the blood donor animal; 2) the perfusion procedure modifies the substrates concentration of the blood donor animal which, in turn, results in the preferential NEFA utilization of the isolated heart. These changes do not affect the functional parameters of the perfused heart.
Animals↗