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Identification of molecular determinants that modulate trafficking of DeltaF508 CFTR, the mutant ABC transporter associated with cystic fibrosis.

Cystic fibrosis is a life-shortening inherited disorder associated primarily with a three-base in frame deletion that eliminates Phe508 in the ABC transporter, cystic fibrosis transmembrane conductance regulator (CFTR). Mutant CFTR, designated deltaF508 CFTR, is misprocessed and retained intracellularly. It is unclear what causes the trafficking impairment despite extensive investigative effort and the disease's prevalence. We hypothesize that the trafficking impairment is mediated by "receptors" of the cellular trafficking machinery that at three sequential "trafficking checkpoints" govern (1) exit from the endoplasmic reticulum (ER), (2) Golgi to the ER retrieval, and (3) targeting from post-Golgi compartments to lysosomes. We propose that, because of the Phe508 deletion and polypeptide misfolding: (1) a forward-directing signal recognized by the sec24 component of the COPII complex that mediates ER exit is eliminated; (2) a basic amino acid signal recognized by the COPI machinery involved in Golgi to ER retrieval becomes activated; and (3) a tyrosine-based sorting signal that targets to the lysosomes likewise becomes activated. We employed recently reported crystal structures of CFTR nucleotide binding domain 1 and sec24 in computational docking models to identify the most plausible CFTR-sec24 recognition domain. Site-directed mutagenesis and heterologous expression were also used to identify amino acid sequences that operate in Golgi to ER and post-Golgi to lysosome targeting. The importance of considering a multiple checkpoint model for trafficking is that rationale design of pharmaceutical interventions would require abrogation of all major checkpoints to deliver deltaF508 CFTR to the cell surface.

ATP-Binding Cassette Transporters↗

Polymorphic fibril formation by residues 10-40 of the Alzheimer's beta-amyloid peptide.

We report investigations of the morphology and molecular structure of amyloid fibrils comprised of residues 10-40 of the Alzheimer's beta-amyloid peptide (Abeta(10-40)), prepared under various solution conditions and degrees of agitation. Omission of residues 1-9 from the full-length Alzheimer's beta-amyloid peptide (Abeta(1-40)) did not prevent the peptide from forming amyloid fibrils or eliminate fibril polymorphism. These results are consistent with residues 1-9 being disordered in Abeta(1-40) fibrils, and show that fibril polymorphism is not a consequence of disorder in residues 1-9. Fibril morphology was analyzed by atomic force and electron microscopy, and secondary structure and inter-side-chain proximity were probed using solid-state NMR. Abeta(1-40) fibrils were found to be structurally compatible with Abeta(10-40): Abeta(1-40) fibril fragments were used to seed the growth of Abeta(10-40) fibrils, with propagation of fibril morphology and molecular structure. In addition, comparison of lyophilized and hydrated fibril samples revealed no effect of hydration on molecular structure, indicating that Abeta(10-40) fibrils are unlikely to contain bulk water.

Amino Acids↗

[Assessment of fetus' hypoxia treatment with actovegin].

The condition of fetus dramatically impairs in the case of pregnancy pathologies, when uterine-placental blood circulation impairment reveals, as it happens during placental presentation followed by bleeding, chronic anemia, heart and lung diseases of mother and pneumonia. Fetus' hypoxia develops when blood circulation in the vessels of cord is impaired, placental blood circulation disorders reveal. Preventive measures of fetus intra-natal hypoxia lay in elimination of obstetric and extra-genital causes. For the treatment of fetus hypoxia the solution Actovegin 4.0+5% glucose 400.0+vitamin "C" 4.0 in dosage of 15-20 drops per minute was applied. Out of 36 pregnant patients treatment was effective in 24 cases. In 12 cases a Caesarean section was performed. In cases of fetus hypoxia Actovegin allows to transfer metabolic processes in the form of anaerobic glycolysis, thus protecting vital centers from oxygen deprivation.

Antioxidants↗

Endocrine crises. Hypermagnesemia.

Hypermagnesemia is an often-overlooked problem in acute medical care situations. Magnesium is used in several areas of medicine and for various reasons. It also is found in many seemingly innocuous cathartics and gastrointestinal medications. Magnesium replacement in enteral or parenteral feeding and magnesium deficiency is addressed often. Despite the necessity to consider magnesium in several situations, many physicians are relatively unfamiliar with the use of magnesium in their patients. Magnesium is often used in patients with renal insufficiency, which further increases the risk of hypermagnesemia. Fortunately, the evaluation and treatment of hypermagnesemia is relatively straightforward. Calcium reversal of life-threatening sequelae, diuresis or dialysis to augment elimination of magnesium, and supportive care until the acute manifestations of the disorder resolve are the mainstays of therapy for hypermagnesemia. Recognition of patients at risk for the disorder and careful consideration of magnesium therapy will allow for prevention or early diagnosis of the disorder.

Adult↗

[Supplementary instrumental examinations in the most frequently occurring peripheral vascular diseases in general practice].

Noninvasive investigative methods are valuable for the practical diagnosis of several peripheral vascular disorders. Doppler ultrasound is very useful for the detection of incompetent saphenous and perforating veins and for the measurement of systolic ankle pressure, which today is the best screening method for arterial stenoses or occlusions. Acral oscillography, photoplethysmography and thermography, combined with vasodilator (nitroglycerin) or vasoconstrictor (cold) stress tests, may disclose small vessel disease and vasospastic disorders (Raynaud phenomenon). To answer the question of whether varicosities should be eliminated by surgery or sclerotherapy in patients with severe stages of chronic venous insufficiency (e.g. crural ulcers), investigations of the venous pump by venous pressure measurement or (photo-)plethysmography with and without digital occlusion of the suspected leakage points are recommended. Doppler probe, plethysmography and thermography are valuable screening methods for deep vein thrombosis and help to restrict phlebography to patients on whom fibrinolysis or thrombectomy is carried out. For the majority of patients undergoing conservative treatment, these noninvasive diagnostic procedures are usually sufficient.

Arterial Occlusive Diseases↗

Renal excretion of pseudoephedrine in the rat.

Pseudoephedrine is an organic base used in the treatment of upper respiratory tract disorders. Surgical techniques and experimental procedures were developed to study the renal elimination mechanisms for this drug in the rat. The ability to measure renal clearance accurately and to demonstrate renal secretion by a carrier-mediated transport system was verified by comparing results from N'-methylnicotinamide (NMN) excretion studies with literature results. Renal tubular secretion of NMN was shown to be saturable and was inhibited by mepiperphenidol to the same extent as that reported in the literature. Pseudoephedrine was cleared by the kidney at a rate in excess of inulin and close to or possibly greater than renal plasma flow. In addition to filtration and secretion, pseudoephedrine appeared to be subject to pH dependent passive reabsorption. When the secretion of pseudoephedrine was studied in detail, it was found to be nonsaturable for plasma levels of pseudoephedrine ranging from 0.16 to 1.5 microgram/ml. Secretion, however, was inhibited by mepiperphenidol suggesting a carrier-mediated process.

Animals↗

[Chronic noncalculous cholecystitis with refractory relapsing course (clinico-laboratory correlates)].

The immunological (lymphocyte blast transformation with PHA, determination of IgA, IgM, IgG), cytochemical (the mean cytochemical index of neutrophil lipids, glycogen, peroxidase content), hematological (the leukocyte, lymphocyte and neutrophil counts), and biochemical tests were employed to study immune responsiveness in 108 patients with chronic non-calculous cholecystitis running a refractory relapsing course. The patients showed the signs of immune deficiency. Some of the above described tests turned out informative for detecting such deficiency. It has been demonstrated that conventional therapy does not provide any stable clinical effect, aggravating the manifestations of immune deficiency. The introduction into the complex of treatment measures of diphenhydramine, saparal and levamisole, in particular, favoured more rapid elimination of the clinical symptoms of a relapse, of allergic reactions, psychoemotional disorders and reduced the signs of a decrease in immune responsiveness in patients with chronic non calculous cholecystitis running a refractory relapsing course.

Anti-Bacterial Agents↗

[State of the osteoarticular apparatus of the craniovertebral region following restorative-reconstructive surgery].

Clinico-radiological examination of patients with a history of various types of operative treatment conducted on the craniovertebral region and cervical segment of the spine located below it established more precisely that in many cases neither decompression nor stabilization could completely arrest and eliminate the pathological process and the appearance of secondary deformities and neurological disorders in this region. That is why many operative methods for the management of lesions in this region require further study and elaboration.

Adolescent↗

Hemophilia A presenting with intracranial hemorrhage in neonate: a case report.

Intracranial hemorrhage (ICH) in a neonate is an uncommon presentation of hemophilia. Its occurrence is invariably preceded by mild-to-moderate head injury, unlike adult hemophiliacs in whom ICH occurs without prior head injury in half the cases. The bleeding event may follow a minor injury of labor (eg, prolonged second stage of labor or the use of forceps). In a recent experience at our hospital, a 6 D/O male baby with hemophilia A presenting with ICH after traumatic delivery was later found to have factor VIII deficiency. We suggest that prenatal management for suspected cases should take family history of bleeding disorders and carrier testing into consideration. Any term neonate with ICH should eliminate the possibility of hemophilia until proved otherwise. Some specific diagnostic and therapeutic recommendations to assist the clinician to evaluate an infant with ICH and prolonged PTT are discussed.

Cerebral Hemorrhage↗

Change in hemorrheological and biochemical parameters following membrane differential filtration.

INTRODUCTION: The elimination of high molecular weight proteins may have a positive influence on disorders of the microcirculation due to an improvement in rheological parameters. We therefore attempted to evaluate the rheological efficacy of membrane differential filtration (MDF). PATIENTS AND METHODS: Ten patients suffering from macular disease underwent MDF. Rheological and biochemical parameters as well as visual acuity were determined one day before and after therapy: The study aimed at a reduction in plasma viscosity, standardized whole blood viscosity at hematocrit 0.45 and erythrocyte aggregation at hematocrit 0.3. RESULTS: Severe side-effects were not observed. The rheological parameters were significantly reduced. In detail the posttreatment values were reduced as compared to the pretreatment values as follows: plasma viscosity 85%, standardised whole blood viscosity 86% (hematocrit 0.45), erythrocyte aggregation 59% (hematocrit 0.3), total protein 81%, IgG 66%, IgA 59%, IgM 33%, alpha-2-macroglobulin 30%, triglycerides 102%, total cholesterol 47%, VLDL cholesterol 94%, LDL cholesterol 33%, HDL cholesterol 62%. Visual acuity was improved in 7/10 patients. CONCLUSIONS: MDF is a safe and highly effective method for lowering biochemical and improving rheological parameters which led to improvement in visual acuity. We have already replaced plasma exchange with MDF in our clinical practice of hemorrheological therapy.

Aged↗

[Biomarkers of hepatotoxic effects: their usefulness in occupational medicine].

Medical screening and the resultant monitoring of health effects induced by hepatotoxins present in workplaces become of still greater importance in the assessment of occupational health and safety. Health effects of occupational and nonoccupational hepatotoxic factors may be acute, subacute or chronic. Laboratory tests (biomarkers) used in screening for detection of asymptomatic damages of the liver should satisfy the following three criteria: 1. they should provide positive or negative predictive information, namely the information about possible development of clinically evident hepatopathy; 2. they should be very sensitive and specific in order to ensure a correct identification of the developing disease; and 3. they should provide information which of clinical biomarkers should be applied subsequently in order to confirm and facilitate the diagnosis of hepatopathy related to exposure to occupational hepatotoxins or to eliminate such a relationship. It should be also remembered that for assessing disorders in hepatic functions those biomarkers should be selected which are most effective in identifying both persons with hepatopathy induced by environmental hepatotoxins and those who are free from the liver damages. It should be stressed that to date none of the existing biomarkers is sensitive and specific enough to assess alone all the functional systems of the liver.

Air Pollutants, Occupational↗

Anomalous correspondence--the cause or consequence of strabismus?

I hypothesize that the functional role of binocular correspondence, whether normal or anomalous, is that of detecting retinal disparity stimuli. Normal correspondence involves disparity stimulus detection that is quantitatively normal and stable, whereas anomalous correspondence involves disparity detection that is quantitatively abnormal and variable. Normal disparity stimuli typically produce motor fusion between normally corresponding biretinal areas. The result is orthotropia, which permits normal single binocular vision and acute stereopsis. In contrast, abnormal disparity stimuli typically produce motor fusion between anomalously corresponding areas. The result is strabismus, usually coupled with anomalous single binocular vision (harmonious anomalous correspondence). Accordingly, corrective prism or muscle surgery only produces vergence movements that restore anomalous motor fusion, rather than eliminating the heterotropia. The inference is that anomalous correspondence involves a neurological disorder in the disparity detection mechanism, either on the convergent side (estropia with anomalous correspondence) or divergent side (exotropia with anomalous correspondence).

Brain Diseases↗

[Pseudo-alcoholic hepatitis and cirrhosis caused by amiodarone (Cordarone)].

Amiodarone is an antiarrhythmic drug widely used to treat a variety of supraventricular and ventricular arrhythmias. However its drawback is a very slow elimination and very frequent adverse effects (thyroid, pulmonary, neurologic, ocular, dermatologic, hepatic disorders). We describe a patient who developed a pseudoalcoholic liver disease and a cirrhosis after use of Amiodarone for a long period of time.

Amiodarone↗