Low flow veno-venous ECMO: an experimental study

Clinical use of extracorporeal membrane oxygenation (ECMO) and carbon dioxide removal (ECCO 2R) have become well established techniques for the treatment of severe respiratory failure; however they require full cardiopulmonary bypass, representing major procedures with high morbidity. We theorized the possibility of an efficient low flow veno-venous extracorporeal membrane gas exchange method. Four mongrel 12 kg dogs were submitted to veno-venous extracorporeal membrane gas exchange via a jugular dialysis catheter using a low flow (10 ml/min) roller pump and a membrane oxygenator for a period of four hours. Respiratory rate was set at 4 breaths/min with a FiO 2 of 21% and ventilatory dead space was increased. Adequate gas exchange was obtained (pO 2139, pCO 224, Sat 99.4%), without major hemodynamic changes or hematuria. Our results demonstrate the feasibility of a low flow, less aggressive system. Further research should be considered.     

Health care reform and the urban crisis

As designed, the Health Security Act will be dysfunctional to those in greatest need, as the majority of the population residing in the 20th Congressional District in Texas. These have limited education, work for low wages, and live in a general state of high poverty. The author identifies specific concerns regarding the adequacy of Clinton's proposal in meeting the needs of that population, and provides a supportive analysis for McDermott's "American Health Security Act," and the possible effect that its single-payer concept may have on the people in the border state of Texas.     

Activation of trans-l,2-dihydro-l,2-dihydroxy-6-aminochrysene to genotoxic metabolites by rat and human cytochromes P450

In order to address the hypothesis that 6-aminochrysene (6-AC)is converted to genotoxic products by cytochrome P450 enzymesvia two activation pathways (N-hydroxylation and epoxidation),the activation of 6-AC and trans-l,2-dihydro-l,2-dihydroxy-6-aminochrysene(6-AC-diol) to genotoxic metabolites was examined in rat andhuman liver microsomal cytochrome P450 enzymes using Salmonellatyphimurium TA1535/pSK1002 and TA1535/pSK1002/pNM12 (NM2009)as tester strains. The latter bacteria, an O-acetyl-transferase-overexpressingstrain, was highly sensitive to metabolites derived from activationof 6-AC, but not those from 6-AC-diol, using liver microsomesfrom phenobarbital-treated rats or a reconstituted monooxygenasesystem containing P4502B1 or -2B2, thus suggesting the rolesof P450 and acetyltransferase systems in the activation process.6-AC-diol, on the other hand, was activated very efficientlyby liver microsomes prepared from ß-naphthoflavone-treatedrats or a reconstituted system containing P4501A1 or -1A2; theactivation reaction is considered to proceed through diol-epoxideformation. The contribution of rat P4501A enzymes towards activationof 6-AC-diol was confirmed by the inhibitory effects on theactivation process of -naphthoflavone, a specific inhibitorof P4501 A-related activities, and antibodies raised againstpurified P4501A1 and -1A2. In humans, P4501A2 was found to bethe major enzyme involved in the activation of 6-AC-diol togenotoxic metabolites while the parent compound 6-AC was activatedmainly by P4503A4. Experiments using recombinant P450 proteinsexpressed in human lymphoblastoid cells lines showed that humanP4501A1 could also activate 6-AC-diol to reactive metabolitesat almost the same rate measured with P4501A2. In addition,P4502B6 was found to efficiently catalyze the activation of6-AC to genotoxic metabolites, and P4503A4 was active in theactivation of 6-AC-diol as well as 6-AC. Addition of purifiedrat epoxide hydrolase to the incubation mixture containing purifiedrat P4501A1 or microsomes expressing human P4501A1 caused inhibitionof activation of 6-AC-diol. These results suggest the existenceof different enzymatic activation pathways for 6-AC and 6-AC-diol.The former carcinogen may be N-hydroxylated principally by P4502Benzymes in rats and P4503A4 and -2B6 in humans and activationto its ultimate metabolites may proceed through esterificationof the N-hydroxy metabolites by an N-acetyltransferase. The6-AC-diol is metabolized to its ultimate diolepoxide productby P4501A enzymes in rat and human liver microsomes. P4503A4(humans) and P4503A2 (rats) may also contribute to some extentin the activation of 6-AC-diol, albeit at lower rates than thoseof P4501A enzymes.     

Influence of dietary-fat on growth of mda-mb231 human breast carcinomas maintained in female athymic nude-mice

The purpose of this study was to assess the effects of the type of dietary fat [corn oil (controls), olive oil, linseed oil, primrose oil, canola oil and fish (Menhaden) oil] and the amount of dietary fat on the growth of MDA-MB231 human breast carcinomas in female athymic nude mice. The different types of fats examined in these studies differ widely in their omega-3, -6 and -9 fatty acid contents, fatty acid chain length and their degree of unsaturation. These fats were fed to the carcinoma bearing mice at 20% of the diet by weight and for 5 to 8 weeks. No significant effect of these diets on mouse body weight gains throughout the study was observed. Compared to the corn oil controls, none of the dietary fats significantly affected the growth of the human breast carcinomas in these animals, with the exception of fish oil which consistently and significantly (P<0.05 to P<0.001) suppressed carcinoma growth. DNA synthesis of the human breast carcinomas derived from the fish oil fed mice was assessed by BrdU and PCNA labeling indices and by H-3-thymidine autoradiographic analysis. Despite the fact that the carcinomas derived from the fish oil fed mice were significantly smaller than the carcinomas from the corn oil fed mice, there were no significant differences in any of these parameters of DNA synthesis between the two groups (corn oil and fish oil) of carcinomas. In contrast, in the human breast carcinomas derived from the fish oil fed mice, a significant increase (P<0.01 to P<0.001) in the rate of (125)IUrd loss (K-L/day) and a significant increase (P<0.05 to P<0.001) in the cell loss factor (phi) (phi=1-T-P/T-D) was observed, compared to carcinomas derived from corn oil fed mice. Analysis of the human breast carcinomas for TBARS, a measure of secondary products of lipid peroxidation, revealed that the carcinomas derived from the fish oil fed mice had significantly increased (P<0.001) concentrations of these products compared to carcinomas derived from corn oil fed mice. These results provide evidence that the suppression of growth of human breast carcinoma MDA-MB231 in athymic nude mice by dietary fish oil appears to be due primarily to an increase in the loss of cells from the carcinomas in lieu of a suppression of DNA synthesis, a phenomenon that may be due to the increased concentration of lipid peroxidation products in the tumor tissue. In the studies designed to examine the effect of the amount of fat on growth of MDA-MB231 human breast carcinomas in athymic nude mice, one group of mice was fed a high fat diet (corn oil, 29%) and a second group of mice was fed a low fat diet (corn oil, 1.8%). Both diets were fed at a restricted level, i.e., 65% of ad libitum. A third group of mice was fed a high fat diet (corn oil, 18.1%) ad libitum. The diets were formulated to assure that mice of each group consumed equal amounts of protein, vitamins, minerals and fiber; mice fed the high fat diets (ad libitum and restricted) consumed equal amounts of fat. Growth of the human breast carcinomas in mice fed the high fat and low fat restricted diets was not significantly different despite the large difference in fat consumption. Growth of the carcinomas in mice fed the high fat diet ad libitum was substantially greater than carcinoma growth in mice fed the restricted high fat diet (P<0.001) despite equal amounts of fat consumption. These results demonstrate that in an environment of energy (caloric) restriction, high levels of dietary fat will not enhance growth of MDA-MB231 human breast carcinomas in athymic nude mice, thus emphasizing the important role for energy (calories) in the enhancement of mammary (breast) tumorigenic processes by high fat diets.     

Adenosine inhibits L-type Ca2+ current and catecholamine release in the rabbit carotid body chemoreceptor cells

In an in vitro preparation of the intact carotid body (CB) of the rabbit, adenosine (100 microM) inhibited hypoxia-induced catecholamine release by 25%. The specific A1 antagonist, 8-cyclopentyl-1,3-dipropylxanthine (DPCPX; 1 microM) prevented the inhibition and increased the response to hypoxia further. In isolated chemoreceptor cells from the same species, adenosine inhibited voltage-dependent Ca2+ currents by 29% at 1 microM (concentration producing half-maximal inhibition, IC50 = 50 nM). This inhibition was mimicked by R(-)N6-(2-phenylisopropyl)-adenosine and 2-chloroadenosine (1 microM), two purinergic agonists poorly active at the intracellular ('P') site, and persisted in the presence of dipyridamole (a blocker of adenosine uptake; 1 microM) and was fully inhibited by 8-phenyltheophylline (10 microM). The A1 antagonists DPCPX (10 microM) and 8-cyclopentyl-1,3-dimethylxantine (0.1 microM) inhibited the effect of adenosine by 93% (IC50 = 0.14 microM) and 59%, respectively. The inhibition of the Ca2+ current (I(Ca)) was reduced by nisoldipine (an L-type Ca2+ channel antagonist) by nearly 50%, and was unaltered by omega-conotoxin GVIA, a blocker of N-type Ca2+ channels. Adenosine did not affect the voltage-dependent Na+ current (I(Na)) or K+ current (I(K)). We conclude that adenosine A1 receptors are located in chemoreceptor cells and mediate the inhibition of L-type Ca2+ channels and thereby the release of catecholamines produced by hypoxia. The data also indicate that endogenous adenosine acts as a physiological negative modulator of the chemoreceptor cell function. The previously reported excitatory action of adenosine on the activity of the sensory nerve of the CB is discussed in terms of a balance between the inhibition mediated by A1 receptors and the excitation mediated by A2 receptors.     

Long-term enhancement of REM sleep by the pituitary adenylyl cyclase-activating polypeptide (PACAP) in the pontine reticular formation of the rat

In rats, rapid eye movement (REM) sleep can be elicited by microinjection of vasoactive intestinal polypeptide (VIP) into the oral pontine reticular nucleus (PnO). In the present study, we investigated whether this area could also be a REM-promoting target for a peptide closely related to VIP: the pituitary adenylyl cyclase-activating polypeptide (PACAP). When administered into the posterior part of the PnO, but not in nearby areas, of freely moving chronically implanted rats, PACAP-27 and PACAP-38 (0.3 and 3 pmol) induced a marked enhancement (60-85% over baseline) of REM sleep for 8 h that could be prevented by prior infusion of the antagonist PACAP-(6-27) (3 pmol) into the same site. Moreover, injections of PACAP into the centre of the posterior PnO resulted in REM sleep enhancement which could last for up to 11 consecutive days. Quantitative autoradiography using [125I]PACAP-27 revealed the presence in the PnO of specific binding sites with high affinity for PACAP-27 and PACAP-38 (IC50 = 2.4 and 3.2 nM, respectively), but very low affinity for VIP (IC50 > 1 microM). These data suggest that PACAP within the PnO may play a key role in REM sleep regulation, and provide evidence for long-term (several days) mechanisms involved in such a control. PAC1 receptors which have a much higher affinity for PACAP than for VIP might mediate this long-term action of PACAP on REM sleep.