Risk Factors and Solutions for the Development of Neurobehavioral Changes After Coronary Artery Bypass Grafting

Background. As operative mortality for coronary artery bypass grafting has decreased, greater attention has focused on neurobehavioral complications of coronary artery bypass grafting and cardiopulmonary bypass.

Methods. To assess risk factors and to evaluate changes in surgical technique, between 1991 and 1994 we evaluated 395 patients undergoing coronary artery bypass grafting with an 11-part neurobehavioral battery administered preoperatively and at 1 and 6 weeks postoperatively. Patients were instrumented with 5-MHz focused continuous-wave carotid Doppler transducers intraoperatively to estimate cerebral microembolism as an instantaneous perturbation of the velocity signal. Microembolism data were quantitated and compared with surgical technical maneuvers during operation and with neurobehavioral deficit (≥20% decline from preoperative performance on two or more neurobehavioral tests) postoperatively. These data and patient demographics were statistically analyzed (χ², t test) and the results at 2 years (1991 and 1992; group A) were used to influence surgical technique in 1993 and 1994 (group B).

Results. Significantly associated with new neurobehavioral deficits were increasing patient age (p < 0.05), more than 100 emboli per case (p < 0.04), and palpable aortic plaque (p < 0.02). Group B patients had a significant decline in the neurobehavioral event rate (group A, 69%, ; versus group B, 60%, ; p < 0.05) of postoperative neurobehavioral deficits at 1 week and at 1 month (group A, 29%, ; versus group B, 18%, ; p < 0.01). The stroke rate was less than 2% in both groups (p = not significant). Modifications of surgical technique used in group B patients included increased use of single cross-clamp technique, increased venting of the left ventricle, and application of transesophageal and epiaortic ultrasound scanning to locate and avoid trauma to aortic atherosclerotic plaques.

Conclusions. Neurobehavioral changes after coronary artery bypass grafting are common and associated with cerebral microembolization. Surgical technical maneuvers designed to reduce emboli production may improve neurobehavioral outcome.     

Enhanced anti-tumor effect of combination therapy with gemcitabine and apigenin in pancreatic cancer

Apigenin is a dietary flavonoid possessing therapeutic potential against cancers. This study was designed to investigate whether combination therapy with gemcitabine and apigenin enhanced anti-tumor efficacy in pancreatic cancer. In vitro, the combination treatment resulted in more growth inhibition and apoptosis through the down-regulation of NF-kappa B activity with suppression of Akt activation in pancreatic cancer cell lines (MiaPaca-2, AsPC-1). In vivo, the combination therapy augmented tumor growth inhibition through the down-regulation of NF-kappa B activity with the suppression of Akt in tumor tissue. The combination of gemcitabine and apigenin enhanced anti-tumor efficacy through Akt and NF-kappa B activity suppression and apoptosis induction.     

Changes in brain and lung angiotensin converting enzyme activity in various shocks

The brain and lung angiotensin converting enzyme (ACE) activities of the rats subjected to haemorrhagic, hypovolemic or endotoxic shock and of the mice immunized and then intravenously challenged with bovine serum albumin were determined by means of a spectrophotometric method. The lung ACE activities of all the shock groups were found significantly higher than those of their Control groups whereas only the brain ACE activities of the rats in endotoxic shock and the mice in anaphylactic shock showed a significant increase compared to their own control values. The results were interpreted as supporting evidence for the idea that peripheral and central renin-angiotensin systems may play a deleterious role in shock.     

Binding of a new multidrug resistance modulator,S9788, to human plasma proteins and erythrocytes

Summary The interactions of S9788 with human plasma proteins have been investigatedin vitro by an erythrocyte partitioning technique that allows an estimation of the plasma proteins and erythrocytes binding parameters. S9788 was 98% bound to plasma and blood. Lipoproteins bound S9788 with high affinities (binding constants of 0.645, 12.8 and 87.0×10⁶M⁻¹ for, HDL, LDL and VLDL, respectively) and accounted for more than 55% of the total circulating S9788. Albumin and alpha₁-acid glycoprotein also bound S9788 with lower binding constants of 0.022 and 0.245×10⁶ M⁻¹. S9788 was mainly distributed in the plasma blood compartment (75–80%) with blood-to-plasma concentrations ratio of 0.6 to 0.7. These results indicate that,in vivo, the fraction of blood S9788 available for tissue diffusion,i.e., the free drug fraction in blood, should depend on lipoprotein concentration in plasma.     

Sites of action of Mojave toxin isolated from the venom of the Mojave rattlesnake

1 Mojave toxin isolated from the venom of the Mojave rattlesnake (Crotalus scutulatus scutulatus) produced an irreversible blockade of the contractile response of the mouse hemidiaphragm to stimulation of the phrenic nerve in vitro, at concentrations of 0.16 to 20 μg/ml; the response to direct stimulation was not affected over a testing period of several hours.     

Novel benzamides as selective and potent gastric prokinetic agents. 1. Synthesis and structure-activity relationships of N-[(2-morpholinyl)alkyl]benzamides

With the purpose of obtaining more potent and selective gastric prokinetic than metoclopramide (1), a new series of N-[(2-morpholinyl)alkyl]benzamides (17-52) were synthesized and their gastric prokinetic activity was evaluated by determining effects on the gastric emptying of phenol red semisolid meal and of resin pellets solid meal in rats and mice. The morpholinyl moiety was newly designed after consideration of the side-chain structure of cisapride (2) and produced the desired activity when coupled with the 4-amino-5-chloro-2-methoxybenzoyl group of both metoclopramide and cisapride. Modification of the substituents of the benzoyl group markedly influenced the activity. In particular, 4-amino-N-[(4-benzyl-2-morpholinyl)methyl]-5-chloro-2-methoxybenzamide (17) and the 4-(dimethylamino) and 2-ethoxy analogues (25 and 29) of 17 showed potent and selective gastric prokinetic activity along with a weak dopamine D2 receptor antagonistic activity.     

SORB-GEL method of analysis of 99mTc-labelled compounds

A SORB-GEL method has been worked out for analysing ^99mTc-labelled compounds which (in a few minutes) enables the pertechnetate content to be determined in a preparation. The method is based upon a different tupe of behaviour of ^99mTc-labelled compound, pertechnetate in the columns packed with Sephadex G-10, and with alumina during elution with saline.Polythene syringes 4.7 cm long and 1 cm in diameter were used as chromotographic columns. A syringe packed with Sephadex G-10 transferred 0.1 ml of ^99mTc-labelled compound into the column, and the activity of the column was then measured in the ionisation chamber. Using a syringe, 20 ml of saline was foreced through this column. The eluate was then removed. Using an injection needle, a second column, packed with alumina, was connected with the first. Similarly, a third column, packed with Sephadex G-10, was connected to the second. Through all of them 40 ml of saline was forced. The third column containing Sephadex G-10 was then disconnected and its activity was measured in the ionisation chamber. The pertechnetate content in the preparation was then calculated from the measured values.The method is suitable for determinating the free pertechnetate content in strong and weak chelate compounds and in particle preparations.     

Avis d’experts pour le traitement des uvéites non infectieuses

Conventional immunosuppressive drugs, anti-TNF alpha and other biotherapies used in clinical practice are capable of controlling non-infectious anterior uveitis, posterior uveitis and panuveitis. The present work has been led by a multidisciplinary panel of experts, internists, rheumatologists and ophthalmologists and is based on a review of the literature. In case of corticodependency or sight-threatening disease, conventional immunosuppressive drugs (methotrexate, azathioprine and mycophenolate mofetil) and/or anti-TNF alpha (adalimumab, infliximab) are used to achieve and maintain remission. Interferon is an efficient immunomodulatory treatment, as a second-line therapy, for some therapeutic indications (refractory macular edema, Behçet's vascularitis). Other biologics, especially tocilizumab, are showing promising results. Local treatments (corticosteroids, sirolimus etc.) are adjuvant therapies in case of unilateral inflammatory relapse. Therapeutic response must be evaluated precisely by clinical examination and repeated complementary investigations (laser flare photometry, multimodal imaging, perimetry, electroretinography measures).     

La fièvre méditerranéenne familiale

Familial Mediterranean Fever (FMF) is the most frequent monogenic auto-inflammatory disease. FMF is an autosomal recessive disease, which affects populations from Mediterranean origin and is associated with MEFV gene mutations encoding for the protein pyrin. Pyrin activation enhances the secretion of interleukin 1 by myelo-monocytic cells. Main features of the disease are acute attacks of serositis mainly located on the abdomen, less frequently on chest and joints, accompanied by fever and biological inflammatory markers elevation. Usually attacks last 1 to 3 days and spontaneously stop. A daily oral colchicine intake of 1 to 2 mg/day is able to prevent attack's occurrence, frequency, intensity and duration among most patients. Colchicine is also able to prevent the development of inflammatory amyloidosis, the most severe complication of FMF. This state of the art article will focus on the diagnosis of FMF, the treatment and an update on the pathophysiology including the recent described dominant form of MEFV-associated new auto-inflammatory diseases.