Antidiabetic compounds from Sarracenia purpurea used traditionally by the Eeyou Istchee Cree First Nation

Through ethnobotanical surveys, the CIHR Team in Aboriginal Antidiabetic Medicines identified 17 boreal forest plants stemming from the pharmacopeia of the Cree First Nations of Eeyou Istchee (James Bay region of Northern Quebec) that were used traditionally against diabetes symptoms. The leaves of Sarracenia purpurea (pitcher plant), one of the identified Cree plants, exhibited marked antidiabetic activity in vitro by stimulating glucose uptake in C2C12 mouse muscle cells and by reducing glucose production in H4IIE rat liver cells. Fractionation guided by glucose uptake in C2C12 cells resulted in the isolation of 11 compounds from this plant extract, including a new phenolic glycoside, flavonoid glycosides, and iridoids. Compounds 6 (isorhamnetin-3-O-glucoside), 8 [kaempferol-3-O-(6″-caffeoylglucoside], and 11 (quercetin-3-O-galactoside) potentiated glucose uptake in vitro, which suggests they represent active principles of S. purpurea (EC(50) values of 18.5, 13.8, and 60.5 μM, respectively). This is the first report of potentiation of glucose uptake by compounds 6 and 8, while compound 11 (isolated from Vaccinium vitis) was previously shown to enhance glucose uptake. Treatment of H4IIE liver cells with the new compound 1, 6'-O-caffeoylgoodyeroside, decreased hepatic glucose production by reducing glucose-6-phosphatase enzymatic activity (IC(50) = 13.6 μM), which would contribute to lowering glycemia and to the antidiabetic potential of S. purpurea.     

Populus balsamifera L. (Salicaceae) mitigates the development of obesity and improves insulin sensitivity in a diet-induced obese mouse model

Ethnobotanical relevance

: In previous in vitro bioassay studies, Populus balsamifera L. (Salicaceae), a medicinal plant ethnobotanically identified from the traditional pharmacopoeia of the Cree of Eeyou Istchee (Eastern James Bay area of Canada), exhibited a strong anti-obesity potential by potently inhibiting adipogenesis in 3T3-L1 adipocytes. The aim of the study is to evaluate the effectiveness of this plant extract in mitigating the development of obesity and the metabolic syndrome in diet-induced obese (DIO) C57BL/6 mice.

Materials and methods

Mice were subjected for eight weeks to a standard diet (CHOW), a high fat diet (HFD; DIO group), or HFD to which Populus balsamifera was incorporated at 125 and 250 mg/kg.

Results

The results showed that Populus balsamifera decreased in a dose-dependent manner the weight gain of whole body, retroperitoneal fat pad and liver as compared to DIO controls and reduced the severity of hepatic macrovesicular steatosis and triglyceride accumulation. This plant extract also decreased glycemia in the second half of the feeding period and improved insulin sensitivity by diminishing insulin levels and the leptin/adiponectin ratio, as well as augmenting adiponectin levels. These effects were associated with slightly but significantly reduced food intake with 250 mg/kg Populus balsamifera as well as with an increase in energy expenditure (increase in skin temperature and increased expression of uncoupling protein-1; UCP-1). Data also suggest other mechanisms, such as inhibition of adipocyte differentiation, decrease of hepatic inflammatory state and potential increase in hepatic fatty acid oxidation.

Conclusion

Taken together, these results confirm the potential of Populus balsamifera as a culturally adapted therapeutic approach for the care and treatment of obesity and diabetes among the Cree.     

A comparative study of clinical and paramedical aspects of multiple sclerosis in Tunisia

INTRODUCTION: Tunisia is considered as a low zone of prevalence for multiple sclerosis (MS). Consequently, only very few studies have taken an interest in this disorder in North Africa. The objective of this study was to compare the clinical and paraclinical parameters and the outcome of the disease in patients affected with MS in Tunisia during two periods (1974-1978 and 1996-2000) and to determine the incidence of the disease and the impact of the use of diagnostic criteria, including the MRI. PATIENTS AND METHODS: We report the results of a retrospective study concerning patients classified with MS and followed in the National Institute of Neurology in Tunis between 1974 and 2000, with 1058 records examined. We divided the patients into two groups belonging to two periods: Group I (1974-1978, 125 patients classified according to the McAlpine criteria) and Group II (1996-2000, 247 patients classified according to Poser's criteria. We compared the clinical and paraclinical parameters of the two groups. RESULTS: The incidence of the disease was evaluated at 1.3 per 100,000 individuals, placing Tunisia in the middle zone of prevalence. There was no significant difference in the mean age of onset (32.4+/-10.1 years) between the two groups. A slight male preponderance was observed in Group I (M/F sex ratio=1.25). The clinical outcome factors were age of onset after 40 years, pyramidal signs as the first symptom, and the progressive forms of the disease. Although Group II had an earlier diagnosis of the disease and a more systematic treatment of relapses, the functional outcome was similar between the two groups. CONCLUSION: MS in Tunisia has the same clinical characteristics and disease outcome as in other countries. The use of MRI allowed earlier diagnosis but did not increase the overall proportion of definite MS.     

Microvascular obstruction and myocardial function after acute myocardial infarction: assessment by using contrast-enhanced cine MR imaging

This study was approved by the Human Investigation Committee of William Beaumont Hospital, and all patients gave informed consent. The purpose of this study was to prospectively compare contrast material-enhanced cine magnetic resonance (MR) imaging with more-standard MR imaging for the evaluation of microvascular obstruction and myocardial function in 80 patients (56 men, 24 women; mean age, 57 years; range, 29-80 years) with acute myocardial infarction after reperfusion therapy. Findings at contrast-enhanced cine MR imaging agreed with the global and transmural extent of microvascular obstruction at first-pass perfusion (intraclass correlation coefficient [IC] of 0.96 [P < .001] and 0.88 [P < .001], respectively) and inversion-recovery gradient-echo (IC of 0.90 [P < .001] and 0.93 [P < .001], respectively) MR imaging. There was no significant difference between myocardial function parameters before and after contrast material enhancement. Contrast-enhanced cine MR imaging reduced imaging time by 34% (11 of 32 minutes) and improved spatial resolution. Supplemental material: radiology.rsnajnls.org/cgi/content/full/240/2/529/DC1     

Duplex ultrasonography rarely changes management decisions in chronic lower extremity ischemia

The purpose of this study was to determine the proportion of patients presenting with lower extremity pain whose treatment plan was altered by duplex ultrasonography. This prospective study evaluated all patients referred for lower extremity pain who had undergone a lower extremity arterial duplex scan. All patients underwent a history and physical examination by the same vascular surgeon. After the completion of the history and physical examination, the surgeon established a preliminary treatment plan. Subsequently, he reviewed the lower extremity duplex results and established a final treatment plan based on the history, physical examination, and duplex results. Treatment was labeled as either (1) conservative, (2) aggressive, or (3) the patient was considered to have no peripheral vascular disease. The proportion of patients whose primary treatment plan was altered by the addition of duplex ultrasonography was determined. Of 103 patients who entered the study, 7% had no peripheral vascular disease based on the history, physical examination, and duplex scan. Based on the history and physical examination alone, 48.5% were to be treated conservatively and 44.7% aggressively. After reviewing duplex results, the treatment plan was changed in only 5.9% of patients. There was no difference in treatment plan after the addition of the duplex results (p = 0.1025). Duplex ultrasonography remains a valuable tool in the evaluation of patients with lower extremity peripheral vascular disease; however, in most patients, the decision to treat conservatively or aggressively can be made without duplex scanning. All patients referred to the vascular clinic for lower extremity evaluation do not require a duplex scan.     

The prone position in acute respiratory distress syndrome: a critical systematic review

Objective

To do a critical systematic review regarding effects of prone positioning (PP) in patients with acute respiratory distress syndrome (ARDS).

Methods

A systematic review (Highwire, Medline, Cochrane Library from 1976 to 2004), using the keywords: prone position, acute respiratory distress syndrome, allowed us to include the human studies on PP in ARDS patients, independantly of their objectives or their type of protocol. To appreciate the studies validity, we scored the quality evidence of the studies in order to grade our conclusions.

Results and conclusion

The qualitative analysis of the 58 included studies (1,500 patients returned prone, 4,000 episodes of PP) led to the following main conclusions: 1) the PP improves oxygenation in the majority of ARDS patients (level of evidence I); 2) the PP improves the pulmonary haemodynamics without altering the systemic haemodynamics (level of evidence III); 3) the PP enhances the recruitment maneuvers (level of evidence III); 4) because there are no formal predictive criteria for response to the PP, a “trial of PP” or better two PP trials are necessary to look for the responders; 5) the PP should be performed as early as possible in the course of severe ARDS; 6) the optimal duration of PP is 18 to 23 hours daily, and it should be continued until improvement of arterial oxygenation, or loss of the positive effect of PP on arterial oxygenation or evidently patient's death.     

Nonischemic dilated cardiomyopathy: results of noninvasive and invasive evaluation in 310 patients and clinical significance of bundle branch block

Background: The survival of patients with idiopathic dilated cardiomyopathy (IDCM) at III and IV stages of New York Heart Association (NYHA) is decreased in those with a bundle branch block (BBB) compared to those without BBB. Less is known on the prognosis of patients at earlier stages of NYHA and who had a left BBB (LBBB) or right BBB (RBBB). We sought to evaluate the prevalence and the clinical significance of LBBB or RBBB in patients with IDCM and classes I and II of NYHA. Methods: Clinical data, noninvasive, and invasive studies were consecutively collected in 310 patients, with IDCM, followed up to 4.8±3.7 years. Results: Seventy‐six patients (25%) had LBBB, 21 (7%) had RBBB, and 212 had no BBB. Patients with BBB were older than other patients (P < 0.009). Left ventricular ejection fraction (LVEF) was lower in LBBB than in RBBB and other patients (P < 0.05). Syncope was more frequent in BBB than in absence (P < 0.05). Incidence of spontaneous ventricular tachycardia (VT) and atrial fibrillation, VT induction, total cardiac events, and sudden death were similar in the presence or absence of BBB. Deaths by heart failure and heart transplantations tended to be more frequent in BBB than in absence. Conclusions: LBBB was present in 25% of patients with IDCM; RBBB was rare. Patients with BBB were older and had more frequent syncope than patients without BBB; LVEF was lower in LBBB than in RBBB or in absence of BBB. BBB did not increase the risk of spontaneous VT, VT induction, or sudden death, and tended to increase deaths by heart failure and the indications of heart transplantation.