The influence of arm ischaemia and arm hyperaemia on subclavian and vertebral artery blood flow in patients with occlusive disease of the subclavian artery and the brachiocephalic trunk. A peroperative study.

A peroperative study of blood flow and flow direction was performed in series of patients with occlusive disease of the subclavian artery. Particular attention was focused on the flow variations caused by arm ischaemia and postischaemic hyperaemia and on the effect of injection of a vasodilator into the distal subclavian artery. The effect on blood flow and flow direction was measured with the aid of an electromagnetic flowmeter. During arm ischaemia induced by an inflated cuff on the arm, the subclavian flow diminished, as did the vertebral artery flow when it was retrograde. If the vertebral artery flow was anterograde, it increased during arm ischaemia. The postischaemic hyperaemia caused an increase of the subclavian flow and of reversed vertebral flow. If the vertebral flow was anterograde, it diminished during the postischaemic hyperaemia. Similar findings were obtained with intra-arterial injection of a vasodilator. The large amount of blood flow passing through the vertebral artery, as well as the flow variations caused by reactive arm hyperaemia, emphasize the role of this artery as a collateral vessel to the upper limb in cases of the subclavian steal phenomenon.     

Identifying Unmet Rehabilitation Needs in Patients After Stroke With a Graphic Rehab-CompassTM

Background

Unmet rehabilitation needs are common among stroke survivors. We aimed to evaluate whether a comprehensive graphic “Rehab-Compass,” a novel combination of structured patient-reported outcome measures, was feasible and useful in facilitating a capture of patients' rehabilitation needs in clinical practice.

Human immunodeficiency virus 1 protease expressed in Escherichia coli behaves as a dimeric aspartic protease.

Recombinant human immunodeficiency virus 1 (HIV-1) protease, purified from a bacterial expression system, processed a recombinant form of its natural substrate, Pr55gag, into protein fragments that possess molecular weights commensurate with those of the virion gag proteins. Molecular weights of the protease obtained under denaturing and nondenaturing conditions (11,000 and 22,000, respectively) and chemical crosslinking studies were consistent with a dimeric structure for the active enzyme. The protease appropriately cleaved the nonapeptide Ac-Arg-Ala-Ser-Gln-Asn-Tyr-Pro-Val-Val-NH2 between the tyrosine and proline residues. HIV-1 protease was sensitive to inactivators of the aspartic proteases. The aspartic protease inactivator 1,2-epoxy-3-(4-nitrophenoxy)propane produced irreversible, time-dependent inactivation of the protease. The pH-dependent kinetics of this inactivator were consistent with the requirement of an unprotonated carboxyl group in the active site of the enzyme, suggesting that HIV-1 protease is also an aspartic protease.     

Regional cerebral blood flow and vertebral angiography at rest and in connection with arm work in patients with the "subclavian steal phenomenon".

Vascular anatomy and haemodynamics of the vertebro-basilar system were investigated by means of vertebral angiography as well as rCBF measurements using the 133Xenon clearance method in 12 patients with occlusive disease of the subclavian artery. Prior to the investigation, the occlusive lesions had been demonstrated by aortocervical angiography, which in 9 out of 12 patients showed reversed vertebral blood flow at rest. All selective vertebral angiographies and rCBF measurements were performed at rest and in connection with graded arm exercise. Patients with the subclavian steal phenomenon were found to have a slightly reduced rCBF. After arm exercise, the intracranial flow velocity of contrast medium in the cerebral vessels remained unchanged, while the velocity of the reversed flow of contrast medium in the vertebral artery was increased. Regional cerebral blood flow in the vertebro-basilar system increased during arm exercise, the average increase being about 16%. The augmentation of flow is probably due to activation of neuronal processes within the brain. The magnitude of these flow alterations in healthy individuals is unknown.     

Ueber das Secret und die Secretion der menschlichen Thränendrüse

Ohne Zusammenfassung     

Inhibition of human immunodeficiency virus 1 protease in vitro: rational design of substrate analogue inhibitors.

Inhibitors of the protease from human immunodeficiency virus 1 (HIV-1) were designed, synthesized, and kinetically characterized. Analogues of a heptapeptide substrate of HIV-1 protease with sequence similar to the p17-p24 cleavage site in the natural substrate, Pr55gag, were synthesized in which the scissile dipeptide bond was replaced with bonds from six categories of stable mimics of an aspartic proteolysis transition state or intermediate. These mimics included an analogue of statine, hydroxyethylene isosteres, two categories of phosphinic acids, a reduced amide isostere, and an alpha,alpha-difluoroketone. The resulting peptide analogues were linear competitive inhibitors of purified recombinant HIV-1 protease with inhibition constants ranging from 18 nM to 40 microM depending on the type of inhibitor. A truncated inhibitor, an analogue of a hexapeptide, retained full inhibitory potency. The most potent inhibitors, containing the hydroxyethylene isostere, effectively blocked the proteolytic processing of a recombinant form of Pr55gag by HIV-1 protease in a cell-free assay.