Thrombophilia and direct thrombin inhibitor lepirudin clinical and monitoring aspects

Thrombophilia (TF) predisposes both to venous and arterial thrombosis at a young age. TF may also impact the thrombosis or stenosis of hemodialysis (HD) vascular access in patients with end-stage renal disease (ESRD). When involved in severe thrombosis TF may associate with inappropriate response to anticoagulation. Lepirudin, a potent direct thrombin inhibitor (DTI), indicated for heparin-induced thrombocytopenia-related thrombosis, could offer a treatment alternative in TF. Monitoring of narrow-ranged lepirudin demands new insights also in laboratory. The above issues constitute the targets in this thesis. We evaluated the prevalence of TF in patients with ESRD and its impact upon thrombosis- or stenosis-free survival of the vascular access. Altogether 237 ESRD patients were prospectively screened for TF and thrombogenic risk factors prior to HD access surgery in 2002-2004 (mean follow-up of 3.6 years). TF was evident in 43 (18%) of the ESRD patients, more often in males (23 vs. 9%, p=0.009). Known gene mutations of FV Leiden and FII G20210A occurred in 4%. Vascular access sufficiently matured in 226 (95%). The 1-year thrombosis- and stenosis-free access survival was 72%. Female gender (hazards ratio, HR, 2.5; 95% CI 1.6-3.9) and TF (HR 1.9, 95% CI 1.1-3.3) were independent risk factors for the shortened thrombosis- and stenosis-free survival. Additionally, TF or thrombogenic background was found in relatively young patients having severe thrombosis either in hepatic veins (Budd-Chiari syndrome, BCS, one patient) or inoperable critical limb ischemia (CLI, six patients). Lepirudin was evaluated in an off-label setting in the severe thrombosis after inefficacious traditional anticoagulation without other treatment options except severe invasive procedures, such as lower extremity amputation. Lepirudin treatments were repeatedly monitored clinically and with laboratory assessments (e.g. activated partial thromboplastin time, APTT). Our preliminary studies with lepirudin in thrombotic calamities appeared safe, and no bleeds occurred. An effective DTI lepirudin calmed thrombosis as all patients gradually recovered. Only one limb amputation was performed 3 years later during the follow-up (mean 4 years). Furthermore, we aimed to overcome the limitations of APTT and confounding effects of warfarin (INR of 1.5-3.9) and lupus anticoagulant (LA). Lepirudin responses were assessed in vitro by five specific laboratory methods. Ecarin chromogenic assay (ECA) or anti-Factor IIa (anti-FIIa) correlated precisely (r=0.99) with each other and with spiked lepirudin in all plasma pools: normal, warfarin, and LA-containing plasma. In contrast, in the presence of warfarin and LA both APTT and prothrombinase-induced clotting time (PiCT®) were limited by non-linear and imprecise dose responses. As a global coagulation test APTT is useful in parallel to the precise chromogenic methods ECA or Anti-FIIa in challenging clinical situations. Lepirudin treatment requires multidisciplinary approach to ensure appropriate patient selection, interpretation of laboratory monitoring, and treatment safety. TF seemed to be associated with complicated thrombotic events, in venous (BCS), arterial (CLI), and vascular access systems. TF screening should be aimed to patients with repeated access complications or prior unprovoked thromboembolic events. Lepirudin inhibits free and clot-bound thrombin which heparin fails to inhibit. Lepirudin seems to offer a potent and safe option for treatment of severe thrombosis. Multi-centered randomized trials are necessary to assess the possible management of complicated thrombotic events with DTIs like lepirudin and seek prevention options against access complications.

Long-term results of operative treatment for Hirschsprung's disease and internal anal sphincter achalasia

The aim of the study was to evaluate long-term results of operative treatment for Hirschsprung's disease(HD) and internal anal sphincter achalasia. Fecal continence and quality of life were evaluated by a questionnaire in 100 adult patients who had undergone surgery for HD, during 1950-75. Fecal continence was evaluated using a numerical scoring described by Holschneider. Fifty-four of the 100 patients underwent clinical examination, rigid sigmoidoscopy and manometric evaluation. In anorectal manometry basal resting pressure(BRP)and maximal squeeze pressure(MSP) were measured and voluntary sphincter force(VSF) was calculated by subtracting the BRP from MSP. The results of operative treatment for adult HD were compared with the results of the patients operated in childhood. In adult HD the symptoms are such mild that the patients attain adolescence or even adulthood. The patients with HD and cartilage-hair-hypoplasia were specifically evaluated. The outcome of the patients with internal anal sphincter achalasia operated on by myectomy was evaluated by a questionnaire and continence was evaluated using a numerical scoring described by Holschneider. Of the 100 patients operated on for HD 38 patients had completely normal bowel habits. A normal or good continence score was found in 91 our of 100 patients. Nine patients had fair continence. One of the patients with fair continence had Down's syndrome and two were mentally retarded for other reasons. Only one patient suffered from constipation. In anorectal manometry the difference in BRP between patients with normal and good continence was statistically significant, whereas the difference between good and fair continence groups was not statistically significant. The differences on MSP and VSF between patient groups with different continence outcome were not statistically significant. The differences between patient groups and normal controls were statistically significant in BRP and MSP. In VSF there was not statistically significant difference between the patients and the normal controls. The VSF reflects the working power of the muscles including external sphincter, levator ani and gluteal muscles. The patients operated at adult age had as good continence as patients operated in childhood. The patients with HD and cartilage-hair-hypoplasia had much more morbidity and mortality than non-cartilage-hair-hypoplasia HD patients. The mortality was as high as 38%. In patients with internal anal sphincter achalasia the constipation was cured or alleviated by myectomy whereas a significant number suffered from soiling-related social problems.

Quantitation and characterization of glutathionyl haemoglobin as an oxidative stress marker in chronic renal failure by mass spectrometry

Objectives: Glutathionyl haemoglobin (GS-Hb) belonging to the class of glutathionylated proteins has been investigated as a possible marker of oxidative stress in different chronic diseases. The purpose of this study was to examine whether glutathionyl haemoglobin can serve as an oxidative stress marker in non-diabetic chronic renal failure patients on different renal replacement therapies (RRT) through its quantitation, and characterization of the specific binding site of glutathione in haemoglobin molecule by mass spectrometric analysis. Design and methods: The study group consisted of non-diabetic chronic renal failure patients on renal replacement therapy (RRT): hemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD) and renal allograft transplant (Txp) patients. Haemoglobin samples of these subjects were analyzed by liquid chromatography electrospray ionization mass spectrometry for GS-Hb quantitation. Characterization of GS-Hb was done by tandem mass spectrometry. Levels of erythrocyte glutathione (GSH) and lipid peroxidation (as thiobarbituric acid reacting substances) were measured spectrophotometrically, while glycated baernoglobin (HbA1c) was measured by HPLC. Results: GS-Hb levels were markedly elevated in the dialysis group and marginally in the transplant group as compared to the controls. GS-Hb levels correlated positively with lipid peroxidation and negatively with the erythrocyte glutathione levels in RRT groups indicating enhanced oxidative stress. De novo sequencing of the chymotryptic fragment of GS-Hb established that glutathione is attached to Cys-93 of the beta globin chain. Mass spectrometric quantitation of total glycated haemoglobin showed good agreement with HbA1c estimation by conventional HPLC method. Conclusions: Glutathionyl haemoglobin can serve as a clinical marker of oxidative stress in chronic debilitating therapies like RRT. Mass spectrometry provides a reliable analytical tool for quantitation and residue level characterization of different post-translational modifications of haemoglobin. (c) 2007 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Reactivity studies of highly electrophilic ruthenium complexes

The 16-electron, coordinatively unsaturated, dicationic ruthenium complex Ru(P(OH)(2)(OMe))(dppe)(2)]OTf](2) (1a) brings about the heterolysis of the C-H bond in phenylacetylene to afford the phenylacetylide complex trans-Ru(C CPh)(P(OH)(2)(OMe))(dppe)(2)]OTf] (2). The phenylacetylide complex undergoes hydrogenation to give a ruthenium hydride complex trans-Ru(H)(P(OH)(2)(OMe))(dppe)(2)]OTf] (3) and phenylacetylene via the addition of H-2 across the Ru-C bond. The 16-electron complex also reacts with HSiCl3 quite vigorously to yield a chloride complex trans-Ru(Cl)(P(OH)(2)(OMe))(dppe)(2)]OTf] (4). On the other hand, the other coordinatively unsaturated ruthenium complex Ru(P(OH)(3))(dppe)(2)]OTf](2) (1b) reacts with a base N-benzylideneaniline to afford a phosphonate complex Ru(P(O)(OH)(2))(dppe)(2)]OTf] (5) via the abstraction of one of the protons of the P(OH)(3) ligand by the base. The phenylacetylide, chloride, and the phosphonate complexes have been structurally characterized. The phosphonate complex reacts with H-2 to afford the corresponding dihydrogen complex trans-Ru(eta(2)-H-2)(P(O)(OH)(2))(dppe)(2)]OTf] (5-H2). The intact nature of the H-H bond in this species was established using variable temperature H-1 spin-lattice relaxation time measurements and the observation of a significant J(H,D) coupling in the HD isotopomer trans-Ru(eta(2)-HD)(P(O)(OH)(2))(dppe)(2)]OTf] (5-HD). (C) 2010 Elsevier B. V. All rights reserved.

Grain size effects on charge-ordering, phase segregation and related properties of rare-earth manganates, Nd(0.5)A(0.5)MnO(3) (A = Ca or Sr)

Grain size has marked effects on charge-ordering and other properties of Nd(0.5)A(0.5)MnO(3) (A=Ca or Sr). Thus, the anti-ferromagnetic (AFM) transition in Nd0.5Ca0.5MnO3 is observed distinctly only in samples sintered at 1273 K or higher. The sample with a small grain size (sintered at 1173 K) shows evidence for greater ferromagnetic (FM) interaction at low temperatures, probably due to phase segregation. The FM transition as well as the charge-ordering transition in Nd0.5Sr0.5MnO3 becomes sharper in samples sintered at 1273 K or higher. The sample sintered at 1173 K does not show the AFM-CO transition around 150 K and is FM down to low temperatures; the apparent T-c-T-co gap decreases with the increase in the grain size. The samples sintered at lower temperatures (<1673 K) show evidence for greater segregation of the AFM and FM domains. (C) 2002 Elsevier Science Ltd. All rights reserved.

Fluorescence quenching of biologically active carboxamide by aniline and carbon tetrachloride in different solvents using Stern-Volmer plots

Fluorescence quenching of biologically active carboxamide namely (E)-2-(4-chlorobenzylideneamino)-N-(2-chlorophenyl)-4,5,6,7-tetrahydrobe nzo[b]thiophene-3-carboxamide [ECNCTTC] by aniline and carbon tetrachloride (CCl(4)) quenchers in different solvents using steady state method and time resolved method using only one solvent has been carried out at room temperature to understand the role of quenching mechanisms. The Stern-Volmer plot has been found to be linear for all the solvents studied. The probability of quenching per encounter p (p') was determined in all the solvents and was found to be less than unity. Further, from the studies of rate parameters and life time measurements in n-heptane and cyclohexane with aniline and carbon tetrachloride as quenchers have been shown that, the phenomenon of quenching is generally governed by the well-known Stern-Volmer (S-V) plot. The activation energy E(a) (or E(a)') of quenching was determined using the literature values of activation energy of diffusion E(d) and the experimentally determined values of p (or p'). It has been found that, the activation energy E(a) (E(a)') is greater than the activation energy for diffusion E(d) in all solvents. Hence, from the magnitudes of E(a) (or E(a)') as well as p (or p') infer that, the quenching mechanism is not solely due to the material diffusion, but there is also contribution from the activation energy. (C) 2011 Elsevier B.V. All rights reserved.

Multi-decadal variation of the net downward shortwave radiation over south Asia: The solar dimming effect

The solar radiation flux at the earth's surface has gone through decadal changes of decreasing and increasing trends over the globe. These phenomena known as dimming and brightening, respectively, have attracted the scientific interest in relation to the changes in radiative balance and climate. Despite the interest in the solar dimming/brightening phenomenon in various parts of the world, south Asia has not attracted great scientific attention so far. The present work uses the net downward shortwave radiation (NDSWR) values derived from satellites (Modern Era Retrospective-analysis for Research and Applications, MERRA 2D) in order to examine the multi-decadal variations in the incoming solar radiation over south Asia for the period of 1979-2004. From the analysis it is seen that solar dimming continues over south Asia with a trend of -0.54 Wm(-2) yr(-1). Assuming clear skies an average decrease of -0.05 Wm(-2)yr(-1) in NDSWR was observed, which is attributed to increased aerosol emissions over the region. There is evidence that the increase in cloud optical depth plays the major role for the solar dimming over the area. The cloud optical depth (MERRA retrievals) has increased by 10.7% during the study period, with the largest increase to be detected for the high-level (atmospheric pressure P < 400 hPa) clouds (31.2%). Nevertheless, the decrease in solar radiation and the role of aerosols and clouds exhibit large monthly and seasonal variations directly affected by the local monsoon system, the anthropogenic and natural aerosol emissions. All these aspects are examined in detail aiming at shedding light into the solar dimming phenomenon over a densely populated area. (C) 2011 Elsevier Ltd. All rights reserved.

Solvatochromic Effect on the Photophysical Properties of Two Coumarins

The absorption and emission spectra of two coumarins namely 7, 8 benzo-4-azidomethyl coumarin (C-1) and 6-methoxy-4-azidomethyl coumarin (C-2) have been recorded at room temperature in solvents of different polarities. The ground state dipole moments (mu(g)) of two coumarins were determined experimentally by Guggenheim method. The exited state (mu(e)) dipole moments were estimated from Lippert's, Bakhshievs and Chamma-Viallet's equations by using the variation of Stoke's shift with the solvent dielectric constant and refractive index. The ground and excited state dipole moments were calculated by means of solvatochromic shift method and also the excited state dipole moments are determined in combination with ground state dipole moments. It was observed that dipole moments of excited state were higher than those of the ground state, indicating a substantial redistribution of the pi-electron densities in a more polar excited state for two coumarins.

Synthesis and evaluation of 2,5-di(4-aryloylaryloxymethyl)-1,3,4-oxadiazoles as anti-cancer agents

A series of 2,5-di(4-aryloylaryloxymethyl)-1,3,4-oxadiazoles 9a-j were obtained via multistep synthesis from hydroxybenzophenones 4a-e. The cytotoxicity of compounds 9a-j was evaluated against human leukemia cell lilies (K562 and CEM). The compounds exhibited moderate to good anti-cancer activity with compounds 9b and 9i having a chloro group exhibiting the best activity (IC50 = 10 mu M). Compound 9i exhibited activity against both the cell lines and 9b only exhibited activity against CEM. Further, a lactate dehydrogenase (LDH) assay and DNA fragmentation studies of the compounds 9a-j were also performed. (C) 2013 Elsevier Masson SAS. All rights reserved.

Synthesis and evaluation of 2,5-di(4-aryloylaryloxymethyl)-1,3,4-oxadiazoles as anti-cancer agents

A series of 2,5-di(4-aryloylaryloxymethyl)-1,3,4-oxadiazoles 9a-j were obtained via multistep synthesis from hydroxybenzophenones 4a-e. The cytotoxicity of compounds 9a-j was evaluated against human leukemia cell lilies (K562 and CEM). The compounds exhibited moderate to good anti-cancer activity with compounds 9b and 9i having a chloro group exhibiting the best activity (IC50 = 10 mu M). Compound 9i exhibited activity against both the cell lines and 9b only exhibited activity against CEM. Further, a lactate dehydrogenase (LDH) assay and DNA fragmentation studies of the compounds 9a-j were also performed. (C) 2013 Elsevier Masson SAS. All rights reserved.

Differential proteomic and genomic profiling of mouse striatal cell model of Huntington's disease and control; probable implications to the disease biology

Huntington's disease (HD) is an autosomal dominant disorder of central nervous system caused by expansion of CAG repeats in exon1 of the huntingtin gene (Htt). Among various dysfunctions originated from the mutation in Htt gene, transcriptional deregulation has been considered to be one of the most important abnormalities. Large numbers of investigations identified altered expressions of genes in brains of HD patients and many models of HD. In this study we employed 2D SDS-PAGE/MALDI-MS coupled with 2D-DIGE and real-time PCR experiments of an array of genes focused to HD pathway to determine altered protein and gene expressions in STHdh(Q111)/Hdh(Q111) cells, a cell model of HD and compared with STHdh(Q7)/Hdh(Q7) cells, its wild type counterpart. We annotated 76 proteins from these cells and observed differential expressions of 31 proteins (by 2D-DIGE) involved in processes like unfolded protein binding, negative regulation of neuron apoptosis, response to superoxides etc. Our PCR array experiments identified altered expressions of 47 genes. Altogether significant alteration of 77 genes/proteins could be identified in this HD cell line with potential relevance to HD biology. Biological significance: In this study we intended to find out differential proteomic and genomic profiles in HD condition. We used the STHdh cells, a cellular model for HD and control. These are mouse striatal neuronal cell lines harboring 7 and 111 knock -in CAG repeats in their two alleles. The 111Q containing cell line (STHdh(Q111)/Hdh(Q111)) mimics diseased condition, whereas the 7Q containing ones (STHdh(Q7)/Hdh(Q7)), serves as the proper control cell line. Proteomic experiments were performed earlier to obtain differential expressions of proteins in R6/2 mice models, Hdh(Q) knock -in mice and in plasma and CSF from HD patients. However, no earlier report on proteomic alterations in these two HD cell lines and control was available in literature. It was, therefore, an important objective to find out differential expressions of proteins in these two cell lines. In this study, we annotated 76 proteins from STHdh(Q7)/Hdh(Q7) and STHdh(Q111)/Hdh(Q111) cells using 2D-gel/mass spectrometry. Next, by performing 2D-DIGE, we observed differential expressions of 31 proteins (16 upregulated and 15 downregulated) between these two cell lines. We also performed customized qRT-PCR array focused to HD pathway and found differential expressions of 47 genes (8 gene exptessions increased and 39 genes were decreased significantly). A total of 77 genes/proteins (Htt downregulated in both the studies) were found to be significantly altered from both the experimental paradigms. We validated the differential expressions of Vim, Hypk, Ran, Dstn, Hspa5 and Sod2 either by qRT-PCR or Western blot analysis or both. Out of these 77, similar trends in alteration of 19 out of 31 and 38 out of 47 proteins/genes were reported in earlier studies. Thus our study confirmed earlier observations on differential gene/protein expressions in HD and are really useful. Additionally, we observed differential expression of some novel genes/proteins. One of this was Hypk, a Htt-interacting chaperone protein with the ability to solubilize mHtt aggregated structures in cell lines. We propose that downregulation of Hypk in STHdh-Qm (Q111)/Hdh(Q111) has a causal effect towards HD pathogenesis. Thus the novel findings from our study need further research and might be helpful to understand the molecular mechanism behind HD pathogenesis. (C) 2015 Elsevier B.V. All rights reserved.

Assessment of driver vision functions in relation to their crash involvement in India

Among the human factors that influence safe driving, visual skills of the driver can be considered fundamental. This study mainly focuses on investigating the effect of visual functions of drivers in India on their road crash involvement. Experiments were conducted to assess vision functions of Indian licensed drivers belonging to various organizations, age groups and driving experience. The test results were further related to the crash involvement histories of drivers through statistical tools. A generalized linear model was developed to ascertain the influence of these traits on propensity of crash involvement. Among the sampled drivers, colour vision, vertical field of vision, depth perception, contrast sensitivity, acuity and phoria were found to influence their crash involvement rates. In India, there are no efficient standards and testing methods to assess the visual capabilities of drivers during their licensing process and this study highlights the need for the same.

"Diagnóstico de suelos y aguas superficiales de la subcuenca del Río Waswalí, Matagalpa, Nicaragua"

El estudio se desarrolló en la subcuenca intermunicipal del Río Waswalí, Matagalpa y Jinotega. El objetivo principal fue determinar las restricciones, limitantes y potencialidades de los recursos edáficos y recursos hídricos superficiales, con el fin de proponer la mejor organización funcional del territorio y la posibilidad de usos múltiples, que contribuya a mejorar la calidad y nivel de vida de sus habitantes. La metodología empleada consistió en: la caracterización del estado actual de los recursos edáficos e hídricos superficiales, mediante el diagnostico biofísico el cual se realizó en las ocho microcuencas adscritas al área de estudio. Entre los resultados: Se evidenció que los suelos en la subcuenca han sido utilizados de manera incorrecta 59.79% del área de la subcuenca esta sobreutilizada, aumentando en los últimos años de forma general por factores socioeconómicos y políticos entre estos la falta de planificación y/o explotación inadecuada de los recursos naturales; lo cual ha afectado el ciclo hidrológico provocando la disminución de la disponibilidad del recurso agua y aumentado la vulnerabilidad a eventos que provocan desastres naturales inundaciones, sequías, deslizamientos de tierras. Debido al paisaje heterogéneo existe una mezcla generalizada de usos de suelo, identificando cuatro categorías de las cuales predominan el pasto más cultivos anuales 64.01 % del área total y solo un 35.92 está con café con sombra y bosque, encontrándose en diferentes estados de intervención por las actividades desarrolladas, con el propósito de garantizar la subsistencia alimentaria. Respecto a los recursos híd ricos superficiales según los parámetros morfométricos de la subcuenca permiten que la respuesta ante los eventos lluviosos sea de forma moderada. Así la pendiente media de la subcuenca es del 28%, lo que favorece los procesos erosivos. Según los balances hídricos el período de déficit de agua inicia en la segunda semana de diciembre y finaliza en mayo así mismo estos cálculos nos indican que el almacenamiento máximo (reserva más exceso), aumenta a medida que se da la época lluviosa que corresponde a partir de junio a noviembre. La oferta hídrica es positiva en el área sin embargo, la mayor cantidad de agua se pierde por escorrentía. El Río Apalilí es el que más agua aporta al cauce principal (Río Waswalí).