Untersuchungen zur induzierbaren Expression des Adhäsionsmoleküls E-Selektin und dessen potentieller Bedeutung bei der Tumormetastasierung

In der vorliegenden Arbeit konnte gezeigt werden, dass sowohl die durch TNFalpha-, als auch durch Röntgenstrahlen vermittelte Expression des Adhäsionsmoleküls E-Selektin in Endothelzellen durch kleine GTPasen der Rho-Proteinfamilie reguliert ist. Hemmung dieser kleinen G-Proteine z.B. durch HMG-CoA Reduktase-Inhibitoren (Statine) oder clostridiale Toxine führt zu verminderter Expression von E-Selektin in humanen Endothelzellen (HUVEC; EA.hy-926). Aus den in der Arbeit erhaltenen Ergebnissen kann außerdem die Schlussfolgerung gezogen werden, dass die Regulation der zytokininduzierten E-Selektin-Genexpression von der gamma-Strahlen-vermittelten Expression des E-Selektingens differiert. Für die strahleninduzierte endotheliale E-Selektin-Expression scheint beispielsweise der Transkriptionsfaktor AP-1 als ein weiterer Kontrollfaktor neben NF-kappaB zu fungieren. Des Weiteren konnte in der vorliegenden Arbeit gezeigt werden, dass eine gesteigerte E-Selektin-Proteinexpression mit erhöhter Tumorzelladhäsion und -transmigration an bzw. durch humane Endothelzellen korreliert. Hemmung der TNFalpha- bzw. gamma-Strahlen-induzierten Expression von E-Selektin durch Statine oder Retinsäuren ist ausreichend, sowohl Tumorzelladhäsion als auch Tumorzelldiapedese zu reduzieren. Zusammenfassend lässt sich festhalten, dass das Adhäsionsmolekül E-Selektin eine vielversprechende Zielstruktur ist, über deren kontrollierte Beeinflussung es auch in vivo möglich sein sollte, das Risiko der Metastasierung zu reduzieren. Mit Statinen und Retinsäurederivaten wurden somit Pharmaka identifiziert, die durch Hemmung der Rho-regulierten E-Selektin-Expression der Tumorzellmetastasierung vorbeugen könnten. Um diese Hypothese in zukünftigen tierexperimentelle Studien zu bestätigen, wurde im Rahmen dieser Arbeit mit der Generierung transgener Tiermodelle begonnen.

The bursting behavior of gas slugs: laboratory and analytical insights into Strombolian volcanic eruptions.

The aim of this thesis is to study how explosive behavior and geophysical signals in a volcanic conduit are related to the development of overpressure in slug-driven eruptions. A first suite of laboratory experiments of gas slugs ascending in analogue conduits was performed. Slugs ascended into a range of analogue liquids and conduit diameters to allow proper scaling to the natural volcanoes. The geometrical variation of the slug in response to the explored variables was parameterised. Volume of gas slug and rheology of the liquid phase revealed the key parameters in controlling slug overpressure at bursting. Founded on these results, a theoretical model to calculate burst overpressure for slug-driven eruptions was developed. The dimensionless approach adopted allowed to apply the model to predict bursting pressure of slugs at Stromboli. Comparison of predicted values with measured data from Stromboli volcano showed that the model can explain the entire spectrum of observed eruptive styles at Stromboli – from low-energy puffing, through normal Strombolian eruptions, up to paroxysmal explosions – as manifestations of a single underlying physical process. Finally, another suite of laboratory experiments was performed to observe oscillatory pressure and forces variations generated during the expansion and bursting of gas slugs ascending in a conduit. Two end-member boundary conditions were imposed at the base of the pipe, simulating slug ascent in closed base (zero magma flux) and open base (constant flux) conduit. At the top of the pipe, a range of boundary conditions that are relevant at a volcanic vent were imposed, going from open to plugged vent. The results obtained illustrate that a change in boundary conditions in the conduit concur to affect the dynamic of slug expansion and burst: an upward flux at the base of the conduit attenuates the magnitude of the pressure transients, while a rheological stiffening in the top-most region of conduit changes dramatically the magnitude of the observed pressure transients, favoring a sudden, and more energetic pressure release into the overlying atmosphere. Finally, a discussion on the implication of changing boundary on the oscillatory processes generated at the volcanic scale is also given.

A Phase Space Box-counting based Method for Arrhythmia Prediction from Electrocardiogram Time Series

Arrhythmia is one kind of cardiovascular diseases that give rise to the number of deaths and potentially yields immedicable danger. Arrhythmia is a life threatening condition originating from disorganized propagation of electrical signals in heart resulting in desynchronization among different chambers of the heart. Fundamentally, the synchronization process means that the phase relationship of electrical activities between the chambers remains coherent, maintaining a constant phase difference over time. If desynchronization occurs due to arrhythmia, the coherent phase relationship breaks down resulting in chaotic rhythm affecting the regular pumping mechanism of heart. This phenomenon was explored by using the phase space reconstruction technique which is a standard analysis technique of time series data generated from nonlinear dynamical system. In this project a novel index is presented for predicting the onset of ventricular arrhythmias. Analysis of continuously captured long-term ECG data recordings was conducted up to the onset of arrhythmia by the phase space reconstruction method, obtaining 2-dimensional images, analysed by the box counting method. The method was tested using the ECG data set of three different kinds including normal (NR), Ventricular Tachycardia (VT), Ventricular Fibrillation (VF), extracted from the Physionet ECG database. Statistical measures like mean (μ), standard deviation (σ) and coefficient of variation (σ/μ) for the box-counting in phase space diagrams are derived for a sliding window of 10 beats of ECG signal. From the results of these statistical analyses, a threshold was derived as an upper bound of Coefficient of Variation (CV) for box-counting of ECG phase portraits which is capable of reliably predicting the impeding arrhythmia long before its actual occurrence. As future work of research, it was planned to validate this prediction tool over a wider population of patients affected by different kind of arrhythmia, like atrial fibrillation, bundle and brunch block, and set different thresholds for them, in order to confirm its clinical applicability.

The effects of hypocalcemia on spatial alternans and ventricular fibrillation studied with the optical mapping technique

The heart is a wonderful but complex organ: it uses electrochemical mechanisms in order to produce mechanical energy to pump the blood throughout the body and allow the life of humans and animals. This organ can be subject to several diseases and sudden cardiac death (SCD) is the most catastrophic manifestation of these diseases, responsible for the death of a large number of people throughout the world. It is estimated that 325000 Americans annually die for SCD. SCD most commonly occurs as a result of reentrant tachyarrhythmias (ventricular tachycardia (VT) and ventricular fibrillation (VF)) and the identification of those patients at higher risk for the development of SCD has been a difficult clinical challenge. Nowadays, a particular electrocardiogram (ECG) abnormality, “T-wave alternans” (TWA), is considered a precursor of lethal cardiac arrhythmias and sudden death, a sensitive indicator of risk for SCD. TWA is defined as a beat-to-beat alternation in the shape, amplitude, or timing of the T-wave on the ECG, indicative of the underlying repolarization of cardiac cells [5]. In other words TWA is the macroscopic effect of subcellular and celluar mechanisms involving ionic kinetics and the consequent depolarization and repolarization of the myocytes. Experimental activities have shown that TWA on the ECG is a manifestation of an underlying alternation of long and short action potential durations (APDs), the so called APD-alternans, of cardiac myocytes in the myocardium. Understanding the mechanism of APDs-alternans is the first step for preventing them to occur. In order to investigate these mechanisms it’s very important to understand that the biological systems are complex systems and their macroscopic properties arise from the nonlinear interactions among the parts. The whole is greater than the sum of the parts, and it cannot be understood only by studying the single parts. In this sense the heart is a complex nonlinear system and its way of working follows nonlinear dynamics; alternans also, they are a manifestation of a phenomenon typical in nonlinear dynamical systems, called “period-dubling bifurcation”. Over the past decade, it has been demonstrated that electrical alternans in cardiac tissue is an important marker for the development of ventricular fibrillation and a significant predictor for mortality. It has been observed that acute exposure to low concentration of calcium does not decrease the magnitude of alternans and sustained ventricular Fibrillation (VF) is still easily induced under these condition. However with prolonged exposure to low concentration of calcium, alternans disappears, but VF is still inducible. This work is based on this observation and tries to make it clearer. The aim of this thesis is investigate the effect of hypocalcemia spatial alternans and VF doing experiments with canine hearts and perfusing them with a solution with physiological ionic concentration and with a solution with low calcium concentration (hypocalcemia); in order to investigate the so called memory effect, the experimental activity was modified during the way. The experiments were performed with the optical mapping technique, using voltage-sensitive dye, and a custom made Java code was used in post-processing. Finding the Nolasco and Dahlen’s criterion [8] inadequate for the prediction of alternans, and takin into account the experimental results, another criterion, which consider the memory effect, has been implemented. The implementation of this criterion could be the first step in the creation of a method, AP-based, discriminating who is at risk if developing VF. This work is divided into four chapters: the first is a brief presentation of the physiology of the heart; the second is a review of the major theories and discovers in the study of cardiac dynamics; the third chapter presents an overview on the experimental activity and the optical mapping technique; the forth chapter contains the presentation of the results and the conclusions.

Ruolo dell'elettrocardiogramma standard nella stratificazione prognostica della cardiomiopatia ipertrofica. Studio multicentrico

Lo scopo di questo studio è di valutare il significato prognostico dell'elettrocardiogramma standard in un'ampia casistica di pazienti affetti da cardiomiopatia ipertrofica. In questo studio multicentrico sono stati considerati 841 pazienti con cardiomiopatia ipertrofica (66% uomini, età media 48±17 anni) per un follow-up di 7.1±7.1 anni, per ognuno è stato analizzato il primo elettrocardiogramma disponibile. I risultati hanno dimostrato come fattori indipendentemente correlati a morte cardiaca improvvisa la sincope inspiegata (p 0.004), il sopraslivellamento del tratto ST e/o la presenza di onde T positive giganti (p 0.048), la durata del QRS >= 120 ms (p 0.017). Sono stati costruiti due modelli per predire il rischio di morte improvvisa: il primo basato sui fattori di rischio universalmente riconosciuti (spessore parietale >= 30 mm, tachicardie ventricolari non sostenute all'ECG Holter 24 ore, sincope e storia familiare di morte improvvisa) e il secondo con l'aggiunta delle variabili sopraslivellamento del tratto ST/onde T positive giganti e durata del QRS >= 120 ms. Entrambi i modelli stratificano i pazienti in base al numero dei fattori di rischio, ma il secondo modello risulta avere un valore predittivo maggiore (chi-square da 12 a 22, p 0.002). In conclusione nella cardiomiopatia ipertrofica l'elettrocardiogramma standard risulta avere un valore prognostico e migliora l'attuale modello di stratificazione per il rischio di morte improvvisa.

Interplay between BDNF,TrkB signalling and GABAergic inhibition in the visual cortex of mice

Der visuelle Kortex ist eine der attraktivsten Modellsysteme zur Untersuchung der molekularen Mechanismen der synaptischen Plastizität im Gehirn. Es hat sich gezeigt, dass der Wachstumsfaktor brain-derived-neurotrophic-factor (BDNF) und die GABAerge Hemmung während der Entwicklung eine essentielle Funktion in der Regulierung der synaptischen Plastizität im visuellen Kortex besitzen. BDNF bindet u.a. an TrkB Rezeptoren, die das Signal intrazellular an unterschiedliche Effektormoleküle weiter vermitteln. Außer BDNF sind auch andere TrkB-Rezeptor Agonisten in der Literatur beschrieben. Einer davon ist das kürzlich identifizierte Flavonoid 7,8-Dihydroxyflavone (7,8-DHF), welchem eine neurotrophe Wirkung zugeschrieben wird. Im ersten Abschnitt der vorliegenden Doktorarbeit wurde der Effekt dieses Agonisten auf die synaptische Übertragung und intrinsischen Zelleigenschaften im visuellen Kortex der Maus untersucht. Dies wurde mit Hilfe der whole-cell patch clamp Methode durchgeführt, wobei die synaptischen Eingänge der Pyramidalzellen der kortikalen Schicht 2/3 von besonderem Interesse waren.rnEine 30 minütige Inkubationszeit der kortikalen Schnitte mit 7,8 DHF (20µM) erzielte eine signifikante Reduktion der GABAergen Hemmung, während die glutamaterge synaptische Übertragung unverändert blieb. Des weiteren konnte in Gegenwart von 7,8 DHF eine Veränderung der intrinsischen neuronalen Zellmembraneigenschaften beobachtet werden. Dies wurde deutlich in der Erhöhung des Eingangwiderstandes und der Frequenz der induzierten Aktionspotentiale. Die chronische Applikation von 7,8 DHF in vivo bestätigte die selektive Wirkung von 7,8 DHF auf das GABAerge System. rnDie Rolle des BDNF-TrkB-Signalweges in der GABAergen Hemmung nach kortikalen Verletzungen ist bisher wenig verstanden. Eine häufig beschriebene elektrophysiologische Veränderung nach kortikaler Verletzung ist eine Reduktion in der GABAergen Hemmung. Im zweiten Abschnitt dieser Doktorarbeit wurde hierzu die Funktion des BDNF-TrkB-Signalweges auf die GABAerge Hemmung nach kortikaler Verletzung untersucht. Es wurde ein "ex-vivo/in-vitro“ Laser-Läsions Modell verwendet, wobei mittels eines Lasers im visuellen Kortex von WT und heterozygoten BDNF (+/−) Mäusen eine definierte, reproduzierbare Läsion induziert wurde. Nachfolgende elektrophysiologische Messungen ergaben, dass die Auswirkung einer Verletzung des visuellen Kortex auf die GABAerge Funktion signifikant von der basalen BDNF Konzentration im Kortex abhängt. Des weiteren konnte beobachtet werden, dass nach kortikaler Verletzung in WT Mäusen sowohl die Frequenz der basalen inhibitorischen, postsynaptischen Potentiale (mIPSCs) reduziert war, als auch ein erhöhtes Paired-Pulse Verhältnis vorlag. Diese Ergebnisse deuten auf Veränderungen der präsynaptischen Funktion inhibitorischer Synapsen auf Pyramidalneurone hin. Im Gegensatz dazu konnte in BDNF (+/−) mice Mäusen eine erhöhte und gleichzeitig verlängerte mIPSC-Amplitude beobachtet werden, induziert durch Reizung afferenter Nervenfasern. Hieraus lässt sich schließen, dass kortikale Verletzungen in BDNF (+/−) mice Mäusen Auswirkungen auf die Eigenschaften von postsynaptischen GABAA-Rezeptoren haben. Die nachfolgende Gabe eines TrkB-Rezeptor Antagonisten bestätigte diese Ergebnisse für das GABAerge System post-Läsion. Dies zeigt auch, dass die Änderungen der synaptischen Hemmung nicht auf eine Reduktion der BDNF-Konzentration zurückzuführen sind. Zusammengefasst zeigen die Ergebnisse der vorliegenden Arbeit, dass der BDNF-TrkB Signalweg eine wichtige Rolle in der Reorganisation der GABAergen Hemmung nach kortikalen Verletzungen spielt. So könnte ein TrkB-Rezeptor Agonist, wie das kürzlich entdeckte 7,8-DHF, über eine Modulation der BDNF-TrB Signalkaskade pharmakologisch die funktionelle Reorganisation des Kortex nach einer fokalen Gehirnverletzung fördern. rnrn

Considerations for prenatal counselling of patients with cardiac rhabdomyomas based on their cardiac and neurologic outcomes

Cardiac rhabdomyomas are benign cardiac tumours with few cardiac complications, but with a known association to tuberous sclerosis that affects the neurologic outcome of the patients. We have analysed the long-term cardiac and neurological outcomes of patients with cardiac rhabdomyomas in order to allow comprehensive prenatal counselling, basing our findings on the records of all patients seen prenatally and postnatally with an echocardiographic diagnosis of cardiac rhabdomyoma encountered from August, 1982, to September, 2007. We analysed factors such as the number and the location of the tumours to establish their association with a diagnosis of tuberous sclerosis, predicting the cardiac and neurologic outcomes for the patients.Cardiac complications include arrhythmias, obstruction of the ventricular outflow tracts, and secondary cardiogenic shock. Arrhythmias were encountered most often during the neonatal period, with supraventricular tachycardia being the commonest rhythm disturbance identified. No specific dimension or location of the cardiac rhabdomyomas predicted the disturbances of rhythm.The importance of the diagnosis of tuberous sclerosis is exemplified by the neurodevelopmental complications, with four-fifths of the patients showing epilepsy, and two-thirds having delayed development. The presence of multiple cardiac tumours suggested a higher risk of being affected by tuberous sclerosis. The tumours generally regress after birth, and cardiac-related problems are rare after the perinatal period. Tuberous sclerosis and the associated neurodevelopmental complications dominate the clinical picture, and should form an important aspect of the prenatal counselling of parents.

Variable Na(v)1.5 protein expression from the wild-type allele correlates with the penetrance of cardiac conduction disease in the Scn5a(+/-) mouse model

BACKGROUND: Loss-of-function mutations in SCN5A, the gene encoding Na(v)1.5 Na+ channel, are associated with inherited cardiac conduction defects and Brugada syndrome, which both exhibit variable phenotypic penetrance of conduction defects. We investigated the mechanisms of this heterogeneity in a mouse model with heterozygous targeted disruption of Scn5a (Scn5a(+/-) mice) and compared our results to those obtained in patients with loss-of-function mutations in SCN5A. METHODOLOGY/PRINCIPAL FINDINGS: Based on ECG, 10-week-old Scn5a(+/-) mice were divided into 2 subgroups, one displaying severe ventricular conduction defects (QRS interval>18 ms) and one a mild phenotype (QRS< or = 18 ms; QRS in wild-type littermates: 10-18 ms). Phenotypic difference persisted with aging. At 10 weeks, the Na+ channel blocker ajmaline prolonged QRS interval similarly in both groups of Scn5a(+/-) mice. In contrast, in old mice (>53 weeks), ajmaline effect was larger in the severely affected subgroup. These data matched the clinical observations on patients with SCN5A loss-of-function mutations with either severe or mild conduction defects. Ventricular tachycardia developed in 5/10 old severely affected Scn5a(+/-) mice but not in mildly affected ones. Correspondingly, symptomatic SCN5A-mutated Brugada patients had more severe conduction defects than asymptomatic patients. Old severely affected Scn5a(+/-) mice but not mildly affected ones showed extensive cardiac fibrosis. Mildly affected Scn5a(+/-) mice had similar Na(v)1.5 mRNA but higher Na(v)1.5 protein expression, and moderately larger I(Na) current than severely affected Scn5a(+/-) mice. As a consequence, action potential upstroke velocity was more decreased in severely affected Scn5a(+/-) mice than in mildly affected ones. CONCLUSIONS: Scn5a(+/-) mice show similar phenotypic heterogeneity as SCN5A-mutated patients. In Scn5a(+/-) mice, phenotype severity correlates with wild-type Na(v)1.5 protein expression.

Acute fluid ingestion in the treatment of orthostatic intolerance - important implications for daily practice

Rapid water ingestion improves orthostatic intolerance (OI) in multiple system atrophy (MSA) and postural tachycardia syndrome (PoTS). We compared haemodynamic changes after water and clear soup intake, the latter being a common treatment strategy for OI in daily practice.

Atrial fibrillation in congestive heart failure

Atrial fibrillation (AF) and heart failure (HF) are common and interrelated conditions, each promoting the other, and both associated with increased mortality. HF leads to structural and electrical atrial remodeling, thus creating the basis for the development and perpetuation of AF; and AF may lead to hemodynamic deterioration and the development of tachycardia-mediated cardiomyopathy. Stroke prevention by antithrombotic therapy is crucial in patients with AF and HF. Of the 2 principal therapeutic strategies to treat AF, rate control and rhythm control, neither has been shown to be superior to the other in terms of survival, despite better survival in patients with sinus rhythm compared with those in AF. Antiarrhythmic drug toxicity and poor efficacy are concerns. Catheter ablation of AF can establish sinus rhythm without the risks of antiarrhythmic drug therapy, but has important procedural risks, and data from randomized trials showing a survival benefit of this treatment strategy are still lacking. In intractable cases, ablation of the atrioventricular junction and placement of a permanent pacemaker is a treatment alternative; and biventricular pacing may prevent or reduce the negative consequences of chronic right ventricular pacing.

Dual-energy multidetector CT: how does it work, what can it tell us, and when can we use it in abdominopelvic imaging?

Dual-energy CT provides information about how substances behave at different energies, the ability to generate virtual unenhanced datasets, and improved detection of iodine-containing substances on low-energy images. Knowing how a substance behaves at two different energies can provide information about tissue composition beyond that obtainable with single-energy techniques. The term K edge refers to the spike in attenuation that occurs at energy levels just greater than that of the K-shell binding because of the increased photoelectric absorption at these energy levels. K-edge values vary for each element, and they increase as the atomic number increases. The energy dependence of the photoelectric effect and the variability of K edges form the basis of dual-energy techniques, which may be used to detect substances such as iodine, calcium, and uric acid crystals. The closer the energy level used in imaging is to the K edge of a substance such as iodine, the more the substance attenuates. In the abdomen and pelvis, dual-energy CT may be used in the liver to increase conspicuity of hypervascular lesions; in the kidneys, to distinguish hyperattenuating cysts from enhancing renal masses and to characterize renal stone composition; in the adrenal glands, to characterize adrenal nodules; and in the pancreas, to differentiate between normal and abnormal parenchyma.

Mitral regurgitation

Mitral regurgitation (MR) involves systolic retrograde flow from the left ventricle into the left atrium. While trivial MR is frequent in healthy subjects, moderate to severe MR constitutes the second most prevalent valve disease after aortic valve stenosis. Major causes of severe MR in Western countries include degenerative valve disease (myxomatous disease, flail leaflet, annular calcification) and ischaemic heart disease, while rheumatic disease remains a major cause of MR in developing countries. Chronic MR typically progresses insidiously over many years. Once established, however, severe MR portends a poor prognosis. The severity of MR can be assessed by various techniques, Doppler echocardiography being the most widely used. Mitral valve surgery is the only treatment of proven efficacy. It alleviates clinical symptoms and prevents ventricular dilatation and heart failure (or, at least, it attenuates further progression of these abnormalities). Valve repair significantly improves clinical outcomes compared with valve replacement, reducing mortality by approximately 70%. Reverse LV remodelling after valve repair occurs in half of patients with functional MR. Percutaneous, catheter-based to mitral valve repair is a novel approach currently under clinical scrutiny, with encouraging preliminary results. This modality may provide a valuable alternative to mitral valve surgery, especially in critically ill patients.

Cardiac troponin testing and the simplified Pulmonary Embolism Severity Index. The SWIss Venous ThromboEmbolism Registry (SWIVTER)

A low simplified Pulmonary Embolism Severity Index (sPESI), defined as age ≤80 years and absence of systemic hypotension, tachycardia, hypoxia, cancer, heart failure, and lung disease, identifies low-risk patients with acute pulmonary embolism (PE). It is unknown whether cardiac troponin testing improves the prediction of clinical outcomes if the sPESI is not low. In the prospective Swiss Venous Thromboembolism Registry, 369 patients with acute PE and a troponin test (conventional troponin T or I, highly sensitive troponin T) were enrolled from 18 hospitals. A positive test result was defined as a troponin level above the manufacturers assay threshold. Among the 106 (29%) patients with low sPESI, the rate of mortality or PE recurrence at 30 days was 1.0%. Among the 263 (71%) patients with high sPESI, 177 (67%) were troponin-negative and 86 (33%) troponin-positive; the rate of mortality or PE recurrence at 30 days was 4.6% vs. 12.8% (p=0.015), respectively. Overall, risk assessment with a troponin test (hazard ratio [HR] 3.39, 95% confidence interval [CI] 1.38-8.37; p=0.008) maintained its prognostic value for mortality or PE recurrence when adjusted for sPESI (HR 5.80, 95%CI 0.76-44.10; p=0.09). The combination of sPESI with a troponin test resulted in a greater area under the receiver-operating characteristic curve (HR 0.72, 95% CI 0.63-0.81) than sPESI alone (HR 0.63, 95% CI 0.57-0.68) (p=0.023). In conclusion, although cardiac troponin testing may not be required in patients with a low sPESI, it adds prognostic value for early death and recurrence for patients with a high sPESI.

Effect of intravenous tropisetron on modulation of pain and central hypersensitivity in chronic low back pain patients

The activation of 5-hydroxytryptamine-3 (5-HT-3) receptors in spinal cord can enhance intrinsic spinal mechanisms of central hypersensitivity, possibly leading to exaggerated pain responses. Clinical studies suggest that 5-HT-3 receptor antagonists may have an analgesic effect. This randomized, double-blind, placebo-controlled crossover study tested the hypothesis that the 5-HT-3 receptor antagonist tropisetron attenuates pain and central hypersensitivity in patients with chronic low back pain. Thirty patients with chronic low back pain, 15 of whom were women (aged 53 ± 14 years) and 15 men (aged 48 ± 14 years), were studied. A single intravenous injection of 0.9% saline solution, tropisetron 2mg, and tropisetron 5mg was administrated in 3 different sessions, in a double-blind crossover manner. The main outcome was the visual analogue scale (VAS) score of spontaneous low back pain before, and 15, 30, 60, and 90 minutes after drug administration. Secondary outcomes were nociceptive withdrawal reflexes to single and repeated electrical stimulation, area of reflex receptive fields, pressure pain detection and tolerance thresholds, conditioned pain modulation, and area of clinical pain. The data were analyzed by analysis of variance and panel multiple regressions. All 3 treatments reduced VAS scores. However, there was no statistically significant difference between tropisetron and placebo in VAS scores. Compared to placebo, tropisetron produced a statistically significant increase in pain threshold after single electrical stimulation, but no difference in all other secondary outcomes was found. A single-dose intravenous administration of tropisetron in patients with chronic low back pain had no significant specific effect on intensity of pain and most parameters of central hypersensitivity.

Evaluation of multimeric tyrosine-O-sulfate as a cytoprotectant in an in vivo model of acute myocardial infarction in pigs

Intracoronary administration of glycosaminoglycan analogs, including the complement inhibitor dextran sulfate, attenuates myocardial ischemia/reperfusion injury (I/R injury). However, dextran sulfate has a distinct anticoagulatory effect, possibly limiting its use in specific situations in vivo. We therefore developed multimeric tyrosine sulfate (sTyr-PAA), a novel, minimally anticoagulatory, fully synthetic non-carbohydrate-containing polyacrylamide conjugate, for in vivo testing in an acute closed-chest porcine model of acute myocardial infarction.