Severe pulmonary hypertension as the initial manifestation of systemic lupus erythematosus: a case report and review of the literature.

Severe pulmonary arterial hypertension (PAH) is rarely observed as the initial manifestation of systemic lupus erythematosus (SLE), and the diagnosis is often delayed. Here we present the case of a 32-year-old woman with severe PAH as the initial manifestation of SLE, who was successfully treated with mycophenolate mofetil and cyclosporine. This case offered the opportunity to critically review the epidemiology data, predictive markers, and pathogenic pathways of SLE-associated PAH (SLE-PAH) in relation to the currently available therapeutic options and to the main clinical trials of the last 10 years focused on the treatment of SLE-PAH. Mycophenolate mofetil and cyclosporine - currently used in the maintenance phase of the disease in certain clinical settings - should be considered, as an alternative to cyclophosphamide, in future clinical trials aimed at evaluating the most effective treatment of SLE-PAH at presentation.

Failure of metoclopramide to affect thyrotropin concentration in the term human fetus.

Metoclopramide (MET), a potent dopamine receptor-blocking drug, or saline was administered to 125 term pregnant women at various time intervals (5-412 min) before delivery. Maternal serum was obtained before and after MET injection. Cord blood was obtained at delivery in MET-treated and saline-treated (control group) women. No significant changes in serum TSH, T4, T3, or rT3 concentrations were observed in maternal or cord blood after MET administration. These results suggest that, in contrast to euthyroid nonpregnant women and men, MET administration does not induce a rise in serum TSH concentration in term pregnant women or in the term fetus. Thus, the dopaminergic inhibitory effect on anterior pituitary TSH secretion may not be an important factor in TSH regulation during pregnancy or in the fetus, or the dose of MET employed may be unable to overcome the dopamine inhibitory effect.

Mutagenic activity of high-energy 532 nm ultra-short laser pulses.

The mutagenic activity of green (532 nm) and infrared (1064 nm) ultra-short laser light pulses was tested in cultured Syrian hamster fibroblasts by a hypoxanthine phosphoribosyl-transferase (HPRT) mutagenesis assay. In 18 irradiation trials, cells were exposed to eight consecutive 100-ps pulses of either 532 nm or 1064 nm light from a Nd:YAG laser at average irradiances of 3.0 GW/cm2. The 532 nm irradiations produced Hprt mutations at an average observed frequency of 5.3-5.6 x 10(-6), 10-fold higher than control trials (P < 0.01), while 1064 nm irradiations produced only background (spontaneous mutation) frequencies. A HAT (hypoxanthine, aminopterin, thymidine) sensitivity test allowed us to infer that Hprt- clones, selected as 6-thioguanine-resistant clones, possessed mutations at the Hprt locus after 532 nm Nd:YAG laser irradiation. The mutagenic effects of 532 nm high-energy laser pulses and not 1064 nm wavelengths are discussed in light of a two-photon absorption hypothesis. These preliminary findings suggest that 460-590 nm visible-light lasers may be mutagenic to mammalian cells either as a result of two-photon absorption or through some other photochemical process that damages DNA.

Effects of physiological changes of serum glucose on the pattern-VEP of healthy volunteers.

The correlation between amplitude and latencies of the pattern-reversal VEP (1.7-3.6 50% contrast) and the serum glucose was studied in six healthy, male volunteers (21-26 yr.; mean: 23.2 +/- 1.6 yr.). Pattern-VEP and serum glucose were obtained at 2-h intervals during a 8-h experimental session. The effect of spatial frequency on VEP (increased latencies and amplitude with increasing spatial frequency) was removed statistically by computing the residuals from the nonlinear regression function vs. the spatial frequency. The residuals were then processed as stimulus-independent variables. At glucose serum concentrations within the physiological range of variability (55-103 mg/dl), the P100 latency increased (p < 0.04) with increasing serum glucose, with a 6.9% estimated latency difference between lower and higher glucose concentrations. This correlation depends mostly on the association of shorter and longer P100 latencies with glucose concentration values in the lower and upper portions of the normal concentration range respectively, but accounts for about 4% of the overall variance and may be accidental (therefore a potential bias in otherwise controlled VEP studies) or suggest functional relationships between glucose availability and vision.

Automatic perimetry and visual P300: differences between upper and lower visual fields stimulation in healthy subjects.

Human visual-evoked potentials (VEPs) from upper and lower hemifield stimulation are thought to reflect the anatomical and functional differences between the hemiretinas and corresponding visual pathways. Conflicting results have, however, been reported in topographic studies on the putative cortical generators. We have estimated by automatic perimetry (Octopus 2000R, Program 32) and compared the sensitivity thresholds of lower and upper hemifields of the retina in 12 healthy subjects with no history or evidence of visual or neurological diseases. A visual P3 that is linked to cognitive function was recorded in an odd-ball paradigm with presentation of high-contrast checkerboards at two different spatial frequencies at 20 degrees eccentricity in each hemifield. VEP and P3 were recorded at O1 and O2 and at Cz according to the 10/20 international system. Lower sensitivity thresholds were found, and higher VEP and event-related potential (ERP) amplitude values were obtained when stimulating the lower, compared with the upper, visual hemifield. The results are consistent with previous findings and anatomical and physiological evidence in animals and man. Interactions between perceptive process in the visual system and higher cognitive functions are a possible explanation for this finding.

Extracellular cyclic AMP during development of the cellular slime mold Polysphondylium violaceum: comparison of accumulation in the wild type and an aggregation-defective mutant.

Cyclic AMP was synthesized by Polysphondylium violaceum after starvation and during the preaggregation stage of development. Most of the newly synthesized cyclic AMP accumulated in the extracellular medium, with very little change in the intracellular cyclic AMP concentration. The addition of 10(-3) to 10(-6) M exogenous cyclic AMP to starved amoebae caused a 20 to 50% decrease in the number of aggregation centers formed compared with untreated controls. An aggregation-defective mutant of P. violaceum (strain aggA586) excreted or accumulated very little cyclic AMP. Strain aggA586 aggregated normally in the presence of a dialyzable, excreted product (D factor) produced by wild-type amoebae. When the mutant was incubated with D factor, cyclic AMP accumulated in the medium, and the amount accumulated depended on the amount of D factor added to the mutant amoebae.

Purification, characterization, and partial structure of D factor from Polysphondylium violaceum.

The A component of D factor (DfA) was overproduced during development of wild type Polyspondylium violaceum strain China after starvation in liquid medium. Crude DfA excreted by strain China was partially purified by ultrafiltration using Amicon YM10 and YM2 filters with DfA extracted from the filtrate by absorption onto a preparative grade C-18 resin. The concentrated material was further purified on a C-18 analytical column using both acetonitrile:water and methanol:water gradients. This highly purified fraction was a single component with a final specific activity of greater than 10(6) units per mg dry weight. Purified DfA is red having a broad visible absorbance at 500 nm and a ultraviolet (uv) absorbance at 290-300 nm. The red chromophore is sensitive to pH and to oxidation-reduction. 1H and 13C nmr studies with purified DfA indicate that it is a C11 compound with both polar and non-polar regions. The non-polar region has been identified as a hexanone and is the same as the side chain of DIF from Dictyostelium discoideum. Purified DfA has been used in studies with the D factor non-producing mutant, tsg-119 cyc-1 aggA586 (A586), to show that neither production of glorin nor chemotactic sensitivity to glorin are affected by D factor. However, founder cells develop in A586 mutant populations only after addition of D factor. These data suggest that DfA may be necessary for induction of aggregate formation by aggregation-competent amoebae.

Developmental regulation of production of an aggregation-stimulating factor from the cellular slime mold Polysphondylium violaceum.

An excreted, dialyzable component(s) produced during development of wild-type Polysphondylium violaceum has been previously shown to stimulate aggregation of aggregateless mutants in the complementation group aggA. Production of this aggregation-stimulating factor, called D factor, is greater during development in liquid culture than during development on a surface. after partial purification of crude D factor using high performance liquid chromatography, multiple species are found that retain the ability to stimulate aggregation of the aggA mutants. The three major components (DfA, DfB, and DfC) show decreasing polarity based on purification using reverse-phase chromatography. The proportion of each component secreted varies, depending on the developmental conditions (surface versus liquid) and the time after starvation when the factors are isolated. Preliminary physical and chemical characterization of the three D factor components suggests that they are related.

Microbiologic contamination during dental radiographic film processing.

This study investigated microbiologic contamination of an automatic dental radiograph processor and daylight loader during a week of simulated clinical use. Pure cultures of Candida albicans, Streptococcus pneumoniae, Staphylococcus aureus, or Klebsiella pneumoniae were used to contaminate 320 vinyl intraoral radiograph packets. Each end of the films was deliberately contaminated during opening. These films and 24 uncontaminated control films were processed. Daylight loader ports, inlet and outlet rollers, fixer and developer samples, and 12 processed films were cultured daily. To simulate a weekend, the processor sites were cultured during 72 hours of inactivity after the contaminated runs. The results showed that contamination of the processor and daylight loader occurred and remained even after 48 hours of inactivity. Films remained contaminated after processing. In addition, cross-contamination of films occurred in the processor.

Effect of metoclopramide on maternal and fetal hyperprolactinemia.

To investigate the effect of metoclopramide (MET), a dopaminergic antagonist drug, on serum PRL concentration in maternal and cord blood (CB) serum, the drug was injected in 94 at term pregnant women whereas 28 mothers received saline. Maternal serum (MS) samples were obtained before MET injection and at the parturition time. According to the interval of time between MET administration and birth, MS specimens were grouped in 7 groups. CB was obtained from neonates whose mothers were injected with saline, group 0 and from newborns whose mothers were treated with MET, groups 1 to 7. In the 7 groups of women the mean PRL concentration before MET ranged between 307 and 439 ng/ml. After MET injection a significant increase has been observed in all groups with a minimum and maximal mean value of 639 and 931 ng/ml. The highest net increment of PRL has been measured in group 1 sampled at 5 to 30 minutes after MET. CB PRL concentration in group 0, saline treated, was not different from the values measured in group 1 to 7, treated groups, with a range between 504 and 703 ng/ml. These findings suggest that maternal lactotropes are still responsive to MET. On the opposite, fetal pituitary does not release PRL after MET injection probably because PRL secretory activity is maximal or because the dopaminergic receptors' system is still immature.

Inhibition by somatostatin of LH-RH-induced LH release in normal menstruating women.

The present study was carried out in order to establish whether the concomitant treatment with somatostatin (SRIH) is capable of modifying gonadotrophin release in response to LH-RH administration in normal women during follicular, periovulatory, and luteal phases. SRIH was administered in a dose of 5.55 micrograms/min over 180 min and LH-RH (100 micrograms) was injected as a bolus at 90 min after the beginning of SRIH infusion. Within the dose used, SRIH significantly reduced LH response to LH-RH, whereas it did not alter FSH response to LH-RH. These results suggest that SRIH may play a part in the regulation of LH secretion in normal women.