Alpha-lipoic acid: effect on glucose uptake, sorbitol pathway, and energy metabolism in experimental diabetic neuropathy.

The peripheral nerve of experimental diabetic neuropathy (EDN) is reported to be ischemic and hypoxic, with an increased dependence on anaerobic metabolism, requiring increased energy substrate stores. When glucose stores become reduced, fiber degeneration has been reported. We evaluated glucose uptake, nerve energy metabolism, the polyol pathway, and protein kinase C (PKC) activity in EDN induced by streptozotocin. Control and diabetic rats received lipoic acid (0, 10, 25, 50, 100 mg/kg). Duration of diabetes was 1 month, and alpha-lipoic acid was administered intraperitoneally 5 times per week for the final week of the experiment. Nerve glucose uptake was reduced to 60, s 37, and 30% of control values in the sciatic nerve, L5 dorsal root ganglion, and superior cervical ganglion (SCG), respectively, in rats with EDN. Alpha-lipoic acid supplementation had no effect on glucose uptake in normal nerves at any dose, but reversed the deficit in EDN, with a threshold between 10 and 25 mg/kg. Endoneurial glucose, fructose, sorbitol, and myo-inositol were measured in sciatic nerve. Alpha-lipoic acid had no significant effect on either energy metabolism or polyol pathway of normal nerves. In EDN, endoneurial glucose, fructose, and sorbitol were significantly increased, while myo-inositol was significantly reduced. Alpha-lipoic acid had a biphasic effect: it dose-dependently increased fructose, glucose, and sorbitol, peaking at 25 mg/kg, and then fell beyond that dose, and it dose-dependently increased myo-inositol. Sciatic nerve cytosolic PKC was increased in EDN. ATP, creatine phosphate, and lactate were measured in sciatic nerve and SCG. Alpha-lipoic acid prevented the reduction in SCG creatine phosphate. We conclude that glucose uptake is reduced in EDN and that this deficit is dose-dependently reversed by alpha-lipoic acid, a change associated with an improvement in peripheral nerve function.

Flavonoids from Cleome droserifolia suppress NO production in activated macrophages in vitro.

The effect of an Egyptian medicinal plant, Cleome droserifolia (Forssk.) Del. on nitric oxide (NO) production in bacillus Calmette-Guérin-induced mouse peritoneal macrophages activated by lipopolysaccharide was investigated in vitro. The methanol extract of C. droserifolia reduced the NO production, and two flavonoids were isolated as the active components. The new one was determined to be 5,4'-dihydroxy-6,7,8,3',5'-pentamethoxyflavone (1) and the other was identified as 5,4'-dihydroxy-6,7,8,3'-tetramethoxyflavone (8-methoxycirsilineol; 2). Compound 1 concentration-dependently suppressed the NO production and was effective at a non-toxic concentration (12.5 micrograms/ml). The suppressive activity of 2 was weaker than that of 1.

Integrating medical and psychiatric treatment in an inpatient medical setting. The type IV program.

This study compares the treatment of patients with comorbid medical and psychiatric illness admitted to a high-acuity (Type IV) integrated medicine and psychiatry inpatient program with patients having psychiatric symptoms on general internal medicine wards (IMWs). More patients in the Type IV program had agitation, suicidal ideation, or psychosis as psychiatric admission behaviors when compared to IMW patients. Medical symptom improvement was comparable in the two settings, whereas, psychiatric symptoms improved more in the Type IV Program than on the IMWs despite more significant illness and comparable lengths of stay. Integrated care on the Type IV unit allowed shorter total lengths of stay for medical patients with serious psychiatric illness than would have occurred had the traditional sequential approach to care been used. The integrated Type IV medicine and psychiatry treatment program represents an efficient and effective process improvement in the way that medical patients with comorbid medical and psychiatric illness can be treated.

A preliminary study of staff perception of psychiatric services in general hospitals.

There has been increasing recognition of the importance of integrating physical and psychiatric care under growing economic pressure. We conducted a survey of staff perception on psychiatric services in four general hospitals. The purpose of this study was to see differences among the staff in their recognition and expectation of the role of the psychiatric department and the need for psychiatric and other staff to work more closely together. Although 81% of psychiatrists recognized their role in acute psychiatry, only 42.6% thought that acute psychiatry was the most important role of psychiatry. Mood disorders were recognized as a psychiatric category in 95.2% of psychiatrists and 54.8% of nonpsychiatrist physicians. Overall satisfaction with psychiatric services in psychiatric and other staff were 54.0% and 68.2%, respectively. Although 85.7% of psychiatrists answered that they supported staff in other departments that have psychiatric or psychological problems, only 53.5% of those staff in other departments were satisfied with their support. Staff in other departments expected psychiatric staff to establish consultation hotlines and to visit other departments regularly. Our results suggest that there are discrepancies between psychiatric and other staff in their perception of psychiatric services, and it is our belief that those gaps must be bridged for better collaboration in general hospitals.

Impaired NO release from bovine aortic endothelial cells exposed to activated platelets.

We have previously shown that aggregated human platelets elicited a decrease in intracellular adenosine triphosphate (ATP), enhanced adenosine egress and damage to mitochondria in bovine aortic endothelial cells (ECs). To test whether such metabolic and ultrastructural changes could be associated with functional impairment of ECs, we investigated the effects of activated platelets on nitric oxide (NO) and prostacyclin release, and on the antiaggregation property of ECs. Pretreatment of ECs with aggregated platelets transiently stimulated basal NO release while prolonged (> or = 30 min) exposure dose-dependently inhibited NO release, both basal and in response to ATP or serotonin, with NO synthase activity being attenuated in these cells. Supplementary L-arginine (L-A) restored NO release completely. Prostacyclin release was also stimulated transiently but not affected by prolonged pretreatment. The antiaggregation property of ECs was attenuated by pretreatment with activated platelets but restored with L-A supplement. Although the effects of activated platelets and 0.5 mM acetylsalicylic acid (ASA) to attenuate the antiaggregation property of ECs were additive, activated platelets had no effect on ECs treated with 0.2 mM N omega-nitro-L-arginine (L-NA), suggesting a common mechanism. We conclude that prolonged exposure to aggregated platelets may affect the antiaggregation property of ECs by directly inhibiting NO synthesis, which may be normalized by L-A supplementation.

Ingested arsenic and internal cancer: a historical cohort study followed for 33 years.

A historical cohort study was conducted to investigate the long-term effect of exposure to ingested arsenic. The 454 residents who had been identified in a list made in 1959 were followed until 1992. They lived in an arsenic-polluted area, called Namiki-cho, Nakajo-machi, in Niigata Prefecture, Japan, and used well water containing inorganic arsenic. The exposure period was estimated to be about 5 years (1955-1959). Death certificates for the people who died between 1959 and 1992 were examined, and a total of 113 of the 454 residents were estimated to have drunk well water containing a high dose of arsenic (> or = 1 ppm). The standardized mortality rate ratios of these 113 residents were 15.69 for lung cancer (observed/expected = 8/0.51; 95% confidence interval (CI) 7.38-31.02) and 31.18 for urinary tract cancer (observed/expected = 3/0.10; 95% CI 8.62-91.75). Cox's proportional hazard analyses demonstrated that the hazard ratios of the highest exposure level group (> or = 1 ppm) versus the background exposure level group (0.001 ppm) were 1.74 (95% CI 1.10-2.74) for all deaths and 4.82 (95% CI 2.09-11.14) for all cancers. The analysis according to the skin signs of chronic arsenicism in 1959 showed that they were useful risk indicators for subsequent cancer development. In the development of lung cancer, there was evidence of synergism between arsenic intake and smoking habit.

From Luc and Phot genes to the hospital bed.

The Luc gene from the firefly Photinus pyralis has been isolated by cloning it in pcDV1 PL plasmid primer and Honjo linker and the Phot gene isolated from Aequorea victoria using the polymerase chain reaction. A method has been established using SP6 RNA polymerase for transcribing and translating bioluminescent genes in vitro. It should now be possible to engineer these genes to measure intracellular ATP and the covalent modification of proteins in single, live cells, providing unique insights into the molecular basis of disease.

Semi-synthetic aequorin. An improved tool for the measurement of calcium ion concentration.

The photoprotein aequorin isolated from the jellyfish Aequorea emits blue light in the presence of Ca2+ by an intramolecular process that involves chemical transformation of the coelenterazine moiety into coelenteramide and CO2. Because of its high sensitivity to Ca2+, aequorin has widely been used as a Ca2+ indicator in various biological systems. We have replaced the coelenterazine moiety in the protein with several synthetic coelenterazine analogues, providing semi-synthetic Ca2+-sensitive photoproteins. One of the semi-synthetic photoproteins, derived from coelenterazine analogue (II) (with an extra ethano group), showed highly promising properties for the measurement of Ca2+, namely (1) the rise time of luminescence in response to Ca2+ was shortened by approx. 4-fold compared with native aequorin and (2) the luminescence spectrum showed two peaks at 405 nm and 465 nm and the ratio of their peak heights was dependent on Ca2+ concentration in the range of pCa 5-7, thus allowing the determination of [Ca2+] directly from the ratio of two peak intensities. Coelenterazine analogue (I) (with a hydroxy group replaced by an amino group) was also incorporated into apo-aequorin, yielding a Ca2+-sensitive photoprotein, which indicates that an electrostatic interaction between the phenolate group in the coelenterazine moiety and some cationic centre in apo-aequorin is not important in native aequorin, contrary to a previous suggestion.

Haemodynamic effects of nicardipine hydrochloride. Studies during its use to control acute hypertension in anaesthetized patients.

Fourteen patients with vascular disease were studied to evaluate the efficacy of nicardipine hydrochloride as a hypotensive agent in the treatment of acute hypertension occurring during anaesthesia. Five patients received a bolus injection of nicardipine hydrochloride 0.5 mg. Another nine patients received bolus injections of nicardipine 1 and 2 mg. Nicardipine 0.5 mg significantly decreased systemic arterial pressure (by about 24%), systemic vascular resistance (SVR), left ventricular stroke work index (LVSWI) and rate-pressure product (RPP). Nicardipine 1 or 2 mg had twice the effect in decreasing arterial pressure as did 0.5 mg, without significant change in heart rate or right and left ventricular filling pressures. Cardiac index and stroke volume index increased and SVR, pulmonary vascular resistance, LVSWI and RPP decreased significantly.