Mechanical arm trainer for the treatment of the severely affected arm after a stroke: a single-blinded randomized trial in two centers.

OBJECTIVE: To test whether training with a new mechanical arm trainer leads to better outcomes than electrical stimulation of the paretic wrist extensors in subacute stroke patients with severe upper limb paresis. Electrical stimulation is a standard and reimbursable form of therapy in Germany. DESIGN: Randomized controlled trial of 54 inpatients enrolled 4-8 wks from stroke onset, mean upper-extremity subsection of Fugl-Meyer assessment (0-66) at admission less than 18. In addition to standard care, all patients practiced 20-30 mins arm trainer or electrical stimulation every workday for 6 wks, totaling 30 sessions. Primary outcome was the Fugl-Meyer assessment, secondary outcomes were the Box and Block test, the Medical Research Council and the modified Ashworth scale, blindly assessed at enrollment, after 6 wks, and at 3-mo follow-up. RESULTS: Both groups were homogeneous at study onset. Shoulder pain occurred in two arm trainer patients. The primary Fugl-Meyer assessment outcome improved for both groups over time (P < 0.001), but this improvement did not differ between groups. The initial (terminal) mean Fugl-Meyer assessment scores were 8.8 +/- 4.8 (19.2 +/- 14.5) for the arm trainer and 8.6 +/- 3.5 (13.6 +/- 7.9) for the electrical stimulation group. No patient could transport a block initially, but at completion significantly more arm trainer patients were able to transport at least three blocks (five vs. zero, P = 0.023). No significant differences were observed between the groups on the secondary Box and Block outcome at follow-up (eight vs. four patients). All Box and Block responders had an initial Fugl-Meyer assessment > or =10. CONCLUSIONS: Arm trainer training did not lead to a superior primary outcome over electrical stimulation training. However, "good performers" on the secondary outcome seemed to benefit more from the arm trainer training.

Antibacterial and antifungal activities of Quassia undulata and Quassia amara extracts in vitro.

Extracts of Quassia undulata and Quassia amara (Simaroubaceae) were screened for in vitro antibacterial and antifungal properties respectively. A total of eight extracts, comprising hexane and methanol extracts of the leaves and stems of each of the two plants were investigated. At a concentration of 5 mg/ml all eight extracts exhibited marked antibacterial and antifungal activities in most cases higher than the standard reference drugs included in the study. The extracts inhibited the growth of Escherichia coli, Streptococcus faecalis, Stapylococcus aureus and Aspergillus niger, even when the standard reference drugs utilized in the study did not. Quassia amara leaf methanol extract singularly exhibited the highest activities in both assays, which included the use of six clinical strains of bacteria and five fungi. The agar cup (10 mm diameter) diffussion and broth dilution techniques were used in both assays, utilising eleven human pathogenic microorganisms. Ampicillin and tioconazole were also included in the assay as reference compounds, while methanol was used as control. Diameter of zones of inhibition ranged between 11.0-29.0 mm for the tested extracts/drugs. All the extracts have shown impressive activities against the commonly encountered microorganisms and have thus confirmed the folklore uses of the plants in the African ethnomedicine.

Eleganoside-A, B and C from Pseudocalymma elegans, a native of Brazil.

The toxic methanol-soluble part of Pseudocalymma elegans (leaves), a native of Brazil, yielded three new iridoidglucosides (1a-3a) as their acetate-derivatives (1-3) named eleganoside-A (1a), B (2a) and C (3a) which have been characterized with the aid of spectroscopic techniques, including 2D NMR.

Influência da administraçäo de extratos de duas plantas calcinogênicas sobre a fertilidade de ratos / Effect of calcinogenic plant extracts on rat fertility

Investigou-se o efeito de extratos aquosos de Solanum malacoxylon (Sendter) Solanaceae (SM) (sin.: S. glaucophyllum) e Nierembergia veitchii (Hook) Solanaceae (NV), plantas calcinogênicas encontradas no Brasil, sobre a reproduçäo de ratos e sobre suas progênies. No experimento 1, ratos e ratas Wistar, em número variável conforme o grupo, receberam por via oral, durante os 40 dias anteriores ao acasalamento, extrato aquoso de ambas as plantas em dosagem equivalente à administraçäo diária de 10,9gxkg elevado a menos um de planta seca. Os resultados foram comparados com os de um grupo tratado diariamente com vitamina D3 (3,0mgxkg elevado a menos um) e com os de um grupo-controle (salina). No experimento 2, ratas prenhes receberam, por via oral, três diferentes doses dos extratos de ambas as plantas (equivalentes à administraçäo diária de 5,4; 10,9 e 21,7gxkg elevado a menos um de planta seca), durante toda a gestaçäo. Os resultados foram comparados com três grupos tratados com vitamina D3 (0,75; 2,25 e 3,75mgxkg elevado a menos um) e um grupo-controle (salina). Quando administradas antes da gestaçäo, o ganho de peso das fêmeas e a fertilidade foram reduzidos nos grupos tratados com SM (11 por cento) e vitamina D3 (11 por cento). No grupo tratado com NV, a fertilidade também foi reduzida (25 por cento), mas o desenvolvimento ponderal durante o tratamento näo foi afetado. Nos grupos tratados com SM e vitamina D3 anterior à gestaçäo, o número de filhotes por ninhada foi reduzido, assim como o seu peso ao nascer. Características de desenvolvimento e desempenho físico dos filhotes näo foram afetados em nenhum dos grupos. O tratamento das fêmeas com extrato aquoso de SM durante a gestaçäo causou reduçäo significativa e dose-dependente nas características reprodutivas estudadas. O mesmo foi observado com as fêmeas tratadas com vitamina D3. Com o extrato aquoso de NV näo foram observadas reduçöes nas taxas reprodutivas, quando as fêmeas foram tratadas durante a gestaçäo. Com as doses 10,9 e 21,7xkg elevado a menos um de NV foram observadas anomalias morfológicas fetais (2,3 e 0,1 por cento, respectivamente), também presentes nos filhotes de fêmeas tratadas com vitamina D3 (2,25mgxkg elevado a menos um). A presença de vitamina D3 e seus metabólitos nas plantas calcinogênicas provavelmente é responsável pela infertilidade observada, näo somente devido à toxicidade sistêmica, mas também devido aos seus efeitos específicos sobre o aparelho reprodutor

In vivo antimalarial activities of Quassia amara and Quassia undulata plant extracts in mice.

Extracts obtained from two Nigerian Simaroubaceae plants, Quassia amara L. and Quassia undulata (Giull and Perr) D. Dietr were screened for antimalarial properties using a total of six extracts. The plant extracts showed significant antimalarial activities in the 4 day suppressive in vivo antimalarial assay in mice inoculated with red blood cells parasitized with Plasmodium berghei berghei. Plant extracts were studied at 100 mg and 200 mg per kg body weight mouse per day, respectively. At a concentration of 100 mg/kg of mouse, Q. amara leaf hexane extract had the highest suppressive activity with a parasite density of 0.16 +/- 0.001%. Q. amara leaf methanol extract had an outstanding activity; of 0.05 +/- 0.03% at 200 mg/kg. Chloroquine (10 mg/kg, positive control) had a suppressive activity of 0.34 +/- 0.02 in the same assay on day 4.

Respiratory syncytial virus infection: its role in aeroallergen sensitization during the first two years of life.

Our aim was to study the influence of infection with the respiratory syncytial virus (RSV) in non-hospitalized infants on sensitization to aeroallergens and the early manifestation of atopy. Six hundred and nine infants from the prospective German Multicenter Cohort Study on Atopy were included, 38% of whom had an elevated atopic risk. RSV IgG and IgM antibodies were tested by ELISA with gradient purified RSV antigen. Specific IgE against mites, cat dandruff, birch and grass pollens and relevant nutritional antigens were tested with CAP-RAST-FEIA (Pharmacia, Sweden). Of the cord sera 99% were positive for RSV-IgG, 44.7% at one year and 64.2% (n = 265) at two years of age. The positivity rate after 12 months varied with the season of birth, the number of siblings and the degree of exposure to tobacco smoke; and correlated closely with attacks of wheezing during infancy. Twenty (2.8%) children were found to be sensitized against at least one aeroallergen at one year, and 28 (10.5%) at two years. By the first birthday, mite sensitization (n = 3) could only be seen in the RSV-infected children; grass pollen sensitization (n = 9) was associated with RSV seropositivity (logistic regression model including the confounders mentioned above: with RSV IgG < p = 0.048 > and IgM < p = 0.0006 >), as was birch sensitization (n = 5) with RSV IgM (p = 0.009). No such differences could be detected at two years. No correlation of RSV seropositivity to any allergic manifestation could be found. We conclude, that it is only in the first year of life, that RSV infection plays a significant role in promoting sensitization against aeroallergens, which do not at this time produce allergic symptoms.

Qualitative and quantitative determination of fluoroacetic acid in Arrabidea bilabiata and Palicourea marcgravii by 19F-NMR spectroscopy.

Qualitative and quantitative examination of Arrabidea bilabiata and Palicourea marcgravii by 19F-NMR spectroscopy has shown the presence of fluoroacetic acid. By acid-base enrichment it is possible to detect amounts of fluoroacetic acid which otherwise are below detection rate. The detection limit (without enrichment) is estimated to be about 4 micrograms/g. Disturbing metal ions of higher oxidation states are also removed by this way. Arrabidea bilabiata contains 64.1 micrograms/g (seeds) and 3.0 micrograms/g (leaves), and Palicourea marcgravii contains 5.4 micrograms/g (leaves).

The CO2 laser for recurrent and therapy-resistant condylomata acuminata.

The medical records of 48 patients who underwent laser vaporization of therapy-resistant or recurrent condylomata acuminata were studied with regard to history of immunosuppression, location of original lesion, type and duration of therapy, and whether magnification devices were used prior to or during therapy. The genitalia of the patients' sexual partners were examined in all cases in which the condylomata recurred after initial control of the lesions with conventional methods. In 46 of the 48 cases, possible reasons for the failure of conventional therapy could be found: unresponsive to chemical therapy (11 patients); reinfection by the sexual partner (4); immunosuppression (8); several factors (6); and incomplete eradication of the lesion (20). Thirty-eight of the 48 patients (79%) were treated successfully with one-time laser ablation of the lesions. Six patients with recurrent condylomata after laser therapy underwent a second laser treatment, and four of the six patients (total, 87%) have remained free of disease. The laser appears to be an effective method of treatment for recurrent or persistent condylomata acuminata provided that (1) the patient is not immunosuppressed, (2) the potentially infected sexual partner is examined and treated, if necessary, and (3) the external genitalia, including the anus, vagina and cervix, are carefully examined colposcopically to rule out the persistence of small lesions.

The August Krogh Principle: "For many problems there is an animal on which it can be most conveniently studied".

The idea stated in the title, first clearly expressed by August Krogh, is illustrated by examples from animal biochemistry, physiology, general cell biology, experimental medicine, ethology and botany. General aspects of the concept are discussed.

Fatty acid metabolism in the perfused rat liver.

1. The formation of acetoacetate, beta-hydroxybutyrate and glucose was measured in the isolated perfused rat liver after addition of fatty acids. 2. The rates of ketone-body formation from ten fatty acids were approximately equal and independent of chain length (90-132mumol/h per g), with the exception of pentanoate, which reacted at one-third of this rate. The [beta-hydroxybutyrate]/[acetoacetate] ratio in the perfusion medium was increased by long-chain fatty acids. 3. Glucose was formed from all odd-numbered fatty acids tested. 4. The rate of ketone-body formation in the livers of rats kept on a high-fat diet was up to 50% higher than in the livers of rats starved for 48h. In the livers of fat-fed rats almost all the O(2) consumed was accounted for by the formation of ketone bodies. 5. The ketone-body concentration in the blood of fat-fed rats rose to 4-5mm and the [beta-hydroxybutyrate]/[acetoacetate] ratio rose to 11.5. 6. When the activity of the microsomal mixed-function oxidase system, which can bring about omega-oxidation of fatty acids, was induced by treatment of the rat with phenobarbitone, there was no change in the ketone-body production from fatty acids, nor was there a production of glucose from even-numbered fatty acids. The latter would be expected if omega-oxidation occurred. Thus omega-oxidation did not play a significant role in the metabolism of fatty acids. 7. Arachidonate was almost quantitatively converted into ketone bodies and yielded no glucose, demonstrating that gluconeogenesis from poly-unsaturated fatty acids with an even number of carbon atoms does not occur. 8. The rates of ketogenesis from unsaturated fatty acids (sorbate, undecylenate, crotonate, vinylacetate) were similar to those from the corresponding saturated fatty acids. 9. Addition of oleate together with shorter-chain fatty acids gave only a slightly higher rate of ketone-body formation than oleate alone. 10. Glucose, lactate, fructose, glycerol and other known antiketogenic substances strongly inhibited endogenous ketogenesis but had no effects on the rate of ketone-body formation in the presence of 2mm-oleate. Thus the concentrations of free fatty acids and of other oxidizable substances in the liver are key factors determining the rate of ketogenesis.

Gluconeogenesis from propionate in kidney and liver of the vitamin B12-deficient rat.

1. Kidney-cortex slices and the perfused livers of vitamin B(12)-deficient rats removed propionate from the incubation and perfusion media at 33 and 17% respectively of the rates found with tissues from rats receiving either a normal or a vitamin B(12)-supplemented diet. There was a corresponding fall in the rates of glucose synthesis from propionate in both tissues. 2. The addition of hydroxocobalamin or dimethylbenzimidazolylcobamide coenzyme to kidney-cortex slices from vitamin B(12)-deficient rats in vitro failed to restore the normal capacity for propionate metabolism. 3. Although the vitamin B(12)-deficient rat excretes measurable amounts of methylmalonate, no methylmalonate production could be detected (probably because of the low sensitivity of the method) when kidney-cortex slices or livers from deficient rats were incubated or perfused with propionate. 4. The addition of methylmalonate (5mm) to kidney-cortex slices from rats fed on a normal diet inhibited gluconeogenesis from propionate by 25%. 5. Methylmalonate formation is normally only a small fraction of the flux through methylmalonyl-CoA. This fraction increases in vitamin B(12)-deficient tissues (as shown by the urinary excretion of methylmalonate) presumably because the concentration of methylmalonyl-CoA rises as a result of low activity of methylmalonyl-CoA mutase (EC 5.4.99.2). Slow removal of methylmalonyl-CoA might depress propionate uptake owing to the reversibility of the steps leading to methylmalonyl-CoA formation.

The redox state of the nicotinamide-adenine dinucleotides in rat liver homogenates.

1. The redox state of the NAD couple of rat liver mitochondria, as measured by the [beta-hydroxybutyrate]/[acetoacetate] ratio, rapidly changed in the direction of oxidation during the preparation of homogenates in a saline medium. The value of the [beta-hydroxybutyrate]/[acetoacetate] ratio fell from 2.3 to 0.15 in 10min. EDTA diminished the fall and succinate prevented it. 2. The redox state of the rat liver cytoplasm, as measured by the [lactate]/[pyruvate] ratio, changed slightly in the direction of reduction during the preparation of homogenate. This was prevented by succinate. 3. In unsupplemented homogenates the differences in the redox states of mitochondria and cytoplasm decreased. Succinate and EDTA together maintained the differences within the physiological range. A measure of the ability of the mitochondria to maintain different redox states in mitochondria and cytoplasm is the value of the expression [lactate][acetoacetate]/[pyruvate][beta-hydroxybutyrate]. If there are no differences in the redox states of the NAD in the two cell compartments the value of the expression is 444 at 37 degrees . The value in the intact rat liver is between 4.7 and 21. 4. alpha-Oxoglutarate or glutamate were still more effective than succinate in maintaining high [beta-hydroxybutyrate]/[acetoacetate] ratios in the homogenates because these substrates supply a reducing agent of NAD(+) and, through succinate, an inhibitor of the oxidation of NADH. 5. When supplemented with alpha-oxoglutarate and EDTA, homogenates readily adjust the redox state of the beta-hydroxybutyrate dehydrogenase system after it has been upset by the addition of either acetoacetate or beta-hydroxybutyrate. 6. Amytal and rotenone raised the value of the [beta-hydroxybutyrate]/[acetoacetate] ratio. This is taken to indicate that the reduction of acetoacetate in the homogenates was not an energy-linked process. 7. 2,4-Dinitrophenol shifted the [beta-hydroxybutyrate]/[acetoacetate] ratio in the presence of succinate in favour of oxidation because it inhibited the oxidation of succinate and accelerated the oxidation of NADH. 8. Rotenone increased the rate of ketone-body formation of liver homogenates, though it decreased the rate of oxygen uptake.

The effects of adenine nucleotides on carbohydrate metabolism in pigeon-liver homogenates.

1. The effects of added AMP on carbohydrate metabolism were investigated in pigeon-liver homogenates, which can degrade glucose and synthesize it from lactate. Suitable experimental conditions were established for studying such effects, including the addition of P(i) (20mm) to stabilize adenine nucleotides and supplementation with NAD(+) (0.5mm). 2. Lactate increased the rate of oxygen consumption and kept the concentration of ATP high and that of AMP relatively low. 3. Added AMP (1.25-5mm) raised the net rate of carbohydrate removal and inhibited the net formation of glucose from lactate, as well as the incorporation of lactate into glucose. These effects were accompanied by a fall in the concentrations of hexose 6-phosphates and a rise in those of fructose diphosphate and triose phosphates. When the activity of glyceraldehyde 3-phosphate dehydrogenase was limited experimentally by a low concentration of NAD(+) or when it was blocked by iodoacetate, the accumulations of fructose diphosphate and triose phosphates were large and accounted for most of the carbohydrate degraded in the presence of AMP. 4. AMP also inhibited the conversion of pyruvate into phosphoenolpyruvate. Data on the concentrations of pyruvate, phosphoenolpyruvate and intermediates of the tricarboxylic acid cycle, as well as on isotope distribution, suggest that the effect was due to inhibition of phosphoenolpyruvate carboxykinase. 5. The results indicate that in the homogenates phosphofructokinase and fructose diphosphatase, controlled in their activity by adenine nucleotides and other cell constituents, are enzymes which regulate the direction of carbohydrate metabolism (degradation or synthesis) in the liver. 6. It is suggested that active transport of adenine nucleotides, citrate, Mg(2+), Ca(2+), P(i) and other cell constituents may play a role in regulating the activity of enzymes which are affected by these substances. 7. A procedure is described for generating alkali in a closed manometer vessel, by mixing mercuric oxide and a solution of sodium iodide, for use in a method for measuring the oxygen consumption at physiological bicarbonate concentrations.