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1.
J Chem Phys ; 160(14)2024 Apr 14.
Article En | MEDLINE | ID: mdl-38597308

Electron pairs have an illustrious history in chemistry, from powerful concepts to understanding structural stability and reactive changes to the promise of serving as building blocks of quantitative descriptions of the electronic structure of complex molecules and materials. However, traditionally, two-electron wavefunctions (geminals) have not enjoyed the popularity and widespread use of the more standard single-particle methods. This has changed recently, with a renewed interest in the development of geminal wavefunctions as an alternative to describing strongly correlated phenomena. Hence, there is a need to find geminal methods that are accurate, computationally tractable, and do not demand significant input from the user (particularly via cumbersome and often ill-behaved orbital optimization steps). Here, we propose new families of geminal wavefunctions inspired by the pair coupled cluster doubles ansatz. We present a new hierarchy of two-electron wavefunctions that extends the one-reference orbital idea to other geminals. Moreover, we show how to incorporate single-like excitations in this framework without leaving the quasiparticle picture. We explore the role of imposing seniority restrictions on these wavefunctions and benchmark these new methods on model strongly correlated systems.

2.
J Phys Chem A ; 128(17): 3458-3467, 2024 May 02.
Article En | MEDLINE | ID: mdl-38651558

We propose a new perturbation theory framework that can be used to help with the projective solution of the Schrödinger equation for arbitrary wave functions. This Flexible Ansatz for N-body Perturbation Theory (FANPT) is based on our previously proposed Flexible Ansatz for the N-body Configuration Interaction (FANCI). We derive recursive FANPT expressions, including arbitrary orders in the perturbation hierarchy. We show that the FANPT equations are well-behaved across a wide range of conditions, including static correlation-dominated configurations and highly nonlinear wave functions.

3.
J Comput Chem ; 44(5): 697-709, 2023 Feb 15.
Article En | MEDLINE | ID: mdl-36440947

Fanpy is a free and open-source Python library for developing and testing multideterminant wavefunctions and related ab initio methods in electronic structure theory. The main use of Fanpy is to quickly prototype new methods by making it easier to convert the mathematical formulation of a new wavefunction ansätze to a working implementation. Fanpy is designed based on our recently introduced Flexible Ansatz for N-electron Configuration Interaction (FANCI) framework, where multideterminant wavefunctions are represented by their overlaps with Slater determinants of orthonormal spin-orbitals. In the simplest case, a new wavefunction ansatz can be implemented by simply writing a function for evaluating its overlap with an arbitrary Slater determinant. Fanpy is modular in both implementation and theory: the wavefunction model, the system's Hamiltonian, and the choice of objective function are all independent modules. This modular structure makes it easy for users to mix and match different methods and for developers to quickly explore new ideas. Fanpy is written purely in Python with standard dependencies, making it accessible for various operating systems. In addition, it adheres to principles of modern software development, including comprehensive documentation, extensive testing, quality assurance, and continuous integration and delivery protocols. This article is considered to be the official release notes for the Fanpy library.


Quantum Theory , Software , Electrons
4.
BMC Med ; 18(1): 280, 2020 10 16.
Article En | MEDLINE | ID: mdl-33059718

BACKGROUND: Classification of primary central nervous system tumors according to the World Health Organization guidelines follows the integration of histologic interpretation with molecular information and aims at providing the most precise prognosis and optimal patient management. According to the cIMPACT-NOW update 3, diffuse isocitrate dehydrogenase-wild type (IDH-WT) gliomas should be graded as grade IV glioblastomas (GBM) if they possess one or more of the following molecular markers that predict aggressive clinical course: EGFR amplification, TERT promoter mutation, and whole-chromosome 7 gain combined with chromosome 10 loss. METHODS: The Cancer Genome Atlas (TCGA) glioma expression datasets were reanalyzed in order to identify novel tumor subcategories which would be considered as GBM-equivalents with the current diagnostic algorithm. Unsupervised clustering allowed the identification of previously unrecognized transcriptomic subcategories. A supervised machine learning algorithm (k-nearest neighbor model) was also used to identify gene signatures specific to some of these subcategories. RESULTS: We identified 14 IDH-WT infiltrating gliomas displaying a "normal-like" (NL) transcriptomic profile associated with a longer survival. Genes such as C5AR1 (complement receptor), SLC32A1 (vesicular gamma-aminobutyric acid transporter), MSR1 (or CD204, scavenger receptor A), and SYT5 (synaptotagmin 5) were differentially expressed and comprised in gene signatures specific to NL IDH-WT gliomas which were validated further using the Chinese Glioma Genome Atlas datasets. These gene signatures showed high discriminative power and correlation with survival. CONCLUSION: NL IDH-WT gliomas represent an infiltrating glioma subcategory with a superior prognosis which can only be detected using genome-wide analysis. Differential expression of genes potentially involved in immune checkpoint and amino acid signaling pathways is providing insight into mechanisms of gliomagenesis and could pave the way to novel treatment targets for infiltrating gliomas.


Brain Neoplasms/genetics , Glioma/genetics , Isocitrate Dehydrogenase/genetics , Machine Learning/standards , Transcriptome/genetics , Adult , Aged , Aged, 80 and over , Brain Neoplasms/mortality , Brain Neoplasms/pathology , Female , Glioma/mortality , Glioma/pathology , Humans , Male , Middle Aged , Mutation , Prognosis , Survival Analysis , Young Adult
5.
Phys Rev Lett ; 124(19): 192701, 2020 May 15.
Article En | MEDLINE | ID: mdl-32469543

The ^{12}C+^{12}C fusion reaction plays a critical role in the evolution of massive stars and also strongly impacts various explosive astrophysical scenarios. The presence of resonances in this reaction at energies around and below the Coulomb barrier makes it impossible to carry out a simple extrapolation down to the Gamow window-the energy regime relevant to carbon burning in massive stars. The ^{12}C+^{12}C system forms a unique laboratory for challenging the contemporary picture of deep sub-barrier fusion (possible sub-barrier hindrance) and its interplay with nuclear structure (sub-barrier resonances). Here, we show that direct measurements of the ^{12}C+^{12}C fusion cross section may be made into the Gamow window using an advanced particle-gamma coincidence technique. The sensitivity of this technique effectively removes ambiguities in existing measurements made with gamma ray or charged-particle detection alone. The present cross-section data span over 8 orders of magnitude and support the fusion-hindrance model at deep sub-barrier energies.

6.
Nature ; 547(7664): 425-427, 2017 07 26.
Article En | MEDLINE | ID: mdl-28748924

Newly formed black holes of stellar mass launch collimated outflows (jets) of ionized matter that approach the speed of light. These outflows power prompt, brief and intense flashes of γ-rays known as γ-ray bursts (GRBs), followed by longer-lived afterglow radiation that is detected across the electromagnetic spectrum. Measuring the polarization of the observed GRB radiation provides a direct probe of the magnetic fields in the collimated jets. Rapid-response polarimetric observations of newly discovered bursts have probed the initial afterglow phase, and show that, minutes after the prompt emission has ended, the degree of linear polarization can be as high as 30 per cent-consistent with the idea that a stable, globally ordered magnetic field permeates the jet at large distances from the central source. By contrast, optical and γ-ray observations during the prompt phase have led to discordant and often controversial results, and no definitive conclusions have been reached regarding the origin of the prompt radiation or the configuration of the magnetic field. Here we report the detection of substantial (8.3 ± 0.8 per cent from our most conservative simulation), variable linear polarization of a prompt optical flash that accompanied the extremely energetic and long-lived prompt γ-ray emission from GRB 160625B. Our measurements probe the structure of the magnetic field at an early stage of the jet, closer to its central black hole, and show that the prompt phase is produced via fast-cooling synchrotron radiation in a large-scale magnetic field that is advected from the black hole and distorted by dissipation processes within the jet.

7.
Afr Health Sci ; 13(2): 183-204, 2013 Jun.
Article En | MEDLINE | ID: mdl-24235915

BACKGROUND: Nodding Syndrome is a seizure disorder of children in Mundri County, Western Equatoria, South Sudan. The disorder is reported to be spreading in South Sudan and northern Uganda. OBJECTIVE: To describe environmental, nutritional, infectious, and other factors that existed before and during the de novo 1991 appearance and subsequent increase in cases through 2001. METHODS: Household surveys, informant interviews, and case-control studies conducted in Lui town and Amadi village in 2001-2002 were supplemented in 2012 by informant interviews in Lui and Juba, South Sudan. RESULTS: Nodding Syndrome was associated with Onchocerca volvulus and Mansonella perstans infections, with food use of a variety of sorghum (serena) introduced as part of an emergency relief program, and was inversely associated with a history of measles infection. There was no evidence to suggest exposure to a manmade neurotoxic pollutant or chemical agent, other than chemically dressed seed intended for planting but used for food. Food use of cyanogenic plants was documented, and exposure to fungal contaminants could not be excluded. CONCLUSION: Nodding Syndrome in South Sudan has an unknown etiology. Further research is recommended on the association of Nodding Syndrome with onchocerciasis/mansonelliasis and neurotoxins in plant materials used for food.


Environmental Exposure , Food Contamination , Nodding Syndrome/etiology , Zoonoses , Animals , Communicable Diseases , Confidence Intervals , Health Surveys , Humans , Nodding Syndrome/epidemiology , Odds Ratio , Qualitative Research , Sudan/epidemiology
8.
Afr Health Sci ; 12(3): 242-8, 2012 Sep.
Article En | MEDLINE | ID: mdl-23382736

BACKGROUND: Nodding syndrome (repetitive nodding and progressive generalized seizures) is assuming epidemic proportions in South Sudan, Tanzania and Uganda. OBJECTIVE: To describe clinical and epidemiological features of nodding syndrome in southern Sudan based on preliminary investigations conducted in 2001 and 2002. METHOD: Household surveys, clinical, electrophysiological (EEG) assessments, informant interviews and case-control studies were conducted in the town of Lui and the village of Amadi in southern Sudan. RESULTS: Nodding syndrome is characterized by involuntary repetitive nodding of the head, progressing to generalized seizures; mental and physical deterioration. The EEGs were consistent with progressive epileptic encephalopathy. Prevalence of Nodding syndrome in Lui and Amadi was 2.3% and 6.7% respectively. All case control studies showed a positive association between cases and Onchocerca volvulus. A history of measles was negatively associated with being a case: 2/13 of cases and 11/19 of controls had had measles: odds ratio 0.13 (95% CI 0.02, 0.76). Environmental assessment did not reveal any naturally occurring or manmade neurotoxic factors to explain Nodding Syndrome, although fungal contamination of food could not be ruled out. CONCLUSION: Nodding Syndrome was strongly associated with Onchocerca volvulus. There was no evidence to suggest an environmental pollutant, chemical agent, or other toxic factor.


Disease Outbreaks , Seizures/epidemiology , Adolescent , Animals , Case-Control Studies , Child , Child, Preschool , Electroencephalography , Electrophysiology , Female , Humans , Male , Onchocerca volvulus/isolation & purification , Onchocerciasis/complications , Onchocerciasis/epidemiology , Prevalence , Risk Factors , Seizures/complications , Seizures/etiology , Sudan/epidemiology , Young Adult
9.
Trop Med Int Health ; 7(8): 685-92, 2002 Aug.
Article En | MEDLINE | ID: mdl-12167095

An increased IgM concentration in cerebrospinal fluid (CSF), occurring as a consequence of massive intrathecal IgM synthesis, is a marker of interest for diagnosis of the meningo-encephalitic stage in human African trypanosomiasis. However, in current practice, IgM in CSF is not determined because of the lack of a simple and robust test that is applicable in African rural regions where the disease prevails. We describe the development of a sensitive semiquantitative card agglutination test, LATEX/IgM, for IgM quantification in CSF. The test is simple and fast and the lyophilized reagent remains stable even at 45 degrees C. CSF end-titres obtained with LATEX/IgM parallel the IgM concentrations determined by nephelometry and enzyme-linked immunosorbent assay. Detection of intrathecal IgM synthesis is the most sensitive marker for CNS involvement in sleeping sickness. At a cut-off value of >or= 8, the sensitivity and specificity of LATEX/IgM for intrathecal IgM synthesis are 89.4 and 92.7%. As a consequence, patients with LATEX/IgM end-titres >or= 8 are likely to have intrathecal IgM synthesis, thus central nervous system involvement and therefore should be treated accordingly. Further studies should concentrate on the relationship between the LATEX/IgM end-titres, presence of intrathecal IgM synthesis and occurrence of treatment failures in patients treated with pentamidine.


Immunoglobulin M/cerebrospinal fluid , Trypanosoma brucei gambiense/immunology , Trypanosomiasis, African/diagnosis , Animals , Antibodies, Protozoan/blood , Antibodies, Protozoan/cerebrospinal fluid , Cerebrospinal Fluid/parasitology , Enzyme-Linked Immunosorbent Assay , Humans , Immunoglobulin M/blood , Latex Fixation Tests/instrumentation , Latex Fixation Tests/methods , Latex Fixation Tests/standards , Nephelometry and Turbidimetry , Parasitology/methods , Reproducibility of Results , Sensitivity and Specificity , Trypanosoma brucei gambiense/isolation & purification
10.
J Bacteriol ; 183(16): 4814-22, 2001 Aug.
Article En | MEDLINE | ID: mdl-11466285

The presence of excess glucose in growth media prevents normal sporulation of Bacillus subtilis. The crsA47 mutation, located in the gene for the vegetative phase sigma factor (sigma(A)) results in a glucose-resistant sporulation phenotype. As part of a study of the mechanisms whereby the mutation in sigma(A) overcomes glucose repression of sporulation, we examined the expression of genes involved in sporulation initiation in the crsA47 background. The crsA47 mutation had a significant impact on a variety of genes. Changes to stage II gene expression could be linked to alterations in the expression of the sinI and sinR genes. In addition, there was a dramatic increase in the expression of genes dependent on the minor sigma factor sigma(H). This latter change was paralleled by the pattern of spo0H gene transcription in cells with the crsA47 mutation. In vitro analysis of RNA polymerase containing sigma(A47) indicated that it did not have unusually high affinity for the spo0H gene promoter. The in vivo pattern of spo0H expression is not predicted by the known regulatory constraints on spo0H and suggests novel regulation mechanisms that are revealed in the crsA47 background.


Bacillus subtilis/genetics , Bacterial Proteins/genetics , Gene Expression Regulation, Bacterial , Glucose/metabolism , Mutation , Sigma Factor/genetics , Transcription Factors/genetics , Bacillus subtilis/growth & development , Bacillus subtilis/physiology , DNA-Binding Proteins/genetics , DNA-Directed RNA Polymerases/genetics , Gene Expression Regulation, Developmental , Genotype , Kinetics , Spores, Bacterial/physiology , Time Factors , Transcription, Genetic
11.
Trop Med Int Health ; 6(5): 342-7, 2001 May.
Article En | MEDLINE | ID: mdl-11348529

A resurgence of sleeping sickness developed in southern Sudan during the past decade. Prevalence of confirmed Trypanosoma brucei gambiense infection in humans now exceeds 5% in several foci. From 1997 to 1999, trypanosomiasis control programmes in three counties of Western Equatoria Province detected 3785 new cases among 67 181 persons screened. A major contributing factor in the re-emergence of epidemic sleeping sickness was the lack of active case-finding throughout the 1990s. Although the situation is improving in sites where trypanosomiasis programmes have been recently implemented, co-ordination and additional international assistance are needed to bring sleeping sickness under control in Sudan.


Communicable Diseases, Emerging/epidemiology , Communicable Diseases, Emerging/prevention & control , Endemic Diseases/prevention & control , Endemic Diseases/statistics & numerical data , Trypanosoma brucei gambiense , Trypanosomiasis, African/epidemiology , Trypanosomiasis, African/prevention & control , Animals , Communicable Diseases, Emerging/parasitology , Humans , Mass Screening/methods , Needs Assessment , Population Surveillance/methods , Prevalence , Risk Factors , Sudan/epidemiology , Trypanosomiasis, African/parasitology
12.
J Adv Nurs ; 32(5): 1108-15, 2000 Nov.
Article En | MEDLINE | ID: mdl-11114995

Although the concepts of belief and meaning are commonly used in the cancer literature, there is often an overlap in the use of the terms. Some consider the two terms as synonyms while others link them as successive elements in adjustment. Using an adaptation of the methods of concept analysis, this article differentiates belief and meaning, and also suggests that meaning exists at two levels. The defining attributes and antecedents of these closely related concepts are identified and a model case illustrating each is presented. Clarity in the conceptual definitions of beliefs and meanings can help researchers select measures that accurately reflect the phenomenon of interest. Similarly, differentiation between the concepts can help practitioners in planning focused interventions that explore clients' existing beliefs and situational and existential meanings.


Attitude to Health , Models, Nursing , Models, Psychological , Neoplasms/nursing , Neoplasms/psychology , Existentialism , Female , Health Knowledge, Attitudes, Practice , Humans , Middle Aged , Nursing Care/methods , Nursing Care/psychology , Nursing Methodology Research , Nursing Theory
13.
J Bacteriol ; 182(15): 4352-5, 2000 Aug.
Article En | MEDLINE | ID: mdl-10894748

Deletion of the 10 C-terminal amino acids of the Bacillus subtilis response regulator Spo0A or valine substitution at D258 and L260 resulted in a sporulation-negative phenotype and loss of in vivo activation of the spoIIG and spoIIA operon promoters. Repression of the abrB promoter was not affected by the mutations. In combination with the previously characterized mutation (A257V), the results identify amino acids at positions 257, 258, and 260 as being required for transcription activation by Spo0A.


Bacillus subtilis/physiology , Bacterial Proteins/chemistry , Spores, Bacterial/chemistry , Transcription Factors/chemistry , Transcriptional Activation , Amino Acid Sequence , Bacterial Proteins/physiology , Molecular Sequence Data , Operon , Promoter Regions, Genetic , Spores, Bacterial/physiology , Structure-Activity Relationship , Transcription Factors/physiology
14.
Am J Trop Med Hyg ; 61(2): 315-8, 1999 Aug.
Article En | MEDLINE | ID: mdl-10463686

Endemic foci of human African trypanosomiasis are present in southern Sudan. In 1996 and 1997, trypanosomiasis increased sharply in Tambura County. To define the magnitude and geographic distribution of the outbreak, we conducted a prevalence survey using population-based cluster sampling in 16 villages: 1,358 participants answered questions about routine activities and tsetse fly contact and received serologic testing. Seroprevalence in the surveyed area was 19.4% (95% confidence interval = 16.9%, 21.8%). We confirmed infection in 66% of seropositive persons who received one parasitologic examination and in 95% of those who had serial examinations of lymph node fluid and blood. Activities related to the civil war, such as temporary migration, were not associated with seropositive status. Since the previous population screening in 1988, the trypanosomiasis prevalence increased two orders of magnitude, and the proportion of villages affected increased from 54% to 100%. Our results suggest that there may be 5,000 cases in Tambura County. The absence of trypanosomiasis control for nearly a decade is a factor in the resurgence of the disease.


Antibodies, Protozoan/blood , Disease Outbreaks , Trypanosoma brucei gambiense/immunology , Trypanosomiasis, African/epidemiology , Adolescent , Adult , Animals , Child , Cluster Analysis , Female , Humans , Male , Middle Aged , Seroepidemiologic Studies , Sudan/epidemiology , Trypanosomiasis, African/blood
15.
Antimicrob Agents Chemother ; 42(12): 3309-12, 1998 Dec.
Article En | MEDLINE | ID: mdl-9835535

We investigated the influence of HMR 3004, a new ketolide antibiotic, on the pulmonary inflammation induced by heat-killed fluorescein isothiocyanate-labeled Streptococcus pneumoniae. HMR 3004 downregulated (P < 0.05) the pneumococcus-induced release of interleukin-6 (IL-6), IL-1beta, and nitric oxide in bronchoalveolar lavage fluid. The drug limited (P < 0.05) neutrophil recruitment to lung tissues and alveoli but did not interfere with phagocytosis. HMR 3004 totally abrogated lung edema. By reducing inflammation in addition to possessing antimicrobial properties, HMR 3004 may participate in improving the outcome of bacterial pneumonia.


Adjuvants, Immunologic/pharmacology , Anti-Bacterial Agents/pharmacology , Inflammation/immunology , Ketolides , Macrolides , Streptococcus pneumoniae/immunology , Adjuvants, Immunologic/metabolism , Animals , Bronchoalveolar Lavage Fluid/immunology , Inflammation/metabolism , Inflammation/pathology , Interleukins/metabolism , Macrophages, Alveolar/drug effects , Macrophages, Alveolar/metabolism , Mice , Neutrophils/drug effects , Neutrophils/metabolism , Nitric Oxide/metabolism , Tumor Necrosis Factor-alpha/metabolism
16.
Urology ; 52(5): 909-14, 1998 Nov.
Article En | MEDLINE | ID: mdl-9801129

OBJECTIVES: To determine whether detrusor muscle strips from a male rat with infravesical outflow obstruction model demonstrate supersensitivity to parasympathomimetic and neurokinin NK-1 and NK-2 selective agonists. METHODS: Bladder instability developed after 6 weeks of partial urethral obstruction. The micturition frequency and voided volume were determined in unanesthetized animals. Detrusor hypertrophy was confirmed by evaluation of bladder weight. In vitro organ bath was used to compare the affinity and maximal activity of bethanechol and neurokinin NK-1 and NK-2 selective agonists on strips from the detrusor muscle of sham and obstructed rats. Bethanechol, N-Ac[Arg6, Sar9, Met(O2)]-SP(6-11), and [beta-Ala8]-NKA(4-10) were used to characterize cholinergic muscarinic, neurokinin NK-1 and NK-2 receptors. Results. No significant differences in affinities and maximal responses were found using 10-mg detrusor muscle strips with each of the three agonists. CONCLUSIONS: Bladder instability produced by outlet obstruction does not involve changes in the affinity or maximal activity of cholinergic muscarinic, neurokinin NK-1 and NK-2 receptors. Furthermore, detrusor supersensitivity to neurokinins or bethanechol was not seen. This suggests that bladder instability is not due to an increased affinity or maximal response to neurokinins or parasympathomimetics.


Bethanechol Compounds/pharmacology , Neurokinin B/agonists , Receptors, Neurokinin-1/drug effects , Receptors, Neurokinin-2/drug effects , Urethral Obstruction/physiopathology , Animals , Disease Models, Animal , Dose-Response Relationship, Drug , In Vitro Techniques , Male , Muscle, Smooth , Rats , Rats, Sprague-Dawley
17.
Virology ; 241(2): 285-97, 1998 Feb 15.
Article En | MEDLINE | ID: mdl-9499803

We previously demonstrated that infection of primary human thymic dendritic cells (DCs) with laboratory strains of HIV leads to the release of soluble factor(s) which induced thymocyte killing. In the present paper, we extend the characterization of this process. Our results reveal that primary HIV-1 isolates are similarly able to induce the production of cytotoxic factor(s) from thymic DCs and that the release of such factor(s) is dependent on viral infection. Interestingly, we observed that CD4+ and CD8+ purified thymocyte subsets, and activated PBMCs are susceptible to the cytotoxic activity, whereas freshly isolated resting PBMCs are resistant to this effect. Cycloheximide treatment prevents the killing of thymocytes exposed to HIV-infected DC supernatant, revealing that this form of cell death is an active biological process requiring protein synthesis. Finally, our data suggest that FasL and TNF alpha could both participate in the killing process. These in vitro observations provide a plausible model, whereby HIV-infected DCs can play a role in vivo in the induction of uninfected thymocyte killing.


Cytotoxicity, Immunologic , Dendritic Cells/immunology , Dendritic Cells/virology , HIV-1/immunology , Proteins/immunology , Thymus Gland/immunology , Animals , Apoptosis , Cell Cycle , Cells, Cultured , Child , Child, Preschool , Culture Media, Conditioned , Cycloheximide/pharmacology , DNA Fragmentation , Dendritic Cells/metabolism , HIV-1/physiology , HLA-DR Antigens/immunology , Humans , Infant , Infant, Newborn , Killer Factors, Yeast , Mice , Protein Biosynthesis , Protein Synthesis Inhibitors/pharmacology , Proteins/metabolism , Thymus Gland/cytology , Tumor Necrosis Factor-alpha/immunology , Virion , fas Receptor/immunology
18.
Crit Care Med ; 24(7): 1150-6, 1996 Jul.
Article En | MEDLINE | ID: mdl-8674327

OBJECTIVE: To characterize the effects of pressor doses of norepinephrine and low-dose dopamine (3 micrograms/kg/min) on renal hemodynamics in man, as well as to determine the clinical relevance of combining dopamine with norepinephrine. DESIGN: Prospective, single-blind, randomized study. SETTING: Clinical research unit of a tertiary care hospital. SUBJECTS. Six healthy male volunteers ranging in age between 20 and 28 yrs. INTERVENTIONS: The subjects were assigned randomly to four treatments (1 wk apart) in which renal hemodynamics and electrolyte excretion were assessed. Treatments consisted of 180-min infusions of the following: a) 0.9% sodium chloride (control); b) pressor doses of norepinephrine; c) dopamine at 3 micrograms/kg/min; and d) pressor doses of norepinephrine and dopamine at 3 micrograms/kg/min. Pressor doses of norepinephrine was defined as doses required to increase mean arterial pressure (MAP) by 20 mm Hg. MEASUREMENTS AND MAIN RESULTS: Glomerular filtration rate and renal blood flow were derived from inulin and para-aminohippurate clearances, respectively. Urine output and urine solute excretion were also determined. The mean norepinephrine dose required to increase MAP by 22 +/- 2 mm Hg was 118 +/- 30 ng/kg/min (range 76 to 164). After the addition of dopamine, similar doses of norepinephrine resulted in an MAP increase of 15 +/- 4 mm Hg. Glomerular filtration rate and urine output were comparable under all conditions. The infusion of norepinephrine decreased renal blood flow from 1241 +/- 208 to 922 +/- 143 mL/min/1.73 m2 (p = .03). The addition of dopamine returned renal blood flow to baseline values. The clearance of urine sodium increased significantly with the infusion of dopamine alone (p = .03). All subjects completed the four treatment periods. Adverse events, manifested mostly as palpitations and flushing, were rare and self-limiting. CONCLUSIONS: The addition of dopamine (3 micrograms/kg/min) to pressor doses of norepinephrine normalized renal blood flow in healthy volunteers. These hemodynamic changes were not reflected in urine output and glomerular filtration rate; hence, these monitoring parameters may be unreliable indicators of renal function in the setting of vasopressor therapy. In addition, systemic effects were observed with dopamine (3 micrograms/kg/min), as indicated by a decrease in MAP.


Dopamine/administration & dosage , Dopamine/pharmacology , Hemodynamics/drug effects , Norepinephrine/pharmacology , Renal Circulation/drug effects , Vasoconstrictor Agents/pharmacology , Adult , Blood Pressure/drug effects , Electrolytes/urine , Glomerular Filtration Rate , Humans , Infusions, Intravenous , Male , Norepinephrine/administration & dosage , Random Allocation
19.
Ann Pharmacother ; 30(4): 372-80, 1996 Apr.
Article En | MEDLINE | ID: mdl-8729892

OBJECTIVE: To review the clinical pharmacology of aprotinin in patients undergoing surgical procedures involving major blood loss, namely, coronary artery bypass graft (CABG). DATA SOURCES: A MEDLINE search was used to identify French- and English-language publications on aprotinin using the indexing terms aprotinin, cardiothoracic surgery, and hemorrhage. The MEDLINE search was supplemented by review of article bibliographies. Data also were obtained from the approved Canadian and US product labels. STUDY SELECTIONS: All abstracts and uncontrolled and controlled clinical trials were reviewed. DATA EXTRACTION: Study design, population, results, and safety information were retained. Efficacy conclusions were drawn from controlled trials. DATA SYNTHESIS: Aprotinin, a serine protease inhibitor isolated from bovine lung tissue, decreases bleeding after cardiac surgery by mechanisms including antifibrinolytic activity and preservation of platelet function. Several trials have shown that aprotinin reduced blood loss and transfusion requirements in patients undergoing CABG. Its use in other surgical procedures involving major blood loss has been reported. Aprotinin is well tolerated, with minor allergic reactions being the most frequently reported adverse effect. Although unsubstantiated, the possibility that aprotinin could create a prothrombic state leading to early graft occlusion and formation of microthrombi in renal and coronary vasculatures is of concern. CONCLUSIONS: Aprotinin is an effective hemostatic agent in CABG. Clear definitions of indications, dosing, safety, and repeated use remain to be investigated thoroughly.


Aprotinin/pharmacology , Coronary Artery Bypass , Hemostasis, Surgical/methods , Hemostatics/pharmacology , Aprotinin/adverse effects , Aprotinin/pharmacokinetics , Drug Interactions , Hemostatics/adverse effects , Hemostatics/pharmacokinetics , Humans
20.
Ann Pharmacother ; 29(6): 582-6, 1995 Jun.
Article En | MEDLINE | ID: mdl-7663029

OBJECTIVE: To report a case of fatal hepatotoxicity associated with the chronic use of oral amiodarone. CASE SUMMARY: Long-term administration of amiodarone for the control of intractable ventricular tachycardia was associated with fatal hepatotoxicity in a patient receiving amiodarone for 14 months. DISCUSSION: Although most hepatic adverse effects associated with amiodarone are transient and reversible with time, deaths resulting from amiodarone-induced hepatotoxicity have been reported. The relation of hepatotoxicity to cumulative dose and duration of therapy is debated. The histopathologic features of amiodarone-induced hepatotoxicity include Mallory bodies, steatosis, intralobular inflammatory infiltrates, fibrosis, and phospholipidosis. CONCLUSIONS: Evidence pertaining to both mild and severe amiodarone toxicity indicates that cumulative dose may correlate with overall toxicity and, therefore, maintenance doses should be kept as low as possible. Patients should be followed with monitoring of liver function test results every 3-6 months.


Amiodarone/adverse effects , Chemical and Drug Induced Liver Injury/etiology , Administration, Oral , Alanine Transaminase/blood , Alkaline Phosphatase/blood , Amiodarone/administration & dosage , Aspartate Aminotransferases/blood , Chemical and Drug Induced Liver Injury/complications , Chemical and Drug Induced Liver Injury/diagnosis , Fatal Outcome , Hepatorenal Syndrome/etiology , Humans , Male , Middle Aged , Tachycardia, Ventricular/drug therapy , gamma-Glutamyltransferase/blood
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