Transient paraplegia due to subarachnoid haemorrhage following spinal anaesthesia.

Spinal subarachnoid haemorrhage is a rare complication of spinal anaesthesia, especially following atraumatic lumbar puncture and in the absence of coagulopathies. The initial presentation of spinal subarachnoid haemorrhage is variable and paraplegia with full recovery within a few hours is rare. Bleeding can extend into the intracranial subarachnoid space, but there are only a few reports of symptomatic intracranial and spinal subarachnoid haemorrhage after spinal anaesthesia. We report co-existing spinal subarachnoid haemorrhage and intracranial subarachnoid haemorrhage after atraumatic spinal anaesthesia in a 69-year-old woman without a coagulopathy. The day after surgery she developed flaccid paraplegia that spontaneously resolved in a few hours. Magnetic resonance imaging demonstrated subarachnoid high signal intensity from T11-S2, consistent with spinal subarachnoid haemorrhage. On the same day the patient complained of severe headache which was later followed by diplopia. Neurological imaging studies revealed diffuse distribution of blood in the subarachnoid space but no intracranial vascular malformations. At the time of diagnosis spontaneous recovery of spinal symptoms had already begun and the clinical manifestations eventually resolved with conservative management. The possibility of an intracranial haemorrhage should always be considered when spinal subarachnoid haemorrhage is identified, even in cases of uncomplicated spinal anaesthesia in patients with no known risk factors for spinal haemorrhage.

ALDH2 Activity Reduces Mitochondrial Oxygen Reserve Capacity in Endothelial Cells and Induces Senescence Properties.

Endothelial cells (ECs) are dynamic cells that turn from growth into senescence, the latter being associated with cellular dysfunction, altered metabolism, and age-related cardiovascular diseases. Aldehyde dehydrogenase 2 (ALDH2) is a mitochondrial enzyme metabolizing acetaldehyde and other toxic aldehydes, such as 4-hydroxynonenal (4-HNE). In conditions in which lipid peroxidation products and reactive oxygen species (ROS) are accumulated, ECs become dysfunctional and significantly contribute to the progression of vascular-dependent diseases. The aim of the present study has been to investigate whether inhibition of ALDH2 alters endothelial functions together with the impairment of bioenergetic functions, accelerating the acquisition of a senescent phenotype. HUVECs transfected with siRNA targeting ALDH2 or treated with daidzin, an ALDH2 inhibitor, were used in this study. We observed an alteration in cell morphology associated with endothelial dysfunctions. Loss of ALDH2 reduced cell proliferation and migration and increased paracellular permeability. To assess bioenergetic function in intact ECs, extracellular flux analysis was carried out to establish oxygen consumption rates (OCR). We observed a decrease in mitochondrial respiration and reserve capacity that coincided with SA-ß-Gal accumulation and an increase in p21 and p53 expression in siALDH2 or daidzin-treated HUVECs. Treatment with N-acetyl-L-cysteine (NAC) reduced endothelial dysfunctions mediated by siALDH2, indicating that oxidative stress downstream to siALDH2 plays an instrumental role. Our results highlight that ALDH2 impairment accelerates the acquisition of a premature senescent phenotype, a change likely to be associated with the observed reduction of mitochondrial respiration and reserve capacity.

The use of radial symmetry to localize retinal landmarks.

Locating the optic disc center and the fovea in digital fundus images is surprisingly difficult due to the variation range in color and contrast and the possible presence of pathologies creating bright spots or changing the appearance of retinal landmarks. These reasons make it difficult to find good templates of optic disc and fovea shape and color for pattern matching. In this paper we propose radial symmetry as the principal cue to locate both optic disc and macula centers. Centers of bright and dark circularly symmetrical regions with arbitrary radii, can be found robustly against changes in brightness and contrast by using the Fast Radial Symmetry transform. Detectors based on this transform coupled with a weak hypothesis on vessel density (optic disc intersects large vessels while the fovea lies in an avascular region), can provide a fast location of both OD and macula with accuracy similar or better than state-of-the-art methods. The approach has been chosen as the default technique for fast localization of the two landmarks in the VAMPIRE software suite.

EGFR signaling upregulates expression of microsomal prostaglandin E synthase-1 in cancer cells leading to enhanced tumorigenicity.

In this report we describe the contribution of prostaglandin E(2) (PGE(2)) derived from the inducible microsomal PGE-synthase type-1 (mPGES-1) to the epidermal growth factor receptor (EGFR) oncogenic drive in tumor epithelial cells and in tumor-bearing mice. EGFR stimulation upregulated expression of mPGES-1 in HT-29, A431 and A549 cancer cells. Egr-1, a transcription factor induced by EGF, mediated this response. The Egr-1 rise provoked the overexpression of mPGES-1 messenger and protein, and enhanced PGE(2) formation. These changes were suppressed either by silencing Egr-1, or by upstream blockade of EGFR or ERK1/2 signals. Further, in a clonogenic assay on tumor cells, EGF induced a florid tumorigenic phenotype, which regressed when mPGES-1 was silenced or knocked down. EGF-induced mPGES-1 overexpression in epithelial cell reduced E-cadherin expression, whereas enhancing that of vimentin, suggesting an incipient mesenchymal phenotype. Additionally, inhibiting the EGFR in mice bearing the A431 tumor, the mPGES-1 expression and the tumor growth, exhibited a parallel decline. In conclusion, these findings provide novel evidence that a tight cooperation between the EGF/EGFR and mPGES-1 leads to a significant tumorigenic gain in epithelial cells, and provide clues for controlling the vicious association.

VAMPIRE: Vessel assessment and measurement platform for images of the REtina.

We present VAMPIRE, a software application for efficient, semi-automatic quantification of retinal vessel properties with large collections of fundus camera images. VAMPIRE is also an international collaborative project of four image processing groups and five clinical centres. The system provides automatic detection of retinal landmarks (optic disc, vasculature), and quantifies key parameters used frequently in investigative studies: vessel width, vessel branching coefficients, and tortuosity. The ultimate vision is to make VAMPIRE available as a public tool, to support quantification and analysis of large collections of fundus camera images.

Building a virtual archive using brain architecture and Web 3D to deliver neuropsychopharmacology content over the Internet.

The vast amount of heterogeneous data generated in various fields of neurosciences such as neuropsychopharmacology can hardly be classified using traditional databases. We present here the concept of a virtual archive, spatially referenced over a simplified 3D brain map and accessible over the Internet. A simple prototype (available at http://aquatics.crs4.it/neuropsydat3d) has been realized using current Web-based virtual reality standards and technologies. It illustrates how primary literature or summary information can easily be retrieved through hyperlinks mapped onto a 3D schema while navigating through neuroanatomy. Furthermore, 3D navigation and visualization techniques are used to enhance the representation of brain's neurotransmitters, pathways and the involvement of specific brain areas in any particular physiological or behavioral functions. The system proposed shows how the use of a schematic spatial organization of data, widely exploited in other fields (e.g. Geographical Information Systems) can be extremely useful to develop efficient tools for research and teaching in neurosciences.

FGF-2 overexpression opposes the beta amyloid toxic injuries to the vascular endothelium.

Recent evidences suggest that Abeta peptides modulate endothelial cell (EC) functions. At low concentrations, Abeta1-40 enhances the pro-angiogenic activity of FGF-2, whereas deposition of excess Abeta causes EC dysfunction and cerebral amyloid angiopathy (CAA). We investigated whether FGF-2 attenuates EC dysfunction caused by pathological Abeta levels. We studied Abeta1-40 on EC survival, as well as on signals responsible of their angiogenic phenotype. At 5-50 microM Abeta1-40 reduced EC population, caused apoptosis, downregulated FGF-2 production, inhibited FGF-2 binding to heparin, and FGFR1 phosphorylation. Toxic effects were owing to lack of FGF-2 stimulation, as EC overexpressing FGF-2 displayed extraordinary resistance to Abeta1-40 injuries. The FGF-2 mechanism responsible for reversing damages, involves the downstream enhancement of Akt, a pathway independent of eNOS activation. In conclusion, we demonstrate that FGF-2 protects EC from the effects of excess Abeta1-40, suggesting that it may attenuate the consequences of Abeta deposition in pathologies as CAA.

Exogenous BH4/Bcl-2 peptide reverts coronary endothelial cell apoptosis induced by oxidative stress.

BACKGROUND: Vascular endothelium undergoes apoptosis when exposed to reactive oxygen species (ROS), including hydrogen peroxide and superoxide radicals. ROS are believed to be the cause of damage to small vessels during ischemia-reperfusion injury and of arterial damage during atherosclerosis. Hydrogen peroxide-induced apoptosis is mediated through the inhibition of Bcl-xl activity and caspase-3 and caspase-9 activation. The BH4 domain of the Bcl-2 family members is responsible for their antiapoptotic activity. The BH4 domains of Bcl-2 and Bcl-xl inhibit cytochrome c release and the loss of mitochondrial membrane potential. METHODS AND RESULTS: The purpose of this project was to study the antiapoptotic effect of cell-permeant derivative of Bcl-2 (BH4 peptide) on endothelial cells exposed to stress conditions. BH4 peptide was conjugated to the cell-permeable peptide TAT and was applied to endothelial cells under conditions of serum starvation and hydrogen peroxide treatment. TAT-BH4 reduced caspase-3 activity and prevented apoptotic cell death. CONCLUSION: Our results indicate that TAT-BH4 peptide can protect endothelial cells from ROS-induced apoptosis.

Reconstruction and web distribution of measurable arterial models.

In this paper a novel framework for the segmentation, 3D reconstruction and web distribution of vessel structures specifically tailored to the assessment of abdominal aortic aneurysms for endovascular surgery planning is presented. Deformable models are used for segmentation, while VRML97 and ECMA scripting are used to obtain models that are not only viewable from any VRML97 enabled browser, but that also allow users to perform, directly from standard web browsers, guided measurements of geometrical parameters, relevant to surgical planning.

The use of optical flow to characterize muscle contraction.

Muscle contraction is usually measured and characterized with force and displacement transducers. The contraction of muscle fibers, however, evokes in the tissue a two and even three-dimensional displacement field, which is not properly quantified by these transducers because they provide just a single scalar quantity. This problem can be circumvented by using optical measurements and standard tools of computer vision, developed for the analysis of time varying image sequences. By computing the so called optical flow, i.e. the apparent motion of points in a time varying image sequence, it is possible to recover a two-dimensional motion field, describing rather precisely the displacement caused by muscle contraction in a flattened piece of skin. The obtained two-dimensional optical flow can be further analyzed by computing its elementary deformation components, providing a novel and accurate characterization of the contraction induced by different motoneurons. This technique is demonstrated analyzing the displacement caused by muscle contraction in the skin of the leech, Hirudo medicinalis. The proposed technique can be applied to monitor and characterize all contractions in almost flat tissues with enough visual texture.

Measurable models of abdominal aortic aneurysm on the Web.

In this paper we describe a method for 3D reconstruction and web distribution of vessel structures specifically designed to allow the remote measurement of parameters of surgical interest. Deformable models are used for segmentation, while VRML and ECMA scripting are used to obtain 3D models that are not only viewable from any VRML97 enabled browser, but that also allow users to interact with the model, navigate along the vessel lumen and perform guided measurements of distances and angles.

An integrated simulator for surgery of the petrous bone.

This paper describes work being undertaken as part of the IERAPSI (Integrated Environment for the Rehearsal and Panning of Surgical Intervention) project. The project is focussing on surgery for the petrous bone, and brings together a consortium of European clinicians and technology providers working in this field. The paper presents the results of a comprehensive user task analysis that has been carried out in the first phase of the IERAPSI project, and details the current status of development of a pre operative planning environment and a physically-based surgical simulator.

Comparison of doxorubicin- and MEN 10755-induced long-term progressive cardiotoxicity in the rat.

The delayed functional cardiotoxic effects of repeated treatment with the new disaccharide anthracycline MEN 10755 and doxorubicin (1.5 mg/kg, i.v., once a week for 5 consecutive weeks) were investigated in the rat. Changes were assessed (2 days and 4 and 13 weeks after the last treatment) in ECG morphology, hemodynamics, in vivo left ventricular contractile responses to beta-adrenergic stimulation, and histopathology of both atria and ventricles. Doxorubicin induced significant and progressive prolongation of the QalphaT interval starting 2 days after suspension of treatment. At 4 and 13 weeks after the last treatment, the ECG showed a further progressive and significant impairment. MEN 10755 induced alterations similar in nature but of lesser severity compared with doxorubicin. In addition, MEN 10755-induced prolongation of the QalphaT interval was not progressive, being similar at 4 and 13 weeks after the last treatment. Although the hemodynamics were only slightly affected by both anthracyclines, a nearly complete ablation of isoprenaline-induced enhancement of ventricular function was observed 4 and 13 weeks after the last treatment with doxorubicin, whereas only mild, if any, reduction was detected in rats receiving MEN 10755. Histopathologic investigations indicated that both anthracyclines produced qualitatively similar alterations in ventricular myocytes. However, only with doxorubicin did these changes show a progression with a further significant worsening at 13 weeks as compared with 4 weeks after the last treatment. In addition, atrial lesions were evident in doxorubicin-treated rats, but not in rats receiving MEN 10755. In conclusion, an equimyelotoxic regimen of MEN 10755 produced, as compared with doxorubicin, lesser ECG alterations, smaller impairment of the ventricular response to adrenergic stimulation, and less severe myocyte lesions. Unlike doxorubicin, the histologic and functional cardiotoxic effects induced by MEN 10755 were not progressive. Further investigations are warranted to define the pharmacodynamic and/or pharmacokinetic mechanism(s) underlying the different cardiotoxic profile exhibited by the two anthracyclines.

Receptor binding profile of Otilonium bromide.

The interaction of Otilonium bromide (OB) with binding sites for 63 different receptors and ion channels in appropriate preparations has been investigated. Experiments were also performed in rat colon, the preferred tissue for OB 'in vivo' uptake after oral administration. Among the receptors investigated OB binds with sub microM affinity to muscarinic M1, M2, M4, M5 and PAF receptors and with microM affinity to the diltiazem binding site on L type Ca2+ channels. In the rat colon OB shows competitive interaction with the verapamil binding site on L type Ca2+ channels and with muscarinic M2 receptors with IC50 of 1020 and 1220 nM, respectively. These findings provide a molecular rationale to explain the spasmolytic action exerted by OB on intestinal smooth muscle. In particular, a combination of antimuscarinic and Ca2+ channel blocker properties seems to best account for the action of this compound.

MEN 11420 (Nepadutant), a novel glycosylated bicyclic peptide tachykinin NK2 receptor antagonist.

1. The pharmacological profile was studied of MEN 11420, or cyclo[[Asn(beta-D-GlcNAc)-Asp-Trp-Phe-Dap-Leu]cyclo(2beta-5beta )], a glycosylated derivative of the potent, selective, conformationally-constrained tachykinin NK2 receptor antagonist MEN 10627 (cyclo(Met-Asp-Trp-Phe-Dap-Leu)cyclo(2beta-5beta)). 2. MEN 11420 competitively bound with high affinity to the human NK2 receptor stably transfected in CHO cells, displacing radiolabelled [125I]-neurokinin A and [3H]-SR 48968 with Ki values of 2.5+/-0.7 nM (n = 6) and 2.6+/-0.4 nM (n = 3), respectively. 3. MEN 11420 showed negligible binding affinity (pIC50 < 6) at 50 different receptors (including tachykinin NK1 and NK3 receptors) and ion channels. 4. In the rabbit isolated pulmonary artery and rat urinary bladder MEN 11420 potently and competitively antagonized tachykinin NK2 receptor-mediated contractions (pK(B) = 8.6+/-0.07, n = 10, and 9.0+/-0.04, n = 12; Schild plot slope = -1.06 (95% c.l. = -1.3; -0.8) and -1.17 (95% c.l. = -1.3; -1.0), respectively). MEN 11420 produced an insurmountable antagonism at NK2 receptors in the hamster trachea and mouse urinary bladder. However, in both preparations, the effect of MEN 11420 was reverted by washout and an apparent pK(B) of 10.2+/-0.14, n = 9, and 9.8+/-0.15, n = 9, was calculated in the hamster trachea and mouse urinary bladder, respectively. 5. MEN 11420 showed low affinity (pK(B) < 6) at guinea-pig and rat tachykinin NK1 (guinea-pig ileum and rat urinary bladder) and NK3 (guinea-pig ileum and rat portal vein) receptors. On the whole, the affinities (potency and selectivity) showed by MEN 11420 for different tachykinin receptors, measured either in binding or in functional bioassays, were similar to those shown by the parent compound, MEN 10627. 6. The in vivo antagonism of the contractions produced by [betaAla8]neurokinin A(4-10) (1 nmol kg(-1)) was observed after intravenous (dose range: 1-10 nmol kg(-1)), intranasal (3-10 nmol kg(-1)), intrarectal (30-100 nmol kg(-1)) and intraduodenal (100-300 nmol kg(-1)) administration of MEN 11420. MEN 11420 was more potent (about 10 fold) and longer lasting than its parent compound MEN 10627, possibly due to a greater metabolic stability. 7. A dose of MEN 11420 (100 nmol kg(-1), i.v.), that produced potent and long lasting inhibition of the contraction of the rat urinary bladder induced by challenge with the NK2 selective receptor agonist [betaAla8]neurokinin A(4-10) (10-300 nmol kg(-1)), was without effect on the responses produced by the NK1 receptor selective agonist [Sar9]substance P sulphone (1-10 nmol kg(-1)). 8. These findings indicate that MEN 11420 is a potent and selective tachykinin NK2 receptor antagonist. The introduction of a sugar moiety did not produce major changes in the affinity profile of this antagonist as compared to MEN 10627, but markedly improved its in vivo potency and duration of action. With these characteristics, MEN 11420 is a suitable candidate for studying the pathophysiological significance of tachykinin NK2 receptors in humans.

ViVa: the virtual vascular project.

The aim of the virtual vascular project (ViVa) is to develop tools for the modern hemodynamicist and cardiovascular surgeon to study and interpret the constantly increasing amount of information being produced by noninvasive imaging equipment. In particular, we are developing a system able to process and visualize three-dimensional (3-D) medical data, reconstruct the geometry of arteries of specific patients, and simulate blood flow in them. The initial applications of the system will be for clinical research and training purposes. In a later stage, we will explore the application of the system to surgical planning. ViVa is based on an integrated set of tools, each dedicated to a specific aspect of the data processing and simulation pipeline: image processing and segmentation; real-time 3-D volume visualization; 3-D geometry reconstruction; 3-D mesh generation; and blood flow simulation and visualization.

On-line analysis of echocardiographic image sequences.

This paper presents a semiautomatic system for the interactive analysis of echocardiographic image sequences, able to provide useful information to cardiologists. The proposed approach combines well known techniques for the detection of left ventricular boundaries with the computation of optical flow. The initial detection of the cavity contour is based on an improved balloon model, with automatic tuning of parameters and optional model-based constraints. The computation of optical flow is performed with a fast correlation technique and the contour tracking is obtained combining motion information provided by the optical flow with model-based constraints and/or a snake-based regularization. The system is able to follow the motion of the ventricular boundaries precisely, to provide several quantitative features of the heartbeat and a dynamic representation of systolic and diastolic motion. Preliminary experimental results are presented and commented on with particular attention to their clinical relevance. Furthermore a distributed implementation of the system suitable for remote examination analysis has been realized and applied to echo images of the carotid artery.

Tachykinin receptors and intestinal motility.

Substance P (SP) and neurokinin A (NKA) are synthesized by enteric cholinergic motorneurons that project to the longitudinal and circular muscle of the mammalian intestine. Thus, acetylcholine, SP, and NKA are the excitatory neuromuscular transmitters in the intestine. Tachykinin NK1 and NK2 receptors are expressed by smooth muscle cells in most regions of the intestine: the corelease of SP and NKA from nerves thus realizes paradigms of tachykininergic cotransmission. Examples have been found in which a cooperative model can be applied to account for the action of SP-NKA acting at NK1 and NK2 receptors (e.g., circular muscle of guinea-pig duodenum), as well as examples in which the message produced by activation of the two receptors diverges sharply in producing responses that have a markedly different time course and use different effector systems (e.g., circular muscle of guinea-pig colon). NK3 receptors are expressed on both excitatory and inhibitory motor neurons: indirect contractions (via release of acetylcholine and tachykinins) and relaxations (via release of nitric oxide) can be evoked in the gut by selective stimulation of NK3 receptors. Although a role of NK3 receptors in certain enteric reflexes has been evidenced, the importance of this system in mediating hexamethonium-resistant enteric transmission appears less important than previously speculated.