The relationship between expressed HIV/AIDS-related stigma and beliefs and knowledge about care and support of people living with AIDS in families caring for HIV-infected children in Kenya.

At the end of 2001, AIDS-related deaths had left an estimated 900,000 living orphans in Kenya (UNAIDS/WHO Epidemiology fact sheet, Kenya report, 2004). Many of those orphans are also HIV+. In Eastern Kenya, the Lea Toto Kangemi Outreach Program provides support to families caring for HIV+ children, many of whom are orphaned or soon to be orphaned. A major challenge for these families is the stigma attached to the family. In 2003, the Kangemi Program conducted a household survey of client families. We examined markers of expressed stigma and the association between expressed stigma and other demographic and belief/knowledge domains. The focus of the present study was the specific belief/knowledge domain surrounding care/support of HIV+ persons. Our goal was to explore this domain in the Kangemi families and to examine its relationship to expressed stigma. We created an AIDS-related stigma scale from selected items in the household survey and cross-tabulated stigma scores with care/support knowledge items. We found significant associations between less expressed stigma and greater care/support knowledge. Our results have implications for interventions that reduce expressed stigma and/or improve quality of care.

Opioid modulation of calcium current in cultured sensory neurons: mu-modulation of baroreceptor input.

We used the whole cell open-patch or perforated-patch technique to characterize mu-opioid modulation of Ca(2+) current (I(Ca)) in nodose sensory neurons and in a specific subpopulation of nodose cells, aortic baroreceptor neurons. The mu-opiate receptor agonist Tyr-D-Ala-Gly-MePhe-Gly-ol enkephalin (DAGO) inhibited I(Ca) in 95% of neonatal [postnatal day (P)1-P3] nodose neurons. To the contrary, only 64% of juvenile cells (P20-P35) and 61% of adult cells (P60-P110) responded to DAGO. DAGO-mediated inhibition of I(Ca) was naloxone sensitive, irreversible in the presence of guanosine 5'-O-(3-thiotriphosphate), absent with guanosine 5'-O-(2-thiodiphosphate), and eliminated with pertussis toxin; DAGO's inhibition of I(Ca) was G protein mediated. Incubation of neurons with omega-conotoxin GVIA eliminated the effect of DAGO in neonatal but not in juvenile cells. In the latter, DAGO reduced 37% of the current remaining in the presence of omega-conotoxin. In the subset of nodose neurons, aortic baroafferents, the effect of DAGO was concentration dependent, with an IC(50) of 1.82 x 10(-8) M. DAGO slowed activation of I(Ca), but activation curves constructed from tail currents were the same with and without DAGO (100 nM). In summary, mu-opiate modulation of I(Ca) in nodose neurons was demonstrated in three age groups, including specifically labeled baroafferents. The demonstration of a mechanism of action of mu-opioids on baroreceptor afferents provides a basis for the attenuation of the baroreflex that occurs at the level of the nucleus tractus solitarii.

Accentuated antagonism in canine subendocardium is not altered by chronic exercise.

Acetylcholine often affects cardiac action potential repolarization only during augmented adrenergic tone, i.e., the phenomenon of accentuated antagonism. Since chronic exercise involves repeated changes in autonomic outflow, we determined whether it also influenced adrenergic/cholinergic interactions in isolated canine cardiac tissue. Using standard micro-electrode techniques in thin ventricular subendocardial slices isolated from exercised (EX: 8-10 wk daily exercise) and sedentary (SED): 8-10 wk cage rest) dogs, we examined transmembrane potential responses to isoproterenol (ISO: 10(-8), 10(-7), 10(-6) M) and to ISO in the presence of ACH (10(-5) M). Control transmembrane characteristics at BCL = 500 ms were similar for EX (N = 8 dogs) and SED (N = 9 dogs). ISO (10(-6) M) decreased action potential duration at 50% repolarization (APD50): EX = -29 +/- 15 ms; SED = 11 ms and at 90% repolarization (APD90): EX = -37 +/- 17 ms; and SED = -24 +/- 14 ms (P > 0.05, EX vs SED). ACH alone did not alter APD. With ACH (10(-5) M), delta APD50 with ISO (10(-6) M) was -5 +/- ms and 0 +/- 5 ms for EX and SED, respectively; delta APD90 was -8 +/- 4 ms and -8 +/- 7 ms for EX and SED, respectively (P > 0.05, EX vs SED). Thus, ACH antagonized ISO-mediated acceleration of repolarization equally in both groups. Chronic daily exercise does not influence adrenergic/cholinergic interactions at the cellular level.

Endothelium-dependent relaxation and hyperpolarization evoked by bradykinin in canine coronary arteries: enhancement by exercise-training.

1. Kinins, which are produced locally in arterial walls, stimulate the release of endothelium-derived vasodilator substances. Therefore, they may participate in the metabolic adaptation to chronic exercise that occurs in the coronary circulation. Experiments were designed to compare the reactivity to bradykinin in coronary arteries isolated from sedentary and exercised-trained dogs (for 8-10 weeks). 2. The organ chambers used in this study were designed for measurement of isometric tension and cell membrane potential with glass microelectrodes. Rings of canine isolated coronary arteries with endothelium were suspended in the organ chambers filled with modified Krebs-Ringer bicarbonate solution (37 degrees C, gassed with 5% CO2 in 95 O2), and were all treated with indomethacin to prevent interference from prostaglandins. 3. Bradykinin evoked concentration-dependent relaxations of the coronary arteries. However, the kinin was significantly less potent in relaxing coronary arteries from the sedentary dogs than those from the trained ones. 4. In the presence of NG-nitro-L-arginine (an inhibitor of nitric oxide synthases), concentration-relaxation curves to bradykinin were shifted to the right in both types of preparations. Nonetheless, the peptide was still significantly more potent in arteries from exercise-trained animals. 5. In the electrophysiological experiments, concentration-hyperpolarization curves to bradykinin obtained in arteries from sedentary dogs were also significantly to the right of those in vessels from exercise-trained animals. Thus, in arteries from exercised animals, bradykinin more potently evoked the release of both nitric oxide (NO) and endothelium-derived hyperpolarizing factor (EDHF). 7. The angiotensin converting enzyme (ACE)-inhibitor, perindoprilat, shifted to the left the concentration-relaxation curves to bradykinin obtained under control conditions and in the presence of NG-nitro-L-arginine. The concentration-hyperpolarization curves to bradykinin were also shifted to the left by perindoprilat. The shift induced by the ACE-inhibitor in either type of preparation was not significantly different. 8. These findings demonstrate that exercise-training augments the sensitivity of the coronary artery of the dog to the endothelium-dependent effects of bradykinin. This sensitization to bradykinin may reflect an increased role of both NO and EDHF, and is not the consequence of differences in ACE activity in the receptor compartment.

Cardiac adrenergic responses and electrophysiology during ischemia: effect of exercise.

Whether exercise protects the myocardium from arrhythmias during ischemia (ISC) or alters electrophysiology is controversial. We used microelectrode techniques in isolated cardiac fibers from exercise-trained (ET: 8-10 wk daily exercise) and sedentary (SED: 8-10 wk cage-rest) dogs to examine the effect of exercise on cellular electrophysiology during simulated ISC. We superfused fibers first with normal Tyrode's, then "ischemic Tyrode's" ([K+]o = 10 mM, pH = 6.7, pO2 < 25 mm Hg), and then again with normal Tyrode's. In automatic fibers, maximum diastolic potential in normal Tyrode's was -98 +/- 1 mV (ET, N = 22) and -97 +/- 1 mV (SED, N = 23); rates were 20 +/- 2 and 18 +/- 3 bpm for ET and SED, respectively. All fibers depolarized to -61 +/- 2 mV with ISC. Abnormal rhythms (abnormal automaticity with or without delayed afterdepolarizations) during ISC alone were seen in 0% of ET and 33% of SED; during ISC with alpha-adrenergic stimulation with 5 x 10(-8) M phenylephrine the incidence was 25% of ET and 0% of SED; during ISC with isoproterenol it was 75% for ET (P < 0.05 vs control) and 38% for SED. Transmembrane potentials in paced subendocardial fibers were similar for ET and SED during control, ISC, and reperfusion. Exercise did not alter cellular electrophysiology but did influence ectopic rhythms seen with beta-stimulation during ISC.

Canine cardiac sarcoplasmic reticulum is not altered with endurance exercise training.

To investigate the effect of exercise training on calcium movements by isolated cardiac sarcoplasmic reticulum (SR), mongrel dogs either remained sedentary (S) or were exercise-trained (E) via running for a period of 8-10 wk. The trained state was confirmed by the increase in skeletal muscle citrate synthase activity and decreases in submaximal exercise heart rates in the E group but not in the S dogs. The properties of isolated cardiac SR were identical between the groups. The variables tested included ATP-dependent calcium transport and calcium-stimulated ATPase activity. Importantly, there was no difference in spontaneous calcium release which occurred after peak ATP-dependent calcium accumulation was reached. Calcium release from passively loaded vesicles induced by calcium and ionophore also did not differ in the SR isolated from the E dogs. The change in the affinity of the SR Ca ATPase for calcium after the addition of the polyanion, heparin, was similar in both groups, indicating that the regulation of calcium-stimulated ATPase activity by the SR protein, phospholamban, is not modified by exercise training. We conclude that exercise training of 8-10 wk duration does not alter the calcium handling properties of cardiac SR isolated from mongrel dogs.

Developmental differences in the electrophysiological response of isolated canine Purkinje fibers to adrenergic stimulation during simulated ischemia.

Developmental differences in adrenergic responsiveness may cause age-related changes in the cellular response to ischemia. Standard microelectrode techniques were used in isolated young and adult canine Purkinje fibers to determine the effect of simulated ischemia ([K+]o = 10 mM, pH 6.7, pO2 < 25 mm Hg) alone or with adrenergic stimulation on the rhythmic activity in spontaneously beating Purkinje fibers and on transmembrane potentials and delayed afterdepolarizations in paced Purkinje fibers (basic cycle length = 800-300 ms). The adrenergic agonists used were phenylephrine (5 x 10(-8) M) and isoproterenol (1 x 10(-6) M). For all automatic fibers studied, the control maximum diastolic potential in adults (-96 +/- 1 mV, n = 37) and in the young (-98 +/- 1 mV, n = 36) went to -62 +/- 1 mV during ischemia in both groups and returned to -96 +/- 2 mV with reperfusion. The incidence of rhythmic activity (expressed as percent) during ischemia alone was similar at both ages: adults, 22%; young, 25%. The incidence of ectopic activity with phenylephrine superfusion during ischemia for adults was 63%, an effect blocked by prazosin (1 x 10(-6) M) but not by propranolol (2 x 10(-7) M); the incidence for the young was 25%. Isoproterenol caused ectopic rhythms in 86% of young fibers and 17% of adult fibers (p < 0.05 young vs. adult). During reperfusion the return to control rhythm was slower in adults after ischemia alone or ischemia + alpha-adrenergic stimulation with phenylephrine. There were no age-related differences in the transmembrane potential response of paced fibers to ischemia or reperfusion, and there were no delayed afterdepolarizations with interruption of pacing at 800, 500, or 300 ms in either group. These data suggest that age-related differences in adrenergic responses alter the cellular response to an ischemic insult. To the extent that an ectopic beat may initiate an abnormal rhythm, these differences in sensitivity to adrenergic agonists may lead to developmental differences in arrhythmogenic potential during ischemia.

The influence of pH on the use-dependent effects of lidocaine in adult and neonatal canine Purkinje fibers.

We used microelectrode techniques to examine the influence of pH on the effects of lidocaine on neonatal and adult canine Purkinje fiber action potentials. Lidocaine, 5 mg/l and 10 mg/l, significantly decreased overshoot, Vmax, and action potential duration in neonatal and adult fibers (basic cycle length 1300 and 300 ms) at pH 7.3 and 6.8. The effects were similar except for that on action potential duration which was greater in adults. Lidocaine, 5 mg/l, caused a comparable tonic block in adults and neonates at pH 7.3 (12 +/- 2 and 11 +/- 2%, respective decreases of Vmax) and at pH 6.8. Onset of use-dependent block (UDB) (pH 7.3) was faster in adults than neonates, 2 +/- 0.3 vs. 6 +/- 0.8 beats (P < 0.05); and tau off was slower in adults (133 +/- 10 ms) than neonates (81 +/- 8 ms; P < 0.05). At pH 6.8 the 'on' rates were 5 +/- 0.8 and 7 +/- 1 beats for adults and neonates, respectively (P > 0.05), and tau off increased to 210 +/- 15 ms for adults and 193 +/- 10 ms for neonates (P > 0.05). Thus, developmental differences in lidocaine action may be modified by the degree of protonation.

Alpha-adrenergic receptor stimulation during simulated ischemia and reperfusion in canine cardiac Purkinje fibers.

We studied the effects of alpha-adrenergic receptor stimulation and calcium on automaticity of isolated canine Purkinje fibers during simulated ischemia and reperfusion. Ischemia included acidosis (pH 6.7), hypoxia (PO2 = 10-25 mm Hg), hyperkalemia (10 mM K+), and either normal or elevated [Ca2+]o (2.7 or 10.8 mM). Control automatic rate and maximum diastolic potential were 18 +/- 2 beats/min and -94 +/- 1 mV, respectively. Simulated ischemia led to depolarization (to -60 +/- 1 mV), cessation of normal automaticity, and in 21% of fibers, bursts of an abnormal automatic rhythm. Phenylephrine, 5 X 10(-8) M, increased the incidence of the automatic rhythm during ischemia to 44%; this effect was blocked by prazosin but not by propranolol. During reperfusion after simulated ischemia at 2.7 mM [Ca2+]o, automatic rhythm and maximum diastolic potential returned toward control values; after simulated ischemia at 10.8 mM [Ca2+]o, automatic rates were greater than those seen after normal Ca2+ ischemia and were associated with sustained membrane depolarization. Phenylephrine (5 X 10(-8) M) at 2.7 mM [Ca2+]o rapidly restored membrane potential during reperfusion, an effect that was blocked by prazosin. At 10.8 mM [Ca2+]o, phenylephrine also restored membrane potential during reperfusion and blunted the increase in reperfusion rate induced by high [Ca2+]o alone. These effects were blocked by propranolol but not by prazosin. Our results show that the effects of phenylephrine on automatic rhythms during simulated ischemia are blocked by alpha-adrenergic receptor antagonists and that rhythms occurring during reperfusion have alpha- and beta-adrenergic receptor components.

Cardiac electrophysiologic effects of AHR 5360C.

We used microelectrode and blood superfusion techniques to study the cardiac electrophysiologic effects of a new drug, AHR 5360C, which has antihypertensive and calcium channel blocking properties in several experimental models. AHR 5360C, 10(-7) M significantly depressed the amplitude of the slow response action potential in canine Purkinje fibers. The fast response action potential was also depressed in a dose-dependent fashion, but with a threshold concentration of 5 X 10(-6) M. AHR 5360C decreased normal automaticity and barium-induced abnormal automaticity at concentrations of 5 X 10(-6) and 10(-5) M respectively, as well as ouabain-induced delayed afterdepolarizations at a threshold concentration of 10(-6) M. In blood superfusion studies; i.v. administration of AHR 5360C, 0.3 mg/kg, significantly reduced blood pressure. Doses of 1.0 mg/kg induced a high degree of A-V block, further reduction of blood pressure, and no physiological changes in heart rate and in the blood superfused fibers. In conclusion, AHR 5360C has calcium blocking properties that depress A-V conduction at concentrations that do not affect the sodium-dependent fast response action potential.

Developmental changes in the effects of nadolol on adult and neonatal canine Purkinje fibers.

We used standard microelectrode techniques to determine developmental differences in the direct membrane and beta-blocking effects of nadolol on the electrophysiologic properties of adult and neonatal canine Purkinje fibers (PF). To study direct membrane effects, we superfused PF with nadolol 1 X 10(-8)-1 X 10(-4) M while stimulating them at a BCL of 800 ms. Nadolol less than 1 X 10(-5) M had no effect on the transmembrane potential in either age group. Nadolol, greater than or equal to 1 X 10(-5) M, increased action potential duration at 100% repolarization (APD100) in adult fibers and nadolol, 1 X 10(-4) M, decreased Vmax and APD at 50% repolarization (APD50) in neonatal fibers (p less than 0.05). The beta-blocking effects of nadolol were studied by examining the chronotropic response in automatic PF to cumulative doses of l-isoproterenol.HCl 3 X 10(-10)-3 X 10(-6) M, alone and then in the continued presence of nadolol 5 X 10(-8)-5 X 10(-6) M. Nadolol caused a concentration-dependent shift to the right of the concentration-response curve in both age groups. pA2 determinations in adult (7.88) and neonatal (7.57) PF indicated that there was no developmental difference in the affinity of nadolol for the beta-receptor (p greater than 0.05). Our results indicate that nadolol shows developmental changes in its direct membrane effects but not its beta-blocking effects. The latter characteristic differs from that of the more highly lipid-soluble beta-blocker, propranolol. This suggests that different beta-blocking molecules have differing abilities to block the beta-receptor at different ages that are influenced importantly by their lipid solubility.

Role of muscle mass and mode of contraction in circulatory responses to exercise.

The roles of the mode of contraction (i.e., dynamic or static) and the active muscle mass as determinants of the cardiovascular responses to exercise were studied. Six healthy men performed static handgrip (SHG), dynamic handgrip (DHG), static two-knee extension (SKE), and dynamic two-knee extension (DKE) to local muscular fatigue in approximately 6 min. Increases in mean arterial pressure were similar for each mode of contraction, 29 +/- 5 and 30 +/- 3 mmHg in SHG and DHG and 56 +/- 2 and 48 +/- 2 mmHg in SKE and DKE (P greater than 0.05) but larger for KE than HG (P less than 0.001). Cardiac output increased more for dynamic than for static exercise and for each mode more for KE than HG (P less than 0.001). Systemic resistance was lower for dynamic than static exercise and fell from resting levels by approximately 1/3 during DKE. The magnitude of the pressor response was related to the active muscle mass but independent of the contraction mode. However, the mode of contraction affected the circulatory changes contributing to the pressor response. Equalization of the pressor responses was achieved by proportionately larger increases in cardiac output during dynamic exercise.

Maximum coronary blood flow and minimum coronary resistance in exercise-trained dogs.

Exercise training has been found to increase coronary vascularity of the heart in experimental animals. Maximum coronary flow and minimum coronary resistance were determined in 16 dogs with the injection of microspheres (15 micron) into the left atrium at rest and during the intravenous infusion of adenosine (0.7 mg X min-1 X kg-1). Heart rate was paced at 150 beats/min. Dogs were divided into three groups with microsphere injections made before and after 4-5 wk of daily exercise (group 1); before and after 8-10 wk of daily exercise (group II); and before and after 8-10 wk of cage rest (group III). Results of average left ventricular maximum myocardial flow before and after daily exercise were 4.08 +/- 0.34 and 4.89 +/- 0.33 ml X min-1 X g-1 for group I, 5.13 +/- 0.32 and 5.55 +/- 0.56 ml X min-1 X g-1 for group II, and 5.24 +/- 0.43 and 4.34 +/- 0.55 ml X min-1 X g-1 for group III. Arterial pressure, maximum coronary flow, and minimum coronary resistance were not significantly different before and after any condition in all three groups of dogs. Peak reactive hyperemia coronary flow was not altered by daily exercise. These results indicate that maximum coronary flow and minimum coronary resistance were not altered by either 4-5 or 8-10 wk of exercise training.