Observational Study on Less Invasive Surfactant Administration (LISA) in Preterm Infants<29 Weeks--Short and Long-term Outcomes.

BACKGROUND: A recent trial has demonstrated short-term benefits of a new minimal invasive procedure of surfactant administration in spontaneously breathing preterm infants ≥ 26 weeks (less invasive surfactant administration, LISA). AIM: To assess safety as well as short- and long-term outcomes of the LISA procedure in preterm infants between 23-28 weeks of gestation. STUDY DESIGN: Preterm infants born between 23+0 and 28+6 weeks gestational age during 2 periods, 18 months before (Period 1, n=44) and 18 months after introduction of LISA (Period 2, n=53), were analyzed for neonatal outcomes. 52% of discharged infants were assessed for neurodevelopmental outcome at corrected age of 3 years. RESULTS: In Period 2, 66% of the preterm infants needing surfactant were treated by the new method of LISA. In this period, fewer patient had to be ventilated during the first 3 days of life (42 vs. 77%, p<0.0005) and overall (55 vs. 77%, p=0.02). The median duration of mechanical ventilation was 2 vs. 3 days (p=0.056). Survival without BPD was 68% in period 1 and 74% in period 2 (p=0.29). In period 2, fewer infants received antibiotics after the third day of life (43 vs. 66%, p=0.04), systemic glucocorticoids were less frequently used (7.5 vs. 23%, p=0.04), and more infants received doxapram (34 vs. 2.3%, p<0.0001). Mental Developmental Index (89 vs. 98, p=0.16) and Physical Developmental Index (83 vs. 91, p=0.03) at 3 years improved between the 2 periods. CONCLUSION: Implementation of the LISA method on a neonatal ward was safe and feasible and was associated with less need for mechanical ventilation in infants >24 weeks. As our study was retrospective the observed trends for better pulmonary and neurocognitive outcomes should be interpreted with caution until results from randomized trials on the LISA procedure are available.

Adenosine A1 and A2 receptor agonists reduce endotoxin-induced cellular energy depletion and oedema formation in the lung.

BACKGROUND AND OBJECTIVE: Tissue depletion of adenosine during endotoxaemia has previously been described in the lung. Therapeutic approaches to prevent adenosine depletion and the role of A1 and A2 receptor agonists, however, have not been investigated until now. METHODS: In isolated and ventilated rabbit lungs, it was tested whether pretreatment with adenosine A1 agonist 2-chloro-N6-cyclopentyladenosine (CCPA; 10(-7) mol, n = 6) or A2 receptor agonist 5'-(N-cyclopropyl)-carboxyamido adenosine (CPCA; 10(-7) mol, n = 6) prior to injection of lipopolysaccharide (LPS) (500 pg mL-1) influenced pulmonary artery pressure (PAP), pulmonary energy content and oedema formation as compared with controls, solely infused with LPS (n = 6). Release rates of adenosine and uric acid were determined by high-performance liquid chromatography. Pulmonary tissue concentrations of high-energy phosphates were measured and the adenine nucleotide pool, adenosine 5'-triphosphate (ATP)/adenosine 5'-diphosphate (ADP) ratio and adenylate energy charge of the pulmonary tissue were calculated. RESULTS: Administration of LPS induced increases in PAP within 2 h up to 20.8 +/- 2.9 mmHg (P < 0.01). While pretreatment with the A1 agonist merely decelerated pressure increase (13.8 +/- 1.1 mmHg, P < 0.05), the A2 agonist completely suppressed the pulmonary pressure reaction (9.6 +/- 1.0 mmHg, P < 0.01). Emergence of lung oedema after exclusive injection of LPS up to 12.0 +/- 2.9 g was absent after A1 (0.6 +/- 0.5 g) and A2 (-0.3 +/- 0.2 g) agonists. These observations were paralleled by increased adenosine release rates compared with LPS controls (P < 0.05). Moreover, tissue concentrations of ADP, ATP, guanosine 5'-diphosphate, guanosine 5'-triphosphate, nicotinamide-adenine-dinucleotide and creatine phosphate were significantly reduced after LPS. Consequently, the calculated tissue adenine nucleotide pool and the adenylate energy charge increased after adenosine receptor stimulation (P = 0.001). CONCLUSIONS: Adenosine A1- and A2-receptor agonists reduced LPS-induced vasoconstriction and oedema formation by maintenance of tissue energy content. Thus, adenosine receptor stimulation, in particular of the A2 receptor, might be beneficial during acute lung injury.

Decreased nocturnal levels of prolactin and growth hormone in women with fibromyalgia.

Fibromyalgia (FM) is a complex syndrome, primarily of women, characterized by chronic pain, fatigue, and sleep disturbance. Altered function of the somatotropic axis has been documented in patients with FM, but little is known about nocturnal levels of PRL. As part of a laboratory study of sleep patterns in FM, we measured the serum concentrations of GH and PRL hourly from 2000--0700 h in a sample of 25 women with FM (mean, 46.9 +/- 7.6 yr) and in 21 control women (mean, 42.6 +/- 8.1 yr). The mean (+/-SEM ) serum concentrations (micrograms per L) of GH and of PRL during the early sleep period were higher in control women than in patients with FM [GH, 1.6 +/- 0.4 vs. 0.6 +/- 0.2 (P < 0.05); PRL, 23.2 +/- 2.2 vs. 16.9 +/- 2.0 (P < 0.025)]. The mean serum concentrations of GH and PRL increased more after sleep onset in control women than in patients with FM [GH, 1.3 +/- 0.4 vs. 0.3 +/- 0.2 (P < 0.05); PRL, 16.2 +/- 2.4 vs. 9.7 +/- 1.5 (P < 0.025)]. Sleep efficiency and amounts of sleep or wake stages on the blood draw night were not different between groups. There was a modest inverse relationship between sleep latency and PRL and a direct relationship between sleep efficiency and PRL in FM. There was an inverse relationship between age and GH most evident in control women. Insulin-like growth factor I levels were not different between the groups. These data demonstrate altered functioning of both the somatotropic and lactotropic axes during sleep in FM and support the hypothesis that dysregulated neuroendocrine systems during sleep may play a role in the pathophysiology of FM.

Wavelength Dependence of Backscatter by use of Aerosol Microphysics and Lidar Data Sets: Application to 2.1- mum Wavelength for Space-Based and Airborne Lidars.

An aerosol microphysics dataset was used to model backscatter in the 0.35-11-mum wavelength range, with the results validated by comparison with measured cw and pulsed lidar backscatter obtained during two NASA-sponsored airborne field experiments. Different atmospheric features were encountered, with aerosol backscatter ranging over 4 orders of magnitude. Modeled conversion functions were used to convert existing lidar backscatter datasets to 2.1 mum. Resulting statistical distribution shows the midtropospheric aerosol backscatter background mode of beta(2.1) to be between ~3.0 x 10(-10) and ~1.3 x 10(-9) m(-1) sr(-1), ~10-20 times higher than that for beta(9.1); and a beta(2.1) boundary layer mode of ~1.0 x 10(-7) to ~1.3 x 10(-6) m(-1) sr(-1), ~3-5 times higher than beta(9.1).

Effects of selective slow wave sleep disruption on musculoskeletal pain and fatigue in middle aged women.

OBJECTIVE: To determine whether disrupted slow wave sleep (SWS) would evoke musculoskeletal pain, fatigue, and an alpha electroencephalograph (EEG) sleep pattern. We selectively deprived 12 healthy, middle aged, sedentary women without muscle discomfort of SWS for 3 consecutive nights. Effects were assessed for the following measures: polysomnographic sleep, musculoskeletal tender point pain threshold, skinfold tenderness, reactive hyperemia (inflammatory flare response), somatic symptoms, and mood state. METHODS: Sleep was recorded and scored using standard methods. On selective SWS deprivation (SWSD) nights, when delta waves (indicative of SWS) were detected on EEG, a computer generated tone (maximum 85 decibels) was delivered until delta waves disappeared. Musculoskeletal tender points were measured by dolorimetry; skinfold tenderness was assessed by skin roll procedure; and reactive hyperemia was assessed with a cotton swab test. Subjects completed questionnaires on bodily feelings, symptoms, and mood. RESULTS: On each SWSD night, SWS was decreased significantly with minimal alterations in total sleep time, sleep efficiency, and other sleep stages. Subjects showed a 24% decrease in musculoskeletal pain threshold after the third SWSD night. They also reported increased discomfort, tiredness, fatigue, and reduced vigor. The flare response (area of vasodilatation) in skin was greater than baseline after the first, and again, after the third SWSD night. However, the automated program for SWSD did not evoke an alpha EEG sleep pattern. CONCLUSION: Disrupting SWS, without reducing total sleep or sleep efficiency, for several consecutive nights is associated with decreased pain threshold, increased discomfort, fatigue, and the inflammatory flare response in skin. These results suggest that disrupted sleep is probably an important factor in the pathophysiology of symptoms in fibromyalgia.

Vertical variability of aerosol backscatter from an airborne-focused continuous-wave CO2 lidar at 9.1-microm wavelength.

Atmospheric aerosol backscatter measurements taken with a continuous-wave focused Doppler lidar at 9.1-microm wavelength were obtained over western North America and the Pacific Ocean from 13 to 26 September 1995 as part of a NASA airborne mission. Backscatter variability was measured for approximately 52 flight hours, covering an equivalent horizontal distance of approximately 30,000 km in the troposphere. Some quasi-vertical backscatter profiles were also obtained during various ascents and descents at altitudes that ranged from approximately 0.1 to 12 km. Similarities and differences for aerosol loading over land and ocean were observed. A midtropospheric aerosol backscatter background mode near 3 x 10(-11) to 1 x 10(-10) m(-1) sr(-1) was obtained, which is consistent with those of previous airborne and ground-based data sets.

Remote sensing of multi-level wind fields with high-energy airborne scanning coherent Doppler lidar.

The atmospheric lidar remote sensing groups of NOAA Environmental Technology Laboratory, NASA Marshall Space Flight Center, and Jet Propulsion Laboratory have developed and flown a scanning, 1 Joule per pulse, CO2 coherent Doppler lidar capable of mapping a three-dimensional volume of atmospheric winds and aerosol backscatter in the planetary boundary layer, free troposphere, and lower stratosphere. Applications include the study of severe and non-severe atmospheric flows, intercomparisons with other sensors, and the simulation of prospective satellite Doppler lidar wind profilers. Examples of wind measurements are given for the marine boundary layer and near the coastline of the western United States.

Signal processing and calibration of continuous-wave focused CO(2) Doppler lidars for atmospheric backscatter measurement.

Two continuous-wave (CW) focused CO(2) Doppler lidars (9.1 and 10.6 µm) were developed for airborne in situ aerosol backscatter measurements. The complex path of reliably calibrating these systems, with different signal processors, for accurate derivation of atmospheric backscatter coefficients is documented. Lidar calibration for absolute backscatter measurement for both lidars is based on range response over the lidar sample volume, not solely at focus. Both lidars were calibrated with a new technique using well-characterized aerosols as radiometric standard targets and related to conventional hard-target calibration. A digital signal processor (DSP), a surface acoustic wave spectrum analyzer, and manually tuned spectrum analyzer signal analyzers were used. The DSP signals were analyzed with an innovative method of correcting for systematic noise fluctuation; the noise statistics exhibit the chi-square distribution predicted by theory. System parametric studies and detailed calibration improved the accuracy of conversion from the measured signal-to-noise ratio to absolute backscatter. The minimum backscatter sensitivity is ~3 × 10(-12) m(-1) sr(-1) at 9.1 µm and ~9 × 10(-12) m(-1) sr(-1) at 10.6 µm. Sample measurements are shown for a flight over the remote Pacific Ocean in 1990 as part of the NASA Global Backscatter Experiment (GLOBE) survey missions, the first time to our knowledge that 9.1-10.6-µm lidar intercomparisons were made. Measurements at 9.1 µm, a potential wavelength for space-based lidar remote-sensing applications, are to our knowledge the first based on the rare isotope (12)C (18)O(2) gas.

2-alpha-(N-dansyl-4-aminophenylthio)-N-acetyl-9-O-acetylneuraminic acid. A new specific and highly sensitive substrate in sialate-O-acetylesterase assay.

2-alpha-(N-Dansyl-4-aminophenylthio)-N-acetyl-9-O-acetylneuraminic acid (10) was prepared as a new specific and highly sensitively detectable sialate-9-O-acetyl-esterase substrate. It is built up from a sialidase-stable aminophenyl-alpha-thioketoside of N-acetylneuraminic acid. By labeling this thioketoside with dansyl chloride a fluorescent neuraminic acid derivative was prepared which allows determinations down to the picomol range. Regioselective acetylation with trimethylorthoacetate results in the corresponding 9-O-acetyl derivative. After incubation with esterase from bovine brain the hydrolysis products were separated on a HPLC column and fluorimetrically detected at 334 nm excitation and 564 nm emission. The Km value of 2.5 mM was in the range between the values of the completely unspecific methylumbelliferyl acetate and the less sensitively detectable N-acetyl-9-O-acetylneuraminic acid which have been used up to now as standard substrates.

Phase-transfer-catalyzed synthesis of aryl alpha-ketosides of N-acetylneuraminic acid. A 2-methylfluoran-6-yl glycoside of N-acetylneuraminic acid, 2-methyl-6-(5-acetamido-3,5-dideoxy-alpha-D-glycero-D-galacto- nonulopyranosylonic acid)xanthene-9-spiro-1'-isobenzofuran-3'-one, a new substrate for neuraminidase assay.

Glycosidation of N-acetylneuraminic acid by phase-transfer catalysis in chloroform-aqueous alkali gave several known and some new aryl alpha-ketosides in a short reaction time and in good yields. The 4-methylumbelliferyl alpha-ketoside, the standard substrate for neuraminidase, was prepared in a yield of up to 70%. New Neu5Ac ketosides were prepared with fluorescein and the fluorescein analog, 2-methyl-6-hydroxyfluoran (2-methyl-6-hydroxyxanthene-9-spiro-1'-isobenzofuran-3'-one) as aglycons, the latter being synthesized from 2-(2-hydroxy-5-methyl-benzoyl) benzoic acid and 3-fluorophenol. The alpha configuration was ascertained by 400-MHz 1H-n.m.r. spectroscopy and by cleavage of the ketosides with neuraminidases from Vibrio cholerae and Clostridium perfringens. The enzymic hydrolysis of the 2-methylfluoran-6-yl ketoside gave Km values of 82 microM (V. cholerae) and 96 microM (C. perfringens).

Phase-transfer-catalysed synthesis of N-acetylneuraminic acid alpha-thioketosides and inhibitor studies with Clostridium perfringens sialidase.

The alpha-thioketosides of methyl 5-acetamido-4,7,8,9-tetra-O-acetylneuraminate with thioacetic acid, thiophenol, 4-nitrothiophenol, 4-aminothiophenol, 2-mercaptopyridin and mercaptobenzothiazol as aglycones were synthesized by phase-transfer catalysis in good yields. The methyl 5-acetamido-4,7,8,9-tetra-O-acetyl-2-thioacetylneuraminate is the analogous thio compound to the methyl 5-acetamido-2,4,7,8,9-penta-O-acetylneuraminate and can be used as intermediate for preparing S-ketosides of Neu5Ac. By Zemplen saponification and mild hydrolysis of the methyl-ester group the free Neu5Ac-alpha-thioketosides with thiophenol, 4-nitrothiophenol, 4-aminothiophenol and 2-mercaptopyridin could be prepared. These ketosides were found to be inhibitors of C. perfringens sialidase with Ki-values between 2.3mM and 6.6mM. The free Neu5Ac-alpha-mercaptobenzothiazolyl ketoside could not be prepared by this procedure. It was completely hydrolysed during Zemplen saponification and methyl-ester hydrolysis in alkaline medium.

Evidence of a tropospheric aerosol backscatter background mode.

Climatologies of aerosol backscatter profiles, derived from airborne a nd ground-basedC 02 lidarr eturns,i ndicate a high frequency of occurrence for a narrow range of low backscatter values within the troposphere-a background mode.

Spectral analysis, digital integration, and measurement of low backscatter in coherent laser radar.

The operation of a surface acoustic wave spectrum analyser and digital integrator is reviewed. Expressions are derived for signal to noise ratio in the measured voltage spectrum with an approximation for the general case and rigorous treatment for the low signal case. A previous calibration study is re-evaluated to provide a final calibration for the atmospheric backscatter data accumulated by the airborne LATAS (laser true airspeed) coherent laser radar system.

A mechanistic and kinetic analysis of the interactions of the diastereoisomers of adenosine 3',5'-(cyclic)phosphorothioate with purified cyclic AMP-dependent protein kinase.

The binding affinities of the diastereoisomers of adenosine 3',5'-(cyclic)phosphorothioate, Sp-cAMP[S] and Rp-cAMP[S], for the cyclic AMP- (cAMP-)binding sites on purified and reconstituted pig heart type II cAMP-dependent protein kinase holoenzyme were determined by measuring the ability of these compounds to displace [3H]cAMP from this enzyme. Sp-cAMP[S], a cAMP agonist, displaced 50% of the [3H]cAMP bound to the holoenzyme at a concentration 10-fold higher than that of cAMP; Rp-cAMP[S], a cAMP antagonist, required a 100-fold higher concentration relative to cAMP. Activation of the isolated holoenzyme, determined as phosphotransferase activity, was measured in the presence of the agonist and in the absence and in the presence of increasing concentrations of the antagonist. The results of fitting the activation data to sigmoid curves with a non-linear-regression program and to Hill plots by using a linear-regression program showed that Rp-cAMP[S] had no effect on Vmax, increased the EC50 values for agonist activation and had no effect on the co-operativity of activation (h). A Ki value of 11 microM was determined for Rp-cAMP[S] inhibition of cAMP-induced activation of purified type II cAMP-dependent protein kinase. Electrophoresis of the holoenzyme on polyacrylamide gels under non-denaturing conditions in the presence of saturating concentrations of the diastereoisomers resulted in 100% dissociation of the subunits with Sp-cAMP[S] and 0% dissociation with Rp-cAMP[S]. Sp-cAMP[S], the isomer with an axial exocyclic sulphur atom, binds to the holoenzyme, releases the catalytic subunit and activates the phosphotransferase activity. Rp-cAMP[S], the isomer with an equatorial exocyclic sulphur atom, binds to the holoenzyme but does not result in dissociation, and thus acts as a competitive inhibitor of phosphotransferase activity.

Inhibition of cAMP-dependent protein kinase by adenosine cyclic 3'-, 5'-phosphorodithioate, a second cAMP antagonist.

A single sulfur substitution for either the axial or the equatorial exocyclic oxygen of adenosine cyclic 3', 5'-phosphate (cAMP) results in diastereometric phosphorothioate analogs of cAMP with agonist versus antagonist properties towards activation of cAMP-dependent protein kinase. Sulfur substitutions for both of the exocyclic oxygens of cAMP results in a dithioate analog of cAMP, adenosine cyclic 3', 5'-phosphorodithioate (cAMPS2), which has antagonist properties. cAMPS2 displaced [3H]cAMP from the binding sites on bovine heart Type II cAMP-dependent protein kinase as demonstrated by equilibrium dialysis experiments with an apparent Kd of 6.3 microM. The addition of 10, 30, or 100 microM cAMPS2 when measuring cAMP-induced activation of pure porcine heart Type II cAMP-dependent protein kinase resulted in a concentration-dependent increase in the amount of cAMP required to produce half-maximal activation (EC50). A plot of the EC50 values as a function of the cAMPS2 concentration resulted in a straight line from which a KI value of 4 microM was derived. cAMPS2 had no significant effect on the degree of cooperativity (n) of cAMP activation of the holoenzyme. These data suggest that the most important structural requirement for the dissociation of the holoenzyme is an equatorial exocyclic oxygen.

Inhibition of cyclic AMP-dependent protein kinase-induced changes in the kinetic properties of hepatic pyruvate kinase by the specific cyclic AMP antagonist, the (Rp)-diastereomer of adenosine cyclic 3',5'-phosphorothioate.

The effects of the diastereomers of adenosine cyclic 3',5'-phosphorothioate, (Sp)- and (Rp)-cAMPS, on the kinetic properties of pyruvate kinase were studied in hepatocytes isolated from fed rats. Incubation of the cells with the cAMP-dependent protein kinase agonist, (Sp)-cAMPS, produced a concentration-dependent increase in S0.5 for phosphoenolpyruvate, but had no effect on Vmax. The (Sp)-cAMPS-treated enzyme was more sensitive to inhibition by alanine and ATP and, under the same conditions, was less responsive to activation by fructose-1,6-bisphosphate when assayed at a subsaturating phosphoenolpyruvate concentration. Incubation of the hepatocytes with only the cAMP-dependent protein kinase antagonist, (Rp)-cAMPS, produced no change in any kinetic parameters, but did suppress the (Sp)-cAMPS- or glucagon-induced increase in the S0.5 for phosphoenolpyruvate with IC50 values of 10 microM and 5 microM (Rp)-cAMPS. (Rp)-cAMPS is exerting an effect on the kinetic properties of pyruvate kinase through inhibition of cAMP-dependent protein kinase.

Effects of the specific cAMP antagonist, (Rp)-adenosine cyclic 3',5'-phosphorothioate, on the cAMP-dependent protein kinase-induced activity of hepatic glycogen phosphorylase and glycogen synthase.

The cAMP-dependent protein kinase-induced effects on phosphorylase and glycogen synthase activities and glucose production were studied in hepatocytes isolated from fed rats in the presence of the diastereomers of adenosine cyclic 3',5'-phosphorothioate, (Sp)-cAMPS and (Rp)-cAMPS. Incubation of hepatocytes with (Sp)-cAMPS or glucagon, both of which lead to cAMP-dependent protein kinase activation, resulted in a concentration-dependent increase in glycogen phosphorylase activity and a decrease in glycogen synthase activity. Incubation of hepatocytes with the cAMP-dependent protein kinase antagonist, (Rp)-cAMPS, in the absence of an agonist, had no significant effect on phosphorylase or glycogen synthase activities. Incubation of hepatocytes with a half-maximally inhibitory concentration of (Rp)-cAMPS shifted the agonist-induced activation curves for phosphorylase and the agonist-induced inhibition curves for glycogen synthase to 5-fold higher concentrations for both (Sp)-cAMPS and glucagon. Phosphorylase activity was very sensitive to the rapid, concentration-dependent inhibition by (Rp)-cAMPS of agonist-induced activation of cAMP-dependent protein kinase. The effects on phosphorylase activity were observable in 30 s and were concentration-dependent with half-maximal inhibition at 10 microM, similar to that observed for cAMP-dependent protein kinase. In contrast, glycogen synthase activity was less sensitive to (Rp)-cAMPS inhibition of agonist-induced activation of cAMP-dependent protein kinase. The effects on glycogen synthase activity lagged behind those on phosphorylase activity and the concentration dependence did not parallel the cAMP-dependent protein kinase effect, but was shifted to higher concentrations of (Rp)-cAMPS with half-maximal inhibition at 60 microM. Glucose (10 to 40 mM) increased the sensitivity of glycogen synthase to (Rp)-cAMPS inhibition of cAMP-dependent protein kinase over a narrow range of agonist concentration, but had no significant effect throughout most of the agonist-induced activation range. Thus, the diastereomers, (Sp)- and (Rp)-cAMPS, influence glycogen metabolism and the glycogenolytic enzymes through their modulation of cAMP-dependent protein kinase levels.