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1.  Remifentanil added to sufentanil-sevoflurane anesthesia suppresses hemodynamic and metabolic stress responses to intense surgical stimuli more effectively than high-dose sufentanil-sevoflurane alone 
BMC Anesthesiology  2015;15(1):3.
Background
Even extremely high-doses of the potent opioid, sufentanil, cannot reliably suppress stress responses to intense surgical stimuli such as sternotomy. The chemically related opioid remifentanil with its different pharmacokinetics and binding affinities for delta- and kappa-opioid receptors might be more effective in attenuating these responses.
Methods
ASA I-III patients scheduled for a surgical procedure with sternotomy under balanced anesthesia (sevoflurane and sufentanil 3 μg.kg-1 bolus, 0.017 μg.kg-1.min-1 infusion) were randomized into two groups. Patients in the study group were supplemented with remifentanil (2 μg.kg-1 bolus, 2–7 μg.kg-1.min-1 infusion) starting ten minutes before sternotomy. Heart rate, arterial blood pressures, cardiac index, ejection fraction, systemic vascular resistance index (SVRI), total body oxygen uptake (VO2) and electric dermal response were measured and compared between the groups.
Results
62 patients were studied (study group 32, control group 30). Systolic and mean arterial blood pressures, SVRI, VO2 and skin conductance increased during sternotomy and sternal spread in the control group but not in the study group. Systolic blood pressure increase: 7.5 ± 19 mmHg vs. -3.4 ± 8.9 (p = 0.005); VO2 increase: 31 ± 46% vs. -0.4 ± 32%; incidence of systolic blood pressure increase greater than 15 percent: 20% vs. 3% (p = 0.035) (control vs. study group).
Conclusion
High-dose remifentanil added to sevoflurane-sufentanil anesthesia suppresses the sympathoadrenergic response to sternotomy and sternal spread better than high-dose sufentanil alone.
Trial registration
Clinical Trial number: DRKS00004327, August 31, 2012
Electronic supplementary material
The online version of this article (doi:10.1186/1471-2253-15-3) contains supplementary material, which is available to authorized users.
doi:10.1186/1471-2253-15-3
PMCID: PMC4322556  PMID: 25670917
Sternotomy; Stress response; Remifentanil; Intraoperative hypertension; Oxygen uptake
2.  In vivo P-glycoprotein function before and after epilepsy surgery 
Neurology  2014;83(15):1326-1331.
Objectives:
To study the functional activity of the multidrug efflux transporter P-glycoprotein (Pgp) at the blood-brain barrier of patients with temporal lobe epilepsy using (R)-[11C]verapamil (VPM)-PET before and after temporal lobe surgery to assess whether postoperative changes in seizure frequency and antiepileptic drug load are associated with changes in Pgp function.
Methods:
Seven patients with drug-resistant temporal lobe epilepsy underwent VPM-PET scans pre- and postsurgery. Patients were followed up for a median of 6 years (range 4–7) after surgery. Pgp immunoreactivity in surgically resected hippocampal specimens was determined with immunohistochemistry.
Results:
Optimal surgical outcome, defined as seizure freedom and withdrawal of antiepileptic drugs, was associated with higher temporal lobe Pgp function before surgery, higher Pgp-positive staining in surgically resected hippocampal specimens, and reduction in global Pgp function postoperatively, compared with nonoptimal surgery outcome.
Conclusions:
The data from our pilot study suggest that Pgp overactivity in epilepsy is dynamic, and complete seizure control and elimination of antiepileptic medication is associated with reversal of overactivity, although these findings will require confirmation in a larger patient cohort.
doi:10.1212/WNL.0000000000000858
PMCID: PMC4189097  PMID: 25186858
3.  Blood pressure response to combined general anaesthesia/interscalene brachial plexus block for outpatient shoulder arthroscopy 
BMC Anesthesiology  2014;14:50.
Background
Shoulder surgery is often performed in the beach-chair position, a position associated with arterial hypotension and subsequent risk of cerebral ischaemia. It can be performed under general anaesthesia or with an interscalene brachial plexus block, each of which has specific advantages but also specific negative effects on blood pressure control. It would be worthwhile to combine the advantages of the two, but the effects of the combination on the circulation are not well investigated. We studied blood pressure, heart rate, and incidence of adverse circulatory events in patients undergoing shoulder surgery in general anaesthesia with or without an interscalene block.
Methods
Prospective, randomised, blinded study in outpatients (age 18 to 80 years) undergoing shoulder arthroscopy. General anaesthesia was with propofol/opioid, interscalene block with 40 ml 1% mepivacaine. Hypotension requiring treatment was defined as a mean arterial pressure <60 mmHg or a systolic pressure <80% of baseline; relevant bradycardia was a heart rate <50 bpm with a decrease in blood pressure.
Results
Forty-two patients had general anaesthesia alone, 41 had general anaesthesia plus interscalene block. The average systolic blood pressure under anaesthesia in the beach-chair position was 114 ± 7.3 vs. 116 ± 8.3 mmHg (p = 0.09; all comparisons General vs. General-Regional). The incidence of a mean arterial pressure under 60 mmHg or a decrease in systolic pressure of more than 20% from baseline was 64% vs. 76% (p = 0.45). The number of patients with a heart rate lower than 50 and a concomitant blood pressure decrease was 8 vs. 5 (p = 0.30).
Conclusion
One can safely combine interscalene block with general anaesthesia for surgery in the beach-chair position in ASA I and II patients.
Clinical trial number
DRKS00005295.
doi:10.1186/1471-2253-14-50
PMCID: PMC4083130  PMID: 25002832
Bezold-Jarisch reflex; Interscalene brachial plexus; Outpatient surgery; Regional anaesthesia; Shoulder surgery
4.  The regulatory toll-like receptor 4 genetic polymorphism rs11536889 is associated with renal, coagulation and hepatic organ failure in sepsis patients 
Background
Toll-like receptor 4 (TLR4), a lipopolysaccharide (LPS) receptor complex signal-transducing molecule, plays a crucial role in sensing LPS from gram-negative bacteria. TLR4 signaling pathway activation by LPS plays a major role in sepsis pathogenesis. A single nucleotide polymorphism, rs11536889, in the 3’-untranslated region of the TLR4 gene is thought to affect TLR4 translation. This study aimed to investigate whether organ failure in sepsis patients is related to the TLR4 rs11536889 genotype.
Methods
Adult Caucasian patients with sepsis from the intensive care unit of a university medical center were followed up for 90 days, and organ failure was recorded as the primary outcome variable. Blood samples were collected at enrollment for TLR4 rs11536889 genotyping. Sepsis-related organ failure assessment (SOFA) scores were quantified at sepsis onset and throughout the observational period to monitor organ failure.
Results
A total of 210 critically ill patients with sepsis were enrolled into this study. Wild-type GG was compared to GC/CC. During their stay in the intensive care unit, GG patients presented significantly higher SOFA scores than did C allele carriers (7.9 ± 4.5 and 6.8 ± 4.2, respectively; p = 0.0005). Analysis of organ-specific SOFA sub-scores revealed significant differences in three organ systems: renal, coagulation and hepatic (p = 0.0005, p = 0.0245 and p < 0.0001, respectively). Additionally, the rs11536889 polymorphism was associated with a higher incidence of gram-negative infections.
Conclusions
These results offer the first evidence that TLR4 rs11536889 is a useful marker of organ failure in patients with sepsis.
doi:10.1186/1479-5876-12-177
PMCID: PMC4085654  PMID: 24950711
Toll-like receptor 4; Single-nucleotide polymorphism (SNP); Intensive care unit; Organ failure marker; SOFA scores
5.  Interaction of 11C-Tariquidar and 11C-Elacridar with P-glycoprotein and Breast Cancer Resistance Protein at the Human Blood-Brain Barrier 
The adenosine triphosphate-binding cassette transporters P-glycoprotein (Pgp) and breast cancer resistance protein (BCRP) are 2 major gatekeepers at the blood-brain barrier (BBB) which restrict brain distribution of several clinically used drugs. In this study we investigated the suitability of the radiolabeled Pgp/BCRP inhibitors 11C-tariquidar and 11C-elacridar to assess Pgp density in human brain with PET.
Methods
Healthy subjects underwent a first PET scan of 120 min duration with either 11C-tariquidar (n = 6) or 11C-elacridar (n = 5) followed by a second PET scan of 60 min duration with (R)-11C-verapamil. During scan 1 (at 60 min after radiotracer injection) unlabeled tariquidar (3 mg/kg) was intravenously administered. Data was analyzed using 1-tissue 2-rate-constant (1T2K) and 2-tissue 4-rate-constant (2T4K) compartment models using either metabolite-corrected or uncorrected arterial input functions.
Results
Following injection of 11C-tariquidar or 11C-elacridar, brain PET signal corrected for radioactivity in vasculature was very low (~0.1 standardized uptake value) with slow washout. In response to tariquidar injection, a moderate, but statistically significant rise in brain PET signal was observed for 11C-tariquidar (+27 ± 15%, P = 0.014, paired t-test) and 11C-elacridar (+21 ± 15%, P = 0.014) without changes in plasma activity concentrations. Low levels of radiolabeled metabolites (<25%) were detected in plasma at time points up to 60 min after injection of 11C-tariquidar or 11C-elacridar. The 2T4K model provided better data fits than the 1T2K model. Model outcome parameters were similar when metabolite-corrected or uncorrected input functions were used. There was no significant correlation between distribution volumes (VT) of 11C-tariquidar or 11C-elacridar and VTs of (R)-11C-verapamil in different brain regions.
Conclusion
The in vivo behavior of 11C-tariquidar and 11C-elacridar was consistent with that of dual Pgp/BCRP substrates. Both tracers were unable to visualize cerebral Pgp density, which was most likely related to insufficiently high binding affinities in relation to the very low density of Pgp in human brain (~1.3 nM). Despite their inability to visualize Pgp density, 11C-tariquidar and 11C-elacridar may find use as a new class of radiotracers to study the interplay of Pgp and BCRP at the human BBB in limiting brain uptake of dual substrates.
doi:10.2967/jnumed.112.118232
PMCID: PMC3882137  PMID: 23833270
P-glycoprotein; breast cancer resistance protein; blood-brain barrier; 11C-tariquidar; 11C-elacridar
6.  The effect of changing the sequence of cuff inflation and device fixation with the LMA-Supreme® on device position, ventilatory complications, and airway morbidity: a clinical and fiberscopic study 
BMC Anesthesiology  2014;14:2.
Background
The conventional sequence when using supraglottic airway devices is insertion, cuff inflation and fixation. Our hypothesis was that a tighter fit of the cuff and tip could be achieved with a consequently lower incidence of air leak, better separation of gastrointestinal and respiratory tracts and less airway morbidity if the device were first affixed and the cuff then inflated.
Methods
Our clinical review board approved the study (public registry number DRKS00003174). An LMA Supreme® was inserted into 184 patients undergoing lower limb arthroscopy in propofol-remifentanil anaesthesia who were randomly assigned to either the control (inflation then fixation; n = 92) or study group (fixation then inflation; n = 92). The cuff was inflated to 60 cmH2O. The patients’ lungs were ventilated in pressure-controlled mode with 5 cmH2O PEEP, Pmax to give 6 ml kg-1 tidal volume, and respiratory rate adjusted to end-tidal CO2 of 4.8 and 5.6 kPa. Correct cuff and tip position were determined by leak detection, capnometry trace, oropharyngeal leak pressure, suprasternal notch test, and lube-tube test. Bowl and cuff position and the presence of glottic narrowing were assessed by fiberscopic examination. Postoperative dysphagia, hoarseness and sore throat were assessed with a questionnaire. Ventilatory impairment was defined as a tidal volume < 6 ml kg-1 with Pmax at oropharyngeal leak pressure, glottic narrowing was defined as an angle between the vocal cords under 16 degrees.
Results
The incidence of incorrect device position (18% vs. 21%), failed ventilation (10% vs. 9%), leak pressure (24.8 vs. 25.2 cmH2O, p = 0.63), failed lube-tube test (16.3% vs. 17.6%) and glottic narrowing (19.3% vs. 14.1%, p = 0.35) was similar in both groups (control vs. study, resp.). When glottic narrowing occurred, it was more frequently associated with ventilatory impairment in the control group (77% vs. 39%; p = 0.04). Airway morbidity was more common in the control group (33% vs. 19%; p < 0.05).
Conclusions
Altering the sequence of cuff inflation and device fixation does not affect device position, oropharyngeal leak pressures or separation of gastrointestinal and respiratory tracts. It reduces the incidence of glottic narrowing with impaired ventilation and also perioperative airway morbidity.
doi:10.1186/1471-2253-14-2
PMCID: PMC3890616  PMID: 24387685
Supraglottic airway; Insertion sequence; Malposition; Endoscopic evaluation; Glottic narrowing; Ventilatory impairment; Airway morbidity
7.  A combined accelerator mass spectrometry-positron emission tomography human microdose study with 14C- and 11C-labelled verapamil 
Clinical pharmacokinetics  2011;50(2):111-120.
Background and Objective
In microdose studies, the pharmacokinetic (PK) profile of a drug in blood after administration of a dose up to 100 μg is measured with sensitive analytical techniques, such as accelerator mass spectrometry (AMS). As most drugs exert their effect in tissue rather than blood, methodology is needed for extending PK analysis to different tissue compartments. In the present study, we combined, for the first time, AMS analysis with positron emission tomography (PET) in order to determine the PK profile of the model drug verapamil in plasma and brain of humans. In order to assess PK dose-linearity of verapamil, data were acquired and compared after administration of an intravenous (iv) microdose and an iv microdose dosed concomitantly with an oral therapeutic dose.
Methods
Six healthy male volunteers received an iv microdose (0.05 mg) (period 1) and an iv microdose dosed concomitantly with an oral therapeutic dose (80 mg) of verapamil (period 2) in a randomized, cross-over, two-period study design. The iv dose was a mixture of (R/S)-[14C]verapamil and (R)-[11C]verapamil and the oral dose was unlabelled racemic verapamil. Brain distribution of radioactivity was measured with PET whereas plasma PK of (R)- and (S)-verapamil was determined with AMS. PET data were analyzed by kinetic modeling to estimate the rate constants for transfer of radioactivity across the blood-brain barrier.
Results
Most PK parameters of (R)- and (S)-verapamil as well as parameters describing exchange of radioactivity between plasma and brain (K1=0.030±0.003 and 0.031±0.005 mL·mL−1·min−1 and k2=0.099±0.006 and 0.095±0.008 min−1 for period 1 and 2, respectively) were not statistically different between the two periods although there was a trend for non-linear kinetics for the (R)-enantiomer. On the other hand, all PK parameters (except for t1/2) differed significantly between the (R)- and (S)-enantiomers for both periods. Cmax, AUC(0-24) and AUC(0-inf) were higher and CL, V and VSS were lower for the (R)- than for the (S)-enantiomer.
Conclusion
Combining AMS and PET microdosing allows long term PK data along with information on drug tissue distribution to be acquired in the same subjects thus making it a promising approach to maximize data output from a single clinical study.
doi:10.2165/11537250-000000000-00000
PMCID: PMC3763674  PMID: 21142292
8.  Conspiracy theories as quasi-religious mentality: an integrated account from cognitive science, social representations theory, and frame theory 
Conspiracy theories (CTs) can take many forms and vary widely in popularity, the intensity with which they are believed and their effects on individual and collective behavior. An integrated account of CTs thus needs to explain how they come to appeal to potential believers, how they spread from one person to the next via communication, and how they motivate collective action. We summarize these aspects under the labels of stick, spread, and action. We propose the quasi-religious hypothesis for CTs: drawing on cognitive science of religion, social representations theory, and frame theory. We use cognitive science of religion to describe the main features of the content of CTs that explain how they come to stick: CTs are quasi-religious representations in that their contents, forms and functions parallel those found in beliefs of institutionalized religions. However, CTs are quasi-religious in that CTs and the communities that support them, lack many of the institutional features of organized religions. We use social representations theory to explain how CTs spread as devices for making sense of sudden events that threaten existing worldviews. CTs allow laypersons to interpret such events by relating them to common sense, thereby defusing some of the anxiety that those events generate. We use frame theory to explain how some, but not all CTs mobilize collective counter-conspiratorial action by identifying a target and by proposing credible and concrete rationales for action. We specify our integrated account in 13 propositions.
doi:10.3389/fpsyg.2013.00424
PMCID: PMC3712257  PMID: 23882235
quasi-religion; social representations; frame theory; conspiracy theory; minimal counter-intuitiveness; sense making; beliefs
9.  A pilot study to assess the efficacy of tariquidar to inhibit P-glycoprotein at the human blood-brain barrier with (R)–11C-verapamil and PET 
Tariquidar, a potent, nontoxic, third-generation P-glycoprotein (P-gp) inhibitor, is a possible reversal agent for central nervous system drug resistance. In animal studies, tariquidar has been shown to increase delivery of P-gp substrates into brain by several-fold. The aim of this study was to measure P-gp function at the human blood-brain barrier (BBB) after tariquidar administration using PET and the model P-gp substrate (R)–11C-verapamil. Methods: 5 healthy volunteers underwent paired (R)–11C-verapamil PET scans and arterial blood sampling, before and at 2 h 50 min after i.v. administration of tariquidar (2 mg/kg body weight). Inhibition of P-gp on CD56+ peripheral lymphocytes of each volunteer was determined by means of the rhodamine-123 efflux assay. Tariquidar concentrations in venous plasma were quantified using liquid chromatography/mass spectrometry. Results: Tariquidar administration resulted in significant increases (Wilcoxon test for paired samples) in the distribution volume (DV, +24±15%) and influx rate constant (K1, +49±36%) of (R)–11C-verapamil across the BBB (DV=0.65±0.13 and 0.80±0.07, p=0.043, K1=0.034±0.009 and 0.049±0.009, p=0.043, before and after tariquidar, respectively). A strong correlation was observed between change in brain DV after administration of tariquidar and tariquidar exposure in plasma (r=0.90, p=0.037). The mean plasma concentration of tariquidar achieved during the second PET scan (490±166 ng/mL) corresponded to 100% inhibition of P-gp function in peripheral lymphocytes. Conclusion: Tariquidar significantly increased brain penetration of (R)–11C-verapamil-derived activity, due to increased influx. As opposed to peripheral P-gp function, central P-gp inhibition appeared to be far from complete after the administered tariquidar dose.
doi:10.2967/jnumed.109.063289
PMCID: PMC3690436  PMID: 19910428
PET; (R)-11C-verapamil; tariquidar; P-glycoprotein; blood-brain barrier
10.  Age dependency of cerebral P-gp function measured with (R)-[11C]verapamil and PET 
Purpose
The aim of this study was to assess the influence of age on the functional activity of the multidrug efflux transporter P-glycoprotein (P-gp) at the human blood-brain barrier.
Methods
7 young (mean age: 27±4 years) and 6 elderly (mean age: 69±9 years) healthy volunteers underwent dynamic (R)-[11C]verapamil (VPM) positron emission tomography (PET) scans and arterial blood sampling. Parametric distribution volume (DV) images were generated using Logan linearisation and age groups were compared with statistical parametric mapping (SPM). Brain regions that SPM analysis had shown to be most affected by age were analysed by a region of interest (ROI)-based approach using a maximum probability brain atlas, before and after partial volume correction (PVC).
Results
SPM analysis revealed significant clusters of DV increases in cerebellum, temporal and frontal lobe of elderly compared to younger subjects. In the ROI-based analysis, elderly subjects showed significant DV increases in amygdala (+30%), insula (+26%) and cerebellum (+25%), before PVC, and in insula (+33%), after PVC.
Conclusions
Increased VPM DV values in the brains of elderly subjects suggest a decrease in cerebral P-gp function with increasing age.
doi:10.1007/s00228-009-0709-5
PMCID: PMC3689922  PMID: 19655132
P-glycoprotein; blood-brain barrier; age; (R)-[11C]verapamil; positron emission tomography
11.  P-glycoprotein mediated interaction between (R)-[11C]verapamil and tariquidar at the human blood-brain barrier studied with positron emission tomography, a comparison with rat data 
Using positron emission tomography (PET) imaging we assessed in vivo the interaction between a microdose of (R)-[11C]verapamil, a P-glycoprotein (Pgp) substrate, and escalating doses of the Pgp inhibitor tariquidar (3, 4, 6 and 8 mg/kg) at the blood-brain barrier (BBB) of healthy human subjects. We compared the dose-response relationship of tariquidar in humans with data obtained in rats using similar methodology. Tariquidar was equipotent in humans and rats to increase (R)-[11C]verapamil brain uptake, expressed as whole brain volume of distribution (VT), with very similar half-maximum effect concentrations. Both in humans and rats, brain VTs approached plateau levels at tariquidar plasma concentrations >1,000 ng/mL. However, Pgp inhibition in humans only led to 2.7-fold increase in brain VT relative to baseline scans without tariquidar compared to 11.0-fold in rats. The results of this translational study add to the accumulating evidence of marked species-dependent differences in Pgp expression and functionality at the BBB.
doi:10.1038/clpt.2011.217
PMCID: PMC3685270  PMID: 22166851
P-glycoprotein; blood-brain barrier; drug-drug interaction; positron emission tomography; (R)-[11C]verapamil; tariquidar; human; rat
12.  Pharmacokinetic modeling of P-glycoprotein function at the rat and human blood–brain barriers studied with (R)-[11C]verapamil positron emission tomography 
EJNMMI Research  2012;2:58.
Background
This study investigated the influence of P-glycoprotein (P-gp) inhibitor tariquidar on the pharmacokinetics of P-gp substrate radiotracer (R)-[11C]verapamil in plasma and brain of rats and humans by means of positron emission tomography (PET).
Methods
Data obtained from a preclinical and clinical study, in which paired (R)-[11C]verapamil PET scans were performed before, during, and after tariquidar administration, were analyzed using nonlinear mixed effects (NLME) modeling. Administration of tariquidar was included as a covariate on the influx and efflux parameters (Qin and Qout) in order to investigate if tariquidar increased influx or decreased outflux of radiotracer across the blood–brain barrier (BBB). Additionally, the influence of pilocarpine-induced status epilepticus (SE) was tested on all model parameters, and the brain-to-plasma partition coefficient (VT-NLME) was calculated.
Results
Our model indicated that tariquidar enhances brain uptake of (R)-[11C]verapamil by decreasing Qout. The reduction in Qout in rats during and immediately after tariquidar administration (sevenfold) was more pronounced than in the second PET scan acquired 2 h after tariquidar administration (fivefold). The effect of tariquidar on Qout in humans was apparent during and immediately after tariquidar administration (twofold reduction in Qout) but was negligible in the second PET scan. SE was found to influence the pharmacological volume of distribution of the central brain compartment Vbr1. Tariquidar treatment lead to an increase in VT-NLME, and pilocarpine-induced SE lead to increased (R)-[11C]verapamil distribution to the peripheral brain compartment.
Conclusions
Using NLME modeling, we were able to provide mechanistic insight into the effects of tariquidar and SE on (R)-[11C]verapamil transport across the BBB in control and 48 h post SE rats as well as in humans.
doi:10.1186/2191-219X-2-58
PMCID: PMC3520775  PMID: 23072492
Nonlinear mixed effects modeling; Positron emission tomography; (R)-[11C]verapamil; P-glycoprotein; Tariquidar; Pilocarpine-induced epilepsy; Species differences
14.  Mild metabolic acidosis impairs the β-adrenergic response in isolated human failing myocardium 
Critical Care  2012;16(4):R153.
Introduction
Pronounced extracellular acidosis reduces both cardiac contractility and the β-adrenergic response. In the past, this was shown in some studies using animal models. However, few data exist regarding how the human end-stage failing myocardium, in which compensatory mechanisms are exhausted, reacts to acute mild metabolic acidosis. The aim of this study was to investigate the effect of mild metabolic acidosis on contractility and the β-adrenergic response of isolated trabeculae from human end-stage failing hearts.
Methods
Intact isometrically twitching trabeculae isolated from patients with end-stage heart failure were exposed to mild metabolic acidosis (pH 7.20). Trabeculae were stimulated at increasing frequencies and finally exposed to increasing concentrations of isoproterenol (0 to 1 × 10-6 M).
Results
A mild metabolic acidosis caused a depression in twitch-force amplitude of 26% (12.1 ± 1.9 to 9.0 ± 1.5 mN/mm2; n = 12; P < 0.01) as compared with pH 7.40. Force-frequency relation measurements yielded no further significant differences of twitch force. At the maximal isoproterenol concentration, the force amplitude was comparable in each of the two groups (pH 7.40 versus pH 7.20). However, the half-maximal effective concentration (EC50) was significantly increased in the acidosis group, with an EC50 of 5.834 × 10-8 M (confidence interval (CI), 3.48 × 10-8 to 9.779 × 10-8; n = 9), compared with the control group, which had an EC50 of 1.056 × 10-8 M (CI, 2.626 × 10-9 to 4.243 × 10-8; n = 10; P < 0.05), indicating an impaired β-adrenergic force response.
Conclusions
Our data show that mild metabolic acidosis reduces cardiac contractility and significantly impairs the β-adrenergic force response in human failing myocardium. Thus, our results could contribute to the still-controversial discussion about the therapy regimen of acidosis in patients with critical heart failure.
doi:10.1186/cc11468
PMCID: PMC3580742  PMID: 22889236
15.  Randomized comparison of the i-gel™, the LMA Supreme™, and the Laryngeal Tube Suction-D using clinical and fibreoptic assessments in elective patients 
BMC Anesthesiology  2012;12:18.
Background
The i-gel™, LMA-Supreme (LMA-S) and Laryngeal Tube Suction-D (LTS-D) are single-use supraglottic airway devices with an inbuilt drainage channel. We compared them with regard to their position in situ as well as to clinical performance data during elective surgery.
Methods
Prospective, randomized, comparative study of three groups of 40 elective surgical patients each. Speed of insertion and success rates, leak pressures (LP) at different cuff pressures, dynamic airway compliance, and signs of postoperative airway morbidity were recorded. Fibreoptic evaluation was used to determine the devices’ position in situ.
Results
Leak pressures were similar (i-gel™ 25.9, LMA-S 27.1, LTS-D 24.0 cmH2O; the latter two at 60 cmH2O cuff pressure) as were insertion times (i-gel™ 10, LMA-S 11, LTS-D 14 sec). LP of the LMA-S was higher than that of the LTS-D at lower cuff pressures (p <0.05). Insertion success rates differed significantly: i-gel™ 95%, LMA-S 95%, LTS-D 70% (p <0.05). The fibreoptically assessed position was more frequently suboptimal with the LTS-D but this was not associated with impaired ventilation. Dynamic airway compliance was highest with the i-gel™ and lowest with the LTS-D (p <0.05). Airway morbidity was more pronounced with the LTS-D (p <0.01).
Conclusion
All devices were suitable for ventilating the patients’ lungs during elective surgery.
Trial registration
German Clinical Trial Register DRKS00000760
doi:10.1186/1471-2253-12-18
PMCID: PMC3434115  PMID: 22871204
Laryngeal mask airway; Leak pressure; Laryngeal Tube
16.  AMPK - Activated Protein Kinase and its Role in Energy Metabolism of the Heart 
Current Cardiology Reviews  2010;6(4):337-342.
Adenosine monophosphate – activated kinase (AMPK) plays a key role in the coordination of the heart’s anabolic and catabolic pathways. It induces a cellular cascade at the center of maintaining energy homeostasis in the cardiomyocytes.. The activated AMPK is a heterotrimeric protein, separated into a catalytic α - subunit (63kDa), a regulating β - subunit (38kDa) and a γ - subunit (38kDa), which is allosterically adjusted by adenosine triphosphate (ATP) and adenosine monophosphate (AMP). The actual binding of AMP to the γ – subunit is the step which activates AMPK.
AMPK serves also as a protein kinase in several metabolic pathways of the heart, including cellular energy sensoring or cardiovascular protection. The AMPK cascade represents a sensitive system, activated by cellular stresses that deplete ATP and acts as an indicator of intracellular ATP/AMP. In the context of cellular stressors (i.e. hypoxia, pressure overload, hypertrophy or ATP deficiency) the increasing levels of AMP promote allosteric activation and phosphorylation of AMPK. As the concentration of AMP begins to increase, ATP competitively inhibits further phosphorylation of AMPK. The increase of AMP may also be induced either from an iatrogenic emboli, percutaneous coronary intervention, or from atherosclerotic plaque rupture leading to an ischemia in the microcirculation. To modulate energy metabolism by phosphorylation and dephosphorylation is vital in terms of ATP usage, maintaining transmembrane transporters and preserving membrane potential.
In this article, we review AMPK and its role as an important regulatory enzyme during periods of myocardial stress, regulating energy metabolism, protein synthesis and cardiovascular protection.
doi:10.2174/157340310793566073
PMCID: PMC3083815  PMID: 22043210
Adenosine monophosphate - activated protein kinase; AMPK; heart failure; cardiac energy metabolism.
18.  Assessment of regional differences in tariquidar-induced P-glycoprotein modulation at the human blood–brain barrier 
We attempted to assess regional differences in cerebral P-glycoprotein (P-gp) function by performing paired positron emission tomography (PET) scans with the P-gp substrate (R)-[11C]verapamil in five healthy subjects before and after i.v. infusion of tariquidar (2 mg/kg). Comparison of tariquidar-induced changes in distribution volumes (DVs) in 42 brain regions of interest (ROIs) failed to detect significant differences among brain ROIs. Statistical parametric mapping analysis of parametric DV images visualized symmetrical bilateral clusters with moderately higher DV increases in response to tariquidar administration in cerebellum, parahippocampal gyrus, olfactory gyrus, and middle temporal lobe and cortex, which might reflect moderately decreased P-gp function and expression.
doi:10.1038/jcbfm.2009.265
PMCID: PMC2949150  PMID: 20010957
blood–brain barrier; P-glycoprotein; positron emission tomography (PET); (R)-[11C]verapamil; regional; tariquidar
22.  ZDHHC8 as a candidate gene for schizophrenia: Analysis of a putative functional intronic marker in case-control and family-based association studies 
BMC Psychiatry  2005;5:35.
Background
The chromosome 22q11 region is proposed as a major candidate locus for susceptibility genes to schizophrenia. Recently, the gene ZDHHC8 encoding a putative palmitoyltransferase at 22q11 was proposed to increase liability to schizophrenia based on both animal models and human association studies by significant over-transmission of allele rs175174A in female, but not male subjects with schizophrenia.
Methods
Given the genetic complexity of schizophrenia and the potential genetic heterogeneity in different populations, we examined rs175174 in 204 German proband-parent triads and in an independent case-control study (schizophrenic cases: n = 433; controls: n = 186).
Results
In the triads heterozygous parents transmitted allele G preferentially to females, and allele A to males (heterogeneity χ2 = 4.43; p = 0.035). The case-control sample provided no further evidence for overall or gender-specific effects regarding allele and genotype frequency distributions.
Conclusion
The findings on rs175174 at ZDHHC8 are still far from being conclusive, but evidence for sexual dimorphism is moderate, and our data do not support a significant genetic contribution of rs175174 to the aetiopathogenesis of schizophrenia.
doi:10.1186/1471-244X-5-35
PMCID: PMC1274335  PMID: 16225675

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