Block of Voltage-dependent Calcium Channel by the Green Mamba Toxin Calcicludine

A number of peptide toxins derived from marine snails and various spiders have been shown to potently inhibit voltage-dependent calcium channels. Here, we describe the effect of calcicludine, a 60 amino-acid peptide isolated from the venom of the green mamba (Dendroaspis angusticeps), on transiently expressed high voltage-activated calcium channels. Upon application of calcicludine, L-type (α_{1 C} ) calcium channels underwent a rapid, irreversible decrease in peak current amplitude with no change in current kinetics, or any apparent voltage-dependence. However, even at saturating toxin concentrations, block was always incomplete with a maximum inhibition of 58%, indicating either partial pore block, or an effect on channel gating. Block nonetheless was of high affinity with an IC₅₀ value of 88 nm. Three other types of high voltage activated channels tested (α_{1 A} , α_{1 B} , and α_{1 E} ) exhibited a diametrically different response to calcicludine. First, the maximal inhibition observed was around 10%, furthermore, the voltage-dependence of channel activation was shifted slightly towards more negative potentials. Thus, at relatively hyperpolarized test potentials, calcicludine actually upregulated current activity of (N-type) α_{1 B} channels by as much as 50%. Finally, the use of several chimeric channels combining the major transmembrane domains of α_{1 C} and α_{1 E} revealed that calcicludine block of L-type calcium channels involves interactions with multiple structural domains. Overall, calcicludine is a potent and selective inhibitor of neuronal L-type channels with a unique mode of action. Received: 22 September 1999/Revised: 1 December 1999     

Minimax D-optimal designs for the logistic model

We propose an algorithm for constructing minimax D-optimal designs for the logistic model when only the ranges of the values for both parameters are assumed known. Properties of these designs are studied and compared with optimal Bayesian designs and Sitter's (1992, Biometrics, 48, 1145-1155) minimax D-optimal kk-designs. Examples of minimax D-optimal designs are presented for the logistic and power logistic models, including a dose-response design for rheumatoid arthritis patients.     

Time-irreversible Subconductance Gating Associated with Ba2+ Block of Large Conductance Ca2+-activated K+ Channels

Ba²⁺ block of large conductance Ca²⁺-activated K⁺ channels was studied in patches of membrane excised from cultures of rat skeletal muscle using the patch clamp technique. Under conditions in which a blocking Ba²⁺ ion would dissociate to the external solution (150 mM N-methyl-d-glucamine⁺ _o, 500 mM K⁺ _i, 10 μM Ba²⁺ _i, +30 mV, and 100 μM Ca²⁺ _i to fully activate the channel), Ba²⁺ blocks with a mean duration of ∼2 s occurred, on average, once every ∼100 ms of channel open time. Of these Ba²⁺ blocks, 78% terminated with a single step in the current to the fully open level and 22% terminated with a transition to a subconductance level at ∼0.26 of the fully open level (preopening) before stepping to the fully open level. Only one apparent preclosing was observed in ∼10,000 Ba²⁺ blocks. Thus, the preopenings represent Ba²⁺-induced time-irreversible subconductance gating. The fraction of Ba²⁺ blocks terminating with a preopening and the duration of preopenings (exponentially distributed, mean = 0.75 ms) appeared independent of changes in [Ba²⁺]_i or membrane potential. The fractional conductance of the preopenings increased from 0.24 at +10 mV to 0.39 at +90 mV. In contrast, the average subconductance level during normal gating in the absence of Ba²⁺ was independent of membrane potential, suggesting different mechanisms for preopenings and normal subconductance levels. Preopenings were also observed with 10 mM Ba²⁺ _o and no added Ba²⁺ _i. Adding K⁺, Rb⁺, or Na⁺ to the external solution decreased the fraction of Ba²⁺ blocks with preopenings, with K⁺ and Rb⁺ being more effective than Na⁺. These results are consistent with models in which the blocking Ba²⁺ ion either induces a preopening gate, and then dissociates to the external solution, or moves to a site located on the external side of the Ba²⁺ blocking site and acts directly as the preopening gate.     

Strategies and counterstrategies to infanticide in mammals

I analyse and summarize the empirical evidence in mammals supporting alternative benefits that individuals may accrue when committing nonparental infanticide. Nonparental infanticide may provide the perpetrator with nutritional benefits, increased access to limited resources, increased reproductive opportunities, or it may prevent misdirecting parental care to unrelated offspring. The possibility that infanticide is either a neutral or maladaptive behaviour also is considered. I devote the second half of this article to reviewing potential mechanisms that individuals may use to prevent infanticide. These counterstrategies include the early termination of pregnancy, direct aggression by the mother against intruders, the formation of coalitions for group defence, the avoidance of infanticidal conspecifics, female promiscuity, and territoriality. I evaluate the support for each benefit and counterstrategy across different groups of mammals and make suggestions for future research.     

超声引导下QLB复合气管插管全麻对于老年患者TEP腹股沟疝无张力修补术影响因素分析

摘要 目的：探讨与分析超声引导下腰方肌阻滞(quadratus lumborum block,QLB)复合气管插管全麻对于老年患者腹腔镜下全腹膜外（totally extraperitoneal prosthetic,TEP）腹股沟疝无张力修补术的影响,以促进该方法的临床使用。方法：2014年9月到2020年6月选择在本院诊治的腹股沟疝老年患者180例,根据随机数字表法分为QLB组与对照组各90例。所有患者都给予腹腔镜下全腹膜外腹股沟疝无张力修补术,对照组给予气管插管全麻,QLB组在对照组麻醉的基础上给予超声引导下QLB,记录两组镇痛与麻醉效果。结果：两组的术中出血量、手术时间等对比差异无统计学意义(P>0.05),QLB组的术后住院时间、术后胃肠功能恢复时间、术后下床活动时间显著短于对照组(P<0.05)。与术后12 h对比,两组术后24 h与36 h的疼痛VAS评分均降低(P<0.05),且QLB组术后12 h、24 h与36 h的疼痛VAS评分都显著低于对照组(P<0.05)。QLB组术后7 d的血肿、呼吸抑制、脏器损伤、腹股沟区包块等并发症发生率为8.9 %,显著低于对照组的21.1 %(P<0.05)。QLB组的瑞芬太尼用量、术后48 h内有效按压自控静脉镇痛泵次数、自控静脉镇痛泵累计用量都显著少于对照组(P<0.05)。结论：超声引导下QLB复合气管插管全麻在老年患者腹腔镜下全腹膜外腹股沟疝无张力修补术中的应用能提高镇痛与麻醉效果,减少术后并发症的发生,有利于促进患者康复。     

Tardive dyskinesia risk with first‐ and second‐generation antipsychotics in comparative randomized controlled trials: a meta‐analysis

Tardive dyskinesia (TD) risk with D2/serotonin receptor antagonists or D2 receptor partial agonists (second‐generation antipsychotics, SGAs) is considered significantly lower than with D2 antagonists (first‐generation antipsychotics, FGAs). As some reports questioned this notion, we meta‐analyzed randomized controlled studies (RCTs) to estimate the risk ratio (RR) and annualized rate ratio (RaR) of TD comparing SGAs vs. FGAs and SGAs vs. SGAs. Additionally, we calculated raw and annualized pooled TD rates for each antipsychotic. Data from 57 head‐to‐head RCTs, including 32 FGA and 86 SGA arms, were meta‐analyzed, yielding 32 FGA‐SGA pairs and 35 SGA‐SGA pairs. The annualized TD incidence across FGA arms was 6.5% (95% CI: 5.3‐7.8%) vs. 2.6% (95% CI: 2.0‐3.1%) across SGA arms. TD risk and annualized rates were lower with SGAs vs. FGAs (RR=0.47, 95% CI: 0.39‐0.57, p<0.0001, k=28; RaR=0.35, 95% CI: 0.28‐0.45, p<0.0001, number‐needed‐to‐treat, NNT=20). Meta‐regression showed no FGA dose effect on FGA‐SGA comparisons (Z=?1.03, p=0.30). FGA‐SGA TD RaRs differed by SGA comparator (Q=21.8, df=7, p=0.003), with a significant advantage of olanzapine and aripiprazole over other non‐clozapine SGAs in exploratory pairwise comparisons. SGA‐SGA comparisons confirmed the olanzapine advantage vs. non‐clozapine SGAs (RaR=0.66, 95% CI: 0.49‐0.88, p=0.006, k=17, NNT=100). This meta‐analysis confirms a clinically meaningfully lower TD risk with SGAs vs. FGAs, which is not driven by high dose FGA comparators, and documents significant differences with respect to this risk between individual SGAs.     

A focus on fixation

Three fixation issues related to immunostaining are discussed here: 1) Generally, a tissue block is fixed, then embedded and sectioned (pre-fixation). The type of fixative applied, crosslinking or coagulating, has an impact on selecting an epitope retrieval method. Individual antigens have a fixation–retrieval characteristic. 2) A long fixation time, especially with crosslinking fixatives, may compromise the result of immunostaining. This negative effect varies among different antigens and can be partially restored by applying a more sensitive/efficient detection system such as tyramide amplification. 3) Sections cut from a fresh frozen tissue block usually are acetone fixed (post-fixation). This was accepted as the “gold standard” for a long time. Post-fixation, however, may have serious consequences for preservation of small peptides leaking from the cut open cells, whereas this is not the case with pre-fixed intact cells. Consequently, the concept of an acetone post-fixed cryostat tissue section as “gold standard” no longer exists and a more appropriate use of the terms immunohistochemistry and immunocytochemistry therefore seems justified. For many antibodies, it is not known whether a formalin fixed, paraffin embedded tissue specimen is appropriate. Suggestions are made for creating a positive control cell block for testing such antibodies.     

七氟醚联合骶管阻滞麻醉对小儿疝气手术的麻醉效果分析

目的:观察七氟醚联合骶管阻滞麻醉对小儿疝气手术的麻醉效果。方法:选取80例行腹股沟疝气手术患儿,按随机数字表法分为两组,对照组(39例)静脉注射氯胺酮,观察组(41例)先吸入8%七氟醚,然后进行骶管阻滞麻醉,通过观察并记录两组患儿生命体征、麻醉诱导时间、苏醒时间、手术麻醉时间、苏醒期躁动评分(Pediatric anesthesia emergence delirium,PAED)和麻醉诱导期合作量表(Induction Compliance Checklist,ICC)及麻醉期间不良反应情况,评价七氟醚联合骶管阻滞麻醉对小儿疝气手术的麻醉效果。结果:两组切皮后T1、T2时心率(HR)、平均动脉压(MAP)水平均高于T0时的值(P0.05),两组切皮后T1、T2时组间HR、MAP水平相比,无统计学差异(P0.05)。两组切皮后T3时HR、MAP水平基本恢复到T0时的水平。两组切皮前后4个时间点的血氧饱和度(Sp O2)相比,无统计学差异(P0.05)。观察组患儿麻醉诱导时间,苏醒时间均明显短于对照组患儿(P0.05),两组术中麻醉持续时间相比,无统计学差异(P0.05),均能达到期望麻醉时间,观察组患儿PAED评分和ICC评分均低于对照组患儿(P0.05),不良反应组间比较无统计学差异(P0.05)。结论:七氟醚联合骶管阻滞麻醉对小儿疝气手术具有良好的麻醉效果,麻醉诱导快,苏醒快,小儿配合度高,术后躁动少,值得临床推广使用。     

Differential response of DPI-modified cardiac Na+ channels to antiarrhythmic drugs: No flicker blockade by lidocaine

Summary Elementary Na⁺ currents were recorded in cell attached patches from short-time cultured neonatal cardiocytes in order to test the hypothesis whether the open state of DPI-modified, noninactivating cardiac Na⁺ channels is basically sensitive to blocking drug molecules such as antiarrhythmics.Lidocaine (300 mol/liter) effectively reduced the open probability of cardiac Na⁺ channels and, at a stimulation rate of 1 Hz, depressed the reconstructed macroscopic peak I _Na to 40+ 3.5% of the predrug value. The same drug concentration failed to influence DPI-modified Na⁺ channels. Their open state proved almost insensitive to lidocaine. _open decreased only slightly to 85 ±2%. Still more importantly, the number of transitions between the conducting and a nonconducting configuration did not increase. At –40 mV, lidocaine may interfere with the open state with an association rate constant of 1.3×10⁵ mol^–1sec^–1 which is about two orders of magnitude smaller than the rate constant obtained with propafenone or prajmalium. Moreover, propafenone (10–20 mol/liter) or prajmalium (30 mol/liter) led to a tremendous increase in the number of transitions between the open and a nonconducting configuration. Lidocaine also failed to evoke a fast flicker blockade with reaction kinetics in the microsecond range.It is concluded that DPI-modified cardiac Na⁺ channels discriminate between lidocaine and other antiarrhythmic drugs. As a tentative explanation, this might be indicative for multiple binding sites for those drugs in cardiac Na⁺ channels.This work was supported by a grant from the Deutsche Forschungs-gemeinschagt (Ko 778/2–3), Bonn.     

超声引导下神经阻滞麻醉联合全身麻醉对股骨头置换老年患者麻醉效果及术后认知功能的影响

摘要 目的：研究超声引导神经阻滞麻醉联合全身麻醉对股骨头置换老年患者的麻醉效果及对术后认知功能的影响。方法：选取2019年1月至2021年12月期间我院收治的150例拟行股骨头置换术的老年患者,随机分为对照组和观察组,各75例。对照组患者行常规全身麻醉,观察组在对照组的基础上行超声引导下神经阻滞麻醉,比较两组患者的血流动力学指标,拔管时间、苏醒时间和复苏室停留时间,苏醒后疼痛,术后认知功能及不良反应的发生率。结果：观察组患者各时间点的心率（HR）和平均动脉压（MAP）均较对照组低（P＜0.05）。观察组拔管时间、苏醒时间和复苏室停留时间均较对照组短（P＜0.05）。观察组患者术后视觉模拟评分（VAS）均低于同一时间点的对照组（P＜0.05）。与对照组相比,观察组患者术后1 h、12 h和24 h的简易智力状态检查（MMSE）评分均较高（P＜0.05）,观察组术后1 h、12 h和24 h术后认知功能障碍（POCD）发生率较对照组低（P＜0.05）。两组患者不良反应发生率无差异（P＞0.05）。结论：超声引导神经阻滞麻醉可稳定血流动力学,缩短拔管、苏醒及复苏室停留时间,减轻术后疼痛,改善术后认知功能,减少POCD的发生,值得临床推广。