Construction of Challenging Proline-Proline Junctions via Diselenide-Selenoester Ligation Chemistry.

Polyproline sequences are highly abundant in prokaryotic and eukaryotic proteins, where they serve as key components of secondary structure. To date, construction of the proline-proline motif has not been possible owing to steric congestion at the ligation junction, together with an n → π* electronic interaction that reduces the reactivity of acylated proline residues at the C-terminus of peptides. Here, we harness the enhanced reactivity of prolyl selenoesters and a trans-γ-selenoproline moiety to access the elusive proline-proline junction for the first time through a diselenide-selenoester ligation-deselenization manifold.

Clinical review: practical recommendations on the management of perioperative heart failure in cardiac surgery.

Acute cardiovascular dysfunction occurs perioperatively in more than 20% of cardiosurgical patients, yet current acute heart failure (HF) classification is not applicable to this period. Indicators of major perioperative risk include unstable coronary syndromes, decompensated HF, significant arrhythmias and valvular disease. Clinical risk factors include history of heart disease, compensated HF, cerebrovascular disease, presence of diabetes mellitus, renal insufficiency and high-risk surgery.

Computer-mediated mobile messaging as collaboration support for nurses.

Collaboration in hospitals is coordinated mainly by communication, which currently happens by face-to-face meetings, phone calls, pagers, notes and the electronic patient record. These habits raise problems e.g.

Diastolic arterial blood pressure: a reliable early predictor of survival in human septic shock.

Background: Emphasis in therapy of human septic shock is shifting towards reliable end points and predictors of survival. Rationale is to study whether the evolution of cardiovascular reactivity in view of the administered doses of norepinephrine is an early predictor of in-hospital survival and to determine the optimal threshold of norepinephrine therapy and its consequences on renal function.

Methods: Observational study of a prospective cohort of patients in septic shock, hospitalized in intensive care unit at least 24 hours before requiring norepinephrine.

[New data in the diagnosis and treatment of stable angina pectoris].

Stable angina pectoris is a manifestation of ischemic heart disease which frequently leeds to acute coronary syndrome. The patient has a short effort or stress situation induced retrosternal pain which is easing after the elimination of its cause, or taking nitroglycerin. Several new data have appeared in the literature about the pathogenesis and diagnosis of stable angina pectoris.

Effects of nebivolol in elderly heart failure patients with or without systolic left ventricular dysfunction: results of the SENIORS echocardiographic substudy.

Aims: The SENIORS trial recently demonstrated that nebivolol reduces the composite risk of all-cause mortality and cardiovascular hospital admission in elderly patients with chronic heart failure and, importantly, that ejection fraction does not influence the clinical effects of nebivolol. An echocardiographic substudy was designed to evaluate the effects of nebivolol on systolic and diastolic left ventricular (LV) function in patients stratified according to the presence or absence of systolic LV dysfunction.

Methods And Results: The substudy randomized 112 patients in 29 European centres, of whom 104 were evaluable for the study; 43 had an ejection fraction (EF) 35%.

[Experiences with serum BNP (B type natriuretic peptide) in patients with systolic and diastolic heart failure].

Current study confirms and extends recent observations concerning the diagnostic usefulness of B type natriuretic peptide. It discriminates well between dyspnea of cardiac and non-cardiac origin in the unselected population. Echocardiography represents useful diagnostic tool for assessment of systolic and diastolic ventricular function.

[The role of ACE inhibitors and angiotensin receptor blockers in the treatment and prevention of chronic heart failure].

The incidence of heart failure is increasing and its prevalence is high, ranging from 1% to 2% in middle aged patients to more than 10% in older patients. Several pharmacologic approaches developed during the past 15 years, have had at least in clinical trials a significant impact on progression of heart failure mortality. The effect of ACE-inhibitors has been documented extensively during the last 15 years.

High incidence of myocardial ischemia during postpartum hemorrhage.

Background: Postpartum hemorrhage remains a major cause of global maternal morbidity and mortality, even in developed countries, despite the use of intensive care units. This study sought to (1) assess whether myocardial ischemia could be associated with and even aggravate hemorrhagic shock in young parturients admitted for postpartum hemorrhage, and (2) identify the independent risk factors for myocardial ischemia.

Methods: On their referral to the intensive care unit, a multidisciplinary team managed parturients with severe postpartum hemorrhage.

Acute right ventricular failure--from pathophysiology to new treatments.

The right ventricle (RV) provides sustained low-pressure perfusion of the pulmonary vasculature, but is sensitive to changes in loading conditions and intrinsic contractility. Factors that affect right ventricular preload, afterload or left ventricular function can adversely influence the functioning of the RV, causing ischaemia and right ventricular failure (RVF). As RVF progresses, a pronounced tricuspid regurgitation further decreases cardiac output and worsens organ congestion.

[Differential diagnosis of acute coronary syndromes].

In recent years there has been an explosion in the understanding of the complex basic mechanisms responsible for the development of acute coronary syndrome. This term is widely accepted and consistent with the common pathophysiological mechanism believed to be responsible for most cases of unstable angina and myocardial infarction, with and without ST-segment elevations. This review summarizes important recent findings, recommendations that are likely to be introduced in our present and near future clinical work.

[Experiences with determination of cardiac Troponin-I and CK-MB serum levels in acute coronary syndrome].

The consideration of the correct diagnosis and prognosis in acute coronary syndrome seems to be a great challenge for cardiologists. Measuring of the serum cardiac Troponin (cTI) level may help solution of this problem. According to the authors the myocardial infarction has been revealed with a great sensitivity and specificity by the cTI level (100%).

Application of pressurized sample preparation methods for the analysis of steels and copper alloys.

Pressurized sample preparation devices (High Pressure Asher, Pressurized Microwave Digestion system, compared with a PTFE decomposition vessel) were used to dissolve certified metal alloy samples (steel, copper) for ICP analysis. Based on the results of the analysis it was established that both up-to-date devices can be advantageously applied to quickly and quantitatively dissolve metal alloy samples. To dissolve the samples, two different kinds of acid mixtures (A: nitric and hydrochloric acid; B: nitric and hydrochloric and sulphuric and phosphoric acid) were used.

Diabetes mellitus associated with late onset congenital adrenal hyperplasia: coincidence or causality?

Diabetes mellitus and late onset congenital adrenal hyperplasia due to 11 beta-hydroxylase deficiency were observed in two female siblings aged 51 and 60 years. Not only coincidence but also causality (hyperinsulinism, glucose intolerance due to hyperandrogenism) should be considered when explaining the association of diabetes mellitus with late onset congenital adrenal hyperplasia.

The turnover of autophagic vacuoles: evaluation by quantitative electron microscopy.

Accumulation of autophagic vacuoles was induced in mouse liver, exocrine pancreas and seminal vesicle cells by intraperitoneal injection of vinblastine, leupeptin, Triton X100 or estron acetate and the turnover of the autophagic vacuole content was estimated by morphometry from the time course of regression of autophagic vacuoles following the administration of cycloheximide to the animals. The volume fractions of autophagic vacuoles increased manifold following the administration of any of the drugs in each cell type investigated. The autophagic vacuoles regressed rapidly after administration of cycloheximide to the animals pretreated with Triton X100, estron acetate and leupeptin and the decay appeared to follow first-order kinetics; the estimated half life of autophagic vacuoles was about 6-9 min.

Hepatic artery embolisation--new approach for treatment of malignant carcinoid syndrome.

A transcatheter embolisation was carried out for treatment of a patient suffering from hepatic metastases of a malignant carcinoid tumour. Recurrent and very severe carcinoid symptoms could be observed; a bronchial carcinoid supposingly the primary tumour without characteristic symptoms was removed six years before. The carcinoid symptoms became resistant to pharmacological agents and finally ended in life-threatening clinical complications.

The effect of experimentally induced myocardial ischemia on the norepinephrine metabolism of the dog heart.

Myocardial ischemia is known to provoke an excess in circulating norepinephrine and thus be related to an increased irritability of the heart. In the present experiments, we studied the norepinephrine and potassium content, oxygen tension, and pH values of the effluent of coronary sinus after thoracotomy and catheter placement into the coronary sinus. Once a steady state was reached, the measurements were repeated in the fifth, tenth, 20th, and 60th minutes of experimental myocardial ischemia provoked by coronary ligation of the left anterior descending coronary artery.