bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanism of oleoylethanolamide on fatty acid uptake in small intestine after food intake and body weight reduction
Authors: Yang Yingkui , Chen Min , Georgeson Keith E. , Harmon Carroll M.
Published: August 2006

The increase in the prevalence of human obesity highlights the need to identify molecular and cellular mechanisms involved in control of feeding and energy balance. Oleoylethanolamide (OEA), an endogenous lipid produced primarily in the small intestine, has been identified to play an important role in the regulation of animal food intake and body weight. Previous studies indicated that OEA activates peroxisome proliferator-activated receptor-α, which is required to mediate the effects of appetite suppression, reduces blood lipid levels, and enhances peripheral fatty acid catabolism. However, the effect of OEA on enterocyte function is unclear. In this study, we have examined the effect of OEA on intestinal fatty acid uptake and FAT/CD36 expression in vivo and in vitro. We intraperitoneally administered OEA to rats and examined FAT/CD36 mRNA level and fatty acid uptake in enterocytes isolated from the proximal small intestine, as well as in adipocytes. Our results indicate that OEA treatment significantly increased FAT/CD36 mRNA expression in intestinal mucosa and isolated jejunal enterocytes. In addition, we also found that OEA treatment significantly increases fatty acid uptake in isolated enterocytes in vitro. These results suggest that in addition to appetite regulation, OEA may regulate body weight by altered peripheral lipid metabolism, including increased lipolysis in adipocytes and enhanced fatty acid uptake in enterocytes, both in conjunction with increased expression of FAT/CD36. This study may have important implications in understanding the mechanism of OEA in the regulation of fatty acid absorption in human physiological and pathophysiological conditions.
Lesions of the anteroventral third ventricle region exaggerate neuroendocrine and thermogenic but not behavioral responses to a novel environment
Authors: Whyte Douglas G. , Johnson Alan Kim
Published: August 2006

Mild psychological stressors provoke an acute rise in core temperature (TC), stimulate the hypothalmo-pituitary-adrenocortical (HPA) axis, and induce various stress-related behaviors. In the present study, we examined the effect of ablation of the anteroventral third ventricle region (AV3V) on both physiological and behavioral responses to a novel environment. TC was monitored in male Sprague-Dawley rats, with either sham or AV3V lesions, during a 5-h exposure to a novel environment. Trunk blood was collected, in a second group of rats, for the assessment of plasma levels of ACTH and corticosterone. Novelty-induced grooming and rearing behaviors were assessed in a third group of animals. TC was elevated in all animals after 30 min in the novel environment, but the rise was exaggerated in rats with AV3V lesions (∼0.5°C). AV3V-lesion rats maintained a higher core temperature for 2 h before it returned to the same level as the control group. Plasma levels of ACTH and corticosterone were also exaggerated in the AV3V lesion group after 30 min in a novel environment. In contrast to the physiological responses, the behavioral measures of grooming and rearing revealed no differences between the groups. The results from the current study suggest that neurons within the AV3V region exert an inhibitory influence on the HPA axis and fever developed in response to stressful psychological stimuli. They also confirm that the physiological and hormonal components of the stress response are independent of certain behavioral measures of stress.
Hypocretin/orexin type 1 receptor in brain: role in cardiovascular control and the neuroendocrine response to immobilization stress
Authors: Samson Willis K. , Bagley Sara L. , Ferguson Alastair V. , White Meghan M.
Published: August 2006

Hypocretin/orexin acts pharmacologically in the hypothalamus to stimulate stress hormone secretion at least in part by an action in the hypothalamic paraventricular nucleus, where the peptide's receptors have been localized. In addition, orexin acts in the brain to increase sympathetic tone and, therefore, mean arterial pressure and heart rate. We provide evidence for the role of endogenously produced hypocretin/orexin in the physiological response to immobilization stress and identify the receptor subtype responsible for this action of the peptide. Antagonism of the orexin type 1 receptor (OX1R) in the brain prevented the ACTH-stimulating effect of centrally administered hypocretin/orexin. Furthermore, pretreatment of animals with the OX1R antagonist blocked the ACTH response to immobilization/restraint stress. The OX1R antagonist did not, however, block the pharmacological or physiological release of prolactin in these two models. Antagonism of the OX1R also blocked the central action of orexin to elevate mean arterial pressures and heart rates in conscious rats. These data suggest receptor subtype-selective responses to hypocretin/orexin and provide further evidence for the importance of endogenously produced peptide in the physiological control of stress hormone secretion.
Cardiac sympathetic afferent stimulation augments the arterial chemoreceptor reflex in anesthetized rats
Authors: Gao Lie , Pan Yan-Xia , Wang Wei-Zhong , Li Yu-Long , Schultz Harold D. , Zucker Irving H. , Wang Wei
Published: August 2006

Chronic heart failure (CHF) is well known to be associated with both an enhanced chemoreceptor reflex and an augmented cardiac “sympathetic afferent reflex” (CSAR). The augmentation of the CSAR may play an important role in the enhanced chemoreceptor reflex in the CHF state because the same central areas are involved in the sympathetic outputs of both reflexes. We determined whether chemical and electrical stimulation of the CSAR augments chemoreceptor reflex function in normal rats. Under anesthesia, renal sympathetic nerve activity (RSNA) and mean arterial pressure (MAP) were recorded. The chemoreceptor reflex was tested by unilateral intra-carotid artery bolus injection of potassium cyanide (KCN) and nicotine. We found that 1) left ventricular epicardial application of capsaicin increased the pressor responses and the RSNA responses to chemoreflex activation induced by both KCN and nicotine; 2) when the central end of the left cardiac sympathetic nerve was electrically stimulated, both the pressor and the RSNA responses to chemoreflex activation induced by KCN were increased; 3) pretreatment with intracerebroventricular injection of losartan (500 nmol) completely prevented the enhanced chemoreceptor reflex induced by electrical stimulation of the cardiac sympathetic nerve; and 4) bilateral microinjection of losartan (250 pmol) into the nucleus tractus solitarii (NTS) completely abolished the enhanced chemoreceptor reflex by epicardial application of capsaicin. These results suggest that both the chemical and electrical stimulation of the CSAR augments chemoreceptor reflex and that central ANG II, specially located in the NTS, plays a major role in these reflex interactions.
Depressed Skull Fractures in Children: Treatment Using an Obstetrical Vacuum Extractor
Authors: de Paul Djientcheu V. , Njamnshi A.K. , Ongolo-Zogo P. , Ako S. , Essomba A. , Sosso M.A.
Published: August 2006

Introduction: A depressed skull fracture is an inward buckling of the skull bones. It is referred to as a ping-pong ball fracture in neonates; in older children, some fractures take a cup shape mimicking ‘ping-pong’ ball fractures. Objective and Methods: The aim of this study was to assess the use of an obstetric vacuum extractor to elevate cup-shaped depressed skull fractures in children irrespective of age. All children admitted into the Central Hospital of Yaounde between 1999 and 2004 with a cup-shaped simple depressed skull fracture and treated with the vacuum extractor were included. Results: Nine children aged from 3 months to 17 years were treated with the vacuum extractor. The cosmetic and radiographic results were satisfactory. The procedure was simple and without any complication. Conclusion: The elevation of ‘ping-pong-ball-like’ or ‘cup-shaped’ skull fractures in older children (beyond the neonatal period) is a simple, effective and safe procedure.
Pattern and Factors Affecting Management Outcome of Spina Bifida Cystica in Ile-Ife, Nigeria
Authors: Alatise O.I. , Adeolu A.A. , Komolafe E.O. , Adejuyigbe O. , Sowande O.A.
Published: August 2006

Background and Objective: There is paucity of data on the pattern and factors affecting the management outcome of patients with spina bifida cystica in the Ife-Ijesa zone, Nigeria. This study was designed to address this research question. Method: One hundred and six consecutive cases of spina bifida cystica who presented in our hospital from January 1990 to December 2004 were reviewed. We obtained information on sociodemographic factors, medical history and management as well as clinical outcome. SPSS was used to analyze the data. Result: Males constituted 54.7% and females 45.2% of cases. Mortality was high in those presented after the 4th week of life (p = 0.04). The malformation occurred in the lumbar and lumbosacral regions in 77.4%. Myelomeningocele was the most common type (86.8%). Hydrocephalus was recorded in 53.8% of patients. Surgical closure was done for 91.5% of the patients. About 77% of all the patients were discharged while 22.7% died. This was significantly related to age at presentation (p = 0.04) and infection before surgery (p = 0.045). Postoperative complications were more frequent in patients with ruptured lesions (p = 0.025), a larger size of defect (p = 0.028) and a lower birth weight (p = 0.006). Conclusion: Myelomeningocele is the most common type of spina bifida cystica in our environment. Late presentation and preoperative infection are associated with high mortality in our patients.
Treatment of Craniosynostosis by Distraction Osteogenesis
Authors: Akai Takuya , Iizuka Hideaki , Kawakami Shigehiko
Published: August 2006

Purpose: Craniosynostosis patients treated with one-stage cranioplasty often have bleeding from the dura mater, fluid collection in the extradural space, and poor wound healing due to skin overstretching. To avoid these complications, we began using distraction osteogenesis. To determine the advantages and disadvantages of the procedure, we retrospectively compared distraction osteogenesis with conventional cranioplasty. Patients and Results: We treated 24 patients with fronto-orbital advancement. Fifteen had one-stage cranioplasty; 9 received distraction osteogenesis. The one-stage operation patients averaged 25.5 months of age at surgery, 289 min of operating time, and 154 ml of intraoperative blood loss. For the distraction group, the average age was 16.6 months, average operating time was 196 min, and average blood loss was 76 ml. Conclusions: Compared with one-stage cranioplasty patients, distraction osteogenesis patients had significantly less intraoperative bleeding and shorter operating times. The disadvantages of distraction treatment were the need for multiple surgeries, prolonged hospitalization, wound infection, and dislocation of the distraction device.
Unusual Clinical and MRI Features of a Cerebellopontine Angle Medulloepithelioma
Authors: Syal Rajan , Reddy S Jaypal , Kumar Raj , Tyagi Isha , Abrar A.A. Wani , Krishnani Narender , Mishra Asht M. , Gupta Rakesh K.
Published: August 2006

We describe for the first time an unusual location and clinical presentation of medulloepithelioma, a rare embryonal tumor. A 5-year-old child presented with sudden onset of bilateral hearing loss. On imaging, the lesion appeared to be extra axial and was located in the right cerebello-pontine (CP) angle, extending into middle fossa along the trigeminal ganglion and in front of the brain stem into the opposite CP angle. It did not show any enhancement following contrast administration and had restricted diffusion on diffusion-weighted imaging, simulating an epidermoid. However, in vivo localized proton MR spectroscopy revealed a creatine peak dominated by a large choline resonance, peak of glycine with lactate/lipid and invisible N-acetylaspartate suggestive of a neoplastic lesion and not an epidermoid. Only subtotal resection could be performed and the patient had a stormy post-operative course due to extensive dissemination of the disease.
Osteochondroma of the Cervical Spine Extending Multiple Segments with Cord Compression
Authors: Moon Kyung-Sub , Lee Jung-Kil , Kim Yeon-Seong , Kwak Hyung-Jun , Joo Sung-Pil , Kim In-Young , Kim Jae-Hyoo , Kim Soo-Han
Published: August 2006

Involvement of the cervical spinal cord by a solitary osteochondroma is rare. We describe a case of cervical osteochondroma extending from C5 to C7 in a 16-year-old male. The tumor, arising from the inner aspect of the C6 spinous process, projected longitudinally into the spinal canal and compressed the spinal cord; this caused clinical symptoms associated with myelopathy and radiculopathy. Total excision of the tumor by C5–C7 hemilaminectomy resulted in a good functional recovery.
Head Injury Caused by an Ostrich: A Rare Entity
Authors: Khan M. Akram , Olumide Adebayo A.
Published: August 2006

Human injuries caused by animals are not uncommon and have been reported in the literature on many occasions. Most of the animals commonly involved are dogs, cats, cows, horses and camels. Injuries are usually on the trunk or limbs and sometimes on the face. Human injuries caused by an ostrich are rare and only three cases have been reported with severe ocular injury. To our knowledge, this is the first reported case of head injury caused by an ostrich in a child.
Excision of Juvenile Pilocytic Astrocytoma of the Midbrain after Radiotherapy
Authors: Tsuboi Koji , Matsuda Wakoto , Nakamura Kazuhiro , Takano Shingo , Matsumura Akira
Published: August 2006

A 13-year-old girl presented with consciousness disturbance, right hemiparesis, and impairment of hearing, swallowing, and ocular movements. A magnetic resonance image demonstrated marked hydrocephalus due to a large cystic tumor (40 × 40 × 30 mm) in the midbrain. Emergency ventricular drainage and stereotactic cyst puncture dramatically improved her condition. Since her family did not agree to surgery on the brain stem, radiotherapy was performed after ventriculoperitoneal shunting. Conventional radiotherapy of 50.4 Gy was temporarily effective, and the growth of the tumor was stabilized until approximately 8 months later when regrowth was noticed. At this stage, with the consent of her family, the tumor was removed via an infratentorial supracerebellar approach. The pathological diagnosis was juvenile pilocytic astrocytoma. The postoperative course was uneventful. No recurrence has been observed during the follow-up period of more than 6 years. This case study shows that initial excision may be appropriate for some low-grade focal lesions in the midbrain when the histological diagnosis and consent have been obtained.
Aneurysmal Bone Cyst of the Orbit
Authors: Marcol Wiesław , Mandera Marek , Malinowska Izabela , Pajak Jacek , Wlaszczuk Paweł , Kluczewska Ewa
Published: August 2006

We report the case of an aneurysmal bone cyst of the left orbital roof in a 12-year-old boy who presented proptosis of the left eye and painless swelling of the left orbital rim. A 3-cm-large tumor developed in less than 3 months, with first visible signs about 2 months after a minor head injury. Radiologically, the lesion was osteolytic and multicystic. The cyst, filled with hematic fluid, was surgically removed via left frontal craniotomy and a simple curettage with high-speed bur. The patient recovered well and has been in good health throughout 14 months of follow-up.
From Selective Thalamotomy with Microrecording to Gamma Thalamotomy for Movement Disorders
Authors: Ohye Chihiro
Published: August 2006

A theoretical and practical process from microrecording-guided thalamotomy to gamma knife thalamotomy was briefly reviewed. Based on our own experiences of selective thalamotomy with microrecording, we are trying to apply gamma knife to the treatment of movement disorders. An important technical problem is how to determine the exact thalamic target. At first we refer to the posterior commissure and coordinate of the standard atlas for approximately determining the lateral part of the ventral intermediate nucleus. Then the point is further corrected by anatomical landmark (45% of the thalamic length) to compensate the individual difference. A final lesion is made by gamma knife using a 4-mm collimator, 130 Gy in 1 shot. The average delay of clinical improvement is about 6 months after irradiation. Thus far the results are satisfactory, being 80–85% successful without any noticeable complications. Only 3 days of hospitalization with minimal invasion could be a big advantage for the patient. Further technical progress may improve the clinical results in the future.
Direct Effect of Subthalamic Nucleus Stimulation on Levodopa-Induced Peak-Dose Dyskinesia in Patients with Parkinson’s Disease
Authors: Katayama Yoichi , Oshima Hideki , Kano Toshikazu , Kobayashi Kazutaka , Fukaya Chikashi , Yamamoto Takamitsu
Published: August 2006

We examined the direct effect of deep brain stimulation of the subthalamic nucleus (STN-DBS) on levodopa-induced peak-dose dyskinesia in 45 patients with Parkinson’s disease (PD) without reducing the levodopa dosage during the early period after surgery. In 8 patients (18%), the dyskinesia was quickly attenuated by bipolar stimulation in an experimental trial (5 min) with the contacts placed within the area above the STN. In contrast, bipolar stimulation using contacts placed within the STN itself tended to provoke or exacerbate the dyskinesia, indicating that dyskinesia could be inhibited by stimulation of the areas above the STN rather than the STN itself. In an attempt to control the cardinal symptoms of PD and dyskinesia at the same time, we employed bipolar stimulation with a longer interpolar distance as a therapeutic procedure (2 weeks), using contacts within the STN as a cathode and contacts within the area above the STN as an anode. Bilateral STN-DBS significantly attenuated the dyskinesia as evaluated by the dyskinesia severity rating scale (p < 0.05). In 24 patients (53%), almost complete control of the dyskinesia was observed. The contacts used as an anode in these patients were located more dorsally compared to those of the remaining patients, suggesting again that the dyskinesia was inhibited by stimulation of the areas above the STN rather than the STN itself. In the area above the STN, pallidothalamic, pallidosubthalamic and subthalamopallidal fibers are densely distributed. It appears that stimulation of these fibers may cause effects similar to thalamic or pallidal DBS and therefore inhibit peak-dose dyskinesia. Bipolar STN-DBS with contacts placed within the area above the STN as an anode appears to represent a useful option for controlling both the cardinal symptoms of PD and peak-dose dyskinesia at the same time.
Thalamic Sensory Relay Nucleus Stimulation for the Treatment of Peripheral Deafferentation Pain
Authors: Yamamoto Takamitsu , Katayama Yoichi , Obuchi Toshiki , Kano Toshikazu , Kobayashi Kazutaka , Oshima Hideki , Fukaya Chikashi
Published: August 2006

We applied chronic deep brain stimulation (DBS) of the thalamic nucleus ventralis caudalis (Vc) for the treatment of peripheral deafferentation pain. The subjects included 11 cases of phantom limb pain and 7 of root or nerve injury pain without phantom sensation. In the phantom limb pain patients, the spike density markedly increased in the same area of the Vc where microstimulation induced paresthesia in the part with phantom sensation. Reorganization of the receptive field representation within the Vc was also demonstrated by microrecording and microstimulation. In the root or nerve injury pain patients with severe allodynia and without phantom sensation, oscillating neural hyperactivity appeared when the allodynia was induced during single-cell recording in the Vc. In both groups stimulation of these areas with the DBS electrode was useful for achieving pain reduction. Inhibition of spinothalamic tract neurons, restoration of the original receptive field representation and modulation of thalamocortical rhythmic oscillations are proposed to play important roles in a possible mechanism of Vc-DBS for the treatment of deafferentation pain.
Pseudo-Pulmonary Embolism as a Sign of Acute Heparin-Induced Thrombocytopenia in Hemodialysis Patients: Safety of Resuming Heparin after Disappearance of HIT Antibodies
Authors: Hartman V. , Malbrain M. , Daelemans R. , Meersman P. , Zachée P.
Published: August 2006

Heparin-induced thrombocytopenia (HIT) is a syndrome caused by platelet-activating antibodies that recognize complexes of platelet factor 4 (PF4) and heparin. Thrombocytopenia is the most common clinical feature of HIT. HIT can be considered as a hypercoagulable state, with a high risk of thrombosis. Another feature of HIT is an acute systemic reaction that characteristically begins 5–30 min after receiving an intravenous bolus of unfractionated heparin, such as is commonly given for hemodialysis (HD). Here we present 4 patients who developed acute HIT at or near the start of their chronic HD. All patients were anticoagulated with the low-molecular-weight heparin, nadroparin, for HD. Three of our patients underwent surgery approximately 1–2 weeks before developing HIT. All patients presented with an acute systemic reaction during HD. All patients were treated and further dialyzed with lepirudin. Under this treatment we observed a quick recovery of the platelet count, and patients remained symptom-free. Antibodies against the PF4-heparin complex were detected with a combination of a ‘quick test’ and an enzyme-linked immunosorbent assay test. The likelihood of having HIT previous to the detection of antibodies was estimated with the pre-test probability score criteria. The tests for PF4-heparin antibodies remained positive for an average of 165 days. Three patients underwent a rechallenge with nadroparin after disappearance of the HIT antibodies in their serum. All 3 remained symptomless when they were further hemodialyzed on nadroparin. Our observations indicate that nadroparin can be successfully reintroduced for HD anticoagulation once the patient’s HIT antibodies have disappeared.
How Does G-CSF Act on the Kidney during Acute Tubular Injury?
Authors: Nishida Masashi , Hamaoka Kenji
Published: August 2006

Recent findings in stem cell research have demonstrated multi-lineage plasticity of bone marrow cells, and also the contribution of hematopoietic bone marrow stem cells to the regeneration of injured organs including the kidney. These findings suggested the possibility of the use of granulocyte colony-stimulating factor (G-CSF) as a therapeutic option to regenerate injured organs. Recently, several studies regarding the effect of G-CSF on renal function have been reported in mouse models of acute renal failure. This series of experiments provided potentially important information regarding the treatment of patients with renal injury. This review summarizes the possible actions of G-CSF on the kidney, especially during acute tubular injury caused by toxic or ischemic insults.
A Critical Look at Growth Factors and Epithelial-to-Mesenchymal Transition in the Adult Kidney
Authors: Wahab Nadia A. , Mason Roger M.
Published: August 2006

In the adult kidney, the cellular phenotypes are maintained by a strict balance of growth factors. Epithelial-to-mesenchymal transition (EMT) is a program whereby injured epithelial cells that function as ion and fluid transporters become matrix remodelling mesenchymal cells. This process requires either transcriptional repression of genes that maintain the epithelial phenotype and transcriptional activation, or relieved repression of genes needed for functional myofibroblasts. The transcriptional regulators are controlled by several integrated signalling pathways which are triggered by growth factors. Emerging evidence indicates that the growth factors TGFβ/CTGF and BMP-7/HGF are the main determinants that maintain the two cellular phenotypes. Both TGFβ and BMP-7 counteract the activity of each other by cross-inducing their respective inhibitory Smads. Both growth factors may also induce the expression of other factors that can change the cellular environment and enhance their function. Chronic kidney diseases (regardless of the aetiology of the disease) are associated with increased TGFβ and CTGF expression levels which, in turn, have an inverse effect on the activity level of BMP-7 and HGF, leading to an EMT of injured tubular epithelial cells and a progression of the disease. A detailed understanding of the complex interrelationship between these growth factors may lead to the development of novel drugs.
Role of Carbon Monoxide and Biliverdin in Renal Ischemia/Reperfusion Injury
Authors: Li Volti G. , Rodella L.F. , Di Giacomo C. , Rezzani R. , Bianchi R. , Borsani E. , Gazzolo D. , Motterlini R.
Published: August 2006

Heme oxygenase (HO) isoforms catalyze the conversion of heme to carbon monoxide (CO) and biliverdin/bilirubin with a concurrent release of iron. There is strong evidence that HO activity and products play a major role in renoprotection, however the exact molecular mechanisms underlying the beneficial effects exerted by this pathway are not fully understood. This review is aimed at illustrating the possible mechanism/s by which HO is renoprotective in the context of ischemia/reperfusion. We will first analyze the effects of exogenous administration of bilirubin/biliverdin and CO and then describe their biological activities once generated endogenously following stimulation of the HO pathway by either pharmacological means or gene targeting-mediated approaches.
Beneficial Effect of TGFβ Antagonism in Treating Diabetic Nephropathy Depends on When Treatment Is Started
Authors: Benigni Ariela , Zoja Carla , Campana Marco , Corna Daniela , Sangalli Fabio , Rottoli Daniela , Gagliardini Elena , Conti Sara , Ledbetter Steve , Remuzzi Giuseppe
Published: August 2006

Background: In diabetic rats with maximal activation of RAS induced by uninephrectomy, late treatment with anti-TGFβ antibody limited renal injury only when combined with ACE inhibitor. We investigated whether in a two-kidney diabetic model the time at which treatment started predicted the response to TGFβ antagonist. Methods: 27 weeks after streptozotocin injection, animals had mild proteinuria and were randomized to receive irrelevant antibody, anti-TGFβ antibody (1D11) or enalapril till 52 weeks (early treatment). The effect of agents alone or combined was also evaluated at the time of overt proteinuria (late treatment, 52–61 weeks). Results: When given early, 1D11 displayed marked antihypertensive and antiproteinuric effects. Glomerulosclerosis was reduced to the extent that a remarkable percentage of glomeruli without sclerosis appeared after treatment. Podocyte number was normalized. Renoprotection of 1D11 was comparable to enalapril. Despite control of blood pressure, in late treatment single agents did not reduce proteinuria significantly. Glomerulosclerosis and podocyte loss were partially limited by 1D11 or enalapril, but full protection was achieved by combination. Conclusions: Renoprotective effect of TGFβ antagonism crucially depends on the time at which treatment started. Effectiveness of early treatment with 1D11 would indicate that TGFβ is a major mediator of damage in early diabetes. To tackle the renal damage in the phase of advanced disease, a combined treatment with ACE inhibitor is needed.
Aquaporin-2 Excretion and Renal Function during the 1st Week of Life in Preterm Newborn Infants
Authors: Iacobelli S. , Addabbo F. , Bonsante F. , Procino G. , Tamma G. , Acito A. , Esposito L. , Svelto M. , Valenti G.
Published: August 2006

In many preterm infants, a characteristic pattern of fluid and electrolyte homeostasis occurs during the 1st week of life, consisting of three phases: prediuretic, diuretic, and postdiuretic. In this study, we evaluated the possible role of aquaporin-2 (AQP2) in renal concentrating ability and correlated it with other markers of the renal function in healthy preterm infants. Daily urine and spot blood samples were collected from 9 healthy preterm (32 ± 1 weeks) infants at postnatal ages 1, 3, and 7 days. Urine and serum osmolality, creatinine, electrolytes, and AQP2 excretion were measured. All infants showed a significant (about 7%) weight loss on day 3 associated with a more than threefold increase in urine output without a significant change in fluid intake (diuretic phase). The creatinine clearance increased on day 3, indicating an increase in glomerular filtration rate. Interestingly, on day 3, the level of total excreted AQP2 (pmol/h) was significantly higher when compared to day 1 and day 7, and the same tendency was observed for urine osmolality. To conclude, the observed increase in urine osmolality and creatinine clearance during the diuretic phase, paralleled by an increase in total AQP2 excretion, suggests that AQP2 can contribute to the urinary concentrating ability early in postnatal life.
The Prevalence of Autonomic Symptoms in Dementia and Their Association with Physical Activity, Activities of Daily Living and Quality of Life
Authors: Allan Louise , McKeith Ian , Ballard Clive , Kenny Rose Anne
Published: August 2006

Background/Aims: There is little published data regarding autonomic symptoms in dementia. This study aimed to examine the prevalence and severity of autonomic symptoms in patients with different subtypes of dementia in comparison with healthy controls, and their association with levels of physical activity, depression, quality of life and ability to carry out activities of daily living. Methods: Prevalence and severity of autonomic symptoms in Parkinson’s disease dementia (PDD, n = 46), dementia with Lewy bodies (DLB, n = 32), vascular dementia (VAD, n = 38), Alzheimer’s disease (AD, n = 40) and healthy controls (n = 42) were assessed using a structured symptom scale. The associations between autonomic symptoms and physical activity, Bristol Activities of Daily Living Score, Geriatric and Cornell Depression Scores and quality of life (Medical Outcomes Study 36-Item Short Form Health Survey, SF-36) were examined by multiple linear regressions. Results: Total autonomic symptom scores, urinary symptoms, constipation and postural dizziness were significantly higher in PDD, DLB and VAD patients than either controls or AD patients (all p < 0.05). Higher autonomic symptom scores were associated with poorer outcomes in all measures of physical activity, activities of daily living, depression and quality of life. Conclusion: The burden of autonomic symptoms is high in non-Alzheimer’s dementias. The identification of such symptoms is of importance because of the detrimental effect of these symptoms upon physical activity, depression, activities of daily living and quality of life.
Decreased Theta Event-Related Synchronization during Working Memory Activation Is Associated with Progressive Mild Cognitive Impairment
Authors: Missonnier Pascal , Gold Gabriel , Herrmann François R. , Fazio-Costa Lara , Michel Jean-Pierre , Deiber Marie-Pierre , Michon Agnès , Giannakopoulos Panteleimon
Published: August 2006

Background: Among the different quantitative electroencephalographic markers, theta activity is known to reflect neural resources involved in memory processes and directed attention. Previous studies suggested that synchronization likelihood analysis in theta-band frequency might be a sensitive method to identify early alterations of neuronal networks in mild cognitive impairment (MCI). Methods: We report here a longitudinal study of 24 MCI patients with theta event-related synchronization (ERS) analysis during the n-back working memory task and neuropsychological follow-up after 1 year. Statistical analysis included analysis of variance and logistic regression to assess the relationship between cognitive decline and theta ERS. Results: Upon follow-up, 13 MCI patients showed progressive MCI and 11 remained stable. In both groups, the phasic increase in theta amplitude after stimulus presentation did not depend on working memory load and electrode sites. Progressive MCI cases displayed significantly lower theta ERS power over all electrode sites compared to stable MCI cases. Theta ERS was significantly related to the cognitive outcome explaining 15.5% of its variability. In terms of MCI classification, the best combination of sensitivity and specificity was 0.87 and 0.60, respectively, with an area under the corresponding receiver operating characteristic curve reaching 76%. Conclusions: The present data indicate that a decrease in the early phasic theta ERS power during working memory activation may predict cognitive decline in MCI. This phenomenon is not related to working memory load but may reflect the presence of early deficits in directed attention-related neural circuits in MCI.
Treatment of Delusions in Alzheimer’s Disease – Response to Pharmacotherapy
Authors: Fischer Corinne , Bozanovic Radenka , Atkins Jana H. , Rourke Sean B.
Published: August 2006

Delusions are commonly encountered symptoms in patients with Alzheimer’s disease and may lead to significant morbidity. The purpose of this article is to review all clinical trials to date focusing on the management of delusions in patients with Alzheimer’s disease to determine the level of evidence for treatment. To achieve this objective, Medline was searched using the key words delusions, dementia, Alzheimer’s disease and psychosis. Three main categories of treatment were identified: atypical antipsychotics, cholinesterase inhibitors, and other miscellaneous treatments. It was concluded that all forms of treatment were effective although the greatest burden of evidence existed for risperidone and donepezil. Side effects were noted in all forms of treatment and included somnolence and extrapyramidal effects for antipsychotic medications, whereas gastrointestinal effects were more prevalent in studies involving cholinesterase inhibitors. Further large scale, double-blind, randomized, controlled studies are required before a definitive conclusion can be reached. To our knowledge this is the only systematic review of this area.
Prevalence of Stroke in an Argentine Community
Authors: Melcon Carlos M. , Melcon Mario O.
Published: August 2006

Objective: To determine the prevalence of stroke and its distribution by age, sex and clinical type, and to use the outcomes for prevention, care and rehabilitation. Design/Method: The survey was conducted in Junín, a town of about 75,000 inhabitants, situated in an agricultural region of the Province of Buenos Aires, Argentina. Systematic sampling was used to select 5,839 dwellings (sampling fraction ∼25%) and 5,648 (97%) households participated in our study, including 17,049 participants. The initial stage of the study involved a case-finding strategy consisting of a two-stage screening approach in the selected households; household screening was followed by neurological examination. We used a point prevalence with reference date January 1, 1991. Stroke was defined according to the WHO criteria. Results: As of January 1, 1991, 148 subjects were identified as cases of stroke (79.6% ischemic and 20.4% hemorrhagic). Point prevalence ratio was 868.1 cases per 100,000 inhabitants in the total population (473.4/100,000 age adjusted to the worldwide population) and 1,867.4 in those patients of 40 years of age or older (1,534.4/100,000 age adjusted to the worldwide population). In both sexes, prevalence increased with age. However, this increase was more significant and sustained in men of 50 years of age and older. Moderate to severe disability was observed in 52% of patients. Conclusion: This is one of the first community-based studies conducted in Argentina about the prevalence of stroke. Final results are similar to those reported in other developed countries.
Surgical Management of Perianal Giant Condyloma Acuminatum (Buschke-Löwenstein Tumor)
Authors: De Toma Giorgio , Cavallaro Giuseppe , Bitonti Andrea , Polistena Andrea , Onesti Maria Giuseppina , Scuderi Nicolò
Published: August 2006

Giant condyloma acuminatum (GCA) is a slow-growing, large, cauliflower-like tumor located in the anogenital region. This tumor has a locally destructive behavior, a high recurrence rate and occasional transformation to squamous cell carcinoma. Risk factors include anoreceptive intercourse, HIV and immunosuppression. There is no general agreement on the choice of treatment for this tumor. Wide radical excision with plastic reconstruction of skin defects seems to be the best treatment, while adjuvant therapies, such as radiotherapy and immunotherapy, may achieve good results, but their effectiveness is still uncertain. Loop colostomy, considered mandatory by several authors in order to minimize wound contamination risk, does not appear to be necessary (except in cases of anal canal involvement beyond the dentate line) if a combination of bowel cleansing, non-fiber diet and loperamide can be administered. The authors report 3 cases of perianal GCA treated by radical local excision and reconstruction by S-plasty grafts, without performing loop colostomy.
Posturography and Risk of Recurrent Falls in Healthy Non-Institutionalized Persons Aged Over 65
Authors: Buatois Séverine , Gueguen René , Gauchard Gérome C. , Benetos Athanase , Perrin Philippe P.
Published: August 2006

Background: A poor postural stability in older people is associated with an increased risk of falling. The posturographic tool has widely been used to assess balance control; however, its value in predicting falls remains unclear. Objective: The purpose of this prospective study was to determine the predictive value of posturography in the estimation of the risk of recurrent falls, including a comparison with standard clinical balance tests, in healthy non-institutionalized persons aged over 65. Methods: Two hundred and six healthy non-institutionalized volunteers aged over 65 were tested. Postural control was evaluated by posturographic tests, performed on static, dynamic and dynamized platforms (static test, slow dynamic test and Sensory Organization Test [SOT]) and clinical balance tests (Timed ‘Up & Go’ test, One-Leg Balance, Sit-to-Stand-test). Subsequent falls were monitored prospectively with self-questionnaire sent every 4 months for a period of 16 months after the balance testing. Subjects were classified prospectively in three groups of Non-Fallers (0 fall), Single-Fallers (1 fall) and Multi-Fallers (more than 2 falls). Results: Loss of balance during the last trial of the SOT sensory conflicting condition, when visual and somatosensory inputs were distorted, was the best factor to predict the risk of recurrent falls (OR = 3.6, 95% CI = 1.3–10.11). Multi-Fallers showed no postural adaptation during the repetitive trials of this sensory condition, contrary to Non-Fallers and Single-Fallers. The Multi-Fallers showed significantly more sway when visual inputs were occluded. The clinical balance tests, the static test and the slow dynamic test revealed no significant differences between the groups. Conclusion: In a sample of non-institutionalized older persons aged over 65, posturographic evaluation by the SOT, especially with repetition of the same task in sensory conflicting condition, compared to the clinical tests and the static and dynamic posturographic test, appears to be a more sensitive tool to identify those at high-risk of recurrent falls.
Mobility Limitations and Cognitive Deficits as Predictors of Institutionalization among Community-Dwelling Older People
Authors: von Bonsdorff Mikaela , Rantanen Taina , Laukkanen Pia , Suutama Timo , Heikkinen Eino
Published: August 2006

Purpose: Mobility limitations and cognitive disorders have often been observed as risks for institutionalization. However, their combined effects on risk of institutionalization among initially community-dwelling older people have been less well reported. Design: A prospective cohort study with 10-year surveillance on institutionalization. Subjects: Study population (n = 476) consisted of 75- and 80-year-old people who were community-dwelling, had not been diagnosed with dementia, and participated in tests on walking speed and cognitive capacity at a research centre. Measures: Cognitive capacity was measured with three validated psychometric tests that were from the Wechsler Adult Intelligence Scale, Wechsler Memory Scale and Schaie- Thurstone Adult Mental Abilities Test. Mobility was measured with walking speed over a 10-m distance. Exclusive distribution based study groups were formed with cut-offs at the lowest third as follows: no limitation, solely mobility limitation, solely cognitive deficits, and combined mobility limitation and cognitive deficits. Cox proportional hazards model was used to determine the relative risks of institutionalization for the study groups. Results: Eleven percent of the participants were institutionalized during the 10-year surveillance. The risk for institutionalization was 4.9 times greater (95% confidence interval: 2.1–11.2) for those who had co-existing mobility limitations and cognitive deficits than for those with no limitations. Conclusions: The findings show that the accumulation of limitations in physical and cognitive performance substantially decreases the possibility for a person remaining at home. This might be due to a decreased reserve capacity and ineffective compensatory strategies. Therefore, interventions targeted to improve even one limitation, or prevent accumulation of these risk factors, could significantly reduce the risk of institutionalization.
Psychological and Physical Activity Training for Older Persons: Who Does Not Attend?
Authors: van Heuvelen Marieke J.G. , Hochstenbach Jacqueline B.H. , Brouwer Wiebo H. , de Greef Mathieu H.G. , Scherder Erik
Published: August 2006

Background: Interventions to promote successful aging include psychological and physical activity programs. Identification of determinants of attendance of older persons may be useful to develop strategies to improve attendance. For physical activity programs determinants of attendance have been investigated extensively. For psychological programs hardly any knowledge is available. Determinants of attendance at psychological and physical activity programs have never been investigated simultaneously. Objective: To identify demographic, physical and psychological determinants of attendance of older subjects following multifaceted psychological training – aimed at promoting active social participation – and physical activity training and to compare the variation of these determinants between the two training programs. Method: 118 subjects aged 65–92 years were randomized over psychological and physical activity training. Determinants of attendance were obtained at pretest with questionnaires and performance-based tests. Results: Mean attendance was 62%. Attendance was not related to type of program. Having chronic diseases facilitated attendance in the psychological training group and limited attendance in the physical activity training group. Low and high levels of Activities of Daily Living performance (ADLs) and walking endurance were related to a high attendance in the psychological training group. A low level of activities of daily living (ADL) and a low walking endurance were related to a low attendance in the physical activity training group. For both training groups, persons living with a partner had higher attendance rates than persons living alone, and persons with a low level of anxiety had higher attendance rates than persons with a moderate or a high level of anxiety. Conclusion: Psychological training may be more suitable for frail older persons with chronic diseases, low ADL levels and low walking endurance than physical activity training, and may help to prepare such persons for physical activity.
Vitamin D Status in Inpatients Admitted to an Internal Medicine Department
Authors: Muscarella Silvana , Filabozzi Paola , D’Amico Grazia , Mascia Maria Lucia , Annese Maria Antonietta , Scillitani Alfredo , Carnevale Vincenzo
Published: August 2006

Background/Aims: A roleof hypovitaminosis D has been advocated in several medical conditions. We investigated vitamin D status in medical inpatients, compared to a blood donors’ group from the same area. Methods: Fifty-nine consecutive medical patients were recruited at hospital admission, concomitantly to 207 blood donors of both genders. Serum calcium, albumin, phosphate, creatinine, alkaline phosphatase total activity, 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) were assessed from April to May 2005. Results: In patients, 25(OH)D values were lower (13.1 ± 9.2 vs. 16.3 ± 8.5 ng/ml; p < 0.02) and PTH values higher (73.9 ± 77.7 vs. 53.4 ± 24.3 pg/ml; p < 0.01) than in controls, whose mean age was lower (62.5 ± 14.5 vs. 45.8 ± 15.6 years, p < 0.01). Such differences were not confirmed when comparing patients to a subgroup of age and sex-matched controls drawn from the whole sample of blood donors. In both patients and controls there was a trend towards a negative correlation between 25(OH)D and age and a positive correlation between PTH and age. The prevalence of 25(OH)D <12 ng/ml was higher in patients than in controls as a whole (58 vs. 34%; χ2 = 9.95; p < 0.002), but not in respect to the subgroup of matched controls (58 vs. 44%; χ2 = 2.09; p = 0.14). The prevalence of severe vitamin D deficiency, 25(OH)D <5 ng/ml, was significantly higher in patients than in matched controls (17 vs. 4%; χ2 = 6.75; p < 0.01). Conclusion: Hypovitaminosis D, defined as 25(OH)D <12 ng/ml, is frequent among inpatients, as in the general population of comparable age. A severe vitamin D deficiency is more common in hospitalized patients.
Effects of Granulocyte Colony Stimulating Factor on Functional Activities of Endothelial Progenitor Cells in Patients With Chronic Ischemic Heart Disease
Authors: Honold Joerg , Lehmann Ralf , Heeschen Christopher , Walter Dirk H. , Assmus Birgit , Sasaki Ken-Ichiro , Martin Hans , Haendeler Judith , Zeiher Andreas M. , Dimmeler Stefanie
Published: August 2006

Objective—

Bone marrow–derived circulating endothelial progenitor cells (EPCs) may contribute to regeneration of infarcted myocardium and enhance neovascularization. Granulocyte colony-stimulating factor (G-CSF) is well-established to mobilize hematopoietic stem cells (HSCs) and might, thereby, also increase the pool of endogenously circulating EPC. Therefore, we investigated the effects of G-CSF administration on mobilization and functional activities of blood-derived EPC in patients with chronic ischemic heart disease (CIHD).

Methods and Results—

Sixteen patients with CIHD received 10 μg/kg per day subcutaneous G-CSF injection for 5 days. Leukocyte counts, the number of HSCs and EPCs, and the migratory response to VEGF and SDF-1 were analyzed before and after G-CSF-therapy. At day 5 of G-CSF treatment, the number of circulating leukocytes, CD34
+
CD45
+
and CD34
+
CD133
+
cells was significantly increased. Likewise, G-CSF treatment augmented the numbers of colony forming units with endothelial cell morphology (EC-CFU). However, the functional activity of the EPC as assessed by the migratory response to VEGF and SDF-1 was significantly reduced after G-CSF treatment (
P
<0.01). Because G-CSF was previously shown to cleave the CXCR4 receptor, we determined the surface expression of the 6H8 epitope of the CXCR4 receptor by fluorescence-activated cell sorter (FACS) analysis. Consistent with the reduced migratory capacity, the surface expression of the functionally active CXCR4 receptor was significantly reduced. To test the functional activity of the cultivated EPCs in vivo, cells were intravenously infused in nude mice after hind limb ischemia. EPCs, which were cultivated before G-CSF administration, increased blood flow recovery and prevented limb necrosis. However, infusion of EPCs, which were isolated 5 days after G-CSF treatment from the same patient, showed a reduced capacity to augment blood flow recovery and to prevent necrosis by 27%.

Conclusion—

G-CSF treatment effectively mobilizes HSCs and EPCs. However, the migratory response to SDF-1 and in vivo capacity of G-CSF-mobilized EPCs was significantly reduced.