Localization of reward-relevant neurons in the pontine tegmentum: a moveable electrode mapping study

Monopolar moveable stimulation electrodes were implanted in male adult rats in order to map the reward substrate in the pontine tegmentum. Electrodes were implanted 6 mm below the surface of the skull and subsequently lowered by steps of 0.16 or 0.32 mm. Each bar press in a Skinner box delivered a train (0.4 s in duration) of cathodal rectangular pulses of fixed intensity (200 microA) and width (0.1 ms). Self-stimulation was recorded from zero to maximum performance by varying the number of pulses per train. The rewarding effectiveness of the stimulation at each positive site was inferred by determining the frequency threshold. Out of 476 sites that were sampled, 137 supported self-stimulation. Eighty-one percent of the positive sites (111 out of 137) were located within 1 mm of the midline. Of the 181 sites that were sampled in the region posterior to the caudal end of the dorsal raphe, only 9 sites (less than 5%) supported self-stimulation. These results suggest that the majority of neurons that constitute the brainstem reward substrate either originate from and/or terminate in the rostral pons.     

The value of EEG-Mapping in focal cerebral lesions

Summary In 148 patients with focal cerebral lesions the findings of EEG mapping, routine EEG and CT were compared. Regarding etiology 43 patients suffered from completed stroke (CS), 43 patients from transient ischemic attack (TIA), 33 patients had an intracerebral hemorrhage (ICH) and 29 an hemispheric tumor. In 37 patients with CS (86%) and 27 patients with TIA (63%) the EEG mapping revealed focal changes, but only in 28 patients with CS (65%) and in 11 patients (26%) with TIA using routine EEG alone. Thus the EEG mapping showed focal abnormalities significantly more often. In the remaining patient groups no significant difference in the results of EEG mapping or routine EEG could be demonstrated. Focal abnormalities corresponding to focal lesions seen in CT were obtained by means of EEG mapping in 27 patients (90%) with CS and 10 patients (77%) with TIA, but only in 17 patients (57%) with CS and 4 patients (31%) with TIA using routine EEG and in that way the EEG mapping could indicate focal lesions in CT significantly more often than routine EEG. In the remaining patient groups no significant difference in the number of focal changes corresponding to lesions in CT could be seen.     

Ablation ektoper rechtsatrialer Tachykardien unter Verwendung eines 20-poligen Mapping-Katheters

INTRODUCTION : Ectopic atrial tachycardia (EAT) are frequently unresponsive to pharmacological antiarrhythmic therapy. Radiofrequency ablation seems to be a safe approach to treat those arrhythmias. In the present study we report our results of radiofrequency ablation of EAT with a new mapping system (Stablemapr, Medtronic). METHODS : Thirty consecutive patients with right atrial tachycardia were included in the study. In 15 patients (G1) the 20-polar Stablemapr was used for localization of the arrhythmia foci. Data were compared with a control group (G2, n=15), in which mapping was performed conventionally. The demographic characteristics and the distribution of the different cardiac diseases were comparable in both groups. In group 1 the identification of the EAT was facilitated by the placement of the 20-pole mapping catheter in the right atrium. In group 2 point by point measurements were performed to find the earliest local atrial activation compared to a reference electrode in the high right atrium (activation mapping), or foci were identified by analysis of the P-wave morphology during stimulation (pacemapping). RESULTS : It was possible to successfully ablate all atrial tachycardias. The distribution of the foci was similar in both groups (G1/G2): near to the superior (3/5) and inferior (1/0) caval vene ostium, on the free wall (3/3), at the coronary sinus ostium (3/3) and on the interatrial septum (5/4). The mean procedure (G1: 88+/-33 vs G2: 151+/-61 min; p= or <0.05) and fluoroscopic times (G1: 19+/-9 vs G2: 38+/-28 min; p= or <0.05) were significantly shorter in group 1. Moreover, the mean number of radiofrequency applications was reduced significantly by using the new mapping system (G1: 10+/-10 vs G2: 16+/-13; p= or <0.05). CONCLUSION : Radiofrequency ablation of EAT with right atrial focus can be performed safely and successfully using a 20-pole mapping catheter. The greatest advantages compared to conventional mapping and ablation strategies lies in the shortened investigation and fluoroscopic time.     

Impulse propagation in late-stage embryonic and neonatal murine ventricular slices

Aim

To evaluate whether field potential recordings from murine ventricular slice preparations serve as a model to investigate impulse propagation.

Method

Late-stage embryonic and neonatal murine hearts were sliced by a vibratome. Slices were placed on planar microelectrode arrays (MEAs). Field potentials of spontaneously beating and electrically stimulated contractions were recorded. The maximal negative deflection of the field potentials (dV / dt) was calculated to assess the local activation time, to create activation sequence maps, and to estimate conduction velocity.

Results

Mapping of impulse propagation of late-stage embryonic and neonatal murine ventricular slices and estimation of conduction velocities is feasible using the MEA technique showing an impulse propagation reflecting anatomical structures and conduction velocities similar to those obtained with other techniques.

Conclusion

The combination of viable ventricular slice preparations with the MEA technique offers a versatile and powerful technique to study cardiac impulse propagation.     

Candidate Gene Region 15q26 and Genetic Susceptibility to Coeliac Disease in Finnish Families

Background: Studies in the Irish and British populations have indicated that chromosome region 15q26 could include a novel non-HLA-linked locus conferring genetic susceptibility to coeliac disease. The locus is of particular interest, since a type I diabetes risk locus, IDDM3, maps to the same position. It was tested whether this locus shows evidence for genetic linkage to coeliac disease in Finland. Methods: Ninety-nine Finnish families with at least one affected sibpair were studied. Five microsatellite markers mapped within ~20 cM region on chromosome 15q26 were typed. Non-parametric linkage (NPL) scores and allelic transmission (TDT) were studied. Results: No evidence for genetic linkage could be obtained by the NPL scores calculated by the Genehunter program. However, transmission/disequilibrium analysis (TDT) revealed that haplotype D15S107*1-D15S120*6 was statistically significantly more frequently transmitted to affected than expected by chance (TDT x² 9.0; P = 0.003). The subgroup of families having this haplotype, however, did not differ from the others, regarding to disease manifestation, HLA status, or geographical origin. Conclusion: The 15q26 region appears not to be a major non-HLA susceptibility locus for gluten sensitivity in Finland, but a particular haplotype which may harbour a susceptibility gene was identified.     

Features of ST segment and T-wave in exercise-induced myocardial ischemia evaluated with multichannel magnetocardiography

BACKGROUND AND AIM. Magnetocardiography (MCG) is a novel, non-contact mapping technique to record cardiac magnetic field. We evaluated MCG criteria for myocardial ischemia in stress testing. METHODS. Multichannel MCG over frontal chest was performed in 44 patients with coronary artery disease (CAD) and 26 healthy controls during supine bicycle exercise test. Of the 44 patients 16 had anterior, 15 posterior, and 13 inferior ischemia documented by coronary angiography and exercise thallium scintigraphy. ST amplitude, ST slope, T-wave amplitude, and ST-T integral were measured. The optimal sites for detecting the ischemiainduced changes on MCG were sought. The orientation of the magnetic field was also determined. RESULTS. The optimal sites for the decrease of ST slope, ST amplitude, T-wave amplitude, and ST-T integral were over the abdomen. The reciprocal increase of these parameters was found over the left parasternal area. The optimal sites were approximately the same for all patient groups. In single-vessel disease patients without previous myocardial infarction (MI), ST slope increase and ST elevation performed the best (area under the receiver operating characteristic curve 92% and 90%, respectively). In post-MI patients with triple-vessel disease the decrease of T-wave amplitude and ST slope performed the best (area under curve 91%, for both). The magnetic field orientation at ST segment performed equally well as the other ST parameters. In stepwise logistic regression analysis, by use of the presence of CAD as the dependent parameter, ST slope increase and ST peak gradient orientation entered the model. CONCLUSIONS: Various ST segment and T-wave parameters detect ischemia in MCG. ST amplitude performs especially well in non-MI patients with less severe CAD. In advanced CAD late development of T-wave amplitude might be more sensitive to ischemia than ST amplitude.     

Myocardial T1 and T2 mapping at 3?T: reference values,influencing factors and implications

Background

Myocardial T₁ and T₂ mapping using cardiovascular magnetic resonance (CMR) are promising to improve tissue characterization and early disease detection. This study aimed at analyzing the feasibility of T₁ and T₂ mapping at 3 T and providing reference values.

Methods

Sixty healthy volunteers (30 males/females, each 20 from 20–39 years, 40–59 years, 60–80 years) underwent left-ventricular T₁ and T₂ mapping in 3 short-axis slices at 3 T. For T₂ mapping, 3 single-shot steady-state free precession (SSFP) images with different T₂ preparation times were acquired. For T₁ mapping, modified Look-Locker inversion recovery technique with 11 single shot SSFP images was used before and after injection of gadolinium contrast. T₁ and T₂ relaxation times were quantified for each slice and each myocardial segment.

Results

Mean T₂ and T₁ (pre-/post-contrast) times were: 44.1 ms/1157.1 ms/427.3 ms (base), 45.1 ms/1158.7 ms/411.2 ms (middle), 46.9 ms/1180.6 ms/399.7 ms (apex). T₂ and pre-contrast T₁ increased from base to apex, post-contrast T₁ decreased. Relevant inter-subject variability was apparent (scatter factor 1.08/1.05/1.11 for T₂/pre-contrast T₁/post-contrast T₁). T₂ and post-contrast T₁ were influenced by heart rate (p < 0.0001, p = 0.0020), pre-contrast T₁ by age (p < 0.0001). Inter- and intra-observer agreement of T₂ (r = 0.95; r = 0.95) and T₁ (r = 0.91; r = 0.93) were high. T₂ maps: 97.7% of all segments were diagnostic and 2.3% were excluded (susceptibility artifact). T₁ maps (pre-/post-contrast): 91.6%/93.9% were diagnostic, 8.4%/6.1% were excluded (predominantly susceptibility artifact 7.7%/3.2%).

Conclusions

Myocardial T₂ and T₁ reference values for the specific CMR setting are provided. The diagnostic impact of the high inter-subject variability of T₂ and T₁ relaxation times requires further investigation.     

A cost-effectiveness analysis of traditional and geographic information system-supported microplanning approaches for routine immunization program management in northern Nigeria

Effective RI microplanning requires accurate population estimates and maps showing health facilities and locations of villages and target populations. Traditional microplanning relies on census figures to project target populations and on community estimates of distances, while GIS microplanning uses satellite imagery to estimate target populations and spatial analyses to estimate distances. This paper estimates the cost-effectiveness of geographical information systems (GIS)-based microplanning for routine immunization (RI) programming in two states in northern Nigeria.For our cost-effectiveness analysis, we captured the cost of all inputs for both approaches to capture the incremental cost of GIS over traditional microplanning and present the incremental cost-effectiveness ratios for each vaccine-preventable illness, death, and disability-adjusted life year (DALY) averted.We considered two scenarios for estimating vaccine requirements for each microplanning approach, one based on administrative vaccination coverage rates and one based on National Nutrition and Health Survey rates. With the administrative rates, GIS microplanning projected approximately 194,000 and 157,000 more required vaccinations than traditional microplanning in Bauchi and Sokoto States; with the survey rates, the additional number of vaccinations required was nearly 113,000 in Bauchi and about 47,000 in Sokoto. For each state under each scenario, we present numbers of and costs per measles and pertussis cases, deaths, and DALYs averted by the additional vaccinations, as well as annual costs.As expected, GIS-based microplanning incurs higher costs than traditional microplanning, due mainly to the additional vaccinations required for populations previously unreached. Our estimates of cost per DALY averted suggest, however, that GIS microplanning is more cost-effective than traditional microplanning in both states under both coverage scenarios and that the higher costs incurred by GIS microplanning are worth adopting.