Investigation of white matter structure in velocardiofacial syndrome: a diffusion tensor imaging study

OBJECTIVE: Velocardiofacial syndrome, caused by a deletion on chromosome 22q11.2, is often accompanied by cognitive, behavioral, and psychiatric impairments. Specifically, velocardiofacial syndrome has been proposed as a disease model for a genetically mediated subtype of schizophrenia. Velocardiofacial syndrome is also known to affect brain structure. The most prominent structural findings in velocardiofacial syndrome are reduced white matter volumes. However, the structure of white matter and extent of specific regional involvement in this syndrome have never been investigated. The current study used diffusion tensor imaging to investigate white matter structure in children and young adults with velocardiofacial syndrome. METHOD: Nineteen participants with velocardiofacial syndrome and 19 age- and gender-matched comparison subjects underwent diffusion-weighted magnetic resonance imaging scans. Whole brain voxel-by-voxel analyses were conducted to investigate white matter fractional anisotropy differences between the groups. RESULTS: Relative to the comparison group, the velocardiofacial syndrome group had reduced white matter anisotropy in the frontal, parietal, and temporal regions as well as in tracts connecting the frontal and temporal lobes. CONCLUSIONS: This study demonstrates that alterations of white matter tract structure occur in velocardiofacial syndrome. Reduced white matter anisotropy was observed in individuals with velocardiofacial syndrome in areas previously implicated in the neurocognitive phenotype of velocardiofacial syndrome. The finding of aberrant parietal white matter tracts as well as aberrant frontotemporal connectivity in velocardiofacial syndrome and in previous schizophrenia studies may be associated with increased vulnerability for development of psychotic symptoms.     

Effects of acute hypotension on expression of cFos-like protein in the vestibular nuclei of rats

The expression and regional distribution of cFos protein, which is an oncogene product and metabolic marker of neural excitation, were investigated in the vestibular nuclear complex following acute hypotension in adult Sprague-Dawley rats. Intravenous administration of nitroprusside elicited a 10-50% reduction in mean blood pressure for 10 min. Unilateral or bilateral chemical labyrinthectomies were performed 14 days before the start of the experiment to eliminate afferent signals from the peripheral vestibular receptors in the inner ear. All of the animals were sacrificed and the tissues were fixed 2 h after the onset of acute hypotension using the cardiac perfusion method for c-Fos immunohistochemical staining. The cFos-like immunoreactive (cFLI) neurons were expressed selectively in the central area of the medial vestibular nucleus following a 10% reduction in blood pressure. Once the blood pressure had fallen by 30%, bilateral expression of cFLI neurons was observed in the superior, medial, and spinal vestibular nuclei, but not in the lateral vestibular nucleus, of control rats with intact labyrinths. The expression of cFLI neurons increased proportionately with reductions in blood pressure. In unilaterally labyrinthectomized rats, acute hypotension induced the expression of cFLI neurons in vestibular nuclei contra lateral to the injured labyrinth, but not in the ipsilateral vestibular nuclei. However, cFLI neurons were not expressed in bilateral vestibular nuclei following acute hypotension in bilateral labyrinthectomized rats. These results suggest that afferent signals from the peripheral vestibular receptors are essential for cFos protein expression in the vestibular nuclei following acute hypotension.     

Synaptic organization of tooth pulp afferent terminals in the rat trigeminal sensory nuclei

Previous studies provide evidence that a structure/function correlation exists in the distinct zones of the trigeminal sensory nuclei. To evaluate this relationship, we examined the ultrastructure of afferent terminals from the tooth pulp in the rat trigeminal sensory nuclei: the principalis (Vp), the dorsomedial part of oral nucleus (Vdm), and the superficial layers of caudalis (Vc), by using transganglionic transport of wheat germ agglutinin conjugated to horseradish peroxidase (WGA-HRP). A total of 93 labeled boutons were serially sectioned, in which some sections were incubated with gamma-aminobutyric acid (GABA) antiserum. Almost all labeled boutons formed asymmetric contact with nonprimary dendrites, in which more than half of labeled boutons in the Vc made synapses with their spines. The labeled boutons could be divided into two types on the basis of numbers of dense-cored vesicles (DCVs) in a boutons: S-type and DCV-type. Almost all labeled boutons in the Vp and Vdm were S-type, whereas two types were distributed evenly in the Vc. In contrast to DCV-type boutons, the S-type was frequently postsynaptic to unlabeled axon terminals containing a mixture of round, oval, and flattened vesicles (p-endings) and forming symmetrical synapses. Most p-endings examined were immunoreactive to GABA. The frequency of axoaxonic contacts was higher for labeled boutons in the Vp than in the Vdm and Vc. These results suggest that the three structures of trigeminal sensory nuclei serve distinct functions in nociceptive processing.     

Predictive factors of the long-term outcome in reflux esophagitis in a low-prevalence gastroesophageal reflux disease region

BACKGROUND: There are no data concerning the long-term outcome of patients with reflux esophagitis in Taiwan. In this study the outcome and the specific prognostic indicators associated with outcome in patients were assessed retrospectively, 7 years after diagnosis of esophagitis. METHODS: The study comprised a total of 128 patients with endoscopic esophagitis, diagnosed between January and June 1995, at Taichung Veterans' General Hospital. The outcome at 7 years after diagnosis was assessed by outpatient or telephone interview. Factors associated with requiring long-term acid suppression therapy were analyzed. RESULTS: In all, 105 patients were eligible for analysis: 61 patients (58.1%) with LA (Los Angeles classification) grade A, 29 patients (27.6%) with grade B, 11 patients (10.5%) with grade C and 4 patients (3.5%) with grade D esophagitis. Seven years after diagnosis, there were 52 patients (49.5%) with no or occasional reflux symptoms, 8 patients (7.6%) with occasional symptoms requiring treatment with histamine-2 receptor antagonists (H2RAs), 12 patients (11.4%) with occasional symptoms requiring treatment with proton pump inhibitors (PPIs), as needed, and 33 patients (31.3%) with sustained symptoms needing daily maintenance with PPIs. CONCLUSION: Nearly 50% of patients in Taiwan with endoscopic esophagitis still required treatment 7 years after diagnosis. Approximately 31% of patients still required daily acid suppression therapy. Presence of hiatal hernia and the severity of esophagitis at initial endoscopy independently were predictive of those who would require long-term acid suppression therapy.     

The relationship between carotid atherosclerosis and platelet aggregation in elderly

The aim of this study is to assess the relationship between the carotid wall intima media thickness (IMT) and atheroma plaques due to atherosclerosis and platelet aggregation among elderly. The first stage of the study was performed by analyzing platelet aggregation in a total of 28 elderly patients divided into two groups. The first group consisted of 14 cases with carotid atheroma plaque (Patient group I) and the second group of patients were without carotid atheroma plaque (Control group I). At the second stage of the study, the cases were regrouped according to the carotid IMT. Patients with IMT above 1 mm (Patient group II, n=10) and under 1 mm (Control group II, n=14) were compared regarding platelet aggregation. Platelet aggregation was induced in the platelet-rich plasma using 5 micro M ADP, 0.2 mg/ml collagen and 1.2 mg/ml ristocetin. Between patients with and without atheroma, no difference was noted in terms of platelet aggregation. Between platelet aggregation results of patients with intimal thickness above and under 1 mm, no significant difference was also noted. Between elderly cases with or without atherosclerosis, there was no difference with respect to platelet aggregation. Platelet aggregation measurements cannot be used as a marker of atherosclerosis in elderly population.     

Effects of implant healing time on crestal bone loss of a controlled-load dental implant

The universally accepted concept of delay-loaded dental implants has recently been challenged. This study hypothesizes that early loading (decreased implant healing time) leads to increased bone formation and decreased crestal bone loss. We used 17 minipigs to study implants under a controlled load, with non-loaded implants for comparison. Radiographic and histological assessments were made of the osseointegrated bone changes for 3 healing times (between implant insertion and loading), following 5 months of loading. The effect of loading on crestal bone loss depended on the healing time. Early loading preserved the most crestal bone. Delayed loading had significantly more crestal bone loss compared with the non-loaded controls (2.4 mm vs. 0.64 mm; P < 0.05). The histological assessment and biomechanical analyses of the healing bone suggested that loading and bioactivities of osteoblasts exert a synergistic effect on osseointegration that is likely to support the hypothesis that early loading produces more favorable osseointegration.     

Complications and results after stapled haemorrhoidopexy as a day surgical procedure

Abstract. Background: The aim of this report is to describe our experience with stapled haemorrhoidopexy as a day surgery procedure. Methods: From January 2000 to January 2003, a total of 214 patients with third- and fourth-degree haemorrhoids underwent stapled haemorrhoidopexy under spinal anaesthesia. We analysed early postoperative complications and long-term results. Patients were followed for 4–36 months (mean, 22 months). Only 3 patients (1%) were hospitalised. The long-term complications were analysed by means of a mailed questionnaire. Results: Minor bleeding at wiping after defecation was observed by 9% of patients and minor haemorrhoidal prolapse by 8% of patients. Pain after defecation was reported by 6% of patients and anal stenosis occurred in 2% of them. Faecal urgency was reported by 3% of patients with previously unknown incontinence problems. Conclusion: According to our experience, stapled haemorrhoidopexy can be safely performed as a day surgery procedure.     

The need for a multidisciplinary approach to cancer care

BACKGROUND: Treatment of the cancer patient is multifaceted. In addition to treating the cancer itself, there are additional important, "noncancer" issues to consider concomitantly, such as the patient's coexistent diseases, their health behaviors, and preventive care measures. While the need for coordination among surgeons, oncologists, and radiation oncologists has been well documented for treatment of the cancer, little attention has been paid to the importance of "noncancer" issues. In an attempt to characterize such issues, we performed a study to describe the prevalence of comorbid diseases as well as other "noncancer" issues (i.e., presence of poor health habits and use of preventive care measures) for four common, surgically related cancers. Finally, we describe the use of provider resources for these cancer patients. METHODS: Using a large population-based, nationwide patient survey, a cross-sectional analysis of lung, prostate, breast, and colon cancer patients who were less than 3 years from their diagnosis was performed. Prevalence of comorbid disease, health behaviors, receipt of preventive health care services, and contact with the health care system were characterized. Comparisons were made with a cohort of age-matched controls without cancer. RESULTS: Three hundred one cancer patients (29 lung, 88 prostate, 119 breast, 65 colon) and 6745 control patients were analyzed. Among the cancer patients, 81% had a coexistent disease, with 59% reporting cardiovascular comorbidity and 17% reporting pulmonary comorbidity. The range of comorbidities was substantial: hypertension (24-48%), coronary disease (8-24%), angina (4-10%), myocardial infarction (8-31%), arrhythmia (8-19%), stroke (3-8%), emphysema (4-10%), asthma (5-12%), diabetes (8-18%), bronchitis (8-13%), renal insufficiency (3-6%), severe arthritic symptoms (34-57%). Of note, 27-39% of cancer patients continued to smoke tobacco (P = 0.03 vs controls), of whom 85% continued to smoke daily. Finally, the rates of preventive care influenza vaccinations in high-risk individuals for the cancer cohort was no higher than the rate in controls, even though the cancer patients saw a health professional significantly more often. Of note, the frequency of "specialists" and surgeon visits was significantly higher for the cancer cohort. CONCLUSION: To optimize cancer outcomes, successful treatment of both the cancer and the "noncancer" issues is required. This study demonstrates that the burden of coexistent diseases is considerable. We also found the prevalence of continued poor health behaviors (i.e., use of tobacco) as well as suboptimal performance of preventive care measures to be notable. Since cancer patients see specialists twice as often as controls, it appears paramount that specialists (surgeons included) maintain diligence in addressing patient comorbidities, health habits, and other "noncancer" measures. If the substantial rates of smoking and suboptimal performance of preventive care measures are an indication of the "noncancer" quality of care that is being provided to the typical cancer patient, then a more concerted effort by all providers needs to be made regarding these and other "noncancer" issues.