Dorsal stream development in motion and structure-from-motion perception

Little is known about the neural development underlying high order visual perception. For example, in detection of structures by coherently moving dots, motion information must interact with shape-based information to enable object recognition. Tasks involving these different motion-based discriminations are known to activate distinct specialized brain areas in adults. Here, we investigate neural development of normally developing children using functional magnetic resonance imaging (fMRI) during perception of randomly moving point-light dots (RM), coherently moving dots that formed a 3D rotating object (SFM) and static dots. Perception of RM enhanced neural activity as compared with static dots in motion processing-related visual areas, including visual area 3a (V3a), and middle temporal area (hMT+) in 10 adults (age 20-30 years). Children (age 5-6 years) showed less pronounced activity in area V3a than adults. Perception of SFM induced enhanced neural activity as compared to RM in adults in the left parietal shape area (PSA), whereas children increased neural activity within dorsal (V3a) and ventral brain areas (lingual gyrus) of the occipital cortex. These findings provide evidence of neural development within the dorsal pathway. First, maturation was associated with enhanced activity in specialized areas within the dorsal pathway during RM perception (V3a) and SFM perception (PSA). Secondly, high order visual perception-related neural development was associated with a shift in neural activity from low level shape and motion specialized areas in children, including partially immature area V3a, to high order areas in the parietal lobule (PSA) in adults.     

The first year post-heart transplantation: use of immunosuppressive drugs and early complications

A large number of heart transplants are performed annually in different transplant centers in the United States. This is partly because of the improved survival of patients who undergo cardiac transplantation, thus making it a more viable option in the management of end-stage heart failure. The survival benefit after heart transplantation is a result of newer immunosuppressive drug regimens and a better understanding of their effects and interactions. Several studies, mostly involving a small number of patients, describe use and comparison of the many distinct immunosuppressive drugs available to date. Interestingly, many transplant centers perform in-house typical induction treatment regimens because of their own experience and intra-institutional preference. This review summarizes current practices of immunosuppressive drug therapy in the first year post-heart transplant based on the available clinical evidence and discusses future options of heart transplant immunosuppressive drug therapies.     

Massage therapy for the treatment of depression: a systematic review

BACKGROUND: People with depressive disorders or subsyndromal symptoms of depression (SSD) often use complementary and alternative therapies, including massage therapy (MT). This systematic review evaluates the evidence, from randomised clinical trials (RCTs), for the effectiveness of multiple sessions of classical European (Swedish) MT for the treatment of depression. METHODS: Eligible RCTs were identified via eight electronic databases and manual searches of references. Two reviewers independently selected trials, assessed trial quality and extracted data. RESULTS: Four RCTs met our inclusion criteria. Three of these RCTs compared MT with relaxation therapies, but provided insufficient data and analyses to contribute meaningfully to the evaluation of MT for depression. The fourth included RCT used MT as a control condition to evaluate a depression-specific acupuncture treatment. This trial provided limited evidence that, in the early stages of treatment, MT is less effective than acupuncture for treating depression, a treatment which itself is not accepted for this condition. CONCLUSIONS: Despite previous research suggesting that MT may be an effective treatment for depression, there is currently a lack of evidence to support this assertion from RCTs that have selected participants for depression or SSD.     

Shock waves activate in vitro cultured progenitors and precursors of cardiac cell lineages from the human heart

Postischemic cardiomyopathy remains one of the disorders in urgent need of effective noninvasive therapy. It is currently accepted that the isolation, expansion and application of resident cardiac stem cells may hold therapeutic promise for the future. Recently, it has been demonstrated that shock waves (SW) could enhance the expression of vascular endothelial growth factor (VEGF) and its receptor, Flt-1. As the development of angiogenic noninvasive therapy is very important for future therapeutic strategies in cardiovascular diseases, we examined in vitro, the effects of SW treatment on adult resident cardiac primitive cells isolated from bioptic fragments of normal human hearts and from explanted pathologic hearts with postischemic cardiomyopathy. This study demonstrates that SW have positive influence on both the proliferation and the differentiation of cardiomyocytes, smooth muscle and endothelial cells precursors, with a more obvious effect being evident in the cells from normal heart than in those taken from pathologic hearts. Our results suggest that SW treatment could inhibit or retard the pathologic remodeling and functional degradation of the heart if applied during the early stages of heart failure.     

Whole body vibration: a new therapeutic approach to improve muscle function in cystic fibrosis?

Disease progression in cystic fibrosis (CF) leads to muscle wasting and loss of muscle function. The aim of this prospective pilot study was to evaluate the effects of whole body vibration (WBV) on muscle function in adult patients with CF. Ten patients (three males; seven females) of the CF Center Cologne, Germany, have completed the 3-month study (age: 24-47 years; forced expiratory volume in 1 s (FEV1) 17-109% predicted (49+/-29) and body mass index (BMI) 16.6-24.4 kg/m2 (19.3+/-2.5). WBV was provided by a vibration platform (Galileo 2000). The patients were standing in an upright position receiving vertical vibration of frequencies between 20 and 25 Hz. The vibration exercise evokes muscle contractions via stretch reflexes improving muscular activity. The training schedule consisted of three 3-min sessions twice a day, 5 days per week for 3 months. Every 4 weeks the following tests were carried out: FEV1, forced vital capacity (FVC), BMI, chair-rising test (CRT), one-leg and two-leg jump test as well as maximal isometric grip force. The study has been approved by the local ethics committee. After 3 months of WBV all parameters in the CRT significantly improved: chair-rising time (P=0.03), maximal force (P=0.02), maximal power (P=0.01) as well as velocity (P=0.02). The peak jump force (P=0.02) and velocity (P=0.01) of the two-leg jump significantly improved. Parameters in the one-leg jump as well as maximal isometric grip force showed no significant improvement. Weight and BMI showed a slightly positive trend whereas FEV1 and FVC did not significantly change. Any change in mechanographic parameters did not correlate with FEV1 or FVC in this study. These results demonstrate that WBV can improve muscle function in CF patients.     

A novel diversion protocol dramatically reduces diversion hours

Introduction

Ambulance diversion is a problem in many communities. When patients are diverted prompt and appropriate medical care may be delayed.

Objective

Compare diversion hours and drop-off times before and after a dramatic change in diversion policy restricting each hospital to 1 hour out of every 8.

Methods

This study was a retrospective study in a county of 600 000 people and 10 hospitals from September 2004 to February 2006. A countywide diversion protocol was implemented in March 2005 that limited diversion hours to 1 hour out of every 8 (maximum of 90 h/mo). No other changes were implemented during the study period. Pretrial (9/04-2/05), interim (3/05-8/05), and posttrial (9/05-2/06) periods were compared. The main outcome measures were ambulance diversion hours and emergency medical service (EMS) drop-off times. Results were compared using analysis of variance and a Tukey post hoc analysis. P < .05 was considered significant.

Results

There was no significant difference in the number of monthly transports comparing the posttrial vs pretrial periods; however, a significant decrease in monthly ambulance diversion hours (difference, 251 hours; 95% CI, 136-368) and significant increase in additional time that EMS crews required to transport patients (drop-off times) (difference, 178 hours; 95% CI, 74-283) were observed. Posttrial diversion hours decreased to 18% of the pretrial values (from 305 to 54).

Conclusion

This novel ambulance diversion protocol dramatically reduced diversion hours at the cost of increasing EMS drop-off times in a large community.     

Palinopsia following discontinuation of venlafaxine

We report for the first time on a patient suffering from palinopsia after discontinuation of venlafaxine. Palinopsia is a rare and peculiar phenomenon which is defined as visual images that persist or recur after the stimulating object is removed and is often associated with posterior cerebral lesion or dysfunction. It also has been detected after usage of serotonergic drugs or in the course of antiserotonergic pharmacotherapy. Withdrawal symptoms after cessation of treatment involving serotonergic antidepressants are widely acknowledged in the literature, but still remain underestimated in clinical practice. It seems reasonable to suggest that clinicians should be aware of the risk of discontinuation symptoms in the case of serotonergic antidepressants, especially concerning those substances with a short half-life. If a decision is made to terminate therapy, it may be necessary to gradually reduce the dose over a number of weeks or to temporarily add a serotonin reuptake inhibitor with longer half-life.     

Protective effect of prion protein via the N-terminal region in mediating a protective effect on paraquat-induced oxidative injury in neuronal cells

Transmissible spongiform encephalopathies are a group of neurodegenerative disorders caused by a posttranslational, conformational change in the cellular isoform of the prion protein (PrP(C)) into an infectious, disease-associated form (PrP(Sc)). Increasing evidence supports a role for PrP(C) in the cellular response to oxidative stress. We investigated the effect of oxidative stress mediated by paraquat exposure on SH-SY5Y neuroblastoma cells. A loss of mitochondrial membrane potential and subsequent reduction in ATP production were demonstrated in untransfected SH-SY5Y cells, an effect that was ameliorated by the expression of PrP(C). Cells expressing either PrP-DeltaOct, which lacks the octapeptide repeats, or PrP-DA, in which the N-terminus is tethered to the membrane, showed increased sensitivity to paraquat compared with cells expressing wild-type PrP(C) as shown by reduced viability, loss of their membrane integrity, and reduced mitochondrial bioenergetic measurements. Exposure of prion-infected mouse SMB15S cells to paraquat resulted in a reduction in viability to levels similar to those seen in the untransfected SH-SY5Y cells. However, "curing" the cells with pentosan sulfate restored the viability to the level observed in the SH-SY5Y cells expressing PrP(C). These data would indicate that the molecular mechanism promoting cellular resistance to oxidative stress had been compromised in the infected SMB15S cells, which could be reinstated upon curing. Our study supports the hypothesis that PrP(C) expression protects cells against paraquat-induced oxidative injury, demonstrates the significance of the N-terminal region of the protein in mediating this protective effect, and also shows that the biochemical consequences of prion infection may be reversed with therapeutic intervention.