Serial magnetic resonance imaging in experimental primate stroke: validation of MRI for pre-clinical cerebroprotective trials

Precise assessment of stroke outcome is critical for pre-clinical testing of cerebroprotective strategies. Differences in stroke volume measured by various magnetic resonance imaging (MRI) techniques are documented in humans, but not well described in experimental primate stroke. This study characterizes changes in stroke volume using serial MRI scans in a baboon model of reperfused cerebral ischemia. The location/area of hyperintensity on MRI corresponded with the TTC-stained infarct region. T2-weighted fast spin echo (T2W FSE), fluid attenuated inversion recovery (FLAIR), and diffusion weighted imaging (DWI) showed a decrease in infarct volume between 72 h and nine days post-ischemia (p = ns, p = 0.029, and p = 0.006). T2W FSE and FLAIR demonstrated an increase in infarct volume from 24 h to nine days post-ischemia, while DWI displayed a decrease over the same period. While early T2W FSE, FLAIR, and DWI all correlated with late infarct volume (p < 0.001), 72 h T2W FSE was the best direct measure (2.39% +/- 1.40% unity deviation). Serial MRI in a nonhuman primate model of focal cerebral ischemia recapitulates findings in clinical stroke. MRI at 72 h accurately predicts late infarct volume.     

Implication of corticosteroid receptors in the regulation of hippocampal structural plasticity

The dentate gyrus is one of the few areas of the adult brain that continues to produce neurons and to express the embryonic polysialylated isoforms of neuronal cell adhesion molecules (PSA-NCAM). The stress hormone corticosterone exerts a complex modulation on neurogenesis and PSA-NCAM, and previous studies have shown that mature granule cells require corticosterone for their survival. Thus, the aim of our work was to investigate the respective role of the different corticosteroid receptors on these three parameters in adrenalectomized rats. It was found that treatment with a low dose of the mineralocorticoid receptor agonist, aldosterone, prevents only the adrenalectomy-induced increase in cell death. Treatment with a higher dose of aldosterone normalized cell proliferation whereas PSA-NCAM expression was normalized only by treatment with the glucocorticoid receptor agonist, RU 28362. It is concluded that stimulation of the mineralocorticoid receptor is sufficient to mediate the effects of corticosterone on neurogenesis and to protect mature cells from cell death whereas stimulation of the glucocorticoid receptor is necessary to modulate PSA-NCAM expression.     

A new interventional procedure in the treatment of iatrogenic pseudoaneurysm

PURPOSE: The incidence of iatrogenic pseudoaneurysms as a complication of angiographic procedures is increasing. The purpose of this study was to test the validity and the efficacy of a new interventional procedure in the treatment of iatrogenic pseudoaneurysms. MATERIAL AND METHODS: Between April 1999 and June 2000, 14 patients suffering from a iatrogenic pseudoaneurysm were treated with the new technique which consists of the direct puncture of the aneurysmal cavity using the Seldinger technique and the introduction of a movable-core Teflon-coated guide wire into the hollow of the sac. Mild external compression with Femostop is then applied for no longer than 120 minutes. The puncture was also performed with colour-Doppler US guidance. RESULTS: We observed the complete healing of the pseudoaneurysms in all of the treated patients with no immediate complications or recurrence in the follow-up period. DISCUSSION AND CONCLUSIONS: The procedure applied to treat our group of patients proved valid, easy to perform and capable of producing satisfactory RESULTS: This new interventional method for treating iatrogenic pseudoaneurysms may be considered an effective alternative to surgery and US-guided compression and capable of achieving a quick recovery. The procedure is particularly suitable in those patients that may suffer discomfort or complications from the widely applied technique of sonographically-guided compression of pseudoaneurysms.     

Correlates of total physical activity among middle-aged and elderly women

Information on correlates of total physical activity (PA) levels among middle-aged and elderly women is limited. This article aims to investigate whether total daily PA levels are associated with age, body mass index, smoking, drinking status, and sociodemographic factors.     

Ethical issues in neonatal intensive care and physicians' practices: A European perspective

An international project (EURONIC) was carried out to explore the end-of-life decision-making process in a large, representative sample of neonatal intensive care units (NICUs) in eight western European countries: France, Germany, Great Britain, Italy, Luxembourg, the Netherlands, Spain and Sweden. Structured questionnaires were used to record data on NICU organization and policies, and to survey staff views and practices regarding ethical decision-making. One hundred and twenty-two NICUs were recruited by census or random sampling (response rate 86%); 1235 physicians and 3115 nurses completed the staff questionnaire (response rates 89 and 85%, respectively). This paper focuses on the physicians' answers. In all countries but Italy, most physicians reported having been involved at least once in setting limits to intensive care because of a baby's incurable condition and/or poor neurological prognosis. Adopted strategies varied between countries. Practices such as the continuation of current treatment without intensifying it and the withholding of emergency manoeuvres appeared widespread. In contrast, the frequency of doctors reporting withdrawal of mechanical ventilation was highest in the Netherlands (93%), Sweden (91%) and the Great Britain (88%), intermediate in France and Germany, and lowest in Spain and Italy (34 and 21%, respectively).
Conclusion: Ethically problematic clinical cases are approached differently in the various countries. The findings of this study may provide an opportunity for physicians to review their practices critically, in light of how other colleagues proceed, and foster an open discussion about these difficult issues.     

Functional GABAB receptors are present in guinea pig nodose ganglion cell bodies but not in peripheral mechanosensitive endings

The effects of the GABAB-selective agonist baclofen were studied on guinea pig nodose ganglion neurones using grease gap and intracellular recording techniques, and on peripheral mechanosensitive endings in the guinea pig oesophagus and stomach with extracellular recordings. GABA dose-dependently reduced the amplitude of the compound action potential of C-type neurones (C spikes, EC50 = 30.9 microM), which was prevented by the GABAA antagonist bicuculline (10 microM). The GABAB agonist baclofen (1-300 microM) did not produce any significant effect on the amplitude of C spikes. In microelectrode studies, baclofen (100 microM) evoked hyperpolarisation (by 2.53 +/- 0.51 mV, n = 6, N = 5) in a subset of nodose neurones (6 out of 26, N = 18). In seven out of eight neurones (N = 8) with a slow after-hyperpolarisation following action potentials, baclofen significantly inhibited its amplitude by 19 +/- 4% (n = 7, p < 0.05). GABA (100 microM) evoked a depolarisation of 9.3 +/- 2.4 mV (10 nodose neurones, N = 9, p < 0.05) associated with a decrease in input impedance of 49 +/- 12% (N = 4, p < 0.05). Baclofen (100-200 microM) did not affect either spontaneous or stretch-evoked firing of distension-sensitive vagal mechanoreceptors of the guinea pig oesophagus and stomach but did inhibit mechanoreceptors in the ferret oesophagus. Antibodies to GABAB receptor 1a splice variants labelled most of the neurones and numerous fibres in the guinea pig nodose ganglion while antibodies to GABAB receptor 1b splice variants stained only nerve cell bodies. There were numerous nerve fibres showing GABAB receptor 1a- and 1b-like immunoreactivity in the myenteric plexus in the guinea pig oesophagus and stomach but not in anterogradely labelled extrinsic vagal nerve fibres. The result indicates that most guinea pig C-type nodose ganglion neurones have GABAB receptors on their cell bodies but their density on distension-sensitive peripheral endings is too low to allow modulation of mechanotransduction. There is a significant species-dependent difference in the expression of GABAB receptors on peripheral vagal mechanosensitive endings.     

Blood volume monitoring in intermittent hemodialysis for acute renal failure

BACKGROUND: Although hypotension commonly accompanies intermittent hemodialysis for acute renal failure (ARF) in the intensive care unit (ICU), little is known about how it may be prevented. Online relative blood volume (RBV) monitoring has been used to reduce hypotension in chronic hemodialysis, but is of unproven benefit in ARF. This study tested the hypothesis that hypotension is predictable using online RBV monitoring in patients dialyzed for ARF in an ICU setting. METHODS: The primary definition of hypotension was mean arterial pressure (MAP) <70 mm Hg; systolic blood pressure (SBP) <100 mm Hg was used as a secondary outcome. Fifty-seven treatments were prospectively studied in twenty consecutive adult patients treated with intermittent hemodialysis. RBV was continuously measured using the Hemoscan device (Gambro). RESULTS: Hypotension occurred in 30% of treatments as defined by MAP, and 18% as defined by SBP. There was no evidence of patient-specific or universal RBV thresholds that were associated with hypotension. Analysis using the kappa statistic showed that concordance of RBV and hypotension (that is, RBV falling prior to hypotensive episodes rather than rising or remaining stable) was no greater than chance. RBV and rate of change in RBV slopes did not predict hypotension as a dichotomous outcome, and were not correlated with MAP or SBP whether autocorrelation was corrected for or neglected. Substituting rate of change in RBV (RBV slopes) for absolute RBV values did not improve predictive power. CONCLUSIONS: These results suggest that strategies based on online RBV monitoring are unlikely to reduce hypotension in intermittent hemodialysis for ARF that is delivered through central venous catheters.     

Skin-sparing reduction effects of thermoplastics used for patient immobilization in head and neck radiotherapy

Skin-sparing benefits derived from the use of megavoltage photon beams can be strongly reduced when filters are inserted between the source and the patient. The use of plastic masks for immobilizing the patient is the most important cause of this reduction in head and neck treatments. The influence of thermoplastics, commercially available for patient immobilization systems (Orfit Raycast (Luxilon Ind. Co.), Posicast (Sinmed bv) and Optimold (WFR Aquaplast Corp.)), on the patient skin dose value has been investigated by using an NE2534 ‘Markus’ chamber. Indicative measurements with moulded masks (carried out with 2-mm Orfit and3.2-mm Optimold layers) show significant differences between masks moulded with the two thermoplastics.