Rehabilitative Therapies Differentially Alter Proliferation and Survival of Glial Cell Populations in the Perilesional Zone of Cortical Infarcts

卒中后的康复治疗能改善神经环路的重塑,促进功能恢复。但人们对其潜在的细胞分子机制却知之甚少。特别是康复训练对在大脑局部缺血的病理生理过程中扮演着重要角色的胶质细胞的影响,一直不甚明了。现在,作者设计一项实验来检测康复训练对光化学诱导的局灶性脑缺血损伤灶周围(梗死灶位于大鼠前肢感觉运动皮质功能区)的不同胶质细胞种群增殖和存活的影响。造模成功后,标准组小鼠即开始在标准笼中接受每日定期的针对损伤前肢的功能训练,强化组大鼠转移到强化环境中饲养,抓取组大鼠仍然放在标准笼中未给予进一步的治疗。作者通过感觉运动行走测试来评价功能恢复情况,并于梗死后2-6d给予BrdU以标记检测增殖的细胞。分贝在梗死后的第10天和第42天,用免疫细胞化学方法对病灶周围增殖和存活的星形胶质细胞、小胶质细胞/巨噬细胞和成熟或未成熟的少突胶质细胞进行定量检测。结果作者发现,强化环境和抓取训练都能显著提高损伤前肢的功能恢复程度。此外,这些治疗能显著减少梗死灶周围小胶质细胞/巨噬细胞的增殖,其中对损伤前肢的每日训练还能明显提高新生星形胶质细胞的存活率。因此,作者的数据证明,皮质梗死后的康复治疗不仅能促进功能恢复,而且显著影响着病灶周围区胶质细胞的反应。     

Inappropriate Discharge of an Implantable Cardioverter Defibrillator During Atrial Flutter and Intermittent Ventricular Antibradycardia Pacing

Inappropriate Discharge of an ICD. Introduction : Inappropriate discharses of an implantable cardioverter defibrillator (ICD) are troublesome to the patient and sometimes a difficult task for the physician trying; to identify and treat the cause.
Methods and Results : For the first time, we report a mechanism of inappropriate ICD discharges during episodes of atrail flutter with a slow ventricular response and intermittent antibradycardia pacing. The episodes occurred in tow patients and were triggered by the unique sensing alogorithm of the Ventitex Cadence® V-100 in combination with the tripolar CPI Endotak® 072 transvenous defibrillation lead, which provides integrated bipolar sensing.
Conclusion : Besides treatment of the underlying arrhythmia, reprogramming of the device, an electrode position far away from the atria, and true bipolar sensing will enhance the performance of ICD systems with respect to the episodes described here. In addition, more flexible sensing algorithms may. in the future, prevent this overall rare complication.     

Crystal structures of the even and odd bolaform amino acid derivatives (11-N-[benzyloxycarbonyl-L-alanyl] aminoundecanoyl)-L-alanyl benzyl ester and (12-N-[benzyloxycarbonyl-L-alanyl]aminododecanoyl)-L-alanyl benzyl ester

Reaction of two α,ω-aminocarboxylic acids with N- and C-protected alanine leads to bolaform compounds with two secondary amide groups on one end and one such group at the other end. Unsymmetric sheet-like structures are formed in the crystals. (11-N-[Benzyloxycarbonyl-L-alanyl]aminoundecanoyl)-L-alanyl benzyl ester (1) and (12-N-[benzyloxycarbonyl-L-alanyl]aminododecanoyl)-L-anyl benzyl ester (2) form triclinic crystals (spacegroup P1, No.1) with a= 4.917, b= 5.614, c= 29.02 Å, α= 88.40, β= 93.50, γ= 100.21°, Z=1 (1) and a= 4.954, b= 5.613, c= 30.23 Å, α= 93.44, β= 90.07, γ= 104.15°, Z=1 (2). The crystal structures were solved via direct methods and refined to R= 0.040 (1) and 0,078 (2) from 2441 and 2125 reflections. © Munksgaard 1997.     

Benefits and Limitations of Rate Adaptive Pacing Under Laboratory and Daily Life Conditions in Patients with Minute Ventilation Single Chamber Pacemakers

Rate adaptive pacing has been shown to improve hemodynamic performance and exercise tolerance during acute testing. However, there remain concerns about its benefit in daily life and possible complications incurred by unnecessary pacing. This double-blind crossover study compared the benefit of rate adaptive (SSIR) versus fixed rate (SSI) pacing under laboratory and daily life conditions in 20 rate incompetent patients with minute ventilation single chamber pacemakers (META II). The heart rate (HR) response during three different exercise tests (treadmill, bicycle ergomctry, walking test) was correlated with the Holler findings during daily life in either pacing mode. The maximal HR was significantly higher in the SSIR-mode compared to the SSI-mode, both during laboratory testing (treadmill: 123 ± 15 vs 93 ± 29 beats/min: ergometry: 118 ± 15 vs 89 ± 27 beats/min; walking test: 127 ± 9 vs 95 ± 26 beats/min, all P values < 0.01) as well as during daily life (Holter: 126 ± 13 vs 103 ± 24 beats/min, P < 0.01). On Holter, the average HR (71 ± 14 vs 71 ± 8 beats/min) and the percentage of paced rhythm (54 % vs 62%, SSI- vs SSIR-mode, P = NS) were not different in either mode. However, despite a 30% rate gain in the SSIR-mode, the exercise capacity remained unchanged, and only 38% of patients preferred the SSIR-mode. Minute ventilation pacemakers provide a physiological rate response to exercise. Irrespective of the protocol used, the findings of laboratory testing are comparable to those during daily life. However, patient selection for rate adaptive single chamber pacing should be made with caution, since the objective benefit of restoring normal chronotropy may subjectively be negligible for most patients.     

Long-Term Effects of Dynamic Atrial Overdrive Pacing on Sleep-Related Breathing Disorders in Pacemaker or Cardioverter Defibrillator Recipients

Introduction: Sleep-related breathing disorders occur in 20–30% of Europeans and North Americans, including 10% of sleep apnea syndrome (SAS). A preliminary study suggested that atrial overdrive pacing with a fixed heart rate might alleviate SAS. However, it is not known whether dynamic atrial overdrive pacing alleviates SAS.
Methods: Patients with indications for a dual chamber pacemaker or implantable cardioverter-defibrillator (ICD) were screened for SAS using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. If PSQI was >5, cardio-respiratory polygraphy was performed before and 4 and 7 months after device implantation. Patients were randomized to algorithm ON–OFF (group A) or OFF–ON (group B) and the apnea-hypopnea index (AHI) was measured.
Results: Out of 105 consecutive patients, 46 (44%) had a positive PSQI. This analysis included 12 patients (mean age = 61 ± 10 years, body mass index 28.9 ± 6.5 kg/m², left ventricular ejection fraction = 38.3 ± 13.6%; 10 men). All patients suffered from obstructive or mixed SAS. There were no significant differences in PSQI or AHI between baseline and follow-up or between the two study groups. Therefore, the study was terminated ahead of schedule.
Conclusions: The prevalence of obstructive or mixed SAS was high in pacemaker or ICD recipients and reduced left ventricular ejection fraction. In these patients, long-term dynamic atrial overdrive pacing using did not improve PSQI or SAS. Therefore, patients with relevant obstructive or mixed SAS should not be offered atrial pacing therapy.     

Symphysitis following transrectal biopsy of the prostate

Transrectal ultrasound-guided needle biopsy of the prostate is a widely accepted technique to obtain prostatic tissue for histological examination. Severe complications are rarely seen. We report a case of symphysitis causing hospitalization and severe pain and discomfort of the patient. Possible etiologic factors are traumatic osseous lesions and transport of rectal bacteria to the periosseous region. Especially in small prostates, care should be taken to avoid this condition. Prolonged perioperative antibiotic prophylaxis is mandatory.