Serotonin and serotonin 1-A receptors in the failure of ethanol-treated rats to adapt to a repeated stress schedule

OBJECTIVE: The effects of repeated-restraint stress on brain 5-hydroxytryptamine; serotonin (5-HT) metabolism and functional responses to a selective 5-HT-1A agonist, 8-hydroxy-2-(di-n-propylamino) tetralin (8-OH-DPAT), are compared in water- and ethanol-treated rats. METHOD: Locally bred male water- or ethanol-treated rats restrained 2 hours per day for 6 days were killed, and whole brains were collected for the neurochemical analysis by high performance liquid chromatography with electrochemical detection (HPLC-EC). In a separate experiment 8-OH-DPAT was injected in water- and ethanol-treated rats to compare elicited hyperactivity syndrome (a postsynaptic response) and effectiveness of the drug in reducing brain 5-HT synthesis (a presynaptic response). RESULTS: A single episode of 2-hour restraint stress decreased 24-hour cumulative food intake in both water- and ethanol-treated rats. Following repeated restraint stress of 2 hours per day for 5 days, the decreases were present in ethanol- but not water-treated rats. The sixth episode of 2-hour restraint stress did not alter brain tryptophan 5-HT and 5-hydroxyindoleacetic acid (5-HIAA) concentrations in water-treated repeatedly restrained rats but decreased tryptophan and increased 5-HT concentration in ethanol-treated rats. Ethanol-treated unrestrained and ethanol-treated repeatedly restrained rats exhibited higher levels of tryptophan 5-HT and 5-HIAA than their respective water-treated controls. Injecting 8-OH-DPAT at a dose of 0.25 mg/kg elicited comparable hyperactivity syndrome in water- and ethanol-treated rats but decreased 5-HT synthesis more in ethanol-treated than in water-treated rats. CONCLUSIONS: The present study shows that ethanol administration for 2 to 3 weeks, although it increases brain 5-HT metabolism, impairs adaptation by increasing the effectiveness of negative feedback control over 5-HT synthesis.     

Transarterial and transvenous embolotherapy of arteriovenous fistulas in the transplanted pancreas

Arteriovenous fistula (AVF) is a rare but well-documented complication of pancreatic allotransplantation. Small, tortuous vessels in the head of the transplanted pancreas may complicate transarterial embolization. The authors recently encountered two women who developed clinical pancreatitis after right pelvic transplant placement with documented AVF in the head of the transplanted pancreas. In the first patient, embolization was successfully performed transarterially. In the second patient, transarterial embolization was not feasible due to the small caliber and extreme tortuosity of the pancreaticoduodenal arcade and transvenous embolic occlusion was successfully performed. Both patients recovered with normalization of enzyme levels and pain reduction.     

Antigen specificity in subsets of mucous membrane pemphigoid

Mucous membrane pemphigoid (MMP) has several subsets based on target antigens recognized by their sera. MMP and ocular cicatricial pemphigoid (OCP) sera recognize beta4 integrin subunit, oral pemphigoid sera recognize alpha6 integrin subunit, and anti-epiligrin cicatricial pemphigoid sera recognize laminin 5. Our aim is to determine if autoantibodies in the sera of patients with MMP, OCP, and oral pemphigoid (OP) recognize only their target antigens, and to see if this specificity is maintained throughout the clinical course. An immunoblot assay using bovine gingival lysate was used as substrate. Fifteen MMP patients, eight with OCP, and 15 OP patients were studied before therapy and at multiple intervals during the clinical course. Absorption and blocking studies were performed to determine binding specificity. Sera of patients with MMP and OCP recognize only beta4 integrin subunit, and sera of OP patients recognize alpha6 integrin throughout the clinical course. The sera of patients in the subsets of MMP described in this report show adherence and selectivity to target antigen during the entire clinical course, without crossover, interaction, or change. Hence, these subsets of MMP provide an excellent model to study clinical correlation with antigen and antibody specificity, in autoimmunity.     

Public Health Emergency of International Concern (PHEIC) has Declared Twice in 2014; Polio and Ebola at the Top

BackgroundThe current Ebola outbreak in West Africa and the large scale wild Polio virus outbreak in several countries are the top most issues among international public health and scientific communities'' debates and concerns. These two outbreaks were judged to be declared as Public Health Emergency of International Concern (PHEIC) during 2014. This is the first time ever to have such circumstance of two PHEICs at the same time.DiscussionPHEIC, which has to be declared by WHO Director General after a recommendation of IHR Emergency Committee; is observed to start in countries with fragile health system and conflict areas. Then it rapidly spread to threaten the global public health. The year 2014 has uniquely witnessed declaration of two events as PHEIC according to IHR (2005); Polio and Ebola Virus Disease (EVD). Both outbreaks are caused by viruses such as H1N1 which was previously declared as PHEIC in 2009.SummaryPublic Health Emergencies of International Concern in 2014 occurred in countries with weak health systems and conflicts and threatening the whole globe. International collaborative work is required to contain the event and to mobilize resources/capacities between countries. Moreover, public health surveillance systems as core capacity for IHR (2005) should be strengthened in all countries with focus on those with limited capacity and ongoing conflicts. The ultimate aim is timely detection of potential PHEIC events in the future along with early preparedness and response plans.     

Boundary‐spanning actors in complex adaptive governance systems: The case of multisectoral nutrition

A growing literature highlights complexity of policy implementation and governance in global health and argues that the processes and outcomes of policies could be improved by explicitly taking this complexity into account. Yet there is a paucity of studies exploring how this can be achieved in everyday practice. This study documents the strategies, tactics, and challenges of boundary‐spanning actors working in 4 Sub‐Saharan Africa countries who supported the implementation of multisectoral nutrition as part of the African Nutrition Security Partnership in Burkina Faso, Mali, Ethiopia, and Uganda. Three action researchers were posted to these countries during the final 2 years of the project to help the government and its partners implement multisectoral nutrition and document the lessons. Prospective data were collected through participant observation, end‐line semistructured interviews, and document analysis. All 4 countries made significant progress despite a wide range of challenges at the individual, organizational, and system levels. The boundary‐spanning actors and their collaborators deployed a wide range of strategies but faced significant challenges in playing these unconventional roles. The study concludes that, under the right conditions, intentional boundary spanning can be a feasible and acceptable practice within a multisectoral, complex adaptive system in low‐ and middle‐income countries.     

Influence of two-electrode montages on the level-specific (LS) CE-Chirp auditory brainstem response (ABR) at multiple intensity levels

Objective: To investigate the influence of two different electrode montages (ipsilateral: reference to mastoid and vertical: reference to nape of neck) to the ABR results recorded using a level-specific (LS)-CE-Chirp® in normally hearing subjects at multiple intensities levels. Design: Quasi-experimental and repeated measure study designs were applied in this study. Two different stopping criteria were used, (1) a fixed-signal averaging 4000 sweeps and, (2) a minimum quality indicator of Fmp?=?3.1 with a minimum of 800 sweeps. Study sample: Twenty-nine normally hearing adults (18 females, 11 male) participated. Results: Wave V amplitudes were significantly larger in the LS CE-Chirp® recorded from the vertical montage than the ipsilateral montage. Waves I and III amplitudes were significantly larger from the ipsilateral LS CE-Chirp® than from the other montages and stimulus combinations. The differences in the quality of the ABR recording between the vertical and ipsilateral montages were marginal. Conclusions: Overall, the result suggested that the vertical LS CE-Chirp® ABR had a high potential for a threshold-seeking application, because it produced a higher wave V amplitude. The Ipsilateral LS CE-Chirp® ABR, on the other hand, might also have a high potential for the site of lesion application, because it produced larger waves I and III amplitudes.     

Identifying infant hydrocephalus in the emergency department with transfontanellar POCUS

Hydrocephalus carries significant morbidity in the infant population. Although clinical symptoms are often nonspecific, hydrocephalus is easily identified using transfontanellar sonography. In this review, we provide the emergency physician with a succinct overview of infant hydrocephalus and the point-of-care ultrasound (POCUS) technique for identification of this pathology.