Neural connectivity between the hypothalamic supramammillary nucleus and appetite‐ and motivation‐related regions of the rat brain

The supramammillary nucleus (SuM) has an emerging role in appetite control. We have shown that the rat SuM is activated during hunger or food anticipation, or by ghrelin administration. In the present study, we characterised the connectivity between the SuM and key appetite‐ and motivation‐related nuclei in the rat. In adult wild‐type rats, or rats expressing Cre recombinase under the control of the tyrosine hydroxylase (TH) promoter (TH‐Cre rats), we used c‐Fos immunohistochemistry to visualise and correlate the activation of medial SuM (SuMM) with activation in the lateral hypothalamic area (LH), the dorsomedial hypothalamus (DMH) or the ventral tegmental area (VTA) after voluntary consumption of a high‐sugar, high‐fat food. To determine neuroanatomical connectivity, we used retrograde and anterograde tracing methods to specifically investigate the neuronal inputs and outputs of the SuMM. After consumption of the food there were positive correlations between c‐Fos expression in the SuMM and the LH, DMH and VTA (P = 0.0001, 0.01 and 0.004). Using Fluoro‐Ruby as a retrograde tracer, we demonstrate the existence of inputs from the LH, DMH, VTA and ventromedial hypothalamus (VMH) to the SuMM. The SuMM showed reciprocal inputs to the LH and DMH, and we identified a TH‐positive output from SuMM to DMH. We co‐labelled retrogradely‐labelled sections for TH in the VMH, or for TH, orexin and melanin‐concentrating hormone in the LH and DMH. However, we did not observe any colocalisation of immunoreactivity with any retrogradely‐labelled cells. Viral mapping in TH‐Cre rats confirms the existence of a reciprocal SuMM‐DMH connection and shows that TH‐positive cells project from the SuMM and VTA to the lateral septal area and cingulate cortex, respectively. These data provide evidence for the connectivity of the SuMM to brain regions involved in appetite control, and form the foundation for functional and behavioural studies aiming to further characterise the brain circuitry controlling eating behaviours.     

The effect of an advanced glycation end-product crosslink breaker and exercise training on vascular function in older individuals: A randomized factorial design trial

Aging leads to accumulation of irreversible advanced glycation end-products (AGEs), contributing to vascular stiffening and endothelial dysfunction. When combined with the AGE-crosslink breaker Alagebrium, exercise training reverses cardiovascular aging in experimental animals. This study is the first to examine the effect of Alagebrium, with and without exercise training, on endothelial function, arterial stiffness and cardiovascular risk in older individuals. Forty-eight non-exercising individuals (mean age 70 ± 4 years) without manifest diseases or use of medication were allocated into 4 groups for a 1-year intervention: Exercise training & Alagebrium (200 mg/day); exercise training & placebo; no exercise training & Alagebrium (200 mg/day); and no exercise training & placebo. We performed a maximal exercise test (VO₂max) and measured endothelial function using venous occlusion plethysmography and intra-arterial infusion of acetylcholine, sodium nitroprusside and N^G-monomethyl-l-arginine. Arterial stiffness was measured using pulse wave velocity. Cardiovascular risk was calculated using the Lifetime Risk Score (LRS). In the exercise training groups, LRS and VO₂max improved significantly (23.9 ± 4.5 to 27.2 ± 4.6mLO₂/min/kg, p < 0.001). Endothelial response to the vasoactive substances did not change, nor did arterial stiffness in any of the four groups. In conclusion, one year of exercise training significantly improved physical fitness and lifetime risk for cardiovascular disease without affecting endothelial function or arterial stiffness. The use of the AGE-crosslink breaker Alagebrium had no independent effect on vascular function, nor did it potentiate the effect of exercise training. Despite the clinical benefits of exercise training for older individuals, neither exercise training nor Alagebrium (alone or in combination) was able to reverse the vascular effects of decades of sedentary aging.     

Injuries in Professional Male Soccer Players in the Netherlands: A Prospective Cohort Study

Context:Injuries are a major adverse event in a soccer player''s career. Reducing injury incidence requires a thorough knowledge of the epidemiology of soccer injuries.Objective:To investigate the incidence and characteristics of injuries in the Dutch premier soccer league.Design:Cohort study.Setting:The Dutch premier soccer league.Results:A total of 286 injuries were recorded, affecting 62.7% of the players. The overall injury incidence was 6.2 injuries per 1000 player-hours, 2.8 in training sessions and 32.8 in matches. Most of the recorded injuries were acute (68.5%). Eight percent of the injuries were classified as recurrent. Injuries were most likely to be located in the lower extremities (82.9%). Injury time loss ranged from 1 to 752 days, with a median of 8 days. Knee injuries had the greatest consequences in terms of days of absence from soccer play (on average, 45 days). The most common diagnosis was muscle/tendon injury of the lower extremities (32.9%).Conclusions:Injury risk in the Dutch premier soccer league is high, especially during matches. Preventive measures should focus on the most common diagnoses, namely, muscle/tendon injuries of the lower extremities.Key Words: football, incidence, epidemiology, elite athletes

Key Points

• Injury risk in the Dutch premier soccer league is high; during 1 season, 62.7% of the players sustained an injury.
• Injuries most often affected the lower extremities (groin, posterior thigh, knee, lower leg/Achilles tendon, and ankle).
• Recurrent injuries caused longer absences than did first-time injuries, and knee injuries had the greatest consequences in time lost from soccer play.
• Preventive measures should focus on the most common diagnoses, namely, muscle/tendon injuries of the lower extremities.

Soccer is the sport with the greatest participation globally.¹ More than 200 million people from 203 nations are members of the Federation of International Football Associations (FIFA), while the Union of European Football Associations (UEFA) has 23 million members in 51 countries.² Outdoor soccer was played by 2635 clubs and approximately 60 500 teams in the Netherlands during the 2011–2012 season. There are currently more than 1.2 million licensed members of the Royal Netherlands Football Association, 45% of whom are adult males.³To obtain a good ranking in competition, soccer players have to be talented, well trained, and healthy, so injuries are a major adverse event in a soccer player''s career. Medical and surgical treatment and rehabilitation interrupt the player''s activity for a period ranging from a few weeks to several months.² If many injuries are sustained, team results can suffer.⁴ Reducing the injury incidence and increasing player safety requires a thorough knowledge of the epidemiology of soccer injuries.⁵ One major problem in the epidemiologic assessment of soccer injuries, however, is the methodologic inconsistency among studies. For example, injury definitions and methods for data collection and recording often differ considerably among studies.^6,7Investigations that describe injury risk and injury patterns in professional soccer have typically been conducted during tournaments,^8–11 have involved only teams at the highest European level,^10,12 have covered only part of a season,¹³ or were related to only 1 team.^14,15 Limited published research has included data on injuries within 1 national professional male soccer competition and involving multiple teams. Hence, little is known about the differences among countries in injury risk and injury patterns in professional male soccer players. During the last 10 years, acute and overuse injuries during matches and training sessions within national professional male soccer competitions have been recorded in Denmark¹³ and Sweden.^16–18 In view of the differences in performance level, medical support, match frequencies, and climate, it is plausible that the incidence and severity of soccer injuries may differ between Scandinavian and other European soccer leagues.¹⁸ Therefore, our study aimed to prospectively record injuries in the Dutch premier soccer league to investigate the incidence and characteristics of injuries in male professional soccer players during 1 entire soccer season.     

An ex vivo biomechanical evaluation of a hydroxyapatite cement for use with kyphoplasty.

BACKGROUND AND PURPOSE: Previous ex vivo biomechanical studies have shown that kyphoplasty with polymethylmethacrylate cement increases vertebral body (VB) strength and restores VB stiffness and height after compression fracture. The purpose of the current study was to determine if a hydroxyapatite cement used as a void filler during kyphoplasty provides mechanical stabilization similar to that of a polymethylmethacrylate cement. METHODS: Simulated compression fractures were experimentally created in 33 osteoporotic VBs harvested from female cadaver spines. VBs were assigned to one of three groups: 1) kyphoplasty with a custom mixture of Simplex P; 2) kyphoplasty with BoneSource; and 3) no treatment. The kyphoplasty treatment consisted of inserting a balloon-like device into the VB via both pedicles, inflating the tamp, and filling the created void with Simplex P bone cement or BoneSource. VBs in the no-treatment group received no interventions. Pre- and posttreatment heights were measured, and the repaired VBs were recompressed to determine posttreatment strength and stiffness values. RESULTS: Kyphoplasty with altered Simplex P restored strength, whereas kyphoplasty with BoneSource and the no-treatment protocol both resulted in significantly weaker VBs relative to initial strength. All treatments resulted in significantly less stiff VBs relative to their initial condition. All VBs lost significant height after initial compression, but a significant amount of lost height was restored by kyphoplasty with either cement. CONCLUSION: Kyphoplasty with either cement significantly restored VB height. Kyphoplasty with altered Simplex P resulted in stronger repairs than did no treatment or kyphoplasty with BoneSource.     

The addition of 4% oxygen to the CO(2) pneumoperitoneum does not decrease dramatically port site metastases

Study ObjectivePort site metastases (PSM) after laparoscopic surgery for advanced-stage ovarian carcinoma are a cause of concern, but the pathophysiology is unknown. Because CO₂ pneumoperitoneum was recently demonstrated to be a cofactor in adhesion formation and tumor implantation in a laparoscopic mouse model, and because both could be prevented by the addition of 4% oxygen to the CO₂ pneumoperitoneum, we wanted to test the hypothesis that PSM could be related to tumor cell hypoxia during CO₂ pneumoperitoneum.DesignA randomized controlled pilot trial to compare the incidence of PSM in women undergoing laparoscopy with a pure CO₂ pneumoperitoneum in comparison with women with CO₂ pneumoperitoneum with the addition of 4% oxygen (Canadian Task Force classification C).SettingUniversity Hospital Gasthuisberg, Leuven, Belgium.PatientsSince January 1, 2007, 22 consecutive women undergoing laparoscopy for suspected ovarian cancer with subsequent debulking laparotomy were included.InterventionsDiagnostic laparoscopy with 100% CO₂ versus laparoscopy with addition of 4% oxygen.Measurements and Main ResultsIn the control group, 9 (47%) PSM found in 19 port sites were excised. In the CO₂+oxygen group, a similar incidence was found, that is, 8 (50%) PSM in 16 port sites. The incidence of PSM was higher in small women (p <.018) and in high-grade malignancies. The pathophysiology of PSM is unknown, but besides direct wound contamination, aerosolization of tumor cells and gas leaks have been suggested together with a causal relationship with the CO₂ pneumoperitoneum. Tumor cell hypoxia probably is not an important mechanism because PSM were not prevented by adding small amounts of oxygen to the CO₂ pneumoperitoneum.ConclusionThe hypothesis of tumor cell hypoxia by the CO₂ pneumoperitoneum as a mechanism for PSM could not be confirmed.     

Aggressive angiomyxoma of the vulva: a case report and review of literature

Background Aggressive angiomyxoma (AA) is a rare vulvovaginal mesenchymal neoplasm with a marked tendency to local recurrence but which usually does not metastasize. Case report We describe a case of AA in the left labium majus pudendi in a 47-year-old woman who underwent incomplete surgical excision. Follow-up 2 years later revealed no recurrence. Conclusion In the past, most authors advocated wide excision even if genitourinary and digestive tract resection were necessary. These days, a less radical surgery is recommended, but the significance of hormonal treatment and/or radiation therapy is not clear yet. Further investigation is necessary.