Body and head position effects on regional lung ventilation in infants: an electrical impedance tomography study

Objective To determine the effects of body and head positions on the spatial distribution of ventilation in nonintubated spontaneously breathing and mechanically ventilated infants using electrical impedance tomography (EIT).Design and setting Prospective study in a neonatal intensive care unit.Patients Ten spontaneously breathing (gestational age 38 weeks, postnatal age 13 days) and ten mechanically ventilated infants (gestational age 35 weeks, postnatal age 58 days).Interventions Supine and prone postures with different head positions (midline and rotated to the left and right side).Measurements and results The distribution of ventilation in the chest cross-section was repeatedly determined from EIT data in each body/head position studied. During spontaneous breathing the tidal volumes in the left lung region were reduced in the supine posture with the head turned to the left as well as in the prone posture with the head rotated to either side when compared with the supine posture with the head in the midline position. During mechanical ventilation the tidal volumes in the left lung region were unaffected by the body and head position except for the prone posture combined with the leftward head rotation which reduced them. In both types of ventilation the tidal volumes in the right lung region were unaffected by the change in body/head position.Conclusion The results indicate that the spatial distribution of ventilation is influenced by the body and head position in spontaneously breathing infants. Prone posture with the leftward head rotation has the most prominent effect which is detectable even during mechanical ventilation.Electronic supplementary material The electronic reference of this article is . The online full-text version of this article includes electronic supplementary material. This material is available to authorised users and can be accessed by means of the ESM button beneath the abstract or in the structured full-text article. To cite or link to this article you can use the above reference.This article is discussed in the editorial available at:     

Enzyme replacement therapy and intraepidermal innervation density in Fabry disease

We prospectively evaluated the effect of enzyme replacement therapy (ERT) on the intraepidermal nerve fiber density (IENFD) and thermal threshold in patients with Fabry disease, an X-linked disorder associated with a painful small-fiber neuropathy and decreased linear IENFD in a length-dependent pattern. Twenty-five hemizygous male patients with Fabry disease were enrolled in a 6-month, randomized, placebo-controlled ERT trial of 0.2 mg/kg of alpha-galactosidase A (agalsidase-alfa) every 2 weeks followed by an additional 12 months of open-label ERT for both populations. IENFD and thermal threshold were measured in the distal thigh at baseline, 6 months, and 18 months from initiation of the trial. We found no significant difference in IENFD between the treatment groups at 6 months. After an additional year of ERT, there was a significant reduction in IENFD in the patient group as a whole, attributable to the declining glomerular filtration rate. Thermal thresholds remained unchanged. We conclude that epidermal nerve fiber regeneration, as measured in the distal thigh, does not occur in this patient population after 12-18 months of ERT.     

Neuropathology provides clues to the pathophysiology of Gaucher disease

To better understand the pathogenesis of brain dysfunction in Gaucher disease (GD), we studied brain pathology in seven subjects with type 1 GD (four also exhibited parkinsonism and dementia), three with type 2 GD and four with type 3 GD. Unique pathologic patterns of disease involving the hippocampal CA2-4 regions and layer 4b of the calcarine cortex were identified. While these findings were common to all three GD phenotypes, the extent of the changes varied depending on the severity of disease. Cerebral cortical layers 3 and 5, hippocampal CA2-4, and layer 4b were involved in all GD patients. Neuronal loss predominated in both type 2 and type 3 patients with progressive myoclonic encephalopathy, whereas patients classified as type 1 GD had only astrogliosis. Adjacent regions and lamina, including hippocampal CA1 and calcarine lamina 4a and 4c were spared of pathology, highlighting the specificity of the vulnerability of selective neurons. Elevated glucocerebrosidase expression by immunohistochemistry was found in CA2-4. Hippocampal (45)Ca(2+) uptake autoradiography in rat brain was performed demonstrating that hippocampal CA2-4 neurons, rather than CA1 neurons, were calcium-induced calcium release sensitive (CICR-sensitive). These findings match recent biochemical studies linking elevated glucosylceramide levels to sensitization of CA2-4 RyaR receptors and 300% potentiation of neuronal CICR sensitivity. In two patients with type 1 GD and parkinsonism, numerous synuclein positive inclusions, similar to brainstem-type Lewy bodies found in Parkinson disease, were also found hippocampal CA2-4 neurons. These findings argue for a common cytotoxic mechanism linking aberrant glucocerebrosidase activity, neuronal cytotoxicity, and cytotoxic Lewy body formation in GD.     

Interrelationships Between Human Classical Differential Electrodermal Conditioning, Orienting Reaction, Responsivity, and Awareness of Stimulus Contingencies

The main purpose of studying the interrelationships listed in the title was to examine the orienting-reaction (OR) and cognitive (awareness) interpretations of differential electrodermal conditioning (DEC). The method was to perform correlational analyses on the data obtained from three DEC experiments (N = 32, 40, and 32, respectively) which together provided variations in such factors as the CS-US interval, and the sensitivity of the awareness measure of subjective contingency (SC). Following Zeiner and Schell (1971), the OR and responsivity measures were obtained, respectively, from preliminary CS+ trials (tone and light) to-be-paired with the US and from US (shock) trials. The results clearly disconfirmed the cognitive interpretation, since SC was not correlated either with DEC or with OR in any of the experiments. The OR interpretation received some support, but could handle the following aspects of the results only with difficulty: (a) some significant correlations of responsivity with DEC; (b) the fact that the apparently large OR-DEC correlations were reduced when statistical control (through partial correlations) was imposed for the influence of consistent individual differences in responding to the CS+ and CS- stimuli before any conditioning had taken place; (c) the fact that when these individual differences were not significantly present (in Exp. III), the OR-DEC correlation was also not significant. It was noted that the first aspect supported an S-R, contiguity-reinforcement account of DEC, an account which differs from the cognitive and OR interpretations inasmuch as it does not attempt to reduce DEC to some other process.     

Gaucher disease with parkinsonian manifestations: does glucocerebrosidase deficiency contribute to a vulnerability to parkinsonism?

Among the phenotypes associated with Gaucher disease, the deficiency of glucocerebrosidase, are rare patients with early onset, treatment-refractory parkinsonism. Sequencing of glucocerebrosidase in 17 such patients revealed 12 different genotypes. Fourteen patients had the common "non-neuronopathic" N370S mutation, including five N370S homozygotes. While brain glucosylsphingosine levels were not elevated, Lewy bodies were seen in the four brains available for study. The shared clinical and neuropathologic findings in this subgroup suggest that the deficiency in glucocerebrosidase may contribute to a vulnerability to parkinsonism.     

Neuropeptides are chemoattractants for human tumor cells and monocytes: a possible mechanism for metastasis

Bombesin (BN), a tetradecapeptide neuropeptide growth factor, is shown to be a potent (ED50 of 5 X 10(-12) M) chemoattractant for human monocytes and small cell lung carcinoma cells (SCCL). These effects are BN receptor-mediated since potencies of several BN analogs to induce chemotaxis and to inhibit [125I-tyr4] BN binding activity correlate well (P less than 0.001). As has been demonstrated for other BN receptor-mediated effects, carboxy-terminal amino acids are required for optimum biological activity. BN is not an exclusive chemoattractant for SCCL cells but was also active in promoting migration of other, but not all, lung tumor cells. Other neuropeptides, such as beta-endorphin, substance P, and arg-vasopressin, are also shown to be chemoattractants for SCCL cells, with EC50's also in the 10(-12) M range. The ability of these ligands to effect monocyte and some tumor cell migration suggest a role for neuropeptides in inflammation and metastasis. In the latter case, tumor cells, in response to neuropeptide chemical gradients, may become localized at specific body sites. Neuropeptide release, in response to cognitive or other stimuli, may thereby modify cell migratory patterns. Additionally, such hormones may influence early developmental events such as tissue organization and histogenesis.     

Interferon induces an antiviral state in ganglioside-deficient transformed mouse fibroblasts

The antiviral activity of mouse fibroblast interferon against vesicular stomatitis virus was investigated in L-929 mouse fibroblasts and the ganglioside-deficient L-929 mutant cells (ATCC clone NCTC 2071). Although it has been widely reported that gangliosides serve as primary receptors for interferon at the cellular membrane, only a small difference in interferon sensitivity was observed between the wild-type L-929 and the ganglioside-deficient NCTC 2071 cells. It was not possible, however, to overcome this difference by administration of exogenous gangliosides.     

The anti-proliferative potency of celecoxib is not a class effect of coxibs

Celecoxib, a COX-2 (cyclooxygenase-2)-selective inhibitor (coxib), is the only NSAID (non-steroidal anti-inflammatory drug) that has been approved for adjuvant treatment of patients with familial adenomatous polyposis. To investigate if the anti-proliferative effect of celecoxib extends to other coxibs, we compared the anti-proliferative potency of all coxibs currently available (celecoxib, rofecoxib, etoricoxib, valdecoxib, lumiracoxib). Additionally, we used methylcelecoxib (DMC), a close structural analogue of celecoxib lacking COX-2-inhibitory activity. Due to the fact that COX-2 inhibition is the main characteristic of these substances (with exception of methylcelecoxib), we conducted all experiments in COX-2-overexpressing (HCA-7) and COX-2-negative (HCT-116) human colon cancer cells, in order to elucidate whether the observed effects after coxib treatment depend on COX-2 inhibition. Cell survival was assessed using the WST proliferation assay. Apoptosis and cell cycle arrest were determined using flow cytometric and Western blot analysis. The in vitro results were confirmed in vivo using the nude mouse model. Among all coxibs tested, only celecoxib and methylcelecoxib decreased cell survival by induction of cell cycle arrest and apoptosis and reduced the growth of tumor xenografts in nude mice. None of the other coxibs (rofecoxib, etoricoxib, valdecoxib, lumiracoxib) produced anti-proliferative effects, indicating the lack of a class effect and of a role for COX-2. Our data emphasize again the outstanding anti-proliferative activity of celecoxib and its close structural analogue methylcelecoxib in colon carcinoma models in vitro and in vivo.