Deep Brain Stimulation of Caudal Zona Incerta for Parkinson's Disease: One-Year Follow-Up and Electric Field Simulations

ObjectiveTo evaluate the effects of bilateral caudal zona incerta (cZi) deep brain stimulation (DBS) for Parkinson's disease (PD) one year after surgery and to create anatomical improvement maps based on patient-specific simulation of the electric field.Materials and MethodsWe report the one-year results of bilateral cZi-DBS in 15 patients with PD. Patients were evaluated on/off medication and stimulation using the Unified Parkinson's Disease Rating Scale (UPDRS). Main outcomes were changes in motor symptoms (UPDRS-III) and quality of life according to Parkinson's Disease Questionnaire-39 (PDQ-39). Secondary outcomes included efficacy profile according to sub-items of UPDRS-III and simulation of the electric field distribution around the DBS lead using the finite element method. Simulations from all patients were transformed to one common magnetic resonance imaging template space for the creation of improvement maps and anatomical evaluation.ResultsMedian UPDRS-III score off medication improved from 40 at baseline to 21 on stimulation at one-year follow-up (48%, p < 0.0005). PDQ-39 summary index did not change, but the subdomain activities of daily living (ADL) and stigma improved (25%, p < 0.03 and 75%, p < 0.01), whereas communication worsened (p < 0.03). For UPDRS-III sub-items, stimulation alone reduced median tremor score by 9 points, akinesia by 3, and rigidity by 2 points at one-year follow-up in comparison to baseline (90%, 25%, and 29%, respectively, p < 0.01). Visual analysis of the anatomical improvement maps based on simulated electrical fields showed no evident relation with the degree of symptom improvement and neither did statistical analysis show any significant correlation.ConclusionsBilateral cZi-DBS alleviates motor symptoms, especially tremor, and improves ADL and stigma in PD patients one year after surgery. Improvement maps may be a useful tool for visualizing the spread of the electric field. However, there was no clear-cut relation between anatomical location of the electric field and the degree of symptom relief.     

Comparison of the effects of a transient outward potassium channel activator on currents recorded from atrial and ventricular cardiomyocytes

Effect of NS5806 on Atrial Currents. Introduction: NS5806 activates the transient outward potassium current (I_to) in canine ventricular cells. We compared the effects of NS5806 on canine atrial versus ventricular tissues and myocytes. Methods and Results: NS5806 (10 μM) was evaluated in arterially perfused canine right atrial and right ventricular wedge preparations. In ventricular wedges NS5806 (10 μM) accentuated phase 1 in epicardium (Epi), with little effect in endocardium (Endo), resulting in augmented J‐waves on the ECG. In contrast, application of NS5806 (10 μM) to atrial preparations had no effect on phase 1 repolarization but significantly decreased upstroke velocity (dV/dt) and depressed excitability, consistent with sodium channel block. Current and voltage‐clamp recordings were made in the absence and presence of NS5806 in (10 μM) enzymatically dissociated atrial and ventricular myocytes. In ventricular myocytes, NS5806 increased I_to magnitude by 80% and 16% in Epi and Endo, respectively (at +40 mV). In atrial myocytes, NS5806 increased peak I_to by 25% and had no effect on the sustained current, I_Kur. Under control conditions, I_Na density in atrial myocytes was nearly double that in ventricular myocytes. NS5806 caused a shift in steady‐state mid‐inactivation (V_1/2) from –73.9 ± 0.27 to –77.3 ± 0.21 mV in ventricular and from –82.6 ± 0.12 to –85.1 ± 0.11 mV in atrial cells, resulting in reduction of I_Na in both cell types. Expression of mRNA encoding putative I_Na and I_to channel subunits was evaluated by qPCR. Conclusion: NS5806 produces a prominent augmentation of I_to with little effect on I_Na in the ventricles, but a potent inhibition of I_Na with little augmentation of I_to in atria. (J Cardiovasc Electrophysiol, Vol. 22, pp. 1057‐1066, September 2011)     

Histamine receptors in the isolated human middle meningeal artery. A comparison with cerebral and temporal arteries

The subtypes of histamine receptors mediating dilatation of human meningeal arteries have been tested in vitro, using "selective" antagonists, and compared with cerebral and temporal arteries previously examined. Dilatory responses were tested after preconstriction with prostaglandin F2 alpha. Both mepyramine and cimetidine caused a parallel shift to the right of the histamine concentration-response curve, suggesting the presence of both H1- and H2-receptors. Combined treatment with mepyramine and cimetidine caused further displacement of the concentration-response curve to the right. Schild analysis indicated pA2 values of 6.3 for cimetidine and 9.8 for mepyramine in situations of near complete blockade of either of the receptors. Both H1- and H2-receptors seem of importance for the histamine-induced dilatation in meningeal arteries and neither appear to dominate. The data considered in conjunction with our previous findings support the finding that experimental histamine-induced headache due to vasodilatation is intracranial of origin.     

Functional coupling between heterologously expressed dopamine D(2) receptors and KCNQ channels

Activation of KCNQ potassium channels by stimulation of co-expressed dopamine D₂ receptors was studied electrophysiologically in Xenopus laevis oocytes and in mammalian cells. To address the specificity of the interaction between D₂-like receptors and KCNQ channels, combinations of KCNQ1–5 channels and D₂-like receptors (D_2L, D₃, and D₄) were investigated in Xenopus oocytes. Activation of either receptor with the selective D₂-like receptor agonist quinpirole (100 nM) stimulated all the KCNQ currents, independently of the subunit combination, indicating a common pathway of receptor-channel interaction. The KCNQ4 current was investigated in further detail and was increased by 19.9±1.6% (n=20) by D_2L receptor stimulation. The effect could be mimicked by injection of GTPS and prevented by injection of Bordetella pertussis toxin, indicating that channel stimulation was mediated via a G protein of the G_i/o subtype. Cells of the human neuroblastoma line SH-SY5Y were co-transfected transiently with KCNQ4 and D_2L receptors. Stimulation of D_2L receptors increased the KCNQ4 current (n=6) as determined in whole-cell patch-clamp recordings. The specificity of the dopaminergic activation of the KCNQ channels was confirmed by co-expression of other neuronal K⁺ channels (BK, K_V1.1, and K_V4.3) with the D_2L receptor in Xenopus oocytes. None of these K⁺ channels responded to stimulation of the D_2L receptor. In the mammalian brain, dopamine D₂ receptors and KCNQ channels co-localise postsynaptically in several brain regions, so modulation of neuronal excitability by dopamine release could in part be mediated via an effect on KCNQ channels.     

Unusual Distribution of Burkholderia cepacia Complex Species in Danish Cystic Fibrosis Clinics May Stem from Restricted Transmission between Patients

Forty-four of 48 Burkholderia cepacia complex strains cultured from Danish cystic fibrosis patients were Burkholderia multivorans, a distribution of species that has not been reported before. Although cases of cross infections were demonstrated, no major epidemic clone was found. The species distribution may represent the sporadic acquisition of bacteria from the environment.Burkholderia cepacia and related bacteria have emerged as significant pathogens in cystic fibrosis (CF) patients due to the risk of cepacia syndrome (a fatal necrotizing pneumonia with bacteremia), the organism''s innate multiresistance to antibiotics, and the transmissibility of bacterial strains between patients by social contact (10, 15). The genus Burkholderia encompasses more than 50 validly published species that can be divided into four groups (21). Strains colonizing the respiratory tract of CF patients are predominantly members of the B. cepacia complex (BCC), with 17 formally named species (23). Chronic infections typically involve a single strain, although strain displacements have been demonstrated (24).Most or all species of the BCC can colonize the lower airways of CF patients, although some of them are infrequently demonstrated. Studies from North America, Europe, and Australasia have shown that Burkholderia cenocepacia is the dominant species being recovered from 46 to 90% of colonized patients (4, 6, 13, 17, 19, 20). Different situations have been described in Lisbon, where contamination of saline solutions used in inhalant therapy by CF patients has resulted in a predominance of B. cepacia (5), and in France, where a small excess of B. multivorans (52%) over B. cenocepacia (45%) has been reported (3).Danish CF patients are treated in two centers, and respiratory cultures are routinely performed at the monthly visit to the outpatient clinic. Four hundred thirty-one patients were alive by 1 January 2007, and 24 (5.6%) were chronically infected with BCC species. A chronic infection was defined as the isolation of BCC bacteria from more than half of sputum cultures for more than 6 months (modified “Leeds criteria” for chronic Pseudomonas aeruginosa infection [14]), and/or the development of ≥2 precipitins measured by crossed immunoelectrophoresis (18). A total of 52 Danish CF patients are known to have been intermittently (n = 11) or chronically (n = 41) infected with BCC bacteria (Fig. ​(Fig.1).1). Intermittently colonized patients may be underrepresented in data from before the routine use of colistin-containing selective agar plates (9), and some of the recent BCC acquisitions may be reclassified as chronic infections with time. In retrospect, the first Danish patient was chronically infected with BCC in the late 1970s (18), but few cases were identified until 1990. The increased rate of BCC colonization after 1990 may be secondary to the widespread use of inhaled colistin for P. aeruginosa infection, which was introduced in the 1980s (11). Since 1993, the rate has stabilized at around three new cases per year (43 BCC acquisitions during 14 years) (Fig. ​(Fig.1).1). In the same time period, 174 Danish patients have been diagnosed with CF (on average, 12.4 ± 4.4 [mean ± standard deviation] new patients per year; range, 6 to 22).Open in a separate windowFIG. 1.Cumulative numbers of Danish CF patients experiencing a first-time isolation of BCC bacteria, separated by status (open bars, chronic infections; gray bars, intermittent colonizations).BCC isolates from 9 intermittently colonized and 39 chronically infected patients were available for characterization. One isolate per patient, cultured between 1994 and 2006, was included in the study. Allocation to species within the BCC was performed by partial atpD and recA sequencing (1); occasional isolates with no PCR product from either amplification were subjected to partial sequencing of fur (16). Two independent sequence-based identifications were thus obtained for all BCC isolates. Only three species were identified in Danish patients, and B. multivorans accounted for more than 90% of the isolates (Table ​(Table1).1). Pulsed-field gel electrophoresis (PFGE) genotypes were assessed after digestion with Xba and SpeI and interpreted as described previously (22). Thirty-eight BCC genotypes were disclosed by both enzymes, and five of the genotypes were identified in more than one patient (two to four patients). Some of these small clusters were epidemiologically related and probably reflect cases of cross infections. Two pairs of siblings each carried the same strain, and one additional patient harbored the same genotype as the two siblings treated in that CF center. Between 1994 and 2003, chronic infections with BCC of a single genotype were established in 4 patients treated in one center. A fourth cluster was composed of patients treated at both of the two Danish CF centers; a possible epidemiological relationship between these three patients was unknown. No patient-to-patient transmission could have occurred in the fifth cluster, where the same genotype was intermittently detected in two patients in 1994 and 1999, respectively, and established a chronic infection in a third patient in 2005. All BCC genotypes identified in more than one patient were B. multivorans.

TABLE 1.

Specific identification of 48 BCC strains isolated from Danish CF patients

Single nucleotide polymorphisms in inflammatory genes and the risk of early onset of lone atrial fibrillation

Background  

Systemic low-grade inflammation is a prognostic risk factor of atrial fibrillation (AF).     

Atrial fibrillation: the role of common and rare genetic variants

Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting 1–2% of the general population. A number of studies have demonstrated that AF, and in particular lone AF, has a substantial genetic component. Monogenic mutations in lone and familial AF, although rare, have been recognized for many years. Presently, mutations in 25 genes have been associated with AF. However, the complexity of monogenic AF is illustrated by the recent finding that both gain- and loss-of-function mutations in the same gene can cause AF. Genome-wide association studies (GWAS) have indicated that common single-nucleotide polymorphisms (SNPs) have a role in the development of AF. Following the first GWAS discovering the association between PITX2 and AF, several new GWAS reports have identified SNPs associated with susceptibility of AF. To date, nine SNPs have been associated with AF. The exact biological pathways involving these SNPs and the development of AF are now starting to be elucidated. Since the first GWAS, the number of papers concerning the genetic basis of AF has increased drastically and the majority of these papers are for the first time included in a review. In this review, we discuss the genetic basis of AF and the role of both common and rare genetic variants in the susceptibility of developing AF. Furthermore, all rare variants reported to be associated with AF were systematically searched for in the Exome Sequencing Project Exome Variant Server.     

Perspectives for clinical measures of dynamic foot function—Reference data and methodological considerations

Several studies have investigated if static posture assessments qualify to predict dynamic function of the foot showing diverse outcomes. However, it was suggested that dynamic measures may be better suited to predict foot-related overuse problems. The purpose of this study was to establish the reliability for dynamic measures of longitudinal arch angle (LAA) and navicular height (NH) and to examine to what extent static and dynamic measures thereof are related. Intra-rater reliability of LAA and NH measures was tested on a sample of 17 control subjects. Subsequently, 79 subjects were tested while walking on a treadmill. The ranges and minimum values for LAA and NH during ground contact were identified over 20 consecutive steps. A geometric error model was used to simulate effects of marker placement uncertainty and skin movement artifacts. Results demonstrated the highest reliability for the minimum NH (MinNH), followed by the minimum LAA (MinLAA), the dynamic range of navicular height (ΔNH) and the range of LAA (ΔLAA) while all measures were highly reliable. Marker location uncertainty and skin movement artifacts had the smallest effects on measures of NH. The use of an alignment device for marker placement was shown to reduce error ranges for NH measures. Therefore, ΔNH and MinNH were recommended for functional dynamic foot characterization in the sagittal plane. There is potential for such measures to be a suitable predictor for overuse injuries while being obtainable in clinical settings. Future research needs to include such dynamic but simple foot assessments in large-scale clinical studies.     

Regional differences in expression of specific markers for human embryonic stem cells

Characterization of human embryonic stem cell (hESC) lines derived from the inner cell masses of blastocysts generally includes expression analysis of markers such as OCT4, NANOG, SSEA3, SSEA4, TRA-1-60 and TRA-1-81. Expression is usually detected by immunocytochemical staining of entire colonies of hESC, using one colony for each individual marker. Four newly established hESC lines showed the expected expression pattern and were capable of differentiating into the three germ layers in vitro. Neighbouring sections of entire colonies grown for 4, 11, 21 and 28 days respectively were stained with different markers to study the regional distribution and cellular co-expression. TRA-1-60 staining defined the hESC territory at all time points analysed. This territory comprised a characteristic OCT4 and NANOG staining often in overlapping subregions. Staining intensity of nuclei varied from strong OCT4 staining to weak or absent NANOG staining, and vice versa. SSEA4 staining was only observed in small clusters or single cells and not confined to the TRA territory. Co-expression of all markers was only detected in small areas. SSEA1 expression was found exclusively outside the TRA territory. In conclusion, pronounced regional differences in the expression of markers considered specific for undifferentiated hESC may suggest the existence of different cell populations.     

Combined inhibition of nitric oxide and prostaglandins reduces human skeletal muscle blood flow during exercise

The vascular endothelium is an important mediator of tissue vasodilatation, yet the role of the specific substances, nitric oxide (NO) and prostaglandins (PG), in mediating the large increases in muscle perfusion during exercise in humans is unclear. Quadriceps microvascular blood flow was quantified by near infrared spectroscopy and indocyanine green in six healthy humans during dynamic knee extension exercise with and without combined pharmacological inhibition of NO synthase (NOS) and PG by l -NAME and indomethacin, respectively. Microdialysis was applied to determine interstitial release of PG. Compared to control, combined blockade resulted in a 5- to 10-fold lower muscle interstitial PG level. During control incremental knee extension exercise, mean blood flow in the quadriceps muscles rose from 10 ± 0.8 ml (100 ml tissue)⁻¹ min⁻¹ at rest to 124 ± 19, 245 ± 24, 329 ± 24 and 312 ± 25 ml (100 ml tissue)⁻¹ min⁻¹ at 15, 30, 45 and 60 W, respectively. During inhibition of NOS and PG, blood flow was reduced to 8 ± 0.5 ml (100 ml tissue)⁻¹ min⁻¹ at rest, and 100 ± 13, 163 ± 21, 217 ± 23 and 256 ± 28 ml (100 ml tissue)⁻¹ min⁻¹ at 15, 30, 45 and 60 W, respectively ( P < 0.05 vs. control). In conclusion, combined inhibition of NOS and PG reduced muscle blood flow during dynamic exercise in humans. These findings demonstrate an important synergistic role of NO and PG for skeletal muscle vasodilatation and hyperaemia during muscular contraction.