Localization of metabotropic GABA receptor subunits GABAB1 and GABAB2 relative to synaptic sites in the rat developing cerebellum

The highest densities of the two metabotropic GABA subunits, GABAB1 and GABAB2, have been reported as occurring around the glutamatergic synapses between Purkinje cell spines and parallel fibre varicosities. In order to determine how this distribution is achieved during development, we investigated the expression pattern and the cellular and subcellular localization of the GABAB1 and GABAB2 subunits in the rat cerebellum during postnatal development. At the light microscopic level, immunoreactivity for the GABAB1 and GABAB2 subunits was very prominent in the developing molecular layer, especially in Purkinje cells. Using double immunofluorescence, we demonstrated that GABAB1 was transiently expressed in glial cells. At the electron microscopic level, immunoreactivity for GABAB receptors was always detected both pre- and postsynaptically. Presynaptically, GABAB1 and GABAB2 were localized in the extrasynaptic membrane of parallel fibres at all ages, and only rarely in GABAergic axons. Postsynaptically, GABAB receptors were localized to the extrasynaptic and perisynaptic plasma membrane of Purkinje cell dendrites and spines throughout development. Quantitative analysis and three-dimensional reconstructions further revealed a progressive developmental movement of the GABAB1 subunit on the surface of Purkinje cells from dendritic shafts to its final destination, the dendritic spines. Together, these results indicate that GABAB receptors undergo dynamic regulation during cerebellar development in association with the establishment and maturation of glutamatergic synapses to Purkinje cells.     

Relationship between the perifornical hypothalamic area and oral pontine reticular nucleus in the rat. Possible implication of the hypocretinergic projection in the control of rapid eye movement sleep

The perifornical (PeF) area in the posterior lateral hypothalamus has been implicated in several physiological functions including the regulation of sleep–wakefulness. Some PeF neurons, which contain hypocretin, have been suggested to play an important role in sleep–wake regulation. The aim of the present study was to examine the effect of the PeF area and hypocretin on the electrophysiological activity of neurons of the oral pontine reticular nucleus (PnO), which is an important structure in the generation and maintenance of rapid eye movement sleep. PnO neurons were recorded in urethane-anesthetized rats. Extracellular recordings were performed by means of tungsten microelectrodes or barrel micropipettes. Electrical stimulation of the ipsilateral PeF area elicited orthodromic responses in both type I (49%) and type II (58%) electrophysiologically characterized PnO neurons, with a mean latency of 13.0 ± 2 and 8.3 ± 5 ms, respectively. In six cases, antidromic spikes were evoked in type I PnO neurons with a mean latency of 3.2 ± 0.4 ms, indicating the existence of PnO neurons that projected to the PeF area. Anatomical studies showed retrogradely labeled neurons in the PeF area from the PnO. Some of these neurons projecting to the PnO contained hypocretin (17.8%). Iontophoretic application of hypocretin-1 through a barrel micropipette in the PnO induced an inhibition, which was blocked by a previous iontophoretic application of bicuculline, indicating that the inhibitory action of hypocretin-1 may be due to activation of GABA_A receptors. These data suggest that the PeF area may control the generation of rapid eye movement sleep through a hypocretinergic projection by inhibiting the activity of PnO neurons.     

Psychological care: social and family support for patients awaiting a liver transplant

Introduction

In patients awaiting a transplant, the help received from friends and/or family members is considered to be an important factor in the transplantation process. Our objective was to determine the level of social/family support for patients on the liver transplant waiting list and to determine the relationship between clinical psychopathology and the level of social/family support.

Materials and methods

The study population consisted of 70 patients on the liver transplant waiting list. We used the following instruments: (1) Medical Outcomes Study-Social Support Survey (MOS) Questionnaire. For size of the social network, four support dimensions and a global support index for emotional support, material/instrumental support, leisure/free time activities, and love/care; (2) Family Apgar Questionnaire for personal perception of family function; (3) SA-45 questionnaire of psychopathologic symptoms for somatizations, obsessive-compulsivity, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism.

Results

The MOS showed that the mean size of the social network of these patients was 12 people. In these patients, social/family support was nonfunctional in 20% of the cases. By dimensions, the patients had the following percentage of nonfunctional support: 24% in emotional support; 10% material/instrumental support; 23% social relations of leisure/free-time activities; and 11% compassionate love/care support. The patients with nonfunctional support had the following associated psychopathologic symptoms (SA-45): depression (79% vs 39%; P = .008), anxiety (86% vs 46%; P = .008), hostility (43% vs 12%; P = .009), and psychoticism (14% vs 2%; P = .039) compared to functional patients. The Family Apgar showed that 27% of patients perceived a family dysfunction. These patients had greater interpersonal sensitivity-type emotional symptoms (32% vs 8%; P = .012), depression (79% vs 35%; P = .001), anxiety (79% vs 45%; P = .011), and hostility (42% vs 10%; P = .002) compared to normally functioning patients.

Conclusions

Nearly a quarter of patients on the liver transplant waiting list have social/family support that is nonfunctional, which leads to greater emotional psychopathologic symptoms that would need to be treated.     

Knowledge of the concept of brain death in the British and Irish population resident in southeast Spain

Introduction

The concept of brain death (BD) is not well understood among the general public, rendering it one of the main psychosocial barriers to favorable attitudes toward donation. Individuals from the British Isles are among the most important migratory groups in southeastern Spain. We sought to analyze the level of understanding of the concept of brain death among the British and Irish populations living in southeastern Spain, and to determine factors affecting their attitudes.

Material and Method

A random sample of the British and Irish population resident in Murcia was stratified according to nationality as part of the “International Collaborative Donor Program” (n = 1611). The self-administered survey in English was completed anonymously. For the statistical analysis, we used the χ² test and a logistical regression analysis.

Results

Approximately half of the respondents (45%; n = 692) understood the concept of BD; they considered it to mean the death of an individual. Among of the other respondents, 39% (n = 605) did not understand this concept, and the remaining 16% (n = 240) erroneously believed that it did not imply a person's death. Respondents coming from Great Britain showed a greater knowledge of the BD concept than did the Irish (46% vs 34%; P < .001). Those who understood the concept of BD were more in favor of deceased donation than those who had an erroneous understanding (49% vs 36%; P < .001). Significant associations were also noted among variables directly or indirectly related to donation and transplantation (P < .05).

Conclusion

The level of understanding of the concept of BD among the population from the British Isles resident in southeastern Spain was limited. Taking into account that the BD concept is a psychosocial factor that affects attitudes toward organ donation, information campaigns should be applied to this emerging population group in southeastern Spain.     

Quality of life measures in Islamic rectal carcinoma patients receiving counselling

Aim This prospective study was conducted to compare changes in the health‐related quality of life (HRQoL) and religious practices of patients who underwent surgery for rectal cancer. Method We prospectively followed 93 Muslim patients after surgery for colorectal carcinoma: abdominoperineal excision (APE, n = 50), sphincter‐saving resection (LAR, n = 22) or anterior resection including sigmoid colectomy (AR, n = 21). The HRQoL was measured pre‐ and postoperatively at 15–18 months with the Medical Outcomes Study Short Form 36 Health Survey (SF‐36) and a modified version of the American Society of Colorectal Surgeons (ASCRS) Fecal Incontinence questionnaire. Life standards, including religious practice, were measured using the Ankara University Life Standard Questionnaire. Results No difference was detected in any SF‐36 Health Survey HRQoL domain among the groups, although there were differences within groups before and after surgery. The ASCRS Fecal Incontinence questionnaire scales of lifestyle, coping/behaviour and depression/self‐perception were similar in the APE and AR groups and were significantly worse than in the AR group (P ≤ 0.004). The embarrassment scale was worse in the APE than in the LAR and AR groups (P < 0.001). Religious worship (praying alone, praying in mosques, fasting during Ramadan and purifying alms) was not significantly different among the groups. Conclusion HRQoL measured by the SF‐36 questionnaire and religious practices were not significantly different after APE compared with AR. Ostomy support and pre‐ and postoperative health‐related and religious counselling may have had beneficial effects.     

Retrograde intrarenal surgery (RIRS). Technical complement for cases of acute lithiasis

IntroductionWashing the renal cavities using minipercutaneous surgery shaft is an ideal technical procedure for retrograde intrarenal surgery (RIRS) when lithiasic fragmentation is significant or if the anatomy of the renal cavities may obstruct the spontaneous elimination of fragments.Materials and methodswe performed 37 RIRS on 35 patients with renal lithiasis (14 men, 21 women) with a mean age of 56 (range 33-72) years, divided into two groups in accordance with the size of their kidney stones. Group A, 23 patients with lithiasis <1.5 cm; Group B, 12 cases with lithiasis >1.5 cm. 28 patients had a single kidney stone and 7 had multiple stones. Approach: Flexible uretrorenoscopy, 7.5 Fr (Flex-X(®, Karl Storz) by means of a ureteral access sheath. Holmium laser lithotripsy (Calculase®, Karl Storz) using 200 and 365 micrometer fibres. Fragment extraction with 1.7 Fr nitinol baskets (N-gage, Cook). In cases of significant fragmented stone burden, the renal cavities were washed with low-pressure fluid irrigation using a ureteral access sheath, which was collected together with the stone fragments carried by the “mini-perc” sheath (Ultrax-x® 18Fr, Cook; Rusch, 14 Fr) placed under radiologic and endoscopic control at the level of the calyx-papilla selected for fragment drainage.Resultsthe mean diameter for group A was 9.13 (range 5-13) mm and 20.25 (range 16-28) mm for group B. The overall mean operating time was 81 (range 30-160) min. Group A required 66.43 ± 35.18 min. and group B 107.5 ± 46.73 min. (p = 0.006). The rate of absence of stones immediately after surgery was 83.2%, 93.1% at 3 months (95.6% for A and 83.3% for B; p = 0.217). In no case was ureteral stenosis observed as a result of the use of ureteral access sheaths. In 7 group B patients (58.3%) with acute lithiasis and/or alteration in their pyelocaliceal anatomy, we performed active lavage of the renal cavities applying the aforementioned percutaneous technique. The mean post-surgery hospital stay was 2.1 (range 1-4) days. There were post-surgery complications (Clavien 1) in 7 patients (20%). Two patients required a second FURS.ConclusionsRIRS can be effective treatment for renal lithiasis >1.5 cm. Lavage of the renal cavities helps to eliminate stone fragments, reducing the possibility of retreatment.     

Relación entre concentración intraoperatoria de parathormona y evolución postoperatoria del hiperparatiroidismo primario

Introduction

The relationship between the intra-operative concentration of parathyroid hormone (IOPTH) and the long-term outcome of patients intervened due to primary hyperparathyroidism (PHPT).

Patients and methods

A prospective observational study was performed with 120 patients. Three determinations were made of PTH in blood: baseline, when the diseases gland was located, and 10 minutes after its extirpation. The calcium, PTH and vitamin D (25-OH-D3) levels were measured during follow up.

Results

A decrease in IOPTH > 50% was observed in 96 (80%) patients, and the post-extirpation value returned to the normal range (Group I), in 18 (15%) a decrease of > 50% but the final value remained higher than normal (Group II) and in 6 (5%) the decrease was < 50% (Group III). Persistent PHPT was detected during follow up in 6 patients (5%): one in Group I (1%), 3 (16.7%) in II and 2 (33.3%) in group III (P < .001). The risk of persistent PHPT was higher in Group II (odds ratio: 19; 95% CI: 1.85-194) and in Group III (odds ratio: 47; 95% CI: 3.53-639). There were no cases of recurrent PHPT. A normal calcium with an increased PTH was detected in 20 patients of Group I (20.8%), 11 (61.1%) in II and 3 (50%) in III (P < .001). These patients had a lower concentration of post-operative vitamin D (17 ng/ml, range: 24; compared to 28 ng/ml, range: 21) (P = .008) and higher frequency of hypovitaminosis D (70.6% compared to 26.2%) (P>.001).

Conclusion

The risk of persistent PHPT is higher when the IOPTH decreases more than 50% but still remains high.