Scaling graphs of heart rate time series in athletes demonstrating the VLF, LF and HF regions

Scaling analysis of heart rate time series has emerged as a useful tool for the assessment of autonomic cardiac control. We investigate the heart rate time series of ten athletes (five males and five females), by applying detrended fluctuation analysis (DFA). High resolution ECGs are recorded under standardized resting conditions over 30 min and subsequently heart rate time series are extracted and artifacts filtered. We find three distinct regions of scale invariance, which correspond to the well-known VLF, LF and HF bands in the power spectra of heart rate variability. The scaling exponents alpha are alpha(HF): 1.15 [0.96-1.22], alpha(LF): 0.68 [0.57-0.84], alpha(VLF): 0.83[0.82-0.99], p < 10(-5)). In conclusion, DFA scaling exponents of heart rate time series should be fitted to the VLF, LF and HF ranges, respectively.     

Neuromedin U partially mediates leptin-induced hypothalamo-pituitary adrenal (HPA) stimulation and has a physiological role in the regulation of the HPA axis in the rat

Intracerebroventricular (ICV) administration of the hypothalamic neuropeptide neuromedin U (NMU) or the adipostat hormone leptin increases plasma ACTH and corticosterone. The relationship between leptin and NMU in the regulation of the hypothalamo-pituitary adrenal (HPA) axis is currently unknown. In this study, leptin (1 nm) significantly increased the release of CRH from ex vivo hypothalamic explants by 207 +/- 8.4% (P < 0.05 vs. basal), an effect blocked by the administration of anti-NMU IgG. The ICV administration of leptin (10 mug, 0.625 nmol) increased plasma ACTH and corticosterone 20 min after injection [plasma ACTH (picograms per milliliter): vehicle, 63 +/- 20, leptin, 135 +/- 36, P < 0.05; plasma corticosterone (nanograms per milliliter): vehicle, 285 +/- 39, leptin, 452 +/- 44, P < 0.01]. These effects were partially attenuated by the prior administration of anti-NMU IgG. Peripheral leptin also stimulated ACTH release, an effect attenuated by prior ICV administration of anti-NMU IgG. We examined the diurnal pattern of hypothalamic NMU mRNA expression and peptide content, plasma leptin, and plasma corticosterone. The diurnal changes in hypothalamic NMU mRNA expression were positively correlated with hypothalamic NMU peptide content, plasma corticosterone, and plasma leptin. The ICV administration of anti-NMU IgG significantly attenuated the dark phase rise in corticosterone [corticosterone (nanograms per milliliter): vehicle, 493 +/- 38; NMU IgG, 342 +/- 47 (P < 0.05)]. These studies suggest that NMU may play a role in the regulation of the HPA axis and partially mediate leptin-induced HPA stimulation.     

Gonadotropin-releasing hormone II stimulates female sexual behavior in marmoset monkeys

GnRH II (pGlu-His-Trp-Ser-Try-Gly-Leu-Arg-Pro-GlyNH2), an evolutionarily conserved member of the GnRH family, stimulates reproductive behavior in a number of vertebrates. To explore a role for GnRH II in regulating primate sexual behavior, eight adult female common marmosets, each fitted with an indwelling intracerebroventricular (icv) cannula, were ovariectomized, implanted subcutaneously with empty (n = 4) or estradiol-filled (n = 4) SILASTIC brand capsules, and pair housed with an adult male mate. After icv infusion of vehicle or peptides, females were placed in an observation cage for 90 min, out of visual contact with other marmosets, before the 30-min behavioral test with their male partner. Compared with vehicle, GnRH II (1 and 10 microg) increased the total number of proceptive (sexual solicitation) behaviors (tongue flicking, proceptive stares, and frozen postures) exhibited by females toward their pair mates and specifically increased the frequency of freeze postures. Effects were maximal at 1 microg and not dependent upon estradiol supplementation. GnRH II agonists/GnRH I antagonists 135-18 (1 microg) and 132-25 (1 microg), which stimulate inositol phosphate production via the marmoset type II receptor, increased the frequency of total proceptive behavior but did not specifically stimulate freeze-posture behavior. In contrast, GnRH I, at 1 mug, did not alter the frequency of proceptive behaviors. Female receptivity (female compliance with male sexual behavior) was not altered by any of the peptides tested. These findings implicate a role for GnRH II and the cognate GnRH type II receptor in stimulating female marmoset sexual behavior.     

Isolation of Toxigenic Hafnia alvei from a Probable Case of Hemolytic Uremic Syndrome

Abstract An 11-year-old girl presented to a central California children’s hospital with a 3-day history of erythematous lesions on her forehead, neck, and trunk, abdominal pain, persistent emesis, and decreased urinary output. One day prior to admission she had a mild bout of diarrhea with a small amount of blood in her stool. Upon admission her condition rapidly worsened with acute renal failure, anemia, and thrombocytopenia. One of the possible causes of this condition included hemolytic uremic syndrome. Stool cultures of this patient tested at the children’s hospital and at a state reference laboratory were repeatedly negative for Escherichia coli O157:H7. However, the state reference laboratory detected a toxigenic strain of Hafnia alvei active on Vero cells from two consecutive stool cultures during the acute phase of her illness.     

Vertical optokinetic nystagmus in Parkinson's disease

Parkinson's disease (PD) is associated with a number of oculomotor deficits; however, little is known about changes in vertical optokinetic nystagmus (OKN) associated with PD. We recorded eye movements in 14 PD patients and 14 age‐matched controls in response to large field OKN stimulation using stimulus velocities of 20°/second and 40°/second. We compared asymmetry of horizontal and vertical responses in the two groups. We found vertical OKN to be strongly asymmetric in PD with reduced gains for downward‐moving stimuli. This asymmetry was significantly greater than that recorded in control volunteers. We postulate that this could result from an abnormal pursuit/early OKN system in PD leading to greater influence of the delayed OKN system. © 2009 Movement Disorder Society     

Neurogenic imbalance of the pelvic organs: Treatment with sympathetic ganglionectomy

This case is illustrative of pelvic plexalgia and the inhibitory role played by the sympathetic nerves in the function of vesical and bowel evacuation.Such a gratifying result is an added stimulus toward further investigation of the physiology of the autonomic system in the hopes that other surgical procedures may afford relief in carefully selected cases.     

Correlation between clinical success and apical dye penetration

AIM: This study was undertaken to examine whether a correlation exists between apical dye penetration and the clinical performance of root fillings. METHODOLOGY: Apical dye penetration into 116 roots of human teeth that had been root-filled at least 6 months prior to extraction was tested in vitro using a vacuum technique and by measuring the length of dye penetration. Endodontic treatment was classified as clinically successful or unsuccessful and results for these groups were compared using analysis of variance and the Student's t-test. Positive and negative controls were used to test the experimental system. RESULTS: All controls performed as expected. Dye penetrated significantly further in unsuccessful cases although the raw data suggested little difference. Overall, dye penetrated 99.5% of the specimens, indicating that the presence of dye in the canal is a poor indicator of whether the technique or material will succeed. However, the extent of dye penetration may be related to the clinical outcome. CONCLUSIONS: Clinically placed root canal fillings do not provide an apical seal that prevents fluid penetration. The outcome of treatment cannot be predicted from the results of apical dye leakage studies.     

Emergency Determination of Decision-making Capacity: Balancing Autonomy and Beneficence in the Emergency Department

The determination of decision-making capacity (DMC) is an essential component of securing voluntary informed consent, for either treatment or refusal of care. Decision-making capacity should be determined on some level during each patient encounter. Decision-making capacity includes the ability to receive, process, and understand information, the ability to deliberate, the ability to make choices, and the ability to communicate those preferences. For patients in whom DMC may be uncertain, a more explicit approach to determination of DMC is recommended. However, DMC determination must neither compromise patient safety nor delay needed care. When DMC determination is challenging, or when the ramifications of a decision are serious, the assistance of a third party (such as a surrogate, a consultant, or another clinician) may be valuable in discerning the most appropriate action. In addition to the obvious clinical utility of DMC assessment, the steps taken in the very establishment of DMC may promote patient trust, professionalism, and humanistic clinical practice. While DMC may be conditional, the compassion and respect we have for our patients must be unconditional.