105Changes in Nitric Oxide Levels After Deep Dermal injury in the Female,Red Duroc Pig (FRDP)

Introduction : Hypertrophic scar is a devastating sequel to burns and other tangential skin injuries. It follows deep dermal injuries and does not occur after superficial injuries. Nitric oxide (NO) plays many important roles in wound healing from inflammation to scar remodeling. Studies have shown that expression of nitric oxide synthase and nitric oxide production are decreased in human hypertrophic scar. However little is known about NO involvement in the early stages of hypertrophic scarring, because of the lack of an animal model. It was recently reported that the female red Duroc pig (FRDP) makes thick scar, which is similar to human hypertrophic scar. We hypothesized that NO production in wounds on the female, red Duroc pig is similar to that of human hypertrophic scar and that NO involvement in deep wounds is different from that in superficial wounds. Methods : Superficial (0.015” to 0.030”) and deep (0.045” to 0.060”) wounds were created on the backs of four FRDPs. Biopsies were collected at weeks 1.5, 4, 8 and 21 post wounding including samples of uninjured skin. Nitric oxide levels were measured with the Griess reaction assay and normalized with tissue protein level. Results : Superficial wounds healed with an invisible scar whereas the deep wounds healed with scar resembling mild hypertrophic scar. The thickness of the scars from the deep wounds was significantly greater than uninjured skin and healed superficial wounds (p < 0.01). NO levels were increased at 1.5 weeks in deep wounds compared to superficial wounds and uninjured skin (p < 0.05). At 8 weeks, NO levels in deep wounds had returned to the level of uninjured tissue and superficial wounds. By 21 weeks, NO levels had decreased significantly when compared to superficial wounds (p < 0.01). There were no differences in NO levels between uninjured skin and superficial wounds at any time point (p > 0.05). Conclusions : NO production is similar in late, deep wounds on the female, red Duroc pig to that reported in the literature for human hypertrophic scar further validating this animal model. NO production is quite different after deep wounds as compared to superficial wounds in the FRDP. Early elevation in nitric oxide production might account for excessive inflammation in deep wounds that become thick scars in the FRDP. Nitric oxide regulators and effects at early stages of scar formation should be elucidated further and the FRDP appears to be a useful model.     

Projections of the ventral subiculum to the amygdala, septum, and hypothalamus: a PHAL anterograde tract-tracing study in the rat.

The projections of the ventral subiculum are organized differentially along the dorsoventral (or septotemporal) axis of this cortical field, with more ventral regions playing a particularly important role in hippocampal communication with the amygdala, bed nuclei of the stria terminalis (BST), and rostral hypothalamus. In the present study we re-examined the projection of the ventral subiculum to these regions with the Phaseolus vulgaris leucoagglutinin (PHAL) method in the rat. The results confirm and extend earlier conclusions based primarily on the autoradiographic method. Projections from the ventral subiculum course either obliquely through the angular bundle to innervate the amygdala and adjacent parts of the temporal lobe, or follow the alveus and fimbria to the precommissural fornix and medial corticohypothalamic tract. The major amygdalar terminal field is centered in the posterior basomedial nucleus, while other structures that appear to be innervated include the piriformamygdaloid area, the posterior basolateral, posterior cortical, posterior, central, medial, and intercalated nuclei, and the nucleus of the lateral olfactory tract. Projections from the ventral subiculum reach the BST mainly by way of the precommissural fornix, and provide rather dense inputs to the anterodorsal area as well as the transverse and interfascicular nuclei. The medial corticohypothalamic tract is the main route taken by fibers from the ventral subiculum to the hypothalamus, where they innervate the medial preoptic area, "shell" of the ventromedial nucleus, dorsomedial nucleus, ventral premammillary nucleus, and cell-poor zone around the medial mammillary nucleus. We also observed a rather dense terminal field just dorsal to the suprachiasmatic nucleus that extends dorsally and caudally to fill the subparaventricular zone along the medial border of the anterior hypothalamic nucleus and ventrolateral border of the paraventricular nucleus. The general pattern of outputs to the hypothalamus and septum is strikingly similar for the ventral subiculum and suprachiasmatic nucleus, the endogenous circadian rhythm generator.     

TREATMENT OF PALMOPLANTER HYPERHIDROSIS BY IONTOPHORESIS

Twenty-seven patients with idiopathic palmoplanter hyperhidrosis were treated with Iontotherapy over a one year period. In twenty-four cases there was a good response but maintenance therapy was required every 3-4 weeks.KEY WORDS: Iontophoresis, Palmoplanter hyperhidrosis     

What ethologically based models have taught us about the neural systems underlying fear and anxiety

Classical Pavlovian fear conditioning to painful stimuli has provided the generally accepted view of a core system centered in the central amygdala to organize fear responses. Ethologically based models using other sources of threat likely to be expected in a natural environment, such as predators or aggressive dominant conspecifics, have challenged this concept of a unitary core circuit for fear processing. We discuss here what the ethologically based models have told us about the neural systems organizing fear responses. We explored the concept that parallel paths process different classes of threats, and that these different paths influence distinct regions in the periaqueductal gray - a critical element for the organization of all kinds of fear responses. Despite this parallel processing of different kinds of threats, we have discussed an interesting emerging view that common cortical-hippocampal-amygdalar paths seem to be engaged in fear conditioning to painful stimuli, to predators and, perhaps, to aggressive dominant conspecifics as well. Overall, the aim of this review is to bring into focus a more global and comprehensive view of the systems organizing fear responses.     

B19 parvovirus replicates in circulating cells of acutely infected patients

B19 parvovirus is the etiologic agent of fifth disease and transient aplastic crisis. In natural infections, B19 antigen and DNA have been detected in sera early in the course of aplastic crisis and only rarely in fifth disease. We have found B19 DNA in circulating cells of infected patients by DNA dot blot with a virus-specific probe: in four of four sickle cell patients with aplastic crisis, in one asymptomatic sibling, and in one normal adult with fifth disease. Only two of the sera showed B19 DNA. High-molecular weight intermediate forms were detected by Southern analysis of DNA extracted from cells, thus indicating active replication of virus in cells rather than passive adsorption to their surface membranes. Separation of cells into high- and low-density fractions resulted in a concentration of the virus DNA in the granulocytic fraction.     

The dorsal premammillary nucleus: an unusual component of the mammillary body.

The results of anterograde and retrograde axonal transport experiments in the rat indicate that the dorsal premammillary nucleus (PMd) gives rise to a branched pathway ending in the anterior thalamic group and brainstem, like the medial and lateral mammillary nuclei. However, unlike these nuclei, the ascending PMd projection courses through and to the anterior hypothalamic nucleus, and the descending PMd projection ends in the periaqueductal gray, superior colliculus, and adjacent parts of the reticular formation. Also unlike the traditional mammillary nuclei, the PMd does not receive a direct input from the columns of the fornix; instead, it receives a bilateral input from the anterior hypothalamic nucleus, which in turn receives inputs from areas related to the prefrontal cortex, amygdala, and hippocampus. The results provide interesting perspectives on the organization of medial hypothalamic circuits underlying the goal-oriented behaviors associated with hunger, thirst, and reproduction.     

Transcutaneous oxygen tension measurements following peripheral transluminal angioplasty procedure has more specificity and sensitivity than ankle brachial index

Objective:

To evaluate the superiority of transcutaneous oxygen pressure (TcPO₂) before, during and after peripheral transluminal angioplasty (PTA) in comparison with ankle brachial index (ABI) in patients with diabetes.

Methods:

40 consecutive patients with diabetes treated by PTA where included. This study shows results before, during and after PTA and their progression for 8 weeks.

Results:

The TcPO₂ increased from 28.11 ± 8.1 to 48.03 ± 8.4 mmHg, 8 weeks after PTA (p < 0.001). The ABI increased from 0.48 ± 0.38 to 0.77 ± 0.39 after PTA (p < 0.001). After PTA, the stenosis of the vessel decreased from 58.33 ± 20.07% to 21.87 ± 13.57% (p < 0.001). TcPO₂ was determined in all the patients, but ABI could not be determined in all patients. Furthermore, we determined patients with “false negatives” with an improvement in ABI and “false positives” in 12.5% of patients. Additionally, in this study, we monitored TcPO₂ while performing PTA, revealing variations in each phase of the radiological procedure.

Conclusion:

The increase in TcPO₂ measurements following PTA procedure has more specificity and sensitivity than does ABI. The use of TcPO₂ may represent a more accurate alternative than traditional methods (ABI) used in assessing PTA results. The TcPO₂ also allows the radiologist to assess changes in tissue oxygenation during PTA, allowing changes to the procedure and subsequent treatment.

Advances in knowledge:

This is the first time that a graph is shown with TcPO₂ results during PTA performance in many patients.Critical limb ischaemia (CLI) is defined as a state of arterial insufficiency that reduces distal perfusion pressure to such an extent that microcirculation and nutrient blood flow to tissues are severely disturbed.¹ Peripheral transluminal angioplasty (PTA) has become an accepted endovascular treatment modality for patients with CLI. The effectiveness of PTA is assessed by determining peripheral pulses, the calculation of ankle brachial index (ABI) or the calculation of the toe brachial index.²However, patients with diabetes with CLI have features that hinder the use of these parameters in assessing the success of PTA.³ Calcification of the arterial wall, complete obstruction of the artery and the presence of collateral circulation cause problems in ABI determinations that exclude up to 30% of patients treated with PTA^4,5 from evaluation. It has even been found that 27% of patients with diabetes successfully treated by PTA, finally had to undergo amputation owing to vascular complications.⁶Currently, the increasing prevalence of diabetic vascular disease induces a bigger number of PTA in patients with diabetes with CLI. Radiologists perform successful PTA that significantly reduces arterial stenosis but does not always lead to an improvement in distal reperfusion. Microcirculation is the most relevant indicator of skin health and therefore wound healing and an improvement of the oxygen pressure. The transcutaneous oxygen pressure (TcPO₂) is an indicator of oxygen and nutrients reaching the tissues through microcirculation.^2,4 The aim of this study was to evaluate TcPO₂ before, during and after PTA in comparison with ABI in patients with diabetes.