Effects of electrical microstimulation of peripheral sympathetic nervous fascicle on glucose uptake in rats

Artificial pancreas systems control insulin-mediated glucose uptake. Although these systems are widely used in the clinical setting, they are still fraught with structural and biological problems. The non-insulin mediated glucose uptake (NIMGU) mechanism could be an alternative candidate as a target system for the artificial control of peripheral glucose uptake. Although the sympathetic nervous system is known to be one of the regulators of NIMGU, the effects of peripheral sympathetic activation on glucose uptake have not been well documented. We electrically stimulated a sympathetic nerve fascicle to clarify the possibility of controlling peripheral glucose uptake. A sympathetic signal was microneurographically obtained in the unilateral sciatic nerve in normal (NRML), insulin-resistant high-fat-fed (HFF), and streptozotocin-induced insulin-depleted (STZ) rats, and electrical stimulation was applied via the microelectrode (microstimulation). The microstimulation was also applied to sites other than the sympathetic fascicles in an additional group of normal rats (NSYMP group). The stimulation applied to the sympathetic fibers resulted in an immediate and transient decrease of blood glucose (BG) in the NRML, HFF, and STZ groups, with little change in the plasma insulin. The change in BG level seemed to depend on the basal BG level (NRML < HFF < STZ). In contrast, no reduction in BG was observed in the NSYMP group. These results suggest that microstimulation in the peripheral sympathetic fascicle could enhance glucose uptake in peripheral tissues—independently of insulin function—and show an alternative possibility for controlling glucose uptake.     

Performance status scale for head and neck scores for oral cancer survivors: predictors and factors for improving quality of life

Objectives

This study aimed to determine the factors associated with long-term quality of life of oral cancer survivors.

Materials and methods

A total of 508 survivors were assessed using the performance status scale for head and neck (PSS-HN), which comprises Eating in Public (E-Public), Normalcy of Diet (N-Diet), and Understandability of Speech (U-Speech). Stepwise multiple linear regression analysis was performed.

Results

The median time between the end of treatment and participating in the survey was 38 months (range, 6–250). Overall, 57–60% of survivors achieved full performance (100 score) of each PSS-HN score, whereas 15% had moderate or severe impairment (≤ 50 score) in E-Public and N-Diet, and 4% had impairment in U-Speech. These three scores deteriorated with increasing T-stage. Age, soft tissue reconstruction, trismus, and missing occlusal contacts on the contralateral side were significantly associated with E-Public and N-Diet. Neck dissection, hard tissue reconstruction, and missing occlusal contacts bilaterally were associated with U-Speech score.

Conclusion

Older age, T4 tumor, and soft tissue reconstruction were predictors of low E-Public and N-Diet performance scores. Increasing mouth opening and maintaining optimal occlusal contacts on the contralateral side may be effective ways to improve N-Diet and E-Public performance. Maintaining optimal occlusal contacts bilaterally may be effective for improving speech performance.

Clinical relevance

Oral health care to increase optimal occlusal contacts and rehabilitation of trismus may be promising factors to improve the functional performance of oral cancer survivors.

     

Inhibitory effects of an ellagic acid glucoside, okicamelliaside, on antigen-mediated degranulation in rat basophilic leukemia RBL-2H3 cells and passive cutaneous anaphylaxis reaction in mice

Degranulation inhibitors in plants are widely used for prevention and treatment of immediate-type allergy. We previously isolated a new ellagic acid glucoside, okicamelliaside (OCS), from Camellia japonica leaves for use as a potent degranulation inhibitor. Crude extracts from leaves also suppressed allergic conjunctivitis in rats. In this study, we evaluated the in vivo effect of OCS using a pure sample and performed in vitro experiments to elucidate the mechanism underlying the extraordinary high potency of OCS and its aglycon. The IC(50) values for degranulation of rat basophilic leukemia cells (RBL-2H3) were 14 nM for OCS and 3 μM for aglycon, indicating that the two compounds were approximately 2 to 3 orders of magnitude more potent than the anti-allergic drugs ketotifen fumarate, DSCG, and tranilast (0.17, 3, and >0.3 mM, respectively). Antigen-induced calcium ion (Ca(2+)) elevation was significantly inhibited by OCS and aglycon at all concentrations tested (p<0.05). Upstream of the Ca(2+) elevation in the principle signaling pathway, phosphorylation of Syk (Tyr525/526) and PLCγ-1 (Tyr783 and Ser1248) were inhibited by OCS and aglycon. In DNA microarray-screening test, OCS inhibited expression of proinflammatory cytokines [interleukin (IL)-4 and IL-13], cytokine-producing signaling factors, and prostaglandin-endoperoxidase 2, indicating that OCS broadly inhibits allergic inflammation. During passive cutaneous anaphylaxis in mice, OCS significantly inhibited vascular hyperpermeability by two administration routes: a single intraperitoneal injection at 10 mg/kg and per os at 5 mg/kg for 7 days (p<0.05). These results suggest the potential for OCS to alleviate symptoms of immediate-type allergy.     

Acute coronary syndrome due to coronary thrombus formed by severe coronary spasm: a case report

A 47-year-old man was admitted to our hospital complaining of chest pain at rest in the early morning. Electrocardiography showed ST segment elevation in leads II, III and aVF. Emergency coronary angiography revealed total occlusion of the right coronary artery at the proximal portion. Intracoronary administration of isosorbide dinitrate successfully recanalized the right coronary artery. However, there was a thrombus image at the culprit lesion. Intracoronary administration of urokinase caused the residual thrombus to disappear completely. Follow-up coronary angiography at 1 week and 3 months revealed no organic stenotic lesion. Intravascular ultrasound showed only a little plaque without signs of ruptured plaque in the right coronary artery. Provocation coronary angiography revealed remarkable spasm causing total occlusion at the proximal portion of the right coronary artery. This case suggests that only severe coronary spasm without plaque rupture could form a thrombus causing acute coronary syndrome.     

The Veterans Health Administration and military sexual trauma

Objectives. We examined the utility of the Veterans Health Administration (VHA) universal screening program for military sexual violence.Methods. We analyzed VHA administrative data for 185 880 women and 4139888 men who were veteran outpatients and were treated in VHA health care settings nationwide during 2003.Results. Screening was completed for 70% of patients. Positive screens were associated with greater odds of virtually all categories of mental health comorbidities, including posttraumatic stress disorder (adjusted odds ratio [AOR]=8.83; 99% confidence interval [CI] = 8.34, 9.35 for women; AOR = 3.00; 99% CI = 2.89, 3.12 for men). Associations with medical comorbidities (e.g., chronic pulmonary disease, liver disease, and for women, weight conditions) were also observed. Significant gender differences emerged.Conclusions. The VHA policies regarding military sexual trauma represent a uniquely comprehensive health care response to sexual trauma. Results attest to the feasibility of universal screening, which yields clinically significant information with particular relevance to mental health and behavioral health treatment. Women’s health literature regarding sexual trauma will be particularly important to inform health care services for both male and female veterans.The persistence of sexual violence within the US armed forces is a fact long recognized by military officials, policymakers, health care professionals, and the media. The risk of exposure to sexual violence within the military is high. The annual incidence of experiencing sexual assault is 3% among active duty women and 1% among active duty men. Sexual coercion (e.g., quid pro quo promises of job benefits or threats of job loss) and unwanted sexual attention (e.g., touching, fondling, or threatening attempts to initiate a sexual relationship) occur at an annual rate of 8% and 27%, respectively, among women and 1% and 5% among men.1 Research on deployment stress finds that such experiences constitute important duty-related hazards.2The Veterans Health Administration (VHA) has adopted the term military sexual trauma (MST) to refer to severe or threatening forms of sexual harassment and sexual assault sustained in military service. In response to such widespread exposure in the military and the lasting deleterious consequences of sexual violence, the VHA has implemented a universal screening program for MST. For patients that screen positive, treatment for any MST-related injury, illness, or psychological condition is provided free of charge regardless of eligibility or co-pay status. These policies may represent the most comprehensive health policy response to sexual violence of any major US health care system. To our knowledge, we are the first to study the VHA’s MST program, which provides an unparalleled opportunity to investigate the feasibility and clinical utility of screening for sexual violence and provides unique data to characterize the burden of illness associated with MST.US epidemiological data indicate significant deleterious health and mental health correlates for sexual trauma. Among traumatic events, rape holds the highest conditional risk for posttraumatic stress disorder (PTSD); these data and data specific to military samples confirm that sexual trauma poses a risk for developing PTSD as high as or higher than combat exposure.3^–5 In addition to PTSD, civilian and veteran women exposed to sexual assault or sexual harassment exhibit a range of other mental health and medical conditions.6^–15 These data have led to a greater awareness of sexual trauma issues among physicians and to the development of interventions and guidelines for the treatment and referral of sexual trauma in health care settings.16^–18These health sequelae may be magnified among veterans, because a number of issues uniquely associated with military settings may intensify the effect of this experience.19 Perpetrators are typically other military personnel, and victims often must continue to live and work with their assailants daily, which increases the risk for distress and for subsequent victimization. Unit cohesion may create environments where victims are strongly encouraged to keep silent about their experiences, have their reports ignored, or are blamed by others for the sexual assault, all of which have been linked to poorer outcomes among civilian assault survivors.20 Preliminary studies of MST among women veterans support this hypothesis and have found increased self-reports of depression, substance abuse, and gynecological, urological, neurological, gastrointestinal, pulmonary, and cardiovascular conditions.6^,10The VHA was first authorized to provide outreach and counseling for sexual assault to women veterans after a series of hearings on veteran women’s issues in 1992. Increased attention to these issues led Congress to extend services to male veterans shortly thereafter. In 1999, the VA’s responsibility was extended from counseling to “all appropriate [MST-related] care and services” and universal screening was initiated. Most recently, Public Law 108-422, signed in 2004, made the VA’s provision of sexual trauma services a permanent benefit. Screening programs and treatment benefits apply only to sexual trauma that occurred during military service. Each VA hospital now has a designated coordinator to oversee MST screening and treatment, and standardized training materials for MST screening are available to all VHA providers.21Universal screening is accomplished through the use of a clinical reminder in the electronic medical record. An alert remains visible to all clinicians until screen results are entered. Documentation of a positive screen enables the provider to code the visit as MST related so that care is delivered free of charge. The extent to which these resources have encouraged providers to screen for MST has not been evaluated. Most research from civilian sectors suggest that only a minority of patients are screened for violence by their health care providers.22 However, VHA screening is integrated with standard clinical procedures, and training on the sensitive nature of MST screening is required at each VA hospital. Both of these factors are reliably associated with better screening compliance.22^,23The utility of screening policies to address this widespread veterans’ health issue is complicated because MST is not a syndrome, diagnosis, or construct associated with clear treatment indications. This stands in contrast to most other health care screening targets, such as cervical cancer or depression. Contrary to the American Medical Association’s recommendation for universal screening for violence against women,24^,25 the US Preventive Services Task Force concluded that the evidence does not currently support this approach, citing a lack of intervention research and insufficient evidence that screening ultimately improves health status.26Rebuttals to the Task Force conclusions emphasize the necessity of a broader view: violence against women is a risk or maintaining factor for a variety of health conditions and therefore a key treatment consideration for these patients.27 This perspective is especially relevant for addressing MST in the VHA health care system. Quantifying the types of health impairment associated with positive screens for MST is a first step toward evaluating the utility of universal screening. If screening detects clinically significant information, a positive screen would be an important factor in selecting appropriate treatment. Further evaluation of screening and treatment programs can then assess access to care according to the specific health outcomes found to be relevant to veteran men and women who have experienced sexual trauma.MST has been primarily considered a women’s issue. Men comprise the majority of the armed forces, however, and the incidence of sexual harassment and assault reported by men during military service is significant. The approach to MST should therefore attend to both women and men and examine gender associated with MST as an initial step in the development of gender-specific interventions. Ours is the first examination of nationwide screening data for MST in the VHA and directly informs continued efforts to develop a gender-specific response to the health-related costs of military service and war. Specifically, we examined 3 issues: (1) whether universal screening detects a substantial population of VHA patients who report MST, (2) whether a greater burden of medical and mental illness is found among patients who screen positive for MST compared with patients who screen negative, and (3) whether the burden of illness associated with MST varies by patient gender.     

Influence of aging on tooth eruption: experimental canine mandibular allograft.

PURPOSE: Aging is clinically related to tooth eruption; however, there are no known studies that have elucidated the relationship. We examined whether tooth eruption would occur normally in a mature subject. MATERIALS AND METHODS: Using vascularized composite tissue mandibular transplantation, we extracted portions of immature mandibles including the tooth germs from young beagle dogs and placed them into unrelated immature and mature beagle dogs. We then examined eruption of the lower first molar in the grafted mandibular bone and compared the results clinically, radiographically, and histologically. RESULTS: Normal tooth eruption was observed in the transplanted mandibles in the young dogs. In the mature dogs, eruption from the gingiva was delayed, whereas that from alveolar bone occurred normally in the transplanted mandibles. Further, the whole crown was covered with a cap of gingival tissue in the mature dogs, although this cap was not gingival overgrowth. CONCLUSIONS: Tooth eruption is influenced by some unknown factors related to aging. Apparently, apoptosis did not occur in the connective tissues between the reduced enamel epithelia and oral epithelia that overlay the teeth in the mature subjects.     

A new modification for safer submental orotracheal intubation

In patients in whom a tracheal tube cannot be inserted through the nostrils due to multiple facial trauma or hypoplasty of the nose, submental orotracheal intubation (SOI) is performed to avoid tracheostomy. We report a new modification for SOI to minimize the risk of apnea. A 20-year-old man was scheduled for sagittal split ramus osteotomy. As the patient had severe hypoplasia of the nose, SOI was planned. Following orotracheal intubation with a spiral tube (first tube), a submental tunnel was surgically created. A second tube that had been confirmed, in advance, to snugly fit into the proximal end of the first tube was passed into the submental tunnel via a polypropylene cylinder and connected between the first tube and the breathing circuit. After careful withdrawal of the second tube through the submental tunnel, the first tube was directly connected to the breathing circuit after removal of the second tube. Although this technique requires additional time, apnea time is minimal even in patients in whom withdrawal of the tracheal tube through the submental tunnel takes time, because the second tube forms a link between the first tube and the breathing circuit, making it possible to ventilate the patient throughout the procedure.