Dural waisting as a sign of subarachnoid extension of cavernous carotid aneurysms: a follow-up case report

OBJECTIVE

Even when augmented by CT and MRI, it can be difficult on angiography to predict which intracavernous carotid artery aneurysms (ICCAA) have subarachnoid extension and therefore pose a higher risk of subarachnoid hemorrhage. Previously we reported a case of an ICCAA, which on angiogram had a focal tapering of the dome that we termed a "waist." At surgery this lesion was found to have subarachnoid extension. We postulated that this dural "waisting" on the arteriogram was a predictor of subarachnoid extension. Herein we report a second case of an ICCAA with the angiographic appearance of a waist that was also confirmed to have subarachnoid extension at surgery, thereby strengthening our original hypothesis.

CLINICAL PRESENTATION

A 40-year-old woman presented with a 3-month history of bitemporal headache, diplopia, and a left sixth nerve palsy. MRI showed a lesion in the vicinity of the left cavernous carotid sinus and an arteriogram confirmed the presence of a large cavernous carotid aneurysm. As in the previous case, the aneurysm fundus was indented, creating a waist on the aneurysm dome.

INTERVENTION

After passing a trial balloon occlusion of the involved carotid artery, the patient was brought to the operating room for lesion trapping. The aneurysm fundus was seen to extend beyond the falciform ligament and with subsequent dissection, the neck of the aneurysm was seen to incorporate the carotid artery distal to the ophthalmic artery. The aneurysm was trapped by ligating the internal carotid artery in the neck and by placing a clip on the intracranial carotid proximal to the posterior communicating artery.

CONCLUSION

The presence of subarachnoid extension of an ICCAA can be difficult to elucidate on an arteriogram. This is an additional case in which a focal narrowing or "waisting" of the aneurysm dome seen on an angiogram served as a marker of subarachnoid extension.

Influencing the specificity of drug mixture discriminations by varying the training procedure

Studies of the discriminative stimulus effects of drug mixtures provide an approach to polydrug abuse and to studies on single drugs with multiple effects. The experiments described here investigated whether the use of the AND-OR procedure increases the specificity of drug mixture discriminations. Rats were trained to discriminate a mixture of nicotine (0.4 mg/ kg) plus midazolam (0.2 mg/kg) from saline (AND-discrimination, n = 10) or to discriminate the same mixture from its component drugs alone (AND-OR discrimination, n = 10). The studies used two-lever operant procedures with a tandem variable interval 1 min fixed ratio 10 (FR 10) schedule of food reinforcement. Under AND-discrimination conditions, there was partial generalization to amphetamine and pentobarbitone when each drug was administered singly. With the AND-OR-discrimination, there was no generalization to amphetamine and partial generalization to pentobarbitone. In 'single substitution' tests, pentobarbitone or amphetamine was co-administered with the training doses of nicotine and midazolam, respectively; there was full generalization in the AND-discrimination and no generalization under AND-OR conditions. In 'dual substitution' tests, mixtures of amphetamine plus pentobarbitone produced full generalization under AND-discrimination conditions, and partial generalization in the AND-OR procedure. Wherever comparisons were made, generalization was less under AND-OR- than under the AND-discrimination procedure, confirming that the AND-OR procedure can increase the specificity of discriminations based on drug mixtures. The similarity with findings reported previously for training with mixtures of amphetamine plus pentobarbitone suggests that this may reflect a general principle rather than a phenomenon restricted to particular training drugs.

Characterization of the rat type III hexokinase gene promoter. A functional octamer 1 motif is critical for basal promoter activity

A 1532-base pair 5'-flanking region of the gene encoding rat type III hexokinase has been cloned and sequenced. The total sequence includes positions -1548 to -17 (A of the translational start ATG as position +1). Using luciferase reporter constructs transfected into PC12 (rat pheochromocytoma) and L2 (rat lung) cells, basal promoter activity has been associated with sequence between -182 and -89. This includes a single transcriptional start site, an adenine at position -134 identified by primer extension. Together with previously cloned cDNA sequence, this accounts for an mRNA of approximately 3.9 kilobases, found by Northern blotting of RNA from rat lung and kidney. Sequence upstream of the transcriptional start site was devoid of canonical TATA and CAAT elements. An octamer 1 (Oct-1) binding site, located between positions -166 and -159 was shown by deletion analysis and site-directed mutation to be critical for promoter activity. Nuclear extracts from PC12 cells contained a protein (or proteins) specifically binding the octamer sequence, and supershift experiments with anti-Oct-1 indicated involvement of this ubiquitously expressed transcription factor in the complex. Sequence including the Oct-1 site and immediately adjacent regions was protected from DNase I digestion in footprinting experiments with nuclear extracts from PC12 cells. Reverse transcription polymerase chain reaction indicated that levels of type III hexokinase mRNA in rat tissues increased in the order brain < liver < lung approximately kidney; immunoblotting indicated that type III hexokinase protein in these tissues increased in a similar manner.

Influence of training paradigm on specificity of drug mixture discriminations

Generalization to different drugs and drug mixtures has been examined in rats trained to discriminate a mixture of amphetamine (0.4 mg/kg) plus pentobarbitone (10 mg/kg) from saline (AND discrimination, n = 8) or to discriminate the same mixture from its component drugs alone (AND-OR discrimination, n = 9). The studies used two-lever operant procedures with a tandem variable interval 1-min fixed-ratio 10 schedule of food reinforcement. There was partial generalization to nicotine and midazolam and no generalization to cocaine, caffeine, or ethanol under AND-discrimination conditions and no generalization to any of these drugs in the AND-OR discrimination. Nicotine or midazolam coadministered with the training doses of pentobarbitone and amphetamine, respectively, produced full generalization in the AND discrimination and partial generalization under AND-OR conditions. Cocaine coadministered with pentobarbitone generalized fully under both procedures, but at larger doses in the AND-OR than in the AND discrimination. Mixtures of either nicotine plus midazolam or caffeine plus ethanol produced very marked generalization under AND-discrimination conditions, but were without significant effect in the AND-OR procedure. The results consistently supported the hypothesis that the AND-OR discrimination procedure increases the specificity of discriminations based on drug mixtures.

Drug mixtures and ethanol as compound internal stimuli

Drug discrimination methods that entail training with mixtures of drugs may shed light on polydrug abuse and on the actions of single drugs that interact with more than one receptor. In AND-discrimination procedures (drug A + drug B vs. vehicle), mixtures are discriminated primarily on the basis of their component drugs: these discriminations may be useful for testing interactions between component drugs in mixtures. The role of training dose, overshadowing and associative blocking in AND-discriminations have been investigated. For example, after prior training with midazolam, it was possible to demonstrate associative blocking of the nicotine element of the mixture stimulus, and vice versa. Using the AND-OR discriminations (drug A + drug B vs. drug A or drug B) increased pharmacological specificity considerably, and these procedures may be valuable for determining whether the effects of a novel mixture are similar to the combined effects of the training drugs. Ethanol is an example of a single drug that may produce a compound cue; rats trained to discriminate ethanol from water generalize (asymmetrically) to GABA(A) enhancers such as chlordiazepoxide (CDP) or pentobarbitone, to NMDA antagonists such as dizocilpine (MK-801), and to some serotonin agonists, such as trifluoromethylphenylpiperazine (5-HT(1B/2C)). In addition, rats trained to discriminate mixtures of either CDP or pentobarbitone plus MK-801 generalize to ethanol. A previous history of training with MK-801 or CDP (prior to ethanol discrimination training) enhanced the MK-801-like and CDP-like effects of ethanol respectively, but associative blocking of proposed elements in the ethanol stimulus was not seen. These studies provide some support for the multielement concept of ethanol discrimination but also suggest that rules governing three-component stimuli (such as those putatively produced by ethanol) may differ from those for the two-component mixtures of drugs studied previously.

Identification, functional characterization, and chromosomal localization of USP15, a novel human ubiquitin-specific protease related to the UNP oncoprotein, and a systematic nomenclature for human ubiquitin-specific proteases

We have identified a novel gene, USP15, encoding a human ubiquitin-specific protease (USP). The USP15 protein consists of 952 amino acids with a predicted molecular mass of 109.2 kDa and contains the highly conserved Cys and His boxes present in all members of the UBP family of deubiquitinating enzymes. USP15 shares 60.5% sequence identity and 76% sequence similarity with the human homolog (UNP/Unph/USP4) of the mouse Unp proto-oncogene. Recombinant USP15 demonstrated ubiquitin-specific protease activity against engineered linear fusions of ubiquitin to beta-galactosidase and glutathione S-transferase. USP15 can also cleave the ubiquitin-proline bond, a property previously unique to Unp/UNP. Chromosomal mapping by fluorescence in situ hybridization and radiation hybrid analyses localized the USP15 gene to chromosome band 12q14, a different location than that of UNP (3p21.3). Analysis of expressed sequence tag databases reveals evidence of alternate polyadenylation sites in the USP15 gene and also indicates that the gene may possess an exon/intron structure similar to that of the Unp gene, suggesting they have descended from a common ancestor. A systematic nomenclature for the human USPs is proposed.

Fractal ion-channel behavior generates fractal firing patterns in neuronal models

Fractal behavior has been observed in both ion-channel gating and neuronal spiking patterns, but a causal relationship between the two has not yet been established. Here, we examine the effects of fractal ion-channel activity in modifications of two classical neuronal models: Fitzhugh-Nagumo (FHN) and Hodgkin-Huxley (HH). For the modified FHN model, the recovery variable was represented as a population of ion channels with either fractal or Markov gating characteristics. Fractal gating characteristics changed the form of the interspike interval histogram (ISIH) and also induced fractal behavior in the firing rate. For the HH model, the K+ conductance was represented as a collection of ion channels with either quasifractal or Markov gating properties. Fractal gating induced fractal-rate behavior without changing the ISIH. We conclude that fractal ion-channel gating activity is sufficient to account for fractal-rate firing behavior.

AND and AND-OR drug mixture discriminations in rats: generalization to single drugs and drug mixtures

RATIONALE

Studies of the discriminative stimulus effects of drug mixtures provide an approach to polydrug abuse and studies on single drugs with multiple effects.

OBJECTIVE

This study was designed to investigate whether the use of the AND-OR procedure increases the specificity of drug mixture discriminations.

METHODS

Rats were trained to discriminate a mixture of amphetamine (0.4 mg/kg) plus pentobarbitone (10 mg/kg) from saline (AND-discrimination, n = 8) or to discriminate the same mixture from its component drugs alone (AND-OR discrimination, n = 9). The studies used two-lever operant procedures with a tandem variable interval 1-min fixed ratio 10 schedule of food reinforcement.

RESULTS

Under AND-discrimination conditions, there was partial generalization to nicotine and midazolam when each drug was administered singly, and there was no generalization to cocaine, caffeine or ethanol. With the AND-OR discrimination, there was no generalization to any of the preceding drugs administered singly. In "single substitution" tests, nicotine or midazolam was co-administered with the training doses of pentobarbitone and amphetamine, respectively; there was full generalization in the AND-discrimination and partial generalization under AND-OR conditions. Cocaine co-administered with pentobarbitone generalized fully under both procedures, but the dose of cocaine needed was much larger in the AND-OR than in the AND-discrimination. In "dual substitution" tests, mixtures of two novel substances were tested. Mixtures of either nicotine plus midazolam or caffeine plus ethanol produced very marked generalization under AND-discrimination conditions, but were without significant effect in the AND-OR procedure. Throughout the studies, in every instance where comparisons were made, generalization was greater or occurred at lower doses under AND- than under the AND-OR discrimination.

CONCLUSIONS

The study yielded extensive evidence supporting the hypothesis that the AND-OR discrimination procedure increases the specificity of discriminations based on drug mixtures.

Predicting coronary disease risk based on short-term RR interval measurements: a neural network approach

Coronary heart disease is a multifactorial disease and it remains the most common cause of death in many countries. Heart rate variability has been used for non-invasive measurement of parasympathetic activity and prediction of cardiac death. Patterns of heart rate variability associated with respiratory sinus arrhythmia have recently been considered as possible indicators of coronary heart disease risk in asymptomatic subjects. The aim of this work is to detect individuals at varying risk of coronary heart disease based on short-term heart rate variability measurements under controlled respiration. Artificial neural networks are used to recognise Poincaré-plot-encoded heart rate variability patterns related to coronary heart disease risk. The results indicate a relatively coarse binary representation of Poincaré plots could be superior to an analogue encoding which, in principle, carries more information.

Analysis of dendritic arbors of native and regenerated ganglion cells in the goldfish retina

The retinas of adult teleost fish can regenerate following injury, but little is known about the neuronal integration of the visual scene that is performed by the regenerated retina. Using goldfish retinal ganglion cells (RGCs) as the experimental system, an evaluation of dendritic arbor structure and passive electrotonic properties was developed, the aim being to quantitatively test the hypothesis that native and regenerated RGC dendritic arbors have similar structural and modeled electrotonic attributes. Fractal dimension was chosen as the descriptor of RGC dendritic arbor complexity, and the arbors' transfer function magnitudes were estimated using an electrically passive, equivalent-circuit analysis. For both native and regenerated RGCs, arbors qualitatively judged to be simple tended to have lower fractal dimension values than arbors judged to be more complex. All cells had similar cut-off frequencies, and for random stimulation of greater than 25% of an RGC's population of dendritic tips, there was a positive correlation between fractal dimension and transfer function magnitude. Some regenerated RGCs had abnormally long primary dendrites, but neither the distributions of fractal dimension values, nor the estimated transfer function magnitudes, were significantly different between native and regenerated RGCs. The results appear to support the hypothesis that structural and modeled electrotonic attributes of regenerated goldfish RGCs are similar to those of native RGCs, suggesting that regenerated RGCs may restore normal visual function.

Frequency control in synchronized networks of inhibitory neurons

We analyze the control of frequency for a synchronized inhibitory neuronal network. The analysis is done for a reduced membrane model with a biophysically based synaptic influence. We argue that such a reduced model can quantitatively capture the frequency behavior of a larger class of neuronal models. We show that in different parameter regimes, the network frequency depends in different ways on the intrinsic and synaptic time constants. Only in one portion of the parameter space, called phasic, is the network period proportional to the synaptic decay time. These results are discussed in connection with previous work of the authors, which showed that for mildly heterogeneous networks, the synchrony breaks down, but coherence is preserved much more for systems in the phasic regime than in the other regimes. These results imply that for mildly heterogeneous networks, the existence of a coherent rhythm implies a linear dependence of the network period on synaptic decay time and a much weaker dependence on the drive to the cells. We give experimental evidence for this conclusion.

Instructional intranets in graduate medical education

Changes in medicine, medical education, and technology have influenced graduate medical education (GME) and have altered many traditional concepts of resident training. Three issues in particular have led to changes. The first is the shortage of time that academic and community physicians have to devote to medical teaching because of the demands to bring in revenue through clinical practice. The second is the limited exposure that residents have to various medical conditions due to a shift in training venues from hospitals to ambulatory care settings. Last is residents' lack of training in using information technologies. The resultant deficits the exist in GME make it more difficult for residents to practice medicine in the most efficient manner. Hence, there is a need for health care professionals' education to address the coming demands of the 21st century. Instructional computer technology can be useful in bridging this gap. Intranets, internal organizational networks, are private versions of the World Wide Web that are often available only to members of a particular organization. This paper reviews changes in medicine and medical education, describes how instructional intranets can be incorporated into GME, and discusses the impact intranet and Internet technologies can have on GME.

Fluid replacement needs of well-trained male and female athletes during indoor and outdoor steady state running

Twelve male and six female well-trained middle distance athletes performed a series of six one hour runs at 75% VO2 peak pace under similar environmental states indoors (treadmill) and outdoors (track). Running was undertaken in control (C, no fluid), followed by water (W) and sports drink (SD) treatments, with each run separated by a one week interval. Both fluid treatments were supplied in volumes equivalent to individual body mass (fluid) losses incurred in the respective indoor and outdoor C treatments. Haemodynamic (plasma volume), physiological (heart rate and body temperature) and blood chemistry (blood lactate and glucose) measures were analysed as pre to post run changes (delta values). During the respective indoor and outdoor C treatments, males demonstrated approximately a twofold change in body mass (fluid) losses (delta 1.81 +/- 0.10 kg and 2.06 +/- 0.13 kg) compared with females (delta 0.93 +/- 0.11 kg and 1.32 +/- 0.12 kg) (all p<0.05). These losses resulted in almost a twofold fluid replacement need relative to body mass during the running phases of respective indoor and outdoor W and SD treatments in males compared with females (all p<0.05). Both W and SD treatments were effective in minimising the pre to post run disturbances in plasma volume, heart rate, body temperature and blood lactate, while SD treatment resulted in enhanced blood glucose changes. The results suggest gender specific differences in fluid replacement needs during steady state running, which need to be incorporated into fluid replacement strategies to compensate for the demands of training and competition in middle distance athletic events.

Time-frequency analysis of transient pressure signals for a mechanical heart valve cavitation study

A series of transient pressure signals (TPSs) can be measured using a miniature pressure transducer mounted near the tip of the inflow side of a mechanical heart valve (MHV) occluder during closure. A relationship appears to exist between the intensity and pattern of the TPS and the cavitation potential of a MHV. To study the relationship between MHV cavitation and the TPSs, we installed an MHV in a valve testing chamber of a digitally controlled burst test loop. A charge coupled device (CCD) camera and a personal computer based image grabbing program was used to visualize cavitation bubbles appearing on or near the occluder surface. One bileaflet MHV was used as the model for this study. Cavitation bubbles were observed within 300 microsec of the leaflet/housing impact. The valve was tested at various driving pressures between 100 and 1,300 mmHg. MHV cavitation bubble intensities were qualitatively classified into three categories: 1) strong, 2) weak, and 3) none. Digital images of the MHV occluder inflow surface were recorded simultaneously with the TPSs. TPSs were studied by the time-frequency analysis method (spectrogram) and correlated to MHV cavitation potential. The intensity of the cavitation bubbles was found to be associated with burst test loop driving pressures during leaflet closure.

The voltage-dependent conductances of rat neocortical layer I neurons

Whole cell patch-clamp techniques were used to study voltage-dependent sodium (Na+), calcium (Ca2+), and potassium (K+) conductances in acutely isolated neurons from cortical layer I of adult rats. Layer I cells were identified by means of gamma-aminobutyric acid (GABA) immunocytochemistry. Positive stainings for the Ca2+-binding protein calretinin in a subset of cells, indicated the presence of Cajal-Retzius (C-R) cells. All investigated cells displayed a rather homogeneous profile of voltage-dependent membrane currents. A fast Na+ current activated at about -45 mV, was half-maximal steady-state inactivated at -66.6 mV, and recovery from inactivation followed a two-exponential process (tau1 = 8.4 ms and tau2 = 858.8 ms). Na+ currents declined rapidly with two voltage-dependent time constants, reaching baseline current after some tens of milliseconds. In a subset of cells (< 50%) a constant current level of < 65 pA remained at the end of a 90 ms step. A transient outward current (Ifast) activated approximately -40 mV, declined rapidly with a voltage-insensitive time constant (tau approximately 350 ms) and was relatively insensitive to tetraethylammonium (TEA, 20 mM). Ifast was separated into two components based on their sensitivity to 4-aminopyridine (4-AP): one was blocked by low concentrations (40 microM) and a second by high concentrations (6 mM). After elimination of Ifast by a conditioning prepulse (50 ms to -50 mV), a slow K+ current (I(KV)) could be studied in isolation. I(KV) was only moderately affected by 4-AP (6 mM), while TEA (20 mM) blocked most (> 80%) of the current. I(KV) activated at about -40 mV, declined monoexponentially in a voltage-dependent manner (tau approximately 850 ms at -30 mV), and revealed an incomplete steady-state inactivation. In addition to Ifast and I(KV), indications of a Ca2+-dependent outward current component were found. When Na+ currents, Ifast, and I(KV) were blocked by tetrodotoxin (TTX, 1 microM), 4-AP (6 mM) and TEA (20 mM) an inward current carried by Ca2+ was found. Ca2+ currents activated at depolarized potentials at about -30 mV, were completely blocked by 50 microM cadmium (Cd2+), were sensitive to verapamil (approximately 40% block by 10 microM), and were not affected by nickel (50 microM). During current clamp recordings, isolated layer I neurons displayed fast spiking behaviour with short action potentials (approximately 2 ms, measured at half maximal amplitude) of relative small amplitude (approximately 83 mV, measured from the action potential threshold).

Differences in detection of alcohol use in a prenatal population (on a Northern Plains Indian Reservation) using various methods of ascertainment

Although Fetal Alcohol Syndrome (FAS) rates have been reported to be higher in American Indian populations, no screening tool has been validated for alcohol use in American Indian women. The objectives of this study were to compare the detection of prenatal alcohol use by a self-administered questionnaire to detection by clinical interview; and to ascertain whether the screening tool would increase detection of pregnant women who are abusing alcohol. The hospital records of the women were reviewed for any history of alcohol-related illnesses or injuries to compare with results obtained from the questionnaire. Seventy women attending their first prenatal clinic visit on a reservation were screened for alcohol use. There was a wide range in detection of prenatal alcohol use (20%-71% of the sample detected) depending on the method used. There was a large variation in sensitivities (7%-93%) of the individual questions in identifying patients detected as "high risk" by the clinicians. The T-ACE screening questions significantly increased detection of alcohol use compared to detection by the clinicians (p = 0.04 Fisher's exact test). Due to the large variation between different methods of detection, it is recommended that screening tools that increase detection of alcohol use should be combined with methods of higher specificity such as using questions about quantity and frequency of alcohol intake, medical chart review and clinical interview. We also found that various interpretations of the screening questions by the patients highlighted the need to tailor the wording of individual questions to the particular patient population.

Noise from voltage-gated ion channels may influence neuronal dynamics in the entorhinal cortex

Neurons of the superficial medial entorhinal cortex (MEC), which deliver neocortical input to the hippocampus, exhibit intrinsic, subthreshold oscillations with slow dynamics. These intrinsic oscillations, driven by a persistent Na+ current and a slow outward current, may help to generate the theta rhythm, a slow rhythm that plays an important role in spatial and declarative learning. Here we show that the number of persistent Na+ channels underlying subthreshold oscillations is relatively small (<10(4)) and use a physiologically based stochastic model to argue that the random behavior of these channels may contribute crucially to cellular-level responses. In acutely isolated MEC neurons under voltage clamp, the mean and variance of the persistent Na+ current were used to estimate the single channel conductance and voltage-dependent probability of opening. A hybrid stochastic-deterministic model was built by using voltage-clamp descriptions of the persistent and fast-inactivating Na+ conductances, along with the fast and slow K+ conductances. All voltage-dependent conductances were represented with nonlinear ordinary differential equations, with the exception of the persistent Na+ conductance, which was represented as a population of stochastic ion channels. The model predicts that the probabilistic nature of Na+ channels increases the cell's repertoire of qualitative behaviors; although deterministic models at a particular point in parameter space can generate either subthreshold oscillations or phase-locked spikes (but rarely both), models with an appropriate level of channel noise can replicate physiological behavior by generating both patterns of electrical activity for a single set of parameters. Channel noise may contribute to higher order interspike interval statistics seen in vitro with DC current stimulation. Models with channel noise show evidence of spike clustering seen in brain slice experiments, although the effect is apparently not as prominent as seen in experimental results. Channel noise may contribute to cellular responses in vivo as well; the stochastic system has enhanced sensitivity to small periodic stimuli in a form of stochastic resonance that is novel (in that the relevant noise source is intrinsic and voltage-dependent) and potentially physiologically relevant. Although based on a simple model that does not include all known membrane mechanisms of MEC stellate cells, these results nevertheless imply that the stochastic nature of small collections of molecules may have important effects at the cellular and network levels.

Oral health status of special athletes in the San Francisco Bay Area

A standardized oral health screening protocol was developed for assessing the oral health status of athletes participating in annual Special Olympics events at sites across the country. This paper reports on results at the San Francisco Bay Area Special Olympics event, where 385 athletes participated in the oral health screening. Trained dental screeners determined the presence or absence of edentulism, untreated decay, filled teeth, missing teeth, tooth injury, fluorosis, and gingival signs, as well as treatment urgency. The frequency of mouth cleaning, having a mouth guard, use of tobacco, and presence or absence of pain were self-reported. Overall, child athletes 9-20 years of age had more untreated decay and substantially more missing permanent teeth than 9-20-year-old children represented in the 1986-87 National Institute of Dental Research Survey of U.S. School Children. Prevalence of missing teeth among adult athletes compared favorably with data from the Third National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System Survey. Approximately one-third of child and adult athletes were determined to need dental care. Continued use of a standardized screening protocol could allow state-specific data to be available on the oral health status of this population; trends could be tracked; and needs could be identified, with strategies developed to meet those needs.

Primary epithelioid hemangioendothelioma of the clivus

We describe the clinical, radiologic, and pathologic features of a primary intracranial hemangioendothelioma arising in the clivus in a 38-year-old female, emphasizing the importance of including this rare entity in the differential diagnosis of tumors arising at the base of the skull. To our knowledge, this is the first reported case of a clival hemangioendothelioma. Aside from its unusual location, this case is also notable for its apparent rapid growth and mixed epithelioid-spindle cell morphology. Appropriate neuroimaging studies may offer crucial information, ensuring that this uncommon entity is included in the differential diagnosis of a clival mass.

Synchronization and oscillatory dynamics in heterogeneous, mutually inhibited neurons

We study some mechanisms responsible for synchronous oscillations and loss of synchrony at physiologically relevant frequencies (10-200 Hz) in a network of heterogeneous inhibitory neurons. We focus on the factors that determine the level of synchrony and frequency of the network response, as well as the effects of mild heterogeneity on network dynamics. With mild heterogeneity, synchrony is never perfect and is relatively fragile. In addition, the effects of inhibition are more complex in mildly heterogeneous networks than in homogeneous ones. In the former, synchrony is broken in two distinct ways, depending on the ratio of the synaptic decay time to the period of repetitive action potentials (tau s/T), where T can be determined either from the network or from a single, self-inhibiting neuron. With tau s/T > 2, corresponding to large applied current, small synaptic strength or large synaptic decay time, the effects of inhibition are largely tonic and heterogeneous neurons spike relatively independently. With tau s/T < 1, synchrony breaks when faster cells begin to suppress their less excitable neighbors; cells that fire remain nearly synchronous. We show numerically that the behavior of mildly heterogeneous networks can be related to the behavior of single, self-inhibiting cells, which can be studied analytically.

Differences in the incidence of injury between rugby league forwards and backs

Evidence with regard to the incidence of injury to forwards and backs in the game of rugby league is extremely limited. A four year prospective study of all the injuries from one professional Rugby League club was conducted. All injuries that were received during match play were recorded, and those for forwards and backs compared. Forwards had a higher overall rates of injury than backs (139.4 [124.2-154.6] vs. 92.7 [80.9-104.6] per 1000 player hours, P < 0.00006). Forwards had a higher rate of injuries to all body sites with the exception of the ankle and the 'others' category of injury. They had significantly higher rates for the arm (11.6 [6.9-16.3] vs. 3.9 [1.4-6.4] per 1000 player hours, P = 0.005) and, the head and neck (53.9 [43.9-63.8] vs. 25.0 [18.7-31.4] injuries per 1000 player hours, P < 0.00006). Forwards had significantly more injuries than backs for contusions (17.1 vs. 7.3 per 1000 player hours, z = 2.85, P = 0.0044), lacerations (26.7 vs. 13.8 per 1000 player hours, z = 2.92, P = 0.0035) and haematomas (20.6 vs. 11.6 per 1000 player hours, z = 2.29, P = 0.02). Forwards were also more likely to be injured when in possession of the ball (70.5 [59.2-81.7] vs. 38.0 [30.2-45.7]), and also when tackling (33.2 [25.3-41.1] vs. 16.8 [11.6-22.1]). The higher rates of injury experienced by forwards were most likely as a result of their greater physical involvement in the game, both in attack and in defence.

cDNA cloning of human retinoic acid-metabolizing enzyme (hP450RAI) identifies a novel family of cytochromes P450

Retinoids, including all-trans-retinoic acid (RA) and its stereoisomer 9-cis-RA play important roles in regulating gene expression, through interactions with nuclear receptors, during embryonic development and in the maintenance of adult epithelial tissues (Chambon, P. (1995) Rec. Prog. Horm. Res. 50, 317-32; Mangelsdorf, D. J., and Evans, R. M. (1995) Cell 83, 841-850; Petkovich, M. (1992) Annu. Rev. Nutr. 12, 443-471). Evidence suggests that 4-hydroxylation of RA inside the target cell limits its biological activity and initiates a degradative process of RA leading to its eventual elimination. However, 18-hydroxylation and glucuronidation may also be important steps in this process. In this paper, we describe the cloning and characterization of the first mammalian retinoic acid-inducible retinoic acid-metabolizing cytochrome P450 (hP450RAI), which belongs to a novel class of cytochromes (CYP26). We demonstrate that hP450RAI is responsible for generation of several hydroxylated forms of RA, including 4-OH-RA, 4-oxo-RA, and 18-OH-RA. We also show that hP450RAI mRNA expression is highly induced by RA in certain human tumor cell lines and further show that RA-inducible RA metabolism may correlate with P450RAI expression. We conclude that this enzyme plays a key role in RA metabolism, functioning in a feedback loop where RA levels are controlled in an autoregulatory manner.

Structure of the gene for type I hexokinase from rat

Based on presumed analogy with the previously characterized gene encoding the Type II isozyme of rat hexokinase (Printz, R.L., Koch, S., Potter, L.R., O'Dougherty, R.M., Tiesinga, J.J., Moritz, S., and Granner, D. K., J. Biol. Chem. 268, 5209-5219, 1993), the locations of splice sites in the gene encoding the rat Type I isozyme of hexokinase have been determined by PCR amplification of intronic DNA. Sequences at the splice sites conform to the consensus sequence, with GT and AG being found at 5' and 3' ends of the introns, respectively. Sizes of exons 1 and 2 were determined directly while others were estimated based on identified splice sites and the previously determined cDNA sequence. These exon sizes were confirmed by PCR amplification, which gave products having sizes consistent with those of introns and exons predicted to be within the amplified sequence. Thus, it is unlikely that the gene encoding the Type I isozyme contains any introns not having analogs in the gene for Type II hexokinase. The deduced structure for the rat Type I hexokinase gene is therefore identical to that for the rat Type II isozyme, and spans over 51 kb. Six tandem repeat sequences of (AC/GT)n have been identified in the 5' flanking region and in introns 10, 11, 12, and 16; this is an unusually high frequency of tandem repeat sequences.

Imaging free zinc in synaptic terminals in live hippocampal slices

Some glutamatergic synapses in the mammalian central nervous system exhibit high levels of free ionic zinc in their synaptic vesicles. The precise role of this vesicular zinc remains obscure, despite suggestive evidence for zinc as a neuromodulator. As a step towards elucidating the role of free zinc in the brain we have developed a method for imaging zinc release in live brain slices. A newly synthesized zinc-sensitive fluorescent probe, N-(6-methoxy-8-quinolyl)-p-carboxybenzoylsulphonamide (TFLZn), was used to monitor intracellular zinc in live rat hippocampal slices. The dye loaded into the zinc-rich synaptic vesicles of the mossy fibre terminals in the hippocampal formation. Direct electrical stimulation of the mossy fibre pathway diminished the fluorescence in the mossy fibre terminals, consistent with a stimulus-dependent zinc release. The synaptic release of zinc was followed by the rapid replenishment of the zinc levels in vesicles from an as yet unidentified intracellular zinc source. Furthermore, we present evidence that zinc may play a role in a form of long-term potentiation exhibited by the mossy fibre pathway.

Analysis of the sit-stand-sit movement cycle in normal subjects

OBJECTIVE: This study aimed to establish a basis of descriptive data for the sit-stand-sit movement cycle in 50 normal subjects, 25 male and 25 female, aged between 20.1 and 78.3 years (mean age 46.8 years). DESIGN: A descriptive design was employed to establish the characteristics of the activity in normal subjects. BACKGROUND: Research has been carried out into kinetic and kinematic characteristics of the sit-to-stand movement, but few researchers have considered stand-to-sit. Most studies have involved small samples, subjects with pathology, or elderly subjects, so a baseline of data from normal subjects has not yet been established. METHOD: Linear displacement and acceleration of the trunk and angular displacement of the knee were recorded simultaneously within the same temporal framework. The measurement system consisted of a vector stereograph, and triaxial accelerometers located at the level of C(7), and an electrogoniometer located at the lateral aspect of the knee. Subjects rose from and descended to the seated position a total of six times at their own self-selected speed. Numerical data were subjected to descriptive analysis, matched-pairs t tests and Pearson's rho correlations. RESULTS: Mean values for the time to rise was 1.91 s and to descend was 1.97 s. Forward lean velocity was greater during rising than descending (P < 0.001), and recovery velocity was greater during descending than rising (P < 0.001). Temporal contributions of forward lean and vertical displacement and the period of overlap between them were identified, and relationships between acceleration and temporal events and components were established. Differences existed among groups, involving primarily the elderly groups and occurring during the rising phase. CONCLUSIONS: This study has proposed a baseline of descriptive data in normal subjects for the sit-stand-sit movement cycle. RELEVANCE: In practical and clinical applications of information gained from analysis of functional activities, establishment of what is accepted as 'normal' is necessary before abnormalities can be identified and analysed, and intervention implemented and evaluated. This study provides that basis.

Report on the Fifth International Workshop on Chromosome 9 held at Eynsham, Oxfordshire, UK, September 4-6, 1996

The Fifth International workshop on chromosome 9 comprised a gathering of 36 scientists from seven countries and included a fairly even distribution of interests along chromosome 9 as well as a strong input from more global activities and from comparative mapping. At least eight groups had participated in the goal set at the previous workshop which was to improve the fine genetic mapping in different regions of chromosome 9 by meiotic breakpoint mapping in allocated regions and this has resulted in some greatly improved order information. Excellent computing facilities were available and all contributed maps were entered not only into SIGMA (and thence submitted to GDB) but also into a dedicated version of ACEDB which can be accessed on the Web in the form of one of 28 slices into which the chromosome has been arbitrarily divided. It was generally agreed that the amount of data is now overwhelming and that the integration and validation of all data is not only unrealistic in a short meeting but probably impossible until the whole chromosome has been sequenced and fully annotated. Sequence-ready contigs presented at the meeting totalled about 3 MB which is about one fiftieth of the estimated length. The single biggest barrier to integration of maps is the problem of non-standard nomenclature of loci. In the past 2 workshops efforts have been made to compare traditional 'consensus' maps made by human insight (still probably best for small specific regions) with those generated with some computer assistance (such as SIGMA) and those generated objectively by defined computer algorithms such as ldb. Since no single form of map or representation is entirely satisfactory for all purposes the maps reproduced in the published version of the report are confined to one of the genetic maps, in which Genethon and older markers have been incorporated, a Sigma map of the genes as symbols together with a listing of known 'disease' genes on chromosome 9, and a revised assessment of the mouse map together with a list of mouse loci predicted to be on human chromosome 9. One of the 28 ACEDB slices is also shown to illustrate strengths and weaknesses of this approach. Workshop files include not only all maps available at the time but also details of loci and details of the meiotic breakpoints in the CEPH families (http:/(/)www.gene.ucl.ac.uk/scw9db.shtml) .

Antagonism of AND and AND-OR drug mixture discriminations in rats

It has been suggested that use of the AND-OR training method may be associated with an enhancement of the pharmacological specificity of discriminations based on mixture of drugs. Rats were trained to discriminate a mixture of nicotine (0.4 mg/kg s.c.) plus midazolam (0.2 mg/kg s.c.) from saline (AND-discrimination, n = 8) or to discriminate the mixture from either drug alone (AND-OR discrimination, n = 6). The studies used two-lever operant procedures with food reinforcers presented on a tandem schedule. After discriminations were acquired to 80% accuracy, the nicotine antagonist mecamylamine (0.03 1.0 mg/kg s.c.) and the benzodiazepine antagonist flumazenil (0.32 10 mg kg i.p.) were tested on the response to the mixture of nicotine plus midazolam. The antagonist effects of either mecamylamine or flumazenil given alone were more marked in rats trained under the AND-OR procedure than in rats trained on the AND-discrimination. Similarly, the antagonist effects of mixtures of mecamylamine plus flumazenil were much more potent under the AND-OR than under the AND-discrimination procedure. The AND-OR method reduced the dose of the antagonist mixture needed to produce complete block by a factor of about 10, as compared with the AND-discrimination. These striking differences in sensitivity to antagonists support the view that AND-OR or related procedures may enhance the pharmacological specificity of complex drug discriminations.

Otolaryngologic manifestations of sarcoidosis: presentation and diagnosis

Neuro-otologic manifestations of sarcoidosis are rare. Dizziness in particular is a rare presenting complaint of the patient afflicted with this systemic granulomatous disorder. Head and neck and sinonasal presentations of this disease are more common. We reviewed our experience with six such patients who presented for management of their otolaryngologic (ORL) manifestations in order to delineate the involvement of the otolaryngologist in the treatment and diagnosis of these patients, with a focus upon the relevant tests and procedures in the otolaryngologist's de novo diagnosis of sarcoidosis. Studies ordered in the course of otolaryngologic evaluation and their utility in the diagnosis of sarcoidosis by the otolaryngologist are reviewed and classified into useful, supportive, and ancillary. The otolaryngologist played an important role in diagnosis, with four of six patients diagnosed to have sarcoidosis on the basis of their otolaryngologic presentations. Biopsy was performed by the otolaryngologist for diagnosis of sarcoidosis in all four of these cases. Steroids were central to treatment. Oral steroid therapy was the principal treatment: both patients with neuro-otologic sarcoid were successfully managed with oral steroids. Intralesional steroids were necessary to treat the skin lesion. One of six patients patients experienced complications related to steroid use.

Spontaneous action potentials due to channel fluctuations

A theoretical and numerical analysis of the Hodgkin-Huxley equations with the inclusion of stochastic channel dynamics is presented. It is shown that the system can be approximated by a one-dimensional bistable Langevin equation. Spontaneous action potentials can arise from the channel fluctuations and are analogous to escape by a particle over a potential barrier. The mean firing rate can be calculated using Kramers' classic result for barrier escape. The probability density function of the interspike intervals can also be estimated. The analytical results compare favorably with numerical simulations of the complete stochastic system.

Identification of the retinoic acid-inducible all-trans-retinoic acid 4-hydroxylase

Retinoic acid (RA) metabolites of vitamin A are key regulators of gene expression involved in embryonic development and maintenance of epithelial tissues. The cellular effects of RA are dependent upon the complement of nuclear receptors expressed (RARs and RXRs), which transduce retinoid signals into transcriptional regulation, the presence of cellular retinoid-binding proteins (CRABP and CRBP), which may be involved in RA metabolism, and the activity of RA metabolizing enzymes. We have been using the zebrafish as a model to study these processes. To identify genes regulated by RA during exogenous RA exposure, we utilized mRNA differential display. We describe the isolation and characterization of a cDNA, P450RAI, encoding a novel member of the cytochrome P450 family. mRNA transcripts for P450RAI are expressed normally during gastrulation, and in a defined pattern in epithelial cells of the regenerating caudal fin in response to exogenous RA. In COS-1 cells transfected with the P450RAI cDNA, all-trans-RA is rapidly metabolized to more polar metabolites. We have identified 4-oxo-RA and 4-OH-RA as major metabolic products of this enzyme. P450RAI represents the first enzymatic component of RA metabolism to be isolated and characterized at the molecular level and provides key insight into regulation of retinoid homeostasis.

Isolation of the promoter for Type I hexokinase from rat

A genomic clone containing sequence identical to the 5' region of the cDNA for rat Type I hexokinase was isolated from a lambda Charon 4A library. A 5.4-kb EcoRI fragment from this clone, containing the matching sequence, was sequenced in its entirety. Rapid amplification of 5' cDNA ends (5' RACE), reverse transcription polymerase chain reaction, and ribonuclease protection experiments were consistent with the existence of multiple transcriptional start sites clustered in three regions approximately 460, 300, and 100 nucleotides upstream from the translational start codon. Together with results of previous work, the 5' untranslated sequence defined in the present study accounts for the 4.3-kb mRNA for Type I hexokinase seen on Northern blots. Fragments from the 5' flanking region were cloned into a reporter vector containing the luciferase coding region. Based on transfection experiments with both PC12 and H9c2 cells, promoter activity was associated with a region lying between nucleotide positions -742 and -516 (with A of the ATG codon at the translational start site defined as +1). The promoter region lacks a TATA sequence and, together with the transcriptional start sites, is located within a GC rich segment (a "CpG island") approximately 1 kb in length. These characteristics have previously been associated with the promoter and transcriptional start sites of genes for "housekeeping enzymes."

Reversal of overshadowing in a drug mixture discrimination in rats

Previous studies have suggested that in some circumstances, learning processes such as overshadowing may determine the effects that one drug has upon the response to another. The experiments described here examined overshadowing in rats trained to discriminate mixtures of nicotine plus midazolam in two-lever operant procedures with food reinforcement. After training for 60 sessions, midazolam (0.32 mg/kg SC) overshadowed nicotine (0.32 mg/kg SC) so that the discriminative stimulus effect of nicotine seen in control rats trained with nicotine alone was abolished (n = 8-10). In the next phase of the study, the discriminative response to midazolam in one group of mixture-trained rats was devalued by means of an extinction procedure which weakened the relationship between administration of midazolam and the response that was reinforced. Dose-response determinations then showed that the devaluation procedure had indeed attenuated the response to midazolam, whereas the previously overshadowed response to nicotine was restored. Post-session injections of drugs were used to equate the pharmacological histories of the groups and the effects seen were therefore attributable to training with the drugs and not simply to repeated exposure to them. Additionally, in the control rats trained with nicotine only (with midazolam given post-session), midazolam markedly reduced response rates, whereas in the three groups of rats trained with the mixture, midazolam had little response rate-depressant effect; this observation suggests that behaviourally contingent tolerance had developed to the response rate-reducing effect of midazolam. Application of devaluation procedures in studies of the discriminative stimulus effects of single drugs with multiple effects may provide a means for manipulating the characteristics of the discriminations obtained and for identifying individual elements of the drug-produced stimulus complex.

Routine surveillance myocardial biopsies are unnecessary beyond one year after heart transplantation

BACKGROUND

Myocardial rejection is most apt to occur in the first 90 days after heart transplantation. Nevertheless, surveillance endomyocardial biopsies are often performed on a regular basis, indefinitely. The benefit of this approach to patient management is uncertain. Our objective was to determine the frequency of abnormalities and the influence of a routine annual endomyocardial biopsy on patient management.

METHODS

In a consecutive series of 235 transplant recipients who survived 1 year or more, the results of 1123 routine endomyocardial biopsies performed 1 year or more after transplantation were reviewed. The incidence of late rejection, presence of Quilty effect (focal endocardial or myocardial lymphocytic aggregates), and therapeutic reaction to the biopsy result were analyzed.

RESULTS

Of 1123 biopsy specimens in 235 patients (1 to 12 years after transplantation), 1115 (99.3%) showed no evidence of significant rejection (grade 0 or 1). Only seven (0.6%) had evidence of rejection grade 2 or worse. Of the seven abnormal biopsy specimens in seven patients, two occurred at 1 year, two at 2 years, and one each at 4, 7, and 8 years. Of these, six were treated for rejection with an increase in the immunosuppressive therapy. One patient was identified as having a symptomatic condition at the time of biopsy. A focal endocardial or myocardial accumulation of lymphocytes (Quilty effect) was present in 311 biopsy specimens (27.6%). Beyond 1 year, 33 patients died, 14 because of graft vascular disease with or without rejection and 19 because of other causes. No deaths were predicted on the basis of a routine surveillance biopsy.

CONCLUSIONS

Myocardial rejection is rare beyond 1 year after transplantation. The routine endomyocardial biopsy does not significantly impact patient management beyond 1 year. A selective approach to myocardial biopsies, on the basis of a change in clinical status or immunosuppressive medications, is justified.

Fructose-1,6-diphosphate or adenosine attenuate leukocyte adherence in postischemic skeletal muscle

The purpose of this study was to determine whether fructose-1,6-diphosphate (FDP) or adenosine (Ado), administered at the onset of reperfusion, would prevent ischemia/reperfusion (I-R)-induced leukocyte adherence and microvascular dysfunction in skeletal muscle. Changes in vascular permeability and tissue neutrophil content were assessed by measurement of the solvent drag reflection coefficient (delta) for total plasma proteins and muscle myeloperoxidase (MPO) activity, respectively, in continuously perfused, isolated canine gracilis muscles and in muscles subjected to I-R alone, I-R + FDP, and I-R + Ado. To determine whether FDP or Ado would attenuate leukocyte-endothelial cell adhesive interactions induced by I-R, leukocyte adherence and emigration were assessed in postischemic mouse cremaster muscles, using intravital microscopy in the presence and absence of FDP or Ado during reperfusion. I-R was associated with a marked increase in microvascular permeability and muscle MPO activity relative to nonischemic controls. These increases were attenuated by FDP and Ado. I-R also increased the number of adherent and emigrated leukocytes relative to control. I-R-induced leukocyte adherence and emigration were significantly attenuated by either FDP or Ado. These results indicate that FDP and Ado attenuate postischemic microvascular barrier dysfunction in skeletal muscle by a mechanism that may be related to their ability to inhibit leukocyte adhesion and emigration.

A bifurcation analysis of neuronal subthreshold oscillations

The conditions under which a noninactivating sodium current and either a potassium current or an inwardly rectifying cation current can generate subthreshold oscillations were analyzed using nonlinear dynamical techniques applied to a neuronal model consisting of two differential equations. Mathematical descriptions of the membrane currents were derived using voltage-clamp data collected from entorhinal cortical neurons. A bifurcation analysis was performed using applied current as the control parameter to map the range of magnitudes of the sodium, potassium/cation, and leakage conductances over which subthreshold oscillations exist. The threshold of the potassium/cation current was an important determinant of the robustness of oscillatory behavior. The activation time constant of the potassium/cation current largely determined the frequency range of emergent oscillations. This result implicates the slow inward rectifier or an as yet undescribed slow outward current in entorhinal cortical oscillations; the latter explanation, while more speculative, is more consistent with the pharmacological properties of subthreshold oscillations and gives oscillations over a larger current range. The shallowness of the sodium activation curve confined emergent oscillations to rise gradually rather than abruptly and extended the current range over which the model oscillated.

The protective effects of thiopental on brain stem ischemia

Thiopental, a barbiturate anesthetic, which at high doses suppresses cortical electroencephalogram activity, was evaluated as a neuroprotective agent in a dog model of reversible, hindbrain ischemia. Fourteen dogs were exposed to 20 minutes of isolated brain stem ischemia after pretreatment with 35 mg per kg of thiopental or placebo. Brain stem auditory evoked potentials (BAEPs) and regional cerebral blood flow were measured before and during the ischemia and for 5 hours after reperfusion. During the ischemic period, both control and thiopental-treated animals experienced dramatic declines in the BAEPs to less than 10% of baseline. On reperfusion for 30 minutes, the BAEPs increased in both groups to near 40% of baseline. In the thiopental-treated animals, the BAEPs continued to recover variably to a mean of 70% of baseline by 5 hours of reperfusion. In contrast, untreated animals showed a decline in BAEPs after 30 minutes of reperfusion. The improved recovery of BAEPs in the thiopental-treated animals suggests that thiopental may be of some value as a cerebroprotective agent, although the mechanism remains unclear. The variability in recovery in this group implies that other factors play a significant role in mediating functional recovery from ischemic brain stem damage.