Functional Unity of the Ponto-Cerebellum: Evidence That Intrapontine Communication Is Mediated by a Reciprocal Loop With the Cerebellar Nuclei

The majority of cerebral signals destined for the cerebellum are handed over by the pontine nuclei (PN), which thoroughly reorganize the neocortical topography. The PN maps neocortical signals of wide-spread origins into adjacent compartments delineated by spatially precise distribution of cortical terminals and postsynaptic dendrites. We asked whether and how signals interact on the level of the PN. Intracellular fillings of rat PN cells in vitro did not reveal any intrinsic axonal branching neither within the range of the cells' dendrites nor farther away. Furthermore, double whole cell patch recordings did not show any signs of interaction between neighboring pontine cells. Using simultaneous unit recording in the PN and cerebellar nuclei (CN) in rats in vivo, we investigated whether PN compartments interact via extrinsic reciprocal connections with the CN. Repetitive electrical stimulation of the cerebral peduncle of ≤40 Hz readily evoked rapid sequential activation of PN and CN, demonstrating a direct connection between the structures. Stimulation of the PN gray matter led to responses in neurons ≤600 μm away from the stimulation site at latencies compatible with di- or polysynaptic pathways via the CN. Importantly, these interactions were spatially discontinuous around the stimulation electrode suggesting that reciprocal PN-CN loops in addition reflect the compartmentalized organization of the PN. These findings are in line with the idea that the cerebellum makes use of the compartmentalized map in the PN to orchestrate the composition of its own neocortical input.

[Identification of the intercycle FSH signal in urine samples (uFSH)]

OBJECTIVE

The intercycle FSH signal that initiates follicular recruitment and marks the functional onset of the menstrual cycle is of small amplitude and while it commonly occurs on cycle day 3, this often varies. Hence, its identification and measurement in serum (sFSH) requires serial daily samplings. We attempted to determine whether urine measurements of FSH (uFSH) could offer a non-invasive alternative, using a model where the intercycle FSH signal is controlled by timely use of exogenous E2.

PATIENTS AND METHODS

Pilot prospective trial in 21 infertile women having received E2, from day 25 of the previous cycle until the 1st Friday after menses. Blood and first void urine samples were collected, starting on the last day of E2 (baseline) for assessing FSH and creatinin. A sonogram was performed for identification of maturing follicles (>12 mm).

RESULTS

uFSH and uFSH/Cr showed good correlation with sFSH (R = 0.52 and 0.63, P < 0.0001 and P < 0.0001, respectively). In 15/21 patients who had an intercycle sFSH elevation, this was confirmed by uFSH elevation, both occurring within 2-4 days after stopping E2. In all these women, the sonogram showed evidence of impending ovulation. The amplitude of the uFSH signal was on average 3 times higher than its sFSH counterpart. In 6/21 women, no intercycle FSH elevation was detected and no ovulation occurred.

DISCUSSION AND CONCLUSION

Our results show that the intercycle FSH signal can easily be identified and measured in urine. This novel approach permits more precise assessments of ovarian physiology than with blood measurements.

Employing ICA and SOM for spike sorting of multielectrode recordings from CNS

For classification of action potential shapes in multineuron recordings, we present a spike sorting system employing independent component analysis (ICA) and an unsupervised artificial neural network (Kohonen's self-organizing map, SOM). We focus on how ICA in the first stage of the spike sorting system can be used to address specific problems arising in recordings using multielectrode arrays in the CNS. Using real data recorded from the pontine nuclei in rats and simulated data, we evaluate the performance of several ICA algorithms to remove cross-talk between electrodes using data from continuous recording (or simulation). When using cut-out data, the standard format of extracellular spike recordings, new problems emerge and robust algorithms are needed. We demonstrate that several ICA algorithms show a good performance on cut-out data from multielectrode array recordings (simulated and real data). In tetrode recordings the same neuron is purposely recorded by several electrodes simultaneously and we show, how independent component analysis can be used in this case to identify redundant information and hence to compress relevant information, improving subsequent clustering of a SOM.

Central Signals Rapidly Switch Tactile Processing in Rat Barrel Cortex during Whisker Movements

Palpatory movements ('active' touch) are an integral part of tactile sensing. It is known that tactile signals can be modulated in certain behavioral contexts, but it is still unresolved to what degree this modulation is related to movement kinematics and whether it stems from tactile receptors or from central sources. Using awake, head-fixed rats, trained to contact an object, we measured trajectories of muscle-propelled whisker movement precisely and compared tactile responses to contacts thus accomplished with 'passive' contacts (motionless whisker contacted by object). Multielectrode extracellular recordings in deep layers of barrel cortex revealed that when the animals moved their whiskers actively, tactile processing switched from high response amplitudes, wide cortical representation and low background firing, to low response amplitudes, narrow spatial representation and elevated background firing. Switching was fast (<100 ms) and unrelated to the degree of alertness as assessed by spectral analysis of pre-contact field potentials. Switching persisted when information about whisker kinematics was interrupted by transection of the infraorbital nerve and contacts were mimicked by peripheral electrical stimulation. Taken together, these characteristics render central signals derived from the motor system a likely contributor to the processing of active touch.

Spatial segregation of different modes of movement control in the whisker representation of rat primary motor cortex

What is mapped on the surface of the primary motor cortex (M1)? The classic somatotopic map holds true on the level of limb representations. However, on the small scale (at within-limb representations), neither somatotopy nor movement dynamics/kinematics seem to be organizational principles. We investigated the hypothesis that integrated into the body representation of M1 there may be separate representation of different modes of motor control, using different subcortical computations but sharing the same motor periphery. Using awake rats and long intracortical stimulation trains in M1 whisker representation (wM1) revealed that natural-like, rhythmic whisking (normally used for tactile exploration) can be evoked from a posteromedial subregion of wM1. Nonrhythmic whisker retraction, on the other hand, was evoked in an adjacent but more anterolaterally located region within wM1. Evoked whisker retraction was always accompanied by complex movements of the face, suggesting that the respective subregion is able to interact with other representations in specific behavioral contexts. Such associations were absent for evoked rhythmic whisking. The respective subregion rather seemed to activate a downstream central pattern generator, the oscillation frequency of which was dependent on the average evoked cortical activity. Nevertheless, joint stimulation of the two neighboring subregions demonstrated their potency to interact in a functionally useful way. Therefore, we suggest that the cause of cortical separation is the specific drive of subcortical structures needed to generate different types of movements rather than different behavioral contexts in which the movements are performed.

Isotopic scaling and the symmetry energy in spectator fragmentation

Isotopic effects in the fragmentation of excited target residues following collisions of 12C on (112,124)Sn at incident energies of 300 and 600 MeV per nucleon were studied with the INDRA 4pi detector. The measured yield ratios for light particles and fragments with atomic number Z < or = 5 obey the exponential law of isotopic scaling. The deduced scaling parameters decrease strongly with increasing centrality to values smaller than 50% of those obtained for the peripheral event groups. Symmetry-term coefficients, deduced from these data within the statistical description of isotopic scaling, are near gamma = 25 MeV for peripheral and gamma < 15 MeV for central collisions.

Neocortex is the major target of sedative concentrations of volatile anaesthetics: strong depression of firing rates and increase of GABAA receptor-mediated inhibition

General anaesthetics cause sedation, amnesia and hypnosis. Although these clinically desired actions are indicative of an impairment of neocortical information processing, it is widely held that they are to a large part mediated by subcortical neural networks. Anaesthetic action on brain stem, basal forebrain and thalamus, all of which are known to modulate cortical excitability, would thus ultimately converge on neocortex, perturbing and reducing action potential activity therein. However, as neocortex harbours molecular targets of anaesthetics in high densities, notably GABA(A) receptors, neocortex itself should be very sensitive to anaesthetics. Here, we performed experiments to reveal the extent to which neocortex proper is a relevant target of the low concentrations of volatile anaesthetics causing sedation and hypnosis. We compared the effects of isoflurane, enflurane and halothane on spontaneous action potential activity of rat neocortical neurons in vivo and in isolated cortical networks in vitro, i.e. in the presence and absence of subcortical arousal systems. We observed that the anaesthetics decreased spontaneous firing of neurons via intracortical mechanisms; concentrations inducing hypnosis in humans reduced discharge rates both in vivo and in vitro to the same extent, approximately 50%. This decrease in neuronal activity was paralleled by a significant enhancement of neocortical GABA(A) receptor-mediated inhibition. These findings challenge the notion of predominantly subcortical effects of volatile anaesthetics and suggest that intracortical targets, among them neocortical GABA(A) receptors, mediate the sedative and hypnotic properties of volatile anaesthetics.

Organization of tectopontine terminals within the pontine nuclei of the rat and their spatial relationship to terminals from the visual and somatosensory cortex

We investigated the spatial relationship of axonal and dendritic structures in the rat pontine nuclei (PN), which transfer visual signals from the superior colliculus (SC) and visual cortex (A17) to the cerebellum. Double anterograde tracing (DiI and DiAsp) from different sites in the SC showed that the tectal retinotopy of visual signals is largely lost in the PN. Whereas axon terminals from lateral sites in the SC were confined to a single terminal field close to the cerebral peduncle, medial sites in the SC projected to an additional dorsolateral one. On the other hand, axon terminals originating from the two structures occupy close but, nevertheless, totally nonoverlapping terminal fields within the PN. Furthermore, a quantitative analysis of the dendritic trees of intracellularly filled identified pontine projection neurons showed that the dendritic fields were confined to either the SC or the A17 terminal fields and never extended into both. We also investigated the projections carrying cortical somatosensory inputs to the PN as these signals are known to converge with tectal ones in the cerebellum. However, terminals originating in the whisker representation of the primary somatosensory cortex and in the SC were located in segregated pontine compartments as well. Our results, therefore, point to a possible pontocerebellar mapping rule: Functionally related signals, commonly destined for common cerebellar target zones but residing in different afferent locations, may be kept segregated on the level of the PN and converge only later at specific sites in the granular layer of cerebellar cortex.

Sirolimus-eluting stents for percutaneous coronary intervention in acute myocardial infarction

BACKGROUND

Given the encouraging results on early restenosis rate with drug-eluting coronary stents, both safety and 6 months outcomes of PCI with sirolimus-eluting stents (SES) in acute myocardial infarction are scarce.

METHODS AND RESULTS

Fifty consecutive patients with acute myocardial infarction were subjected to acute PCI with SES and compared to 50 matched control patients who received a bare metal stent (BMS). All patients were followed over 6 months; in addition repeat angiography was obtained in 88.0% of SES and 92.0% of BMS patients. As a result of matching both groups were similar with regard to demographic, clinical, and infarction characteristics, as well as procedural data and adjunctive medication. SES diameter was 3.0 +/- 0.1 versus 3.3 +/- 0.5 mm with BMS, while the length of stented segment was 24 +/- 11 mm with SES versus 16 +/- 8 mm with BMS (p<0.05). No subacute stent thrombosis occurred in either group. At 6 months, all-cause mortality was 2.0% with SES, and 4.0% with BMS (n. s.); reinfarction rate was 2.0% in both groups, but binary restenosis rate (4.0 versus 18.0%; p<0.05) and target vessel revascularization (TVR) were improved with SES (2.0 versus 16.0%; p<0.05) resulting in lower MACE rate of 6.0 versus 22.0% with BMS (p<0.05).

CONCLUSION

Placement of SES with PCI for myocardial infarction is feasible and as safe as BMS; 6-month outcome is superior with SES due to the lower rate of both angiographic restenosis and TVR.

Medical thoracoscopy: hormone receptor content in pleural metastases due to breast cancer

Pleural metastases are common in the course of breast cancer, but, to date, the role of oestrogen receptor (OR) and progesterone receptor (PgR) content in metastatic tissue has been poorly evaluated. A series of 50 consecutive patients with a history of breast cancer (median age 64 yrs, range 40-86 yrs), which presented with pleural effusion and therefore underwent medical thoracoscopy, was analysed. Metastatic pleural involvement was histologically confirmed in all patients. The hormone receptor status of the pleural metastases was investigated using the immunohistochemical method in 49 and the biochemical method in 31 cases. The immunohistochemical test was performed using monoclonal antibodies. Biochemical analysis was performed on specimens quick-frozen in liquid nitrogen. OR and PgR were measured with the dextran-coated charcoal assay and Scatchard analysis. Immunohistochemical analysis yielded 29 OR-positive and 25 PgR-positive cases and biochemical analysis yielded 16 OR-positive and four PgR-positive cases, sometimes discrepant to hormone status of the primary breast cancer. Using a semiquantitative immunoreactive score, there was a significant association between receptor positivity and survival, but only for PgR positivity. Immunohistochemical and biochemical detection of hormone receptors (oestrogen and progesterone) in pleural metastases of breast cancer is feasible based on medical thoracoscopy as the method of choice, by which sufficient specimens may be obtained. The receptor status may enable a decision on antihormonal treatment. Whether a positive receptor status in pleural metastatic tissue is associated with a better prognosis remains to be confirmed.

Restless legs syndrome: an overview of the current understanding and management

Over the last few years, major progress in research has improved our understanding of the restless legs syndrome (RLS). Although frequently under-diagnosed, several epidemiological studies have estimated its prevalence in western countries at 4-10% of the general population. Its diagnosis is usually made on a clinical basis, according to the criteria established by the International RLS Study Group (Mov Disord 1995; 10:634). Furthermore, major advances have also been achieved regarding our understanding of the pathophysiology of the disorder. Thus, several brain imaging studies, as well as pharmacological challenges, suggest the presence of a dopaminergic dysfunction playing a major role in its causation. In addition, a strong association has been discovered between brain iron deficiency and RLS. Eventually, dopaminergic drugs have shown therapeutic efficacy in various large-scale therapeutic trials, and, today, dopaminergic agonists represent the first line of treatment. In conclusion, these and other recent findings shed light on our understanding and management of one of the most common movement disorders.

Shower PUVA: A Novel Variant of Photochemotherapy

Shower PUVA is a new variant of photochemotherapy suitable for therapy of various skin disorders. Psoralen, e.g. trioxsalen-containing water recirculates in a closed shower system and wets the skin continuously. After showering, whole-body UVA irradiation (320-400 nm) is performed. In order to prove the equal distribution of photosensitivity in vivo minimal phototoxic dose (MPD) was determined in different skin areas of healthy individuals. Additionally, we investigated the accumulation of trioxsalen in psoriasis lesions under the conditions described by quantifying psoralen in scales collected after showering. In a randomized study 20 healthy volunteers (skin type I-III) took showers for 5 and 10 min in trioxsalen (0.27 mg/l)-containing water at 37 degrees C. Immediately afterwards, MPD was tested on the inside of the upper arms and on the buttocks by using a polychromator light source (315-400 nm). The applied UVA doses were 0.06-0.75 J/cm(2) with steps of 0.125 J/cm(2). MPD was evaluated after 72 h. Equal distribution of photosensitivity was defined as equal MPD on the insides of the upper arm and the buttocks (+/-0.125 J/cm(2)). Skin scales of 21 patients with psoriasis were collected by scratching after showering with trioxsalen-containing water (0.27 mg/l) for 5 min. For quantification of trioxsalen in the scales HPLC was performed. An equal distribution of photosensitivity was achieved in 70% (14/20) cases after 10-min showering in trioxsalen-containing water. Showering for 5 min only revealed a 30% (6/20) rate of equal distributed photosensitivity. After 10-min shower time MPD was 0.325 J/cm(2) (median; range: 0.06-0.625 J/cm(2)). The average amount of trioxsalen found in the scales was 2.03 ng/mg scales (range: 0.38-7.2 ng/mg). For shower PUVA using trioxsalen, 10 min shower time is recommended to achieve sufficient distribution of photosensitivity on the skin. Clinical efficacy of shower PUVA can be explained by skin accumulation of trioxsalen which enters from the aqueous phase into the upper skin layers in detectable amounts. This is the first report demonstrating the efficacy of shower PUVA which in short shower time allows an uptake of psoralen by the skin.

L-DOPA-induced excessive daytime sleepiness in PD: a placebo-controlled case with MSLT assessment

A 74-year-old patient with idiopathic Parkinson's disease was evaluated for unintended sleep episodes that occurred after long-term treatment with 400 mg/day of L-dopa. Overnight sleep studies and multiple sleep latency testing were carried out under double-blind administration of either L-dopa or placebo. Mean sleep latency with L-dopa was 7 minutes, in contrast to a normal value of 19 minutes, 25 seconds with placebo. The authors' results suggest that L-dopa may cause daytime somnolence in some patients with Parkinson's disease.

Spatiotemporal effects of microstimulation in rat neocortex: a parametric study using multielectrode recordings

Using microstimulation to imprint meaningful activity patterns into intrinsically highly interconnected neuronal substrates is hampered by activation of fibers of passage leading to a spatiotemporal "blur" of activity. The focus of the present study was to characterize the shape of this blur in the neocortex to arrive at an estimate of the resolution with which signals can be transmitted by multielectrode stimulation. The horizontal spread of significant unit activity evoked by near-threshold focal electrical stimulation (charge transfer 0.8-4.8 nC) and multielectrode recording in the face representation of the primary somatosensory cortex of ketamine anesthetized rats was determined to be about 1,350 microm. The evoked activity inside this range consisted in a sequence of fast excitatory response followed by an inhibition lasting >100 ms. These 2 responses could not be separated by varying the intensity of stimulation while a slow excitatory rebound after the inhibitory response was restricted to higher stimulus intensities (>2.4 nC). Stimulation frequencies of 20 and 40 Hz evoked repetitive excitatory response standing out against a continuous background of inhibition. At 5- and 10-Hz stimulation, the inhibitory response showed a complex interaction pattern attributed to highly sublinear superposition of individual inhibitory responses. The present data help to elucidate the neuronal underpinnings of behavioral effects of microstimulation. Furthermore, they provide essential information to determine spatiotemporal constraints for purposeful multielectrode stimulation in the neocortex.