Point-light display: a new tool to improve verb recovery in patients with aphasia? A pilot study

Some studies have demonstrated that Action Observation (AO) could help patients with aphasia to recover use of verbs. However, the role of kinematics in this effect has remained unknown. The main aim was to assess the effectiveness of a complementary intervention based on the observation of action kinematics in patients with aphasia. Seven aphasic patients (3 males, 4 females) aged between 55 and 88 years participated in the studies. All patients received a classical intervention and an additional, specific intervention based on action observation. This consisted in visualizing a static image or a point-light sequence representing a human action and in trying to name the verb representing the action. In each session, 57 actions were visualized: 19 represented by a static drawing, 19 by a non-focalized point-light sequence, i.e., a point-light display with all dots in white, and 19 by a focalized point-light sequence, i.e., a point-light display (PLD) with the dots corresponding to the main limbs in yellow. Before (pre-test) and after (post-test) the intervention, each patient performed the same denomination task, in which all actions were presented in photographs. The results showed a significant improvement in performance between pre and post-test, but only when the actions were presented in focalized and non-focalized point-light sequences during the intervention. The presentation of action kinematics seems crucial in the recovery of verbs in patients with aphasia. This should be considered by speech therapists in their interventions.

Spinal Cord Stimulation-Naïve Patients vs Patients With Failed Previous Experiences With Standard Spinal Cord Stimulation: Two Distinct Entities or One Population?

INTRODUCTION

Nowadays, the success of spinal cord stimulation (SCS) is evaluated separately in patients who have previous experiences with standard SCS and in SCS-naïve patients. Nevertheless, it is yet to be evaluated whether both patient groups are effectively distinct patient groups. Therefore, the aims of this study are twofold: 1) Are there clusters in the data to distinguish between both patient groups? 2) Can we discriminate both patient groups based on routinely collected clinical parameters?

MATERIALS AND METHODS

Baseline data from the Discover study were used, in which 263 patients with persistent spinal pain syndrome type 2 were included (185 neurostimulation-naïve patients and 78 patients with previous SCS experience). Pain intensity scores for low back and leg pain, functional disability, medication use, and health-related quality of life utility scores were used in the analysis. Model-based clustering was performed on standardized data. Discriminant analysis was performed with linear and quadratic discriminant analysis, with leave-one-out cross-validation to evaluate model performance.

RESULTS

Model-based clustering revealed two different clusters in the data. None of the clusters clearly separated SCS-naïve patients from patients with previous SCS experience. Linear discriminant analysis resulted in a leave-one-out cross-validation error rate of 30.0% to discriminate between both patient groups, based on routinely collected clinical parameters.

CONCLUSIONS

Clustering analysis did not result in clusters that separate SCS-naïve patients from patients with previous SCS experience. This may suggest that both patient groups should not be considered as two different patient groups when comparing them on routine clinical parameters, with potentially profound implications for research and clinical settings.

CLINICAL TRIAL REGISTRATION

The Clinicaltrials.gov registration number for the Discover study is NCT02787265.

A 6-Month Home-Based Functional Electrical Stimulation Program for Foot Drop in a Post-Stroke Patient: Considerations on a Time Course Analysis of Walking Performance

Foot drop is a common disability in post-stroke patients and represents a challenge for the clinician. To date, ankle foot orthosis (AFO) combined with conventional rehabilitation is the gold standard of rehabilitation management. AFO has a palliative mechanical action without actively restoring the associated neural function. Functional electrical stimulation (FES), consisting of stimulation of the peroneal nerve pathway, represents an alternative approach. By providing an FES device (Bioness L-300, BIONESS, Valencia, CA, USA) for 6 months to a post-stroke 22-year-old woman with a foot drop, our goal was to quantify its potential benefit on walking capacity. The gait parameters and the temporal evolution of the speed were collected with a specific connected sole device (Feet Me^®) during the 10-m walking, the time up and go, and the 6-minute walking tests with AFO, FES, or without any device (NO). As a result, the walking speed changes on 10-m were clinically significant with an increase from the baseline to 6 months in AFO (+0.14 m.s⁻¹), FES (+0.36 m.s⁻¹) and NO (+0.32 m.s⁻¹) conditions. In addition, the speed decreased at about 4-min in the 6-minute walking test in NO and AFO conditions, while the speed increased in the FES conditions at baseline and after 1, 3, and 6 months. In addition to the walking performance improvement, monitoring the gait speed in an endurance test after an ecological rehabilitation training program helps to examine the walking performance in post-stroke patients and to propose a specific rehabilitation program.

The Link Between Spinal Cord Stimulation and the Parasympathetic Nervous System in Patients With Failed Back Surgery Syndrome

OBJECTIVES

In patients with chronic pain, a relative lower parasympathetic activity is suggested based on heart rate variability measurements. It is hypothesized that spinal cord stimulation (SCS) is able to influence the autonomic nervous system. The aim of this study is to further explore the influence of SCS on the autonomic nervous system by evaluating whether SCS is able to influence skin conductance, blood volume pulse, heart rate, and respiration rate.

MATERIALS AND METHODS

Twenty-eight patients with Failed Back Surgery Syndrome (FBSS), who are treated with SCS, took part in this multicenter study. Skin conductance and cardiorespiratory parameters (blood volume pulse, heart rate, and respiration rate) were measured during on and off states of SCS. Paired statistics were performed on a 5-min recording segment for all parameters.

RESULTS

SCS significantly decreased back and leg pain intensity scores in patients with FBSS. Skin conductance level and blood volume pulse were not altered between on and off states of SCS. Heart rate and respiration rate significantly decreased when SCS was activated.

CONCLUSIONS

Parameters that are regulated by the sympathetic nervous system were not significantly different between SCS on and off states, leading to the hypothesis that SCS is capable of restoring the dysregulation of the autonomic nervous system by primarily increasing the activity of the parasympathetic system, in patients with FBSS.

Wolbachia strain wAlbA blocks Zika virus transmission in Aedes aegypti

Transinfections of the maternally transmitted endosymbiont Wolbachia pipientis can reduce RNA virus replication and prevent transmission by Aedes aegypti, and also have the capacity to invade wild-type populations, potentially reaching and maintaining high infection frequencies. Levels of virus transmission blocking are positively correlated with Wolbachia intracellular density. Despite reaching high densities in Ae. aegypti, transinfections of wAlbA, a strain native to Aedes albopictus, showed no blocking of Semliki Forest Virus in previous intrathoracic injection challenges. To further characterize wAlbA blocking in Ae. aegypti, adult females were intrathoracically challenged with Zika (ZIKV) and dengue viruses, and then fed a ZIKV-containing bloodmeal. No blocking was observed with either virus when challenged by intrathoracic injection. However, when ZIKV was delivered orally, wAlbA-infected females showed a significant reduction in viral replication and dissemination compared with uninfected controls, as well as a complete absence of virus in saliva. Although other Wolbachia strains have been shown to cause more robust viral blocking in Ae. aegypti, these findings demonstrate that, in principle, wAlbA could be used to reduce virus transmission in this species. Moreover, the results highlight the potential for underestimation of the strength of virus-blocking when based on intrathoracic injection compared with more natural oral challenges.

Wolbachia transinfections in Culex quinquefasciatus generate cytoplasmic incompatibility

Culex quinquefasciatus is an important mosquito vector of a number of viral and protozoan pathogens of humans and animals, and naturally carries the endosymbiont Wolbachia pipientis, strain wPip. Wolbachia are used in two distinct vector control strategies: firstly, population suppression caused by mating incompatibilities between mass-released transinfected males and wild females; and secondly, the spread of pathogen transmission-blocking strains through populations. Using embryonic microinjection, two novel Wolbachia transinfections were generated in C. quinquefasciatus using strains native to the mosquito Aedes albopictus: a wAlbB single infection, and a wPip plus wAlbA superinfection. The wAlbB infection showed full bidirectional cytoplasmic incompatibility (CI) with wild-type C. quinquefasciatus in reciprocal crosses. The wPipwAlbA superinfection showed complete unidirectional CI, and therefore population invasion potential. Whereas the wAlbB strain showed comparatively low overall densities, similar to the native wPip, the wPipwAlbA superinfection reached over 400-fold higher densities in the salivary glands compared to the native wPip, suggesting it may be a candidate for pathogen transmission blocking.

Renal dysfunction by baseline CD4 cell count in a cohort of adults starting antiretroviral treatment regardless of CD4 count in the HIV Prevention Trials Network 071 [HPTN 071; Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART)] study in South Africa

OBJECTIVES

Renal dysfunction is a significant cause of morbidity and mortality among HIV-positive individuals. This study evaluated renal dysfunction in a cohort of adults who started antiretroviral treatment (ART) regardless of CD4 count at three Department of Health (DOH) clinics included in the HIV Prevention Trials Network 071 (HPTN 071) Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART) trial.

METHODS

A retrospective cohort analysis of routine data for HIV-positive individuals starting ART between January 2014 and November 2015 was completed. Incident renal dysfunction was defined as an estimated glomerular filtration rate (eEGFR) < 60 mL/min after ART initiation among individuals with a baseline (pre-ART) eGFR ≥ 60 mL/min.

RESULTS

Overall, 2423 individuals, with a median baseline CD4 count of 328 cells/μL [interquartile range (IQR) 195-468 cells/μL], were included in the analysis. Forty-seven individuals had a baseline eGFR < 60 mL/min. Among 1634 nonpregnant individuals started on a tenofovir-containing ART regimen and with a baseline eGFR ≥ 60 mL/min, 27 developed an eGFR < 60 mL/min on ART. Regression analysis showed lower odds of baseline eGFR < 60 mL/min at baseline CD4 counts of > 500 cells/μL [adjusted odds ratio (aOR) 0.29; 95% confidence interval (CI) 0.11-0.80], 351-500 cells/μL (aOR 0.22; 95% CI 0.08-0.59) and 201-350 (aOR 0.48; 95% CI: 0.24-0.97) compared with baseline CD4 counts < 200 cells/μL.

CONCLUSIONS

This study showed low rates of renal dysfunction at baseline and on ART, with lower rates of baseline renal dysfunction among individuals with baseline CD4 counts > 200 cells/μL. Strategies that use baseline characteristics, such as age, to identify individuals at high risk of renal dysfunction on ART for enhanced eGFR monitoring may be effective and should be the subject of future research.

Brain organic cation transporter 2 controls response and vulnerability to stress and GSK3β signaling

Interactions between genetic and environmental factors, like exposure to stress, have an important role in the pathogenesis of mood-related psychiatric disorders, such as major depressive disorder. The polyspecific organic cation transporters (OCTs) were shown previously to be sensitive to the stress hormone corticosterone in vitro, suggesting that these transporters might have a physiologic role in the response to stress. Here, we report that OCT2 is expressed in several stress-related circuits in the brain and along the hypothalamic-pituitary-adrenocortical (HPA) axis. Genetic deletion of OCT2 in mice enhanced hormonal response to acute stress and impaired HPA function without altering adrenal sensitivity to adrenocorticotropic hormone (ACTH). As a consequence, OCT2(-/-) mice were potently more sensitive to the action of unpredictable chronic mild stress (UCMS) on depression-related behaviors involving self-care, spatial memory, social interaction and stress-sensitive spontaneous behavior. The functional state of the glycogen synthase kinase-3β (GSK3β) signaling pathway, highly responsive to acute stress, was altered in the hippocampus of OCT2(-/-) mice. In vivo pharmacology and western blot experiments argue for increased serotonin tonus as a main mechanism for impaired GSK3β signaling in OCT2(-/-) mice brain during acute response to stress. Our findings identify OCT2 as an important determinant of the response to stress in the brain, suggesting that in humans OCT2 mutations or blockade by certain therapeutic drugs could interfere with HPA axis function and enhance vulnerability to repeated adverse events leading to stress-related disorders.

Treatment with prolonged-release oxycodone/naloxone improves pain relief and opioid-induced constipation compared with prolonged-release oxycodone in patients with chronic severe pain and laxative-refractory constipation

PURPOSE

Laxative-refractory opioid-induced constipation (OIC) is defined as OIC despite using 2 laxatives with a different mechanism of action (based on the Anatomical Therapeutic Chemical Classification System level 4 term [contact laxatives, osmotically acting laxatives, softeners/emollients, enemas, and others]). OIC has a significant impact on the treatment and quality of life of patients with severe chronic pain. This noninterventional, observational, real-life study in Belgium investigated the efficacy of prolonged-release oxycodone/naloxone combination (PR OXN) treatment regarding pain relief and OIC compared with previous prolonged-release oxycodone (PR OXY) treatment for laxative-refractory OIC in daily clinical practice.

METHODS

Laxative-refractory OIC patients with severe chronic pain were treated with PR OXN for 12 weeks (3 visits). Pain relief (assessed on a numerical rating scale) and OIC (assessed by using the Bowel Function Index [BFI]) were evaluated at each visit. A responder was defined as a patient who had: (1) no worsening of pain at the last visit compared with visit 1 or a numerical rating scale ≤4 at visit 3/last visit; and (2) a reduction in BFI ≥12 units at visit 3/last visit compared with visit 1; or (3) a BFI ≤28.8 at visit 3/last visit.

FINDINGS

Sixty-eight laxative-refractory OIC patients with severe chronic pain (mean (sd) age 59.8 (13.3) years, 67.6% female and 91.2% non-malignant pain) were treated for 91 days with PR OXN (median daily dose, 20 mg). Treatment with PR OXN resulted in a significant and clinically relevant decrease of pain of 2.1 units (P < 0.001; 95% CI, 1.66-2.54) and of BFI by 48.5 units (P < 0.001; 95% CI, 44.4-52.7) compared with PR OXY treatment; use of laxatives was also significantly reduced (P < 0.001). Approximately 95% of patients were responders, and quality of life (as measured by using the EQ-5D) improved significantly. Adverse events were opioid related, and PR OXN treatment was well tolerated.

IMPLICATIONS

Treatment with PR OXN resulted in a significant and clinically relevant reduction in OIC compared with previous PR OXY treatment for these patients with severe chronic pain and laxative-refractory OIC. Treatment with PR OXN also resulted in a significant improvement in pain relief and quality of life. ClinicalTrials.gov identifier: NCT01710917.

Transdermal buprenorphine in pain management--experiences from clinical practice: Five case studies

Buprenorphine is a semi-synthetic opioid derived from thebaine. The transdermal formulation of buprenorphine has been available in Belgium for 3 years, during which time the Pain Clinic of the St Elisabeth of Verviers Hospital has gained experience in the use of transdermal buprenorphine for the treatment of moderate-to-severe pain. This paper presents four cases of chronic, non-malignant pain, and one case of chronic cancer pain. By starting patients on low doses and slowly titrating upwards, transdermal buprenorphine matrix patches provided effective analgesia and were well tolerated. Low doses of transdermal buprenorphine were created by cutting the smallest available matrix patch (35 mug/h) into halves or quarters. The initial dose was then gradually titrated upwards to the dose needed for optimum pain relief by the patients. No problems were encountered in switching patients from prior analgesic therapy with other opioids to transdermal buprenorphine.

[Bronchial obstruction and the ideopathic hyper-eosinophilic syndrome]

The idiopathic hyper-eosinophilic syndrome is defined as a peripheral blood eosinophilia greater than 1.5 x 10(9)/litre present for at least 6 months and associated with visceral involvement. It may only be accepted after carefully excluding the other common or rare causes of hyper-eosinophilia and should remain a diagnosis of exclusion. The associated visceral lesions are multiple and non-specific. Among these neurological, digestive, dermatological and cardiac manifestations are the most frequently described. Whereas pleuro-pulmonary involvement is also common, asthma is rarely reported. We report a case of ideopathic hyper-eosinophilic syndrome presenting as asthma. This was secondary to eosinophilic infiltration of the bronchial mucosa as demonstrated by cytological examination of induced sputum.

[Post-traumatic endocrine deficits : analysis of a series of 93 severe traumatic brain injuries]

OBJECTIVE

The aim of the study is to measure the incidence in severe traumatic brain injury of endocrine deficits with special consideration for hypotestosteronemia in male patients.

PATIENTS AND METHODS

Retrospective analysis of a series of 115 TBIs consecutively admitted to our brain injury unit. Endocrine screening is routinely performed at admission and includes radioimmunological assays for T3, T4, TSH, testosterone or oestradiol and progesterone, FSH, LH and cortisol. Twenty-two records were incomplete and excluded from further analysis. The analysis relies on 93 records among which those of 75 males.

RESULTS

One partial hypothyroidism of pituitary origin (low T3, T4 and TSH and no raise of TSH after stimulation by TRH) and one posthypophyseal deficit were found. The incidence of hypotestosteronemia is 28%. All are of central origin (low testosterone and low or normal LH). In one case the hypothalamic origin is demonstrated by the considerable increase of LH after injection of GnRH. We found no correlation between the occurrence of endocrine deficit and either the Glasgow Coma Scale or the existence of basal skull fracture.

DISCUSSION - CONCLUSION

These results show that endocrine deficits are not exceptional in TBIs and that isolated hypotestosteronemia is frequent. These deficits are not necessarily all of functional origin, but further studies including longitudinal follow up are required to conclude on this point. Further studies addressing the opportunity of substitution in some patients should also be conducted.

Reversion of the differentiated phenotype and maturation block in Sertoli cells in pathological human testis

To study the relationship between abnormal Sertoli cell differentiation and spermatogenic impairment, we examined the expression of Sertoli cell markers normally lost at puberty, cytokeratin 18 (CK18), anti-Müllerian hormone (AMH) and M2A antigen, in three children (aged 1-2 years), 50 adults (aged 19-45 years) with obstructive or non-obstructive azoospermia or oligozoospermia, and six patients (aged 1-18 years) with 5 alpha-reductase deficiency. There was CK18 and/or AMH expression, but never M2A antigen expression, associated with spermatogonial arrest or Sertoli cell-only (SCO) syndrome in infertile men. Loss of M2A antigen suggests the transition of Sertoli cells to an adult phenotype, while CK18 and/or AMH expression may be a manifestation of de-differentiation of Sertoli cells. In 5 alpha-reductase deficiency, there was a sequential loss of CK18, M2A antigen and AMH around puberty, associated with partial spermatogenesis. The persistence of immature Sertoli cells expressing M2A antigen was associated with prepubertal seminiferous cords and SCO syndrome. Therefore, 5 alpha-reductase deficiency may prevent the maturation of Sertoli cells, resulting in impairment of spermatogenesis, and loss of M2A antigen expression coincides with a critical step in the Sertoli cell maturation. High follicle stimulating hormone concentrations due to failure of normal Sertoli cell differentiation indicate a normal development pattern of the hypothalamic-pituitary-gonadal axis.

Receptors for anti-müllerian hormone on Leydig cells are responsible for its effects on steroidogenesis and cell differentiation

Strong overexpression of anti-Müllerian hormone (AMH) in transgenic mice leads to incomplete fetal virilization and decreased serum testosterone in the adult. Conversely, AMH-deficient mice exhibit Leydig cell hyperplasia. To probe the mechanism of action of AMH on Leydig cell steroidogenesis, we have studied the expression of mRNA for steroidogenic proteins in vivo and in vitro and performed a morphometric analysis of testicular tissue in mice overexpressing the hormone. We show that overexpression of AMH in male transgenic mice blocks the differentiation of Leydig cell precursors. Expression of steroidogenic protein mRNAs, mainly cytochrome P450 17 alpha-hydroxylase/C17-20 lyase (P450c17), is decreased in transgenic mice overexpressing AMH and in AMH-treated purified Leydig cells. In contrast, transgenic mice in whom the AMH locus has been disrupted show increase expression of P450c17. In vitro, but not in vivo, AMH also decreases the expression of the luteinizing hormone receptor. The effect of AMH is explained by the presence of its receptor on Leydig cells. Our results provide insight into the action of AMH as a negative modulator of Leydig cell differentiation and function.

Testicular dysgenesis does not affect expression of anti-müllerian hormone by Sertoli cells in premeiotic seminiferous tubules

Anti-Müllerian hormone (AMH) immunoreactivity was studied on paraffin sections obtained from archival testicular biopsies of 29 children with intersex disorders and of 22 controls. Strong AMH immunoreactivity was observed in Sertoli cell cytoplasm from 8 fetal weeks until puberty. During pubertal maturation, in both normal and intersex patients, AMH expression was present in premeiotic seminiferous tubules, but was no longer detected in neighboring tubules with meiotic development. AMH immunostaining was abolished in the testis of one patient with persistent Müllerian ducts due to a mutation of the AMH gene, but was conserved in the testes of two patients with mutations of the AMH receptor gene. Testicular dysgenesis usually results in sexual ambiguity, with low testosterone and AMH serum levels and persistence of Müllerian derivatives. AMH immunoreactivity was conserved in premeiotic seminiferous tubules of dysgenetic testes, and also in sex-cord cells of a gonadoblastoma. In patients with asymmetric gonadal differentiation, the streak gonad was AMH-negative. In conclusion, secretion of AMH is a constitutive feature of the immature Sertoli cell and its expression is altered only by mutations of the AMH gene, but not by gonadal dysgenesis. The degree of regression of Müllerian ducts and serum AMH levels reflect the number, not the functional value, of Sertoli cells present in the immature testis.

Immunohistochemical detection of immature Sertoli cell markers in testicular tissue of infertile adult men: a preliminary study

Testicular biopsy specimens from oligozoospermic infertile patients are characterized by different types of spermatogenic impairment in adjacent seminiferous tubules, a phenomenon called mixed atrophy. In order to evaluate possible involvement of the state of Sertoli cell differentiation, the distribution pattern of anti-Müllerian hormone (AMH), vimentin and cytokeratin intermediate filament proteins was investigated by means of immunohistochemistry. AMH immunoactivity occurs in Sertoli cells of the normal postnatal prepubertal testis, but it is absent in the adult testis with normal spermatogenesis. In the case of mixed atrophy, AMH immunoactivity was found in Sertoli cells of tubules showing spermatogenic arrest at the level of spermatogonia and in tubules showing Sertoli-cell-only (SCO) syndrome. Vimentin was expressed regularly in Sertoli cells independent of spermatogenic impairment or the state of Sertoli cell differentiation. Cytokeratin immunoactivity occurs in Sertoli cells of the normal postnatal prepubertal testis. Furthermore, cytokeratin expression was found in Sertoli cells of tubules showing spermatogenic arrest at the level of spermatogonia and in some SCO tubules. Co-expression of AMH and cytokeratin suggests that spermatogenic impairment such as spermatogenic arrest and SCO syndrome in human seminiferous tubules is associated with a population of Sertoli cells showing a prepubertal stage of development. The different pattern of AMH and cytokeratin expression in SCO tubules indicates that Sertoli cells in SCO syndrome show a mosaic pattern of differentiation.

Ontogeny of reproductive abnormalities induced by deregulation of anti-müllerian hormone expression in transgenic mice

Anti-müllerian hormone, normally responsible for the regression of müllerian ducts in male fetuses, induces stunting, germ cell loss, and seminiferous tubule formation in ovaries of bovine freemartin fetuses and of transgenic mice, which express the human anti müllerian hormone gene under the control of the metallothionein promoter. Because the latter have been studied only after birth, we undertook a detailed chronological study of their reproductive organs. Müllerian ducts of transgenic female fetuses regressed at the same time as those of normal or transgenic males. Maximal reduction of germ cell number occurred between 16 days postcoitus and birth, when most transgenic oocytes were still in the leptotene stage of the meiotic prophase, whereas normal oocytes had already reached the pachytene phase. Interference with progression of the meiotic prophase and germ cell loss in the fetal ovary are probably responsible for subsequent ovarian regression and retardation of follicle growth. Seminiferous tubule formation was not detectable prior to birth and occurred only rarely in postnatal ovaries. Aromatase activity of fetal transgenic ovaries was decreased, as well as serum concentration of testosterone in adult transgenic males, suggesting that high levels of anti-müllerian hormone may impair Leydig cell steroidogenesis.

Bronchopulmonary sequestration: prenatal diagnosis with clinicopathologic correlation

A patient was referred at 21 weeks' gestation for evaluation of an echogenic mass in the fetal right chest. Color-doppler sonography facilitated the diagnosis of a bronchopulmonary sequestration. Clinicopathologic correlation was possible after termination at 2.3 weeks' gestation. Pathologic examination confirmed the prenatal diagnosis and demonstrated the systemic vascular supply seen on color-doppler sonography. Color doppler is a useful adjunct in the sonographic evaluation of the fetus with an echogenic chest mass.

Maternal awareness and neonatal outcome after ketamine induction of anaesthesia for Caesarean section

Ketamine was used as the sole anaesthetic during the induction-to-delivery interval in 20 full-term patients undergoing elective Caesarean section. The intravenous administration of ketamine 1.5 mg.kg-1 was followed by succinylcholine 1.5 mg.kg-1 and tracheal intubation. The mother's lungs were then ventilated using 100 per cent oxygen until the baby was delivered. Intraoperative maternal awareness was assessed by the isolated forearm technique. The Apgar scores of the newborn at one and five minutes, as well as their umbilical vein blood gases were also evaluated and correlated with the induction-to-delivery (I-D) and the uterine incision-to-delivery (U-D) intervals. In 13 patients (Group A) the I-D interval was less than 10 min and U-D interval less than 90 sec, while in seven (Group B) the I-D interval was greater than or equal to 10 min and the U-D interval greater than or equal to 90 sec. The isolated arm test was negative in all patients having an I-D interval less than 10 min, and was positive in three patients when the I-D interval exceeded ten minutes. The newborns of group A showed higher Apgar scores at one minute, as well as higher umbilical vein PO2 than was achieved in Group B. It was concluded that the technique used was not associated with maternal awareness or neonatal depression, provided that the I-D interval was less than 10 min and the U-D interval was less than 90 sec.

Awareness following different techniques of general anaesthesia for caesarean section

Using the isolated arm technique, the frequency of awareness was evaluated in 50 full-term patients undergoing elective Caesarean section under general anaesthesia. In 20 patients, anaesthesia was induced with thiopentone 4 mg kg-1, and in the other 30 patients, induction was with ketamine 1.5 mg kg-1. Following suxamethonium 1.5 mg kg-1 and tracheal intubation, anaesthesia was supplemented during the induction-delivery period in the thiopentone group with 50% nitrous oxide and 0.5% halothane in oxygen in 10 patients, and with 1% halothane in 100% oxygen in the other 10 patients. In the ketamine group, the patients underwent ventilation with 50% nitrous oxide and 0.5% halothane in oxygen in 10 patients, with 1% halothane in 100% in 10 patients, and with 100% oxygen only in the last 10 patients. Awareness was significantly greater after induction with thiopentone (14/20) than after ketamine (4/30). There were no significant differences in Apgar scores or umbilical vein blood-gas values in the newborns.

Pulmonary hypoplasia and osteogenesis imperfecta type II with defective synthesis of alpha I(1) procollagen

Perinatal lethal osteogenesis imperfecta (OI type II), a heritable disorder of connective tissue occurs approximately once in 60,000 live births. Phenotypic characteristics include defective cranial ossification and severe skeletal deformity due to intrauterine rib and long bone fractures. Lethal OI may be associated with intracranial hemorrhage or severe respiratory insufficiency. Pulmonary hypoplasia has been previously observed in OI type II, but has not been defined clinically. The infant described herein was born with OI type II and pulmonary hypoplasia. Pathological examination of airway branching patterns indicated that lung development had progressed to only the 10 week stage with immature acinar development. Investigation type I collagen synthesis by cultured dermal fibroblasts revealed the presence of electrophoretically abnormal alpha 1(I) polypeptides. These findings suggest that biochemically regulated processes, as well as mechanical factors, may impeded pulmonary development in similar cases of OI type II.

A method for determining simultaneously the dose and the elapsed time since irradiation using TLDs

Information about the time that has elapsed since an external radiation exposure is useful in order to determine the time of occurrence of an abnormal exposure in personal and accidental dosimetry is presented. This information can be obtained from certain irradiated thermoluminescent dosimeters. A computational method based on decay rates of thermoluminescence glow peaks has been used to estimate a range of suitable values of trap lifetimes of low temperature glow peaks. This provides a basis for the selection of an appropriate thermoluminescent material to assess not only the absorbed dose from a radiation exposure, but also the elapsed time. Experimental studies have been used to obtain additional information on decay rates as a function of energy, temperature and absorbed dose.

Obstetric diagnosis and perinatal mortality

A multidisciplinary team composed of obstetricians, pediatricians, and pathologists examined the causes of 453 consecutive perinatal deaths, which occurred between 1978 to 1982. A clear distinction between obstetric diagnosis and infant cause of death was made, and a prinicpal obstetric and infant diagnosis was assigned to each death. Perinatal death rates by obstetric category were calculated. The rates varied from 6.1 per 1000 births in uncomplicated cases to 217.4 per 1000 births in isolated intrauterine growth retardation. The causes of perinatal death within obstetric categories were tabulated. Nonviability or the complications of prematurity (65%) were the leading causes of death when there was third-trimester bleeding, premature labor, or premature rupture of membranes. Anoxia (59%) was the most frequent cause of death when there was hypertension/pre-eclampsia or other uteroplacental insufficiency states. Death from congenital abnormality accounted for 17.7% of all perinatal deaths. A focus on the causes of perinatal death with obstetric diagnostic categories helps weigh the risk of prematurity versus the risk of anoxia in the management of high-risk gravidas.

Receptor-assay for endogenous inhibitors of Na-K ATPase

It is now accepted that there is an endogenous digitalis-like substance (EDLS), previously called natriuretic factor, present in different mammalian species which participates to the regulation of the sodium balance and at least in some situations, to the genesis of hypertension. The physiological and pathophysiological role of this substance is well recognized. However, its chemical nature remains elusive. Our purpose was to define a receptor assay for this EDLS in order to be able to measure its concentration in urine and blood. To do so, we first prepared a pool of lyophylised urine from salt loaded men. The active material was isolated by Sephadex G25 chromatography. Using the same active fraction, we investigated its biological effects. Series of experiments have demonstrated the various properties of the EDLS: inducing natriuresis when injected into a rat, diminishing short circuit current in toad's bladder and colonic mucosa of rat in in vitro preparations, inhibiting Na-K ATPase activity in isolated toad's bladder cells, binding to ouabain receptors and cross-reacting with different antibodies directed against digoxin. Among these properties, the binding to ouabain receptors offers the unique opportunity to progress in our knowledges of the substance, making possible the calculation of its constant of affinity and the estimation of the molality of the active material contained in a gram of crude extract. Knowing the constant of affinity of the EDLS for its receptor would provide the best identification of the substance as long as we do not know its exact chemical nature.(ABSTRACT TRUNCATED AT 250 WORDS)

Are opioid peptides co-localized with vasopressin or oxytocin in the neural lobe of the rat?

The content of vasopressin, oxytocin, neurophysin, leucine-enkephalin, methionine-enkephalin, dynorphin-(1-13), and alpha-neoendorphin in the rat neurohypophysis was measured after different periods of dehydration and after depolarisation of isolated neural lobes and of neurosecretory nerve endings. The rates at which the amount of neurohypophysial hormone and opioid peptides decreased, and the changes in the ratios between the amount of vasopressin or oxytocin and opioid peptide in the neurohypophysis after dehydration and in the incubation medium after depolarization in vitro cast some doubt on, and can be explained by mechanisms other than co-localisation of the different peptides.

The value of endocervical curettage as part of the standard colposcopic evaluation

Whether to perform endocervical curettage (ECC) as part of a routine colposcopic examination in patients with an abnormal Papanicolaou smear remains controversial. Some studies consider ECC an essential part of a colposcopic examination regardless of the level of the squamocolumnar junction (SCJ); others consider it superfluous in cases where the SCJ can be visualized. Between January 1980 and December 1982, 278 new patients with abnormal Papanicolaou smears underwent colposcopy. Directed biopsies established the degree of cervical intraepithelial neoplasia (CIN) and ruled out invasive disease. ECC was done on every patient. A total of 51 patients (18%) had a positive ECC. Seven patients could not be evaluated because their records were incomplete. Of the 44 evaluable patients, 32 (73%) had satisfactory colposcopy. In the remaining 12 (27%) the upper limit of the transformation zone could not be seen clearly; in that group the degrees of CIN on colposcopic biopsy and ECC were in agreement in two cases; ECC revealed the degree to be less severe in four cases and more severe in six (50%). In the group with satisfactory examinations, 15 had the same degree of CIN on colposcopic biopsy and ECC; ten had less severe and seven (22%), more severe degrees of CIN on ECC. Of greatest clinical importance was that, overall, 11.5% had a positive ECC despite a satisfactory colposcopic examination. This study indicated that ECC provides unique and important information, justifying its inclusion as part of the standard evaluation of every patient undergoing colposcopy for abnormal cervical cytology.

Fetal neuroblastoma and catecholamine-induced maternal hypertension

A case of congenital neuroblastoma is presented. The interesting features are maternal symptomatology consistent with fetal production of catecholamines and the dilemmas of differential diagnosis. Observations are made on the frequency and diagnosis of fetal neoplasia. Antepartum detection of catecholamine metabolites may be the basis for the diagnosis of fetal neuroblastoma.

Simultaneous radioimmunoassay for plasma arginine-vasopressin and oxytocin using DEAE Sephadex A 25 extraction

A sensitive and specific radioimmunoassay method for simultaneous measurement of plasma arginine vasopressin (AVP) and oxytocin (OT) has been developed utilizing an extraction technique on DEAE Sephadex A25. This procedure resulted in mean recoveries of 70.7% (AVP) and 65.4% (OT) in the peptide range of 5 to 100 pg/4 ml. The sensitivity of the assay is 0.5 pg/tube for AVP and 2 pg/tube for OT. The lower limit of detection for plasma extracts was 1.2 pg AVP/ml and 5 pg OT/ml plasma. Employing this method in normal human non smokers and ad libitum fluid the basal levels (mean +/- SE) of plasma AVP are 3.5 +/- 0.2 pg/ml in males and 4.6 +/- 0.4 pg/ml in females and the basal concentrations of plasma OT are 5.1 +/- 0.3 pg/ml in males and 5.4 +/- 0.3 pg/ml in females. Dehydration and water loading produced significant changes in plasma AVP and OT concentrations and a significant correlation exists between plasma AVP and plasma (r = 0.96, p less than 0.001) and urinary (r = 0.84, p less than 0.01) osmolality, but not between plasma OT concentrations and plasma (r = 0.11, NS) and urinary (r = 0.27, NS) osmolality. These results suggest that a wide range of physiological and pathophysiological changes in plasma AVP and OT can be simultaneously measured by the extraction procedure and the radioimmunoassay described.

Phagocytosis and onset of human labor

An in vitro experimental model has been developed which allows the study of amnion lysosomal enzyme release under controlled conditions. Briefly, a layer of human amnion membrane mounted on a specially designed reaction vessel serves as the reaction surface. We have noted that the addition of particulate material to these membranes incubating in pseudoamniotic fluid results in an increased release of the lysosomal marker enzyme N-acetylglucosaminidase when compared to the release in the absence of particles. This release is completely inhibited by iodoacetate and slightly by azide. A similar increased release is also noted with the use of term amniotic fluid as incubation medium when compared to centrifuged (30,000 g/20 min) amniotic fluid. Lecithin and lysolecithin were effective in releasing increasing amounts of enzyme. This increased release was noted only from membranes of placentas collected from subjects who had undergone cesarean section prior to labor. Membranes collected from vaginal deliveries after labor showed a baseline increased release but no further stimulation upon the addition of any of the substances. These results suggest that the release of lysosomal enzymes from amnion membranes is brought about by substance(s) present in amniotic fluid. Very probably, these are surfactants. The interaction of these substances with amnion cells would eventually result in an exponential burst of prostaglandin synthesis, which would result in labor.