Geospatial epidemiology of Staphylococcus aureus in a tropical setting: an enabling digital surveillance platform

Delivery of information to clinicians on evolving antimicrobial susceptibility needs to be accurate for the local needs, up-to-date and readily available at point of care. In northern Australia, bacterial infection rates are high but resistance to first- and second-line antibiotics is poorly described and currently-available datasets exclude primary healthcare data. We aimed to develop an online geospatial and interactive platform for aggregating, analysing and disseminating data on regional bacterial pathogen susceptibility. We report the epidemiology of Staphylococcus aureus as an example of the power of digital platforms to tackle the growing spread of antimicrobial resistance in a high-burden, geographically-sparse region and beyond. We developed an online geospatial platform called HOTspots that visualises antimicrobial susceptibility patterns and temporal trends. Data on clinically-important bacteria and their antibiotic susceptibility profiles were sought from retrospectively identified clinical specimens submitted to three participating pathology providers (96 unique tertiary and primary healthcare centres, n = 1,006,238 tests) between January 2008 and December 2017. Here we present data on S. aureus only. Data were available on specimen type, date and location of collection. Regions from the Australian Bureau of Statistics were used to provide spatial localisation. The online platform provides an engaging visual representation of spatial heterogeneity, demonstrating striking geographical variation in S. aureus susceptibility across northern Australia. Methicillin resistance rates vary from 46% in the west to 26% in the east. Plots generated by the platform show temporal trends in proportions of S. aureus resistant to methicillin and other antimicrobials across the three jurisdictions of northern Australia. A quarter of all, and up to 35% of methicillin-resistant S. aureus (MRSA) blood isolates in parts of the northern Australia were resistant to inducible-clindamycin. Clindamycin resistance rates in MRSA are worryingly high in regions of northern Australia and are a local impediment to empirical use of this agent for community MRSA. Visualising routinely collected laboratory data with digital platforms, allows clinicians, public health physicians and guideline developers to monitor and respond to antimicrobial resistance in a timely manner. Deployment of this platform into clinical practice supports national and global efforts to innovate traditional disease surveillance systems with the use of digital technology and to provide practical solutions to reducing the threat of antimicrobial resistance.

Home Arm Assistance Progression Initiative (HAAPI) Trial: Robotic-Assisted Telerehabilitation for Stroke

Date Presented 4/18/2015

Stroke survivors in rural areas lack access to the specialized occupational therapy needed for functional gains in the upper extremity (UE). The Home Arm Assistance Progression Initiative (HAAPI) trial demonstrates robotic-assisted telerehabilitation as a viable means to deliver occupational therapy remotely, maintain a client-centered relationship, improve quality of life (QoL), and promote UE neuromotor recovery.

The HAAPI (Home Arm Assistance Progression Initiative) Trial: A Novel Robotics Delivery Approach in Stroke Rehabilitation

BACKGROUND

Geographical location, socioeconomic status, and logistics surrounding transportation impede access of poststroke individuals to comprehensive rehabilitative services. Robotic therapy may enhance telerehabilitation by delivering consistent and state-of-the art therapy while allowing remote monitoring and adjusting therapy for underserved populations. The Hand Mentor Pro (HMP) was incorporated within a home exercise program (HEP) to improve upper-extremity (UE) functional capabilities poststroke.

OBJECTIVE

To determine the efficacy of a home-based telemonitored robotic-assisted therapy as part of a HEP compared with a dose-matched HEP-only intervention among individuals less than 6 months poststroke and characterized as underserved.

METHODS

In this prospective, single-blinded, multisite, randomized controlled trial, 99 hemiparetic participants with limited access to UE rehabilitation were randomized to either (1) the experimental group, which received combined HEP and HMP for 3 h/d ×5 days ×8 weeks, or (2) the control group, which received HEP only at an identical dosage. Weekly communication between the supervising therapist and participant promoted compliance and progression of the HEP and HMP prescription. The Action Research Arm Test and Wolf Motor Function Test along with the Fugl-Meyer Assessment (UE) were primary and secondary outcome measures, respectively, undertaken before and after the interventions.

RESULTS

Both groups demonstrated improvement across all UE outcomes.

CONCLUSIONS

Robotic + HEP and HEP only were both effectively delivered remotely. There was no difference between groups in change in motor function over time. Additional research is necessary to determine the appropriate dosage of HMP and HEP.

The home stroke rehabilitation and monitoring system trial: a randomized controlled trial

RATIONALE

Because many individuals poststroke lack access to the quality and intensity of rehabilitation to improve upper extremity motor function, a home-based robotic-assisted upper extremity rehabilitation device is being paired with an individualized home exercise program.

AIMS/HYPOTHESIS

The primary aim of this project is to determine the effectiveness of robotic-assisted home therapy compared with a home exercise program on upper extremity motor recovery and health-related quality of life for stroke survivors in rural and underserved locations. The secondary aim is to explore whether initial degree of motor function of the upper limb may be a factor in predicting the extent to which patients with stroke may be responsive to a home therapy approach. We hypothesize that the home exercise program intervention, when enhanced with robotic-assisted therapy, will result in significantly better outcomes in motor function and quality of life.

DESIGN

A total of 96 participants within six-months of a single, unilateral ischemic, or hemorrhagic stroke will be recruited in this prospective, single-blind, multisite randomized clinical trial.

STUDY OUTCOMES

The primary outcome is the change in upper extremity function using the Action Research Arm Test. Secondary outcomes include changes in: upper extremity function (Wolf Motor Function Test), upper extremity impairment (upper extremity portion of the Fugl-Meyer Test), self-reported quality of life (Stroke Impact Scale), and affect (Centers for Epidemiologic Studies Depression Scale).

DISCUSSION

Similar or greater improvements in upper extremity function using the combined robotic home exercise program intervention compared with home exercise program alone will be interpreted as evidence that supports the introduction of in-home technology to augment the recovery of function poststroke.

Feasibility studies of robot-assisted stroke rehabilitation at clinic and home settings using RUPERT

Task based repetitive therapy has been proposed to help stroke survivors to regain functional control of arm movement. We developed a wearable exoskeleton rehabilitation robot with associated control algorithm and safety protection mechanisms, and a graphic user interface that is easy to use and intuitive to patients and therapists, as the framework for automated and customizable robot-assisted rehabilitation system for clinic and home based therapy. The system was tested in two feasibility studies. The first study involved 6 patients to receive therapeutic training during three time weekly clinic visits for 4 weeks. The second study set up the robot-assisted rehabilitation system at patient's house, where the therapeutic training was practiced on a daily base. Two patients were recruited for the home application study. Patients' performances were assessed using clinical evaluation tools, including Wolf Motor Function Test and Fugl Meyer Assessment (FMA), both before and after the training. The performances of patients during the training weeks were also objectively evaluated by using the robot sensory data.

RUPERT closed loop control design

Robot-assisted rehabilitation is an active area of research in the field of stroke rehabilitation. RUPERT is a wearable robotic exoskeleton powered by pneumatic muscle actuators. In this study, we described the structure of the controllers for the five degrees of freedom currently used by RUPERT. We applied the RUPERT on 6 stroke patients to provide robot-assisted rehabilitation therapy in a clinical study. Statistical χ(2) test on the proportion of successfully reaching targets showed that 3 out of the 6 patients demonstrated significant improvement in reaching targets successfully, and the remaining 3 did not show performance improvement or deterioration. We plan to implement the RUPERT in the patient's house for easier access and more frequent use. More significant performance results are expected.

Mapping water table depth using geophysical and environmental variables

Despite its importance, accurate representation of the spatial distribution of water table depth remains one of the greatest deficiencies in many hydrological investigations. Historically, both inverse distance weighting (IDW) and ordinary kriging (OK) have been used to interpolate depths. These methods, however, have major limitations: namely they require large numbers of measurements to represent the spatial variability of water table depth and they do not represent the variation between measurement points. We address this issue by assessing the benefits of using stepwise multiple linear regression (MLR) with three different ancillary data sets to predict the water table depth at 100-m intervals. The ancillary data sets used are Electromagnetic (EM34 and EM38), gamma radiometric: potassium (K), uranium (eU), thorium (eTh), total count (TC), and morphometric data. Results show that MLR offers significant precision and accuracy benefits over OK and IDW. Inclusion of the morphometric data set yielded the greatest (16%) improvement in prediction accuracy compared with IDW, followed by the electromagnetic data set (5%). Use of the gamma radiometric data set showed no improvement. The greatest improvement, however, resulted when all data sets were combined (37% increase in prediction accuracy over IDW). Significantly, however, the use of MLR also allows for prediction in variations in water table depth between measurement points, which is crucial for land management.

Functional neuroimaging with MEG: normative language profiles

The reliability of language-specific brain activation profiles was assessed using Magnetoencephalography (MEG) in five experiments involving ninety-seven normal volunteers of both genders ranging in age from seven to eighty-four years. MEG data were analyzed with a fully automated method to eliminate subjective judgments in the process of deriving the activation profiles. Across all experiments, profiles were characterized by significant bilateral activity centered in the superior temporal gyrus, and in activity lateralized to the left middle temporal gyrus. These features were invariant across age, gender, variation in task characteristics, and mode of stimulus presentation. The absolute amount of activation, however, did decline with age in the auditory tasks. Moreover, contrary to the commonly held belief that left hemisphere dominance for language is greater in men than in women, our data revealed an opposite albeit a not consistently significant trend.

Comparative changes in plasma concentrations of progesterone, oestradiol and LH during the ovulatory cycle in a multiple ovulating male line and a single ovulating traditional line of turkeys

The aim of this study was to compare the profile of circulating concentrations of LH, progesterone and oestradiol in a multiple ovulating male line with that of a single ovulating line of traditional turkeys. Plasma samples from seven traditional and 12 male-line turkeys were obtained every 3 h for 36 h. Male-line and traditional turkeys had single peaks of LH and progesterone that were of similar duration in both lines. The mean height of the plasma peaks of LH and progesterone were similar in the two lines and there was no detectable peak plasma oestrogen concentration. Mean plasma concentrations of LH and oestrogen were higher in single compared with multiple ovulating turkeys, whereas there were no differences in mean plasma progesterone concentrations. The results indicate that the multiple ovulation state in genetically selected high-growth lines of turkey may be the result of a correlated response in the steroidogenic capacity of ovarian tissue associated with low plasma concentrations of oestrogen rather than of a disturbance in the hormone profile of the ovulatory cycle.

Comparative changes in plasma concentrations of progesterone, oestradiol and LH during the ovulatory cycle in a multiple ovulating male line and a single ovulating traditional line of turkeys

The aim of this study was to compare the profile of circulating concentrations of LH, progesterone and oestradiol in a multiple ovulating male line with that of a single ovulating line of traditional turkeys. Plasma samples from seven traditional and 12 male-line turkeys were obtained every 3 h for 36 h. Male-line and traditional turkeys had single peaks of LH and progesterone that were of similar duration in both lines. The mean height of the plasma peaks of LH and progesterone were similar in the two lines and there was no detectable peak plasma oestrogen concentration. Mean plasma concentrations of LH and oestrogen were higher in single compared with multiple ovulating turkeys, whereas there were no differences in mean plasma progesterone concentrations. The results indicate that the multiple ovulation state in genetically selected high-growth lines of turkey may be the result of a correlated response in the steroidogenic capacity of ovarian tissue associated with low plasma concentrations of oestrogen rather than of a disturbance in the hormone profile of the ovulatory cycle.

Sequestration and phosphorylation of the prostaglandin E2 EP4 receptor: dependence on the C-terminal tail

The prostaglandin E2 (PGE2) EP4 subtype is one of four prostanoid receptors that use PGE2 as the preferred ligand. We have investigated the agonist-mediated regulation of EP4 using a multifaceted approach. Short-term (30 min) agonist challenge of recombinant EP4 expressed in human embryonic kidney 293 cells (EP4-HEK293 cells) with PGE2 (1 microM) resulted in the desensitization of intracellular cyclic AMP (cAMP) accumulation and a reduction in cell surface [3H]PGE2 specific binding sites. These events correlated with sequestration of EP4, as visualized by immunofluorescence confocal microscopy and phosphorylation, as shown by [32P]orthophosphate labeling of the receptor. Stimulation of protein kinase A activity in EP4-HEK293 cells (10 microM forskolin or 1 mM 8-bromo-cAMP) did not induce EP4 desensitization, sequestration, or phosphorylation. In contrast, stimulation of protein kinase C activity (100 nM phorbol 12-myristate 13-acetate) attenuated PGE2-induced adenylyl cyclase activity and increased EP4 phosphorylation, but did not induce sequestration or a reduction in [3H]PGE2 specific binding sites. EP4 receptors containing a third intracellular loop deletion [EP4 (del. 215-263)] or a carboxyl-terminal tail truncation [EP4 (del. 355)] of EP4 were used to demonstrate that the C-terminal tail governs sequestration as well as phosphorylation of the receptor.

Prospective randomised concurrent comparison of the COBE spectra version 4.7, COBE spectra version 6 (Auto PBSCtrade mark), and haemonetics MCS+ cell separators for leucapheresis in patients with haematological and non haematological malignancies

A prospective study of three cell separators was undertaken to compare the mononuclear cell, CD34+ cell and CFU-GM yield. Twenty patients were entered in the study; all had received chemotherapy and daily G-CSF (5 microg/kg subcutaneously) up to and including the first day of leucapheresis. The first leucapheresis was performed on the first day the peripheral blood absolute CD34+ cell count was > or =20 cells/microl. All patients underwent two leucaphereses on consecutive days. The patients were randomised to undergo either the first or second leucapheresis using the COBE Spectra Version 4.7 and then randomised to either the COBE Spectra Version 6 or Haemonetics MCS+ for the other leucapheresis. The target durations of the procedure on the COBE Spectra Version 4.7 and Version 6 were 180 minutes or 2 total blood volumes (TBV), and for the Haemonetics MCS+ was 20 cycles with four recirculations. All machines were operated on the 1997 software supplied by the respective manufacturers. The time taken for the procedure was significantly longer with both the Haemonetics MCS+ and the COBE Spectra Version 6 than the COBE Spectra Version 4.7. Both COBE Spectra versions processed significantly larger volumes of blood than the Haemonetics MCS+. The absolute yield of mononuclear cells, CFU-GM and CD34+ cells were all significantly lower with the Haemonetics MCS+ compared with both COBE Spectra versions, as were the yields per unit volume of blood processed. The product volume was significantly higher with the COBE Spectra Version 4.7 compared to the other two machines. There was no significant difference in the reduction in the platelet count following leucapheresis with any of the machines. The COBE Spectra Version 6 is particularly useful for patients with potentially poor peripheral venous access because of its increased interface stability.

Ovarian steroid hormone production in a multiple ovulating male line and a single ovulating traditional line of turkeys

Ovarian production of oestradiol and progesterone was investigated in a single ovulating traditional line and a multiple ovulating male line of turkeys. The oestradiol output from small follicles in response to LH stimulation and the aromatase activity of the residual ovary were also compared. The multiple hierarchy of follicles in the male line was shown to consist of a series of follicles of a similar size and stage of physiological maturation. The follicles of the traditional line produced significantly greater quantities of oestradiol than those of the male line. Impaired oestradiol production may have resulted in the lower plasma oestradiol concentration observed in the male line. There was no difference in follicular progesterone output between the traditional-line and male-line turkeys. The oestradiol output of whole small white follicles in response to LH stimulation was similar in the two lines and the depressed steroidogenesis of the male line was not changed. The aromatase activity of the small follicles was also lower in the male line, and there was no evidence that the male line ovary produced oestradiol in quantities proportional to its size. The results demonstrated that the hierarchy of follicles in the male line consisted of groups of follicles of similar mass and hormone output and indicated that selection for increased meat yield may have resulted in reduced ovarian steroidogenesis in male-line turkeys, in comparison with traditional, unselected turkeys.

Ovarian steroid hormone production in a multiple ovulating male line and a single ovulating traditional line of turkeys

Ovarian production of oestradiol and progesterone was investigated in a single ovulating traditional line and a multiple ovulating male line of turkeys. The oestradiol output from small follicles in response to LH stimulation and the aromatase activity of the residual ovary were also compared. The multiple hierarchy of follicles in the male line was shown to consist of a series of follicles of a similar size and stage of physiological maturation. The follicles of the traditional line produced significantly greater quantities of oestradiol than those of the male line. Impaired oestradiol production may have resulted in the lower plasma oestradiol concentration observed in the male line. There was no difference in follicular progesterone output between the traditional-line and male-line turkeys. The oestradiol output of whole small white follicles in response to LH stimulation was similar in the two lines and the depressed steroidogenesis of the male line was not changed. The aromatase activity of the small follicles was also lower in the male line, and there was no evidence that the male line ovary produced oestradiol in quantities proportional to its size. The results demonstrated that the hierarchy of follicles in the male line consisted of groups of follicles of similar mass and hormone output and indicated that selection for increased meat yield may have resulted in reduced ovarian steroidogenesis in male-line turkeys, in comparison with traditional, unselected turkeys.

A prospective randomised concurrent comparison of the COBE Spectra Version 4.7, COBE Spectra Version 6 (auto PBSC) and Haemonetics MCS+ cell separators for leucapheresis in patients with haematological and non-haematological malignancies

A prospective study of the CD34+ cell collection efficiency of three cell separators was undertaken comparing the mononuclear cell, CD34+ cell and CFU-GM yield. Twenty patients were entered in the study, all had received mobilising chemotherapy and daily G-CSF (5 microg/kg subcutaneously). The first leucapheresis was performed when the peripheral blood absolute CD34+ cell count was > or = 20 cells/microl. All patients underwent two leucaphereses on consecutive days. The patients were randomised to undergo either the first or second leucapheresis using the COBE Spectra Version 4.7 and then randomised to either the COBE Spectra Version 6 or Haemonetics MCS+ for the other leucapheresis. The target durations of the procedure on the COBE Spectra Version 4.7 and Version 6 were 180 min or two total blood volumes (TBV), and for the Haemonetics MCS+ was 20 cycles with four recirculations. All machines were operated on the 1997 software supplied by the respective manufacturers. The time taken for the procedure was significantly longer with both the Haemonetics MCS+ and the COBE Spectra Version 6 than the COBE Spectra Version 4.7. Both COBE Spectra versions processed significantly larger volumes of blood than the Haemonetics MCS+. The absolute yield of mononuclear cells, CFU-GM and CD34+ cells were all significantly lower with the Haemonetics MCS+ compared with both COBE Spectra Versions, as were the yields per unit volume of blood processed. There was no significant difference in the reduction in the platelet count following leucapheresis with any of the machines.

Development of the reproductive system in turkeys with a high or low susceptibility to prolapse of the oviduct

Lines of turkeys selected for rapid growth and high meat yield have an increased incidence of prolapse of the oviduct compared with unselected or traditional strains of turkeys. The development of the reproductive system and changes in plasma estrogen concentrations were compared in sire line and traditional turkeys with the aim of identifying any morphological or hormonal differences that could be associated with the high incidence of prolapse in the male line. Four turkeys from each strain were killed weekly from 0 to 7 wk postphotostimulation, and samples from prolapsed birds were obtained from field cases. There were no differences in the rate of development of the ovary, oviduct, uterus, vagina, sphincter ani muscle, or muscular cord of the ventral ligament between the two strains that could predispose the sire line to prolapse. Histological investigation of the uterus, vagina, muscular cord of the ventral ligament, and sphincter ani muscle 5 wk postphotostimulation in traditional, sire line, and prolapsed sire line turkeys did not reveal any differences that could be associated with prolapse. No prelay peak in plasma estradiol concentration was observed in either strain, and there was no evidence to suggest that plasma estradiol was higher in the sire line compared with the traditional turkeys. It was concluded that prolapse of the oviduct in sire line turkeys was not associated with any anatomical abnormalities or high plasma estradiol during reproductive development.

Effects of food restriction or delayed photostimulation on ovarian follicle number, plasma oestradiol concentration and vaginal collagen content in male-line turkeys

1. An experiment was conducted to test the hypothesis that severe food restriction throughout the onset of lay or delaying photostimulation by 5 weeks would decrease the number of ovarian hierarchical follicles in male-line turkeys. It was proposed that a decrease in the number of hierarchical follicles would lower plasma oestradiol concentration and be associated with higher vaginal collagen content and a lower propensity to prolapse of the oviduct. 2. Five weeks after photostimulation, neither restriction to 63% of ad libitum body weight nor delayed onset of photostimulation had any significant effect on follicle number, plasma oestradiol concentration or vaginal collagen content. 3. It was concluded that neither food restriction nor delayed photostimulation can be used to control the over-development of the ovarian hierarchy in male-line turkeys.

The relationships between vaginal collagen, plasma oestradiol and uterine prolapse in turkeys

Uterine and vaginal collagen content and plasma oestradiol concentration were measured in traditional, male-line and prolapsed male-line turkeys to investigate the higher incidence of uterine prolapse in the male-line strain. The effect of exogenous oestradiol on vaginal collagen and plasma oestradiol was also tested in the traditional and male-line strains. Vaginal collagen was significantly lower in the male-line compared to the traditional-line, while it was lowest in prolapsed male-line turkeys. Plasma oestradiol concentration was higher in the traditional-line than the male-line. No difference in plasma oestradiol concentration was found between prolapsed and non-prolapsed male-line turkeys. Administration of oestradiol for 7 days significantly raised plasma oestradiol concentration but had no effect on vaginal collagen. Decreased vaginal collagen content was associated with uterine prolapse and may predispose the male-line strain to uterine prolapse. There was no evidence from these results to support an involvement of oestradiol in uterine prolapse in male-line turkeys.

Passive immunotherapy in advanced HIV infection and therapeutic plasmapheresis in asymptomatic HIV-positive individuals: a four-year clinical experience

We have been treating patients with advanced HIV disease using passive immunotherapy (PIT). Earlier studies of PIT which have been published concerned relatively short periods of treatment: our study is by far the longest and reports also on the long-term effects of plasmapheresis on healthy HIV-infected individuals. Fifty-nine patients with an average CD4+ T-cell count of 55 per cu.mm. at baseline were transfused at monthly intervals with 500 ml of hyperimmune plasma. No disease progression or death occurred among the 8 asymptomatic patients under the treatment, which lasted for 36.25 months on average. Seven of the 15 ARC patients progressed to AIDS but none died in an average period of 25.9 months. Seven of the 36 symptomatic AIDS patients with advanced disease died in an average period of 19.6 months. PIT appears to be nontoxic and to have beneficial effects lasting at least four years under continuous treatment. It probably delays disease progression in ARC and AIDS patients, and almost certainly does so in asymptomatic late HIV infection with a very low CD4+ T-cell count. None of the 51 donors suffered adverse effects, nor did any progress to ARC or AIDS in an average period of 30.1 months. Their laboratory parameters indicated a nearly stable condition: in particular, their average CD4+ T-cell count rose from 478 to 498. The study of our plasma donors indicated that repeated and frequent plasma donation by asymptomatic HIV-infected individuals could delay disease progression, although further studies are needed to investigate this.

Differential labelling of laminin alpha 2 in muscle and neural tissue of dy/dy mice: are there isoforms of the laminin alpha 2 chain?

Laminin alpha 2, a sub-unit of the basement membrane component laminin-2, is deficient in the dy/dy and allelic dy2 J/dy2 J mouse. It is also the defective protein in a proportion of children with congenital muscular dystrophy. Linkage and mutational analysis have established that this is a primary effect caused by defects in the LAMA2 gene. Laminin alpha 2 has previously been shown to be deficient in dy/dy skeletal muscle, peripheral nervous system and brain. We report here preliminary observations on differences in detection of laminin alpha 2 in muscle, peripheral nerves and brain of dy/dy mice using three, well characterized antibodies. In normal muscle laminin alpha 2 is localized to the basement membrane of the myofibres and the Schwann cells of peripheral nerves, whilst in adult brain it is only detected on blood vessels. Our results show that there is appreciable, but slightly reduced, expression of laminin alpha 2 in skeletal muscle of dy/dy mice but almost no detectable protein in the brain, peripheral nerve and spinal nerve roots. Our observations are at present unexplained but they raise the possibility for the first time that there may be different tissue specific isoforms of laminin alpha 2. Molecular characterization of possible differences responsible for our observations may aid the identification of the mutation in the dy/dy mouse and lead to a better understanding of the role and expression of laminin alpha 2 in pathological conditions.

Riga-Fedes syndrome: natal or neonatal teeth associated with tongue ulceration. Case report

A case of natal teeth associated with traumatic ulceration to the ventral surface of the tongue (Riga-Fedes syndrome) in a four week old boy is presented. On radiographic examination, two teeth, present at birth, were found to be early erupted deciduous lower central incisors. A family history of natal teeth, all involving both lower deciduous central incisors associated with trauma to the tongue during suckling, was elicited. The ulceration healed over a period of four weeks using an innovative conservative treatment regime, involving the use of Stomahesive Wafer. Four months later the only sign of any previous pathosis was a fibrous scar on the ventral surface of the tongue.

Characterization of single-unit activity in the mediodorsal nucleus of the thalamus during expression of differential heart rate conditioning in the rabbit

Much recent evidence has shown that the thalamic-prefrontal axis is involved in Pavlovian conditioning in rabbits. However, while single cell activity in the prefrontal cortex has been previously studied during classical conditioning in rabbits, that of its thalamic projection nucleus, the mediodorsal (MD) nucleus, has not. Consequently, in the present research we recorded neuronal activity from individual cells in MD during expression of conditioned bradycardia in rabbits that received differential Pavlovian conditioning in which tones served as conditioned stimuli and periorbital shock served as unconditioned stimuli. The pattern of firing in MD was similar to that evoked in the medial prefrontal cortex (mPFC). Of 84 cells sampled, approximately 35% showed CS-evoked activity. Ninety percent of these cells showed increases in activity, while the remainder were biphasic, showing an initial increase followed by a decrease. Also, like the mPFC, some cells showed initial increases, which declined during CS presentation, while others showed gradual increases which reached their maximum at CS offset. Also some cells were responsive to the CS+ and others to the CS-. Thus, MD cells, like mPFC cells, are somewhat heterogenous with regard to responding to conditional stimuli, although, unlike the mPFC, no strictly inhibitory cells were found.

Magnetoenterography (MENG): noninvasive measurement of bioelectric activity in human small intestine

The basic electrical rhythm (BER) of the gastrointestinal tract creates minute magnetic fields that have been measured in animals using a Superconducting QUantum Interference Device (SQUID) gradiometer. The aim of this study was to measure noninvasively the biomagnetic fields of human stomach and small intestine. Twenty-one human volunteers were studied using a 37-channel SQUID gradiometer positioned over the epigastrium and umbilicus. In one volunteer additional biomagnetic recordings were performed in order to map the spatial variation of the biomagnetic fields. Cyclical waveforms consistent with gastric BER [3.0+/-0.5 cycles per minute (cpm)] and small intestine BER (10.26+/-1.74 cpm) were seen in the epigastrium and umbilicus, respectively. The mapping study identified the expected frequency gradient (12.0 cpm in duodenum, 11.3 cpm in jejunum, to 9.7 cpm in ileum) within the small intestine. Noninvasive recordings of human gastric and small intestinal BER can be obtained using a SQUID gradiometer.

Differential effects of tetrodotoxin (TTX) and high external K+ on A and C fibre compound action potential peaks in frog sciatic nerve

Monophasic compound action potentials were recorded from Rana sciatic nerves. Three distinct peaks were observed and designated A alpha, A delta and C. All peaks were abolished by replacement of the external medium with Na(+)-free solution. However, the C peak alone was unaffected by external application of 1 microM tetrodotoxin (TTX), both A peaks were completely suppressed. The C peak was also the most resistant to chronic depolarization caused by increased external K+. K+ (17.6 mM) solution reduced peak areas to 5 +/- 4, 27 +/- 11 and 63 +/- 14% of control for A alpha, A delta and C components. The C peak was therefore Na(+)-dependent, TTX-resistant and K(+)-depolarization resistant. These attributes are similar to those described for somatal TTX-resistant Na+ channels in other species. But, application of 1 microM TTX to a K(+)-depolarized nerve caused a further reduction in C peak area, suggestive of a voltage-dependent block by TTX similar to that reported for cardiac muscle Na+ channels.

Bronchial carcinoid tumors: a retrospective analysis of 126 patients

From 1970 until 1990, 8,958 cases of primary carcinoma of the lung were diagnosed at the Duke University Medical Center. During the same period, 126 patients (mean age, 53 +/- 13 years) were diagnosed with bronchial carcinoid. The overall survival was 78% for 5 years and 71% for 10 years. Surgical treatment in 106 patients included pneumonectomy (15), lobectomy (63 with 9 bronchoplastic procedures), stapled wedge resection (22), and bronchoscopic laser resection (6). The method of diagnosis was chest roentgenography (121), chest computed tomography (77), mediastinal tomography (31), bronchoscopy (81), bronchoscopic brushing and washing (50), bronchoscopic biopsy (40), transthoracic needle biopsy (27), thoracotomy (100), and autopsy (5). Univariate analysis of the medical history, presenting signs and symptoms, diagnostic test results, and pathologic data predicted improved survival (p less than 0.001) for: female sex (n = 58), asymptomatic presentation (n = 47), normal serum serotonin or urinary hydroxyindoleacetic acid levels (n = 76), peripheral location of the primary tumor (n = 50), pathologic stage I or II (n = 91), negative lymph nodes (n = 80), primary tumor 2 cm or less in diameter (n = 67), and typical histology (n = 80). No significance (p greater than 0.1) was observed for age, smoking history, race, family history of carcinoid, environmental exposure, or hemoptysis. The most important factors affecting survival defined by multivariate analysis were (p less than 0.01) pathologic stage, atypical histology, and asymptomatic presentation. Bronchial carcinoid tumors are unique, making up 1% to 2% of primary lung neoplasms and having an excellent prognosis after resection with a 95% 5-year and 93% 10-year survival for pathologic stage I disease.

Light-induced charge separation in Rhodopseudomonas viridis reaction centers monitored by Fourier-transform infrared difference spectroscopy: the quinone vibrations

Static FTIR light-induced difference spectra have been recorded for reaction centers from Rhodopseudomonas viridis in the following charge-separated states: P+QA(-)-PQA, P+QB(-)-PQB, I(-)-I, I-QA(-)-IQA, and I-QA(2-)-IQA. A comparison of the I(-)-I difference spectra with the I-QA(-)-IQA difference spectra reveals new bands which can be assigned to QA- vibrations; these vibrations are also observed in the P+QA(-)-PQA and P+QB(-)-PQB difference spectra. Through an analysis of all of the static difference spectra, the electron-transfer pathway can be monitored in the infrared from the primary donor, P, to the secondary acceptor, QB, via the intermediate acceptor, I, and the primary acceptor, QA. The difference spectra are dominated by absorbance changes of prosthetic groups, with very few identifiable contributions from amino acids and little overall structural change in the protein backbone, involving only one or two residues for the various charge-separated states. Oxidation of the primary donor in the reaction center shows the characteristic absorbance changes of the 9-keto and 10-ester carbonyl groups observed upon oxidation of bacteriochlorophyll b in a non-hydrogen-bonded environment [Ballschmiter, K. H., & Katz, J. J. (1969) J. Am. Chem. Soc. 91, 2661-2677]. Reduction of the quinones in the reaction center yields absorbance changes of the carbonyls observed during reduction of quinones in a hydrogen-bonded environment [Bauscher, M., Nabedryk, E., Bagley, K., Breton, J., & Mäntele, W. (1990) FEBS Lett. 261, 191-195].(ABSTRACT TRUNCATED AT 250 WORDS)