Neuronal response to high negative affective stimuli in major depressive disorder: An fMRI study

BACKGROUND

Disturbed emotion processing underlies depression. We examined the neuronal underpinnings of emotional processing in patients (PAT) with major depressive disorder (MDD) compared to healthy volunteers (HV) using functional magnetic resonance (fMRI) scan.

METHODS

Thirty-six MDD patients and 30 HV underwent T2-weighted fMRI assessments during the presentation of an implicit affective processing task in three conditions. They differed regarding their affective quality (=valence, high negative, low negative and neutral stimuli) and regarding the arousal based on stimuli from the International Affective Picture System.

RESULTS

Group contrasts showed lower left-sided activation in dorsolateral prefrontal cortex (DLPFC), anterior PFC, precentral and premotor cortex in PAT compared with HV (Cluster-level threshold, 5000 iterations, p<0.01). We found a significant interaction effect of valence and group, a significant effect of emotional valence and a significant effect of group. All effects were shown in brain regions within the emotional network (Cluster-level threshold, 5000 iterations, p<0.01). Higher arousal (rho=-0.33, p<0.01) and higher valence (rho=-0.33, p<0.01) during high negative stimuli presentation as well as more severe depression (Beck Depression Inventory II [BDI II]; r = 0.39, p = 0.01) were significantly negatively associated with left DLFPC activity in patients.

LIMITATIONS

Potential influence of psychopharmacological drugs on functional activation is one of the most discussed source of bias in studies with medicated psychiatric patients.

CONCLUSIONS

The results highlight the importance of left DLPFC during the processing of negative emotional stimuli in MDD. The integration of a neurophysiological model of emotional processing in MDD may help to clarify and improve therapeutic options.

Use of the round window microcatheter in the treatment of Meniere's disease

OBJECTIVES/HYPOTHESIS

Transtympanic gentamicin is an increasingly popular treatment for Meniere's disease. The present report examines the 2-year follow-up of our first 27 patients with Meniere's disease treated with the use of microdose gentamicin through the Round Window Microcatheter. We applied the 1995 American Academy of Otolaryngology-Head and Neck Surgery criteria to this patient group to analyze the results of treatment.

STUDY DESIGN

This study is an evaluation of consecutive patients with predetermined data collection on each patient.

METHODS

Patients with confirmed Meniere's disease underwent placement of the Round Window Microcatheter, which was filled with 10 mg/mL gentamicin, after placement into the round window niche was confirmed. Ten milligrams per milliliter of gentamicin was injected into the catheter by hand on two occasions after device placement in the first several patients. The remaining patients had continuous infusion of 10 mg/mL gentamicin at 1microL/h for the next 10 days. The catheter was removed 10 days after placement. All patients underwent an extensive set of hearing and vestibular tests on several occasions before, during, and after treatment.

RESULTS

In the patients in the study, vertigo was eliminated in 92.6%, with 3.7% of patients (1/27) demonstrating a mild permanent threshold shift in hearing. Tinnitus and pressure were significantly reduced in more than 65% of patients. Only one patient demonstrated a reduction of vestibular function after treatment.

CONCLUSIONS

Results of this study on this group of patients indicate that vertigo can be controlled in the long term using microdose gentamicin without a significant reduction in cochlear or vestibular function in most of the patients in our series. Our results are compared with the published literature examining transtympanic injection. In addition, the underlying science supporting this type of treatment is examined.

Length of the eustachian tube and its postnatal development: computer-aided three-dimensional reconstruction and measurement study

Eleven normal human temporal bone-eustachian tube (ET) specimens obtained from 11 individuals whose ages were 3 months to 88 years were studied to investigate the path length along the ET lumen and its postnatal development by means of a computer-aided 3-dimensional reconstruction and measurement method. The path length of the ET lumen of the 3-month-old infant was 21.2 mm, and its growth was in correlation with age to attain its adult length (average, 37.00 +/- 4.16 mm). The ratio of the length of the cartilaginous portion together with the junctional portion to the length of the bony portion was 8:1 in an infant at the age of 3 months and 4:1 in adults. That the bony portion of the ET develops relatively more than the cartilaginous and junctional portions may cause this finding. In addition, there is a developmental shift in the orientation of the cartilaginous portion with respect to the bony portion of the ET. In children, the cartilaginous and bony portions are both aligned with the line that connects the pharyngeal orifice and the tympanic orifice. In adults, however, the cartilaginous portion is angled inferiorly and laterally from the bony portion. This change may reflect the relative growth of the face.

Distribution of psammoma bodies in the internal auditory canal and its extended areas in the human temporal bone

The internal auditory canal (IAC) and its extended areas of 27 normal human temporal bone specimens were investigated histologically for the distribution of psammoma bodies. A total of 145 +/- 25 (mean +/- SE) psammoma bodies were counted in series of every tenth 30-microm-thick section. Psammoma bodies were observed in the IAC and around the labyrinthine portion of the facial nerve (FN), the geniculate ganglion of the FN, and the posterior ampullary nerve in the singular canal. The number of psammoma bodies increases with age. We believe that psammoma bodies are a normal finding of aging in the IAC. The compression of the FN by psammoma bodies in the labyrinthine portion of the facial canal and the distribution of numerous psammoma bodies surrounding the posterior ampullary nerve in the narrow singular canal raise the questions of the involvement of psammoma bodies in the FN and in vestibular dysfunction and the presence of psammoma bodies in the subarachnoid space.

Morphologic changes in the inner ear of Chinchilla laniger after middle ear administration of gentamicin in a sustained-release vehicle

The use of transtympanic gentamicin has become a popular method of treating Meniere's disease; nevertheless, many questions still remain regarding this therapy. Until investigators can control the exact amount of medicine that is administered to the ear and have an understanding of the kinetics of gentamicin, therapy will continue to rely on empirical data. Previously we described the use of a fibrin-based sustained-release vehicle impregnated with gentamicin in the middle ears of chinchillas. With this model a kinetics curve of gentamicin was defined. The inner ears of these animals were submitted for immunohistochemical and histologic analysis. We discuss the ultrastructural changes seen and correlate this to our kinetics data. We also examine measurement of hair cell damage with heat shock protein levels. By better understanding the actions of gentamicin in this animal model, we hope to facilitate safer use of intratympanic medicines in our patient population.

Postnatal development of Eustachian tube: a computer-aided 3-D reconstruction and measurement study

The postnatal development of the Eustachian tube (ET) and its surrounding structures was investigated by means of computer-aided three-dimensional (3-D) reconstruction methods in 13 normal human temporal bones, obtained from individuals 3 months to 71 years old. The cross-sectional area, width and height of the lumen in most of the cartilaginous portion of the ET were significantly smaller in children than in adults. In particular, there was a marked, age-associated difference in the shape of the lumen in the cartilaginous portion of the ET. In adults, the cross-sectional area of the lumen declined monotonically between a large opening at the pharyngeal orifice and the narrowest portion of the ET (near the border of the cartilaginous and junctional regions). In children, by contrast, the ET lumen was uniformly smaller over the first 80% of its length from the pharyngeal orifice. It is suggested that this immature morphology of the ET lumen may confer increased risk of developing otitis media during childhood.

Migraine-related vestibulopathy

Migraine has been associated with specific vestibular disorders, including benign paroxysmal vertigo of childhood and benign recurrent vertigo in adults. Migraine may also play a role in chronic nonspecific vestibulopathy. Because scant data exist that describe the clinical findings and vestibular function abnormalities in suspected migraine-related vestibulopathy, we reviewed the history, physical examination, vestibular tests (electronystagmography, rotational chair, posturography), and response to treatment of 100 patients with diagnoses of migraine-related vestibulopathy. Dominant clinical features included chronic movement-associated dysequilibrium, unsteadiness, space and motion discomfort, and occasionally, episodic vertigo as an aura prior to headache, or true vertigo without headache. Common vestibular test abnormalities included a directional preponderance on rotational testing, unilateral reduced caloric responsiveness, and vestibular system dysfunction patterns on posturography. Treatment was usually directed at the underlying migraine condition by identifying and avoiding dietary triggers and prescribing prophylactic anti-migraine medications. Symptomatic relief was also provided using anti-motion sickness medications, vestibular rehabilitation, and pharmacotherapy directed at any associated anxiety or panic disorder.

Mesolimbic dopamine mediates gastric mucosal protection by central neurotensin

Bilateral microinjection (1.0 microliter/side) of neurotensin (NT; 0.3, 1.5, and 3.0 micrograms/side) into the nucleus accumbens (NACB) and ventral tegmental area (VTA) but not in substantia nigra and striatum reduced gastric mucosal injury produced by 2 h of cold-water restraint (CWR). The minimal effective dose for NT-induced protection was 10-100 times lower when administered directly into NACB than into the lateral ventricle. These effects were blocked by pretreatment with the dopamine (DA) receptor antagonist, haloperidol (Hal; 0.5 microgram/side) given directly into NACB. Injection of 6-hydroxydopamine into VTA depleted endogenous DA and inhibited gastric mucosal protection against CWR-induced injury afforded by NT pretreatment. NT, given into either VTA and NACB, inhibited pentagastrin-stimulated gastric acid secretion. These results suggest that VTA and NACB, which represent the mesolimbic DA system, are important locations for interaction between NT and DA receptors to produce gastric mucosal protection against CWR-induced injury.

A new simple controlled release delivery system

The chemical pulping of wood without subsequent drying affords low-cost hollow fibers with microporous multilamellar cell walls saturated with water. Simple impregnation of these never-dried pulp fibers with solutions of biologically active chemicals followed by drying yields collapsed cellulose ribbons containing entrapped impregnant. The release characteristics of exemplary composites containing an analgesic (acetylsalicylic acid), a growth stimulant (alpha-naphthylacetic acid), or a herbicide (2,4-dichlorophenoxyacetic acid) are reported both for in vitro and in vivo evaluations.

[Cancer of the kidney. Natural history and therapeutic problems]

Radical nephrectomy with initial ligation of the renal artery and removal en bloc of the perirenal fat and lumboaortic lymphadenectomy was carried out according to the technique of Robson (1969) in 10 cases at the University of Parma 1st Surgical Clinic between 1976 and 1978. The usefulness and superiority of the technique were demonstrated in this albeit small series, which included four stage I, two stage II, one stage III, and four stage IV patients, according to the classification of Flocks et al. Supplementary antiblastic and/or hormonal treatment was given, except in stage I cases. 1.4 mg/m2 Velbe i.v. (1st day) followed by 80 mg/m2 BCNU i.v. (2nd, 3rd, 4th days) was of no avail, whereas progesterone (Depot-provera 200-500 mg/day for 1-3 months) and testosterone propionate (300 mg/week) still seem to be effective. Improvements in this oncological sector, however, are geared to the outcome of radical nephrectomy.

Antigens with glycoprotein structure in the gastric juice. I. Immunological and chemical determinations

To demonstrate the presence of specific antigens in the normal and malignant gastric juice the immunological and chemical features of certain antigens with glycoprotein structure from malignant gastric jucice and gastric tumors were studied comparatively with those of antigens obtained from normal gastric juice and gastric tissue. The investigation was carried out in tumor tissue extracts from 7 patients with malignant gastric tumors and in gastric juice from 45 patients with other non-cancerous diseases. From the five fractions obtained, which gave immunoelectrophoretic precipitin lines in the beta and alpha-globulin regions with the antiserum against total normal gastric juice, a single specific was separated by means of successive chromatographies on sephadex G--100 and DEAE-Sephadex -a--50 (eluted in NaCl concentration gradient). This fraction represented 11.1 per cent of the total proteins. None of the five fractions could be identified with carcinoembryonic antigen (value in gastric juice and gastric malignant tumors = 2 to 10 ng per mg lyophilized products).