Effects of weight loss on myocardial energetics and diastolic function in obesity

A reduced myocardial phosphocreatine/adenosine triphosphate (PCr/ATP) ratio is linked to both diastolic dysfunction and heart failure. Although obesity is well known to cause diastolic dysfunction a link to impaired cardiac energetics has only recently been established. We assessed whether or not long-term weight loss in obesity, which is known to reduce mortality, is accompanied by both improved cardiac energetics and diastolic function. Normal weight (BMI 22 ± 2; n = 18) and obese subjects (BMI 34 ± 4; n = 13) underwent cine-MRI (1.5 Tesla) to determine left ventricular diastolic function using volume-time curve analysis, and (31)P-MR spectroscopy (3 Tesla) to assess cardiac energetics (PCr/ATP ratio). Obese subjects (n = 13) underwent repeat assessment after 1 year of supervised weight loss. Obesity, in the absence of identifiable cardiovascular risk factors, was associated with significantly impaired myocardial high energy phosphate metabolism (PCr/ATP ratio, normal; 2.03 ± 0.27 vs. obese; 1.58 ± 0.47, p = 0.002) and significantly lower peak diastolic filling rate (normal; 4.8 ± 0.8 vs. obese; 3.8 ± 0.7 EDV/s, p = 0.01). Weight loss (on average 9 kg, 55% excess weight) over 1 year resulted in a 24% increase in PCr/ATP ratio (p = 0.01) and an 18% improvement in peak diastolic filling rate (p = 0.01). Myocardial PCr/ATP ratio remained positively correlated with peak diastolic filling rate after weight loss (r = 0.63, p = 0.02). In obesity, weight loss improves impaired cardiac energetics and myocardial relaxation. Improved myocardial energetics appear to play a key role in diastolic functional recovery accompanying weight loss.

7 Tesla (T) human cardiovascular magnetic resonance imaging using FLASH and SSFP to assess cardiac function: validation against 1.5 T and 3 T

We report the first comparison of cardiovascular magnetic resonance imaging (CMR) at 1.5 T, 3 T and 7 T field strengths using steady state free precession (SSFP) and fast low angle shot (FLASH) cine sequences. Cardiac volumes and mass measurements were assessed for feasibility, reproducibility and validity at each given field strength using FLASH and SSFP sequences. Ten healthy volunteers underwent retrospectively electrocardiogram (ECG) gated CMR at 1.5 T, 3 T and 7 T using FLASH and SSFP sequences. B1 and B0 shimming and frequency scouts were used to optimise image quality. Cardiac volume and mass measurements were not significantly affected by field strength when using the same imaging sequence (P > 0.05 for all parameters at 1.5 T, 3 T and 7 T). SSFP imaging returned larger end diastolic and end systolic volumes and smaller left ventricular masses than FLASH imaging at 7 T, and at the lower field strengths (P < 0.05 for each parameter). However, univariate general linear model analysis with fixed effects for sequence and field strengths found an interaction between imaging sequence and field strength (P = 0.03), with a smaller difference in volumes and mass measurements between SSFP and FLASH imaging at 7 T than 1.5 T and 3 T. SSFP and FLASH cine imaging at 7 T is technically feasible and provides valid assessment of cardiac volumes and mass compared with CMR imaging at 1.5 T and 3 T field strengths.

Assessment of left atrial volumes at 1.5 Tesla and 3 Tesla using FLASH and SSFP cine imaging

PURPOSE

To investigate left atrial volumes and function and their variability in healthy volunteers using steady state free precession (SSFP) and fast low angle shot (FLASH) sequences at both 1.5 and 3 T using both the short-axis and biplane area-length methods.

MATERIALS AND METHODS

Ten healthy volunteers underwent CMR at both 1.5 and 3 Tesla. The biplane area-length method utilized volumes from the horizontal and vertical long axis images.

RESULTS

There were no significant differences between left atrial short-axis volumes or function between 1.5 and 3 T assessed using either FLASH or SSFP sequences. The biplane area-length method underestimated maximal left atrial volume using FLASH by 12 mL at 3 T (18%) and by 10 mL (14%) at 1.5 T (p = 0.003 and p = 0.05 respectively). Variability was larger for left atrial measurements using the biplane area-length method.

CONCLUSION

Field strength had no effect on left atrial volume and function assessment using either FLASH or SSFP. The use of the short-axis method for the acquisition of left atrial parameters is more reproducible than the biplane area-length for serial measurements.

Magnetic resonance imaging of facial muscles

Facial and tongue muscles are commonly involved in patients with neuromuscular disorders. However, these muscles are not as easily accessible for biopsy and pathological examination as limb muscles. We have previously investigated myasthenia gravis patients with MuSK antibodies for facial and tongue muscle atrophy using different magnetic resonance imaging sequences, including ultrashort echo time techniques and image analysis tools that allowed us to obtain quantitative assessments of facial muscles. This imaging study had shown that facial muscle measurement is possible and that useful information can be obtained using a quantitative approach. In this paper we aim to review in detail the methods that we applied to our study, to enable clinicians to study these muscles within the domain of neuromuscular disease, oncological or head and neck specialties. Quantitative assessment of the facial musculature may be of value in improving the understanding of pathological processes occurring within facial muscles in certain neuromuscular disorders.

Evolution of the diffusion-weighted signal and the apparent diffusion coefficient in the late phase after minor stroke: a follow-up study

INTRODUCTION

Diffusion-weighted imaging (DWI) is mainly used in acute stroke, and signal evolution in the acute phase has been studied extensively. However, patients with a minor stroke frequently present late. Recent studies suggest that DWI may be helpful at this stage, but only very few published data exist on the evolution of the DW-signal in the weeks and months after a stroke. We performed a follow-up study of DWI in the late stages after a minor stroke.

METHODS

28 patients who presented 48 hours to 14 days after a minor stroke underwent serial MRI at baseline, 4 weeks, 8 weeks, 12 weeks, 6 months and>or=9 months after their event. Signal intensity within the lesion was determined on T2-weighted images, DW-images and the Apparent Diffusion Coefficient (ADC) map at each time-point, and ratios were calculated with contralateral normal values (T2r, DWIr, ADCr).

RESULTS

T2r was increased in all patients from the beginning, and showed no clear temporal evolution. ADCr normalized within 8 weeks in 83% of patients, but still continued to increase for up to 6 months after the event. The DW-signal decreased over time, but was still elevated in 6 patients after>or=6 months. The evolution of ADCr and DWIr showed statistically highly significant inter-individual variation (p<0.0001), which was not accounted for by age, sex, infarct size or infarct location.

CONCLUSION

The ADC and the DW-signal may continue to evolve for several months after a minor ischaemic stroke. Signal evolution is highly variable between individuals. Further studies are required to determine which factors influence the evolution of the ADC and the DW-signal.

Cardiovascular Magnetic Resonance Imaging for Non-Invasive Assessment of Vascular Function: Validation against Ultrasound

Ultrasound is an established modality for quantification of vascular function in clinical studies of cardiovascular disease. We determined whether cardiovascular magnetic resonance imaging (CMR) can provide a comparable assessment of vascular function. In seventeen control subjects, we used CMR to quantify endothelium-dependent (flow mediated dilatation, FMD) and endothelium-independent dilatation of the brachial artery, brachial and carotid distensibility, aortic compliance, and pulse wave velocity. These were compared to brachial and carotid measurements obtained by established ultrasound protocols. Twelve of the volunteers then underwent repeated measurements with both modalities. There was good agreement between imaging modalities for measures of endothelial function and arterial structure in the same subjects (difference between CMR and ultrasound for FMD = 0.14 +/- 6.8%, and brachial artery area = - 0.7 +/- 2.2 mm2, correlation between modalities for FMD = 0.62, p = 0.01 and for area = 0.87, p = < 0.0001). Inter-study reproducibility was also similar (coefficient of variation (CV) for FMD: CMR = 0.3, ultrasound = 0.3, CV for brachial artery area: CMR = 0.1, ultrasound = 0.1). Comparability and reproducibility were not as strong for functional measures if repeated studies were several days apart (CV for FMD by ultrasound on the same day = 0.1 and several days apart = 0.4). CMR and ultrasound show good agreement for quantitative measures of vascular structure and function with good reproducibility for both modalities. The major advantage of CMR is that it allows one-stop integrated assessment of both peripheral and central measures of vascular function.

Improved cine cardiovascular magnetic resonance using Clariscan (NC100150 injection)

We evaluated the use of Clariscan 0.75, 2, and 5 mg Fe/kg body weight in six patients to determine optimal dosing for short repetition time cine imaging. Breathhold cine images were acquired in the vertical and horizontal long axes and the short axis. Blood-pool signal-to-noise ratio increased significantly in all planes (p < 0.01) but was least marked in the short axis. Myocardial signal-to-noise ratio increased by a lesser amount (p < 0.05). Myocardial to blood-pool signal-difference-to-noise ratio improved significantly in the long axes (p < 0.05) and was greatest at 2 mg Fe/kg body weight, but changes in the short axis were minor. With the 5-mg Fe/kg body weight dose, the response was reduced or reversed due to T2* effects. Visual assessment improved in all planes (p < 0.05) and was optimal at 2 mg Fe/kg body weight. In conclusion, Clariscan improves short repetition time cardiac breathhold cine imaging, particularly in the long axis planes, with an optimal dose of 2 mg Fe/kg body weight.

Multiple behavioral effects of cocaine- and amphetamine-regulated transcript (CART) peptides in mice: CART 42-89 and CART 49-89 differ in potency and activity

Cocaine- and amphetamine-regulated transcript (CART) encodes a neuropeptide precursor protein that is highly abundant in cells of the hypothalamus. To date, the major research focus into the function of CART peptides has been feeding behavior. However, CART mRNA is found in other areas of the brain as well as some peripheral tissues, suggesting possible broader functions of this peptide. In this study, we investigated the effects of two CART peptides, CART 42-89 and CART 49-89, in several behavioral assays. Peptides were administered by i.c.v. route of administration. Both CART 42-89 and CART 49-89 inhibited food intake with the minimally effective dose of CART 42-89 (0.5 microg) being 5-fold greater than that of CART 49-89 (0.1 microg). Both peptides also produced significant antinociceptive effects in the hot-plate assay with similar potency differences. CART 42-89 significantly inhibited the acoustic startle response (ASR) of pulse alone trials at doses of 0.1 and 0.5 microg. In contrast, CART 49-89 did not affect ASR of pulse alone trials at doses of 0.05 and 0.1 (microg). For prepulse inhibition (PPI) trials, in general, both peptides appeared to enhance the magnitude of PPI and CART 42-89 was less potent than CART 49-89. Overall, these data suggest CART peptides may have multiple roles in central nervous system function and there may be biological differences between two processed forms of CART peptide.

Establishment and performance of a magnetic resonance cardiac function clinic

Our objective was to establish a cardiovascular magnetic resonance (CMR) cardiac function clinic to provide an assessment of cardiac volume, mass, and function in patients with heart failure on the same day as their cardiology outpatient clinic appointment. Sixty-four patients attended the CMR function clinic. The reproducibility, patient acceptability, and time efficiency of the CMR clinic were assessed and compared with radionuclide ventriculography (RNV) and echocardiography (echo). Reports were available in the cardiology outpatient clinic within 2 hr of the CMR appointment time. The reproducibility of volumes, ejection fraction, and mass in this heart failure population was good and comparable with CMR studies in the normal population. CMR was more acceptable to the patients than both RNV and echo (p < 0.05). The total time for CMR was less than that of RNV (42 +/- 4 and 61 +/- 4 min, respectively; p < 0.001) but more than that of echo (echo, 23 +/- 2 min; p < 0.001). Comparison of ejection fractions revealed a correlation between CMR and RNV of 0.7, but Bland-Altman limits of agreement were wide (-10.5% to 18.9%). For CMR versus echo, the correlation was 0.6, and the limits of agreement were wider (-29.9% to 23.3%). The correlation between RNV and echo was 0.2 with wider limits of agreement (-29.8% to 24. 9%). In conclusion, CMR can provide a rapid, reproducible, and patient acceptable assessment of cardiac function in heart failure patients, whereas other methods appear to have a wider variance. The high reproducibility of CMR lends itself to the follow-up of clinical progression and the effect of treatment in patients with heart failure.

Treatment of claustrophobia for cardiovascular magnetic resonance: use and effectiveness of mild sedation

Claustrophobia is associated with cardiovascular magnetic resonance (CMR) due to the nature of the technique and lengthy examination times. We report the incidence and treatment of claustrophobia in a prospective study on the use of intravenous (IV) and oral diazepam for CMR from August 1997 to June 1999 in 1754 adult patients referred for clinical (1226) and research (528) purposes. Patients under 16 yr of age and adults with learning difficulties were excluded. The initial refusal rate of clinical and research patients was 4.2% (54 clinical and 19 research). Because ethical approval to administer diazepam to research patients had not been granted at the beginning of this study, further analysis of the results excludes the 19 research patients. Of the 54 clinical patients, 31 were given IV diazepam (mean dose, 7.5 mg; range, 2.5-20 mg) with successful scanning in 30 (97%). Eight patients refused sedation, and scanning was not possible. The examination was attempted without sedation by five patients in the claustrophobic group and was terminated early; however, sufficient diagnostic information had been acquired in all cases. A further four patients took oral diazepam up to 1 hr before their appointment, with a 100% success rate. Three patients refused to attend the department due to known severe claustrophobia (2) and concerns over gradient noise (1), and three had medical contraindications to diazepam. Therefore, after the administration of diazepam to alleviate claustrophobia, the failure rate decreased to from 54 (4.4% of clinical patients) to 20 (1.6%) patients, a reduction of 63%. When it is possible to give diazepam to patients with claustrophobia at the time of CMR, it is a safe, predictable, and highly effective method of obtaining a successful result. A protocolfor the use of diazepam has been developed and is now also approved by our institutional ethics committee for use in research patients.

Use of the intravascular contrast agent NC100150 injection in spin-echo and gradient-echo imaging of the heart

This is the first study of the intravascular iron oxide particle contrast agent, NC100150 Injection (Nycomed Imaging AS, Oslo, Norway, a part of Nycomed Amersham) in magnetic resonance imaging of the human heart. Eighteen healthy male volunteers were studied at both 0.5 and 1.5 T before and after the administration of NC100150 Injection. Transaxial spin-echo images were acquired at both field strengths, conventional gradient-echo cine images at 0.5 T, and breathhold Turbo-FLASH cine images at 1.5 T. Optimized cine imaging sequences were used postcontrast, with a high flip angle of 60-70 degrees. In the spin-echo images there was a significant reduction in the blood pool flow artifact at the level of the right atrium (0.5 T, 57%, p < 0.01; 1.5 T, 41%, p = 0.01) and the left ventricle (LV) (0.5 T, 45%, p = 0.01; 1.5 T, 45%, p < 0.01). In the conventional gradient-echo cines at 0.5 T, there was a significant increase in the LV blood pool and myocardial signal difference-to-noise ratio (SDNR) in the diastolic (56%, p = 0.01) and systolic (141%, p < 0.001) frames. There was also a significant increase in the signal intensity (SI) gradient at the LV blood pool-myocardial border in the diastolic and systolic frames (both p < 0.001). At higher doses of NC100150 Injection (3 and 4 mg/kg), a rim of signal void around the LV blood pool was observed, perfectly defining the LV blood pool-myocardial border. In the Turbo-FLASH breathhold cines at 1.5 T, there was a significant increase in the LV blood pool-myocardial SDNR in the diastolic (221%, p < 0.001) and systolic (916%, p < 0.001) frames. Again, there was also a significant increase in the SI gradient at the LV blood pool-myocardial border in the diastolic and systolic frames (both p = 0.003). In conclusion, NC100150 Injection was given safely to 18 healthy subjects. Image quality and LV blood pool-myocardial definition were improved after the administration of NC100150 Injection. These improvements enable better spin-echo anatomical definition, better definition of myocardial wall motion, and should improve the capability of automated edge detection algorithms.

Reduction in sample size for studies of remodeling in heart failure by the use of cardiovascular magnetic resonance

Fast breathhold cardiovascular magnetic resonance (CMR) has become a reference standard for the measurement of cardiac volumes, function, and mass. The implications of this for sample sizes for remodeling studies in heart failure (HF) have not been elucidated. We determined the reproducibility of CMR in HF and calculated the sample size requirements and compared them with published values for echocardiography. Breathhold gradient echo cines of the left ventricle were acquired in 20 patients with HF and 20 normal subjects. Sample size values were calculated from the interstudy standard deviation of the difference. The percentage variability of the measured parameters in our HF group of intraobserver (2.0-7.4%), interobserver (3.3-7.7%), and interstudy (2.5-4.8%) measurements was slightly larger than for our normal group (1.6-6.6%, 1.6-7.3%, and 2.0-7.3%, respectively) but remained comparable with previous studies in normal subjects. The calculated sample sizes in patients with HF for CMR to detect a 10-ml change in end-diastolic volume (n = 12) and end-systolic volume (n = 10), a 3% change in ejection fraction (n = 15), and a 10-g change in mass was (n = 9) were substantially smaller than recently published values for two-dimensional echocardiography (reduction of 81-97%). Breathhold CMR is a fast comprehensive technique for the assessment of cardiac volumes, function, and mass in HF that is accurate but also highly reproducible. This allows a considerable reduction in the patient numbers required to prove a hypothesis in research studies, which suggests a potential for important research cost savings.

The analgesic potential of intraventricular polymer-encapsulated adrenal chromaffin cells in a rodent model of chronic neuropathic pain

Adrenal chromaffin cells reportedly produce analgesic effects when implanted in the periaqueductal gray and the intrathecal space near the spinal cord. Chromaffin cells implanted in the cerebral ventricles may also produce analgesic effects, and the availability of the cerebral ventricles as a potential implant site could be advantageous for some patients. In fact, some of the first patients were implanted in the intraventricular site, even though the analgesic potential of that site had never been demonstrated. The present study was conducted to assess the analgesic potential of intraventricular, polymer-encapsulated calf adrenal chromaffin cells in the Bennett model. Sciatic nerve ligations produced substantial, long-lasting pain-related behaviors. However, there was no evidence that polymer-encapsulated adrenal chromaffin cells implanted in the cerebral ventricles produce analgesic effects in this model of chronic neuropathic pain.

Transforming growth factor-beta 1 induces apoptosis independently of p53 and selectively reduces expression of Bcl-2 in multipotent hematopoietic cells

Transforming growth factor-beta1 (TGF-beta1) can inhibit cell proliferation or induce apoptosis in multipotent hematopoietic cells. To study the mechanisms of TGF-beta1 action on primitive hematopoietic cells, we used the interleukin-3 (IL-3)-dependent, multipotent FDCP-Mix cell line. TGF-beta1-mediated growth inhibition was observed in high concentrations of IL-3, while at lower IL-3 concentrations TGF-beta1 induced apoptosis. The proapoptotic effects of TGF-beta1 occur via a p53-independent pathway, since p53(null) FDCP-Mix demonstrated the same responses to TGF-beta1. IL-3 has been suggested to enhance survival via an increase in (antiapoptotic) Bcl-x(L) expression. In FDCP-Mix cells, neither IL-3 nor TGF-beta1 induced any change in Bcl-x(L) protein levels or the proapoptotic proteins Bad or Bax. However, TGF-beta1 had a major effect on Bcl-2 levels, reducing them in the presence of high and low concentrations of IL-3. Overexpression of Bcl-2 in FDCP-Mix cells rescued them from TGF-beta1-induced apoptosis but was incapable of inhibiting TGF-beta1-mediated growth arrest. We conclude that TGF-beta1-induced cell death is independent of p53 and inhibited by Bcl-2, with no effect on Bcl-x(L). The significance of these results for stem cell survival in bone marrow are discussed.

Bcr-Abl protein tyrosine kinase activity induces a loss of p53 protein that mediates a delay in myeloid differentiation

Chronic myeloid leukaemia is a haemopoietic stem cell disorder, the hallmark of which is the expression of the Bcr-Abl Protein Tyrosine Kinase (PTK). We have previously reported that activation of a temperature sensitive Bcr-Abl PTK in the multipotent haemopoietic cell line FDCP-Mix for short periods resulted in subtle changes including, a transient suppression of apoptosis and no inhibition of differentiation. In contrast, activation of the Bcr-Abl PTK for 12 weeks results in cells that display a delay in differentiation at the early granulocyte stage. Flow cytometric analysis also indicates that the expression of cell surface differentiation markers and nuclear morphology are uncoupled. Furthermore, a significant number of the mature neutrophils display abnormal morphological features. Prolonged exposure to Bcr-Abl PTK results in interleukin-3 independent growth and decreased p53 protein levels. FDCP-Mix cells expressing a dominant negative p53 and p53null FDCP-Mix cells demonstrate that the reduction in p53 is causally related to the delay in development. Returning the cells to the restrictive temperature restores the p53 protein levels, the growth factor dependence and largely relieves the effects on development. We conclude that prolonged Bcr-Abl PTK activity within multipotent cells results in a reduction of p53 that drives a delayed and abnormal differentiation.

Intrathecal polymer-encapsulated bovine adrenal chromaffin cells fail to produce analgesic effects in the hotplate and formalin test

Numerous publications have reported that adrenal chromaffin cells implanted in the lumbar intrathecal space produce analgesic effects in rodent models of pain. The present study was intended to replicate and extend on the results of those previous publications. This study was conducted to determine: (1) if analgesic effects of polymer-encapsulated intrathecal adrenal chromaffin cells could be detected in the more sensitive low temperature hot-plate test without using nicotine to stimulate chromaffin cell output, (2) if a dose-response curve can be produced in the hot-plate and formalin tests with different numbers of adrenal chromaffin cells (0K, 120K, or 330K), (3) if cell viability and/or the magnitude of analgesic effects are affected by differences in implant site (i.e. thoracic versus lumbar implant site), and (4) the magnitude of the analgesic effects of adrenal chromaffin cells relative to doses of systemic morphine. No analgesic effects related to chromaffin cells were detected in the present study in the formalin test or in the hot-plate test, even with nicotine stimulation, regardless of the number of cells implanted or the intrathecal implant site. The reliability and sensitivity of the behavioral measures to the effects of mild analgesics are supported by the fact that consistent differences in performance between individual rats could be detected, the effects of fairly modest doses of nicotine and morphine were detectable, and consistent dose-response curves were evident with respect to both nicotine and morphine. Device performance appeared to be within the range of previous studies that reported analgesic effects of encapsulated adrenal chromaffin cells. It is unclear why analgesic effects of adrenal chromaffin cells were not detected in the present study.

Behavioral characterization of neuropeptide Y knockout mice

An extensive behavioral characterization was conducted with mice lacking the gene for neuropeptide Y (NPY) including response to 24 and 48 h fast and challenge with small molecule antagonists of NPY receptors implicated in mediating the feeding effects of NPY (i.e., Y1 and Y5). In addition, wildtype (WT) and NPY knockout (KO) mice were tested in locomotor monitors, elevated plus maze, inhibitory avoidance, acoustic startle, prepulse inhibition, and hot plate assays. One of the major findings was that the NPY KO mice have a reduced food intake relative to WT controls in response to fasting. Also, based on data from the behavioral models, the NPY KO mice may have an anxiogenic-like phenotype, and appear to be hypoalgesic in the hot plate paradigm. The data from these studies provide further evidence of involvement of NPY in energy balance, anxiety, and possibly nociception.

Chronic morphine reduces pain-related disability in a rodent model of chronic, inflammatory pain

Chronic pain is disabling, and the adverse effects of morphine are also disabling. The best way to assess the beneficial effects relative to the potential adverse effects of chronic morphine may be through the use of quantitative measures of functional disability in people and animals experiencing pain. If chronic morphine alleviates chronic pain and its beneficial analgesic effects outweigh whatever adverse effects it may produce, then it should reduce pain-related disability. Rats with adjuvant-induced arthritis were implanted with subcutaneous morphine pellets. Continuous morphine reduced pain-related disability in tasks motivated by food reward or shock avoidance throughout the 35 days of continuous administration--first, in tests that primarily assessed the function of the less severely affected forelimbs, and later, as the inflammation subsided, in tests more dependent on the function of the more severely affected hind limbs.

Systemic treatment with GPI 1046 improves spatial memory and reverses cholinergic neuron atrophy in the medial septal nucleus of aged mice

Systemic treatment with GPI 1046, a non-immunosuppressive ligand of the immunophilin FKBP12 (FK-506-binding protein 12 kDa), has previously been shown to promote morphological recovery of the nigrostriatal dopaminergic projection after MPTP lesion in mice, and of lesioned sciatic nerve fibres after nerve crush in rats. In the present study, we investigated whether chronic systemic treatment with GPI 1046 could affect the decline of spatial learning and memory, and the atrophy of medial septal cholinergic neurons, associated with late senescence in C57 black mice. Three-month old (young) and 18-19-month old (aged) male C57BL/6N-Nia mice were first trained in a place learning task in the Morris water maze. Based on their performance relative to young controls, aged animals were then allocated to treatment groups (10 mg/kg GPI 1046, or vehicle). Retention of the spatial platform location was assessed after 3 weeks of dosing. We found that aged animals that had been dosed with GPI 1046 now performed at a significantly better level than their vehicle control group. Aged animals that had shown the greatest degree of impairment during training in the place learning task showed the greatest relative degree of improvement under treatment and were statistically indistinguishable from young, or aged unimpaired control animals. Cell volumes of cholinergic cells in the medial septal nucleus were assessed after an additional 10 months of dosing at 30 months of age, using stereological methods. We found that aged animals displayed a significant 34% decrease in volume of these cells relative to young controls. This atrophy was significantly reversed in aged GPI 1046-treated animals (13% shrinkage). We conclude that chronic systemic treatment with GPI 1046 positively affects memory mechanisms in the aged mouse, possibly by acting on the septohippocampal cholinergic system.

First-pass myocardial perfusion imaging and equilibrium signal changes using the intravascular contrast agent NC100150 injection

In this phase I clinical study, the new ultrasmall superparamagnetic iron oxide contrast agent, NC100150 Injection (Nycomed AS, Oslo, Norway, a part of Nycomed Amersham), was assessed for first-pass magnetic resonance myocardial perfusion studies and its ability to produce equilibrium signal changes, as a possible indicator of myocardial blood volume. Data were acquired in 18 healthy male volunteers at 0.5 T and 1.5 T. At both field strengths, first-pass studies using T1-weighted sequences were acquired. Long TE spin-echo echoplanar imaging (EPI) was used at 0.5 T and short TE fast low-angle shot (FLASH) imaging at 1.5 T. With both sequences, T1 effects dominated the images for low doses, and time intensity curves potentially suitable for perfusion analysis were generated. At higher doses, T2 and T2* effects were observed. At 1.5 T, these predominantly affected the blood pool signal; however, at 0.5 T the myocardial signal was also involved, reflecting the relative T2 and T2* sensitivity of the spin-echo EPI sequence as a result of the long TE and long readout window, respectively. Equilibrium changes were assessed at both field strengths using T1-weighted FLASH sequences and in addition at 1.5 T using T2*-weighted gradient-echo EPI. With the T1-weighted images at both field strengths, signal changes were observed in all subjects; however, no dose-response relationship could be shown. With the T2*-weighted EPI there was significantly lower signal (P < 0.05) with the 3 and 4 mg/kg doses than with the 2 mg/kg dose. In conclusion, NC100150 Injection is useful for first-pass myocardial perfusion using T1-weighted sequences; however, low doses in combination with short TE sequences are required to minimize sensitivity to T2* effects. Equilibrium signal changes can also be induced in the myocardium. More work is required to optimize the imaging sequences and dose of NC100150 Injection for first-pass studies and also to determine whether the equilibrium signal changes can be used to measure myocardial blood volume changes in ischemic heart disease.

Safety and preliminary findings with the intravascular contrast agent NC100150 injection for MR coronary angiography

In this Phase I clinical study, a novel ultrasmall superparamagnetic iron oxide contrast agent, NC100150 Injection (Nycomed Imaging, Oslo, Norway, a part of Nycomed Amersham), was used in two-dimensional magnetic resonance coronary angiography (MRCA). Safety and imaging data were acquired from 18 healthy male volunteers at both 0.5 and 1.5 T, before and after the administration of NC100150 Injection. Through-plane and in-plane images of the right coronary artery were analyzed. The postcontrast imaging sequences used prepulses and a high flip angle, to introduce T1 weighting. At 1.5 T (TE 2.6 msec), the through-plane coronary artery signal-to-noise ratio (SNR) (P = 0.04), coronary artery-to-fat signal difference-to-noise ratio (SDNR) (P = 0.001), coronary artery-to-myocardium SDNR (P<0.001), and coronary artery delineation (P<0.001) were improved by the administration of NC100150 Injection. For in-plane imaging, coronary artery delineation improved, but there were no significant changes in the SNR and SDNR. At 0.5 T, with the longer TE (6.7 msec) imaging sequence used, there was a reduction in the SNR (P = 0.01), the fat SDNR (through-plane P = 0.02; in-plane P = 0.25), and the coronary artery diameter (P<0.01 in both imaging planes). There was a trend toward improvement in the myocardial SDNR and coronary artery delineation. In conclusion, NC 100150 Injection was given safely to 18 healthy subjects, with no major adverse reactions. Coronary artery delineation was improved in both imaging planes at 1.5 T, with a trend toward improvement at 0.5 T. At 1.5 T, with a short TE imaging sequence, the marked T1 shortening effects of NC100150 Injection were dominant, leading to an improvement in the quantitative parameters for the through-plane images. At 0.5 T, with a longer TE imaging sequence, the T2* effects of the contrast agent played a role in reducing the quantitative image parameters. With further optimization of imaging sequences, to take advantage of the long-lived intravascular T1 shortening effect of NC100150 Injection, further improvements in MRCA will be possible.

Abl protein kinase abrogates the response of multipotent haemopoietic cells to the growth inhibitor macrophage inflammatory protein-1 alpha

The clonogenic cells of chronic myeloid leukaemia (CML), unlike normal haemopoietic progenitor cells, are resistant to the growth inhibitory effects of the chemokine macrophage inflammatory protein-1 alpha (MIP-1alpha). CML is also relatively resistant to chemotherapy and the disease is difficult to cure using conventional therapeutic routes. CML is associated with increased abl oncogene protein tyrosine kinase (PTK) activity. Here, we have tested the hypothesis that these aberrant responses to MIP-1alpha and the relative resistance to chemotherapy are directly related to this increased abl PTK activity in primitive haemopoietic cells. To do this we have expressed a temperature sensitive abl PTK in a growth factor dependent, multipotent stem cell line (FDCP-Mix) in which growth is normally suppressed by MIP-1alpha. In FDCP-Mix cells expressing the ts v-abl PTK and grown at the restrictive temperature for PTK activity the cells were relatively sensitive to cytotoxic agents such as cytosine arabinoside and 5-fluorouracil but MIP-1alpha could induce growth inhibition and confer some degree of protection from these agents. At the permissive temperature for abl PTK, the cells were relatively resistant to cytotoxic drugs and MIP-1alpha treatment neither induced growth inhibition nor protected the cells from cytotoxic drug induced cell death. This lack of response to MIP-1alpha was not due to receptor down modulation as neither the affinity nor the number of 125I-MIP-1alpha binding sites was altered by activating Abl PTK. However, MIP-1alpha mediated increases in cytosolic Ca2+ levels were abrogated by switching cells to the permissive temperature for Abl PTK activity. These data suggest that the relative resistance of CML progenitor cells to therapeutic drugs and the lack of response to MIP-1alpha occurs as a direct consequence of abl PTK activity and involves desensitisation of signal transduction events stimulated by MIP-1alpha receptors. Thus one contributory mechanism to transformation of primitive haemopoietic cells is abrogation of response to a growth inhibitor.

India ink tattooing in the esophagus

BACKGROUND

Precise endoscopic measurement of esophageal landmarks is difficult and inaccurate because of the ability of the esophagus to lengthen and foreshorten.

METHODS

Nineteen patients enrolled to date in a study of Barrett's esophagus had an India ink tattoo placed at the most proximal level of the squamocolumnar junction and were examined endoscopically at 3, 9, 15, 24, and 36 months.

RESULTS

Eighteen of nineteen patients (94.7%) were judged to have a good to excellent tattoo persistence at 3 months. One of the 19 patients (5.3%) had poor tattoo persistence and was retattooed at the 3-month interval. Eventually, 15 of the 15 patients (100%) who remained in the study had a good or excellent tattoo persistence at 36 months. There were no complications related to India ink tattooing including chest pain, bleeding, or perforation. At follow-up endoscopy, no ulcers, inflammation, break in the mucosa, or pain were noted.

CONCLUSION

India ink tattooing in the esophagus is safe and persistent and may be used as an effective method for longitudinal follow-up of lesions in the esophagus.

Dissociable long-term cognitive deficits after frontal versus sensorimotor cortical contusions

Cognitive deficits are the most enduring and disabling sequelae of human traumatic brain injury (TBI), but quantifying the magnitude, duration, and pattern of cognitive deficits produced by different types of TBI has received little emphasis in preclinical animal models. The objective of the present study was to use a battery of behavioral tests to determine if different impact sites produce different patterns of behavioral deficits and to determine how long behavioral deficits can be detected after TBI. Prior to surgery, rats were trained to criteria on delayed nonmatching to position, radial arm maze, and rotarod tasks. Rats received sham surgery (controls), midline frontal contusions (frontal TBI, 2.25 m/sec impact), or unilateral sensorimotor cortex contusions (lateral TBI, 3.22 m/sec impact) at 12 months of age and were tested throughout the next 12 months. Cognitive deficits were more robust and more enduring than sensorimotor deficits for both lateral TBI and frontal TBI groups. Lateral TBI rats exhibited transient deficits in the forelimb placing and in the rotarod test of motor/ambulatory function, but cognitive deficits were apparent throughout the 12-month postsurgery period on tests of spatial learning and memory including: (1)reacquisition of a working memory version of the radial arm maze 6-7 months post-TBI, (2) performance in water maze probe trials 8 months post-TBI, and (3) repeated acquisition of the Morris water maze 8 and 11 months post-TBI. Frontal TBI rats exhibited a different pattern of deficits, with the most robust deficits in tests of attention/orientation such as: (1) the delayed nonmatching to position task (even with no delays) 1-11 weeks post-TBI, (2) the repeated acquisition version of the water maze--especially on the first "information" trial 8 months post-TBI, (3) a test of sensorimotor neglect or inattention 8.5 months post-TBI, and (4) a DRL20 test of timing and/or sustained attention 11 months after surgery. These results suggest that long-term behavioral deficits can be detected in rodent models of TBI, that cognitive deficits seem to be more robust than sensorimotor deficits, and that different TBI impact sites produce dissociable patterns of cognitive deficits in rats.

A case of idiopathic fecal incontinence. Evaluation and management

Idiopathic fecal incontinence is a clinical entity described mostly in the colorectal surgical literature and seldom encountered by the physiatrist. Evidence exists suggesting neuropathic injury to the external anal sphincter. Several reports have linked this syndrome to the descending perineum syndrome. A final answer to this diagnostic puzzle is yet to be found. This article presents a case of probable "idiopathic" fecal incontinence presenting during an evaluation for low back pain. Full evaluation yielded a denervating lesion of unknown etiology to the pudendal nerve. The patient was managed with a bowel program without success. Because physiatrists often find themselves managing cases of neurogenic bowel or bladder, it is important for the physiatrist to have a thorough understanding of idiopathic fecal incontinence. A discussion of the differential diagnosis and management of fecal incontinence is included.

Pain-related disability and effects of chronic morphine in the adjuvant-induced arthritis model of chronic pain

Functional disability has been identified as one of the most important aspects of chronic pain, yet modeling pain-related disability has received little attention. Adjuvant-induced arthritis was induced, and one group of arthritic rats was implanted with SC 75-mg morphine pellets 1 week postadjuvant, and reimplanted every 2 weeks thereafter. The results confirm that the rodent adjuvant-induced arthritis model of severe chronic pain can be used to model pain-related disability: spontaneous activity levels and ambulatory function were reduced in arthritic rats and they exhibited substantial weight loss. The results of the present study suggest that the operant delayed nonmatching-to-position task can be used as a measure of pain-related disability, which may be especially relevant to the effects of chronic pain on performance in a work setting. The delayed nonmatching-to-position operant bar-pressing task is an "apical" test that is sensitive to deficits across a wide range of behavioral functions: motor ability, attention, motivation, learning, and memory, and arthritic rats were severely impaired in this task. In addition, analgesic treatments that impair functional abilities in normal healthy rats may actually improve the performance of rats exhibiting pain-related disability. Previous work demonstrated that acute morphine injections of only 4 mg/kg impaired performance in the delayed matching-to-position task. The results of the present study demonstrate that chronic morphine attenuates the degree of pain-related disability exhibited by arthritic rats in the test of ambulatory function and the delayed nonmatching-to-position bar-pressing test. These results demonstrate that novel analgesic treatments can be screened preclinically, both with respect to their direct analgesic effects, and with respect to their ability to reduce pain-related disability.

Rats with partial striatal dopamine depletions exhibit robust and long-lasting behavioral deficits in a simple fixed-ratio bar-pressing task

It is widely accepted that enduring parkinsonian symptoms are only evident if there are few remaining dopaminergic neurons in the substantia nigra and dopamine levels in the basal ganglia are very low [26,41]. In the present study, partial dopamine depletions were produced by infusing 6-OHDA bilaterally into the ventrolateral striatum as previously described [11,12,44]. Consistent with previous studies, behavioral deficits were detectable in rats with partial lesions with a simple fixed-ratio bar-pressing task. The present study demonstrated that these behavioral deficits were long-lasting, and that the sensitivity of this bar-pressing task could be increased by manipulating the level of difficulty of the task-higher fixed ratios were more sensitive to partial dopamine depletions. Deficits in rats with partial dopamine depletions could also be detected using non-automated neurological tests of parkinsonian symptoms developed for rats with severe unilateral dopamine depletions, but these deficits were transient and not as robust as those detected with the bar-pressing task. Oral Sinemet (L-DOPA:carbidopa) did not attenuate behavioral deficits related to partial dopamine depletions in this simple fixed-ratio bar-pressing task, but the present results suggest that Parkinson's patients might be identifiable earlier in the disease process, at a time when they could benefit from treatment with neuroprotective/neurotrophic agents. In addition, the results of the present study demonstrate that robust behavioral deficits may emerge with age. Mild dopamine depletions that were not detectable behaviorally at the time of the insult became clearly evident 10 months after the lesion with this bar-pressing task, and this may represent a more clinically relevant rodent model of Parkinson's disease.

Postoperative retinal ischemia with self-sealing cataract surgery incisions

PURPOSE

To report the potential for retinal ischemia caused by high intraocular pressure and to suggest a simple test for this condition.

METHODS

We measured the intraocular pressure and directly examined the optic nerve head in four eyes of four patients at the conclusion of cataract surgery.

RESULTS

With intraocular pressure above 40 mm Hg, elderly patients may abruptly lose the ability to perceive microscope illumination. The central retinal artery pulsated at these pressures. Light perception returned immediately upon reduction of intraocular pressure.

CONCLUSION

Testing for light perception at the conclusion of surgery can indicate retinal ischemia with loss of light perception, which may occur during sealing of the cataract surgical wound.