Endoscopic neuroanatomy through the sphenoid sinus

OBJECT

The aim of the study was to perform endoscopic anatomical studies of skull base structures through the sphenoid sinus in order to better understand endoscopic approaches to skull base lesions.

METHODS

Anatomical studies were performed on six cadavers using sinus endoscopes. The sphenoid sinus was entered via a sublabial nasoseptal approach. Stepwise removal of bone surrounding the sphenoid sinus was done to expose the suprasellar area, the retrosphenoid area and the cavernous sinus. The suprasellar dissection exposed the anterior communicating artery (ACom) complex, optic apparatus, pituitary stalk, lamina terminalis, third ventricle and pituitary gland. The retrosphenoid dissection exposed the mamillary bodies, basilar artery and its branches, the mid-brain, the pons, and the third, fifth, sixth, seventh and eighth cranial nerves. The cavernous sinus dissection exposed the carotid artery, and the third, fourth, fifth and the sixth cranial nerves.

CONCLUSION

Through the sphenoid sinus, most of the structures in the suprasellar area, cavernous sinus and retrosphenoid area can be reached.

Statistical analysis of MPSS measurements: application to the study of LPS-activated macrophage gene expression

Massively Parallel Signature Sequencing (MPSS), a recently developed high-throughput transcription profiling technology, has the ability to profile almost every transcript in a sample without requiring prior knowledge of the sequence of the transcribed genes. As is the case with DNA microarrays, effective data analysis depends crucially on understanding how noise affects measurements. We analyze the sources of noise in MPSS and present a quantitative model describing the variability between replicate MPSS assays. We use this model to construct statistical hypotheses that test whether an observed change in gene expression in a pair-wise comparison is significant. This analysis is then extended to the determination of the significance of changes in expression levels measured over the course of a time series of measurements. We apply these analytic techniques to the study of a time series of MPSS gene expression measurements on LPS-stimulated macrophages. To evaluate our statistical significance metrics, we compare our results with published data on macrophage activation measured by using Affymetrix GeneChips.

Vitamin A deficiency reduces liver and colon docosahexaenoic acid levels in rats fed high linoleic and low alpha-linolenic acid diet

Studies indicate that the transcription factor peroxisome proliferator-activated receptors (PPARs) regulate the activity of delta-6 and -5 desaturases and several key enzymes of peroxisomal beta-oxidation, including acyl-CoA oxidase. These enzymes are vital for the synthesis of docosahexaenoic (22:6 omega 3; DHA) and osbond (22:5 omega 6, OA) acids. An activated PPAR must form a hetrodimer with the obligate cofactor retinoid X receptor (RXR) to interact with a peroxisome proliferator responsive element (PPRE) of a target gene and to regulate transcriptional expression. The vitamin A metabolite, 9-cis retinoic acid, is the most potent ligand of RXR. We have tested the possibility that deficiency of vitamin A would compromise tissue levels of both DHA and OA in rats. Two groups of male Wistar rats were randomly distributed to receive vitamin A deficient (VAD) or sufficient (VAS) diet. After seven weeks of feeding, the rats were killed and colon and liver tissues removed for the analysis of fatty acids and antioxidant status. The VAD compared to the VAS rats had elevated levels of arachidonic (AA, P<0.001), adrenic acid (22:4 omega 6, P<0.005) and OA (P<0.0001) and reduced proportions of eicosapentaenoic (EPA, docosapentaenoic (DPA), DHA and total omega 3 fatty (P<0.0001) in colon choline phosphoglycerides (CPG). Similarly, liver CPG of the VAD rats had higher AA and adrenic acid and OA (P<0.0001), and lower EPA, DPA and DHA (P<0.0001) than the VAS rats. There was a similar fatty acid pattern in ethanolamine phosphoglycerides of the colon and liver tissues. These differences could not be explained by the conventional microsomal-peroxisomal pathway of the synthesis of the long-chain omega 6 and omega 3 polyunsaturated fatty acids. We postulate that deficiency of dietary vitamin A and the consequential depletion of retinoids inhibits DHA, and enhances OA, synthesis by differential effects on the independent synthetic pathways of the two fatty acids in the mitochondria. Various studies have documented that both DHA and vitamin A are vital for optimal visual and neural development and function. There is a need for further investigations to elucidate how vitamin A deficiency reduces membrane DHA level, and to delineate the synergistic effect of the two nutrients on vision, learning and memory.

Expression of TNFalpha by CD3+ and F4/80+ cells following irradiation preconditioning and allogeneic spleen cell transplantation

The pathogenesis of acute graft-versus-host disease (aGVHD) includes tumor necrosis factor-alpha (TNFalpha) expression by macrophages and T cells. However, the temporal comparison of donor vs host cells to TNFalpha expression in response to irradiation conditioning and alloreactivity has not been reported. This study compared intracellular TNFalpha expression in donor vs host spleen T cells and macrophages using a murine model of aGVHD. Total body irradiation conditioning alone resulted in increased frequency of F4/80+/TNFalpha+ cells, but no increase in CD3+/TNFalpha+ cells. Syngeneic transplantation resulted in an increased frequency of F4/80+/TNFalpha+ cells, while CD3+/TNFalpha+ cells increased on days 1 and 3 but declined on day 5. Allogeneic transplantation resulted in an increased frequency of donor CD3+/TNFalpha+ cells, while the frequency of host CD3+/TNFalpha+ cells declined. Similarly, donor F4/80+/TNFalpha+ cells also increased in frequency after allotransplantation, while the frequency of host F4/80+/TNFalpha+ cells was increased on day 1 and declined through days 3 and 5. In absolute cell numbers, CD3+/TNFalpha+ cells were greater than F4/80+/TNFalpha+ cells post allotransplantation. We conclude that (1) both donor and host CD3+ and F4/80+cells are present in the post transplant period and contribute to TNFalpha production and (2) in terms of frequency, the majority of TNFalpha producing cells in the spleen after allogeneic BMT are CD3+.

Cellular origin of ionizing radiation-induced NF-kappaB activation in vivo and role of NF-kappaB in ionizing radiation-induced lymphocyte apoptosis

PURPOSE

To investigate the cellular origin of ionizing radiation (IR)-induced NF-kappaB activation in vivo and the role of NF-kappaB in IR-induced lymphocyte apoptosis.

MATERIALS AND METHODS

NF-kappaB activities were analysed by gel shift/supershift assay in isolated murine T- and B-cells, macrophages (MPhi) and tissues from normal and T- and B-cell-deficient Rag1 mice with or without exposure to IR. IR-induced lymphocyte apoptosis was determined by analysis of 3,3'-dihexyloxacarbocyanine iodide (DiOC(6)) uptake, annexin-V staining and the sub-G0/1 population, or by TUNEL assay.

RESULTS

The results showed that IR activated NF-kappaB in lymphocytes, including both T- and B-cells, but failed to do so in MPhi. Furthermore, T- and B-cell-deficient Rag1 mice exposed to IR exhibited a significant reduction in NF-kappaB activation as compared with normal mice. Although NF-kappaB1 (p50) gene knockout or NF-kappaB decoy oligonucleotide treatment specifically inhibited IR-induced lymphocyte NF-kappaB activation, they had no significant effect on IR-induced lymphocyte apoptosis.

CONCLUSIONS

This finding suggests that lymphocytes are the main cellular origin of IR-induced NF-kappaB activation in vivo. However, NF-kappaB activation has no significant effect on IR-induced lymphocyte apoptosis.

Determinants of Perioperative Morbidity and Mortality after Pneumonectomy

BACKGROUND

Pneumonectomy remains a relatively high-risk procedure. However, the underlying mechanism is still unknown. Thus, the effort to find out predisposing factors for surgical risks continues. We investigated the effect of both water-load control and sampling lymphadenectomy technique on perioperative morbidity and mortality after pneumonectomy.

MATERIAL AND METHODS

A hundred and three consecutive patients undergoing simple pneumonectomy were included in the prospective study. Pneumonectomy was performed for lung cancer in 92 patients and for benign diseases in 11 cases; 81 patients were male and 22 female, and the mean age was 53.4 +/- 11.4 years. Both sampling and completion lymphadenectomy techniques were used randomly. Water-load was carefully limited to values as low as possible, depending on stable hemodynamics during and after operation.

RESULTS

There were no deaths, and none of the patients needed postoperative mechanical ventilation. Major complications included dyspnea in 9 patients and supraventricular arrhythmias in 13 patients. Completion lymphadenectomy increased morbidity in both right and left pneumonectomy.

CONCLUSIONS

Both water-load limitation and sampling lymphadenectomy technique may decrease morbidity and mortality after pneumonectomy.

Dose equivalent, absorbed dose and charge spectrum investigation in low Earth orbit

Particle intensity, dose equivalent and absorbed dose have been measured on board the space shuttle Endeavour during STS-108 in December 2001 by Dublin Institute for Advanced Studies (DIAS). The dose estimates are based on very accurate measurements of recoils produced in CR-39 by cosmic ray primary and secondary protons and heavier nuclei and by secondary neutrons. The corresponding LET spectra were used to determine dose equivalent and absorbed dose values. Estimates of the total flux of Z > or = 2 nuclei have been undertaken and a preliminary charge spectrum was measured. Some comparisons are made with preliminary data obtained on STS-105 (ISS Expedition) and other missions using CR-39 detectors.

Acupuncture for Bell's palsy

BACKGROUND

Bell's palsy or idiopathic facial palsy is an acute facial paralysis due to inflammation of the facial nerve. A number of studies published in China have suggested acupuncture is beneficial for facial palsy.

OBJECTIVES

The objective of this review was to examine the efficacy of acupuncture in hastening recovery and reducing long-term morbidity from Bell's palsy.

SEARCH STRATEGY

We searched the Cochrane Neuromuscular Disease Group Register, MEDLINE (January 1966 to December 2002), EMBASE (January 1980 to December 2002), LILACS (from January 1982 to December 2002) and the Chinese Biomedical Retrieval System (January 1978 to December 2002) for randomised controlled trials using 'Bell's palsy' and its synonyms, 'idiopathic facial paralysis' or 'facial palsy' as well as search terms including 'acupuncture'. Chinese journals in which we thought we might find randomised controlled trials or controlled clinical trials relevant to our study were handsearched. We reviewed the bibliographies of the randomised trials and contacted the authors and known experts in the field to identify additional published or unpublished data.

SELECTION CRITERIA

We included all randomised or quasi-randomised controlled trials involving acupuncture in the treatment of Bell's palsy irrespective of any language restrictions.

DATA COLLECTION AND ANALYSIS

Two reviewers identified potential articles from the literature search and extracted data independently using a data extraction form. The assessment of methodological quality included allocation concealment, patient blinding, differences at baseline of the experimental groups and completeness of follow-up. Two reviewers assessed quality independently. All disagreements were resolved by discussion between the reviewers.

MAIN RESULTS

Three studies including a total of 238 patients met the inclusion criteria. Two of them used acupuncture while the third used acupuncture combined with drugs. No trials reported on the outcomes specified for this review. Three included studies showed that the therapeutic effect of acupuncture alone was superior to that of medication or that acupuncture combined with medication was better than medication alone. Harmful side-effects were not reported in any of the trials. Flaws in study design or reporting (particularly uncertain allocation concealment and substantial loss to follow-up) and clinical differences between trials prevented a meta-analysis.

REVIEWER'S CONCLUSIONS

The quality of the included trials was inadequate to allow any conclusion about the efficacy of acupuncture. More research with high quality trials is needed.

Expression of Na+/H+ and HCO3−-dependent transporters in Na+/H+ exchanger isoform 1 null mutant mouse brain

Acid-base transporters, such as the sodium-hydrogen exchangers (NHEs) and bicarbonate-dependent transporters, play an important role in the regulation of intracellular pH (pH(i)) in the CNS. Previous studies from our laboratory have shown that the absence of the major NHE isoform 1 (NHE1) reduced the steady-state pH(i) and recovery rate from an acid load in the hippocampal neurons not only in HEPES but also in HCO(3)(-) solutions (Yao et al., 1999). The purpose of the current study was to determine whether the NHE1 null mutation affects the expression of pH-regulatory transporters in the mouse CNS. Immunoblotting and semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) were performed to examine the protein and mRNA levels of NHE1-4, electrogenic sodium-bicarbonate cotransporter 1 variants (NBCe1), and brain-specific anion exchanger 3 (AE3) in four brain regions (cerebral cortex, hippocampus, cerebellum and brainstem-diencephalon). NHE1 null mutant mice were compared with their wild type controls at the average age of approximately 4 weeks. Our results revealed that the NHE1 null mutation caused a significant increase in NHE3 in the cerebellum (84% for protein, 105% for mRNA), an increase in NBCe1 expression in the brainstem-diencephalon (approximately 40-50% for protein, 9-15% for mRNA), as well as a decrease in AE3 in the hippocampus (approximately 60% for protein, 24% for mRNA). We conclude that the NHE1 null mutation does alter the expression of other membrane transporters at both protein and mRNA levels. The alteration is region-specific. An increase in acid extruders (e.g. NHE3) and a decrease in acid loaders (e.g. AE3) suggest that there are some compensatory mechanisms that occur in NHE1 null mutant mice.

Immune biology of macaque lymphocyte populations during mycobacterial infection

Immune responses of lymphocyte populations during early phases of mycobacterial infection and reinfection have not been well characterized in humans. A non-human primate model of Mycobacterium bovis bacille Calmette-Guerin (BCG) infection was employed to characterize optimally the immune responses of mycobacteria-specific T cells. Primary BCG infection induced biphasic immune responses, characterized by initial lymphocytopenia and subsequent expansion of CD4+, CD8+ and gammadelta T cell populations in the blood, lymph nodes and the pulmonary compartment. The potency of detectable T cell immune responses appears to be influenced by the timing and route of infection as well as challenge doses of BCG organisms. Systemic BCG infection introduced by intravenous challenge induced a dose-dependent expansion of circulating CD4+, CD8+ and gammadelta T cells whereas, in the pulmonary compartment, the systemic infection resulted in a predominant increase in numbers of gammadelta T cells. In contrast, pulmonary exposure to BCG through the bronchial route induced detectable expansions of CD4+, CD8+ and gammadelta T cell populations in only the lung but not in the blood. A rapid recall expansion of these T cell populations was seen in the macaques reinfected intravenously and bronchially with BCG. The expanded alphabeta and gammadelta T cell populations exhibited their antigen specificity for mycobacterial peptides and non-peptide phospholigands, respectively. Finally, the major expansion of T cells was associated with a resolution of active BCG infection and reinfection. The patterns and kinetics of CD4+, CD8+ and gammadelta T cell immune responses during BCG infection might contribute to characterizing immune protection against tuberculosis and testing new tuberculosis vaccines in primates.

Depletion effect on partial organization of atactic polymer chain segments in microcells

Glass transition for atactic poly(methyl methacrylate) (a-PMMA) prepared in nano-cells by microemulsion polymerization was measured at a faster heating rate after slow cooling of the sample from a temperature above Tg. An additional enthalpy relaxation and glass transition were observed at higher temperatures for the a-PMMA sample due to the partial organization of the chain segments which occurred during microemulsion polymerization. The re-precipitated a-PMMA did not show any self-organization under the same thermal conditions, although there are no changes in molecular weight or tacticity of the polymer chains. A depletion-interaction phenomenon was understood to provide entropic force for the self-organization of polymer chains inside the walls of the microemulsion cells.

Identification of a new HLA allele, A*1114, in a Chinese family

A novel HLA-A allele, A*1114, was initially detected in two generations of a Chinese family by unusual polymerase chain reaction based sequence-specific primers ( PCR-SSP) reaction patterns and ambiguous sequence-based typing (SBT). Molecular cloning and sequencing analysis indicated that this new allele differs from HLA-A*1102 by three nucleotide substitutions in exon 3, 524 A-->G, 526 G-->C, and 527 C-->G, thus changing codon 175 from His to Arg (CAT-->CGT) and codon 176 from Ala to Arg (GCG-->CGG). Segregation analysis showed that the proband inherited his mother's HLA haplotype A*1114, B*5801, DRB1*1405. The serologic equivalent of A*1114 is a split antigen HLA-A11.2. A PCR-SSP method was developed to distinguish A*1114 from other A*11 alleles. No further individuals with A*1114 were found in 5000 Chinese bone marrow donors.

Identification of a novel allele HLA-B*5610 in a Chinese potential bone marrow donor

A novel HLA-B allele, B*5610, has been identified in a potential bone marrow donor, his mother and brother using DNA-based typing and molecular cloning methods. The B*5610 allele differs from the closest matching HLA sequence of B*5602 by two nucleotide substitutions in exon 3, 559 C-->A and 560 T-->C, resulting in an amino acid change from Leu (CTG) to Thr (ACG) at codon 187. This new allele was segregated together with A*24020101 and DRB1*140101 in the proband's family. Serology study revealed that B*5610 is associated with B22 specificity. A PCR-SSP method was developed to distinguish B*5610 from other B*56 alleles. No further individuals with B*5610 were detected in 5000 Chinese bone marrow blood donors.

Cosmic ray measurements at aircraft altitudes and comparison with predictions of computer codes

Extensive measurements of dose exposure of aircrew have been carried out in recent years using passive detectors on subsonic and supersonic air routes by DIAS (Dublin Institute for Advanced Studies). Studies were based on measurement of LET spectra using nuclear recoils produced in CR-39 nuclear track detectors by high energy neutrons and protons. The detectors were calibrated using energetic heavy ions. Data obtained were compared with the predictions of the EPCARD and CARI-6 codes. Good agreement has been found between the experimental and theoretical values.

In vitro and in vivo effect of levopraziquantel, dextropraziquantel versus racemic praziquantel on different developmental stages of Schistosoma japonicum

AIM

To compare the antischistosomal effect of racemic praziquantel (Pra) and its enantiomers, levopraziquantel (L-Pra) and dextropraziquantel (D-Pra), on different developmental stages of Schistosoma japonicum.

METHODS

The in vitro effects of the drugs were determined in different stages of schistosomes maintained in RPMI 1640 supplemented with 20% calf serum. In vivo study mice infected with schistosome cercariae were treated intragastrically (ig) with Pra, L-Pra or D-Pra at different intervals after infection. The efficacy of the drugs was evaluated by residual mean worm number.

RESULTS

Based on the degree of tegument damage induced by L-Pra, d28 and d35 schistosomes were most susceptible to L-Pra, while d14 schistosomules being least susceptible. At comparable concentrations of 0.1-1 g/ml, L-Pra was more active than Pra even when the concentration of L-Pra was reduced to one-half of the minimum effective concentration of Pra. At above-mentioned concentrations D-Pra exhibited no apparent in vitro effect on different stages of schistosomes. When infected mice were treated ig with L-Pra, Pra or D-Pra at a single dose of 300 mg/kg or 500 mg/kg, only the former two drugs showed apparent effect on d0, d21, d28 and d35 schistosomes and less or much less effect on d3, d7 and d14 schistosomules. D-Pra only exhibited a negligible effect on d35 adult schistosomes as compared with L-Pra and Pra. When mice infected with d35 adult schistosmes were treated ig with L-Pra 150 mg/kg, the efficacy was similar to that of mice treated with Pra 300 mg/kg.

CONCLUSION

L-Pra is the principal active component against schistosomes in racemic Pra.

Three-dimensional vibration analysis of a torus with circular cross section

The free vibration characteristics of a torus with a circular cross section are studied by using the three-dimensional, small-strain, elasticity theory. A set of three-dimensional orthogonal coordinates system, comprising the polar coordinate (r, theta) at each circular cross section and the circumferential coordinate phi around the ring, is developed. Each of the displacement components u(r), v(theta), and w(phi) in the r, theta, and phi directions, respectively, is taken as a product of the Chebyshev polynomials in the r direction and the trigonometric functions in the theta and phi directions. Eigenfrequencies and vibration mode shapes have been obtained via a three-dimensional displacement-based extremum energy principle. Upper bound convergence of the first seven eigenfrequencies accurate to at least six significant figures is obtained by using only a few terms of the admissible functions. The eigenfrequency responses due to variation of the ratio of the radius of the ring centroidal axis to the cross-sectional radius are investigated in detail. Very accurate eigenfrequencies and deformed mode shapes of the three-dimensional vibration are presented. All major modes such as flexural thickness-shear modes, in-plane stretching modes, and torsional modes are included in the analysis. The results may serve as a benchmark reference for validating other computational techniques for the problem.

Metabolic signals, hormones and neuropeptides involved in control of energy balance and reproductive success in hamsters

In the 'postgenome era', most research on the neuroendocrine control of energy homeostasis has focused on hormonal and neuropeptide control of food intake (i.e. the amount of food eaten) in rats and mice. The amount of food consumed is influenced by both the motivation to procure food and the consummatory act of ingestion. In some species, the rate of food intake remains relatively constant, while survival is maintained via changes in food procurement, external storage and internal expenditure. For example, in hamsters, metabolic signals, peripheral hormones and central neuropeptides influence hunger motivation, food hoarding and changes in energy expenditure without necessarily influencing the amount of food ingested. A similar suite of metabolic signals, hormones and neuropeptides is involved in optimizing reproductive success under fluctuating energetic conditions. Reproductive processes are inhibited or delayed when energy expenditure outstrips energy intake and mobilization from storage. Estrous cyclicity in Syrian hamsters is sensitive to the availability of oxidizable glucose, but the presence of central glucose alone is not sufficient for normal estrous cycles. Food deprivation-induced anestrus does not depend upon food deprivation-induced increases in concentrations of adrenal hormones such as glucocorticoids. If hormones such as insulin and leptin play a role, they might do so by modulating the availability of glucose detected at extra-hypothalamic sites, instead of or in addition to direct effects on the mechanisms that control gonadotropin releasing hormone secretion. Despite our ability to measure and manipulate gene transcription, understanding of fuel homeostasis requires examination of indirect effects of hormones and neuropeptides on peripheral metabolism, attention to the motivational as well as consummatory aspects of ingestion, and the study of behaviour in a natural or seminatural context.

Rotating Gamma System radiosurgery for cerebral arteriovenous malformations

One hundred and thirty-two patients with cerebral arteriovenous malformations (AVMs) were treated using the Rotating Gamma System, a new radiosurgical system between November 1996 and May 2000. The average size of the AVMs was 23 mm in diameter (range 6 to 69 mm). The mean dose delivered to the AVM margin was 19.2 Gy (range 13 to 25 Gy), and that delivered to the center of the AVMs was 37.6 Gy (range 32.5 to 50 Gy). One hundred and six patients were followed up for an average of 18.4 months (range 5 to 44 months). Five patients (4.7%) experienced rebleeding which took place between 5 and 13 months after treatment, but none of them died from hemorrhage. No bleeding took place after complete angiographic obliteration. Neuroimaging studies showed radiation-induced edema in 19 (22%) of the 87 patients, none of whom had severe permanent neurological deficits. Of the 68 patients followed up for more than one year, 57 underwent angiography at 1 year after treatment. The complete obliteration was demonstrated in 24 patients (42%) at 1 year. Of the 27 patients followed for more than 2 years, 23 patients underwent angiography 2 years after treatment, and complete obliteration was demonstrated in 18 patients (78%). These results are comparable to the results of treatment with other radiosurgical systems.