A contribution of neurokinin-1 receptor to formalin-induced c-fos expression in the rat spinal dorsal horn

Formalin applied to a hindpaw of the rat resulted in c-fos expression in the spinal dorsal horn neurons on the ipsilateral side of stimulation. The role of neurokinin-1 (NK-1) receptor in this response was examined using a selective NK-1 antagonist L-668169. L-668169 administered intrathecally (1 microg/10 microl, 10 microg/10 microl) 15 min before injection of 2% formalin into one hindpaw significantly decreased the number of Fos-labeled neurons in the dorsal horn. A smaller dose of L-668169 (0.1 microg/10 microl) was ineffective. It was also showed that a selective NK-1 agonist Sar-SP perfused intrathecally (10 microg/10 microl) did result in the production of c-fos mainly in laminae I and that SP-like immunoreactive varicosities apposed neurons with Fos-labeled nuclei at their perikaryal membrane in the superficial laminae. These results indicate that NK-1 receptors may contribute to the activation of c-fos in the spinal dorsal horn neurons.

[Fetal fibronectin and preterm birth]

OBJECTIVE

To determine whether fetal fibronectin is a sensitive test for the diagnosis and prediction of preterm birth.

METHODS

Fetal fibronectin was measured by enzyme-labeled immunosorbent assay (ELISA) methods in sample of cervical secretion from 38 women with threatened preterm delivery (study group) and 43 normal pregnanty women with same gestational weeks (control group).

RESULTS

The positive rate of fetal fibronectin in women with threatened preterm birth was significantly higher than that in the normal control group.

CONCLUSION

Fetal fibronectin is an important marker. It can be used for diagnosis and prediction of preterm birth.

X-Ray Focusing Optics and Its Applications in XRMF and XRL

A brief review of the research on capillary x-ray focusing optics (the x-ray lens) at the X-Ray Optics Laboratory of the Institute of Low Energy Nuclear Physics at Beijing Normal University is presented. As a new tool for controlling powerful wide-bandwidth x-ray beams, the x-ray lens has very broad applications in both pure and applied sciences and in industry. Research toward developing such optics continues to grow in Russia, United States, and China. Some applications of x-ray lenses have also been developed. The preliminary results of theoretical and experimental studies on applications of x-ray lenses in x-ray microfluorescence and deep submicron lithography are quite encouraging. These achievements anticipate the appearance of a new generation of x-ray equipment.

[Chemical anatomy of the nociceptive transmission and modulation in the spinal dorsal horn]

The present study had been made to study the distribution and synaptic characteristics of primary afferent C fibers and the normal chemical architecture of some neurotransmitters in spinal dorsal horn. The changes of the neurotransmitters with acute nociceptive stimulation were measured quantitatively. We demonstrated the synaptic relationships among primary afferent C fibers, inhibitory interneurons and nociceptive dorsal horn neurons and discussed their function in nociceptive transmission and modulation. These results provide evidence that acute pain evolved co-release of substance P and glutamate from C-fiber terminals may constitute a driving force for secondary activation of ascending projection neurons or of internal GABAergic antinoceciptive system directly via their receptors in the dorsal horn of the spinal cord.

In vitro effect of hemodilution on activated clotting time and high-dose thrombin time during cardiopulmonary bypass

BACKGROUND

Extreme dilution of clotting factors, as may occur during pediatric or neonatal cardiopulmonary bypass, often leads to inadequate monitoring of anticoagulation with activated clotting time (ACT). In this study we postulate that the high-dose thrombin time (HiTT) is less influenced by extreme dilution of clotting factors because it stimulates clotting through the common pathway.

METHODS

Heparinized prebypass blood was obtained from 30 adult cardiac surgical patients and was diluted in a laboratory setting with saline solution to mimic the clinical clear prime solution (group I; n = 10), with saline solution containing similar heparin as in the prebypass blood (group II; n = 10), and with fresh frozen plasma to substitute clotting factors in the diluted blood (group III; n = 10). Blood was diluted to four different degrees: a control without dilution, 25%, 50%, and 75% dilution. The ACT and HiTT were measured and compared.

RESULTS

In group I, significant prolongation of ACT was observed in blood diluted to 75% as compared with the nondiluted blood (p < 0.01). In contrast, HiTT was not prolonged at any degree of dilution but reduced proportionally to dilution up to 75%, reflecting the concomitant reduction of heparin. In group II, ACT increased at 25% dilution (p < 0.01) whereas HiTT increased at 50% dilution (p < 0.01). In group III, no prolongation of ACT or HiTT was found in any degree of dilution. Furthermore, adding fibrinogen to the diluted blood (n = 4) did not cause ACT to recover at 75% dilution, suggesting that dilution of other factors in the early clotting cascade rather than fibrinogen alone increases ACT.

CONCLUSIONS

These results imply that when blood is extremely diluted during cardiopulmonary bypass with a clear prime without substituted clotting factors, HiTT is a better test than ACT for anticoagulation monitoring.

A regional integrated information system to assure maternal-child health services: a progress report

Priorities for improving the health of our nation include rebuilding the public health infrastructure through increasing assessment, policy development, and assurance capacities in our communities. Capacity building necessitates formalizing and strengthening public health practice linkages to achieve Year 2000 objectives. Determining progress in achieving objectives requires development of public health infrastructure surveillance and data system capabilities. The Tracking Center of Tracking and Outreach Program for St. Louis (TOPS), through unique collaboration among academic and practice partners, laid the foundation for a Regional Integrated Information System (RIIS) by developing a centralized maternal-child health data base for prenatal and pediatric care providers. The RIIS model provides an example of a capacity building system designed to provide public health surveillance, assessment, planning, and evaluation capabilities. Medical Subject Headings (MeSH): health information systems, prenatal care, immunization, maternal-child health care, public health surveillance.

Blockade of capsaicin-induced reduction of GABA-immunoreactivity by spantide in cat spinal superficial dorsal horn

In our previous study, perineural application of capsaicin not only produced release and depletion of substance P from primary nociceptive afferent terminals, but also reduced GABA immunoreactivity in the superficial dorsal horn. The aim of the present study was to determine whether the release of GABA is triggered by substance P released from primary nociceptive afferent terminals by capsaican. GABA and substance P immunoreactivity in the lumbar dorsal horn was examined in two groups: in the first group the tibial nerve was treated with 3% capsaicin, and in the second group the dorsal surface of the lumbar cord was infused with spantide (50 nM), a substance P receptor antagonist, before application of capsaicin to the tibial nerve. Following perineural treatment of capsaicin for 30 min, both the GABA-immunostaining density and the number of GABA immunoreactive neurons were reduced significantly in the ipsilateral laminae I-II at L5 through L7. GABA immunoreactivity was reduced by 54.12%, 44.46% and 31.0% in the medial, central and lateral parts of the ipsilateral laminae I-II at L7, respectively. With pre-application of spantide to the spinal cord, GABA immunoreactivity was reduced only to 14.4%, 16.4% and 10.16%, respectively, in the medial, central and lateral parts of laminae I-II at L7 and no reduction of GABA immunoreactive neurons was observed. Additionally, capsaicin-induced reduction of substance P immunoreactivity was partially blocked by spantide. These results suggest that capsaicin produces substance P release from primary nociceptive afferent terminals, and that substance P, in turn, activates the second-order GABAergic interneurons in the dorsal horn. The functional significance of capsaicin-induced activation of GABAergic neurons in modulation of spinal nociception is discussed.

Effect of TENS-like stimulation on C afferent-induced c-fos expression in the rat spinal cord

Transcutaneous electrical nerve stimulation (TENS) has been widely used to relieve pain. This study examined the effect of TENS-like stimulation on primary C afferent-induced c-fos expression in the rat spinal dorsal horn. Fos-like immunoreactivity (FLI) evoked by excitation of C fibres of the tibial nerve was found ipsilaterally in laminae I-VIII and X of the spinal cord. The greatest number of FLI neurones was located in the medial half of laminae I-II0 and V at L5. When TENS-like stimulation (100 Hz) was applied proximally to the same tibial nerve, the number of FLI neurones by C afferents was reduced remarkably in ipsilateral laminae I-II0 and IV-VII. The results suggest that TENS stimulation-induced reduction of c-fos expression may reflect an inhibition of spinal nociception.

Are PRO discharge screens associated with postdischarge adverse outcomes?

OBJECTIVE

We evaluate whether patient outcomes may be affected by possible errors in care at discharge as assessed by Peer Review Organizations (PROs).

DATA SOURCES/STUDY SETTING

The three data sources for the study were (1) the generic screen results of a 3 percent random sample of Medicare beneficiaries age 65 years or older who were admitted to California hospitals between 1 July 1987 and 30 June 1988 (n = 20,136 patients); (2) the 1987 and 1988 California Medicare Provided Analysis and Review (MEDPAR) data files; and (3) the American Hospital Association (AHA) 1988 Annual Survey of Hospitals.

STUDY DESIGN

Multivariate logistic regression analysis was used to evaluate the association between the results of generic discharge administered by the PROs and two patient outcomes: mortality and readmission within 30 days. The analysis was adjusted for other patient characteristics recorded on the uniform discharge abstract.

PRINCIPAL FINDINGS

Four discharge screens indicated an increased risk of an adverse outcome-absence of documentation of discharge planning, elevated temperature, abnormal pulse, and unaddressed abnormal test results at discharge. The other three discharge screens examined-abnormal blood pressure, IV fluids or drugs, and wound drainage before discharge-were unrelated to postdischarge adverse outcomes.

CONCLUSIONS

Generic discharge screens based on inadequate discharge planning, abnormal pulse, increased temperature, or unaddressed abnormal tests may be important indicators of substandard care. Other discharge screens apparently do not detect errors in care associated with major consequences for patients.

[A study of relation of cardiac function and deformity degree in children with pectus excavatum]

40 children with pectus excavatum were divided into subgroups according to the FI (> 0.2 or < 0.2) and underwent M-ME examination for their cardiac function. 28 of 40 patients had their cardiac function and thoracic index re-examined after the operation. The results showed the cardiac function of children with pectus excavatum was damaged as FI of the patients was less than 0.2 and their cardiac function was getting well as their thoracic index improved.

[Excision of mid-lower rectal carcinoma through abdomen and anogenital space]

28 men with male mid and lower rectal carcinoma were treated by dissecting sigmoid colon and rectum in the abdomen through the anogenital space, which refers to the potential coronoid space located between the deep transverse perineal muscles and anal sphincter muscles. The rectal segment was pulled out through the anogenital space to accomplish resection and anastomosis outside the pelvic cavity. Follow-up for 9-57 months showed that 26 cases (92.9%) survived without recurrence of carcinoma and 1 had local recurrence. The advantages of the procedure include clear exploration, minimal trauma, super-lower anastomoses under direct vision, good recovery of defecating function, and less contamination of pelviccavity.

Neurobehavioral effects of phenytoin and carbamazepine in patients recovering from brain trauma: a comparative study

OBJECTIVE

To compare the effects of prophylactic anticonvulsant use of phenytoin and carbamazepine on the cognitive and emotional status of the patient after brain injury.

DESIGN

Double-blind, placebo-controlled study with assessments before and after withdrawal from drug treatment.

SETTING

Patients had been initially treated by neurosurgeons at a university hospital and were followed up during the study on an outpatient basis.

PATIENTS

Forty of 64 patients receiving phenytoin and 42 of 127 patients receiving carbamazepine from 6 to 44 months for seizure prophylaxis after brain injury met study criteria and were assigned to continue or discontinue treatment. Groups were balanced for age, sex, race, weight, intelligence, type of injury, duration of therapy, and drug plasma concentration at screening.

INTERVENTION

A battery of neuropsychological tests was administered twice during a 4-week baseline period, at the end of a 4- to 5-week period of continued drug treatment or placebo, and after 4 weeks of not receiving medication.

MAIN OUTCOME MEASURES

Attention and concentration, psychomotor speed, memory, verbal fluency, and emotional state.

RESULTS

No significant differences were found in the performance of patients in medication and placebo groups for either drug at the end of the placebo phase. Patients in the combined groups showed significant improvement (P < .01) on several measures of motor and speeded performance following cessation of drug treatment. Multivariate analyses showed additional differences between phenytoin and carbamazepine and also suggested a significant practice effect on some measures used.

CONCLUSIONS

Both phenytoin and carbamazepine seem to have negative effects on cognitive performance, particularly on tasks with significant motor and speed components. Practice effects were noted and may account for much of the improvement when patients stopped taking the drugs. Overall effects of the drugs were small and of limited clinical significance, but differences among subjects were noted that may affect selection of a particular drug for the individual patient.

Comparison of corneal epithelial wound healing rates in scrape vs. lamellar keratectomy injury

Previous in vivo studies evaluating the effects of growth factors on epithelial regeneration have used the scrape injury model in rabbit eyes. Since growth factors act principally on the mitotic activity of regenerating cells, the rapid wound closure rates following scrape injury may not adequately access the effects of these agents on epithelial repair. In this study, we evaluated the rates of wound healing following scrape (8.6 mm) and lamellar keratectomy (8.6 mm) injury in 25 albino rabbits. Eyes were left untreated or received daily application (two to three times) of (a) Tears Naturale II, (b) 50 mM Tris/NaCl, and (c) commercial vehicle for EGF. Eyes were evaluated daily by fluorescein staining with Ophthalmic Fluoro-Strips followed by clinical photography. The area of staining was quantitated by computer-assisted planimetry and rates calculated by linear regression analysis. Eyes receiving scrape injuries epithelialized by 3 days following surgery. Rates of wound closure in two separate groups (six eyes each) were 25.83 mm2/day (r = 0.96) and 29.56 mm2/day 9r = 0.97). Lamellar keratectomy injuries epithelialized by 7 to 8 days, which is substantially longer than that observed for scrape injuries. Rates of wound healing in two separate untreated groups (8 and 10 eyes) were 10.88 mm2/day (r = 0.95) and 9.00 mm2/day (r = 0.93), respectively, which were not significantly different. Analysis of variance comparing rates of wound closure indicated that lamellar keratectomy injuries heal at a significantly slower rate when compared to scrape injury (p less than 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Venous bridge used in free flap transfer for the lower leg in the presence of venous hypertension: a case report

Reconstruction with free flaps for the lower leg in the presence of venous thrombosis or venous hypertension has a high risk of failure. We describe the use of the contralateral leg for venous drainage through a pedicled skin bridge containing a tributary of the long saphenous vein. The recipient artery was a main artery of the ipsilateral leg. Two weeks later, once there was a well-established venous communication between flap and recipient site, the venous bridge was divided. Because the arterial inflow to the flap was not interrupted by the division of the skin bridge, the flap has good viability and good resistance to infection or ulceration 3 years later.

Evidence for t-tubular conduction failure in frog skeletal muscle induced by elevated extracellular calcium concentration

In order to investigate the mechanism by which elevated extracellular calcium ions decrease tetanus tension in frog skeletal muscle, we made mechanical, electrophysiological and photographic measurements on single fibres or small bundles of fibres. Three lines of evidence point to t-tubular conduction failure as the primary mechanism of action of high calcium. They are a decrease in amplitude of the late afterpotential, attenuation or elimination of the notch and hump configuration of the early afterpotential, and the appearance of wavy myofibrils in the axial core of fibres during tetanus. These effects are fully reversible and are shared by other bivalent cations. High calcium concentration causes a change in the time course of the early afterpotential but does not alter the passive cell membrane characteristics, as reflected by the time course of decay of applied hyperpolarizing pulses.