Relative changes in blood flow with functional electrical stimulation during exercise of the paralyzed lower limbs

Eight spinal cord injured (SCI) patients performed three sets of exercise with two conditions, 60% and 80% of VO2peak, with an arm crank ergometer. Functional neuromuscular stimulation was used to induce static leg contractions in two of the above sets of exercise. The three exercise sets were performed with no functional neuromuscular stimulation (NOS); with functional neuromuscular stimulation at 40 milliamperes; and with functional neuromuscular stimulation at 80 milliamperes (HIS). The lower limb blood flow was estimated by a photoelectric plethysmograph. Results showed that the lower limb blood flow was consistently reduced across both functional neuromuscular stimulation levels (17.4% from NOS to LOS; 13.8% from LOS to HIS; and 28.8% from NOS to HIS), and work loads (15.3% from rest to 60% VO2peak; 38.0% from 60% VO2peak to 80% VO2peak; and 47.5% from rest to 80% VO2peak). Rate-pressure product was decreased by 8.3% between NOS and HIS at 60% VO2peak (15.7 +/- 3.4 to 14.4 +/- 3.8), by 6.8% between NOS and HIS at 80% VO2peak (18.9 +/- 53 to 17.6 +/- 4.8), and by 12.4% between LOS and HIS at 80% VO2peak (20.1 +/- 6.7 to 17.6 +/- 4.8). These data indicate that in SCI (a) functional neuromuscular stimulation-induced contractions of the lower limb muscles can increase blood flow and thus reduce venous blood pooling in the paralyzed muscles, and (b) such improvements are associated with a reduced rate pressure product.(ABSTRACT TRUNCATED AT 250 WORDS)

Yohimbine facilitated acoustic startle in combat veterans with post-traumatic stress disorder

Preclinical and clinical studies have suggested that the acoustic startle reflex (ASR) is a useful model to investigate the neurochemical basis of anxiety and fear states. This work has revealed that the anxiogenic alpha-2 receptor antagonist, yohimbine, increases the amplitude of the ASR in laboratory animals and in healthy human controls. Because of the growing body of data that support the hypothesis that severe stress results in substantial alterations in noradrenergic neuronal reactivity, the present investigation evaluated the effects of yohimbine on the ASR of 18 patients with PTSD and 11 healthy combat controls. Subjects received IV yohimbine (0.4 mg/kg) or saline placebo on 2 separate days in a randomized double blind placebo control design. A trial of two tone frequencies with varied intensity (90, 96, 102, 108, 114 dB) white noise and instantaneous rise time, was delivered binaurally through headphones. Tones were delivered every 25-60 s, for a 40-ms duration. Startle testing was performed 80 min post-infusion and lasted 15-20 min. Yohimbine significantly increased the amplitude, magnitude and probability of the ASR in combat veterans with PTSD, but did not do so in combat controls. Overall startle was significantly larger in the PTSD subjects; however, this did not account for the differential effect of yohimbine, since yohimbine had no significant effect in the control group. This study demonstrates an excitatory effect of yohimbine on the amplitude, magnitude and probability of the ASR in PTSD patients that is not seen in combat controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Mechanisms subserving temporal modulation sensitivity in silent-cone substitution

Temporal contrast sensitivity data were collected with sine-wave-modulated lights for achromatic, chromatic, and silent-cone-substitution stimuli. Achromatic (556- and 642-nm lights in phase) and chromatic (556- and 642-nm lights in counterphase) modulation sensitivities were measured at a constant time-average retinal illuminance of 1256 trolands (Td) and chromaticity of 595 nm. These data were considered to represent isolated temporal responses of luminance and red-green chromatic channels, respectively. Silent cone substitution was achieved with counterphase modulation of the 556- and the 642-nm lights and by suitable adjustment of the modulations or the radiances of the two lights. (1) The peak modulation depth of the 642-nm light was reduced to silence the long-wavelength-sensitive (LWS) cone, and the peak modulation depth of the 556-nm light was reduced to silence the middle-wavelength-sensitive (MWS) cone. These protocols maintained the time-average retinal illuminance and chromaticity as for the control conditions. (2) The luminance of the 642-nm light was decreased to silence the LWS cone and was increased to silence the MWS cone. In this procedure the time-average retinal illuminance and chromaticity differ for the silenced-LWS-cone (1047 Td and 589.5 nm) and the silenced-MWS-cone (4358 Td and 622 nm) conditions. The response modulation of the achromatic and the chromatic channels was calculated for the silent-substitution conditions. The chromatic channel is more sensitive at low frequencies, with a transition to greater achromatic channel sensitivity near 13 Hz for the silenced-LWS-cone condition and near 6 Hz for the silenced-MWS-cone condition.(ABSTRACT TRUNCATED AT 250 WORDS)

Sex differences in neonatal stress reactivity

The question of whether a sexually dimorphic stress reaction exists prior to extensive socialization was addressed by examining sex differences in physiological and behavioral stress reactivity, in healthy, term neonates, after a mildly stressful behavioral assessment procedure. The Neonatal Behavior Assessment Scale (NBAS; Brazelton, 1973) was administered to 18 male and 18 female neonates. Heart rate (HR), salivary cortisol, and behavioral states were assessed before and after the exam. Sex differences included higher cortisol response in males and a greater change in HR and higher NBAS motor performance cluster score in females. Salivary cortisol, HR change, NBAS cluster scores, and behavioral states after NBAS provided 100% discrimination between male and female infants. These findings suggest that there are neonatal sex differences in behavioral and physiological stress reactivity prior to socialization.

Prepulse inhibition of the acoustic startle reflex using visual and auditory prepulses: disruption by apomorphine

The amplitude of the acoustic startle reflex can be reduced reliably when preceded at short intervals by a weak stimulus (prepulse) which itself does not elicit startle. The magnitude of this prepulse inhibition effect is attenuated by several dopamine agonists, such as apomorphine, especially when there is a relatively small difference between the intensity of the prepulse and the intensity of the background noise over which the prepulse is superimposed. One goal of the present experiment was to test the generality of this disruptive effect of apomorphine on prepulse inhibition by using either an auditory prepulse that included both a change in intensity and a change in frequency relative to the background noise or a visual prepulse stimulus. Apomorphine reduced auditory prepulse inhibition when induced by a small change in stimulus intensity, but not when induced by a change in both intensity and frequency. Apomorphine consistently reduced visual prepulse inhibition with a complete blockade at 100-ms test interval. However, it did not fully block the usual reduction in startle onset latency or even attenuate the increase in startle amplitude when a visual prepulse was presented 5, 10 or 15 ms before the startle stimulus. Consistent with conclusions from other laboratories using auditory prepulse inhibition, these data suggest that apomorphine did not prevent the animal from detecting prepulse presentation under conditions where the drug completely blocked prepulse inhibition. Moreover, they indicate that the blockade of prepulse inhibition by apomorphine was independent of prepulse modality, adding generality to the original finding. Visual prepulse inhibition may be a useful alternative procedure for evaluating the effects of drugs on this attentional process.

Electromyograph analysis of the popliteus muscle in level and downhill walking

It has been proposed that the popliteus muscle is a source of lateral knee pain, typically after downhill activities. Electromyography of the popliteus muscle was recorded in 9 normal subjects during level walking, downhill walking, and walking downhill wearing a 40-lb backpack (to simulate hiking). Popliteal muscle intensity during the midstance phase of walking downhill with weights increased significantly over that of level walking (30% versus 13%, respectively) (p < 0.05). There was a nonsignificant trend (p = 0.07) for a similar increase at terminal swing (51% versus 36%). Significantly greater knee flexion was recorded at loading response, midstance, and terminal stance (p < 0.01) during both downhill trials as compared with level walking. Initial contact position showed no differences. Velocities for downhill walking (72.9 m/min) and downhill walking with weights (71.1 m/min) were significantly less than those of level walking (83.9 m/min) (p < 0.01). Stride analysis showed no significant difference in stance phase duration or in initial double-limb support times between level walking and either downhill condition. These data suggest that increased popliteal muscle activity during midstance in downhill walking with weights is in response to weight bearing with an increased load on a flexed knee. Increased Electromyographic activity may be associated with overuse of the popliteus muscle.

Effect of corticosterone on the enhancement of the acoustic startle reflex by corticotropin releasing factor (CRF)

The present study evaluated the effects of adrenalectomy and chronic administration of corticosterone on the ability of CRF given intraventricularly to increase the amplitude of the acoustic startle reflex in rats. Experiment 1 showed that CRF-enhanced startle was not affected by adrenalectomy, indicating a central effect independent of the integrity of the hypothalamic-pituitary-adrenal axis. In Experiment 2, chronic injection of corticosterone augmented CRF-enhanced startle using a dose of CRF (0.25 micrograms) that normally is ineffective in increasing startle amplitude. Chronic injection of corticosterone by itself did not increase startle amplitude (Experiment 3). We suggest that the potentiation of CRF-enhanced startle by corticosterone may result from an activation of CRF in the central nucleus of the amygdala.

Instructional conditions and stereotyped behavior: the function of prompts

The relationship of instructional prompts to rate of task completion and stereotypy was studied in one adolescent student with autism and high-frequency stereotypic behavior. Using an ABAB design, one experiment was conducted which systematically examined the role of prompts on (a) task completion and (b) time engaged in stereotyped behavior. Results suggested that prompts had little effect on the rate of task completion across sessions but did reduce time spent in stereotypies. These results are discussed in relation to stereotypies and implications for intervention and instruction.

Long-term safety of treatment with recombinant human granulocyte colony-stimulating factor (r-metHuG-CSF) in patients with severe congenital neutropenias

Congenital neutropenias include a heterogenous group of diseases characterized by a decrease in circulating neutrophils. In phase I/II/III studies in patients with severe congenital and cyclic neutropenia, treatment with recombinant human granulocyte colony-stimulating factor (r-metHuG-CSF) resulted in a rise in the absolute neutrophil counts (ANC) and a reduction in infections. We report the effects of long-term safety of subcutaneous r-metHuG-CSF administration in 54 patients (congenital n = 44. cyclic n = 10) treated for 4-6 years. A sustained ANC response was seen in 40/44 severe congenital neutropenia patients and 10/10 cyclic neutropenia patients. Two patients required an increase of > 25% in dose to maintain a clinical response; one patient became refractory to therapy. A significant decrease in the incidence of severe infections and the need for intravenous antibiotics was noted. Significant adverse events noted which may or may not be related to therapy included: osteopenia (n = 15), splenomegaly (n = 12), hypersplenism (n = 1), vasculitis (n = 2), glomerulonephritis (n = 1), BM fibrosis (n = 2), MDS/leukaemia (n = 3), and transient inverted chromosome 5q with excess blasts (n = 1). R-metHuG-CSF has been well tolerated in the majority of patients and resulted in a long-term improvement in their clinical status.

Recovery of epinephrine response but not hypoglycemic symptom threshold after intensive therapy in type 1 diabetes

PURPOSE

Patients with intensively treated insulin-dependent diabetes mellitus (IDDM) exhibit more severe defects in counterregulatory hormone secretion and symptom recognition during hypoglycemia than do conventionally treated patients. In this prospective study in patients with preexisting defects in counterregulation, we examined the induction and reversibility of impaired symptomatic and adrenomedullary responses to hypoglycemia in 5 patients with IDDM (diabetes duration of 2 to 16 years; aged 19 to 36 years; 3 women, 2 men) who were receiving intensive therapy.

METHODS

Counterregulatory responses were assessed by using a single-step (approximately 2.8 mmol/L plasma glucose) and multiple-step (from approximately 5 mmol/L to 2.2 mmol/L plasma glucose) clamped hypoglycemia procedure. Patients were first studied after a stable period of conventional insulin therapy (glycosylated hemoglobin [HbA1c] 9.5 +/- 1.2%), then after 3 to 5 months of intensive therapy (HbA1c 6.6 +/- 0.2%), and a third time after resuming conventional therapy (HbA1c 8.7 +/- 0.9%).

RESULTS

Intensive therapy was associated with a 44% decline (P < 0.01) in the average plasma epinephrine increase during hypoglycemia, and the plasma glucose level required to stimulate epinephrine secretion fell from 3.7 +/- 0.2 to 3.0 +/- 0.1 mmol/L (P < 0.01). The threshold, but not the magnitude, of the plasma norepinephrine response was similarly altered. Hypoglycemic symptoms also decreased in intensity (by 67%, P < 0.01), and the glucose level required for symptom activation fell from 3.4 +/- 0.3 to 2.7 +/- 0.2 mmol/L, P < 0.01). When conventional therapy was resumed, the abnormalities in the epinephrine response due to intensive therapy were almost completely reversed. However, the reduction in symptoms and the altered thresholds for plasma norepinephrine were not reversed.

CONCLUSIONS

There is dissociation between the treatment-associated defects in hypoglycemia counterregulation in IDDM, and an increase in average glycemia produced by a return to conventional insulin therapy is not sufficient to reverse hypoglycemia unawareness worsened by intensive therapy.

Stress-induced activation of prefrontal cortex dopamine turnover: blockade by lesions of the amygdala

Stress consistently has been found to activate peripheral and central catecholamine systems. Dopamine (DA) turnover in the prefrontal cortex is especially sensitive to stress produced by relatively mild footshock, conditioned fear, or exposure to a novel cage. Because lesions of the central nucleus of the amygdala block the effects of both stress and fear in many experimental paradigms, the present study evaluated whether such lesions would block stress-induced increases in prefrontal dopamine turnover using either mild footshock or novelty as stressors. In Experiment 1 electrolytic lesions of the central nucleus of the amygdala attenuated the increase in the dopamine metabolite homovanillic acid (HVA) in the prefrontal cortex evaluated in post-mortem tissue normally produced by footshock. In Experiment 2 similar lesions attenuated the increase in dopamine turnover in the prefrontal cortex using a different stressor, novelty, and a different measure of dopamine turnover, DOPAC/DA ratios. These data provide further evidence for the critical role of the amygdala in stress.

Geobacter sulfurreducens sp. nov., a hydrogen- and acetate-oxidizing dissimilatory metal-reducing microorganism

A dissimilatory metal- and sulfur-reducing microorganism was isolated from surface sediments of a hydrocarbon-contaminated ditch in Norman, Okla. The isolate, which was designated strain PCA, was an obligately anaerobic, nonfermentative nonmotile, gram-negative rod. PCA grew in a defined medium with acetate as an electron donor and ferric PPi, ferric oxyhydroxide, ferric citrate, elemental sulfur, Co(III)-EDTA, fumarate, or malate as the sole electron acceptor. PCA also coupled the oxidation of hydrogen to the reduction of Fe(III) but did not reduce Fe(III) with sulfur, glucose, lactate, fumarate, propionate, butyrate, isobutyrate, isovalerate, succinate, yeast extract, phenol, benzoate, ethanol, propanol, or butanol as an electron donor. PCA did not reduce oxygen, Mn(IV), U(VI), nitrate, sulfate, sulfite, or thiosulfate with acetate as the electron donor. Cell suspensions of PCA exhibited dithionite-reduced minus air-oxidized difference spectra which were characteristic of c-type cytochromes. Phylogenetic analysis of the 16S rRNA sequence placed PCA in the delta subgroup of the proteobacteria. Its closest known relative is Geobacter metallireducens. The ability to utilize either hydrogen or acetate as the sole electron donor for Fe(III) reduction makes strain PCA a unique addition to the relatively small group of respiratory metal-reducing microorganisms available in pure culture. A new species name, Geobacter sulfurreducens, is proposed.

Effects of small angle discrepancies on interpretations of subtraction images

The present study examines interpretations of subtraction images of pairs of radiographs taken at 0 degrees, 1 degree, or 2 degrees of angle discrepancy. The radiographs were taken at each of 48 alveolar crestal sites on 15 dried human skulls. Computer-simulated lesions were induced at the sites on three fourths of the radiographs. Ten instructed dentists were asked to interpret the subtraction images as to the presence or absence of crestal change. A 2-degree angle discrepancy between radiographs resulted in a significant difference in sensitivity from that of radiographic pairs with a 0-degree discrepancy. However, we found no significant difference in sensitivity between 1-degree and 0-degree pairs of radiographs. In conclusion, a 1-degree geometric difference between pairs of radiographs does not significantly contribute to errors in interpretation of subsequent subtraction images.

Pre- and posttraining infusion of N-methyl-D-aspartate receptor antagonists into the amygdala impair memory in an inhibitory avoidance task

Involvement of amygdaloid N-methyl-D-aspartate (NMDA) receptors in memory processes was investigated. Rats with cannulas implanted in the basolateral amygdala were trained on a 1 trial step-through inhibitory avoidance task and tested for 24-hr retention. Pretraining infusion of 2-amino-5-phosphonovaleric acid (APV) into the amygdala, but not striatum or hippocampus, produced a dose-dependent retention deficit, which was attenuated by immediate posttraining intra-amygdala infusion of NMDA. Posttraining APV infusion also caused a dose- and time-dependent retention deficit. Pretest APV infusion had no effect on performance in the retention test. Further, pre- or posttraining infusion of 5.0 micrograms APV failed to affect acquisition and retention in the Morris water maze task. These findings suggest that amygdala NMDA receptors are normally activated by aversive training and play a critical role in memory formation for affective experience.

AIDS and behavioural risk factors in women in inner city Baltimore: a comparison of telephone and face to face surveys

STUDY OBJECTIVE

The study aimed to investigate the influence the mode of administration of a questionnaire (telephone or face to face) on reports of sexual behaviour and attitudes of HIV risk among woman of reproductive age.

DESIGN

Two cross sectional surveys--one, a modified random digit dialing telephone survey, the second, a face to face street sample--were carried out by the same interviewers using similar questionnaires in the same neighbourhoods.

SETTING AND PARTICIPANTS

Two socially deprived, inner city neighbourhoods of Baltimore City were assessed in early 1990 before a community health intervention was carried out in one of them. Women between 17 and 35 years were surveyed.

MAIN RESULTS

Altogether 775 and 416 women in the target age group were interviewed by telephone and face to face methods: the response rates were 66.4% and 77% respectively. Telephone respondents tended to be older, had more education, were more often married, were less likely to live in subsidised housing, and were more likely to report HIV testing. The proportions of respondents who reported a previous abortion and had had a surgical sterilisation were higher among the telephone respondents (34.7% v 24.1% and 26.4% v 20.6%, respectively). With regard to sexual risk behaviour, the only statistically significant differences were found in the proportion who reported having used drugs (10.6% of the face to face v 2.4% of the telephone sample) or alcohol (30.5% v 16.3%) at last sexual intercourse. The observed method effect on these variables remained unchanged after adjusting for age, education, employment, and marital status. This effect was even stronger for a subgroup of face to face respondents who reported not having a telephone at home. The adjusted odds ratios for reporting alcohol consumption and use of drugs at the last sexual encounter in this group compared with the telephone respondents were 3.7 (2.1, 6.6) and 14.1 (5.7, 34.5) respectively.

CONCLUSIONS

Despite the socioeconomic bias associated with the mode of data collection, there are only a few differences between the telephone and personal survey methods in reports of sexual behaviour. These differences are mostly concentrated in young women (under 20 years), and in a particularly socioeconomically deprived subgroup identified through telephone ownership.

Inclusion of women in AIDS clinical research: a political and legal analysis

Thirteen years into a devastating epidemic that is having a serious impact on women of color, we are only a few steps closer to genuine participation by women in AIDS clinical trials. Those who depend most heavily on research settings not only for the promise of an accessible cure, but also for life-prolonging therapies and state-of-the-art medical care are hurt most by exclusionary policies. Restrictive and contradictory federal policies, pharmaceutical company reluctance to complete animal toxicology and reproductive studies, inadequate informed consent, and unfounded industry fear of liability all play a part in keeping women with AIDS from participating in clinical research.

Mannitol revisited

Investigation into the use of osmotic therapy for ICP reduction began in 1919. Mannitol is the osmotic agent currently in use. Mannitol's effectiveness in reducing ICP has been shown. Osmotic therapy using mannitol reduces ICP by mechanisms that remain unclear. Mannitol is thought to decrease brain volume by decreasing overall water content, to reduce blood volume by vasoconstriction and to reduce CSF volume by decreasing water content. Mannitol may also improve cerebral perfusion by decreasing viscosity or altering red blood cell rheology. Lastly, mannitol may exert a protective effect against biochemical injury. The most common complications of therapy are fluid and electrolyte imbalances, cardiopulmonary edema and rebound cerebral edema. Nursing care of the patient receiving mannitol requires vigilant monitoring of electrolytes and overall fluid balance, and observation for the development of cardiopulmonary complications in addition to neurologic assessment.

Human envenomation from a wandering garter snake

Garter snake bites are generally innocuous to human beings. We report a case of human envenomation from the Wandering Garter snake (Thamnophis elegans vagrans). The patient, who was bitten on his right third fingertip, rapidly developed local edema, ecchymosis, and hemorrhagic vesicles. Systemic signs and symptoms did not develop. The clinical picture was similar to that in three previous patients with Thamnophis envenomation in that clinical signs followed a prolonged bite. Thamnophis species have Duvernoy's glands, which may be analogous to venom glands in Crotalidae (pit viper) species. The progressive local effects produced by secretions of these glands may be confused with early Crotalidae envenomation.

Neurotransmission in the rat amygdala related to fear and anxiety

An impressive amount of evidence from many different laboratories using a variety of experimental techniques indicates that the amygdala plays a crucial role in the acquisition, consolidation and retention or expression of conditioned fear. Electrophysiological data are beginning to detail the transmitters and inter-amygdala connections that transmit information to, within, and out of the amygdala. In general, treatments that increase the excitability of amygdala output neurons in the basolateral nucleus (for example, by decreasing opiate and GABA transmission, and increasing noradrenergic transmission) improve aversive conditioning, whereas treatments that decrease excitability of these neurons (by increasing opiate and GABA transmission, and decreasing NMDA and noradrenergic transmission) retard aversive conditioning as well as producing anxiolytic effects in appropriate animal tests. A better understanding of brain systems that inhibit the amygdala, as well as the role of its very high levels of peptides, might eventually lead to the development of more effective pharmacological strategies for treating clinical anxiety and memory disorders.