Structural and functional neuroprotection in glaucoma: role of galantamine-mediated activation of muscarinic acetylcholine receptors

Glaucoma is the leading cause of irreversible blindness worldwide. Loss of vision due to glaucoma is caused by the selective death of retinal ganglion cells (RGCs). Treatments for glaucoma, limited to drugs or surgery to lower intraocular pressure (IOP), are insufficient. Therefore, a pressing medical need exists for more effective therapies to prevent vision loss in glaucoma patients. In this in vivo study, we demonstrate that systemic administration of galantamine, an acetylcholinesterase inhibitor, promotes protection of RGC soma and axons in a rat glaucoma model. Functional deficits caused by high IOP, assessed by recording visual evoked potentials from the superior colliculus, were improved by galantamine. These effects were not related to a reduction in IOP because galantamine did not change the pressure in glaucomatous eyes and it promoted neuronal survival after optic nerve axotomy, a pressure-independent model of RGC death. Importantly, we demonstrate that galantamine-induced ganglion cell survival occurred by activation of types M1 and M4 muscarinic acetylcholine receptors, while nicotinic receptors were not involved. These data provide the first evidence of the clinical potential of galantamine as neuroprotectant for glaucoma and other optic neuropathies, and identify muscarinic receptors as potential therapeutic targets for preventing vision loss in these blinding diseases.

Bimodal modulation and continuous stimulation in optical imaging to map direction selectivity

In the visual system, neurons with similar functional properties such as orientation and direction selectivity are clustered together to form modules. Optical imaging recordings in combination with episodic paradigms have been previously used to estimate direction selectivity, a fundamental property of visual neurons. The major drawback of the episodic approach is that the extraction of the signal from various forms of physiological noise is difficult, leading to a poor estimation of direction. Recent work, based on periodic stimulation and Fourier decomposition improved the extraction of periodic stimulus responses from noise and thus, reduced the recording time considerably. Given the success of this new paradigm in mapping orientation, the present study evaluated its reliability to measure direction selectivity in the visual cortex of anesthetized cats. Here, a model that exploits the harmonics of the Fourier decomposition is proposed where the first harmonic is related to direction responses, and the second to orientation. As expected, the first harmonic was absent when a static stimulus was presented. Contrarily, the first harmonic was present when moving stimuli were presented and the amplitude was greater with random dots kinematograms than with drifting gratings. The phase of the first harmonic showed a good agreement with direction preference measured by episodic paradigm. The ratio of the first/the second harmonic amplitude, related to a direction index, was weaker in fracture. It was also weaker in areas of the ventral pathway (areas 17 and 21a) where direction selectivity is known to be reduced. These results indicate that a periodic paradigm can be easily used to measure specific parameters in optical signals, particularly in situations when short acquisition periods are needed.

Sex differences in mortality in patients with COPD

Little is known about survival and clinical prognostic factors in females with chronic obstructive pulmonary disease (COPD). The aim of the present study was to determine the survival difference between males and females with COPD and to compare the value of the different prognostic factors for the disease. In total, 265 females and 272 males with COPD matched at baseline by BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) and American Thoracic Society/European Respiratory Society/Global Initiative of Chronic Obstructive Lung Disease criteria were prospectively followed. Demographics, lung function, St George's Respiratory Questionnaire, BODE index, the components of the BODE index and comorbidity were determined. Survival was documented and sex differences were determined using Kaplan-Meier analysis. The strength of the association of the studied variables with mortality was determined using multivariate and receiver operating curves analysis. All-cause (40 versus 18%) and respiratory mortality (24 versus 10%) were higher in males than females. Multivariate analysis identified the BODE index in females and the BODE index and Charlson comorbidity score in males as the best predictors of mortality. The area under the curve of the BODE index was a better predictor of mortality than the forced expiratory volume in one second for both sexes. At similar chronic obstructive pulmonary disease severity by BODE index and forced expiratory volume in one second, females have significantly better survival than males. For both sexes the BODE index is a better predictor of survival than the forced expiratory volume in one second.

Survival, population size, and gonotrophic cycle duration of Nyssomyia neivai (Diptera: Psychodidae) at an endemic area of American cutaneous leishmaniasis in southeastern Brazil

The survival, absolute population size, gonotrophic cycle duration, and temporal and spatial abundance of Nyssomyia neivai (Pinto) were studied in a rural area endemic for American cutaneous leishmaniasis (ACL) in Conchal, São Paulo State, southeastern Brazil, using mark-release-recapture techniques and by monitoring population fluctuation. The monthly abundance exhibited a unimodal pattern, with forest and domicile habitats having the highest relative abundances. A total of 1,873 males and 3,557 females were marked and released during the six experiments, of which 4.1-13.0% of males and 4.1-11.8% of females were recaptured. Daily survivorship estimated from the decline in recaptures per day was 0.681 for males and 0.667 for females. Gonotrophic cycle duration was estimated to be 4.0 d. Absolute population size was calculated using the Lincoln Index and ranged from 861 to 4,612 males and from 2,187 to 19,739 females. The low proportion of females that reach the age when they are potentially infective suggests that N. neivai has a low biological capacity to serve as a vector and that factors such as high biting rates and opportunistic feeding behavior would be needed to enable Leishmania (Viannia) braziliensis Vianna transmission. This agreed with the epidemiological pattern of ACL in southeastern Brazil that is characterized by low incidence, with isolated cases acquired principally within domiciliary habitats.

Complex motion sensitivity of neurons, in the visual part of the anterior ectosylvian cortex in cats

In cats, it is generally believed that the visual part of the anterior ectosylvian cortex (AEV) is involved in motion integration. It receives a substantial proportion of its afferents from cortical (e.g. lateral suprasylvian cortex) and subcortical (e.g. lateral posterior-pulvinar complex) areas known to participate in complex motion analysis. It has been established that a subset of AEV neurons can code the veridical motion of a moving plaid pattern (pattern-motion selectivity). In our study, we have further investigated the possibility that AEV neurons may play a role in higher-order motion processing by studying their responses to complex stimuli which necessitate higher order spatial and temporal integration. Experiments were performed in anesthetized adult cats. Classical receptive fields were stimulated with (1) complex random-dot kinematograms (RDKs), where the individual elements of the pattern do not provide coherent motion cues; (2) optic flow fields which require global spatial integration. We report that a large proportion of AEV neurons were selective to the direction and speed of RDKs. Close to two-thirds of the cells were selective to the direction of optic flow fields with about equal proportions being selective to contraction and expansion. The complex RDK and optic flow responsive units could not be systematically characterized based on their responses to plaid patterns; they were either pattern- or component-motion selective. These findings support the proposal that AEV is involved in higher-order motion processing. Our data suggest that the AEV may be more involved in the analysis of motion of visual patterns in relation to the animal's behavior rather than the analysis of the constituents of the patterns.

Complex motion selectivity in PMLS cortex following early lesions of primary visual cortex in the cat

In the cat, the analysis of visual motion cues has generally been attributed to the posteromedial lateral suprasylvian cortex (PMLS) (Toyama et al., 1985; Rauschecker et al., 1987; Rauschecker, 1988; Kim et al., 1997). The responses of neurons in this area are not critically dependent on inputs from the primary visual cortex (VC), as lesions of VC leave neuronal response properties in PMLS relatively unchanged (Spear & Baumann, 1979; Spear, 1988; Guido et al., 1990b). However, previous studies have used a limited range of visual stimuli. In this study, we assessed whether neurons in PMLS cortex remained direction-selective to complex motion stimuli following a lesion of VC, particularly to complex random dot kinematograms (RDKs). Unilateral aspiration of VC was performed on post-natal days 7–9. Single unit extracellular recordings were performed one year later in the ipsilateral PMLS cortex. As in previous studies, a reduction in the percentage of direction selective neurons was observed with drifting sinewave gratings. We report a previously unobserved phenomenon with sinewave gratings, in which there is a greater modulation of firing rate at the temporal frequency of the stimulus in animals with a lesion of VC, suggesting an increased segregation of ON and OFF sub-regions. A significant portion of neurons in PMLS cortex were direction selective to simple (16/18) and complex (11/16) RDKs. However, the strength of direction selectivity to both stimuli was reduced as compared to normals. The data suggest that complex motion processing is still present, albeit reduced, in PMLS cortex despite the removal of VC input. The complex RDK motion selectivity is consistent with both geniculo-cortical and extra-geniculate thalamo-cortical pathways in residual direction encoding.

The 6-min walking distance: long-term follow up in patients with COPD

The 6-min walking distance (6MWD) test is used in clinical practice and research into patients with chronic obstructive pulmonary disease (COPD). However, little is known about natural long-term change in this parameter. The 6MWD was measured at baseline and then annually for 5 yrs in 294 patients with COPD and its annual rate of decline was determined. Forced expiratory volume in one second (FEV1) was also measured and the relationship between changes in both markers was explored. At baseline, the median 6MWD was 380 m (range 160-600 m). It declined by 19% (16 m.yr(-1)) over the 5 yrs compared with baseline in patients with American Thoracic Society/European Respiratory Society stage III COPD (FEV1 30-50% predicted) and by 26% (15 m.yr(-1)) in patients with stage IV COPD (FEV1 <30% pred). Over the 5-yr follow-up, the proportion of patients with a minimal clinically significant decline of 54 m increased with the severity of the disease. It was 24% in stage II, 45% in stage III, and 63% in stage IV disease. In contrast, the rate of decline of FEV1 was greater in patients with milder airflow obstruction and lesser in patients with lower absolute FEV1 values. In conclusion, the 6-min walking distance test provides increasingly useful information as the severity of chronic obstructive pulmonary disease increases.

Innovative social behavior in chimpanzees (Pan troglodytes)

We present evidence of agonistic buffering in captive chimpanzees, recorded from 1993 until 2005, mainly from ad libitum sampling in over 2000 hr of observation. A total of 33 agonistic buffering episodes were analyzed for context and effects of this complex social behavior. Agonistic buffering was directed at the whole chimpanzee colony as they supported an individual who initially received aggression from the alpha male, independently of the victim's age, sex or social rank. Chimpanzee agonistic buffering behavior is compared with that in other nonhuman primate species, and we describe some particularities of chimpanzee agonistic buffering: the status of the buffers used-socially important offspring such as those from the alpha female-and the social rank of the adult male responsible for the buffering episode-alpha male. Possible functions for this behavior in chimpanzees are suggested as appeasement of group members in a particularly crowded captive setting, and/or as a "forced reconciliation" mechanism. Chimpanzees exhibit behavioral flexibility by adapting themselves to new social and physical situations and use novel behavior to achieve social benefits.

Global motion integration in the postero-medial part of the lateral suprasylvian cortex in the cat

In cats, the postero-medial part of lateral suprasylvian cortex (PMLS) is generally considered a key area for motion processing. While behavioral studies have indeed supported the role of PMLS cortex in higher order motion integration (Cereb Cortex 6:814-822, 1996), there is no evidence that individual PMLS cells can perform such analysis (Vis Neurosci 5:463-468, 1990; J Neurophysiol 63:1529-1543, 1990). Given the fundamental importance of understanding the neural substrate subtending higher order motion processing, we investigated whether PMLS neurons can signal the direction of motion of complex random dot kinematograms (RDKs) wherein comprising elements do not provide any local coherent motion cues. Results indicated that most PMLS cells (82%) can integrate the displacement of individual elements into a global motion percept. Their large receptive fields allowed the integration of motion for elements separated by large spatial intervals (up to 4 degrees ). In most cases, the analysis of complex RDK motion necessitated the contribution of the area of the visual field beyond the classical receptive field. None of the complex RDK-sensitive cells were found to be pattern-motion selective when tested with plaid patterns. Our results provide the first evidence that receptive fields of PMLS neurons can perform global motion analysis and support the behavioral evidence that this area is implicated in complex motion processing (Cereb Cortex 6:814-822, 1996). It also further corroborates the findings that PMLS neurons cannot signal the true direction of a plaid pattern (Vis Neurosci 5:463-468, 1990; J Neurophysiol 63:1529-1543, 1990). Providing that these same neurons can signal the direction of complex RDKs, there may be distinct cortical mechanisms for processing different types of complex motion.

C-reactive protein levels and clinically important predictive outcomes in stable COPD patients

The aim of this study was to determine the relationship between C-reactive protein (CRP) levels and factors known to predict outcome in stable chronic obstructive pulmonary disease (COPD) patients. The following were studied in 130 stable COPD patients: spirometry, lung volume, arterial oxygen tension (P(a,O2)), dyspnoea, 6-min walk distance (6MWD), body mass index, fat-free mass index, BODE (body mass index, obstruction, dyspnoea and exercise capacity), health-related quality of life, smoking status, the presence of cardiovascular risk factors or disease, corticosteroid use and number of exacerbations in the previous year. CRP levels were measured in these patients and in 65 controls. Using univariate and multivariate analyses, any possible association with the predictors of outcomes was evaluated. CRP levels were higher in COPD patients than in controls (4.1 versus 1.8 mg.L(-1), respectively). Correlation was found with the following variables: forced expiratory volume in one second (FEV1; -0.23), FEV1 % (-0.20), forced vital capacity (FVC; -0.24), FVC % (-0.24), Global Initiative for Chronic Obstructive Lung Disease stage (0.17), BODE (0.17), inspiratory capacity/total lung capacity (-0.20), P(a,O2) (-0.40) and 6MWD (-0.30). Using multivariate analysis, P(a,O2) and 6MWD manifested the strongest negative association with CRP levels. C-reactive protein levels in stable chronic obstructive pulmonary disease patients are best correlated with arterial oxygen tension and 6-min walk distance. This should be considered when C-reactive protein levels are measured in stable chronic obstructive pulmonary disease patients.

[Lateral fixation of the vocal fold (Lichtenberger's technique): interest in the bilateral laryngeal immobilities]

In patients presenting a bilateral laryngeal immobility, the potential reversibility of certain cases, the refusal or the bad tolerance of long term tracheotomy bring up the question of the choice of the surgical technique if it is indicated.

OBJECTIVES

To report our experience with the technique of lateralization of the paralyzed vocal fold (arytenoidopexy) suggested by Lichtenberger.

CLINICAL CASES

After having described the technique, we report 5 cases (3 pos-thyroidectomy, I of central origine, 1 post-burn). From 1 to 12 months after surgery 2 patients were fully satisfied, a patient (central origin) recovered spontaneously at the end of a month and the 2 last had a partial result. Only one patient required several surgical gestures.

CONCLUSION

The Lichtenberger's technique combines theoretical reversibility and conservation of a functional glottic plan. It avoids tracheotomy. This approach can according to us validly replace the traditional techniques, medium or long term tracheotomy , or endoscopic arythenoid or posterior vocal fold resection.

[Evaluation of a university hospital unit specialising in treating adults at risk of suicide]

In France, suicide prevention has been a public health priority since 1992. Half of all suicide attempts are repeated attempts made by people who have already tried to commit suicide, and the risk of death increases by 1% after the first attempt. Today, hospitalisation has become an unavoidable consequence for those who have attempted suicide, and recommendations for best practice were recently issued in France (1998). The objective of this study was two-fold: 1) to assess the quality of management and care provided for patients hospitalised in a university hospital in Angers after having attempted suicide, an evaluation that was based in part on the criteria of the National Agency on Health Accreditation and Evaluation (ANAES); and 2) the demonstrate the value and high utility of such a unit specialising in caring for patients recovering from attempted suicide. The unit has now been in existence for over 5 years, and has treated 42% of such patients who require hospitalisation. One investigator was responsible for asking 251 patients (on the day of their release) who had been hospitalised anytime during the given 6 month period (November 2002 - May 2003) to complete a questionnaire containing approximately 100 items. In order to be eligible for the study, patients had to be older than 16 years and hospitalised for at least 48 hours. 155 questionnaires were completed (62%), and there were 96 patients were notable to participate on the day of their release. Nine of the 14 criteria recommended by the ANAES were met in over 65% of the cases, and three in less than 40%. Following the analysis of the data through logic regression, it remained clear that unit specialising in the care of people who have attempted suicide was better able and equipped to meet the standards of the ANAES' recommendations than a standard hospital medical unit. Visits with a psychiatrist or psychiatric nurse occurred more frequently in the specialised unit (p < 0.04), interviews with the patients' family members were more frequent (p < 0.01), the confidentiality of the discussions from the interviews was more often respected and maintained (p < 0001), and the information provided by the caregivers and staff was more effective in the specialised unit (p < 0.03). One of the main benefits and results of these aforementioned differences is that the patients in the suicide unit more often perceived a distinct improvement in their depression (p < 0.007). All of these arguments indicate that hospitalisation in a special unit provides real benefits to patients, and the results of this study advocate strongly in favour of increasing the capacity of the unit, which is currently limited to only 6 beds.

Effects of the intravitreal administration of dopaminergic ligands on the b-wave amplitude of the rabbit electroretinogram

In the retina of mammals, dopamine (DA) is generally released by amacrine cells and is known to alter the physiology of most retinal cells. It is well known that DA reduces the amplitude of the b-wave of the electroretinogram (ERG) in rabbit. However, the specific receptor subtypes that mediate this action have not yet been elucidated. To do this, we recorded flash ERGs before and after the intravitreal injection of D1-like DA receptor agonists (SKF38393, A77693) and antagonist (SCH23390), and of D2-like agonist (R(-)-propylnorapomorphine hydrochloride; NPA) and antagonist ((S)-(-)-sulpiride). Contralateral control eyes were injected with the vehicle only. Both D1 agonists provoked a reduction of the ERG b-wave amplitude (34.0% and 59.2% of the pre-injection level, respectively). The D2-like agonist NPA had no significant effects on ERG components. Unexpectedly, both D1- and D2-like antagonists also reduced the b-wave amplitude (28.9% and 59.8%). Overall, these data suggest that the previously described effect of DA on the rabbit ERG b-wave came from activation of D1-like receptors. On the basis of the effects observed with D2-like antagonist, a subtle contribution of D2-like presynaptic receptors cannot be ruled out.

Increased gastro-oesophageal reflux disease in patients with severe COPD

The prevalence and clinical consequences of gastro-oesophageal reflux disease (GERD) in chronic obstructive pulmonary disease (COPD) are not well characterised. The present study prospectively studied 42 males with COPD (forced expiratory volume in one second % predicted: 35%, range 20-49) and 16 healthy volunteers of similar age without respiratory or gastro-oesophageal symptoms. The diagnosis of GERD was confirmed using oesophageal 24 h pH monitoring. In the current study group, reflux symptoms were measured using the Vigneri score, cough and dyspnoea with the modified Medical Research Council questionnaire, and pulmonary function with bronchodilator response and health status using St George's Respiratory Questionnaire. Pathological reflux was documented in 26 out of 42 patients (62%) and in three volunteers (19%). In patients with GERD, 15 patients (58%) did not report any reflux symptoms. There were no differences in symptoms, health status, bronchodilator treatment and pulmonary function test between patients with and without GERD. Oxygen desaturation coincided with episodes of increased oesophageal acidity in 40% of patients with GERD. Patients with severe chronic obstructive pulmonary disease have a high prevalence of asymptomatic gastro-oesophageal reflux. The association between this reflux and oxygen desaturation deserves further attention.