CNS location of uterine-related neurons revealed by trans-synaptic tracing with pseudorabies virus and their relation to estrogen receptor-immunoreactive neurons

Retrograde, transneuronal tracing with Bartha's strain of pseudorabies virus was used in rats to identify spinal cord, brainstem and hypothalamic loci of uterine-related neurons that could function in the regulation of uterine activity. Based on the premise that estrogen might influence such uterine-related neurons, the existence of estrogen receptors in neurons in these same loci was examined. Viral injections were made into the uterine cervix, body and cervical end of the uterine horns, and the rats allowed to survive for four to six days. After four days, mainly the spinal cord, medulla and pons contained virus-infected neurons. After longer survival times, progressively higher levels of the neuraxis contained viral-labeled neurons, so that by six days hypothalamic uterine-related neurons were identified. First-order virus-infected neurons were visualized by immunohistochemistry in the pelvic paracervical parasympathetic ganglia and in inferior mesenteric sympathetic ganglia. Preganglionic and putative interneurons were labeled in the lumbosacral spinal cord and thoracic spinal cord mainly in the lateral horn area (sacral parasympathetic nucleus and intermediolateral nucleus), lateral aspect of the dorsal horn, intermediate gray, lamina X and dorsal gray commissural area. In the brainstem, labeling was most evident and consistent in the nucleus tractus solitarius, ventrolateral medulla, raphe magnus and pallidus nuclei, parapyramidal area, A5 cell group, Barrington's nucleus of the pons and periaqueductal gray of the midbrain. In the hypothalamus, virus-infected neurons were most marked in the paraventricular nucleus, with fewer in the medial preoptic area and ventromedial hypothalamic nucleus. Estrogen receptor-immunoreactive neurons were most often present among the virus-labeled uterine-related neurons of the spinal cord, nucleus tractus solitarius, ventrolateral medulla, periaqueductal gray, medial preoptic area and ventromedial hypothalamic nucleus. These results identify a multisynaptic pathway of neurons whose eventual output is involved in uterine functions, whose distribution is similar to that revealed by pseudorabies virus tracing from other visceral organs, and which are often mixed among estrogen-responsive neurons.

A sequential study assessing functional outcomes of first-time stroke survivors 1 to 5 years after rehabilitation

The purpose of this study was to assess the functional outcomes of first-time cerebrovascular accident survivors 1 to 5 years after rehabilitation. Subjects (n=68) consisted of individuals discharged from a regional rehabilitation center between 1992 and 1996 with the diagnosis of first-time cerebrovascular accident. The Adult Functional Independence Measure (FIM), an on-site outcomes measurement tool, was used to assess subjects' admittance and discharge total FIM scores. The Adult Functional Independence Measure, a phone interview methodology, was used to assess individuals' functional levels from 1 through 5 years after discharge from rehabilitation. Motor (Rasch Motor) and cognitive (Rasch Cognitive) components of the FIM also were analyzed over time. Data pertaining to differences in function between genders, site of lesion, family support, and whether therapy was received after discharge were collected. Data were analyzed to determine changes in function over time. Significant increases in total FIM and motor and cognitive scores occurred between admittance and discharge and between discharge and 1 year after discharge. Although not significant, slight increases were noted in all three measures up to 3 years after discharge. From 3 to 5 years after discharge, a steady decline was noted. First-time cerebrovascular accident survivors who did not experience additional medical problems continued to improve during the first 3 years after discharge from a rehabilitation center. After this time, however, declines were noted in total FIM, Rasch Motor, and Rasch Cognitive scores.

Inhibition of isoproterenol-induced tachycardia by azimilide in the isolated perfused guinea pig heart

The class III antiarrhythmic agent, azimilide, has been shown to inhibit dihydroalprenolol binding to the beta-adrenergic receptor of rat brain and heart in an in-vitro ligand-binding assay. Azimilide, was assessed for beta-adrenergic activity, either agonist or antagonist, in the isolated perfused guinea pig heart in comparison with class III reference agents and the class II agent, propranolol. Varying concentrations of compound (0.03-100 microM) were retrogradely perfused and the effects on corrected QT interval, baseline heart rate, and isoproterenol-stimulated heart rate were measured. Propranolol, dl-sotalol, azimilide, and d-sotalol inhibited isoproterenol-induced tachycardia with IC50 values (the concentration giving 50% inhibition of isoproterenol-stimulated heart rate) of 0.12, 1.4, 14.6, and 38.0 microM, respectively. Clofilium, dofetilide, and sematilide did not affect the action of isoproterenol. Dofetilide, clofilium, azimilide, sematilide, dl-sotalol, and d-sotalol increased the QTc interval approximately 20 ms at concentrations of 0.1, 0.3, 1.0, 3.0, 30.0, and 100.0 microM, respectively. The class III antiarrhythmic agents also slowed baseline heart rate and exhibited linear R-R and QT-interval relationships of similar slope. Azimilide's antagonism of isoproterenol in this isolated heart model may reflect a direct receptor interaction or a contribution from the bradycardic action of the compound, which distinguishes it from several other pure IKr-blocking class III antiarrhythmic agents.

An unusual presentation of intoeing in a child

Ganglion cysts are commonly seen in orthopedic and general practice. Compression of the common peroneal nerve by a ganglion cyst is rare in children; to the authors' knowledge, only five cases in patients younger than 18 years have been reported. A ganglion cyst was found in a 3-year-old child who was brought in for an evaluation of intoeing and was found subsequently to have a mass in the proximal aspect of the right leg. The literature is reviewed with attention to specific recommendations for the evaluation of soft tissue masses and the utility of imaging modalities.

Cardiopulmonary sympathetic afferent input does not require dorsal column pathways to excite C1-C3 spinal cells in rats

Effects of electrically stimulating the left stellate ganglion to activate cardiopulmonary sympathetic afferent (CPSA) fibers were determined on C1-C3 dorsal horn neurons in anaesthetized rats. Fifty-two of 53 dorsal horn neurons affected by CPSA stimulation were excited and one neuron was inhibited. In 6 experiments, dorsal columns and ventrolateral funiculi were sequentially lesioned to determine neuronal pathways involved in CPSA activation of C1-C3 neurons. In 6 additional experiments, spinal transection at rostral C1 was used to determine the contribution of supraspinal relays. We concluded that CPSA input to C1-C3 segments travelled bilaterally in ventrolateral pathways, and that supraspinal relays were not required for CPSA excitation of C1-C3 neurons. These results suggest that neurons in C1-C3 segments might play an important role in processing visceral spinal afferent information.

Cardiac troponin T is a sensitive, specific biomarker of cardiac injury in laboratory animals

A reliable serum assay that can discriminate between cardiac and skeletal muscle injury is not available for diagnostic use in laboratory animals. We tested and supported the hypotheses that serum cardiac troponin T (cTnT) was widely applicable in laboratory animals as a biomarker of cardiac injury arising from various causes; that it increased in proportion to severity of cardiac injury; and that it was more cardiospecific than creatine kinase (CK) or lactate dehydrogenase (LD) isozyme activities. In canine and rat models of myocardial infarction, cTnT concentration increased 1,000- to 10,000-fold and was highly correlated with infarct size within 3 h of injury. Serum CK and LD isozymes were substantially less effective biomarkers and, in contrast to cTnT, were ineffective markers in the presence of moderate skeletal muscle injury, with resulting serum CK activity > 5,000 U/L. Using these animal models, and mouse and ferret models, we also showed cTnT to be an effective biomarker in doxorubicin cardiotoxicosis, traumatic injury, ischemia, and cardiac puncture. Reference range serum concentrations for all species were at the detection limit of the assay, except those for mice, in which they were slightly increased, possibly because mice were used to generate assay monoclonal antibodies. We conclude that cTnT is a powerful biomarker in laboratory animals for the sensitive and specific detection of cardiac injury arising from various causes.

Barriers to hospice care: family physicians' perceptions

The purpose of this study was to examine barriers family physicians face when providing hospice care. A questionnaire was developed by the authors, and was mailed to 1,013 randomly selected AAFP members. The questionnaire addressed the various hospice care barriers. The respondents felt comfortable with hospice care, but felt that they did not receive adequate education in this area. They stated that they do have access to hospice programs. There is a general belief on the part of the respondents that their education in death and dying issues, and in hospice care was inadequate. The respondents, however, did feel comfortable in providing hospice care.

Localization of estrogen receptor protein and estrogen receptor messenger RNA in peripheral autonomic and sensory neurons

The presence of estrogen receptor protein and estrogen receptor messenger RNA was revealed in peripheral ganglionic neurons of the rat. The pelvic parasympathetic autonomic ganglion and lumbosacral dorsal root sensory ganglia were examined for estrogen receptor-containing neurons because they have known projections to the uterus and uterine cervix. The vagal nodose ganglia were studied for estrogen receptor-containing neurons because they are suspected sources of influence on the uterus. Immunohistochemistry. in situ hybridization histochemistry and retrograde tracing were utilized. Immunoreactivity for estrogen receptors was evident in the nuclei of a subpopulation of neurons in the pelvic ganglia, sixth lumbar and first sacral dorsal root ganglia and nodose ganglia. Some estrogen receptor-positive neurons also contained the retrograde tracer FluoroGold that previously had been injected into the uterus and uterine cervix. Estrogen receptor messenger RNA was also evident in a subpopulation of ganglionic neurons. These data suggest that a certain population of neurons in autonomic and sensory ganglia are capable of synthesizing estrogen receptors and these receptors can serve as binding sites for estrogen. Thus, certain aspects of the structure, function and neurochemistry of some autonomic and sensory neurons may be influenced by the sex steroid estrogen.

The axon as a metabolic compartment: protein degradation, transport, and maximum length of an axon

We present a model that predicts the maximum axonal length from the apparent velocity of slow axonal transport and cytoskeletal protein half-life. The model assumes that in mature axons the apparent velocity of slow transport varies with position, but that the density of cytoskeletal proteins and protein degradation are uniform. The model predicts that the apparent transport velocity of cytoskeletal proteins if highest near the cell body and decreases linearly along the axon, and that when axons branch the apparent velocity of transport decreases across the branch point. The predictions of this model are shown to be consistent with experiments. These results explain the variation in these fundamental metabolic parameters in different axons and species.

Women's health. Sexually transmitted diseases

When providing health care for women, one of the more common problems facing the primary care physician is sexually transmitted diseases (STDs). It is important to be able to develop an accurate diagnosis and appropriate treatment plan for STDs to reduce the potential long-term sequelae of these infections. It is also vital for the primary care physician to provide counseling for patients with STDs to improve compliance with the treatment regimens and prevent any further risk-taking behavior.

Major depression: assessing the role of new antidepressants

Major depression is a common disorder. Historically, tricyclic antidepressants have been the standard pharmacologic agents in the treatment of this disorder. Unfortunately, the occurrence of significant side effects has limited the use of these drugs. In the past decade, however, antidepressants that are pharmacologically distinct from the tricyclics have been introduced. These newer drugs are tolerated better than the tricyclics and have been reported to have similar efficacy. Thus, because these newer agents provide effective, well-tolerated treatment of mild to moderate depression, they are now generally preferred to the tricyclic antidepressants, despite their greater cost.

Tubulin transport in neurons

A question of broad importance in cellular neurobiology has been, how is microtubule cytoskeleton of the axon organized? It is of particular interest because of the history of conflicting results concerning the form in which tubulin is transported in the axon. While many studies indicate a stationary nature of axonal microtubules, a recent series of experiments reports that microtubules are recruited into axons of neurons grown in the presence of a microtubule-inhibitor, vinblastine (Baas, P.W., and F.J. Ahmad. 1993.J. Cell Biol. 120:1427-1437: Ahmad F.J., and P.W. Baas. 1995. J. Cell Sci, 108:2761-2769; Sharp, D.J., W. Yu, and P.W. Baas. 1995. J. Cell Biol, 130:93-103; Yu, W., and P.W. Baas. 1995. J. Neurosci. 15:6827-6833.). Since vinblastine stabilizes bulk microtubule-dynamics in vitro, it was concluded that preformed microtubules moved into newly grown axons. By visualizing the polymerization of injected fluorescent tubulin, we show that substantial microtubule polymerization occurs in neurons grown at reported vinblastine concentrations. Vinblastine inhibits, in a concentration-dependent manner, both neurite outgrowth and microtubule assembly. More importantly, the neuron growth conditions of low vinblastine concentration allowed us to visualize the footprints of the tubulin wave as it polymerized and depolymerized during its slow axonal transport. In contrast, depolymerization resistant fluorescent microtubules did not move when injected in neurons. We show that tubulin subunits, not microtubules, are the primary form of tubulin transport in neurons.

Efficacy of the class III antiarrhythmic agent azimilide in rodent models of ventricular arrhythmia

Azimilide exhibited antiarrhythmic activity in several rodent models of ventricular arrhythmias. In the mouse chloroform model, azimilide provided limited efficacy by the i.p. route (50% at 100 mg/kg versus 20% by vehicle), and no efficacy by the oral route (300 mg/kg). In a rat model in which arrhythmias are induced by ligation and reperfusion of the left descending coronary artery (CALR model), azimilide provided dose-dependent (1-18 mg/kg) efficacy by the intravenous route. The estimated dose that suppressed ventricular fibrillation (VF) was 5.0 mg/kg i.v. At 18 mg/kg i.v. azimilide also partially suppressed ventricular tachyarrhythmia (VT) and extrasystoles (VES). Rats dosed orally (100 mg/kg) were fully protected from VF. In isolated guinea pig hearts exposed to 1 microM ouabain, azimilide at 10 microM prevented the VT and VF seen in 69% and 23%, respectively, of control hearts. In anesthetized guinea pigs, azimilide at 10 and 30 mg/kg i.v. increased the dose of ouabain required to induce VES. While sematilide, dofetilide, and E-4031 significantly increased sensitivity to the arrhythmogenic actions of ouabain (by lowering the dose that caused VF), azimilide did not. Azimilide's antiarrhythmic profile in these rodent models differs from that of other class III agents, since azimilide had less efficacy in the mouse chloroform model, could suppress VT and VES as well as VF in the CALR rat model, and protected from or did not aggravate cardiac glycoside-induced arrhythmias in guinea pigs. These results demonstrating the antiarrhythmic efficacy of azimilide in the intact animal suggest that the compound has a different profile than other class III agents.

The effects of state terrorism and exile on indigenous Guatemalan refugee children: a mental health assessment and an analysis of children's narratives

This study examined the mental health and psychosocial development of 58 Guatemalan Mayan Indian children living in 2 refugee camps in the Mexican state of Chiapas. Conventional assessment instruments were adapted for use in this unique context, and semistructured interviews were utilized to gather phenomenological data from children regarding various developmental, sociocultural, and political topics. Data are presented that show minimal evidence of psychological trauma in this sample, and various factors are suggested to account for this finding. In addition, data are presented showing a positive relationship between children's mental health and the health status (physical and mental) of their mothers. In particular, a strong association was found between depressive symptomatology in girls and poor health status in their mothers. Qualitative data from the interviews are presented, focusing on children's understandings of why their families fled Guatemala, the nature and causes of the violence, and their thoughts and feelings regarding the prospect of returning to Guatemala at some future point.

Medical students' and private family physicians' perceptions of family practice

BACKGROUND

Many studies have attempted to determine what factors influence medical students' career selections. This study determined students' perceptions of family practice, examined what variables influenced these perceptions, and measured whether medical students' perceptions were similar to or different from those of practicing family physicians.

METHODS

The two populations studied were students sampled at an Ohio medical school over the first 3 years of their training and a random sample of Ohio family physicians. Each subject was asked to complete a questionnaire that asked about perceptions of family practice and demographic information.

RESULTS

A total of 719 (69%) students and 295 (59%) family physicians responded to the survey. Sixty-seven percent of the physician responders were actively involved in medical student teaching. More than 94% of the students had exposure to family physicians during their preclinical education. Students' perceptions were different than physicians' perceptions about lifestyle issues, patient care, and practice characteristics; over time, these approached the physicians' perceptions. However, the perceptions of family physicians and students about professional issues were similar.

DISCUSSION

Medical students and family physicians have different perceptions about family practice. Students' perceptions become similar to physicians' perceptions as they progress through the educational system, while, at the same time, their interest in family practice declines.

Gifted and talented: fourth-, fifth-, and sixth-grade students' evaluations of a gifted program

A pull-out program for gifted students was evaluated in reports (qualitative evaluations) from a sample of 60 program participants from the fourth, fifth, and sixth grades. The students identified six areas in their evaluations: cognitive aspects, program satisfaction, self-expression, self-esteem, boredom, and learning environment. Students who identified cognitive aspects of their program also were likely to identify program satisfaction and not being bored. Statements about opportunities to be self-expressive were made more by girls than by boys and more by fifth and sixth graders than by fourth graders.

Mentoring for medical students interested in family practice

Formal mentoring programs have been suggested as one strategy to increase student interest in primary care. Mentoring has long been a part of the business world but has only recently become a formal part of family medicine training. This paper reviews the literature on mentoring and provides applications to family practice. Mentoring has been found to develop a deeper relationship than role modeling or preceptoring and should benefit the student and mentor. The mentor's roles and functions are varied and numerous; the mentor guides, assists, and counsels students longitudinally through their development as professionals. Mentoring is based in the present but is directed toward the future. Mentors need to have charisma, leadership and motivational skills, inspiration, competence, compassion, empathy, and willingness to share with the student. Strategies used when developing a mentoring program need to incorporate the positive qualities of mentoring while minimizing the negative components, as described in this paper. The tasks of mentoring are of less importance than the personal characteristics of the mentor. Mentors should not be involved in formally evaluating the student. Faculty development and monitoring of the relationships on a regular basis are important aspects of a successful program.

Playing to grow: a primary mental health intervention with Guatemalan refugee children

Adaptation and implementation of a primary mental health project based on work with children affected by political repression in Guatemala and Argentina are described. This intervention model utilizes a variety of expressive arts techniques to help children express their thoughts and feelings about growing up in exile. The model emphasizes the training of community members in the theory and methods of the intervention.

Conformation of the oligosaccharide receptor for E-selectin

A tetrasaccharide related to the blood group oligosaccharides, known as sialyl LewisX, has been proposed as the receptor for the lectin responsible for leukocyte adhesion named alternatively as E-selectin or ELAM-1. The 13C- and 1H-nmr spectra have been completely assigned for a tetrasaccharide model of this receptor, Neu5Ac alpha-(2-->3)-Gal beta-(1-->4)-[Fuc alpha-(1-->3)-]GlcNAc beta-NHAc. Quantitative nuclear Overhauser data (NOESY) have been recorded and analyzed by a complete spin matrix simulation method. Conformational space was exhaustively searched and all conformational models whose simulated NOESY spectra matched the experiment were found. Molecular mechanics and molecular dynamics calculations were carried out to test whether the experimental conformations are low energy and thus likely to represent true single conformations for the tetrasaccharide. It was concluded that while the LewisX trisaccharide portion of the compound adopts a single conformation, there is likely to be some flexibility about the Neu5Ac alpha-(2-->3)-linkage. A model featuring fast exchange between two different conformations of this linkage is found to be consistent with both the nmr experiments and the molecular dynamics simulations.

Glutaminase-like immunoreactivity in rat spinomesencephalic tract cells

Retrograde transport of the fluorescent tracer Fluorogold was used in combination with immunohistochemical staining for the enzyme glutaminase to identify putative glutamatergic neurons belonging to the rat spinomesencephalic tract. Glutaminase-like staining in spinal projection neurons suggests that the relay of nociceptive information from the spinal cord to midbrain may involve the excitatory amino acid glutamate.

Glutaminase immunoreactive neurons in the rat dorsal root ganglion contain calcitonin gene-related peptide (CGRP)

The co-localization of glutaminase and calcitonin gene-related peptide (CGRP) was examined with immunohistochemistry in the rat dorsal root ganglion (DRG). The majority of the DRG neurons were immunoreactive for glutaminase and all DRG neurons that contained CGRP also contained glutaminase. These results indicate that some DRG neurons release glutamate and CGRP from the same axon terminals in the spinal cord. Co-release of glutamate and CGRP from primary afferents may have multiple effects including fast and slow neurotransmission of sensory information in the spinal cord.

Solution structure of the Lewis x oligosaccharide determined by NMR spectroscopy and molecular dynamics simulations

The Lewis x (Lex) determinant is a trisaccharide fragment that has been implicated as a specific differentiation antigen, as a tumor antigen, and as a key component of the ligand for the endothelial leukocyte adhesion molecule, ELAM-1. High-resolution nuclear magnetic resonance spectroscopy shows it to have a relatively rigid structure. Only a small range of glycosidic dihedral angles in the trisaccharide produce simulated nuclear Overhauser effect spectra agreeing with data measured for the human milk pentasaccharide, lacto-N-fucopentaose-3, which contains the Lex determinant. Independently, the same average structure for the Lex determinant arises from in vacuo molecular dynamics simulations. The proposed conformation of the Lex trisaccharide is very similar to that recently determined for the closely related Lea trisaccharide. In agreement with the recent finding that both sialylated Lea and Lex react with ELAM-1, the results presented here show that the Lea and Lex determinants contain very similar carbohydrate domains.