Neuroprotective effect of inhaled nitric oxide on excitotoxic-induced brain damage in neonatal rat

Background

Inhaled nitric oxide (iNO) is one of the most promising therapies used in neonates. However, little information is known about its impact on the developing brain submitted to excitotoxic challenge.

Methodology/Principal Findings

We investigated here the effect of iNO in a neonatal model of excitotoxic brain lesions. Rat pups and their dams were placed in a chamber containing 20 ppm NO during the first week of life. At postnatal day (P)5, rat pups were submitted to intracranial injection of glutamate agonists. At P10, rat pups exposed to iNO exhibited a significant decrease of lesion size in both the white matter and cortical plate compared to controls. Microglia activation and astrogliosis were found significantly decreased in NO-exposed animals. This neuroprotective effect was associated with a significant decrease of several glutamate receptor subunits expression at P5. iNO was associated with an early (P1) downregulation of pCREB/pAkt expression and induced an increase in pAkt protein concentration in response to excitotoxic challenge (P7).

Conclusion

This study is the first describe and investigate the neuroprotective effect of iNO in neonatal excitotoxic-induced brain damage. This effect may be mediated through CREB pathway and subsequent modulation of glutamate receptor subunits expression.

[Regional analgesia after lower limb orthopaedic surgery]

To provide postoperative analgesia, the anaesthesist has at his disposal a panel of different medications and also regional techniques of neural blockade. Loco-Regional analgesia (epidural or peripheral nerve block), by the use of local anaesthetics, blocks conduction of the painful influx to th central nervous system. Pain relief using peripheral nerve blocks after lower limb surgery represents as good alternative to the epidural analgesia and is superior to controlled analgesia with morphine. Peripheral nerve blocks, by decreasing the use of opioids in the postoperative period, reduce the incidence of side effects related to these molecules. They are also devoided of the adverse events due to the epidural analgesia like urinary retention or need for continuous monitoring. Analgesia after total knee prosthesis and hallux valgus surgery has considerably evolved. Postoperative analgesia is important in these cases: it facilitates physical therapy and improves patient's rehabilitation and satisfaction, it also shortens hospital stay. The aim of this review is to explain the different techniques of peripheral neural blockade and assess the value of this technique for the postoperative period after these two surgeries.

Sci-Sat AM(1): Imaging-08: Small animal APD PET detector with submillimetric resolution for molecular imaging

Visualization and quantification of biological processes in mice, the preferred animal model in most preclinical studies, require the best possible spatial resolution in positron emission tomography (PET). A new 64-channel avalanche photodiode (APD) detector module was developed to achieve submillimeter spatial resolution for this purpose. The module consists of dual 4 × 8 APD arrays mounted in a custom ceramic holder. Individual APD pixels having an active area of 1.1 × 1.1 mm2 at a 1.2 mm pitch can be fitted to an 8 × 8 LYSO scintillator block designed to accommodate one-to-one coupling. An analog test board with four 16-channel preamplifier ASICs was designed to be interfaced with the existing LabPET digital processing electronics. At a standard APD operating bias, a mean energy resolution of 27.5 ± 0.6% was typically obtained at 511 keV with a relative standard deviation of 13.8% in signal amplitude for the 64 individual pixels. Crosstalk between pixels was found to be well below the typical lower energy threshold used for PET imaging applications. With two modules in coincidence, a global timing resolution of 5.0 ns FWHM was measured. Finally, an intrinsic spatial resolution of 0.8 mm FWHM was measured by sweeping a 22Na point source between two detector arrays. The proposed detector module demonstrates promising characteristics for dedicated mouse PET imaging at submillimiter resolution.

Open surgery for abdominal aortic aneurysm or aorto-iliac occlusive disease--clinical and ultrasonographic long-term results

OBJECTIVE

To determine postoperative and long-term outcome and assess the relevance of abdominal ultrasound (US) after surgery for abdominal aortic aneurysm (AAA) or aortoiliac occlusive disease (AIOD).

METHODS

Records of 1704 consecutive patients having graft implantation from 1988 to 2000, either for AAA (n = 1144) or for AIOD (n = 560), were reviewed. In 2006, follow-up was 9180 patients-years for the AAA group and 5450 patients-years for the AIOD group. Among 1006 alive patients, 377 were invited randomly for US and clinical examination.

RESULTS

Hospital death occurred in 99 patients (8.6%) of the AAA group (53% in ruptured and 2% in elective AAA), and in 18 patients of the AIOD group (3.2%). There were 581 late deaths, including eight due to prosthesis infection, one to pseudo-aneurysm rupture, and one to graft thrombosis (0.6% graft-related mortality). Prosthesis thrombosis occurred in 32 patients (26 in AIOD group, p < 0.001), and graft infection in 26 (17 in AAA group, p < 0.01). Pseudoaneurysms developed in 90 patients (68 in AIOD group, p < 0.001), including eight at the proximal aortic, one at the distal aortic, two at the iliac and 79 at the femoral anastomosis. In the AAA group only, surgery was required for a new thoraco-abdominal and pararenal aneurysm in eight and four patients, respectively, while US evidenced a 26-35 and a 36-50 mm supraanastomotic aortic dilatation in 65 (32%) and in 14 (7%) patients, at a mean follow-up of 10.5 and 9.3 years, respectively.

CONCLUSION

Long-term results are good after open surgery for AAA or AIOD. Prosthesis infection and anastomotic pseudo-aneurysm are the main causes of graft-related mortality and morbidity, respectively. Because of high incidence of asymptomatic supraanastomotic aortic dilatation, all patients with a history of AAA repair should have regular abdominal US.

[Analgesia for wound dressing by continuous peripheral nerve block]

We present the case of a patient with a circumferential venous ulcer at the level of the calf. She is hospitalized for surgical treatment by continuous aspiration dressing and coverage with skin graft. This patient presents a history of chronic pain, on which classical medications have few effects and are accompanied by side effects. After discussion with the patient, a double continuous peripheral nervous block (femoral and sciatic nerve) is set up to improve the tolerance to wound dressing. This technique presents favorable antalgic results. The indications and the different techniques of block performance (by electrostimulation or echo-guided) are described. The infectious risks related to the presence of catheter near cutaneous wounds are clarified according to recent data of literature. The relevance of these techniques in correlation with the development of chronic pain and on the trophicity of the wounds are also discussed.

Description and evaluation of a simplified technique for replacement of the ascending aorta and proximal arch in degenerative aneurysmal disease

The distal extension of ascending aorta pathology often requires prosthetic grafting into the proximal arch. In order to perform optimal distal anastomosis, an open technique under a short period of circulatory arrest (CA) was adopted. For this purpose we evaluated prospectively a simplified technique for surgery and perfusion. The aneurysmal aorta was directly cannulated to cool down the patient to 26 degrees C. Under CA and retrograde cerebral perfusion, the diseased aorta and aortic cannulation site were resected. After completion of the distal anastomosis, antegrade rewarming was performed via recannulation of the AAo graft (side branch graft) whilst surgery was proceeded on the root and/or aortic valve. This technique clearly addresses the safety of cannulation into the aneurismal aorta. The issues of cerebral and visceral protection during CA and antegrade reperfusion and rewarming have been analysed prospectively in eight patients operated on over a period of 6 months. Our preliminary results indicate that this technique of arterial cannulation and CA at 26 degrees C for the management of degenerative AAo disease involving the proximal arch appears safe both in terms of cerebral and systemic (visceral, muscular) protection. By this way, the complications related to deep hypothermia and prolonged cardiopulmonary bypass are avoided. This assumption may be only valid for a CA period less than 30 min. This preliminary study is limited by its small size and heterogeneity of the pathologies. However, the simplicity, surgical ease, rapidity and efficacy conveyed by this technique warrant further consideration and evaluation.

[The ostium primum or partial atrioventricular septal defect]

Often assimilated to simple inter-atrial communication, the ostium primum, or partial atrio-ventricular septal defect, is an entity that is characterized by a different embryological mechanism and requires some specific surgical expertise. Basically, knowledge of the morphology of the common atrioventricular valve with 5 components, the topography of the A-V node and His bundle, and the ventricular consequences of the absence of atrio-ventricular septal structures must be taken into account.

Varicella outbreak among primary school students--Beijing, China, 2004

INTRODUCTION

On June 9, 2004, a varicella outbreak was reported in a Beijing primary school affecting approximately 80% of children in one preschool classroom. An outbreak investigation was initiated to identify factors contributing to the high rate of transmission and to assess the effectiveness of control measures.

METHODS

A varicella case was defined as onset of a generalized, vesicular pruritic rash lasting >4 days in a student at the school during January 1-June 26, 2004. Parents of all students in the four lowest grades (K-2) were questioned concerning varicella illness before January 1, 2004. Exposure and vaccination histories of 111 ill students and 120 control students with no history of varicella were compared.

RESULTS

During January 1-June 26, 2004, of 1,407 students, 138 (9.8%) had varicella; 488 (35%) K-2 students had no history of varicella before the outbreak. In five classrooms in which attack rates (ARs) were high (>40%), a primary-case student had remained in school 2 days while ill with a rash. The secondary attack rate (SAR) in these classrooms was 21%, compared with 1.7% in classrooms in which the first ill student was sent home immediately (risk ratio [RR] = 10; 95% confidence interval [CI] = 3.7-29.0). A total of 111 (70%) ill students rode the school bus daily, compared with 120 (33%) control students (odds ratio [OR] =4.9; CI = 2.7-9.0). A total of 73 (33%) ill students had a history of varicella vaccination before January 1, 2004, compared with 32 (69%) control-students (OR = 0.22; CI = 0.08-0.59).

CONCLUSION

Students who were not excluded from school on the first day of rash were key contributors to the spread of varicella in their classrooms. High susceptibility to varicella at school entry indicates that vaccination of susceptible students might be the only effective measure to control this recurrent problem.

Salmonellosis outbreak among factory workers--Huizhou, Guangdong Province, China, July 2004

INTRODUCTION

During July 9--14, 2004, an outbreak of gastroenteritis occurred among workers at an electronics factory in Huizhou, Guangdong Province, China; 199 cases were reported. A case-control investigation was initiated to identify the agent and the mode of transmission.

METHODS

Stool samples were collected from 142 workers and food handlers and cultured for enteric pathogens. A questionnaire concerning meals and foods eaten in the factory cafeteria during July 11--13 was administered to 92 ill workers and 100 controls.

RESULTS

Of approximately 2,000 workers who worked during the outbreak, 197 (10%) had illness consistent with the case definition. Salmonella enteritidis was identified from 44 (31%) of 142 stool samples collected from ill workers. Ill workers were more likely than controls to have eaten breakfast in the factory cafeteria during July 11--13. Of eight foods served at breakfast in the factory cafeteria, three were associated with illness: cake, bread (on July 12 only), and congee (i.e., rice porridge). Stratification of bread and congee exposure by cake consumption indicated that only bread eaten on July 12 was associated with gastroenteritis. The cake was baked on July 11, and a mixture that included raw eggs was poured on top; the cake was then stored at room temperature and served for breakfast on 3 consecutive days (July 11--13). The bread was stored together with the cake on July 11 and 12. No leftover food was tested.

DISCUSSION

The investigation indicated that an outbreak of S. enterica serotype Enteritidis resulted from consumption of an unusual food vehicle (i.e., cake) that had been contaminated from a more typical source (i.e., raw eggs). The bread was stored at room temperature together with cake on which a mixture made from raw eggs had been poured. The bread was probably contaminated by contact with the cake.

CONCLUSION

Food handlers should be instructed that intact fresh eggs can harbor S. enteritidis, foods made from eggs must be cooked, and prepared food must be stored under refrigeration.

Étude rétrospective des résultats du traitement chirurgical de 21 pseudarthroses de l'humérus

INTRODUCTION

The morbidity of surgery for non-union of the humerus is not insignificant: the aims of this retrospective study were to study the results of these rather difficult procedures and to make some logical suggestions regarding surgical technique.

PATIENTS AND METHODS

Between 1996 and 2000, 21 patients had a surgical procedure for non-union of the humeral shaft. At follow-up, the mean age was 40 years. The causes of the initial trauma were: 12 road accidents, seven standing height falls, one fall from a window, one farm machine accident. The commonest fracture site was the middle third. In 17 procedures, we performed plate osteosyntesis. Three patients were treated by external fixator because of infection. In one patient we used a nail. For the follow-up evaluation, we used the score of the Western Orthopaedic Society.

RESULTS

According to the "WOS" score evaluation, we noted: ten very good results, five good results, three poor results and one bad result. The bad result corresponded to the patient in whom consolidation was not obtained.

DISCUSSION AND CONCLUSION

Management of non-union of the humerus should be by immediate surgery. The best treatment of non-union of the humerus is its prevention by correct management of the initial fracture.

Analysis of the transition from upright stance to steady state locomotion in children with under 200 days of autonomous walking

The aim of this paper was to study, from a developmental perspective, the transient phase of gait during the period between the standing posture and the achievement of steady state gait, using temporal and biochemical parameters. Eight children who had been walking autonomously for 90 to 200 days were observed. A total of 64 sequences of steps were analyzed. A sequence of steps began with the child standing still and was executed on a large force plate. From the determination of the instantaneous velocity of center of gravity results establish that, unlike adults, progression velocity in children end of the first step, but after two to four steps. The gait initiation process does not depend on the steady state velocity, but results from an initial fall. The duration of the movement up to the end of the first step is independent of the progression velocity but depends only upon the body mass and moment of inertia of the children.

[Indications for epidural steroids in back pain and in radiculopathy]

Back pain is very frequent in western countries and it represents a very high social cost. The treatment is based on five modalities: medication, physiotherapy, invasive technics, rehabilitation programs and psycho-social approaches. Several treatments may be proposed simultaneously and introduced gradually. Steroid administration by epidural injection is frequently used in Belgium, even though no prospective randomised studies have shown a real benefit over the long term. The indications for epidural injection must be carefully chosen. These include subacute pain (less than six months) in the lower limbs despite a well observed medical treatment. Patients are invited to give informed consent; the technic must be performed in an appropriate environment by an experienced physician. The initial treatment of back pain is medical. This pathology is multifactorial and the relief of symptoms is often incomplete. The patient should be urged to feel responsible for and involved in his treatment.

[Chronic pain management: a multidisciplinary approach]

Assessment of chronic pain is one of medicine's most difficult challenges. A structured and flexible multidisciplinary approach allows full characterisation of the various components of the pain syndrome. This then allows the use of a rational combination of pharmacologic, physical, psychological, and surgical techniques. It is essential to gain the patient's confidence, collaboration, and compliance. Patients can better manage their situation when their needs are clarified and when care is oriented toward concrete therapeutic objectives.

Metformin to restore normal menses in oligo-amenorrheic teenage girls with polycystic ovary syndrome (PCOS)

PURPOSE

To describe our clinical experience in using Metformin combined with a high protein-low carbohydrate diet to restore normal menstrual cycles in teenaged females with polycystic ovary syndrome (PCOS).

METHODS

To enter the study, patients had to have well-documented PCOS, be oligo- (six cycles or less in the preceding year) or amenorrheic (absence of menstrual cycles for 1 year), and not have exclusionary diseases or drugs. Accompanying a high protein-low carbohydrate diet, Metformin (1.5-2.55 g/day) was given for 10.5 +/- 6.4 months (range, 4.5-26.5 months). Follow-up every 8-10 weeks for > or =6 months was scheduled with interval history, review of menstrual status, assessment of any Metformin-related side effects, brief physical examination, and determination of weight and blood pressure.

RESULTS

All 11 girls had normal fasting blood glucose and glycohemoglobin. Pre-Metformin, five girls were amenorrheic, three had only one menstrual cycle in the previous year, and three had > or =6 cycles/year. With Metformin, 10 of 11 girls (91%) resumed regular normal menses; 39% of 38 follow-up visits with regular normal menstrual cycles were ovulatory with normal luteal-phase serum progesterone (> or =2.3 ng/mL). Of the 11 girls, nine (82%) lost weight; five girls lost > or =11 lb and seven lost > or =5 lb. After adjusting for weight reduction, with Metformin, estradiol and progesterone rose (p =.0014,.027, respectively) (changes consistent with resumption of regular normal menses), total plasma cholesterol fell (p =.026), and there was a downward trend in testosterone (p =.068).

CONCLUSION

Metformin safely ameliorates the endocrinopathy of PCOS in previously oligo-amenorrheic teenage females with PCOS, facilitating resumption of normal menses in most girls.

Investigating the efficacy of a nonpowered pressure-reducing therapeutic mattress: a retrospective multi-site study

To ascertain the ability of combining data to examine the effectiveness of a lateral support surface, data from independent studies were analyzed. Patients placed on the surface (N = 75) were elderly (mean age 70.2 years), had multiple comorbities, and an average Braden score of 12.66. Of these patients, 8.4% had a history of preexisting pressure ulcers and their average albumin was 3.56. Seventeen patients without wounds and believed to be "at risk" (average Braden score = 10.75) were treated prophylactically for an average of 63.3 days. Records of 45 wounds (32 subjects) were sufficiently complete to be included in the wound healing rate analysis. No ulcers occurred in the preventive group. No impact was associated with combining the data across the setting. A slight impact was anticipated when combining the data by setting and wound stage. Wounds on 28 of the subjects healed or were reduced in size, three remained unchanged, and one worsened. Overall, wound size reduced by an average of 68.85% over 84.69 days on the mattress, or 25.5% per week (n = 45, P = 0.0004). Stage I pressure ulcers reduced 46% per week (n = 6, P = 0.022), Stage II ulcers at 33% per week (n = 22, P = 0.05), Stage III ulcers at 6.97% per week (n = 13, P = 0.004), and Stage IV at 3.24% per week (n = 4, P = 0.058). The results of this retrospective review indicate that data from various sites can be combined and that the support surface may be an effective intervention modality. However, wound healing is a complex process, and support surfaces are only one of many interventions needed to facilitate healing. Future research using valid wound-healing instruments is needed.

Bean Anthracnose: Virulence of Colletotrichum lindemuthianum Isolates from Burundi, Central Africa

The diversity of Colletotrichum lindemuthianum is a major limiting factor in control of anthracnose on bean (Phaseolus vulgaris), and race characterization of this pathogen is an important tool in breeding programs. Race characterization has been carried out on isolates from North, Central, and South America; Europe; and Asia, but little or no information exists on the diversity of C. lindemuthianum in Africa. In this work, 12 isolates from the major bean-growing areas of Burundi, Central Africa, were characterized. Their virulence was tested on 12 bean differential cultivars (1) and on 4 bean cultivars commonly grown in Burundi: 2 from local germ plasm (Muyinga-1 and Urubonobono) and 2 from Colombia (A 321 and Calima). Detached unifoliate bean leaves from 8-day-old plants were placed on a humid surface in trays and sprayed until runoff with a suspension of 10⁶ spores ml^-1. Trays covered with transparent plastic sheets to keep a minimum relative humidity of 92% were incubated at 20°C. Seven days after inoculation, symptoms were evaluated for severity on a scale of 1 to 9. Leaves scored as 1 to 3 were considered resistant. Races were characterized according to a numerical binary system (1). Nine races were identified: 9, 69, 87, 384, 385, 401, 448, 449, and 485. Seven of these races (9, 69, 87, 384, 401, 448, and 485) were described for the first time in Africa. Races 401 and 485 have not yet been reported in the literature. The most susceptible differential cultivars were Michelite, PI 207262, To, and Mexico 222. Muyinga-1, Urubonobono, and A 321 were sensitive to nine, six, and five races, respectively. There is a high diversity of C. lindemuthianum in Burundi, and the local germ plasm tested is very susceptible to the characterized races. Breeding programs in Burundi should focus on lines and cultivars, such as Tu, AB 136, G 2333, and Calima, that are resistant to all the races characterized in this study. Reference: (1) M. A. Pastor-Corrales. Phytopathology 81:694, 1991.

Metformin-induced resumption of normal menses in 39 of 43 (91%) previously amenorrheic women with the polycystic ovary syndrome

In 43 amenorrheic women with polycystic ovary syndrome (PCOS), 31 (74%) with fasting hyperinsulinemia (> or =20 microU/mL), our aim was to determine whether Metformin (Bristol-Myers Squibb, Princeton, NJ), which reduces hyperinsulinemia, would reverse the endocrinopathy of PCOS, allowing resumption of regular normal menses. A second aim was to assess the effects of weight loss versus other Metformin-induced effects on ovarian function, and to determine if there were different responses to Metformin between those who lost weight and those who did not. A third aim was to assess associations between PCOS, 4G/5G polymorphism in the promoter sequence of the plasminogen activator inhibitor-1 gene (PAI-1 gene), and PAI activity (PAI-Fx). Of the 43 women, 40 (93%) had normal fasting blood glucose and 37 had normal hemoglobin A1C (HgA1C); onlythree (7%) had type 2 diabetes mellitus. Metformin (1.5 to 2.25 g/d) was given for 6.1+/-5.1 months (range, 1.5 to 24), to 16 patients for less than 3 months, to 12 for 3 to 6 months, and to 15 for at least 6 months. On Metformin, 39 of 43 patients (91%) resumed normal menses. The percentage of women resuming normal menses did not differ among treatment duration groups (P<.1) or among dose groups (P>.1). The body mass index (BMI) decreased from 36.4 + 7 Kg/m2 at study entry to 35.1+/-6.7 on Metformin (P=.0008). Of 43 patients, 28 (67%) lost weight (1 to 69 pounds), with nine (21%) losing at least 12 pounds. On Metformin, the median fasting serum insulin decreased from 26 microU/mL to 22 (P=.019), testosterone decreased from 61 ng/dL to 47 (P=.003), and estradiol increased from 41 pg/mL to 71 (P=.0001). Metformin-induced improvements in ovarian function were independent of weight loss (testosterone decrease, P<.002; estradiol increase, P<.0004). The change in response variables on Metformin did not differ (P>.05) between those who lost weight and those who did not, excepting Lp(a), which increased 4 mg/dL in those who lost weight and decreased 9 mg/dL in those who did not (P = .003). The change in response variables on Metformin did not differ among the five quintiles of weight loss, excepting fasting glucose (P<.05), which increased 6 mg/dL in those who lost the least weight on Metformin versus those in the 60th to 80th percentile for weight loss, in whom glucose decreased 33 mg/dL. Although the pretreatment fasting serum insulin was not significantly correlated with testosterone (r=.24, P=.13) or androstenedione (r=.27, P=.09), on Metformin, the change in insulin correlated positively with the change in testosterone (r=.35, P=.047) and with the change in androstenedione (r=.48, P=.01). Patients were more likely than normal controls (83% v 64%, P=.016) to be heterozygous or homozygous for 4G polymorphism of the PAI-1 gene and were also more likely to have high PAI-Fx (> or =22 U/mL, 28% v3%, chi(2)=10.1, P=.001). Metformin reduces the endocrinopathy of PCOS, allowing resumption of normal menses in most (91%) previously amenorrheic women with PCOS.

A quantitative analysis of pressure and shear in the effectiveness of support surfaces

PURPOSE

We compared pressure and shear among 3 support surfaces in a controlled laboratory setting.

METHODS

In this comparative study, interface pressure and shear were measured in 11 healthy subjects with use of 3 different Medicare-approved, group 2 therapeutic support surfaces. Each surface was placed on 1 of 3 identical platforms, allowing for a fixed, 45-degree head-of-bed (HOB) elevation. Multiple pressure readings were taken at each test site and each HOB position until a measurement that was determined to be reliable was obtained. A shear force measurement was obtained using a noninvasive instrument of proprietary design, and a formula linking the effects of shear force and pressure was calculated. Data were then compared using analysis of variance; specific differences were identified using the post hoc Duncan test.

FINDINGS

Pressure readings on the nonpowered fluid overlay device were lower at the trochanter than when compared with the powered, air-filled overlay (23.7 mm Hg vs 36.7 mm Hg; P = .017). Both the nonpowered fluid overlay and the powered air-filled mattress provided pressure readings at the sacrum with HOB elevation that were lower than those recorded on the powered air-filled overlay (16.2 mm Hg and 19.6 mm Hg vs 27.5 mm Hg, respectively; P < .001). Pressure measurements taken at the heels, supine sacrum, and scapula were not significantly different for any of the surfaces. Shear force readings were significantly lower on the nonpowered fluid overlay when compared with the powered air-filled overlay and powered air-filled mattress (79.3 g vs 257.82 g and 231.38 g, respectively; P = .015).

CONCLUSIONS

Measurements of shear obtained on the nonpowered fluid overlay support surface were significantly lower than those obtained on either of the powered support surfaces. Reduction in shear force might explain the accelerated healing observed in patients being treated with the nonpowered support surface. Randomized clinical trials to validate perceptions of enhanced healing rates are required.