Functional magnetic resonance imaging study on dysphagia after unilateral hemispheric stroke: a preliminary study

BACKGROUND

Swallowing dysfunction is common and disabling after acute stroke; however, the mechanism of dysphagia or recovery of swallowing from dysphagia remains uncertain. The purpose of this study was to explore cerebral activation of swallowing in dysphagia using functional MRI (fMRI) to compare the functional anatomy of swallowing in unilateral hemispheric stroke patients and healthy adults.

METHODS

In total, five left hemispheric stroke patients with dysphagia, five right hemispheric stroke patients with dysphagia and 10 healthy controls were examined with event related fMRI while laryngeal swallow related movements were recorded. Data were processed using the general linear model.

RESULTS

A multifocal cerebral representation of swallowing was identified predominantly in the left hemisphere, in a bilateral and asymmetrical manner. Cerebral activation during swallowing tasks was localised to the precentral, postcentral and anterior cingulate gyri, insula and thalamus in all groups. Activation of volitional swallowing in dysphagic unilateral hemispheric stroke patients might require reorganisation of the dominant hemispheric motor cortex, or a compensatory shift in activation to unaffected areas of the hemisphere.

CONCLUSIONS

The results indicate that unilateral stroke of either cerebral hemisphere can produce dysphagia. Effective recovery is associated with cerebral activation related to cortical swallowing representation in the compensating or recruited areas of the intact hemisphere. Functional MRI is a useful method for exploring the spatial localisation of changes in neuronal activity during tasks that may be related to recovery. Therefore, the subsequent information gleaned from changes in neural plasticity could be useful for assessing the prognosis of dysphagic stroke.

Total saponins of Panax ginseng (TSPG) promote erythroid differentiation of human CD34+ cells via EpoR-mediated JAK2/STAT5 signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Total saponins of Panax ginseng (TSPG), main constituents extracted from Panax ginseng, a highly valued traditional Chinese medicine, have been shown to be an effective agent on hematopoiesis.

OBJECTIVE

To investigate the effect and mechanism underlying in which TSPG promote human CD34(+) hematopoietic stem and progenitor cells to differentiate into erythroid-lineage cells.

MATERIALS AND METHODS

The effect of TSPG on erythroid differentiation of purified CD34(+) cells derived from umbilical cord blood (UCB) was determined by methylcellulose assay system and colorimetry for hemoglobin content. The changes of EpoR expression in umbilical cord blood mononuclear cells (UCB-MNCs) and purified CD34(+) cells were detected with Western blotting and flow cytometry, respectively, and observed under laser scanning confocal microscope (LSCM). RT-PCR was performed to examine EpoR mRNA expression in CD34(+) cells. The effects of TSPG-pretreatment on Epo-induced JAK(2) and STAT(5) tyrosine phosphorylation were analyzed by immunoprecipitation.

RESULTS

The addition of TSPG (20-70 mg/L) increased the colony formation rate of BFU-E. TSPG (50 mg/L) alone used significantly increased the hemoglobin content, the addition of AG490 evidently reduced TSPG-induced elevation of hemoglobin content. TSPG increased the expression of EpoR on the surface membrane of CD34(+) cells but did not change the expression of EpoR in total UCB-MNCs. TSPG also increased the expression of EpoR mRNA in CD34(+) cells. TSPG markedly enhanced Epo-induced tyrosine phosphorylation of JAK(2) and STAT(5) in UCB-MNCs.

CONCLUSION

These findings suggest that TSPG may enhance the erythroid differentiation of hematopoietic stem and progenitor cells via Epo/EpoR-mediated JAK(2)/STAT(5) signaling pathway.

Hypovitaminosis D in Chinese type 2 diabetes: lack of impact on clinical metabolic status and biomarkers of cellular inflammation

OBJECTIVE

Low vitamin D (25 OH vitamin D) is implicated in the development of diabetes and the metabolic syndrome. We examined whether hypovitaminosis D has a clinically significant impact on glycaemia, metabolic status and inflammatory markers in Chinese patients with established type 2 diabetes.

METHODS

Characteristics of 109 patients aged over 50 years were stratified by 25 OH vitamin D status. Patients identified as 25 OH vitamin D deficient (<or= 50 nmol/L) received cholecalciferol 2,000 IU daily for three months. Measurement of HbA1c, metabolic syndrome parameters, 25 OH vitamin D, calcium, phosphate, PTH, hsCRP and ferritin were taken at baseline and then 25 OH vitamin D, PTH, calcium, phosphate monthly for three months in those on replacement therapy.

RESULTS

Vitamin D deficiency was common, affecting 36% of patients. There was no impact of hypovitaminosis D on metabolic syndrome status, HbA1c or insulin use (p >or= 0.4 for all) and no association between 25OHVitD and ferritin or hsCRP (p >or= 0.3 for all). Neither BMI nor the metabolic syndrome affected the incremental rise in 25OHVitD levels during supplementation.

CONCLUSION

There is no relationship between hypovitaminosis D and metabolic control or inflammatory markers in established type 2 diabetes.This suggests that at least in Chinese populations, the effect of low vitamin D is not clinically significant once diabetes is established. Future 25OHVitD intervention trials should therefore focus on prevention in pre-diabetes.

Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study

BACKGROUND

The treatment of unstable displaced proximal humeral fractures, especially in the elderly, remains controversial. The objective of the present prospective, multicenter, observational study was to evaluate the functional outcome and the complication rate after open reduction and internal fixation of proximal humeral fractures with use of a locking proximal humeral plate.

METHODS

One hundred and eighty-seven patients (mean age, 62.9 +/- 15.7 years) with an acute proximal humeral fracture were managed with open reduction and internal fixation with a locking proximal humeral plate. At the three-month, six-month, and one-year follow-up examinations, 165 (88%), 158 (84%), and 155 (83%) of the 187 patients were assessed with regard to pain, shoulder mobility, and strength. The Constant score was determined at each interval, and the Disabilities of the Arm, Shoulder and Hand (DASH) score was determined for the injured and contralateral extremities at the time of the one-year follow-up.

RESULTS

Between three months and one year, the mean range of motion and the mean Constant score for the injured shoulders improved substantially. Twelve months after surgery, the mean Constant score for the injured side was 70.6 +/- 13.7 points, corresponding to 85.1% +/- 14.0% of the score for the contralateral side. The mean DASH score at the time of the one-year follow-up was 15.2 +/- 16.8 points. Sixty-two complications were encountered in fifty-two (34%) of 155 patients at the time of the one-year follow-up. Twenty-five complications (40%) were related to incorrect surgical technique and were present at the end of the operative procedure. The most common complication, noted in twenty-one (14%) of 155 patients, was intraoperative screw perforation of the humeral head. Twenty-nine patients (19%) had an unplanned second operation within twelve months after the fracture.

CONCLUSIONS

Surgical treatment of displaced proximal humeral fractures with use of the locking proximal humeral plate that was evaluated in the present study can lead to a good functional outcome provided that the correct surgical technique is used. Because many of the complications were related to incorrect surgical technique, it behooves the treating surgeon to perform the operation correctly to avoid iatrogenic errors.

Vascular Pathology in Male Lewis Rats following Short-Term, Low-Dose Rotenone Administration

The long-term administration of low doses of rotenone has been used to produce a model of Parkinson disease (PD) in rats. However, only about 50% of similarly treated rats develop the PD-like syndrome, with many dying during the first few days of treatment. The lesions in male Lewis rats that became moribund or died after short-term, low-dose rotenone administration are described. Dosed rats had fibrinoid change and acute hemorrhage involving small arteries and arterioles of the brain and lungs. The thalamus, hypothalamus, and medulla oblongata were most frequently and severely affected. Blood vessels in the brain of some male Lewis rats appeared acutely susceptible to the effects of rotenone. Understanding the selective nature of the fibrinoid change and hemorrhage might explain how rotenone produces PD-like signs and lesions in rats, and it might also provide the basis for a model of intraparenchymal hemorrhagic cerebrovascular disease (i.e., hemorrhagic strokes) in humans.

Quantitative detection of cytokeratin 20 mRNA in urine samples as diagnostic tools for bladder cancer by real-time PCR

AIM

To determine and compare cytokeratin 20 (CK20) mRNA expression in urine of patients with transitional cell carcinomas of bladder (TCCB), urological benign diseases, and healthy volunteers.

METHODS

Taqman probe was designed according to the sequence of CK20 cloned gene. The quantitative PCR reaction system was optimized and evaluated. The CK20 mRNA level was screened by real-time polymerase chain reaction (RT-PCR) in 95 urine samples and analyzed according to the following parameters: urinary cytology, nuclear matrix protein 22 (NMP22) expression, tumor stage and grade.

RESULTS

For 60 TCCB patients urinary cytology was positive in 28 (46.7%), control group had no false-positive results (specificity 100%). CK20 expression was positive in RT-PCR of 51 cases (85%) of TCCB, but control group was positive in 2 cases (specificity 94.3%) with a cutoff value of crossover point (CT) = 30. Two methods have significant variation in sensitivity (p < 0.001), NMP22 expression was positive in 47 cases (78.3%), but control group was positive in 9 cases (specificity 85%). In the simultaneous evaluation of CK20 and NMP22 mRNA expression, there were 54 positive cases (90%). CK20 mRNA values in TCCB group (mean 27712.57 copies/microl) were significantly higher than in non-cancer disease urological group (mean 74.45 copies/microl) and control group (mean 8.47 copies/microl) (p < 0.001, p < 0.001, respectively). CK20 mRNA values increased gradually with higher tumor grade and stage: G1 differs significantly from G2 (p = 0.016); T(is) /T(a) differs significantly from T(1-2) (p = 0.022).

CONCLUSION

Our results indicate that CK20 mRNA expression could be regarded as a potential marker for TCCB. We demonstrated correlation between CK20 expression and the clinicopathologic features of TCCB (tumor stage and grade); simultaneous use of CK20 and NMP22 markers will elevate the sensitivity of the method. CK20 RT-PCR is a sensitive, quantitative, rapid and specific method to detect free cancer cells in the urine, and could be recommended for be wide application in the diagnostics of TCCB and evaluation of therapeutic effect.

A mechanical model of the human heart relating septal function to myocardial work and energy

A thorough understanding of ventricular interaction and the effects of septal function on right and left ventricular performance in the human heart requires measurement of interventricular pressure gradients using high fidelity pressure transducers. The advent of newer echocardiographic techniques provides an opportunity to combine high resolution images with bi-ventricular catheterization data in the cardiac catheterization laboratory, and obtain the detailed hemodynamic and echocardiographic information necessary to more fully understand the clinical manifestations of normal and abnormal septal and free wall mechanical function. We have anticipated these developments and modified the description of heart mechanics in our integrated multi-scale model of the human cardio-respiratory system (H-CRS) to closely analyze how the mechanical properties of the inter-ventricular septum affect the work, energy utilization, and oxygen consumption of the atria, ventricles, septum, and each ventricular free wall. Combined with the H-CRS model, these modifications allow one to observe how tissue properties of the septum affect the entire heart and circulation. For example, the normal septum transfers energy from the left to the right ventricle, and assists the pre-load of both, acting as a third pump. Diseases that increase septal elastance cause abnormalities resembling left ventricular diastolic dysfunction (LVDD), including a decrease in cardiac output and an increase in pulmonary pressures despite a normal left ventricular ejection fraction. Similar applications of the H-CRS model to other regional disorders such as hypertrophic obstructive cardiomyopathy and myocardial infarction might likewise allow one to study their clinical implications in greater detail.

Biologic diversity of polyomavirus BK genomic sequences: Implications for molecular diagnostic laboratories

Data on polyomavirus genomic diversity has greatly expanded in the past few years. The implications of viral DNA sequence variation on the performance of molecular diagnostic assays have not been systematically examined. 716 BK, 1626 JC, and 73 SV40 virus sequences available in GenBank were aligned using Clustal-X. Five different published BKV PCR assays currently in use at major medical centers were evaluated for primer and probe mismatches with available GenBank sequences. Coverage of naturally occurring BKV strains varied amongst different assay methods. Targeted viral sequences showed major mismatch with primer or probe sequence in up to 30.7% of known BKV strains. BKV subtypes IVa, IVb, and IVc were more prone to this problem, reflecting common use of Type I Dun sequence for assay design. Despite the known polymorphism of this gene, 484 VP-1 sequences with conserved areas potentially suitable for PCR assay design are available. Assay targets in the Large T-antigen and agnogene are less subject to genetic variation, but sequence information corresponding to the latter two genes is available only for 164 and 174 published strains, respectively. Cross reactivity of appropriately selected BKV primers with JCV and SV40 sequences available in current databases was not a significant problem.

Oncolytic virotherapy with an HSV amplicon vector expressing granulocyte–macrophage colony-stimulating factor using the replication-competent HSV type 1 mutant HF10 as a helper virus

Direct viral infection of solid tumors can cause tumor cell death, but these techniques offer the opportunity to express exogenous factors to enhance the antitumor response. We investigated the antitumor effects of a herpes simplex virus (HSV) amplicon expressing mouse granulocyte-macrophage colony-stimulating factor (mGM-CSF) using the replication-competent HSV type 1 mutant HF10 as a helper virus. HF10-packaged mGM-CSF-expressing amplicon (mGM-CSF amplicon) was used to infect subcutaneously inoculated murine colorectal tumor cells (CT26 cells) and the antitumor effects were compared to tumors treated with only HF10. The mGM-CSF amplicon efficiently replicated in CT26 cells with similar oncolytic activity to HF10 in vitro. However, when mice subcutaneously inoculated with CT26 cells were intratumorally injected with HF10 or mGM-CSF amplicon, greater tumor regression was seen in mGM-CSF amplicon-treated animals. Furthermore, mGM-CSF amplicon treatment prolonged mouse survival. Immunohistochemical analysis revealed increased inflammatory cell infiltration in the solid tumor in the mGM-CSF amplicon-treated animals. These results suggest that expression of GM-CSF enhances the antitumor effects of HF10, and HF10-packaged GM-CSF-expressing amplicon is a promising agent for the treatment of subcutaneous tumors.

Maternal mortality in Yunnan, China: recent trends and associated factors

OBJECTIVE

Yunnan Province, located in southwest China, is one of the poorest province in China. The maternal mortality ratio (MMR) is about twice the national average (56.2/100,000 live births), and in remote mountainous regions, the rate is five times higher. This study aimed to examine the progress in reduction of maternal mortality in the 1990s and early 2000s and the factors associated with this reduction in Yunnan.

DESIGN

A population-based, longitudinal, ecological correlation study.

SETTING

A remote province of China with a proportionately large indigenous population.

POPULATION

Populations at county, prefecture and provincial level.

METHODS

Using maternal mortality data collected at the province, prefecture/region and county levels, trend and time series analyses and multivariate linear regression analyses were performed using SPSS (Version 13).

MAIN OUTCOME MEASURE

MMR and its change over time.

RESULTS

MMR declined substantially in the 1990s at a rate of 3.0% per year. Utilisation of prenatal and obstetric care increased and was significantly correlated with the declining trend in MMR. Hospital delivery was a strong predictor of MMR, independent of social and economic development. Both low income and illiteracy were significantly associated with increased MMR.

CONCLUSIONS

Declines in maternal mortality in Yunnan over the past 14 years appear to reflect health, social and economic interventions implemented in the 1990s. The association of hospital delivery with maternal mortality may be due to the effective management of severe pregnancy and birth complications. Low income and illiteracy were associated with MMR but primarily through their impact on the use of prenatal and obstetric care.

Generation of shock-free pressure waves in shaped resonators by boundary driving

Investigation of high amplitude pressure oscillations generated by boundary driving in shaped resonators has been carried out both theoretically and experimentally. In the theoretical modeling, the acoustic resonance in an axisymmetric resonator is studied by the Galerkin method. The resonator is exponentially expanded and the boundary driving is provided by a piston at one end. The pressure wave forms, amplitudes, resonance frequencies, and ratio of pressures at the two ends of the resonator are calculated for various expansion flare constants and driving strengths. These results are partially compared with those generated by shaking the resonator. They are also verified in the experiment, in which an exponentially expanded resonator is connected to a speaker box functioning as the piston. The experiment is further extended to a horn-shaped resonator with a rectangular cross section. The boundary driving in this case is generated by a circular piezoelectric disk, which forms one sidewall of the resonator cavity. The characteristics of axisymmetric resonators, such as the resonance frequency and amplitude ratio of pressures at the two ends, are observed in this low aspect ratio rectangular resonator with the sidewall driving.

Polymorphism of Growth-Correlated Genes Associated with Fatness and Muscle Fiber Traits in Chickens

Thirty single nucleotide polymorphisms (SNP) and one 6-bp insertion-deletion (indel) from 8 genes of somatotropic axis were used to study the association with chicken fatness and muscle fibers. The allele frequency difference between Xinghua and White Plymouth Rock chickens was observed, and their effects on fatness and muscle fiber traits were also evaluated by linkage analyses. The G143831A (G+1705A) SNP of the growth hormone (GH) gene was related to fat width, and the G144762A (G+119A) SNP of the GH gene was significantly associated with abdominal fat pad weight, abdominal fat pad ratio, and crude fatty content of the breast muscle. The 6-bp indel of the growth hormone secretagogue receptor (GHSR) gene was significantly linked with the fat traits. The C51978309T SNP of the insulin-like factor-I (IGF-I) gene was significantly linked with the transversal area of the leg muscle fiber and transversal area of the breast muscle fiber. There was significant linkage between the insulin (INS) gene and 2 traits of the transversal area of transversal area of the leg muscle fiber and transversal area of the breast muscle fiber. Association of 30 SNP and one 6-bp indel from 8 genes of somatotropic axis with chicken fatness and muscle fiber traits was analyzed in the present study. The GH, GHSR, and leptin receptor genes were significantly related to chicken fatness. The INS and IGF-I genes were linked with muscle fiber density. Therefore, the genes of somatotropic axis not only affected chicken growth and body composition but also were associated with fatness and muscle fiber traits.

Using a Human Cardiopulmonary Model to Study and Predict Normal and Diseased Ventricular Mechanics, Septal Interaction, and Atrio-Ventricular Blood Flow Patterns

We upgraded our human cardiopulmonary (CP) model with additional data that enables it to more accurately simulate normal physiology. We then tested its ability to explain human disease by changing two parameter values that decrease ventricular compliance, and found that it could predict many of the hemodynamic, gas exchange, and autonomic abnormalities found in patients with left ventricular diastolic dysfunction (LVDD). The newly incorporated information includes high-fidelity pressure tracings simultaneously recorded from the RV and LV of a normal human in a cardiac catheterization laboratory, Doppler echocardiographic inlet flow velocity patterns, measures of right and left ventricular impedance, and atrial volumes. The revised cardiovascular section details the hemodynamics of a normal subject to the extent that it can now explain the effects of septal compliance on ventricular interaction, the differences in left and right ventricular pressure development, and venous blood gas mixing in the right atrium. The model can isolate the highly interrelated features of normal and abnormal physiology, and simultaneously demonstrate their interaction in a manner that would be very difficult or impossible using an intact organism. It may therefore help physicians and scientists understand, diagnose, and improve their treatment of complicated cardiovascular and pulmonary diseases. It could also simulate the hemodynamic and respiratory effects of ventricular and pulmonary assist devices, and thus help with their development.

Oculomotor plasticity during vestibular compensation does not depend on cerebellar LTD

Vestibular paradigms are widely used for investigating mechanisms underlying cerebellar motor learning. These include adaptation of the vestibuloocular reflex (VOR) after visual-vestibular mismatch training and vestibular compensation after unilateral damage to the vestibular apparatus. To date, various studies have shown that VOR adaptation may be supported by long-term depression (LTD) at the parallel fiber to Purkinje cell synapse. Yet it is unknown to what extent vestibular compensation may depend on this cellular process. Here we investigated adaptive gain changes in the VOR and optokinetic reflex during vestibular compensation in transgenic mice in which LTD is specifically blocked in Purkinje cells via expression of a peptide inhibitor of protein kinase C (L7-PKCi mutants). The results demonstrate that neither the strength nor the time course of vestibular compensation are affected by the absence of LTD. In contrast, analysis of vestibular compensation in spontaneous mutants that lack a functional olivo-cerebellar circuit (lurchers) shows that this form of motor learning is severely impaired. We conclude that oculomotor plasticity during vestibular compensation depends critically on intact cerebellar circuitry but not on the occurrence of cerebellar LTD.