Proteomic changes in the hippocampus of large mammals after total-body low dose radiation

There is a growing interest in low dose radiation (LDR) to counteract neurodegeneration. However, LDR effects on normal brain have not been completely explored yet. Recent analyses showed that LDR exposure to normal brain tissue causes expression level changes of different proteins including neurodegeneration-associated proteins. We assessed the proteomic changes occurring in radiated vs. sham normal swine brains. Due to its involvement in various neurodegenerative processes, including those associated with cognitive changes after high dose radiation exposure, we focused on the hippocampus first. We observed significant proteomic changes in the hippocampus of radiated vs. sham swine after LDR (1.79Gy). Mass spectrometry results showed 190 up-regulated and 120 down-regulated proteins after LDR. Western blotting analyses confirmed increased levels of TPM1, TPM4, PCP4 and NPY (all proteins decreased in various neurodegenerative processes, with NPY and PCP4 known to be neuroprotective) in radiated vs. sham swine. These data support the use of LDR as a potential beneficial tool to interfere with neurodegenerative processes and perhaps other brain-related disorders, including behavioral disorders.

Proteomic Changes in the Hippocampus after Repeated Explosive-Driven Blasts

Repeated blast-traumatic brain injury (blast-TBI) has been hypothesized to cause persistent and unusual neurological and psychiatric symptoms in service members returning from war zones. Blast-wave primary effects have been supposed to induce damage and molecular alterations in the brain. However, the mechanisms through which the primary effect of an explosive-driven blast wave generate brain lesions and induce brain consequences are incompletely known. Prior findings from rat brains exposed to two consecutive explosive-driven blasts showed molecular changes (hyperphosphorylated-Tau, AQP4, S100β, PDGF, and DNA-polymerase-β) that varied in magnitude and direction across different brain regions. We aimed to compare, in an unbiased manner, the proteomic profile in the hippocampus of double blast vs sham rats using mass spectrometry (MS). Data showed differences in up- and down-regulation for protein abundances in the hippocampus of double blast vs sham rats. Tandem mass tag (TMT)-MS results showed 136 up-regulated and 94 down-regulated proteins between the two groups (10.25345/C52B8VP0X). These TMT-MS findings revealed changes never described before in blast studies, such as increases in MAGI3, a scaffolding protein at cell-cell junctions, which were confirmed by Western blotting analyses. Due to the absence of behavioral and obvious histopathological changes as described in our previous publications, these proteomic data further support the existence of an asymptomatic blast-induced molecular altered status (ABIMAS) associated with specific protein changes in the hippocampus of rats repeatedly expsosed to blast waves generated by explosive-driven detonations.

Low-dose brain radiation: lowering hyperphosphorylated-tau without increasing DNA damage or oncogenic activation

Brain radiation has been medically used to alter the metabolism of cancerous cells and induce their elimination. Rarely, though, brain radiation has been used to interfere with the pathomechanisms of non-cancerous brain disorders, especially neurodegenerative disorders. Data from low-dose radiation (LDR) on swine brains demonstrated reduced levels of phosphorylated-tau (CP13) and amyloid precursor protein (APP) in radiated (RAD) versus sham (SH) animals. Phosphorylated-tau and APP are involved in Alzheimer's disease (AD) pathogenesis. We determined if the expression levels of hyperphosphorylated-tau, 3R-tau, 4R-tau, synaptic, intraneuronal damage, and DNA damage/oncogenic activation markers were altered in RAD versus SH swine brains. Quantitative analyses demonstrated reduced levels of AT8 and 3R-tau in hippocampus (H) and striatum (Str), increased levels of synaptophysin and PSD-95 in frontal cortex (FCtx), and reduced levels of NF-L in cerebellum (CRB) of RAD versus SH swine. DNA damage and oncogene activation markers levels did not differ between RAD and SH animals, except for histone-H3 (increased in FCtx and CRB, decreased in Str), and p53 (reduced in FCtx, Str, H and CRB). These findings confirm the region-based effects of sLDR on proteins normally expressed in larger mammalian brains and support the potential applicability of LDR to beneficially interfere against neurodegenerative mechanisms.

Reduction of pTau and APP levels in mammalian brain after low-dose radiation

Brain radiation can occur from treatment of brain tumors or accidental exposures. Brain radiation has been rarely considered, though, as a possible tool to alter protein levels involved in neurodegenerative disorders. We analyzed possible molecular and neuropathology changes of phosphorylated-Tau (pTau), all-Tau forms, β-tubulin, amyloid precursor protein (APP), glial fibrillary acidic protein (GFAP), ionized calcium binding adaptor molecule 1 (IBA-1), myelin basic protein (MBP), and GAP43 in Frontal Cortex (FC), Hippocampus (H) and Cerebellum (CRB) of swine brains following total-body low-dose radiation (1.79 Gy). Our data show that radiated-animals had lower levels of pTau in FC and H, APP in H and CRB, GAP43 in CRB, and higher level of GFAP in H versus sham-animals. These molecular changes were not accompanied by obvious neurohistological changes, except for astrogliosis in the H. These findings are novel, and might open new perspectives on brain radiation as a potential tool to interfere with the accumulation of specific proteins linked to the pathogenesis of various neurodegenerative disorders.

Current-conveyor-based wide-band current driver for electrical impedance tomography

OBJECTIVE

In this paper a wide-band integrated current driver for electrical impedance tomography (EIT) is presented. The application is primarily for prostate and breast cancer detection which require the tissue to be interrogated at frequencies up to 10 MHz while achieving low harmonic distortion and high accuracy.

APPROACH

The current driver is based on current conveyor architecture and can deliver 1.2 mA of peak to peak ac current between frequencies of 100 Hz-10 MHz. It is fabricated in CMOS 0.18 [Formula: see text]m technology with a power supply of 3.3 V, and occupies a core area of 0.26 [Formula: see text].

MAIN RESULTS

The measured harmonic distortion for a peak current of 1.2 mA is  <[Formula: see text] for frequencies less than 100 kHz, and increases to [Formula: see text] at 10 MHz. The measured output impedance of the current driver is 101 k[Formula: see text] at 1 MHz and 19.5 k[Formula: see text] at 10 MHz.

SIGNIFICANCE

The circuit is suitable for high frequency active electrode applications.

A survey of seizures and current treatments in 15q duplication syndrome

OBJECTIVE

Seizures are common in individuals with duplications of chromosome 15q11.2-q13 (Dup15q). The goal of this study was to examine the phenotypes and treatments of seizures in Dup15q in a large population.

METHODS

A detailed electronic survey was conducted through the Dup15q Alliance containing comprehensive questions regarding seizures and their treatments in Dup15q.

RESULTS

There were 95 responses from Dup15q families. For the 83 with idic(15), 63% were reported to have seizures, of which 81% had multiple seizure types and 42% had infantile spasms. Other common seizure types were tonic-clonic, atonic, myoclonic, and focal. Only 3 of 12 individuals with int dup(15) had seizures. Broad spectrum antiepileptic drugs (AEDs) were the most effective medications, but carbamazepine and oxcarbazepine were also effective, although typical benzodiazepines were relatively ineffective. There was a 24% response rate (>90% seizure reduction) to the first AED tried. For those with infantile spasms, adrenocorticotropic hormone (ACTH) was more effective than vigabatrin.

SIGNIFICANCE

This is the largest study assessing seizures in Duplication 15q syndrome, but because this was a questionnaire-based study with a low return rate, it is susceptible to bias. Seizures are common in idic(15) and typically difficult to control, often presenting with infantile spasms and progressing to a Lennox-Gastaut-type syndrome. Seizures in those with int dup(15) are less common, with a frequency similar to the general autism population. In addition to broad spectrum AED, medications such as carbamazepine and oxcarbazepine are also relatively effective in controlling seizures in this population, suggesting a possible multifocal etiology, which may also explain the high rate of infantile spasms. Our small sample suggests a relative lack of efficacy of vigabatrin and other γ-aminobutyric acid (GABA)ergic medications, such as typical benzodiazepines, which may be attributable to abnormal GABAergic transmission resulting from the duplication of a cluster of GABAβ3 receptor genes in the 15q11.2-13 region.

Arterial Wall Enhancement Overlying Carotid Plaque on CT Angiography Correlates With Symptoms in Patients With High Grade Stenosis

Background and Purpose— The degree of internal carotid artery (ICA) stenosis is an established primary risk factor for embolic stroke. Recent publications suggest that inflammatory features may also play an important role. Our purpose was to correlate acute neurological symptoms with either carotid artery wall enhancement or plaque calcification, on axial CT angiographic source images (CTA-SI) of patients with severe (≥70%) ICA stenosis.

Methods— 75 consecutive patients with ≥70% ICA stenosis on CTA-SI were identified. Each case was classified as symptomatic (n=37) or asymptomatic (n=38), and as having either calcified or noncalcified plaque. The latter group was stratified into those with versus without arterial wall enhancement, measured in absolute and relative Hounsfield Units (HU).

Results— Calcified plaque was present in 39% (15/38) of the symptomatic patients and in 62% (23/37) of the asymptomatic patients ( P =0.065). Of the 37 patients without calcified plaque, carotid wall enhancement was observed in 83% (19/23) of the symptomatic, but only in 57% (8/14) of the asymptomatic patients ( P =0.041). When the “calcified plaque” and “no carotid wall enhancement” groups were pooled, versus the “carotid wall enhancement” group, enhancement was more likely in symptomatic patients (OR 3.625, CI 95% 1.3229 to 9.93, P =0.01 Fisher Exact test).

Conclusions— In patients with severe ICA stenosis, additional stratification of stroke risk may be possible based on the presence of carotid wall enhancement on CTA-SI. Patients with carotid wall enhancement are more likely to be symptomatic, compared to those with either calcified plaque or no enhancement.

Contrast-enhanced MR angiography is not more accurate than unenhanced 2D time-of-flight MR angiography for determining > or = 70% internal carotid artery stenosis

BACKGROUND AND PURPOSE

Internal carotid artery (ICA) atheromatous disease is an important cause of ischemic stroke, and endarterectomy or stent placement is typically indicated for symptomatic patients with > or = 70% stenosis. Our purpose was to compare contrast-enhanced MR angiography (CE-MRA) with unenhanced 2D time-of-flight MR angiography (2D TOF MRA) in detecting hemodynamically significant ICA stenosis, by using CT angiography (CTA) as the reference standard.

MATERIALS AND METHODS

This was an institutional review board-approved retrospective study. We identified 177 consecutive patients (354 ICAs) who received correlative CE-MRA, 2D TOF MRA, and CTA. Two neuroradiologists blinded to the CTA data graded the degree of ICA stenosis according to a 5-point scale. Additionally, luminal signal-intensity characteristics including 1) signal intensity drop-out, 2) distal-vessel narrowing, and 3) distal-vessel signal-intensity reduction were recorded. MRA results were correlated with those of CTA, and receiver-operating-characteristic (ROC) curves were constructed.

RESULTS

On CTA, there were 55 ICAs with and 299 without > or = 70% stenosis. CE-MRA was 84% sensitive and 96% specific for detecting > or = 70% stenosis; 2D TOF MRA was 80% sensitive and 95% specific. The area under the ROC curve was 0.97 for CE-MRA and 0.95 for 2D TOF MRA (P = .51, not significant). For both MRA studies, each of the luminal signal-intensity characteristics had high specificity (> 98%) but poor-to-mild sensitivity (35%-66%) in detecting > or = 70% stenosis.

CONCLUSIONS

Although it is established that CE-MRA more accurately delineates neurovascular anatomy than does unenhanced 2D TOF MRA, the administration of gadolinium did not offer a significant advantage in distinguishing surgically treatable ICA stenosis. This conclusion may be important in patients with contraindications to gadolinium.

Challenges to using a business case for addressing health disparities

The authors consider the challenges to quantifying both the business case and the social case for addressing disparities, which is central to achieving equity in the U.S. health care system. They describe the practical and methodological challenges faced by health plans exploring the business and social cases for undertaking disparity-reducing interventions. Despite these challenges, sound business and quality improvement principles can guide health care organizations seeking to reduce disparities. Place-based interventions may help focus resources and engage health care and community partners who can share in the costs of-and gains from-such efforts.

Reconstructions of conductive and insulating targets using the D-bar method on an elliptical domain

The D-bar algorithm based on A Nachman's 2D global uniqueness proof for the inverse conductivity problem (Nachman 1996 Ann. Math. 143 71-96) is implemented on an elliptical domain. The scattering transform is computed on an ellipse and the complete electrode model (CEM) for the forward problem is computed with the finite element method (FEM) in order to obtain static conductivity reconstructions of conductive and insulating targets in a saline-filled tank. It is demonstrated that the spatial artifacts in the image are significantly reduced when the domain is properly modeled in the reconstruction, as opposed to being modeled as a disk.

Region-specific regulation of glucocorticoid receptor/HSP90 expression and interaction in brain

The hippocampal glucocorticoid receptor (GR) is involved in negative feedback regulation of the hypothalamo-pituitary-adrenal axis and is believed to transduce the deleterious effects of glucocorticoids in depression and age-related memory loss. Regulation and intracellular trafficking of the GR are critical determinants of GR action in both health and disease. Here, we show dynamic regulation of GR and its interaction with its principal intracellular chaperone, heat-shock protein (HSP) 90, across the circadian cycle. Our initial experiments indicate that cytosolic hippocampal GR protein is elevated in the evening (PM), whereas nuclear GR and cytosolic HSP90, HSP70 and heat-shock cognate 70 (HSC70), are unchanged. In contrast, there are no changes in examined proteins in the hypothalamus. Immunoprecipitation experiments reveal increased GR-HSP90 associations in the hippocampus in the PM, whereas binding in the hypothalamus is decreased in the PM. Given that GR requires HSP90 for ligand binding, the data suggest that circadian GR signaling capacity is regulated in a region-specific pattern.

CNS glucagon-like peptide-1 receptors mediate endocrine and anxiety responses to interoceptive and psychogenic stressors

Responses to stressors serve to adjust physiology and behavior to increase short-term survival at the potential expense of increasing susceptibility to disease over the long term. We show that glucagon-like peptide-1 (7-36) amide (GLP-1) increases levels of the stress-activated hormones ACTH and corticosterone when administered directly into the rat brain and increases levels of anxiety as measured by the elevated plus maze. The endocrine response is preferentially activated by GLP-1 administration in the paraventricular nucleus of the hypothalamus, whereas the anxiety response is preferentially activated by administration in the central nucleus of the amygdala. Furthermore, GLP-1 antagonists block increases in stress hormones associated with the toxin LiCl and both the endocrine and anxiety responses to vertical heights. Although diverse neural circuits must necessarily process disparate stressors, the current data implicate a role for the GLP-1 system as a critical mediator of multiple stress responses.

Corticotropin-releasing hormone receptor blockade fails to alter stress-evoked catecholamine release in prefrontal cortex of control or chronically stressed rats

Although it is well documented that stress can increase the activity of central dopamine and norepinephrine neurons, little is known about the role of other neurotransmitters in modulating this response. Previous studies have implicated corticotropin-releasing hormone in modulating stress-evoked changes in the activity of locus coeruleus neurons. The present study examines whether corticotropin-releasing hormone contributes to stress-evoked increases in extracellular norepinephrine and dopamine in rat medial prefrontal cortex, as monitored by in vivo microdialysis. As noted previously, 30 min of tail-shock increased extracellular levels of norepinephrine and dopamine in the medial prefrontal cortex of naïve rats, and this was enhanced in rats previously exposed to chronic cold ( approximately 5 degrees C for 2-3 weeks). Previous intraventricular administration of a corticotropin-releasing hormone antagonist (D-Phe-corticotropin-releasing hormone; 3 and 9 microg) did not alter the tail-shock evoked in increase in extracellular levels of norepinephrine and dopamine in either naïve or chronically cold-exposed rats. Intraventricular administration of 3 microg of D-Phe-corticotropin-releasing hormone attenuated the increase in extracellular norepinephrine induced by co-administration of 3 microg of corticotropin-releasing hormone, confirming the efficacy of this compound. Results of the present study suggest that endogenous corticotropin-releasing hormone does not play a role in modulating the release of norepinephrine and dopamine occurring in response to acute tail-shock or the expression of a potentiated response to tail-shock in rats exposed chronically to cold.

Corticotropin-releasing hormone (CRH) expression and protein kinase A mediated CRH receptor signalling in an immortalized hypothalamic cell line

Corticotropin-releasing hormone (CRH) is a 41 amino acid neuropeptide which plays an important role in the stress response in the hypothalamus. We describe the development of an immortalized hypothalamic cell line which expresses CRH. We hypothesized that this cell line would possess the relevant characteristics of parvocellular CRH-expressing neurones such as glucocorticoid receptor (GR) expression and vasopressin (VP) coexpression. For production of hypothalamic cells, embryonic day 19 rat pup hypothalami were dissected and dissociated into tissue culture dishes. They were immortalized by retrovirus-mediated transfer of the SV40 large T antigen gene at 3 days of culture and then screened for expression of CRH following dilution cloning. One cell line was chosen (IVB) which exhibited CRH-like immunoreactivity (CRH-LI) and expressed CRH, VP and CRH1 receptor RNA via the reverse transcriptase-polymerase chain reaction. In addition, the cell line expressed the neuronal marker, microtubule-associated protein-2. We verified that the CRH-LI from IVB cell lysates coeluted with CRH standard via reversed-phase high-performance liquid chromatography (HPLC). Furthermore, oxidation of the lysate converted its HPLC profile to that identical with oxidized CRH standard. In addition, IVB cells exhibited high affinity binding to CRH. Incubation of IVB cells with CRH lead to increases in cAMP levels and protein kinase A activity in a concentration-dependent manner. Incubation of IVB cells with CRH also resulted in increases in phospho-cyclic-AMP response element binding protein (CREB) immunostaining as detected by immunocytochemical analysis. Finally, CRH treatment of IVB cell lines has been linked to CREB-mediated gene expression as determined via the PathDetect CREB trans-reporting system. The characteristics of IVB cells, such as CRH and VP coexpression, GR expression and a biologically active CRH-R1-mediated signalling pathway, suggest that this neuronal cell line may serve as model of parvocellular CRH neurones.

Decrements in nuclear glucocorticoid receptor (GR) protein levels and DNA binding in aged rat hippocampus

Hippocampal glucocorticoid receptors (GRs) are believed to play a major role in age-related cognitive decline and cellular vulnerability. It has been proposed that these receptors mediate damaging effects of elevated glucocorticoid secretion on cellular function. In the present report we present evidence that intracellular trafficking of the GR is impaired with hippocampal aging, manifest as decreased nuclear translocation and deficient DNA binding. We also present evidence that chaperone proteins responsible for GR nuclear translocation are decreased with hippocampal aging. Age-related nuclear GR decreases are not observed in hypothalamus, indicating regional specificity of trafficking deficits. Aging did not affect nuclear or cytosolic MR levels. These data suggest that GR signaling is diminished, rather than enhanced, during hippocampal aging. Diminished GR signaling capacity may attenuate the beneficial effects of glucocorticoids on hippocampal regulation of memory and stress integration.

"Captain of the ship" doctrine continues to take on water

The captain of the ship doctrine, which has been interpreted to mean that the surgeon's mere presence in the OR subjects him or her to legal liability for everyone's negligence in that room (akin to the responsibility of the captain of a ship who is held responsible for everything that happens on that ship), emerged in 1949 and grew in popularity through the 1950s. The major reason for this doctrine's popularity was that injured patients were precluded from suing hospitals under the then applicable charitable immunity doctrine. Charitable immunity declined in the 1960s, and by the 1970s, so too was the captain of the ship doctrine in decline. Pennsylvania, which first used the picturesque phrase in 1949, rejected the doctrine in 1974. In the meantime, it has come under much criticism, even among states that adopted it. Despite this decline and despite court language that sometimes borders on ridicule (e.g., anachronistic, prostrate doctrine, indiscriminate repetition), the felicity of the phrase has kept it alive in some states and in many ORs, even in states that have expressly rejected the doctrine. Even more than 20 years after its first rejection, however, courts still are being asked to adopt the doctrine. In 2001, the Wisconsin Supreme Court declined to adopt the doctrine, adding to the litany of states that have taken an express position against it.

Individual malpractice insurance decisions revisited

Nurses' professional obligations to their patients include financial accountability. Whether nurses best provide this through self-insurance, coverage by an employer's insurance policy, or by purchase of an individual policy remains a personal decision. Changes in law and the health care market, however, should prompt a revisiting of this decision because the relative costs and benefits of each option may have changed. The pace of these changes, the unexpected consequences of some of the legal changes, and the individual differences in each nurse's situation may require seeking legal counsel to identify and evaluate the risk/benefits in that situation. The cost of that counsel may well exceed the cost of the policy premium.

NASPE expert consensus document: use of i.v. (conscious) sedation/analgesia by nonanesthesia personnel in patients undergoing arrhythmia specific diagnostic, therapeutic, and surgical procedures

Use of IV (Conscious) Sedation/Analgesia by Nonanesthesia Personnel in Patients Undergoing Arrhythmia Specific Diagnostic, Therapeutic, and Surgical Procedures. This article is intended to inform practitioners, payers, and other interested parties of the opinion of the North American Society of Pacing and Electrophysiology (NASPE) concerning evolving areas of clinical practice or technologies or both, that are widely available or are new to the practice community. Expert consensus documents are so designated because the evidence base and experience with the technology or clinical practice are not yet sufficiently well developed, or rigorously controlled trials are not yet available that would support a more definitive statement. This article has been endorsed by the American College of Cardiology, October 1997.

Monitoring i.v. conscious sedation, the legal scope of practice

Registered nurses who are not CRNAs and are undertaking the administration and/or monitoring of patients receiving IV conscious sedation should consult their state board of nursing, undertake and document the additional education or training to monitor IV conscious sedation patients safety and document the successful achievement of competency in these services, and work with nursing, surgery, and anesthesia staff members to develop written protocols and policies. Written policies must include the provisions, if any, as prescribed by the state's board of nursing. The provisions of other state boards of nursing could be considered for possible inclusion. Policies should reflect nursing practice as described in the professional literature. Professional association position statements, such as those issued by the ANA and endorsed by AORN and other specialty associations and those issued by AANA, should be consulted. AORN's "Recommended practices for monitoring patients receiving intravenous conscious sedation" in the 1993 edition of AORN Standards and Recommended Practices for Perioperative Nursing should be incorporated into the institution policy as appropriate.

Issues regarding parents in the operating room during their children's care

The presence of parents in the operating room does have possible legal ramifications. Taking an upset child from a parent's arms, however, is not a positive situation either. Perioperative nurses should not automatically weigh legal implications more heavily than the patient benefit that may be derived from the presence of parents. Whether parents should or should not be allowed to accompany their children into the operating room should be a carefully considered institutional policy.