Region-Specific Enhancement of c-fos Expression by Combined Treatment With NMDA Receptor Agonists and Antagonists With Antidepressant Potential

Rapastinel, formerly Glyx-13, is a novel positive allosteric modulator of the N-methyl-D-aspartate-receptor (NMDAR) that counteracts psychotomimetic actions of NMDAR antagonists. We set out to evaluate the effect of rapastinel alone or in combination with the global and GluN2B subunit-specific NMDAR antagonists MK-801 and Ro25-6981, respectively, on neuronal activation in relevant regions using c-fos brain mapping. Whereas rapastinel alone did not trigger significant c-fos expression beyond the prelimbic cortex, it strongly increased the c-fos expression induced by MK-801 in hippocampal, cingulate, and retrosplenial areas. Similar results were obtained when rapastinel was replaced by D-cycloserine. Our results reveal new interactions at network level between NMDAR modulators with possible implications regarding their therapeutic effects.

Dopamine Transporter Knockout Rats Show Impaired Wellbeing in a Multimodal Severity Assessment Approach

In preclinical psychiatry research, animals are central to modeling and understanding biological mechanisms of behavior and psychiatric disorders. We here present the first multimodal severity assessment of a genetically modified rat strain used in psychiatric research, lacking the dopamine transporter (DAT) gene and showing endophenotypes of several dopamine-associated disorders. Absence of the DAT leads to high extracellular dopamine (DA) levels and has been associated with locomotor hyperactivity, compulsive behaviors and stereotypies in the past. The German Animal Welfare Law, which is based on the EU Directive (2010/63/EU), requires a prospective severity assessment for every animal experiment, depending on the extent of the expected degree of pain, suffering, distress or lasting harm that the animals will experience. This should consider all procedures but also the impact of the genotype on the phenotype. Therefore, we examined multiple parameters indicating animal welfare, like burrowing behavior, social interaction, saccharin preference, baseline stress hormone levels and nesting behavior. Additionally, a footprint analysis was performed and home cage activity was analyzed for a more detailed characterization of locomotion. DAT KO rats demonstrated reduced burrowing, social interaction and saccharin preference. We also found pronounced stereotypies and alterations in the gait analysis in DAT KO rats. Moreover, we confirmed the hyperactivity and the impaired sensorimotor gating mechanisms to assure that our rats are exhibiting the correct phenotype. In conclusion, we provide evidence that DAT KO rats show alterations in natural behavior patterns and deduce that the marked stereotypies are a sign for coping difficulties, both indicating a negative influence of the genotype on wellbeing. We suggest to assess further rat models in an objectified severity assessment as previously done in mice to create a relative severity assessment based on scientific evidence. Until then, we propose the classification of homozygous DAT KO rats as “moderate” in accordance with the criteria of the EU directive 2010/63.

Treatment of a large postsurgical para-anastomotic aortic aneurysm using endovascular stent grafts. A case report with four-year follow-up

This case report describes the outcome of straight endograft placement for treating a large para-anastomotic aortic aneurysm (PAA). A 43-year-old woman was admitted to the emergency department because of a vast PAA (8.7 cm in maximum transverse diameter). Since 1983, she has undergone multiple vascular operations for arterial occlusive disease. In 1990, an aortobifemoral bypass operation was performed. In this most recent intervention, we implanted three tube Excluder® endografts. The procedure was uneventful. Considering the size of the aneurysm sac, particular attention was paid to possible sequelae during the over 4-year follow-up period. No complications developed and the last computed tomography (CT) scan showed a remarkable decrease of 50 mm in aneurysm size. In conclusion, the use of straight endografts seems to be effective and lasting, even in large para-anastomotic aneurysmatic lesions.

Angioplasty and stenting of the cervical carotid bifurcation under filter protection: a prospective study in a series of 53 patients

The aim of this study is to assess safety, reliability, ease of use and usefulness of filter protection devices during angioplasty and stenting of stenotic lesions of the cervical carotid bifurcation. Over a period of 42 months, 53 patients harboring a cervical carotid bifurcation stenotic lesion were treated, by angioplasty and/or stenting using filter protection devices of different kinds. The stenosis was atherosclerotic in 48 cases, post-surgical in four and post-radiation in one case. In all cases, the treatment was successful, with good restoration of the luminal diameter. There were three major strokes (5.6%) and one minor stroke (1.9%). Two of these (one major, one minor) occurred a few hours after the stenting procedure and both seemed by all evidence due to a hemorrhagic hyperperfusion syndrome. One hemiparesis and dysphasia occurred two days after the procedure, secondary to subacute thrombosis with occlusion of the stent. One patient complained of three episodes of decrease in visual acuity of the eye ipsilateral to the stenting in the two weeks following treatment. In conclusion, in our experience, use of the devices adds only few minutes to the procedure time; direct lesions of the arterial wall, such as dissections or intraluminal thrombi, related to the use of filters were never observed, and spasm of the distal I.C.A. also proved rapidly regressive. The content of all filters, if any, was histologically examined, but plaque material was found only in one case, probably owing to our primary stenting technique without use of pre-dilation. The major technical drawback is in-filter coagulation, which occurred in 16 cases, occluding the membrane of the filter and thus slowing or blocking intracranial flow. Such an event can be counteracted by a more aggressive anti-coagulation protocol, which could, however, be responsible for the two complications with hemorrhagic brain infarction. Furthermore, we observed two other major neurological events, which bring the incidence of neurological complications in this series as high as 7.5%. Therefore, it is our opinion that safety of filters is not yet proven, and consequently great care must be taken in their use.

Hypnosis instead of general anaesthesia in paediatric radiotherapy: report of three cases

PURPOSE

This report proposes hypnosis as a valid alternative to general anaesthesia for immobilisation and set-up in certain cases in paediatric radiotherapy.

METHODS

We report three cases of children who underwent radiotherapy in 1994 and were treated using hypnosis for set-up during irradiation. The first and the second were two cases of macroscopic resection of cerebellar medulloblastoma in which craniospinal irradiation was necessary, while the third patient suffered of an endorbitary relapse of retinoblastoma previously treated with bilateral enucleation, radiotherapy and chemotherapy; in this last situation the child needed radiation as palliative therapy. Hypnosis was used during treatment to obtain the indispensable immobility. Hypnotic conditioning was obtained by our expert psychotherapist while the induction during every single treatment was made by the clinician, whose voice was presented to the children during the conditioning.

RESULTS

Every single fraction of the radiation therapy was delivered in hypnosis and without the need for narcosis.

CONCLUSIONS

Hypnosis may be useful in particular situations to prepare paediatric cancer patients during irradiation, when lack of child collaboration might necessitate the use of general anaesthesia and when anaesthesia itself is not possible.

Double-blind randomized study of lonidamine and radiotherapy in head and neck cancer

PURPOSE

Preclinical studies showed lonidamine to potentiate the effects of x-irradiation by inhibiting the repair of potentially lethal damage. This Phase III double blind, placebo-controlled study was performed to evaluate whether lonidamine can increase the tumor control of radiotherapy in the treatment of advanced head and neck cancer without any synergistic toxic effects on the exposed normal tissues.

METHODS AND MATERIALS

Ninety-seven patients with Stages II-IV squamous cell carcinoma of the head and neck were enrolled. Separate analyses were done on the 96 eligible patients and the 90 patients who completed the prescribed treatment regimen. Patients received radiotherapy up to a planned total of 60-66 Gy, in 2 daily fractions of 1.5 Gy each and either lonidamine (450 mg p.o. in three divided daily doses) or placebo, given continuously for 3 months or up to 1 month after the end of radiotherapy.

RESULTS

The rate of tumor clearance was 66% (32/48) in the lonidamine group and 65% (31/48) in the placebo group, while the subsequent failure rate was 50% and 77%, respectively (p < 0.05). The 3 and 5 year locoregional control rates in the adequately treated patients achieving complete tumor clearance were 66% and 63% for lonidamine vs. 41% and 37% for placebo. The disease-free survival in adequately treated patients was significantly better in the lonidamine group (p < 0.03), with 3 and 5 year rates of 44% and 40%, respectively, vs. 23% and 19% in the placebo group. The overall survival rate for all eligible patients at both 3 and 5 years was 44% in the lonidamine group and 44% and 31%, respectively, in the placebo group. Both acute and late radiation reactions were similar in the two groups. Myalgia and testicular pain were the most frequent side effects of lonidamine with an incidence of 8.5% and 4.2%, respectively.

CONCLUSION

The addition of lonidamine to hyperfractionated radiotherapy was correlated with a statistically and clinically significant proportion of long-term disease-free patients. The toxicity of radiotherapy was not aggravated by the drug and the overall tolerance of the combined regimen was acceptable.

[Radiotherapy as a single local regional treatment of non-oat cell carcinoma of the lung]

The records of 168 patients treated by definitive radiation therapy for non-oat-cell-carcinoma of the lung in the Radiotherapy Department of the "Ospedale Regionale Multizonale" of Varese, Italy, from may 1979 to december 1984, were analyzed. Cumulative probability of survival from the beginning of radiotherapy were 48 +/- 4% at 12 months and 8 +/- 3% at 60 months. It appears to be no significant difference in survival according to TNM classes, UICC stages, histology and grading. Significant differences in survival were found grouping patients by performance status (I.K. less than 70 v.s. greater than or equal to 70), total absorbed dose (dose less than 56 Gy v.s. greater than or equal to 56 Gy), total isoeffect levels (CRE less than 17 reu v.s. greater than or equal to 17 reu), and response to treatment. The latter could be the most important prognostic factor. Median survival for CR, PR and NC categories were 48.5, 12 and 10 months respectively. We suggest that RT may be of value in improving quality of life and survival of patients affected by non operable non-oat-cell-carcinoma of the lung.

Lonidamine and radiotherapy in head and neck cancers. A pilot study

The tolerance and antitumor activity of Lonidamine combined with radiotherapy were studied on 40 patients with head and neck cancer and compared with a historical control group. Lonidamine was well tolerated. 26 and 17 complete responses were seen in the Lonidamine-treated group and in the historical control group, respectively.

Prophylaxis of thrombo/embolic complications in hip surgery

The problem of the prophylaxis of post-operative phlebitis and pulmonary embolism, which may sometimes be fatal, has received considerable attention in recent medical literature. The combined experience of the Division of Orthopaedics and Traumatology and the Division of Vascular Surgery of the United Hospitals of Bergamo in the prevention of these complications in surgery of the hip are reported. The efficiency of drugs inhibiting platelet aggregation in patients suffering from vascular disease other than thrombophlebitis has already been reported in a previous study, and is now confirmed in its application to orthopaedic surgery (Losapio G. M., Setti M., et al.).