Control of feeding by a bottom-up midbrain-subthalamic pathway

Investigative exploration and foraging leading to food consumption have vital importance, but are not well-understood. Since GABAergic inputs to the lateral and ventrolateral periaqueductal gray (l/vlPAG) control such behaviors, we dissected the role of vgat-expressing GABAergic l/vlPAG cells in exploration, foraging and hunting. Here, we show that in mice vgat l/vlPAG cells encode approach to food and consumption of both live prey and non-prey foods. The activity of these cells is necessary and sufficient for inducing food-seeking leading to subsequent consumption. Activation of vgat l/vlPAG cells produces exploratory foraging and compulsive eating without altering defensive behaviors. Moreover, l/vlPAG vgat cells are bidirectionally interconnected to several feeding, exploration and investigation nodes, including the zona incerta. Remarkably, the vgat l/vlPAG projection to the zona incerta bidirectionally controls approach towards food leading to consumption. These data indicate the PAG is not only a final downstream target of top-down exploration and foraging-related inputs, but that it also influences these behaviors through a bottom-up pathway.

Synaptic and intrinsic plasticity within overlapping lateral amygdala ensembles following fear conditioning

Introduction

New learning results in modulation of intrinsic plasticity in the underlying brain regions. Such changes in intrinsic plasticity can influence allocation and encoding of future memories such that new memories encoded during the period of enhanced excitability are linked to the original memory. The temporal window during which the two memories interact depends upon the time course of intrinsic plasticity following new learning.

Methods

Using the well-characterized lateral amygdala-dependent auditory fear conditioning as a behavioral paradigm, we investigated the time course of changes in intrinsic excitability within lateral amygdala neurons.

Results

We found transient changes in the intrinsic excitability of amygdala neurons. Neuronal excitability was increased immediately following fear conditioning and persisted for up to 4 days post-learning but was back to naïve levels 10 days following fear conditioning. We also determined the relationship between learning-induced intrinsic and synaptic plasticity. Synaptic plasticity following fear conditioning was evident for up to 24 h but not 4 days later. Importantly, we demonstrated that the enhanced neuronal intrinsic excitability was evident in many of the same neurons that had undergone synaptic plasticity immediately following fear conditioning. Interestingly, such a correlation between synaptic and intrinsic plasticity following fear conditioning was no longer present 24 h post-learning.

Discussion

These data demonstrate that intrinsic and synaptic changes following fear conditioning are transient and co-localized to the same neurons. Since intrinsic plasticity following fear conditioning is an important determinant for the allocation and consolidation of future amygdala-dependent memories, these findings establish a time course during which fear memories may influence each other.

A dual-pathway architecture enables chronic stress to promote habit formation

Chronic stress can change how we learn and, thus, how we make decisions by promoting the formation of inflexible, potentially maladaptive, habits. Here we investigated the neuronal circuit mechanisms that enable this. Using a multifaceted approach in male and female mice, we reveal a dual pathway, amygdala-striatal, neuronal circuit architecture by which a recent history of chronic stress shapes learning to disrupt flexible goal-directed behavior in favor of inflexible habits. Chronic stress inhibits activity of basolateral amygdala projections to the dorsomedial striatum to impede the action-outcome learning that supports flexible, goal-directed decisions. Stress also increases activity in direct central amygdala projections to the dorsomedial striatum to promote the formation of rigid, inflexible habits. Thus, stress exerts opposing effects on two amygdala-striatal pathways to promote premature habit formation. These data provide neuronal circuit insights into how chronic stress shapes learning and decision making, and help understand how stress can lead to the disrupted decision making and pathological habits that characterize substance use disorders and other psychiatric conditions.

Miniscope-LFOV: A large-field-of-view, single-cell-resolution, miniature microscope for wired and wire-free imaging of neural dynamics in freely behaving animals

Imaging large-population, single-cell fluorescent dynamics in freely behaving animals larger than mice remains a key endeavor of neuroscience. We present a large-field-of-view open-source miniature microscope (MiniLFOV) designed for large-scale (3.6 mm × 2.7 mm), cellular resolution neural imaging in freely behaving rats. It has an electrically adjustable working distance of up to 3.5 mm ± 100 μm, incorporates an absolute head orientation sensor, and weighs only 13.9 g. The MiniLFOV is capable of both deep brain and cortical imaging and has been validated in freely behaving rats by simultaneously imaging >1000 GCaMP7s-expressing neurons in the hippocampal CA1 layer and in head-fixed mice by simultaneously imaging ~2000 neurons in the dorsal cortex through a cranial window. The MiniLFOV also supports optional wire-free operation using a novel, wire-free data acquisition expansion board. We expect that this new open-source implementation of the UCLA Miniscope platform will enable researchers to address novel hypotheses concerning brain function in freely behaving animals.

Local memory allocation recruits memory ensembles across brain regions

Memories are thought to be stored in ensembles of neurons across multiple brain regions. However, whether and how these ensembles are coordinated at the time of learning remains largely unknown. Here, we combined CREB-mediated memory allocation with transsynaptic retrograde tracing to demonstrate that the allocation of aversive memories to a group of neurons in one brain region directly affects the allocation of interconnected neurons in upstream brain regions in a behavioral- and brain region-specific manner in mice. Our analysis suggests that this cross-regional recruitment of presynaptic neurons is initiated by downstream memory neurons through a retrograde mechanism. Together with statistical modeling, our results indicate that in addition to the anterograde flow of information between brain regions, the establishment of interconnected, brain-wide memory traces relies on a retrograde mechanism that coordinates memory ensembles at the time of learning.

POS1166 GOUT AND SERIOUS KIDNEY DISEASE IN THE US: A NATIONAL PERSPECTIVE

Background

There is a strong association between gout and kidney disease due to the kidney’s key role in uric acid excretion.1-4 Several studies have also demonstrated that serum uric acid is an independent risk factor for decline in renal function1,2. There are little national data available regarding the clinical burden of kidney disease in gout patients in the US.

Objectives

To estimate the percentage of US hospitalizations with a concomitant diagnosis of gout and either acute or chronic kidney disease compared with percentage of hospitalizations with kidney disease in the general population.

Methods

The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. Detailed information including clinical and nonclinical data elements on each hospital stay including International Classification of Diseases (ICD) 10 diagnosis, age, gender, length of stay, payer, charges, and comorbidities etc. is available.

We examined all hospitalizations with acute renal failure (ICD10 codes N170-179), chronic kidney disease stages 3-5 (ICD10 codes N183-185), N19 (unspecified kidney failure), and end-stage renal disease (ICD10 code N186) in persons with gout (ICD 10 codes M10.* and M1A.*) and compared these with hospitalizations with kidney disease in the general US population.

Results

In 2019, there were 35.4 million all-cause hospitalizations in the US. Of these, 7.9 million had a diagnosis of serious kidney disease (22.3%). There were 915,070 hospitalizations with primary or secondary diagnosis of gout in the US (mean age 70.8 years, 68.4% men and 31.6% women). Of these 533,365 hospitalizations (mean age 72.6 years, 65.9% men) also had a concomitant diagnosis of serious kidney disease (58.3%, p<0.0001 compared to general population).

Concomitant diagnosis of serious kidney disease increased with age, reaching 38.3% of all hospitalizations in 65 years and older in the general population compared to 62.5% in persons with gout (p<0.001).

Table 1.

Kidney disease-related hospitalization in the US general and gout populations.

GENERAL US HOSPITALIZATIONSUS HOSPITALIZATIONS WITH COMORBID GOUTPatient AgeOverall HospitalizationsNHospitalizations with Serious Kidney Diseasen (%)Overall HospitalizationsNHospitalizations with Serious Kidney Disease n (%)18-44 years8,356,284622,170 (7.4%)32,44513,480 (41.5%)45-64 years8,440,8312,160,220 (25.6%)232,695116,490 (50.1%)≥65 years13,421,1545,257,220 (39.2%)649,865414,620 (83.8%)Total in 201935,419,0237,907,730 (22.3%)915,070533,365 (58.3%)

Note: Total numbers include patients 0-17 years old.

Conclusion

Acute and chronic kidney disease are highly prevalent comorbid conditions in overall US hospitalizations. Among patients admitted with a diagnosis of gout, the proportion of kidney dysfunction is significantly higher affecting 58% of these hospitalizations. The high prevalence of kidney dysfunction in hospitalized gout patients in the US may represent an impactful component to the duration, complexity, and costs of hospital care.

References

[1]Jung SW, et al. Am J Physiol Renal Physiol 2020;318:F1327-40.

[2]Obermayr RP, et al. J Am Soc Nephrol 2008;19:2407-13.

[3]Roughley MJ, et al. Arthritis Res Ther 2015;17:90.

[4]Juraschek SP, et al. Semin Arthritis Rheum 2013;42:551-61.

Disclosure of Interests

Gurkirpal Singh Grant/research support from: Horizon Therapeutics (unrestricted research grant), Maanek Sehgal: None declared, Brad Marder Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Brian LaMoreaux Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Alka Mithal: None declared

Dorsal premammillary projection to periaqueductal gray controls escape vigor from innate and conditioned threats

Escape from threats has paramount importance for survival. However, it is unknown if a single circuit controls escape vigor from innate and conditioned threats. Cholecystokinin (cck)-expressing cells in the hypothalamic dorsal premammillary nucleus (PMd) are necessary for initiating escape from innate threats via a projection to the dorsolateral periaqueductal gray (dlPAG). We now show that in mice PMd-cck cells are activated during escape, but not other defensive behaviors. PMd-cck ensemble activity can also predict future escape. Furthermore, PMd inhibition decreases escape speed from both innate and conditioned threats. Inhibition of the PMd-cck projection to the dlPAG also decreased escape speed. Intriguingly, PMd-cck and dlPAG activity in mice showed higher mutual information during exposure to innate and conditioned threats. In parallel, human functional magnetic resonance imaging data show that a posterior hypothalamic-to-dlPAG pathway increased activity during exposure to aversive images, indicating that a similar pathway may possibly have a related role in humans. Our data identify the PMd-dlPAG circuit as a central node, controlling escape vigor elicited by both innate and conditioned threats.

POS1143 GOUT AND JOINT REPLACEMENTS IN THE US

Background:

Irreversible joint damage in gout has been linked to a possible increase in knee and hip joint replacements1. In addition, the strong association between gout and osteoarthritis2,3 could also lead to an increased risk of joint replacements in patients with gout. Population-based data from the UK and Taiwan have shown hazard rates of 1.14 and 1.16 respectively for knee replacements in patients with gout compared to age and gender matched controls1. However, there is little national data in the US on clinical and economic burden of joint replacements in patients with gout.

Objectives:

To evaluate total or partial hip and knee joint replacements in patients with gout in the US and to estimate their economic impact

Methods:

The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. Detailed information including clinical and nonclinical data elements on each hospital stay including International Classification of Diseases (ICD)10 diagnosis and procedure codes, age, gender, length of stay, payer, charges, comorbidities etc. is available. We examined hospitalizations in patients with gout with hip and knee joint replacements in NIS 2018, the most recent year of data.

Results:

In 2018, there were 914,510 hospitalizations with primary or secondary diagnosis of gout in the US. Of these 43,615 were for joint replacement surgeries (knee (24,840) and hip (18,755)). Patients with knee replacement were on an average 68.5 years old (95% confidence intervals 68.2 years -68.8 years). Patients with hip replacement were slightly older (mean age 70.3 years, 95% confidence intervals 69.8 years -70.7 years). Unlike general population statistics, men formed a majority of these joint replacements (68% for the knee and 72% for the hip). The average charge per hospitalization was $69,279 and $72,944 for knee and hip replacement respectively. The total annual national cost estimate was $3.09 billion, with government insurances (Medicare and Medicaid) responsible for 67% of knee replacement and 70% of hip replacement costs.

Conclusion:

Joint replacements in gout patients have a large clinical and economic burden in the US. This calls for an increased awareness and management of associated hip and knee arthritis in patients with gout.

References:

[1]Kuo CF, Chou IJ, See LC, et al. Urate-lowering treatment and risk of total joint replacement in patients with gout. Rheumatology. Dec 1 2018;57(12):2129-2139.

[2]Howard RG, Samuels J, Gyftopoulos S, et al. Presence of gout is associated with increased prevalence and severity of knee osteoarthritis among older men: results of a pilot study. Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases. Mar 2015;21(2):63-71.

[3]Roddy E, Zhang W, Doherty M. Are joints affected by gout also affected by osteoarthritis? Annals of the rheumatic diseases. Oct 2007;66(10):1374-1377.

Disclosure of Interests:

Gurkirpal Singh Shareholder of: Pfizer, Merck, Sanofi, Grant/research support from: Horizon, Maanek Sehgal: None declared, Alka Mithal: None declared.

Modulation of intrinsic excitability as a function of learning within the fear conditioning circuit

Experience-dependent neuronal plasticity is a fundamental substrate of learning and memory. Intrinsic excitability is a form of neuronal plasticity that can be altered by learning and indicates the pattern of neuronal responding to external stimuli (e.g. a learning or synaptic event). Associative fear conditioning is one form of learning that alters intrinsic excitability, reflecting an experience-dependent change in neuronal function. After fear conditioning, intrinsic excitability changes are evident in brain regions that are a critical part of the fear circuit, including the amygdala, hippocampus, retrosplenial cortex, and prefrontal cortex. Some of these changes are transient and/or reversed by extinction as well as learning-specific (i.e. they are not observed in neurons from control animals). This review will explore how intrinsic neuronal excitability changes within brain structures that are critical for fear learning, and it will also discuss evidence promoting intrinsic excitability as a vital mechanism of associative fear memories. This work has raised interesting questions regarding the role of fear learning in changes of intrinsic excitability within specific subpopulations of neurons, including those that express immediate early genes and thus demonstrate experience-dependent activity, as well as in neurons classified as having a specific firing type (e.g. burst-spiking vs. regular-spiking). These findings have interesting implications for how intrinsic excitability can serve as a neural substrate of learning and memory, and suggest that intrinsic plasticity within specific subpopulations of neurons may promote consolidation of the memory trace in a flexible and efficient manner.

Effect of different stripping techniques on pulpal temperature: in vitro study

Introduction:

Proximal stripping of enamel is a routine clinical procedure employed in orthodontics to create space or for balancing tooth size discrepancies. This procedure may result in heat transfer to the pulp, predisposing it to histopathological changes and necrosis of the pulp tissue.

Objective:

To measure the temperature changes in the pulp chamber during different stripping procedures.

Methods:

80 proximal surfaces of 40 extracted human premolar teeth were stripped using four techniques: diamond burs in air-rotor handpiece with air-water spray; diamond burs in micromotor handpiece, with and without a coolant spray; and hand-held diamond strips. A J-type thermocouple connected to a digital thermometer was inserted into the pulp chamber for evaluation of temperature during the stripping procedure.

Results:

An increase in the pulpal temperature was observed for all stripping method. Diamond burs in micromotor handpiece without coolant resulted in the higher increase in temperature (3.5^oC), followed by hand-held diamond strips (2.8^oC), diamond burs in air-rotor with air-water spray (1.9^oC); and the smallest increase was seen with diamond burs in micromotor handpiece with coolant (1.65^oC). None of the techniques resulted in temperature increase above the critical level of 5.5^oC.

Conclusion:

Frictional heat produced with different stripping techniques results in increase in the pulpal temperature, therefore, caution is advised during this procedure. A coolant spray can limit the increase in temperature of the pulp.

Memory formation depends on both synapse-specific modifications of synaptic strength and cell-specific increases in excitability

The modification of synaptic strength produced by long-term potentiation (LTP) is widely thought to underlie memory storage. Indeed, given that hippocampal pyramidal neurons have >10,000 independently modifiable synapses, the potential for information storage by synaptic modification is enormous. However, recent work suggests that CREB-mediated global changes in neuronal excitability also play a critical role in memory formation. Because these global changes have a modest capacity for information storage compared with that of synaptic plasticity, their importance for memory function has been unclear. Here we review the newly emerging evidence for CREB-dependent control of excitability and discuss two possible mechanisms. First, the CREB-dependent transient change in neuronal excitability performs a memory-allocation function ensuring that memory is stored in ways that facilitate effective linking of events with temporal proximity (hours). Second, these changes may promote cell-assembly formation during the memory-consolidation phase. It has been unclear whether such global excitability changes and local synaptic mechanisms are complementary. Here we argue that the two mechanisms can work together to promote useful memory function.

Identification of genetic variation in NOD-like receptor 2 gene and influence of polymorphism on gene structure and function in buffalo (Bubalus bubalis)

Nucleotide-binding oligomerization domain (NOD)-like receptor 2 is one of the important mediators of innate as well as adaptive immune response to microbial infections. In this study, NOD-like receptor-2 was characterized by determining the full gene sequence and analyzing genetic diversity in Indian buffaloes. Sequence analysis of buffalo NOD2 revealed 3042 nucleotides long ORF, encoding 1013 amino acids from 12 exons. Domain structure analysis indicated existence of 8 leucine-rich repeat (LRR) domains in buffalo, cattle, sheep and mouse, along with central NACHT/NOD domain and two N-terminal CARD domains. Comparative sequence analysis among different buffalo breeds identified 46 polymorphic sites in NOD2 gene. Among coding region SNPs, 10 were non-synonymous, 7 synonymous and 3 were present in 5'UTR. Genotyping of two nsSNPs, revealed significant differences in the allele frequencies, distinguishing swamp and riverine buffaloes, having different utilities. Association analysis with mastitis in dairy buffaloes indicated significant variation in allelic frequencies at G1135A locus, between mastitis affected and non-affected animals. Further, NOD2 gene expression was quantified in different riverine buffalo tissues, using real-time PCR and lymph node displayed highest expression, compared to others organs included in the study. Overall, the study revealed buffalo NOD2 gene attributes, important to understand species specific immune response in ruminants.

CCR5 is a suppressor for cortical plasticity and hippocampal learning and memory

Although the role of CCR5 in immunity and in HIV infection has been studied widely, its role in neuronal plasticity, learning and memory is not understood. Here, we report that decreasing the function of CCR5 increases MAPK/CREB signaling, long-term potentiation (LTP), and hippocampus-dependent memory in mice, while neuronal CCR5 overexpression caused memory deficits. Decreasing CCR5 function in mouse barrel cortex also resulted in enhanced spike timing dependent plasticity and consequently, dramatically accelerated experience-dependent plasticity. These results suggest that CCR5 is a powerful suppressor for plasticity and memory, and CCR5 over-activation by viral proteins may contribute to HIV-associated cognitive deficits. Consistent with this hypothesis, the HIV V3 peptide caused LTP, signaling and memory deficits that were prevented by Ccr5 knockout or knockdown. Overall, our results demonstrate that CCR5 plays an important role in neuroplasticity, learning and memory, and indicate that CCR5 has a role in the cognitive deficits caused by HIV.

Learning enhances intrinsic excitability in a subset of lateral amygdala neurons

Learning-induced modulation of neuronal intrinsic excitability is a metaplasticity mechanism that can impact the acquisition of new memories. Although the amygdala is important for emotional learning and other behaviors, including fear and anxiety, whether learning alters intrinsic excitability within the amygdala has received very little attention. Fear conditioning was combined with intracellular recordings to investigate the effects of learning on the intrinsic excitability of lateral amygdala (LA) neurons. To assess time-dependent changes, brain slices were prepared either immediately or 24-h post-conditioning. Fear conditioning significantly enhanced excitability of LA neurons, as evidenced by both decreased afterhyperpolarization (AHP) and increased neuronal firing. These changes were time-dependent such that reduced AHPs were evident at both time points whereas increased neuronal firing was only observed at the later (24-h) time point. Moreover, these changes occurred within a subset (32%) of LA neurons. Previous work also demonstrated that learning-related changes in synaptic plasticity are also evident in less than one-third of amygdala neurons, suggesting that the neurons undergoing intrinsic plasticity may be critical for fear memory. These data may be clinically relevant as enhanced LA excitability following fear learning could influence future amygdala-dependent behaviors.

Learning to learn - intrinsic plasticity as a metaplasticity mechanism for memory formation

"Use it or lose it" is a popular adage often associated with use-dependent enhancement of cognitive abilities. Much research has focused on understanding exactly how the brain changes as a function of experience. Such experience-dependent plasticity involves both structural and functional alterations that contribute to adaptive behaviors, such as learning and memory, as well as maladaptive behaviors, including anxiety disorders, phobias, and posttraumatic stress disorder. With the advancing age of our population, understanding how use-dependent plasticity changes across the lifespan may also help to promote healthy brain aging. A common misconception is that such experience-dependent plasticity (e.g., associative learning) is synonymous with synaptic plasticity. Other forms of plasticity also play a critical role in shaping adaptive changes within the nervous system, including intrinsic plasticity - a change in the intrinsic excitability of a neuron. Intrinsic plasticity can result from a change in the number, distribution or activity of various ion channels located throughout the neuron. Here, we review evidence that intrinsic plasticity is an important and evolutionarily conserved neural correlate of learning. Intrinsic plasticity acts as a metaplasticity mechanism by lowering the threshold for synaptic changes. Thus, learning-related intrinsic changes can facilitate future synaptic plasticity and learning. Such intrinsic changes can impact the allocation of a memory trace within a brain structure, and when compromised, can contribute to cognitive decline during the aging process. This unique role of intrinsic excitability can provide insight into how memories are formed and, more interestingly, how neurons that participate in a memory trace are selected. Most importantly, modulation of intrinsic excitability can allow for regulation of learning ability - this can prevent or provide treatment for cognitive decline not only in patients with clinical disorders but also in the aging population.

Trace fear conditioning enhances synaptic and intrinsic plasticity in rat hippocampus

Experience-dependent synaptic and intrinsic plasticity are thought to be important substrates for learning-related changes in behavior. The present study combined trace fear conditioning with both extracellular and intracellular hippocampal recordings to study learning-related synaptic and intrinsic plasticity. Rats received one session of trace fear conditioning, followed by a brief conditioned stimulus (CS) test the next day. To relate behavioral performance with measures of hippocampal CA1 physiology, brain slices were prepared within 1 h of the CS test. In trace-conditioned rats, both synaptic plasticity and intrinsic excitability were significantly correlated with behavior such that better learning corresponded with enhanced long-term potentiation (LTP; r = 0.64, P < 0.05) and a smaller postburst afterhyperpolarization (AHP; r = -0.62, P < 0.05). Such correlations were not observed in pseudoconditioned rats, whose physiological data were comparable to those of poor learners and naive and chamber-exposed control rats. In addition, acquisition of trace fear conditioning did not enhance basal synaptic responses. Thus these data suggest that within the hippocampus both synaptic and intrinsic mechanisms are involved in the acquisition of trace fear conditioning.

Thiazolidinedione precipitated thyroid associated ophthalmopathy

Thyroid associated ophthalmopathy (TAO), a cardinal clinical pointer to diagnose Graves' disease (GD), is seen less frequently in our country than in the West, but can have sight threatening consequences. Smoking, diabetes, male gender, increasing age and radioactive iodine treatment for thyrotoxicosis are known precipitating factors for TAO. We report four cases of thiazolidinediones (TZD) precipitated TAO. All were male, had autoimmune thyroid disease (three had Graves' disease and one had Hashimoto's thyroiditis) and type 2 diabetes mellitus (T2DM). They developed eye symptoms three to four months after taking TZDs for glycaemic control. Two of them responded to medical treatment, the other two underwent surgical decompression.

Evaluating the effectiveness of school-based dental health education program among children of different socioeconomic groups

The aim of the present study was to evaluate the effectiveness of Dental Health Education programs among school children of different socioeconomic groups. The investigators made a visit to three different schools and studied 500 children. A ten items, open-ended, self-administered questionnaire was pretested on the primary and higher primary school children before and after an educational intervention. A second visit was made to one of the schools 1 year later and the same questionnaire was re-administered to those subjects who had participated in the original study. Results showed that although educational intervention was successful in improving the Dental health awareness of most children, the socioeconomic background is an important determinant for the same. Also, single-lecture technique seems to be inadequate in improving the knowledge of children in the long term.

Association between state level drinking and driving countermeasures and self reported alcohol impaired driving

OBJECTIVES

In 1999, alcohol related motor vehicle crashes in the United States claimed 15786 lives and injured more than 300000 persons. Drinking and driving behavior is shaped by individual and environmental level influences. In this study, the association between each state's driving under the influence of alcohol (DUI) countermeasures and self reported alcohol impaired driving was explored.

METHODS

Mothers Against Drunk Driving's (MADD's) Rating the States 2000 survey, which graded states on their DUI countermeasures from 1996-99, was used as an index of each state's comprehensive DUI prevention activities. Information on alcohol impaired driving from residents of each state was obtained from the 1997 Behavioral Risk Factor Surveillance System (BRFSS) survey. The association between the MADD state grades and alcohol impaired driving was assessed using multiple logistic regression.

RESULTS

Of the 64162 BRFSS respondents who reported drinking any alcohol during the past month, 2.1% of women and 5.8% of men reported at least one episode of alcohol impaired driving in the past month. Those living in states with a MADD grade of "D" were 60% more likely to report alcohol impaired driving than those from states with a MADD grade of "A" (odds ratio 1.6, 95% confidence interval 1.3 to 2.1). The association existed for men and women.

CONCLUSION

These findings suggest that stronger state level DUI countermeasures are associated with lower rates of self reported alcohol impaired driving.

Driving cessation: what older former drivers tell us

OBJECTIVES

To understand why older drivers living in a community setting stop driving.

DESIGN

A cross-sectional study within a longitudinal cohort.

SETTING

A geographically defined community in southern California.

PARTICIPANTS

1,950 respondents age 55 and older who reported ever being licensed drivers.

MEASUREMENTS

A mailed survey instrument of self-reported driving habits linked to prior demographic, health, and medical information.

RESULTS

Of the 1,950 eligible respondents, 141 had stopped driving within the previous 5 years. Among those who stopped, mean age was 85.5 years, 65.2% were female, and the majority reported they were in very good (43.4%) or good (34.0%) health. Nearly two-thirds reported driving less than 50 miles per week prior to stopping and 12.1% reported a motor vehicle crash during the previous 5 years. The most common reasons reported for stopping were medical (41.0%) and age-related (19.4%). In bivariate analyses, age and miles driven per week were each associated with cessation (P < or = .001). Medical conditions, crashes in the previous 5 years, and gender did not reach statistical significance at the P < or = .05 level. Logistic regression results found that the number of medical conditions was inversely associated with driving cessation.

CONCLUSION

The relationship between medical conditions and driving is complex; while medical conditions were the most common reason given for driving cessation, those who stopped had fewer medical conditions than current drivers. This suggests that a broader measure of general health or functional ability may play a dominant role in decisions to stop driving.

Effect of asthma on the quality of life among children and their caregivers in the Atlanta Empowerment Zone

BACKGROUND AND OBJECTIVE

Asthma is the most common chronic pediatric disease and exacts a toll on the health-related quality of life of affected children and their primary caregivers. This investigation describes the relationship between the clinical severity of asthma among inner-city children and their quality of life and that of their primary adult caregivers.

METHODS

Telephone interview data were collected from individual adult caregivers of 5-12-year-old children with asthma. Questions addressed the history, diagnosis, and management of the child's asthma, the child's family and social background, the family's socioeconomic status, the caregiver's knowledge and attitude about asthma, and the health-related quality of life of both the child and the caregiver. An asthma severity score was calculated from the caregiver's responses to questions about their child's wheezing frequency, nocturnal and early morning symptoms, and speaking during an asthma attack, as well as the impact of the disease on their child's physical activity and breathing during the prior 4-month period. A clinical asthma triage score was determined from information collected at the emergency department about the child's oxygen saturation, alertness, use of accessory respiratory muscles, extent of breathlessness, and peak expiratory flow. Spearman correlation coefficients were used to identify association between quality of life and disease severity, caretaker's asthma knowledge, and functional impact of asthma symptoms.

RESULTS

Data from 240 of 755 eligible children were analyzed. Most children were younger than 11 years, male, black, and non-Hispanic. The children's median duration of asthma diagnosis was 86% of their life (range less than 1 to 11.3 years, median 5.0 years). Of the primary caregivers, 69% had at least completed high school, and 90% reported a total monthly household income of $1,600 or less. The maximum possible quality-of-life score and the median for caregivers were 91 and 70, respectively; for children, the same scores were 69 and 58, respectively. In addition, there was significant negative correlation of the quality-of-life scores of both the caregivers and children with the number of schooldays the children missed (r = -0.24 and r = -0.26, respectively, P < .001 for both) and the caregivers' and children's asthma severity scores (r = -0.39 and r = -0.47, respectively, P < .001 for both). The quality-of-life scores of the children and caregivers did not correlate significantly with the asthma triage scores.

CONCLUSIONS

The questionnaires captured baseline quality-of-life information about this urban population and will facilitate longitudinal monitoring. The fact that the quality-of-life scores of children with asthma correlated with those of their adult caregivers, but not with their clinical triage scores, highlights the impact of asthma on families and the importance of having a long-term comprehensive management plan that is not based on exacerbations, but that includes both the children and their primary caregivers.

Positron emission tomography in cochlear implant and auditory brain stem implant recipients

OBJECTIVE

The purpose of this study was to determine whether similar cortical regions are activated by speech signals in profoundly deaf patients who have received a multichannel cochlear implant (CI) or auditory brain stem implant (ABI) as in normal-hearing subjects.

STUDY DESIGN

Positron emission tomography (PET) studies were performed using a variety of discrete stimulus conditions. Images obtained were superimposed on standard anatomic magnetic resonance imaging (MRI) for the CI subjects. The PET images were superimposed on the ABI subject's own MRI.

SETTING

Academic, tertiary referral center.

PATIENTS

Five subjects who have received a multichannel CI and one who had received an ABI.

INTERVENTION

Multichannel CI and ABI.

MAIN OUTCOME MEASURE

PET images.

RESULTS

Similar cortical regions are activated by speech stimuli in subjects who have received an auditory prosthesis.

CONCLUSIONS

Neuroimaging provides a new approach to the study of speech processing in CI and ABI subjects.

Spontaneous tension pneumopericardium complicating staphylococcal pneumonia

The authors describe a patient with spontaneous pneumopericardium complicating staphylococcal pneumonia and empyema that resulted in cardiac tamponade. Spontaneous pneumopericardium is an unusual disorder. The causes and clinical findings of pneumopericardium are reviewed, as are the radiographic features that differentiate this condition from pneumomediastinum. Early recognition of pneumopericardium is important, because emergent pericardiocentesis may be required if there is clinical evidence of tamponade.

Effect of 'Mentat' on the pharmacokinetics of single and multiple doses o phenytoin in rabbits

The effect of 'Mentat', a herbal preparation, was studied on pharmacokinetics of single and multiple doses of phenytoin in rabbits. No significant effect was found after single oral dose of 'Mentat' on single dose kinetics of phenytoin. However, 'Mentat' administration for 7 days increased the steady state kinetic parameters. Peak plasma phenytoin concentration, area under the implasma concentration and elimination half life were significantly increased and t-max was significantly reduced, indicating the suppression of phenytoin metabolism by 'Mentat'.

PET imaging of cochlear-implant and normal-hearing subjects listening to speech and nonspeech

Functional neuroimaging with positron emission tomography (PET) was used to compare the brain activation patterns of normal-hearing (NH) with postlingually deaf, cochlear-implant (CI) subjects listening to speech and nonspeech signals. The speech stimuli were derived from test batteries for assessing speech-perception performance of hearing-impaired subjects with different sensory aids. Subjects were scanned while passively listening to monaural (right ear) stimuli in five conditions: Silent Baseline, Word, Sentence, Time-reversed Sentence, and Multitalker Babble. Both groups showed bilateral activation in superior and middle temporal gyri to speech and backward speech. However, group differences were observed in the Sentence compared to Silence condition. CI subjects showed more activated foci in right temporal regions, where lateralized mechanisms for prosodic (pitch) processing have been well established; NH subjects showed a focus in the left inferior frontal gyrus (Brodmann's area 47), where semantic processing has been implicated. Multitalker Babble activated auditory temporal regions in the CI group only. Whereas NH listeners probably habituated to this multitalker babble, the CI listeners may be using a perceptual strategy that emphasizes 'coarse' coding to perceive this stimulus globally as speechlike. The group differences provide the first neuroimaging evidence suggesting that postlingually deaf CI and NH subjects may engage differing perceptual processing strategies under certain speech conditions.

The prevalence of disability from chronic conditions due to injury among adults ages 18-69 years: United States, 1994

PURPOSE

To describe the causes and determine the prevalence of disability from chronic conditions due to injury among US civilian non-institutionalized persons aged 18-69 years.

METHODS

Data from the National Health Interview Survey Disability (NHIS-D) Supplement Phase I, United States 1994 were analysed and six disability categories were examined: activities of daily living (ADL), instrumental activities of daily living (IADL), functional activities (FA), sight, hearing, and communication.

RESULTS

In 1994, 5.6 million persons aged 18-69 years reported a disability because of a chronic condition that was caused by injury. The prevalence of ADL disability due to chronic conditions caused by injury was 370 per 100000 population; IADL disability was 1256; FA disability was 2512; sight was 231; hearing was 339; and communication was 91 per 100000 population. Fifty per cent of ADL, IADL, and FA disabilities were attributed to motor vehicle crashes and falls, as were 31% of sight, 19% of hearing, and 23% of communication disabilities.

CONCLUSIONS

Though these estimates may be conservative, this study indicates that injury is a major cause of disability in addition to a leading cause of death in the US.

Speech perception performance of nucleus multichannel cochlear implant users with partial electrode insertions

OBJECTIVE

The present investigation examined the speech perception performance of five children with ossified cochleas who received partial insertions of the Nucleus 22-channel cochlear implant.

DESIGN

The partial-insertion subjects' preimplant and 1.5 yr postimplant performance on a battery of speech perception tests was compared to the average performance of age-matched control subjects who received full electrode insertions. All the partial-insertion subjects were fit with their Nucleus cochlear implant between the ages of 2 and 5 yr, and had used their device for at least 1.5 yr. More extended comparisons also were made for the two partial-insertion subjects who had used their cochlear implants for a longer period of time.

RESULTS

The subjects with partial electrode insertions performed similarly to the control group at both the preimplant and 1.5 yr postimplant intervals. Furthermore, the partial-insertion subjects showed continued improvements in speech perception performance with increased device experience past 1.5 yr, again similar to the full-insertion control group.

CONCLUSIONS

The present results suggest that partial insertion of a multichannel implant device is an appropriate and feasible approach to the surgical management and auditory rehabilitation of children with extensive or complete ossification of the cochlea.

Regional left ventricular wall thickness and systolic function during the first year after index anterior wall myocardial infarction: serial effects of ventricular remodeling

There is controversy regarding changes in regional left ventricular systolic function and thickness during remodeling after infarction. To address this, electron beam computed tomography was done in 22 patients with an index anterior wall infarction at discharge, 6 weeks, 6 months and 1 year, and global ventricular chamber volumes and mass quantified. A mid-ventricular short-axis scan from each study was divided into 4, 90 degrees sectors (anterior, septal, lateral and posterior walls). Regional wall thickness, ejection fraction, and absolute and percent wall thickening were determined and compared with 10 normal adults. Global infarct size was estimated at 24.2%+/- 3.4% of the ventricle. In these subjects, the ventricular chamber enlarged steadily during the year, while global ventricular mass initially decreased during the first 6 weeks, but then increased by 1 year. Regional ejection fraction changed little during the year, apart from the lateral wall, which was less than normal. Absolute wall thickening was reduced in the anterior (infarct) and septal walls throughout the year, but was normal and unchanged in the posterior and lateral walls. Regional percent wall thickening was not different from normal individuals. The anterior wall was thinned at discharge and tended to thin further during the year. The lateral wall was thinner than normal 6 weeks after infarction, but remained unchanged thereafter. The posterior wall tended to thin for the first 6 months, but the values at any time were not above normal. There was little change in septal wall thickness throughout the year. It is concluded that, after a moderate size, uncomplicated index anterior infarction, regional systolic function remains generally unaffected by remodeling. However, regional walls tend to thin and/or remain at normal thickness. These data confirm differential regional patterns after anterior infarction for systolic function, muscle atrophy and/or minimal hypertrophy which accompany serial changes in global ventricular chamber volumes and mass.

Neurologic manifestations of Churg-Strauss syndrome

OBJECTIVE

To determine the frequency and the types of neurologic involvement in a series of patients with Churg-Strauss syndrome (CSS).

DESIGN

We reviewed the medical records of 47 consecutive patients with CSS who were examined at the Mayo Clinic between January 1974 and June 1992.

MATERIAL AND METHODS

The study patients were classified into two groups: (1) those with a histopathologically confirmed diagnosis of CSS who had evidence of either vasculitis or Churg-Strauss granuloma, the presence of asthma, and peripheral eosinophilia (more than 10% eosinophils) on at least one differential leukocyte count (N = 33) and (2) those with a clinical diagnosis of CSS who had evidence of vasculitis based on either multiple mononeuropathy or necrotizing cutaneous lesions, the presence of asthma, and peripheral eosinophilia (more than 10% eosinophils) on at least one differential leukocyte count (N = 14).

RESULTS

Of the 47 patients, 29 (62%) had neurologic involvement. Peripheral neuropathy was detected in 25 patients: 17 had multiple mononeuropathy, 7 had distal symmetric polyneuropathy, and 1 had an asymmetric polyneuropathy. Three patients had cerebral infarctions. Less commonly identified problems included radiculopathies, ischemic optic neuropathy, and bilateral trigeminal neuropathy. Asthma preceded the onset of neurologic involvement in all cases (mean duration, 6.7 years. Follow-up data, when available, showed that corticosteroid therapy usually yielded improvement or stabilization.

CONCLUSION

Neurologic involvement is common in CSS, usually manifesting as peripheral neuropathy. In this series of patients, asthma preceded the neurologic manifestations.

Rorschach hostility content and its relation to anxiety, neuroticism and P-E-N measures

Assessed the relationships between Rorschach hostility scores and anxiety, neuroticism, overt/covert hostility, intelligence, and Eysenck's Personality Questionnaire. The sample consisted of 200 (100 male, 100 female) Indian undergraduates aged 15 to 20 years. There were some indications that high hostility scores on the Rorschach tended to be worldly wise, covertly hostile, independent, stubborn, and poor fakers. A factor analysis of the intercorrelations showed six interpretable factors: Anxiety, Neuroticism, Body measures. Hostility, Psychoticism and Tender-minded, respectively. Further, it was concluded that Eysenck's Psychoticism is factorially a complex measure and that projective and direct verbal measures of hostility seem to be measuring dissimilar constructs. A few hypotheses for independent verification were proposed.