The Role of Hypoxia-Inducible Factor 1 Alpha in Acute-on-Chronic Liver Failure

Acute-on-chronic liver failure (ACLF) is associated with increased mortality. Specific therapy options are limited. Hypoxia-inducible factor 1 alpha (HIF-1α) has been linked to the pathogenesis of chronic liver disease (CLD), but the role of HIF-1α in ACLF is poorly understood. In the current study, different etiologies of CLD and precipitating events triggering ACLF were used in four rodent models. HIF-1α expression and the intracellular pathway of HIF-1α induction were investigated using real-time quantitative PCR. The results were verified by Western blotting and immunohistochemistry for extrahepatic HIF-1α expression using transcriptome analysis. Exploratory immunohistochemical staining was performed to assess HIF-1α in human liver tissue. Intrahepatic HIF-1α expression was significantly increased in all animals with ACLF, regardless of the underlying etiology of CLD or the precipitating event. The induction of HIF-1α was accompanied by the increased mRNA expression of NFkB1 and STAT3 and resulted in a marked elevation of mRNA levels of its downstream genes. Extrahepatic HIF-1α expression was not elevated. In human liver tissue samples, HIF-1α expression was elevated in CLD and ACLF. Increased intrahepatic HIF-1α expression seems to play an important role in the pathogenesis of ACLF, and future studies are pending to investigate the role of therapeutic HIF inhibitors in ACLF.

Transcranial magnetic stimulation in study of the visual pathway

The authors critically reviewed experiments in which transcranial magnetic stimulation (TMS) and repetitive TMS (rTMS) of the higher visual pathway were used. Topics include basic mechanisms of neural excitation by TMS and their relevance to the visual pathway (excitatory and inhibitory effects), TMS and rTMS of calcarine cortex (suppression, unmasking, and phosphenes), TMS of V5 (suppression), TMS and rTMS of higher level temporoparietooccipital areas (perceptual errors, unmasking, and inattention), the role of frontal lobe output in visual perception, and vocalization of perceived visual stimuli (role of consciousness of linguistic symbols).

[Clinical experiences with local capsaicin treatment of chronic rhinopathy]

Eighty-four patients with clinical findings of hyperactive rhinopathy and no significant septal deviations were treated for 4 weeks with topical applications of capsaicin, which is the pungent substance in hot peppers. A neutral solution of low-dose capsaicin allowed patients to administer self-therapy without the need for local anesthesia. The majority of the patients showed a marked reduction in symptoms without significant side effects. Patients with (additional) allergic or medication-related rhinopathy seemed to show fewer therapeutic effects when compared to patients with only hyperactive rhinopathy.

The polarity of the induced electric field influences magnetic coil inhibition of human visual cortex: implications for the site of excitation

Human perception of 3 briefly flashed letters in a horizontal array that subtends a visual angle of 3 degrees or less is reduced by a magnetic coil (MC) pulse given, e.g., 90 msec later. Either a round or a double square MC is effective when the lower windings or central junction region, respectively, are tangential to the skull overlying calcarine cortex and symmetrical across the midline. The modeled, induced electric field has peak amplitude at the midline, but the peak spatial derivatives lie many centimeters laterally. Thus, the foveal representation near the midline is closer to the peak electric field than to its peak spatial derivatives, i.e., excitation of calcarine cortex differs from excitation of a straight nerve. With an MC pulse that induces an electric field which is substantially monophasic in amplitude, the lateral-most letter (usually the right-hand letter) in the trigram is preferentially suppressed when the electric field in the contralateral occipital lobe is directed towards the midline. Inferences from using peripheral nerve models imply that medially located bends in geniculo-calcarine or corticofugal fibers are the relevant sites of excitation in visual suppression; end excitation of fiber arborizations or apical dendrites is considered less likely. This conclusion is supported by the fact that the induced electric field polarity in paracentral lobule for optimally eliciting foot movements is opposite to that for visual suppression, the major bends occurring at different portions of the fiber trajectories in the two systems.

Measurement of information processing delays in human visual cortex with repetitive magnetic coil stimulation

Previous work disclosed that single magnetic coil (MC) pulses applied over human calcarine cortex could suppress perception of letters briefly presented, e.g. 80-100 ms earlier. Although individual MC stimuli presented 0-60 ms, or more than 140 ms after the visual stimulus were apparently ineffective, combinations of 2 or 3 MC pulses at such intervals temporarily depressed visual perception. Thus, progressing of such language information could be slowed, without being abolished. By contrast, when the first MC pulse was delivered 120 ms or later, a second MC pulse 40 ms later had no detectable effect, implying that calcarine cortex had already transmitted the information. Perceptual recovery of 5-character words initially occurred no earlier than that of random letters, nor or random letters vs. arbitrary linear patterns, implying that the processing delays in calcarine cortex were similar.

Unmasking human visual perception with the magnetic coil and its relationship to hemispheric asymmetry

Visual suppression by a magnetic coil (MC) pulse delivered over human calcarine cortex after a transient visual stimulus 80-100 ms earlier has been used to suppress the representation of a 'masking' visual stimulus and thus to unmask a 'target' visual stimulus given, e.g., 100 ms before the mask. The resulting target unmasking as a function of the interval between mask and MC pulse is approximately the inverse of the visual suppression curve. Arbitrary visual linear patterns can similarly be unmasked. At the long target-mask interval used, the site of masking is deduced to lie beyond calcarine cortex. In several right-handed subjects tested, powerful MC stimulation of the left (but not right) temporo-parieto-occipital cortex also led to (weaker) unmasking.

Modelling magnetic coil excitation of human cerebral cortex with a peripheral nerve immersed in a brain-shaped volume conductor: the significance of fiber bending in excitation

To help elucidate some basic principles of magnetic coil (MC) excitation of cerebral cortex, a model system was devised in which mammalian phrenic nerve, or amphibian sciatic nerve with its branches was suspended in appropriate Ringer's solution in a human brain-shaped volume conductor, an inverted plastic skull. The nerve was recorded monophasically out of the volume conductor. The site of nerve excitation by the MC was identified by finding where along the nerve a bipolar electrical stimulus yielded a similar action potential latency. MC excitation of hand-related corticospinal (CT) neurons was modelled by giving the distal end of nerve attached to the lateral skull an initial radial (perpendicular) trajectory, with subsequent bends towards the base and posterior part of the skull; this nerve was optimally excited by a laterally placed figure 8 or round MC when the induced electric field led to outward membrane current at the initial bend. By contrast, nerve given a trajectory modelling CT neurons related to the foot was optimally excited when the coil windings were across the midline, but again when membrane current flowed outward at the first bend. Corticocortical fibers were modelled by placing the nerve in the anteroposterior axis lateral to the midline; with the round MC vertex-tangentially orientated, optimal excitation occurred at the bend nearest the interaural line, i.e., near the peak electric field. The findings emphasize the importance of orientation and direction of current in the MC and fiber bends in determining nerve excitation. The findings in the peripheral nerve-skull model help explain (1) why lateral and vertex-tangentially orientated MCs preferentially excite arm-related CT neurons directly and indirectly (through corticocortical fibers), respectively, and (2) why the MC orientations for optimally exciting directly arm and leg-related CT neurons differ.

Stimulation of the human nervous system using the magnetic coil

The magnetic coil (MC) is a unique probe that can be used to elucidate basic neurophysiological mechanisms in humans. Either by excitation or inhibition of responding neural elements, we have been able to investigate: (1) the distribution of the electric field induced within isotropic and anisotropic volume conductors by round and figure-eight MCs; (2) the theoretical relationship between electric field distribution and excitation of distal peripheral nerve, nerve root, cranial nerve, and motor cortex; (3) the effect of focal MC stimulation of motor and visual systems; (4) perturbation of sequential digit movements by MC stimulation of human premotor cortex; (5) activation of frontal motor areas related to speech; (6) elicitation of a sense of movement in an ischemic paralyzed limb by focal MC cortical stimulation; and (7) the effect of stimulation of the human visual system to (a) suppress and unmask visual perception using single MC stimuli and (b) prolong visual suppression using short trains of MC stimuli. In the future, prolongation of MC action by using repetitive stimuli should be useful in further investigating functions concerned with language, speech, and cognition.

Spatial distribution of the electric field induced in volume by round and figure '8' magnetic coils: relevance to activation of sensory nerve fibers

The electric fields induced in finite homogeneous volume conductors by a round and a figure '8' magnetic coil (MC) were measured and related to MC stimulation of the median nerve. The volume conductors, filled with isotonic saline, consisted of a large rectangular trough ('unrestricted') and a smaller trough, whose dimensions approximated human forearm ('restricted'). Various MC orientations were applied to the volume conductor. Bipolar recordings were obtained with a coaxial electrode, which measured the voltage gradient between the exposed edge of the cable shield and the central wire at its tip, 1 cm distant (a linear probe). The probe was moved in 3 dimensions, allowing computer reconstruction of the electric field as a function of the 3 spatial axes. When the probe was parallel to the plane of the round MC and tangential to the direction of current in its windings, the induced electric field was maximal; it tended towards zero when the probe was over the center of the MC, or when the probe, remaining parallel to the plane of the MC, was radial (i.e., perpendicular) to the direction of the current in the windings. For a variety of MC orientations, the electric field was consistently increased when the probe was adjacent and parallel to the edge of the trough, indicating the important effect of boundaries. The electric field was greatly increased focally when the round MC was applied orthogonally to the volume conductor, or when the figure '8' MC was applied tangentially (i.e., flat) to the volume conductor. With the figure '8' MC, a sharp central peak parallel to the long axis was bounded on each side by smaller (less than half amplitude) peaks. The findings from physical modeling led to correct predictions as to the most effective orientations of round and figure '8' MCs for eliciting sensory nerve action potentials (SNAPs) from the median nerve.

Suppression of visual perception by magnetic coil stimulation of human occipital cortex

Magnetic coil (MC) stimulation percutaneously of human occipital cortex was tested on perception of 3 briefly presented, randomly generated alphabetical characters. When the visual stimulus-MC pulse interval was less than 40-60 msec, or more than 120-140 msec, letters were correctly reported; at test intervals of 80-100 msec, a blur or nothing was seen. Shifting the MC location in the transverse and rostro-caudal axes had effects consistent with the topographical representation in visual cortex, but incompatible with an effect on attention or suppression from an eyeblink. The MC pulse probably acts by eliciting IPSPs in visual cortex. The neural activity subserving letter recognition is probably transmitted from visual cortex within 140 msec of the visual stimulus.