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Neuropsychological correlates of positive vs. negative schizophrenic symptomatology.

This study attempts to further the validity of the subtype hypothesis in schizophrenia by testing the relationship of neuropsychological functions in schizophrenics with predominantly positive vs. negative symptoms. The Brief Psychiatric Rating Scale (BPRS) was used to parse schizophrenics into positive and negative symptom groups, while a neuropsychological test battery was administered to both types of patients. The results indicate that positive schizophrenic symptomatology is related to frontal executive tasks, whereas negative schizophrenic symptomatology is related to mental tracking tasks that require motoric and dexterous manipulation. However, the absence of non-overlapping symptomatic and neuropsychological functioning groups raises the possibility that a three or more factor model may be more reasonable for reflecting the variety of symptom and neuropsychological patterns in patients, rather than the two-type positive vs. negative dichotomy. The results further the hypothesis that schizophrenia is not a single disease entity.

Adult↗

Haematopoietic capacity of colony-forming cells mobilized in hepatic inflammatory reactions as compared to that of normal bone marrow cells.

Chronic inflammatory periovular granulomatous reactions elicited in liver by schistosomal infection are a site of active myelopoiesis. We quantified the colony-forming cells (CFCs) in granulomas and found that the whole liver contains a number of CFCs roughly equivalent to 50% of a femur. Clonogenic analysis showed the presence of committed as well as pluripotent and totipotent CFCs. Long-term Dexter-type cultures showed that the granuloma-derived totipotent CFCs do not have self-renewal capacity. Hence, they did not correspond functionally to haematopoietic stem cells, despite the fact that the stroma established by adherent cells harvested from granulomas had the capacity to sustain long-term proliferation of bone-marrow-derived haematopoietic stem cells. We conclude that myelopoietic cytokines produced by inflammatory reactions in schistosomiasis elicit mobilization of bone marrow CFCs into the circulation, which can settle in hepatic granulomas. This environment may induce their proliferation and differentiation, but not their self-renewal, sustaining temporary production of myeloid cell lineages which nevertheless depends upon cell renewal from the bone marrow pool of haematopoietic precursors.

Animals↗

Rapid rate transcranial magnetic stimulation--a safety study.

We assessed the safety of repeated short trains (4 stimuli) of rapid-rate transcranial magnetic stimulation (rrTMS) over the left motor cortex in 6 healthy normal subjects. rrTMS involved two separate blocks of 50 consecutive trains of 4 stimuli at a frequency of 20 Hz and an intensity of 5-10% above active motor threshold. We monitored EEG, and assessed aspects of neurological (balance, gait, two-point discrimination, blood pressure, pulse rate), cognitive (attention, memory, executive function) and motor function (speed of movement initiation and execution and manual dexterity) before and after the two blocks of rrTMS. EMG was also recorded from a number of hand, forearm and arm muscles contralateral to the site of stimulation. Two blocks of repeated rrTMS at 20 Hz and 5-10% above active motor threshold did not produce any adverse effects. Measures of neurological, cognitive and motor function showed no change following rrTMS. From the EMG recording there was evidence of increase in the amplitude of the motor evoked potentials (MEPs) recorded from the biceps in one subject during the first block of rrTMS, but this did not occur in the second block. A similar magnification of MEPs was also observed in another subject only during the second block of stimulation. When applied using parameters falling within published guidelines (Pascual-Leone et al., 1993; Pascual-Leone et al., 1994), repeated rrTMS is a relatively safe technique in healthy normal subjects. As rrTMS allows disruption of cortical function for a longer period, it has the potential of becoming a particularly useful tool for the study of cognitive function as well as sensory or motor function.

Adult↗

Effects of chronic haloperidol and clozapine treatments on frontal and caudate neurochemistry in schizophrenia.

N-Acetyl-aspartate (NAA), a marker of neuronal integrity, has been found to be reduced in frontal regions in schizophrenia. However, the impact of antipsychotic drug type on NAA has not been carefully evaluated. We studied outpatients with schizophrenia/schizoaffective disorders chronically treated with haloperidol or clozapine and normal controls with single-voxel 1H-MRS of the caudate nuclei and the left frontal lobe. Concentrations of NAA, choline containing compounds (Cho) and creatine plus phosphocreatine (Cre) were determined and corrected for the proportion of cerebrospinal fluid (CSF) in each voxel. The haloperidol-treated group had significantly lower CSF-uncorrected and CSF-corrected left frontal NAA than the normal controls, with the clozapine group having intermediate concentrations. The haloperidol-treated group had significantly lower CSF-uncorrected caudate NAA than the normal controls, but the three groups did not differ after correcting for CSF fraction. Performance times in the Grooved Pegboard, a measure of motor dexterity and proxy for parkinsonism, were correlated with CSF-uncorrected and CSF-corrected left frontal NAA. Demographic and illness-related variables were not related to NAA. Exposure to haloperidol-like drugs may in part account for the frontal NAA reductions previously reported in schizophrenia. Adjustment for proportion of voxel CSF should be considered in 1H-MRS studies.

Adolescent↗

The electric sense of the paddlefish: a passive system for the detection and capture of zooplankton prey.

Behavioral and electrophysiological experiments have shown that the elongated paddlefish rostrum, with its extensive population of ampullae of Lorenzini, constitutes a passive electrosensory antenna of great sensitivity and spatial resolution. As demonstrated in juvenile paddlefish, the passive electrosense serves a novel function in feeding serving as the primary, if not exclusive sensory modality for the detection and capture of zooplanktonic prey. Ampullary receptors are sensitive to the weak electrical fields of plankton from distances up to 9 cm, and juvenile paddlefish capture plankton individually with great swimming dexterity in the absence of vision or other stimulus signals. Paddlefish also detect and avoid metal obstacles, the electrical signatures of which are a potential hindrance to their feeding and reproductive migrations. The ampullary receptors, their peripheral innervation and central targets in the dorsal octavolateral nucleus, are described. We also describe the ascending and descending neuronal circuitry of the electrosensory system in the brain based on tracer studies using dextran amines.

Action Potentials↗

Experience-induced plasticity of cutaneous maps in the primary somatosensory cortex of adult monkeys and rats.

In a first study, the representations of skin surfaces of the hand in the primary somatosensory cortex, area 3b, were reconstructed in owl monkeys and squirrel monkeys trained to pick up food pellets from small, shallow wells, a task which required skilled use of the digits. Training sessions included limited manual exercise over a total period of a few hours of practice. From an early clumsy performance in which many retrieval attempts were required for each successful pellet retrieval, the monkeys exhibited a gradual improvement. Typically, the animals used various combinations of digits before developing a successful retrieval strategy. As the behavior came to be stereotyped, monkeys consistently engaged surfaces of the distal phalanges of one or two digits in the palpation and capture of food pellets from the smallest wells. Microelectrode mapping of the hand surfaces revealed that the glabrous skin of the fingertips predominantly involved in the dexterity task was represented over topographically expanded cortical sectors. Furthermore, cutaneous receptive fields which covered the most frequently stimulated digital tip surfaces were less than half as large as were those representing the corresponding surfaces of control digits. In a second series of experiments, Long-Evans rats were assigned to environments promoting differential tactile experience (standard, enriched, and impoverished) for 80 to 115 days from the time of weaning. A fourth group of young adult rat experienced a severe restriction of forepaw exploratory movement for either 7 or 15 days. Cortical maps derived in the primary somatosensory cortex showed that environmental enrichment induced a substantial enlargement of the cutaneous forepaw representation, and improved its spatial resolution (smaller glabrous receptive fields). In contrast, tactile impoverishment resulted in a degradation of the forepaw representation that was characterized by larger cutaneous receptive fields and the emergence of non-cutaneous responses. Cortical maps derived in the hemispheres contralateral to the immobilized forelimb exhibited a severe decrease of about 50% in the overall areal extent of the cutaneous representation of the forepaw, which resulted from the invasion of topographically organized cortical zones of non-cutaneous responses, and numerous discontinuities in the representation of contiguous skin territories. The size and the spatial arrangement of the cutaneous receptive fields were not significantly modified by the immobilization of the contralateral forelimb. Similar results were obtained regardless of whether the forelimb restriction lasted 7 or 15 days. These two studies corroborate the view that representational constructs are permanently reshaped by novel experiences through dynamic competitive processes. These studies also support the notion that subject-environment interactions play a crucial role in the maintenance of basic organizational features of somatosensory representations.

Animals↗

Morphological characteristics of the tongue and its papillae in the donkey (Equus asinus): a light and scanning electron microscopical study.

The morphology of the donkey tongue and its papillae were investigated by macroscopy and by light and scanning electron microscopy in ten adult animals (six males and four females). The spatula-shaped tongues measured about 28 cm in length, 4.5 cm in breadth and 3.5 cm in thickness. Samples from different areas of four tongues were grossly examined and pieces were processed for light and scanning electron microscopy. Filiform papillae were distributed mainly on the dorsum of the tongue, being thin and relatively short at the apex, conical and scaly in the main part (triangular zone) of the body, and thin and longer at the caudal part of the body. Few of them were found on the lateral surfaces. Fungiform papillae appeared scattered mainly on the lateral surfaces. They were mostly rounded (about 1.0 mm in diameter), but lobulated forms were also observed. Filiform and fungiform papillae were both completely devoid of taste buds, indicating a more mechanical function. The vallate papillae were 2-3 in number, located at the most caudal part of the body. They were three to four times as large as the fungiform papillae (about 5.6 mm in diameter) each with a wide circular groove around the central bulbous projection. Secondary grooves originating from the primary one were also demonstrated. The vallate papillae contained many taste buds with taste pores opening deeply into the papillary groove. Fine filiform papillae were demonstrated on the bulb-like part of the vallate papillae. The donkey tongue had sinister and dexter well-developed sets of foliate papillae close to the basis of the palatoglossal arch. They were arranged in the form of numerous leaves separated by deep, variably wide grooves and contained a very large number of taste buds. It is believed that the existence of well developed foliate papillae in donkey may substitute the comparatively few vallate papillae in this species.

Animals↗

The microangioarchitecture of the conducting system in cattle.

Macroscopic researches on heart vascularization have indicated that the angioarchitecture of the conducting system differs from that of the normal myocardium. In order to observe this variance, eight cow hearts were dissected for perfusion through the Ramus ventricularis dexter and Ramus septalis of the A. coronaria dextra with Ringer's solution, and then injected with Mercox. After corrosion in KOH the casts were prepared for observation in a SEM. In the region of the sinoatrial node no special capillary arrangement was observed, but only valves on the venous side. At the atrioventricular node and the bundle of His, the arterioles showed a diffuse formation, filling this area with a regular caliber, without any special capillary orientation. The arteries that reach the right bundle dichotomized and ran collateral to the opposite extremity of this structure, lying parallel. The vessels with the biggest caliber were deeply positioned. In the left bundle the arterioles showed a net like figure, mainly in one plane. Following the form of the bundle, and below the conducting tissue a big anastomotic venous arrangement is observable.

Animals↗

Alternatives to HRT in prevention and treatment.

Oestrogen hormone replacement therapy remains the first choice for the treatment and prevention of osteoporosis in postmenopausal women, but for patients who are unsuitable for this therapy, which of course includes men, other satisfactory treatments are available. Several placebo-controlled studies have demonstrated that bisphosphonates and calcitonin prevent bone loss or perhaps increase bone density over 2-3-year periods, and reduce the rate of fracture. It is not known whether these treatments will increase bone density over longer periods of time. Cyclical etidronate has recently become licensed in the UK for use in the treatment of osteoporosis, and it is hoped that other bisphosphonates and intranasal calcitonin will soon be added to the available treatments. Fluoride appears to increase bone density but, at doses above a very narrow therapeutic window, it increases the fracture rate, either because of bone redistribution, formation of poor quality bone or a toxic effect on osteoblasts. At present, fluoride remains a treatment to be used only under expert supervision or within the context of controlled clinical trials. Anabolic steroids may be of value in selected elderly patients with osteoporosis. The patient may be able to contribute to the prevention of osteoporotic fracture by exercising, which will improve dexterity and may have a small effect to increase bone density, and by avoiding the factors that predispose to falls, such as icy paths and excess alcohol. Changes in the diet are unlikely to play a major role in the maintenance of bone density in women living in the Western world.

Bone Density↗

Anesthetic implications of the addition of an operative robot for endoscopic surgery: a case report.

Laparoscopic surgery has become increasingly popular over the last decade. However, this surgical technique has a number of limitations. It is difficult to work in a three-dimensional space while viewing a two-dimensional monitor, long instruments amplify natural tremor, and traditional instruments have limited mobility due to few degrees of freedom. Robot-assisted surgery has been developed in response to these limitations. A three-dimensional viewer allows the surgeon to operate in a realistic environment, natural tremor is eliminated by translating the surgeon's hand motions to robotic movements, and the robotic surgical instruments are designed to have the same dexterity as a human wrist. We describe a case of robot-assisted laparoscopic Nissen fundoplication and discuss the anesthetic issues associated with this new surgical technique. In addition to the anesthetic issues associated with traditional laparoscopic surgery, robot-assisted laparoscopic surgery presents some unique challenges.

Adult↗

Influence of secondary structure on the decay kinetics of fluorescent donor-acceptor labelled peptides.

Time-resolved fluorescence decays from a series of methoxynaphthalene labelled peptides in ethyl acetate were monitored over the temperature range -40 to 60 degrees C. The quenching effect of a piperidone acceptor group placed at various positions along the peptide chain relative to the fluorescent methoxynaphthalene donor was studied. In this moderately polar solvent the mechanism of quenching is most likely electron transfer, although a Dexter exchange mechanism cannot be ruled out. Both donor and acceptor moieties were covalently attached to the side-chains of glutamic acid residues. These were either placed adjacently, in the case of a dipeptide, or separated by three and six amino acids within a 12 and 15 amino-acid oligopeptide, respectively. The presence of the piperidone group resulted in a reduction in the fluorescence lifetime and a change from a simple monoexponential decay to more complex behaviour. This was found to vary reversibly with temperature and not to be caused by impurities. Modelling of the fluorescence decays was carried out using either the sum of two exponentials or a distribution of decays. For the dipeptide the best fit was a distribution while in the case of the 12-mer two clearly distinguishable populations could be observed. The results for the 15-mer were equivocal. Importantly, regardless of the fitting method used the quenching rate was found to be fastest for the 12-mer. The slower quenching rates observed for the dipeptide compared to the oligopeptides provide strong evidence that secondary structure promotes better electronic coupling between the donor and acceptor. The biexponential fluorescence behaviour for the 12 amino-acid oligopeptide is ascribed to two slowly (> 10 ns) interconverting conformational states. Comparison with circular dichroism and infrared obtained in acetonitrile indicates these two conformers are likely to be an alpha-helix and a 3(10)-helix with electronic coupling strongest in the latter case.

Fluorescence↗

Advanced thoracoscopic procedures are facilitated by computer-aided robotic technology.

OBJECTIVE: Computer (robotic) enhancement has been used to facilitate simple thoracoscopic procedures such as internal mammary artery (IMA) mobilization. This report describes the use of robotic technology in advanced thoracoscopic procedures. METHODS: Ten patients underwent advanced thoracoscopic procedures utilizing the Da Vinci robotic surgical system (Intuitive Surgical, Mountain View, CA) at our institution. RESULTS: Patients 1-6 underwent endoscopic phrenic nerve mobilization with insertion of phrenic nerve pacemakers. The indications were quadriplegia (n=2), central hypoventilation syndrome (n=2), and intractable hiccups (n=2). Three 1-cm incisions were made to access each hemithorax. Patients 7 and 8 underwent robotically assisted resection of posterior mediastinal masses. Patient 9 underwent robotically assisted thoracoscopic left lower lobectomy for a lung mass. Patient 10 underwent robotically assisted left ventricular lead placement for biventricular pacing for heart failure. CONCLUSIONS: Robotic technology can be used to perform advanced intrathoracic maneuvers thoracoscopically. The increased visualization and instrument dexterity afforded by this technology may facilitate the development of minimally invasive thoracic approaches that were previously not feasible.

Adolescent↗

Early experience with robot-assisted laparoscopic radical prostatectomy.

INTRODUCTION: We assessed the feasibility of a robot-assisted laparoscopic radical prostatectomy (rLRP) programme through a review of our early experience. PATIENTS AND METHODS: Seventeen patients underwent rLRP between 1 February 2003 and 31 December 2003 at Singapore General Hospital. All patients had histologically confirmed adenocarcinoma on prostate biopsy and a negative bone scan. The Da Vinci robot was employed. The Montsouris technique was used for our first eight patients, and the Vattikuti Institute Prostatectomy technique was used for all subsequent patients. We studied perioperative parameters and early surgical outcome prospectively. RESULTS: The mean age at diagnosis was 63.9 +/- 5.6 years. The median Gleason sum was 6 (range, 5-9), and mean pretreatment prostate-specific antigen level was 10.5 +/- 5.4 ng/mL. The mean set-up time was 34 +/- 18 minutes, and mean dissection time was 247 +/- 43 minutes. Perioperative blood loss averaged 494 +/- 330 mL, and three patients required blood transfusion. Normal diet was resumed after 1.7 +/- 0.6 days. The mean duration of bladder catheterization was 9.8 +/- 6.1 days, and mean hospital stay was 2.7 +/- 1.3 days. There was no perioperative mortality or major complications, and no conversion to open radical prostatectomy. From Case 9 onwards, there was significant reduction in operating time (284 vs 215 minutes), blood loss (650 vs 400 mL) and hospital stay (3.8 vs 1.8 days). CONCLUSIONS: rLRP is feasible in a practice with a low volume of radical prostatectomies. Significant improvement in perioperative parameters occurs after the first eight cases. This technique confers the benefits of enhanced precision and dexterity for complex laparoscopic work in the pelvic cavity.

Adenocarcinoma↗

Rehabilitation of peripheral nerve injuries.

Traumatic injuries to peripheral nerves pose complex challenges to both military and civilian physicians. Treatment of nerve injuries must consider all aspects of the inherent disability. Pain control is of paramount importance. Little will be accomplished until pain is brought down to tolerable levels. Rehabilitation needs to be instituted as first-line treatment. Focus must be first placed on protection of the affected area from complications stemming from disuse and immobility and then on enhancement of strength, flexibility, sensory discrimination, and dexterity. Early intervention sets the stage for optimal physiologic and functional recovery.

Anti-Inflammatory Agents, Non-Steroidal↗

Endobronchial therapy of neoplasms.

The techniques and modalities provided by interventional pulmonology play a major role in the management of patients with symptomatic airways obstruction. The majority of these obstructions are part of pulmonary involvement by primary lung neoplasms or metastatic lesions from other organs. Benign lesions, although capable of producing similar symptoms, are more rare. Performance of successful interventional pulmonology is dependent on the skill and dexterity of the operator paired with a highly trained and dedicated ancillary team of nurses, anesthetists, and respiratory therapists. Successful endobronchial management of airway obstruction not only provides significant improvement in patients' quality of life, it also adds to their survival time. Both results fulfill the stated goals of appropriate and desired palliative therapy. Interventional pulmonology also contributes to research of the process of lung carcinogenesis and the introduction of targeted therapy for early minimally invasive cancer and the potential chemotherapy of premalignant lesions.

Airway Obstruction↗

Neurodevelopmental vulnerability of the corpus callosum to childhood onset localization-related epilepsy.

Recent research has suggested that childhood onset of localization-related (focal) temporal lobe epilepsy is associated with a generalized adverse effect on cognition and brain structure, especially cerebral white matter volume. This study examined the neurodevelopmental impact of childhood onset epilepsy on corpus callosum volume and the cognitive consequences of reduced cerebral connectivity. Healthy controls (n = 15) and patients with temporal lobe epilepsy (n = 32) were matched on gender and handedness, and childhood and adult onset epilepsy groups were matched on duration of epilepsy (mean = 19 years) but varied in neurodevelopmental age at onset of recurrent seizures. Results showed that childhood onset of temporal lobe epilepsy was associated with significant volumetric reduction of the corpus callosum compared to both late onset and healthy controls, with the latter two groups not differing from one another. The volumetric loss was most evident in posterior followed by anterior corpus callosum. Volumetric reduction of the corpus callosum in temporal lobe epilepsy was of clinical significance with smaller volumes associated with poorer performance on measures of nonverbal problem solving, immediate memory, speeded complex psychomotor ability and fine motor dexterity. These findings indicate that childhood onset of temporal lobe epilepsy is associated with an adverse neurodevelopmental impact on brain connectivity which is of clinical consequence and theoretical interest.

Adolescent↗

Functional reorganization of brain in children affected with congenital hemiplegia: fMRI study.

Using functional magnetic resonance imaging, the brain activation related to unilateral sequential finger-to-thumb opposition was studied in six children with a right congenital hemiplegia of cortical origin. They were compared to six age-matched controls. In the control group, movements with either hand asymmetrically activated the sensorimotor cortex and premotor areas in both cerebral hemispheres with a typical contralateral predominance. By contrast, paretic finger movements activated both hemispheres in the hemiplegic patients, with a strong ipsilateral predominance favoring the undamaged hemisphere. The activation induced by nonparetic finger movements was restricted to the contralateral undamaged hemisphere. Furthermore, the level of activation in the undamaged cortex was partly related to residual finger dexterity, according to covariance analysis. These activation patterns indicate an adaptive reorganization of the cortical motor networks in this group of patients, with a prominent involvement of the undamaged hemisphere in the control of finger movements with either hand.

Adolescent↗

Differences in contraceptive methods used by women with physical disabilities compared to women without disabilities.

Women with physical disabilities face unique challenges often not addressed by gynecologists regarding choices of contraceptive method. Interactions between some hormonal methods of contraception and disability-related medications, inability to use barrier methods because of limitations in manual dexterity, potentially elevated risk for DVT, and need for menstrual management are factors that complicate decisions about contraceptive methods for this growing population.Objective: This study assessed similarities and differences in the use of and satisfaction with different methods of birth control between women with disabilities and women without disabilities, while controlling for age at onset and severity of disability.Methods: As part of a national survey, 616 women of childbearing age (315 with a variety of physical disabilities, 301 without disabilities) reported their use of and satisfaction with various forms of contraception.Results: Women with physical disabilities were significantly less likely than women without disabilities to use hormonal (11.7%/19.6%) or barrier methods (11.1%/17.6). They were significantly more likely to have had a hysterectomy (8.9%/4.3%) or use no method (41.9%/33.4%). There were no significant differences in the use of surgical methods (22.9%/22.6%) or natural methods (3.5%/2.7%). Women with more severe disabilities were significantly more likely to have had hysterectomies or use surgical or no method of contraception. Women with disabilities were least satisfied with barrier methods.Conclusion: Women with disabilities are more likely to use permanent methods or no method of contraception. Further research is needed to understand the impact of functional limitations and other disability-related factors on the use of other contraceptive methods in this population.

Journal Article↗