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Reproductive study. II: Prenatal and postnatal development study with candoxatril in Sprague-Dawley rats.

Candoxatril, a prodrug for candoxatrilat, a selective inhibitor of neutral endopeptidase, was administered orally to groups of 24 female rats at doses of 0, 120, 400 or 1200 mg/kg/day from gestation day 6 to lactation day 21 to assess effects on pre- and postnatal development of F1 offspring. All dams were allowed to litter and to raise their F1 offspring until lactation day 21. The F1 offspring were examined for postnatal developmental indices, reflex behaviors and memory. A functional observational battery (FOB) was also conducted. A marked increase in spontaneous activity of the dams was observed in all candoxatril-treated groups. Maternal body weight gain was decreased in the 400 and 1200 mg/kg/day groups during the treatment periods. No significant differences were found for reproductive parameters. The male and female pups in the 1200 mg/kg/day group had significantly lower body weights beginning on postnatal days 21 and 14, respectively, through to the end of the study. There were no drug-related effects on pre- and postnatal developmental indices, FOB, sensory function tests or memory test. The no observed adverse effect levels were 120 and 400 mg/kg/day for the F0 dams and F1 offspring, respectively.

Animals↗

Sensory reinnervation of muscle receptor in human.

This report describes sensory reinnervation of muscle receptors in humans. In this study, sensory function was investigated in fourteen patients with brachial plexus injury, whose musculocutaneous nerve was surgically sutured with intercostal nerves for reconstruction of elbow flexion. Tapping the intercostal nerve-reinnervated brachial biceps muscle (IC-biceps) induced somatosensory evoked potentials (IC-biceps SEP) in four patients. Tapping also induced reflex IC-biceps activity in all IC-biceps SEP (+) patients, but not in eight out of nine IC-biceps SEP (-) patients. Results show that muscle afferent fibers in the intercostal nerves reinnervated mechanoreceptors in IC-biceps, and induced both cortical sensory activity and muscle activity that indicated the classical stretch reflex.

Adolescent↗

Neurologic evaluation of the optimally healthy oldest old.

OBJECTIVE: Individuals aged 85 years or older (the "oldest old") are the fastest-growing age group in the United States. Because there is little information characterizing expected neurologic function in this group, our goal was to determine clinical neurologic traits characteristic of the optimally healthy oldest old. DESIGN: Standardized neurologic evaluation findings of optimally healthy persons older than 84 years compared with those of equally healthy control subjects aged 65 to 74 years. SETTING: Community-based, longitudinal aging study. PARTICIPANTS: Community-residing, consecutively recruited volunteers who were screened for the absence of chronic disease or medication use. MAIN OUTCOME MEASURE: Standardized neurologic examination coded into ordinal or interval variables. RESULTS: Significant between-group differences were greatest for tests of mental status, sensory function (ie, smell, hearing, vibratory discrimination, and stereognosis), oculomotor function, distal movement speed, and balance. Discriminant function analysis suggests that of these changes, membership in the oldest group is best predicted by poor performance on clinical tests of balance (heel-toe walking and one-leg balancing with eyes closed), smell, and visual pursuit. CONCLUSIONS: Many neurologic signs appear with aging that cannot be attributed to disease, even in the very old. Deficits in balance, olfaction, and visual pursuit discriminate best between the aging changes of the healthy very old and changes seen in younger elderly persons.

Aged↗

Exercise training improves functional recovery and motor nerve conduction velocity after sciatic nerve crush lesion in the rat.

OBJECTIVE: To observe the effects of exercise training on recuperation of sensorimotor function in the early phase of regeneration, and to monitor the long-term effects of exercise on electrophysiological aspects of the regenerating nerve. DESIGN: After sciatic nerve crush in 20 male Wistar rats, one random selected group was subjected to 24 days of exercise training, whereas the other group served as sedentary controls. INTERVENTIONS: Exercise training was induced for 24 days, starting the first postoperation day, by placing bottles of water at such a height that the exercising rats had to maximally erect on both hindpaws to drink. MAIN OUTCOME MEASURES: Recovery of motor and sensory function in the early phase was monitored by analysis of the free walking pattern and the foot reflex withdrawal test, respectively. Electrophysiological measurements on postoperation days 50, 75, 100, 125, and 150 were used to evaluate the late phase of recovery of nerve conduction velocity. RESULTS: During the early phase of the recovery period, exercise training enhanced functional recovery. The motor nerve conduction velocity (MNCV), as measured in the late phase of recovery, was significantly better in the trained group than in the control group (p < .01). CONCLUSIONS: We conclude that exercise training enhances the return of sensomotoric function in the early phase of recovery from peripheral nerve lesion. Furthermore, these results suggest that the beneficial effects of 24 days of exercise training after crush persist in the late phase of peripheral nerve recovery.

Animals↗

Gunshot injuries to the brachial plexus.

OBJECTIVE: Gunshot wounds to the brachial plexus present a specific problem in peripheral nerve surgery. The purpose of this study is to analyze the characteristics of these injuries and the possibilities for functional recovery after their surgical treatment. DESIGN: Retrospective analysis of nerve lesions and results of surgery. MATERIALS AND METHODS: The series consists of 54 patients operated on, with 148 injured nerve elements, i.e., with 163 injured nerve elements when individual components of complex brachial plexus structures are included. Surgical procedures involved exploration, neurolysis, and nerve grafting, or their combination, depending on intraoperative findings. The surgical results were analyzed in 46 patients (85.1%) with 119 (80.1%) of the 148 nerve elements, with follow-up periods of more than 24 months. Standard grading scores for motor and sensory function were used and ranged according to functional priorities in the surgery of brachial plexus and individual nerves. MEASUREMENTS AND MAIN RESULTS: Neurolysis and nerve grafting generally gave similar rates of functional recovery, 90.2 and 87.8%, respectively. They were successful in all cases with injuries to the upper spinal nerves, the upper trunk, the lateral and posterior cord, and the musculocutaneous and axillary nerves. The failures were related to neurolysis or grafting of the ulnar and radial nerve lesions. CONCLUSION: Compared with previous studies, the number of lesions with complete functional loss and complete anatomic loss of continuity is larger. In cases that were prognostically favorable according to the location of injury, the results are similar regardless of the type of nerve repair.

Adolescent↗

Problems in toe-to-hand transfers.

The problems encountered by the author in 70 cases of toe-to-hand transfers are considered under three main headings: (1) operative problems (2) post-operative problems and (3) functional problems. The operative problem of preserving the integrity of the donor vessels is related to the varying patterns of vasculature of the foot. Bony fixation of the donor toe to the recipient site and the selection of veins of the right size and length are the other main operative problems. The post-operative problems are concerned with the problem of survival of the transplanted toe and these include venous congestion, diminished arterial blood flow due to thrombosis or spasm, bleeding and delayed healing, especially at the donor site. In thumb reconstructions, both motor and sensory functional recovery were good when reconstruction was done at the M-P joint level, but less satisfactory if done at a more proximal level. Similarly, the functional problem in finger reconstructions resembled those of thumb reconstruction. At the donor site, the main foot functions were maintained, though delayed healing and scarring may prove troublesome in a few cases.

Amputation, Traumatic↗

Local anesthetic neurotoxicity does not result from blockade of voltage-gated sodium channels.

To investigate whether local anesthetic neurotoxicity results from sodium channel blockade, we compared the effects of intrathecally administered lidocaine, bupivacaine, and tetrodotoxin (TTX), the latter a highly selective sodium channel blocker, on sensory function and spinal cord morphology in a rat model. First, to determine relative anesthetic potency, 25 rats implanted with intrathecal catheters were subjected to infusions of lidocaine (n = 8), bupivacaine (n = 8), or TTX (n = 9). The three drugs produced parallel dose-effect curves that differed significantly from one another: the EC50 values for lidocaine, bupivacaine, and TTX were 28.2 mM (0.66%), 6.6 mM (0.19%), and 462 nM, respectively. Twenty-five additional rats were then given intrathecal lidocaine (n = 8), bupivacaine (n = 8), or TTX (n = 9) at concentrations 10 times the calculated EC50 for sensory block. Lidocaine and bupivacaine induced persistent sensory impairment, whereas TTX did not. Finally, 28 rats were given either intrathecal bupivacaine (n = 10) or TTX (n = 9) at 10 times the EC50, or normal saline (n = 9). Significant sensory impairment again occurred after infusion of bupivacaine, but not after infusion of TTX or saline. Neuropathologic evaluation revealed moderate to severe nerve root injury in bupivacaine-treated animals; histologic changes in TTX- and saline-treated animals were minimal, similar, and restricted to the area adjacent to the catheter. These results indicate that local anesthetic neurotoxicity does not result from blockade of the sodium channel, and suggest that development of a safer anesthetic is a realistic goal.

Animals↗

Nicotinic system involvement in Alzheimer's and Parkinson's diseases. Implications for therapeutics.

Advances in our understanding of the structure, function and distribution of nicotinic acetylcholine receptors in the CNS have provided the impetus for new studies examining the role(s) that these receptors and associated processes may play in CNS functions. Further motivation has come from the realisation that such receptors must be involved in the maintenance of cigarette smoking, and from clues provided by studies of degenerative neurological diseases such as Alzheimer's disease and Parkinson's disease, in which the loss of nicotinic receptors has been described. Ongoing investigations of the molecular substructure of central nicotinic receptors and their pharmacology have begun to open up new possibilities for novel CNS therapeutics with nicotinic agents. Exploiting these possibilities will require understanding of the role(s) that these receptor systems play in human cognitive, behavioural, motor and sensory functioning. Clues from careful studies of human cognition are beginning to emerge and will provide direction for studies of potentially therapeutic novel nicotinic agents. Despite the promising results of acute studies, few long term studies with nicotine or nicotinic drugs have been performed in dementing disorders. Thus there is uncertainty as to whether long term nicotinic treatment will provide sustained cognitive benefit. It is even more uncertain whether such cognitive benefit will have a significant clinical impact on patients and their families. To maximise the potential benefit of long term treatment with nicotinic agonists (or other cholinergic drugs), we suggest that drug treatment should be combined with cognitive rehabilitation strategies. This will enable patients and/or their families to focus on the particular cognitive domains that may be improved.

Alzheimer Disease↗

[Excitatory amino acids and prostanoids release in spinal cord injury].

UNLABELLED: Acute spinal cord trauma may initiate a cascade of hemodynamic and biochemical events characterized by direct mechanical destruction of neurons, hemorrhages and significant increases in active substances (glutamate, prostaglandins (PGs), ets.). However, there are no data which define the effect of acute spinal cord trauma on biochemical changes in the spinal cord. The aim of the present study was to examine time-dependent biochemical changes in the spinal cord by intrathecal microdialysis in the acute stage of spinal cord turama. METHODS: Male Sprague-Dawley rats (300-325g) were implanted with a dialysis catheter and PE-10 catheter in the intrathecal space of the lumbar spinal cord. Three days later the animals were anesthetized with halothane and 10-min dialysis samples were collected. Compression spinal cord injury was produced by inflating an extradural 2F-Fogarty balloon catheter (L4-L5) for 60 sec. After compression, samples were collected while the animals remained anesthetized for 30 min, and additional samples were collected until 4hr post-injury. At the end of the dialysis period neurological function was briefly evaluated. Microdialysate samples were analyzed for glutamate, aspartate, and taurine by HPLC-UV and for PGE2 by RIA. RESULTS: Compression of the spinal cord caused significant increases in the levels of all amino acids. The greatest in creases were in glutamate and aspartate at 10 min, followed by a decrease over the rest of the 4-hr period. Similarly, PGE2 showed an immediate increase after compression, with normalization between 1-2 hr, but this was followed by a secondary increase at 2-4 hr. Neurologically, all animals displayed complete paralysis with loss of sensory function that remained unchanged for the 4-hr period. COMMENT: The present study clearly demonstrated the time course of spinal amino acids and PGE2 release by using a chronically implanted dialysis catheter after spinal cord compression and also showed a correlation with neurological deterioration. These biochemical changes in the extracellular space may display various, multiphasic patterns reflecting progressively developing edema and corresponding ischemia.

Animals↗

A mechanism for sensing noise damage in the inner ear.

Our sense of hearing requires functional sensory hair cells. Throughout life those hair cells are subjected to various traumas, the most common being loud sound. The primary effect of acoustic trauma is manifested as damage to the delicate mechanosensory apparatus of the hair cell stereocilia. This may eventually lead to hair cell death and irreversible deafness. Little is known about the way in which noxious sound stimuli affect individual cellular components of the auditory sensory epithelium. However, studies in different types of cell cultures have shown that damage and mechanical stimulation can activate changes in intracellular free calcium concentration ([Ca(2+)](i)) and elicit intercellular Ca(2+) waves. Thus an attractive hypothesis is that changes in [Ca(2+)](i), propagating as a wave through support cells in the organ of Corti, may constitute a fundamental mechanism to signal the occurrence of hair cell damage. The mechanism we describe here exhibits nanomolar sensitivity to extracellular ATP, involves regenerative propagation of intercellular calcium waves due to ATP originating from hair cells, and depends on functional IP(3)-sensitive intracellular stores in support cells.

Adenosine Triphosphate↗

Vision and driving in the elderly.

BACKGROUND: This is an overview of a program of research to identify visual and cognitive factors which place older drivers at risk for vehicle crashes. METHODS: A sample of 294 older drivers participated in a protocol which assessed eye health, visual sensory function (i.e., acuity, contrast sensitivity, peripheral field sensitivity), the size of the useful field of view (UFOV), and cognitive status. The sample was age- and crash-stratified to ensure inclusion of older adults covering a wide range of ages (55 to 90 years) and crash frequencies during the previous 5 years (0 to 4 crashes). The major dependent variable was the number of at-fault crashes incurred during the 5-year period before our protocol test date (retrospective study) and during the 3-year period after our test date (prospective study). RESULTS: Older drivers with visual sensory impairment, cognitive impairment, and/or a constriction in the size of the useful field of view were at greater risk for crashes than were those without these problems. The UFOV test had better sensitivity and specificity than visual sensory or mental status tests in identifying those older drivers at risk for crashes. CONCLUSIONS: The UFOV test's superior predictability is most likely due to its reliance on both visual sensory abilities and higher order attentional skills. This study suggests that interventions which reduce either visual sensory or attentional impairment may also reduce accident risk in older drivers, an issue we are currently investigating.

Accidents, Traffic↗

Role of thymic peptides as transmitters between the neuroendocrine and immune systems.

Thymic peptides, a heterogenous family of polypeptidic hormones synthesized within the thymus, not only exert important regulatory effects within both the immune and neuroendocrine systems but are also themselves subject to control by hormones derived from the hypothalamic-pituitary-adrenal axis (HPA) and other endocrine glands. Regarding thymic hormonal function, thymulin production is up-regulated by several hormones, including prolactin, growth hormone and thyroid hormones. Other aspects of the physiology of thymic epithelial cells can also be modulated by hormones and neuropeptides, particularly cytokeratin expression, cell growth and production of extracellular matrix proteins, thus characterizing the pleiotrophic action of these molecules on the thymic epithelium. Conversely, thymic-derived peptides also regulate hormone release from the HPA axis and may act directly on target endocrine glands of this axis, modulating gonadal tissues. In addition, it has recently been shown that thymulin can modulate some peripheral nervous sensory functions, including those related to sensitivity to pain. According to the dose given, thymulin induces or reduces hyperalgesia related to both mechanical and thermal nociceptors and thus represents an important interface between the immune, endocrine and nervous systems.

Animals↗

[Evaluation of the sphincter function and rectal sensitivity in rectal prolapse associated with fecal incontinence].

It has been suggested that incontinent patients with rectal prolapse develop a relaxation of the internal sphincter at a lower filling volume than those with the same disorder who were continent. A constant relaxation of the internal sphincter during filling before the individual experiences a need to defecate could be a contributory cause of the incontinence in these patients. Aiming to evaluate the former observations we have investigated continent and incontinent patients, with complete and internal rectal prolapse, by mean of the recto-anal manovolumetry. 31 patients were studied, 21 had a complete rectal prolapse and 10 had internal rectal prolapse and 28 sex and age matched controls were selected among volunteers. No difference has been found between the continent and incontinent patients with rectal prolapse, in term of sensory function studied by graded isobaric distention. Moreover, no difference has been found between the rectal volume at which perception of filling and relaxation of the internal sphincter during filling occurs. Therefore, in this respect, the present data are not in agreement with the theory proposed.

Adult↗

Overexpression of copper/zinc-superoxide dismutase in transgenic mice markedly impairs regeneration and increases development of neuropathic pain after sciatic nerve injury.

Despite the general capacity of peripheral nervous system to regenerate, peripheral nerve injury is often followed by incomplete recovery of function, sometimes with the burden of neuropathic pain. The mechanisms of both regeneration and nociception have not been clarified, but it is known that inflammatory reactions are involved. Cu/Zn-superoxide dismutase (SOD1) is an important scavenger protein that acts against oxidative stress. It has been shown to play an important role in apoptosis and inflammation. The aim of this study was to examine the role of SOD1 overexpression in peripheral nerve regeneration and neuropathic pain-related behavior in mice. Sciatic nerves of SOD1-overexpressing and FVB/N wild type-mice were transected and immediately resutured. Evaluation of motor and sensory function and autotomy was carried out during 4 weeks of followup. We found markedly worse sciatic function index outcome as well as more significant atrophy of denervated muscles in SOD1-overexpressing animals compared with wild type. Autotomy was markedly worse in SOD1 transgenic mice than in wild-type animals. Histological evaluation revealed that the intensity of regeneration features, including numbers of GAP-43-positive growth cones, Schwann cells, and macrophages in the distal stump of the transected nerve, was also decreased in transgenic mice. Neuroma formation at the injury site was significantly more prominent in this group. Taken together, our findings suggest that SOD1 overexpression is deleterious for nerve regeneration processes and aggravates neuropathic pain-like state in mice. This can be at least partially ascribed to disturbed inflammatory reactions at the injury site.

Analysis of Variance↗

Circulation and sensation at the fingertips of claw hands.

Measurements of skin blood flow (by laser Doppler flowmetry) and temperature were made under environmental conditions promoting peripheral vasodilatation at the fingertips of a disfigured 'clawed' hand in 12 leprosy patients long-resident at Baba Baghi Leprosy Hospital, Tabriz, Iran. Sensory function was assessed by measuring the responses to light touch, pain and temperature of each finger, and peripheral autonomic function was gauged by estimating palmer sweating and by measuring skin vasomotor reflexes in response to inspiratory gasp. In 2 patients all measured fingers had laser Dopper flux (LDFlux) values and skin temperatures lower than the 95% confidence limits for the mean of 20 healthy controls, i.e. were impaired; in 2 patients all fingers had normal values for LDFlux and temperature; and in 8 patients there was a combination of impairment with most fingers normal for these parameters but with the small finger most commonly impaired. There were 10 (67%) fingers with impaired LDFlux and temperature values who had significant sensory impairment, whereas only 5 (18%) of the fingers with normal LDFlux values and temperatures had a similar sensory deficit. Overall, the fingers with the most impaired sensation had significantly (P < 0.05) lower LDFlux and temperature values than those with no sensory deficit. Microcirculatory impairment was not related to disordered skin vasometer reflexes or dysfunction of sweating. We concluded that the relationship between motor (skeletal muscle) nerve paralysis and any subsequent sensory neuropathy and/or microcirculatory impairment is more complex than might be expected from previous understanding of the disease.

Adult↗

Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study.

PURPOSE: The Swedish Rectal Cancer Trial has unequivocally demonstrated that preoperative high-dose (5 x 5 Gy) radiotherapy reduces local failure rates and improves overall survival. This will have an impact on the primary treatment of rectal cancer. This study investigates the effect of preoperative high-dose radiotherapy on long-term bowel function in patients treated with anterior resection. METHODS: A questionnaire was answered by 92 percent (203/220) of patients who were included in the Swedish Rectal Cancer Trial and who were alive after a minimum of five years. Thirty-two patients were excluded, mainly because of postoperative stomas and dementia, which left 171 for analysis. RESULTS: Median bowel frequency per week was 20 in the irradiated group (n = 84) and 10 in the surgery-alone group (n = 87; P < 0.001). Incontinence for loose stools (P < 0.001), urgency (P < 0.001), and emptying difficulties (P < 0.05) were all more common after irradiation. Sensory functions such as "discrimination between gas and stool" and "ability to safely release flatus" did not, however, differ between groups. Thirty percent of the irradiated group stated that they had an impaired social life because of bowel dysfunction, compared with 10 percent of the surgery-alone group (P < 0.01). CONCLUSIONS: The study indicates that high-dose radiotherapy influences long-term bowel function, thus emphasizing the need for finding predictive factors for local recurrence to exclude patients with a very high probability for cure with surgery alone and to use optimized radiation techniques.

Adult↗

Insertion mutation at the C-terminus of the serotonin transporter disrupts brain serotonin function and emotion-related behaviors in mice.

The 5-hydroxytryptamine transporter (5-HTT) regulates 5-hydroxytryptamine (5-HT) neurotransmission by removing 5-HT from the synaptic cleft. Emerging evidence from clinical and genetic studies implicates the 5-HTT in various neuropsychiatric conditions, including anxiety and depression. Here we report that a 5-HTT null mutant mouse line was generated by gene trapping that disrupted the sequence encoding the C-terminus of 5-HTT. This mutation resulted in significant reduction of 5-HTT mRNA and loss of 5-HTT protein. Brain levels of 5-HT and its major metabolite, 5-hydroxyindoleacetic acid, were markedly decreased in C-terminus 5-HTT -/- mice, while 5-HT uptake or 5-HT content in platelets was absent. Behavioral phenotyping showed that C-terminus 5-HTT -/- mice were normal on a screen for gross behavioral, neurological, and sensory functions. In the tail suspension test for depression-related behavior, C-terminus 5-HTT -/- mice showed increased immobility relative to their +/+ controls. By comparison, a previously generated line of 5-HTT -/- mice lacking exon 2, encoding the N-terminus of the 5-HTT, showed abnormally high immobility in response to repeated, but not acute, exposure to the tail suspension test. In a novel, brightly-lit open field, both C-terminus 5-HTT -/- mice and N-terminus 5-HTT -/- mice displayed decreased center time and reduced locomotor activity compared with their +/+ controls. Both mutant lines buried significantly fewer marbles than their +/+ controls in the marble burying test. These findings further demonstrate the neurobiological functions of the 5-HTT and add to a growing literature linking genetic variation in 5-HTT function with emotional abnormalities.

Analysis of Variance↗

Effects of venlafaxine, buspirone, and placebo on colonic sensorimotor functions in healthy humans.

BACKGROUND & AIMS: We have shown that venlafaxine-XR, a serotonin (5-HT) and norepinephrine reuptake inhibitor, enhanced gastric accommodation, whereas buspirone, a 5-HT(1A) receptor agonist, reduced postprandial symptoms after a fully satiating meal. Our aim was to compare the effects of venlafaxine, buspirone, and placebo on colonic sensorimotor functions in healthy adults. METHODS: In this randomized, double-blind, parallel-group, placebo-controlled trial of 60 healthy adults, we assessed the effects of oral venlafaxine, 150 mg; buspirone, 20 mg; and placebo on colonic sensorimotor functions. RESULTS: Venlafaxine increased colonic compliance relative to placebo; thus it decreased the intracolonic balloon pressure at half-maximum volume (P = 0.001) and altered the overall shape of the compliance curve, beta (P = 0.01). Venlafaxine also decreased fasting colonic tone (P = 0.02) and the tonic response to a meal (P = 0.003) compared with placebo; no differences in high amplitude phasic contractile events were observed. Pressure thresholds for first sensation (P = 0.1) and gas (P = 0.07) were not statistically significant with venlafaxine. The increase in pain scores per unit pressure during phasic distentions were affected by treatment (P = 0.02), with smallest changes on venlafaxine and highest on placebo. Buspirone did not significantly alter colonic compliance, tone, or sensation relative to placebo. CONCLUSIONS: Venlafaxine alters colonic compliance and tone, and tends to reduce sensation during colonic distention in healthy humans. These data support the need for further clinical and physiologic studies of venlafaxine in colonic disorders affecting motor and possibly sensory functions.

Adult↗