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Biomedical subjects

A Williamson

Publications and source records attributed to A Williamson.

At least 37 records · Page 2Linked to original sources
PubMed1999

Decrease in inhibition in dentate granule cells from patients with medial temporal lobe epilepsy.

Alterations in synaptic inhibition are associated with epileptiform activity in several acute animal models; however, it is not clear if there are changes in inhibition in chronically epileptic tissue. We have used intracellular recordings from granule cells of patients with temporal lobe epilepsy to determine whether synaptic inhibition is compromised. Two groups of patients with medial temporal lobe epilepsy were used, those with medial temporal lobe sclerosis (MTLE), and those with extrahippocampal masses (MaTLE) where the cell loss and synaptic reorganization that characterize MTLE are not seen. Although the level of tonic inhibition at the somata was not significantly different in the two patient groups, there was a reduction in the conductance of polysynaptic perforant path-evoked fast and slow inhibitory postsynaptic potentials (IPSPs) (53% and 66%, respectively). We found that there was a comparable decrease in the monosynaptic IPSP conductances examined in the presence of glutamatergic antagonists as that seen for the polysynaptically evoked IPSPs. These data suggest that the decrease in inhibition seen in normal artificial cerebrospinal fluid in MTLE granule cells cannot be solely explained by a decrease in excitatory input onto inhibitory interneurons and may reflect changes at the interneuron-granule cells synapse or in the number of specific inhibitory interneurons.

2-Amino-5-phosphonovalerate↗
PubMed1999

Metastatic neuroblastoma with ganglioneuromatous differentiation and mandibular involvement.

Neuroblastic tumors comprise neuroblastoma (NB), ganglioneuroblastoma, and ganglioneuroma (GN). NBs have shown remarkable differentiation capabilities, which include spontaneous regression. In the last 3 decades, the prognosis for metastatic NB has improved significantly. The ability to distinguish prognostic subtypes based on clinical and biologic features allows for understanding of this disease process and development of management procedures. NBs are often asymptomatic and remain undetected until a large abdominal mass or metastasis is found. GN, the most differentiated variant, is a benign neoplasm with significant growth potential and ability to cause clinical complications. GN of the mandible has seldom been reported in the literature in English. We present a case of NB metastatic to the mandible exhibiting ganglioneuromatous differentiation. We discuss the current understanding of the biology, grading, classification, and prognostic implications of NB.

Abdominal Neoplasms↗
PubMed1999

NPY inhibits glutamatergic excitation in the epileptic human dentate gyrus.

Neuropeptide Y (NPY) has been shown to depress hyperexcitable activity that has been acutely induced in the normal rat brain. To test the hypothesis that NPY can also reduce excitability in the chronically epileptic human brain, we recorded intracellularly from dentate granule cells in hippocampal slices from patients with hippocampal seizure onset. NPY had a potent and long-lasting inhibitory action on perforant path-evoked excitatory responses. In comparison, the group 3 metabotropic glutamate receptor agonist L-2-amino-4-phosphonobutyric acid (L-AP4) evoked a mild and transient decrease. NPY-containing axons were found throughout the hippocampus, and in many epileptic patients were reorganized, particularly in the dentate molecular layer. NPY may therefore play a beneficial role in reducing granule cell excitability in chronically epileptic human tissue, and subsequently limit seizure severity.

2-Amino-5-phosphonovalerate↗
PubMed1999

Lack of correlation between neuronal hyperexcitability and electrocorticographic responsiveness in epileptogenic human neocortex.

OBJECT: The purpose of this study was to determine whether intrinsic neuronal properties and synaptic responses differed between interictally active and inactive tissue removed in neocortical resections from patients undergoing surgical treatment for epilepsy. METHODS: Whole-cell patch recordings were performed in layer 2 or 3 and layer 5 pyramidal cells in neocortical slices obtained from tissue surgically removed from patients for the treatment of medically intractable seizures. Synaptic responses to stimulation at the layer 6-white matter border were used to classify cells as nonbursting if they responded with only a single action potential for all above-threshold stimuli (80%). These responses were usually followed by biphasic inhibitory postsynaptic potentials (IPSPs). Cells were classified as bursting if they fired at least three action potentials in response to synaptic stimulation (20%). These cells typically showed no IPSPs and responded in either an all-or-nothing or graded fashion. Approximately twice as many cells at layer 2 or 3 (29%) than cells at layer 5 (14%) fired synaptic bursts. Synaptic bursting was not associated with an alteration in a cell's response properties to gamma-aminobutyric acid. It was notable that, in tissue samples determined by electrocorticography (ECoG) to be either interictally active or not active, the proportion of cells that burst was exactly the same in both groups (24%). We found no cells with intrinsic burst firing. CONCLUSIONS: We conclude that synaptic bursting was characteristic of a small proportion of cells from epileptic tissue; however, this did not correlate with interictal spikes on ECoG.

Electric Conductivity↗
PubMed1998

Maximizing the cost-effectiveness of lipid-lowering therapy.

Cardiovascular disease, including coronary heart disease, is the leading cause of death both in men and in women in the United States. The purpose of this review is to describe the effectiveness of lipid-lowering therapy in reducing cardiovascular morbidity and mortality, which has recently been extended to patients with mild to moderate hypercholesterolemia, and the cost of providing therapy, which would be prohibitive if all persons with hypercholesterolemia received treatment. Cost-effectiveness analysis provides a rational means of allocating limited health care resources by allowing the comparison of the costs of lipid-lowering therapy, in particular, therapy with beta-hydroxy-beta-methylglutaryl-CoA (coenzyme A) reductase inhibitors (statins), with the costs of atherosclerosis that could be prevented by lowering cholesterol. To extend the benefits of treatment to the large number of persons not receiving therapy, we need to implement more cost-effective treatment by improving risk assessment, increasing treatment effectiveness, and reducing the cost of therapy.

Anticholesteremic Agents↗
PubMed1998

The reported training and experience of editors in chief of specialist clinical medical journals.

CONTEXT: The majority of the peer-reviewed clinical literature is edited by editors whose training in editorial matters may be limited or nonexistent. We suspect that editors are selected for their clinical or academic rather than editorial ability. OBJECTIVE: To test the hypothesis that editors of medical specialist clinical journals were recruited from active clinicians rather than those with evident ability or training as editors. DESIGN, SETTING, AND SUBJECTS: Anonymous mail survey to editors of the 262 peer-reviewed clinical journals that had received at least 1000 citations in the 1994 Science Citation Index. MAIN OUTCOME MEASURES: Training and editorial practices of editors. RESULTS: Replies were received from 191 editors (73%): in 1994 the journals they edited had 6060 (27300/1000 [maximum/minimum]) citations, 234 (740/31) source items, and an impact factor of 2.10 (18.3/0.2); nonresponders' journals had similar characteristics. Of the responding editors, 181 (95%) were part-time, 132 (69%) treated patients, and 164 (86%) were recruited by one of the following methods: election by a scientific society (49 [30%]), nomination by the previous editor (41 [25%]), or response to an advertisement (29 [18%]). There was no strong association between method of recruitment or formal editorial training and the status of the journal. Only 9% of editors in the United States send at least half of the papers to reviewers outside their own country, compared with 41% of editors in the United Kingdom and 73% in other countries, and 69% do not feel bound to follow the advice they receive concerning acceptance of papers. CONCLUSIONS: Clinical journals are usually edited by practicing clinicians who are self-taught part-time editors, but willing to accept further training. They usually consult 2 reviewers, but exercise independent judgment on the acceptability of papers.

Peer Review↗
PubMed1997

Balancing work and rest to combat driver fatigue: an investigation of two-up driving in Australia.

This study is the fourth in a series examining driver fatigue in the Australian long distance road transport industry. Thirty-seven long haul truck drivers were measured on a routine 4500 km round trip. Two types of driving operations were compared, single driving, involving a solo driver, and two-up driving, where a pair of drivers operate a truck continuously and alternate between work and rest. Two-up drivers reported higher levels of fatigue than single drivers overall and tended to show poorer levels of performance. However, this result appeared to reflect differential fatigue at the start of the trip. Both two-up and single drivers showed marked increases in fatigue across the first half of the trip, followed by a substantial recovery of alertness and performance provided that drivers had stationary overnight rest at mid trip or had shorter trips. Fatigue continued to increase on the second half of the trip for drivers who did longer trips without the benefit of a substantial night rest or who did not have access to on-board rest, that is single drivers. The use of overnight rest, in combination with two-up driving, appeared to be the most successful strategy for managing fatigue across the trip.

Accidents, Occupational↗
PubMed1997

Dynorphin and the kappa 1 ligand [3H]U69,593 binding in the human epileptogenic hippocampus.

The distribution of dynorphin (DYN), one of its binding sites (kappa 1 receptor) and their relationship to neuronal loss and granule cell hyperexcitability was examined in hippocampi from patients with temporal lobe epilepsy (TLE). In hippocampi that were not the seizure focus (mass associated temporal lobe epilepsy, MaTLE; and paradoxical temporal lobe epilepsy, PTLE) DYN-like immunoreactivity was localized in the dentate granule cells and their mossy fiber terminals within the hilus and area CA3. In hippocampi that were the seizure focus (MTLE), 89% showed an additional band of immunoreactivity confined to the inner molecular layer (IML) of the dentate gyrus, representing recurrent mossy fiber collaterals. In 11% of MTLE patients no staining was found in the IML (MTLE/DYN-). The MTLE/DYN- hippocampi were also characterized by a significantly lower degree of cell loss than in MTLE hippocampi in the dentate granule cell layer, the hilus and CA3. Both MTLE and MTLE/DYN- hippocampi showed evoked epileptiform bursting in granule cells while MTLE showed greater polysynaptic EPSPs and spontaneous excitatory activity. Thus granule cell recurrent collateral sprouting may account for only some aspects of hyperexcitability. In 30% of the MTLE group, hilar neurons of a variety of morphological types expressed DYN immunoreactivity in their somata and dendrites. The density of [3H]U69,593 binding sites in MaTLE and PTLE patients was highest in areas CA1 and the subiculum-regions having little or no DYN-staining. In the dentate molecular layer, hilus and CA3--regions with the most DYN immunoreactivity--there was a low density of ligand binding. The significance of this transmitter/receptor mismatch is yet unknown.

Adolescent↗
PubMed1996

Long-term modifications of synaptic efficacy in the human inferior and middle temporal cortex.

The primate temporal cortex has been demonstrated to play an important role in visual memory and pattern recognition. It is of particular interest to investigate whether activity-dependent modification of synaptic efficacy, a presumptive mechanism for learning and memory, is present in this cortical region. Here we address this issue by examining the induction of synaptic plasticity in surgically resected human inferior and middle temporal cortex. The results show that synaptic strength in the human temporal cortex could undergo bidirectional modifications, depending on the pattern of conditioning stimulation. High frequency stimulation (100 or 40 Hz) in layer IV induced long-term potentiation (LTP) of both intracellular excitatory postsynaptic potentials and evoked field potentials in layers II/III. The LTP induced by 100 Hz tetanus was blocked by 50-100 microM DL-2-amino-5-phosphonovaleric acid, suggesting that N-methyl-D-aspartate receptors were responsible for its induction. Long-term depression (LTD) was elicited by prolonged low frequency stimulation (1 Hz, 15 min). It was reduced, but not completely blocked, by DL-2-amino-5-phosphonovaleric acid, implying that some other mechanisms in addition to N-methyl-DL-aspartate receptors were involved in LTD induction. LTD was input-specific, i.e., low frequency stimulation of one pathway produced LTD of synaptic transmission in that pathway only. Finally, the LTP and LTD could reverse each other, suggesting that they can act cooperatively to modify the functional state of cortical network. These results suggest that LTP and LTD are possible mechanisms for the visual memory and pattern recognition functions performed in the human temporal cortex.

2-Amino-5-phosphonovalerate↗
PubMed1996

Functional and pharmacological properties of human neocortical neurons maintained in vitro.

The availability of neocortical tissue obtained during brain surgery has allowed for detailed studies of the membrane and synaptic properties of neurons maintained in vitro in a slice preparation. Many of the findings obtained in these studies are summarized here. The majority of the basic electrophysiological properties appear to be similar when human and rodent neurons are compared. However, some notable exceptions regarding specific membrane properties have been reported. Since the majority of the material used in these studies is obtained from epileptic patients, several neuroscientists have tried to determine whether this tissue retains any sign of epileptogenicity when analyzed in vitro. Abnormal synaptic activity was only seen in a fraction of neurons near identified anatomical foci, including tumors, or within neocortical areas that displayed abnormal electrographic activity in situ. This cellular activity included both the presence of all-or-none and graded synaptic bursts. Epileptiform activity comparable to that seen in rodent tissue has been obtained in vitro using several pharmacological procedures including the disinhibition and the Mg(2+)-free model. In conclusion, electrophysiological and pharmacological studies of the human neocortex obtained during surgery have so far been unsuccessful in isolating any definite cellular mechanism that may account for the expression of the epileptiform activity in situ. Nevertheless, these studies have provided valuable information on the cellular and synaptic properties of human neocortex under normal conditions, and following experimental procedures capable of increasing neuronal excitability.

Cells, Cultured↗
PubMed1996

Germ cell development in Drosophila.

More than 100 years have passed since Weismann first recognized the role of germ cells in the continuity of a species. Today, it remains unclear how a germ cell is initially set aside from somatic cells and how it chooses its unique developmental path. In this review, we address various aspects of germ cell development in Drosophila, such as germ cell determination, germ cell migration, gonad formation, sex determination, and gametogenesis. Many aspects of germ cell development, including the morphology of germ cells, their migratory behavior, as well as the processes of gonad formation and gametogenesis, show striking similarities among organisms. Considering the conservation of factors that regulate somatic development, it is likely that some aspects of germ cell development are shared not only on a morphological but also on the molecular level between Drosophila and other organisms.

Animals↗
PubMed1996

Protein A immunoadsorption column versus splenectomy in the treatment of steroid-resistant immune thrombocytopenic purpura. A cost-effectiveness analysis.

The protein A immunoadsorption column is a new treatment for immune thrombocytopenic purpura (ITP). We used a decision-analytic approach with a Markov process to model the cost effectiveness of this treatment compared with splenectomy for steroid-resistant ITP patients. Data informing the model were obtained from published literature, a panel of physicians, and public databases. We found initial treatment with the protein A immunoadsorption column to be less expensive and more effective than initial treatment with splenectomy.

Adrenal Cortex Hormones↗
PubMed1995

Zinc reduces dentate granule cell hyperexcitability in epileptic humans.

The hippocampi of epileptic patients with medial temporal lobe epilepsy exhibit a characteristic pattern of anatomical changes including cell loss and sprouting of the granule cell axons, the mossy fibers, into the inner molecular layer of the dentate. In addition to glutamate, mossy fibers release Zn2+. In the present study we investigated the action of Zn2+ on excitatory synaptic potentials in the dentate granule cells of patients with medial temporal lobe epilepsy. We show here that Zn2+ limits the duration of excitatory responses in these cells, probably by blocking the N-methyl-D-aspartate (NMDA) receptors. Zinc may, therefore, play an important role in limiting epileptiform activity in this issue.

2-Amino-5-phosphonovalerate↗
PubMed1995

Depth electrode studies and intracellular dentate granule cell recordings in temporal lobe epilepsy.

Hippocampal depth electrodes are often used to localize seizure onset in patients who may have temporal lobe epilepsy (TLE). A number of features of the spontaneous seizures and of their ictal onset patterns can be analyzed from these recordings. We compared a number of the typical electroencephalographic (EEG) changes at seizure onset with several cellular parameters recorded in dentate granule cells from the same 14 patients diagnosed with medial temporal sclerosis (MTS) to examine the pathophysiological correlates of this spontaneous EEG activity in this form of TLE. The intracellularly recorded parameters include the propensity to fire evoked epileptiform bursts, the absence of evoked inhibitory potentials, the presence of polysynaptic excitatory postsynaptic potentials, and the presence of spontaneous excitatory activity. We noted several correlations between the EEG data and the intracellular recordings. The absence of synaptically evoked bursts was correlated with the presence of low-voltage fast activity at seizure onset. In addition, the loss of inhibitory postsynaptic potentials was correlated with the presence of periodic spiking pre-ictally. Several other correlations were also noted. These data indicate that EEG findings may be predictive of anatomical and cellular pathological changes and provide clues to the physiological mechanisms involved in this form of epilepsy.

Action Potentials↗
PubMed1995

Prolonged GABA responses in dentate granule cells in slices isolated from patients with temporal lobe sclerosis.

1. Medial temporal lobe sclerosis is a common pathological finding in patients with medically intractable temporal lobe epilepsy. This disease is characterized by extensive cell loss in the hilus and the hippocampal CA1 and CA3 cell fields in addition to synaptic reorganization throughout the dentate gyrus. 2. The dentate granule cells from hippocampal slices of patients diagnosed with medial temporal lobe sclerosis exhibit reduced synaptic inhibition with concommitant hyperexcitability. These physiological changes were studied relative to the hippocampi of patients with temporal lobe tumors in which the cell loss and synaptic reorganization are not seen. 3. We attempted to determine if this disinhibition was because of changes in the postsynaptic sensitivity to the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by studying the responses to exogenously applied transmitter. As in rodents, the GABA responses in human dentate granule cells studied at the resting membrane potential were depolarizing and were mediated primarily by GABAA receptors. In many cases, these depolarizing GABA responses could trigger action potentials. Thus in some situations, GABA could act as an excitatory neurotransmitter. 4. We found that GABAA receptor-mediated responses in the sclerotic hippocampi were approximately 80% longer than in the comparison population. This difference was not because of changes in either the GABA reversal potential or the GABA-induced conductance change. The data support the hypothesis that the GABA transport system is impaired in sclerotic tissue: application of the GABA uptake inhibitor NNC711 (a tiagibine derivative) greatly prolonged the GABA responses in the tumor-related temporal lobe epilepsy tissue, but had little effect on the sclerotic tissue.

Action Potentials↗
PubMed1995

Relationship between synaptic activity and prolonged field bursts in the dentate gyrus of the rat hippocampal slice.

1. Previous studies in the dentate granule cell layer of the rat hippocampal slice have demonstrated that nonsynaptic, seizurelike prolonged field bursts occur in conditions of low extracellular Ca2+ concentration ([Ca2+]o) and elevated [K+]o. We hypothesize that the extracellular ion concentration changes induced by synaptic activation of dentate granule cells would be sufficient to initiate these nonsynaptic bursts. 2. Using ion-selective electrode recording, we observed large changes in [Ca2+]o (from 1.3 mM baseline to approximately 0.7 mM) and [K+]o (from 3.5 to approximately 12 mM) in the dentate granule cell layer during repetitive electrical stimulation of the perforant path in rat hippocampal slices. Concomitant with these changes, bursts of population spikes similar to those seen during spontaneous prolonged field bursts appeared between the individual stimulus-evoked responses in the dentate gyrus in many of the slices studied (19 of 27). 3. Blockade of N-methyl-D-aspartate (NMDA), non-NMDA, and gamma-aminobutyric acid-A (GABAA)-mediated synaptic transmission during perforant path stimulation resulted in a marked reduction of the ion concentration changes and a loss of both stimulus-evoked and stimulus-independent population spikes in the dentate gyrus. 4. When slices were perfused with solutions containing [Ca2+]o and [K+]o equivalent to those measured during perforant path stimulation (i.e., 0.7 and 12 mM, respectively), spontaneous prolonged field bursts appeared in the dentate gyrus. Addition of NMDA, non-NMDA, and GABAA receptor antagonists did not prevent the occurrence of these spontaneous bursts. 5. We conclude that changes in [Ca2+]o and [K+]o sufficient to produce prolonged field bursts may be created in the dentate granule cell layer by perforant path stimulation. These effects are dependent on synaptic transmission. Once these ionic conditions occur, they are sufficient to trigger prolonged field bursts independent of fast amino-acid-mediated synaptic transmission. A similar mechanism could be important during the interictal-ictal transition in vivo.

Animals↗
PubMed1994

Electrophysiological characterization of CA2 pyramidal cells from epileptic humans.

The CA2 region of the hippocampus is more resistant to the principal cell loss seen in CA1 and CA3 in both animal models of temporal lobe epilepsy and in medial temporal lobe sclerosis (MTS), a common neuropathological finding in human temporal lobe epilepsy. There is extensive synaptic reorganization in the MTS hippocampi that is not seen in the hippocampi of patients with tumor-associated temporal lobe epilepsy (TTLE). The authors examined the electrophysiological properties of CA2 pyramidal cells from these two types of human hippocampi. The two main findings are that most MTS cells do not have clear evidence for inhibition yet do not fire synaptically evoked bursts; and that mossy fiber stimulation could evoke excitatory postsynaptic potentials (EPSPs) in the MTS tissue, but not the TTLE cells. These data suggest that in MTS, CA2 cells are resistant to firing epileptiform bursts which may account for their survival. Moreover, the granule cell-CA2 cell connection represents a novel form of synaptic plasticity in this disease.

Animals↗