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Sensory and multisensory responses in the newborn monkey superior colliculus.

Superior colliculus (SC) neurons have the ability to synthesize information from different sensory modalities, resulting in enhancements (or depressions) of their activity. This physiological capacity is, in turn, closely tied to changes in overt attentive and orientation responses. The present study shows that, in contrast to more altricial species, many deep layer SC neurons in the rhesus monkey are multisensory at birth. Such neurons can respond to stimuli from different sensory modalities, and all convergence patterns seen in the adult are represented. Nevertheless, these neurons cannot yet synthesize their multisensory inputs. Rather, they respond to combinations of cross-modal stimuli much like they respond to their individual modality-specific components. This immature property of multisensory neurons is in contrast to many of the surprisingly sophisticated modality-specific response properties of these neurons and of their modality-specific neighbors. Thus, although deep SC neurons in the newborn have longer latencies and larger receptive fields than their adult counterparts, they are already highly active and are distributed in the typical adult admixture of visual, auditory, somatosensory, and multisensory neurons. Furthermore, the receptive fields of these neurons are already ordered into well organized topographic maps, and the different receptive fields of the same multisensory neurons show a good degree of cross-modal spatial register. These data, coupled with those from cat, suggest that the capacity to synthesize multisensory information does not simply appear in SC neurons at a prescribed maturational stage but rather develops only after substantial experience with cross-modal cues.

Acoustic Stimulation↗

[Sensory extinction phenomenon of double simultaneous stimulation: the analysis of consecutive stroke series with acute and unilateral lesions].

We evaluated consecutive stroke patients with an acute, unilateral lesion, in order to elucidate the anatomical correlates and the clinical course of sensory extinction phenomenon as well as its relation with unilateral spatial neglect (USN) and anosognosia for hemiplegia (AHP). Subjects consisted of 76 patients with right cerebral hemispheric lesions (RHL) and 43 with left cerebral hemispheric lesions (LHL). Twelve of 76 patients with RHL and 18 of 43 patients with LHL were excluded from this study, because of consciousness disturbance, aphasia, severe sensory disturbance, hemianopia, or severe dementia. All of the patients included in this study had an ischemic or hemorrhagic stroke, who admitted to our hospital within 24 hours after the onset of stroke. We repeatedly examined the patients to detect the presence of sensory extinction phenomenon, USN, and AHP from their acute to chronic stage. The incidence of extinction phenomenon in RHL was 33% (11/19 with cortical lesions and 10/45 with deep-seated lesions). When we excluded the patients with a lacunar stroke or TIA, 10 of 13 patients with subcortical lesions had sensory extinction phenomenon. Nineteen of 21 patients with RHL who showed sensory extinction phenomenon also accompanied USN, and twelve had associated AHP. The sensory extinction phenomenon disappeared within 20 days in 6 of 10 patients with subcortical lesions and 3 of 11 with cortical lesions. In contrast, three of 25 (12%) patients with LHL showed extinction phenomenon, the incidence being much rarer than the lesion in the right. Of these, two had USN and one had AHP together. All the deficits disappeared within 20 days after the onset of stroke in patients with LHL. Our studies may show that subcortical lesions present with extinction phenomenon more frequently than cortical lesions, although the phenomenon caused by the subcortical lesions of often disappear in a few weeks.

Aged↗

[Results of the exercise (ergometer) test as a diagnostic screening procedure in children with short stature].

The so-called Exercise Test of Lacey and coworkers (1973) is based on the fact that a functioning pituitary can be stimulated by physical exercise. The test was performed in 28 children of short stature as an out-patient screening test. The results were satisfactory since a growth-hormone deficiency could be excluded in 70% of the cases. The convenience of this test, which entails the investigation of only two blood samples, is stressed in respect to paediatric practice.

Adolescent↗

Enzyme immunoassay detection of platelet-derived microparticles and RANTES in acute coronary syndrome.

Platelet-derived microparticles (PDMPs) are produced by platelet activation or physical stimulation under various conditions. To evaluate changes in platelet and chemokine function in patients undergoing percutaneous transluminal coronary angioplasty (PTCA), we measured and compared levels of PDMPs and a C-C chemokine, regulated on activation normally T-cell express and secreted (RANTES), by ELISA. Levels of PDMP and RANTES in patients with acute coronary syndrome were significantly higher than those in the control groups (PDMP: 20.1 +/- 2.9 vs 80.4 +/- 7.3 U/ml, p < 0.001; RANTES: 18.6 +/- 3.7 vs 52.1 +/- 4.6 ng/ml, p < 0.01), but did not differ between the control groups and patients with stable angina. PDMP levels were higher in patients with acute myocardial infarction (AMI) than in patients with unstable angina (PDMP: 115.0 +/- 7.1 vs 63.9 +/- 6.2 U/ml, p < 0.001). There was no difference in the RANTES levels, however, between patients with AMI and patients with unstable angina. PDMP and RANTES levels were significantly decreased after PTCA (PDMP, p < 0.001; RANTES, p < 0.05), but without differences between the two groups. In addition, the level of PDMP was significantly correlated with that of RANTES or soluble CD40 ligand. These findings suggest that PTCA may prevent the development of AMI-associated complications in which activated platelets and RANTES play roles. Our ELISA method appears to be sufficient for monitoring PDMP and RANTES levels after PTCA in patients with acute coronary syndrome.

Acute Disease↗

Treatment of postherpetic neuralgia.

Postherpetic neuralgia (PHN) is the most common and feared complication of herpes zoster. The more severe and painful the initial zoster outbreak, the more likely that PHN will develop, with elderly patients being at greatest risk. There are no proven treatments that have a large impact in reducing the risk of PHN. Tricyclic antidepressants are the mainstay of treatment for established PHN, aided by transcutaneous electrical nerve stimulation, physical therapy techniques, and cautious use of other medications. Topical agents, such as capsaicin, aspirin, and lidocaine, may soon become one of the mainstays of therapy for PHN.

Analgesia↗

[Anesthesia for a patient with pemphigus erythematosus].

An 82-year-old female with pemphigus erythematosus had the head of femur replaced. In her case, systemic lupus erythematosus and myasthenia gravis, typical complications of pemphigus erythematosus, were not present. As even slight friction easily causes blisters in patients with pemphigus, we paid attention mainly to fragility of the skin and the mucus membranes and were careful to minimize physical stimulation of the skin. Because the mucosa of the pharynx or oral cavity could easily be damaged and form blisters during intubation, which in turn might make the management of the upper airway more difficult, we selected spinal anesthesia. No serious perioperative complications, except a few blisters around the wound were observed. We thus successfully managed anesthesia of a patient with pemphigus erythematosa.

Aged↗

Aging, food patterns and disability.

To lay the groundwork for devising, improving and implementing strategies to prevent or delay the onset of disability in the elderly, a systematic literature review was conducted of longitudinal studies published between 1985 and 2001 that reported statistical significant associations between individual baseline nutritional risk factors and subsequent functional status in community-living older persons. The review revealed that nutrition has been neglected in past research. Not more than three studies fulfilled the methodological criteria (e.g. control for baseline functional status, control for confounding or attrition rate). The association between increased and decreased body mass index and functional decline was high. This and other available information regarding the importance of nutrition for the disablement process underline how important adequate intakes of energy and nutrients today are for the ability to manage activities of daily living tomorrow. Vulnerable groups of elderly people can be identified by questions on number of meals a day, food group intake and assessment of weight change. Policy makers and health care professionals should put a joined effort in optimising the food intake of these vulnerable elderly people. On one hand by stimulating physical activity to animate food intake and on the other hand by facilitating the availability of attractive nutritious foods.

Activities of Daily Living↗

Electroencephalographical study of the Rett syndrome with special reference to the monorhythmic theta activities in adult patients.

The long-term course of the EEG in the Rett syndrome is documented with reference to past studies. The monorhythmic theta activities in the waking state which were characteristically seen in adults with the Rett syndrome were investigated in patients aged between 27 and 28, using auto power spectra. They were often suppressed when the patients were excited or strained. Then the suppression was thought to elevate their conscious levels. The theta activities were often suppressed by calling, but not easily suppressed by other stimuli, especially the somatosensory stimuli of pain and touch. There were also abnormal findings in the ABR and blink reflexes. In the Rett syndrome we, therefore, suspect there are disturbances in the brain stem functions especially in the ascending reticular activating system which is related to elevation of the conscious level.

Acoustic Stimulation↗

Development of a rehabilitative program for unilateral neglect.

PURPOSE: The aim of the present paper is to review several studies which assessed the validity of a visuo-spatial training for the rehabilitation of neglect patients. In addition two peripheral stimulations (TENS and Optokinetic Stimulation) have been studied to assess the improvements of neglect disorders when used in combination with the visuo-spatial training. Also we analyzed the potential effect of training for attention on neglect and, viceversa, the effect of visuo-spatial training on attentional impairments. METHODS: the goals have been investigated by both group studies and descriptions of single cases. RESULTS: The visuo-spatial training produced significant improvements on the performance of neglect patients which generalized to every day living situations: the results showed to be stable over time and had positive effects on a variety of other neurological impairments. It was also shown that the improvements are confined to tasks involving spatial exploration of extrapersonal space, but did not extend to other neglect disorders, such as representational and personal neglect. The use of peripheral stimulations, at variance with other studies in the literature, did not add any advantage as compared to the improvements produced by the visuo-spatial training. No transfer between training for neglect and attention was observed. CONCLUSIONS: the present review pointed out that neglect disorders can be improved in a clinically meaningful way: the studies described also showed some limitations and proposed the need of further researches in order to extend the improvements to several other aspects of the neglect syndrome.

Animals↗

[Advances in our knowledge of the causation and pathophysiology of reflex epilepsies].

AIMS: In recent years our knowledge of the pathophysiology and aetiology of reflex seizures and epilepsies has advanced significantly due to the contributions made by modern functional neuroimaging and neurophysiology techniques, as well as the findings of research being conducted in molecular biology. The aim of our review is to summarise and integrate these contributions in order to describe the current state of our knowledge on the subject. DEVELOPMENT: The fundamental pathophysiological pattern is common to all types of reflex epilepsy and is based on the existence of a hyperexcitable cortical or subcortical neuronal area that can respond to a physiological stimulus in an exaggerated manner. This focal hyperexcitability may derive from a predisposing genetic substrate (idiopathic reflex epilepsy) or from a focal cortical lesion (lesional reflex epilepsy). Some genetic substrates have been reported in isolated families and there are many candidate genes, but we still do not know enough about the genetic base. The lesion-based aetiology is very heterogeneous, but disorders affecting cortical development are the lesions with the greatest capacity to cause reflex epilepsy. Clinical expression is conditioned by the topography of the lesion and not by the type of underlying lesion. CONCLUSIONS: Future characterisation of reflex epileptic seizures and syndromes must include a diagnosis centred around three axes, that is, topographic, lesional and genetic.

Animals↗

Ontogeny of ribonucleic acid content in rat cortical neurons influenced by early stimulation.

Developmental changes in the total RNA content were studied in pyramidal cells of the frontal, parietal (somesthetic), temporal (auditory) and occipital (visual) cortical areas in Wistar rats aged 13, 14, 15, 21, 28, 35 and 56 days, and compared with those after complex, visual and acoustic stimulation. In all areas neuronal RNA content reached peak values at the age of 3 weeks, except the parietal cortex, where the values were highest as early as at 15 days (in 21-day pups they were only insignificantly lower). Between the age of 3 and 4 weeks, RNA content of cortical neurons decreased in all three projection areas, whereas in the frontal cortex a significant decline came later--in the 5th week. In the occipital cortex neuronal RNA at 8 weeks reached reliably lower values than in 13-day pups. Neuronal RNA increased at the time of eye-lid opening (13-15 days), highly significantly in the visual cortex. Complex visual and acoustic stimulation raised neuronal RNA content in projection areas of modality involved in stimulation and, moreover, acoustic stimulation did so in the frontal and occipital cortex. On the contrary, complex and visual stimulation decreased RNA contents in the frontal cortex. Developmental dependence, stimulation contingency, and specificity vs. nonspecificity of the observed changes are discussed, and compared with other biochemical, morphological and functional changes that have been found in the period of peaking RNA content, or immediately thereafter.

Acoustic Stimulation↗

Chronic exposure to ionizing radiation as a tumor promoter in mouse skin.

We have tested chronic exposure to 90Y beta radiation for its action as a complete tumor promoter, a stage I tumor promoter, or a stage II tumor promoter in SENCAR mouse skin. In skin initiated with a single application of 7,12,dimethylbenz[a]anthracene (DMBA, 10 nmol), chronic exposure to beta radiation as a complete promoter (0.5 Gy, twice/week, 13 weeks) produced no tumors and, when added to a complete chemical promoter (TPA), reduced tumor frequency about 30%. A similar result was observed when beta radiation was tested as a stage II promoter. DMBA-initiated mice that received chemical (12-O-tetradecanoylphorbol-13-acetate, TPA) stage I promotion followed by 13 weeks of beta-radiation exposure (0.5 Gy, twice/week) as stage II promotion produced essentially no tumors, and combining the same chronic beta-radiation exposure with chemical (mezerein) stage II promotion reduced tumor frequency about 20% when compared to a similar group that was not irradiated. Chronic beta-radiation exposure was tested two ways as a stage I tumor promoter in initiated skin that was subsequently treated with mezerein as a stage II promoter. Stage I promotion was shown to proceed with the passage of time, indicating this process occurs naturally in the absence of chemical or physical stimulation. Hyperthermia, previously shown to be a potent inhibitor of chemically stimulated stage I promotion, had no effect on the natural process, indicating at least some differences in mechanism between the two processes. The natural process was, in fact, inhibited by chemical tumor promoters, but not by radiation. In addition to the increase resulting from this natural process, tumor frequency was further increased slightly but significantly (12-15%, P less than or equal to 0.05) when chronic radiation exposure was given as a stage I promoter (0.5 Gy, twice/week, 13 weeks) subsequent to initiation, in spite of the expected 20% reduction resulting from this dose. Exposure of initiated animals to radiation (0.5 or 1.0 Gy, twice/week, 2 weeks) in addition to TPA as stage I promotion produced a similar increase in tumor frequency (P less than 0.02). At higher radiation doses, however, tumor frequency was reduced compared to unirradiated controls. In a third test as a stage I promoter, beta radiation (0.5 Gy twice/week, 4 weeks) was given prior to initiation with N-methyl-N'-nitro-N-nitrosoguanidine in animals subsequently promoted by TPA (twice/week, 13 weeks), and again the radiation slightly but significantly (P less than 0.03) increased tumor frequency compared to the unirradiated control group.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Clinical profile of severe birth asphyxia.

In this retrospective analysis, 56 babies with Apgar score 3 and less were studied. In 33, successful bag-mask ventilation was carried out. Seventeen babies received endotracheal IPPV. In 9 out of them bag-mask ventilation was never tried whereas in 8 bag-mask ventilation had failed. In 6 babies physical stimulation and blast of oxygen on the face was adequate. Following this experience, in the subsequent years, endotracheal intubation was required mainly in extremely low birth weight babies or babies with Apgar score 0 at birth. During the study period, drugs were used in about 50% babies. In subsequent years this figure has come down to 10%, that too in special situations. This study helped us to evolve a policy in resuscitations severely asphyxiated babies. Bag-mask ventilation is the first choice. Failure to achieve progressively improving Apgar score by 1 minute, usually 4-5, is an indication for endotracheal intubation. Drugs are required in special situations only.

Apgar Score↗