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Projection from the external pallidum to the reticular thalamic nucleus in the squirrel monkey.

Small injections of biocytin in the external segment of the pallidum (GPe) of the squirrel monkey (Saimiri sciureus) led to anterograde labeling of fibers in the thalamic reticular nucleus (NRT). These fibers reached NRT by coursing along the ventral tip of the internal capsule or by directly piercing the internal capsule more dorsally. They arborized profusely within the entire rostrocaudal extent of the nucleus. Within NRT, biocytin-labeled fibers were long, slightly varicosed, and emitted numerous short collaterals whose terminal portions consisted of clusters of large varicosities. Some of these varicosities were closely apposed to cell bodies and proximal dendrites of NRT neurons. Small injections of wheat germ-agglutinated horseradish peroxidase in the rostral pole of NRT led to retrograde cell labeling within the entire rostrocaudal extent of GPe. These retrogradely-labeled cells did not display immunoreactivity for choline acetyltransferase. Hence, beside the well-established projection from the internal pallidum to the thalamus, our findings support the existence of another pallidothalamic projection whereby GPe neurons could exert a powerful influence upon the thalamocortical neurons via a relay in NRT.

Animals↗

New research paradigm.

Scientists are looking at a variety of ways to prevent disease and help insure wellness across the lifespan. Health and disease are linked to human behavior, environment, and biology. Biological influences are many, including a person's sex. Age-old infectious diseases continue to warrant out attention, whether they are acute or chronic. Changing models of disease are focusing on quality of life issues, taking into account the physiological and social influences that affect one's life from cradle to grave. This article reviews recent discoveries in the area of antibiotics, premedication, genetics, obesity, tongue piercing, and tongue splitting. As oral health care professionals, dental hygienists should be aware of the latest trends in research, and models of disease prevention and maintenance of wellness.

Antibiotic Prophylaxis↗

Tongue piercing resulting in hypotensive collapse.

Tongue piercing remains popular. A variety of complications have been reported, including life-threatening infection, airway problems and damaged teeth or mucosal surfaces. A patient who collapsed after continuous profuse bleeding following tongue piercing is presented. It is recommended that piercing practitioners be licensed and inspected. A list of written post piercing instructions for customers is included on how to deal with, or who to contact regarding potential complications including haemorrhage.

Adult↗

Anatomy and physiology of the liver in relation to clinical assessment.

As nurses assume expanded roles in patient care, skills in history-taking and in performing a physical examination are expected. Of the various diagnostic procedures the history and physical examination are the most direct and expeditious methods of obtaining facts about patients' problems. As represented in this article, detailed knowledge of the liver's anatomy and physiology as well as that of other body systems is prerequisite to these skills. To understand and document the complexity of life disturbances occuring in patients with hepatic problems, integration of social-behavioral and mental health concepts is needed.

Bile Acids and Salts↗

[Hyperactivity and anorexia nervosa: behavioural and biological perspective].

Anorexia nervosa is an eating disorder defined by a symptomatic triad, anorexia, emaciation and amenorrhoea. This disease mainly affects young women. Besides these three symptoms, hyperactivity is often associated with anorexia nervosa. Hyperactivity can be considered as a strategy to lose weight, but studies on animal models have shown that it could be explained by more complicated mechanisms. Hyperactivity is defined by an excess of physical activity, which can induce social, professional and family consequences. Hyperactivity can take different forms, most striking is the restless one. Patients with anorexia nervosa are not all hyperactive. Brewerton et al. have compared patients with anorexia nervosa and hyperactivity to patients without hyperactivity. Hyperactive patients are more dissatisfied by their body image, they use less means of purging (laxatives, vomiting), and they start starving earlier than patients without hyperactivity. Many factors can promote the emergence and maintenance of hyperactivity, especially social and cultural requirements, sports environment, family influences. Various models can explain the links between excessive exercise and anorexia nervosa. Epling and Pierce have exposed a behavioural model which shows how hyperactivity can lead to starvation, creating a self-maintained cycle. Eisler and Le Grande have described four models to explain the links between hyperactivity and anorexia nervosa. First, excessive exercise can be considered as a symptom of anorexia nervosa. It can also promote the development of eating disorders. Anorexia nervosa and hyperactivity can be a manifestation of an other psychiatric disorder. At least, hyperactivity can be a variant of anorexia nervosa, which has the same effects, as weight loss. Hyperactivity can also be considered as a kind of obsessive compulsive disorder. Hyperactivity and obsessive compulsive disorders actually share some clinical and neurochemical characteristics. An other model consists in comparing excessive exercise in anorexia nervosa to an addictive behaviour. Self-starvation exacerbated by hyperactivity can be considered as an addiction to endogenous opioid. Few studies are carried out in order to estimate the prevalence of high level exercise in the eating disorders. Davis et al. have achieved a prevalence study. The results indicate that a large majority of patients with anorexia nervosa (80,8%) were exercising excessively during an acute phase of the disorder. Research on animals, specially on rats, brings us an interesting model explaining interactions between anorexia nervosa and hyperactivity. With animal models, we have noticed that, when rats with access to a running wheel, are restricted in their food intake, they become excessively active, and paradoxically reduce food consumption. Many searchers have tried to explain this phenomenon. Morse et al. have pointed from animal models that the level of hyperactivity was linked to the severity of food restriction. This result can be explained by a failure of a part of the brain involved in rest and activity regulation. Animal research brings us explanations about the effects of starvation on the endocrine system and the neurotransmitters. Broocks et al. have shown that corticosterone concentration in plasma was synergistically increased by semi starvation and exercise, and the reduction of triiodothyronine by semi starvation was significantly greater in the running wheel group. An other study of Broocks et al. has revealed an increased hypothalamic serotonin metabolism with the combined effect of hyperactivity and food restriction. Tryptophan, an amid acid involved in serotonin synthesis, can also play a role in the maintenance of anorexia nervosa. In starvation conditions, opioid releasing caused by physical exercise would decrease food intake. Exner's study and Adan's one have shown that leptin would be involved in semi starvation induced hyperactivity mechanisms. In spite of animal models can not be entirely generalized to human, they are useful to try to explain biological supports of hyperactivity. Hyperactivity is not only a strategy to lose weight, but also a specific symptom which completes the clinical triad. Animal studies have led to promising results; we might use medicine, such as serotonin reuptake inhibitors or opioid antagonists in the treatment of hyperactivity in anorexia nervosa.

Anorexia Nervosa↗

[Spinal injury caused by a nail fired from a stud gun].

The patient, a 52-year-old male foreign citizen working as a construction worker, was attacked by his coworker who had fired a drive stud, 70 mm long, with reverse hooks from a powered gun at him; the stud pierced the worker's spine at the scapular level. The patient was taken to the nearest surgical ward. On the basis of clinical presentation and X-ray of the thoracic spine, the diagnosis of penetrating injury to the spinal column at the 7th thoracic vertebra level was made. Subsequently, the patient was admitted to the intensive care unit of our department. On admission the patients showed slight paresis of the right lower extremity and hypesthesia of the right thigh, but no other neurological deficit. After preoperative examination, the patient was operated on within six hours of the injury. Intraoperatively, a 3-mm-thick stud, piercing the T7 vertebral arch, was found on the left side, lateral to the T7 spinous process. After partial resection of the arch around the stud, the spinal canal was inspected. The stud passed paramedially on the right side through the dura mater and the centre of the spinal cord into the body of the 7th thoracic vertebra. The stud was gently removed. Subsequently, some sanguineous liquor appeared. The dura mater was sutured and the wound was closed layer by layer. The postoperative period was uneventful, and the patient was allowed to stand up on day 2. The drain was removed on day 4. Healing by first intention took place. At 6 weeks after surgery slight neurological deficit still remained. Key words: spinal penetrating injury, spinal gunshot injury.

Foreign Bodies↗

Embedded earrings: a complication of the ear-piercing gun.

Ear-piercing techniques include needles, safety pins, sharpened studs, and self-piercing kits. Complications from ear piercing are well documented and may involve local infection, sepsis, keloid scar formation, sarcoid granulomas, cyst formation, bifid ear lobe deformity, and organizing hematoma. The use of the spring-loaded ear-piercing instrument has resulted in an increased frequency of the complication of the earring backing becoming embedded in the ear lobe and helix. The embedded earring complication may result from improper aseptic technique, insufficient training of personnel at ear-piercing centers, or piercing the ears of young. To diminish the risk of embedded earrings we recommend aseptic technique, proper training, limiting ear piercing to the lobe, frequent cleansing of the lobe, and removal of the earring if signs of infection develop.

Adolescent↗

UVB irradiation stimulates deposition of new elastic fibers by modified epithelial cells surrounding the hair follicles and sebaceous glands in mice.

UVB irradiation stimulates the synthesis of elastin in the skin of humans and experimental animals. In this study we localized the site and the cells that are responsible for the synthesis of murine dermal elastic fibers. SKH-1 hairless mice were irradiated with UVB and the skin removed for light microscopy, electron microscopy, in situ hybridization, immunohistochemistry, and biochemical studies. In response to chronic low doses of UVB there was an initial moderate increase in tropoelastin mRNA in the papillary dermis. By contrast, there was a continuous marked elevation of collagen alpha1(I) message localizing to sites of inflammatory cell influx throughout the upper and lower dermis. After 25 wk of UV irradiation there was a 2-fold increase in skin elastin, yet total collagen remained unchanged. Serial desmosine analysis from en face sections indicated the increase in elastin content was due to dermal elastic fibers, an increase in the size and number of the dermal cysts, and an increase in subpanniculus elastic fibers. Elastin stains of en face sections suggested that the elastic fibers in the upper dermis were exclusively derived from cells lining the epithelial root sheath and sebaceous glands. In response to UV irradiation, the elastic fibers increased in number and size, wrapping around these structures and aligning in both directions as long fibers parallel to the body axis. Electron micrographs indicated that modified epithelial cells in close proximity to the flattened epithelial cells that encircled the root sheath and sebaceous glands were the source of the elastic fibers.

Animals↗

Amine oxidases, programmed cell death, and tissue renewal.

Embryonal carcinoma cells, with embryonic (ECaE) or trophectodermal (ECaT) potential, have been used in a colony assay to determine regulatory mechanisms in the blastocyst. The mechanism that regulates ECaE and results in chimera formation is dependent upon a soluble factor in blastocoele fluid and contact with trophectoderm. Two mechanisms contribute to the regulation of ECaT: one involves a factor in blastocoele fluid and the other contact with either trophectoderm or inner cell mass which results in differentiation of the cells into trophectoderm, and the other involves the killing of at least 40% of the cells by blastocoele fluid alone. This cytotoxic activity probably causes the programmed cell death that occurs in the inner cell mass during blastulation as it loses the potential to differentiate into trophectoderm. A toxic activity similar to that of normal blastocysts has been obtained from embryoid bodies. This activity is caused by amine oxidase-dependent catabolism of polyamines, and it is postulated that programmed cell death in the embryo and chalone activity in the adult may have similar mechanisms.

Animals↗

Recombinant murine GM-CSF increases resistance of some factor dependent hematopoietic progenitor cells to low-dose-rate gamma irradiation.

The effects of murine recombinant IL-3 (multi-CSF) and murine recombinant GM-CSF (granulocyte-macrophage colony stimulating factor) on the radiation biology of clonal hematopoietic progenitor cell lines were evaluated. Four clonal cell lines with growth response to either IL-3 or GM-CSF (FDCP-1JL26, and bg/bg d64) or exclusively dependent on IL-3 (32D cl 3 and B6SUtA), were pre-incubated in IL-3, or GM-CSF, for 7 days prior to gamma irradiation, then washed and irradiated at 5 cGy/min, or 116 cGy/min, and transferred to semisolid medium supplemented with either IL-3, or GM-CSF, for assay of 7 day greater than or equal to 50 cell colonies. The cell lines demonstrated similar radiosensitivity and lack of a detectable dose-rate effect when grown in IL-3 (FDCP-1JL26: D0 154, n 1.05 at 5 cGy/min, and D0 138, n 1.16 at 116 cGy/min; bg/bg d64: D0 95.7, n 1.16 at 5 cGy/min, and D0 97.7 n .993 at 116 cGy/min; B6SUtA: D0 101, n 1.29 at 5 cGy/min, D0 100, n 1.27 at 116 cGy/min; and cell line 32D cl 3: D0 123, n 1.65 at 5 cGy/min, and D0 126, n 1.17 at 116 cGy/min). In contrast, FDCP-1JL26 cells demonstrated a significant relative radioresistance at low-dose-rate when grown in recombinant GM-CSF, (D0 217, n 1.27 at 5 cGy/min, D0 138, n 1.34 at 116 cGy/min, p less than .005). The increase in radioresistance of FDCP-1 cells at low-dose-rate was induced either by preincubation in GM-CSF with transfer to IL-3, or by preincubation in IL-3 and transfer to recombinant GM-CSF. Growth factor independent malignant subclones of lines B6SUtA and FDCP-1JL26 demonstrated a significant increase in radioresistance at low-dose-rate (B6SUtA EL4JL: D0 187, n 1.39 at 5 cGy/min, and D0 133, n 1.73 at 116 cGy/min (p. less than .05); and FDCP-1JL26 F7 cl 2: D0 191, n 1.17 at 5 cGy/min, and D0 150, n 1.31 at 116 cGy/min [p less than .05]). Thus, some hematopoietic progenitor cell lines are induced by GM-CSF to grow after irradiation at low-dose-rate similar to the growth of clonal malignant cell lines. The data may have implications for the radiation biology of normal hematopoietic progenitor cells in two circumstances: (a) selective survival of GM-CSF responsive cells after total body irradiation, and (b) selective survival of some hematopoietic progenitors in vivo during clinical recombinant GM-CSF infusion.

Animals↗

Apoptosis: understanding the new molecular pathway.

Advances in science have increased the knowledge of how cells die in the body (apoptosis). A basic understanding of this process can improve nurses' ability to review new scientific literature and enable them to provide safer bedside care.

Acquired Immunodeficiency Syndrome↗

Femur fractures resulting from stair falls among children: an injury plausibility model.

BACKGROUND: Stair falls are common among young children and are also common false histories in cases of child abuse. When a child presents with a femur fracture and a stair-fall history, a judgment of plausibility must be made. A lack of objective injury and biomechanical data makes plausibility determination more difficult. Our objective was to characterize key features associated with femur fractures from reported stair falls, to develop a model for assessing injury plausibility (IP). METHODS: Children 2 to 36 months of age who presented with a femur fracture from a reported stair fall were studied prospectively. Detailed history recording, examinations, fracture characterization, and injury scene analyses were conducted, and biomechanical measures associated with injury prediction were calculated. With our proposed IP model, all cases were then scored for the detail of history, biomechanical compatibility of fracture morphologic features, time to seeking care, and presence of other injuries. RESULTS: Twenty-nine children were diagnosed with a femur fracture resulting from a reported stair fall. The IP model made a clear distinction between 2 groups, designated plausible and suspicious. Significant differences were observed for the detail of history, biomechanical compatibility of fracture, time to seeking care, presence of other injuries, and total IP scores. In the plausible group, the minimal linear momentum associated with a transverse fracture was almost 10-fold greater than that for spiral or buckle fracture types. CONCLUSIONS: This study adds new information to the current body of knowledge regarding injury biomechanics and fractures among children. The IP model provides an objective means of assessing plausibility of reported stair-fall-related femur fractures and identifies key characteristics to facilitate decision-making.

Accidental Falls↗

Perforation of the gastrointestinal tract secondary to ingestion of foreign bodies.

INTRODUCTION: Ingesting a foreign body (FB) is not an uncommon occurrence. Most pass through the gastrointestinal (GI) tract uneventfully, and perforation is rare. The aim of this study was to report our experience with ingested FB perforations of the GI tract treated surgically at our institution. METHODS: A total of 62 consecutive patients who underwent surgery for an ingested FB perforation of the GI tract between 1990 and 2005 were retrospectively reviewed. Three patients with no definite FB demonstrated intraoperatively were included. RESULTS: The patients had a median age of 58 years, and 37 (60%) were male. Of the 59 FBs recovered, 55 (93%) were toothpicks and dietary FBs such as fish bones or bone fragments. A definitive preoperative history of FB ingestion was obtained for only two patients, and 36 of 52 patients (69%) wore dentures. Altogether, 18 (29%) perforations occurred in the anus or distal rectum, and 44 perforations were intraabdominal, with the most common abdominal site being the distal ileum (39%). Patients with FB perforations in the stomach, duodenum, and large intestine were significantly more likely to be afebrile (P = 0.043), to have chronic symptoms (> 3 days) (P < 0.001), to have a normal total white blood cell count (P < 0.001), and to be asymptomatic or present with an abdominal mass or abscess (P < 0.001) compared to those with FB perforations in the jejunum and ileum. CONCLUSIONS: Ingested FB perforation in the adult population is most commonly secondary to unconscious accidental ingestion and is frequently caused by dietary FBs especially fish bones. A preoperative history of FB ingestion is thus rarely obtained, although wearing dentures is a common risk factor. FB perforations of the stomach, duodenum, and large intestine tend to present with a longer, more innocuous clinical picture than perforations in the jejunum or ileum.

Adult↗

[Establishment of arthroscopic trans-septal approach and its clinical application].

OBJECTIVE: To investigate the method and result of arthroscopic trans-septal approach (ATS). METHODS: Ten fresh cadaveric knees were prepared for anatomical study about the posterior septum, and 65 posterior compartment arthroscopy of the knees were performed to view the structure of the posterior septum. The initial diagnosis included: rheumatoid arthritis, pigmented villonodular synovitis, osteoarthritis, loose body or foreign body in the posterior compartment, posterior cruciate ligament (PCL) injury or avulsion fracture, posterior horn tear of meniscus, undiagnosed swollen knee with pain and effusion, osteochondritis dissecans, pyogenic arthritis, gout. From January 2002 to June 2005, 22 cases of ATS were applied. Anterolateral portal was initially created, followed by posterolateral portal under the viewing of arthroscopy which was located at the anterolateral portal. Anteromedial and posteromedial portals were also created using the same technique. Arthroscopy was then transferred to the posteromedial portal, and blade was introduced from the anteromedial portal to gradually remove the synovium covering PCL. Arthroscopy was relocated to the anteromedial portal, Wissinger rod was introduced from the posteromedial portal and pointed to the posterior septum adjacent to the posterior edge of the midportion of PCL. The Wissinger rod was pushed carefully to pierce through the posterior septum under the sight of arthroscopy which was located at the posterolateral portal. ATS was finally created. RESULTS: The posterior septum was in the middle of posterior compartment of the knee, which was film screen-like at the sagittal plane and sandwich-like at the transverse plane. The synovium covered the posterior septum at arthroscopic inspection. Twenty-two cases of ATS were successfully created, amounting to 34% (22/65) of all cases at the same period which had received the arthroscopy of posterior compartments of the knees. Synovectomy of the posterior compartments of the knees was performed in 7 cases, loose body removal was in 6 cases, PCL reconstruction was in 4 cases, reduction and fixation of PCL avulsion fracture was in 2 cases. Chondroplasty, inflammatory synovectomy, and meniscectomy were performed accordingly in 6 osteoarthritis cases. No vascular or nervous injury was encountered. At an average of 20 months follow-up (range, 4 to 45 months), 9 cases still had mild knee pain or swelling, 2 cases had severe pain and were recommended for total knee replacement, the other 11 cases had no recurrence of knee pain or swelling. CONCLUSIONS: ATS has no blind area under arthroscopic vision and facilitate trans-septal operation. It is a safe and effective method to treat the diseases of the posterior compartment of the knee. The direction of inside to outside to create ATS is comparatively reliable, and PCL could be identified as an interior landmark during the passage of Wissinger rod through posterior septum to create ATS.

Adult↗

[Facial injury caused by an umbrella spoke].

We report an unusual injury of the face caused by the spoke of an automatic telescoping umbrella that come loose when the umbrella was opened. Due to the shot-like force of the spoke, the left nostril, septum and right wall of the nasal cavity were pierced. The part with the joint penetrated into the maxillary antrum. In order to remove the spoke, wire scissors had to be used to cuff off the spoke's joint inside the surgically opened maxillary sinus.

Female↗

Subarachnoid hemorrhage and spinal root injury caused by acupuncture needle--case report.

The authors report a case of subarachnoid hemorrhage and spinal root injury caused by an acupuncture needle buried in the posterior neck about 30 years before onset. A 33-year-old female presented with sudden onset of severe occipital headaches. Plain x-ray films of the cervical spine revealed a fine gold needle, about 1.5 cm in length, between the C1 and C2 vertebrae. The needle was piercing the spinal nerve root through the dural vein, and was removed. Postoperatively, the pain exacerbated by neck movement disappeared.

Acupuncture Therapy↗

Rendering the inedible edible: circumvention of a millipede's chemical defense by a predaceous beetle larva.

The larva of the phengodid beetle, Phengodes laticollis, feeds on the millipede, Floridobolus penneri, without risking exposure to the repellent benzoquinones ordinarily ejected by the millipede from its defensive glands when attacked. The phengodid subdues the millipede by piercing the millipede's integument with its hollow sickle-shaped mandibles and apparently injecting gastric fluid. The infusion abruptly paralyzes the millipede, which thereby is prevented from discharging its glands. As the phengodid then imbibes the liquefied systemic contents of the dead millipede, the millipede's benzoquinones remain harmlessly confined to the glands, prevented from diffusing into the millipede's body cavity by the glands' impervious cuticular lining. At the end of the meal only the millipede's skeletal armor and glandular sacs remain uneaten. Analysis of such discarded sacs showed these to contain benzoquinones in amounts commensurate with those present in replete glands of living millipedes.

Animals↗

Ballistic aspects of tandem-loaded cartridges of identical caliber.

Tandem loading of a cartridge of the same caliber is possible only if the diameter of the barrel is sufficiently wide. This requirement is met by the .22 long shot Anschütz miniature clay pigeon gun. Ballistic experiments with tandem-loaded cartridges of the same caliber as those loaded in the normal way showed the bullet of the regularly loaded cartridge to impact the muzzle-loaded cartridge. On firing a shot, the bullet of the posterior cartridge penetrates the anterior one, expanding the case of the first cartridge to the diameter of the barrel and disintegrating the bullet. Regardless of whether the muzzle-loaded cartridge is ignited or not, the discharge speed of the projectiles (v0) is considerably below that of single shots. Calculations yielded a theoretical reduction by about 60%. In accordance with the formula E=1/2*m*v2, in terms of the energy released, the elevated mass of the projectile is of secondary importance compared with the reduction of v0. Although the "projectile" mass is more than twice the normal rate, the energy density is significantly reduced and the biological effect is attenuated. This also became apparent in the failed suicide attempt of a 43-year-old male who used a miniature clay pigeon gun to shoot himself in the forehead at a range of a few centimeters. He had inserted a second cartridge, base to head with the first cartridge, in the factory-bored barrel of the gun. The leading cartridge was destroyed by the regularly loaded one. The pierced and expanded case of the leading cartridge was found nearby the injured man and was at first taken to be the jacket of a larger-caliber bullet.

Adult↗