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PubMed1992

Patterns of inter- and intralaminar GABAergic connections distinguish striate (V1) and extrastriate (V2, V4) visual cortices and their functionally specialized subdivisions in the rhesus monkey.

Local GABAergic connections are undoubtedly important for the operation of cerebral cortex, including the tuning of receptive field properties of visual cortical neurons. In order to begin to correlate specific configurations of GABAergic networks with particular receptive field properties, we examined the arrangement of GABAergic neurons projecting to foci in compartments of known functional specialization in striate (area V1) and extrastriate (areas V2, V4) cortices of rhesus monkeys. GABAergic cells were detected autoradiographically following microinjections into supragranular, granular, or infragranular layers of 5, 10, or 50 nl of 3H-nipecotic acid, which selectively exploits the GABA reuptake mechanism. These injections produced complex inter- and intralaminar distributions of retrograde perikaryal labeling that was selective for GABA-immunopositive neurons and glia. The pattern of retrograde labeling depended on both the laminar and cytoarchitectonic location of injection sites. In all cases, a high density of labeled neurons was present in the immediate vicinity of injection sites, with the density of labeled neurons decreasing for the most part uniformly with horizontal distance. Injections in supragranular layers produced relatively widespread labeling (up to 1.5-1.7 mm from the center of injections) in upper layers, whereas in granular and infragranular layers, labeling was confined to a radius of 0.25-0.5 mm. Conversely, injections in infragranular layers produced labeling that was widest (up to 1 mm) in lower layers, but more laterally restricted in supragranular layers. Injections in granular layers, on the other hand, produced an even distribution of labeling, 0.6-1.0 mm in diameter, throughout all layers. Comparably placed injections in V1, V2, and V4 resulted in patterns of labeling that were distinguished by features including stepwise increases in the lateral extent of labeling from striate to extrastriate areas, and the circular versus markedly elongated intralaminar distribution of labeled neurons in V1 and V4 versus V2. Further, for superficial injections, labeling was present in all layers in V1 and V2, but did not extent below the top layer V in area V4. These findings offer clear examples of organizational differences in the intrinsic inhibitory connections of visual cortices. The results also demonstrate that the number of GABAergic neurons projecting to any spot in cortex decreases systematically with horizontal distance from the spot, and that radiolabeled cells do not coalesce to form slabs, columns, or clusters. This relatively even distribution of retrogradely labeled cells in the tangential plane is consistent with recent computer simulations (Worgotter and Koch, 1991) that suggest that inhibitory neurons broadly tuned as a population can produce the specific response properties of cortical neurons.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed2006

Antibiotic therapy of hospitalized patients with community-acquired pneumonia: an international perspective from the CAPO Cohort Study.

The American Thoracic Society and the Infectious Diseases Society of America have developed evidence-based guidelines for the therapy of hospitalized patients with community-acquired pneumonia (CAP). In an attempt to evaluate if the care provided to hospitalized patients with CAP is in compliance with the care recommended by national guidelines, an international network of investigators has been collecting data from 40 hospitals in 13 countries. The care provided in the following areas of antibiotic therapy was analyzed: empiric antibiotic therapy, timing of initial antibiotic therapy, and switch from intravenous to oral antibiotic therapy. Lack of compliance with national guidelines was identified in all areas of antibiotic therapy. Compliance at the local level can be improved with the implementation of a hospital-based pneumonia quality improvement team. Improving compliance with national guidelines recommendations will produce a beneficial effect in CAP clinical and economic outcomes.

Anti-Bacterial Agents↗

PubMed1995

[Evaluation of the surveillance system of chlorination of public water supply in the province of Albacete].

OBJECTIVE: The aim was to study the reliability of the available data, stemming from the concordance between two different observers' measurement of the level of free residual chlorine. DESIGN: An observational, crossover study, using measurements of the level of free residual chlorine repeated on the same day by two different observers. SETTING: Health Area of Albacete. PATIENTS AND OTHER PARTICIPANTS: 176 double measurements of chlorine, carried out during the study period in 69 networks distributing different waters. MEASUREMENTS AND MAIN RESULTS: Concordance between observers on the absence or presence of chlorination was low (I.Kappa = 0.261), showing a bias in favour of the presence of chlorination in the measurements made by local technicians (McNemar p < 0.01). Applying a logistic regression model, it was observed that the risk of disagreement was as much as 8.5 times greater when chlorine measurement required the local technician to travel. CONCLUSIONS: We concluded that the data available was of questionable value and that it would be useful to put forward some new proposals to improve the supervision of the network.

Chlorine↗

PubMedDate not supplied

Telemedicine by mobile communication.

A concept of mobile telemedicine has been proposed to provide emergency care in a moving vehicle. The practicality of this technique was investigated through technical considerations required to realize mobile telemedicine. Some problems with this technique were identified, and measures to resolve the problems were devised. Then, theoretical analysis verified the feasibility of the proposed technique. Different multiplexing techniques for the multiple medical data transmission by mobile communication were investigated. An experimental system that can simultaneously transmit color images, an audio signal, three-channel ECGs, and blood pressure from a moving vehicle to a fixed station was developed. Experiments on the transmission of multichannel medical data from a moving ambulance, a navigating ship, and a flying aircraft were conducted. The results of these experiments verified the practical feasibility of the proposed technique. In the practical application of this technique, there may be some legal problems: for example, whether medical treatment through a communication medium would be legally acceptable or not, and whether the transmission of medical data violates the protection of personal privacy. However, considering the emergency nature of this technique and the significance of the results, both problems seem to be either legally or technically solvable. This application of mobile communication to telemedicine is not confined to merely a proposal to use new techniques. It can also bring about a methodological change in the concept of conventional telemedicine by changing it from static to dynamic, and by enlarging its scope from a local area to a global or cosmic area. It may also have an impact on conventional emergency medicine in that it will open up a new field of application that applies to moving vehicles.

Aircraft↗

PubMed2002

Lymphatic networks in the periodontal tissue and dental pulp as revealed by histochemical study.

The structural organization and fine distribution of the lymphatic networks in the periodontal tissues (gingiva, periodontal membrane, and alveolar process) and dental pulp of animals and humans were reviewed with special reference to histochemical examination by light and electron microscopy. The distinction between lymphatics and blood vessels was made on cryostat sections of undecalcified and calcified teeth treated with EDTA solution and whole mount preparations of periodontal membranes using 5'-nucleotidase (5'-Nase)-alkaline phosphatase (ALPase) double staining. This staining procedure allowed lymphatic vessels in the periodontal tissue and dental pulp to be differentiated from blood vessels. The specificity and localization of the enzyme reactions were confirmed by comparative histochemical studies of the same specimen with light microscopy and scanning or transmission electron microscopy. Well-developed 5'-Nase-positive lymphatic networks were observed on the tissue sections and whole mount preparations of the gingiva, periodontium, and dental pulp. More lymphatic vessels were seen in the root area of the periodontium than in the cervical area. In the dental pulp, lymphatic vessels were more numerous in the central part than in the peripheral odontoblastic layer. These distributions of the lymphatic capillary networks are discussed in relation to their ability to supply lymph to the teeth.

5'-Nucleotidase↗

PubMed1997

Functional anatomy of human auditory attention studied with PET.

Positron emission tomography was used to investigate the functional anatomy of selective auditory attention in 17 right-handed male volunteers who submitted to different tasks: silent rest (REST) listening to frequent low- or rare high-pitched tones (LIS) delivered randomly to the right or the left ear, selective auditory attention where subjects had to attend to deviants in one ear, right (ATTR) or left (ATTL). Six subjects had the series REST, LIS, ATTR twice, eight subjects the series REST, LIS, ATTL, and the last three subjects the sereis REST, ATTR, ATTL. Event-related potentials were simultaneously recorded with PET and showed significant task and electrode site effects on the N100 amplitude. When compared to REST, LIS elicited bilateral temporal activations of the Heschl's gyri and the planum temporale, with a significant rightward asymmetry, and of the posterior part of the superior temporal gyrus. Significant right precentral and anterior cingulate gyri normalized regional cerebral blood flow increases were observed in the frontal lobe. Both the ATTR and the ATTL conditions, compared to LIS, activated the supplementary motor area, bilateral precentral, and left postcentral cortices without any temporal cortex activation. In addition, the ATTL condition resulted in a right prefrontal cortex activation. Pooling the 14 subjects revealed an asymmetry in the superior temporal gyrus favoring the cortex contralateral to the attended ear. Two major networks seem thus to be involved during selective auditory attention: (1) a local temporal network, on which selective attention produces a modulation of the functional lateralization, and (2) a frontal network that could mediate the temporal cortex modulation by attention.

Adult↗

PubMed2002

The neural correlates of aversive auditory stimulation.

Previous neuroimaging studies indicate that the human amygdala activates during exposure to aversive visual, olfactory and gustatory stimuli. To examine amygdala responses to aversive auditory stimuli, we exposed healthy human subjects to unpleasant sounds while regional cerebral blood flow (rCBF) was assayed with O-15 PET. Eight subjects, all of whom described themselves as reactive to aversive sounds, participated in the study. Relative to white noise, the aversive sounds produced significant rCBF increases in the lateral amygdala/claustrum region. Significant activations also localized to the dorsal brainstem, medial temporal pole, basal forebrain (nucleus accumbens), insula, right auditory association cortices, putamen, thalamus and cerebellum. These data indicate that the amygdala responds to aversive auditory stimuli in a manner similar to its response to unpleasant stimuli in other sensory modalities. The data further highlight a widely distributed network of cortical and subcortical areas activated during exposure to aversive sounds.

Acoustic Stimulation↗

PubMed1988

Distribution of DT diaphorase in the rat brain: biochemical and immunohistochemical studies.

DT diaphorase [NAD(P)H:quinone oxidoreductase] activity was measured in subcellular fractions from homogenates of striatum, frontal cortex, hippocampus, cerebellum, hypothalamus and substantia nigra. This flavoprotein, which by definition oxidizes dihydronicotinamide adenine dinucleotide and dihydronicotinamide adenine dinucleotide phosphate at equal rates and is completely inhibited by 10(-5) M dicoumarol, was found to constitute 80-90% of the total dihydronicotinamide adenine dinucleotide- and dihydronicotinamide adenine dinucleotide phosphate-reductase activities in all brain regions studied. Antibodies raised against purified cytosolic DT diaphorase from the rat liver cross-reacted with the brain enzyme and inhibited soluble DT diaphorase from striatum and cerebellum to 80-90%. Immunohistochemical studies with the same antibodies demonstrated the occurrence of DT diaphorase immunoreactivity in a population of neurons in the substantia nigra and ventral tegmental area. In some neurons there was a colocalization of DT diaphorase and tyrosine hydroxylase-like immunoreactivity. The dense network of DT diaphorase-immunoreactive fibres in the striatum disappeared along with the dopaminergic innervation after 6-hydroxydopamine lesion. DT diaphorase immunoreactivity was also found in Bergmann glia, astrocytes and tanycytes. No correlation appeared to exist between the localization of neuronal DT diaphorase immunoreactivity and the dihydronicotinamide adenine dinucleotide phosphate-diaphorase-like activity, as defined by tetrazolium salt staining, used as a marker for certain peptidergic and cholinergic neurons. However, in, for example, glial cells in the cerebellum, DT diaphorase might contribute or be responsible for the histochemical dihydronicotinamide adenine dinucleotide phosphate-diaphorase activity.

Animals↗

PubMed2005

Worldwide perspective of the quality of care provided to hospitalized patients with community-acquired pneumonia: results from the CAPO international cohort study.

National organizations from multiple countries have developed evidence-based recommendations for the management of hospitalized patients with community-acquired pneumonia (CAP). Good quality of care in CAP can be defined as patient care provided in compliance with evidence-based recommendations. To evaluate the quality of care provided to hospitalized patients with CAP, an international network of investigators is collecting local data on quality indicators from 36 hospitals in 14 countries. Participating countries in four regions are performing worldwide benchmarking: North America (region I), Europe (region II), Latin America (region III), and Asia and Africa (region IV). The quality of care provided to 2750 hospitalized patients with CAP was evaluated in the following areas: diagnosis, hospitalization, respiratory isolation, microbiological workup, empirical therapy, switch therapy, hospital discharge, and prevention. The greatest opportunities for improvement were identified in the areas of prevention of CAP, initial empirical therapy, and switch from intravenous to oral antibiotics. This study indicates that the care recommended by national guidelines is not being appropriately delivered to adults in all regions of the world. New interventions to advance quality of care are necessary to improve clinical and economic outcomes in CAP.

Community-Acquired Infections↗

PubMed2001

Areal and callosal connections in the somatosensory cortex of the star-nosed mole.

Star-nosed moles have a well-developed somatosensory cortex with multiple cortical areas representing the behaviorally important tactile star. In each of three cortical representations, the 11 mechanosensory appendages from the contralateral nose are represented in a series of dark cytochrome oxidase modules. Here the connections of this complex cortical network were explored with injections of the neuroanatomical tracer wheat germ agglutinin conjugated to horseradish peroxidase (WGA-HRP). The main goal was to determine the connection patterns of the somatosensory areas that represent the star. Injections of tracer made in or around the primary somatosensory representation (S1) of the star allowed us to determine the topography of local cortical connections and the projection and termination sites of corresponding interhemispheric connections. The results revealed precise topographic corticocortical connections reciprocally interconnecting the S1 star representation with its counterparts in S2 and in a third representation (S3) unique to star-nosed moles. Callosal connections from a widespread area of the contralateral hemisphere terminated primarily in the septa between cytochrome oxidase dark modules and in areas of cortex surrounding the star representations. However, midline structures of the star represented in S1 and S2 exhibited a high level of callosally labeled cells and terminals. This included label both within septa and within the centers of cytochrome oxidase dense modules representing midline appendages.

Animals↗

PubMed1992

Distribution of interleukin 1 receptor antagonist protein (IRAP), interleukin 1 receptor, and interleukin 1 alpha in normal and psoriatic skin. Decreased expression of IRAP in psoriatic lesional epidermis.

The distribution of interleukin 1 alpha (IL-1 alpha), type 1 interleukin 1 receptor (IL-1R), and the interleukin 1 receptor antagonist protein (IRAP), was investigated in biopsies of normal skin, and in uninvolved and lesional skin of patients with psoriasis, using specific monoclonal antibodies. We report the novel finding that IRAP is distributed throughout the living layers of the epidermis in normal skin, and is also associated with sebaceous glands and eccrine sweat glands. Our finding that the inhibitor protein IRAP is present in areas where the pro-inflammatory cytokine IL-1 alpha is distributed provides strong evidence in favour of a cytokine regulatory system in normal skin. We further document for the first time that IL-1R in normal skin is localized to the living layers of the epidermis, sebaceous and eccrine glands, as well as to a prominent network of dermal dendritic cells, and upper dermal blood vessels. There was a consistent reduction in the level of IRAP expression in lesional compared with uninvolved skin in biopsies from six out of seven psoriasis patients. Decreased IRAP expression in lesions of psoriasis indicates that alterations in the level of this inhibitor protein may be important in the pathogenesis of inflammatory skin conditions.

Epidermis↗

PubMed2002

Processes and challenges: how the Sri Lankan health system managed the integration of leprosy services.

At the end of 1999, the Ministry of Health in Sri Lanka took the bold decision to integrate its Leprosy Services within the country's general health system. The integration was completed in February 2001 and is already starting to bear fruit, but implementing the necessary changes has been a challenging task. Many new procedures had to be established, logistics improved, attitudes changed and health workers trained. A broad bridge between curative and preventative health services needed to be built. Integration efforts were supported by an advertising campaign to inform people that leprosy, like any other illness, can be treated at all health facilities. Contrary to the expectation that quality of service would drop following integration, more cases are now detected and an extensive network of government doctors is able to diagnose, treat and manage leprosy patients more efficiently. Prevalence has increased by 36% and the new case load by 41%. A few areas still need more attention, such as integrating MDT supplies within existing systems and improving the flow of information, but nonetheless the ownership of leprosy is shifting rapidly to local health services.

Delivery of Health Care, Integrated↗

PubMed2001

Achieving better health through health impact assessment.

OBJECTIVE: Health Impact Assessment (HIA) provides a method of predicting the health impacts of policies and activities, in order to recommend changes that would improve health. We piloted approaches to health impact assessment and made recommendations for its use as part of the planning and policy making processes in Scotland. DESIGN: Two Health Impact Assessments were done as case studies. One assessed the City of Edinburgh Council's Local Transport Strategy. The other assessed North Edinburgh Area Renewal Housing Strategy. Both were done in partnership with the professionals responsible for developing the strategies. RESULTS: The main health impacts of transport strategy were in the areas of: accidents, pollution, access to amenities, jobs and social contacts, opportunities for physical activity in walking and cycling and impacts on community networks. Overall, housing strategy impacted most on mental health, especially stress and depression. The recommendations of both HIAs are being used in developing the strategies further. CONCLUSIONS: Health impact assessment can make explicit the health consequences of decisions in different sectors, including impacts on health inequalities. Health Impact Assessment should be done as part of community planning and other partnership activities. Consideration of health impacts should become part of routine decision making.

Community Participation↗

PubMed1984

Cytochemical and ultrastructural changes in aflatoxin-induced injury to rat liver cells.

Young male Sprague-Dawley rats were injected intraperitoneally with a single dose of aflatoxin B1 (AFB1, 3 mg/kg). At 3, 6, 12, and 24 hours and 1, 2, and 5 weeks, the rats were killed and liver samples were taken for examination of sequential ultrastructural changes and localization of acid phosphatase (AcPase), thiamine pyrophosphatase (TPPase) and glucose-6-phosphatase (G6Pase) activity. At 3-6 hrs of AFB1 treatment, the nucleoli became compacted and the network forms of nucleolonema disappeared. Parallel arrays of rough ER encountered in normal liver cells became deranged. Smooth ER increased to form groups of SER anastomosis or vesicles near the golgi area. At 12-24 hours, disruptions of nucleoli, ER systems, and polysomes became more evident. Parallel arrays of ER membranes, forming whorls in the cytoplasm as well as in the cytoplasmic patches (CP), were G6Pase-positive, although the CP were AcPase-negative. The TPPase reaction in bile canaliculi was frequently diminished, but was present in some measure in the Golgi saccules. By 1-2 weeks, most of the injured cells had recovered gradually. The CP disappeared and parallel arrays of RER were observed again in most parenchymal cells. At 5 weeks, the appearance of the nucleoli was normal, as was that of the other organelles. We concluded that the hepatic parenchymal cells had serious lesions at 12 and 24 hours of AFB1 treatment and then recovered nonsynchronously. The response, resistance, and ability to recover from the toxicity of AFB1 varied among the parenchymal cells. The three marker enzymes persisted throughout all regimens of AFB1 treatment.

Acid Phosphatase↗

PubMed2002

Anatomy of the brain neurogenic zones revisited: fractones and the fibroblast/macrophage network.

Cytogenesis in adult peripheral organs, and in all organs during development, occurs nearby basal laminae (BL) overlying connective tissue. Paradoxically, cytogenesis in the adult brain occurs primarily in the subependymal layer (SEL), a zone where no particular organization of BL and connective tissue has been described. We have reinvestigated the anatomy of the area considered the most neurogenic in the adult brain, the SEL of the lateral ventricle, in zones adjacent to the caudate putamen, corpus callosum, and lateral septal nucleus. Here, we report structural (confocal microscopy using laminin as a marker) and ultrastructural evidence for highly organized extravascular BL, unique to the SEL. The extravascular BL, termed fractones because of their fractal organization, were regularly arranged along the SEL and consisted of stems terminating in bulbs immediately underneath the ependyma. Fractones contacted local blood vessels by means of their stems. An individual fractone engulfed in its folds numerous processes of astrocytes, ependymocytes, microglial cells, and precursor cell types. The attachment site (base) of stems to blood vessels was extensively folded, overlying large perivascular macrophages that belong to a fibroblast/macrophage network coursing in the perivascular layer and through the meninges. In addition, collagen-1, which is associated with BL and growth factors during developmental morphogenetic inductions, was immunodetected in the SEL and particularly regionalized within fractones. Because macrophages and fibroblasts produce cytokines and growth factors that may concentrate in and exert their effect from the BL, we suggest that the structure described is implicated in adult neurogenesis, gliogenesis, and angiogenesis.

Animals↗

PubMed2002

The perception of breast cancer: what differentiates missed from reported cancers in mammography?

RATIONALE AND OBJECTIVES: Mammographers map endogenous and exogenous factors into decisions whether to report the presence of a malignant finding in a mammogram case. Thus, to understand how image-based elements are translated into observer-based decisions, the authors used spatial frequency analysis to model the areas on mammograms that attracted visual attention, in addition to the areas localized as abnormal. MATERIALS AND METHODS: Four mammographers read 40 two-view mammogram cases, of which 30 contained at least one malignant lesion visible on one or two views. Their eye positions were recorded during visual search. Once the mammographer felt confident enough to provide an initial impression of the case ("normal" or "abnormal"), the eye position monitoring was turned off and the mammographer indicated, with a mouse-controlled cursor, the location and nature of any malignant findings. Regions that elicited an overt or a covert response by the mammographers were extracted for processing by means of wavelet packets and artificial neural networks. RESULTS: Different decision outcomes yielded different energy representations, in the spatial frequency domain. These energy representations were used by an artificial neural network to predict decision outcome in areas of interest, derived from eye position analysis, on mammograms from new cases. Individual trends were observed for each mammographer. CONCLUSION: Spatial frequency representation of regions that attracted a given mammographer's visual attention may be useful for characterizing how that mammographer will respond to the visually selected areas.

Analysis of Variance↗

PubMed2004

Alzheimer pathology disorganizes cortico-cortical circuitry: direct evidence from a transgenic animal model.

It has been proposed that Alzheimer disease (AD) is associated with a "disconnection syndrome" due to the gradual loss of morphological and functional integrity of cortico-cortical pathways. This hypothesis derives from indirect neuropathological observations, but definitive evidence that AD primarily targets cortico-cortical networks is still lacking. By means of neuroanatomical anterograde tracing methods, we have investigated, in a murine transgenic model of AD, the impact of the amyloid burden on axonal terminals in different neural systems. Axonal tracings revealed, in accordance with the "disconnection syndrome" hypothesis, that cortico-cortical fibers are significantly disorganized. Terminal fields in local and distant cortical areas contained numerous swollen dystrophic neurites often grouped in grape-like clusters at the plaque periphery. In contrary to fibers of cortical origin, those originating from subcortical brain structures only showed limited signs of degeneration upon reaching their cortical targets. These observations suggest a selective disruption of cortico-cortical connections induced by AD brain pathology.

Alzheimer Disease↗

PubMed2005

Lymphatic regeneration following hind limb replantation: an experimental study in the dog.

Different types of trauma to the lymphatic system can often occur, but surgical intervention can be performed only in specific cases. We report on lymphatic regeneration following limb replantation in traumatic amputations and replantation of extremities. The aim of this study was to observe the progression and reaction after surgical trauma that is similar to other kinds of trauma, both in children or adults, and to monitor the possible lymphatic regeneration. Particular attention was paid to two parameters: firstly, the physical examination of the replanted limbs by checking the post-traumatic lymphoedema, and secondly, the study of the images taken from indirect lymphangiography of the replanted limbs. Histological specimens of the surgical trauma area were also examined to reconfirm or exclude lymphatic regeneration. The study population consisted of sixteen mongrel dogs, divided into two groups of eight animals each, who underwent hind limb elective amputation and replantation combined with (group A) or without (group B) sciatic nerve division. Lymphoedema formation was followed quantitatively by measurement of the circumference of the hind limb for 21 days after replantation. Indirect lymphography, never performed before in such cases, and histopathology, were performed to evaluate and confirm lymphatic regeneration. Lymphatic regeneration after replantation of the operated hind limbs was first confirmed between 7th and 11th postoperative day by indirect lymphangiography and clinical observation of the post-traumatic lymphoedema of these limbs. The mean time of visualisation of lymphatic regeneration through lymphography was 10.12 days for group A and 9.37 days for group B. However, nerve transection had no effect on lymphatic regeneration (p = 0.46). Histopathological examination showed first evidence of lymphatic regeneration on the ninth postoperative day and a network of newly formed capillary lymphatics on the 21st postoperative day. It is concluded that lymphatic regeneration following replantation of the extremities without anastomosing of the interrupted lymph vessels, is an unquestionable fact. To achieve the best lymphatic drainage and use of the replanted extremities it is important to resect all non-vital tissues of the replantation area. Local or general infections decelerate lymphatic regeneration. Indirect lymphography with iotrolan is a reliable, easy to perform technique without complications that may be used repeatedly for confirmation and evaluation of post-traumatic lymphoedema.

Animals↗