RESUMEN
BACKGROUND: Greater understanding about the prevention and treatment of overweight and obesity in preschool children within public health care is needed. This study assessed the impact of The First Steps module in routine primary health care including mapping of height/weight and diet followed by parental counselling of healthy habits on overweight and obesity in children aged 2 to 7 years. Further, we explored the experiences of public health nurses (PHNs) with the module. METHODS: Body weight and height obtained in 2014 and 2016 were extracted retrospectively for 676 children from the health records of children at 2, 4, or 6 years of age in five child health centers in Southern Norway. Sex- and age-adjusted body mass index (BMI) z-scores and weight status classifications were calculated according to the International Obesity Task Force reference values. Impact was assessed as change in mean BMI z-scores for children with under-, normal-, and overweight, respectively, and as proportion of children with overweight and obesity. In focus groups, PHNs described their experiences with the practical application of the module. Focus group transcripts were analyzed using Braun and Clarke's thematic analysis. RESULTS: Mean BMI z-scores decreased from 2014 to 2016 in overweight children (- 0.26) and increased in children with under- (0.63) and normal weight (0.06), whereas the proportion of children with overweight and obesity was stable. PHNs believed that the module provides them with new tools that are useful for addressing the intricacies of childhood obesity. They described counseling sessions with families as "moving upstream in a river" and that overweight and obesity may be one of many complex challenges for these families. CONCLUSIONS: Mean BMI z-score decreased in children with overweight during the 2 years after initiation of The First Steps module. PHNs considered the module as useful for addressing children's overweight and obesity, which was perceived as one of several complex challenges for most of these families. Specialist and evidence-based support is needed to address overweight and obesity in children in primary care. Further research should focus on integrating the issues relating to overweight and obesity within other family problems.
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Obesidad Infantil , Índice de Masa Corporal , Preescolar , Humanos , Noruega/epidemiología , Sobrepeso/epidemiología , Sobrepeso/prevención & control , Obesidad Infantil/epidemiología , Obesidad Infantil/prevención & control , Salud Pública , Estudios RetrospectivosRESUMEN
The aim of this study was to investigate the effects of vitamin C and E supplementation on changes in muscle mass (lean mass and muscle thickness) and strength during 12 weeks of strength training in elderly men. Thirty-four elderly males (60-81 years) were randomized to either an antioxidant group (500 mg of vitamin C and 117.5 mg vitamin E before and after training) or a placebo group following the same strength training program (three sessions per week). Body composition was assessed with dual-energy X-ray absorptiometry and muscle thickness by ultrasound imaging. Muscle strength was measured as one-repetition maximum (1RM). Total lean mass increased by 3.9% (95% confidence intervals: 3.0, 5.2) and 1.4% (0, 5.4) in the placebo and antioxidant groups, respectively, revealing larger gains in the placebo group (P = 0.04). Similarly, the thickness of m. rectus femoris increased more in the placebo group [16.2% (12.8, 24.1)] than in the antioxidant group [10.9% (9.8, 13.5); P = 0.01]. Increases of lean mass in trunk and arms, and muscle thickness of elbow flexors, did not differ significantly between groups. With no group differences, 1RM improved in the range of 15-21% (P < 0.001). In conclusion, high-dosage vitamin C and E supplementation blunted certain muscular adaptations to strength training in elderly men.
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Antioxidantes/farmacología , Ácido Ascórbico/farmacología , Composición Corporal/efectos de los fármacos , Músculo Cuádriceps/efectos de los fármacos , Entrenamiento de Fuerza , Vitamina E/farmacología , Absorciometría de Fotón , Anciano , Anciano de 80 o más Años , Suplementos Dietéticos , Humanos , Masculino , Persona de Mediana Edad , Fuerza Muscular , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/efectos de los fármacos , Tamaño de los Órganos , Músculo Cuádriceps/diagnóstico por imagen , UltrasonografíaRESUMEN
Deep brain stimulation (DBS) represents an established treatment option in a growing number of movement disorders. Recent case reports suggest beneficial effect of globus pallidus internus (GPi)-DBS in selected patients suffering from Huntington's disease with marked disabling chorea. We present a 41-year-old man with genetically confirmed HD following quadruple GPi- and subthalamic nucleus (STN)-DBS. Motor function was assessed by Abnormal Involuntary Movement Scale (AIMS) and by Unified Huntington Disease Rating Scale (UHDRS) presurgery and postsurgery for up to 4 years. Furthermore, cognitive, neuropsychiatric state and quality of life (QoL) including life satisfaction (QLS) were annually evaluated. Chorea assessed by AIMS and UHDRS subscores improved by 52 and 55 %, 45 and 60 %, 35 and 45 % and 55-66 % at 1-4 years, respectively, compared to presurgical state following GPi-STN-DBS. During these time periods bradykinesia did not increase following separate STN- and combined GPi-STN-DBS compared to presurgical state. Mood, QoL and QLS were ameliorated. However, dysexecutive symptoms increased at 4 years postsurgery. The present case report suggests that bilateral GPi- and STN-DBS may represent a new treatment avenue in selected HD patients. Clinically, GPi-DBS attenuated chorea and was associated with a larger effect-adverse effect window compared to STN-DBS. However, GPi-DBS-induced bradykinesia may emerge as one main limitation of GPi-DBS in HD. Thus, quadruple GPi-STN-DBS may be indicated, if separate GPi-DBS does not result in sufficient control of motor symptoms. Future controlled studies need to confirm if the present anecdotal observation of additive beneficial effects of GPi- and STN-DBS in a HD patient with severe generalized chorea and relatively intact cognitive and affective functions indeed represents a new therapeutic option.
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Estimulación Encefálica Profunda/métodos , Globo Pálido/fisiopatología , Enfermedad de Huntington/fisiopatología , Enfermedad de Huntington/terapia , Núcleo Subtalámico/fisiopatología , Adulto , Estimulación Encefálica Profunda/efectos adversos , Globo Pálido/patología , Humanos , Enfermedad de Huntington/patología , Enfermedad de Huntington/psicología , Imagen por Resonancia Magnética , Masculino , Actividad Motora/fisiología , Núcleo Subtalámico/patología , Resultado del TratamientoRESUMEN
OBJECTIVE: To estimate the associations between maternal pre-pregnancy body mass index (BMI) or gestational weight change (GWC) during pregnancy and offspring BMI at 3 years of age, while taking several pre-and postnatal factors into account. DESIGN: The Norwegian Mother and Child Cohort Study is a population-based pregnancy cohort study of women recruited from all geographical areas of Norway. SUBJECTS: The study includes 31 169 women enrolled between 2000 and 2009 through a postal invitation sent to women at 17-18 weeks of gestation. Data collected from 5898 of the fathers were included. MAIN OUTCOME MESURES: Offspring BMI at 3 years was the main outcome measured in this study. RESULTS: Mean maternal pre-pregnancy BMI was 24.0 kg m(-2) (s.d. 4.1), mean GWC in the first 30 weeks of gestation was 9.0 kg (s.d. 4.1) and mean offspring BMI at 3 years of age was 16.1 kg m(-2) (s.d. 1.5). Both maternal pre-pregnancy BMI and GWC were positively associated with mean offspring BMI at 3 years of age. Pre-pregnancy BMI and GWC also interacted, and the strength of the interaction between these two factors was strongly associated with the increase in offspring BMI among mothers who gained the most weight during pregnancy and had the highest pre-pregnancy BMI. Our findings show that results could be biased by not including pre-pregnant paternal BMI. CONCLUSION(S): This large population-based study showed that both maternal pre-pregnancy BMI and GWC were positively associated with mean offspring BMI at 3 years of age.
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Índice de Masa Corporal , Lactancia Materna/estadística & datos numéricos , Madres/estadística & datos numéricos , Obesidad/epidemiología , Efectos Tardíos de la Exposición Prenatal/epidemiología , Fumar/epidemiología , Aumento de Peso , Adulto , Preescolar , Estudios de Cohortes , Padre/estadística & datos numéricos , Conducta Alimentaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Obesidad/prevención & control , Vigilancia de la Población , Embarazo , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To report that antibodies to synaptic proteins may occur in association with slow, progressive cognitive decline. METHODS: A total of 24 patients with progressive cognitive dysfunction of unclear etiology were examined for onconeuronal and synaptic receptor antibodies. The effect of serum was examined in cultures of dissociated mouse hippocampal neurons. RESULTS: Seven patients had immunoglobulin A (IgA), but no immunoglobulin G (IgG), antibodies against NMDA receptor (NMDAR). Anti-NMDAR IgA positive patients' serum, but not serum from control individuals, caused dramatic decrease of the levels of NMDAR and other synaptic proteins in neurons, along with prominent changes in NMDAR-mediated currents. These effects correlated with the titer of IgA NMDAR antibodies and were reversed after removing patients' serum from the culture media. When available, comprehensive clinical assessment and brain metabolic imaging showed neurologic improvement after immunotherapy. CONCLUSIONS: A subset of patients with slowly progressive cognitive impairment has an underlying synaptic autoimmunity that decreases the density of NMDAR and other synaptic proteins, and alters synaptic currents. This autoimmunity can be demonstrated examining patients' serum and CSF for NMDAR IgA antibodies, identifying possible candidates for immunotherapy.
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Trastornos del Conocimiento/inmunología , Inmunoglobulina A/sangre , Inmunoglobulina A/inmunología , Intercambio Plasmático , Receptores de N-Metil-D-Aspartato/inmunología , Sinapsis/inmunología , Corticoesteroides/administración & dosificación , Anciano , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/inmunología , Anticuerpos Monoclonales de Origen Murino/administración & dosificación , Atrofia , Autoinmunidad , Biomarcadores/sangre , Western Blotting , Trastornos del Conocimiento/metabolismo , Trastornos del Conocimiento/terapia , Ciclofosfamida/administración & dosificación , Progresión de la Enfermedad , Electrofisiología , Femenino , Fluorodesoxiglucosa F18/metabolismo , Lóbulo Frontal/diagnóstico por imagen , Lóbulo Frontal/metabolismo , Lóbulo Frontal/patología , Hipocampo/patología , Humanos , Inmunohistoquímica , Inmunoterapia/métodos , Enfermedad por Cuerpos de Lewy/diagnóstico , Enfermedad por Cuerpos de Lewy/inmunología , Imagen por Resonancia Magnética , Neuronas/inmunología , Tomografía de Emisión de Positrones/métodos , Radiofármacos/metabolismo , Rituximab , Lóbulo Temporal/diagnóstico por imagen , Lóbulo Temporal/metabolismo , Lóbulo Temporal/patología , Resultado del TratamientoRESUMEN
OBJECTIVE: Prospective memory (PM) describes the ability to fulfill previously planned intentions and is highly dependent on executive functions. Previous studies have shown deficits in executive functions in patients with juvenile myoclonic epilepsy (JME) and in their unaffected siblings. JME has a strong genetic predisposition and it is hypothesized that cognitive deficits are also genetically determined. The present study aimed at investigating potential differences in PM between patients with JME, their siblings, and healthy controls. METHODS: Nineteen patients with JME, 21 siblings, and 21 healthy controls were examined with a complex PM paradigm allowing us to evaluate the different phases of PM (i.e., intention formation, intention retention, intention initiation, intention execution). RESULTS: Patients with JME and siblings showed specific deficits during intention formation and intention execution of PM. Patients with JME were more impaired than both siblings and healthy controls. Correlation analysis revealed an influence of planning on prospective memory abilities in patients with JME. CONCLUSION: The results of this study support the hypothesis of frontal dysfunctions being part of the epileptic syndrome and therefore genetically determined. As in this study patients with JME are more severely cognitively impaired than their siblings, additional influencing factors, such as side effects of anticonvulsants or cognitive effects of subclinical epileptic discharges, might contribute to patients' performance.
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Cognición , Función Ejecutiva , Memoria , Epilepsia Mioclónica Juvenil/psicología , Hermanos/psicología , Adolescente , Adulto , Estudios de Casos y Controles , Electroencefalografía , Femenino , Predisposición Genética a la Enfermedad , Humanos , Masculino , Epilepsia Mioclónica Juvenil/genética , Epilepsia Mioclónica Juvenil/fisiopatología , Pruebas Neuropsicológicas , Retención en Psicología , Adulto JovenRESUMEN
PURPOSE: To evaluate in a.-p. digital chest radiograms of an ex vivo system if increased latitude and enhanced image detail contrast (EVP) improve the accuracy of detecting artificial air space opacities in parts of the lung that are superimposed by the diaphragm. MATERIALS AND METHODS: 19 porcine lungs were inflated inside a chest phantom, prepared with 20-50 ml gelatin-stabilized liquid to generate alveolar air space opacities, and examined with direct radiography (3.0 × 2.5 k detector/ 125 kVp/ 4 mAs). 276 a.-p. images with and without EVP of 1.0-3.0 were presented to 6 observers. 8 regions were read for opacities, the reference was defined by CT. Statistics included sensitivity/specificity, interobserver variability, and calculation of Az (area under ROC curve). RESULTS: Behind the diaphragm (opacities in 32/92 regions), the median sensitivity increased from 0.35 without EVP to 0.53-0.56 at EVP 1.5-3.0 (significant in 5/6 observers). The specificity decreased from 0.96 to 0.90 (significant in 6/6), and the Az value and interobserver correlation increased from 0.66 to 0.74 and 0.39 to 0.48, respectively. Above the diaphragm, the median sensitivity for artificial opacities (136/276 regions) increased from 0.71 to 0.77-0.82 with EVP (significant in 4/6 observers). The specificity and Az value decreased from 0.76 to 0.62 and 0.74 to 0.70, respectively, (significant in 3/6). CONCLUSION: In this ex vivo experiment, EVP improved the diagnostic accuracy for artificial air space opacities in the superimposed parts of the lung (area under the ROC curve). Above the diaphragm, the accuracy was not affected due to a tradeoff in sensitivity/specificity.
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Diafragma/diagnóstico por imagen , Aumento de la Imagen/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Fantasmas de Imagen , Alveolos Pulmonares/diagnóstico por imagen , Intensificación de Imagen Radiográfica/métodos , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodos , Algoritmos , Animales , Inteligencia Artificial , Variaciones Dependientes del Observador , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: High-frequency stimulation of the globus pallidus internus (GPi) is a highly effective therapy in primary dystonia. Recent reports have also demonstrated almost immediate improvement of motor symptoms in patients with tardive dystonia after pallidal deep brain stimulation (DBS). Here, we show the long-term effect of continuous bilateral GPi DBS in tardive dystonia on motor function, quality of life (QoL), and mood. METHODS: Nine consecutive patients undergoing DBS for tardive dystonia were assessed during continuous DBS at 3 time points: 1 week, 3 to 6 months, and last follow-up at the mean of 41 (range 18-80) months after surgery using established and validated movement disorder and neuropsychological scales. Clinical assessment was performed by a neurologist not blinded to the stimulation settings. RESULTS: One week and 3 to 6 months after pallidal DBS, Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) motor scores were ameliorated by 56.4 +/- 26.7% and 74.1 +/- 15.8%, BFMDRS disability scores by 62.5 +/- 21.0% and 88.9 +/- 10.3%, and Abnormal Involuntary Movement Scale (AIMS) scores by 52.3 +/- 24.1% and 69.5 +/- 27.6%, respectively. At last follow-up, this improvement compared with the presurgical assessment was maintained as reflected by a reduction of BFMDRS motor scores by 83.0 +/- 12.2%, BFMDRS disability scores by 67.7 +/- 28.0%, and AIMS scores by 78.7 +/- 19.9%. QoL improved significantly in physical components, and there was a significant improvement in affective state. Furthermore, cognitive functions remained unchanged compared with presurgical status in the long-term follow-up. No permanent adverse effects were observed. CONCLUSION: Pallidal deep brain stimulation is a safe and effective long-term treatment in patients with medically refractory tardive dystonia.
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Estimulación Encefálica Profunda/métodos , Trastornos Distónicos/terapia , Globo Pálido/fisiología , Adulto , Afecto/fisiología , Anciano , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/fisiopatología , Trastornos del Conocimiento/terapia , Estimulación Encefálica Profunda/estadística & datos numéricos , Evaluación de la Discapacidad , Trastornos Distónicos/fisiopatología , Trastornos Distónicos/psicología , Femenino , Globo Pálido/anatomía & histología , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Humor/etiología , Trastornos del Humor/fisiopatología , Trastornos del Humor/terapia , Movimiento/fisiología , Satisfacción del Paciente , Calidad de Vida/psicología , Recuperación de la Función/fisiología , Índice de Severidad de la Enfermedad , Tiempo , Resultado del TratamientoRESUMEN
Visual stimuli are judged for their emotional significance based on two fundamental dimensions, valence and arousal, and may lead to changes in neural and body functions like attention, affect, memory and heart rate. Alterations in behaviour and mood have been encountered in patients with Parkinson's disease (PD) undergoing functional neurosurgery, suggesting that electrical high-frequency stimulation of the subthalamic nucleus (STN) may interfere with emotional information processing. Here, we use the opportunity to directly record neuronal activity from the STN macroelectrodes in patients with PD during presentation of emotionally laden and neutral pictures taken from the International Affective Picture System (IAPS) to further elucidate the role of the STN in emotional processing. We found a significant event-related desynchronization of STN alpha activity with pleasant stimuli that correlated with the individual valence rating of the pictures. Our findings suggest involvement of the human STN in valence-related emotional information processing that can potentially be altered during high-frequency stimulation of the STN in PD leading to behavioural complications.
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Emociones/fisiología , Juicio/fisiología , Enfermedad de Parkinson/fisiopatología , Reconocimiento Visual de Modelos/fisiología , Núcleo Subtalámico/fisiopatología , Síntomas Afectivos/etiología , Síntomas Afectivos/fisiopatología , Anciano , Ritmo alfa , Terapia por Estimulación Eléctrica/efectos adversos , Potenciales Evocados/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Enfermedad de Parkinson/psicología , Enfermedad de Parkinson/terapia , Estimulación LuminosaRESUMEN
Bilateral deep brain stimulation (DBS) of the globus pallidus internus (GPi) alleviates symptoms in patients with dystonia but its effects on cognition, neuropsychiatric status, and quality of life have not been examined. This is a case series report of 15 consecutive patients with different forms of dystonia who underwent bilateral implantation of DBS electrodes in the GPi. The patients were evaluated preoperatively and after 3-12 months of DBS with tests of cognition (Mattis Dementia Rating Scale, Stroop Test, Trail Making Test, Phonemic and Category Word Fluency, Digit Span, Rey Auditory Verbal Learning Test, Tonic and Phasic Alertness), neuropsychiatric status (Beck Depression and Anxiety Inventories, Montgomery Asberg Depression Rating Scale, Snaith-Hamilton Pleasure Scale, Brief Psychiatric Rating Scale), quality of life, and motor functions. GPi DBS significantly improved dystonic symptoms, functional abilities, and quality of life allowing for a significant reduction of antidystonic medications. No deterioration was observed in cognitive scores and neuropsychiatric measures. The present case series report thus provides preliminary evidence for the safety of GPi DBS regarding cognitive and neuropsychiatric functions in patients with dystonia.
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Estimulación Encefálica Profunda , Distonía/terapia , Globo Pálido/fisiología , Adolescente , Adulto , Afecto , Anciano , Cognición , Estimulación Encefálica Profunda/efectos adversos , Estimulación Encefálica Profunda/métodos , Electrodos Implantados , Femenino , Lateralidad Funcional , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Resultado del TratamientoRESUMEN
BACKGROUND: There is some evidence that patients with Parkinson's disease may impaired in prospective memory performance (planning and self initiated realisation of delayed intentions). Little is known about the effect of the disease on distinct phases of prospective memory and the potential mechanisms underlying these effects. OBJECTIVE: To investigate intention formation, intention retention, intention initiation, and intention execution of patients with Parkinson's disease and test for the mediating influence of working memory, inhibition, short term retrospective memory, and divided attention. METHODS: 16 patients with Parkinson's disease and 16 age and education matched normal controls were given a complex event based prospective memory task which differentiates four phases of prospective remembering. In addition, participants completed tasks assessing potential cognitive mediators. RESULTS: On the prospective remembering task, Parkinson patients were impaired in the intention formation phase and showed a trend towards impairment in the intention initiation. In contrast, there were no impairments of retrospective intention retention or the fidelity with which the patients executed their previously developed plan. The group effects were related to interindividual differences in working memory span. CONCLUSIONS: The results suggest that the planning phase of prospective remembering is specifically impaired in Parkinson's disease, and that the impairment is related to working memory deficit. In contrast, even when complex intentions have to be remembered, the retrospective storage of intentions to be performed is not impaired.
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Trastornos del Conocimiento/etiología , Intención , Enfermedad de Parkinson/complicaciones , Anciano , Atención , Trastornos del Conocimiento/diagnóstico , Femenino , Humanos , Inhibición Psicológica , Masculino , Trastornos de la Memoria/diagnóstico , Persona de Mediana Edad , Pruebas Neuropsicológicas , Estudios Prospectivos , Retención en Psicología , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
The authors report a 73-year-old patient with a natural history of early-onset ALS for 49 years presenting with limb and bulbar amyotrophy and a pyramidal syndrome. Analysis of the locus SPG4 identified a heterozygous duplication mutation (c.304_309dupGCCTCG) within exon 1 of the spastin gene. We propose that sequence alterations of spastin may comprise a genetic risk factor in a greater spectrum of motor neuron disorders including clinical variants of ALS.
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Adenosina Trifosfatasas/genética , Esclerosis Amiotrófica Lateral/genética , Esclerosis Amiotrófica Lateral/fisiopatología , Predisposición Genética a la Enfermedad/genética , Mutación/genética , Sobrevivientes , Edad de Inicio , Anciano , Esclerosis Amiotrófica Lateral/diagnóstico , Parálisis Bulbar Progresiva/diagnóstico , Parálisis Bulbar Progresiva/genética , Parálisis Bulbar Progresiva/fisiopatología , ADN/análisis , ADN/genética , Análisis Mutacional de ADN , Progresión de la Enfermedad , Exones/genética , Humanos , Masculino , Linaje , Tractos Piramidales/fisiopatología , EspastinaRESUMEN
The authors report a patient with familial hemiplegic migraine type II who developed a long-lasting attack including fever, right-sided hemiplegia, aphasia, and coma. Quantitative analysis of early gadolinium-enhanced MRI revealed a mild but significant left-hemispheric blood-brain barrier (BBB) opening limited to the cortex and preceding cortical edema. The findings suggest that the delayed cortical edema was vasogenic in the severe migraine aura variant of this ATP1A2 mutation carrier.
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Barrera Hematoencefálica/fisiopatología , Edema Encefálico/genética , Arterias Cerebrales/fisiopatología , Corteza Cerebral/fisiopatología , Migraña con Aura/complicaciones , Adulto , Afasia/genética , Afasia/patología , Afasia/fisiopatología , Barrera Hematoencefálica/patología , Edema Encefálico/patología , Edema Encefálico/fisiopatología , Arterias Cerebrales/patología , Corteza Cerebral/irrigación sanguínea , Corteza Cerebral/patología , Coma/genética , Coma/patología , Coma/fisiopatología , Análisis Mutacional de ADN , Progresión de la Enfermedad , Fiebre/genética , Fiebre/patología , Fiebre/fisiopatología , Lateralidad Funcional/genética , Hemiplejía/genética , Hemiplejía/patología , Hemiplejía/fisiopatología , Humanos , Imagen por Resonancia Magnética , Masculino , Meninges/patología , Meninges/fisiopatología , Migraña con Aura/genética , Migraña con Aura/fisiopatología , Mutación/genética , ATPasa Intercambiadora de Sodio-Potasio/genética , Factores de TiempoRESUMEN
We describe a 72-year-old patient with rapidly progressive dementia and a complex focal seizure. Magnetic resonance (MR) imaging revealed leukoencephalopathy with the involvement of the U-fibers as well as cortical and subcortical microbleeds. Brain biopsy confirmed the diagnosis of cerebral Abeta amyloid angiopathy (CAA). The presented case illustrates the significance of CAA as a cause of rapidly progressive dementia and leukoencephalopathy and points out the importance of T2-weighted MR imaging in the evaluation of dementia.
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Isquemia Encefálica/diagnóstico , Angiopatía Amiloide Cerebral/diagnóstico , Hemorragia Cerebral/diagnóstico , Demencia/diagnóstico , Leucoencefalitis Hemorrágica Aguda/diagnóstico , Anciano , Isquemia Encefálica/complicaciones , Angiopatía Amiloide Cerebral/complicaciones , Hemorragia Cerebral/complicaciones , Demencia/etiología , Progresión de la Enfermedad , Humanos , Leucoencefalitis Hemorrágica Aguda/complicaciones , Masculino , SíndromeRESUMEN
UNLABELLED: Nerve terminals containing neuronal nitric oxide synthase (nNOS) are localized in the renal pelvic wall where the sensory nerves containing substance P and calcitonin gene-related peptide (CGRP) are found. We examined whether nNOS is colocalized with substance P and CGRP. All renal pelvic nerve fibers that contained nNOS-like immunoreactivity (-LI) also contained substance P-LI and CGRP-LI. In anesthetized rats, renal pelvic perfusion with the nNOS inhibitor S-methyl-L-thiocitrulline (L-SMTC, 20 microM) prolonged the afferent renal nerve activity (ARNA) response to a 3-min period of increased renal pelvic pressure from 5 +/- 0.4 to 21 +/- 2 min (P < 0.01, n = 14). The magnitude of the ARNA response was unaffected by L-SMTC. Similar effects were produced by N(omega)-nitro-L-arginine methyl ester (L-NAME) but not D-NAME. Increasing renal pelvic pressure produced similar increases in renal pelvic release of substance P before and during L-SMTC, from 5.9 +/- 1.4 to 13.6 +/- 4.2 pg/min before and from 4.9 +/- to 12.6 +/- 2.7 pg/min during L-SMTC. L-SMTC also prolonged the ARNA response to renal pelvic perfusion with substance P (3 microM) from 1.2 +/- 0.2 to 5.6 +/- 1.1 min (P < 0.01, n = 9) without affecting the magnitude of the ARNA response. IN CONCLUSION: activation of NO may function as an inhibitory neurotransmitter regulating the activation of renal mechanosensory nerve fibers by mechanisms related to activation of substance P receptors.
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Riñón/inervación , Fibras Nerviosas/enzimología , Neuronas Aferentes/metabolismo , Óxido Nítrico/metabolismo , Receptores de Neuroquinina-1/metabolismo , Animales , Péptido Relacionado con Gen de Calcitonina/análisis , Técnica del Anticuerpo Fluorescente , Ganglios Espinales/citología , Riñón/fisiología , Masculino , Mecanorreceptores/química , Mecanorreceptores/fisiología , Fibras Nerviosas/química , Neuronas Aferentes/química , Neuronas Aferentes/ultraestructura , Óxido Nítrico Sintasa/análisis , Óxido Nítrico Sintasa/antagonistas & inhibidores , Óxido Nítrico Sintasa de Tipo I , Presión , Ratas , Ratas Sprague-Dawley , Sustancia P/análisisRESUMEN
Increased renal pelvic pressure or bradykinin increases afferent renal nerve activity (ARNA) via PGE(2)-induced release of substance P. Protein kinase C (PKC) activation increases ARNA, and PKC inhibition blocks the ARNA response to bradykinin. We now examined whether bradykinin mediates the ARNA response to increased renal pelvic pressure by activating PKC. In anesthetized rats, the ARNA responses to increased renal pelvic pressure were blocked by renal pelvic perfusion with the bradykinin B(2)-receptor antagonist HOE 140 and the PKC inhibitor calphostin C by 76 +/- 8% (P < 0.02) and 81 +/- 5% (P < 0.01), respectively. Renal pelvic perfusion with 4beta-phorbol 12,13-dibutyrate (PDBu) to activate PKC increased ARNA 27 +/- 4% and renal pelvic release of PGE(2) from 500 +/- 59 to 1, 113 +/- 183 pg/min and substance P from 10 +/- 2 to 30 +/- 2 pg/min (all P < 0.01). Indomethacin abolished the increases in substance P release and ARNA. The PDBu-mediated increase in ARNA was also abolished by the substance P-receptor antagonist RP 67580. We conclude that bradykinin contributes to the activation of renal pelvic mechanosensitive neurons by activating PKC. PKC increases ARNA via a PGE(2)-induced release of substance P.
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Bradiquinina/metabolismo , Dinoprostona/metabolismo , Riñón/inervación , Mecanorreceptores/fisiología , Neuronas Aferentes/enzimología , Proteína Quinasa C/metabolismo , Sustancia P/metabolismo , Antagonistas Adrenérgicos beta/farmacología , Analgésicos/farmacología , Animales , Antimetabolitos/farmacología , Bradiquinina/análogos & derivados , Bradiquinina/farmacología , Antagonistas de los Receptores de Bradiquinina , Inhibidores de la Ciclooxigenasa/farmacología , Activación Enzimática/efectos de los fármacos , Activación Enzimática/fisiología , Inhibidores Enzimáticos/farmacología , Indoles/farmacología , Isoindoles , Pelvis Renal/fisiología , Masculino , Naftalenos/farmacología , Natriuresis/fisiología , Antagonistas del Receptor de Neuroquinina-1 , Neuronas Aferentes/química , Neuronas Aferentes/efectos de los fármacos , Forbol 12,13-Dibutirato/farmacología , Presión , Proteína Quinasa C/antagonistas & inhibidores , Ratas , Ratas Sprague-Dawley , Receptor de Bradiquinina B2 , Receptores de Bradiquinina/metabolismo , Receptores de Neuroquinina-1/metabolismoRESUMEN
Stretching of the renal pelvic wall activates renal mechanosensitive neurons, resulting in an increase in afferent renal nerve activity (ARNA). Prostaglandin (PG)E(2) plays a crucial role in the activation of renal mechanosensitive neurons through facilitation of the release of substance P from the sensory neurons in the renal pelvic wall. Because wall stretch may induce cyclooxygenase-2 activity, we examined whether cyclooxygenase-2 was expressed in the renal pelvic wall and whether activation of cyclooxygenase-2 contributed to the ARNA response produced through increased renal pelvic pressure. In situ hybridization showed a strong cyclooxygenase-2 mRNA signal in the papilla and subepithelial layer of the renal pelvic wall from time control kidneys and from kidneys exposed to 15 minutes of increased renal pelvic pressure in anesthetized surgically operated rats. In anesthetized rats, an increase in renal pelvic pressure increased ARNA by 40+/-2% and increased renal pelvic release of PGE(2) from 289+/-46 to 1379+/-182 pg/min (P<0.01). Renal pelvic perfusion with the cyclooxygenase-2 inhibitor etodolac reduced the increases in ARNA and PGE(2) by 66+/-7% and 55+/-13%, respectively (P<0.01). Likewise, the cyclooxygenase-2 inhibitor 5, 5-dimethyl-3-(3-fluorophenyl)-4-(4-methylsulfonyl)phenyl-2(5H)-furanone reduced the increases in ARNA and PGE(2) by 43+/-5% and 47+/-8%, respectively. We conclude that cyclooxygenase-2 is expressed in the renal pelvic wall and that the activation of cyclooxygenase-2 contributes to the stimulation of renal mechanosensitive neurons in the pelvic wall.
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Isoenzimas/metabolismo , Pelvis Renal/inervación , Neuronas Aferentes/enzimología , Prostaglandina-Endoperóxido Sintasas/metabolismo , Animales , Transporte Biológico/efectos de los fármacos , Transporte Biológico/fisiología , Presión Sanguínea/efectos de los fármacos , Ciclooxigenasa 2 , Inhibidores de la Ciclooxigenasa 2 , Inhibidores de la Ciclooxigenasa/farmacología , Dinoprostona/metabolismo , Etodolaco/farmacología , Regulación Enzimológica de la Expresión Génica/fisiología , Hibridación in Situ , Isoenzimas/genética , Masculino , Mecanorreceptores/fisiología , Presión , Prostaglandina-Endoperóxido Sintasas/genética , ARN Mensajero/análisis , Ratas , Ratas Sprague-Dawley , Sodio/metabolismoRESUMEN
PURPOSE: A prospective study was designed to evaluate, whether multiplanar imaging with rotational digital subtraction angiography (R-DSA) could improve assessment of carotid artery bifurcation stenosis. PATIENTS AND METHODS: 45 patients with suspected stenosis of the ICA were examined with DSA in standard projections (0 degree-(45 degrees)-90 degrees) and additional R-DSA of each ICA from 0-90 degrees in 10 degrees steps. We compared imaging quality and degree of stenosis as well as exposure of the patients to radiation and contrast media. RESULTS: 79/82 R-DSA (96%) were suitable for evaluation of stenosis, 58/82 (70%) matched the quality standard of single projection DSA. Specificity and sensitivity of the R-DSA to diagnose high grade ACI stenosis were 100% and 94%, respectively. 7/79 R-DSA revealed a higher and 3/79 a lower degree of stenosis than the corresponding DSA. Regarding the degree of stenosis there was no significant difference between the two modalities (p > 0.05), but R-DSA detected 4 stenoses greater than 60% that were estimated to be lower than 60% by DSA. Radiation dose for R-DSA was equivalent to one DSA run (170 cGycm2). The average amount of contrast media (25 ml) was slightly higher than for 2-3 single-projection DSA (19.8 ml). CONCLUSIONS: R-DSA provides high quality imaging of the carotid bifurcation with multiplanar projections facilitating exact grading of vessel stenosis. The number of cases (n = 2) is to small to judge the value of R-DSA as to (tandem-) stenosis of the distal ICA. Still, diagnostic value and low radiation exposure justify the use of R-DSA as additional series to standard protocols.
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Angiografía de Substracción Digital/métodos , Arteria Carótida Común/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Interpretación Estadística de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
RATIONALE: Previous fluorescence studies employing 1,6-diphenyl-1,3,5-hexatriene (DPH) have revealed an increase in the fluidity of platelet membranes from individuals with Alzheimer's disease (AD) and their first-degree relatives. This biophysical alteration has been reported to be relatively specific for the hydrocarbon core of platelet membranes, where DPH preferentially localizes; this effect is not reflected by the fluorescent reporter triethylamino-DPH, which labels membranes at the lipid-aqueous interface. OBJECTIVE: The goal of this study was to explore the validity and reproducibility of these findings using an independent biophysical technique, electron spin resonance (ESR) spectroscopy. METHODS: Platelet membranes prepared from first-degree relatives of patients with AD were labeled with DPH, or the spin-labeled fatty acid probes 5-doxylstearate (5-DS) and 12-doxylstearate (12-DS). These spin labeled probes provide an index of structural order at the respective depths of their nitroxide moieties in the membrane. The resulting preparations were examined by fluorescence and ESR spectroscopy. RESULTS: Increased platelet membrane fluidity (PMF), as determined by the fluorescence anisotropy of DPH, was associated with only a modest reduction in the order parameter derived for 5-DS labeled membranes. In contrast, the mean order parameters derived from the paired samples labeled with 12-DS differed substantially from each other, and revealed decreased order (increased fluidity) in the hydrocarbon 12-C region where DPH preferentially localizes. CONCLUSIONS: These results provide an independent validation of the biophysical alterations of platelet membranes that are manifested by a subgroup of patients with AD and their first-degree relatives.
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Enfermedad de Alzheimer/etiología , Plaquetas/química , Fluidez de la Membrana , Adulto , Anciano , Anisotropía , Espectroscopía de Resonancia por Spin del Electrón , Femenino , Humanos , Masculino , Persona de Mediana Edad , Riesgo , Espectrometría de FluorescenciaRESUMEN
Elevated plasma norepinephrine (PNE) has been shown to be an important predictor of morbidity and mortality in patients with congestive heart failure (CHF). Moxonidine selectively stimulates imidazoline receptors located in the medulla, which centrally inhibit sympathetic outflow. PNE is suppressed and peripheral vasodilation reduces systemic blood pressure. This study evaluated the acute neurohumoral and hemodynamic effects of a single dose of oral moxonidine in 32 patients (22 men, mean +/- SD age 66 +/- 10 years) with CHF. All patients were in New York Heart Association functional class III and stabilized on chronic therapy with diuretics, digitalis, and angiotensin-converting enzyme inhibitors. The mean PNE concentration was 509 +/- 304 pg/ml at baseline. Patients underwent invasive hemodynamic monitoring after double-blind randomization to either placebo (n = 12), moxonidine 0.4 mg (n = 9), or moxonidine 0.6 mg (n = 11). Moxonidine produced a dose-dependent, vasodilator response compared with placebo. Analysis of the time-averaged change from baseline over 6 hours demonstrated that moxonidine 0.6 mg caused significant reductions in mean systemic arterial pressure (p <0.0001), mean pulmonary arterial pressure (p <0.005), systemic vascular resistance (p <0.05), pulmonary vascular resistance (p <0.01), and heart rate (p <0.05). Stroke volume was unchanged. PNE was reduced substantially (-180 pg/ml at 4 hours, p <0.005) and the reduction was highly correlated with the baseline level (r = -0.968). Moxonidine was well tolerated in this single-dose study and resulted in a modest, dose-dependent, vasodilator response, with substantial reductions in systemic and pulmonary arterial blood pressure. Trials designed to evaluate the clinical efficacy of chronic moxonidine therapy in CHF added to conventional therapy would be appropriate.