Search

BackgroundEmerging evidence demonstrates that diet-induced obesity disrupts corticolimbic circuits underlying emotional regulation. Studies directed at understanding how obesity alters brain and behavior are easily confounded by a myriad of complications related to obesity. This study investigated the early neurobiological stress response triggered by an obesogenic diet. Furthermore, this study directly determined the combined impact of a short-term obesogenic diet and adolescence on critical behavioral and molecular substrates implicated in emotion regulation and stress.MethodsAdolescent (postnatal day 31) or adult (postnatal day 81) Lewis rats were fed for one week with an experimental Western-like high-saturated fat diet (WD, 41% kcal from fat) or a matched control diet (CD, 13% kcal from fat). We used the acoustic fear-potentiated startle (FPS) paradigm to determine the effects of the WD on cued fear conditioning and fear extinction. We used c-Fos mapping to determine the functional influence of the diet and stress on corticolimbic circuits.ResultsWe report that one-week WD consumption was sufficient to induce fear extinction deficits in adolescent rats, but not in adult rats. We identify fear-induced alterations in corticolimbic neuronal activation and demonstrate increased prefrontal cortex CRHR1 mRNA levels in the rats that consumed the WD.ConclusionsOur findings demonstrate that short-term consumption of an obesogenic diet during adolescence heightens behavioral and molecular vulnerabilities associated with risk for anxiety and stress-related disorders. Given that fear extinction promotes resilience, and that fear extinction principles are the foundation of psychological treatments for PTSD, understanding how obesogenic environments interact with the adolescent period to affect the acquisition and expression of fear extinction memories is of tremendous clinical relevance.HIGHLIGHTSShort-term WD consumption during adolescence impairs cued fear extinction memory retention in a fear-potentiated startle paradigm.Short-term WD consumption during adolescence attenuates neuronal activation to electric footshock stress in the basomedial nuclei of the amygdala.Short-term WD consumption increases CRHR1 mRNA levels in the medial prefrontal cortex.Adult LEW rats exhibit increased basal HPA axis tone and heightened emotional reactivity to footshock stress relative to adolescent rats.

Objective: To report a case series of Tessier 3, 4, 7 and combined 4,7 craniofacial clefts, their clinical presentations, surgical approaches and outcomes in light of the current literature. Methods: Study Design: Case series Setting: Tertiary Government Hospital Subjects: 5 patients Results: Five patients aged 3 to 14-years-old with Tessier 3, 4 (2 cases), 7 and combined 4,7 were included in this study: Tessier 3 – medial orbitomaxillary cleft extending through the bony skeleton traversing obliquely across the lacrimal groove, Tessier 4 – median orbitomaxillary cleft traversing vertically thru the inferior eyelid, infraorbital rim and orbital floor extending to the lip between the philtral crest and the oral commissure (2 cases), Tessier 7 - macrostomia and cleft oral commissure, and combined Tessier 4 and 7, combining features described above. Four underwent 2- or 3-stage surgeries while 1 declined. Conclusion: Five craniofacial clefts were presented. Because of the varying patterns of craniofacial deformities, a series of surgical procedures, tailor-made for each individual were performed on four. Otolaryngologists who perform maxillofacial and cosmetic surgery should have good background knowledge about craniofacial defects and be familiar with the surgical approaches at their disposal to yield favorable results that are appropriate to their local contexts. Keywords: Tessier Clefts No. 3, 4 and 7, oculoplasty, commisuroplasty, alar transpositional flap, canthopexy

Sludge, which occludes biliary stents, forms mainly around the side-holes of such stents. It has been reported that omitting the side-holes results in less sludge formation and theoretically improves drainage. To compare the clinical efficacy of biliary stents with and without side-holes, we randomized patients with malignant or benign strictures to receive 10FG polyethylene stents either with side-holes (SH) or without side-holes (NSH). The patients were seen at 4, 12, 20, and 28 weeks after stenting for symptom evaluation and serum liver enzyme and bilirubin assays. The stents were replaced only when clinical symptoms of cholangitis developed. Each group included 35 patients. The mean age of patients in the SH group was 68 years, and the ratio of men to women was 1:1.3. In the NSH group, the mean age of patients was 67 years, and the ratio of men to women was 1:1.4. Eight patients with SH stents and eight with NSH stents died before the stents were removed; two NSH stents migrated into the duodenum. During a mean follow-up period of 8.1 weeks (range, 1.1 to 28 weeks for the SH group and 0.6 to 28 weeks for the NSH group), 18 stents were found to be occluded in the SH group and 17 in the NSH group. The median time before total occlusion was 7.8 weeks (range, 2.6 to 28) for SH stents and 7.9 weeks (range, 0.6 to 28) for NSH stents ( p > 0.1, NS). The occluded stents removed from these patients were freeze-dried and weighed to quantitate the sludge blocking the stent lumen. The mean (± SD) weight gain for SH stents was 4.0 ± 1.7 mg/cm and for NSH stents 4.3 ± 2.2 mg/cm ( p > 0.1, NS). In conclusion, the benefits of omitting side-holes in polyethylene stents used in the treatment of obstructive jaundice cannot be substantiated. (Gastrointest Endosc 1994;40:321-5.)

One hundred consecutive patients with acute suppurative cholangitis were randomized in a prospective, controlled clinical trial to receive either ciprofloxacin (200 mg bd iv) or triple therapy comprising ceftazidime (1 g bd iv), ampicillin (500 mg qds iv) and metronidazole (500 mg tds iv) ; 46 and 44 patients in the ciprofloxacin and triple therapy groups respectively were suitable for inclusion in the analysis of efficacy. In two-thirds of the patients biliary obstruction was caused by ductal calculi and in one-third by malignant or benign strictures of the biliary tract. Bacteraemia was documented in 38% of patients in the ciprofloxacin group and in 34% of patients in the triple therapy group, while bile cultures were positive in 87% and 92% of patients in the ciprofloxacin and triple therapy groups respectively. Escherichia coli, Klebsiella spp. and Enterococcus spp. were the most common biliary isolates. Eighty-five per cent of evaluable patients in the ciprofloxacin group and 77% of those in the triple therapy group responded to therapy. The mean durations of fever, septicaemic shock and hospitalization were also similar in the two treatment groups. Six (13%) patients in the ciprofloxacin group and seven (16%) in the triple therapy group required urgent endoscopy or surgery for uncontrolled infection. Recurrence of fever after an initial response was documented in one (2%) patient receiving ciprofloxacin and in three (7%) patients receiving triple therapy. The incidences of mortality were 4% in the ciprofloxacin group and 2% in the triple therapy group. The results of this study suggest that ciprofloxacin alone is adequate empirical therapy for patients with cholangitis.

Iodide-induced hypothyroidism has been observed in subjects treated with compounds with mild antithyroid activity. The hypoglycemic agent tolbutamide belongs to the aminoheterocyclic group, a class of compounds with antithyroid effect. Thus it was thought interesting to study the effect of large doses of iodide on thyroid function in diabetics chronically treated with tolbutamide. Basal thyroid function as assessed by clinical examination and iodothyronine and TSH concentrations was normal in all patients. Furthermore, in diabetics treated with tolbutamide, hormone concentrations were not different from those of patients treated with insulin or diet. Serum T4, T3 and TSH did not show any significant variation throughout the investigation period. Our results suggest that thyroid function is not affected by chronic treatment with tolbutamide even when large doses of iodide are administered.