Search

This is the largest and longest clinical study to date to examine statin usage and overall patient survival following clinically localized prostate cancer. In a retrospective examination of 938 consecutive patients with early-stage prostate cancer treated wtih brachytherapy, 191 patients were documented to be taking statin medications. The patients taking statin medications had significantly lower prostate-specific antigen values, percent positive biopsies, and prostate volume than those patients not taking statin medications. Statin usage resulted in a nonstatistical improvement in all survival parameters with the results most pronounced for atorvastatin. Improving prostate cancer survival with statins could have important treatment implications and could potentially limit or even improve the role of supplemental therapies. A prospective trial of statin medications in conjunction with definitive local treatment for prostate cancer is recommended. [ABSTRACT FROM AUTHOR]

Background and Objectives: To evaluate the rate of return of disease activity after cessation of multiple sclerosis (MS) disease-modifying therapy., Methods: This was a retrospective cohort study from 2 large observational MS registries: MSBase and OFSEP. Patients with relapsing-remitting MS who had ceased a disease-modifying therapy and were followed up for the subsequent 12 months were included in the analysis. The primary study outcome was annualized relapse rate in the 12 months after disease-modifying therapy discontinuation stratified by patients who did, and did not, commence a subsequent therapy. The secondary endpoint was the predictors of first relapse and disability accumulation after treatment discontinuation., Results: A total of 14,213 patients, with 18,029 eligible treatment discontinuation epochs, were identified for 7 therapies. Annualized rates of relapse (ARRs) started to increase 2 months after natalizumab cessation (month 2-4 ARR 0.47, 95% CI 0.43-0.51). Commencement of a subsequent therapy within 2-4 months reduced the magnitude of disease reactivation (mean ARR difference: 0.15, 0.08-0.22). After discontinuation of fingolimod, rates of relapse increased overall (month 1-2 ARR: 0.80, 0.70-0.89) and stabilized faster in patients who started a new therapy within 1-2 months (mean ARR difference: 0.14, -0.01 to 0.29). The magnitude of disease reactivation for other therapies was low but reduced further by commencement of another treatment 1-10 months after treatment discontinuation. Predictors of relapse were a higher relapse rate in the year before cessation, female sex, younger age, and higher EDSS score. Commencement of a subsequent therapy reduced both the risk of relapse (HR 0.76, 95% CI 0.72-0.81) and disability accumulation (0.73, 0.65-0.80)., Discussion: The rate of disease reactivation after treatment cessation differs among MS treatments, with the peaks of relapse activity ranging from 1 to 10 months in untreated cohorts that discontinued different therapies. These results suggest that untreated intervals should be minimized after stopping antitrafficking therapies (natalizumab and fingolimod)., Classification of Evidence: This study provides Class III that disease reactivation occurs within months of discontinuation of MS disease-modifying therapies. The risk of disease activity is reduced by commencement of a subsequent therapy., (© 2022 American Academy of Neurology.)

Background and Objectives: The severity of multiple sclerosis (MS) varies widely among individuals. Understanding the determinants of this heterogeneity will help clinicians optimize the management of MS. The aim of this study was to investigate the association between latitude of residence, UV B radiation (UVB) exposure, and the severity of MS., Methods: This observational study used the MSBase registry data. The included patients met the 2005 or 2010 McDonald diagnostic criteria for MS and had a minimum dataset recorded in the registry (date of birth, sex, clinic location, date of MS symptom onset, disease phenotype at baseline and censoring, and ≥1 Expanded Disability Status Scale score recorded). The latitude of each study center and cumulative annualized UVB dose at study center (calculated from National Aeronautics and Space Administration's Total Ozone Mapping Spectrometer) at ages 6 and 18 years and the year of disability assessment were calculated. Disease severity was quantified with Multiple Sclerosis Severity Score (MSSS). Quadratic regression was used to model the associations between latitude, UVB, and MSSS., Results: The 46,128 patients who contributed 453,208 visits and a cumulative follow-up of 351,196 patient-years (70% women, mean age 39.2 ± 12 years, resident between latitudes 19°35' and 56°16') were included in this study. Latitude showed a nonlinear association with MS severity. In latitudes <40°, more severe disease was associated with higher latitudes (β = 0.08, 95% CI 0.04-0.12). For example, this translates into a mean difference of 1.3 points of MSSS between patients living in Madrid and Copenhagen. No such association was observed in latitudes <40° (β = -0.02, 95% CI -0.06 to 0.03). The overall disability accrual was faster in those with a lower level of estimated UVB exposure before the age of 6 years (β = - 0.5, 95% CI -0.6 to 0.4) and 18 years (β = - 0.6, 95% CI -0.7 to 0.4), as well as with lower lifetime UVB exposure at the time of disability assessment (β = -1.0, 95% CI -1.1 to 0.9)., Discussion: In temperate zones, MS severity is associated with latitude. This association is mainly, but not exclusively, driven by UVB exposure contributing to both MS susceptibility and severity., (© 2022 American Academy of Neurology.)

A 57-year-old patient presented with a long history of minimally symptomatic mitral valve prolapse (MVP). The patient eventually developed severe mitral regurgitation (MR) and clinical evidence of congestive heart failure over 10 years duration before admission. He described a 34-year history of MVP. A transesophageal echocardiography examination demonstrated left atrial enlargement and severe prolapse of the posterior mitral leaflet associated with severe MR to the dome of the left atrium. Left ventricular size and function were normal. A quadrangular resection of prolapse segment and placement of a posterior annuloplasty ring were used to successfully repair the valve using a minimally invasive approach. The current case emphasizes that patients with MVP complicated by MR may remain clinically asymptomatic for prolonged periods, only to subsequently develop left atrial enlargement, severe MR, and congestive heart failure late in the natural history of the disease.

Background and Objectives: The treatment of photodamaged skin with potassium-titanyl-phosphate (KTP) laser and intense pulsed light (IPL) has been reported in several studies. Each device has strengths and weaknesses; however, patient and device variability have made it difficult to ascertain the optimal device for photorejuvenation. The objective of this study was to obtain a head-to-head comparison of IPL and KTP laser for photorejuvenation. Each patient received one KTP laser treatment on one side of the face and one IPL treatment on the other side., Study Design/materials and Methods: Seventeen patients with skin types I-IV were accepted into the study based on existence of dyschromias (pigmented and vascular) and/or discrete telangiectases. After performance of test spots on each patient to determine optimal settings for both devices, patients were treated with both devices in a split face manner. Evaluations and photographs were performed 1 week and 1 month after treatment. Patient and observer evaluations of results were recorded, as well as time to perform each treatment, and patient feedback with regard to pain and edema. No anesthesia was used in these treatments. Photographs were reviewed by a panel of blinded observers to assess changes in red and brown dyschromias., Results: One month average improvement (evaluator) for IPL side was (mean) 38.16%/35.08% for vascular/pigment lesions versus 41.99%/30.21% for KTP side. Patient self-evaluated global improvement at 1 month was (mean) 65.59% for IPL side versus 60.88% for KTP side. A majority of patients found the KTP to be slightly more painful with a mean pain rating of 5.27 of 10 versus 4.4 of 10 for IPL. A majority of patients experienced subjectively greater post-procedure swelling on the KTP side. Time to conduct treatment was an average of 10.0 minutes for IPL, 8.7 minutes for KTP., Conclusions: Both large spot KTP and IPL achieved marked improvement in vascular and pigmented lesions in one session. The KTP laser caused slightly more discomfort and edema than the IPL. On the other hand, the KTP laser was faster, and more ergonomically flexible., (Copyright 2005 Wiley-Liss, Inc.)

The way in which the cerebellum influences the output of the motor cortex is not known. The aim of this study was to establish whether information about force, velocity or duration of movement is encoded in cerebellar thalamic discharge and could therefore be involved in the modulation of motor cortical activity. Extracellular single cell recordings were made from the cerebellar thalamus (66 neurones) and VPLc (49 neurones) of four conscious macaques performing simple wrist movements with various load and gain conditions imposed. A significant correlation (Spearman's; P<0.05) was found between movement duration and the duration of neuronal discharge of most cerebellar thalamic neurones (65%), the velocity of movement and rate of neuronal discharge of some cerebellar thalamic neurones (23%), but not between force of movement and rate of neuronal discharge of any cerebellar thalamic neurones. Similar relationships were found between the activity of VPLc neurones and these movement parameters. The strength of the correlations increased when many cells were grouped and analysed as an ensemble, suggesting that populations of cerebellar thalamic (and VPLc) neurones can encode a signal with higher fidelity than single neurones alone. The ensemble data confirmed that the most robust association was between the duration of neuronal discharge and movement duration. We propose that the cerebellum does not provide the motor cortex with specific information about movement force or velocity, but rather that its major role is in activating many motor cortical regions for a specific duration, thus influencing the timing of complex movements involving many muscles and joints.

Three monkeys were trained to perform stereotyped wrist movements to track a target (phase 1). Changing the gain between the wrist movement and visual display required the monkey to adapt its wrist movement. This adaptation consisted of progressive reduction of movement amplitude over a number of trials (phase 2) until a stereotyped movement accommodating the new gain was learned (phase 3). The experiment's aim was to investigate whether cerebellar thalamic neuronal discharge (ND) changed during motor adaptation and whether this change was related to scaling of kinematic parameters or movement error. Extracellular single-cell recordings were made from "wrist-related" neurones in the cerebellar thalamus (59) and the nucleus ventro-posterior lateralis caudalis (VPLc) (37) of each monkey while they performed the movement paradigm. Neurones were selected for further analysis (37/59 cerebellar thalamic and 23/37 VPLc) if phase-1 movements were stereotyped and motor adaptation occurred in phase 2 (according to statistical definitions). When the gain initially changed, there were positional errors in the form of overshoot. Adaptation to the new gain was achieved by a variety of strategies, including modification of the amplitude of kinematic parameters and positional error in addition to reduction of time to peak velocity and movement time. During stereotyped movements, most cerebellar thalamic neurones fired before movement onset and before VPLc neurones. During adaptation, this order of onset of firing was reversed, and cerebellar thalamic neurones discharged after VPLc neurones and close to the onset of movement. During motor adaptation, the mean rate of phasic ND rose in a large proportion of cerebellar thalamic and VPLc neurones, and the proportion of cerebellar thalamic neurones that encoded a signal about positional error and movement amplitude also increased. In addition, there is set-related activity in the discharge of a majority of cerebellar thalamic and VPLc neurones. This does not appear to be specifically related to motor adaptation, but is related to the movement amplitude. We have discussed the role of the cerebello-thalamo-cortical pathway in error detection in the light of the similarities between discharge patterns of cerebellar thalamic and VPLc neurones. We speculate that, when learned movements are performed, the discharge of cerebellar thalamic neurones occurs before movement, perhaps representing an efference copy of the intended movement. During adaptation, this signal is gated out, and later-arriving peripheral afferent input dominates cerebellar thalamic discharge.

In a previous paper (Churchward PR, Butler EG, Finkelstein DI, Aumann TD, Sudbury A, Horne MK. J Neurosci Methods 1997;76:203-210), we showed that a simple back propagation neural network could reliably model visual inspection by human observers in detecting the point of change of neuronal discharge patterns. The data for that study was deliberately chosen so that the point of change was readily detected and there would be high concordance between human observers. We wished to extend this investigation by comparing a variety of automatic analysis methods on more complex data sets. Two automatic analysis methods have been discussed in this paper. The knowledge based spike train analysis (KBSTA) was designed to emulate the detection of bursts by human observers. The self-organizing feature map (SOFM) spike train analysis determined a burst by classifying the patterns of neuronal discharge. Neuronal discharge was recorded from the motor thalamus and nucleus ventralis posterior lateralis caudalis (VPLc) of a monkey performing consecutive trials of skilled wrist movements. Recordings were made from 36 neurons whose discharge patterns were related to wrist movement. Three hundred and sixty trials performed during the recording of these 36 neurons were chosen at random and used to compare the three methods, KBSTA, SOFM, and visual inspection. The main results of this study show that for the 360 trials the three detection methods have very similar results in detecting the onset and offset of neuronal bursts. The SOFM method is not the best first approach for detecting a burst, but it does provides independent evidence to support the KBSTA and visual inspection methods. In conclusion we propose the KBSTA method as a practical, automatic technique to identify bursts of neuronal discharge.

Extracellular single-cell recordings were made from the cerebellar thalamus (89 neurones) and the VPLc (53 neurones) of three conscious monkeys. The animals were trained to perform wrist movement paradigms including: (a) visually triggered skilled, voluntary movements; (b) 100-ms duration torque pulse perturbations applied during a hold period (termed Pa perturbations); (c) 100-ms perturbations that commenced 100 ms after the visual trigger but during preparation before a skilled, voluntary movement (termed Pb perturbations); and (d) 100-ms perturbations during the skilled, voluntary movement (termed Pm perturbations). These Pb and Pm perturbations were used to identify central and peripheral influences on patterns of neuronal discharge in the ventrolateral thalamus. There was no systematic difference between the responses to Pb and Pm perturbations of neurones in the cerebellar thalamus and those in VPLc. The responses of VPLc and cerebellar thalamic neurones to Pa perturbations were considered to represent transduction of peripheral afferent input, and these responses were compared with the responses to the other types of perturbations. Up to 40% of neurones in cerebellar thalamus and VPLc responded to Pb and Pm perturbations in a similar pattern to that which followed Pa perturbations, and therefore most likely represented faithful transduction of peripheral input. However, the response of over half the neurones in VPLc and cerebellar thalamus to Pb or Pm perturbations differed from Pa perturbations in a manner suggesting that central influences had gated the peripheral input. The short-latency response in cerebellar thalamus which was modified by central influences is appropriately timed to contribute to the "intended" response to perturbations of motor cortical neurones.

The discharge pattern of two thalamic neurones was recorded from a conscious monkey performing voluntary movements about the wrist joint. The neuronal discharge was displayed as a raster centred on movement of the wrist. The discharge patterns of both neurones was very strongly correlated with movement. Three experienced researchers were asked to examine the data and to classify every part of each trial as background discharge, 'on' (increased firing rate) or 'off' (decreased or zero firing rate) and to mark the times that neuronal discharge changed state. A 'standard output' was made from these classifications. A back-propagation artificial Neural Network (the Network) was used to model the standard output and cumulative sums (CUSUMs) and maximum likelihood was then performed on the data and compared with the Network. There was a high correlation between the output of each observer (r > 0.61) and the standard output and between the Network and the standard output (r > 0.99). However the correlation between standard output and CUSUMs (r = 0.06) and standard output and maximum likelihood (r = 0.36) was much lower. The Network could be trained with as few as 12 trials, indicating a high degree of constancy in the methods employed by the observers. The Network was also highly efficient at detecting changes in state of neuronal activity (r > 0.99). In summary, when used on single trial data, visual inspection is a reliable method for detecting timing of change neuronal discharge and is superior to CUSUM and maximum likelihood. As well it is capable of detecting neuronal discharge state: that is whether firing rate is increased, normal or decreased. Neural Networks promise to be a useful method of confirming the consistency of visual inspection as a means of detecting changes in neuronal discharge pattern.

This study was designed to further investigate the role of the subthalamic nucleus (STN) and globus pallidus internus (GPi) in the pathophysiology of Parkinson's disease. The prevailing theory about the pathophysiology of Parkinson's disease (PD) predicts that there is overactivity of the subthalamo-pallidal pathway. In order to inactivate that pathway, naive and hemiparkinsonian monkeys were locally administered either muscimol (to reversibly inactivate the contralateral STN) or kynurenic acid (to reduce glutamatergic activity in the contralateral GPi). Three naive and 2 hemiparkinsonian monkeys were studied. Intra-carotid MPTP was administered to produce 2 hemiparkinsonian monkeys. Injection sites of muscimol and kynurenic acid in the brain were confirmed electrophysiologically and histologically. Injections of muscimol into the STN in naive and hemiparkinsonian monkeys caused reversible contralateral dystonia, but did not alleviate Parkinsonism. Only one kynurenic acid injection into GPi partially alleviated Parkinsonism. On the basis of the results in this study, aspects of the currently accepted hypothesis of the pathophysiology of PD cannot be confirmed. However, this study reports that the STN has an important role in the production of dystonia. This experimental model of dystonia will prove suitable for further study of both the mechanisms causing dystonia as well as for possible therapeutic approaches to its treatment.

Extracellular recordings were made from single neurones in the cerebellar thalamus (75 neurones) and the VPLc (44 neurones) of four conscious moving monkeys. The experiment was designed to establish the discharge of ventrolateral thalamic neurones encodes information about kinematic parameters. The animals were trained to resist unexpected perturbations of the wrist and to perform skilled, voluntary wrist movements, producing stereotyped reflex and active movements with a wide range of durations and amplitudes. Statistical analysis of the discharge pattern associated with individual trials of movement was performed. In various maintained wrist positions there was a significant correlation (P < 0.05) between frequency of tonic discharge and joint position in 40% of the cerebellar thalamic neurones and in 54% of VPLc neurones. The phasic neuronal discharge associated with stereotyped movement often appeared "velocity-or acceleration-like'. However, statistical analyses revealed that the phasic discharge of only a small percentage of cerebellar thalamic and VPLc neurones was correlated with duration of movement, peak velocity or acceleration. The percentage of cerebellar thalamic neurones with discharge correlated to kinematic parameters was much greater when an unexpected change in the gain between joint angle and screen display led to errors in tracking the target. It is concluded that the cerebello-thalamo-cortical (CTC) pathway, carries information regarding maintained joint position but not velocity or acceleration of movement during a stereotyped task. However, the CTC pathway has a greater capacity to signal information about movement velocity and acceleration when there is a mismatch between the intended and actual movement.

U.S military medical personnel are currently trained to care for combat casualties using the principles taught in the Advanced Trauma Life Support (ATLS) course. The appropriateness of many of the measures taught in ATLS for the combat setting is unproven. A 2-year study to review this issue has been sponsored by the United States Special Operations Command. This paper presents the results of that study. We will review some of the factors that must be considered in caring for wounded patients on the battlefield with an emphasis on the Special Operations environment. A basic management protocol is proposed that organizes combat casualty care into three phases and suggests appropriate measures for each phase. A scenario-based approach is needed to plan in more detail for casualties on specific Special Operations missions, and several sample scenarios are presented and discussed.

Studies of lesions of the primate cerebellum leave little doubt that the cerebellum is necessary for the execution of smooth and accurate movements. How the cerebellum fulfills this role at a neuronal level remains unknown. It is likely that the cerebellum exerts the same effect on a number of different efferent targets. In order to influence voluntary movement, a major output from the cerebellum projects to the motor cortex via the cerebello-thalamo-cortical (CTC) pathway. By examining neuronal activity in the cerebellar thalamus, and comparing this with activity recorded from its connections with the deep cerebellar nuclei and motor cortex, conclusions can be made regarding cerebellar function. Current data does not support a role for the CTC pathway in the initiation of movement or the control of trans-cortical reflexes. Also, the evidence does not support the hypothesis that the cerebellum prevents terminal movement oscillations by predictively sending a message to the antagonist muscle to brake the movement. The available literature supports the Eccles theory that during normal movement, the CTC pathway receives a form of efference copy from the motor cortex and compares this message with that derived from peripheral afferents about the actual progress of the movement. However, there is not a significant degree of kinematic information passing through this pathway in the course of a voluntary movement. Therefore the actual site of comparison or error-detection in this system awaits further elucidation.

1. To examine the role of the anterior ventrolateral thalamic nucleus (VLa) in motor control, extracellular single-cell recordings were made from the VLa nucleus in three conscious monkeys performing visually triggered, rapid movements requiring flexion and extension of the wrist joint. The movement paradigms consisted of three components: an initial hold period, a ballistic movement, and a final hold period. 2. Cerebellar nuclear stimulation was used to physiologically identify thalamic neurons receiving input from the cerebellum. Neurons subsequently confirmed histologically as lying within the VLa nucleus were located anterior to those "driven" by cerebellar stimulation. 3. The activities of 261 VLa neurons displaying movement-related behavior were examined. In the absence of movement, the activity of these neurons ranged from 5 to 80 spikes/s, the majority of cells (222/261; 85%) firing between 10 and 30 spikes/s. Neural activity was not influenced by afferent input from skin, joint, or muscle but altered markedly when the animal engaged in active movement. 4. The relationship between neural activity and movement at a specific joint was determined in 189 of the 261 neurons. The majority of these neurons (161/189; 85%) modulated their activity in response to movement confined to a single joint; the remaining neurons displayed multijoint motor responses, their activity being best related to a motor act, such as grasping, reaching, or feeding. There was no clear segregation in the representation of body parts in the VLa nucleus to suggest the presence of clearly defined somatotopy. 5. The activities of wrist-related neurons (45 of the 261) were examined to determine the motor characteristics of the VLa nucleus. Three distinctive activity patterns were exhibited by these neurons during the performance of the movement paradigms: 1) a phasic burst of < 300 ms in duration (34/45; 76%); 2) a sustained change in neural activity lasting > 300 ms (typically up to 1,000 ms; 4/45; 9%); and 3) both a phasic and a sustained response, the sustained response occurring either prior or subsequent to the phasic response (7/45; 15%). 6. The movement-related activity of the wrist-related neurons occurred late, 52% firing after the onset of the forearm electromyogram (EMG). In 47% of the neurons, discharge rate was related to movement direction and, in a smaller proportion (13%), joint position. No relationship was found between neural activity patterns and amplitude of movement or velocity of movement. (ABSTRACT TRUNCATED AT 400 WORDS)

1. Extracellular single-cell recordings were made from the cerebellar thalamus, the ventro-posterior lateralis par caudalis (VPLc) and motor cortex of three conscious monkeys. Recordings were made from the thalamus as well as the cortex in two monkeys. In all, recordings were made from the thalamus in four hemispheres and from the motor cortex in four hemispheres. The animals were trained to permit a detailed examination when relaxed. Unexpected perturbations were applied to the wrist. Seventy-seven wrist-related neurones were recorded in the cerebellar thalamus, forty-two neurones from the VPLc and eighty-four neurones in motor cortex. 2. Cerebellar nuclear stimulation was used to physiologically identify thalamic neurones receiving input from the cerebellum. The location of all neurones was verified histologically. 3. The majority of cerebellar thalamic neurones had deep sensory receptive fields related to a single muscle, a group of synergists or a single joint. There was a distinct topographical organization. These fields were similar to sensory fields in motor cortical neurones, but had higher thresholds. 4. VPLc neurones had discrete deep or cutaneous sensory fields, or a combination of these fields, which suggests convergence. VPLc neurones had fields with lower thresholds than cerebellar thalamic neurones. The somatotopically located forelimb area in the VPLc was posterior to and continuous with the forelimb area in the cerebellar thalamus. 5. VPLc neurones responded with a shorter latency to wrist perturbations than did cerebellar thalamic neurones. VPLc neurones with deep sensory fields changed firing significantly earlier than those with cutaneous fields. The VPLc is likely to be the major source of sensory input to the motor cortex, and based on the results of this study we suggest that the VPLc is the thalamic nucleus best placed to transmit short-latency afferent input from the forelimb. 6. The timing of the neuronal discharge of cerebellar thalamic and VPLc cells, which resulted from perturbations of the wrist, was best linked to the duration of movement rather than its amplitude. The cells began firing as soon as the velocity changed sign and continued firing until the sign of the velocity changed again. In subsequent corrective movements neuronal discharge in the VPLc appeared to also encode movement acceleration.

1. Three monkeys were trained to perform a reaction-time task of the wrist and single-cell recordings were made from the motor cortex (eighty-four cells), ventro-posterior lateralis par caudalis (VPLc) (forty-two cells) and cerebellar thalamus (seventy-seven cells). 2. The majority (43/77, 56%) of cerebellar thalamic neurones fired phasically during movement, whereas in the motor cortex most neurones (53/84, 64%) had a phasic-tonic discharge pattern. Most neurones in both locations discharged in relation to the direction of movement (reciprocal pattern). 3. The cerebellar thalamus is unlike the motor cortex in that it does not usually encode a signal for force or joint position in its discharge. 4. Twenty-two per cent (17/77) of cerebellar thalamic neurones had a period of reduced discharge rate before the phasic burst of activity, and represent a pattern of discharge not seen in motor cortex or VPLc neurones. 5. The onset of phasic activity in the cerebellar thalamus was significantly later (average 94 ms) than in the motor cortex but occurred just before electromyogram (EMG) activity. The phasic activity in the cerebellar thalamus usually ended before the phasic component of motor cortex discharge was completed. 6. Phasic activity in VPLc neurones commenced after the onset of EMG discharge and on average 26 ms after the commencement of movement. Most neurones with deep sensory receptive fields fired with a reciprocal pattern, while neurones with cutaneous fields usually fixed bidirectionally in relation to the task. Almost one-third of neurones signalled force and a similar number had discharge levels that encoded characteristics of the joint position. 7. The duration of discharge of VPLc neurones during the voluntary movement was marginally less than the duration of the movement velocity peak and the VPLc may therefore be signalling the duration of the velocity. Phasic activity in cerebellar thalamic neurones fired for a duration similar to the VPLc neurones, but commenced before the movement. Therefore, if the cerebellar thalamus is carrying information about the duration of the velocity, it does so before the movement starts. 8. The phasic burst of activity in cells of the cerebellar thalamus is timed so that it can contribute to the later component of the phasic burst of motor cortical discharge. Thus we speculate that in skilled, ballistic movements, the cerebellum may provide a response which travels via the cerebellar thalamus and helps to determine the magnitude and duration of the phasic part of cortical discharge.(ABSTRACT TRUNCATED AT 400 WORDS)

1. Extracellular recordings were made in three monkeys while recording from neurones in the motor cortex (eighty-four cells), ventro-posterior lateralis pars caudalis (VPLc, forty-two cells) and cerebellar thalamus (seventy-seven cells). 2. This experiment was designed to produce active and reflex movements of varying velocities in order to study the relationship between amplitude of velocity and magnitude of neuronal discharge of thalamic neurones. The active movements were voluntary rapid alternating movements (RAMs) of the wrist and the reflex movements were produced by forcibly oscillating the wrist joint between frequencies of 1 and 7 Hz (forced oscillations). 3. This study was also designed to examine cerebellar influences on a reflex path, namely the transcortical reflex loop. Forced oscillations were predicted to provide circumstances where active damping was required to prevent excessive oscillations in the reflex path. Rapid alternating movements of the wrist were predicted to provide circumstances where oscillations at the natural frequency in that reflex path would support and propagate the movements. 4. Forced oscillations from 1 to 7 Hz produced movements of different velocities. VPLc and cerebellar thalamic neurones discharged in relation to the duration of movement in a particular direction, but their discharge levels were unrelated to the magnitude of the velocity. Motor cortex neurones fired in a pattern which was related to the timing but not the magnitude of the acceleration. 5. In forced oscillations of the wrist the resonant frequency was between 3 and 7 Hz. They may be controlled in part by a transcortical reflex. The cerebellar thalamic neurones did not fire before motor cortex neurones. Therefore, it is unlikely that the cerebello-thalamo-cortical pathway is necessary to damp these potentially unstable oscillations by an effect on antagonist-related cortical neurones. 6. Rapid alternating movements (RAMs) of monkeys' wrists were performed in a stereotyped fashion over a narrow range of frequencies with the greatest displacement in joint angle and peak velocity at the natural frequency of 3-5 Hz. 7. During the performance of RAMs, neuronal discharge modulated sinusoidally in the VPLc, cerebellar thalamus and motor cortex. There was no relationship between velocity and neuronal discharge of the cerebellar thalamic and motor cortical neurones but there did appear to be a relationship between velocity and VPLc neuronal discharge. 8. The onset of electromyogram (EMG) discharge changed earlier than neuronal discharge in the motor cortex and thalamus during the performance of RAMs.(ABSTRACT TRUNCATED AT 400 WORDS)

The uricosuric drug benzbromarone (3,5-dibromo-4-hydroxyphenyl)-1-(2-ethyl-3-benzofuranyl)methanone, a benzofurane derivative, was studied for its effects on parameters related to hepatic peroxisome proliferation. Groups of male F-344 rats were fed either basal diet, the peroxisome proliferator clofibrate at 5000 ppm as a comparison compound, or benzbromarone at two doses, 1000 and 2000 ppm. Benzbromarone and clofibrate produced hepatomegaly and increases in the activities of catalase, acyl CoA oxidase, malate dehydrogenase, and glycerol-3-phosphate dehydrogenase. Benzbromarone and clofibrate also both induced similar histologic and ultrastructural changes in hepatocytes, including induction of peroxisomes. Therefore, benzbromarone acted as a peroxisome-proliferating agent in rats under these conditions. Benzbromarone differs from other peroxisome proliferators in its chemical structure, uricosuric action, and the morphology of liver peroxisomes that were induced by exposure.

A technical grade of lactofen (1'[carboethoxy]ethyl 5-[2-chloro-4-[trifluoro-methyl] phenoxy]-2-nitrobenzoate) has been shown to induce liver tumors in mice. To determine a possible mechanism of action, the effect of exposure for 7 weeks to dietary concentrations of 2, 10, 50, and 250 ppm technical grade lactofen and 250 ppm of pure lactofen was studied for various liver parameters in groups of male and female CD-1 mice. Liver-weight to body-weight ratio, liver catalase, liver acyl-CoA oxidase, liver cell cytoplasmic eosinophilia, nuclear and cellular size, and peroxisomal staining were increased by the tumorigenic dose of lactofen, i.e., 250 ppm, in a fashion similar to the comparison chemical nafenopin (500 ppm), which is a peroxisome proliferator. Lower doses of lactofen that were reported as nontumorigenic had little or no effect on these parameters. Thus, pure and technical grade lactofen appear to induce murine liver tumors through a mechanism similar to epigenetic hepatocarcinogens of the peroxisome proliferating type.

A semiautomated system for spectrophotometric measurement of enzyme activity is described. In comparison to a 1-ml reaction volume monitored continuously by a conventional spectrophotometer, this system requires 1/10 to 1/100 the volume of sample, and 1/8 to 1/4 the time for measurement and computation of 96 enzyme assays. The system hardware consists of a 96-well platereader interfaced to a personal computer. Absorbances of 96 reactions are measured at timed intervals. These data are transmitted electronically from the platereader to the computer through the modem port using a modem program. The reaction rates are computed from the timed absorbance readings using a spreadsheet program. Three enzyme assays are presented, but the method has been used for several other assays and is applicable to many spectrophotometric rate assays. Many laboratories currently possess one or both of the two major components of the relatively inexpensive system described.

This report details a most unusual case of cystic cerebral metastasis. The patient developed symptoms due to carcinoid deposits in the brain. The clinical course has been protracted and the primary source of the carcinoid tumour remains unknown.

The effect of dietary exposures to peroxisome-proliferating, hypolipidemic agents on serum esterases was determined in rats and mice. Four genotypes of mice were fed nafenopin (1000 ppm) for six weeks and clofibrate (5000 ppm) was fed to young and aged rats for three weeks. The exposures significantly increased serum cholinesterase activity levels and decreased serum arylesterase activity levels in all groups of both species.

Enzyme activities relating to H2O2 production (peroxisomal acyl-CoA oxidase) and degradation (catalase and glutathione peroxidase) were measured in the livers of male mice of the inbred strains C57BL/6J (C57) and C3H/HeJ (C3H) and their F1 hybrid, B6C3F1. Groups of the three genotypes were maintained on either a basal diet or one containing 0.1% of the peroxisome-proliferating agent, nafenopin, for six weeks. In both control and nafenopin-exposed groups, the C57 strain displayed higher acyl-CoA oxidase activity levels than the C3H mice, whereas the activity levels of catalase and glutathione peroxidase were not different for the two inbred strains. The groups of similarly fed B6C3F1 hybrids had intermediate values for acyl-CoA oxidase. Several other parameters relating to peroxisome proliferation did not differ among the three genotypes. Acyl-CoA oxidase levels in cultured hepatocytes from C57 mice were greater than those in hepatocytes obtained from the C3H strain during two days in culture and this difference was maintained for 4 days by nafenopin exposure. Acyl-CoA oxidase is central to the hypothetical H2O2 mechanism of peroxisome proliferator-induced hepatocarcinogenesis and, therefore, the genetic difference documented here may lead to a useful approach in testing this hypothesis.

Hydrolysis and covalent binding to nonessential esterases are two biochemical processes which can prevent paraoxon from reacting with the essential enzyme, acetylcholinesterase. Both processes have been proposed as the primary route of paraoxon detoxification in vivo. These experiments were designed to assess the relative contribution of each pathway to the disappearance of paraoxon in the rabbit. In vitro, paraoxon disappeared from whole rabbit blood with a t 1/2 of 17.7 sec. Hydrolysis by paraoxonase (EC 3.1.1.2) accounted entirely for this disappearance and covalent binding contributed essentially nothing. In vivo, following an iv injection of 0.15 mg/kg paraoxon, serum paraoxonase hydrolyzed as much as 41% of the injected dose within the first 30 sec. Pretreatment of rabbits with an ip injection of tri-o-tolyl phosphate eliminated more than 95% of the paraoxon binding sites. However, pretreatment with tri-o-tolyl phosphate had no significant effect on the t 1/2 or volume of distribution of paraoxon, indicating that covalent binding sites did not contribute significantly to the clearance of paraoxon from whole rabbits under these conditions. Hydrolysis of paraoxon by tissue paraoxonases, in addition to that catalyzed by paraoxonase in the blood, could account for its rapid metabolism. These findings demonstrate that paraoxonase has a major role in the disappearance of paraoxon in the rabbit. This suggests that susceptibility of people to chronic paraoxon poisoning may vary, according to their inherited level and type of serum paraoxonase.

Spinal subdural abscess is a rare condition that is clinically similar to spinal epidural abscess. A case of spinal subdural abscess is reported, and the characteristic clinical findings and specific myelographic features in this patient are noted. Urgent myelography and surgery are necessary to prevent the rapid deterioration that often occurs in this condition.

A patient with severe end-stage Parkinson's disease and troublesome fluctuations in motor function was treated with a long-term intraventricular infusion of dopamine. There was modest improvement in speech and mentation and there was smoother control of motor symptoms that was superior to that achieved by conventional oral medications.

A case is reported of obstructive hydrocephalus secondary to the mass effect of a plaque of acute demyelination in the brainstem. The literature on the CT scan appearances in multiple sclerosis is briefly discussed in relation to this case.