A role for the cerebellum in motor-triggered alleviation of anxiety.

Physical exercise is known to reduce anxiety, but the underlying brain mechanisms remain unclear. Here, we explore a hypothalamo-cerebello-amygdalar circuit that may mediate motor-dependent alleviation of anxiety. This three-neuron loop, in which the cerebellar dentate nucleus takes center stage, bridges the motor system with the emotional system. Subjecting animals to a constant rotarod engages glutamatergic cerebellar dentate neurons that drive PKCδ+ amygdalar neurons to elicit an anxiolytic effect. Moreover, challenging animals on an accelerated rather than a constant rotarod engages hypothalamic neurons that provide a superimposed anxiolytic effect via an orexinergic projection to the dentate neurons that activate the amygdala. Our findings reveal a cerebello-limbic pathway that may contribute to motor-triggered alleviation of anxiety and that may be optimally exploited during challenging physical exercise.

Empirical Antibiotic Treatment in Diabetic Foot Infection: A Study Focusing on the Culture and Antibiotic Sensitivity in a Population From Southern China.

Diabetic foot and subsequent diabetic ulcer infections are the most devastating complication of diabetes. This study was conducted to explore the bacterial spectrum, sensitivity of microbials, and analysis of the empirical antibiotic regimens in our health center. The study included patients with diabetic foot ulcer infection (DFI) seen from 2009 to 2014. The patients included had all information covering the physical examination, laboratory tests, and image examinations. We sent appropriately obtained specimens for culture prior to starting empirical antibiotic therapy in all participants. A total of 312 patients were included: 52, 112, 95 and 53 patients within uninfected, mild, moderate, and severe infection groups. The total percentages of Gram-positive cocci (GPCs) and Gram-negative rods (GNRs) were 54% and 48.8% ( P = 0.63). The most common GPC was Staphylococcus aureus (22.4%) and GNR was Pseudomonas aeruginosa (11.9%). Methicillin-resistant Staphylococcus aureus was isolated from 21 patients (6.7%). Even in the mild infection group, there was no significant difference between GPC and GNR infection, irrespective of recent antibiotic use ( P = 0.053). The most frequently used empirical antibiotics in our center were second-/third-generation cephalosporin ± clindamycin, both in the mild and moderate/severe infection groups. In our center, the amoxicillin/clavulanate or ampicillin/sulbactam (ß-L-ase 1) and second-/third-generation cephalosporins were highly resistant to the common GNR (30%-60%). The ticarcillin/clavulanate, piperacillin/tazuobactam (ß-L-ase 2), fluoroquinolone, and group 2 carbapenem had good sensitivity. This study presents a comprehensive microbiological survey of diabetic foot ulcers in inpatients and provides reliable evidence of the local microbial epidemiology and sensitivity of antibiotics, which may help us improve clinical outcomes in DFI patients.

Prevention of macrovascular disease in patients with short-duration type 2 diabetes by multifactorial target control: an 8-year prospective study.

A longitudinal prospective study was undertook to investigate the effect of multifactorial target control, recommended by the American Diabetes Association (ADA), on macrovascular disease in patients with short-duration type 2 diabetes. Patients who were newly diagnosed with type 2 diabetes or within 1 year and had no previous vascular diseases or atherosclerosis plaques were enrolled in the present study. All patients received multifactorial intervention, with pharmacologic therapy targeting hyperglycemia, hypertension, dyslipidemia, along with secondary prevention of vascular disease with aspirin when necessary according to the ADA recommendation. Patients were followed up for 8 years (2002-2010). The ultrasounds of arteries (carotid, iliac and femoral arteries) were measured every year. The primary endpoint was the time to the first occurrence of atherosclerosis plaques of the arteries. The second endpoint was clinical evidence of cardiovascular diseases. One hundred and forty-three patients were recruited, and the mean age was 50 (6.92) years. During the study, atherosclerosis plaques occurred in 49 patients. Systolic blood pressure less than 130 mmHg [hazard ratio (HR), 0.236; 95 % confidence interval (CI) 0.076-0.734; P = 0.013] and fasting plasma glucose less than 7 mmol/l (HR, 0.457; 95 % CI 0.210-0.994; P = 0.048) were significantly associated with decreased onset of atherosclerosis plaques. Simultaneous target control of systolic blood pressure and fasting plasma glucose reduced the risk of atherosclerosis plaques by 18 % (P = 0.097) and cardiovascular diseases by 16 % (P = 0.046). Multifactorial target treatment in patients with short-duration type 2 diabetes can effectively reduce the risk of macrovascular complications.

A novel "in-situ tulip-bud deployment" method for transcatheter closure of secundum atrial septal defect.

OBJECTIVE: We devised a new technique for interventional closure of atrial septal defect (ASD) using the Amplatzer Septal Occluder (ASO), and validated this by comparing it with a cohort using the conventional method. BACKGROUND: Transcatheter closure of ASD is a widely accepted modality of treatment. Although the outcome is good, there are occasional technical difficulties encountered. METHOD: In this three-step technique, the device is protruded to form a "tulip bud." This "tulip bud" is then aligned adjacent to and along the plane of the ASD. The second step involves withdrawing the sheath in quick succession to deploy atrial discs over the septal defect. Finally, good placement of the occluder is checked before release. RESULTS: Twenty-seven consecutive patients (1.4-77.2 years of age, median = 15) underwent device closure by this method. Nineteen (70.4%) had a deficient aortic rim (< 5 mm). Mean (+/- SD) ASD size by transesophageal echocardiography (TEE) was 16.0 +/- 5.1 mm. The chosen ASO size was 122 +/- 8% of the ASD size. The mean (+/- SD) duration of deployment and of deployment to release was 1.27 +/- 1.91 minutes and 5.18 +/- 2.63 minutes, respectively. The total fluoroscopy and procedure time was 9.93 +/- 5.61 minutes and 68.67 +/- 28.39 minutes, respectively. Twenty-one out of 27 patients (77.8%) had closure in one attempt. Comparing these 27 patients with the previous 48 consecutive patients with a deficient aortic rim by the conventional method, there was no difference in age, body weight, Qp/Qs, ASD size and ASO size or degree of oversizing (p > 0.05). The percentage of patients with aortic root deficiency was slightly higher in "tulip-bud" group compared to the conventional group (63.2% vs. 58.4%; p = 0.039). No complications were observed in either series. CONCLUSION: This is a promising new method to circumvent some of the difficulties associated with closure of large ASDs and deficient aortic rim.