Quantifying inter-individual anatomical variability in the subcortex using 7 T structural MRI.

Functional magnetic resonance imaging (MRI) data are usually registered into standard anatomical space. However, standard atlases, such as LPBA40, the Harvard-Oxford atlas, FreeSurfer, and the Jülich cytoarchitectonic maps all lack important detailed information about small subcortical structures like the substantia nigra and subthalamic nucleus. Here we introduce a new subcortical probabilistic atlas based on ultra-high resolution in-vivo anatomical imaging from 7 T MRI. The atlas includes six important but elusive subcortical nuclei: the striatum, the globus pallidus internal and external segment (GPi/e), the subthalamic nucleus, the substantia nigra, and the red nucleus. With a sample of 30 young subjects and carefully cross-validated delineation protocols, our atlas is able to capture the anatomical variability within healthy populations for each of the included structures at an unprecedented level of detail. All the generated probabilistic atlases are registered to MNI standard space and are publicly available.

Evidence for Distinct Forms of Compulsivity in the SAPAP3 Mutant-Mouse Model for Obsessive-Compulsive Disorder.

The specific mechanisms underlying compulsive behavior in obsessive-compulsive disorder (OCD) are unknown. It has been suggested that such compulsivity may have its origin in cognitive dysfunction such as impaired processing of feedback information, received after the completion of goal-directed actions. The signal attenuation (SA) task models such a processing deficit in animals by attenuating the association strength between food reward and audiovisual feedback (signal) presented after performance of an operant response. The compulsive-like responding resulting from SA is well characterized in rats, but was so far not established in mice, a species for which powerful genetic OCD models exist. Thus, first, we demonstrate that the SA task can be implemented in mice and show that attenuation of reward-associated response feedback produces similar behavior in C57BL/6 mice as previously reported in rats. Second, we tested the hypothesis that SAPAP3 knock-out mice (SAPAP3-/-), prone to exhibit several OCD-like abnormalities including excessive grooming, show enhanced compulsive-like behavior in the SA task compared with their wild-type (WT) littermates. However, task-related compulsivity measures in SAPAP3-/- and WT did not yield significant differences, neither following SA nor during "regular" extinction of operant behavior. Thus, compulsive-like instrumental behavior following feedback distortion was not potentiated in compulsively grooming mice, implicating specifically that (1) a general deficit in feedback processing is not related to excessive grooming in SAPAP3-/- and (2) different manifestations of compulsivity may be driven by independent mechanisms.

Enhancing the family medicine curriculum in deliveries and emergency medicine as a way of developing a rural teaching site.

BACKGROUND: The urban family practice residencies of Memphis were not providing sufficient training or encouragement to young physicians for practice in rural communities. METHODS: In 1990, the Department of Family Medicine, in partnership with the State of Tennessee Health Access Act and the Baptist Health Care System, developed a teaching practice in a rural county of western Tennessee. The family practice curriculum included special skills in advanced women's health care and emergency medicine so that uniformly trained physicians could provide around-the-clock coverage in the hospital, including the delivery of babies and first-hour emergency care. RESULTS: After 7 years, the group now includes six full-time board-certified, OB-capable family physicians. In addition, faculty members from the department's urban program in Memphis are required to contribute a "mini locum tenens" of 2-3 days of rural coverage per month. Since 1992, the practice has provided care for more than 54,000 continuity office visits, 81,000 emergency department visits, more than 3,500 hospital admissions, and 621 obstetrical deliveries. Since 1994, residents have been assigned to the site full time, with growth to 12 (4-4-4) residents assigned to this location as of 1997. Several graduates from the initial group of residents have remained in the community after graduation, and three others have established practices in rural areas. Most recently, control of the practice is being transferred from the family medicine department to the university's corporate group practice. This may result in fundamental changes in the practice's operation. CONCLUSIONS: The approach described in this report may be useful for the expansion of urban departments of family medicine into rural and underserved communities.

Lymphogranuloma venereum vs. incarcerated inguinal hernia: the Gordian knot unraveled.

A 33-year-old woman presented with a two-day history of left inguinal pain and a palpable "knot." She was suspected of having an incarcerated inguinal hernia but instead was found to have lymphogranuloma venereum. The diagnosis is typically made from a history and physical examination, but may be supported by serologic complement fixation studies or by testing of lesion aspirates using immunofluorescent antibody testing.

Accidental veterinary antibiotic injection into a farm worker.

A 29-year-old white male farm worker accidentally injected tilmicosin, a bovine antibiotic, into his finger. He developed temporary pulmonary, gastrointestinal, and neuromuscular symptomatology and a more persistent subjective asthenia.

Commotio cordis: clinical implications of blunt cardiac trauma.

Blunt cardiac trauma can result not only in major structural impairments but also in subtle derangements without an apparent organic defect. Cardiac dysrhythmias, including ventricular fibrillation and sudden cardiac arrest, can occur in both cardiac contusion and cardiac concussion (commotio cordis) and may be fatal. The true incidence of these nonstructural cardiac injuries is unknown. Continuous electrocardiographic monitoring, assessment of cardiac troponin I and transesophageal echocardiograms are important aids in the evaluation of cardiac contusion and concussion.