Distribution and projection pattern of motoneurons that innervate hindlimb muscles in the quail.

We characterized the motoneuron pool positions and projection patterns in the embryonic quail hindlimb and compared them to those in the chick to determine the degree of similarity and to form a baseline for future chimeric experiments. We find that the most similar parameters of pool position correlate with the major axonal pathway choices. First, the medial-lateral pool position, which is highly conserved among birds and mammals, is identical in the quail and chick and correlates with the dorsal-ventral pathway choice, the first and least plastic of the choices within the limb. Second, although quail pools were known to be compressed into seven rather than eight segments, we show that the map of pools is compressed about a central point (segment three) that preserves the spatial relationships between anterior pools and the crural plexus, and between posterior pools and the sciatic plexus. Access to guidance cues that are restricted to each plexus region is thus maintained between species. Third, pool position along the anterior-posterior axis is the least similar parameter between species. In fact, the entire lumbosacral motor complex may shift by +/- half a segment in individual quail. Despite the consequent differences in segmental projections, the specific projection pattern within each quail hindlimb is identical to that in the chick. There is no need to preserve the exact segmental pattern either phylogenetically or during development, because motoneurons accommodate to modest variations in their position along the anterior-posterior axis by sorting out at the limb base. The contrast between variable segmental and constant limb projections also demonstrates that neither the specification nor the precise projection of motoneurons is dependent upon the specification or development of somites.

Tyrosine hydroxylase and neuropeptide Y are increased in ciliary ganglia of sympathectomized rats.

We have examined the expression of tyrosine hydroxylase and neuropeptide Y in ciliary ganglia of normal adult rats and of adult rats in which the environment of these neurons was altered by sympathectomy at birth. Following neonatal 6-hydroxydopamine treatment, the proportion of tyrosine hydroxylase-immunoreactive and neuropeptide Y-immunoreactive neurons in ciliary ganglia was significantly increased. In ciliary neurons of both control and sympathectomized rats, neuropeptide Y immunoreactivity was preferentially co-localized with tyrosine hydroxylase. Immunoblot analysis confirmed the presence of tyrosine hydroxylase and its increase following sympathectomy. In situ hybridization studies revealed that many ciliary neurons contain mRNA for tyrosine hydroxylase and for neuropeptide Y. Like tyrosine hydroxylase immunoreactivity, the number of ciliary neurons containing tyrosine hydroxylase mRNA and the amount of mRNA per cell were increased in 6-hydroxydopamine-treated rats. In contrast, neuropeptide Y mRNA levels were the same in control and 6-hydroxydopamine-treated rats. Nerve growth factor is a candidate for mediating the effects of sympathectomy and most ciliary neurons in control and sympathectomized rats expressed immunoreactivity for the low-affinity nerve growth factor receptor. In addition, ciliary neurons from 6-hydroxydopamine-treated animals possessed increased nerve growth factor receptor immunoreactivity. These studies indicate that both tyrosine hydroxylase and neuropeptide Y in the ciliary ganglion are regulated by alterations in their environment. Their expression was enhanced by chemical sympathectomy which does not affect ciliary neurons directly but, rather, removes sympathetic innervation of shared targets, including the iris. In situ hybridization analysis suggests that the increased tyrosine hydroxylase and neuropeptide Y levels result from different mechanisms and provides evidence that neuropeptide levels can be regulated without changes in mRNA levels.

Umbilical artery Doppler velocimetry as a predictor of fetal hypoxia and acidosis at birth.

We studied the relationship between preoperative umbilical artery Doppler waveforms and umbilical vein pO2 and pH at elective cesarean section. An absence of end-diastolic velocities had a strong statistical association with hypoxia and acidosis, and was an accurate clinical test for hypoxia (sensitivity 78%, specificity 98%, positive predictive value 88%, and negative predictive value 98%) and acidosis (sensitivity 90%, specificity 92%, positive predictive value 53%, and negative predictive value 100%). It was also a clinically sensitive indicator of perinatal morbidity and mortality. Most fetuses with no end-diastolic velocities were growth-retarded, but the reverse was not true. The absence of end-diastolic velocities also divided both mature and immature fetuses into high- and low-risk groups for hypoxia and acidosis. In the presence of end-diastolic velocities, only very high S/D ratios (above 4.5) have any association with hypoxia. As a noninvasive test of fetal umbilical vein pO2 and pH, umbilical artery Doppler performs well.

Sinuatrial disease causing persistent fetal bradycardia: intrauterine detection and management.

We report a case of sustained sinus bradycardia, detected at 32 weeks gestation and confirmed by echocardiography, where emergency caesarian section was avoided by demonstration of normal intrauterine cord blood pH and oxygen tension. Delivery at 37 weeks produced a healthy girl who required no resuscitation. The bradycardia persisted and, in the absence of structural heart disease, was attributed to sinuatrial disease. Persistent fetal sinus bradycardia is not necessarily an indication for urgent delivery.

X-ray crystal spectrometer upgrade for ITER-like wall experiments at JET.

The high resolution X-Ray crystal spectrometer at the JET tokamak has been upgraded with the main goal of measuring the tungsten impurity concentration. This is important for understanding impurity accumulation in the plasma after installation of the JET ITER-like wall (main chamber: Be, divertor: W). This contribution provides details of the upgraded spectrometer with a focus on the aspects important for spectral analysis and plasma parameter calculation. In particular, we describe the determination of the spectrometer sensitivity: important for impurity concentration determination.

Simulation of electron paramagnetic resonance spectra of spin-labeled molecules from replica-exchange molecular dynamics.

We report a general approach for the simulation of the electron paramagnetic resonance (EPR) spectra of spin labels attached to peptides and proteins directly from replica-exchange molecular dynamics (REMD) trajectories. Conventional MD trajectories are generally inadequate for the prediction of EPR line shapes since the label can become trapped in one or more of a set of rotameric states, thus preventing both conformational sampling and accurate estimates of the exchange rates between different rotamers. The advantage of using REMD is its ability to provide both efficient conformational sampling and kinetic information for spin-label dynamics. Our approach is illustrated with spin-labeled peptide. This approach to REMD-EPR simulation paves the way for the wider application of MD modeling to the simulation and interpretation of EPR spectra of spin-labeled molecules.

Enhancements to the JET poloidally scanning vacuum ultraviolet∕visible spectrometers.

Enhancements to the JET poloidally scanning spectrometers are presented, which will aid the exploitation of the recently installed ITER-like wall in JET. They include the installation of visible filter∕photomultiplier tube assemblies and spectrometers and the replacement of large rotating mirrors in the JET vacuum with small oscillating mirrors outside. The upgrade has resulted in a more robust and reliable diagnostic than before, which is described. Drifts in the mirror angle reconstructed from quadrature encoder signals are found, a reference signal being required. The use of the small scanning mirrors necessitated the inclusion of focusing mirrors to maintain throughput into the vacuum ultraviolet spectrometers. The mirror design has taken account of the extreme sensitivity of the focusing to the grazing angle of incidence, an aspect of importance in the design of grazing incidence focusing components on future machines, such as ITER. The visible system has been absolutely calibrated using an in-vessel light source.

Disruption of target interactions prevents the development of enkephalin immunoreactivity in sympathetic neurons.

We compared the development of enkephalin (Enk) expression in normal rats and rats in which target contact was transiently disrupted with 6-hydroxydopamine (6-OHDA). During the first 3 postnatal weeks, there was a striking increase in Enk immunoreactivity (-IR) in superior cervical ganglia (SCG) assayed by radioimmunoassay (RIA). This increase was correlated with the appearance of Enk-IR in postganglionic neurons. In the caudal region of the SCG, the proportion of Enk-IR neurons and their immunoreactivity increased until one-third of the neurons possessed Enk-IR between postnatal days (P) 14 and 21. After P21, the number of Enk-IR neurons and their immunofluorescence decreased. By 6 weeks, only occasional neurons possessed moderate Enk-IR. The increases in Enk-IR were correlated with increased ganglionic proenkephalin A mRNA detected by in situ hybridization. The decrease in IR after P21 was not, however, paralleled by a comparable decrease in proenkephalin A mRNA. To determine whether interactions between SCG neurons and their target tissues influence Enk expression, we disrupted them by treating neonatal rats with a single dose of 6-OHDA at P0. This treatment transiently reduced sympathetic fiber density in the submandibular gland, one target of Enk-IR neurons, over 90%. Two weeks later, the fiber density in glands of treated animals was not different from control. Following 6-OHDA, the concentration of Enk-IR in SCG extracts and the number of Enk-IR neurons and their immunofluorescence intensity failed to increase. SCG from treated rats also contained fewer neurons with proenkephalin A mRNA. In contrast, the content of neuropeptide Y (NPY) and the proportion of NPY-IR neurons were not decreased by 6-OHDA treatment. Our results indicate that the developmental history of Enk expression differs from that of other neuropeptides in rat sympathetic ganglia, suggesting that distinct mechanisms regulate the expression of individual neuropeptides. Further, they provide evidence that target contact during a critical period is important for the induction of Enk.

The appearance of NPY and VIP in sympathetic neuroblasts and subsequent alterations in their expression.

Mature sympathetic neurons contain one or more neuropeptides in addition to a classical neurotransmitter. We compared the development of two peptides, neuropeptide Y (NPY) and vasoactive intestinal peptide (VIP), in rat superior cervical (SCG) and stellate ganglia. NPY immunoreactivity (-IR) was first detected at embryonic day (E) 12.5. It was of similar immunofluorescence intensity in almost all tyrosine hydroxylase (TH)-IR cells. In contrast, VIP-IR, of variable fluorescence intensity, appeared at E14.5 in a subset of TH-IR cells in the stellate ganglion but not in SCG. Both peptides were present in bromodeoxyuridine-labeled neuronal precursors as well as neurons. The intensity of NPY immunofluorescence increased until E16.5. Subsequently, while it continued to increase in some neurons, the intensity decreased in others so that at birth approximately 55% of SCG and stellate neurons were NPY-IR. Developmental changes in NPY concentration, determined by radioimmunoassay, were similar in both ganglia, increasing between E14.5 and E16.5 and then decreasing 60% between E16.5 and birth. VIP expression differed from that of NPY. The proportion of VIP-IR cells began to decrease the day after VIP-IR was first detected. Although VIP-IR was present in one-third of E14.5 TH-IR stellate cells, at birth only 2% were VIP-IR. VIP-IR, measured by radioimmunoassay, was uniformly severalfold more concentrated in the stellate than SCG, and its concentration decreased throughout embryonic development, 40% between E14.5 and E16.5 and 95% by birth. In situ hybridization revealed detectable mRNA for both NPY and VIP at E14.5 in stellate ganglion and mRNA for NPY, but not VIP, in SCG. Initially, ganglionic neuropeptide mRNA appeared uniformly distributed but became heterogeneous. Our data indicate that features of the diverse peptidergic phenotypes expressed by sympathetic neurons are present when peptides are first detected while others arise subsequently. The final acquisition of peptidergic phenotypic diversity is complex, entailing both early induction in many cells and subsequent restriction to specific subpopulations.

Effects of ciliary neurotrophic factor (CNTF) and depolarization on neuropeptide expression in cultured sympathetic neurons.

We examined the effects of ciliary neurotrophic factor (CNTF) and depolarization, two environmental signals that influence noradrenergic and cholinergic function, on neuropeptide expression by cultured sympathetic neurons. Sciatic nerve extract, a rich source of CNTF, increased levels of vasoactive intestinal peptide (VIP), substance P, and somatostatin severalfold while significantly reducing levels of neuropeptide Y (NPY). No change was observed in the levels of leu-enkephalin (L-Enk). These effects were abolished by immunoprecipitation of CNTF-like molecules from the extract with an antiserum raised against recombinant CNTF, and recombinant CNTF caused changes in neuropeptide levels similar to those of sciatic nerve extract. Alterations in neuropeptide levels by CNTF were dose-dependent, with maximal induction at concentrations of 5-25 ng/ml. Peptide levels were altered after only 3 days of CNTF exposure and continued to change for 14 days. Depolarization of sympathetic neuron cultures with elevated potassium elicited a different spectrum of effects; it increased VIP and NPY content but did not alter substance P, somatostatin, or L-Enk. Depolarization is known to block cholinergic induction in response to heart cell conditioned medium and we found that it blocked the induction of choline acetyltransferase (ChAT) and peptides by recombinant cholinergic differentiation factor/leukemia inhibitory factor (CDF/LIF). In contrast, it did not antagonize the effects of CNTF on either ChAT activity or neuropeptide expression. Thus, while CNTF has effects on neurotransmitter properties similar to those previously reported for CDF/LIF, the actions of these two factors are differentially modulated by depolarization, suggesting that the mechanisms of cholinergic and neuropeptide induction for the two factors differ. In addition, in contrast to CDF/LIF, CNTF did not alter levels of ChAT, VIP, substance P, or somatostatin in cultured dorsal root ganglion neurons. These observations indicate that CNTF and depolarization affect the expression of neuropeptides by sympathetic neurons and provide evidence for an overlapping yet distinct spectrum of actions of the two neuronal differentiation factors, CNTF and CDF/LIF.

Should maternal alpha-fetoprotein estimation be carried out in centers where ultrasound screening is routine? A sensitivity analysis approach.

We describe a case of small, open spina bifida that was detected on the basis of maternal serum alpha-fetoprotein levels but consistently missed on careful ultrasound examination. This prompted us to reexamine the policy (adopted by an increasing number of departments) of relying exclusively on ultrasound examination for the detection of spinal lesions. In this article we therefore analyze the number of additional cases of spina bifida that could be detected by offering maternal serum alpha-fetoprotein screening in addition to a routine ultrasound examination. Our calculations are made on the basis of published assessments of the performance of these tests and on the assumptions about test independence. We test our conclusions against a wide variety of test performance values in a detailed sensitivity analysis. The final decision to carry out maternal serum alpha-fetoprotein testing is a value judgment, but this decision should be based on realistic numeric estimates of the potential benefits and hazards of this procedure.

Pressure amplification explains why pulse pressure is unrelated to risk in young subjects.

Pulse pressure rather than diastolic pressure is the best predictor of coronary heart disease risk in older subjects, but the converse is true in younger subjects. We hypothesized that this disparity results from an age-related difference in pressure amplification from the aorta to brachial artery. Data from 212 subjects age < 50 years and 230 subjects age > or =50 years were abstracted from a community database. All subjects were free from cardiovascular disease, diabetes, and medication. Peripheral blood pressure was assessed by sphygmomanometry. Radial artery waveforms recorded noninvasively by applanation tonometry were used to derive central blood pressure. Pressure amplification (peripheral/central pulse pressure ratio) was linearly related to age (r=0.7; P<0.001). There was an inverse, linear relationship between amplification and diastolic pressure in the younger group (r=0.3; P<0.001) but not in older subjects (r=0.1; P=0.2). There was no relationship in either group when the amplification ratio was calculated with nonaugmented central pressure. Amplification is reduced in older subjects because of enhanced wave reflection. In younger, but not older, subjects, amplification declines as diastolic pressure rises. Therefore, peripheral pulse pressure underestimates the effect that diastolic pressure has on central pulse pressure in younger subjects. This may explain why diastolic pressure is a better predictor of risk in this age group and suggests that assessment of central pressure may improve risk stratification further.

Randomized comparison of routine vs highly selective use of Doppler ultrasound and biophysical scoring to investigate high risk pregnancies.

OBJECTIVE: To compare routine versus highly selective use of Doppler ultrasound and biophysical scoring in higher risk pregnancy. DESIGN: A pragmatic randomized trial. SETTING: St James's University Hospital, Leeds. SUBJECTS: 500 pregnant women at high risk of intrauterine growth retardation or still birth. INTERVENTIONS: Regular monitoring with biophysical profile assessment and Doppler velocity waveform recording in umbilical and uteroplacental arteries. Results immediately available to clinicians. MAIN OUTCOME MEASURES: Gestational age at delivery, obstetric intervention rates and short-term neonatal morbidity. RESULTS: Risk factors were distributed very evenly between the 250 patients in the study and control groups respectively. A total of 902 biophysical profile and Doppler assessments were done in the 250 study group patients and only in 12 patients in the control group. In the study group, absent end-diastolic flow was found in only 2.7% of all 902 measurements. A persistently abnormal biophysical score was always associated with absence of end-diastolic flow. The mean gestational age at induction of labour was statistically and clinically similar in the two groups and there was no overall statistically significant difference in intervention rates between the two groups. There was a statistically significant lower frequency of depressed 5-min Apgar scores in the study group. Serious neonatal morbidity was also statistically significantly more common in the control group than in the study group. CONCLUSIONS: The use of Doppler ultrasound in higher risk pregnancies does not lead to an increase in iatrogenic preterm delivery. The total rate of positive tests on Doppler ultrasound is very low and persistently abnormal biophysical scores are unlikely to be found in patients where umbilical end-diastolic blood flow is present. Surrogate measures for fetal damage seem to be improved when clinicians have access to Doppler ultrasound assessments.

Inconsistencies in clinical decisions in obstetrics.

Analysis of the increasing incidence of caesarean section in an English teaching hospital over a 15-year period revealed that emergency caesarean section for the diagnosis of fetal distress in labour made a major contribution to this increasing trend. A retrospective audit of a sample of these operations by the consultants of the hospital indicated that 30% of the operations were unnecessary. There were two other disturbing findings in our audit. First, there was significant disagreement between auditors in the decision whether to do a caesarean section or not. Second, and perhaps more importantly, when faced with identical information at a different time, the auditors were inconsistent in 25% of cases. The disturbing clinical situation highlighted by this study may have implications for medical jurisprudence.