Ultradian rhythmicity of plasma cortisol is necessary for normal emotional and cognitive responses in man.

Glucocorticoids (GCs) are secreted in an ultradian, pulsatile pattern that emerges from delays in the feedforward-feedback interaction between the anterior pituitary and adrenal glands. Dynamic oscillations of GCs are critical for normal cognitive and metabolic function in the rat and have been shown to modulate the pattern of GC-sensitive gene expression, modify synaptic activity, and maintain stress responsiveness. In man, current cortisol replacement therapy does not reproduce physiological hormone pulses and is associated with psychopathological symptoms, especially apathy and attenuated motivation in engaging with daily activities. In this work, we tested the hypothesis that the pattern of GC dynamics in the brain is of crucial importance for regulating cognitive and behavioral processes. We provide evidence that exactly the same dose of cortisol administered in different patterns alters the neural processing underlying the response to emotional stimulation, the accuracy in recognition and attentional bias toward/away from emotional faces, the quality of sleep, and the working memory performance of healthy male volunteers. These data indicate that the pattern of the GC rhythm differentially impacts human cognition and behavior under physiological, nonstressful conditions and has major implications for the improvement of cortisol replacement therapy.

Continuous Free Cortisol Profiles-Circadian Rhythms in Healthy Men.

CONTEXT: The pituitary-adrenal axis had historically been considered a representative model for circadian rhythms. A recently developed portable collection device has provided the opportunity to evaluate free cortisol profiles using the microdialysis approach in individuals free to conduct their day-to-day activities in their own surroundings. METHODS: Two separate experiments were conducted in healthy male volunteers. The total and subcutaneous (SC) free cortisol levels were measured at 10-minute intervals for a 24-hour period in one experiment, and the SC free cortisol levels were measured at 20-minute interval for 72 consecutive hours in free-living individuals in the second experiment. RESULTS: The characteristic circadian rhythm was evident in both serum total and SC free cortisol, with the lowest levels achieved and maintained in the hours surrounding sleep onset and the peak levels occurring in every individual around waking. In all free-living individuals, the circadian rhythm was consistent across the 72-hour period, despite a wide range of activities. All the participants also showed increased cortisol after the consumption of lunch. The lowest levels during all 24-hour periods were observed during the hours after lights off, at the onset of sleep. CONCLUSIONS: To the best of our knowledge, the present study is the first to report up to three consecutive 24-hour measurements of SC free cortisol in healthy individuals. We believe our study is a landmark study that paves the way for ambulatory monitoring of free cortisol profiles continuously for a period of 72 hours in free-living individuals performing their day-to-day activities whether healthy or with diseases involving the hypothalamic-pituitary-adrenal axis.

Experimental Nipah virus infection in pteropid bats (Pteropus poliocephalus).

Seventeen grey-headed fruit bats (Pteropus poliocephalus) were inoculated subcutaneously with an isolate of Nipah virus derived from a fatally infected human. A control group of eight guinea-pigs was inoculated intraperitoneally with the same isolate in order to confirm virulence. Three of eight infected guinea-pigs developed clinical signs 7-9 days post-inoculation. Infected fruit bats developed a subclinical infection characterized by the transient presence of virus within selected viscera, episodic viral excretion and seroconversion. A range of histopathological changes was observed within the tissues of infected bats. Nipah virus was excreted in bat urine while neutralizing antibody was present in serum. This intermittent, low-level excretion of Nipah virus in the urine of bats may be sufficient to sustain the net reproductive value of the virus in a species where there is regular urine contamination of the fur, mutual grooming, and where urine droplets are a feature of the environment.

The importance of biological oscillators for hypothalamic-pituitary-adrenal activity and tissue glucocorticoid response: coordinating stress and neurobehavioural adaptation.

The hypothalamic-pituitary-adrenal (HPA) axis is critical for life. It has a circadian rhythm that anticipates the metabolic, immunoregulatory and cognitive needs of the active portion of the day, and retains an ability to react rapidly to perceived stressful stimuli. The circadian variation in glucocorticoids is very 'noisy' because it is made up from an underlying approximately hourly ultradian rhythm of glucocorticoid pulses, which increase in amplitude at the peak of circadian secretion. We have shown that these pulses emerge as a consequence of the feedforward-feedback relationship between the actions of corticotrophin hormone (ACTH) on the adrenal cortex and of endogenous glucocorticoids on pituitary corticotrophs. The adrenal gland itself has adapted to respond preferentially to a digital signal of ACTH and has its own feedforward-feedback system that effectively amplifies the pulsatile characteristics of the incoming signal. Glucocorticoid receptor signalling in the body is also adapted to respond in a tissue-specific manner to oscillating signals of glucocorticoids, and gene transcriptional and behavioural responses depend on the pattern (i.e. constant or pulsatile) of glucocorticoid presentation. During major stressful activation of the HPA, there is a marked remodelling of the pituitary-adrenal interaction. The link between ACTH and glucocorticoid pulses is maintained, although there is a massive increase in the adrenal responsiveness to the ACTH signals.

Comparison of ceftriaxone with cefotaxime in serious chest infections.

Ceftriaxone is a new, third-generation cephalosporin that, because of its long half-life, offers potential advantages of cost and convenience over similar agents such as cefotaxime. We compared the two drugs in a prospective, randomized study of the treatment of chest infections in seriously ill patients. Fifty-one patients (90 percent of whom were mechanically ventilated) received either ceftriaxone, 2g IV once daily, or cefotaxime, 2 g IV thrice daily, for five days. The two groups of patients appeared demographically comparable. Ceftriaxone in a single daily dose of 2 g once daily may not be satisfactory for the treatment of serious chest infections.

Immunohistochemistry in the identification of a number of new diseases in Australia.

Immunohistochemistry plays an important part in the diagnosis of some viral diseases. Demonstration of viral antigen in a lesion is an important contribution to diagnosis, either at the time of investigation or retrospectively. At the CSIRO Australian Animal Health Laboratory, the most frequent use of immunohistochemistry has been in the diagnosis of the important avian diseases, highly pathogenic avian influenza and Newcastle disease. The technology took key roles in the diagnoses of Hendra virus infections, and, later, an immunoperoxidase test gave the first indication of the existence of Australian bat lyssavirus. The test can often confirm that a virus isolated in an animal is the actual virus causing disease and not a coincidental isolation. Good examples of that in some more new diseases were the association of Wallal virus with blindness in kangaroos, and of the new porcine Menangle virus in natural and experimental cerebral disease in foetal piglets.

Rapid diagnosis of highly pathogenic avian influenza using pancreatic impression smears.

The 1985 outbreak of high-pathogenicity avian influenza (HPAI) in Victoria, Australia, took 5 days to confirm by standard laboratory tests, during which time infected chickens continued excreting virus, thus creating the opportunity for transmission to other farms. An immunofluorescence test for the detection of viral antigen in tissue impression smears was evaluated as a rapid diagnostic test for HPAI virus infections of poultry. Several test configurations were compared for background reactions and strength of fluorescence, with the optimum combination found to be an influenza A group-specific monoclonal antibody, detected by an anti-mouse fluorescein isothiocyanate conjugate. Immunohistochemical examination of tissues from chickens experimentally infected with low-pathogenicity and HPAI viruses identified the pancreas as the organ most consistently containing high concentrations of HPAI viral antigen. This test has since been used in Australia in the rapid laboratory confirmation of three avian influenza outbreaks and in showing that numerous other suspect cases were not caused by avian influenza.

Experimental Nipah virus infection in pigs and cats.

A human isolate of Nipah virus from an outbreak of febrile encephalitis in Malaysia that coincided with a field outbreak of disease in pigs was used to infect eight 6-week-old pigs orally or subcutaneously and two cats oronasally. In pigs, the virus induced a respiratory and neurological syndrome consistent with that observed in the Malaysian pigs. Not all the pigs showed clinical signs, but Nipah virus was recovered from the nose and oropharynx of both clinically and sub-clinically infected animals. Natural infection of in-contact pigs, which was readily demonstrated, appeared to be acute and self-limiting. Subclinical infections occurred in both inoculated and in-contact pigs. Respiratory and neurological disease was also produced in the cats, with recovery of virus from urine as well as from the oropharynx. The clinical and pathological syndrome induced by Nipah virus in cats was comparable with that associated with Hendra virus infection in this species, except that in fatal infection with Nipah virus there was extensive inflammation of the respiratory epithelium, associated with the presence of viral antigen. Viral shedding via the nasopharynx, as observed in pigs and cats in the present study, was not a regular feature of earlier reports of experimental Hendra virus infection in cats and horses. The findings indicate the possibility of field transmission of Nipah virus between pigs via respiratory and oropharyngeal secretions.

The attitudes and experience of community dental officers in Northern Ireland in treating disabled people.

The views of community dental officers working in Northern Ireland were obtained concerning the difficulties they experience in treating disabled people. A closed questionnaire was used and a response rate of 84 per cent was achieved (60 officers). Thirty-seven per cent of the officers had received postgraduate training in this area. Lack of experience and knowledge concerning the treatment of the disabled was the commonest reason for not offering comprehensive dental care. Emotional upset and embarrassment or the length of time for treatment were the least cited. One-fifth perceived no barriers, a slight majority indicated two or less and only two officers indicated more than five. Those who were qualified ten years or longer, had greater difficulty than the more recently qualified in providing treatment for mentally and physically disabled children and medically compromised patients.

A study of the barriers to dental care in a sample of patients with cerebral palsy.

The study examined the potential barriers to dental care for a selected sample of 57 adults suffering from cerebral palsy. The majority (60 per cent) were regular dental attenders and they received dental care in general dental practice and community dental practice in almost equal numbers. Those with mobility or communication difficulties were significantly more likely to attend the community or hospital dental services (P < 0.05). Their most common perceived barriers to dental care were fear, the need to be accompanied and negative attitudes, while cost was a rarely stated barrier. A dislike of dental treatment was significantly related to irregular attendance (P < 0.05) but neither anxiety nor the need to be accompanied were significantly related to attendance pattern.

Epidemic of blindness in kangaroos--evidence of a viral aetiology.

OBJECTIVE: To determine the cause of an epidemic of blindness in kangaroos. DESIGN AND PROCEDURES: Laboratory examinations were made of eyes and brains of a large number of kangaroos using serological, virological, histopathological, electron microscopical, immunohistochemical methods, and PCR with cDNA sequencing. In addition, potential insect viral vectors identified during the disease outbreak were examined for specific viral genomic sequences. SAMPLE POPULATION: For histopathological analysis, 55 apparently blind and 18 apparently normal wild kangaroos and wallabies were obtained from New South Wales, Victoria, South Australia, and Western Australia. A total of 437 wild kangaroos and wallabies (including 23 animals with apparent blindness) were examined serologically. RESULTS: Orbiviruses of the Wallal and Warrego serogroups were isolated from kangaroos affected with blindness in a major epidemic in south-eastern Australia in 1994 and 1995 and extending to Western Australia in 1995/96. Histopathological examinations showed severe degeneration and inflammation in the eyes, and mild inflammation in the brains. In affected retinas, Wallal virus antigen was detected by immunohistochemical analysis and orbiviruses were seen in electron microscopy. There was serological variation in the newly isolated Wallal virus from archival Wallal virus that had been isolated in northern Australia. There were also variations of up to 20% in genotype sequence from the reference archival virus. Polymerase chain reactions showed that Wallal virus was present during the epidemic in three species of midges, Culicoides austropalpalis, C dycei and C marksi. Wallal virus nucleic acid was also detected by PCR in a paraffin-embedded retina taken from a blind kangaroo in 1975. CONCLUSION: Wallal virus and perhaps also Warrego virus are the cause of the outbreak of blindness in kangaroos. Other viruses may also be involved, but the evidence in this paper indicates a variant of Wallal virus, an orbivirus transmitted by midges, has the strongest aetiological association, and immunohistochemical analysis implicates it as the most damaging factor in the affected eyes.

Development of an automated blood sampling system for use in humans.

Many hormones are released in a pulsatile or burst-like pattern resulting in fluctuating blood levels that can undergo rapid modulation by physiological and pathological signals. To accurately measure these changes in hormone concentration requires frequent blood sampling, often over extended periods as the overall rhythmicity may vary over 24 hours. The aim of this study was to develop a computerized, automated blood sampling system which allows repeated stress-free blood sample collection from humans over an extended period under basal or test conditions. The system incorporates a peristaltic pump, fraction collector and standard infusion pump together with a custom built electronic control unit linked to a personal computer. Disposable tubing prevents cross-contamination between study participants. The computer programme is modifiable to adjust for the number of specimen tubes and volume of blood collected per sampling cycle. Patency of the collecting line is maintained with 0.9% saline, without the need for heparinization. To validate the system, 10-minute samples for cortisol were collected over 24 hours from five healthy volunteers, of whom two had additional concomitant ACTH sampling. Deconvolution analysis revealed an expected number of hormone secretory episodes and a non-pathological degree of orderliness within the data. There was high concordance between ACTH and cortisol secretory events. The ability of the system to allow multiple measurements and of the software program to link with other physiological monitoring equipment provides a powerful tool to study physiologic/pathophysiologic change in relation to blood hormone and other biomarker levels.

The lesions of experimental equine morbillivirus disease in cats and guinea pigs.

Nine cats and four guinea pigs became affected with severe disease during experiments on the infectivity of equine morbillivirus, a newly recognized cause of respiratory disease in horses and humans. Four of the cats were challenged by subcutaneous inoculation, two by intranasal installation, two by oral dosage, and one by direct contact with a cat previously infected by subcutaneous inoculation. All four guinea pigs were inoculated subcutaneously. Gross pathology seen in all affected cats was characterized by hydrothorax and dark, heavy, wet, congested and/or hemorrhagic lungs with froth sometimes found in the respiratory passages. Pulmonary lymph nodes were enlarged and edematous. Six cats also had congested ceca with accompanying edema of mesenteric lymph nodes. Histologically, the lesions in the lungs of the cats were those of severe interstitial pneumonia characterized by serofibrinous alveolar edema, alveolar macrophages, intra-alveolar hemorrhage, thrombosis of small veins, alveolar wall necrosis, and syncytial cells. Clearly defined vascular lesions included intramural hemorrhage, edema, and necrosis and syncytial cells in the endothelium of pulmonary arteries and veins, 20-80 microm in diameter. Vascular lesions accompanied by parenchymal degeneration were also seen in the gastrointestinal and lymphoid organs. Syncytial cells were also visible in the lymphoid tissues of lymph nodes, spleen, and Peyer's patches. At necropsy, all guinea pigs were cyanosed and had congestion and edema in the gastrointestinal tract. Histologically, there was widespread vascular disease in arteries and veins, 20-80 microm in diameter, in many organs such as the lungs, kidneys, spleens, lymph nodes, gastrointestinal tracts, and skeletal and intercostal muscles, but there was no severe pulmonary edema as seen in horses and cats. Sections of tissues of the cats and guinea pigs, examined by indirect immunocytochemical stains, confirmed that the vascular damage was associated with the presence of equine morbillivirus antigen. The syncytia in small blood vessels in the lungs and other organs of both cats and guinea pigs were similar to those seen in horses, and their presence was interpreted as an important characteristic of the disease consistent with a reaction to a morbillivirus.

Lesions of experimental equine morbillivirus pneumonia in horses.

Laboratory examinations of equine morbillivirus included experimental reproductions of the disease caused by the virus by transmission of mixed lung and spleen taken from two field equine cases into two horses and by inoculating tissue culture virus into a further two horses. The most distinctive gross lesions of the diseases that developed in three of the horses was that of pulmonary edema characterized by gelatinous distension of subpleural lymphatics. Histologically, the lesions in the lungs were those of serofibrinous alveolar edema, alveolar macrophages, hemorrhage, thrombosis of capillaries, and syncytial cells. Clearly defined vascular lesions in three horses that became clinically affected within 8 days of inoculation of virus included intramural hemorrhage, edema, and necrosis and syncytial cells in the endothelium of pulmonary vessels (approximately 40-70 microm in diameter). Vascular lesions accompanied by parenchymal degeneration were also seen in the heart, kidney, brain, spleen, lymph node, and stomach. A fourth horse, which survived for 12 days, had detectable lesions only in the lungs, which were more chronic than those in the other three horses, a greater degree of cellular infiltration, and fewer well-defined vascular lesions. Sections stained by an indirect immunocytochemical method showed equine morbillivirus antigen was present in the vascular lesions and along alveolar walls. When endothelial cells were examined by electron microscope, cytoplasmic virus inclusion bodies containing filamentous structures were seen that reacted to an immunogold test to equine morbillivirus antigen. The presence of the syncytia in the small blood vessels in the lungs and other organs was interpreted as an important characteristic of the disease and consistent with a reaction to a morbillivirus.