No long-term tunnel enlargement following anterior cruciate ligament reconstruction using autograft hamstring tendon with dual suspensory fixation.

PURPOSE: Bone tunnel widening following anterior cruciate ligament reconstruction (ACLR) is well documented, although the aetiology and clinical significance of this phenomenon remain unclear. At mid-term follow-up, a greater prevalence of tunnel enlargement has been reported with the use of hamstring (HS) grafts. However, there are paucity of data on what happens in the longer term. The aim of this study was to assess the change in femoral and tibial tunnel dimensions 15 years after four-strand HS ACLR. METHODS: This is a retrospective review of 15 patients who underwent arthroscopic ACLR using HS autograft tendon and were followed up radiographically at 4 months, 2 years and 15 years. Suspensory fixation was used for both ends of the graft. The diameters of the bone tunnels on posteroanterior (PA) and lateral radiographs were measured using digital callipers. Repeated measures analysis of variance (ANOVA) was used to examine change in tunnel width over time. RESULTS: Radiographic tunnel width did not significantly change between 4 months and 2 years. However, a significant decrease in width was found for both the femoral and tibial tunnels between the 2- and 15-year follow-up (P < 0.01): the femoral tunnel decreased by 50% and 51% in the PA and lateral views, respectively; the tibial tunnel decreased by 77% and 91% in the PA and lateral views respectively. There was no significant correlation between femoral or tibial tunnel width and flexion and extension deficits or with side to side differences in anterior tibial laxity at 15 years. CONCLUSIONS: This radiographic follow-up study of bone tunnel widening following HS ACLR with suspensory fixation demonstrated that tunnel width did not increase beyond 4 months and in fact had decreased significantly at long-term (15 years) follow-up. There was no correlation between tunnel width changes and clinical assessment of flexion and extension deficits or with side-to-side anterior knee laxity at 15-years. LEVEL OF EVIDENCE: IV.

A walking program for people with severe knee osteoarthritis did not reduce pain but may have benefits for cardiovascular health: a phase II randomised controlled trial.

OBJECTIVE: The primary aim was to evaluate the effect of a dosed walking program on knee pain for patients with severe knee osteoarthritis (OA). Secondary aims evaluated the effects on cardiovascular health, function and quality of life. DESIGN: Participants with severe knee OA and increased cardiovascular risk were randomly assigned to a 12-week walking program of 70 min/week of at least moderate intensity, or to usual care. The primary outcome was knee pain (0-10). Secondary outcomes were of cardiovascular risk including physical activity, blood pressure, blood lipid and glucose levels, body mass index and waist circumference; WOMAC Index scores; physical function; and quality of life. RESULTS: Forty-six participants (23 each group) were recruited. Sixteen participants (70%) adhered to the walking program. Intention to treat analysis showed no between-group difference in knee pain. The walking group had increased odds of achieving a healthy systolic blood pressure (OR = 5.7, 95% CI 1.2-26.9), and a faster walking speed (Mean Difference (MD) = 0.12 m/s, 95% CI 0.02-0.23). Per protocol analysis based on participant adherence showed the walking group had more daily steps (MD = 1345 steps, 95% CI 365-2325); more time walking (MD = 18 min/day, 95% CI 5-31); reduced waist circumference (MD = -5.3 cm, 95% CI -10.5 to -0.03); and increased knee stiffness (MD = 0.9 units, 95% CI 0.07-1.8). CONCLUSIONS: Patients with severe knee OA prescribed a 12-week walking program of 70 min/week may have had cardiovascular benefits without decreasing knee pain. Australian New Zealand Clinical Trials Registry ACTRN12615000015549.

The maximum tolerated dose of walking for people with severe osteoarthritis of the knee: a phase I trial.

OBJECTIVE: To determine how much physical activity, in the form of walking, can be safely and feasibly tolerated for people with severe knee osteoarthritis (OA). DESIGN: Phase I dose response trial with escalating walking doses of 10, 20, 35, 50, 70, and 95 min over 1 week, were prescribed non-randomly to people with severe knee OA. The primary stopping rule was a substantial increase in knee pain. The primary outcomes were an estimation of the maximum tolerated dose of walking; and the proportion of people who did not complete the dose for feasibility reasons. The secondary outcomes were pain, stiffness and activity limitation Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: Twenty-four participants (13 women) aged 53-83 years, and average body mass index (BMI) of 34 kg/m(2) (SD 9) were recruited. Three participants were assigned to each dose between 10 and 70 min, and nine participants assigned to the 95-min dose. The trial was stopped at 95 min due to the maximum number of adverse events occurring at this dose. Therefore, the maximum tolerated dose was 70 min. No participant stopped due to reasons related to feasibility. There was a moderate association between dose and increased activity (linear R(2) = 0.31, cubic R(2) = 0.69) and reduced stiffness (linear R(2) = 0.20, cubic R(2) = 0.52), with increased benefits at moderate to higher doses. CONCLUSIONS: There is preliminary evidence that 70 min per week of moderate intensity supervised walking was safe and feasible for people with severe OA of the knee; for higher doses there was a risk of exacerbating knee pain levels.

What proportion of people with hip and knee osteoarthritis meet physical activity guidelines? A systematic review and meta-analysis.

OBJECTIVE: To determine the proportion of people with hip and knee osteoarthritis that meet physical activity guidelines recommended for adults and older adults. METHOD: Systematic review with meta-analysis of studies measuring physical activity of participants with hip and knee osteoarthritis using an activity monitor. Physical activity levels were calculated using the mean average [95% confidence interval (CI)] weighted according to sample size. Meta-analyses determined the proportion of people meeting physical activity guidelines and recommendations of (1) ≥150 min per week of moderate to vigorous physical activity (MVPA) in bouts of ≥10 min; (2) ≥150 min per week of MVPA in absence of bouts; (3) ≥10,000 steps per day and ≥7000 steps per day. The Grades of Research, Assessment, Development and Evaluation (GRADE) approach was used to determine the quality of the evidence. RESULTS: For knee osteoarthritis, 21 studies involving 3266 participants averaged 50 min per week (95% CI = 46, 55) of MVPA when measured in bouts of ≥10 min, 131 min per week (95% CI = 125, 137) of MVPA, and 7753 daily steps (95% CI = 7582, 7924). Proportion meta-analyses provided high quality evidence that 13% (95% CI = 7, 20) completed ≥150 min per week of MVPA in bouts of ≥10 min, low quality evidence that 41% (95% CI = 23, 61) completed ≥150 min per week of MVPA in absence of bouts, moderate quality evidence that 19% (95% CI = 8, 33) completed ≥10,000 steps per day, and low quality evidence that 48% (95% CI = 31, 65) completed ≥7000 steps per day. For hip osteoarthritis, 11 studies involving 325 participants averaged 160 min per week (95% CI = 114, 216) of MVPA when measured in bouts of ≥10 min, 189 min per week (95% CI = 166, 212) of MVPA, and 8174 daily steps (95% CI = 7670, 8678). Proportion meta-analyses provided low quality evidence that 58% (95% CI = 18, 92) completed ≥150 min per week of MVPA in absence of bouts, low quality evidence that 30% (95% CI = 13, 50) completed ≥10,000 steps per day, and low quality evidence that 60% (95% CI = 47, 73) completed ≥7000 steps per day. CONCLUSION: A small to moderate proportion of people with knee and hip osteoarthritis met physical activity guidelines and recommended daily steps. Future research should establish the effects of increasing physical activity in this population to meet the current physical activity guidelines.

Levels of circulating angiogenic cells are not altered in women with endometriosis.

STUDY QUESTION: Are levels of circulating angiogenic cells (CACs) affected by the presence of endometriosis? SUMMARY ANSWER: Levels of CACs are equivalent in women with and without endometriosis. WHAT IS KNOWN ALREADY: Murine models have suggested a role for CACs in the development of endometriosis, but their levels in humans have not yet been studied. STUDY DESIGN, SIZE, DURATION: Eighty-seven women participated in this study. Recruitment took place from July 2010 to May 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS: All women underwent laparoscopy for investigation of symptoms suggestive of endometriosis. Thirty women had no evidence of endometriosis, and 47 women were found to have endometriosis at laparoscopy. CAC levels were determined in peripheral blood by flow cytometry in 64 women. Colony forming unit (CFU) analysis was conducted in 30 women. A separate group of 10 healthy, asymptomatic women donated blood at four time points to assess the effect of the menstrual cycle on CAC levels. MAIN RESULTS AND THE ROLE OF CHANCE: For the whole sample, CAC levels (0.0797 ± 0.0052%) and CFU number (10.68 ± 1.98) were equivalent in women with and without endometriosis. CAC levels and CFU number were also unaffected by the stage of disease. No changes in CACs were detected during the menstrual cycle. LIMITATIONS, REASONS FOR CAUTION: A difference of at least one standard deviation between the groups would be required to detect a difference with this sample size. Therefore, while CAC levels are not a useful biomarker of disease it is still possible that they are modestly altered by the presence of endometriosis. We did not describe specific types of lesion and it is possible that CAC elevation only occurs when vessel development is at its most prolific. Furthermore, although signals from endometriotic lesions may recruit CACs from blood, this may be insufficient to alter peripheral levels. WIDER IMPLICATIONS OF THE FINDINGS: These data show that CACs are not a useful biomarker of endometriosis and indicate that they may be unaffected by the presence of this disease. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by grants from the MRC (New Investigator Award, G0601458 to C.M.B.), the Oxford Partnership Comprehensive Biomedical Research Centre with funding from the Department of Health's NIHR Biomedical Research Centres Scheme and the Oxfordshire Health Services Research Committee (OHSRC). There are no conflicts of interest to be declared.

Multi-scaled drivers of ecosystem state: quantifying the importance of the regional spatial scale.

The regional spatial scale is a vital linkage for the informed extrapolation of results from local to continental scales to address broad-scale environmental problems. Among-region variation in ecosystem state is commonly accounted for by using a regionalization framework, such as an ecoregion classification. Rarely have alternative regionalization frameworks been tested for variables measuring ecosystem state, nor have the underlying relationships with the variables that are used to define them been assessed. In this study, we asked two questions: (1) How much among-region variation is there for ecosystems and does it differ by regionalization framework? (2) What are the likely causes of this among-region variation? We present a case study using a large data set of lake water chemistry, uni- and multi-scaled hydrogeomorphic and anthropogenic driver variables that likely influence lake chemistry at the subcontinental scale, and seven existing regionalization frameworks. We used multilevel models to quantify and explain within- and among-region variation in lake water chemistry. Our models account for local driver variables of ecosystem variation within regions, differences in regional mean ecosystem state (i.e., random intercepts in multilevel models), and differences in relationships between local drivers and ecosystem state by region (i.e., random slopes in multilevel models). Using one of the best performing regionalization frameworks (Ecological Drainage Units), we found that for lake phosphorus and alkalinity: (1) a majority of all the variation in water chemistry among the studied lakes occurred among regions, (2) very few regional-scale landscape driver variables were required to explain among-region variation in lake water chemistry, (3) a much higher proportion of the total variation among lakes was explained at the regional scale than at the local scale, and (4) some relationships between local-scale driver variables and lake water chemistry varied by region. Our results demonstrate the importance of considering the regional spatial scale for broad-scale research and ecosystem management and conservation. Our quantitative approach can be easily applied to other response variables, ecosystem types, geographic areas, and spatial extents to inform ecosystem responses to global environmental stressors.

Greater peak rearfoot eversion predicts foot orthoses efficacy in individuals with patellofemoral pain syndrome.

OBJECTIVE: There is growing evidence for the provision of foot orthoses when treating individuals with patellofemoral pain syndrome (PFPS), and prescription is frequently based on the assessment of foot posture/function. However, evaluation of the link between abnormal foot posture/function and foot orthoses outcomes has previously been limited to static alignment measures and has produced inconsistent findings. In this study, the ability of baseline foot kinematics associated with pronation to predict marked improvement 12 weeks following foot orthoses prescription in individuals with PFPS was evaluated. METHODS: 26 individuals with PFPS were issued with prefabricated foot orthoses, and patient-reported level of improvement was documented at 12 weeks. Potential predictors of marked improvement at 12 weeks were measured during walking at baseline and included forefoot dorsiflexion and abduction, and rearfoot eversion. RESULTS: Of the 25 participants who completed the study, seven (28%) reported marked improvement with the foot orthoses after 12 weeks. Discriminant function analysis revealed a greater peak rearfoot eversion to be the only significant independent predictor of marked improvement. CONCLUSION: These findings provide preliminary evidence that greater peak rearfoot eversion is predictive of marked improvement 12 weeks following prefabricated foot orthoses prescription in individuals with PFPS. Therefore, foot orthoses may be most effective in the subgroup of people with PFPS and increased dynamic foot pronation.

A prospective longitudinal study to assess psychological changes following anterior cruciate ligament reconstruction surgery.

OBJECTIVE: To determine whether the psychological characteristics of athletes who have undergone an anterior cruciate ligament (ACL) reconstruction change during rehabilitation are related to returning to competitive sport. DESIGN: Prospective longitudinal study. METHOD: 87 athletes completed the Emotional Response of Athletes to Injury Questionnaire (ERAIQ) and the ACL Return to Sport after Injury scale (ACL-RSI) at 3, 6 and 12 months following ACL reconstruction surgery. Physical outcome measures were also taken at each time point. RESULTS: At 12 months 44 (51%) participants had returned to competitive sport and 43 (49%) participants had not returned. There were no differences in physical recovery or scores on the ERAIQ between the two groups. Participants who had returned to competitive sport at 12 months, however, scored significantly higher on the ACL-RSI scale (reflecting a more positive psychological response about sport participation) at both 6 and 12 months than participants who had not returned to competitive sport. CONCLUSIONS: During rehabilitation there are significant psychological differences regarding sport resumption between athletes who do, and do not, resume competitive sport 12 months following ACL reconstruction. These differences occur as early as 6 months postoperatively and highlight the importance of addressing all aspects of an athlete's recovery in order to help facilitate the athlete returning to sport.

The management of menopause in women with a history of endometriosis: a systematic review.

BACKGROUND: Endometriosis is typically regarded as a premenopausal disease, resolving after natural or iatrogenic menopause due to declining oestrogen levels. Nonetheless, case reports over the years have highlighted the incidence of recurrent postmenopausal endometriosis. It is now clear that both recurrence and malignant transformation of endometriotic foci can occur in the postmenopausal period. Postmenopausal women are commonly treated with hormone replacement therapy (HRT) to treat climacteric symptoms and prevent bone loss; however, HRT may reactivate endometriosis and stimulate malignant transformation in women with a history of endometriosis. Given the uncertain risks of initiating HRT, it is difficult to determine the best menopausal management for this group of women. OBJECTIVE AND RATIONAL: The aim of this study was to systematically review the existing literature on management of menopausal symptoms in women with a history of endometriosis. We also aimed to evaluate the published literature on the risks associated with HRT in these women, and details regarding optimal formulations and timing (i.e. initiation and duration) of HRT. SEARCH METHODS: Four electronic databases (MEDLINE via OVID, Embase via OVID, PsycINFO via OVID and CINAHL via EbscoHost) were searched from database inception until June 2016, using a combination of relevant controlled vocabulary terms and free-text terms related to 'menopause' and 'endometriosis'. Inclusion criteria were: menopausal women with a history of endometriosis and menopausal treatment including HRT or other preparations. Case reports/series, observational studies and clinical trials were included. Narrative review articles, organizational guidelines and conference abstracts were excluded, as were studies that did not report on any form of menopausal management. Articles were assessed for risk of bias and quality using GRADE criteria. OUTCOMES: We present a synthesis of the existing case reports of endometriosis recurrence or malignant transformation in women undergoing treatment for menopausal symptoms. We highlight common presenting symptoms, potential risk factors and outcomes amongst the studies. Sparse high-quality evidence was identified, with few observational studies and only two randomized controlled trials. Given this paucity of data, no definitive conclusions can be drawn concerning risk. WIDER IMPLICATIONS: Due to the lack of high-quality studies, it remains unclear how to advise women with a history of endometriosis regarding the management of menopausal symptoms. The absolute risk of disease recurrence and malignant transformation cannot be quantified, and the impact of HRT use on these outcomes is not known. Multicentre randomized trials or large observational studies are urgently needed to inform clinicians and patients alike.

Kinematic patterns associated with accuracy of the drop punt kick in Australian Football.

Research into the kinematics of movement associated with the accuracy of the drop punt kick in Australian Football has been limited. The aim of this study was to examine pelvic and lower limb kinematics during the performance of a drop punt kick, in order to identify factors associated with accurate kicking performance. Ten professional Australian Football League (AFL) players performed 20 drop punt kicks towards a target situated 15m away, using their preferred leg. A three-dimensional motion analysis system was used to record the kicking motion from heel contact of the support limb through to ball contact. The subjects were divided into an accurate group (> or =50% accuracy; n=5) and an inaccurate group (<50% accuracy; n=5) based on target hit rate. Kinematic profiles for both kicking and support limbs were compared between the two groups. Results showed that the accurate group had significantly greater hip flexion in both limbs and greater knee flexion in the support limb throughout the kicking movement. The accurate group also had significantly greater anterior pelvic tilt at heel contact (accurate 20.8 degrees ; inaccurate 12.7 degrees ). These data show that kinematic differences in lower limb joint angles may be related to kicking accuracy.

The organisation of the spinotectal projection. An experimental study in the rat.

The spinal grey projects upon the contralateral superior colliculus via two overlapping pathways in the lateral funiculus. One, more ventrally placed, is the classical spinotectal tract, which crosses immediately in the spinal cord and remains crossed. The other, lying more dorsally, ascends homolaterally but is subject to delayed crossing in the brainstem (especially the intertectal) commissures to reach the contralateral colliculus. Both sets of fibers end only in the caudal half of the colliculus, predominantly in the stratum album intermedium. The projections from individual cord segments distribute in an ordered fashion as a series of transverse, overlapping bands, the cervical cord projecting most rostrally, the sacro-coccygeal most caudally. Additional fibers, which distribute with less marked topography, end in the lateral extreme of the stratum griseum profundum and stratum album profundum.

The projection of the retina upon the optic tectum of the pigeon.

The projection of the retina onto the optic tectum of the pigeon has been investigated using silver impregnation methods for degenerating axons and terminals, autoradiographic tracing, and the Golgi methods. Degenerating optic afferents distribute to sublaminae a-d and f of the stratum griseum et fibrosum superficiale over the whole tectum, but two major fields are observed. One occupies the caudal and ventral tectum (in which region laminar cytoarchitecture is marked), and the other rostral and dorsal tectum (where demarcation of cell laminae is relatively poor). Degeneration in the latter field is coarse and clearly distributes in a distinctly laminated fashion within the stratum griseum et fibrosum superficiale. In contrast, degeneration in the caudo-ventral region is fine, and laminated distribution less clear. The evolution of the degeneration pattern over survival periods from 3 to 56 days suggests that these laminar distributions reflect the existence of several different types of optic terminal ramification present in all parts of the tecum. A selective laminar distribution of such optic afferent types correlates well with our own and other Golgi studies. The results of the autoradiography experiments are broadly compatible with these findings.

An electron microscope study of the retino-receptive layers of the pigeon optic tectum.

The fine structure of the superficial layer of the optic tectum of the pigeon, Columba livia, has been examined both in normal animals and after unilateral eye removal. Optic afferent terminals distributed throughout sublaminae IIa-f, are principally concentrated at three depths in the retinoreceptive zone. At first, degeneration of optic afferent terminals occurs as swelling of synaptic vesicles and accumulation of neurofilaments and later as dense degeneration. There appear to be several classes of optic afferent terminals in the retino-receptive zone, as would be expected from most previous studies of the avian tectum. The non-optic components of the neuropil, which include glomerular and pleomorphic vesicle terminals, and the synaptic interrelationships between optic and non-optic components are described. Optic afferent terminals mainly make synaptic contact with the branches of radial dendrites but also, in sublaminae IIb and IIc, with the dendrites of non-radial cells. In sublamina IIc afferent terminals synapse onto the horizontal presynaptic dendrites of spindle cells and triplet synaptic arrays including optic afferent terminals, horizontal dendrites and radial dendrite profiles and radial dendrite profiles are found. This optic projection to non-radial elements in IIb c, is discussed in relation to light microscope and electrophysiological studies.

The effects of capsaicin applied to peripheral nerves on responses of a group of lamina I cells in adult rats.

In adult rats, the sciatic and saphenous nerves on one side were treated topically with capsaicin. The capsaicin treatment had the effect of increasing the latency for withdrawal of the foot from hot water; 11-22 days later, the animals were decerebrated, and cells in the superficial dorsal horn of the lumbar cord with axons projecting in the contralateral dorsolateral funiculus (DLF) were examined electrophysiologically on the treated and untreated sides of the cord. HRP was applied to cut axons of the DLF at C4, in other rats, and retrograde labelling of cells in the lumbar cord indicated that most or all of the recordings in the capsaicin-treated animals were likely to originate from lamina 1. The dorsal horn cells, with receptive fields on the foot, showed decreased responses to electrically evoked afferent impulses in C fibres and grossly altered receptive fields. After capsaicin treatment, the proportion of cells responding to C afferents fell from 83% to 14%. The proportion responding only to C afferents and not to A afferents fell from 9% to 0%. The receptive fields (RFs) of these cells showed two gross abnormalities; 32% of the cells on the treated side had no apparent RF or an ill-defined, intermittent RF, whereas such cells were rare on the untreated side or in intact animals. By contrast 49% of the cells had grossly expanded RFs with an average area of 430 mm2 against the normal average size of 130 mm2.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytoarchitectural fields and retinal termination: an axonal transport study of laminar organization in the avian optic tectum.

The cytoarchitecture in the retinoreceptive zone of the pigeon optic tectum has been studied in Nissl-stained sections taken in four planes. As suggested by a previous study, two cytoarchitectural fields are present. Reconstructed views of the tectum show that the fields are separated by a narrow transition zone approximating to the tectal representation of the retina's horizontal meridian. In field 1 (which is upper and rostral), sublayer IIb is wide, IIc wide and trilaminate, IId narrow and IIe continuous; in field 2, IIb and c are narrow, IId wide and IIe discontinuous. The distribution of retinal terminals was investigated by the anterograde axonal transport of [3H]proline or horseradish peroxidase from intravitreal injections. The depth distribution of grains or reaction product throughout the entire tectum was quantified by scanning with a microdensitometer. Both autoradiography and horseradish peroxidase transport show two patterns of lamination separated by a narrow transition zone and these two terminal fields correspond closely to the cytoarchitectural fields. In field 1 optic terminals are concentrated in sublayer IIb, superficial c, d, and to a lesser extent in f; in field 2 concentrations are present at the IIb/c boundary, across deep IIc and d, and a small concentration is found IIf. The patterns of retinal termination with depth in the tectum found by axonal transport are compatible with those found by electron microscopy, and are discussed in relation to the optic termination found by other techniques. Study of the time course of axonal transport shows that both radioactive material and horseradish peroxidase are fast transported to all the bands of optic terminals at about 150 mm/day. Horseradish peroxidase gradually accumulates in the retinoreceptive zone, filling clusters of terminals and horizontal processes. At 12 days, it has begun to disappear from the zone and a few diffusely filled profiles, that may be transcellularly labelled, are present. Electron microscope autoradiography of fast transported material shows clusters of grains over optic terminals and preterminals and a percentage density analysis confirms that these profiles are specifically labelled. The two tectal fields each contain the projection from specialized areas of the retina, suggesting functional specialization in the tectum for the processing of different kinds of visual information.

A qualitative and quantitative analysis of the distributions of cells in the spinal cord and spinomedullary junction projecting to the thalamus of the rat.

Horseradish peroxidase retrograde transport has been used to locate and make a quantitative study of neurons of the rat spinal cord which project to the thalamus. Across the grey, labelled cells were found in the head and neck of the dorsal horn (in three locations, but not the substantia gelatinosa); in the region of the internal basilar nucleus of Ramón y Cajal; in the intermediate grey zone; in the lateral cervical nucleus and funiculus; and in the ventral horn. The latter contains the largest population of neurons projecting ipsilaterally. The most significant finding concerns the craniocaudal distribution of the cells. More than 50% of the thalamically projecting neurons are confined to the upper four cervical segments, where every population is represented. Some populations are continuous with thalamically projecting populations in the lower medulla. The cervical enlargement contains less than 5% of spinothalamic cells. The lumbar enlargement contains 33%, most of which are in the region of the internal basilar nucleus. This population is also marked in the upper cervical segments. Thus, in the rat, the origin of the spinothalamic tract is distributed along the cord in a very uneven manner. This may indicate that sensory information delivered to any one segment of the spinal cord by a primary afferent is not always relayed direct to the thalamus by a local second order neuron; that different parts of the body are not represented to the same extent in the spinothalamic system; or that these two factors combine to produce the observed distribution.

A quantitative study of the projections of the gracile, cuneate and trigeminal nuclei and of the medullary reticular formation to the thalamus in the rat.

Following injection of horseradish peroxidase into the thalamus of one side, the numbers of labelled neurons in the nuclei of the dorsal funiculi and in the trigeminal sensory complex were counted. A comparative study was made of the pattern of labelling after a range of survival times, and animals surviving for 72 h after injection were used to provide detailed quantitative information about the patterns of distribution of labelled cells. The principal sensory nucleus of the trigeminal nerve (8683 labelled neurons) and the nucleus of the spinal trigeminal tract, pars interpolaris (1920) label heavily after thalamic injection. Pars oralis of the spinal nucleus labels more sparsely (524 labelled neurons), while the pars caudalis (260 labelled neurons) shows a laminar labelling pattern which continues across the spinomedullary junction into the upper cervical segments. The gracile (2152 labelled neurons) and cuneate (2339) nuclei also show rostrocaudal variation in labelling density: the middle one-third of each nucleus contains 66% of labelled gracile and cuneate cells. The findings are correlated with known features of the arrangement of the ascending sensory projections from these nuclei in various species, and are compared with previous findings on the distribution of thalamically-projecting cells in the upper cervical segments of the spinal cord.

The roles of vertex sharp waves and K-complexes in the generation of N300 in auditory and respiratory-related evoked potentials during early stage 2 NREM sleep.

STUDY OBJECTIVES: To determine the scalp topography of the N300 response to stimuli of different modalities and to investigate the relationship of the N300 component to K-complexes and vertex sharp waves seen in the un-averaged EEG. DESIGN: Two experiments were conducted one using auditory; the other using respiratory occlusion stimuli presented during stage 2 sleep. Trials were classified on the basis of whether they produced a K-complex, a vertex sharp wave, or some other response. Auditory stimuli were presented in the form of an oddball paradigm, and averaged separately depending on whether they were "frequent" or "rare". In both experiments, responses were averaged separately based on the appearance of K-complexes, vertex sharps waves, or some "other" response to the stimuli. SETTING: Data were collected in the Melbourne University Sleep Laboratory. PARTICIPANTS: Young healthy male adults, eight in experiment 1 and six in experiment 2. INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: Data were collected from 29 scalp sites. In all cases, N300 amplitude was maximal in the vertex sharp wave averages, despite being clearly present in the averages of K-complexes and "other" responses. The vertex maximal scalp topography of the N300 did not differ across response conditions or as a function of stimulus modality. This is consistent with the N300 being produced by the same intracranial generators in all cases. There were no effects of stimulus or response type on N300 latency. CONCLUSIONS: N300 should be viewed as a multi-modal component with a different underlying generator mechanism than that of the K-complex.

Multichannel EEG analysis of respiratory evoked-potential components during wakefulness and NREM sleep.

Airway occlusion in awake humans produces a somatosensory evoked response called the respiratory-related evoked potential (RREP). In the present study, 29 channel evoked-potential recordings were obtained from seven men who were exposed to 250-ms inspiratory airway occlusions during wakefulness, stage 1, stage 2, and slow-wave sleep. The RREP recorded during wakefulness was similar to previous reports, with the unique observation of an additional short-latency positive peak with a mean latency of 25 ms. Short-latency RREP components were maintained in non-rapid-eye-movement (NREM) sleep. The clearly seen N1 vertex and late positive complex components during wakefulness were markedly attenuated during NREM sleep, and two large negative components (N300 and N550) dominated the sleep RREP. These findings indicate the maintenance of central nervous system monitoring of respiratory afferent information during NREM sleep, presumably to facilitate protective arousal responses to pathophysiological respiratory phenomena.

Distribution of primary afferent fibres from the forelimb of the rat to the upper cervical spinal cord in relation to the location of spinothalamic neuron populations.

Half the monosynaptic spinothalamic neurons in the rat spinal cord lie in the first 4 cervical segments, predominantly in the internal basilar column and ventral horn. The present study shows that both these regions receive primary afferents from the forelimb. The superficial dorsal horn receives few, and the region of the lateral cervical nucleus no primary afferents from the brachial plexus. We suggest that internal basilar column cells may represent localised relays concerned with the limbs, and that the gracile and cuneate nuclei are not unique, but are paralleled by other neuron populations in the upper cord.