GLUT2 expression by glial fibrillary acidic protein-positive tanycytes is required for promoting feeding-response to fasting.

Feeding behavior is a complex process that depends on the ability of the brain to integrate hormonal and nutritional signals, such as glucose. One glucosensing mechanism relies on the glucose transporter 2 (GLUT2) in the hypothalamus, especially in radial glia-like cells called tanycytes. Here, we analyzed whether a GLUT2-dependent glucosensing mechanism is required for the normal regulation of feeding behavior in GFAP-positive tanycytes. Genetic inactivation of Glut2 in GFAP-expressing tanycytes was performed using Cre/Lox technology. The efficiency of GFAP-tanycyte targeting was analyzed in the anteroposterior and dorsoventral axes by evaluating GFP fluorescence. Feeding behavior, hormonal levels, neuronal activity using c-Fos, and neuropeptide expression were also analyzed in the fasting-to-refeeding transition. In basal conditions, Glut2-inactivated mice had normal food intake and meal patterns. Implementation of a preceeding fasting period led to decreased total food intake and a delay in meal initiation during refeeding. Additionally, Glut2 inactivation increased the number of c-Fos-positive cells in the ventromedial nucleus in response to fasting and a deregulation of Pomc expression in the fasting-to-refeeding transition. Thus, a GLUT2-dependent glucose-sensing mechanism in GFAP-tanycytes is required to control food consumption and promote meal initiation after a fasting period.

Prevention of postischaemic ventricular fibrillation by long term beta adrenoceptor blockade with acebutolol in the anaesthetised dog.

Acute occlusions of the proximal left circumflex coronary arteriovenous pedicle were performed in open chest anaesthetised dogs. Twenty eight dogs were randomly allocated to receive acebutolol (3 mg X kg-1 twice daily) or placebo given blindly by mouth for five days; a control group of 14 dogs without any pretreatment underwent the same procedure. Coronary ligations in the randomised study were performed during seven consecutive days, and four dogs were operated on each day. This schedule was chosen in order to measure acebutolol plasma concentrations just before ligation from 60 to 540 min after the last dose of the drug. Long term oral treatment with acebutolol protected against postischaemic ventricular fibrillation and significantly reduced the incidence of both early phase (0-10 min postocclusion) ventricular arrhythmias and ventricular fibrillation. As a result the outcome was significantly improved after 60 min of ischaemia in acebutolol compared with placebo treated animals. The results in the control animals were similar to those in the placebo treated dogs. The protective effect of long term oral treatment with acebutolol lasted for nine hours and was apparently independent of the plasma concentrations of the drug. These data show that improved outcome in this canine model is due to the prevention of ischaemia induced ventricular fibrillation by long term beta adrenoceptor blockade, which is able to overcome the effect, if any, of partial agonist activity of acebutolol. A direct myocardial anti-ischaemic effect might explain the effectiveness of long term oral treatment, which is independent of plasma concentrations of the drug.

Molsidomine prevents post-ischaemic ventricular fibrillation in dogs.

Forty anaesthetized dogs were subjected to left circumflex coronary artery ligation followed by reperfusion. Molsidomine was randomly administered to 20 dogs (50 micrograms kg-1 as an i.v. bolus - 15 min prior to coronary occlusion - followed by an infusion of 0.05 micrograms kg-1 min-1. Standard electrocardiographic leads 2 and 3 were continuously recorded to measure ST segment and delta R% changes and to document both the number of ventricular premature beats and the onset of ventricular fibrillation; aortic pressure and cardiac output were measured; thromboxane B2 plasma levels, platelet aggregation produced by ADP, and molsidomine plasma levels were determined before and at 10, 30 and 75 min after the start of the drug protocol. Molsidomine protected the treated animals from early (10 min) post-ischaemic ventricular fibrillation (0 of 20 vs 6 of 20, P = 0.0202), reduced the incidence of overall post-occlusion ventricular fibrillation (3 of 20 vs 10 of 20, P = 0.0407) and improved the total survival rate (P = 0.0067). In molsidomine treated dogs: mean aortic pressure and the rate-pressure product were lowered 10 min after the start of the drug; immediate post-occlusion (3 min) ST segment changes (0.82 +/- 0.52 vs 1.52 +/- 0.78 mV, P less than 0.025) and delta R% changes (37 +/- 50 vs 90 +/- 84%, P less than 0.025) were less marked; the number of ventricular premature beats was lowered and finally, a progressive decline of platelet aggregation produced by ADP was achieved after 75 min of drug infusion. These results were obtained in the presence of mean plasma levels of molsidomine ranging from 20 to 28 ng ml-1. The time-action curve of the antifibrillatory effect of molsidomine parallels those at the level of post-ischaemic electrocardiographic changes.

Age-specific prevalence of Epstein-Barr virus antibodies in adult patients with affective disorders.

It has been suggested that prior Epstein-Barr virus (EBV) infection is a necessary condition for the development of affective disorders. To address this issue, the authors performed serologic screening for the presence of EBV antibodies in 60 adult patients seen at an affective disorders investigational unit. Six patients with clinically significant mood disorders, all aged 32 years or younger, had no detectable EBV antibodies. The authors conclude that the onset of clinical mood disorders can occur before primary EBV infection; thus, EBV infection is not a necessary condition for the development of mood disorders.

Effects of cicletanine in the left circumflex coronary artery occlusion-reperfusion canine model of sudden death: analysis of 107 experiments using Cox's proportional hazards model.

Multivariate analysis of survival using Cox's proportional hazards model demonstrates that several clinically measurable covariates are determinants of life-threatening arrhythmias following left circumflex coronary artery occlusion-reperfusion in 107 dogs. These are heart rate, ST segment elevation and mean aortic pressure immediately (3 min) following occlusion, and the presence of early (0-10 min) post-occlusion sustained ventricular tachycardia. The risk of occlusion-reperfusion ventricular fibrillation was determined according to Cox's solution based on ST segment elevation, thus enabling quantification of the role of cicletanine. Since cicletanine-treated dogs had reduced mean ST segment elevation at 3 min post-occlusion, lower incidence of early post-occlusion (0-10 min) sustained ventricular tachycardia, and increased endogenous production of prostacyclin, and the latter was inversely correlated with the level of ST segment elevation, it is concluded that such favourable effects on the ischaemic myocardium were contributory to the improved outcome in these experiments. These effects on the ischaemic myocardium obtained in spite of a hypotensive action in the experimental setting might be regarded as desirable and it is therefore suggested that they should be further investigated by pharmacodynamic studies in human subjects.

[Mitral valve replacement with bioprosthesis in children]. / Remplacement valvulaire mitral par bioprothèse chez l'enfant.

Forty seven bioprostheses were used for mitral valve replacement between January 1975 and June 1980, with no operative mortality, in children under 19 years of age. This study was undertaken to evaluate the medium and longterm outcome of 43 patients followed up for at least 2 years. The late mortality was higher in children under 13 years of age (11.1% per patient/year) than in older children (3% per patient/year). The incidence of reoperation for deterioration of the bioprosthesis was 5,5% per patient/year. The actuarial longevity of bioprostheses without any complications was 48 +/- 16% at 5 years. After a review of the literature, the authors discuss their present therapeutic attitude: whenever possible, mitral valvuloplasty is the operation of choice, but when valve replacement is necessary, two criteria must be considered: the age of the patient and conditions of follow up. If medical follow-up facilities are good: mechanical prostheses are preferred in patients under 13 years of age: after puberty especially in girls, the bioprosthesis is the valve of choice. If medical follow-up facilities are poor: the valve of choice is a bioprosthesis at all ages because of the risk of thromboembolism and the relatively slow clinical aggravation in cases of bioprosthetic deterioration.

[Ventricular arrhythmia following repair of Fallot's tetralogy. Apropos of 59 cases]. / Troubles du rythme ventriculaire après réparation de tétralogie de Fallot. A propos de 59 cas.

Fifty-nine patients operated for Fallot's tetralogy were reviewed over 3 years after surgery. The average age at surgery was 7.4 years (range 6 months to 37 years). The review included ECG, chest X-ray, echocardiography, exercise stress testing and Holter monitoring, completed by cardiac catheterisation in 10 cases and electrophysiological investigation in 4 cases. Forty-eight of the 59 patients (81.3 p. 100) had no signs of ventricular arrhythmia or only benign ventricular extrasystoles (Group I). Four patients (6.8 p. 100) had severe ventricular arrhythmias (Group II). Seven patients (11.9 p. 100) had one or more episodes of ventricular tachycardia (VT) (Group III) and, in 3 of these patients, VT was recorded during Holter monitoring or exercise stress testing. One patient in Group III died after reoperation, but there were no cases of sudden death in this series. The high risk patients Groups II and III) were operated late (after 5 years), had bi- or trifascicular block (7 out of 11 cases), ventricular extrasystoles on resting ECGs (9 out of 11 cases), cardiomegaly (6 out of 7 cases in Group III), echocardiographic dilatation of the infundibulum (6 out of the 8 patients undergoing echocardiography in Groups II and III). They had significant residual malformation but without right ventricular hypertension (as judged mainly by immediate postoperative data). Ventricular arrhythmias occurred over 6 years after surgery. However, none of the patients operated before 2 years of age had ventricular arrhythmias or VT with a mean follow-up period of 7.5 years, perhaps because LV function was protected.(ABSTRACT TRUNCATED AT 250 WORDS)

[Use of elastic laces with attached needle in coronary surgery]. / Utilisation de lacs élastiques sertis en chirurgie coronaire.

Using elastic laces with attached needle for surgery of the coronary arteries ensures adequate exposure, presentation and drying up of these vessels during distal anastomosis.

[Selective tricuspid annuloplasty without prosthetic support]. / Annuloplastie tricuspidienne sélective sans support prothétique.

Two techniques of plastic surgery are currently used to treat tricuspid insufficiency: a prosthetic reductor or a continuous running suture. In the technique advocated here a double continuous suture is inserted into the tricuspid annulus, one running from the antero-septal to the antero-external commissures and the other, from the postero-septal to the antero-external commissures. When these two sutures are tied separately, the circumferences of the two parts of the annulus, which are diversely dilated, can be reduced. The authors have used this technique in 141 patients and a Carpentier's annulus in 41 patients. Perioperative mortality and 5-year survival were the same in both series, but the incidence of postoperative atrioventricular block was much lower in the first one. Another advantage of the double continuous suture technique is that foreign material is reduced to a minimum.

Tanycytes: a gateway to the metabolic hypothalamus.

The central regulation of energy balance relies on the ability of the brain to promptly and efficiently sense variations of metabolic state. To achieve this, circulating hormonal and metabolic signals have to cross the blood-brain interface, where unusual glial cells named tanycytes have been described to play a key role in this process. Tanycytes are specialised polarised ependymoglial cells that line the floor of the third ventricle and send a single process to contact hypothalamic neurones and blood vessels. Although their role in the regulation of energy balance via the modulation of neuronal activity or their chemosensitivity has been already described, recent studies ascribe a new function to tanycytes in the regulation of energy homeostasis as a result of their capacity to regulate the access of metabolic signals to the hypothalamus. This review discusses the peculiar place of tanycytes within the blood-hypothalamus interface, as well as a striking capacity to remodel their own interface to ensure an adaptive metabolic response to energy imbalances.

Contourographic QT interval measurement.

A new presentation of ECG tracings is presented (contourography) which is suitable for ECG intervals measurements, particularly QT for prolonged periods of time. Possible applications of this method are looked for in the future.

Cryotherapy versus electrocautery in the treatment of genital warts.

Forty-two male patients with ano-genital warts were randomly allocated to a single-blind study of cryotherapy versus electrocautery. There was no significant difference in the success rates of these two forms of treatment in patients followed for three months. Cryotherapy was qualitatively much more acceptable to the patients than electrocautery. It seems particularly suited to patients with widely scattered warts who are unable to attend for regular treatment.

Double-blind comparison of a single dose and a five-day course of metronidazole in the treatment of trichomoniasis.

Although there have been reports of the results of treating trichomoniasis with metronidazole 2 g in a single dose, no randomised double-blind comparison of this treatment with a multiple-dose regimen has been reported. In such a comparison, 96 women were treated with metronidazole 2 g in a single dose and 96 women with metronidazole 400 mg twice daily for five days. Forty-eight of 52 women followed for 14 days after the single dose were cured, as were 61 of 66 women followed for 14 days after the start of the five-day regimen. These results compare favourably with previous reports. Side effects were trivial, and we recommend the single 2-g dose, for it is effective, economical, and can be given under supervision in the clinic.