Sports Eligibility After Risk Assessment and Treatment in Children with Asymptomatic Ventricular Pre-excitation.

BACKGROUND AND OBJECTIVE: Many studies concern the management of young patients with symptomatic Wolff-Parkinson-White (WPW) syndrome, but little information exists on the significance and prognosis of ventricular pre-excitation (VPE) in asymptomatic children. The aim of the study was to evaluate the risk of sudden death in young athletes with asymptomatic VPE by transesophageal electrophysiological study (TEEPS) and their sports eligibility after the risk assessment and/or ablative treatment. METHODS: Ninety-one asymptomatic children and adolescents underwent TEEPS both at rest and during adrenergic stress (exercise testing or isoproterenol infusion). After electrophysiological testing, patients were assessed in the 36 months of follow-up. RESULTS: Thirty-three patients (36.3 %) had a benign form of VPE and were allowed to participate in competitions. Ten patients (11 %) were at borderline risk; thus, sport eligibility was evaluated individually. Forty-eight patients (52.7 %) showed inducible sustained atrioventricular reentrant tachycardia and/or atrial fibrillation (AF), 11 of whom (12.1 % of total population) had a potential risk of sudden cardiac death due to AF inducibility during physical stress. Forty-five young athletes underwent transcatheter ablation (TCA). TCA was interrupted in 12 patients (26.7 %) because of the high procedural risk linked to septal accessory pathway (AP) location. There were no TCA-related complications, and all patients remained asymptomatic during follow-up. CONCLUSION: Most of the young athletes with asymptomatic VPE may be allowed to participate in competitive sports after an adequate risk assessment and/or ablative treatment. However, in our opinion, special care should be taken to avoid procedural complications, which are unacceptable in asymptomatic patients.

Stress and corticosterone increase the readily releasable pool of glutamate vesicles in synaptic terminals of prefrontal and frontal cortex.

Stress and glucocorticoids alter glutamatergic transmission, and the outcome of stress may range from plasticity enhancing effects to noxious, maladaptive changes. We have previously demonstrated that acute stress rapidly increases glutamate release in prefrontal and frontal cortex via glucocorticoid receptor and accumulation of presynaptic SNARE complex. Here we compared the ex vivo effects of acute stress on glutamate release with those of in vitro application of corticosterone, to analyze whether acute effect of stress on glutamatergic transmission is mediated by local synaptic action of corticosterone. We found that acute stress increases both the readily releasable pool (RRP) of vesicles and depolarization-evoked glutamate release, while application in vitro of corticosterone rapidly increases the RRP, an effect dependent on synaptic receptors for the hormone, but does not induce glutamate release for up to 20 min. These findings indicate that corticosterone mediates the enhancement of glutamate release induced by acute stress, and the rapid non-genomic action of the hormone is necessary but not sufficient for this effect.

Effects of excessive energy intake and supplementation with chromium propionate on insulin resistance parameters in nonlactating dairy cows.

The objective was to compare insulin resistance parameters in cows with adequate or excessive energy intake as well as in cows with excessive energy intake receiving Cr supplementation as chromium propionate. Thirteen multiparous, nonlactating Gir × Holstein cows were ranked by BW and BCS and assigned to 1 of 3 dietary treatments on d 0: 1) diet to meet their ME requirements without Cr supplementation (MAN; n = 4), 2) diet to exceed their ME requirements without Cr supplementation (HIGH; n = 4), and 3) HIGH with 2.5 g/d of chromium propionate (HIGHCR; n = 5, with 10 mg of Cr/cow daily). Diets were formulated to provide 100% of daily ME requirements of MAN and 177% of daily ME requirements of HIGH and HIGHCR cows and offered twice daily via individual self-locking head gates from d 0 to 88. Cow BW and BCS were recorded on d 0 and 88 of the experiment. Blood samples were collected before and 2 h after the morning feeding twice weekly. Preprandial revised quantitative insulin sensitivity check index (RQUICKI) was determined using serum glucose, insulin, and NEFA concentrations obtained before feeding. Glucose tolerance tests (GTT) were performed on d 32 and 88 by infusing cows with 0.5 g of glucose/kg of BW whereas blood samples were collected at -15, 0, 10, 20, 30, 45, 60, and 90 min relative to infusion. Change in BCS tended to be greater in HIGH and HIGHCR (P = 0.09) compared with MAN cows. Within samples collected twice weekly, serum concentrations of glucose, insulin (beginning on d 14 of the experiment), and NEFA (preprandial samples only) were greater (P ≤ 0.05) in HIGH compared with HIGHCR cows and tended to be greater in HIGH compared with MAN cows (P ≤ 0.10) but did not differ (P ≥ 0.52) between HIGHCR and MAN cows. Moreover, HIGH cows had reduced RQUICKI compared with MAN (P = 0.02) and HIGHCR cows (P = 0.05) whereas RQUICKI was similar between MAN and HIGHCR cows (P = 0.53). Within samples collected during the GTT, mean serum insulin concentrations and insulin:glucose ratio were greater (P < 0.01) in HIGH compared with HIGHCR cows, tended (P ≤ 0.09) to be greater in HIGH compared with MAN cows, and were similar (P ≥ 0.16) between HIGHCR and MAN cows. Serum glucose concentrations were greater (P < 0.01) for HIGH compared with MAN and HIGHCR cows 20 min relative to infusion. In conclusion, chromium propionate supplementation prevented the increase in insulin resistance caused by excessive energy intake in nonlactating dairy cows.

Treatment of rosacea.

A range of treatment options are available in rosacea, which include several topical (mainly metronidazole, azelaic acid, other antibiotics, sulfur, retinoids) and oral drugs (mainly tetracyclines, metronidazole, macrolides). In some cases, the first choice is a systemic therapy because patients may have sensitive skin and topical medications can be irritant. Isotretinoin can be used in resistant cases of rosacea. Unfortunately, the majority of studies on rosacea treatments are at high or unclear risk of bias. A recent Cochrane review found that only topical metronidazole, azelaic acid, and oral doxycycline (40 mg) had some evidence to support their effectiveness in moderate to severe rosacea and concluded that further well-designed, adequately-powered randomised controlled trials are required. In our practice, we evaluate our patients for the presence of two possible triggers, Helicobacter pylori infection and small intestinal bacterial overgrowth. When they are present we use adapted antibiotic protocols. If not, we use oral metronidazole or oral tetracycline to treat papulopustolar rosacea. We also look for Demodex folliculorum infestation. When Demodex concentration is higher than 5/cm(2) we use topical crotamiton 10% or metronidazole.

Treatments for pityriasis rosea.

Pityriasis rosea is a common skin disorder in children and young adults. It is a self-limiting disease with symptoms that are typically mild and tolerable. Consequently, the best treatment remains the one followed so far by generations of dermatologists: reassuring the patient and letting the condition go away on its own. However, there are times when treatment is recommended. In this paper, we review the available treatments for this skin disease.

A water-soluble carbon monoxide-releasing molecule (CORM-3) lowers intraocular pressure in rabbits.

BACKGROUND: Carbon monoxide-releasing molecules (CORMs) are a novel group of substances that are capable of modulating physiological functions via the liberation of CO. AIMS: This study was undertaken to investigate the effects of CORM-3, a water-soluble CO-releasing agent, on two rabbit models of ocular hypertension. METHODS: Ocular hypertension was induced by injecting alpha-chymotrypsin in the rabbit eye. The dose-response effect of CORM-3 on IOP was assessed by topical administration of the drug (0.001, 0.01, 0.1 and 1%). Ocular hypertension was also obtained by weekly subconjunctival injection of betamethasone, and animals were treated topically with CORM-3. A group of animals in both models was treated with the inactive form of the drug (iCORM-3). RESULTS: CORM-3 induced a dose-dependent reduction in IOP in rabbits treated with alpha-chymotrypsin. A similar reduction in IOP was observed in rabbits with betamethasone-induced ocular hypertension treated with the drug. Treatment with the iCORM-3 had no effect on IOP in both models. CONCLUSIONS: Treatment with CORM-3 is associated with a reduction in IOP in two different rabbit models of ocular hypertension. These results support previous findings on the effect of haem oxygenase-derived CO on IOP and suggest a direct involvement of CO system in the regulation of ocular pressure probably through the modulation of aqueous humour dynamics.

Acute low doses of melatonin restore full sexual activity in impotent male rats.

Evidence exists that repeated injections of melatonin in rather large doses inhibit sexual performance in male rats. In contrast, systemic injection of small doses of this hormone stimulates sexual activity of normal male rats. In these experiments, systemic acute administration of melatonin in small doses (10-100 microg/kg) induced the appearance of ejaculations in impotent Wistar male rats that were selected as showing null sexual approach or showing mounts, intromissions but no ejaculations. This effect was partially abolished by the simultaneous peripheral injection of the non-selective melatonin receptor antagonist, luzindole, or by the acute administration of serotonin or of the 5HT(2A) receptor agonist, 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI), into the amygdala or the ventral hypothalamus. These results suggest that melatonin may stimulate, in a dose-dependent manner, several copulatory parameters of male sexual behavior and may restore sexual activity in impotent animals by interacting with brain receptors, i. e. melatonin and serotonin receptors.

Phospholipid liposomes potentiate the inhibitory effect of antidepressant drugs on immobility of rats in a despair test (constrained swim).

Male rats forced to swim in a cylinder assumed an immobile posture. Immobility was reduced by antidepressant drugs, such as imipramine, desimipramine, iproniazid and mianserin injected 24, 5 and again 1 h prior to behavioral testing. Subchronic (4, 7 and 10 days) treatment with sonicated preparations of bovine hypothalamic phospholipid liposomes potentiated the inhibitory effect of all antidepressant drugs in the despair test. Acute administration of phospholipid liposomes failed to influence the drug effect. Furthermore, neither subchronic nor acute administration of phospholipid liposomes per se modified the immobility in the despair test. It is possible that the action of phospholipid liposomes on the inhibitory effect of antidepressant drugs on immobility of rats in the despair test may depend on potentiation of antidepressant-induced change in the sensitivity of monoamine receptors in the brain.

In vivo and in vitro interference of phosphatidylserine liposomes on prolactin secretion in the rat.

The effect of sonicated suspensions of phosphatidylserine (PS), an acidic phospholipid, was investigated on prolactin secretion utilizing in vivo and in vitro approaches. Acute and chronic administration of PS reduced plasma prolactin levels during different phases of circadian rhythms. The phospholipid was able to inhibit the plasma prolactin surge, which occurs in cycling female rats on the afternoon of proestrus. The time course of PS on prolactin secretion was characterized by a short latency (15 min) and a long duration of action (6 h). In rats with hypothalamic deafferentation PS partially reduced the increase of circulating prolactin induced by pretreatment with alpha-methyltyrosine. An inhibition of prolactin release was observed if anterior pituitary glands were incubated in presence of PS. This effect was prevented by the addition of the dopamine antagonist sulpiride to the medium. In conclusion, PS decreases prolactin secretion both in vivo and in vitro. The inhibition of the hormone secretion appears to be due to the action of PS at the level of the pituitary; however, a concomitant stimulatory action on the turnover of the tuberoinfundibular neurons cannot be ruled out.

Possible role of prolactin in the modification of medial basal hypothalamic glutamic acid decarboxylase activity.

The effects of acute and chronic injections of haloperidol, sulpiride and apomorphine on serum prolactin (PRL) levels and medial basal hypothalamus (MBH) glutamic acid decarboxylase (GAD) activity were investigated in male rats. Parallel changes in PRL and GAD activity were observed in acutely treated animals. Conversely, a return to normal of the GAD activity associated with high plasma PRL levels was induced by chronic haloperidol and sulpiride treatment. Results are discussed in the light of the possible existence of a hypothetical PRL-gamma-aminobutyric acid (GABA) subsidiary feedback loop.