SUBACUTE ARTERIAL BLEEDING AFTER SIMULTANEOUS MASTOPEXY AND BREAST AUGMENTATION WITH IMPLANTS: CASE REPORT.

Breast augmentation with implants is one of the most commonly performed plastic surgery procedures. The goal of the operation is to increase the size, shape or fullness of the breast. It is accomplished by placing silicone, saline or alternative composite breast implants under the chest muscles, fascia or the mammary gland. This type of operation is no exception with regards to concerning the occurrence of complications. The most common early complications include an infectious process, a seroma, and a hematoma, and the late ones include capsular contracture, reoperation, implant removal, breast asymmetry, and a rupture or deflation of the implant. The authors present a case of subacute arterial bleeding after simultaneous mastopexy and breast augmentation with silicone implants in a 27-year-old woman. The patient complained of worsening swelling and pain in the right breast. The patient denied having had any traumas. Ultrasonography indicated 2.5 cm heterogeneous fluid collections around the implant. Therefore, revision surgery was performed, and a hematoma of 650 mL was removed. Hemorrhage from a branch of the internal mammary artery was found. After the revision, the implant was returned to the lodge. The postoperative period was uneventful. This case report presents a description of a subacute hematoma after simultaneous mastopexy and breast augmentation with silicone implants, which is an extremely rare complication in aesthetic surgery.

A multi-channel low-power system-on-chip for single-unit recording and narrowband wireless transmission of neural signal.

This paper reports a multi-channel neural recording system-on-chip (SoC) with digital data compression and wireless telemetry. The circuit consists of a 16 amplifiers, an analog time division multiplexer, an 8-bit SAR AD converter, a digital signal processor (DSP) and a wireless narrowband 400-MHz binary FSK transmitter. Even though only 16 amplifiers are present in our current die version, the whole system is designed to work with 64 channels demonstrating the feasibility of a digital processing and narrowband wireless transmission of 64 neural recording channels. A digital data compression, based on the detection of action potentials and storage of correspondent waveforms, allows the use of a 1.25-Mbit/s binary FSK wireless transmission. This moderate bit-rate and a low frequency deviation, Manchester-coded modulation are crucial for exploiting a narrowband wireless link and an efficient embeddable antenna. The chip is realized in a 0.35- εm CMOS process with a power consumption of 105 εW per channel (269 εW per channel with an extended transmission range of 4 m) and an area of 3.1 × 2.7 mm(2). The transmitted signal is captured by a digital TV tuner and demodulated by a wideband phase-locked loop (PLL), and then sent to a PC via an FPGA module. The system has been tested for electrical specifications and its functionality verified in in-vivo neural recording experiments.

The determinants of the onset dynamics of action potentials in a computational model.

Action potentials (APs) in the soma of central neurons exhibit a sharp, step-like onset dynamics, which facilitates the encoding of weak but rapidly changing input signals into trains of action potentials. One possibility to explain the rapid AP onset dynamics is to assume cooperative activation of sodium channels. However, there is no direct evidence for cooperativity of voltage gated sodium channels in central mammalian neurons. The fact that APs in cortical neurons are initiated in the axon and backpropagate into the soma, prompted an alternative explanation of the sharp onset of somatic APs. In the invasion scenario, the AP onset is smooth at the initiation site in the axon initial segment, but the current invading the soma before somatic sodium channels are activated produces a sharp onset of somatic APs. Here we used multicompartment neuron models to identify ranges of active and passive cell properties that are necessary to reproduce the sharp AP onset in the invasion scenario. Results of our simulations show that AP initiation in the axon is a necessary but not a sufficient condition for the sharp onset of somatic AP: for a broad range of parameters, models could reproduce distal AP initiation and backpropagation but failed to quantitatively reproduce the onset dynamics of somatic APs observed in cortical neurons. To reproduce sharp onset of somatic APs, the invasion scenario required specific combinations of active and passive cell properties. The required properties of the axon initial segment differ significantly from the currently accepted and experimentally estimated values. We conclude that factors additional to the invasion contribute to the sharp AP onset and further experiments are needed to explain the AP onset dynamics in cortical neurons.

A compact multichannel system for acquisition and processing of neural signals.

An increasing popularity of multichannel recordings from freely behaving animals and the need to develop a practical brain-machine interface has fuelled the development of miniature multichannel recording systems. Here we describe our prototype miniature 64-channel acquisition system that could be used for multichannel recordings in freely behaving monkeys or other large animals. The system's features include an high impedance input for neurophysiology electrodes, an integrated battery fed circuitry with a 64 low-noise multiplexed amplifiers array that permits the parallel recording of all channels, a 10-bit resolution ADC, an FPGA digital core for online processing and data transmission, a USB 2.0 link and a custom software for data visualization and whole system control.

A simple method for efficient spike detection in multiunit recordings.

A number of spike detection and sorting methods exist and the availability of powerful desktop computers may suggest that the problem of spike detection is solved. However, for portable multi-channel systems, when one takes into account the power consumption limitations, computationally simple methods can be advantageous when compared to more complex algorithms. Here we describe a simple spike detection method that reduces approximately two-fold the rate of false detections compared to the single threshold spike detection method. The proposed algorithm can be employed in an analog electronic chip thus eliminating the need for the digitization of the original signal. Consequently, only the times of spike occurrence can be transmitted for further analysis.

Cell-based biosensors: current trends of the development.

In the last decade, a number of laboratories have developed devices that combine electronic components with living cells, including neurons. These devices can be used as cell-based biosensors or labs-on-a-chip for testing of the tumor cell sensitivity to anti-cancer drugs, detection of toxins and chemical substances and pre-clinical evaluation of new drugs. Here we review briefly the existing types of the cell-based biosensors and the strategies employed to improve these complex devices. We argue that, for the neuron-based biosensors, introduction of structure in the connections of the synaptic network should significantly improve the utility of such devices.

A switched-capacitor neural preamplifier with an adjustable pass-band for fast recovery following stimulation.

For extracellular recordings from neurons, it is desirable to use the same electrode for stimulation as well as for recording. Since neural preamplifiers usually exhibit high-pass filtering at frequencies as low as 0.1 Hz, the recovery from saturation is typically very slow. Consequently, following stimulation, no signal can be detected for up to several seconds. This is unacceptably slow response of the preamplifier because the majority of neurons fires action potentials within first milliseconds following stimulation. Here we propose to use a switched-capacitor preamplifier with adjustable pass-band for fast recovery from saturation caused by stimulation via the recording electrode. The idea was tested in a real preamplifier manufactured with a standard CMOS technology (0.35 microm). In control conditions, the high-pass filter was set to 100 Hz and, during stimulation, was shifted to 10 kHz. Such a shift allows the reduction of the recovery time from tens of milliseconds to sub-millisecond range.

Integrating live cells with semiconductor devices: A biocompatibility assay.

There is increasing interest in the development of small hybrid cell-semiconductor systems for the non-invasive evaluation of the physiological state of a cell population. These miniature devices can be used in many areas of biomedical applications, ranging from basic research to drug screening during cancer chemosensitivity testing in clinics. A prerequisite for the biological and medical application of these devices is that cells retain their functional and growth properties when in contact with the semiconductor sensor material. The sensor surface is usually coated with dielectric silicon dioxide (SiO2 ) or a silicon nitride layer (Si3 N4 ); therefore, cellular adhesion to these materials and cellular viability on these surfaces are of crucial im-portance. This is especially true for bone cells that are sensitive to the surface microstructure. Therefore, we investigated the short-term (1-7 days) behavior of model bone cells (MG63 human osteosarcoma cells) grown on silicon samples coated with SiO2 . Cell adhesion and morphology were evaluated by scanning electron microscopy (SEM) 1 day after seeding and cell pro-liferation was evaluated by Alamar Blue assay at 2, 3 and 7 days after seeding. No adverse cellular reactions could be detected with these assays suggesting that the tested substrate is suitable for the hybrid cell-semiconductor systems that test bone tumor chemosensitivity.

Kv4.2 mRNA abundance and A-type K(+) current amplitude are linearly related in basal ganglia and basal forebrain neurons.

A-type K(+) currents are key determinants of repetitive activity and synaptic integration. Although several gene families have been shown to code for A-type channel subunits, recent studies have suggested that Kv4 family channels are the principal contributors to A-type channels in the somatodendritic membrane of mammalian brain neurons. If this hypothesis is correct, there should be a strong correlation between Kv4 family mRNA and A-type channel protein or aggregate channel currents. To test this hypothesis, quantitative single-cell reverse transcription-PCR analysis of Kv4 family mRNA was combined with voltage-clamp analysis of A-type K(+) currents in acutely isolated neurons. These studies revealed that Kv4.2 mRNA abundance was linearly related to A-type K(+) current amplitude in neostriatal medium spiny neurons and cholinergic interneurons, in globus pallidus neurons, and in basal forebrain cholinergic neurons. In contrast, there was not a significant correlation between estimates of Kv4.1 or Kv4.3 mRNA abundance and A-type K(+) current amplitudes. These results argue that Kv4.2 subunits are major constituents of somatodendritic A-type K(+) channels in these four types of neuron. In spite of this common structural feature, there were significant differences in the voltage dependence and kinetics of A-type currents in the cell types studied, suggesting that other determinants may create important functional differences between A-type K(+) currents.

Expression of the transcription factor deltaFosB in the brain controls sensitivity to cocaine.

Acute exposure to cocaine transiently induces several Fos family transcription factors in the nucleus accumbens, a region of the brain that is important for addiction. In contrast, chronic exposure to cocaine does not induce these proteins, but instead causes the persistent expression of highly stable isoforms of deltaFosB. deltaFosB is also induced in the nucleus accumbens by repeated exposure to other drugs of abuse, including amphetamine, morphine, nicotine and phencyclidine. The sustained accumulation of deltaFosB in the nucleus accumbens indicates that this transcription factor may mediate some of the persistent neural and behavioural plasticity that accompanies chronic drug exposure. Using transgenic mice in which deltaFosB can be induced in adults in the subset of nucleus accumbens neurons in which cocaine induces the protein, we show that deltaFosB expression increases the responsiveness of an animal to the rewarding and locomotor-activating effects of cocaine. These effects of deltaFosB appear to be mediated partly by induction of the AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazole) glutamate receptor subunit GluR2 in the nucleus accumbens. These results support a model in which deltaFosB, by altering gene expression, enhances sensitivity to cocaine and may thereby contribute to cocaine addiction.

Properties of Q-type calcium channels in neostriatal and cortical neurons are correlated with beta subunit expression.

In brain neurons, P- and Q-type Ca(2+) channels both appear to include a class A alpha1 subunit. In spite of this similarity, these channels differ pharmacologically and biophysically, particularly in inactivation kinetics. The molecular basis for this difference is unclear. In heterologous systems, alternative splicing and ancillary beta subunits have been shown to alter biophysical properties of channels containing a class A alpha1 subunit. To test the hypothesis that similar mechanisms are at work in native systems, P- and Q-type currents were characterized in acutely isolated rat neostriatal, medium spiny neurons and cortical pyramidal neurons using whole-cell voltage-clamp techniques. Cells were subsequently aspirated and subjected to single-cell RT-PCR (scRT-PCR) analysis of calcium channel alpha(1) and beta (beta(1-4)) subunit expression. In both cortical and neostriatal neurons, P- and Q-type currents were found in cells expressing class A alpha(1) subunit mRNA. Although P-type currents in cortical and neostriatal neurons were similar, Q-type currents differed significantly in inactivation kinetics. Notably, Q-type currents in neostriatal neurons were similar to P-type currents in inactivation rate. The variation in Q-type channel biophysics was correlated with beta subunit expression. Neostriatal neurons expressed significantly higher levels of beta(2a) mRNA and lower levels of beta(1b) mRNA than cortical neurons. These findings are consistent with the association of beta(2a) and beta(1b) subunits with slow and fast inactivation, respectively. Analysis of alpha(1A) splice variants in the linker between domains I and II failed to provide an alternative explanation for the differences in inactivation rates. These findings are consistent with the hypothesis that the biophysical properties of Q-type channels are governed by beta subunit isoforms and are separable from toxin sensitivity.

Delayed rectifier currents in rat globus pallidus neurons are attributable to Kv2.1 and Kv3.1/3.2 K(+) channels.

The symptoms of Parkinson disease are thought to result in part from increased burst activity in globus pallidus neurons. To gain a better understanding of the factors governing this activity, we studied delayed rectifier K(+) conductances in acutely isolated rat globus pallidus (GP) neurons, using whole-cell voltage-clamp and single-cell RT-PCR techniques. From a holding potential of -40 mV, depolarizing voltage steps in identified GP neurons evoked slowly inactivating K(+) currents. Analysis of the tail currents revealed rapidly and slowly deactivating currents of similar amplitude. The fast component of the current deactivated with a time constant of 11. 1 +/- 0.8 msec at -40 mV and was blocked by micromolar concentrations of 4-AP and TEA (K(D) approximately 140 microM). The slow component of the current deactivated with a time constant of 89 +/- 10 microseconds at -40 mV and was less sensitive to TEA (K(D) = 0.8 mM) and 4-AP (K(D) approximately 6 mM). Organic antagonists of Kv1 family channels had little or no effect on somatic currents. These properties are consistent with the hypothesis that the rapidly deactivating current is attributable to Kv3.1/3.2 channels and the slowly deactivating current to Kv2.1-containing channels. Semiquantitative single-cell RT-PCR analysis of Kv3 and Kv2 family mRNAs supported this conclusion. An alteration in the balance of these two channel types could underlie the emergence of burst firing after dopamine-depleting lesions.

Basal forebrain neurons adjacent to the globus pallidus co-express GABAergic and cholinergic marker mRNAs.

Semi-quantitative single cell RT-PCR techniques were used to determine the expression of mRNAs related to GABAergic and cholinergic neurotransmission in neurons of the rat globus pallidus and adjacent basal forebrain region. Neurons of the globus pallidus expressed relatively high levels of GAD67 and GABA vesicular transporter mRNA but undetectable levels of ChAT or ACh vesicular transporter mRNA. In contrast, nominally basal forebrain neurons co-expressed ChAT and GAD67 mRNAs and mRNAs for both ACh and GABA vesicular transporters. These results suggest that the neurons along the medial border of the globus pallidus may co-release GABA and ACh.

Somatodendritic depolarization-activated potassium currents in rat neostriatal cholinergic interneurons are predominantly of the A type and attributable to coexpression of Kv4.2 and Kv4.1 subunits.

Unlike other neostriatal neurons, cholinergic interneurons exhibit spontaneous, low-frequency, repetitive firing. To gain an understanding of the K+ channels regulating this behavior, acutely isolated adult rat cholinergic interneurons were studied using whole-cell voltage-clamp and single-cell reverse transcription-PCR techniques. Cholinergic interneurons were identified by the presence of choline acetyltransferase (ChAT) mRNA. Depolarization-activated potassium currents in cholinergic interneurons were dominated by a rapidly inactivating, K+-selective A current that became active at subthreshold potentials. Depolarizing prepulses inactivated this component of the current, leaving a delayed, rectifier-like current. Micromolar concentrations of Cd2+ dramatically shifted the voltage dependence of the A current without significantly affecting the delayed rectifier. The A-channel antagonist 4-aminopyridine (4-AP) produced a voltage-dependent block (IC50, approximately 1 mM) with a prominent crossover at millimolar concentrations. On the other hand, TEA preferentially blocked the sustained current component at concentrations <10 mM. Single-cell mRNA profiling of subunits known to give rise to rapidly inactivating K+ currents revealed the coexpression of Kv4.1, Kv4.2, and Kv1.4 mRNAs but low or undetectable levels of Kv4.3 and Kv3.4 mRNAs. Kv1.1, beta1, and beta2 subunit mRNAs, but not beta3, were also commonly detected. The inactivation recovery kinetics of the A-type current were found to match those of Kv4.2 and 4.1 channels and not those of Kv1.4 or Kv1. 1 and beta1 channels. Immunocytochemical analysis confirmed the presence of Kv4.2 but not Kv1.4 subunits in the somatodendritic membrane of ChAT-immunoreactive neurons. These results argue that the depolarization-activated somatodendritic K+ currents in cholinergic interneurons are dominated by Kv4.2- and Kv4. 1-containing channels. The properties of these channels are consistent with their playing a prominent role in governing the slow, repetitive discharge of interneurons seen in vivo.

Sensitization of pain pathways in the spinal cord: cellular mechanisms.

Sensitization is manifested as an increased response of neurones to a variety of inputs following intense or noxious stimuli. It is one of the simplest forms of learning and synaptic plasticity and it represents an important feature of nociception. In the spinal cord, repeated stimulation (at constant strength) of dorsal root afferents including nociceptive C fibres can elicit a progressive increase in the number of action potentials generated by motoneurones and interneurones. This phenomenon is termed "action potential windup" and is used as a cellular model of pain sensitization developing at the level of the central nervous system. Understanding the mechanisms responsible for windup generation might allow clarification of the cellular mechanisms of pain signalling and development of new strategies for pain treatment. Action potential windup is observed in a minority of cells only, indicating that certain cell-specific mechanisms are responsible for its generation. The most reliable index to predict windup generation is the rate at which the membrane potential is depolarized during repetitive stimulation. This phenomenon has been proposed to be due to gradual recruitment of NMDA receptor activity, to summation of slow excitatory potentials mediated by substance P (and related peptides) or to facilitation of slow calcium channels by metabotropic glutamate receptors. Little is known about the role of synaptic inhibition in windup, although it should not be underestimated. Each theory per se is unable to account for all the experimental observations. Since NMDA receptors are involved in many forms of synaptic plasticity, additional mechanisms such as summation of slow peptidergic potentials, facilitation of slow Ca2+ currents and disinhibition are proposed as necessary to impart specificity to pain-induced sensitization. These additional mechanisms might be species specific and change during development or chronic pain states.

NMDA receptor-independent mechanisms responsible for the rate of rise of cumulative depolarization evoked by trains of dorsal root stimuli on rat spinal motoneurones.

The mechanisms responsible for the rate of rise (RR) of cumulative depolarization induced by dorsal root stimulus trains were investigated with intracellular recordings from motoneurones of the rat isolated spinal cord. The NMDA receptor antagonists CPP or APV depressed the cumulative depolarization but not its RR which could still be fast enough to elicit action potential wind-up. RR size was correlated with a slow synaptic potential (detected in CPP or APV solution) with which it shared similar voltage dependence. The NK1 antagonist SR 140333 depressed cumulative depolarization, RR and slow synaptic potentials. It appears that the RR (and the ability to express wind-up) was determined by summation of slow synaptic potentials partly mediated via activation of NK1 receptors.

Membrane potential oscillations of neonatal rat spinal motoneurons evoked by electrical stimulation of dorsal root fibres.

Intracellular recording from lumbar motoneurons of the neonatal rat isolated spinal cord bathed in standard saline solution was used to study membrane potential oscillations which accompanied the decay phase of excitatory postsynaptic potentials (EPSP) induced by single electrical pulses to an adjacent dorsal root. About 60% of motoneurons displayed rhythmic oscillations of 10 +/- 2 mV maximal amplitude and 7 +/- 0.5 Hz frequency. Ability to generate oscillations could not be correlated to the cell membrane properties or to the age of the preparation (5-13 days). The oscillation frequency was independent of membrane potential (-100 to -45 mV) or of the intensity of dorsal root stimuli. The oscillation amplitude was linearly related to the cell potential within the same voltage level. Fast Fourier transform analysis showed that the power spectrum of oscillations peaked at approximately 8 Hz. Electrically evoked activities and spontaneous events displayed similar cut-off frequencies. When the cell membrane potential was steadily depolarized, a hyperpolarizing pulse applied during the decay phase of the EPSP promptly revealed the presence of oscillatory behaviour. Pharmacological block of neurokinin-1 or N-methyl-D-aspartate receptors depressed the decay phase of the EPSP and the associated oscillatory responses. It is suggested that rhythmic oscillations were probably due to summated synaptic potentials generated at the premotoneuron level and are perhaps of functional relevance to motoneuron behaviour.

An NK1 receptor-dependent component of the slow excitation recorded intracellularly from rat motoneurons following dorsal root stimulation.

Intracellular recording from lumbar motoneurons of the neonatal rat spinal cord in vitro was used to study how recently developed non-peptide antagonists such as SR-140333 and SR-48698, known to block distinct subtypes of tachykinin receptors peripherally, might affect synaptic transmission elicited by electrical stimulation of dorsal root fibres. SR-140333 (1 microM) preferentially antagonized responses mediated by an exogenously applied agonist acting on the NK1 receptor subclass, while SR-48968 (0.5 microM) preferentially reduced responses mediated by an exogenously applied agonist acting on the NK2 receptor subclass. SR-48968 did not affect fast or slow excitatory postsynaptic potentials (EPSPs) or 'wind-up' responses induced by repetitive, low-frequency stimulation (mimicking certain types of nociceptive input); binding studies using this radiolabelled ligand disclosed specific binding activity (21 fmol/mg protein) selectively displaced by an NK2 receptor agonist. SR-140333 reduced the late component of fast and slow EPSPs, and of wind-up. Pharmacological block of ionotropic glutamate receptors abolished all dorsal root-evoked EPSPs. In comparison to glutamate receptor blockers, SR-140333 was a weaker antagonist of slow synaptic responses, though it displayed preferential antagonism towards some components of the wind-up phenomenon. The present results provide evidence obtained with a novel NK1 antagonist that a neuropeptide (presumably substance P), although not directly released by primary afferents onto motoneurons, is a neurotransmitter (acting via NK1 receptors) in the pathway mediating slow synaptic responses of motoneurons, and is presumably involved in signalling nociceptive inputs from the periphery.

Effects of RP 67580 on substance P-elicited responses and postsynaptic potentials of motoneurones of the rat isolated spinal cord.

The effect of RP 67580, a recently developed antagonist selective for the NK1 tachykinin receptors of peripheral tissues, was studied with intracellular recording from motoneurones of the rat isolated spinal cord. In the presence of RP 67580 (1-2 microM), membrane depolarization induced by the putative transmitter substance P (SP) was either unchanged or enhanced (an effect prevented by tetrodotoxin; TTX). Neither short nor long excitatory synaptic potentials (EPSPs) were antagonized by RP 67580. Sustained synaptically evoked depolarizations (mimicking noxious stimuli and thus presumed to be at least partly mediated by SP) were also insensitive to RP 67580. These data suggest the existence of a pharmacologically distinct NK1 receptor population insensitive to RP 67580) in the neonatal rat spinal cord.

Multiple types of tachykinin receptor mediate a slow excitation of rat spinal motoneurones in vitro.

Using intracellular current clamp recording from motoneurones of the neonatal rat spinal cord in vitro, the action of tachykinin receptor agonists was investigated. Test drugs included the endogenously occurring neuropeptide substance P and synthetic compounds, such as substance P methylester (SPMeO), [beta Ala8]neurokinin A4-10 ([Ala]NKA), [MePhe7]neurokinin B ([MePhe]NKB) and senktide. SPMeO and [Ala]NKA were used as selective agonists at NK1 and NK2 receptors, respectively, while [MePhe]NKB or senktide were employed to activate NK3 receptors. In control solution, all compounds produced sustained depolarization with increase in input resistance although at comparable levels of membrane depolarization different patterns of motoneuronal firing were observed dependent on the type of agonist tested. In tetrodotoxin (TTX; 1 microM) solution, the depolarization caused by substance P or SPMeO largely persisted while in the majority of cells the effect of [Ala]NKA, [MePhe]NKB or senktide was blocked. It is suggested that NK1 receptors primarily mediated the actions of substance P on spinal motoneurones and that activation of NK2 or NK3 receptors, predominantly found on interneurones, induced motoneuronal depolarization with different firing patterns.