The influence of naturalistic experience on plasticity markers in somatosensory cortex and hippocampus: effects of whisker use.

We have previously demonstrated that exposure of adult rat to a type of enriched environment, known as 'naturalistic habitat' (NH), induces extensive functional plasticity in the whiskers' representations within the primary somatosensory cortex. Here we have investigated the molecular basis for such functional plasticity involved in this model. Based on the role of BDNF on synaptic plasticity and neuronal growth, the focus of this study is on BDNF and its downstream effectors CREB, synapsin I, and GAP-43. In particular, we determined the effects of natural whisker use during 2, 7 or 28 days exposure to a NH on barrel cortex and hippocampus, as compared to standard cage controls. Naturalistic whisker use resulted in increased levels of mRNAs and proteins for BDNF and its downstream effectors. Level changes for these markers were already detected after 2 days in the naturalistic habitat and grew larger over longer exposures (7 and 28 days). The cerebral cortex was found to be sensitive to the naturalistic habitat exposure at all time points, and more sensitive than the hippocampus to the trimming of the whiskers. Trimming of the whiskers decreased the level of most of the markers under study, suggesting that whiskers exert a tonic influence on plasticity markers that can be further enhanced by naturalistic use. These results implicate BDNF and its downstream effectors in the plasticity induced by the naturalistic habitat. The critical action of experience on molecular substrates of plasticity seems to provide molecular basis for the design of experienced-based rehabilitative strategies to enhance brain function.

Intrinsic signal optical imaging of brain function using short stimulus delivery intervals.

Intrinsic signal optical imaging (ISOI) can be used to map cortical function and organization. Because its detected signal lasts 10+s consisting of three phases, trials are typically collected using a long (tens of seconds) stimulus delivery interval (SDI) at the expense of efficiency, even when interested in mapping only the first signal phase (e.g., ISOI initial dip). It is unclear how the activity profile can change when stimuli are delivered at shorter intervals, and whether a short SDI can be implemented to improve efficiency. The goals of the present study are twofold: characterize the ISOI activity profile when multiple stimuli are delivered at 4s intervals, and determine whether successful mapping can be attained from trials collected using an SDI of 4s (offering >10x increase in efficiency). Our results indicate that four stimuli delivered 4s apart evoke an activity profile different from the triphasic signal, consisting of signal dips in a series at the same frequency as the stimuli despite a strong rise in signal prior to the 2nd to 4th stimuli. Visualization of such signal dips is dependent on using a baseline immediately prior to every stimulus. Use of the 4-s SDI is confirmed to successfully map activity with a similar location in peak activity and increased areal extent and peak magnitude compared to using a long SDI. Additional experiments were performed to begin addressing issues such as SDI temporal jittering, response magnitude as a function of SDI duration, and application for successful mapping of cortical function topography.

Prevalence of HIV infection among inpatients and outpatients in Department of Veterans Affairs health care systems: implications for screening programs for HIV.

OBJECTIVES: We sought to determine the prevalence of HIV in both inpatient and outpatient settings in 6 Department of Veterans Affairs (VA) health care sites. METHODS: We collected demographic data and data on comorbid conditions and then conducted blinded, anonymous HIV testing. We conducted a multivariate analysis to determine predictors of HIV infection. RESULTS: We tested 4500 outpatient blood specimens and 4205 inpatient blood specimens; 326 (3.7%) patients tested positive for HIV. Inpatient HIV prevalence ranged from 1.2% to 6.9%; outpatient HIV prevalence ranged from 0.9% to 8.9%. Having a history of hepatitis B or C infection, a sexually transmitted disease, or pneumonia also predicted HIV infection. The prevalence of previously undocumented HIV infection varied from 0.1% to 2.8% among outpatients and from 0.0% to 1.7% among inpatients. CONCLUSIONS: The prevalence of undocumented HIV infection was sufficiently high for routine voluntary screening to be cost effective in each of the 6 sites we evaluated. Many VA health care systems should consider expanded routine voluntary HIV screening.

The triphasic intrinsic signal: implications for functional imaging.

Intrinsic signal optical imaging with red illumination (ISOI) is used extensively to provide high spatial resolution maps of stimulus-evoked hemodynamic-related signals as an indirect means to map evoked neuronal activity. This evoked signal is generally described as beginning with an undershoot or "dip" in signal that is faster, more transient, and weaker compared with the subsequent signal overshoot. In contrast, the evoked signal detected with blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) is generally described as containing an undershoot after the initial dip and overshoot, even though it, too, detects hemodynamic-related signals and its first two phases appear complementary to those of ISOI. Here, we used ISOI with 635 nm illumination to image over 13.5 s after a 1 s stimulus delivery to detect and successfully use the ISOI undershoot phase for functional mapping. Eight spatiotemporal attributes were assessed per signal phase including maximum areal extent and peak magnitude, both of which were largest for the ISOI overshoot, followed by the undershoot and then the initial dip. Peak activity location did not colocalize well between the three phases; furthermore, we found mostly modest correlations between attributes within each phase and sparse correlations between phases. Extended (13.5 s) electrophysiology recordings did not exhibit a reoccurrence of evoked suprathreshold or subthreshold neuronal responses that could be associated with the undershoot. Beyond the undershoot, additional overshoot/undershoot fluctuations were also mapped, but were typically less spatiotemporally specific to stimulus delivery. Implications for ISOI and BOLD fMRI are discussed.

HIV testing of at risk patients in a large integrated health care system.

OBJECTIVE: Early identification of HIV infection is critical for patients to receive life-prolonging treatment and risk-reduction counseling. Understanding HIV screening practices and barriers to HIV testing is an important prelude to designing successful HIV screening programs. Our objective was to evaluate current practice patterns for identification of HIV. METHODS: We used a retrospective cohort analysis of 13,991 at-risk patients seen at 4 large Department of Veterans Affairs (VA) health-care systems. We also reviewed 1,100 medical records of tested patients. We assessed HIV testing rates among at-risk patients, the rationale for HIV testing, and predictors of HIV testing and of HIV infection. RESULTS: Of the 13,991 patients at risk for HIV, only 36% had been HIV-tested. The prevalence of HIV ranged from 1% to 20% among tested patients at the 4 sites. Approximately 90% of patients who were tested had a documented reason for testing. CONCLUSION: One-half to two-thirds of patients at risk for HIV had not been tested within our selected VA sites. Among tested patients, the rationale for HIV testing was well documented. Further testing of at-risk patients could clearly benefit patients who have unidentified HIV infection by providing earlier access to life-prolonging therapy.

Potential validity of conducting research on headache in internet populations.

OBJECTIVE: While it is technically feasible to conduct migraine research on the Internet, can one be sure that the subjects who participate actually have the disorder? We examined this issue in 109 sequential subjects in an Internet study of migraineurs' symptoms. BACKGROUND: The increasing use of the Internet by the US population provides an opportunity for using this medium in clinical research, but, to be useful, the results of such research must be valid and generalizable. METHODS: Using postings to Internet newsgroups of migraineurs, we recruited subjects to a migraine research site. We examined reported symptoms by comparing them with the International Headache Society's criteria for diagnosis of migraine and by subjective review by a neurologist. We also attempted to contact the subject's primary care physicians to confirm their diagnosis. RESULTS: We found considerable evidence for the validity of the participants' self-reported diagnoses. Most subjects with professed migraine reported quality of pain (97%) and associated symptoms (92%) consistent with that diagnosis, and review of their symptoms and questionnaire responses by the neurologist suggested that almost all subjects (97%) had migraine. Personal physicians confirmed a diagnosis of migraine in 90% of consenting subjects (n=49). CONCLUSIONS: The validity of self-reported diagnosis of migraine does not appear to be an obstacle to conducting research in subject populations on the Internet.