Beneficial effects of exercise on chemotherapy-induced peripheral neuropathy and sleep disturbance: A review of literature and proposed mechanisms.

The goal of this narrative review is to evaluate the literature regarding exercise training as a therapy to prevent or mitigate deleterious side effects of chemotherapy, specifically peripheral neuropathy and sleep disturbances and to make concrete recommendations for implementation for the practicing oncologist. A literature search was conducted for studies that included an exercise intervention to be implemented for patients undergoing or previously treated with chemotherapy along with an analysis of its effect on either chemotherapy-induced peripheral neuropathy (CIPN) or chemotherapy-induced sleep disturbances. Studies were subsequently analyzed and summarized in order to determine the overall promise of exercise as a therapy in this setting. Five studies met inclusion criteria to be assessed with regard to the effect of exercise on CIPN and eight were included for sleep disturbances. Exercise was found to be a significantly beneficial therapy in preventing, mitigating, or improving the symptoms of CIPN and sleep disturbances in cancer patients in the majority of studies evaluated. Exercise is an effective intervention and should be specifically prescribed concurrently with chemotherapy to maximize potential of avoiding these debilitating side effects, which significantly and negatively impact quality of life in cancer survivors.

Epicardial ultrasound in a case of myocardial bridge and apical hypertrophic cardiomyopathy.

A 59-year-old male with a history of unstable angina was diagnosed with a myocardial bridge of the left anterior descending artery (LAD) and apical variant hypertrophic cardiomyopathy (AHCM). He underwent unroofing of the myocardial bridge and a left ventricular apical myectomy. Intraoperatively, epicardial ultrasound was used to identify the myocardial bridge with systolic compression of the LAD and confirm resolution of this compression postoperatively. Furthermore, epicardial ultrasound was used for guiding the degree of apical resection of the decompressed heart. This novel use of intraoperative epicardial ultrasound can help guide surgeons preoperatively and confirm results immediately after an operation.

Estimated compliance for removal of specified risk materials from 18 U.S. beef packing plants.

The removal of 18,345 specified risk materials was observed during audits of 18 U.S. beef processing facilities that, in total, account for over 90% of total U.S. beef slaughtered. Audited plants varied in capacity (280 to 6,000 head per day) and processed both "fed (young cattle)" and "nonfed (mature cows/bulls)" cattle. When all observations for removal of specified risk materials were combined from plants and adjusted for type of cattle processed, overall compliance with specified risk material removal regulations was 98.08%. A 100% compliance rate for removal of brains and distal ileums was recorded based on a total of 600 observations for removal of brains and a total of 2,400 observations for removal of distal ileums. Observations for removal of dorsal root ganglia were collected from 16 of the 18 plants, and overall compliance for dorsal root ganglia removal was 99.6% (4,783 of 4,800). Fifteen of the 16 plants were 100% compliant. For tonsils, data from 18 plants were collected, and tonsils were correctly removed from 92.8% (4,777 of 5,145) of tongues and heads. Data for spinal cord removal were collected from 18 plants, and the spinal cord was removed completely in line with U.S. Department of Agriculture-Food Safety and Inspection Service regulations for 99.43% of the observations. Based on the results of this study, packing plants have demonstrated that they are complying with regulations for removal of specified risk materials from beef meat products intended for human consumption greater than 98% of the time. To continue to assure food safety and consumer confidence, continued vigilance and provision of training programs for plant workers are essential.

Developing and implementing an assessment method to evaluate a virtual canine anatomy program.

A computer-based anatomy program, Virtual Canine Anatomy: The Head, was incorporated into a first-year veterinary dissection laboratory two years ago to address challenges inherent in the traditional pedagogical approach. The program uses specimen photographs, QuickTime Virtual Reality, and interactive features to help students study the dissection, osteology, and radiology of the canine head. Photographs of each phase of dissection are displayed in the program, along with dissection instructions. Students can click on anatomical structures in each photograph to highlight the selected structure and display a complete description of it. Related structures and views are accessible through hyperlinks. This study was designed to measure student and faculty attitudes toward the instructional software, to gauge its effect on student achievement, and to propose evaluation methodology and instrumentation for similar projects. Observations, interviews, focus groups, surveys, and test results were used for this assessment. Results suggest positive student and faculty attitudes toward the program. Students felt the program met their needs, increased their confidence and efficiency, and was easy to use. Both students and instructors felt the program was beneficial during dissection. There was no significant change in student achievement on course tests. Future research will measure the program's effect on student-instructor interactions.

Peripherally administered insulin-like growth factor-I preserves hindlimb reflex and spinal cord noradrenergic circuitry following a central nervous system lesion in rats.

The blood-central nervous system-barrier (B-CNS-B) is widely considered a significant impediment to the use of protein neurotrophic factors for the treatment of brain diseases and disorders. In this study, we tested the hypothesis that systemic administration of insulin-like growth factor I (IGF-I) can ameliorate functional damage to the central nervous system. Intracisternal injection of 6-hydroxydopamine (6-OHDA) normally results in loss of both the descending spinal cord noradrenergic (NA) fibers and the hindlimb withdrawal reflex. Ten minutes after 6-OHDA or solvent injection, 1 week duration osmotic minipumps containing IGF-I or vehicle were implanted subcutaneously in the mid-back of adult rats. Three weeks post-surgery, the maximum stimulus-evoked withdrawal force of the hindlimb was measured. This withdrawal reflex was significantly reduced in 6-OHDA lesioned vs. nonlesioned rats (P <.0002). The mean maximum reflex force was significantly larger in IGF-I vs. vehicle-treated lesioned rats (P < 0.008). Following reflex testing, serial sections of the spinal cord were taken through the lumbar enlargement containing the motoneurons mediating the hindlimb reflexes. The interspersed NA axons and their bead-like varicosities were stained with an anti-dopamine-beta-hydroxylase antibody. The mean number of NA varicosities per unit area in the ventral horn was profoundly reduced in lesioned vs. nonlesioned rats (P < 0.0002), but significant numbers (51%) were retained in lesioned rats treated with IGF-I vs. vehicle (P < 0.02). These data suggest that blood-borne IGF-I preserves both reflex function and spinal cord circuitry following injury to NA axons and that the blood-CNS fluid barriers may not be an impediment for IGF-I entry into the CNS.

Neuron loss and axon reorganization in the dentate gyrus of cats infected with the feline immunodeficiency virus.

The pathophysiological bases of cognitive, motor, and behavioral abnormalities in patients infected with the human immunodeficiency virus (HIV-1) remain largely unknown. To test the possibility that changes in hippocampal neuronal structure may contribute to these neurologic abnormalities, we examined the brains of cats infected with the feline immunodeficiency virus (FIV), an animal model of HIV-1 infection. We evaluated the dentate gyrus by using Timm's staining to estimate the extent of granule cell axon reorganization and by using Nissl staining, immunocytochemistry, and the optical fractionator method to estimate changes in the number of different neuronal subtypes. FIV-infected cats had abnormally high amounts of Timm's staining in the inner molecular layer and granule cell layer and loss of Nissl-stained, somatostatin-immunoreactive, and parvalbumin-immunoreactive neurons in the hilus. An inverse correlation existed between hilar neuron numbers and extent of aberrant Timm's staining. Increased Timm's staining and hilar neuron loss occurred throughout the septotemporal axis of the hippocampus. This type of neuronal loss and synaptic reorganization may provide an anatomic basis for some of the neurologic symptoms found in FIV-infected cats and HIV-infected humans.

Axonal sprouting in hippocampus of cats infected with feline immunodeficiency virus (FIV).

Neurologic dysfunction and neuropathology are common findings in patients infected with HIV and in cats infected with feline immunodeficiency virus (FIV). The pathogenesis of lentivirus-associated alterations in the central nervous system (CNS) is multifactorial. Because seizures, alterations in memory, and behavioral changes are clinical manifestations in adults and children infected with HIV, we explored the possibility that changes in neuronal structure may occur in the hippocampus. To do this, we examined the dentate gyrus of FIV-infected cats, an animal model of HIV infection. Neuropathologic findings included gliosis within the hilus of the dentate gyrus and granule cell axonal sprouting. Using the Timm's method, which labels axons of dentate gyrus granule cells, abnormally high amounts of staining were observed in the inner one third of the molecular layer in 45% of FIV-infected cats (n = 11) and in none of the controls (n = 19). Prominent axonal sprouting was seen in three FIV-infected cats that were infected as kittens, suggesting that younger cats may be more susceptible. Axon reorganization of the dentate granule cells has been hypothesized to underlie complex partial seizure activity in human temporal lobe epilepsy. These results suggest that FIV infection causes granule cell axon reorganization in the hippocampus of cats. A similar neuropathogenetic mechanism may contribute to neurologic dysfunction in HIV-infected patients.

Grid-mapped freeze-fracture analysis of gap junctions in gray and white matter of adult rat central nervous system, with evidence for a "panglial syncytium" that is not coupled to neurons.

In white matter regions of the brain and spinal cord of adult mammals, gap junctions previously were observed linking astrocytes to astrocytes, as well as to oligodendrocytes and ependymacytes. The resulting "functional syncytium" was proposed to modulate the ion fluxes that occur during electrical activity of the associated axons. Gap junctions also have been reported linking neurons with glia, and functional neuronal-glial coupling has been postulated. To investigate the glial syncytium and the neuron-to-glial coupling hypotheses, we used "grid-mapped freeze fracture," conventional thin-section electron microscopy, and light microscope immunocytochemistry to examine and characterize neurons and glia in gray and white matter of adult rat brain and spinal cord. We have obtained quantitative evidence for the abundance and widespread distribution of gap junctions interlinking the three primary types of macroglia throughout both gray and white matter of the mammalian central nervous system (CNS), thereby extending the concept to that of a functional panglial syncytium. In contrast to previous reports, we show that of more than 400 gap junctions in which both participating cells were identified, none were between neurons and glia. Thus, neuronal coupling and glial coupling involved separate and distinct pathways. Finally, putative water channels (i.e., "square arrays") were confirmed to be abundant and in close association with gap junctions in astrocytes and ependymacytes. Because the astrocyte "intermediaries" extend cytoplasmic conduits throughout gray and white matter of brain and spinal cord, from the ependymal layer to the pia-glial limitans, and from oligodendrocytes surrounding axons to astrocyte endfeet surrounding capillaries, the proposed panglial syncytium, with its abundance of water channels and intercellular ion channels, is optimally positioned and equipped to modulate water and ion fluxes across broad regions of the CNS.

Pityriasis rubra pilaris: an unusual cutaneous complication of AIDS.

Pityriasis rubra pilaris is an uncommon hyperkeratotic, papulosquamous disorder that has been reported in patients infected by HIV. We recount a case of pityriasis rubra pilaris in an HIV-seropositive man. A 36-year-old man with a history of ulcerative colitis and recurrent otitis externa had diffuse psoriaform erythroderma. He was treated initially with methotrexate and isoretinoin without clinical improvement. Skin examination showed large, erythematous, orange, scaly patches on the upper extremities and thickening of the nail beds. The palms and soles were hyperkeratotic. Skin biopsy revealed changes that were consistent with pityriasis rubra pilaris. Six months before the onset of symptoms, results of an enzyme-linked immunosorbent assay (ELISA) and Western Blot assay for HIV were negative. Six months after symptoms, results of repeat enzyme-linked immunosorbent assay and Western blots for HIV were positive (CD4+ T-cell count = 200 cells/ mm3). Clinical course had been complicated by episodes of Staphylococcus aureus bacteremia, mucocutaneous candidiasis, and development of localized squamous cell carcinoma of the skin. The increased severity of pityriasis rubra pilaris should prompt clinicians to consider coinfection with HIV in patients who have disease that is refractory to treatment. Clinicians also should remain vigilant for the development of squamous cell carcinoma.

An oligopeptide of the feline leukemia virus envelope glycoprotein is associated with morphological changes and calcium dysregulation in neuronal growth cones.

Neuropathogenic processes that affect the pathfinding properties of neuronal growth cones could account for many of the dysfunctions unique to retroviral infection of developing nervous systems. Pediatric HIV-1 infection, for example, is associated with a distinctive neuropathogenesis that includes marked cortical atrophy, cognitive disorders, and pyramidal dysfunction. The ability of HIV's envelope glycoprotein, gp120, to produce increased intracellular free calcium ([Ca2+]i) leading to neuronal death has been documented. We hypothesize that gp120 and the envelope glycoproteins of other retroviruses may have similar calcium-increasing effects in advancing growth cones, a property which could disrupt the orderly development of the nervous system. To explore this possibility, we exposed chick ciliary ganglion neurons in culture to a known cytopathic region (CVR5) of the feline leukemia virus' envelope glycoprotein. CVR5 produced [Ca2+]i increases and dose-dependent morphological changes in growth cones isolated from their cell bodies by axotomy. These responses of growth cones to CVR5 suggest that the neurotoxic effects of retroviruses could be mediated at the level of the individual growth cone through exposure to envelope glycoproteins and could constitute one mechanism by which these viruses perturb the normal development of the nervous system.

FeLV envelope protein (gp70) variable region 5 causes alterations in calcium homeostasis and toxicity of neurons.

In humans and animals, retroviruses have been implicated in nervous system disease. Our objective was to characterize the neurotoxicity of a peptide sequence derived from an animal retrovirus, the feline leukemia virus (FeLV). Using a peptide sequence from the subtype FeLV-C envelope protein variable region 5 (VR5), cytotoxicity was demonstrated in studies that evaluated neuronal survival, neurite outgrowth, and alterations in intracellular calcium ion concentration. The FeLV subtype isolate FeLV-CSarma possesses an envelope protein VR5 amino acid sequence that varies by four amino acids from the VR5 amino acid sequence of subtype FeLV-AGlasgow. The polypeptide representing the VR5 of FeLV-CSarma (FeLV-CVR5) is significantly more neurotoxic than the polypeptide sequence representing the VR5 of FeLV-AGlasgow (FeLV-AVR5). FeLV-CVR5 (> or = 3 microM) exposure resulted in significant dose-dependent neurotoxicity. Antibodies to FeLV-CVR5 blocked this effect. Neurite outgrowth was significantly reduced at all tested concentrations (3-12 microM) of FeLV-CVR5, with a 92% reduction in neurite length at 12 microM. FeLV-AVR5 was significantly less neurotoxic with respect to neurite outgrowth than was FeLV-CVR5. The significant reduction in neurotoxicity for FeLV-AVR5 illustrates the importance of the 4-amino-acid difference between it and FeLV-CVR5. Alterations in intracellular calcium ion concentration were associated with this neurotoxicity.

Neurologic dysfunctions caused by a molecular clone of feline immunodeficiency virus, FIV-PPR.

FIV is a lentivirus of domestic cats that causes a spectrum of diseases that is remarkably similar to the clinical syndrome produced by HIV infection in people. Both HIV and FIV has been shown to cause neurologic dysfunction. Specific Pathogen-Free (SPF) cats were placed into one of three groups: FIV-PPR infected; DU-FIV-PPR (a dUTPase mutant of the FIV-PPR clone) infected; or an age-matched control group. In both infected groups, the general clinical signs of infection included lymphadenopathy, oral ulcerations, rough hair coat, and conjuntivitis. Specific neurological changes in the FIV-PPR infected cats included hind limb paresis; delayed righting and pupillary reflexes; behavioral changes; delayed visual and auditory evoked potentials; decreased spinal and peripheral nerve conduction velocities; and marked alterations in sleep patterns. Most of these changes were also observed in the DU-FIV-PPR infected cats. However, these cats tended to have a slightly less severe disease. In this study, we have demonstrated that an infectious molecular clone of FIV closely parallels the disease course of wild type FIV-infected cats. By using a knockout gene mutant of this clone, we were able to demonstrate that the dUTPase gene is not essential for neuropathogenesis. Further use of the FIV-PPR clone should prove useful in determining the essential viral elements that are important in the neuropathogenesis of lentiviral infections.

Mixed synapses discovered and mapped throughout mammalian spinal cord.

Previously, synaptic activity in the spinal cord of adult mammals was attributed exclusively to chemical neurotransmission. In this study, evidence was obtained for the existence, relative abundance, and widespread distribution of "mixed" (chemical and electrical) synapses on neurons throughout the spinal cords of adult mammals. Using combined confocal microscopy and "grid-mapped freeze fracture," 36 mixed synapses containing 88 "micro" gap junctions (median = 45 connexons) were found and mapped to 33 interneurons and motor neurons in Rexed laminae III-IX in cervical, thoracic, and lumbosacral spinal cords of adult male and female rats. Gap junctions were adjacent to presumptive active zones, where even small gap junctions would be expected to increase synaptic efficacy. Two morphological types of mixed synapse were discerned. One type contained distinctive active zones consisting of "nested" concentric toroidal deformations of pre- and postsynaptic membranes, which, because of their unusual topology, were designated as "synaptic sombreros." A second type had gap junctions adjacent to active zones consisting of broad, flat, shallow indentations of the plasma membrane. Morphometric analysis indicates that mixed synapses correspond to 3-5% of all synapses on the somata and proximal dendrites, but, because of their subcellular location and morphology, they could represent 30-100% of excitatory synapses. The relative abundance of mixed synapses on several classes of neurons in spinal cords of adult rats suggests that mixed synapses provide important but previously unrecognized pathways for bidirectional communication between neurons in the mammalian central nervous system.

Evidence for glutamate-mediated activation of hippocampal neurons by glial calcium waves.

Communication from astrocytes to neurons has recently been reported by two laboratories, but different mechanisms were though to underlie glial calcium wave activation of associated neurons. Neuronal calcium elevation by glia observed in the present report is similar to that reported previously, where an increase in neuronal calcium was demonstrated in response to glial stimulation. In the present study hippocampal neurons plated on a confluent glial monolayer displayed a transient increase in intracellular calcium following a short delay after the passage of a wave of increased calcium in underlying glia. Activated cells displayed action potentials in response to glial waves and showed antineurofilament immunoreactivity. Finally, the N-methyl-D-aspartate glutamate receptor antagonist DL-2-amino-5-phosphonovaleric acid and the non-NMDA glutamate receptor antagonist 6,7-dinitroquinoxaline-2,3-dione significantly reduced the responsiveness of neurons to glial calcium waves. Our results indicate that hippocampal neurons growing on hippocampal or cortical astrocytes respond to glial calcium waves with elevations in calcium and increased electrical activity. Furthermore, we show that in most cases this communication appears to be mediated by ionotropic glutamate receptor channels.

Reduced insulin-like growth factor-I mRNA content in liver, adrenal glands and spinal cord of diabetic rats.

Circulating insulin-like growth factor I (IGF-I) concentrations are known to be reduced in experimental and clinical diabetes mellitus. The IGF-I mRNA content was measured in several tissues of rats treated with streptozotocin to determine whether a correlation with neuropathy could be found. IGF-I mRNA content was sharply reduced relative to total and poly(A)+ RNA in diabetic liver and adrenal glands. In contrast, histone 3.3 mRNA content was not significantly reduced relative to poly(A)+ RNA in liver, and alpha-tubulin mRNA content instead was increased in adrenal glands, showing that the decline in IGF-I mRNAs in these tissues was selective. In addition, spinal cord IGF-I mRNA content was significantly reduced per tissue, total RNA, and poly(A)+ RNA after 1 and 2 weeks of diabetes. This was correlated with a concurrent and significant decrease in conduction velocity in both spinal cord and peripheral nerves in a separate study. The decline in liver and spinal cord IGF-I mRNA was not due to streptozotocin toxicity, because it was significantly opposed by insulin which was continuously infused beginning the day after diabetes induction. These results, when taken together with those of others, indicate that the reduction in IGF-I mRNA content may be widespread among diabetic tissues, and might contribute in part to certain syndromes of diabetes, such as neuropathy.

Isolation of a novel subgroup B feline leukemia virus from a cat infected with FeLV-A.

Proviruses were cloned directly from a cat that developed neurological disorders approximately 28 months after inoculation with a molecularly cloned, minimally pathogenic subgroup A feline leukemia virus (FeLV-A). In addition to FeLV-A proviruses that were nearly identical to the inoculated virus, we detected a subgroup B-like variant in brain, bone marrow, and lymph node that apparently had acquired the major portion of its extracellular envelope gene (gp70) from endogenous FeLV-related sequences. A similar recombinant was also detected, by PCR, at low levels in bone marrow from an early time postinfection (2.5 months). A full-length proviral variant with this recombinant structure cloned from brain tissue encoded a replication-defective virus. A chimera encoding the 5' gag-pol portion of FeLV-A and the 3' env-LTR portion of the defective brain-derived clone was replication-competent and had the extended host range properties of FeLV-B.

Sensory nerve conduction velocity of the caudal cutaneous sural and medial cutaneous antebrachial nerves of adult horses.

Maximal conduction velocities of compound action potentials evoked by stimuli of 2 times threshold in the caudal cutaneous sural (CCSN) and medial cutaneous antebrachial (MCAN) nerves were determined by averaging potentials evoked and recorded through percutaneous needle electrodes. Mean maximal conduction velocities of compound action potentials were: CCSN = 61.3 +/- 2.0 meters/second (m/s) and MCAN = 56.4 +/- 2.8 m/s. To confirm accuracy of our percutaneous recordings, compound action potentials were recorded through bipolar chlorided silver electrodes from the exposed surfaces of fascicles of the CCSN and the MCAN. The maximal conduction velocities of these potentials were in agreement with the conduction velocities of compound action potentials that were evoked and recorded through percutaneous needle electrodes. The specificity of stimulating and recording sites was verified by recording before and after section of the nerves. Stimuli from 3 to 5 times threshold evoked a second, longer latency, compound action potential that consisted of a variable number of components in the CCSN and MCAN. The configurations and conduction velocities of the shorter latency potentials were the same as those of the single compound action potentials evoked by stimuli of 2 times threshold. Mean conduction velocities of the longer latency potentials were: CCSN = 24.4 +/- 2.6 m/s and MCAN = 24.5 +/- 2.2 m/s. Needle electrode and direct stimulation of either the CCSN or the MCAN at 3 to 5 times threshold failed to evoke contractions of limb muscles. Therefore, action potentials that contributed to the evoked compound potentials recorded in these horses arose, most likely, from afferent nerve fibers.

Effects of cultured adrenal chromaffin cell implants on hindlimb reflexes of the 6-OHDA lesioned rat.

The effects of implantation of cultured adrenal medullary cells on the recovery of neurotransmitter specific reflex activity were studied in the rat spinal cord using electrophysiological testing methods. Cell suspensions of cultured neonatal adrenal medullary chromaffin (AM) cells (which produce catecholamines), or Schwann (Sc) cells (controls) were implanted into the lumbar region of the spinal cord 2 weeks after catecholamine (CA) denervation by intracisternal injection of 6-hydroxydopamine (6-OHDA). All cells were taken from 7 day neonates and cultured for 10 days in the presence of nerve growth factor (NGF). Three months after implantation, the extent of implant-associated recovery of reflex activity was determined by measuring electromyogram (EMG) activity and force associated with the long latency component of the hindlimb withdrawal reflex (which is CA modulated). After the electrophysiological testing, rats were anesthetized, and the spinal cords were rapidly removed and frozen. Spinal cords were sectioned longitudinally, and implanted cells were visualized using glyoxylic acid techniques. Labelled sections were examined to determine cell survival. Results indicate that 1) chromaffin cells survive for 3 months in the segments of the cord into which they have been implanted and 2) rats implanted with AM cells have significantly more forceful withdrawal reflexes than those that received Sc cells or received no implant after lesioning.

CNS white matter can be altered to support neuronal outgrowth.

Previous work has demonstrated that white matter in the adult mammalian CNS inhibits cell adhesion and neurite outgrowth. This phenomenon has been investigated most recently by culturing neurons on cryostat sections of the adult CNS. Employing this same technique, we have found, in accord with others, that neurons seldom adhere to or grow on central nervous system white matter but will attach and grow on gray matter. In the experiments presented here, embryonic rat hippocampal neurons were grown on cryostat sections from the adult rat CNS, in the presence of brain derived glial cocultures. It was found that the white matter in cryostat sections can be modified by interaction with medium conditioned by brain-derived glial cells. Neurons plated on sections pretreated by such media show significant increases in both attachment and neurite outgrowth. The activity contained in glial conditioned medium is likely complex in nature. While the majority of the activity can be eliminated by heat treatment and trypsinization, neural adhesion but not neurite initiation is affected by protease treatment. Therefore, cell attachment and neurite outgrowth may be regulated by different factors in the conditioned media.