Treatment Seeking Practices and Etiology of Infertile Couples in Bangladesh.

Infertility is a major reproductive health problem, at least in part, a cultural problem also. In developing countries like Bangladesh, infertility is a devastating experience for a couple, particularly in women. For this reason many women suffer from many social and medical consequences. Most of the infertile patients of Bangladesh have no access to adequate comprehensive treatment. Also due to lack of proper knowledge, some couples use varied traditional methods and religious practices. This study was done to assess the treatment seeking behavior of infertile couple and also to find out the gross causes of infertility of patients attending at Motherhood Fertility center, Dhaka, Bangladesh. This prospective study was done over 3 years from June 2016 to June 2019. Two thousand two hundred and fifty (2250) patients attending a secondary infertility center at Dhaka were included in this study. Out of 2250 infertile patients 56.00% were rural and 44.00% urban. Of 737 (58.49%) rural and 658 (66.46%) urban infertile patients had consulted with General practitioner and Gynae specialist before coming to secondary and tertiary care center. Out of 1260 rural, 463(36.75%) and 990 urban, 291 (29.39%) had visited the infertility center as the first choice for treatment. Still about 8.8% infertile couple visited quacks and traditional healers for solving infertility. The overall primary and secondary infertility were 67.69% and 32.31% respectively. In 12.57% couples, male factor was the obvious cause (azoospermia and abnormal semen parameters). In 27.43%, female factors and in 28.0% couples both male and female had obvious reasons responsible for infertility. Thirty two percent (32.00%) cases were unexplained infertility. Out of female factors 43.00% anovulation, 29.00% tubal factors, 11.00% endometriosis, 5.00% Uterine factors, 2.00% POF (premature ovarian failure) and 10.00% others (Thyroid disorder, DM, Hyper-prolactinemia, Luteal phase defect). Infertility is an important health problem in Bangladesh. Etiology of infertility varies from regional, social and cultural conditions so that it requires proper diagnosis and then treats this problem accordingly. It is necessary to build up proper referral system and also proper training should be needed to service provider and traditional healers. Reproductive technology should be widely available in our society where motherhood is one of the most desired stages of a women's life.

Feasibility and Safety of Chorionic Villus Sampling (CVS) for Prenatal Diagnosis of Thalassemia in Bangladesh.

Thalassaemia is one of the commonest inherited disorders in Bangladesh. Since population is rapidly increasing in Bangladesh, therefore birth of large number of new cases is expected every year. Chorionic villus sampling (CVS) is an invasive diagnostic procedure done in early pregnancy to obtain fetal cells for the prenatal diagnosis of chromosomal and genetic disorders like thalassemia. To investigate the feasibility, safety, and outcome of transabdominal Chorionic Villus Sampling (CVS) for prenatal diagnosis of Beta Thalassemia, this retrospective analytical study was carried out on women who had undergone transabdominal CVS for prenatal diagnosis of Beta thalassemia. All CVS are done at Fetal Medicine Centre, Family Foundation, Green Road, Dhaka, Bangladesh from June 2013 to December 2016. A total of 236 couples who were referred for prenatal diagnosis of thalassemia (Beta thalassemia & Hb-E beta thalassemia) were studied. Transabdominal CVS was done under local anesthesia and real-time ultrasound guidance. A 18G/88mm Spinal Needle (B Braun, Germany) was used. Most procedures were done between 11 and 13 weeks (range 11-14 weeks). All CVS were performed with the "2 operators" technique. The samples were sent for prenatal diagnosis by genetic analysis. Results were recorded and analyzed for descriptive statistics. Out of 236, 123 (52.1%) fetuses were diagnosed as trait (Beta trait or HbE trait), 64 (27.1%) as healthy fetuses and 49 (20.7%) as affected fetuses. A total of 236 CVSs were performed as outdoor basis. Most aspirations (95.1%) were easy; however, in 4.8% cases the aspiration was difficult due to a variety of factors. The overall success rate was 100%. Minor complications like placental hematoma and pervaginal (P/V) bleeding occurred in 2% & 1.3% respectively which were subsided by conservative management. The procedure related miscarriage within three weeks not occurred in any cases. Transabdominal CVS under real-time sonography is a useful outdoor procedure for prenatal diagnosis of beta thalassaemia in early pregnancy without significant risk to the mother and the fetus.

Moving Bragg grating solitons in a semilinear dual-core system with dispersive reflectivity.

The existence, stability and collision dynamics of moving Bragg grating solitons in a semilinear dual-core system where one core has the Kerr nonlinearity and is equipped with a Bragg grating with dispersive reflectivity, and the other core is linear are investigated. It is found that moving soliton solutions exist as a continuous family of solutions in the upper and lower gaps of the system's linear spectrum. The stability of the moving solitons are investigated by means of systematic numerical stability analysis, and the effect and interplay of various parameters on soliton stability are analyzed. We have also systematically investigated the characteristics of collisions of counter-propagating solitons. In-phase collisions can lead to a variety of outcomes such as passage of solitons through each other with increased, reduced or unchanged velocities, asymmetric separation of solitons, merger of solitons into a quiescent one, formation of three solitons (one quiescent and two moving ones) and destruction of both solitons. The outcome regions of in-phase collisions are identified in the plane of dispersive reflectivity versus frequency. The effects of coupling coefficient, relative group velocity in the linear core, soliton velocity and dispersive reflectivity and the initial phase difference on the outcomes of collisions are studied.

iCap: Instrumented assessment of physical capability.

OBJECTIVES: The aims of this study were to (i) investigate instrumented physical capability (iCap) as a valid method during a large study and (ii) determine whether iCap can provide important additional features of postural control and gait to categorise cohorts not previously possible with manual recordings. STUDY DESIGN: Cross-sectional analysis involving instrumented testing on 74 adults who were recruited as part of a pilot intervention study; LiveWell. Participants wore a single accelerometer-based monitor (lower back) during standardised physical capability tests so that outcomes could be compared directly with manual recordings (stopwatch and measurement tape) made concurrently. MAIN OUTCOME MEASURES: Time, distance, postural control and gait characteristics. RESULTS: Agreement between manual and iCap ranged from moderate to excellent (0.649-0.983) with mean differences between methods low and deemed acceptable. Additionally, iCap successfully quantified (i) postural control characteristics which showed sensitivity to distinguish between 5 variations of the standing balance test and (ii) 14 gait characteristics known to be sensitive to age/pathology. CONCLUSIONS: Our findings show that iCap can provide robust quantitative data about physical capability during standardised tests while also providing sensitive (age/pathology) postural control and gait characteristics not previously quantifiable with manual recordings. The methodology which we propose may have practical utility in a wide range of clinical and public health surveys and studies, including intervention studies, where assessment could be undertaken within diverse settings. This will need to be tested in further validation studies in a wider range of settings.

Instrumented assessment of test battery for physical capability using an accelerometer: a feasibility study.

Recent work has identified subdomains (tests) of physical capability that are recommended for assessment of the healthy ageing phenotype (HAP). These include: postural control, locomotion, endurance, repeated sit-to-stand-to-sit and TUG. Current assessment methods lack sensitivity and are error prone due to their lack of consistency and heterogeneity of reported outcomes; instrumentation with body worn monitors provides a method to address these potential weaknesses. This work proposes the use of a single tri-axial accelerometer-based device with appropriate algorithms (referred to here as a body worn monitor, BWM) for the purposes of instrumented testing during physicality capability assessment. In this pilot study we present 14 BWM-based outcomes across the subdomains which include magnitude, frequency and spatio-temporal characteristics. Where possible, we compared BWM outcomes with manually recorded values and found no significant differences between locomotion and TUG tasks (p ≥ 0.319). Significant differences were found for the total distance walked during endurance (p = 0.037) and times for repeated sit-to-stand-to-sit transitions (p < 0.000). We identified reasons for differences and make recommendations for future testing. We were also able to quantify additional characteristics of postural control and gait which could be sensitive outcomes for future HAP assessment. Our findings demonstrate the feasibility of this method to enhance measurement of physical capacity. The methodology can also be applied to a wide variety of accelerometer-based monitors and is applicable to a range of intervention-based studies or pathological assessment.

An outbreak of hepatitis E in an urban area of Bangladesh.

We investigated an outbreak of jaundice in urban Bangladesh in 2010 to examine the cause and risk factors and assess the diagnostic utility of commercial assays. We classified municipal residents reporting jaundice during the preceding 4 weeks as probable hepatitis E cases and their neighbours without jaundice in the previous 6 months as probable controls. We tested the sera collected from probable cases and probable controls for IgM anti-hepatitis E virus (HEV), and the IgM-negative sera for IgG anti-HEV using a commercial assay locally. We retested the IgM-positive sera for both IgM and IgG anti-HEV using another assay at the Centre for Disease Control and Prevention (CDC), USA. Probable cases positive for IgM anti-HEV were confirmed cases; probable controls negative for both IgM and IgG anti-HEV were confirmed controls. We explored the local water supply and sanitation infrastructure and tested for bacterial concentration of water samples. Probable cases were more likely than probable controls to drink tap water (adjusted odds ratio: 3.4; 95% CI: 1.2-9.2). Fifty-eight percentage (36/62) of the case sera were IgM anti-HEV positive; and 75% of the IgM-positive samples were confirmed positive on retesting with another assay at CDC. Compared to confirmed controls, cases confirmed using either or both assays also identified drinking tap water as the risk factor. Two tap water samples had detectable thermotolerant coliforms. Research exploring decentralized water treatment technologies for sustainable safe water might prevent HEV transmission in resource-poor cities. Detection of serological markers in a majority of probable cases implied that available diagnostic assays could adequately identify HEV infection during outbreaks.

Diagnostic evaluation of supraclavicular lymphadenopathy.

Patients presented with the supraclavicular lymphadenopathy in the medicine department have a strong suspicion of serious illness like tuberculosis, sarcoidosis, toxoplasmosis and malignancy of lymphnode, blood, lung, upper GIT, breast, ovary, testes, and other sites of body. This prospective type of observational study carried out in the indoor and out patient department of medicine of Mymensingh Medical College Hospital over a period of 6 month from April 2011 to September 2011 to diagnose the causes of supraclavicular lymphadenopathy. Patient of either sex, 18 years or above presented with supraclavicular lymphadenopathy were included. Biopsy or FNAC were done. The study showed that mean age of the patient of supraclavicular lymphadenopathy that finally diagnosed as malignant was 49.7 years and that of non malignant was 33.7 years. Male patient have suffered more (60%) from malignant disease than that of female patient (40%). Discrete, hard, non tender either fixed or non fixed supraclavicular lymphadenopathy was found malignant (18 of 18 cases, 100%) and discrete, firm, tender lymphnode were found non malignant (5 of 5 cases, 100%). Increased frequency (11 of 28, 39.3%) of granulomatous inflammation from the tuberculoid lymphadenitis were found among the patient undergone supraclavicular lymphnode biopsy. FNAC result was also of simillar type and finally it was found that frequency of tuberculosis (20 of 53, 37.7%) was highest and bronchial carcima was the second most frequent diagnosis (14 of 53, 26.4%). This study showed that supraclavicular lymphadenopathy is associated mostly with serious disease like tuberculosis and malignancy.

Fasting glycaemic and lipidaemic status in acute coronary syndrome patients within 24 hours of onset of chest pain.

This is a descriptive type of cross sectional study done in Mymensingh Medical College Hospital during the period of June 2008 to November 2009 to estimate and analyze the fasting blood glucose (FBG) and fasting lipid profile of acute coronary syndrome (ACS) patients within 24 hours of onset of chest pain. Total 50 patients of either sex diagnosed as acute coronary syndrome whose fasting blood sample would have been collected within 24 hours of chest pain were included. Among 50 patients 42(84%) were male and 8(16%) were female. Age range was 30-80 years with a mean ± SD of 50.74 ± 12.05 years. Among 50 ACS patients, 9 patients (18%) suffered from unstable angina (US), 2(4%) from non-ST segment elevation myocardial infarction (NSTEMI) and 39(78%) suffered from ST segment elevation myocardial infarction (STEMI). Study results revealed 41(82%) patients had euglycemia (70-110 mg/dl), 2(4%) patients had impaired fasting glucose (IFG) (110-125 mg/dl), and 7(14%) patients had hyperglycemia (>126 mg/dl). Dyslipidemia found in 38(76%) patients. Among them total cholesterol (TC) >200mg/dl in 14(28%), decreased level of HDL-C (< 40 mg/dl in male and <50mg/dl in female) in 22(44%), increased level LDL-C ≥ 130 mg/dl in 13(26%), and TG >150 mg/dl was found in 16(32%) patients.

Single dose (400 mg) versus 7 day (200 mg) daily dose itraconazole in the treatment of tinea versicolor: a randomized clinical trial.

Tinea (pityriasis) versicolor is a superficial fungal infection and one of the most commonly found pigmentary disorders of skin caused by the yeast Malassezia. Multiple topical as well as systemic therapies are available for treatment. Systemic therapies are used for extensive disease, frequent relapse or where topical agents have failed. The aim that translates the rationale of the study was to compare the efficacy, safety, tolerability and cost effectiveness of single dose 400mg versus 7 day 200 mg daily dose of itraconazole in the treatment of tinea versicolor. A clinical study was done to compare the efficacy of single dose (400 mg) of itraconazole and 7 day 200 mg daily dose of itraconazole in the treatment of extensive tinea versicolor. Total 60 patients (aged 18-50 years) were selected for the study during the period of June 2007 to May 2008 in the department of Dermatology of three different hospitals in Bangladesh. Cases having with extensive involvement, diagnosed clinically and confirmed by wood's lamp and KOH microscopy were taken. Patients were randomly allocated into equal groups. Group A was given single dose 400 mg itraconazole and Group B was given 7 day 200 mg daily itraconazole. Fifty three (88%) male and 7(12%) female were included in the study. The mean age of group A was 32.37+/-9 years and in group B 33.23+/-8 years. The mean duration of the disease in group A was 2.63+/-2 months and 2.76+/-2 months in group B. In group A clinical responders was found cure 22(73.33%) and improvement 5(16.33%) and in group B it was found cure 24(79.99%) and improvement 4(13.33%). The measure at the End point (EP1) equals to 90% response and in-group B it was found cure 24 (79.99%) and improvement 4(13.33%). (Here the End point EP2) equals to 93.33%. The EP clinical analysis however shows 91.66% response. Both single dose and 7 day daily dose of itraconazole can be effective in the treatment of tinea versicolor with extensive involvement but single dose appears to be better for improving compliance and decreasing the cost of treatment.

Histopathological changes in different stages of alopecia areata.

Alopecia areata is a common disorder affecting any of the hair bearing areas of the body. Most of the cases are diagnosed on the clinical ground only. Histopathological changes may help in the diagnosis in difficult cases. The present study was designed to observe the histopathologic changes of alopecia areata at different stages. Thirty consecutive patients suffering from alopecia areata were enrolled. Face to face interview was performed using a structured pre-tested questionnaire. At the initial visit, one 4mm punch scalp biopsy specimen was taken from an area of hair loss. Biopsy specimens were sent in a test tube filled with formalin to the department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU) where tissue was processed, sectioned and slides were prepared. Haematoxylin and eosin stains were used. Aanagen hairs were decreased in all stages of alopecia areata. Telogen hairs increased in acute and chronic stages whereas catagen hairs increased markedly in sub-acute stage. Although miniaturized (atrophic) follicle was frequently found in chronic stage. It was absent in acute and sub-acute stages. Moderate to dense peribulbar infiltration of lymphocytes were observed in acute stage and mild to moderate infiltration in sub-acute stage. In chronic stage either no or mild infiltrations were observed. Peribulbar infiltration of eosinophils and macrophages were seen in all stages of alopecia areata. Alopecia areata can be diagnosed with some confidence, even when inflammatory infiltrate is absent, based on increased numbers of telogen hairs in the acute and chronic stages, increased miniaturized hairs in chronic stage and markedly increased catagen hairs in sub-acute stage.

Cutis laxa: a case report and an update.

Very few cases of Cutis Laxa are reported worldwide. This is the first case report of its kind from Bangladesh. A 10 year-old girl looking very aged was admitted in the paediatric ward of Dhaka Medical College with most striking skin feature. There was loosely hanging skin over the face which was inelastic, hyper extensible and which recoils slowly after stretching. She had downward slanting palpebral fissures, periorbital oedema, a broad flat nose with everted nostril, sagging cheeks, and large and soft ears. Skin biopsy showed fragmentation of the elastic tissue with collagen tissue in the dermis, which was suggestive of Cutis Laxa. Her chest x-ray showed hypertranslucent lung fields, prominence of pulmonary conus area and some ring like opacity near the lower zone with cardiomegaly, which is suggestive of corpulmonale with bronchiectasis. Her echocardiography showed dilated right atrium, ventricle and pulmonary artery which were suggestive of corpulmonale. All these confirmed the diagnosis.

Cutaneous leishmaniasis.

Leishmaniasis is an increasingly prevalent, major world health problem caused by infection with a protozoan which is transmitted by sand fly bites. It is endemic in 88 countries on 4 countries. More than 90% of visceral leishmaniasis cases occur in Bangladesh, Brazil, India and Sudan. Although Bangladesh is one of four countries those bearing the most burden of visceral leishmaniasis, cutaneous leishmaniasis is rare in Bangladesh. Cases of cutaneous leishmaniasis (CL) are usually imported to Bangladesh from other endemic countries. A patient from an endemic area of cutaneous leishmaniasis, a non-healing nodulo-ulcerative lesion with "volcanic crater" on exposed part of the body, constant dermal infiltration with lymphocytes, histiocytes and plasma cells and demonstration of intracellular parasites in lesional skin establish the diagnosis of cutaneous leishmaniasis. We here represent a case of cutaneous leishmaniasis in an overseas worker, returned from Saudi Arabia. He presented with multiple asymptomatic nodulo-ulcerative lesions on exposed part of the body. The patient's clinical history, morphology of lesions, laboratory analysis and histopathological examination of lesional skin were consistent with cutaneous leishmaniasis, a rare disease for Bangladesh. Cutaneous leishmaniasis may arise as a health problem among people returned from the Middle-East. Our findings of high titre (>1:64000) direct agglutination test (DAT) in cutaneous leishmaniasis may be an additional point of further study.

Association between morphological changes of nail and nail arsenic level in patients with arsenicosis.

This case-control type of analytical study was conducted in the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh to find out the association between morphological changes of nail and nail arsenic level in arsenicosis patients. Majority of arsenicosis patients were male (56.67%). The mean age of the cases was 43.07+/-13.73 years. Nail changes were found in 26.67% of cases, most were nail dystrophy (23.33%) and rest were Mee's line (3.34%). There was significant difference between cases with or without nail changes and nail arsenic level. But cases with or with out nail changes had a significant difference between duration of intake of arsenic contaminated water. There was no correlation between nail changes and nail arsenic level for nail dystrophy and Mee's line. The study result failed to establish association between the morphological changes of nail and nail arsenic level.

Fixed drug eruptions due to cotrimoxazole.

This prospective study on Fixed Drug Eruption (FDE) was carried out between January 2003 to December 2006 in Dermatology department of Mymensingh Medical College Hospital & private chambers. This study was carried out with an objective to see the specific site of involvement and other clinical parameters in FDE due to cotrimoxazole. In each case, a detailed history was taken and a thorough physical examination was done by at least one dermatologist. Patients with suspected FDE, who had consented, were included in the study. Oral re-challenge test was done in each case after written or verbal consent of the patient or legal guardian. For oral re-challenge, usually half of the usual therapeutic dose of the suspected drug (s) was given first and reactions were observed and if no reaction, then full therapeutic dose was given and then again reactions were observed. In case of no reaction to one drug, the next drug was tested after 2 to 7 days. Age & sex distribution, number of attacks of FDE, number of lesions, distribution of sites of involvement were determined in each case of FDE. All informations were recorded in pre-tested data sheet. Among 93 patients of suspected FDE, 61 patients were confirmed as FDE with identified causes, of which 36 cases were due to cotrimoxazole (59.02%). Age range of patients was from 5 years to 65 years with mean of 24.92 years. Male was predominantly affected (M:F=6.2:1). In 50% cases presenting attack was the 2nd attack. Rest 50% had 3 to more than 10 attacks. Number of lesions was: 2-5 lesions in 50%, solitary lesion in 16.67%, 6-10 lesions in 13.89% and more than 10 lesions in 19.44% cases. Sites of involvement in cases of FDE due to cotrimoxazole (n=36) were as follows: lips 58.33%, genitalia 33.33%, oral 13.89%, trunk 38.89%, limbs 55.56%, hands 16.67%, feet 19.44%, face 19.44% and conjunctiva 2.78%.

Management of external hernias: analysis of 1020 [corrected] cases.

A prospective study was done to find out the incidence of different external hernias, identify the predisposing factors and type of repair performed. Over a period of 8 years, 1020 patients were admitted with different varieties of external hernias in Chittagong Medical College Hospital. Among them 743 patients had inguinal hernia, 130 had incisional hernia, 58% had indirect inguinal hernia, 29% had direct inguinal hernia, Bilateral inguinal hernia was present in 13% cases. 272 (32.08%) presented with complications like, irreducibility, obstruction, strangulation, 576 (67.92%) was admitted from out-patient department for elective operation. 97.04% of patients with inguinal hernia were male, 2.96% of patients were female. But among incisional hernia 77.70% are female and 22.30% are male patients. The highest incidence of both inguinal hernia and incisional hernia were found in 4th decade of life. Predisposing factors could be identified in 42.06% cases. 90.76% patients approached doctors for advice after 6 months of noticing hernia only 36.37% could mention the cause of delay. Out of 1020 patients (812) 72.18% patients underwent different operations. 2.5% patients were inoperable due to associated disease like Ca-liver, IHD, renal transplant, CLD, uncontrolled DM. Others refused or absconded, being afraid of operation. Effort for post operative follow up was not very satisfactory as only a small number could be followed for a limited period.

Possible link between glycolysis and apoptosis induced by sodium fluoride.

Fluoride has been used to prevent caries in the dentition, but the possible underlying mechanisms of cytotoxicity induction by this compound are still unclear. Since fluoride is known as an inhibitor of glycolytic enzymes, we investigated the possible connection between NaF-induced apoptosis and glycolysis in human promyelocytic leukemia HL-60 cells. NaF-induced apoptotic cell death is characterized by caspase activation, internucleosomal DNA fragmentation, loss of mitochondrial membrane potential, and production of apoptotic bodies. Higher activation of caspases-3 and -9, as compared with that of caspase-8, suggested the involvement of an extrinsic pathway. Utilization of glucose was nearly halted by NaF, whereas that of glutamine was rather enhanced. NaF enhanced the expression of Bad protein, but not that of Bcl-2 and Bax proteins, and reduced HIF-1alpha mRNA expression. Analysis of these data suggests a possible link between glycolysis and apoptosis.

A case of molluscum contagiosum.

Molluscum contagiosum is a benign contagious disease caused by a poxvirus. The virus proliferates within keratinocytes and forms intracytoplasmic Molluscum bodies. Though it is a common clinical condition, histologically is not yet reported from this region of Mymensingh. We received a skin biopsy specimen in a pathology laboratory for histological examination. The Haematoxylin and Eosin stained sections revealed typical intracytoplasmic Molluscum bodies in keratinocytes. The lesions were in the trunk, which is a common site for Molluscum Contagiosum (MC). As the diagnosis of Molluscum contagiosum is easy by histological examination, every patient suspected to be this disease is recommended to be examined histologically to exclude other similar types of lesions.

Changes in corticothalamic modulation of receptive fields during peripheral injury-induced reorganization.

The influence of corticothalamic projections on the thalamus during different stages of reorganization was determined in anesthetized raccoons that had undergone previous removal of a single forepaw digit. Single-unit recordings were made from 522 sites in the somatosensory nucleus of the thalamus (ventroposterior lateral nucleus) before and after lesioning parts of primary somatosensory cortex. In those parts of ventroposterior lateral nucleus that had intact input from the periphery, the cortical lesion resulted in an immediate 85% increase in receptive field (RF) size. In animals studied 2-6 weeks after digit amputation, peripherally denervated thalamic neurons had unique RFs that were larger than normal, and these were not further enlarged by cortical lesion. However, at longer periods of reorganization (>4 mo), when the new RFs of denervated neurons had decreased in size, cortical lesion again produced expansion of RF size. These data demonstrate that corticothalamic fibers modulate the spatial extent of thalamic RFs in intact animals, probably by controlling intrathalamic inhibition. This corticothalamic modulation is ineffective during the early stages of injury-induced reorganization when new RFs are being formed, but is reinstated after the new RFs have become stabilized. The fact that neurons in the denervated thalamic region retained their unique RFs after cortical lesion indicates that their new inputs are not being relayed from a reorganized cortex and support the view that some plasticity occurs in or below the thalamus.

Corticocortical inhibition of peripheral inputs within primary somatosensory cortex: the role of GABA(A) and GABA(B) receptors.

A conditioning-test pulse paradigm was used in combination with microiontophoresis to examine the corticocortical modulation of somatosensory processing. Single-cell recordings were made in the glabrous digit representation of primary somatosensory (S1) cortex in anesthetized raccoons. Test stimulation of the periphery (the on-focus digit) was preceded by conditioning stimulation of the cortical area that represents an adjacent digit at interstimulus intervals ranging from 5 to 200 ms. An early and prolonged inhibitory modulation was produced in most of the 61 neurons examined, and an early facilitation followed by inhibition was produced in about one-third of the cells. Microiontophoretic administration of a potent GABA(B) receptor antagonist, CGP 55845, blocked the inhibition and in many cases revealed a facilitation of the sensory response. Microiontophoretic administration of a GABA(A) receptor antagonist, gabazine, blocked inhibition at short interstimulus intervals and reduced the longer inhibition by half. These results indicate that connections between glabrous digit representations within S1 cortex produce predominantly inhibitory modulation of sensory input and that both GABA(A) and GABA(B) receptors contribute to this modulation. The relevance of these connections to the effects of peripheral nerve injury and subsequent reorganization is discussed.

Critical roles of CD30/CD30L interactions in murine autoimmune diabetes.

CD30/CD30L is a member of tumour necrosis factor (TNF) receptor/TNF superfamily and has been implicated in immune-regulation. A genetic study has also suggested a possible implication of CD30 in spontaneous autoimmune diabetes in NOD mice. In this study, we investigated the involvement of CD30/CD30L in the development of diabetes in NOD mice. Flow cytometric analysis showed that CD30 and CD30L were highly expressed on CD4+ or CD8+ T cells in the spleen and pancreatic lymph node of younger NOD mice. In addition, islet-specific CD4+ or CD8+ T cell lines expressed CD30 and CD30L. Administration of a neutralizing anti-CD30L monoclonal antibody (mAb) from 2 to 10 week of age completely suppressed the development of spontaneous diabetes in NOD mice. In addition, the treatment with anti-CD30L mAb also inhibited the development of diabetes induced by adoptive transfer of spleen cells from diabetic NOD mice or islet-specific CD4+ or CD8+ T cell lines into NOD-SCID mice. Furthermore, anti-CD30L mAb inhibited T cell proliferation in response to islet antigens. These results suggested that CD30/CD30L interaction plays important roles in both induction and effector phases of autoimmune diabetes in NOD mice.