The anaesthetist's SonoSite Probe - Successful adjunct to complex intradural spinal surgery or poor man's intraoperative ultrasound?

The use of expensive, sophisticated, intraoperative ultrasound systems is established in cranial neurosurgery and less so in the realms of intradural spine. For units yet to acquire such costly devices, we demonstrate our experience of the readily available, anaesthetist's SonoSite™ probe in intradural spinal surgery.

Nodal to nodeless superconducting energy-gap structure change concomitant with fermi-surface reconstruction in the heavy-fermion compound CeCoIn(5).

The London penetration depth λ(T) was measured in single crystals of Ce_{1-x}R_{x}CoIn_{5}, R=La, Nd, and Yb down to T_{min}≈50 mK (T_{c}/T_{min}∼50) using a tunnel-diode resonator. In the cleanest samples Δλ(T) is best described by the power law Δλ(T)∝T^{n}, with n∼1, consistent with the existence of line nodes in the superconducting gap. Substitutions of Ce with La, Nd, and Yb lead to similar monotonic suppressions of T_{c}; however, the effects on Δλ(T) differ. While La and Nd substitution leads to an increase in the exponent n and saturation at n∼2, as expected for a dirty nodal superconductor, Yb substitution leads to n>3, suggesting a change from nodal to nodeless superconductivity. This superconducting gap structure change happens in the same doping range where changes of the Fermi-surface topology were reported, implying that the nodal structure and Fermi-surface topology are closely linked.

Giant Nernst effect and bipolarity in the quasi-one-dimensional metal Li0.9Mo6O17.

The Nernst coefficient for the quasi-one-dimensional metal, Li{0.9}Mo{6}O{17}, is found to be among the largest known for metals (ν≃500 µV/KT at T∼20 K), and is enhanced in a broad range of temperature by orders of magnitude over the value expected from Boltzmann theory for carrier diffusion. A comparatively small Seebeck coefficient implies that Li{0.9}Mo{6}O{17} is bipolar with large, partial Seebeck coefficients of opposite sign. A very large thermomagnetic figure of merit, ZT∼0.5, is found at high field in the range T≈35-50 K.

Observation of a martensitic structural distortion in V, Nb, and Ta.

Thermal-expansion measurements of the Group 5 elements V, Nb, and Ta reveal a structural distortion below 300 K. Data for single-crystalline Nb and Ta display anisotropic thermal expansion, martensitic in character, that is inconsistent with cubic crystal structures at low temperature. Published results on V show similar behavior. Interstitial impurities suppress the transition.

Robust upward dispersion of the neutron spin resonance in the heavy fermion superconductor Ce1-xYbxCoIn5.

The neutron spin resonance is a collective magnetic excitation that appears in the unconventional copper oxide, iron pnictide and heavy fermion superconductors. Although the resonance is commonly associated with a spin-exciton due to the d(s±)-wave symmetry of the superconducting order parameter, it has also been proposed to be a magnon-like excitation appearing in the superconducting state. Here we use inelastic neutron scattering to demonstrate that the resonance in the heavy fermion superconductor Ce1-xYbxCoIn5 with x=0, 0.05 and 0.3 has a ring-like upward dispersion that is robust against Yb-doping. By comparing our experimental data with a random phase approximation calculation using the electronic structure and the momentum dependence of the -wave superconducting gap determined from scanning tunnelling microscopy (STM) for CeCoIn5, we conclude that the robust upward-dispersing resonance mode in Ce1-xYbxCoIn5 is inconsistent with the downward dispersion predicted within the spin-exciton scenario.

Corpus callosum changes following shunting for hydrocephalus: case report and review of the literature.

Diffuse callosal signal changes can rarely occur following successful shunting for obstructive hydrocephalus. We report on a patient who underwent ventriculoperitoneal shunting for aqueductal stenosis and required two revisions for neurological deterioration and presumed shunt malfunction. Extensive changes involving the corpus callosum, periventricular white matter and optic chiasm were noted after the first, and were prominent after second shunt revision. Thus, post-shunting callosal changes may be associated with more extensive white matter disease, and may not imply wide pressure fluctuations. However, they need not prompt further intervention.

What does Cruzan mean to the practicing physician?

The United States Supreme Court's recent decision in the Cruzan case declared that the states have broad powers to formulate their own rules in "right to die" cases. The Court held that competent adults have a constitutionally protected "liberty interest" that allows them to accept or refuse medical treatments. Since liberty interests are subject to rational state regulation, the narrow holding in Cruzan affirmed Missouri's authority to require a "clear and convincing" evidence standard to determine a patient's wishes before life-sustaining treatment could be withdrawn from a formerly competent adult now in a persistent vegetative state. For practicing physicians, some of the implications of Cruzan are as follows: (1) For competent adult patients, physicians should respect patient wishes regarding life-sustaining treatment. (2) Physicians also should discuss with competent patients their wishes for life-sustaining treatment at a future time, when a patient may no longer be able to participate in such decisions. (3) Physicians should record these wishes in a legally acceptable instrument that addresses two aspects of care that may arise in the future if the patient becomes incompetent. What would the patient want done? Who would the patient wish to designate as a surrogate or proxy? (4) For patients who are now incompetent, but for whom decisions must be made about life-sustaining treatment, physicians should focus on the previously expressed wishes of the patient rather than on the patient's current quality of life or on the wishes of the patient's family.

Weak hybridization and isolated localized magnetic moments in the compounds CeT2Cd20 (T = Ni, Pd).

We report the physical properties of single crystals of the compounds CeT2Cd20 (T = Ni, Pd) that were grown in a molten Cd flux. Large separations of ∼6.7-6.8 Šbetween Ce ions favor the localized magnetic moments that are observed in measurements of the magnetization. The strength of the Ruderman-Kittel-Kasuya-Yosida magnetic exchange interaction between the localized moments is severely limited by the large Ce-Ce separations and by weak hybridization between localized Ce 4 f and itinerant electron states. Measurements of electrical resistivity performed down to 0.138 K were unable to observe evidence for the emergence of magnetic order; however, magnetically-ordered ground states with very low transition temperatures are still expected in these compounds despite the isolated nature of the localized magnetic moments. Such a fragile magnetic order could be highly susceptible to tuning via applied pressure, but evidence for the emergence of magnetic order has not been observed so far in our measurements up to 2.5 GPa.

Decline in the CD4+ lymphocyte population in the blood of SIV-infected macaques is not reflected in lymph nodes.

Although loss of CD4+ lymphocytes in peripheral blood is a standard criterion for evaluating the course of HIV disease, little is known about changes within lymphoid organs, which contain the bulk (> 50%) of the body's lymphocytes. Because such studies are feasible only by using non-human primates, we have examined lymph nodes (LNs), spleen, and blood from monkeys infected with two isolates of simian immunodeficiency virus (SIV). During both the acute and chronic phases of these infections, characteristic reductions in the blood CD4+ cell levels are not reflected in LN, where the CD4+ pool remains within normal levels. However, when circulating CD4/CD8 ratios have consistently fallen to approximately 0.5, striking decreases in the percentage of CD4 cells (CD4%) and CD4/CD8 ratios in LN occur concomitantly with dramatic increases in viral antigen expression on follicular dendritic cells within LN germinal centers (GCs). The data suggest that loss from the total T cell pool in minimal until the final stages of SIV and HIV disease and that the immunological deterioration of LN is the event that precipitates the increased susceptibility to infections and progression to AIDS.

Immunological and virological changes associated with decline in CD4/CD8 ratios in lymphoid organs of SIV-infected macaques.

The decline in CD4/CD8 ratios in lymph nodes (LNs) of SIV macaques and HIV-infected individuals occurs later than that in blood. In a previous study, long-term SIV-infected macaques were delineated into two groups: (1) those whose LNs had normal CD4/CD8 ratios and (2) those whose LNs had low CD4/CD8 ratios. In the present investigation, LNs, spleens, and blood from these groups have been further analyzed to ascertain the cellular and virological events, particularly those involving CD8+ cells, that occur concomitantly with LN CD4% decline. An increase in the percent of CD69-, IL-2R(p75)-, CD45RA1o CD8+ cells was the most constant event observed in lymphoid tissue from mid- to late-stage SIV-infected monkeys. Such cells were sometimes observed in LNs prior to any other immunological or morphological changes. However, decline in LN CD4/CD8 ratios and the associated degeneration of follicular dendritic cells (FDCs) in the germinal centers (GCs) of these nodes were observed only when both CD8+ cell infiltration of GCs and accumulation of viral antigens within the FDC network could be demonstrated. These dramatic changes were also associated with significantly reduced responsiveness to mitogens throughout the lymphoid compartment. In terms of viral burden, immunological and structural collapse of LNs was not always associated with increased viral DNA levels. Despite the CD4+ cell decline in blood during HIV and SIV infections, the immunological and architectural collapse of the lymphoid compartment, which comprises the bulk of the lymphocytes in the body, appears to be a critical event leading to the onset of AIDS. The present findings suggest that increased CD8+ cell activity as well as decrease in CD4+ cell function both contribute to this process.

The metabolic clearance rate of corticosterone in lean and obese male Zucker rats.

The obese Zucker rat is an animal model of human juvenile-onset obesity. These rats exhibit numerous endocrine and metabolic abnormalities. Adrenalectomy of obese rats has been shown to reduce or reverse several of these abnormalities, thereby implying that corticosterone may contribute to the expression of obesity in this animal. Furthermore, it has been shown that the circadian rhythm of plasma corticosterone is disturbed in obese Zucker rats resulting in elevated morning plasma corticosterone concentrations in obese rats as compared to lean rats. In a effort to better elucidate the mechanism of the elevated morning levels of plasma corticosterone, the metabolic clearance rate of corticosterone was determined in the morning for lean and obese male Zucker rats (12 to 20 weeks). Additionally, the biliary and urinary excretion of labeled corticosterone and/or its metabolites were determined. The metabolic clearance rate of corticosterone was significantly greater in obese rats than in their lean counterparts. Both the metabolic clearance rate and the volume of compartments significantly correlated with body weight. No correlation was found between body weight and the elimination rate constant. The increased metabolic clearance rate of obese rats appeared to be due to an increase in the physiologic distribution of corticosterone and not to an alteration in the enzymes responsible for corticosterone metabolism. It appears that the metabolic clearance rate of corticosterone in obese Zucker rats does not contribute to elevated morning concentrations of plasma corticosterone previously observed in these animals. It suggests that the adrenal corticosterone secretion rate must actually be greater than one would expect from the plasma corticosterone concentrations alone.

ICV administration of anti-NPY antisense oligonucleotide: effects on feeding behavior, body weight, peptide content and peptide release.

Neuropeptide-Y (NPY) is a potent stimulator of feeding, and chronic administration of the peptide has been shown to increase body weight. This study determined the chronic effects of repeated daily injections of an antisense phosphorothioate oligonucleotide complementary to the rat mRNA for NPY (aNPY) on food intake, feeding behavior and body weight change in rats. Five micrograms of the aNPY oligonucleotide in ten microliters of vehicle or a missense control oligonucleotide were administered intracerebroventricularly (ICV) for seven consecutive days. Cumulative food intake, meal size and meal duration were significantly lowered in aNPY-treated animals. Body weight change of aNPY-injected animals was significantly lower than controls, and the effect was reversed after treatments ceased. A two-bottle taste aversion paradigm was employed to determine the behavioral specificity of the anorectic effect, and the phosphorothioate oligonucleotide was found not to be aversive at the dosage used. Following an additional five day injection period, animals were killed and paraventricular nuclei (PVN) were dissected. In vitro release and tissue content of NPY from this brain area were evaluated by heterologous radioimmunoassay. Content of NPY was unchanged in this brain area. Paradoxically, in vitro release of NPY was increased in aNPY-treated animals.

Neuropeptide Y antibody attenuates 2-deoxy-D-glucose induced feeding in rats.

2-deoxy-D-glucose (2-DG) has been shown to induce increased feeding responses in animals. Recent studies suggest the possible involvement of neuropeptide Y (NPY) in 2-DG-induced feeding. The present study examined the effect of immunoneutralization of endogenous NPY on 2-DG-induced feeding. NPY antibody injected into the paraventricular nucleus of the rats significantly attenuated 2-DG-induced feeding, suggesting that hypothalamic NPY may mediate, at least partly, the effect of 2-DG on food intake.

Elevated hypothalamic neuropeptide Y levels in rats with dorsomedial hindbrain lesions.

Lesions centered on the area postrema (AP) and adjacent nucleus of the solitary tract (AP/mNTS-lesions) are reported to result in increased consumption of highly palatable diets. Recent studies suggest that neuropeptide Y (NPY) may cause a preference for carbohydrate-rich diets. Thus, it is possible that NPY may play a role in the enhanced intake of highly palatable diets by AP/mNTS-lesioned rats. In the studies reported here, we found that lesions centered on the AP result in increased levels of NPY-immunoreactivity in the paraventricular nucleus of the hypothalamus. Additionally, steady-state NPY mRNA in the basomedial hypothalamus including the arcuate nucleus was elevated. Enhanced NPY was not found throughout the hypothalamus however, as NPY-immunoreactivity was not elevated in the lateral hypothalamus or the tissue bordering the anteroventral third ventricle. These data suggest the possibility that elevated hypothalamic NPY, particularly in the arcuate and paraventricular nuclei, may contribute to the altered food intake and energy balance observed in rats with lesions centered on the AP.

Neuropeptide Y expression in rat brain: effects of adrenalectomy.

Neuropeptide Y (NPY) messenger RNA was measured by hybridization of mRNA from the cortex, hippocampus, hypothalamus and striatum of rat brains. Adrenalectomized rats showed lowered level of NPY message in the striatum. A similar decline was found in the hypothalamus, while the cortex and hippocampus were unchanged. Levels of NPY message per unit total RNA were about the same for hypothalamus, cortex and striatum and about 50% less for hippocampus. Adrenalectomized rats that received replacement corticosterone had levels of NPY message that had returned to the levels found in rats receiving sham operation. Response elements consistent with our findings are reported in the NPY genomic sequence.

Adrenalectomy decreases neuropeptide Y mRNA levels in the arcuate nucleus.

Recent studies suggest that glucocorticoids may increase NPY and NPY mRNA levels. To determine if endogenous corticosterone affects the level of NPY mRNA in areas that control NPY levels in the paraventricular nucleus, we examined the effects of adrenalectomy and corticosterone replacement on NPY mRNA levels in the arcuate nucleus and brainstem. Rats were either adrenalectomized, adrenalectomized and corticosterone replaced, or sham-operated. The arcuate nucleus, hypothalamus (excluding arcuate nucleus), and brainstem were collected and the RNA isolated. Dot blots were made of each tissue and the NPY mRNA quantitated by densitometry. Adrenalectomy significantly reduced NPY mRNA levels in the arcuate nucleus, while corticosterone replacement restored the NPY mRNA levels. NPY mRNA levels in the remainder of the hypothalamus were not affected by adrenalectomy. Adrenalectomy also had no affect on NPY mRNA levels in the brainstem. These data suggest that the paraventricular nucleus may be affected by glucocorticoids via an NPY pathway and that the two major afferent pathways of NPY-containing neurons to the paraventricular nucleus may be regulated by different mechanisms.

Effects of age on the feeding response to moderately low dietary protein in rats.

Moderately low levels of dietary protein are associated with increased food intake and body fat. We propose that the generation of this feeding signal is dependent on the level of dietary protein relative to the protein requirement of the animal, that is, that protein-dependent feeding is maximized when the level of dietary protein is around the animal's protein requirement. One of the factors that affects an animal's protein requirement is age. We predict that young, growing animals are more responsive to a moderately low level of dietary protein than are mature animals. The feeding response to moderately low dietary protein (10% casein) was determined in young ( approximately 190 g) and more mature ( approximately 340 g) Sprague-Dawley rats for 12 days. As an index of amino acid deamination, serum urea nitrogen concentrations were determined, as was the in vitro release of neuropeptide Y (NPY) from hypothalamic tissue containing the paraventricular nucleus. Young rats were more responsive to the feeding effects of moderately low dietary protein than mature animals. In young rats, cumulative food intake was inversely correlated with serum urea nitrogen concentration. No correlation was found in mature animals. Although the amount of NPY remaining in hypothalamic tissue after incubation was significantly greater (p = 0.04) in young rats fed 10% casein as compared with rats fed the standard 20% casein diet, no dietary difference in K(+)-stimulated NPY release was observed. We hypothesize that the signal for low-protein-induced hyperphagia is a reduction in a compound whose production is coupled to the level of amino acid deamination in the brain.

Protein selection, food intake, and body composition in response to the amount of dietary protein.

Though not universally observed, moderately low-protein diets have been found to increase caloric intake and body fat. It appears that animals overeat in calories in order to obtain more dietary protein. For animals to control protein intake, they must be able to distinguish between two isocaloric diets containing different percentages of protein and make the appropriate dietary selection on the basis of their previous history of protein intake. Experiment 1 examined the 24-h diet selection (5 vs. 35% casein) of Sprague-Dawley rats that had been previously fed diets containing various percentages of dietary protein (5, 10, 20, 35, or 60% casein). Animals fed 5, 10, or 20% dietary protein showed a preference for the higher protein selection diet. In contrast, no significant diet preference was found in animals pre-fed the two higher levels of dietary protein (35 or 60% casein). In this study, daily food intake and body fat of rats fed the low-protein diets (5 and 10% casein) were similar to rats fed the 20% casein diet. Experiment 2 examined the effects of the level of methionine supplementation on rats fed 10% casein. In this study, food intake and body fat were increased by approximately 20% in rats fed 10% casein diets, regardless of the level of methionine supplementation (0.3 vs. 0.15%). Together, the results suggest that the presence of low-protein-induced hyperphagia helps maintain body protein levels in the face of moderately low dietary protein and promotes an increase in the amount of body fat and energy.

Affinity of hepatic glucocorticoid receptors is influenced by energy/feeding status.

Genetically obese animals have been shown to have a reduced number and affinity of glucocorticoid receptors. The relationship between the alterations in receptor binding and the regulation of energy balance is not known. We sought to determine the role of body energy/feeding status on the binding characteristics of glucocorticoid receptors. To accomplish this, we examined the effect of long-term food restriction on the number and affinity of hepatic glucocorticoid receptors from Sprague-Dawley rats. After 3 weeks of food restriction (40% of ad lib), animals were bilaterally adrenalectomized. Livers were removed, a crude cytosolic glucocorticoid receptor fraction was isolated, and radioreceptor assays were performed. Glucocorticoid receptors from food-restricted rats showed a significant reduction in the dissociation constant (Kd) as compared to receptors derived from free-feeding controls. No difference in receptor number was observed. These results suggest that energy or feeding status of the animal may influence the affinity of hepatic glucocorticoid receptors, while receptor number may be independent of this status.

Current ethical and legal issues in gastrointestinal endoscopy.

The ethical and legal aspects of gastroenterology practice have changed over the past 20 years just as remarkably as the technological features of care. Answers to questions like "May competent adult patients refuse medical treatment?" and "Is the medically-mediated delivery of nutrition and hydration a 'medical treatment'?" must be considered in light of the Cruzan case and new arguments about the benefits and burdens of feeding tubes.