Clinical usability study of a home-based self-administration transcranial direct current stimulation for primary dysmenorrhea: A randomized controlled trial.

This study tested the usability of a home-based self-administration transcranial direct current stimulation (tDCS) device designed specifically for women's health needs. This is a single center triple blinded clinical usability study for a new wireless, Bluetooth-controlled wearable tDCS device for women's health. The study aims to evaluate the usability and effective blinding of a home-based tDCS system. A total of forty-nine women of reproductive age were randomly allocated (1:1) to receive one session of active tDCS (n = 24) or sham tDCS (n = 25) over the motor and dorsolateral prefrontal cortex. Each participant self-administered one 20-minute session without supervision following guidance on a software application alone. The System Usability Scale (SUS) and the Patient Global Impression of Change (PGIC) were used to evaluate the usability of the system. Regardless of sham or active conditions, all users found the system easy to use without the support of researchers. Usability scores were considered to be "excellent" in both groups and no significant difference was found between sham and active groups showing effective blinding of the device (Active group: 93.7 (83.1-97.5); Sham group 90 (86.2-95) p = 0.79) and PGIC (Active group: 2 (1-2.75); Sham group 2 (1-2) p = 0.99) using an unpaired t-test or non-parametric statistical tests accordingly. The new Bluetooth-controlled wearable tDCS device is easy, safe to use and completely controlled by a smartphone app. This device is focused on women's health and will be tested as an alternative treatment for chronic pelvic pain and mood disturbance associated with menstrual cycles in further research.

Development of leprosy and type 1 leprosy reactions after treatment with infliximab: a report of 2 cases.

Humanized monoclonal antibodies to tumor necrosis factor- alpha are valuable for the treatment of rheumatologic conditions, but they have been associated with the development of serious infections. We report the first 2 cases of leprosy developing after treatment with infliximab. After discontinuation of infliximab, both patients developed type 1 ("reversal") leprosy reactions.

Development of leprosy and type 1 leprosy reactions after treatment with infliximab: a report of 2 cases

Humanized monoclonal antibodies to tumor necrosis factor- alpha are valuable for the treatment of rheumatologic conditions, but they have been associated with the development of serious infections. We report the first 2 cases of leprosy developing after treatment with infliximab. After discontinuation of infliximab, both patients developed type 1 ([quot ]reversal[quot ]) leprosy reactions.

Mesoaccumbens dopamine neuron synapses reconstructed in vitro are glutamatergic.

The mesoaccumbens projection, formed by ventral tegmental area dopamine neurons synapsing on nucleus accumbens gamma-aminobutyric acid neurons, has been implicated in the pathogenesis of schizophrenia and drug addiction. Despite intensive study, the nature of the signal conveyed by dopamine neurons has not been fully resolved. In addition to several slower, dopamine-mediated, modulatory actions, several lines of evidence suggest that dopamine neurons have fast excitatory actions. To test this, we placed dopamine neurons together with accumbens neurons in microcultures. Surprisingly, most dopamine neurons made excitatory recurrent connections (autapses), which provided a basis for their identification; accumbens gamma-aminobutyric acid neurons were identified by their distinctive size. In 75% of mesoaccumbens cell pairs, stimulation of the dopamine neuron evoked a glutamate-mediated, excitatory synaptic response in the accumbens neuron. Immunostaining revealed dopamine neuron varicosities that were predominantly dopaminergic, ones that were predominantly glutamatergic, and ones that were both dopaminergic and glutamatergic. Despite close appositions of both glutamatergic and dopaminergic varicosities to the dendrites of accumbens neurons, only glutamatergic synaptic responses were seen. In the majority of cell pairs, pharmacologic activation of D2-type dopamine receptors inhibited glutamatergic responses, presumably via immunocytochemically-visualized presynaptic D2 receptors. In some cell pairs, the evoked autaptic and synaptic responses were discordant, suggesting that D2 receptors may be differentially trafficked to different presynaptic varicosities.Thus, dopamine neurons appear to mediate both slow dopaminergic and fast glutamatergic actions via separate sets of synapses. Together with evidence for glutamate cotransmission in serotonergic raphe neurons and noradrenergic locus coeruleus neurons, these results add a new dimension to monoamine neuron signaling that may have important implications for neuropsychiatric disorders.

The effects of 8-OH-DPAT and (+/-)-pindolol on isolation-induced ultrasonic vocalizations in 3-, 10-, and 14-day-old rats.

It has been established that administration of 5-HT1A agonists attenuates the rate of isolation-induced ultrasonic vocalizations (USV) in 10-day-old rat pups. In this study we extended these findings by examining the effects of administration of the serotonergic 1A receptor agonist, 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT), and mixed 5-HT1A antagonist/beta adrenergic antagonist, (+/-)-pindolol, in 3-, 10-, and 14-day-old rat pups in order to assess the effect of these drugs from a developmental perspective. At all three ages, 8-OH-DPAT significantly reduced the rate of isolation-induced USV. While only the highest dose (1.0 mg/kg) of 8-OH-DPAT administered to the 10- and 14-day-olds significantly reduced the rate of vocalization, both the 0.1- and 1.0-mg/kg doses significantly attenuated the vocalization rate in the 3-day-olds. Pindolol administration did not alter the rate of USV at any age nor did it block the quieting effect that generally occurs when an anesthetized littermate is placed with the isolated pup. We conclude that 8-OH-DPAT is effective as early as 3 days of age in the quieting of isolation-induced USV and that the regional age-dependent development of 5-HT1A receptors and projections are important factors in the observed differential sensitivity to 8-OH-DPAT administration during development.

Dopamine neurons make glutamatergic synapses in vitro.

Interactions between dopamine and glutamate play prominent roles in memory, addiction, and schizophrenia. Several lines of evidence have suggested that the ventral midbrain dopamine neurons that give rise to the major CNS dopaminergic projections may also be glutamatergic. To examine this possibility, we double immunostained ventral midbrain sections from rat and monkey for the dopamine-synthetic enzyme tyrosine hydroxylase and for glutamate; we found that most dopamine neurons immunostained for glutamate, both in rat and monkey. We then used postnatal cell culture to examine individual dopamine neurons. Again, most dopamine neurons immunostained for glutamate; they were also immunoreactive for phosphate-activated glutaminase, the major source of neurotransmitter glutamate. Inhibition of glutaminase reduced glutamate staining. In single-cell microculture, dopamine neurons gave rise to varicosities immunoreactive for both tyrosine hydroxylase and glutamate and others immunoreactive mainly for glutamate, which were found near the cell body. At the ultrastructural level, dopamine neurons formed occasional dopaminergic varicosities with symmetric synaptic specializations, but they more commonly formed nondopaminergic varicosities with asymmetric synaptic specializations. Stimulation of individual dopamine neurons evoked a fast glutamatergic autaptic EPSC that showed presynaptic inhibition caused by concomitant dopamine release. Thus, dopamine neurons may exert rapid synaptic actions via their glutamatergic synapses and slower modulatory actions via their dopaminergic synapses. Together with evidence for glutamate cotransmission in serotonergic raphe neurons and noradrenergic locus coeruleus neurons, the present results suggest that glutamatergic cotransmission may be the rule for central monoaminergic neurons.

Ontogeny of Fos protein-like immunoreactivity in the suprachiasmatic nucleus.

This study examined the normal development of neuronal activity in the suprachiasmatic nuclei (SCN) of rats between age 3-60 days, using Fos protein-like immunoreactivity (Fos-LI) as a marker. At age 3 days, Fos-positive nuclei are sparsely distributed throughout the SCN. Between age 3-10 days, the density of labeled nuclei increases significantly. Fos-LI labeling is maximal at 10 days. Between age 10-14 days, the number of labeled nuclei decreases and remains relatively constant thereafter, although the intensity of the reaction product diminishes as the animal matures. By age 60 days, the number of Fos-LI labeled nuclei in the SCN is substantially decreased and is essentially the same as in the 3-day-old rat. The appearance of Fos-LI nuclei in the SCN during development appears to reflect the development of visual system afferents to the nucleus as well as the development of intrinsic SCN synaptology.

Mammalian myosin I alpha, I beta, and I gamma: new widely expressed genes of the myosin I family.

A polymerase chain reaction strategy was devised to identify new members of the mammalian myosin I family of actin-based motors. Using cellular RNA from mouse granular neurons and PC12 cells, we have cloned and sequenced three 1.2-kb polymerase chain reaction products that correspond to novel mammalian myosin I genes designated MMI alpha, MMI beta, MMI gamma. The pattern of expression for each of the myosin I's is unique: messages are detected in diverse tissues including the brain, lung, kidney, liver, intestine, and adrenal gland. Overlapping clones representing full-length cDNAs for MMI alpha were obtained from mouse brain. These encode a 1,079 amino acid protein containing a myosin head, a domain with five calmodulin binding sites, and a positively charged COOH-terminal tail. In situ hybridization reveals that MMI alpha is highly expressed in virtually all neurons (but not glia) in the postnatal and adult mouse brain and in neuroblasts of the cerebellar external granular layer. Expression varies in different brain regions and undergoes developmental regulation. Myosin I's are present in diverse organisms from protozoa to vertebrates. This and the expression of three novel members of this family in brain and other mammalian tissues suggests that they may participate in critical and fundamental cellular processes.

The appearance of Fos protein-like immunoreactivity in the hypothalamus of developing rats in response to cold ambient temperatures.

This study examined cellular activity in the hypothalamus of developing rats in response to cold environmental temperatures. The appearance of the nuclear protein, Fos, in response to cold ambient temperatures in rats three to 35 days of age was used as a marker of neuronal activation. Fos-positive nuclei were first seen in response to cold ambient temperatures in the ventromedial nucleus at three days of age, the paraventricular nucleus at eight days of age, the preoptic-anterior hypothalamus at 10 days of age and the anterior hypothalamic nucleus at 21 days of age. The rectal temperature of the 10-day-old pups dropped by less than half that measured in the nine-day-old pups after 1 h in the cold. It is possible that the activation of neurons in the preoptic-anterior hypothalamus in the 10-day-old animal may contribute to the decreased hypothermia observed in the 10-day-old after 1 h in the cold. The high density of Fos-like immunoreactive-labeled nuclei in the preoptic-anterior hypothalamus in the 10-day-old rats that were exposed to the cold environment indicates increased neuronal activity at this site. The results suggest that, at least in the preoptic-anterior hypothalamus, the appearance of the cellular response to cold ambient temperatures is coincidental with a thermogenic response.

The development of cholecystokinin in the interpeduncular nucleus of rats.

This study describes the development and late disappearance of cholecystokinin-like immunoreactivity (CCK-LI) in the interpeduncular nucleus (IPN) of rats. Between one and 7 days of age, CCK-positive fiber labeling was sparse and restricted to the lateral subnuclei of the caudal IPN. By 28 days of age the density of CCK-positive fibers increased and labeling was found in the lateral, rostral and apical subnuclei, and medial to the dorsolateral subnuclei. At 35 days of age CCK-LI fiber labeling was absent in the lateral subnuclei and medial to the dorsolateral subnuclei. No additional changes in fiber labeling were observed after 35 days of age. These results suggest that significant anatomical or biochemical reorganization may occur in projections to the IPN between 28 and 35 days of age.

Distribution of the 3.05-Mdal "Toronto" beta-lactamase plasmid among penicillinase-producing isolates of Neisseria gonorrhoeae in the Far East.

One hundred and fifty-two beta-lactamase-producing Neisseria gonorrhoeae isolates from Japan (n = 25; 1983, 1985, 1986), Taiwan (n = 14; 1983, 1984), and the Republics of Singapore (n = 58; 1986, 1987) and the Philippines (n = 55; 1989) isolated from 1983 through 1989 were characterized by auxotype, serovar, and plasmid content to determine the distribution and diversity of penicillinase-producing N. gonorrhoeae (PPNG) strains possessing the 3.05-Mdal "Toronto" beta-lactamase plasmid. PPNG isolates possessing a 3.05-Mdal beta-lactamase plasmid were isolated in Japan (1/25: 4%), Taiwan (4/14: 29%), and the Republic of the Philippines (3/55: 5%); no PPNG isolates with the 3.05-Mdal plasmid were isolated in the Republic of Singapore. All isolates possessing the 3.05-Mdal plasmid also possessed a 24.5-Mdal conjugative plasmid and belonged to the auxotype/serovar class, Proto/IB-1. Studies with five isolates possessing the 3.05-Mdal plasmid, and representing isolates from each country in which they were found, confirmed that the beta-lactamase plasmid in these strains could not be transferred to another gonococcal isolate by conjugation. PPNG isolates possessing the "Toronto" plasmid are widespread in the Far East; spread of these isolates may, however, be limited to the physical spread of a single strain.

Antigens of Entamoeba histolytica recognized by immune sera from liver abscess patients.

Immune sera from 11 patients cured of amebic liver abscess was used to identify antigens of Entamoeba histolytica. Strain HM1-IMSS, among the most virulent in axenic culture, was used. The 37 and 90 Kd antigens were surface glycoproteins as indicated by lactoperoxidase iodination and by Concanavalin A blotting; the 59 Kd antigen was a mannose containing glycoprotein that did not appear to be on the cell surface. Western blots of 11 different immune sera revealed specific binding of immune IgG to 9 amebic proteins. Most frequently recognized proteins were of molecular weight 37, 59, and 90 Kd. The immunoblot pattern in 5 patients was unchanged for up to 30 months post-treatment for liver abscess.

Upper extremity swelling and hyperpigmentation due to onchocerciasis in an American.

An American woman who had lived in Equatorial Guinea was seen in the United States with intermittent swelling, pruritus, hyperpigmentation, and mild cutaneous atrophy of the right arm. Filarial diseases were considered in the differential diagnosis; skin snips subsequently revealed Onchocerca volvulus microfilariae. There was no evidence of ocular involvement. The case illustrates the importance of obtaining a history of international travel, the need to consider "exotic" parasitic diseases in travelers returning from the tropics, and several of the presenting features of onchocerciasis. In the past, onchocerciasis was treated with diethylcarbamazine and suramin, both of which have appreciable toxicity. A major recent advance has been the introduction of ivermectin, which appears to be more effective and less toxic, and is currently undergoing clinical evaluation in the United States and abroad.

Recognition of the galactose- or N-acetylgalactosamine-binding lectin of Entamoeba histolytica by human immune sera.

Cure of amebic liver abscess is associated with resistance to recurrent invasive amebiasis and the development of a humoral and cell-mediated immune response. We determined whether human immune sera contain blocking antibody for the 170-kilodalton (kDa) galactose or N-acetylgalactosamine (Gal/GalNAc)-binding lectin of Entamoeba histolytica. By Western blot (immunoblot) of whole amebae subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis, all eight immune sera studied here prominently recognized a 170-kDa amebic protein. Western blot of the purified Gal/GalNAc lectin with pooled human immune sera (PHIS) confirmed that the 170-kDa band was the adherence lectin. Immunoprecipitation of [35S]methionine-metabolically-labeled amebae with the antilectin monoclonal antibody H8-5 and with PHIS demonstrated that the 170-kDa lectin was the major antigen recognized by PHIS. The in vitro adherence of E. histolytica trophozoites to CHO cells at 4 degrees C was inhibited by prior exposure of amebae to greater than or equal to 1.0% PHIS. The humoral response to the Gal/GalNAc-binding lectin of the parasite may contribute to the development of protective immunity against invasive amebiasis.

Direct neural inhibition of insulin secretion in response to systemic hypoglycemia.

The innervated pancreas of an anesthetized small "pancreas" dog was cross-perfused with blood from a large "support" dog in order to separate neural from blood-borne influences on the immunoreactive insulin secretion rate (ISR). The arterial plasma reducing sugar (sugar) concentration could be varied independently in the pancreas dog systemic circulation and in its pancreas. After tying of the hepatic arteries and portal vein in the pancreas dog, its systemic arterial plasma sugar concentration was allowed to fall in 10 experiments. This was prevented in five control experiments by intravenous glucose infusion (7 mg/kg-min). In all experiments, pancreatic arterial plasma sugar concentration was sustained, and at 40 min it was elevated 50 mg/100 ml by glucose infusion into the pancreatic blood supply. Bilateral splanchnic nerve section at 120 min caused an increase of the ISR in all experiments, but a greater rise occurred from the pancreases of the 10 dogs allowed to become hypoglycemic (P less than .02). In two further experiments, the splanchnic nerves were not cut, and no rise in ISR occurred. In conclusion, systemic hypoglycemia can inhibit insulin secretion by means of the splanchnic nerves.