Special issues in brain plasticity, repair and rehabilitation: 20 years of a publishing strategy.

The journal Restorative Neurology and Neuroscience (RNN) is focused on the emerging field of brain plasticity, repair and rehabilitation, including original and review papers both in basic research (in vitro studies, animal experiments) and in the clinical domain, including brain imaging studies. The publication of special issues on vital topics, summarizing the work of leading experts in the field of restoration and plasticity has become a major strategy of RNN and has attracted worldwide attention. Special issues are typically organized by specialized guest-editors familiar with the respective science field. Special issues cover a particular sub-discipline and often contain laboratory review papers. The first special issue appeared in 1990, and until today RNN has published a total of 25 special issues on a variety of basic science and clinical matters. In this way, RNN promotes the dissemination of information in the field of neuroplasticity, repair and rehabilitation, providing the reader with up-to-date information prepared by leading experts in the field.

Toxicity of peracetic acid (PAA) to tomonts of IIchthyophthirius multifiliis.

The free-living infective theront of Ichthyophthirius multifiliis historically has been thought to be the only stage susceptible to treatment. Here we introduce a technique to determine the toxicity of compounds to the newly released tomont, the encysted tomont and the developing tomites within the tomont that emerge as theronts. The toxicity of Wofasteril E400 (40% peracetic acid, PAA) to free-living forms of I. multifiliis was determined shortly after tomonts were physically removed from the surface of the fish and at 2.5 and 24 h after removal. Results indicate that 0.6 to 0.9 mg l(-1) PAA killed 39 to 82% of the newly released tomonts within 48 h when treated immediately. In a second experiment, tomonts were allowed to settle for 2.5 h after sampling from the skin and then treated for 12 h; concentrations > or =0.5 mg l(-1) PAA produced significantly fewer theronts than the controls. In a third experiment, encysted tomonts that were exposed to PAA 24 h after sampling from the skin and treated for 2 or 4 h produced a variable amount of theronts, but the concentrations tested (0.5 to 3.0 mg l(-1)) did not halt theront production. This research demonstrates that encysted I. multifiliis are less susceptible to chemical treatments.

Publishing in the field of brain plasticity, repair and rehabilitation: The 20th Anniversary issue of Restorative Neurology and Neuroscience.

The journal Restorative Neurology and Neuroscience (RNN) now celebrates its 20th anniversary. Since 1989 RNN has published scientific findings in the emerging fields of brain plasticity, repair and rehabilitation via original scientific publications and review papers in basic research (animal experiments, in vitro studies) and clinical science. During the last decade RNN had a steady progress in reference value and scientific impact, reaching an ISI-impact factor of 1.978 (2008) and has published a total of 717 papers. The journal's success can be explained by different factors: (1) neuroplasticity, regeneration, recovery and rehabilitation have developed to main stream subjects with a worldwide increase in the number of publications and their citation rate, (2) RNN has published numerous special issues which summarize the work of leading experts in specialized sub-fields, (3) a dedicated, highly qualified editorial board (4) the quality of papers submitted to RNN has increased over time. RNN has now become a visible and leading source of original scientific information in the space of brain plasticity, rehabilitation and repair.

Upper abdominal symptoms in patients with Type 1 diabetes: unrelated to impairment in gastric emptying caused by autonomic neuropathy.

AIMS: Diabetic gastroparesis is a common condition occurring in some 30-50% of patients with long-term diabetes. Some studies have found a relationship between autonomic neuropathy and diabetic gastroparesis. In addition to autonomic neuropathy, acute changes in plasma glucose concentration can also affect gastric emptying. The objective was to examine the relationship between autonomic nerve function, glucose concentration, gastric emptying, and upper abdominal symptoms in Type 1 diabetic patients. METHODS: Gastric emptying of solids and liquids was measured with scintigraphy in 27 patients with longstanding Type 1 diabetes with upper abdominal symptoms. Autonomic nerve function was examined by standardized cardiovascular tests, and plasma glucose concentrations were measured during scintigraphy. Severity of abdominal symptoms and quality of life were explored by validated questionnaires. RESULTS: Seven patients (26%) had delayed gastric emptying of solids and three (11%) of liquids. Mean gastric half-emptying time of solids was 128 +/- 116 min and of liquids 42 +/- 30 min. Of the 26 patients undergoing tests, 16 (62%) had autonomic nerve dysfunction. Autonomic neuropathy score (1.6 +/- 1.7) correlated positively with the gastric emptying rate of solids (P = 0.006), a rate unrelated to symptom scores or plasma glucose concentrations during scintigraphy. Quality of life in patients with abdominal symptoms was lower than in the normal Finnish population. CONCLUSIONS: Impaired gastric emptying of solids in patients with Type 1 diabetes is related to autonomic neuropathy, but not to actual glycaemic control. The upper abdominal symptoms observed in these patients cannot be explained, however, by impaired gastric emptying.

Publishing in the field of brain plasticity, repair and rehabilitation: an emerging neuroscience niche journal.

The journal Restorative Neurology and Neuroscience (RNN) is now published in its 25th volume since its inception in 1989. RNN focuses on the emerging field of brain plasticity, repair and rehabilitation, including original and review papers both in basic research (animal experiments, in vitro studies) and in the clinical domain, including brain imaging studies. During the last decade RNN has experienced a steady progress in its reference value and scientific impact. The ISI-impact factor has risen from 1.117 (1997) to 2.862 (2006). This places the journal at the 81st rank among all 200 neuroscience journals, i.e. 60% of all neuroscience journals have a lower impact factor. When compared to other journals in the field of rehabilitation, RNN ranks number 1. Causes for this positive development are, among others: (1) the field of neuroplasticity, regeneration, recovery and rehabilitation is an emerging field in medicine and therefore the number of publications and their citation rate overall increases, (2) the special issues strategy, (3) a top level editorial board, and (4) the quality of papers submitted to RNN continuously improves as RNN is gaining increasing acceptance in the scientific community. Thus, in the space of neuroscience in general, and rehabilitation in particular, RNN has become a visible, high impact journal and a leading source of original scientific information pertaining to brain plasticity , rehabilitation and repair. RNN is likely to gain more momentum as the field matures further.

Ankle brachial index measurements in critical leg ischaemia--the influence of experience on reproducibility.

BACKGROUND AND AIMS: While the use of ankle brachial indices (ABI) in the screening for peripheral arterial obstructive disease is widely accepted, the applicability of ABI in the identification of critical leg ischaemia (CLI) is far from settled. The aim was to assess inter-observer variability of ABI measurements in patients with CLI. MATERIAL AND METHODS: The study was conducted in two parts. In both parts a hand-held 9.5 MHz Doppler device was used. PART A: ABI was measured by 7 measurers with variable measurement experience in 22 limbs of patients admitted to the surgical ward because of CLI. The agreement between the measurements was assessed. PART B: Inter-observer agreement in measuring ABI was assessed between 2 trained vascular technicians measuring 33 limbs in patients with CLI on the vascular outpatient clinic. RESULTS AND CONCLUSIONS: Part A: 16% of the ABI-values differed 0.15 or more from the median and the mean coefficient of variation was 56.1. Part B: The difference between measurements did not exceed 0.14 with a mean coefficient of variation of 3.2. To obtain reproducible and quantitative measurement values the measurements have to be performed by trained personnel. Measurements performed by untrained personnel can only be regarded as qualitative.

Claudication does not always precede critical leg ischemia.

Prevalence of intermittent claudication is often used to calculate the prevalence of critical leg ischemia (CLI), a more severe form of peripheral arterial disease (PAD). Although this logical course of the disease is intellectually appealing, not all patients with CLI have experienced any symptoms of previous claudication. A total of 100 consecutive patients with objective evidence of critical ischemia, as evaluated by non-invasive testing in the authors' vascular laboratory, were subjected to a structured interview to evaluate how often peripheral arterial disease is presented with symptoms of CLI as the initial complaint. In all, 37 patients had never experienced claudication prior to the development of CLI. Furthermore, 12 of 63 patients who suffered from previous claudication did not have any claudication symptoms at the time of the development of CLI. Of the 37 patients with CLI as the first sign of PAD, 20 had diabetes--four of whom with manifest diagnosed neuropathy. The patients without previous claudication more frequently had ulcers as the initial symptom of CLI (89%) than those with claudication (59%), whose disease first progressed to rest pain. Altogether, 25 patients did not walk enough to develop symptoms of claudication. In conclusion, every patient presenting with symptoms potentially related to CLI should undergo vascular laboratory measurements regardless of whether he/she has a history of claudication or not. This is especially true in limbs with unhealed skin lesions.

Increased preoperative c-reactive protein level as a prognostic factor for postoperative amputation after femoropopliteal bypass surgery for CLI.

BACKGROUND AND AIMS: We evaluated the possible predictive role of C-reactive protein (CRP) on the immediate postoperative outcome after femoropopliteal bypass surgery for critical leg ischaemia (CLI). MATERIAL AND METHODS: 138 patients with CLI who underwent 143 femoropopliteal reconstructions. RESULTS: The immediate postoperative period secondary patency rate was 87%, leg salvage rate was 94%, and survival rate 97%. Nine patients (6.3%) had 30-day postoperative major amputation, three of them despite a patent bypass graft because of progression of foot infection. The preoperative serum concentration of CRP was the only predictor of postoperative major amputation (p = 0.004; for an increase of 10 mg/l: OR, 1.188; CI 95%, 1.059-1.332). The median preoperative serum concentration of CRP among patients who did not have major amputation was 13.0 mg/l (range, 1-185), whereas it was 47.5 mg/l (range, 5-168) among those who had amputation after bypass graft occlusion, and 115.0 mg/l (range, 34-222) among those who had amputation despite a patent bypass graft (p = 0.008). CONCLUSIONS: CRP may be a useful marker in risk stratification for postoperative amputation in patients undergoing femoropopliteal bypass surgery for CLI.

Transfer function index of pulse volume recordings: a new method for vein graft surveillance.

OBJECTIVE: Color flow duplex scanning is currently the best method available for vein graft surveillance. However, it puts a considerable strain on the workload of a vascular unit and requires a highly trained operator. The aim of this study was to develop and validate a new, noninvasive tool for graft surveillance. The utility of transfer function index (TFI) of pulse volume recordings is tested for this purpose. METHODS: The design of the study was a blind comparative study that involved 70 testing procedures that were performed on 58 different infrainguinal vein bypass grafts. The TFI was measured with a portable vascular laboratory multi-cuff unit. Ankle/brachial indexes were obtained with the same device. Color flow duplex scanning was used as a diagnostic standard. A graft was defined as at risk, according to duplex scanning, if a local stenosis with a V2/V1 more than 2 was found or if peak systolic velocity remained less than 45 cm/s throughout the graft. The repeatability of the method was tested on 30 grafts. RESULTS: A total of 63 tests were available for analysis. Seven tests were excluded. Four were excluded because they had unreliable TFI measurement due to cardiac arrhythmias, and in three tests, the whole graft could not be visualized in the duplex scan. Forty normal and 22 at-risk grafts were found. One graft was occluded. The TFI was significantly lower for at-risk grafts (0.89) versus normal grafts (1.09; P =.005). A TFI of 1.02 or less correctly detected 21 of 22 at-risk grafts. The sensitivity, specificity, and accuracy were 96%, 65%, and 76%, respectively. The ability of the ankle/brachial index to detect the at-risk grafts was clearly inferior to the TFI. The repeatability of the method at proximal thigh, distal thigh, and proximal calf was +/- 0.21, +/- 0.07, and +/- 0.14, respectively. CONCLUSION: The TFI is a sensitive and reliable method to detect an at-risk graft. The examination is noninvasive, simple, quick to perform, and well tolerated by the patients. We suggest that the TFI could be the first-line screening method in vein graft surveillance.

Limits of infrapopliteal bypass surgery for critical leg ischemia: when not to reconstruct.

The aim of this study was to identify the risk factors affecting the immediate 30-day postoperative outcome of infrapopliteal bypass grafts. A series of 511 revascularization procedures to the infrapopliteal arteries have been performed in 439 patients with critical leg ischemia. There were 306 crural bypasses and 205 pedal bypasses. The 30-day postoperative primary and secondary patency rates were 77.5% and 83.4%, respectively; the leg salvage rate was 89.8%; the survival rate was 94.7%; and 85.1% of patients were alive with a salvaged leg. A history of myocardial infarction, angina pectoris, or stroke had a great impact on the postoperative cardiac and cerebrovascular fatal and nonfatal complications. C-reactive protein arose as an important predictor of the length of hospital stay (p = 0.03), postoperative cardiac complications (p = 0.02), leg salvage (p = 0.009), amputation with patent graft (p = 0.009), and patients who survived with a salvaged leg (p = 0.006). Poor results were achieved in patients on long-term dialysis. Surgical experience had an influence on leg salvage (p = 0.02) and on patients alive with salvaged leg rates (p = 0.009). Infrapopliteal bypass surgery is a demanding procedure requiring high surgical skill and experience. Revascularization may be contraindicated when severe coronary disease, previous stroke, renal failure requiring long-term dialysis, diabetes, or high serum concentration of C-reactive protein coexist with critical leg ischemia, as these patients are at high risk for early postoperative leg or life loss.

Behavioral and immunological effects of exogenous butyrylcholinesterase in rhesus monkeys.

Although conventional therapies prevent organophosphate (OP) lethality, laboratory animals exposed to such treatments typically display behavioral incapacitation. Pretreatment with purified exogenous human or equine serum butyrylcholinesterase (Eq-BuChE), conversely, has effectively prevented OP lethality in rats and rhesus monkeys, without producing the adverse side effects associated with conventional treatments. In monkeys, however, using a commercial preparation of Eq-BuChE has been reported to incapacitate responding. In the present study, repeated administration of commercially prepared Eq-BuChE had no systematic effect on behavior in rhesus monkeys as measured by a six-item serial probe recognition task, despite 7- to 18-fold increases in baseline BuChE levels in blood. Antibody production induced by the enzyme was slight after the first injection and more pronounced following the second injection. The lack of behavioral effects, the relatively long in vivo half-life, and the previously demonstrated efficacy of BuChE as a biological scavenger for highly toxic OPs make BuChE potentially more effective than current treatment regimens for OP toxicity.

Does saphenous vein arterialisation prevent major amputation in critical leg ischaemia? A comparative study.

BACKGROUND: Arterialisation of the great saphenous vein has been suggested to improve distal circulation in patients with critical leg ischaemia not accessible for reconstructive surgery. As the technique has been a matter of controversy the aim was to assess the outcome of a series of own patients treated with arterialisation and compare them with conservatively treated patients. EXPERIMENTAL DESIGN: a retrospective cohort study. SETTING: an academic referral centre (Department of Surgery, Helsinki University Central Hospital) together with a district hospital (Peijas-Rekola Hospital). PATIENTS AND INTERVENTIONS: 14 consecutive patients with critical leg ischaemia treated with arterialisation of the great saphenous vein in the district hospital were compared with 14 age, sex, diabetes and symptom severity-matched controls with critical leg ischaemia treated conservatively in the academic referral centre. MEASURES: major amputations and patient survival. RESULTS: The leg salvage rate was 57% at one year in the arterialisation group and 54% in the conservative group (NS) but the survival rate at one year was 92% in the operative group and 64% in the control group (NS). CONCLUSIONS: Arterialisation did not have any effect on leg salvage. The results of this study do not support the use of arterialisation as a treatment for critical leg ischaemia

Haemodynamic results of femoropopliteal percutaneous transluminal angioplasty.

OBJECTIVES: To determine the utility of percutaneous transluminal angioplasty (PTA) of the femoropopliteal segment in patients with claudication and critical leg ischaemia (CLI). DESIGN: Longitudinal observational study. SETTING: A university based vascular surgical centre. MATERIAL: Ninety-five patients with stenosing or occlusive arterial lesions of the femoropopliteal segment underwent 52 primary PTA for claudication and 50 primary PTA for CLI. METHODS: The procedure was considered haemodynamically successful when the increase of immediate postprocedural ABI was 0.15 or more. The criterion for haemodynamic success during follow-up was an ABI having not decreased by more than 0.15 from the immediate postprocedural level. The run-off arteries were graded according to the scoring system proposed by the SVS/ISCVS. RESULTS: Among the technically successful procedures (83%), the haemodynamic success rate was 77% at 1 month, 55% after 1 year, and 51% after 2 years. The cumulative haemodynamic success rates were 83%, 66% and 61% in claudicants, and 70%, 42%, and 38% in CLI (p = 0.03). In patients with a run-off score < or = 7.5, the success rates were 84%, 67%, and 60%, respectively, whereas in those with a crural score > 7.5 these were 61%, 39%, and 39%, respectively (p = 0.04). CONCLUSIONS: The haemodynamic results suggest that PTA to the femoropopliteal segment is seldom a procedure of choice for critically ischaemic legs with poor run-off. The run-off score is useful in identifying patients who may benefit from PTA.

How maximum diameter affects the decision to repair aortic aneurysm.

BACKGROUND AND AIMS: The aneurysm size at which operative or endovascular repair is indicated is still a matter of dispute. The aim of the study was to assess how Finnish surgeons decide and what they regard as indication for elective operation. MATERIAL AND METHODS: The material was collected with a questionnaire handed out at two surgical meetings. The smallest aneurysm diameters at which operation was indicated according to the opinion of the respondents were recorded. RESULTS: 41 questionnaires were returned. The diameters showed a great variation although 85% of the surgeons placed their limit for treatment between 40 and 50 mm as maximum diameter. 83% held the opinion that a patient with a high operative risk could still be treated using endoluminal stent grafts. CONCLUSIONS: There is no consensus among surgeons regarding the size limits for aneurysm surgery, especially in the evolving field of endovascular surgery.

Influence of surgical experience on the results of carotid surgery. The Finnvasc Study Group.

OBJECTIVE: To assess the 30-day mortality and morbidity rates related to carotid endarterectomy on a nation-wide basis. DESIGN: Retrospective cross-sectional study based on vascular registry Finnvasc. MATERIALS AND METHODS: A total of 17,465 recorded vascular and endovascular procedures included exactly 1600 carotid endarterectomies performed by 104 surgeons in 23 hospitals. Fourteen per cent of the patients were operated on for asymptomatic carotid stenosis. RESULTS: The combined mortality and permanent stroke rate was 3.3%, without any difference between operations done on symptomatic or asymptomatic patients. There was a clear inverse association between surgeon's carotid case load and poor outcomes in carotid surgery (p < 0.005), the critical patient mass per surgeon and year being 10 operations. There was no association between outcome after carotid surgery and hospital volume of carotid operations. CONCLUSIONS: Surgeon's experience in carotid surgery clearly improves the results of carotid surgery.

Primacy and recency effects in rhesus monkeys (Macaca mulatta) using a serial probe recognition task. III. A developmental analysis.

In children, the recency effect emerges prior to the primacy effect. To determine whether this dissociation is also seen in nonhuman primates, we evaluated the development of the primacy and recency effect in 3 young adult (35 months) and 4 adolescent (21 months) male rhesus monkeys (Macaca mulatta) using a six-item serial probe recognition (SPR) task. As predicted, the young adult monkeys displayed both effects, while the adolescent monkeys only displayed the recency effect. Not until after 26 months of training on the SPR task did the adolescent monkeys exhibit both the primacy and recency effect. Interference and strategy differences are discussed in terms of the results along with an interpretation of Rudy's (1992) configural association theory of cognitive development. Additional possible explanations for this developmental dissociation include the delayed maturation of the neocortical, hippocampal, and/or cholinergic systems, the latter two having been shown to be important in the expression of the primacy but not the recency effect.

Mortality in abdominal aortic aneurysm surgery--the effect of hospital volume, patient mix and surgeon's case load.

OBJECTIVE: Assessment of mortality in abdominal aortic aneurysm surgery. DESIGN: A 4-year cross sectional study based on a nationwide vascular registry: Finnvasc. MATERIAL AND METHODS: A total of 17,465 vascular interventions included 929 elective repairs for abdominal aortic aneurysms (AAA), and 610 emergency cases with 454 ruptures. Fifty-three percent of the operations were done in university hospitals, 44% in central hospitals and 3% in district hospitals. RESULTS: The 30-day mortality rate for AAA repair was 5.1% in elective and 46% in ruptured cases. A clear dependence of operative mortality on surgeon's experience in AAA surgery was observed, both regarding the surgeon's total vascular case load (p < 0.01) and the number of operated elective aneurysms (p < 0.01), but not the number of operated ruptured aneurysms. However, no association was found between hospital volume and mortality in AAA surgery. CONCLUSIONS: Vascular surgical experience clearly improves the results of elective aneurysm surgery.

Survival of a microvascular muscle flap despite the late occlusion of the inflow artery in a neuroischaemic diabetic foot.

A microsurgical free rectus abdominis flap was connected to a popliteodistal vascular reconstruction because of a limb-threatening ischaemic ulcer in an 84 year old diabetic patient. After six months the inflow vessel occluded, but the flap stayed viable, apparently receiving its nutrition through newly developed collaterals.

Outcome of unreconstructed chronic critical leg ischaemia.

OBJECTIVE: To assess the outcome of unreconstructed chronic critical leg ischaemia with a special reference to the definition of CLI. DESIGN AND SETTING: A retrospective study with 1 year follow-up in an academic referral center (Fourth Department of Surgery, Helsinki University Central Hospital). MATERIAL: 105 consecutive unreconstructed patients with 136 critically ischaemic legs as defined by the European Consensus Document on Chronic Critical Leg Ischaemia. MAIN OUTCOME MEASURES: Major amputations and mortality. RESULTS: 81% of the 136 critically ischaemic legs survival 1 month, 70% three months and 54% one year. Of the 105 patients 93%, 77% and 46% were alive at 1, 3 and 12 months, respectively, whereas survival of patients with nonamputated leg was only 71%, 56% and 28%. Patients with bilateral CLI had a worse prognosis in terms of survival and leg salvage. The leg outcome was not worsened by the presence of diabetes nor by the distal extent of arterial changes. CONCLUSIONS: Although the selection of the present material is likely to cause some bias, unreconstructed CLI seemed to predict a very poor outcome in terms of survival and limb salvage.