Safety and efficacy of forefoot surgery under ankle block anaesthesia.

BACKGROUND: Ankle block as the sole anaesthetic for forefoot surgery is not used uniformly throughout the UK despite obvious advantages and widespread use internationally. AIM: Evaluation of safety and effectiveness of performing elective forefoot surgery under ankle block anaesthesia alone in a pilot cohort of patients in a Scottish unit. METHODS: Data were collected from 81 consecutive forefoot procedures (71 patients) using a standardised questionnaire including incremental pain assessment (0-10; 0 no pain, 10 severe pain). RESULTS: Seven patients reported pain during surgery; average score 0.17. Average pain scores 6, 12, 24 and 48 h following surgery were 1.5, 3.09, 2.3 and 1.9, respectively. All patients were discharged home and walking on the same day. CONCLUSION: Forefoot surgery under ankle block alone may be safe and effective. Anaesthesia obtained permitted routine forefoot procedures and provided lasting post-operative analgesia. Combined with intra-operative sedation, use of ankle tourniquet and same day discharge, it had very high patient acceptance and satisfaction.

Non-invasive, non-radiological quantificationof anteroposterior knee joint ligamentous laxity: A study in cadavers.

OBJECTIVES: We performed in vitro validation of a non-invasive skin-mounted system that could allow quantification of anteroposterior (AP) laxity in the outpatient setting. METHODS: A total of 12 cadaveric lower limbs were tested with a commercial image-free navigation system using trackers secured by bone screws. We then tested a non-invasive fabric-strap system. The lower limb was secured at 10° intervals from 0° to 60° of knee flexion and 100 N of force was applied perpendicular to the tibia. Acceptable coefficient of repeatability (CR) and limits of agreement (LOA) of 3 mm were set based on diagnostic criteria for anterior cruciate ligament (ACL) insufficiency. RESULTS: Reliability and precision within the individual invasive and non-invasive systems was acceptable throughout the range of flexion tested (intra-class correlation coefficient 0.88, CR 1.6 mm). Agreement between the two systems was acceptable measuring AP laxity between full extension and 40° knee flexion (LOA 2.9 mm). Beyond 40° of flexion, agreement between the systems was unacceptable (LOA > 3 mm). CONCLUSIONS: These results indicate that from full knee extension to 40° flexion, non-invasive navigation-based quantification of AP tibial translation is as accurate as the standard validated commercial system, particularly in the clinically and functionally important range of 20° to 30° knee flexion. This could be useful in diagnosis and post-operative evaluation of ACL pathology. Cite this article: Bone Joint Res 2013;2:233-7.

Entropy and local uncertainty of data from sensory neurons.

We present an empirical comparison between neural interspike interval sequences obtained from two different kinds of sensory receptors. Both differ in their internal structure as well as in the strength of correlations and the degree of predictability found in the respective spike trains. As a further tool in this context, we suggest the local uncertainty, assigning a well-defined predictability to individual spikes. The local uncertainty is demonstrated to reveal significant patterns within the interspike interval sequences, even when its overall structure is (almost) random. Our approach is based on the concept of symbolic dynamics and information theory.

Stochastic biperiodic oscillations in the electroreceptors of paddlefish.

We report that the electroreceptors in paddlefish possess the novel property of being biperiodic, that is, being composed of two intrinsic self-sustained noisy oscillators, one residing in the hair cells, and another in the terminals of primary afferent neurons. The two oscillators are coupled unidirectionally. Thus the receptor system as a whole undergoes stochastic biperiodic oscillations. We characterize the spontaneous activity of this system of coupled biological oscillators, and also discuss the impact of the biperiodic organization on the transduction of external sensory stimuli. In particular, we show that the existence of hair cell oscillations leads to additional variability of afferent spike trains.

Behavioral stochastic resonance: how a noisy army betrays its outpost.

Juvenile paddlefish prey upon single zooplankton by detecting a weak electric signature resulting from its feeding and swimming motions. Moreover, it has recently been shown that paddlefish make use of stochastic resonance near the threshold for prey detection: a process termed behavioral stochastic resonance. But this process depends upon an external source of electric noise. A swarm of plankton, for example, Daphnia, can provide this noise. Assuming that juvenile paddlefish attack single Daphnia as outliers in the vicinity of the swarm, making use of noise from the swarm, we calculate the spatial distribution of the average phase locking period for the subthreshold signals acting at the paddlefish rostrum. Numeric evaluation of analytic formulas supports the notion of a noise-induced widening of the capture area quantitatively.

Stochastic resonance enhances the electrosensory information available to paddlefish for prey capture.

Recent behavior experiments have demonstrated that paddlefish can make use of stochastic resonance while feeding on Daphnia plankton. Here we calculate the information content of the noisy Daphnia signal at the paddlefish rostrum using an exact statistical treatment of threshold stochastic resonance as a minimal neural model. These calculations compare well with experimentally obtained data on paddlefish strikes at Daphnia prey.

Use of behavioural stochastic resonance by paddle fish for feeding.

Stochastic resonance is the phenomenon whereby the addition of an optimal level of noise to a weak information-carrying input to certain nonlinear systems can enhance the information content at their outputs. Computer analysis of spike trains has been needed to reveal stochastic resonance in the responses of sensory receptors except for one study on human psychophysics. But is an animal aware of, and can it make use of, the enhanced sensory information from stochastic resonance? Here, we show that stochastic resonance enhances the normal feeding behaviour of paddlefish (Polyodon spathula), which use passive electroreceptors to detect electrical signals from planktonic prey. We demonstrate significant broadening of the spatial range for the detection of plankton when a noisy electric field of optimal amplitude is applied in the water. We also show that swarms of Daphnia plankton are a natural source of electrical noise. Our demonstration of stochastic resonance at the level of a vital animal behaviour, feeding, which has probably evolved for functional success, provides evidence that stochastic resonance in sensory nervous systems is an evolutionary adaptation.

Embedding of neural tissue in agarose or glyoxyl agarose for vibratome sectioning.

Agarose was used to embed the brain or spinal cord of lampreys or rats before cutting vibratome sections. Agarose embedding was compatible with immunocytochemistry or the use of horseradish peroxidase as a neuroanatomical tracer. Concentrated agarose with high intrinsic gel strength was optimal for embedding glutaraldehyde fixed neural tissue. A quick procedure was to blot tissue and embed in 5% (w/v) Sigma type I-A or Litex type LSL agarose at 45-55 C dissolved in 50 mM neutral-pH TRIS buffer before cutting 50-100 microns vibratome sections. An alternative procedure that improved retention of tissue sections in the agarose was to rinse the tissue in H2O, blot and embed in 5% (w/v) Sigma type I-A or Litex type LSL agarose at 45-55 C dissolved in H2O, then equilibrate the block overnight in buffer. Phosphate buffer prevented complete dissolving of agarose. Tissue could be covalently linked to the embedding matrix using a novel aldehyde-derived agarose (NuFix, FMC BioProducts). Slices of spinal cord from neonatal rats could be cut after embedding in 5% FMC SeaPrep agarose in rat Ringer's at 23-26 C.

Respiratory pattern generation in adult lampreys (Lampetra fluviatilis): interneurons and burst resetting.

The central pattern generator for the respiratory rhythm in adult lampreys was studied in isolated brain preparations. At least three different types of respiratory units were found in intra- and extracellular recordings near the trigeminal nucleus (Fig. 1), including: units that start firing before the motorneurons, recorded from the ventral surface (Figs. 2 and 3), follower cells near rostral nucleus V (Fig. 4), units bursting after the motorneurons, found in the sulcus limitans (Figs. 5 and 6). Transections of the medulla indicated that the rostral half of nucleus V could be removed without reducing the respiratory frequency (Fig. 8). The earliest respiratory events that could be recorded from the ependymal surface or the cranial nerves were observed near nuclei IX-VII-caudal V during quiet breathing. There was a rostrocaudal delay in the onset of bursts of more caudal motorneurons (Figs. 9, 10, and 12). The rostrocaudal delay became reversed, such that bursts started earlier in n.X than n.IX, during episodes of intense breathing that were accompanied by prolonged discharges in the medial reticular formation (Fig. 11). Stimulation of the medulla surface, near the base of nerve V, could trigger bursts prematurely and reset the timing of the respiratory rhythm, yielding a discontinuous phase response curve (Fig. 14). In sum, 6 types of respiratory interneurons can presently be distinguished (Fig. 15). The sulcus limitans near nucleus V is a candidate location for components of the pattern generator.

Pattern and reset analysis of the gastric mill rhythm in a spiny lobster, Panulirus interruptus.

The burst pattern of the gastric mill rhythm was studied by varying its cycle period in in vitro preparations comprising the stomatogastric (STG), oesophageal and (paired) commissural ganglia. Reset tests using intracellular polarization of identified STG neurones showed that the CI, LC, GP and GM cells can all strongly affect the cycle period, and therefore apparently play a role in generating the gastric rhythm. Variation in the cycle period could be obtained by: (i) cutting certain input nerves; (ii) relative coordination between the gastric and oesophageal rhythms; or (iii) intracellular polarization of identified STG cells, especially the LC motoneurone. Variation in the cycle period by any of these means showed that the gastric pattern (in such preparations) comprises two basic alternating phases: a variable-duration 'powerstroke' and a constant-duration 'returnstroke'. The powerstroke is taken to include bursts in the LC, GP and GM motoneurones (since they evoke closing of the gastric mill teeth and mastication of food), along with the interburst intervals of the other cells. The durations of all these events co-varies over a large range, as a linear function of the cycle period. The activity level of neurones bursting during the powerstroke is directly proportional to their burst length, and hence appears to be a basic parameter affecting the cycle period. The returnstroke is taken to include bursts in the CP, AM and LG motoneurones (since they evoke opening and resetting of the gastric mill teeth), along with the interburst intervals of the powerstroke cells. All these events tended to assume a fixed duration. The two-part gastric mill pattern can be analogized to other two-part rhythms, e.g. for terrestrial locomotion, in which the load-bearing phase has a variable duration and accounts for most of the variation in the cycle period whereas the unloaded phase tends to assume a constant duration.

Neural basis of teeth coordination during gastric mill rhythms in spiny lobsters, Panulirus interruptus.

Motoneurones that drive the closing of the lateral teeth during gastric mill rhythms in spiny lobsters start firing before the motoneurones that drive the medial tooth powerstroke. This has the expected behavioural interpretation that the lateral teeth must close on a food particle before the medial tooth is pulled across it. The neural basis of the teeth coordination was examined. Experiments were made during gastric rhythms in in vitro preparations comprising the stomatogastric, oesophageal and (paired) commissural ganglia. Identified neurones in the stomatogastric ganglion were polarized to study their functional effects on the phasing and amplitude of bursts in other cells. Evoked firing of the lateral teeth closer motoneurones (especially LC) would evoke a discharge in the medial tooth powerstroke (GM) motoneurones, and suppress the firing of the medial tooth returnstroke (CP) motoneurone. Therefore the coordination pathway starts directly with the lateral teeth closer motoneurones. The CI interneurone was found to be an important link in the coordination pathway. It exerted opposite effects on the medial tooth motoneurones, suppressing firing of the powerstroke GM cells while evoking bursts in the returnstroke CP cell. CI affected other features of the pattern as well. Non-spiking inhibition from the lateral teeth closer motoneurones (LC and GP) to the lateral teeth opener motoneurones (LGs) was found to occur conjointly with spike-mediated IPSPs. Hyperpolarization of the LC, GP or CI neurones could temporarily abolish the gastric rhythm, but bursting in some or all of the other cells would eventually return, although in some cases the phase pattern was altered. It appears that no individual neurone in the gastric network is necessary for rhythm production. The coordination system can be viewed as several 'levels' of synaptic connections, each level being redundant and synergistic with the others.

Endogenous burst capability in a neuron of the gastric mill pattern generator of the spiny lobster Panulirus interruptus.

The gastric system of the lobster stomatogastric ganglion has previously been thought to include no neurons capable of endogenous bursting. We describe conditions under which one of the motorneurons, the CP cell, can burst endogenously in a free-running manner in the absence of other phasic network activity. Isolated preparations of the foregut nervous system were used, and the CP bursting was either spontaneous or was activated by continuous stimulation of an input nerve. Three criteria were applied to establish the endogenous nature of such burst generation in CP: absence of phasic input, reset of the bursting pattern by pulses of current in a characteristic phase-dependent manner, and modulation of burst rate by sustained injected current. (1) The firing of other cells which are known to be related synaptically to CP was monitored in nerve records. These other cells were either silent or fired only tonically. Cross-correlograms showed that CP bursting was not ascribable to phasic activity in these other network cells. (2) A depolarizing current pulse of sufficient strength injected intracellularly between bursts triggered a burst prematurely and reset the subsequent rhythm. A hyperpolarizing pulse during a burst terminated it and reset the subsequent rhythm. Reset behavior was similar to that described for other endogenous bursters. (3) Application of a positive-going ramp current initially caused an increase in burst rate, as described for other endogenous bursters. However, further depolarization caused a slower burst rate due to lengthening of the individual bursts, although mean firing frequency continued to increase throughout the range tested. Such free-running endogenous repetitive bursting appeared to result from the CP's ability to produce slow regenerative depolarizations ("plateau potentials"). When bursting was present, so was the plateau property, as determined by I-V analysis and by the ability of brief current pulses to trigger and terminate bursts. The previous inability to observe endogenous bursting in preparations with central input removed may be due to the usual absence of the plateau property in such preparations. CP bursting during normal gastric mill rhythms, while underlain by plateau potentials, is strongly controlled by network interactions. CP appears not to be well placed in the network to be considered a source of normal gastric rhythmicity. Nevertheless, endogenous bursting in CP may explain some of the partial gastric rhythms seen in behavioral studies, and illustrates one way that cellular properties might contribute to rhythmic behaviors.

Synaptic regulation of cellular properties and burst oscillations of neurons in gastric mill system of spiny lobsters, Panulirus interruptus.

The properties of neurons in the stomatogastric ganglion (STG) participating in the pattern generator for the gastric mill rhythm were studied by intracellular current injection under several conditions: during ongoing gastric rhythms, in the nonrhythmic isolated STG, after stimulation of the nerve carrying central nervous system (CNS) inputs to the STG, or under Ba2+ or Sr2+. Slow regenerative depolarizations during ongoing rhythms were demonstrated in the anterior median, cardiopyloric, lateral cardiac, gastropyloric, and continuous inhibitor (AM, CP, LC, GP, and CI) neurons according to criteria such as voltage dependency, burst triggering, and termination by brief current pulses, etc. Experiments showed that regenerative-like behavior was not due to synaptic network interactions. The slow regenerative responses were abolished by isolating the stomatogastric ganglion but could be reestablished by stimulating the input nerve. This indicates that certain CNS inputs synaptically induce the regenerative property in specific gastric neurons. Slow regenerative depolarizations were not demonstrable in gastric mill (GM) motor neurons. Their burst oscillations and firing rate were instead proportional to injected current. CNS inputs evoked a prolonged depolarization in GM motor neurons, apparently by a nonregenerative mechanism. All the gastric cells showed prolonged regenerative potentials under 0.5-1.5 mM Ba2+. We conclude that the gastric neurons of the STG can be divided into three types according to their properties: those with a regenerative capability, a repetitively firing type, and a nonregenerative "proportional" type. The cells are strongly influenced by several types of CNS inputs, including "gastric command fibers."

On the control of myotomal motoneurones during "fictive swimming" in the lamprey spinal cord in vitro.

Intracellular recordings have been made from myotomal motoneurones during "fictive swimming" in the in vitro preparation of the lamprey spinal cord, while monitoring the efferent burst activity in the ventral roots. The pattern of rhythmic activity in the motoneurones is described, as well as how synaptic inputs from the premotoneuronal level exert their control of motoneurone activity. (1) All motoneurones investigated displayed rhythmic, symmetric oscillations of their membrane potential during "fictive swimming". The period of depolarization occurred in phase with the burst discharge in the ventral root containing the motoneurone axon. (2) About one-third of the cells fired bursts of action potentials during the depolarized phase, while the remaining motoneurones exhibited subthreshold oscillations. (3) Intracellular injection of chloride ions reversed the sign of the hyperpolarized phase, demonstrating phasic active inhibition of the motoneurones during rhythmicity. (4) The depolarized phase was unaffected after chloride injection, showing that the motoneurones also received phasic active excitation. (5) "Pre-triggered" averaging of the motoneurone recording (using the ventral root spikes from other motoneurones for triggering), revealed that some degree of synchronous excitation of several motoneurones occurred, suggesting common excitation from the same premotor-interneurones. It is concluded that the rhythmic oscillations of membrane potential in lamprey myotomal motoneurones during "fictive locomotion" depend on phasic excitation alternating with phasic active inhibition. The premotoneuronal mechanism responsible for this control may consist of reciprocally organized groups of excitatory and inhibitory interneurones.

Slow active potentials and bursting motor patterns in pyloric network of the lobster, Panulirus interruptus.

1. Neurons in the central pattern generator for the "pyloric" motor rhythm of the lobster stomatogastric ganglion were investigated for the possible involvement of regenerative membrane properties in their membrane-potential oscillations and bursting output patterns. 2. Evidence was found that each class of pyloric-system neurons can possess a capability for generating prolonged regenerative depolarizations by a voltage-dependent membrane mechanism. Such responses have been termed plateau potentials. 3. Several tests were applied to determine whether a given cell possessed a plateau capability. First among these was the ability to trigger all-or-none bursts of nerve impulses by brief depolarizing current pulses and to terminate bursts in an all-or-none fashion with brief hyperpolarizing current pulses. Tests were made under conditions of a high level of activity in the pyloric generator, often in conjunction with the use of hyperpolarizing offsets to the cell under test to suppress ongoing bursting. 4. For each class, the network of synaptic interconnections among the pyloric-system neurons was shown to not be the cause of the regenerative responses observed. 5. Plateau potentials are viewed as a driving force for axon spiking during bursts and as interacting with the synaptic network in the formation of the pyloric motor pattern.

An immunoperoxidase study of immunological factors in skin lesions across the spectrum of leprosy.

The immunoperoxidase technique was used to assess the quantity and situation of various immunological factors in 24 skin biopsies which represented the leprosy spectrum from TT to LL. The factors were immunoglobulins (IgG and IgM), complement components (C3, C3d and Clq), plasminogen, muramidase (lysozyme), C-reactive protein and alpha-1-antitrypsin. The results were compared with previous reports on the assessment of these factors in serum. The quantities of these factors in the lesions produced peaks at TT and LL, with a dip in the BT-BB region (C-reactive protein and alpha-1-antitrypsin excepted). The immunoglobulins, present mainly in plasma cells and lymphocytes, correlated in general with reports of serum levels. The complement components were present in appreciable amounts, though the serum levels are depressed; they were seen in young mononuclear cells with a low bacterial load. All factors produced an ascending gradient in active lesions from BT to BL or LL, which correlated with the bacterial load and its viability. In regression (studied only in LL) there was a decrease in all factors. In TT there was an increase in most factors which did not correlate with the antigen load, and which probably resulted in an excess of antibody over antigen. In active LL there is probably an antigen excess. The results suggest the possibility that there is a common defect from BT to LL, in which the generation of immunological factors within the lesion of immunological factors within the lesion is a secondary response to the antigenic load. In TT alone (a rare group) is there an enhanced immunological response unrelated to the antigen load. In support of this was the finding of Ia antigen only in TT lesions.

A multiaction synapse evoking both EPSPs and enhancement of endogenous bursting.

Selective stimulation of two identified input neurons called the 'IV neurons' has a dual influence on the endogenous bursting activity of certain 'PD' motorneurons in the stomatogastric ganglion of the spiny lobster. The effects include: (i) large, conventional and apparently monosynaptic EPSPs; and (ii) enhancement of the endogenous bursting of the pyloric dilator (PD) cells, seen as an increased amplitude of PD oscillations and a higher spiking rate during bursts. The burst enhancement decayed relatively slowly after stimulation ceased, over seconds or tens-of-seconds, depending on stimulus parameters. Modification of the voltage-dependent membrane properties of the PD cells appeared to underlie this effect. The dual-action nature of the IV-to-PD connection was confirmed by selectively blocking the brief EPSP component with 5 x 10(-4) M curare, under which conditions the burst enhancement still persisted. Data from low-Ca2+ experiments were consistent with a conventional mode of synaptic transmitter release underlying the burst enhancement. Enhancement was found to differ significantly from actions of injected current. The IV inputs appear to act on at least two types of synaptic receptors on PD neurons: a curare-sensitive receptor for the brief conventional EPSP, and a curare-resistant receptor for burst enhancement. Analogies may be drawn to the nicotinic and muscarinic cholinergic receptors of vertebrates. These findings may be considered within the contexts of multiaction synapses, modification of cellular properties, and mechanisms for the CNS activation of motor pattern generators.