Differential impact of a complex environment on positive affect in an animal model of individual differences in emotionality.

Anhedonia, or the inability to experience positive feelings is a hallmark of depression. However, few animal models have relied on decreased positive affect as an index of susceptibility to depression. Rats emit frequency-modulated ultrasonic vocalizations (USVs), designated as "positive" calls in the 50-kHz range. USVs have been associated with pharmacological activation of motivational reward circuits. Here we utilized selectively-bred rats differing in "emotionality" to ask whether there are associated differences in USVs. Rats bred based on locomotor response to novelty and classified as bred High Responders (bHRs) or bred Low Responders (bLRs) exhibit inborn differences in response to environmental cues, stress responsiveness, and depression-like behavior. These animals also exhibit differences in anxiety-like behavior, which are reversed by exposure to environmental complexity (EC). Finally, these animals exhibit unique profiles of responsiveness to rewarding stimuli accompanied with distinct patterns of dopamine regulation. We investigated whether acute and chronic environmental manipulations impacted USVs in bHRs and bLRs. We found that, relative to bLRs, bHRs emitted significantly more 50-kHz USVs. However, if a bLR is accompanied by another bLR, there is a significant increase in 50-kHZ USVs emitted by this phenotype. bHRs emitted increases in 50-kHZ UVSs upon first exposure to EC, whereas bLRs showed a similar increase only after repeated exposure. bLRs' increase in positive affect after chronic EC was coupled with significant positive correlations between corticosterone levels and c-fos mRNA in the accumbens. Conversely, a decline in the rate of positive calls in bHRs after chronic EC was associated with a negative correlation between corticosterone and accumbens c-fos mRNA. These studies demonstrate that inborn differences in emotionality interact with the environment to influence positive affect and underscore the potential interaction between glucocorticoids and the mesolimbic reward circuitry in modulating 50-kHz calls.

[Continent urinary diversion: the Mitrofanoff principle]. / Derivación urinaria continente: principio de Mitrofanoff.

INTRODUCTION: Continent urinary diversion (based on Mitrofanoff's principle), despite its complexity, is the gold standard in the treatment of those vesicourethral disfunctions that need clean intermittent catheterization (CIC) to achieve complete vesical voiding, in patients with non easily catheterizable native urethra. AIM: To analize our experience in continent urinary diversion at our centre. PATIENTS AND METHODS: We have reviewed the records of the 14 cases of continent urinary diversion in the last 8 years. They were grouped in order to the underliying condition: 1-Bladder exstrophy group (n=5): Mean age at diversion time was 5.5 years (range 3-7). In all patients the original Mitrofanoff s technique was performed (continent cutaneous appendicovesicostomy). Associated procedures were: ureterovesical reimplantation in all 5 cases; bladder neck reconstruction also in all 5 (3 of them needed vesicourethral transection); and bladder augmentation in two cases, using ileum and sigmoid respectively. 2- Myelomeningocele group (n=9, 10 procedures): Mean age was 11.5 years (range 6-16). Appendicovesicostomy was performed in 7 cases and a reconfigured ileum with the Casale technique was used in 3 cases (primarily in 2 and as an alternative in one). Associated procedures were: ureterovesical reimplantetion in 5 cases and bladder augmentation in 7 (using sigmoid in 4, ileum in 2 and urether in one case). RESULTS: In all patients complete continence was achieved. Complications found were: one appendicostomy prolapse, one appendix necrosis (that was then diverted with Casale's technique), one appendicular conduit stenosis and one case with catheterization difficulties that needed a tappering of the ileum conduit. Nowadays, 13 out of 14 pacients follow the CIC program each 3-4 hours without complication. CONCLUSION: Continent urinary diversion improves autonomy and life quality in those patients that need a definitive urinary diversion and have a long life expectancy. We have used these procedure with good results in patients with severe vesicourethral disfunction (of an intrinsic or neuropathic origin) in which clean intermittent catheterization was not possible through native urethra, or in patients with refractary incontinence in which vesicourethral transection was the only effective treatment.

Derivación urinaria continente: principio de Mitrofanoff / Continent urinary diversion: the Mitrofanoff principle

Introducción. La derivación urinaria continente (DUC, basada en el principio de Mitrofanoff), pese a su complejidad, es la técnica de elección en el tratamiento de aquellas patologías vesicouretrales que necesitan de sondaje intermitente limpio (SIL) para conseguir un vaciamiento vesical completo y en los cuales la uretra no es fácilmente cateterizable. Objetivo. Analizar la experiencia en el uso de las derivaciones urinarias continentes en nuestro centro. Material y método. Fueron revisados los 14 casos de DUC en los últimos8 años. Se agruparon según la patología de base: 1) Grupo extrofiavesical (n=5): la edad media en el momento de la derivación fue de5,5 años (rango 3-7). En todos los pacientes se practicó la técnica de Mitrofan off original (apendicovesicostomía cutánea continente). Los procedimientos asociados fueron: reimplante vesicoureteral en los 5casos; reconstrucción del cuello vesical también en los 5 (de los cuales3 precisaron una transección vesicouretral), y enterocistoplastia de aumento en 2 casos (con íleon y colon sigmoide respectivamente). 2) Grupo mielomeningocele (n=9, 10 derivaciones): la edad media fue de11,5 años (rango 6-16). En 7 derivaciones se utilizó la apendicovesicostomía y en tres un segmento ileal retubularizado con la técnica de Casale (en 2 de ellos primariamente y en el otro como alternativa). Los procedimientos asociados fueron: reimplante vesicoureteral en 5 casos y cistoplastia de aumento en 7 casos (con colon sigmoide en 4, con íleon en 2 y con uréter en un caso).Resultados. En todos los pacientes la continencia de la derivación estotal. Como complicaciones se registraron: un prolapso de apendicostomía, que se corrigió quirúrgicamente; una necrosis apendicular(que se re derivó con un conducto ileal), una estenosis del conducto apendicular, y un caso de dificultad de sondaje (que requirió remodelaje del conducto). Actualmente, 13 de los 14 pacientes siguen el programa de SIL cada 3-4 horas sin complicaciones. Conclusión. La DUC mejora la calidad de vida y la autonomía en los pacientes que requieren una derivación urinaria definitiva y tienen una expectativa de vida larga. Hemos utilizado satisfactoriamente esta técnica en pacientes con disfunción vesicouretral grave (de causa intrínseca o neuropática) en los cuales el cateterismo intermitente limpio no se podía realizar a través de la uretra nativa, y en pacientes con incontinencia refractaria en los cuales la transección vesicouretral fue el único tratamiento curativo (AU)

Introduction. Continent urinary diversion (based on Mitrofanoff’sprinciple), despite its complexity, is the gold standard in the treatment of those vesicourethral disfunctions that need clean intermittent catheterization (CIC) to achieve complete vesical voiding, inpatients with non easily catheterizable native urethra. Aim. To analize our experience in continent urinary diversion at our centre. Patients and methods. We have reviewed the records of the 14 casesof continent urinary diversion in the last 8 years. They were grouped inorder to the underliying condition: 1-Bladder exstrophy group (n=5):Mean age at diversion time was 5.5 years (range 3-7). In all patients the original Mitrofanoff’s technique was performed (continent cutaneous appendico vesicostomy). Associated procedures were: uretero-vesical reimplantation in all 5 cases; bladder neck reconstruction also in all 5(3 of them needed vesicourethral transection); and bladder augmentation in two cases, using ileum and sigmoid respectively. 2- Myelomeningocele group (n=9, 10 procedures): Mean age was 11.5 years (range6-16). Appendico vesicostomy was performed in 7 cases and a reconfigured ileum with the Casale technique was used in 3 cases (primarily in 2 and as an alternative in one). Associated procedures were: ureterovesical reimplantetion in 5 cases and bladder augmentation in 7 (using sigmoid in 4, ileum in 2 and urether in one case).Results. In all patients complete continence was achieved. Complications found were: one appendicostomy prolapse, one appendix necrosis(that was then diverted with Casale’s technique), one appendicular conduit stenosis and one case with catheterization difficulties that needed a tappering of the ileum conduit. Nowadays, 13 out of 14 patients follow the CIC program each 3-4 hours without complication. Conclusion. Continent urinary diversion improves autonomy and life quality in those patients that need a definitive urinary diversion and have a long life expectancy. We have used these procedure with good results in patients with severe vesicourethral disfunction (of an intrinsic or neuropathicorigin) in which clean intermittent catheterization was not possible through native urethra, or in patients with refractary incontinence in which vesicourethral transection was the only effective treatment (AU)

[Thoracoscopic thymectomy]. / Timectomía toracoscópica.

BACKGROUND/PURPOSE: The use of videothoracoscopy in thoracic pediatric pathology has been progressively accepted in different diagnostic and therapeutic procedures along last decade. The aim of this work is to analyze our initial experience in thymectomy through this approach. PATIENTS AND METHODS: We have used the thoracoscopic approach in the last two cases of thymus pathology with surgical indication. Case 1: 9 year-old patient recently diagnosed on myasthenia gravis and several hospital admissions because of clinical worsening. Case 2: 9 year-old patient with a 7x8x3.5 cm. cervico-mediastinal tumour. FINAL DIAGNOSIS: Multilocular cystic thymoma. In both cases we used right approach in lateral decubitus, and the harmonic scalpel. RESULTS: Mean operating time was 125 minutes. No procedure-related complications. They were discharged on the 6th and 4th postoperative day. After 6 and 7 month follow-up, no incidences have been found, and case 1 has shown a sympthomatic improvement and a decrease in drug dosage. CONCLUSIONS: Thoracoscopy is a good alternative in thymus approach. Its cosmetic and recovery advantages upon transcervical and transsternal are obvious. Despite our very initial experience, we believe that this approach at least equals classic ones in the ability to resect the whole thymus.

Novel computer-based assessment of asthma strategies in inner-city children.

BACKGROUND: Childhood asthma continues to be a growing medical concern in the United States, affecting > 17 million children in 1998. The mortality rate from asthma in children aged 5 to 14 years has nearly doubled, from 1.7 deaths per million to 3.2 deaths per million between 1980 and 1993. OBJECTIVE: To evaluate the use of artificial neural networks (ANNs) to rate problem-based strategies for asthma management in a defined population of children. METHODS: The participants in our study were recruited from a local inner-city medical facility in Los Angeles. The majority of participants had received the diagnosis of mild-to-moderate-persistent asthma. Each participant was given 10 asthma-based problems and asked to manage them. Each management decision and its order were entered into a database. This database was used to train an artificial neural network (ANN). The trained ANN was then used to cluster the various performances, and outputs were evaluated graphically. RESULTS: Three hundred five performances were analyzed through our trained neural network. Our ANN classified five major clusters representing different approaches to solving an acute asthma case. CONCLUSIONS: ANNs can build rich models of complex phenomena through a training and pattern-recognition process. Such networks can solve classification problems with ill-defined categories in which the patterns are deeply hidden within the data, and models of behavior are not well defined. In our pilot study, we have shown that ANNs can be useful in automating evaluation and improving our understanding of how children manage their asthma.

Time-related decay of the benefits of biofeedback therapy.

Although immediate results are good to excellent in great majority of patients who undergo biofeedback treatment (BFT) for chronic constipation and fecal incontinence, they tend to loose the benefit over a period of time. The purpose of this study was to evaluate the long-term sustainability of results after successful biofeedback treatment. Two groups of patients who successfully completed BFT at our institution from 1995 to 1997 were created based on the date of completion. The first had a mean follow-up of 35 months and the second group was followed for an average of 12 months. Both groups were questioned as to the presence of constipation and incontinence. The questioning was focused depending on the patient's diagnosis. This information was then compared with the initial BFT results. Overall, all patients were satisfied by the initial BFT results. All patients initially had an excellent or good response to BFT. However, after a mean of 35 months, in the first group, 19 of 22 patients had a near complete regression back to their pre-biofeedback status. In the 14 patients in the second group with mean follow-up of 12 months, 11 had a significant decay in benefits. Only time was a significant factor in the decay of BFT benefits. In conclusion, BFT is highly effective in the treatment of selected patients with complex defecation disorders. Although there is a high initial success rate, there is a clear loss of the immediate benefits over time. Other factors such as dietary habits, pelvic floor exercises, manometry, invasive EMG, and rectal sensation did not correlate with long-term outcomes. The comparison between the two groups reveals a linear model describing the time decay of the benefits of BFT. Based on the linear model, patients may need reevaluation after one year and may benefit from additional BFT.

Two novel naturally occurring alpha-methoxy acids from the phospholipids of two Caribbean sponges.

The novel (5Z)-2-methoxy-5-hexadecenoic acid (1) was identified in the phospholipids of the sponge Tethya crypta while the also novel acid (6Z)-2-methoxy-6-hexadecenoic acid (2) was found in the phospholipids of the Caribbean sponge Spheciospongia cuspidifera. The methoxy-fatty acids were mainly associated with phosphatidylethanolamine. The double bond positions were determined by gas chromatography/mass spectrometry on the corresponding dimethyl-disulfide adducts and the double bond stereochemistry was ascertained by gas chromatography/Fourier transform infrared spectroscopy. The fatty acid composition of the two sponges is reported.

[Autoimmune phenomena in the elderly]. / Fenómenos autoinmunes en la tercera edad.

We analyzed sera from 102 subjects older than 65 years of age with no clinical evidence of autoimmune disorders, inflammatory diseases or pharmacological interventions. Positive titers for antinuclear antibodies were found in 18.6%, anti-smooth muscle fibre in 16.6%, and rheumatoid factor in 11.8%. These values were significantly higher than those of a control group of healthy younger adults (p < 0.0001). Anti mitochondrial antibodies were present in 1% (NS). Thus, a greater proportion of autoimmune phenomena is demonstrated in the elderly.