Neurokinin-1 receptor antagonism attenuates neuronal activity triggered by stress-induced reinstatement of alcohol seeking.

Substance P (SP) and its cognate neurokinin-1 receptor (NK1R) are involved in alcohol-related behaviors. We have previously reported that NK1R antagonism attenuates stress-induced reinstatement of alcohol seeking and suppresses escalated alcohol self-administration, but does not affect primary reinforcement or cue-induced reinstatement. Here, we administered an NK1R antagonist or vehicle prior to footshock-induced reinstatement of alcohol seeking, and mapped the resulting neuronal activation using Fos immunohistochemistry. As expected, vehicle treated animals exposed to footshock showed induction of Fos immunoreactivity in several regions of the brain stress circuitry, including the amygdala (AMG), nucleus accumbens (NAC), dorsal raphe nucleus (DR), prefrontal cortex (PFC), and bed nucleus of the stria terminalis (BNST). NK1R antagonism selectively suppressed the stress-induced increase in Fos in the DR and NAC shell. In the DR, Fos-induction by stress largely overlapped with tryptophan hydroxylase (TrpH), indicating activation of serotonergic neurons. Of NAC shell neurons activated during stress-induced reinstatement of alcohol seeking, about 30% co-expressed dynorphin (DYN), while 70% co-expressed enkephalin (ENK). Few (<1%) activated NAC shell neurons coexpressed choline acetyltransferase (ChAT), which labels the cholinergic interneurons of this region. Infusion of the NK1R antagonist L822429 into the NAC shell blocked stress-induced reinstatement of alcohol seeking. In contrast, L822429 infusion into the DR had no effect, suggesting that the influence of NK1R signaling on neuronal activity in the DR is indirect. Taken together, our results outline a potential pathway through which endogenous NK1R activation mediates stress-induced alcohol seeking.

Object localization in cluttered acoustical environments.

In nature, sounds from objects of interest arrive at the ears accompanied by sound waves from other actively emitting objects and by reflections off of nearby surfaces. Despite the fact that all of these waveforms sum at the eardrums, humans with normal hearing effortlessly segregate one sound source from another. Our laboratory is investigating the neural basis of this perceptual feat, often called the "cocktail party effect", using the barn owl as an animal model. The barn owl, renowned for its ability to localize sounds and its spatiotopic representation of auditory space, is an established model for spatial hearing. Here, we briefly review the neural basis of sound-localization of a single sound source in an anechoic environment and then generalize the ideas developed therein to cases in which there are multiple, concomitant sound sources and acoustical reflection.

ED identification of cardiac septal abscess using conduction block on ECG.

A case of cardiac septal abscess in a patient with a porcine bioprosthetic aortic valve who gradually developed a complete atrioventricular block on successive electrocardiograms (ECG) is reported. Emergency physicians should consider endocarditis with septal abscess in a patient with a prosthetic heart valve who presents with fever and a new conduction defect on ECG.

Systemic effects of trauma in clinic couples: an exploratory study of secondary trauma resulting from childhood abuse.

Clinical literature suggests that those close to a trauma survivor may experience intrapersonal and interpersonal distress because of indirect or secondary effects of the trauma. The focus of this study is on the association between reported childhood physical and sexual abuse and current individual stress symptoms, relationship satisfaction, and family adjustment. The participants included 96 clinic couples who reported a history of childhood physical or sexual abuse in one or both partners and 65 clinic couples in which neither partner reported such abuse. Couples in which one or both partners reported childhood abuse reported significantly lower marital satisfaction, higher individual stress symptoms, and lower family cohesion than couples with no abuse history. No significant differences were found between individuals who reported a history of abuse and their partners who reported no history of childhood abuse, suggesting support for secondary trauma theory. Clinical and future research implications are discussed.

Betel nut: a common drug used by naturalized citizens from India, Far East Asia, and the South Pacific Islands.

Betel nut is a common masticatory drug used in Far East Asia, India, and the South Pacific. It is used daily by 600 million people worldwide, yet is unknown to most Western physicians. As the world becomes more culturally and ethnically interconnected, emergency physicians will encounter the use of betel nut. Significant illness can be associated with its use, including asthma exacerbation, cholinergic crisis, cardiac arrhythmias, acute psychosis, milk-alkali syndrome, and oropharyngeal tumors. We describe its source, pharmacology, composition, presentation, and treatment in the emergency department.

Traumatically injured Jehovah's Witnesses: a sixteen-year experience of treatment and transfusion dilemmas at a level I trauma center.

Traumatically injured Jehovah's Witnesses pose difficult management problems because of their refusal to accept blood transfusions. This retrospective review of all inpatient traumatically injured Jehovah's Witnesses at a level I trauma center over the past 16 years revealed 77 patients with 92% blunt and 8% penetrating injuries. The primary physician was aware of their unique religious status in only 32% of cases. Transfusion was performed in only 4 (5.2%) cases even though it was desired by the physician in 11 (14%) cases. One transfusion was performed against the patient's will. One minor was transfused using a court order. Two transfusions were performed in the trauma room before the patients' religious status was known. Major changes in therapeutic plans were made as a result of the patients' Jehovah's Witness status in 10 cases (13%). Early knowledge of the patient's religious status is essential to optimize patient care.