Review: cognitive and psychological outcomes in pediatric heart transplantation.

OBJECTIVE: To review empirical literature investigating the cognitive and psychological effects of pediatric heart transplantation. METHODS: Electronic and library searches were used to identify empirical studies examining the cognitive and psychological effects of pediatric heart transplantation. Only studies investigating cognitive or psychological outcomes, either prospectively or cross-sectionally, were reviewed. RESULTS: Preliminary findings suggest that children and adolescents generally functioned within the normal range on most measures of cognitive functioning post-transplant. However, a complicated transplant course caused by infections or rejections may place these recipients at increased risk for cognitive difficulties post-transplant. Studies also suggested that approximately 20%-24% of pediatric heart transplant recipients experienced significant symptoms of psychological distress (e.g., anxiety, depression, behavior problems) during the first year post-transplant. CONCLUSIONS: Research suggests that some recipients are at risk for cognitive and psychological difficulties post-transplant and may require additional academic remediation and/or psychological intervention to address these challenges. Given the limited number of empirical studies available at this time, continued research investigating cognitive and psychological outcomes following pediatric heart transplantation is needed.

Localized sinus inflammation in a rabbit sinusitis model induced by Bacteroides fragilis is accompanied by rigorous immune responses.

We evaluated inflammatory and immune responses against Bacteroides fragilis in a rabbit sinusitis model. Bacteroides was inoculated into the left maxillary sinus, and inflammatory (histology, cell number/cytology, lactose dehydrogenase, and apoptosis) and immune responses in the sinus, airway, and peripheral blood (PB) were determined for up to 4 weeks. In the inflamed sinus, the lactose dehydrogenase level was markedly elevated, with neutrophilic infiltration, severe tissue inflammation, and increased apoptosis. Low-grade tissue inflammation was present in the contralateral and sham-operated sinuses, but other parameters remained unchanged, and so did those in the airway and PB in the inoculated rabbits. Serum IgG antibody levels increased rapidly, were highest at 3 weeks, and began to decline at 4 weeks. Cellular immune responses (proliferation and interferon-gamma mRNA expression) against Bacteroides were detected in the PB of all inoculated rabbits. Vigorous immune responses against Bacteroides may have localized but failed to terminate inflammation in the sinus, indicating importance of microenvironmental factors.

Labeling of calcitonin gene-related peptide and substance P increases in subnucleus caudalis of rabbit during maxillary sinusitis.

Calcitonin gene-related peptide-like immunoreactivity (CGRP-LI) and substance P-like immunoreactivity (SP-LI) were evaluated in subnucleus caudalis following induction of sinusitis. Three days after induction, intensity of labeling for CGRP-LI and SP-LI increased in ipsilateral subnucleus caudalis. Labeling for CGRP-LI and SP-LI appeared normal at later time points (20 and 28 days). Early changes in these neuropeptides may contribute to the inflammatory process and painful symptoms accompanying sinusitis.

Central projections of nerves innervating the rabbit maxillary sinus localized using wheat germ agglutinin-horseradish peroxidase or choleragenoid-horseradish peroxidase.

Central projections of nerves innervating the rabbit maxillary sinus were localized by using wheat germ agglutinin-horseradish peroxidase (WGA-HRP) or choleragenoid-horseradish peroxidase (B-HRP). Tracer was placed into the left maxillary sinus; rabbits were killed 3 or 5 days later, and histochemical localization of transported WGA-HRP or B-HRP was performed. Labeled cell bodies (437-545/animal) were seen in the ipsilateral trigeminal ganglion. Very few labeled cell bodies (zero to three/animal) were observed in the contralateral ganglion. The area of cell bodies labeled by WGA-HRP appeared similar to the area of cell bodies labeled by B-HRP. Transganglionic projections from either tracer were localized to lamina II of the ipsilateral subnucleus caudalis. In addition, WGA-HRP labeling was occasionally observed in lamina I. No labeling was present in other areas of the brainstem. In contrast to the above results, other studies have demonstrated that B-HRP produces terminal-like labeling in deeper layers of the gray matter. We injected B-HRP into the infraorbital nerve and sciatic nerve, which are known to contain projections to deep layers of the gray matter. Labeling was observed in the deep layers of the medullary or spinal dorsal horn 5 days later, suggesting that nerves innervating the sinus only project to superficial laminae. These results suggest that neurons in superficial laminae of the subnucleus caudalis may be important for the reflex initiation of the increased glandular secretions in the maxillary sinus during sinusitis.

A nitric oxide synthesis inhibitor (L-NAME) reduces licking behavior and Fos-labeling in the spinal cord of rats during formalin-induced inflammation.

Formalin injected subcutaneously into the hindpaw of the rat produces an animal model of inflammation that exhibits a phasic component and a tonic component of pain. We evaluated the effects of a nitric oxide synthase inhibitor, N omega-nitro-L-arginine methyl ester (L-NAME), on a formalin-induced behavior, hindpaw licking, and on Fos-labeling of nuclei in the fifth lumbar spinal segment. Our results demonstrated that pretreatment with intrathecal doses of 0.3 and 1.0 mg of L-NAME significantly reduced licking behavior associated with injection of formalin into the left hindpaw of the rat. In addition, these same doses of L-NAME reduced formalin-induced Fos-labeling in the ipsilateral dorsal gray matter (as compared to the contralateral gray matter). Qualitative assessment suggested that the reduction in labeling occurred primarily in the superficial dorsal horn. The stereoisomer, D-NAME, administered at the same doses had little to no effect on either formalin-induced licking or Fos-labeling. Finally, our results revealed that total licking time was related to Fos-labeling. Rats that spent less time licking the hindpaw exhibited a smaller increase in Fos-labeling. Our results suggest that the production of nitric oxide is associated with licking behavior resulting from formalin injection into the hindpaw of rats. Our results also suggest that the production of nitric oxide and Fos are associated. Indeed, these substances may be involved in spinal pathways associated with nociception.