Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema: Effect on intracranial pressure and lateral displacement of the brain

OBJECTIVE: To determine the effect of continuous hypertonic (3%) saline/acetate infusion on intracranial pressure (ICP) and lateral displacement of the brain in patients with cerebral edema. DESIGN: Retrospective chart review. SETTINGS: Neurocritical care unit of a university hospital. PATIENTS: Twenty-seven consecutive patients with cerebral edema (30 episodes), including patients with head trauma (n = 8), postoperative edema (n = 5), nontraumatic intracranial hemorrhage (n = 8), and cerebral infarction (n = 6). INTERVENTION: Intravenous infusion of 3% saline/acetate to increase serum sodium concentrations to 145 to 155 mmol/L. MEASUREMENTS AND MAIN RESULTS: A reduction in mean ICP within the first 12 hrs correlating with an increase in the serum sodium concentration was observed in patients with head trauma (r2 = .91, p = .03), and postoperative edema (r2 = .82, p = .06), but not in patients with nontraumatic intracranial hemorrhage or cerebral infarction. In patients with head trauma, the beneficial effect of hypertonic saline on ICP was short-lasting, and after 72 hrs of infusion, four patients required intravenous pentobarbital due to poor ICP control. Among the 21 patients who had a repeat computed tomographic scan within 72 hrs of initiating hypertonic saline, lateral displacement of the brain was reduced in patients with head trauma (2.8 +/- 1.4 to 1.1 +/- 0.9 [SEM]) and in patients with postoperative edema (3.1 +/- 1.6 to 1.1 +/- 0.7). This effect was not observed in patients with nontraumatic intracranial bleeding or cerebral infarction. The treatment was terminated in three patients due to the development of pulmonary edema, and was terminated in another three patients due to development of diabetes insipidus. CONCLUSIONS: Hypertonic saline administration as a 3% infusion appears to be a promising therapy for cerebral edema in patients with head trauma or postoperative edema. Further studies are required to determine the optimal duration of benefit and the specific patient population that is most likely to benefit from this treatment.     

Structure-based design of cathepsin K inhibitors containing a benzyloxy-substituted benzoyl peptidomimetic

Peptidomimetic cathepsin K inhibitors have been designed using binding models which were based on the X-ray crystal structure of an amino acid-based, active site-spanning inhibitor complexed with cathepsin K. These inhibitors, which contain a benzyloxybenzoyl group in place of a Cbz-leucine moiety, maintained good inhibitory potency relative to the amino acid-based inhibitor, and the binding models were found to be very predictive of relative inhibitor potency. The binding mode of one of the inhibitors was confirmed by X-ray crystallography, and the crystallographically determined structure is in close qualitative agreement with the initial binding model. These results strengthen the validity of a strategy involving iterative cycles of structure-based design, inhibitor synthesis and evaluation, and crystallographic structure determination for the discovery of peptidomimetic inhibitors.     

Effects of different doses of apomorphine on the glutamate decarboxylase activity of the substantia nigra and the medial basal hypothalamus

The activity of gamma-aminobutyric acid (GABA) synthesizing enzyme glutamic acid decarboxylase (GAD, EC 4.1.1.15) was assayed in the rat substantia nigra (SN) and medial basal hypothalamus (MBH) following systemic injection of different doses of the dopamine receptor agonist apomorphine. In SN, the highest dose of apomorphine (1000 micrograms/kg) causes an increase of the GAD activity whilst an opposite effect is observed with the lowest dose (35 micrograms/kg). Results obtained in SN are in accordance with previous neurochemical and behavioural data suggesting an opposite action of high (500 micrograms/kg) and low doses (100 micrograms/kg) of apomorphine in nigro-striatal system, probably due to the existence of two classes of dopamine receptors, i.e. classical postsynaptic dopamine receptors and presynaptic inhibitory dopamine autoreceptors. In MBH, the evidence for similar effects of low and high doses of apomorphine (the decrease of GAD activity) may suggest that, as already reported, at this level only one class of dopamine receptors is present.     

Letter: Electrical method of detecting optimum time to inseminate

Recently translated studies of the electrical resistance of cervical mucus as a test for the optimum time of insemination of agricultural animals are reviewed. The technique involves the measurement of the electrical conductivity of the surface of the mucosa in the vaginal vestibule. Experiments with cows and sows have shown that pregnancy or fertilization rates are considerably higher when mucosal electrical resistance is low at the time of insemination than when resistance is high. It has also been demonstrated in sows that mucosal resistance is higher in pregnant than in nonpregnant animals. Further research into these results is recommended.     

Sex and the single hemisphere: specialization of the right hemisphere for spatial processing

Specialization of the right hemisphere for spatial processing was studied in 200 normal boys and girls between 6 and 13 years of age. Boys performed in a manner consistent with right hemisphere specialization as early as the age of 6. Girls showed evidence of bilateral representation until the age of 13. The results suggest a sexual dimorphism in the neural organization underlying cognition during a major period of childhood. The results, which have implications for reading instruction, are discussed in terms of a possible sex difference in neural plasticity during development and the clinical consequences of such a difference.     

Content-based and collaborative techniques for tag recommendation: an empirical evaluation

The rapid growth of the so-called Web 2.0 has changed the surfers’ behavior. A new democratic vision emerged, in which users can actively contribute to the evolution of the Web by producing new content or enriching the existing one with user generated metadata. In this context the use of tags, keywords freely chosen by users for describing and organizing resources, spread as a model for browsing and retrieving web contents. The success of that collaborative model is justified by two factors: firstly, information is organized in a way that closely reflects the users’ mental model; secondly, the absence of a controlled vocabulary reduces the users’ learning curve and allows the use of evolving vocabularies. Since tags are handled in a purely syntactical way, annotations provided by users generate a very sparse and noisy tag space that limits the effectiveness for complex tasks. Consequently, tag recommenders, with their ability of providing users with the most suitable tags for the resources to be annotated, recently emerged as a way of speeding up the process of tag convergence. The contribution of this work is a tag recommender system implementing both a collaborative and a content-based recommendation technique. The former exploits the user and community tagging behavior for producing recommendations, while the latter exploits some heuristics to extract tags directly from the textual content of resources. Results of experiments carried out on a dataset gathered from Bibsonomy show that hybrid recommendation strategies can outperform single ones and the way of combining them matters for obtaining more accurate results.     

Primary aortic mural thrombus: presentation and treatment

Schizophrenic patients are extremely heavy tobacco smokers. However, a lower incidence of lung cancer in schizophrenic patients has been observed in comparison to other heavy smokers. Nicotine increases the proliferation of pulmonary neuroendocrine tissue, causing the release of a bombesin-like peptide. Thus, bombesin-like peptide levels in urine may be an indicator of precancerous, cigarette-induced lung damage. Bombesin-like peptide levels of 10 schizophrenic smokers and 11 schizophrenic nonsmokers were compared to those of nonschizophrenic subjects matched for age and pack-years of smoking. The nonschizophrenic smokers showed the expected increase in urinary bombesin-like peptide levels, as compared to nonschizophrenic nonsmokers. Schizophrenic patients had lower bombesin-like peptide levels independent of smoking effects. The mechanism of the difference in bombesin-like peptide levels between schizophrenic patients and nonschizophrenic subjects is unknown, but one possibility involves alteration in the alpha 7-nicotinic acetylcholine receptor, which mediates the growth of some neuroendocrine cell lines in vitro.