Altered responsiveness of the kidney to activation of the renal nerves in fat-fed rabbits

We tested whether mild adiposity alters responsiveness of the kidney to activation of the renal sympathetic nerves. After rabbits were fed a high-fat or control diet for 9 wk, responses to reflex activation of renal sympathetic nerve activity (RSNA) with hypoxia and electrical stimulation of the renal nerves (RNS) were examined under pentobarbital anesthesia. Fat pad mass and body weight were, respectively, 74% and 6% greater in fat-fed rabbits than controls. RNS produced frequency-dependent reductions in renal blood flow, cortical and medullary perfusion, glomerular filtration rate, urine flow, and sodium excretion and increased renal plasma renin activity (PRA) overflow. Responses of sodium excretion and medullary perfusion were significantly enhanced by fat feeding. For example, 1 Hz RNS reduced sodium excretion by 79 ± 4% in fat-fed rabbits and 46 ± 13% in controls. RNS (2 Hz) reduced medullary perfusion by 38 ± 11% in fat-fed rabbits and 9 ± 4% in controls. Hypoxia doubled RSNA, increased renal PRA overflow and medullary perfusion, and reduced urine flow and sodium excretion, without significantly altering mean arterial pressure (MAP) or cortical perfusion. These effects were indistinguishable in fat-fed and control rabbits. Neither MAP nor PRA were significantly greater in conscious fat-fed than control rabbits. These observations suggest that mild excess adiposity can augment the antinatriuretic response to renal nerve activation by RNS, possibly through altered neural control of medullary perfusion. Thus, sodium retention in obesity might be driven not only by increased RSNA, but also by increased responsiveness of the kidney to RSNA.

The role of blood pressure in glaucoma

Although intraocular pressure (IOP) remains an important risk factor for glaucoma, it is clear that other factors can also influence disease development and progression. More recently, the role that blood pressure (BP) has in the genesis of glaucoma has attracted attention, as it represents a clinically modifiable risk factor and thus provides the potential for new treatment strategies beyond IOP reduction. The interplay between blood pressure and IOP determines the ocular perfusion pressure (OPP), which regulates blood flow to the optic nerve. If OPP is a more important determinant of ganglion cell injury than IOP, then hypotension should exacerbate the detrimental effects of IOP elevation, whereas hypertension should provide protection against IOP elevation. Epidemiological evidence provides some conflicting outcomes of the role of systemic hypertension in the development and progression of glaucoma. The most recent study showed that patients at both extremes of the blood pressure spectrum show an increased prevalence of glaucoma. Those with low blood pressure would have low OPP and thus reduced blood flow; however, that people with hypertension also show increased risk is more difficult to reconcile. This finding may reflect an inherent blood flow dysregulation secondary to chronic hypertension that would render retinal blood flow less able to resist changes in ocular perfusion pressure. Here we review both clinical and experimental studies that have attempted to clarify the relationships among blood pressure, OPP and blood flow autoregulation in the pathogenesis of glaucoma.

Implications for Australian anaesthetists and proceduralists of a recent court decision regarding informed consent and patient positioning

 This article discusses the medicolegal implications of a recent judgment in relation to a patient who suffered significant morbidity as a result of patient positioning during an operative procedure. The patient developed an unexpected serious complication following surgery, in the context of a preoperative consent that did not cover every potential complication or contingency. The court held that the failure to warn of a particular risk that would have prevented the patient from undergoing a procedure but did not occur will not necessarily result in a finding of negligence in relation to another risk where the harm did occur. This finding is well aligned to current clinical practice and at the same time does not abrogate the practitioner's duty to provide a comprehensive list of possible complications during the consent process for any proceduralist. In the context of a procedure requiring anaesthesia, the importance of communication and understanding between the anaesthetist and proceduralist as to which aspects of the consent process are undertaken by whom, and to ensure the process is done comprehensively, is of great importance and is indirectly highlighted by this recent judgment.

Exploring retinal and functional markers of diabetic neuropathy

Diabetic peripheral neuropathy (DPN) is one of the most debilitating complications of diabetes. DPN is a major cause of foot ulceration and lower limb amputation. Early diagnosis and management are key factors in reducing morbidity and mortality. Current techniques for clinical assessment of DPN are relatively insensitive for detecting early disease or involve invasive procedures such as skin biopsies. There is a need for less painful, non-invasive, safe evaluation methods. Eye-care professionals already play an important role in the management of diabetic retinopathy but recent studies have indicated that the eye may also be an important site for the diagnosis and monitoring of neuropathy. Corneal nerve morphology is a promising marker of diabetic neuropathy occurring elsewhere in the body. Emerging evidence tentatively suggests that retinal anatomical markers and a range of functional visual indicators could similarly provide useful information regarding neural damage in diabetes, although this line of research is less well established. This review outlines the growing body of evidence supporting a potential diagnostic role for retinal structure and visual functional markers in the diagnosis and monitoring of peripheral neuropathy in diabetes.

Combining ganglion cell topology and data of patients with glaucoma to determine a structure-function map

PURPOSE

Corneal markers of diabetic neuropathy

Diabetic neuropathy is a significant clinical problem that currently has no effective therapy, and in advanced cases, leads to foot ulceration and lower limb amputation. The accurate detection, characterization and quantification of this condition are important in order to define at-risk patients, anticipate deterioration, monitor progression, and assess new therapies. This review evaluates novel corneal methods of assessing diabetic neuropathy. Two new noninvasive corneal markers have emerged, and in cross-sectional studies have demonstrated their ability to stratify the severity of this disease. Corneal confocal microscopy allows quantification of corneal nerve parameters and noncontact corneal esthesiometry, the functional correlate of corneal structure, assesses the sensitivity of the cornea. Both these techniques are quick to perform, produce little or no discomfort for the patient, and are suitable for clinical settings. Each has advantages and disadvantages over traditional techniques for assessing diabetic neuropathy. Application of these new corneal markers for longitudinal evaluation of diabetic neuropathy has the potential to reduce dependence on more invasive, costly, and time-consuming assessments, such as skin biopsy.

A randomized head to head trial of MoodSwings.net.au: an internet based self-help program for bipolar disorder.

Adjunctive psychosocial interventions are efficacious in bipolar disorder, but their incorporation into routine management plans are often confounded by cost and access constraints. We report here a comparative evaluation of two online programs hosted on a single website (www.moodswings.net.au). A basic version, called MoodSwings (MS), contains psychoeducation material and asynchronous discussion boards; and a more interactive program, MoodSwings Plus (MS-Plus), combined the basic psychoeducation material and discussion boards with elements of Cognitive Behavioral Therapy. These programs were evaluated in a head-to-head study design.

Short term fat feeding rapidly increases plasma insulin but does not result in dyslipidaemia

Although the association between obesity and hypertension is well known, the underlying mechanism remains elusive. Previously, we have shown that 3 week fat feeding in rabbits produces greater visceral adiposity, hypertension, tachycardia and elevated renal sympathetic nerve activity compared to rabbits on a normal diet. Because hyperinsulinaemia, hyperleptinemia and dyslipidaemia are independent cardiovascular risk factors associated with hypertension we compared plasma insulin, leptin and lipid profiles in male New Zealand White rabbits fed a normal fat diet (NFD 4.3% fat, n = 11) or high fat diet (HFD 13.4% fat, n = 13) at days 1, 2, 3 and weeks 1, 2, 3 of the diet. Plasma concentrations of diacylglyceride (DG), triacylglyceride (TG), ceramide and cholesteryl esters (CE) were obtained after analysis by liquid chromatography mass spectrometry. Plasma insulin and glucose increased within the first 3 days of the diet in HFD rabbits (P <0.05) and remained elevated at week 1 (P <0.05). Blood pressure and heart rate followed a similar pattern. By contrast, in both groups, plasma leptin levels remained unchanged during the first few days (P >0.05), increasing by week 3 in fat fed animals alone (P <0.05). Concentrations of total DG, TG, CE and Ceramide at week 3 did not differ between groups (P >0.05). Our data show plasma insulin increases rapidly following consumption of a HFD and suggests that it may play a role in the rapid rise of blood pressure. Dyslipidaemia does not appear to contribute to the hypertension in this animal model.

Building Nature’s Safety Net 2014 : A decade of protected area achievements in Australia

The single most important asset for the conservation of Australia’s unique and globally significant biodiversity is the National Reserve System, a mosaic of over 10,000 discrete protected areas on land on all tenures: government, Indigenous and private,including on-farm covenants, as well as state, territory and Commonwealth marine parks and reserves.THE NATIONAL RESERVE SYSTEMIn this report, we cover major National Reserve System initiatives that have occurred in the period 2002 to the present and highlight issues affecting progress toward agreed national objectives. We define a minimum standard for the National Reserve System to comprehensively, adequately and representatively protect Australia’s ecosystem and species diversity on sea and land. Using government protected area, species and other relevant spatial data, we quantify gaps: those areas needing to move from the current National Reserve System to one which meets this standard. We also provide new estimates of financial investments in protected areas and of the benefits that protected areas secure for society. Protected areas primarily serve to secure Australia’s native plants and animals against extinction, and to promote their recovery.BENEFITSProtected areas also secure ecosystem services that provide economic benefits forhuman communities including water, soil and beneficial species conservation, climatemoderation, social, cultural and health benefits. On land, we estimate these benefitsare worth over $38 billion a year, by applying data collated by the Ecosystem ServicesPartnership. A much larger figure is estimated to have been secured by marineprotected areas in the form of moderation of climate and impact of extreme eventsby reef and mangrove ecosystems. While these estimates have not been verified bystudies specific to Australia, they are indicative of a very large economic contributionof protected areas. Visitors to national parks and nature reserves spend over $23.6 billion a year in Australia, generating tax revenue for state and territory governments of $2.36 billion a year. All these economic benefits taken together greatly exceed the aggregate annual protected area expansion and management spending by all Australian governments, estimated to be ~$1.28 billion a year. It is clear that Australian society is benefiting far greater than its governments’ investment into strategic growth and maintenance of the National Reserve System.Government investment and policy settings play a leading role in strategic growth of the National Reserve System in Australia, and provide a critical stimulus fornon-government investment. Unprecedented expansion of the National Reserve System followed an historic boost in Australian Government funding under Caring for Our Country 2008–2013. This expansion was highly economical for the Australian Government, costing an average of only $44.40 per hectare to buy and protect land forever. State governments have contributed about six times this amount toward the expansion of the National Reserve System, after including in-perpetuity protected area management costs. The growth of Indigenous Protected Areas by the Australian Government has cost ~$26 per hectare on average, including management costs capitalised in-perpetuity, while also delivering Indigenous social and economic outcomes. The aggregate annual investment by all Australian governments has been ~$72.6 million per year on protected area growth and ~$1.21 billion per year on recurrent management costs. For the first time in almost two decades, however, the Australian Government’s National Reserve System Program, comprising a specialist administrative unit and funding allocation, was terminated in late 2012. This program was fundamental in driving significant strategic growth in Australia’s protected area estate. It is highly unlikely that Australia can achieve its long-standing commitments to an ecologically representative National Reserve System, and prevent major biodiversity loss, without this dedicated funding pool. The Australian Government has budgeted ~$400 million per year over the next five years (2013-2018) under the National Landcare and related programs. This funding program should give high priority to delivery of national protected area commitments by providing a distinct National Reserve System funding allocation. Under the Convention on Biological Diversity (CBD), Australia has committed to bringing at least 17 percent of terrestrial and at least 10 per cent of marine areas into ecologically representative, well-connected systems of protected areas by 2020 (Aichi Target 11).BIODIVERSITY CONSERVATIONAustralia also has an agreed intergovernmental Strategy for developing a comprehensive, adequate and representative National Reserve System on land andsea that, if implemented, would deliver on this CBD target. Due to dramatic recent growth, the National Reserve System covers 16.5 per cent of Australia’s land area, with highly protected areas, such as national parks, covering 8.3 per cent. The marine National Reserve System extends over one-third of Australian waters with highly protected areas such as marine national parks, no-take or green zones covering 13.5 per cent. Growth has been uneven however, and the National Reserve System is still far from meeting Aichi Target 11, which requires that it also be ecologically representative and well-connected. On land, 1,655 of 5,815 ecosystems and habitats for 138 of 1,613 threatened species remain unprotected. Nonetheless, 436 terrestrial ecosystems and 176 threatened terrestrial species attained minimum standards of protection due to growth of the National Reserve System on land between 2002 and 2012. The gap for ecosystem protection on land – the area needed to bring all ecosystems to the minimum standard of protection – closed by a very substantial 20 million hectares (from 77 down to 57 million hectares) between 2002 and 2012, not including threatened species protection gaps. Threatened species attaining a minimum standard for habitat protection increased from 27 per cent to 38 per cent over the decade 2002–2012. A low proportion of critically endangered species meeting the standard (29 per cent) and the high proportion with no protection at all (20 per cent) are cause for concern, but one which should be relatively easy to amend, as the distributions of these species tend to be small and localised. Protected area connectivity has increased modestly for terrestrial protected areas in terms of the median distance between neighbouring protected areas, but this progress has been undermined by increasing land use intensity in landscapes between protected areas.A comprehensive, adequate and representative marine reserve system, which meetsa standard of 15 per cent of each of 2,420 marine ecosystems and 30 per cent of thehabitats of each of 177 marine species of national environmental significance, wouldrequire expansion of marine national parks, no-take or green zones up to nearly 30per cent of state and Australian waters, not substantially different in overall extentfrom that of the current marine reserve system, but different in configuration.Protection of climate change refugia, connectivity and special places for biodiversityis still low and requires high priority attention. FINANCING TO FILL GAPS AND MEET COMMITMENTSIf the ‘comprehensiveness’ and ‘representativeness’ targets in the agreed terrestrial National Reserve System Strategy were met by 2020, Australia would be likely to have met the ‘ecologically representative’ requirement of Aichi Target 11. This would requireexpanding the terrestrial reserve system by at least 25 million hectares. Considering that the terrestrial ecosystem protection gap has closed by 20 million hectares over the past decade, this required expansion would be feasible with a major boost in investment and focus on long-standing priorities. A realistic mix of purchases, Indigenous Protected Areas and private land covenants would require an Australian Government National Reserve System investment of ~$170 million per year over the five years to 2020, representing ~42 per cent of the $400 million per year which the Australian Government has budgeted for landcare and conservation over the next five years. State, territory and local governments, private and Indigenous partners wouldlikewise need to boost financial commitments to both expand and maintain newprotected areas to meet the agreed National Reserve System strategic objectives.The total cost of Australia achieving a comprehensive, adequate and representativemarine reserve system that would satisfy Aichi Target 11 is an estimated $247 million.

Coiled polymeric growth factor gradients for multi-luminal neural chemotaxis

In the injured adult nervous system, re-establishment of growth-promoting molecular gradients is known to entice and guide nerve repair. However, incorporation of three-dimensional chemotactic gradients in nerve repair scaffolds, particularly in those with multi-luminal architectures, remains extremely challenging. We developed a method that establishes highly tunable three-dimensional molecular gradients in collagen-filled multi-luminal nerve guides by anchoring growth-factor releasing coiled polymeric fibers onto the walls of collagen-filled hydrogel microchannels. Differential pitch in the coiling of neurotrophin-eluting fibers generated sustained three-dimensional chemotactic gradients that appropriately induced the differentiation of Pheochromocytoma (PC12) cells into neural-like cells along an increasing concentration of nerve growth factor (NGF). Computer modeling estimated the stability of the molecular gradient within the luminal collagen, which we confirmed by observing the significant effects of neurotrophin gradients on axonal growth from dorsal root ganglia (DRG). Neurons growing in microchannels exposed to a NGF gradient showed a 60% increase in axonal length compared to those treated with a linear growth factor concentration. In addition, a two-fold increment in the linearity of axonal growth within the microchannels was observed and confirmed by a significant reduction in the turning angle ratios of individual axons. These data demonstrate the ability of growth factor-loaded polymeric coiled fibers to establish three-dimensional chemotactic gradients to promote and direct nerve regeneration in the nervous system and provides a unique platform for molecularly guided tissue repair.

Neuronal classification and distribution in the central nervous system of the female mud crab, Scylla olivacea

The mud crab, Scylla olivacea, is one of the most economically valuable marine species in Southeast Asian countries. However, commercial cultivation is disadvantaged by reduced reproductive capacity in captivity. Therefore, an understanding of the general and detailed anatomy of central nervous system (CNS) is required before investigating the distribution and functions of neurotransmitters, neurohormones, and other biomolecules, involved with reproduction. We found that the anatomical structure of the brain is similar to other crabs. However, the ventral nerve cord (VNC) is unlike other caridian and dendrobrachiate decapods, as the subesophageal (SEG), thoracic and abdominal ganglia are fused, due to the reduction of abdominal segments and the tail. Neurons in clusters within the CNS varied in sizes, and we found that there were five distinct size classes (i.e., very small globuli, small, medium, large, and giant). Clusters in the brain and SEG contained mainly very small globuli and small-sized neurons, whereas, the VNC contained small-, medium-, large-, and giant-sized neurons. We postulate that the different sized neurons are involved in different functions. Microsc. Res. Tech. 77:189–200, 2014. © 2013 Wiley Periodicals, Inc.

The ProCaSP study: quality of life outcomes of prostate cancer patients after radiotherapy or radical prostatectomy in a cohort study urological oncology

Background: This study describes and compares health-related quality of life (HRQOL) of prostate cancer patients who received either radical prostatectomy (nerve-sparing, nsRP, or non-nerve-sparing, nnsRP) or radiotherapy (external RT, brachytherapy, or both combined) for treatment of localised prostate cancer. Methods: The prospective, multicenter cohort study included 529 patients. Questionnaires included the IIEF, QLQ-C30, and PORPUS-P. Data were collected before (baseline), three, six, twelve, and twenty-four months after treatment. Differences between groups' baseline characteristics were assessed; changes over time were analysed with generalised estimating equations (GEE). Missing values were treated with multiple imputation. Further, scores at baseline and end of follow-up were compared to German reference data. Results: The typical time trend was a decrease of average HRQOL three months after treatment followed by (partial) recovery. RP patients experienced considerable impairment in sexual functioning. The covariate-adjusted GEE identified a significant - but not clinically relevant - treatment effect for diarrhoea (b∈=∈7.0 for RT, p∈=∈0.006) and PORPUS-P (b∈=∈2.3 for nsRP, b∈=∈2.2 for RT, p∈=∈0.045) compared to the reference nnsRP. Most of the HRQOL scores were comparable to German norm values. Conclusions: Findings from previous research were reproduced in a specific setting of a patient cohort in the German health care system. According to the principle of evidence-based medicine, this strengthens the messages regarding treatment in prostate cancer and its impacts on patients' health-related quality of life. After adjustment for baseline HRQOL and other covariates, RT patients reported increased symptoms of diarrhoea, and nnsRP patients decreased prostate-specific HRQOL. RP patients experienced considerable impairment in sexual functioning. These differences should be taken into account by physicians when choosing the best therapy for a patient.

Triceps surae fascicle stretch is poorly correlated with short latency stretch reflex size

INTRODUCTION: The short latency stretch reflex (SLR) is well described, but the stimulus that evokes the SLR remains elusive. One hypothesis states that reflex size is proportional to muscle fiber stretch, so in this study we examined the relationship between these 2 parameters in human triceps surae muscles. METHODS: Achilles tendon taps and dorsiflexion stretches with different amplitudes and preactivation torques were applied to 6 participants while electromyography and muscle fascicle length changes were recorded in soleus and medial gastrocnemius (MG). RESULTS: In response to tendon taps, neither fascicle length nor velocity changes were correlated with SLR size in either muscle, but accelerometer peaks were observed immediately after hammer-tendon contact. Similar results were obtained after dorsiflexion stretches. CONCLUSION: Muscle fascicle stretch is poorly correlated with SLR size, regardless of perturbation parameters. We attribute the SLR trigger to the transmission of vibration through the lower limb, rather than muscle fiber stretch. Muscle Nerve, 2015.

Spatial variation in tuber depletion by swans explained by differences in net intake rates

We tested whether the spatial variation in resource depletion by Tundra Swans (Cygnus columbianus) foraging on belowground tubers of sago pondweed (Potamogeton pectinatus) was caused by differences in net energy intake rates. The variation in giving-up densities within the confines of one lake was nearly eightfold, the giving-up density being positively related to water depth and, to a lesser extent, the silt content of the sediment. The swans' preference (measured as cumulative foraging pressure) was negatively related to these variables. We adjusted a model developed for diving birds to predict changes in the time allocation of foraging swans with changes in power requirements and harvest rate. First, we compared the behavior of free-living swans foraging in shallow and deep water, where they feed by head-dipping and up-ending, respectively. Up-ending swans had 1.3-2.1 times longer feeding times than head-dipping swans. This was contrary to our expectation, since the model predicted a decrease in feeding time with an increase in feeding power. However, up-ending swans also had 1.9 times longer trampling times than headdipping swans. The model predicted a strong positive correlation between trampling time and feeding time, and the longer trampling times may thus have masked any effect of an increase in feeding power. Heart rate measurements showed that trampling was the most energetically costly part of foraging. However, because the feeding time and trampling time changed concurrently, the rate of energy expenditure was only slightly higher in deep water (1.03-1.06 times). This is a conservative estimate since it does not take into account that the feeding costs of up-ending are possibly higher than that of head-dipping. Second, we compared captive swans foraging on sandy and clayey sediments. We found that the harvest rate on clayey sediment was only 0.6 times that on sandy sediment and that the power requirements for foraging were 1.2-1.4 times greater. Our results are in qualitative agreement with the hypothesis that the large spatial variation in giving-up densities was caused by differences in net rates of energy intake. This potentially has important implications for the prey dynamics, because plant regrowth has been shown to be related to the same habitat factors (water depth and sediment type).