Advances in nonimplantable electrical stimualtors for correction of urinary incontinence.

The nonimplantable electrical stimulators are widely used as rehabilitation aids for correction of urinary incontinence. The advances in the field of the design of nonimplantable electrical stimulators such as automatic vaginal electrical stimulator VAGICON-X and anal pressure controlled electrical stimulator are described. The evaluation of VAGICON-X in patients suffering from stress and urge incontinence as well as preliminary results of acute application of anal pressure electrical stimulation in patients with stress incontinence as presented.     

Cardiac Resuscitation—The Present Status of Defibrillation and Stimulation Techniques

Recent advances in electrical treatment and control of the heart are reviewed. The methods which have evolved for AC and DC countershock defibrillation and arrhythmia correction are outlined, and the parameters defined for determination of the efficacy of treatment.The principal types of cardiac stimulation are described and evaluated in terms of their electrical energy requirements. Externally controlled and implanted stimulators are compared and causes of failure stated.Current developments, reported at a recent Conference on Pacemakers, are included, with a summary of discussions by leading investigators in the field.Studies conducted by the National Research Council (Canada) medical electronics laboratory are also discussed.     

Diagnosis and repair of malfunctions of implanted central nervous system stimulators

Neurostimulator malfunctions must be located and repaired if patients are to receive maximum benefit from central nervous system stimulation. This report lists the problems encountered with the stimulators from four manufacturers. Procedures for locating the source of malfunctions are discussed in some detail.     

Treatment of spasmodic torticollis by dorsal column stimulation.

A new method is described to treat spasmodic torticollis with the implantation of a dorsal column stimulator at the C1--2 level or with transcutaneous stimulation. 22 patients were evaluated. 3 had sufficient relief to be treated with transcutaneous stimulation only. An additional 6 patients had surgically implanted dorsal column stimulators. It was empirically determined that a frequency of 800--1,100 Hz gave the best relief from torticollis. 1 patient had an excellent result; 3 have had good results; 1 had a fair result, and 1 had a poor result. An additional patient with dystonia musculorum deformans was considerably improved by the use of dorsal column stimulation.     

Murine T-cell hybridomas that produce lymphokine with macrophage-activating factor activity as a constitutive product

Responder spleen cells primed to alloantigens in vivo could generate high degree of cytotoxicity against low- or nonimmunogenic stimulators such as thymocytes or uv light-treated spleen cells in vitro. However, a removal of adherent cells from primed responder cells remarkably reduced the cytotoxicity after stimulation with such low-immunogenic stimulators. Adding a small number of peritoneal adherent cells (PACs) also suppressed the cytotoxic activity of unseparated responders against low-immunogenic stimulators. These suppressive effects by PACs were blocked by indomethacin. By adding prostaglandin E₂, cytotoxic T lymphocyte (CTL) generation of primed unseparated responders against low-immunogenic stimulators was suppressed; however, cytotoxic activity against mitomycin C-treated stimulators was not suppressed. These results suggested that prostaglandins released from PACs selectively inhibited the function of splenic adherent cells that were required for CTL generation of primed responder spleen cells against low-immunogenic stimulators in vitro.     

A simple method for analysis of DNA histograms in human myeloid cells perturbed by stimulators of DNA synthesis

In the past, phase fractionation has been used as a determinate of the level of stimulation of cells perturbed by stimulators and inhibitors of DNA synthesis. This method has, in our hands, proven to be insensitive and unreliable with human myeloid cells. A new method of analysis is described in this paper which involves utilization of the magnitude of the slope of a line fit to the mid-portion of S phase as an index of the level of stimulation of cultured human myeloid cells. This method is fast, reliable and simple to implement on an inexpensive microcomputer.     

Differential effects of prostaglandin synthetase stimulators on inhibition of cyclooxygenase.

The different effects of prostaglandin synthetase stimulators on inhibition of the cyclooxygenase by structurally distinct classes of nonsteroidal antiinflammatory agents suggest that the enzyme is altered by interaction with these stimulators. Reversible stimulation of prostaglandin synthetase activity by phenols and some other compounds and the relative influence of these stimulators on inhibitors of the cyclooxygenase were determined quantitatively. Two distinct classes of inhibitors were established. The fenamates were relatively weak inhibitors alone but were much more potent in the presence of phenolic compounds. In contrast, ibuprofen, indomethacin, and flurbiprofen were more potent than the fenamates and were reduced in effectiveness by the stimulators, as expected on the basis of two opposing actions. The relative potency of the cyclooxygenase stimulators (phenol greater than norepinephrine greater than tryptophan greater than benzoquinone greater than anisole) paralleled their synergistic action on the fenamates and their antagonist action on the nonfenamates. This correlation suggests that an enzyme alteration which leads to cyclooxygenase stimulation may also result in increased sensitivity to fenamates and decreased sensitivity to the other inhibitors, possibly by altering their capacity to bind.     

Further characterization of low density mononuclear cells: FACS-assisted analysis of human MLR stimulators

Previously, we reported that all of the potent stimulators of the allogeneic mixed leukocyte reaction (MLR) are contained in a heterogeneous low density fraction of human peripheral blood mononuclear (PBM) cells. We have further characterized human MLR stimulators by staining them with highly specific monoclonal antibodies, and then analyzing and separating them with the fluorescence-activated cell sorter. These studies revealed two populations of low density cells with potent allogeneic stimulatory activity. One population is a monocyte subset that reacts with anti-OKM1, MO.2, and expresses C3b as well as Fc-IgG receptors. The second population exhibits even greater stimulatory capacity and does not express any of these monocyte markers. Moreover, these cells are not phagocytic and do not react with alpha-naphthyl esterase. They comprise approximately 10% of the low density fraction or 0.5% of PBM. These cells are most likely lymphoid dendritic cells, described in various species as potent MLR stimulators. In contrast to the allogeneic MLR, only the low density cell type exhibiting dendritic cell characteristics induced a potent autologous MLR.     

Deafferentation of the urinary bladder and implantation of a sacral anterior root stimulator (SARS) for treatment of the neurogenic bladder in paraplegic patients.

Since 25 years electrical stimulation has become an established and widely acknowledged therapy option. Today, FES is widely employed, e.g. for cardiostimulation, diaphragm stimulation, kinetotherapy, for treatment of tremor in Parkinson patients, and finally for bladder stimulation in patients with bladder voiding dysfunctions. Brindley was the first researcher who succeeded in stimulating the spinal nerves via implanted electrodes in an animal model. In the years 1978/79 Brindley implanted five paraplegic patients with so-called sacral anterior root stimulators; all of them were able to void under stimulation. This method of sacral anterior root stimulation (SARS) proved an alternative to frequent one-way catheterisation for patients with severe voiding dysfunctions, without achieving complete continence, however. The following study is to provide an overview over the latest insights in the context of implanting sacral anterior root stimulators; it discusses the preconditions required for such interventions and presents criteria to decide in which cases there is a contraindication for sacral deafferentation of the posterior roots. Moreover, it contrasts advantages and disadvantages of the intradural and extradural implantation methods and presents the currently available long-term follow-up results with SDAF and SARS for treatment of bladder voiding dysfunctions.     

Calcium/Ganglioside-Dependent Protein Kinase Activity in Rat Brain Membrane

The effects of gangliosides on phosphorylation were studied in rat brain membrane. Gangliosides stimulated phosphorylation only in the presence of Ca2+ with major phosphoproteins of 45,000, 50,000, 60,000, and 80,000 daltons and high-molecular-weight species. In addition, gangliosides inhibited the phosphorylation of three proteins with molecular weights of 15,000, 20,000, and 78,000 daltons. The two low-molecular-weight proteins comigrated with rat myelin basic proteins. Ganglioside stimulation was dependent on the formation of a Ca2+-ganglioside complex since the calcium salt of gangliosides stimulated phosphorylation maximally. Disialo and trisialo gangliosides were more potent stimulators of kinase activity than the monosialo GM1 X GD1a was the most potent activator tested. Asialo-GM1, cerebroside, sialic acid, neuraminyllactose, sulfatide, and the acidic phospholipids phosphatidylserine and phosphatidylinositol did not stimulate kinase activity. The Ca2+-dependent, ganglioside-stimulated phosphorylation was qualitatively similar to the pattern for calmodulin-dependent phosphorylation. However, while calmodulin-dependent kinase activity was inhibited with an IC50 of 10 microM trifluoperazine, ganglioside-stimulated kinase was inhibited with an IC50 of 200 microM trifluoperazine. These results indicate that gangliosides have complex effects on membrane-associated kinase activities and suggest that Ca2+-ganglioside complexes are potent stimulators of membrane kinase activity.     

The effect of veratrole on carotenoid biosynthesis by Phycomyces blakesleeanus

A number of chemical compounds are known to affect the biosynthetic pathways of β-carotene. Both site-specific inhibitors as well as general stimulators of carotenogenesis have been described. It has been reported that veratrole enhances β-carotene synthesis when applied to agar cultures of Phycomyces blakesleeanus but we found no significant stimulation of β-carotene production in submerged culture. Moreover, veratrole in high concentrations (> 0.1% w/v), unlike diphenylamine, inhibits the formation of phytoene, resulting in an almost total block of carotenoid biosynthesis.     

Trisporoids under the stimulation of carotenogenesis in Blakeslea trispora

The patterns of trisporoid synthesis in joint cultivation of Blakeslea trispora mates have been studied. The pair of the not-zygospore-forming carotenoid overproducer strains T(+) and T(?) was found to synthesize a large amount of trisporoids, which did not differ in biological activity from those in the wild type strains. While the ??-carotene synthesis stimulator ??-ionone increased the amount of trisporoids, the share of trisporic acids in their composition decreased considerably. The lycopene synthesis stimulator 2-amino-6-methylpyridine caused a decrease in the content of trisporoid which had no trisporic acids in their composition. Emergence of a new substance with the maximum absorption at 250 nm, which accounted for up to 45% of the sum of trisporoids, was a general regularity in the action of both stimulators. The combined action of these two effectors resulted in additional stimulation of lycopene synthesis and was accompanied by the disappearance of trisporic acids. The aggregate findings indicate that both carotenogenesis stimulators inhibit the synthesis of trisporic acids, i.e., their action is not mediated by stimulation of trisporoid synthesis.     

Inhibition of stimulation in murine mixed lymphocyte cultures with an alloantiserum directed against a shared Ia determinant.

Pools of high titered alloantisera were raised by immunizing (B10.A/SgSn X A/WySn)F1 mice with C57BL/10Sn(B10) spleen cells. This serum (F1 anti-B10), when added to one-way mixed lymphocyte cultures (MLC), inhibited stimulation of B10.A splenic responders by both B10 and B10.D2/nSn irradiated, splenic stimulators. The B10 stimulation was suppressed approximately 85% whereas the mean suppression of B10.D2 stimulation was approximately 60%. In the ofrmer case, the serum contained antibodies reactive with multiple major histocompatibility complex determinants on the stimulator cells. In the latter case, the cytoxic reactivity of the serum was directed principally against an I region-associated determinant Ia.8) shared by B10 and B10.D2 and coded for by a gene(s) in the I-A subregion. The magnitude of the suppression of the response to B10.D2 cells (60%) was similar to the reduction in stimulation observed when the Ia.8 difference was eliminated genetically by using (B10 X B10.A)F1 responder cells against irradiated B10.D2 stimulators. Ihhibition of MLC by this antiserum was a function of reactivity with stimulator and not responder cells. Although some pools of F1 anti-B10 antiserum produced partial inhibition of the responder cell in a B10.D2 vs B10.Ax MLC combination, the results were inconsistent and not correlated with the anti-Ia.8 cytotoxicity titers. In addition, an F1 anti-B10 antiserum pool, which consistently failed to inhibit the responder cell, nevertheless inhibited both irradiated B10.D2 and (B10.A X B10.D2)F1 cells from stimulating B10.A responder cells. However, this same antiserum did not inhibit stimulation of B10.D2 responder cells by the (B10.A X B10.D2)F1 stimulators. Thus, the binding of antibodies to the non-stimulating antigens on the F1 stimulator cell did not interfere with the capacity of the appropriate stimulating antigens to cause stimulation. All of these results are consistent with the hypothesis that Ia allo-antigens are the major stimulating determinants of I region-associated MLC reactions.     

Advances in functional electrical stimulation (FES)

This review discusses the advancements that are needed to enhance the effects of electrical stimulation for restoring or assisting movement in humans with an injury/disease of the central nervous system. A complex model of the effects of electrical stimulation of peripheral systems is presented. The model indicates that both the motor and sensory systems are activated by electrical stimulation. We propose that a hierarchical hybrid controller may be suitable for functional electrical stimulation (FES) because this type of controller acts as a structural mimetic of its biological counterpart. Specific attention is given to the neural systems at the periphery with respect to the required electrodes and stimulators. Furthermore, we note that FES with surface electrodes is preferred for the therapy, although there is a definite advantage associated with implantable technology for life-long use. The last section of the review discusses the potential need to combine FES and robotic systems to provide assistance in some cases.     

Analysis of the effects of fatty acids and related compounds on the synthesis of phosphatidylcholine in lymphocytes

Phosphatidylcholine synthesis in cultured bovine lymphocytes is stimulated by cis-unsaturated fatty acids. This stimulation is correlated with an activation of the enzyme cytidyltransferase (EC 2.7.7.15) and its apparent translocation from the cytosol to the membrane/particulate of cells. In addition, these agents increase the levels of cytidine diphosphocholine - a product of the cytidyltransferase reaction and a precursor to phosphatidylcholine. Retinoic acid and 5,8,11,14-eicosatetraynoic acid both activate cytidyltransferase activity and raise cytidine diphosphocholine levels, yet they are ineffective as stimulators of overall phosphatidylcholine synthesis. The effects of all of these lipids are reversed by the delayed addition of bovine serum albumin. The data point to the view that cytidyltransferase activation is required but is not sufficient for stimulation of phosphatidylcholine synthesis: regulation at another step is suggested.     

Dorsal column stimulation in multiple sclerosis: effects on bladder and long term findings.

The effect of dorsal column stimulation on bladder function in 15 patients with established multiple sclerosis was analysed by urodynamic tests. Significant improvement in flow rate and urethral sphincter pressure was recorded in about two thirds. Of 31 patients examined over five years only 13 showed initial benefit from stimulation and were given permanent stimulators; of these, only three appeared to receive lasting benefit. Early complications occurred in nine patients and five had a relapse of their disease. These results suggest that at present stimulation of the dorsal column does not have a place in the routine management of multiple sclerosis.     

NAADP: a new second messenger comes of age

Nicotinic acid adenine dinucleotide phosphate (NAADP) is one of the most potent stimulators of intracellular Ca(2+) mobilization in a variety of cell types. Its role in physiological processes is increasingly demonstrated by NAADP increases following cellular stimulation. As a second messenger NAADP shows unique features such as the ability to mobilize Ca(2+) from stores that are physically distinct from those connected to the Ca(2+) channels located in the endoplasmic reticulum, namely, the inositol-1,4,5-trisphosphate and the cyclic-ADP-ribose/ ryanodine receptors. Furthermore, the NAADP-induced self-inactivation mechanism is suggestive of an irreversible binding of NAADP to its putative receptor.     

Structural specificity of steroids in stimulating DNA synthesis and protooncogene expression in primary rat hepatocyte cultures

Among the chemical compounds of varied structure which possess liver tumour-promoting are steroids, such as estrogens, pregnenolone derivatives and anabolic steroids. Although the mechanism(s) of tumour promotion in liver by these xenobiotics is not well understood, it is clear that growth stimulation is one important element in their action. As a basis for better defining whether steroids stimulate growth by a common mechanism or fall into sub-groups with differing actions, the effects of 46 steroids on DNA synthesis and the expression of protooncogenes c-fos and c-myc were examined in primary cultures of normal rat hepatocytes. Tentative groupings of steroids have been identified based on apparent structural requirements for stimulation of DNA synthesis, and effects of auxiliary factors in modulating this growth stimulus. For a "progestin" group, insulin appeared to be permissive for stimulation of DNA synthesis, and presence of an ester or hydroxyl group at 17alpha-position in combination with a non-polar group at C(6) appeared to be required for stimulation. For the pregnenes, dexamethasone was stimulatory. Structural requirements include a non-polar substitution at 16alpha-position and presence of a 6alpha-methyl group. Androgens were weak or ineffective stimulators of DNA synthesis. Anabolic steroids were weak to strong stimulators and alteration to A ring structure in combination with non-polar substitution at 17alpha-position appeared to be required for the activity. With the exception of the anabolic steroid, dianabol, there do not appear to be strong correlation between ability to stimulate DNA synthesis and ability to induce protooncogene expression among the steroids. This study provides a starting point for future more detailed examination of growth-stimulatory mechanism(s) of action of steroids in the liver.     

Battery-powered miniature implant for electrical nerve stimulation.

The range of application of implantable stimulators in functional electrical stimulation (FES) for therapeutic purposes and for the restoration of lost or damaged functions has steadily grown within the last 20 years. Each time a clinically used method is improved, a new field of FES application explored or basic research conducted, animal experiments are needed to check and evaluate the findings and results. It is precisely for this use that the stimulation system described in this paper was developed. The battery-powered single-channel stimulator can be used for the excitation of motor and sensory nerves with monophasic or biphasic impulses. All parameters and functions are programmable via the bidirectional telemetry circuit. Implant programming is achieved by a laptop computer, supported by a graphical user interface, instead of by a specially designed programmer. The maximum settings of the stimulation parameters are: frequency 100 Hz, monophasic pulse duration 0.8 ms, biphasic pulse duration 1.6 ms, stimulation current 3 mA. The implant volume was reduced to 2 cm3 (length 23 mm, width 13 mm, height 7.5 mm), lowering the weight to 3.6 g. Due to this small volume the implant can be used in small animals. The power supply via battery obviates the need for transcutaneous tunneling or permanent external high-frequency senders and facilitates the keeping of the animals.