. Activation of the insular cortex is affected by the intensity of exercise. J. Appl. Physiol. 87(3): 1213-1219, 1999.-The purpose of this investigation was to determine whether there were differences in the magnitude of insular cortex activation across varying intensities of static and dynamic exercise. Eighteen healthy volunteers were studied: eight during two intensities of leg cycling and ten at different time periods during sustained static handgrip at 25% maximal voluntary contraction or postexercise cuff occlusion. Heart rate, blood pressure (BP), perceived exertion, and regional cerebral blood flow (rCBF) distribution data were collected. There were significantly greater increases in insular rCBF during lower (6.3 Ϯ 1.7%; P Ͻ 0.05) and higher (13.3 Ϯ 3.8%; P Ͻ 0.05) intensity cycling and across time during static handgrip (change from rest for right insula at 2-3 min, 3.8 Ϯ 1.1%, P Ͻ 0.05; and at 4-5 min, 8.6 Ϯ 2.8%, P Ͻ 0.05). Insular rCBF was decreased during postexercise cuff occlusion (Ϫ5.5 Ϯ 1.2%; P Ͻ 0.05) with BP sustained at exercise levels. Right insular rCBF data, but not left, were significantly related, with individual BP changes (r 2 ϭ 0.80; P Ͻ 0.001) and with ratings of perceived exertion (r 2 ϭ 0.79; P Ͻ 0.01) during exercise. These results suggest that the magnitude of insular activation varies with the intensity of exercise, which may be further related to the level of perceived effort or central command.human; brain; single-photon emission-computed tomography; magnetic resonance imaging; autonomic nervous system THE CEREBRAL CORTEX HAS long been recognized as having an important role in the regulation of autonomic function; this realization occurred even before the identification of any specific cortical region (10, 12). Studies implicating various cerebral cortical regions as possible sites for autonomic regulation were reviewed by Cechetto and Saper (3). Using specific criteria, they concluded that the insular cortex played a significant role. The insular cortex is a forebrain autonomic nucleus involved in the integration of sensory and visceral information (26). Of particular interest is the role played by the insular cortex in cardiovascular regulation (6,11,17,18,23,24). The right and left insular cortices possess reciprocal connectivity with numerous subcortical sites, including the lateral hypothalamus (31), ventrolateral medulla (31), and the nucleus tractus solitarii (NTS) (20, 31). These specific subcortical sites are known to be prominently involved in cardiovascular regulation at rest, as well as during physical activity (27). During exercise, when blood pressure (BP) must be regulated to sustain flow to both the brain and working musculature, signals from higher cortical centers (central command) and muscle afferent input (exercise pressor reflex) from the working limbs appear to converge at these sites to dictate an integrated cardiovascular response (16,27).Activation of the insular cortex has been shown to occur during volitional exercise (29). However, there was no si...

A method for quantitative extraction of oxytocin from blood is described. The disappearance of injected oxytocin from the circulation in rats was shown to depend upon its uptake in the kidneys and in organs of the splanchnic vascular area. In lactating rats there was uptake by an additional organ or tissue, probably the mammary gland. In animals without kidneys or lactating mammary glands and with no circulation in the splanchnic area oxytocin was distributed into a volume greater than the extracellular fluid volume, and after equilibration the concentration in plasma did not change significantly. During severe haemorrhage increased amounts of antidiuretic activity were detected in blood when there was no significant increase in oxytocic activity.

A growing evidence base suggests services that address social factors with an impact on health, such as transportation and caregiver support, must be integrated into new models of care if the Institute for Healthcare Improvement's Triple Aim is to be realized. We examined early evidence from seven innovative care models currently in use, each with strong social support services components. The evidence suggests that coordinated efforts to identify and meet the social needs of patients can lead to lower health care use and costs, and better outcomes for patients. For example, Senior Care Options--a Massachusetts program that coordinates the direct delivery of social support services for patients with chronic conditions and adults with disabilities--reported that hospital days per 1,000 members were just 55 percent of those generated by comparable patients not receiving the program's extended services. More research is required to determine which social service components yield desired outcomes for specific patient populations. Gaining these deeper insights and disseminating them widely offer the promise of considerable benefit for patients and the health care system as a whole.

Stereotactic procedures for movement disorders requiring high precision can be safely and successfully performed without the use of microelectrode recording techniques. Meticulous alignment of MRI and computed tomographic scans based on visualized anatomy allows precise lesion placement and avoids the distortion inherent in MRI scans.