[Cooperation between the health visitor and the physician as one of the pillars of the 108-year-old Hungarian Health Visitor Service]

INTRODUCTION

Despite the more than 100-year history of the Hungarian Health Visitor Service, no study has yet been carried out that looked back at the cooperation between health visitors and physicians.

OBJECTIVE

Our aim was 1) to explore the professional advances of the health visitor service and the cooperation between health visitor and physician by examining historical documents, legal and professional regulations governing the work of health visitor, furthermore, 2) to investigate whether there are compulsory training elements in today's training for health visitors that prepare students for health visitor and physician collaboration, moreover, 3) to search for old tools and documents used by health visitors and doctors in the North-West of Transdanubia.

METHOD

A literature search was carried out to identify documents relating to the development of the work of health visitors, the cooperation between health visitors and physicians, past and current legal and professional regulations, the current regulation on training of health visitors. Through field research, we tracked down old tools and documents of health visitors and physicians.

RESULTS

The establishment of the Hungarian Health Visitor Service is associated with the names of professors of medicine. The historical documents and regulations testify the development of the work of the health visitor, the expansion of her competences and the importance of the health visitor and physician cooperation. The training competences required for the cooperation between health visitors and physicians, health visitors and specialists are regulated by the regulation on training of health visitors. We have found many old objects and documents used in the work of the health visitor and doctor.

DISCUSSION

The documents that have preserved almost invariably describe the health visitor as a person working alongside the physician, in cooperation with the physician. Nowadays, the regulation of cooperation covers for all specialties in the field of health visitor.

CONCLUSION

Based on our research, it is fair to say that the health visitor-physician cooperation is an important pillar of the 108-year-old Hungarian Health Visitor Service. Orv Hetil. 2023; 164(33): 1311-1318.

Recruitment of Corticotropin-Releasing Hormone (CRH) Neurons in Categorically Distinct Stress Reactions in the Mouse Brain

Corticotropin-releasing hormone (CRH) neurons in the paraventricular hypothalamic nucleus (PVH) are in the position to integrate stress-related information and initiate adaptive neuroendocrine-, autonomic-, metabolic- and behavioral responses. In addition to hypophyseotropic cells, CRH is widely expressed in the CNS, however its involvement in the organization of the stress response is not fully understood. In these experiments, we took advantage of recently available Crh-IRES-Cre;Ai9 mouse line to study the recruitment of hypothalamic and extrahypothalamic CRH neurons in categorically distinct, acute stress reactions. A total of 95 brain regions in the adult male mouse brain have been identified as containing putative CRH neurons with significant expression of tdTomato marker gene. With comparison of CRH mRNA and tdTomato distribution, we found match and mismatch areas. Reporter mice were then exposed to restraint, ether, high salt, lipopolysaccharide and predator odor stress and neuronal activation was revealed by FOS immunocytochemistry. In addition to a core stress system, stressor-specific areas have been revealed to display activity marker FOS. Finally, activation of CRH neurons was detected by colocalization of FOS in tdTomato expressing cells. All stressors resulted in profound activation of CRH neurons in the hypothalamic paraventricular nucleus; however, a differential activation of pattern was observed in CRH neurons in extrahypothalamic regions. This comprehensive description of stress-related CRH neurons in the mouse brain provides a starting point for a systematic functional analysis of the brain stress system and its relation to stress-induced psychopathologies.

The metabolic stress response: Adaptation to acute-, repeated- and chronic challenges in mice

There is a strong relationship between stress and metabolism. Because acute traumatic- and chronic stress events are often accompanied with metabolic pathophysiology, it is important to understand the details of the metabolic stress response. In this study we directly compared metabolic effects of acute stress with chronic repeated- and chronic unpredictable stress in mouse models. All types of adversities increased energy expenditure, chronic stress exposure decreased body weight gain, locomotor activity and differentially affected fuel utilization. During chronic exposure to variable stressors, carbohydrates were the predominant fuels, whereas fatty acids were catabolized in acutely and repeatedly restrained animals. Chronic exposure to variable stressors in unpredictable manner provoked anxiety. Our data highlight differences in metabolic responses to acute- repeated- and chronic stressors, which might affect coping behavior and underlie stress-induced metabolic and psychopathologies.

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All forms of stress exposure increase energy expenditure and resting metabolic rate

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Increased energy expenditure is fueled in challenge-specific manner

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Acute restraint increases, chronic stress decreases locomotor activity

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Chronic variable stress, but not repeated restraint provokes anxiety/depression

Stress Adaptation and the Brainstem with Focus on Corticotropin-Releasing Hormone

Stress adaptation is of utmost importance for the maintenance of homeostasis and, therefore, of life itself. The prevalence of stress-related disorders is increasing, emphasizing the importance of exploratory research on stress adaptation. Two major regulatory pathways exist: the hypothalamic–pituitary–adrenocortical axis and the sympathetic adrenomedullary axis. They act in unison, ensured by the enormous bidirectional connection between their centers, the paraventricular nucleus of the hypothalamus (PVN), and the brainstem monoaminergic cell groups, respectively. PVN and especially their corticotropin-releasing hormone (CRH) producing neurons are considered to be the centrum of stress regulation. However, the brainstem seems to be equally important. Therefore, we aimed to summarize the present knowledge on the role of classical neurotransmitters of the brainstem (GABA, glutamate as well as serotonin, noradrenaline, adrenaline, and dopamine) in stress adaptation. Neuropeptides, including CRH, might be co-localized in the brainstem nuclei. Here we focused on CRH as its role in stress regulation is well-known and widely accepted and other CRH neurons scattered along the brain may also complement the function of the PVN. Although CRH-positive cells are present on some parts of the brainstem, sometimes even in comparable amounts as in the PVN, not much is known about their contribution to stress adaptation. Based on the role of the Barrington’s nucleus in micturition and the inferior olivary complex in the regulation of fine motoric—as the main CRH-containing brainstem areas—we might assume that these areas regulate stress-induced urination and locomotion, respectively. Further studies are necessary for the field.

EFFECT OF DIFFERENT ECOLOGICAL CONDITIONS ON CONTENT OF PHYTONUTRIENTS IN INDUSTRIAL TOMATOES

Tomatoes (Solanum lycopersicon L.) are one of the most important and most widely consumed vegetables in the world. The fruit contains considerable amount of different phytonutrients such as carotenoids, tocopherols, and vitamin C. In the present work, effects of some abiotic factors on the concentration of phytonutrients were investigated in tomato cultivated in two different types of soil. It was found that the type of soil had slight effect on the most important vital nutrients, while the ecological factors, particularly precipitation and average temperature 3 weeks before harvest, were of significant influence on such nutrients. It was found that low temperature and high precipitation before harvest caused the levels of carotenoids, tocopherol, and vitamin C to significantly increase by 65%, 46%, and 28%, respectively.

Gastrointestinal (non-systemic) antibiotic rifaximin differentially affects chronic stress-induced changes in colon microbiome and gut permeability without effect on behavior

Chronic stress is often accompanied by gastrointestinal symptoms, which might be due to stress-induced shift of gut microbiome to pathogenic bacteria. It has been hypothesized that stress alters gut permeability and results in mild endotoxemia which exaggerates HPA activity and contributes to anxiety and depression. To reveal the relationship between microbiome composition, stress-induced gastrointestinal functions and behavior, we treated chronically stressed mice with non-absorbable antibiotic, rifaximin. The "two hits" stress paradigm was used, where newborn mice were separated from their mothers for 3 h daily as early life adversity (maternal separation, MS) and exposed to 4 weeks chronic variable stress (CVS) as adults. 16S rRNA based analysis of gut microbiome revealed increases of Bacteroidetes and Proteobacteria and more specifically, Clostridium species in chronically stressed animals. In mice exposed to MS + CVS, we found extenuation of colonic mucosa, increased bacterial translocation to mesenteric lymph node, elevation of plasma LPS levels and infiltration of F4/80 positive macrophages into the colon lamina propria. Chronically stressed mice displayed behavioral signs of anxiety-like behavior and neophobia. Rifaximin treatment decreased Clostridium concentration, gut permeability and LPS plasma concentration and increased colonic expression of tight junction proteins (TJP1, TJP2) and occludin. However, these beneficial effects of rifaximin in chronically stressed mice was not accompanied by positive changes in behavior. Our results suggest that non-absorbable antibiotic treatment alleviates stress-induced local pathologies, however, does not affect stress-induced behavior.

Az Ehlers–Danlos-szindrómák korszerű osztályozása és multidiszciplináris tünettana

Abstract:

In this review article, the authors summarize the clinical aspects of the novel classification of Ehlers–Danlos syndrome, which is a group of rare, hereditary connective tissue disorders. The leading symptom of the Ehlers–Danlos syndrome group is joint hypermobility, skin hyperextensibility and generalized tissue fragility. Ehlers–Danlos syndrome displays a high clinical and genetic heterogeneity and harbors many multidisciplinary properties. Certain subtypes only affect the quality of life, while other forms may lead to severe, even fatal vascular or intestinal complications. Last year, based on the data of various international genotype-phenotype correlation studies of large populations, a new classification of the syndrome’s clinical subtypes was introduced. The novel international nosology of Ehlers–Danlos syndromes published in 2017 delineates 13 clinical subtypes, describes their genetic background and defines major and minor diagnostic criteria for each subtype. We gathered the complex, multidisciplinary symptoms of Ehlers–Danlos syndromes in a table to assist the diagnosis from a differential diagnostic point of view. In the clinical practice, the proper diagnosis of patients affected by the Ehlers–Danlos syndrome group is essential to give optimal clinical care and to prevent the development of severe complications. Orv Hetil. 2019; 160(16): 603–612.

Evidence for the therapeutic effect of the organic content in Szigetvár thermal water on osteoarthritis: a double-blind, randomized, controlled clinical trial

The therapeutic effects of mineral waters have been attributed to the inorganic components alone; however, biologically active organic components are also present. We aimed to investigate whether the healing effect of Szigetvár thermal mineral water could relate to the organic matter in patients suffering from osteoarthritis of the hips and the knees. XAD macroreticular resins were used to prepare the organic fraction. Patients received a 30-min thermal water (34 °C) treatment in a bath tub, five times a week for 3 weeks. After randomization, patients were divided into three groups: tap water, mineral water, and organic fraction group. Primary outcomes were range of movement (ROM), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and visual analog scale (VAS) for pain severity, and the Short Form 36 (SF-36) questionnaire was used. These scores and indices were measured at baseline, after the last treatment, and at the end of the 3-month follow-up period. Seventy-four patients (age 67.3 ± 4.48 years) were enrolled: tap water n = 24, mineral water n = 26, and organic fraction n = 24. Treatment with the redissolved organic fraction significantly improved ROM, WOMAC, and SF-36 scores compared to the tap water. Our clinical trial provided evidence for the beneficial health effects of the organic fraction of Szigetvár medicinal water.

Changes in Quality of Life in Parkinson's Disease: How Large Must They Be to Be Relevant?

BACKGROUND

Minimal clinically important difference (MCID) is the smallest change in an outcome, which a patient identifies as meaningful. Although the 2 most frequently applied Parkinson's disease (PD) "quality of life" questionnaires (the PDQ-39 and PDQ-8) provide encouragingly similar results, their MCID thresholds appear to be vastly different. Our aim was to calculate the MCID estimates for both PDQ-39 and PDQ-8 Summary Indices (PDQ-39-SI and PDQ-8-SI) by the utilization of both anchor- and distribution-based techniques.

METHODS

Nine hundred eighty-five paired investigations of 365 patients were included. Three different techniques were used simultaneously to calculate the MCID values.

RESULTS

First, we replicated the previously published results demonstrating how both PDQ-39-SI and PDQ-8-SI provide similar values and respond in a similar way to changes. Subsequently, we calculated the MCID thresholds. The most optimal estimates for MCID thresholds for PDQ-39-SI were -4.72 and +4.22 for detecting minimal clinically important improvement and worsening. For PDQ-8-SI, these estimates were -5.94 and +4.91 points for detecting minimal clinically important improvement and worsening respectively.

CONCLUSIONS

Our study is the first one that directly compared the MCID estimates for both PDQ-39-SI and PDQ-8-SI on a large pool of patients including all disease severity stages. These MICD estimates varied across PD severity.

Test-retest validity of Parkinson's disease sleep scale 2nd version (PDSS-2)

BACKGROUND AND AIMS

The aim of the present study was to measure the test-retest validity of Parkinson's Disease Sleep Scale 2nd version (PDSS-2) on PD patients with stable medication and motor symptoms over the period of 4 weeks.

METHODS

The subject population consisted of 92 PD patients. Besides PDSS-2, Unified PD rating scale, Montgomery-Asberg Depression Rating Scale and EQ-5D were assessed at baseline and 4 weeks later.

RESULTS

The total score of PDSS-2 decreased from 19.06 ± 10.78 points to 18.00 ± 9.34 points (p > 0.05). For the total score of PDSS-2 the Intra-class and Lin's Concordance Correlation Coefficients were 0.782 and 0.799. The average difference between the baseline and follow-up total PDSS-2 scores was -1.06 points with the 95% confidence interval of -7.96 and +5.84 points.

CONCLUSIONS

Our data supports that the items and the total score of PDSS-2 have acceptable test-retest reliability over a four week period on patients with stable PD symptoms and pharmacological therapy.

A three-year follow-up study of the development of joint contractures in 131 patients with systemic sclerosis

OBJECTIVES

To analyse the correlation between the number of joint-contractures and other major clinical findings in a follow-up study of 131 patients with systemic sclerosis (SSc).

METHODS

The range of motion of joints (ROM), HAQ-DI, and the major clinical characteristics were assessed.

RESULTS

A high frequency of contractures (ROM<75% of the normal) were present at baseline in small joints of the hand (82%), wrists (75%), and shoulders (50%). ROM of the dominant side hand was significantly more decreased compared to the non-dominant side. The number of the upper extremity contractures correlated positively with ESR (p<0.01), CRP (p<0.01), HAQ-DI (p<0.01), and negatively with forced vital capacity (FVC) (p<0.05). The number of contractures was not significantly different in cases with early (≤ 4 years) and late disease duration in both the limited and diffuse subgroups. During the three-year follow-up period, an increase in the number of joint contractures (ROM<75%) was associated with an increase of ESR, modified Rodnan's skin score, and the European Scleroderma Study Group Activity Index by multiple linear regression analysis. Univariate analysis over a six-year period demonstrated poor outcome in patients with more than ten contractures, or more than four contractures of unilateral hand-joints.

CONCLUSIONS

Contractures predominantly develop during the early years following disease onset in both SSc subgroups. Inflammation and skin-involvement are significant contributing factors for the development of contractures. The dominant hand may be more pronouncedly impaired compared to the non-dominant side. A high number of joint-contractures might be an unfavourable prognostic factor in SSc.

The role of MRI in the assessment of the local status of anal carcinomas and in their management

This study aims to define the role of Magnetic Resonance (MR) examinations in the assessment and therapy of anal cancer (AC), and to present the main features of the MR examinations and the typical tumor spread pattern. The MR examinations of 67 anal cancer patients with histologically confirmed planocellular cancer were analyzed retrospectively. The tumor size and the signal intensity, the nodal status were examined before and after the treatment, and in recidive tumors (N = 13). At the time of the diagnosis the primary tumor was in early stage (Tis, T1, T2) in 71.5 % of the cases, and it was localized in 97 %. In 97.4 % of the cases the tumor had relatively increased signal intensities compared to the adjacent muscles. Patients received chemo-radiotherapy (CRT). After CRT in 26 out of 39 patients (66.7 %) the size of the tumor decreased (in 75 %), and the signal intensity decreased on the T2 weighted (T2w) images. In the residual tumor cases (19/39) verified 6 patients out of 19 had further decrease in size, and signal intensity a year after the end of the therapy. The MR examination plays a key role in the therapy of AC, by assessing the precise local status, the possible recidive tumors, and monitoring the therapy.

[Treatment of tardive syndromes]

Tardive syndromes associated with dopamine-receptor blocking agents have heterogeneous appearance. The treatment of tardive dyskinesia, dystonia, myoclonus, tourettism, tremor and akathisia is challenging for both psychiatrists and neurologists. Lack of randomized and controlled examinations for many routinely applied clinical therapeutic options make the development of clinical guidelines difficult. The present review article summarizes the available evidence for the treatment of tardive syndromes. According to the treatment guideline published by the American Academy of Neurology in 2013, the usage of clonazepam, ginkgo biloba, amantadine and tetrabenazine has enough evidence to draw conclusions. Although lowering or stopping the eliciting agent, changing to atypical antipsychotics, and adding anticholinergics are widely used techniques, there are no convincing controlled studies available to support their efficacy. The usage of Vitamin E, levetiracetam, propranolol, botulinum toxin and deep brain stimulation may be promising treatment options in the future.

Clinical, radiological and genetic aspects of leukodystrophies

The authors summarize the pathomechanism of the myelination process, the clinical, radiological and the genetical aspects of the leukodystrophies, as in 18q deletion syndrome, adrenoleukodysrtophy, metachromatic leukodystrophy, Pelizaeus-Merzbacher leukodystrophy, Alexander disease and olivo-ponto-cerebellar atrophy (OPCA).

Plasma carnitine ester profiles in Crohn's disease and ulcerative colitis patients with different IGR2230a_1 genotypes

An association has been repeatedly demonstrated between inflammatory bowel disease (IBD) and the IBD5 locus in the 5q31 chromosomal region. The aim of the present study was to examine the prevalence of the IGR2230a_1 intronic nucleotide polymorphism of the slc22a5 gene (coding for the OCTN2 carnitine transporter protein) lying within this region, and its possible relationship with the carnitine metabolism in Hungarian IBD patients and controls. We genotyped by restriction fragment length polymorphism 200 Crohn's disease (CD) and 246 ulcerative colitis (UC) patients, as well as 187 healthy controls. From plasma samples we determined detailed carnitine ester profiles of 76 CD, 43 UC patients and 45 control persons using electrospray ionization triple quadruple tandem mass spectrometry. The distribution of the genotypes was not significantly different in the CD or the UC group compared with the controls. We found no significant alterations of the carnitine profile in the carrier/non-carrier or the homozygote/non-homozygote comparisons in both the CD and the UC groups, stratified by IGR2230a_1 genotype. Our data suggest that this polymorphism alone is not associated with CD and UC in the Hungarian population, and has no effect on the carnitine metabolism.

The involvement of heme oxygenase-1 activity in the therapeutic actions of 5-aminosalicylic acid in rat colitis

The mechanism of action of 5-aminosalicylic acid (5-ASA), the active therapeutic moiety of a number of clinically used anti-colitic agents, is unclear. The present study investigates whether the beneficial effects in vivo could involve induction of the heat shock protein, heme oxygenase-1 (HO-1), known to provide endogenous anti-oxidant and anti-inflammatory moieties which can modulate colonic inflammation. The effects of 5-ASA on the colonic expression and activity of HO-1 along with its effect on the inflammatory damage have been evaluated in the colitis provoked by instillation of trinitrobenzene sulphonic acid (TNBS) over 48 h in the rat. Intracolonic administration of 5-ASA (8, 25 and 75 mg/kg/day) dose-dependently reduced the TNBS-provoked macroscopic colonic inflammatory injury, myeloperoxidase (MPO) activity and TNF-alpha levels, while also dose-dependently increasing colonic heme oxygenase enzyme activity. Colonic HO-1 protein expression, determined by Western blot analysis in this colitis model, was likewise further induced by 5-ASA. Intracolonic administration of 5-ASA alone under unchallenged conditions also induced colonic HO-1 protein expression and stimulated heme oxygenase enzyme activity. Administration of zinc protoporphyrin (50 micromol/kg/day, s.c.), which prevented the increase in colonic heme oxygenase activity, abolished the anti-colitic effect of 5-ASA. These results suggest that 5-ASA may exert its colonic anti-oxidant and anti-inflammatory effects in vivo in part through the up-regulation of HO-1 enzyme expression and activity.

The involvement of heme oxygenase-1 activity in the therapeutic actions of 5-aminosalicylic acid in rat colitis

The mechanism of action of 5-aminosalicylic acid (5-ASA), the active therapeutic moiety of a number of clinically used anti-colitic agents, is unclear. The present study investigates whether the beneficial effects in vivo could involve induction of the heat shock protein, heme oxygenase-1 (HO-1), known to provide endogenous anti-oxidant and anti-inflammatory moieties which can modulate colonic inflammation. The effects of 5-ASA on the colonic expression and activity of HO-1 along with its effect on the inflammatory damage have been evaluated in the colitis provoked by instillation of trinitrobenzene sulphonic acid (TNBS) over 48 h in the rat. Intracolonic administration of 5-ASA (8, 25 and 75 mg/kg/day) dose-dependently reduced the TNBS-provoked macroscopic colonic inflammatory injury, myeloperoxidase (MPO) activity and TNF-alpha levels, while also dose-dependently increasing colonic heme oxygenase enzyme activity. Colonic HO-1 protein expression, determined by Western blot analysis in this colitis model, was likewise further induced by 5-ASA. Intracolonic administration of 5-ASA alone under unchallenged conditions also induced colonic HO-1 protein expression and stimulated heme oxygenase enzyme activity. Administration of zinc protoporphyrin (50 micromol/kg/day, s.c.), which prevented the increase in colonic heme oxygenase activity, abolished the anti-colitic effect of 5-ASA. These results suggest that 5-ASA may exert its colonic anti-oxidant and anti-inflammatory effects in vivo in part through the up-regulation of HO-1 enzyme expression and activity.

Plasma carnitine ester profiles in Crohn's disease patients characterized for SLC22A4 C1672T and SLC22A5 G-207C genotypes

Crohn's disease (CD) is a chronic inflammatory bowel disorder caused by environmental and genetic factors. The purpose of this study was to analyse the possible influence of functional variants of genes of OCTN cation transporters on the carnitine ester profile of patients with CD. Genotyping for SLC22A4 1672C --> T, SLC22A5-207G --> C mutations and three common NOD2 variants (R702W, G908R and 1007finsC) were performed in 100 adult CD patients and in ninety-four healthy controls by direct sequencing. The carnitine ester profile was determined using ESI triple quadrupole tandem MS. Contrary to the NOD2/CARD15 mutations, none of the SLC variants showed increased prevalence in the CD group, the prevalence of TC haplotype did not differ between the patients and the controls. In the mixed group of CD patients the fasting propionyl- (0.243 (sem 0.008) v. 0.283 (sem 0.014) micromol/l), butyryl- (0.274 (sem 0.009) v. 0.301 (sem 0.013)) and isovalerylcarnitine (0.147 (sem 0.006) v. 0.185 (sem 0.009)) levels were decreased; while the level of octenoyl- (0.086 (sem 0.006) v. 0.069 (sem 0.005)), myristoleyl- (0.048 (sem 0.003) v. 0.037 (sem 0.003)), palmitoyl- (0.140 (sem 0.005) v. 0.122 (sem 0.004)) and oleylcarnitine (0.172 (sem 0.006) v. 0.156 (sem 0.008); P < 0.05 in all comparisons) were increased. After sorting the patients into SLC22A genotype-specific subgroups, no significant differences could be observed between them. The carnitine ester profile data suggest selective involvement of the carnitine esters in CD patients, probably due to their altered metabolism.

Comparative evaluation of Estredox, a brain-targeted estradiol delivery system versus traditional estrogen replacement therapy

Estredox is a novel brain-targeted delivery system for estradiol (E2). The mechanism of this estradiol-chemical delivery system (E2-CDS) is based on an interconvertible dihydropiridine <--> pyridinium salt carrier (targetor) attached to E2. After administration of the E2-CDS, the targetor moiety is oxidized to a quaternary pyridinium salt (E2-Q+). Here we demonstrate that a single i.v. injection with E2-CDS (3 mg/kg) resulted in sustained presence of E2-Q+ in three various brain regions. The sustained and gradual release of estradiol from E2-Q+ is reflected by the time-course of plasma estrogen level. At the end of repeated administration of E2-CDS (daily once 0.3 mg/kg i.v. for 10 consecutive days) we found a sharp decrease in the levels of plasma estradiol followed by a gradual decrease. The levels of E2-Q+ in the investigated brain regions decreased gradually from the first post-treatment day, however, a detectable amount of E2-Q+ was still present in the hypothalamus, striatum, and cortex even on the 24th post-treatment day. Strikingly different plasma estradiol levels were found in the groups of orchidectomized rats that received daily i.v. injections of estradiol benzoate (E2-BZ). The plasma estradiol levels in these animals were much higher compared to E2-CDS-treated animals throughout the treatment period but the level sharply dropped immediately after the treatments. In contrast to the E2-CDS-treated animals there was no estradiol in any of the brain regions of E2-BZ-treated rats on the 1st and 2nd post-treatment day. All of these data are in line with the long-lasting pharmacological effects of E2-CDS-treatment on estrogen-mediated functions in castrated rats and give further experimental support for brain-targeting estrogen-treatment approach as opposed to the traditional estrogen replacement therapy.

Changes of plasma fasting carnitine ester profile in patients with ulcerative colitis

AIM: To determine the plasma carnitine ester profile in adult patients with ulcerative culitis (UC) and compared with healthy control subjects.

METHOD: Using ESI triple quadrupole tandem mass spectrometry, the carnitine ester profile was measured in 44 patients with UC and 44 age- and sex-matched healthy controls.

RESULTS: There was no significant difference in the fasting free carnitine level between the patients with UC and the healthy controls. The fasting propionyl- (0.331 ± 0.019 vs 0.392 ± 0.017 μmol/L), butyryl- (0.219 ± 0.014 vs 0.265 ± 0.012), and isovalerylcarnitine (0.111 ± 0.008 vs 0.134 ± 0.008) levels were decreased in the UC patients. By contrast, the level of octanoyl- (0.147 ± 0.009 vs 0.114 ± 0.008), decanoyl- (0.180 ± 0.012 vs 0.137 ± 0.008), myristoyl- (0.048 ± 0.003 vs 0.039 ± 0.003), palmitoyl- (0.128 ± 0.006 vs 0.109 ± 0.004), palmitoleyl- (0.042 ± 0.003 vs 0.031 ± 0.002) and oleylcarnitine (0.183 ± 0.007 vs 0.163 ± 0.007; P < 0.05 in all comparisons) were increased in the patients with UC.

CONCLUSION: Our data suggest selective involvement of the carnitine esters in UC patients, probably due to their altered metabolism.

MRI-assessed volume of left and right hippocampi in females correlates with the relative length of the second and fourth fingers (the 2D:4D ratio)

Atrophy of the left or right side of the hippocampus has been related to cognitive deficits and psychiatric disease. In this study, we examined the correlation between the hippocampal volume laterality index and the relative lengths of the second (index finger) and fourth (ring finger) digits (2D:4D) in healthy female subjects. The 2D:4D ratio is fixed in utero, and the ratio is higher in women than in men. There is evidence that this ratio is an indicator of the intrauterine concentration of testosterone, which influences the development of different regions of the brain. Assessing the volume of different parts of the brain of 40 healthy adult female students by magnetic resonance imaging (MRI), we found that the 2D:4D ratio was associated with an asymmetry in the hippocampal sub-regions. Smaller volume on the left side was found in the posterior part of the hippocampus in females with a low (masculine type) 2D:4D ratio. On the other hand, smaller volume on the left side was found in the middle part of the hippocampus in females with a high (female type) 2D:4D ratio. Thus, the development of the middle and posterior regions of the hippocampal formation may respond in opposite ways to prenatal levels of testosterone. Other brain regions such as the amygdala, the cerebral cortex, the total volume hippocampus, and the head of the hippocampus did not show such a difference.

Endotoxin can decrease isolated rat parotid acinar cell amylase secretion in a nitric oxide-independent manner

Salivary mucus and amylase have an anti-bacterial nature. Bacterial endotoxin is considered to decrease mucus secreting cell activity by nitric oxide-dependent mechanisms. In this study, the actions of endotoxin on amylase secreting cell activity have been studied. Endotoxin (Escherichia coli lipopolysaccharide; 3 mg/kg, i.v., 5 h) evoked nitric oxide synthase 2 (NOS2) induction in the rat whole parotid tissue (assessed by Western blot and the citrulline assay) and in rat isolated parotid acinar cells (assessed by Western blot and immunohistochemistry), and reduced basal and acetylcholine-stimulated amylase secretion from these isolated cells. However, N(G)-nitro-L-arginine methyl ester (0.1 mg/ml, 4 days in drinking water, yielding a dose of 25 mg/kg/day) did not affect amylase release under basal or acetylcholine-stimulated conditions, either in control acinar cells or those from endotoxin challenged rats. Thus, basal, acetylcholine-evoked or endotoxin-decreased cellular amylase secretion from rat isolated parotid acinar cells does not appear to be modulated by endogenous nitric oxide.

Anti-inflammatory effect and soft properties of etiprednol dicloacetate (BNP-166), a new, anti-asthmatic steroid

In vitro and in vivo anti-inflammatory properties and soft characteristics of etiprednol dicloacetate (BNP-166) a new steroid, which has been developed for the treatment of asthma, were investigated in this study. The compound effectively decreased cytokine production in lipopolysaccharide stimulated lymphocytes and attenuated lectin-induced proliferation of blood mononuclear cells in tissue culture. In an animal model of allergen sensitized and challenged Brown Norway rats, using topical treatment, etiprednol dicloacetate substantially attenuated the extent of allergen induced bronchoalveolar fluid eosinophilia. At every examined parameter its pharmacological effects were comparable to those of budesonide. By means of in vitro biological and analytical methods the soft character of BNP-166 was also investigated. The anti-inflammatory effect of etiprednol dicloacetate in vitro was shown to be the function of the quantity of serum components, present in the assay. This loss of activity was most likely the result of the fast metabolism of etiprednol dicloacetate, which in the presence of sera could have been demonstrated by LC/MS/MS. Our data indicate that the significant local effect of the compound will very likely be accompanied with a drastically reduced systemic activity indicating an encouraging selectivity of the pharmacological action of etiprednol dicloacetate.

What may be the anatomical basis that secretin can improve the mental functions in autism?

Autism was first described and characterized as a behavioral disorder more than 50 years ago. The major abnormality in the central nervous system is a cerebellar atrophy. The characteristic histological sign is a striking loss or abnormal development in the Purkinje cell count. Abnormalities were also found in the limbic system, in the parietal and frontal cortex, and in the brain stem. The relation between secretin and autism was observed 3 years ago. Clinical observations by Horváth et al. [J. Assoc. Acad. Minor. Physicians 9 (1998) 9] supposed a defect in the role of secretin and its receptors in autism. The aim of the present work was to study the precise localization of secretin immunoreactivity in the nervous system using an immunohistochemical approach. No secretin immunoreactivity was observed in the forebrain structures. In the brain stem, secretin immunoreactivity was observed in the mesencephalic nucleus of the trigeminal nerve, in the superior olivary nucleus, and in scattered cells of the reticular formation. The most intensive secretin immunoreactivity was observed in the Purkinje cells of the whole cerebellum and in some of the neurons of the central cerebellar nuclei. Secretin immunoreactivity was also observed in a subpopulation of neurons in the primary sensory ganglia. This work is the first immunohistochemical demonstration of secretin-immunoreactive elements in the brain stem and in primary sensory ganglia.

Toxicity of methylsulfonylmethane in rats

Methylsulfonylmethane (MSM) is a popular dietary supplement used in a variety of conditions including pain, inflammation, allergies, arthritis, parasitic infections and the maintenance of normal keratin levels in hair, skin and nails. Despite its popularity, there is little published toxicology data on MSM. The objective of this study was to evaluate the acute and subchronic toxicity of MSM in rats at a dose five to seven times the maximum recommended dose in humans. MSM administered in a single gavage dose of 2 g/kg resulted in no adverse events or mortality. MSM administered as a daily dose of 1.5 g/kg for 90 days by gavage resulted in no adverse events or mortality. Necropsy did not reveal any gross pathological lesions or changes in organ weights. Renal histology of treated animals was normal. It is concluded that MSM is well tolerated in rats at an acute dose of 2 g/kg and at a subacute chronic dose of 1.5 g/kg.

[Volumetric measurements of the hippocampus and amygdala with MRI in healthy adults]

INTRODUCTION

Volumetric analysis of brain magnetic resonance images (MRI) measures structural changes associated with neurological and neuropsychiatric disorders. In recent years several studies have shown the utility of the volumetric measurement of the medial temporal lobe structures, especially the amygdala and the hippocampus in temporal lobe epilepsy, memory disorders, Alzheimer disease and schizophrenia.

AIM

The purpose of this study was to measure and establish our normal values of the hippocampus and amygdala volumes.

METHODS

All studies were performed using a 1.0 T Siemens unit with FISP 3D sequence. One millimeter, contiguous coronal scans of 40 healthy volunteers aged 19-26 years were obtained. The regions of interest were outlined using a mouse driven cursor. To determine the anatomic boundaries of the hippocampus and the amygdala the authors followed a generally accepted protocol previously described by C. Watson.

RESULTS

The mean right and left hippocampal volumes were 2.12 cm3 (SD = 0.31) and 2.07 cm3 (SD = 0.3) and the mean right and left amygdaloid volume were 1.19 cm3 (SD = 0.19) and 1.2 cm3 (SD = 0.2) respectively. The mean asymmetry between the right and left hippocampus and amygdala was 3.17% and 3.48%, respectively. The inter-observer reliability range (alpha) was between 0.97 and 0.77. Subregional analysis of hippocampus was calculated as well.

CONCLUSIONS

Normal volumetric data measured in our study fell in the midrange of the values in the literature. The volumetric analysis of the hippocampal subregions may allow assessment of providing more sensitive determination of the atrophic area, which may be important in epileptic disorders.

[Highlights of CNS research at IDR: 2,3-benzodiazepines]

2,3-benzodiazepines (2,3-BDZs) synthesized and investigated at the Institute for Drug Research (IDR) represent a unique family among CNS active compounds. Though sharing common chemical backbone, 2,3-BDZs are pharmacologically different. Over the clinically non-sedative anxiolytic parent compound tofisopam, further derivatives with specific distribution of selective binding sites in the CNS have been found. Furthermore, dopamine-uptake inhibitors with stimulant character were also described. Finally but most importantly compounds with unusually broad anticonvulsant spectrum were also discovered. From this latter series the first non-competitive AMPA antagonist, GYKI-52,466 serves today as the golden standard for investigating the glutamate neurotransmission and the therapeutical potential of glutamate antagonists. The present paper summarizes the main pharmacological actions of the most prominent members of the 2,3-BDZ family.

Highlights of CNS research at IDR: 2,3-benzodiazepines

2,3-Benzodiazepines (2,3-BDZs) synthesized and investigated at IDR represent a unique family among CNS active compounds. Though sharing common chemical backbone, 2,3-BDZs are pharmacologically different. Over the clinically nonsedative anxiolytic parent compound tofisopam, further derivatives with specific distribution of selective binding sites in the CNS have been found. Furthermore, dopamine-uptake inhibitors with stimulant character were also described. Finally but most importantly compounds with unusually broad anticonvulsant spectrum were also discovered. From this series the first non-competitive AMPA antagonist, GYKI-52466 serves today as the golden standard for investigating glutamate neurotransmission and the therapeutical potential of glutamate antagonists. The present paper summarizes the main pharmacological actions of the 2,3-BDZ family.

Three-dimensional time-of-flight MR angiography in trigeminal neuralgia on a 0.5-T system

The goal of this study was to analyze the diagnostic value of three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA), performed on a 0.5-T system in the detection of neurovascular compression in patients with trigeminal neuralgia (TN). One hundred seventy-two TN patients were examined using plain and contrast-enhanced 3D TOF MRA on a 0.5-T system. Maximum intensity projection (MIP) reconstruction was performed in three standard planes. Both the original and the reconstructed images were studied to search for vascular compression shown by close neurovascular contact and/or dislocation of the trigeminal nerve. Forty-two TN patients underwent surgical exploration of the posterior fossa. Results of MRA were compared with clinical data in all cases and to result of surgery in the surgically treated cases. Neurovascular contact at the root entry zone of the trigeminal nerve was detected on the symptomatic side in 94 patients, and on the asymptomatic side in 12 patients. Sensitivity, specificity, accuracy, as well as positive and negative predictive value of 3D TOF MRA in the detection of neurovascular compression in the patient group undergoing surgery, were 97.6, 92.5, 95.0, 93.0, and 97.4%, respectively. Three-dimensional TOF MRA performed on a 0.5-T system appears to be not less effective than similar examinations by higher field strength devices in the detection of neurovascular contact. This sequence accurately demonstrates the presence of neurovascular compression, and in this way valuable information may be achieved for the planning of surgical therapy of patients with trigeminal neuralgia.

New non competitive AMPA antagonists

New halogen atom substituted 2,3-benzodiazepine derivatives condensed with an azole ring on the seven membered part of the ring system of type 3 and 4 as well as 5 and 6 were synthesized. It was found that chloro-, dichloro- and bromo-substitutions in the benzene ring and additionally imidazole ring condensation on the diazepine ring can successfully substitute the methylenedioxy group in the well known molecules GYKI 52466 (1) and GYKI 53773 (2) and the 3-acetyl-4-methyl structural feature in 2, respectively, preserving the highly active AMPA antagonist characteristic of the original molecules. From the most active compounds (3b,i) 3b (GYKI 47261) was chosen for detailed investigations. 3b revealed an excellent, broad spectrum anticonvulsant activity against seizures evoked by electroshock and different chemoconvulsive agents indicating a possible antiepileptic efficacy. 3b was found to be highly active in a transient model of focal ischemia predictive of a therapeutic value in human stroke. 3b also reversed the dopamine depleting effect of MPTP and antagonized the oxotremorine induced tremor in mice indicating a potential antiparkinson activity.

[The possibilities of GC/MS and HPLC in the analysis of sugars and acids in natural matrices]

A GC/MS procedure is described for the simultaneous quantitation of the minor and major constituents of several natural matrices, including fruits, vegetables, mushrooms, drug/industrial plants and honeys, as their trimethylsilyl derivatives, from one solution, by one injection. Selected minor components have been determined on the basis of their characteristic fragment ions, in the presence of extremely high excess of saccharides of various degree of polymerization. Selective fragmentation of these minor compounds in the ion trap detector provided possibilities for distinguishing them. In the case of honeys the method permitted the simultaneous quantitation of o-phosphoric, malic, shikimic, citric/isocitric, quinic, margaric, oleic and stearic acids, 5-hydroxymethylfurfurol and proline with the extremely high sugar contents of honeys (fructose, glucose, galacturonic acid, inositol, sucrose, trehalose, turanose, maltose, gentiobiose, isomaltose, raffinose, erlose, melezitose, maltotriose, panose, isomaltotriose) and allowed the fast evaluation of sugar and acid constituents of fifteen honeys from various floral and geological origin. Results revealed that (i) the minor components varied in the concentration range of 0.0001 to 0.43%, and, (ii) together with the saccharides of honeys made up the total of identified and determined constituents from 87.8% to 98.5%. Quantitative evaluation of the minor constituents was performed on the basis of their selective fragment ion values with an average reproducibility of 6.7% (RSD).

[Rhabdoid meningioma: a potentially aggressive new variant]

Rhabdoid meningioma is a recently recognized clinicopathologic entity characterized histologically by cytoplasmic aggregates of intermediate filaments, and clinically by the propensity of such tumors to pursue an aggressive course. The authors report on clinical, radiologic and pathologic findings in three cases of rhabdoid meningioma identified in a retrospective surgical series of 204 meningothelial tumors. Patients included two females, aged 39 and 55 years, and a 54-year-old male. In the first two cases the tumors were located on the right and left lesser sphenoid wing, respectively; in the third case, the right cerebellopontine angle was affected. All three neoplasms evolved on a background on transitional meningioma and were conspicuous for dis-cohesive tumor cells and suppression of syncytical architecture. Immunohistochemistry and ultrastructural examination confirmed the meningothelial origin of inclusion-bearing rhabdoid cells. Although none of the tumors showed evidence of histologic anaplasia and Ki-67 labeling indices remained inferior to 2%, infiltrative growth into adjacent brain was noted in all three cases. On follow-up ranging from 8 months to 6 years, the patients remained either disease-free or alive with nonprogressive residual tumor. On account of their clinical behavior, well-differentiated rhabdoid meningiomas will be accommodated in the category of atypical meningiomas (WHO grade II). Their pathogenesis is likely to involve disrupted cytoskeletal integration of cell motility and proliferation, of which the rhabdoid phenotype may possibly represent a morphologic correlate.

Primary renal and retroperitoneal actinomycosis

A case of the rare condition of renal and retroperitoneal actinomycosis is presented. The clinical and imaging (ultrasonography and computed tomography) findings are described and attention is drawn to the diagnostic difficulties in this rare disease.

Anxiolytic 2,3-benzodiazepines, their specific binding to the basal ganglia

Over the past 20 years, several members of the 2,3-benzodiazepine family have been synthesized. Some of these compounds--tofisopam (Grandaxin), girisopam, nerisopam--exert significant anxiolytic and antipsychotic activities. Sites where actions of 2,3-benzodiazepines are mediated differ from those of 1,4-benzodiazepines. Binding of 2,3-benzodiazepines to neuronal cells in the central nervous system shows a unique and specific distribution pattern: their binding sites are located exclusively to the basal ganglia. Chemical lesioning of the striato-pallido-nigral system, surgical transections of the striato nigral pathway and the activation of c-fos expression in the basal ganglia after application of 2,3-benzodiazepines suggest that these compounds mainly bind to projecting neurons of the striatum. The binding sites are transported from the striatum to the substantia nigra and the entopeduncular nucleus. Recent studies on mechanism of action of 2,3-benzodiazepines indicate their possible role in opioid signal transduction since 2,3-benzodiazepines augment the agonist potency of morphine to induce catalepsy and analgesia, and their action is diminished in morphine tolerant animals. The possible biochemical target of 2,3-benzodiazepines is an alteration in the phosphorylation of protein(s) important in the signal transduction process. Agents affecting emotional responses evoked by endogenous opioids without danger of tolerance and dependence may represent a new therapeutic tool in the treatment of addiction and affective disorders.