Water thermodynamics and lipid oxidation in stored whey butter

Whey butter is the result of the rational use of the whey component, which is cream whey. It is an alternative to milk cream butter. The aim of the presented study was to analyze the effect of storage conditions on water thermodynamics and cholesterol oxidation products as reliable markers of quality and safety. After 4 mo of storage, the water loss (at 3°C and 13°C) and water activity in whey butter (only at 13°C) were reduced. Three-factorial ANOVA showed that the value of water activity was independent of the type of butter in interaction with the storage temperature. The duration of the translational movement of water molecules from the inside of whey butter was definitely longer than in butter and shortened with storage time. This was in contrast to butter. For whey butter stored at 13°C, the kinetics of the movement of water molecules was at the highest speed. In the case of whey butter and butter, the higher storage temperature almost doubled the gloss. Increasing the temperature to 13°C resulted in different yellowness index, chroma, and browning index between whey butter and butter. There were no statistically significant differences in the percentage of fatty acids and triacylglycerols in whey butter and milk cream butter during storage. In whey butter, compared with butter, the cholesterol content was higher, but the amount of cholesterol oxidation products was smaller. However, in whey butter, these amounts increased significantly. The presence of epoxides and their transformation products (i.e., triol cholesterol) was found in storage whey butter.

Heating and storage of structured acylglycerols with succinyl-linked stigmasterol residue does not cause negative chemical or biological changes

Four structured acylglycerols with stigmasterol bonded by a succinyl linker were investigated and their stability were analyzed. Samples were heated to 60 °C and kept at that temperature to simulate storage, and to 180 °C to simulate frying conditions. The degradation of the synthesized compounds and formed derivatives was determined, and their cytotoxicity and genotoxicity on normal human cells from the digestive system was determined. Holding at 180 °C resulted in greater degradation of the compounds than holding at 60 °C. The most stable compound in each sample proved to be one with oleic acid in its structure-1,3-dioleoyl-2-stigmasterylsuccinoyl-sn-glycerol (DO2SSt) at 60 °C and 1,2-dioleoyl-3-stigmasterylsuccinoyl-sn-glycerol (DO3SSt) at 180 °C. These results indicate that the type of fatty acid in the molecule is more important than its position in the glycerol structure. None of the diacylmonostigmasterylsuccinoyl-sn-glycerols (DASStGs) before or after heating exhibited cytotoxic or genotoxic potential to small intestine and colon mucosa cells.

Mesenchymal Chondrosarcoma from Diagnosis to Clinical Trials

Mesenchymal chondrosarcoma (MCS) is a rare subtype of chondrosarcoma with a poor prognosis. Although these tumors are sensitive to radiotherapy/chemotherapy, the standard treatment for localized MCS is only surgical resection, and there are no established treatment guidelines for patients with advanced and metastatic MCS. Due to the low incidence of MCS, the pathology of these tumors is still unknown, and other therapeutic options are lacking. Some studies show the potential role of the PDGF/PPI3K/AKT, PKC/RAF/MEK/ERK, and pRB pathways, and BCL2 overexpression in the pathogenesis of MCS. These findings provide an opportunity to use protein kinases and BCL2 inhibitors as potential therapy in MCS. In this review, we summarize the current knowledge about MCS diagnosis and treatment options. We show the immunological and molecular biomarkers used in the diagnosis of MCS. In addition, we discuss the known prognostic and predictive factors in MCS. Finally, we present the novel trends, including targeted therapies and ongoing clinical trials using protein kinase inhibitors and the death receptor 5 (DR5) agonist, which may be the focus of future MCS treatment studies.

Epidemiology of Blastocystis Infection: A Review of Data from Poland in Relation to Other Reports

Blastocystis is a common gut protist of humans and various animals worldwide, with a high level of genetic diversity. Neither its zoonotic potential and transmission routes nor its pathogenicity are fully known. This fact, and the fact that Blastocystis is the most abundant eukaryote in human faeces, raises the question of its relevance to public health. Here, we summarise (in relation to other reports) the results of studies on the prevalence and genotypic variation of Blastocystis, which were carried out in animals, humans, and in water environments in Poland. In humans, the prevalence ranged between 0.14 and 23.6%, in some animals reached 58.97%, and in water environments was 5.1%. Seven subtypes were identified in humans (ST1-ST4, ST6, ST7, and ST9), of which ST3 was the most common. Among animals (wild, livestock, and pet animals), eleven STs were identified, with differential host specificity. Humans and animals shared ST1, ST2, ST3, ST6, and ST7, while ST1 and ST3 were present in humans, animals, and water sources. These observations indicate the possibility of Blastocystis transmission between animals and humans. Further studies should be continued in search of the sources and transmission routes of Blastocystis in order to prevent the spread of infections among humans and animals.

Thermo-oxidative stability and safety of new acylglycerols with stigmasterol residue: Effects of fatty acids saturation and position in the glycerol backbone

The safety and thermoxidative stability of new diacyl-stigmasterylcarbonoyl-sn-glycerols (DAStGs) with two molecules of palmitic or oleic acids and one molecule of stigmasterol at the sn-2 or sn-3 position were studied. After heating to 60 °C, the compounds with stigmasterol at the sn-2 position were more stable than those with stigmasterol at the sn-3 position. The lowest level of degradation of stigmasterol after heating to 180 °C was detected for both compounds with oleic acid, followed by the samples with palmitic acid. The high content of SOPs, especially triolSt, as well as the high level of dimers showed the most effect on the cytotoxicity of DAStGs heated at both temperatures. DAStGs with oleic acid at sn-1,3 and stigmasterol at sn-2 position were the most stable compounds. Both oleic acid and the location of stigmasterol in the middle of the glycerol molecule play an important role in increasing the thermoxidative stability of stigmasterol.

Rare Occurrence of Blastocystis in Pet Animals and Their Owners in the Pomeranian Voivodeship in Poland in the Light of Literature Data

Blastocystis is an intestinal microeukaryote with ambiguous pathogenicity, commonly detected in human feces worldwide. It comprises at least 28 genetically diverse subtypes (STs), 12 of which also occur in a wide range of animal species, giving rise to suspicion of zoonotic transmission. To investigate this, we conducted a molecular study of 145 stool samples of pet animals, and 67 of their owners, living in an urban area in Poland. Blastocystis was detected in only three (2.1%) animal samples (of two bearded agamas and a leopard gecko), while all dogs, cats, and pet rodents were Blastocystis-negative. Blastocystis was also present in three (4.5%) owners of animals, but they were cat owners, not reptile owners, and the subtypes identified in them differed significantly from those of reptiles. Additionally, the frequency of Blastocystis in different groups of dogs (depending on how they were kept) was analyzed. This work is the first to find Blastocystis in pet reptiles, and we encourage further investigation of Blastocystis in this poorly examined group of animals, as well as continued study on the transmission of this microorganism between humans and animals.

Thermo-oxidative stability of asymmetric distigmasterol-modified acylglycerols as novel derivatives of plant sterols

The study investigated the thermo-oxidative stability of distigmasterol-modified acylglycerols as a new structured acylglycerols. Samples were heated at 60 and 180 °C for 8 h. Their percentage degradation and products formed during heating were compared with free stigmasterol and stigmasteryl esters. The remaining of stigmasterol and fatty acid parts, the formation of stigmasterol oxidation products and the composition of polar and non-polar fractions were analysed using chromatographic methods. The cytotoxicity and genotoxicity were determined with the use of an MTT test and a comet assay, respectively. The highest stability during heating was observed for 2,3-distigmasterylsuccinoyl-1-oleoyl-sn-glycerol (dStigS-OA) and the lowest for 2,3-distigmasterylcarbonoyl-1-oleoyl-sn-glycerol (dStigC-OA). Data showed that the formation of thermo-oxidative degradation products is affected by the temperature and chemical structure of lipids present in the molecule. The dStigMAs bonded by a succinate linker and products formed during their thermo-oxidation showed no cytotoxic or genotoxic activity to normal human cells.

Photosensitized oxidation of cholesterol and altered oxysterol levels in sour cream: Effects of addition of cucumber pickles

The aim of this research was to examine whether sour cream (18% fat) is an exogenous source of oxysterols and whether it is possible to improve its antioxidative properties and to modulate cholesterol transformation by adding cucumber. To determine whether cucumber modifies the properties of sour cream, fresh cucumber or cucumber pickle (pH 3.3; 1.5% lactic acid) was added in an amount of 20%. The sour cream samples were then stored under light (450 lx, 590 cd, 120 lm) for 3 wk. After storage, the addition of the cucumber pickle increased total mesophilic aerobic bacteria from 7.5 to 9.3 log cfu/g and increased the l-lactic acid content from 6.1 to 9.7 g/L. The total conjugated linoleic acid content in sour cream with cucumber pickle also increased to 4.5 mg/g fat after storage, whereas the cholesterol content decreased to 3.44 g/kg fat. Importantly, with the addition of cucumber pickle, the total content of cholesterol oxidization products (COP) did not change after storage (1.7 mg/kg fat). By contrast, the total COP content in the control sour cream sample increased from 1.7 to 7.3 mg/kg fat over 3 wk of storage. The dominant COP before and after storage was 7β-hydroxycholesterol. Thus, despite exposure to light, adding cucumber pickle to sour cream modulates cholesterol transformation and effectively inhibits the formation of oxysterols.

Molecular Characterization of Blastocystis from Animals and Their Caregivers at the Gdańsk Zoo (Poland) and the Assessment of Zoonotic Transmission

Blastocystis is a highly genetically diverse gut protist commonly found in humans and various animals. The role of animals in human infection is only partly understood. The aim of this study was to determine the host specificity and possibility of zoonotic transmission of this microorganism. Subtypes of Blastocystis isolated from 201 zoo animals and their 35 caregivers were identified by sequencing of the SSU rRNA gene. Blastocystis was found in 26.86% of animal and 17.14% of human samples. Both mammalian (ST1-ST3, ST5, ST8, ST10, ST13, ST14) and non-mammalian subtypes were detected. Of the subtypes found in non-human primates (ST1, ST2, ST3, and ST13), two subtypes (ST1 and ST3) were also detected in humans. The presence of identical ST1 sequences in three monkeys and their caregiver indicates the possibility of direct transmission of Blastocystis between these animals and humans. Detection of ST5 only in wild boars and peccaries, ST8 only in Marsupial, ST10 and ST14 only in Bovidae, and non-mammalian subtypes in reptiles suggests higher host specificity for these subtypes, and indicates that their transmission between animals and humans is unlikely. Additionally, this was probably the first time that ST5 was found in peccaries, ST2 in patas monkeys, and ST8 in red kangaroos.

Botulinum toxin type-A preparations are not the same medications - clinical studies (Part 2)

The growing number of Botulinum neurotoxin type A (BoNT/A) preparations on the market has resulted in a search for pharmacological, clinical and pharmacoeconomic differences. Patients are occasionally switched from one botulinum toxin formulation to another. The aim of this paper was to review studies that have made direct comparisons of the three major BoNT/A preparations presently on the market: ona-, abo- and incobotulinumtoxinA. We also review the single medication Class I pivotal and occasionally Class II-IV studies, as well as recommendations and guidelines to show how effective doses have been adopted in well-established indications such as blepharospasm, hemifacial spasm, cervical dystonia and adult spasticity. Neither direct head-to-head studies nor single medication studies between all preparations allow the formation of universal conversion ratios. All preparations should be treated as distinct medications with respect to their summary of product characteristics when used in everyday practice.

Effect of age of Japanese quail on physical and biochemical characteristics of eggs

The aim of the study was to investigate the effects of age of birds on egg quality in Japanese quail. The eggs were randomly selected from among all eggs laid on the same day when the birds were 15, 23 and 31 weeks old. At each time point, 90 fresh eggs were evaluated for their physical and biochemical characteristics. Egg weights were similar over time. At 23 and 31 weeks, the eggs had less shell than at 15 weeks. Crude fat and ash contents of the eggs increased with the age of the birds. Crude protein was also highest in eggs of the oldest quail. At 31 weeks old, the eggs were lowest in pH of yolk and white. Quail that were 23 and 31 weeks old laid eggs with significantly higher polyunsaturated fatty acid (PUFA) and lower saturated fatty acid (SFA) contents. The lowest cholesterol content was in egg yolks from 23-week-old quail. The oldest birds had the highest contents of sodium, potassium, zinc, selenium, copper, and manganese. The content and activity of lysozyme decreased with ageing of the birds. From the consumers’ point of view, eggs from older birds appeared to be the most valuable. At the same time, as the quail ages, the antibacterial properties of eggs deteriorate, which may indicate a shorter shelf life.

First Report on the Occurrence and Subtypes of Blastocystis in Pigs in Poland Using Sequence-Tagged-Site PCR and Barcode Region Sequencing

Blastocystis is an enteric microorganism commonly found in humans and animals worldwide. Its pathogenic role in humans and transmission patterns has not been fully explained. However, nine subtypes (ST1-8, ST12) are considered as potentially zoonotic. Studies from various regions of the world show that pigs are mainly infected with ST5. Although pigs are important farmed animals in Poland, the question of Blastocystis infection in these animals has not yet been investigated. Herein, 149 pig stool samples from 10 Polish pig farms were analyzed using sequence-tagged-site PCR and barcode region sequencing. The percentage of samples in which Blastocystis was identified using each method separately was similar: 38.25% and 37.58%, respectively. However, the percentage of positive results obtained by combining both methods was 46.97%, which means that, depending on the method used, the number of undetected samples varied between 8.72% and 9.39%. This shows the methodological limitations of up-to-date molecular approaches commonly used in Blastocystis research. A moderate infection rate (44.4-50%) observed in different pig age groups with a vital predominance of ST5 (94.28%) in every age group shows that pigs are a likely natural host of ST5. A small percentage of mixed infections, namely ST5/ST1 (5.26%), ST5/ST3 (1.75%), and ST3/ST1 (1.75%), was observed only in animals of older age, suggesting that ST3 and ST1 can be acquired by pigs during contact with humans. This study provides the first data on the prevalence and Blastocystis subtypes (STs) distribution in pigs in Poland. The results also highlight the need for the development of new methods capable of detecting highly genetically diverse Blastocystis isolates and mixed infections.

Blastocystis subtypes isolated from travelers and non-travelers from the north of Poland - A single center study

Blastocystis is a common, enteric protist of humans and animals with a worldwide distribution and unclear clinical relevance. Nine out of 17 genetically diverse subtypes occur in humans. We analysed the distribution of Blastocystis subtypes and the intensity of invasion in relation to the gastrointestinal tract disorders and travels to different continents. 122 Blastocystis stool cultures were subtyped via polymerase chain reaction (PCR) with seven pairs of subtype-specific, sequence-tagged-site (STS) primers. Five subtypes of Blastocystis were detected: ST3 (59%), ST2 (19.7%), ST1 (13.1%), ST6 (3.3%), ST7 (3.3%), and two mixed infections with ST1/ST3 (1.6%). ST1 was detected exclusively in travelers to hot climate zones and ST2 was found more frequently in people visiting other continents compared to those who never left Poland. We found no correlation between gastrointestinal tract disorders, Blastocystis STs, and parasite load. There was no age predisposition to the Blastocystis infection. We established the distribution of Blastocystis STs among Poles traveling to different continents and never leaving Poland. Our study sheds more light on the problem of importing Blastocystis infection. It shows that certain subtypes detected in Europe can be imported due to travel or migration. Collecting data on the travel history of the surveyed persons is necessary to clarify this matter.

Column chromatography as a method for minor components removal from rapeseed oil

The purpose of this study was to verify the influence of different chromatographic column beds (silicic acid, activated charcoal, aluminum oxide, silica gel) on the concentration of individual minor components (sterols, tocopherols, carotenoids and chlorophyll) in rapeseed oil. With the use of a combination of these beds, a three-stage optimized method for removing minor components from rapeseed oil was developed. It was demonstrated that the combination of silicic acid and activated charcoal removed about half of the sterols present from the oil. Aluminum oxide turned out to be the most effective bed in removing tocopherols, purifying the oil to their minimum level (2.6 mg/kg). All adsorbents used had similar capacity to purify oil from pigments (carotenoids and chlorophyll). In the three-stage purification process free sterols were almost completely removed (to the level 90.0 mg/kg). Purification of β-carotene and chlorophyll from the oil was also very effective. Tocopherols were completely removed with this method, except for a small amount of α-tocopherol (0.4 mg/kg), which results from its relatively weak interaction with a hydrophilic bed. The developed method may be used in studies on the effect of association colloids on bulk oil autoxidation processes.

Neurological and neuropsychological complications in the course of chronic Whipple's disease - case report

INTRODUCTION

Whipple's disease (WD) is a chronic, multisystemic infectious disease caused by Gram-positive bacillus Tropheryma whipplei (T.w.). Its common symptoms arise in the digestive system, however, during the infection the CNS (Central Nervous System) may also be affected.

AIM

The aim of this work is to present a case report of a patient diagnosed with Whipple's disease with dominant neuropsychological and behavioural complications in the late phase.

CONCLUSIONS

Whipple's disease is a rare disease with possible neurological and neuropsychiatric complications. Neurological disorders (eye movement disorders, myoclonus, oculoskeletal miorhythmia, progressive dementia) may develop in spite of correct pharmacological treatment. Apart from its classical symptoms, unspecified cognitive function disorders and autonomic nervous system disorders may develop. Providing right antibiotic treatment may not always lead to complete remission or prevent neuropsychiatric complications. However, early diagnosis and clinical alertnessallow to administer right treatment and improve further prognosis.

Clinical usefulness of Western blotting and ELISA avidity for the diagnosis of human toxocariasis

The serodiagnosis of human toxocariasis is difficult. Specific IgGs detected routinely with ELISA based on Toxocara excretory-secretory (TES) antigens often persist for years at an elevated level, which does not allow either the differentiation between an active and persistent infection or monitoring of the effect of treatment. Additionally, false-positive results may occur in co-infections with other helminths due to cross-reactions. We evaluated the usefulness of an IgG avidity index (AI) and a Western blotting (WB) IgG in the diagnosis of patients suspected of Toxocara infection. We studied 138 subjects who were submitted to serological testing two or more times. Confirmation of an infection by WB was achieved in 73.2% of patients. A high AI was obtained in 89.1% of patients, and low AI and borderline AI were found in only 10.9%. Low and borderline values of AI remained at similar levels in subsequent studies over 2-3 years. The results showed the necessity of obligatory verification of all ELISA IgG positive and questionable results by WB. The index of IgG avidity may be helpful in excluding recent infection, but its usefulness in detecting an active phase of invasion requires further research.

Eye movement abnormalities in essential tremor

Essential tremor (ET) is the most prevalent movement disorder, characterized mainly by an action tremor of the arms. Only a few studies published as yet have assessed oculomotor abnormalities in ET and their results are unequivocal. The aim of this study was to assess the oculomotor abnormalities in ET patients compared with the control group and to find the relationship between oculomotor abnormalities and clinical features of ET patients. We studied 50 ET patients and 42 matched by age and gender healthy controls. Saccadometer Advanced (Ober Consulting, Poland) was used to investigate reflexive, pace-induced and cued saccades and conventional electrooculography for evaluation of smooth pursuit and fixation. The severity of the tremor was assessed by the Clinical Rating Scale for Tremor. Significant differences between ET patients and controls were found for the incidence of reflexive saccades dysmetria and deficit of smooth pursuit. Reflexive saccades dysmetria was more frequent in patients in the second and third phase of ET compared to the first phase. The reflexive saccades latency increase was correlated with severity of the tremor. In conclusion, oculomotor abnormalities were significantly more common in ET patients than in healthy subjects. The most common oculomotor disturbances in ET were reflexive saccades dysmetria and slowing of smooth pursuit. The frequency of reflexive saccades dysmetria increased with progression of ET. The reflexive saccades latency increase was related to the severity of tremor.

Assessment of Gait Therapy Effectiveness in Patients with Parkinson's Disease on the Basis of Three-Dimensional Movement Analysis

Objective

The aim of this study was to assess the effect of physical exercise on gait pattern disorders, based on three-dimensional gait analysis in the sagittal plane in a group of people with Parkinson’s disease (PD).

Methods

Thirty-two subjects with PD (14 women and 18 men; age: 50–75 years) were qualified for the study, which ran for 3 weeks and included 18 therapeutic sessions. Thirty-five control subjects were included in the research (13 women and 19 men; age: 52–77 years). Gait analysis using the Vicon 3D system took place in the Biokinetics Laboratory. The research group was tested before and after treatment, and the control group was tested once.

Results

Comparing the average peak angle changes and average standard time results (% gait cycle) corresponding with angles of movement in the lumbar spine, cervical spine, elbow joint, and shoulder joint, statistically significant changes were observed. The study results are indicative of differences in spatiotemporal parameters and angular changes in gait for both groups. After therapeutic treatment, we observed improvement in the angular range of changes in thorax tilting, but there were no difference between the most affected and less affected side. For the cervical spine, a significant reduction in flexion during dual support was observed. The angular range of changes in shoulder joint was significant only in less affected shoulder during the initial contact (F1), terminal stance (F4), and terminal stance (F8) phases of gait (p < 0.05). After therapeutic treatment, significant angle and setting changes in the most affected limb of the elbow joint occurred during the initial contact and terminal swing phases (F1, F8). In the terminal stance phase (F4), an increase in range of motion by about ±4° was observed (p < 0.05).

Conclusion

Exercise therapy slightly increased the range of movement in the examined joints of PD’s patients. Results of pathological walking patterns occurring prior to treatment improved after treatment and moved closer to the physiological gait pattern.

Is hypertension a risk factor of hemifacial spasm?

OBJECTIVES

The published data on the relation between arterial hypertension (AH) and hemifacial spasm (HFS) are controversial. The aim of the study was to determine the prevalence of AH in HFS patients and the relation of AH and compression of the brainstem at the region of vasomotor center.

MATERIALS AND METHODS

The study included 60 of primary HFS patients and 60 healthy controls matched by age. AH was defined according to WHO criteria. The vessel compression of the brainstem was measure on MRI scans in selected region of vasomotor center located in the ventro-lateral medulla (VLM), between the pontomedullary junction, retro-olivary sulcus and the root entry zone (REZ) of the IX and X nerves. Modeling and compression severity of the VLM was graded in the 0-3 scale.

RESULTS

The prevalence of AH in HFS patients did not differ significantly from the control group (61.6% vs 45.0%, p=ns). VML compression by vessel was frequently found in HFS patients with AH than without AH (97.2% vs 60.9%, χ(2)=11.0, p=0.0009). A similar relation was also found in the control group. The higher rate of VML vascular compression was related to the presence of AH in both, HFS patients and control group.

CONCLUSION

The prevalence of AH in HFS patients does not differ from controls. The VLM compression in HFS patients and controls is related to AH diagnosis. The association between AH and VLM compression is stronger in patients with higher degree of VLM compression.

The effects of physiotherapy with PNF concept on gait and balance of patients with Huntington's disease - pilot study

BACKGROUND AND PURPOSE

Huntington's disease (HD) is a neurodegenerative, progressive disorder of the central nervous system which causes significant gait and balance disturbances. This is a pilot study which aims to determine the effects of a physiotherapy programme with use of Proprioceptive Neuromuscular Facilitation (PNF) on gait and balance in HD patients.

MATERIAL AND METHODS

30 HD patients aged 21-60 with genetically confirmed diagnosis participated in the study. Participants followed a 3-week-long PNF-based physiotherapy programme. Gait and balance were evaluated twice in each participant: first at baseline and then after the course of physiotherapy. The following methods were used for gait disturbances: Tinetti Gait Assessment Tool, Up and Go Test, Timed Walking Tests for 10m and 20m (TWT10m, TWT20m). Balance was assessed with use of Berg Balance Scale, Pastor Test and Functional Reach Test.

RESULTS

There was a significant improvement in all measures of balance and gait.

CONCLUSION

PNF-based physiotherapy is effective and safe in HD patients.

[Clinical variability of Juvenile Huntington's Disease phenotype]

Huntington's disease is rare, genetically determinated, neurodegenerative disorder. It is determined by dynamic mutation of IT15 gene on short arm of 4 chromosome. Characteristic symptomatology include involuntary movements, cognitive decline and wide spectrum of mood and behaviour disorders. It typically becomes noticeable in mid-adult life, but there are reported cases of appaers of symptoms between 2 and 80 year of life. Especially interesting is juvenile Huntington's disease- the Westphal variant with the beginning in childchood (before 20 year of age) because of clinical differences causing diagnostic difficulties. It affects 5-10% of carries of the mutant gene. Symptoms became noticeable before 10 year of age only in 1% of them.

[Systemic lupus erythematosus of the nervous system--selected aspects]

Neurological symptoms in SLE are still the challenge for the practitioners. It is assumed that that the central nervous system (CNS) is affected in 95% patients with SLE. It is a cause significantly worsening the prognosis, responsible for the mortality increase in this disease. In 1999 American Academy of Rheumatology published the first formal classification of the neurological symptoms in SLE. 19 types of the neuropsychiatric systemic lupus erythematosous (NPSLE) are distinguished. Ischaemic strokes of CNS, transistent ischaemic attaks, epileptic seizures and mobility disturbances are the most common symptoms. It is assumed that antiphospholipid antibodies are the most important factors in the NPSLE pathogenesis. These antibodies reveal prothrombotic and proinflammatory activities with vasculitis as the effect of this action. However it should be stressed that cause-effect relationship between the action of specific antibodies and neurological symptoms are still unclear. Better understanding of neurological and psychiatric symptoms of SLE may allow faster diagnosis, as well as the disease exacerbation and the application of proper therapy.

[Psychotic disorder in the course of Systemic Lupus Erythematosus with subcortical calcifications--case report]

Systemic Lupus Erythematosus (SLE) is autoimmunological disease of connective tissue which is characterized with clinical symptoms of many systems and organs injury. There are often neuropsychiatric symptoms. Psychotic disorder is the least frequent syndrome. Neuropsychiatric symptoms are important because they deteriorate the quality of life and are poor prognostic factor.

AIM

The aim of the study is to present the patient with chronic, lasting for many years, skin lesions and laboratory tests results characteristic for SLE, who had psychotic disorder diagnosed as schizophrenia and in the next few years there were observed other neuropsychiatric symptoms including cognitive impairment and mood disorder.

CONCLUSIONS

Psychotic disorder is rare syndrome of neuropsychiatric SLE (NPSLE). It may primarily originate from SLE or be secondary either to the therapy or the complications of the disease. It is not possible to define if the psychosis is the primary schizophrenic process or secondary to the autoimmune disease in presented patient. However the clinical picture pays attention to the significance of careful diagnostic process, including neuroimaging. In head CT of presented patient there were revealed massive, bilateral, calcifications of subcortical structures which probably substantially enhanced neuropsychiatric symptoms.

A rare sequence variant in intron 1 of THAP1 is associated with primary dystonia

Although coding variants in THAP1 have been causally associated with primary dystonia, the contribution of noncoding variants remains uncertain. Herein, we examine a previously identified Intron 1 variant (c.71+9C>A, rs200209986). Among 1672 subjects with mainly adult-onset primary dystonia, 12 harbored the variant in contrast to 1/1574 controls (P < 0.01). Dystonia classification included cervical dystonia (N = 3), laryngeal dystonia (adductor subtype, N = 3), jaw-opening oromandibular dystonia (N = 1), blepharospasm (N = 2), and unclassified (N = 3). Age of dystonia onset ranged from 25 to 69 years (mean = 54 years). In comparison to controls with no identified THAP1 sequence variants, the c.71+9C>A variant was associated with an elevated ratio of Isoform 1 (NM_018105) to Isoform 2 (NM_199003) in leukocytes. In silico and minigene analyses indicated that c.71+9C>A alters THAP1 splicing. Lymphoblastoid cells harboring the c.71+9C>A variant showed extensive apoptosis with relatively fewer cells in the G2 phase of the cell cycle. Differentially expressed genes from lymphoblastoid cells revealed that the c.71+9C>A variant exerts effects on DNA synthesis, cell growth and proliferation, cell survival, and cytotoxicity. In aggregate, these data indicate that THAP1 c.71+9C>A is a risk factor for adult-onset primary dystonia.

Role of Gα(olf) in familial and sporadic adult-onset primary dystonia

The vast majority of patients with primary dystonia are adults with focal or segmental distribution of involuntary movements. Although ~10% of probands have at least one first- or second-degree relative to dystonia, large families suited for linkage analysis are exceptional. After excluding mutations in known primary dystonia genes (TOR1A, THAP1 and CIZ1), whole-exome sequencing identified a GNAL missense mutation (c.682G>T, p.V228F) in an African-American pedigree with clinical phenotypes that include cervical, laryngeal and hand-forearm dystonia. Screening of 760 subjects with familial and sporadic primary dystonia identified three Caucasian pedigrees with GNAL mutations [c.591dupA (p.R198Tfs*13); c.733C>T (p.R245*); and c.3G>A (p.M1?)]. These mutations show incomplete penetrance. Our findings corroborate those of a recent study which used whole-exome sequencing to identify missense and nonsense GNAL mutations in Caucasian pedigrees of mixed European ancestry with mainly adult-onset cervical and segmental dystonia. GNAL encodes guanine nucleotide-binding protein G(olf), subunit alpha [Gα(olf)]. Gα(olf) plays a role in olfaction, coupling D1 and A2a receptors to adenylyl cyclase, and histone H3 phosphorylation. African-American subjects harboring the p.V228F mutation exhibited microsmia. Lymphoblastoid cell lines from subjects with the p.V228F mutation showed upregulation of genes involved in cell cycle control and development. Consistent with known sites of network pathology in dystonia, immunohistochemical studies indicated that Gα(olf) is highly expressed in the striatum and cerebellar Purkinje cells, and co-localized with corticotropin-releasing hormone receptors in the latter.

Novel pathogenic mutations and copy number variations in the VPS13A gene in patients with chorea-acanthocytosis

Chorea-acanthocytosis (ChAc) is a rare autosomal recessive neurodegenerative disorder caused by loss of function mutations in the vacuolar protein sorting 13 homolog A (VPS13A) gene that encodes chorein. It is characterized by adult-onset chorea, peripheral acanthocytes, and neuropsychiatric symptoms. In the present study, we performed a comprehensive mutation screen, including sequencing and copy number variation (CNV) analysis, of the VPS13A gene in ChAc patients. All 73 exons and flanking regions of VPS13A were sequenced in 35 patients diagnosed with ChAc. To detect CNVs, we also performed real-time quantitative PCR and long-range PCR analyses for the VPS13A gene on patients in whom only a single heterozygous mutation was detected. We identified 36 pathogenic mutations, 20 of which were previously unreported, including two novel CNVs. In addition, we investigated the expression of chorein in 16 patients by Western blotting of erythrocyte ghosts. This demonstrated the complete absence of chorein in patients with pathogenic mutations. This comprehensive screen provides an accurate and useful method for the molecular diagnosis of ChAc.

The c.-237_236GA>TT THAP1 sequence variant does not increase risk for primary dystonia

BACKGROUND

Sequence variants in coding and noncoding regions of THAP1 have been associated with primary dystonia.

METHODS

In this study, 1,446 Caucasian subjects with mainly adult-onset primary dystonia and 1,520 controls were genotyped for a variant located in the 5'-untranslated region of THAP1 (c.-237_236GA>TT).

RESULTS

Minor allele frequencies were 62/2892 (2.14%) and 55/3040 (1.81%) in subjects with dystonia and controls, respectively (P=0.202). Subgroup analyses by gender and anatomical distribution also failed to attain statistical significance. In addition, there was no effect of the TT variant on expression levels of THAP1 transcript or protein.

DISCUSSION

Our findings indicate that the c.-237_236GA>TT THAP1 sequence variant does not increase risk for adult-onset primary dystonia in Caucasians.

Tremor in hemifacial spasm patients

Tremor often accompanies dystonia and some other movement disorders. There are no reports describing tremor in patients with hemifacial spasm (HFS). The aim of the study was to assess the occurrence, type and parameters of tremor in HFS patients. The study included 47 HFS patients (mean age: 58.6 ± 10.7-years-old) and 48 healthy volunteers matched by sex and age. Tremor was assessed clinically and objectively using a triaxial accelerometer and EMG. A load test with 500 g weight was performed in order to identify physiological tremor. The Clinical Global Impression-Severity scale (CGI-S) was used to assess the severity of HFS. Neurological examination revealed tremor in 19 patients and 5 control subjects, and the objective methods postural and kinetic hand tremor was confirmed. Among the patients we identified: one case of psychogenic tremor, two patients were diagnosed with essential tremor, six patients had essential tremor in one hand and enhanced physiologic tremor in the other, seven patients had essential tremor in both hands and three patients had physiological tremor in both hands. Five control subjects revealed enhanced the physiological tremor type. The occurrence of hand tremor was associated with higher severity of HFS, as assessed by CGI score. Tremor accompanies HFS in 40% of cases and 10% of control subjects. The aetiology of hand tremor in patients with HFS is unknown. However, it may be associated with compression of the tremor oscillator located in the medulla.

The clinical and neuroimaging studies in Holmes tremor

AIM

Holmes tremor (HT) is a combination of rest, postural and action tremor. A parallel dysfunction of cerebello-thalamic and nigrostriatal pathways seems necessary to produce this kind of tremor. We present the clinical and neuroimaging study verifying that hypothesis.

MATERIAL AND METHODS

A total of 10 patients: five male, five female, fulfilling consensus criteria were included. Demographic, clinical and neuroimaging data (MRI = 9; CT = 1, SPECT with the use of 123-I-FP CIT: DaTSCAN in six patients to assess the presynaptic dopaminergic nigrostriatal system involvement, indices of asymmetry for ligand uptake for each striatum were calculated) were analyzed.

RESULTS

Hemorrhage was the most frequent etiology and thalamus - the most commonly involved structure. Contrary to the previous reports, the visual assessment did not reveal remarkable interhemispheric differences of DaTSCAN uptake. Quantitative measurements showed only minimal differences.

CONCLUSIONS

It is open to debate whether nigrostriatal pathway damage is crucial for the phenomenology of HT. Alternative hypothesis is presented that HT represents the heterogeneous spectrum of tremors with similar phenomenology, but different pathophysiology.

Hemifacial spasm non-motor and motor-related symptoms and their response to botulinum toxin therapy

Hemifacial spasm (HFS) is a chronic movement disorder which presents as clonic and/or tonic facial muscle contractions frequently accompanied by many other sensory (visual or auditory disturbances, pain), motor (facial weakness, trismus, bruxism, dysarthria) and/or autonomic (lacrimation, salivation) symptoms. The aim of the study was to assess the occurrence of HFS non-motor and motor-related symptoms and their responsiveness to botulinum toxin type A (BTX-A) therapy. 56 HFS patients were included in the open-label design study. Patients were examined three times: before BTX-A injection, and 2 and 12 weeks later. The occurrence of non-motor and motor-related symptoms was assessed by a special questionnaire, and the severity of HFS was rated by the Clinical Global Impression-Severity scale (CGI-S) and depression symptoms by the Beck Depression Inventory (BDI). Over 81% of the patients before BTX-A therapy reported HFS non-motor and motor-related symptoms. Almost 50% of the patients reported more than three symptoms. The most frequent symptoms were: tearing (44.5%), eye irritation (39.3%), facial paraesthesia (26.8%) and hearing of a "clicking" sound (25.0%). 2 weeks after BTX-A injection 75% of the patients did not report any symptoms and 20% reported only one or two. 3 months later the number of symptoms had increased again, with 57% of patients reporting at least one. The number of HFS non-motor and other symptoms did not correlate with the patients' age, disease duration and the presence of neuro-vascular conflict, but were positively correlated with the CGI-S and BDI scores. This study showed that muscle contractions in HFS patients are commonly accompanied by non-motor and other motor-related symptoms and most of them are reduced following BTX-A treatment.

Spiral drawing time as a measure of bradykinesia

BACKGROUND AND PURPOSE

Bradykinesia, which is commonly defined as slowness of movements, is one of the cardinal signs of Parkinson's disease (PD) and parkinsonian syndromes. Simple clinical rating scales are used commonly to measure bradykinesia in routine clinical practice although this kind of assessment is biased. The aim of the study was to evaluate the time of spiral drawing as a measure of bradykinesia.

MATERIAL AND METHODS

Fifty-four patients with PD and 39 healthy age- and sex-matched volunteers were examined. The severity of parkinsonism was assessed using UPDRS and bradykinesia was assessed using instrumental methods: the BRAIN test, Nine-Hole Peg Board (NHPB) test and Quantitative Tremor Analysis on the Graphic Digitizing Tablet (QTAGDT). QTAGDT registers patients' hand movements during the spiral drawing task and generates several data characterizing tremor and the spiral drawing time as an additional result.

RESULTS

The spiral drawing time was significantly longer in PD patients when compared to normal controls (p <0.001). The bradykinesia assessment using the spiral drawing time showed a significant correlation with the clinical rating score of the UPDRS (R = 0.64, p = 0.001) and with the results of other instrumental methods: the BRAIN Test and NHPB test (R = -0.52, p = 0.0007, R = 0.55, p = 0.03, respectively). Hand tremor seemed to have no impact on bradykinesia assessment, and the new method was found to be highly test-retest reliable (R = 0.95, p < 0.0001).

CONCLUSION

The spiral drawing time is a simple, quick and objective assessment of upper limb bradykinesia.

Causes and risk factors of falls in patients with Parkinson's disease

BACKGROUND AND PURPOSE

Falls are a common and serious problem among Parkinson's disease (PD) patients. However, knowledge about the causes and risk factors of falls is limited. There have been a few attempts to classify the causes of falls. The classification suggested by Olanow seems to be the most comprehensive one. The aim of this study was to analyze retrospectively the causes of falls and risk factors of falls in PD patients.

MATERIAL AND METHODS

One hundred and four patients with moderately advanced PD were included in the study. The patients were asked to describe the circumstances and consequences of falls which occurred during 12 months preceding the examination. The falls were classified according to the Olanow classification of causes of falls.

RESULTS

Fifty-two patients (50%) reported at least one fall during the previous year with a mean number of 1.5 falls per year. The most common causes of falls were environmental factors, sudden falls and postural instability. There were no falls caused by severe dyskinesia, drugs or cardiovascular disorders. The only independent risk factors of the recurrent falls identified in this study were UPDRS part II score (OR 1.17, 95% CI: 1.02-1.37) and Mini Mental State Examination score (OR 0.85, 95% CI: 0.72-0.99).

CONCLUSIONS

Considering these results we may be able to prevent most falls by means of the education of patients about environmental factors and using adequate rehabilitation techniques concentrating on postural stability and gait.

Quantitative tremor measurement with the computerized analysis of spiral drawing

BACKGROUND AND PURPOSE

There are several instrumental and clinical methods to assess hand tremor. The clinical methods, e.g. rating scales, have the advantage that they are available to most clinicians; however, they require experience, and are not as repeatable as instrumental methods. The study describes the use of a method based on a digitizing tablet and artificial neuronal networks in the assessment of tremor. The Automated Computer Tremor Score (ACTS) is based on spiral drawings on a graphic digitizing tablet. The aim of the study was to evaluate a new method and compare it with the standardized methods of tremor assessment.

MATERIAL AND METHODS

A hundred and one patients with idiopathic Parkinson's disease (IPD) and 52 patients with essential tremor (ET) were examined. All subjects were asked to draw an Archimedes spiral on the graphic tablet. The drawn spirals were evaluated using ACTS and clinically by three independent raters according to a ten-point scale. Tremor was additionally assessed using the volumetric method. The Automated Computer Tremor Score correlated considerably with tremor rates provided by every rater (r=0.68 vs. r=0.76, p<0.0001), and with measures obtained using the volumetric method (r=0.63, p=0.01 and r=0.56, p= 0.03). ACTS also correlated with ADL score among ET patients (r=0.56, p=0.0004).

CONCLUSIONS

The study shows that neuronal networks may be taught to rate tremor severity analogically to human rating and automated scoring may be a useful method in clinical practice.