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Sabaei M, Rahimian S, Haj Mohamad Ebrahim Ketabforoush A, Rasoolijazi H, Zamani B, Hajiakhoundi F, Soleimani M, Shahidi G, Faramarzi M. Salivary levels of disease-related biomarkers in the early stages of Parkinson's and Alzheimer's disease: A cross-sectional study. IBRO Neurosci Rep 2023; 14:285-292. [PMID: 36942319 PMCID: PMC10023984 DOI: 10.1016/j.ibneur.2023.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction Finding a non-invasive and repeatable tool has been recommended to make an accurate diagnosis of Alzheimer's disease (AD) and Parkinson's disease (PD). Methods 70 volunteers participated in three groups: 24 with mild dementia of AD, 24 in the first and second stages of PD, and 22 healthy controls. After valuing the scores of cognitive tests, the salivary levels of phosphorylated tau (p-tau), total alpha-synuclein (α-syn), and beta-amyloid 1-42 (Aβ) proteins have been evaluated. Finally, the cutoff points, receiver operating characteristic (ROC), sensitivity, and specificity have been calculated to find accurate and detectable biomarkers. Results Findings showed that the salivary level of Aβ was higher in both PD (p < 0.01) and AD (p < 0.001) patients than in controls. Moreover, the level of α-syn in both PD and AD patients was similarly lower than in controls (p < 0.05). However, the level of p-tau was only higher in the AD group than in the control (p < 0.01). Salivary Aβ 1-42 level at a 60.3 pg/ml cutoff point revealed an excellent performance for diagnosing AD (AUC: 0.81). Conclusion Evaluation of p-tau, α-syn, and Aβ 1-42 levels in the saliva of AD and PD patients could help the early diagnosis. The p-tau level might be valuable for differentiation between AD and PD. Therefore, these hopeful investigations could be done to reduce the usage of invasive diagnostic methods, which alone is a success in alleviating the suffering of AD and PD patients. Moreover, introducing accurate salivary biomarkers according to the pathophysiology of AD and PD should be encouraged.
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Key Words
- AD, Alzheimer's disease
- Alzheimer's disease
- Aβ, Beta-amyloid 1–42
- BDRS, Blessed Dementia Rating Scale
- Beta-amyloid
- CSF, Cerebrospinal fluid
- CT scan, Computed tomography scan
- ELISA, Enzyme-linked immunosorbent assay
- MDS-UPDRS, MDS-Unified Parkinson’s Disease Rating Scale
- MMSE, MCI (mild cognitive impairment mini-mental state examination
- MRI, Magnetic resonance imaging
- MoCA, Montreal Cognitive Assessment
- NFTs, Neurofibrillary Tangles
- NIA-AA, National Institute on Aging-Alzheimer’s Association
- PD, Parkinson's disease
- Parkinson's disease
- Phosphorylated tau
- ROC, Receiver operating characteristic
- Total alpha-synuclein
- p-tau, Phosphorylated tau
- α-syn, Total alpha-synuclein
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Affiliation(s)
- Masoomeh Sabaei
- Anatomy Department, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Cellular & Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saba Rahimian
- Dentistry School, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Homa Rasoolijazi
- Anatomy Department, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Cellular & Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Zamani
- Neurology Department, Rasool Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Fahime Hajiakhoundi
- Neurology Department, Rasool Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mansoureh Soleimani
- Anatomy Department, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Cellular & Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamali Shahidi
- Neurology Department, Firoozgar Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mahmood Faramarzi
- Research center of pediatric infectious diseases, institute of immunology and infectious diseases, Rasool Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Thuan DD, Nguyet NT, Chi LD, Van Nhat D, Hung DV, Khanh N, Thao PN, Xuan NT. A case report: Ruptured aneurysm with a wide neck treated by flow diverter stent and coil embolization. Radiol Case Rep 2022; 18:862-868. [PMID: 36589494 PMCID: PMC9798131 DOI: 10.1016/j.radcr.2022.11.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022] Open
Abstract
Diagnosis and endovascular treatment for ruptured wide neck aneurysms are challenges in clinics, particularly in developing countries. In the present study, we described a clinical case with a ruptured wide neck aneurysm in Vietnam treated by flow diverter stent and coil embolization. A 77-year-old- female patient had a right droopy eyelid for 2 months. The patient was admitted to hospital on the second day after being presented with a sudden-severe headache. Cerebral computed tomography (CT) and magnetic resonance imaging (MRI) were taken on the second day and fifth day after the onset of the headache. The results showed an aneurysm in the right internal carotid artery but no potential subarachnoid hemorrhage (SAH) was displayed. An uncoagulated blood was found in cerebrospinal fluid indicated by a lumbar puncture test. Digital subtraction angiography provided images with one wide-neck right internal carotid aneurysm. The patient was treated by flow diverter stent and coil embolization and the dual antiplatelet therapy with ticagrelor and aspirin at home. After 45 days, the patient did not face with any complication, no neurological symptoms, and the aneurysm was partially thrombosed indicated by MRI images. These results suggested that a lumbar puncture should be analyzed on the patient with brain aneurysm appeared a sudden severe headache and even no potential SAH on brain MRI or CT was found. The combination of flow diverter stent and coil embolization to treat cases with ruptured wide necked aneurysms should be considered in the future.
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Affiliation(s)
- Do Duc Thuan
- Department of Stroke, 103 Military Hospital, Vietnam Military Medical University, 261 Phung Hung Street, Ha Dong District, Ha Noi city, Vietnam
| | - Nguyen Thi Nguyet
- Department of Stroke, 103 Military Hospital, Vietnam Military Medical University, 261 Phung Hung Street, Ha Dong District, Ha Noi city, Vietnam
| | - Le Duy Chi
- Department of Ultrasound, 103 Military Hospital, Vietnam Military Medical University, 261 Phung Hung Street, Ha Dong District, Ha Noi city, Vietnam
| | - Dao Van Nhat
- Department of Urology, 103 Military Hospital, Vietnam Military Medical University, 261 Phung Hung Street, Ha Dong District, Ha Noi city, Vietnam
| | - Dinh Viet Hung
- Department of Psychiatry, 103 Military Hospital, Vietnam Military Medical University, 261 Phung Hung Street, Ha Dong District, Ha Noi city, Vietnam
| | - Nguyen Khanh
- Department of Thoracic Surgery, 103 Military Hospital, Vietnam Military Medical University, 261 Phung Hung Street, Ha Dong District, Ha Noi city, Vietnam
| | - Pham Ngoc Thao
- Department of Functional Diagnosis, 103 Military Hospital, Vietnam Military Medical University, 261 Phung Hung Street, Ha Dong District, Ha Noi city, Vietnam,Corresponding authors.
| | - Nguyen Thanh Xuan
- Department of Senior Officer, 103 Military Hospital, Vietnam Military Medical University, 261 Phung Hung Street, Ha Dong District, Ha Noi city, Vietnam,Corresponding authors.
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Hakomäki H, Eskola S, Kokki H, Lehtonen M, Räsänen J, Laaksonen S, Voipio HM, Ranta VP, Kokki M. Central Nervous System Distribution of Buprenorphine in Pregnant Sheep, Fetuses and Newborn Lambs After Continuous Transdermal and Single Subcutaneous Extended-Release Dosing. Eur J Pharm Sci 2022; 178:106283. [PMID: 36029997 DOI: 10.1016/j.ejps.2022.106283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022]
Abstract
Buprenorphine is used during pregnancy for the treatment of opioid use disorder. Limited data exist on the central nervous system (CNS) permeation and distribution, and on the fetal exposure to buprenorphine. The aim of our study was to determine the extent of buprenorphine distribution to CNS in the pregnant sheep, and their fetus at steady-state, and their newborn lambs postdelivery, using three different dosing regimens. Twenty-eight pregnant ewes in late gestation received buprenorphine via 7-day transdermal patch releasing buprenorphine 20 µg/h (n=9) or 40 µg/h (n=11), or an extended-release 8 mg/week subcutaneous injection (n=8). Plasma, cerebrospinal fluid, and CNS tissue samples were collected at steady-state from ewes and fetuses, and from lambs 0.33 - 45 hours after delivery. High accumulation of buprenorphine was observed in all CNS tissues. The median CNS/plasma concentration -ratios of buprenorphine in different CNS areas ranged between 13 and 50 in the ewes, and between 26 and 198 in the fetuses. In the ewes the CNS/plasma -ratios were similar after the three dosing regimens, but higher in the fetuses in the 40 µg/h dosing group, medians 65 - 122, than in the 20 µg/h group, medians 26 - 54. The subcutaneous injection (theoretical release rate 47.6 µg/h) produced higher concentrations than observed after 40 µg/h transdermal patch dosing. The median fetal/maternal concentration -ratios in different dosing groups ranged between 0.21 and 0.54 in plasma, and between 0.38 and 1.3 in CNS tissues, respectively, with the highest ratios observed in the spinal cord. Buprenorphine concentrations in the cerebrospinal fluid were 8 - 13 % of the concurrent plasma concentration in the ewes and 28 % in the fetuses. Buprenorphine was quantifiable in the newborn lambs' plasma and CNS tissues two days postdelivery. Norbuprenorphine was analyzed from all plasma, cerebrospinal fluid, and CNS tissue samples but was nondetectable or below the LLOQ in most. The current study demonstrates that buprenorphine accumulates into CNS tissues at much higher concentrations than in plasma in pregnant sheep, fetuses, and their newborn lambs even 45 hours after delivery.
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Key Words
- BUP, Buprenorphine
- CL, Plasma clearance
- CNS, Central nervous system
- CSF, Cerebrospinal fluid
- F/M -ratio, Fetal to maternal concentration ratio
- HPLC, , High-performance liquid chromatography
- L/M -ratio, Lamb to maternal concentration ratio
- LC/MS/MS, Liquid chromatography - tandem mass spectrometry
- LLOQ, Lower limit of quantification
- NBUP, Norbuprenorphine
- brain
- buprenorphine
- pharmacokinetics, pregnancy
- sheep
- tissue
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Affiliation(s)
| | - Sophia Eskola
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Hannu Kokki
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Marko Lehtonen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Juha Räsänen
- Fetal Medicine Center, Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sakari Laaksonen
- Department of Comparative Medicine, Oulu Laboratory Animal Centre, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Hanna-Marja Voipio
- Department of Comparative Medicine, Oulu Laboratory Animal Centre, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Veli-Pekka Ranta
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Merja Kokki
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
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Hosaagrahara Ramakrishna S, Kasala MB, Perumal K, Malleeswaran S, Patcha RV, Varghese J, Sathiyasekaran M, Reddy MS. When Push Comes to Shove! Emergency ABO-Incompatible Pediatric Living Donor Liver Transplant for Acute Wilson's Disease. J Clin Exp Hepatol 2022; 12:658-663. [PMID: 35535085 PMCID: PMC9077158 DOI: 10.1016/j.jceh.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/09/2021] [Indexed: 12/12/2022] Open
Abstract
ABO-incompatible living donor liver transplantation (ABOi-LDLT) is on the rise as a viable option in countries with limited access to deceased donor grafts. While reported outcomes of ABOi-LT in children are similar to ABO- Compatible liver transplant (ABOc-LT), most children beyond 1-2 years of age will need desensitization to overcome the immunological barrier of incompatible blood groups. The current standard protocol for desensitization is Rituximab that targets B lymphocytes and is given 2-3 weeks prior to LT. However, this timeline may not be feasible in children requiring emergency LT for acute liver failure (ALF) or acute-on-chronic liver failure (ACLF). In this emergency situation of ABOi-LT, a safe multipronged approach may be an acceptable alternative solution. We report a child with acute Wilson's disease with rapidly deteriorating liver function who underwent a successful ABOi-LDLT using a rapid desensitization protocol.
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Key Words
- ABOc-LT, ABO-compatible liver transplantation (ABOi-LDLT)
- ABOi-LDLT, ABO-incompatible living donor liver transplantation
- ACLF, Acute-on-chronic liver failure
- ALF, Acute liver failure
- AMR, Antibody-mediated rejection
- CMV, Cytomegalovirus
- CSF, Cerebrospinal fluid
- GRWR, Graft-to-recipient weight ratio
- LDLT, Living donor liver transplantation
- LT, Liver transplant
- MMF, Mycophenolate mofetil
- PVT, Portal vein thrombosis
- Rituximab
- acute Wilson’s disease
- acute-on-chronic liver disease
- emergency ABOi-LDLT
- living donor liver transplantation
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Affiliation(s)
| | - Mohan Babu Kasala
- Department of Pediatric Intensive Care, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | - Karnan Perumal
- Department of Pediatric Intensive Care, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | - Selvakumar Malleeswaran
- Liver Anesthesia and Critical Care, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | - Rajanikanth V Patcha
- Department of Liver Transplant and Hepatopancreaticobiliary Surgery, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | - Joy Varghese
- Department of Hepatology and Liver Transplant, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | - Malathy Sathiyasekaran
- Senior Pediatric Gastroenterologist, MGM, Rainbow and Kanchi Kamakoti CHILDs Trust Hospitals, Chennai, India
| | - Mettu Srinivas Reddy
- Department of Liver Transplant and Hepatopancreaticobiliary Surgery, Gleneagles Global Health City, Perumbakkam, Chennai, India
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Mahmoudvand G, Ebrahimzadeh F, Mahmoudvand B, Tarhani F. Epidemiology of findings of lumbar puncture among pediatric patients. Ann Med Surg (Lond) 2021; 72:103093. [PMID: 34876982 PMCID: PMC8632850 DOI: 10.1016/j.amsu.2021.103093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 11/25/2022] Open
Abstract
Objective Lumbar Puncture (LP) is a common invasive procedure where cerebrospinal fluid is obtained for the diagnosis of neurological anomalies. The purpose of this study was to evaluate the results of CSF analysis in patients admitted to pediatric wards. Methods In this retrospective descriptive study, records of the pediatric patients (aged <18 years) who were referred to our centers for lumbar puncture were evaluated. A checklist was prepared for all the patients where demographic data, findings of CSF and blood analysis and clinical presentations were recorded. The data obtained was analyzed using SPSSv22. Results In this study a total number of 247 patients were included where 57.9% of the cases were of boys. 55.8% patients aged under 1 year and 62.3% of patients had a body temperature of 38 °C and above. 15.3% of the children were diagnosed with meningitis, 27.1% had febrile seizures, 9.3% had neonatal sepsis and for 48.2% cases other clinical diagnoses were made. There was a significant relationship between the diagnosis and the number of WBCs seen in CSF (P < 0.001). Also, there was a significant relationship between the diagnosis and amount of protein (P < 0.001) and glucose in CSF (P = 0.005). The age group and the type of fever and seizure were also significantly correlated, (P < 0.001). Conclusion Lumbar puncture is an important procedure for the diagnosis of several neurological diseases. Further studies including neuroimaging and therapeutic measures are recommended in this regard.
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Affiliation(s)
- Golnaz Mahmoudvand
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Farzad Ebrahimzadeh
- Department of Biostatistics, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran.,Nutritional Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Behnaz Mahmoudvand
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Tarhani
- Department of Pediatrics, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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Nielsen JE, Maltesen RG, Havelund JF, Færgeman NJ, Gotfredsen CH, Vestergård K, Kristensen SR, Pedersen S. Characterising Alzheimer's disease through integrative NMR- and LC-MS-based metabolomics. Metabol Open 2021; 12:100125. [PMID: 34622190 PMCID: PMC8479251 DOI: 10.1016/j.metop.2021.100125] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 12/14/2022] Open
Abstract
Background Alzheimer's Disease (AD) is a complex and multifactorial disease and novel approaches are needed to illuminate the underlying pathology. Metabolites comprise the end-product of genes, transcripts, and protein regulations and might reflect disease pathogenesis. Blood is a common biofluid used in metabolomics; however, since extracellular vesicles (EVs) hold cell-specific biological material and can cross the blood-brain barrier, their utilization as biological material warrants further investigation. We aimed to investigate blood- and EV-derived metabolites to add insigts to the pathological mechanisms of AD. Methods Blood samples were collected from 10 AD and 10 Mild Cognitive Impairment (MCI) patients, and 10 healthy controls. EVs were enriched from plasma using 100,000×g, 1 h, 4 °C with a wash. Metabolites from serum and EVs were measured using liquid chromatography-mass spectrometry (LC-MS) and nuclear magnetic resonance (NMR) spectroscopy. Multivariate and univariate analyses were employed to identify altered metabolites in cognitively impaired individuals. Results While no significant EV-derived metabolites were found differentiating patients from healthy individuals, six serum metabolites were found important; valine (p = 0.001, fold change, FC = 0.8), histidine (p = 0.001, FC = 0.9), allopurinol riboside (p = 0.002, FC = 0.2), inosine (p = 0.002, FC = 0.3), 4-pyridoxic acid (p = 0.006, FC = 1.6), and guanosine (p = 0.004, FC = 0.3). Pathway analysis revealed branched-chain amino acids, purine and histidine metabolisms to be downregulated, and vitamin B6 metabolism upregulated in patients compared to controls. Conclusion Using a combination of LC-MS and NMR methodologies we identified several altered mechanisms possibly related to AD pathology. EVs require additional optimization prior to their possible utilization as a biological material for AD-related metabolomics studies.
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Key Words
- ACE, Addenbrooke's cognitive examination
- AD, Alzheimer's Disease
- AUC, Area under the curve
- Alzheimer
- Aβ, Amyloid-β
- BBB, Blood-brain barrier
- BCAA, Branched-chain amino acid
- Blood
- CNS, Central nervous system
- CSF, Cerebrospinal fluid
- CV, Cross-validation
- EVs, Extracellular vesicles
- Extracellular vesicles
- FAQ, Functional activities questionnaire
- FDR, False discovery rate
- MCI, Mild cognitive impairment
- MMSE, Mini-mental state examination
- Mass spectrometry
- Metabolites
- Nuclear magnetic resonance
- PCA, Principal component analysis
- ROC, Receiver operating characteristics
- p-tau, Phospho-tau
- sPLS-DA, Sparse partial least squared discriminant analysis
- t-tau, Total-tau
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Affiliation(s)
- Jonas Ellegaard Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Raluca Georgiana Maltesen
- Translational Radiation Biology and Oncology Laboratory, Centre for Cancer Research, Westmead Institute of Medical Research, Westmead, Australia.,Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper F Havelund
- Department of Biochemistry and Molecular Biology, Villum Center for Bioanalytical Sciences, University of Southern Denmark, Odense, Denmark
| | - Nils J Færgeman
- Department of Biochemistry and Molecular Biology, Villum Center for Bioanalytical Sciences, University of Southern Denmark, Odense, Denmark
| | | | | | - Søren Risom Kristensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Shona Pedersen
- Department of Basic Medical Sciences, College of Medicine, Qatar University, Qatar Health, Doha, Qatar
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Wafford KA. Aberrant waste disposal in neurodegeneration: why improved sleep could be the solution. Cereb Circ Cogn Behav 2021; 2:100025. [PMID: 36324713 PMCID: PMC9616228 DOI: 10.1016/j.cccb.2021.100025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 06/16/2023]
Abstract
Sleep takes up a large percentage of our lives and the full functions of this state are still not understood. However, over the last 10 years a new and important function has emerged as a mediator of brain clearance. Removal of toxic metabolites and proteins from the brain parenchyma generated during waking activity and high levels of synaptic processing is critical to normal brain function and only enabled during deep sleep. Understanding of this process is revealing how impaired sleep contributes an important and likely causative role in the accumulation and aggregation of aberrant proteins such as β-amyloid and phosphorylated tau, as well as inflammation and neuronal damage. We are also beginning to understand how brain slow-wave activity interacts with vascular function allowing the flow of CSF and interstitial fluid to drain into the body's lymphatic system. New methodology is enabling visualization of this process in both animals and humans and is revealing how these processes break down during ageing and disease. With this understanding we can begin to envisage novel therapeutic approaches to the treatment of neurodegeneration, and how reversing sleep impairment in the correct manner may provide a way to slow these processes and improve brain function.
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Key Words
- AQP4, aquaporin-4
- Alzheimer's disease
- Amyloid
- Aquaporin-4
- Astrocyte
- Aβ, beta amyloid
- BOLD, blood-oxygen level dependent imaging
- CAA, cerebral amyloid angiopathy
- CSF, Cerebrospinal fluid
- Clearance
- EEG, electroencephalography
- EMG, electromyography
- Glymphatic
- ISF, interstitial fluid
- MCI, mild cognitive impairment
- MRI, magnetic resonance imaging
- NOS, nitric oxide synthase
- NREM, non-rapid eye movement
- OSA, obstructive sleep apnea
- PET, positron emission tomography
- REM, rapid-eye movement
- SWA, slow wave activity
- SWS, slow-wave sleep
- Slow-wave sleep
- iNPH, idiopathic normal pressure hydrocephalus
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Axelsen TM, Vammen TL, Bak M, Pourhadi N, Stenør CM, Grønborg S. Case report: 'AARS2 leukodystrophy'. Mol Genet Metab Rep 2021; 28:100782. [PMID: 34285876 DOI: 10.1016/j.ymgmr.2021.100782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 12/17/2022] Open
Abstract
Background Mitochondrial alanyl-tRNA synthetase 2 gene (AARS2) related disease is a rare genetic disorder affecting mitochondrial metabolism, leading to severe cardiac disease in infants or progressive leukodystrophy in young adults. The disease is considered ultra-rare with only 39 cases of AARS2-leukodystrophy previously reported. Case presentation We present the case of a young man of consanguineous heritage suffering from cognitive decline and progressive spasticity as well as weakness of the proximal musculature. Utilizing MRI and whole genome sequencing, the patient was diagnosed with a homozygous AARS2 missense variant (NM_020745.3:c.650C > T; p.(Pro217Leu)) and a homozygous CAPN3 variant (NM_000070.2: c.1469G > A; p.(Arg490Gln)), both variants have previously been identified in patients suffering from AARS2 related leukodystrophy and limb-girdle muscular dystrophy, respectively. Conclusions This case report presents a case of homozygous AARS2 leukodystrophy and serves to highlight the importance of whole genome sequencing in diagnosing rare neurological diseases as well as to add to the awareness of adult onset leukodystrophies.
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Key Words
- AARS2
- AARS2, Mitochondrial alanyl-tRNA synthetase 2 gene
- AARS2-L, Mitochondrial alanyl-tRNA synthetase 2 gene leukodystrophy
- ADLs, activities of daily living
- ALSP, Adult-Onset Leukoencephalopathy With Axonal Spheroids and Pigmented Glia
- Adult onset leukodystrophies
- CSF, Cerebrospinal fluid
- CSF1R, Colony stimulating factor-1 receptor
- Case report
- DARS2, Deficiency of aspartyl-tRNA
- EARS2, Deficiency of glutamate-tRNA synthetase
- HDLS, Hereditary Diffuse Leukodystrophy with axonal Spheroids
- IEM, Inborn errors of metabolism
- Inborn errors of metabolism
- LGMD R1, Limb-girdle muscular dystrophy R1 calpain3-related
- Limb-girdle muscular dystrophy
- MMSE, Mini-Mental State Examination
- Mt-aaRS, Mitochondrial aminoacyl-tRNA synthetase
- Whole genome sequencing
- mtDNA, Mitochondrial DNA
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Jabeen A, Vijayram R, Ranganathan S. A two-stage computational approach to predict novel ligands for a chemosensory receptor. Curr Res Struct Biol 2021; 2:213-221. [PMID: 34235481 PMCID: PMC8244491 DOI: 10.1016/j.crstbi.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 11/01/2022] Open
Abstract
Olfactory receptor (OR) 1A2 is the member of largest superfamily of G protein-coupled receptors (GPCRs). OR1A2 is an ectopically expressed receptor with only 13 known ligands, implicated in reducing hepatocellular carcinoma progression, with enormous therapeutic potential. We have developed a two-stage screening approach to identify novel putative ligands of OR1A2. We first used a pharmacophore model based on atomic property field (APF) to virtually screen a library of 5942 human metabolites. We then carried out structure-based virtual screening (SBVS) for predicting the potential agonists, based on a 3D homology model of OR1A2. This model was developed using a biophysical approach for template selection, based on multiple parameters including hydrophobicity correspondence, applied to the complete set of available GPCR structures to pick the most appropriate template. Finally, the membrane-embedded 3D model was refined by molecular dynamics (MD) simulations in both the apo and holo forms. The refined model in the apo form was selected for SBVS. Four novel small molecules were identified as strong binders to this olfactory receptor on the basis of computed binding energies.
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Key Words
- APF, Atomic property field
- Amber, Assisted model Building with Energy Refinement
- Atomic property field
- Binding free energy calculation
- CSF, Cerebrospinal fluid
- ECL, Extracellular loop
- GPCR, G protein coupled receptor
- HCMV, Human cytomegalovirus
- HMDB, Human metabolome database
- Hydrophobicity correspondence
- LBVS, Ligand based virtual screening
- LC, Lung carcinoids
- MD, Molecular dynamics
- MMGBSA, Molecular mechanics generalized born surface area
- MMPBSA, Molecular mechanics Poisson–Boltzmann surface area
- Molecular dynamics
- NAFLD, Non-alcoholic fatty liver disease
- NASH, Nonalcoholic steatohepatitis
- OR, olfactory receptor
- OR1A2
- Olfactory receptor
- PMEMD, Particle-Mesh Ewald Molecular Dynamics
- POPC, 1-palmitoyl-2-oleoyl-sn-glycero- 3-phosphatidylcholine
- RMSD, Root mean square deviation
- RMSF, Root mean square fluctuation
- SBVS, Structure based virtual screening
- SSD, Sum of squared difference
- TM, Transmembrane
- Virtual ligand screening
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Affiliation(s)
- Amara Jabeen
- Department of Molecular Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Ramya Vijayram
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai 600036, Tamilnadu, India
| | - Shoba Ranganathan
- Department of Molecular Sciences, Macquarie University, Sydney, NSW 2109, Australia
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10
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Hackert J, Maßmann L, Sure U, Forsting M, Kleinschnitz C, Pul R, Hagenacker T. Immunotherapies in chronic adhesive arachnoiditis - A case series and literature review. eNeurologicalSci 2021; 24:100350. [PMID: 34195394 PMCID: PMC8225987 DOI: 10.1016/j.ensci.2021.100350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/10/2021] [Accepted: 06/09/2021] [Indexed: 01/02/2023] Open
Abstract
Chronic spinal adhesive arachnoiditis (CSAA) is a rare condition with limited therapeutic options. Surgical treatment proves effective in approximately 60% of cases. Conservative treatment options have not been extensively investigated. Here, we report the course of the disease, analyze the effect of immune treatments in patients with CSAA who were treated in the University Hospital Essen between 2015 and 2020, and conduct a literature review. Three out of four patients showed no improvement after treatment with corticosteroids, methotrexate, or plasmapheresis. All non-responders suffered from CSAA for several years, while one patient who had a disease duration of less than one month fully recovered. It is necessary to verify whether treatment at an early stage of the disease is better than treatment after chronic adhesion manifestation, as it interrupts the development of adhesions and all subsequent complications. Surgical treatment of CSAA patients proves effective in approx. 60% of cases. High-dose steroid treatment may be effective in early stages of CSAA. Only conservative therapy cannot be recommended in long-standing CSAA.
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Affiliation(s)
- Jana Hackert
- University Medicine Essen, Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, Hufelandstrasse 55, 45147 Essen, Germany
| | - Louisa Maßmann
- University Medicine Essen, Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, Hufelandstrasse 55, 45147 Essen, Germany
| | - Ulrich Sure
- University Medicine Essen, Department of Neurosurgery and Spine Surgery, Hufelandstrasse 55, 45147 Essen, Germany
| | - Michael Forsting
- University Medicine Essen, Institute of Diagnostic and Interventional Radiology and Neuroradiology, Hufelandstrasse 55, 45147 Essen, Germany
| | - Christoph Kleinschnitz
- University Medicine Essen, Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, Hufelandstrasse 55, 45147 Essen, Germany
| | - Refik Pul
- University Medicine Essen, Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, Hufelandstrasse 55, 45147 Essen, Germany
| | - Tim Hagenacker
- University Medicine Essen, Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, Hufelandstrasse 55, 45147 Essen, Germany
- Corresponding author.
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11
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Stead GA, Cresswell FV, Jjunju S, Oanh PK, Thwaites GE, Donovan J. The role of optic nerve sheath diameter ultrasound in brain infection. eNeurologicalSci 2021; 23:100330. [PMID: 33728383 PMCID: PMC7935708 DOI: 10.1016/j.ensci.2021.100330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/18/2021] [Indexed: 11/24/2022] Open
Abstract
Brain infections cause significant morbidity and mortality worldwide, especially in resource-limited settings with high HIV co-infection rates. Raised intracranial pressure [ICP] may complicate brain infection and worsen neurological injury, yet invasive ICP monitoring is often unavailable. Optic nerve sheath diameter [ONSD] ultrasound may allow detection of raised ICP at the bedside; however, pathology in brain infection is different to traumatic brain injury, in which most studies have been performed. The use of ONSD ultrasound has been described in tuberculous meningitis, cryptococcal meningitis and cerebral malaria; however correlation with invasive ICP measurement has not been performed. Normal optic nerve sheath values are not yet established for most populations, and thresholds for clinical intervention cannot be assumed to match those used in non-infective brain pathology. ONSD ultrasound may be suitable for use in resource-limited settings by clinicians with limited ultrasound training. Standardisation of scanning technique, consensus on normal ONSD values, and action on abnormal results, are areas for future research. This scoping review examines the role of ONSD ultrasound in brain infection. We discuss pathophysiology, and describe the rationale, practicalities, and challenges of utilising ONSD ultrasound for brain infection monitoring and management. We discuss the existing evidence base for this technique, and identify knowledge gaps and future research priorities.
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Key Words
- AIDS, Acquired immunodeficiency syndrome
- Brain infection
- CSF, Cerebrospinal fluid
- HIV, Human immunodeficiency virus
- ICP, Intracranial pressure
- IQR, Interquartile range
- IRIS, Immune reconstitution inflammatory syndrome
- LP, Lumbar puncture
- MAP, Mean arterial pressure
- Meningitis
- ONSD, Optic nerve sheath diameter
- Optic nerve sheath diameter
- ROC, Receiver-operator characteristic
- Raised intracranial pressure
- SD, Standard deviation
- TB meningitis, Tuberculous meningitis
- TBI, Traumatic brain injury
- Ultrasound
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Affiliation(s)
| | - Fiona V. Cresswell
- Infectious Diseases Institute, Kampala, Uganda
- Clinical Research Department London School of Hygiene and Tropical Medicine, London, United Kingdom
- Medical Research Council – Uganda Virus Research Institute - London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Pham K.N. Oanh
- Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Guy E. Thwaites
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Centre for Tropical Medicine, Ho Chi Minh City, Viet Nam
| | - Joseph Donovan
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Centre for Tropical Medicine, Ho Chi Minh City, Viet Nam
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12
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Choudhary A, Varshney R, Kumar A, Kaushik K. A Prospective Study of Novel Therapeutic Targets Interleukin 6, Tumor Necrosis Factor α, and Interferon γ as Predictive Biomarkers for the Development of Posttraumatic Epilepsy. World Neurosurg X 2021; 12:100107. [PMID: 34195601 PMCID: PMC8233159 DOI: 10.1016/j.wnsx.2021.100107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/24/2021] [Indexed: 12/02/2022] Open
Abstract
Background Posttraumatic epilepsy (PTE) is a serious and debilitating consequence of traumatic brain injury (TBI). Sometimes, the management of PTE becomes a challenging task on account of its resistance to existing antiepileptic drugs and often contributes to poor functional and psychosocial outcomes after TBI. We investigated the role of inflammatory markers interleukin 6 (IL-6), tumor necrosis factor α (TNF-α), and interferon γ (INF-γ) in predicting the development of PTE. Methods A prospective analysis was performed of 254 patients who were admitted with head injury to our hospital, 35 of whom had posttraumatic epilepsy (32 males and 3 females); 30 adults (28 men, 2 women) with a similar demographic profile were selected randomly as control individuals. Blood levels of TNF-α, IL-6, and INF-γ were evaluated in all participants. Results IL-6 levels were significantly higher in the PTE group (121.36 pg/mL; standard deviation [SD], 89.23) than in the nonseizure group (65.30 pg/mL; SD, 74.75; P = 0.01), whereas there was no significant difference between the seizure group (11.42 pg/mL; SD, 7.84) and the nonseizure groups (10.58 pg/mL; SD, 7.84) in terms of TNF-α level (P = 0.343). The level of INF-γ in the seizure group tended to be higher (mean, 1.88 pg/mL, SD, 2.13 in seizure group vs. 1.10 pg/mL, SD, 1.45 in the nonseizure group); however, no statistically significant difference was detected among the 2 groups (P = 0.09). Conculsions Posttraumatic epilepsy has a strong association with an increased level of IL-6 in the blood. INF-γ may or may not be associated with PTE. However, TNF-α was not associated with PTE.
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Key Words
- CI, Confidence interval
- CNS, Central nervous system
- CSF, Cerebrospinal fluid
- Cytokines
- Epileptogenesis
- GCS, Glasgow Coma Scale
- IL-6, Interleukin 6
- INF-γ, Interferon γ
- Immunomodulators
- NMDA, N-methyl-d-aspartate
- Neuroplasticity
- PTE, Posttraumatic epilepsy
- PTS, Posttraumatic seizures
- ROC, Receiver operating characteristic
- Seizures
- TBI, Traumatic brain injury
- TNF-α, Tumor necrosis factor α
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Affiliation(s)
| | - Rahul Varshney
- To whom correspondence should be addressed: Rahul Varshney, M.Ch.
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13
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Osawa I, Kozawa E, Mitsufuji T, Yamamoto T, Araki N, Inoue K, Niitsu M. Intravenous enhanced 3D FLAIR imaging to identify CSF leaks in spontaneous intracranial hypotension: Comparison with MR myelography. Eur J Radiol Open 2021; 8:100352. [PMID: 34026946 PMCID: PMC8134034 DOI: 10.1016/j.ejro.2021.100352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/27/2021] [Accepted: 05/08/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To evaluate the clinical utility of intravenous gadolinium-enhanced heavily T2-weighted 3D fluid-attenuated inversion recovery (HT2-FLAIR) imaging for identifying spinal cerebrospinal fluid (CSF) leaks in patients with spontaneous intracranial hypotension (SIH). Methods Patients with SIH underwent MR myelography and post-contrast HT2-FLAIR imaging after an intravenous gadolinium injection. Two types of CSF leaks (epidural fluid collection and CSF leaks around the nerve root sleeve) at each vertebral level were compared between the 2 sequences. The total numbers of CSF leaks and vertebral levels involved were recorded for the whole spine. The sequence that was superior for the overall visualization of epidural and paraspinal fluid collection was then selected. Results Nine patients with SIH were included in the present study. HT2-FLAIR imaging was equivalent or superior to MR myelography at each level for detecting the 2 types of CSF leaks. In the 2 types of CSF leaks, the total numbers of CSF leaks and levels involved were higher on HT2-FLAIR images than on MR myelography, while no significant difference was observed for CSF leaks around the nerve root sleeve. In all 9 patients, HT2-FLAIR imaging was superior to MR myelography for the overall visualization of epidural and paraspinal fluid collection. Conclusion Intravenous gadolinium-enhanced HT2-FLAIR imaging was superior to MR myelography for the visualization of CSF leaks in patients with SIH. This method can be useful for identifying spinal CSF leaks.
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Key Words
- CHESS, Chemical shift selective
- CSF, Cerebrospinal fluid
- FLAIR, Fluid-attenuated inversion recovery
- HT2-FLAIR, Heavily T2-weighted fluid-attenuated inversion recovery
- Heavily T2-weighted 3D FLAIR
- Intravenous gadolinium-enhanced MR imaging
- MIP, Maximum intensity projection
- MPR, Multiplanar reconstruction
- MR myelography
- MRI, Magnetic resonance imaging
- SIH, Spontaneous intracranial hypotension
- Spinal cerebrospinal fluid leak
- Spontaneous intracranial hypotension
- T1W, T1-weighted
- T2W, T2-weighted
- TSE, Turbo spin echo
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Affiliation(s)
- Iichiro Osawa
- Department of Radiology, Saitama Medical University Hospital, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
- Corresponding author at: 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan.
| | - Eito Kozawa
- Department of Radiology, Saitama Medical University Hospital, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Takashi Mitsufuji
- Department of Neurology, Saitama Medical University Hospital, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Toshimasa Yamamoto
- Department of Neurology, Saitama Medical University Hospital, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Nobuo Araki
- Department of Neurology, Saitama Medical University Hospital, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Kaiji Inoue
- Department of Radiology, Saitama Medical University Hospital, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Mamoru Niitsu
- Department of Radiology, Saitama Medical University Hospital, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
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14
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Wassenberg T, Geurtz BPH, Monnens L, Wevers RA, Willemsen MA, Verbeek MM. Blood, urine and cerebrospinal fluid analysis in TH and AADC deficiency and the effect of treatment. Mol Genet Metab Rep 2021; 27:100762. [PMID: 33996491 PMCID: PMC8093927 DOI: 10.1016/j.ymgmr.2021.100762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background Aromatic L-amino acid decarboxylase (AADC) deficiency and tyrosine hydroxylase (TH) deficiency are rare inherited disorders of monoamine neurotransmitter synthesis which are typically diagnosed using cerebrospinal fluid examination of monoamine neurotransmitter metabolites. Until now, it has not been systematically studied whether analysis of monamine neurotransmitter metabolites in blood or urine has diagnostic value as compared to cerebrospinal fluid examination, or whether monoamine neurotransmitter metabolites in these peripheral body fluids is useful to monitor treatment efficacy. Methods Assessment, both by literature review and retrospective analysis of our local university hospital database, of monoamine neurotransmitter metabolites in urine, blood and cerebrospinal fluid, and serum prolactin levels, before and during treatment in patients with AADC and TH deficiency. Results In AADC deficiency, 3-O-methyldopa in serum or dried blood spots was reported in 34 patients and found to be (strongly) increased in all, serotonin in serum was decreased in 7/7 patients. Serum prolactin was increased in 34/37 and normal in 3 untreated patients. In urine, dopamine was normal or increased in 21/24 patients, 5-hydroxyindoleacetic acid was decreased in 9/10 patients, and vanillactic acid was increased in 19/20 patients. No significant changes were seen in monoamine neurotransmitter metabolites after medical treatment, except for an increase of homovanillic acid in urine and cerebrospinal fluid after levodopa therapy, sometimes even in absence of a clinical response. After gene therapy, cerebrospinal fluid homovanillic acid increased in most patients (8/12), but 5-hydroxyindoleacetic acid remained unchanged in 9/12 patients. In TH deficiency, serum prolactin was increased in 12/14 and normal in the remaining untreated patients. Urinary dopamine was decreased in 2/8 patients and normal in 6. Homovanillic acid concentrations in cerebrospinal fluid increased upon levodopa treatment, even in the absence of a clear treatment response. Conclusions This study confirms that cerebrospinal fluid is the most informative body fluid to measure monoamine neurotransmitter metabolites when AADC or TH deficiency is suspected, and that routine follow-up of cerebrospinal fluid measurements to estimate treatment response is not needed. 3-O-methyldopa in dried blood spots and vanillactic acid in urine are promising peripheral biomarkers for diagnosis of AADC deficiency. However, in many patients with TH or AADC deficiency dopamine in urine is normal or increased thereby not reflecting the metabolic block. The value of serum prolactin for follow-up of AADC and TH deficiency should be further studied.
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Key Words
- 3-OMD, 3-O-methyldopa
- 5-HIAA, 5-Hydroxyindoleacetic acid
- 5-HTP, 5-Hydroxytryptophan
- AADC deficiency
- AADC, Aromatic L-amino acid decarboxylase
- Aromatic L-amino acid decarboxylase deficiency
- Biomarkers
- CSF, Cerebrospinal fluid
- HVA, Homovanillic acid
- MHPG, 3-methoxy 4-hydroxyphenylglycol
- Monoamine neurotransmitter deficiency
- TH deficiency
- TH, Tyrosine hydroxylase
- TML, Translational Metabolic Laboratory
- Tyrosine hydroxylase deficiency
- VLA, Vanillactic acid
- VMA, Vanillylmandelic acid
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Affiliation(s)
- Tessa Wassenberg
- Radboud university medical center, Department of Neurology (943), Donders Institute for Brain, Cognition and Behaviour, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.,Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Pediatrics, Pediatric Neurology Unit, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ben P H Geurtz
- Radboud university medical center, Department of Laboratory Medicine, Translational Metabolic Laboratory (830), PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Leo Monnens
- Radboud university medical center, Department of Physiology (392), PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Ron A Wevers
- Radboud university medical center, Department of Laboratory Medicine, Translational Metabolic Laboratory (830), PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Michèl A Willemsen
- Radboud university medical center, Amalia Children's Hospital, Department of Pediatric Neurology (801), Donders Institute for Brain, Cognition and Behaviour, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Marcel M Verbeek
- Radboud university medical center, Department of Neurology (943), Donders Institute for Brain, Cognition and Behaviour, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.,Radboud university medical center, Department of Laboratory Medicine, Translational Metabolic Laboratory (830), PO Box 9101, 6500 HB, Nijmegen, the Netherlands
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15
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Sokhi D, Suleiman A, Manji S, Hooker J, Mativo P. Cases of neuromyelitis optica spectrum disorder from the East Africa region, highlighting challenges in diagnostics and healthcare access. eNeurologicalSci 2021; 22:100320. [PMID: 33553703 PMCID: PMC7844578 DOI: 10.1016/j.ensci.2021.100320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/22/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) is an auto-immune disease of the central nervous system (CNS) associated with the IgG-antibody against aquaporin-4 (AQP4-IgG). There is little published epidemiology of NMOSD from sub-Saharan Africa (SSA). Methods We retrospectively collated NMOSD cases admitted to our tertiary regional neurology centre. Results We identified 11 cases (10 female, average age 30 years). 64% (7/11) were seropositive for AQP4-IgG, measured using indirect immunofluorescence. The remaining cases could either not afford tests, or had pathognomonic radiological features. 57% (4/7) of seropositive cases had concurrent/recent CNS infection. All patients were treated with high-dose intravenous methylprednisolone (IVMP), and 36% (4/11) also had plasma exchange. Only 55% (6/11) of the patients were seen by a neurologist at presentation: they had less relapses (1.3 vs 2.4), less diagnostic delay (2.3 vs 7.4 months), and were less disabled at the end of our review period. 10 cases were immunosuppressed long-term: 60% on mycophenolate, 30% azathioprine, and one on rituximab. Conclusion Our study is the largest case series of NMOSD from the East Africa region. Patients faced challenges of access to appropriate and affordable testing, and timely availability of a neurologist at onset, which had impacts on their functional outcomes. The majority of the seropositive cases had recent/concurrent CNS infections, suggesting triggered auto-immunity.
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Key Words
- CNS, Central nervous system
- CSF, Cerebrospinal fluid
- EDSS, Extended Disability Status Scale
- HIV, Human immunodeficiency virus
- HSV-2, Herpes simplex virus type 2
- ICD-10, nternational Classification of Diseases version 10
- IPND, International Panel for NMOSD Diagnosis
- IVMP, Intravenous methylprednisolone
- LETM, Longitudinally extensive tranverse myelitis
- MMF, Mycophenolate mofetil
- MOG, Myelin oligodendrocyte glycoprotein
- MRI, Magnetic resonance imaging
- NMOSD, Neuromyelitis optica spectrum disorder
- Neuro-immunology
- Neuro-inflammation
- Neuromyelitis optica spectrum disorder
- OCBs, Oligoclonal bands
- ON, Bilateral simultaneous or sequential optic neuritis
- PLEX, Plasma exchange
- RRMS, Relapsing-remitting multiple sclerosis
- RTX, Rituximab
- Sub-Saharan Africa
- TPHA, Treponema pallidum haemagglutination assay
- nd, not done
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Affiliation(s)
- Dilraj Sokhi
- Department of Medicine, Faculty of Health Sciences, Aga Khan University Medical College of East Africa, Nairobi, Kenya.,The Aga Khan University Hospital, Nairobi, Kenya
| | - Adil Suleiman
- Department of Medicine, Faculty of Health Sciences, Aga Khan University Medical College of East Africa, Nairobi, Kenya.,The Aga Khan University Hospital, Nairobi, Kenya
| | - Soraiya Manji
- Department of Medicine, Faculty of Health Sciences, Aga Khan University Medical College of East Africa, Nairobi, Kenya.,The Aga Khan University Hospital, Nairobi, Kenya
| | - Juzar Hooker
- The Aga Khan University Hospital, Nairobi, Kenya
| | - Peter Mativo
- Department of Medicine, Faculty of Health Sciences, Aga Khan University Medical College of East Africa, Nairobi, Kenya.,The Aga Khan University Hospital, Nairobi, Kenya
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16
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Kataria S, Tandon M, Melnic V, Sriwastava S. A case series and literature review of multiple sclerosis and COVID-19: Clinical characteristics, outcomes and a brief review of immunotherapies. eNeurologicalSci 2020; 21:100287. [PMID: 33163634 PMCID: PMC7605741 DOI: 10.1016/j.ensci.2020.100287] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/04/2020] [Accepted: 10/27/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In view of the emerging coronavirus pandemic, the demand for knowledge about the impact of SARS-CoV-2 on people with Multiple Sclerosis (MS) continues to grow. Patients receiving disease modifying therapy (DMT) for MS have a higher background risk of infection-related health care utilization when compared to the general population. Therefore, there is a need of evidence-based recommendations to reduce the risk of infection and also managing MS patients with SARS-CoV-2. CASE DESCRIPTION We present three patients with history of Multiple Sclerosis (MS) on DMTs presenting with worsening MS symptoms likely pseudo exacerbation who were diagnosed with COVID-19. DISCUSSION An extensive review of 7 articles was performed, in addition to a brief review on DMTs use in MS patients with COVID-19. In our cases, all patients were on DMT and severe course of disease was noted in 2 cases. No fatality was observed. CONCLUSIONS This review provides a base on the clinical characteristics, outcomes and the roles of DMTs in MS patients suffering from n-cov-2. Physicians need to be vigilant about considering COVID-19 infection related relapse in the MS patients, especially in this COVID-19 pandemic era and look for pseudo-exacerbation. As most cases are found to have mild course and full recovery on DMTs, further research is needed to formulate evidence-based guidelines. This review will particularly be helpful for the researchers and registries to collect future data on MS and COVID-19.
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Key Words
- ALT, Alanine Transaminase
- AST, Aspartate Transaminase
- ATS/IDSA, American Thoracic Society and Infectious Disease Society of America
- Antigen presenting cells, (APCs)
- BUN, Blood Urea Nitrogen
- COVID-19
- COVID-19, Coronavirus Disease 2019
- CRP, C-Reactive Protein
- CSF, Cerebrospinal fluid
- CT, Computed Tomography
- DMT, Disease Modifying Therapy
- EDSS, Expanded Disability Status Score
- IV, Intravenous
- Immunotherapies
- JCV, John Cunnigham virus
- L, Liters
- MS, Multiple Sclerosis
- Multiple sclerosis
- NK cells, Natural Killer Cells
- Novel coronavirus
- Ocrelizumab
- PPMS, Primary Progressive Multiple Sclerosis
- Progressive multifocal leukoencephalopathy, (PML).
- RRMS, Relapsing Remitting Multiple Sclerosis
- RT PCR, Reverse Transcription Polymerase Chain Reaction
- SARS-CoV-2
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
- Terminally differentiated late effector memory T cells, (TEMRA)
- n-Cov2, Novel coronavirus 2
- ul, Microliters
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Affiliation(s)
- Saurabh Kataria
- Department of Neurology, University of Missouri Healthcare at Columbia, MO
| | | | - Violina Melnic
- Department of Neurology, West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Shitiz Sriwastava
- Department of Neurology, West Virginia University School of Medicine, Morgantown, WV, United States of America
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Alqahtani F, Imran I, Pervaiz H, Ashraf W, Perveen N, Rasool MF, Alasmari AF, Alharbi M, Samad N, Alqarni SA, Al-Rejaie SS, Alanazi MM. Non-pharmacological Interventions for Intractable Epilepsy. Saudi Pharm J 2020; 28:951-962. [PMID: 32792840 PMCID: PMC7414058 DOI: 10.1016/j.jsps.2020.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022] Open
Abstract
In 30% of epileptic individuals, intractable epilepsy represents a problem for the management of seizures and severely affects the patient's quality of life due to pharmacoresistance with commonly used antiseizure drugs (ASDs). Surgery is not the best option for all resistant patients due to its post-surgical consequences. Therefore, several alternative or complementary therapies have scientifically proven significant therapeutic potential for the management of seizures in intractable epilepsy patients with seizure-free occurrences. Various non-pharmacological interventions include metabolic therapy, brain stimulation therapy, and complementary therapy. Metabolic therapy works out by altering the energy metabolites and include the ketogenic diets (KD) (that is restricted in carbohydrates and mimics the metabolic state of the body as produced during fasting and exerts its antiepileptic effect) and anaplerotic diet (which revives the level of TCA cycle intermediates and this is responsible for its effect). Neuromodulation therapy includes vagus nerve stimulation (VNS), responsive neurostimulation therapy (RNS) and transcranial magnetic stimulation therapy (TMS). Complementary therapies such as biofeedback and music therapy have demonstrated promising results in pharmacoresistant epilepsies. The current emphasis of the review article is to explore the different integrated mechanisms of various treatments for adequate seizure control, and their limitations, and supportive pieces of evidence that show the efficacy and tolerability of these non-pharmacological options.
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Key Words
- ASDs, Antiepileptic drugs
- ATP, Adenosine triphosphate
- Anaplerotic diet
- BBB, Blood-brain barrier
- CKD, Classic ketogenic diet
- CSF, Cerebrospinal fluid
- EEG, Electroencephalography
- EMG, Electromyography
- GABA, Gamma-aminobutyric acid
- Intractable epilepsy
- KB, Ketone bodies
- KD, Ketogenic diet
- Ketogenic diet
- LC, Locus coeruleus
- LCFA, Long-chain fatty acids
- MAD, Modified Atkin's diet
- MCT, Medium-chain triglyceride
- MEP, Maximal evoked potential
- Music therapy
- NTS, Nucleus tractus solitaries
- PPAR, Peroxisome proliferator-activated receptor
- PUFAs, Polyunsaturated fatty acids
- RNS, Responsive neurostimulation
- ROS, reactive oxygen species
- SMR, Sensorimotor rhythm
- TCA, Tricarboxylic acid cycle
- TMS, Transcranial magnetic stimulation
- Transcranial magnetic stimulation Biofeedback therapy
- VNS, Vagus nerve stimulation
- Vagus nerve stimulation
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Affiliation(s)
- Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Hafsa Pervaiz
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Waseem Ashraf
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Nadia Perveen
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Abdullah F Alasmari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Metab Alharbi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Noreen Samad
- Department of Biochemistry, Faculty of Science, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Saleh Abdullah Alqarni
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Salim S Al-Rejaie
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohammed Mufadhe Alanazi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
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Jayaraj RL, Azimullah S, Beiram R. Diabetes as a risk factor for Alzheimer's disease in the Middle East and its shared pathological mediators. Saudi J Biol Sci 2020; 27:736-750. [PMID: 32210695 PMCID: PMC6997863 DOI: 10.1016/j.sjbs.2019.12.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/14/2019] [Accepted: 12/18/2019] [Indexed: 02/07/2023] Open
Abstract
The incidence of Alzheimer's disease (AD) has risen exponentially worldwide over the past decade. A growing body of research indicates that AD is linked to diabetes mellitus (DM) and suggests that impaired insulin signaling acts as a crucial risk factor in determining the progression of this devastating disease. Many studies suggest people with diabetes, especially type 2 diabetes, are at higher risk of eventually developing Alzheimer's dementia or other dementias. Despite nationwide efforts to increase awareness, the prevalence of Diabetes Mellitus (DM) has risen significantly in the Middle East and North African (MENA) region which might be due to rapid urbanization, lifestyle changes, lack of physical activity and rise in obesity. Growing body of evidence indicates that DM and AD are linked because both conditions involve impaired glucose homeostasis and altered brain function. Current theories and hypothesis clearly implicate that defective insulin signaling in the brain contributes to synaptic dysfunction and cognitive deficits in AD. In the periphery, low-grade chronic inflammation leads to insulin resistance followed by tissue deterioration. Thus insulin resistance acts as a bridge between DM and AD. There is pressing need to understand on how DM increases the risk of AD as well as the underlying mechanisms, due to the projected increase in age related disorders. Here we aim to review the incidence of AD and DM in the Middle East and the possible link between insulin signaling and ApoE carrier status on Aβ aggregation, tau hyperphosphorylation, inflammation, oxidative stress and mitochondrial dysfunction in AD. We also critically reviewed mutation studies in Arab population which might influence DM induced AD. In addition, recent clinical trials and animal studies conducted to evaluate the efficiency of anti-diabetic drugs have been reviewed.
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Key Words
- AAV, Adeno-associated virus
- ABCA1, ATP binding cassette subfamily A member 1
- AD, Alzheimer’s disease
- ADAMTS9, ADAM Metallopeptidase With Thrombospondin Type 1 Motif 9
- AGPAT1, 1-acyl-sn-glycerol-3-phosphate acyltransferase alpha
- Alzheimer’s disease
- Anti-diabetic drugs
- ApoE, Apolipoprotein E
- Arab population
- Aβ, Amyloid-beta
- BACE1, Beta-secretase 1
- BBB, Blood-Brain Barrier
- BMI, Body mass index
- CALR, calreticulin gene
- CIP2A, Cancerous Inhibitor Of Protein Phosphatase 2A
- COX-2, Cyclooxygenase 2
- CSF, Cerebrospinal fluid
- DM, Diabetes mellitus
- DUSP9, Dual Specificity Phosphatase 9
- Diabetes mellitus
- ECE-1, Endotherin converting enzyme 1
- FDG-PET, Fluorodeoxyglucose- positron emission tomography
- FRMD4A, FERM Domain Containing 4A
- FTO, Fat Mass and Obesity Associated Gene
- GLP-1, Glucagon like peptide
- GNPDA2, Glucosamine-6-phosphate deaminase 2
- GSK-3β, Glycogen synthase kinase 3 beta
- IDE, Insulin degrading enzyme
- IGF-1, Insulin-like growth factor 1
- IR, Insulin receptor
- IR, Insulin resistance
- Insulin signaling
- LPA, Lipophosphatidic acid
- MC4R, Melanocortin 4 receptor
- MCI, Myocardial infarction
- MENA, Middle East North African
- MG-H1, Methylglyoxal-hydroimidazolone isomer trifluoroactic acid salt
- MRI, Magnetic resonance imaging
- NDUFS3, NADH:Ubiquinone Oxidoreductase Core Subunit S3
- NF-κB, nuclear factor kappa-light-chain-enhancer of activated B cells
- NFT, Neurofibrillary tangles
- NOTCH4, Neurogenic locus notch homolog protein 4
- PI3K, Phosphoinositide-3
- PP2A, Protein phosphatase 2
- PPAR-γ2, Peroxisome proliferator-activated receptor gamma 2
- Pit-PET, Pittsburgh compound B- positron emission tomography
- RAB1A, Ras-related protein 1A
- SORT, Sortilin
- STZ, Streptozotocin
- T1DM, Type 1 Diabetes Mellitus
- T2DM, Type 2 Diabetes Mellitus
- TCF7L2, Transcription Factor 7 Like 2
- TFAP2B, Transcription Factor AP-2 Beta
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Affiliation(s)
| | | | - Rami Beiram
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
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19
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Nihonmatsu A, Nishimura F, Park YS, Motoyama Y, Nakagawa I, Yamada S, Tamura K, Matsuda R, Takeshima Y, Takamura Y, Nakase H. Late-Onset Intractable Cerebrospinal Fluid Leakage After Stereotactic Radiotherapy After Resection of Giant Nonfunctioning Pituitary Adenoma. World Neurosurg X 2019; 4:100055. [PMID: 31360918 PMCID: PMC6639739 DOI: 10.1016/j.wnsx.2019.100055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 06/20/2019] [Indexed: 11/23/2022] Open
Abstract
Background Late-onset skull base cerebrospinal fluid (CSF) leakage after stereotactic radiotherapy (SRT) is a very rare complication. Case Description A 54-year-old woman came to our department for convulsions and was admitted. Brain magnetic resonance imaging revealed a giant tumor in the skull base region, including the sphenoid sinus, pituitary fossa, right cavernous sinus, right middle fossa, and right basal ganglia. Mild left hemiparesis was noted. An ophthalmologic examination revealed left side homonymous hemianopsia. Using an endonasal endoscopic surgical approach, tumor removal was performed, with the residual tumor removed with a transcranial approach. Residual tumor tissue remained around the right cavernous sinus; therefore, SRT was performed 1 month after the second procedure, which resulted in good control of growth. Four years later, spontaneous CSF leakage occurred, for which endoscopic endonasal surgery was performed. One month later, CSF leakage recurred, and the same procedure was again used. A third episode of recurrent CSF leakage occurred 5 days later. A transcranial approach was finally used for repair, and the patient showed complete recovery. Conclusions Late-onset CSF leakage after SRT for a pituitary adenoma can be intractable, and several aggressive repair procedures may be needed, including a combination of endonasal and transcranial approaches.
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Affiliation(s)
- Ayano Nihonmatsu
- Department of Neurosurgery, Nara Medical University, Kashihara City, Nara, Japan
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University, Kashihara City, Nara, Japan
| | - Yong-Soo Park
- Department of Neurosurgery, Nara Medical University, Kashihara City, Nara, Japan
| | - Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University, Kashihara City, Nara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara City, Nara, Japan
| | - Shuichi Yamada
- Department of Neurosurgery, Nara Medical University, Kashihara City, Nara, Japan
| | - Kentaro Tamura
- Department of Neurosurgery, Nara Medical University, Kashihara City, Nara, Japan
| | - Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University, Kashihara City, Nara, Japan
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University, Kashihara City, Nara, Japan
| | - Yoshiaki Takamura
- Department of Neurosurgery, Nara Medical University, Kashihara City, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara City, Nara, Japan
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20
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Vale F, Pinto Junior VL, Casella MI, Poças J. Community-acquired Escherichia coli meningitis and spondylodiscitis in an adult patient with discoid lupus erythematosus. IDCases 2019; 17:e00573. [PMID: 31338297 PMCID: PMC6624638 DOI: 10.1016/j.idcr.2019.e00573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/08/2019] [Accepted: 06/08/2019] [Indexed: 11/30/2022] Open
Abstract
Acute bacterial meningitis has a high impact on adult mortality worldwide. Community-acquired Escherichia coli meningitis (CA-ECM) is a rare and poorly described condition and the available knowledge is based on low evidence research, mainly from case reports. We describe a case of CA-ECM in Portugal in an adult patient with discoid lupus erythematosus under immunomodulatory therapy. A 73-year-old woman was admitted to the emergency department with fever and altered mental status over 48 h. Cerebrospinal fluid analysis showed 185 leukocytes/μL, including 85% neutrophils, hypoglycorrhachia (less than 5 mg/dL) and elevated protein of 423 mg/dL with positive culture for Escherichia coli. She was treated with ceftriaxone. Imaging studies also demonstrated spondylodiscitis and arthritis. She responded well to antimicrobial therapy and completed the treatment as an outpatient.
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Key Words
- CA-ECM, Community-acquired Escherichia coli meningitis
- CRP, C-reactive protein
- CSF, Cerebrospinal fluid
- CT, Computed tomography
- Discoid lupus erythematosus
- E. coli, Escherichia coli
- ESR, Erythrocyte sedimentation rate
- Escherichia coli
- GCS, Glasgow coma scale
- HIV, Human immunodeficiency virus
- MRI, Magnetic resonance imaging
- Meningitis
- PCR, Polymerase chain reaction
- PET, Positron emission tomography
- RT-PCR, Reverse transcription polymerase chain reaction
- STIR, Short-TI inversion recovery
- SUVmax, Maximum standardized uptake value
- Spondylodiscitis
- WBC, White blood cell
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Affiliation(s)
- Francisco Vale
- Infectious Diseases Department, São Bernardo Hospital, Setúbal, Portugal
| | | | | | - José Poças
- Infectious Diseases Department, São Bernardo Hospital, Setúbal, Portugal
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21
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Sun J, Xu X, Wang Y, Yuan X, Shi J, Yang H, Guo Y, Kong Q, Wang Y, Sun K, Zhao Q. How to Avoid Postoperative Remaining Ossification Mass in Anterior Controllable Antedisplacement and Fusion Surgery. World Neurosurg X 2019; 3:100034. [PMID: 31225525 PMCID: PMC6584598 DOI: 10.1016/j.wnsx.2019.100034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/25/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives To retrospectively review the cases with ossification of the posterior longitudinal ligament (OPLL) treated with anterior controllable antedisplacement and fusion (ACAF). Patients with postoperative remaining ossification mass (PROM) are analyzed to figure out the causes and preventions of this problem. Methods A total of 115 patients were included. PROM was identified as remaining OPLL existed in the spinal canal other than included in the vertebral-OPLL complex on postoperative computed tomography. The Japanese Orthopaedic Association scoring system was used to evaluate the neurologic status. Surgery-related complications such as cerebrospinal fluid (CSF) leakage and spinal cord or nerve injury were all recorded. The patients with the PROM group and those without the PROM group were compared. Results There were 14 patients with wide-base OPLL (12.2%) and 10 patients (8.7%) with PROM among the 115 patients with OPLL. The 10 patients with PROM were all with wide-base OPLL. The average improvement rate of Japanese Orthopaedic Association score in patients without PROM was significantly larger than that in patients with PROM (69.5 ± 22.6% vs. 36.7 ± 22.0, P < 0.01). Incidence rate of postoperative CSF leakage and neural deterioration were significantly higher in patients with PROM than that in patients without PROM (CSF leakage, 40.0% vs. 5.9%; neural deterioration, 50.0% vs. 3.0%). No other complications were observed. Conclusions The occurrence of PROM might cause complications and poor neural function recovery in patients treated with ACAF. Surgical techniques should be noted to avoid PROM in ACAF surgery.
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Key Words
- ACAF, Anterior controllable antedisplacement and fusion
- Anterior controllable antedisplacement and fusion
- CSF, Cerebrospinal fluid
- CT, Computed tomography
- Complication
- IR, Improvement rate
- JOA, Japanese Orthopaedic Association
- MRI, Magnetic resonance imaging
- OPLL, Ossification of the posterior longitudinal ligament
- Ossification of the posterior longitudinal ligament
- PROM, Postoperative remaining ossification mass
- Postoperative remaining ossification mass
- VOC, Vertebral-OPLL complex
- WBO, Wide-base OPLL
- Wide-base OPLL
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Affiliation(s)
- Jingchuan Sun
- Second Department of Spine Surgery, Changzheng Hospital, Shanghai, China
| | - Ximing Xu
- Second Department of Spine Surgery, Changzheng Hospital, Shanghai, China
| | - Yuan Wang
- Second Department of Spine Surgery, Changzheng Hospital, Shanghai, China
| | - Xiaoqiu Yuan
- Second Department of Spine Surgery, Changzheng Hospital, Shanghai, China
| | - Jiangang Shi
- Second Department of Spine Surgery, Changzheng Hospital, Shanghai, China
| | - Haisong Yang
- Second Department of Spine Surgery, Changzheng Hospital, Shanghai, China
| | - Yongfei Guo
- Second Department of Spine Surgery, Changzheng Hospital, Shanghai, China
| | - Qingjie Kong
- Second Department of Spine Surgery, Changzheng Hospital, Shanghai, China
| | - Yingjie Wang
- Second Department of Spine Surgery, Changzheng Hospital, Shanghai, China
| | - Kaiqiang Sun
- Second Department of Spine Surgery, Changzheng Hospital, Shanghai, China
| | - Qingrong Zhao
- Second Department of Spine Surgery, Changzheng Hospital, Shanghai, China
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22
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Udayakumaran S, Joseph T. Can We Predict Early Endoscopic Third Ventriculostomy Failure? The Role of Ultra-Early Postoperative Magnetic Resonance Imaging in Predicting Early Endoscopic Third Ventriculostomy Failure. World Neurosurg X 2019; 2:100013. [PMID: 31218288 PMCID: PMC6580897 DOI: 10.1016/j.wnsx.2019.100013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/26/2018] [Indexed: 11/22/2022] Open
Abstract
Background The success of endoscopic third ventriculostomy (ETV) depends on multiple preoperative and intraoperative factors. The multifactorial influence adds an element of unpredictability to the outcome of the most well-planned procedure. Clinical symptoms and signs may not reflect the status of the ETV stoma postprocedure and the morbidity associated with ETV failure could be catastrophic. In this study, the authors look at the role of early magnetic resonance imaging (MRI) to predict failure to avoid morbidity secondary to malfunction and propose a modified success criterion to guide treatment plan post-ETV failure. Our aim is to prospectively and retrospectively study the use of early postoperative MRI in predicting potential early ETV failure. Methods Patients who underwent ETV at Amrita Institute of Medical Sciences from March 2011 to August 2017. The study was a retrospective and prospective observational blinded study. Inclusion criteria included patients with any form of obstructive hydrocephalus who underwent ETV and had undergone an early postoperative MRI in the first 48 hours—or latest by discharge—with a follow-up of at least 3 months. The patient details and the presence of the flow void in the immediate postoperative MRI were documented. Follow-up was for at least 3 months to identify early failures. Results A total of 67 ETVs were performed in 65 patients. At 3 months follow-up, of the 59 ETVs with flow void on MRI, 53 were successful, whereas 6 failed. Of the 8 without flow void, 4 were successful. The overall sensitivity was 93.0, whereas specificity was 40.0. With increasing age, the negative predictive value improved from 25% in age <1 year to 100% in age >5 years, with an accuracy reaching 96% to predict failure of ETV. Conclusions An early postoperative MRI is very sensitive to failure of ETV, but not highly specific. The negative predictive value and accuracy of MRI improve significantly with increasing age and in non-hemorrhagic non-infective obstructive etiology.
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Key Words
- 3D, 3-Dimensional
- CSF, Cerebrospinal fluid
- Complications
- ETV, Endoscopic third ventriculostomy
- ETVSS, Endoscopic third ventriculostomy success score
- Endoscopic third ventriculostomy
- FSE, Fast spin echo
- Flow void
- MRI, Magnetic resonance imaging
- NPV, Negative predictive value
- PHH, Posthemorrhagic hydrocephalus
- PIH, Postinfective hydrocephalus
- PPV, Positive predictive value
- TSE, Turbo spin echo
- VP, Ventriculoperitoneal
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23
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Vola E, Russo C, Macera A, Del Vecchio W, Puoti G, Caranci F, Elefante A. Unusual CLIPPERS presentation and role of MRI examination in the proper diagnostic assessment: A case report. Eur J Radiol Open 2019; 6:212-4. [PMID: 31198819 DOI: 10.1016/j.ejro.2019.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/14/2019] [Indexed: 11/26/2022] Open
Abstract
CLIPPERS is a recently described, underestimated CNS inflammatory disorder involving midbrain and cerebellum. Unusual clinical presentation can make the diagnosis particularly challenging to the clinician. MRI plays a pivotal role in the correct diagnostic assessment, helping discriminate CLIPPERS from potential mimickers.
Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids syndrome (CLIPPERS) is a newly described, underestimated CNS inflammatory disorder involving predominantly the midbrain and the cerebellum. CLIPPERS pathogenesis is largely unknown, and its clinical manifestations are polymorphic and sometimes confounding. Recently clinical, radiological and pathological diagnostic criteria have been proposed to discriminate CLIPPERS from potential mimickers, but the diagnosis still remains challenging. Here we present the case of a patient with radiological findings consistent with CLIPPERS but with atypical clinical presentation, highlighting the importance of a proper diagnostic assessment.
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24
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Kirsch V, Boegle R, Keeser D, Kierig E, Ertl-Wagner B, Brandt T, Dieterich M. Beyond binary parcellation of the vestibular cortex - A dataset. Data Brief 2019; 23:103666. [PMID: 30788394 PMCID: PMC6369267 DOI: 10.1016/j.dib.2019.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 01/01/2019] [Accepted: 01/07/2019] [Indexed: 10/27/2022] Open
Abstract
The data-set presented in this data article is supplementary to the original publication, doi:10.1016/j.neuroimage.2018.05.018 (Kirsch et al., 2018). Named article describes handedness-dependent organizational patterns of functional subunits within the human vestibular cortical network that were revealed by functional magnetic resonance imaging (fMRI) connectivity parcellation. 60 healthy volunteers (30 left-handed and 30 right-handed) were examined on a 3T MR scanner using resting state fMRI. The multisensory (non-binary) nature of the human (vestibular) cortex was addressed by using masked binary and non-binary variations of independent component analysis (ICA). The data have been made publicly available via github (https://github.com/RainerBoegle/BeyondBinaryParcellationData).
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Key Words
- A1, Primary auditory cortex
- ACC, Anterior cingulate cortex
- BA, Brodmann areal
- C, Common cluster
- CSF, Cerebrospinal fluid
- IC, Independent component
- ICA, Independent component analysis
- IPL, Inferior parietal lobule
- L, Left
- L-I, Laterality-index
- LH, Left-handed
- M/STG, Middle and superior temporal gyrus
- M1, Primary motor cortex
- MR, Magnetic resonance
- MRI, Magnetic resonance imaging
- MST, Medial superior temporal area
- MSTd, Dorsal medial superior temporal area
- MT, Middle temporal area
- OP, Operculum
- OP2, Operculum 2
- P, Parcel
- P-P, Parcel to parcel correlation
- P-RSN, Parcel to resting state network correlation
- PET, Positron emission tomography
- PIVC, Parieto-insular vestibular cortex
- R, Right
- RH, Right-handed
- ROI, Region of interest
- RSN, Resting-state network
- S1, Primary somatosensory cortex
- SD, Standard deviation
- SMA, Supplementary motor area
- STG, Superior temporal gyrus
- SVV, Subjective visual vertical
- TP, Temporo-parietal
- U, Unique voxel
- V1–5, Primary, secondary and tertiary visual cortices
- VOG, Video-oculography
- VOR, Vestibular-ocular reflex
- VPS, Visual posterior sylvian area
- fCBP, Functional connectivity based parcellation
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Affiliation(s)
- V Kirsch
- Department of Neurology, Ludwig-Maximilians Universität, Munich, Germany.,Graduate School of Systemic Neuroscience, Ludwig-Maximilians Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig-Maximilians Universität, Munich, Germany
| | - R Boegle
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig-Maximilians Universität, Munich, Germany
| | - D Keeser
- Department of Radiology, Ludwig-Maximilians Universität, Munich, Germany.,Department of Psychiatry, Ludwig-Maximilians Universität, Munich, Germany
| | - E Kierig
- Department of Neurology, Ludwig-Maximilians Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig-Maximilians Universität, Munich, Germany
| | - B Ertl-Wagner
- German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig-Maximilians Universität, Munich, Germany.,Department of Radiology, Ludwig-Maximilians Universität, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - T Brandt
- German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig-Maximilians Universität, Munich, Germany.,Clinical Neuroscience, Ludwig-Maximilians Universität, Munich, Germany
| | - M Dieterich
- Department of Neurology, Ludwig-Maximilians Universität, Munich, Germany.,Graduate School of Systemic Neuroscience, Ludwig-Maximilians Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig-Maximilians Universität, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Takeshima Y, Matsuda R, Nishimura F, Nakagawa I, Motoyama Y, Park YS, Nakase H. Sequential Enlargement of Posterior Fossa After Duraplasty for Chiari Malformation Type 1. World Neurosurg X 2019; 2:100004. [PMID: 31218279 PMCID: PMC6580881 DOI: 10.1016/j.wnsx.2018.100004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 12/10/2018] [Indexed: 11/24/2022] Open
Abstract
Objective There are several material options for duraplasty in surgery for foramen magnum decompression (FMD). We retrospectively analyzed surgical results and the impact of sequential alteration of posterior fossa (PF) size in patients with Chiari malformation type 1 after duraplasty using local fascia. Methods The patients with Chiari malformation type 1 who underwent FMD with duraplasty using local fascia at our institution between 2004 and 2015 were included in the study. Some pediatric patients who underwent FMD without duraplasty and patients with insufficient follow-up data were excluded. Improvement of clinical signs, regression of syrinx, and temporal alteration of PF size were analyzed with perioperative magnetic resonance imaging. Postoperative clinical outcomes were evaluated at the final follow-up using the Chicago Chiari Outcome Scale. Correlations between the PF size alteration and size of dural patch or Chicago Chiari Outcome Scale were statistically analyzed. Results Twelve patients were included in this study. The mean age of the patients was 31.9 (range, 18–48) years. Syrinx was incorporated in 11 patients and regressed postoperatively in all patients. The PF was significantly enlarged sequentially over time (P < 0.05). The degree of enlargement was positively correlated with size of the fascial patch (r = 0.540). Postoperative clinical outcomes at final follow-up were positively correlated with the degree of PF enlargement (r = 0.678). Conclusions The PF was enlarged sequentially over time after duraplasty using local fascia. The degree of enlargement was positively correlated with the size of the fascial patch and the likelihood of a favorable postoperative outcome.
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Affiliation(s)
- Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
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Aragón-Arreola JF, Moreno-Villegas CA, Armienta-Rojas DA, De la Herrán-Arita AK. An insight of sleep disorders in Africa. eNeurologicalSci 2016; 3:37-40. [PMID: 29430534 PMCID: PMC5803062 DOI: 10.1016/j.ensci.2016.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 02/09/2016] [Accepted: 02/22/2016] [Indexed: 12/25/2022] Open
Abstract
Sleep is a recurrent physiologic and fundamental process in every human being, regardless of ethnicity, gender, birthplace, or occupation; however, the features of sleep are swayed by genetic background and environmental influences. All these factors have an intricate relationship, and arise from a complex and assorted genetic repertoire in the alleles that promote a higher genetic variation in human populations. Sleep disorders have become an uprising public health problem in the modern society; in addition, the correlation between sleep disorders and the development of late chronic diseases has been extensively studied, finding an important causality between them. Therefore, an adequate evaluation of the current situation in a developing continent such as Africa is essential to develop satisfactory health policies. In this review, we will reprise several aspects that influence the sleep-wake cycle in individuals with African heritage (including African Americans and sub-Saharan Africans), such as genetic background, HIV infection, tropical diseases, immunological markers, cultural aspects, and place them into Africa's context in order to have a better comprehension of its situation.
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Key Words
- African heritage
- CNS, Central nervous system
- CRP, C-reactive protein
- CSF, Cerebrospinal fluid
- Cry, Cryptochrome
- HAT, Human African trypanosomiasis
- IL-6, Interleukin 6
- IL1R2, Interleukin 1 receptor type 2
- Inflammatory markers
- OSA, Obstructive sleep apnea
- Obstructive sleep apnea
- PER, Period
- PLEK, Plekstrin
- SES, Socioeconomic status
- SNP, Single nucleotide polymorphism
- Sleep disorders
- Tropical diseases
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27
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Westhoff D, Witlox J, van Aalst C, Scholtens RM, de Rooij SE, van Munster BC, de Jonghe JFM, Houdijk APJ, Eikelenboom P, van Westerloo DJ, van de Beek D, van Gool WA, Koenderman L. Preoperative protein profiles in cerebrospinal fluid in elderly hip fracture patients at risk for delirium: A proteomics and validation study. BBA Clin 2015; 4:115-22. [PMID: 26675981 PMCID: PMC4661734 DOI: 10.1016/j.bbacli.2015.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/12/2015] [Accepted: 10/26/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND A neuroinflammatory response is suggested to play an important role in delirium, a common complication in older hospitalized patients. We examined whether hip fracture patients who develop postoperative delirium have a different proteome in cerebrospinal fluid (CSF) prior to surgery. METHODS Patients (≥ 75 years) were admitted for hip fracture surgery. CSF was collected during spinal anaesthesia; proteins were separated using gel electrophoresis and identified with mass spectrometry. We compared the proteome of patients with and without postoperative delirium. Findings were validated in an independent, comparable cohort using immuno-assays. RESULTS In the derivation cohort 53 patients were included, 35.8% developed postoperative delirium. We identified differences in levels of eight CSF proteins between patients with and without subsequent delirium: complement factor C3, contactin-1, fibulin-1 and I-beta-1,3-N-acetylglucosaminyltransferase were significantly lower in patients with postoperative delirium, while neural cell adhesion molecule-2, fibrinogen, zinc-α-2-glycoprotein and haptoglobin levels were significantly higher. In the validation cohort 21.2% of 52 patients developed postoperative delirium. Immuno-assays confirmed contactin-1 results although not statistically significant. Complement factor C3 was significantly higher in patients with postoperative delirium. CONCLUSION Our results show the complexity of pathophysiological mechanisms involved in delirium and emphasizes the need of independent validation of findings. GENERAL SIGNIFICANCE This study highlights the challenges and inconsistent findings in studies of delirium, a serious complication in older patients. We analysed proteins in CSF, the most proximal fluid to the brain. All patients were free from delirium at the time of sampling.
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Affiliation(s)
- Dunja Westhoff
- Department of Neurology, Academic Medical Center, PO box 22660, 1100 DD Amsterdam, The Netherlands
| | - Joost Witlox
- Department of Geriatrics, Medical Center Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
| | - Corneli van Aalst
- Department of Respiratory Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rikie M Scholtens
- Department of Geriatrics, Academic Medical Center, PO box 22660, 1100 DD Amsterdam, The Netherlands
| | - Sophia E de Rooij
- Department of Geriatrics, Academic Medical Center, PO box 22660, 1100 DD Amsterdam, The Netherlands ; Department of Geriatrics, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Barbara C van Munster
- Department of Geriatrics, Academic Medical Center, PO box 22660, 1100 DD Amsterdam, The Netherlands ; Department of Geriatrics, Gelre hospitals, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands
| | - Jos F M de Jonghe
- Department of Geriatrics, Medical Center Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
| | - Alexander P J Houdijk
- Department of Surgery, Medical Center Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands ; Trial Center Holland Health, Alkmaar, The Netherlands
| | | | - David J van Westerloo
- Department of Intensive Care Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, Academic Medical Center, PO box 22660, 1100 DD Amsterdam, The Netherlands
| | - Willem A van Gool
- Department of Neurology, Academic Medical Center, PO box 22660, 1100 DD Amsterdam, The Netherlands
| | - Leo Koenderman
- Department of Respiratory Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Peng J, Chen L, Zhu ZG, Zhu ZR, Hu Q, Fang Y. Effect of Corticosteroids on RVNA production of a patient with acute disseminated encephalomyelitis following rabies vaccination as well as administration of HRIG. Hum Vaccin Immunother 2015; 10:3622-6. [PMID: 25668669 DOI: 10.4161/21645515.2014.979621] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
It has not been reported that administration of combining rabies vaccines and immunoglobulin resulted in acute disseminated encephalomyelitis (ADEM) yet. This report described that an old man acquired ADEM after being administrated with purified Vero cell rabies vaccine (PVRV) and Human Rabies Immunoglobulin (HRIG). Then he was given intravenous and oral glucocorticoids. Simultaneously, rabies vaccination was continued with purified Chick embryo cell vaccines (PCECV) instead of PVRV. Furthermore, we analyzed the rabies virus neutralizing antibodies (RVNA) levels in the patient's blood at different time points after rabies vaccination. Collectively, we observed that PCECV vaccination did not affect the prognosis of ADEM, and glucocorticoid was crucial and effective, which had no significant influence on efficacy of PCECV.
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Key Words
- ADEM
- ADEM, acute disseminated encephalomyelitis
- ANCA, Antineutrophil cytoplasmic antibodies
- ASO, Anti-streptolycin O
- CRP, C-reactive protein
- CSF, Cerebrospinal fluid
- CT, Computed tomography
- EEG, electroencephalography
- ESR, Erythrocyte sedimentation rate
- FLAIR, fluid-attenuated inversion recovery
- HDCV, human diploid cell vaccine
- HRIG
- HRIG, Human Rabies Immunoglobulin
- MRI, magnetic resonance image
- MS, multiple sclerosis
- PCECV, purified Chick embryo cell vaccines
- PEP, post-exposure prophylaxis
- PPRC, Pharmacopoeia of the People's Republic of China
- PVRV
- PVRV, purified Vero cell rabies vaccine
- RABV, rabies virus
- RFFIT, rapid fluorescent focus inhibition test
- RVNA
- RVNA, rabies virus neutralizing antibodies
- T2W, T2-weighted
- glucocorticoids
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Affiliation(s)
- Jun Peng
- a Department of Neurology; Union Hospital; Tongji Medical College ; Huazhong University of Science and Technology ; Wuhan , China
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29
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Abstract
Overall health has been linked to socioeconomic status, with the gap between social strata increasing each year. Studying the impact of social position on health and biological functioning in nonhuman primates has allowed researchers to model the human condition while avoiding ethical complexities or other difficulties characteristic of human studies. Using female cynomolgus macaques (Macaca fascicularis), our lab has examined the link between social status and stress for 30 years. Female nonhuman primates are especially sensitive to social stressors which can deleteriously affect reproductive health, leading to harmful consequences to their overall health. Subordinates have lower progesterone concentrations during the luteal phase of menstrual cycle, which is indicative of absence or impairment of ovulation. Subordinate animals receive more aggression, less affiliative attention, and are more likely to exhibit depressive behaviors. They also express higher stress-related biomarkers such as increased heart rates and lower mean cortisol. While no differences in body weight between dominant and subordinate animals are observed, subordinates have lower bone density and more visceral fat than their dominant counterparts. The latter increases risk for developing inflammatory diseases. Differences are also observed in neurological and autonomic function. A growing body of data suggests that diet composition may amplify or diminish physiological stress responses which have deleterious effects on health. More experimental investigation of the health effects of diet pattern is needed to further elucidate these differences in an ongoing search to find realistic and long-term solutions to the declining health of individuals living across the ever widening socioeconomic spectrum.
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Key Words
- 5-HT, Serotonin
- ACTH, Adrenocorticotropic hormone
- ANS, Autonomic nervous system
- CAA, Coronary artery atherosclerosis
- CRH, Corticotropin-releasing hormone
- CSF, Cerebrospinal fluid
- HDL-C, High-density lipoprotein cholesterol
- HPA, Hypothalamic-pituitary-adrenal
- HR, Heart rate
- HVA, Homovanillic acid
- IGF-1, Insulin-like growth factor-1
- Mediterranean diet
- Nonhuman primates
- PET, Positron emission tomography
- Social status
- Social stress
- TPC, Total plasma cholesterol
- TPH, Tryptophan hydroxylase
- Western diet
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Affiliation(s)
- Carol A. Shively
- Department of Pathology/Comparative Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston–Salem, NC 27157-1040, USA
| | - Stephen M. Day
- Integrative Physiology & Pharmacology Graduate Program, Department of Pathology/Comparative Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston–Salem, NC 27157-1040, USA
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30
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Kumar R, Farahvar S, Ogren JA, Macey PM, Thompson PM, Woo MA, Yan-Go FL, Harper RM. Brain putamen volume changes in newly-diagnosed patients with obstructive sleep apnea. Neuroimage Clin 2014; 4:383-91. [PMID: 24567910 PMCID: PMC3930100 DOI: 10.1016/j.nicl.2014.01.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 01/17/2014] [Accepted: 01/21/2014] [Indexed: 11/24/2022]
Abstract
Obstructive sleep apnea (OSA) is accompanied by cognitive, motor, autonomic, learning, and affective abnormalities. The putamen serves several of these functions, especially motor and autonomic behaviors, but whether global and specific sub-regions of that structure are damaged is unclear. We assessed global and regional putamen volumes in 43 recently-diagnosed, treatment-naïve OSA (age, 46.4 ± 8.8 years; 31 male) and 61 control subjects (47.6 ± 8.8 years; 39 male) using high-resolution T1-weighted images collected with a 3.0-Tesla MRI scanner. Global putamen volumes were calculated, and group differences evaluated with independent samples t-tests, as well as with analysis of covariance (covariates; age, gender, and total intracranial volume). Regional differences between groups were visualized with 3D surface morphometry-based group ratio maps. OSA subjects showed significantly higher global putamen volumes, relative to controls. Regional analyses showed putamen areas with increased and decreased tissue volumes in OSA relative to control subjects, including increases in caudal, mid-dorsal, mid-ventral portions, and ventral regions, while areas with decreased volumes appeared in rostral, mid-dorsal, medial-caudal, and mid-ventral sites. Global putamen volumes were significantly higher in the OSA subjects, but local sites showed both higher and lower volumes. The appearance of localized volume alterations points to differential hypoxic or perfusion action on glia and other tissues within the structure, and may reflect a stage in progression of injury in these newly-diagnosed patients toward the overall volume loss found in patients with chronic OSA. The regional changes may underlie some of the specific deficits in motor, autonomic, and neuropsychologic functions in OSA. Global and regional putamen volumes were examined in newly-diagnosed OSA. Global volumes are higher, but subareas showed increases and decreases. The volume increases suggest transient tissue swelling from hypoxic action. Altered sites likely contribute to motor and other functional deficits in OSA.
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Key Words
- 3D surface morphometry
- 3D, Three dimensional
- AHI, Apnea–hypopnea index
- Autonomic
- BAI, Beck Anxiety Inventory
- BDI-II, Beck Depression Inventory II
- Basal ganglia
- CSF, Cerebrospinal fluid
- Cognition
- ESS, Epworth Sleepiness Scale
- FA, Flip angle
- FOV, Field of view
- GRAPPA, Generalized autocalibrating partially parallel acquisition
- Intermittent hypoxia
- MNI, Montreal Neurological Institute
- MPRAGE, Magnetization prepared rapid acquisition gradient-echo
- MRI, Magnetic resonance imaging
- Magnetic resonance imaging
- Motor
- OSA, Obstructive sleep apnea
- PD, Proton density
- PSQI, Pittsburgh Sleep Quality Index
- TE, Echo time
- TIV, Total intracranial volume
- TR, Repetition time
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Affiliation(s)
- Rajesh Kumar
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, USA ; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, USA ; The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Salar Farahvar
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Jennifer A Ogren
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Paul M Macey
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095, USA ; The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Paul M Thompson
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, USA ; Department of Psychiatry, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Mary A Woo
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Frisca L Yan-Go
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Ronald M Harper
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, USA ; The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA
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