Vagus nerve stimulation in refractory epilepsy: effects on pro- and anti-inflammatory cytokines in peripheral blood

OBJECTIVE

The vagus nerve has important immunological functions that may be relevant for its anticonvulsive action. We postulate that this anticonvulsive action is activated by a shift in the immune system resulting in a reduction of neurotoxic and an increase of neuroprotective tryptophan metabolites.

METHODS

Eleven patients with refractory epilepsy and 11 controls matched for age and gender were included in this study. The primary outcome measure was a 50% seizure reduction. Other variables were pro-inflammatory cytokines IL-6 and TNF-α, anti-inflammatory cytokine IL-10, cortisol, and the tryptophan metabolites 3-hydroxykynurenine (3-OH-KYN), kynurenic acid (KYNA), kynurenine, serotonin (5-HT) and 5-hydroxyindol acetic acid (5-HIAA). Blood samples were scheduled during baseline, and in week 28 of add-on treatment.

RESULTS

IL-6 levels were higher in the responders than in the control group, and decreased after vagus nerve stimulation (VNS), whereas IL-10 was low and increased after VNS. In nonresponders, VNS resulted in an increase of IL-6 plasma levels and in a decrease of IL-10. Cortisol concentrations are higher in the epilepsy group than in the control group. After VNS, these concentrations decreased. The concentrations of the tryptophan metabolites were lower in the epilepsy group than in the control group. The KYNA ratios are defined as the ratio of neuroprotective KYNA versus neurotoxic 3-OH-KYN and KYNA versus neurotoxic kynurenine: these ratios were lower in epilepsy patients than in controls, and they both moderately increased after VNS.

CONCLUSION

The outcome of this preliminary study indicates that VNS causes a rebalancing of the immune system. This results in: (1) a reduction of neurotoxic and an increase of neuroprotective kynurenine metabolites and (2) in the normalization of cortisol levels.

Inflammation and depression: is there a causal connection with dementia?

Epidemiological studies show that there is a correlation between chronic depression and the likelihood of dementia in later life. There is evidence that inflammatory changes in the brain are pathological features of both depression and dementia. This suggests that an increase in inflammation-induced apoptosis, together with a reduction in the synthesis of neurotrophic factors caused by a rise in brain glucocorticoids, may play a role in the pathology of these disorders. A reduction in the neuroprotective components of the kynurenine pathway, such as kynurenic acid, and an increase in the neurodegenerative components, 3- hydroxykynurenine and quinolinic acid, contribute to the pathological changes. Such changes are postulated to cause neuronal damage and thereby predispose chronically depressed patients to dementia.

Safety, efficacy and cross-protectivity of a live intranasal aerosol haemorrhagic septicaemia vaccine

The safety, efficacy and cross-protectivity of a live intranasal aerosol haemorrhagic septicaemia vaccine containing Pasteurella multocida serotype B:3,4 were tested in young cattle and buffaloes in Myanmar, where more than 1.5 million animals had been inoculated with this vaccine between 1989 and 1999. A recommended dose of 2 x 10(7) viable organisms was used for the efficacy test. The administration of 100 times the recommended dose to 50 cattle and 39 buffalo calves was innocuous. Seven months after they were vaccinated, three of three buffaloes were protected and 12 months after they were vaccinated, three of four buffaloes were protected against a subcutaneous challenge with serotype B:2 which killed three of three unvaccinated buffaloes. Twelve months after they were vaccinated, eight of eight cattle survived a serotype B:2 challenge, which killed four of four unvaccinated controls. The vaccinated cattle had developed serum antibodies detectable by the passive mouse protection test. Indirect haemagglutination tests on sera taken from cattle 10 days and five weeks after they were vaccinated showed high titres of antibodies. The serum of vaccinated cattle cross-protected passively immunised mice against infection with P. multocida serotypes E:2, F:3,4 and A:3,4.

Mammary myofibroblastoma with leiomyomatous differentiation

An unusual example of mammary myofibroblastoma in a 36-year-old woman was reported. The central portion resembled mammary myofibroblastoma or solitary fibrous tumor of other sites and showed reactivity for CD34 and muscle-specific actin, with few cells staining for desmin. The peripheral portion resembled leiomyoma and showed strong reactivity for actin and desmin but only focal staining for CD34. We interpret this tumor as mammary myofibroblastoma showing frank peripheral leiomyomatous differentiation. Although closely related to solitary fibrous tumor, mammary myofibroblastoma appears slightly different because of its consistent slant toward myoid differentiation in the form of actin and variable desmin reactivity as opposed to the rare and sparse immunohistochemical expression of myoid features by solitary fibrous tumors of other sites. This case demonstrates this phenomenon carried to an extreme, a feature not previously documented in mammary myofibroblastoma. It is of interest to note the modulation of the antigenic profile with the differentiation process, that is, loss of CD34 and gain of desmin accompanying the myoid differentiation.

Concentric and eccentric knee extension strength in older and younger men and women

Decrements in isometric and concentric (Conc) muscular strength with increased age are well documented. However, little information is available on the effects of aging on eccentric (Ecc) strength, even though Ecc or lengthening muscle actions are used in most physical activities. This study examined Conc and Ecc peak torques (PT) during knee extension at 90 degrees/sec in healthy older (62 to 89 yrs) and younger (20 to 29 yrs) men and women. Conc PT decreased more with age than did Ecc (p < 0.01), for both men and women. PT values for the older men and women as a percentage of those of the younger ones were 58.3 and 46.6% for Conc, and 75.1 and 61.7% for Ecc, respectively. These age differences need to be considered during isokinetic evaluations of Conc versus Ecc strength. Other muscle groups should be investigated, and mechanisms remain to be determined.

Development of a simple indirect enzyme-linked immunosorbent assay for the detection of immunoglobulin M antibody in serum from patients following an outbreak of chikungunya virus infection in Yangon, Myanmar

During 1984, 1548 children were admitted to the Yangon [Rangoon] Children's Hospital in Myanmar [Burma] with haemorrhagic fever. No evidence of recent dengue infection was found in 577 of the 803 children from whom paired sera were obtained, raising the possibility of reappearance of Chikungunya virus infection in Myanmar. An enzyme-linked immunosorbent assay (ELISA) for the detection of anti-Chikungunya virus immunoglobulin M (IgM) antibody was prepared and standardized using only reagents which are commercially available or which could be prepared without the use of sophisticated equipment. While there was 90% agreement between haemagglutination inhibition (HI) tests and the IgM ELISA in the diagnosis of acute Chikungunya virus infections, 12 additional patients with stationary anti-Chikungunya virus HI antibody titres could be identified as having acute Chikungunya infections using the ELISA. Furthermore, the ELISA could identify twice as many patients (31/103) at the time of admission to hospital as the HI test (15/103). There was no false positive IgM reaction with the ELISA which could be attributed to the presence of rheumatoid factor. Using the test, 103 of a sample of 163 children who presented to the Yangon Children's Hospital with fever/haemorrhagic fever were diagnosed as Chikungunya patients, 4 had possible dual Chikungunya and dengue infections, 16 had dengue, 30 had neither Chikungunya nor dengue infections, and a definitive diagnosis could not be made for 10 patients. Routine use of the ELISA would alert authorities to future outbreaks of Chikungunya virus infection and avoid admission to hospital of patients with a non-life-threatening viral disease.

Prevention of haemorrhagic septicaemia in buffaloes and cattle with a live vaccine

Young cattle and buffaloes were vaccinated subcutaneously and intradermally with a live vaccine containing Pasteurella multocida serotype B:3,4. Twelve months after vaccination three of five young cattle in the subcutaneously vaccinated group and three of four in the intradermally vaccinated group were protected against serotype B:2 challenge. Eleven buffaloes vaccinated subcutaneously and two vaccinated intradermally survived the same challenge 13 months after vaccination.

Prevention of experimental haemorrhagic septicaemia with a live vaccine

Pasteurella multocida serotype B:3,4 isolated from a fallow deer in England was used as a vaccine to prevent haemorrhagic septicaemia. The deer strain was less virulent for calves than typical serotype B:2 of haemorrhagic septicaemia strains. It elicited antibodies in cattle that protected mice against serotype B:2 infection. The live deer vaccine containing 2 X 10(7) viable organisms per dose was used to immunise calves. Six months after vaccination, five of six calves were protected against serotype B:2 challenge. Two calves challenged nine months after vaccination survived the same challenge. The live vaccine was more efficacious than an alum precipitated vaccine in protecting calves against B:2 challenge.

Squamous cysts in renal dysplasia

We report two cases of renal dysplasia with squamous cysts. The histological features in one case suggest that the cysts may develop through metaplasia of the tubular epithelium.

Epidemiologic study of 600 villagers of oral precancerous lesions in Bilugyun: preliminary report

A house-to-house survey of 11 villages selected by random sampling was carried out in Bilugyun. Chaung-zone township. Mon State of South Eastern Burma to study the prevalence of oral precancerous lesions and smoking and chewing. A total of 6000 villagers who were above 15 years at the time of this study were examined. The prevalence of preleukoplakia was 0.3%, leukoplakia 1.7%, lichen planus 0.4%, leukokeratosis nicotina palati 2.3, erythroplakia 0.1%, submucous fibrosis 0.1%, and cancer 0.03%. A correlation was done between habits and lesions.