Short-term plasticity of central benzodiazepine receptors in status epilepticus: case report

(123)I-iomazenil SPECT is of value in determining an epileptogenic focus, however, transient uptake change has been rarely reported in epileptic disorders. A 78-year-old woman diagnosed as status epilepticus (SE) showed transient reduction in (123)I-iomazenil uptake within the epileptic foci on SPECT images during a couple of weeks. It suggests a seizure-related 'short-term' plasticity in the central benzodiazepine receptors and dynamic change in the regulatory mechanisms of inhibitory neurotransmitter system within the epileptic foci in patients with SE.

Nonviscous metallic liquid Se

Viscosity is one of the fundamental physical properties of liquids; for different melts it varies in an extremely wide range. Selenium is among the first elementary substances to have manifested, at compression, a phase transformation in the liquid state accompanied by melt metallization. Direct measurements by means of a real-time radiography show that the viscosity of liquid Se under pressure drops by 500 times to a very low level of 8 mPa s. This is the first case of viscosity measurements being performed both for a relatively viscous semiconducting state and a low-viscous metallic state of the same liquid substance. The viscosity of the Se melt strongly decreases with pressure along the melting curve in a semiconducting state and experiences a further significant drop at melt metallization. A similar phenomenon is expected to be observed in many chalcohenide, halogenide, and oxide melts.

Developments in inhaled immunosuppressive therapy for the prevention of pulmonary graft rejection

Cyclosporin is the main immunosuppressive treatment for lung and heart-lung transplantation. When combined with azathioprine and oral corticosteroids, repeated episodes of acute rejection are limited to a minority of transplant patients. Despite early successful transplantation, many patients developed a disabling and fatal condition called obliterative bronchiolitis. This is currently thought to be a result of chronic rejection. The principal risk factor for the development of obliterative bronchiolitis is undercontrolled acute rejection in the first 3 months after transplantation. Frequent early acute rejection increases the later risk of death and disability. A new approach to immunosuppressive therapy is needed to prevent this complication. Simply increasing the dosage of cyclosporin or oral corticosteroids results in the major complications of opportunistic infection and renal failure. Targeted immunosuppressive treatment delivered to the transplanted organ may offer certain advantages, since a high topical inhaled dosage should be relatively free from systemic complications. The lung as a transplanted organ is easily accessible to targeted therapy by means of inhalation. Inhaled nebulised corticosteroids have been shown to be effective in preventing obliterative bronchiolitis in patients at risk after heart-lung transplantation. Similarly, inhaled cyclosporin has also been reported to be more effective than oral administration, with substantially lower blood concentrations. Such new approaches to targeting immunosuppressive treatment could have specific advantages in long term therapy of lung and heart-lung transplant recipients. They might also be of use in other types of solid organ transplantation.

Transformation in intermediate-range structure of vitreous silica under high pressure and temperature

The pressure dependence of the structure factor for vitreous silica was measured up to 8.3 GPa at 500 °C by means of an in situ x-ray diffraction method. The position of the first sharp diffraction peak (FSDP) moved to a higher momentum transfer as the pressure increased. It moved rapidly between 3.3 and 5.8 GPa, and then the slope of the FSDP position as a function of pressure decreased. The pressure dependence of the position is the same as that for a sample heated to 500 °C after room-temperature compression. On decompression at 500 °C, the position of the FSDP showed hysteresis. The pressure dependence of the FSDP position suggests that the permanent densification of vitreous silica is realized due to preservation of the intermediate-range structure stabilized at high pressure and temperature.

Abortion in a thoroughbred mare associated with an infection with avirulent Rhodococcus equi

An eight-year-old thoroughbred mare with no previous history of illness aborted a fetus at 196 days of gestation, and its internal tissues were examined immunohistologically and bacteriologically. The placenta was not examined, but specimens of the intrauterine fluids and the dam's faeces were collected four days after the abortion and examined bacteriologically. No significant histological lesions were found in the fetus but the amnion and the umbilical cord were oedematous and had petechial haemorrhages. Rhodococcus equi was isolated in pure culture from the lung, heart and stomach contents of the fetus and from an intrauterine specimen and faeces of the dam. The anti-R equi antibody titre of the mare was high after the abortion. The diagnosis was confirmed in the lung of the fetus by immunohistochemical staining with R equi-specific antibodies. Isolates from the fetus and mare were identified as avirulent R equi by pcr and the mouse pathogenicity test. The avirulent isolates were characterised by pulsed-field gel electrophoresis, which yielded only one VspI profile in all the isolates from the fetus and its dam.

Extracranial carotid plaque is increasing in Japanese ischemic stroke patients

OBJECTIVE

The objectives of this study were to investigate the prevalence of extracranial carotid plaque and the association between risk factors and carotid plaque in Japanese patients with ischemic stroke.

METHODS

We consecutively recruited patients with ischemic stroke admitted to our hospital from January 2000 to September 2002. Neurologic signs and a brain magnetic resonance imaging diagnosed ischemic stroke. All subjects underwent a carotid ultrasonography. Multiple logistic regression analysis was used to determine the risk factors that independently contributed to the presence of carotid plaques.

RESULTS

Carotid plaques were identified in 76.2% of the patients and bilateral plaques were found in 58.2%. These lesions were more frequent in comparison with previous Japanese reports. The risk factors that independently contributed to the presence of extracranial carotid plaques were hypertension, age, smoking and past history of ischemic stroke.

CONCLUSIONS

This study demonstrates that extracranial carotid plaque is increasing in Japanese patients with ischemic stroke.

Combination Therapy Using tPA and Edaravone Improves the Neurotoxic Effect of tPA

SUMMARY

In acute ischemic stroke patients, administration of tissue plasminogen activator (tPA) was proven to improve clinical outcome. On the other hand, neurotoxic effects of tPA have been reported in animal experimental studies. Using a rat thromboembolic stroke model, we examined whether or not the free radical scavenger, edaravone, could attenuate such neurotoxic effect of tPA administered for the purpose of fibrinolysis. Even when early recanalization was induced by administering tPA at 30 minutes after the onset of ischemia, significant amount of tPA was extravasated through the cerebral vessels. Edaravone significantly attenuated extravasation of tPA. Combination therapy using tPA and edaravone appears to be a promising strategy for diminishing the negative effects of tPA.

Molecular-network-ionic structure transitions in liquid AlCl(3) and ZnCl(2) halogenides under pressure

We present the in situ high-pressure-high-temperature x-ray diffraction study of the liquid AlCl(3) and ZnCl(2) halogenides having a quasi-molecular network structure in liquid state at normal pressure. These liquids are intermediate between pure covalent and ionic melts. Structural study of these liquid halogenides is indicative of a rapid and strong breakdown of an intermediate-range order in a tetrahedral network of melts for the initial pressure range, 0-2.5 GPa for AlCl(3) and 0-1.8 GPa for ZnCl(2), and points to rather sharp transitions in liquids with the formation of a short-range order structure similar to ionic melt structures around 4 GPa for AlCl(3) and 3 GPa for ZnCl(2). Thus, pseudo-covalent liquid halogenides like AlCl(3) and ZnCl(2) provide testimony to two phenomena under high pressures, namely, a gradual decay of structural correlations in the tetrahedral network of the melt and a sharp transition from molecular-network to ionic structure in liquid on further compression. Such a two-stage structural transformation under pressure is the general feature for a wide class of simple melts, including most of the pseudo-covalent halogenides.

Apoplexy accompanying pituitary adenoma as a complication of preoperative anterior pituitary function tests

Pituitary apoplexy occurs as a very rare complication of the pituitary function test. We have experienced two cases of pituitary apoplexy following anterior pituitary function tests for preoperative assessment: a triple bolus test and a TRH test. To elucidate such a rare complication, we outline our two cases and review 28 cases from the literature. The clinical characteristics, etiology, pathophysiology, and diagnostic and therapeutic implications are also discussed. The combined data suggest that pituitary function tests have the potential to precipitate pituitary apoplexy, and its manifestations range from a clinically benign event to a catastrophic presentation with permanent neurological deficits or even death, although most patients may fortunately have a good outcome. We suggest that the pituitary function test should not be done as a routine test, and when such a test is planned, the patient should be observed with caution for any symptomatic changes for at least 2 hours following the test for appropriate treatment. Further, MRI, especially enhanced studies, may provide an earlier diagnosis of the pituitary apoplexy since CT scan images often fail to demonstrate either density changes or obvious enlargement of the pituitary adenoma at the acute stage.

In situ XAFS and XRD studies of pressure-induced local structural change in liquid AgI

In order to examine the pressure-induced structural change of liquid silver iodide (AgI), high-pressure and high-temperature in situ x-ray absorption fine structure (XAFS) and x-ray diffraction (XRD) studies have been carried out up to 1200 K and 6 GPa. The modifications in the x-ray absorption near edge structure (XANES) spectra and x-ray structure factors, S(Q), with increasing pressure provide evidence for changes in the short-range order of liquid AgI. The I-Ag bond length in liquid AgI increases by compression up to 2 GPa, which proposes that components with higher coordination than fourfold are introduced. The I-Ag bond length decreases monotonically with compression above 2 GPa, indicating that the structural change involving a coordination-number change is completed below 2 GPa and then a high-pressure form of liquid AgI is stabilized. Comparing the I-Ag bond lengths of liquid AgI with those of crystalline phases, we conclude that the high-pressure form of liquid AgI has a rocksalt-like structure with large vacancies.

Rapid microglial activation induced by traumatic brain injury is independent of blood brain barrier disruption

Following CNS injury, microglia respond and transform into reactive species exhibiting characteristic morphological changes that have been termed "activated" or "ameboid" microglia. In an attempt to establish that microglial reactions induced immediately after injury are caused by intrinsic mechanisms rather than infiltration of blood and its constituents, oxygenized Ringer's solution was perfused into the cerebral circulation of rats so that the circulating blood could be eliminated prior to injury induction. Under artificial respiration, a catheter was inserted from the cardiac apex into the ascending aorta, and oxygenized Ringer's solution was immediately perfused with a pulsatile blood pump, resulting in wash out of the circulating blood from the brain within 1 min. Subsequently, a cortical contusion was induced in the unilateral parietal cortex using a controlled cortical impact (CCI) device. At 5 min following the injury, the brain was fixed by perfusion of fixative through the catheter and removed. Coronal vibratome sections were then processed for CR3 immunohistochemistry to examine the microglial activation. It appeared that microglial activation with both morphological transformation and an increase in CR3 immunoreactivity was induced throughout the hemisphere ipsilateral to the injury side exclusively, even in rats with elimination of circulating blood. The microglial reactions did not differ substantially from those observed in the control rats with extensive BBB disruption. The present results thus provide direct evidence that the microglial activation induced immediately after injury is independent of infiltration of circulating blood induced by concurrent BBB disruption.

Preclinical evidence of Alzheimer changes in progressive mild cognitive impairment: a qualitative and quantitative SPECT study

OBJECTIVES

Baseline brain single-photon emission computed tomography (SPECT) can predict mild cognitive impairment (MCI) patients at risk for progressive MCI (PMCI).

METHODS

Twenty-eight subjects [12 MCI, 6 with probable Alzheimer's Disease (AD), and 10 normal subjects] underwent baseline brain SPECT and were clinically followed for a mean period of 36 months.

RESULTS

Of 12 MCI patients, 6 progressed to PMCI and 6 remained stable. Baseline SPECT identified asymmetric perfusion reduction in the parahippocampus (-5%), lateral parietal (-8%), and posterior cingulate (-11%) cortices--reductions consistent with that of mild AD--in five of the six PMCI patients. Significant perfusion reduction was observed particularly in the frontal cortices of probable AD when compared with PMCI (P < 0.05).

CONCLUSION

Baseline SPECT can identify brain perfusion abnormalities among patients with MCI for progression to PMCI. This imaging modality may aid in MCI treatment stratification.

Pressure-induced site-selective disordering of Ge2Sb2Te5: a new insight into phase-change optical recording

We demonstrate that , the material of choice in phase-change optical recording (such as DVD-RAM), can be rendered amorphous by the application of hydrostatic pressure. It is argued that this structural change is due to a very strong second-nearest-neighbor Te-Te interaction that determines the long-range order in the metastable cubic phase of and also to the presence of vacancies. This newly discovered phenomenon suggests that pressure is an important factor for the formation of the amorphous phase which opens new insight into the mechanism of phase-change optical recording.

Acute hemispheric swelling associated with thin subdural hematomas: pathophysiology of repetitive head injury in sports

INTRODUCTION

The most common head injury in sports is concussion, and repeated concussions occurring within a short period occasionally can be fatal. Acute subdural hematoma is the most common severe head injury and can be associated with severe neurologic disability and death in sports. We investigated severe brain damage resulting from repetitive head injury in sports, and evaluated the pathophysiology of sports-related repetitive injury.

METHODS

We reviewed the literature containing detailed descriptions of repetitive severe sports-related head injury. In total, 18 cases were analyzed with regard to age, gender, type of sports, symptoms before second injury, and pathology of brain CT scans.

RESULTS

The majority of cases involved young males aged 16 to 23 years old, who sustained a second head injury before symptoms from the first head injury had resolved. Ten of 15 cases did not suffer loss of consciousness at insult. Eight cases were confirmed on brain CT scans after the second injury, and all 8 cases revealed brain swelling associated with a thin subdural hematoma.

CONCLUSIONS

Second impact syndrome is thought to occur because of loss of autoregulation of cerebral blood flow, leading to vascular engorgement, increased intracranial pressure, and eventual herniation. Our investigation suggests that the existence of subdural hematoma is a major cause of brain swelling following sports-related, repetitive head injury.

Matrix metalloproteinase-9 is associated with blood-brain barrier opening and brain edema formation after cortical contusion in rats

Matrix metalloproteinases (MMPs) are associated with blood-brain opening and may be involved in the pathophysiology of acute brain injury. Previous research demonstrated that knockout mice deficient in MMP-9 subjected to transient focal cerebral ischemia had reduced blood-brain barrier (BBB) disruption and attenuated cerebral infarction. In this study, we examined MMP-9 up-regulation, BBB disruption, and brain edema formation after cortical impact injury in rats. Cortical contusion was induced by controlled cortical impact. Animals were sacrificed at intervals after injury. MMP up-regulation was assessed by gelatin zymography, and BBB integrity was evaluated using Evans blue dye with a spectrophotometric assay. Brain water content was measured by comparing wet and dry weights of each hemisphere as an indicator of brain edema. Zymograms showed elevated MMP-9 as early as at 3 hours after injury, reaching a maximum at 18 hours. Peak levels of BBB disruption occurred 6 hours after injury. Brain edema became progressively more severe, peaking 24 hours after injury. Compared to control group, treatment with MMP-inhibitor GM6001 significantly reduced BBB disruption 6 hours and brain water content (85.9 +/- 0.5% vs. 82.6 +/- 0.3%; p < 0.05) 24 hours after injury. These findings suggest that MMP-9 may contribute to BBB disturbance and subsequent brain edema after traumatic brain injury.

Surgical management of early massive edema caused by cerebral contusion in head trauma patients

Early massive edema caused by severe cerebral contusion results in elevation of intracranial pressure (ICP) and clinical deterioration within 24-72 hours post-trauma. Previous studies indicate that cells in the central area of the contusion undergo shrinkage, disintegration, and homogenization, whereas cellular swelling is predominant in the peripheral area, suggesting that early massive edema is attributable to high osmolality within necrotic brain tissue and may generate an osmotic potential across central and peripheral areas. We analyzed the effects of surgical excision of necrotic brain tissue in 182 patients with cerebral contusion registered with Japan Neurotrauma Data Bank; 121 patients (66%; Group I) were treated conservatively, and 61 (34%; Group II) were treated surgically. Most Group II cases (90%) underwent complete excision of necrotic brain tissue and evacuation of clots. Group I demonstrated higher mortality at 6 months post-trauma compared to Group II (48%) vs. 23%; p = 0.0001; n = 182). Striking differences were observed in patients scoring 9 or more on Glasgow Coma Scale at admission (56% vs. 17%); p = 0.017; n = 45) and demonstrated "talk-and-deteriorate" (64% vs. 22%: p = 0.026; n = 29), supporting our hypothesis that early massive edema is caused by cerebral contusion accompanied by necrotic brain tissue, indicating that surgical excision of necrotic brain tissue provides satisfactory control of progressive elevation in ICP and clinical deterioration in many cases.

Cerebral blood oxygenation changes induced by bypass blood flow in moyamoya disease and non-moyamoya cerebral ischaemic disease

BACKGROUND

Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis has been used to prevent stroke in patients with moyamoya disease (MD) and non-moyamoya ischaemic disease (non-MD). However, little is yet known regarding the difference between these groups of patients in the extent to which the bypass contributes to maintaining adequate cerebral blood oxygenation (CBO), or the temporal changes after surgery. In the present study, we evaluated the CBO changes induced by bypass blood flow in patients with MD and non-MD during the peri-operative periods employing optical spectroscopy.

METHODS

We investigated 13 patients who underwent STA-MCA anastomosis, including 5 MD and 8 non-MD patients. We evaluated the effects of STA blood flow on the CBO in the MCA territory on the anastomosis side, employing visual light spectroscopy during surgery and near infrared spectroscopy (NIRS) at one week after surgery.

FINDINGS

In 4 MD patients and one non-MD patient, the STA blood flow increased the oxyhaemoglobin and cortical oxygen saturation (CoSO2), indicating that the bypass supplied blood flow to the ischaemic brain; the CBO changes were observed more frequently in MD than in non-MD patients (p<0.02). The pre-anastomosis CoSO2 (65.4+/-5.4%) in MD was significantly lower than that (72.8+/-7.6%) in non-MD (p<0.05). Postoperative NIRS demonstrated that the bypass began to supply blood flow to the brain in 5 non-MD patients whose bypass did not supply blood flow during surgery.

CONCLUSIONS

Although MD has vessels of small diameter as compared to non-MD, the bypass begins to supply blood flow to the ischaemic brain earlier in MD than in non-MD after anastomosis. The fact that the CoSO2 in MD was lower than that in non-MD suggested that the perfusion pressure in MD was lower than that in non-MD, and this might account for the difference in the bypass blood supply after anastomosis between MD and non-MD. Our data suggest that, even if the bypass does not supply blood to the brain during surgery in non-MD, the bypass blood flow gradually increases after surgery.

Effects of obesity phenotype on fat metabolism in obese men during endurance exercise

OBJECTIVE

The effects of obesity phenotype on fat metabolism during endurance exercise are unclear. This study aimed to investigate in obese men whether body fat distribution would influence plasma fat availability and oxidation during endurance exercise.

DESIGN

Fourteen sedentary men (body mass index (BMI) > 25 kg/m2) were divided into two groups by visceral fat (VF) area: VF obese (VF-Ob) (n = 7, age; 52.0 +/- 2.5 (s.e.) years) and abdominal subcutaneous fat obese (SF-Ob) (n = 7, age; 57.3 +/- 2.8 (s.e.) years). All participants performed stationary cycling exercise for 60 min at 50% of peak oxygen uptake.

MEASUREMENTS

Blood and respiratory gas samples were taken for analysis of hormone, metabolite and substrate oxidation in each participant at rest and during exercise.

RESULTS

There is a significant group x time interaction in the plasma concentration of free fatty acid (FFA) (P < 0.05) and glycerol (P < 0.05) during the exercise bout. In addition, total plasma concentration of FFA (area under the curve) was 59.2% higher in VF-Ob compared with SF-Ob men during endurance exercise (1.99 +/- 0.24 and 1.25 +/- 0.13 mEq/l/min, respectively; P < 0.05). Total plasma concentration of glycerol (area under the curve) was 102.3% higher in VF-Ob than SF-Ob men during the exercise (69.6 +/- 12.5 and 34.4 +/- 5.1 mg/dl/min, respectively; P < 0.05). However, fat oxidation was not different throughout the exercise between VF-Ob and SF-Ob men (176.5 +/- 25.7 and 183.0 +/- 12.8 kcal/60 min, respectively).

CONCLUSION

During moderate endurance exercise, plasma fat availability may be higher in men with VF obesity compared to men with SF obesity. However, total fat oxidation is similar between obesity phenotype.

Pallidal high-frequency deep brain stimulation for camptocormia: an experience of three cases

INTRODUCTION

The term "camptocormia" describes a forward-flexed posture. It is a condition characterized by severe frontal flexion of the trunk. Recently, camptocormia has been regarded as a form of abdominal segmental dystonia. Deep brain stimulation (DBS) is a promising therapeutic approach to various types of movement disorders. The authors report the neurological effects of DBS to the bilateral globus pallidum (GPi) in three cases of disabling camptocormia.

METHODS

Of the 36 patients with dystonia, three had symptoms similar to that of camptocormia, and all of these patients underwent GPi-DBS. The site of DBS electrode placement was verified by magnetic resonance imaging (MRI). The Burke Fahn and Marsden dystonia rating scale (BFMDRS) was employed to evaluate the severity of dystonic symptoms preoperatively and postoperatively.

RESULTS

Significant functional improvement following GPi-DBS was noted in the majority of dystonia cases. At a follow-up observation after more than six months, the overall improvement rate was 71.2 +/- 27.0%, in all dystonia cases who underwent the GPi-DBS. In contrast, the improvement rate of the three camptocormia cases was 92.2 +/- 5.3%. It was confirmed that the improvement rate for camptocormia was much higher than for other types of dystonia.

CONCLUSION

According to our experience, a patient with a forward-bent dystonic posture indicative of camptocormia is a good candidate for GPi-DBS. The findings of this study add further support to GPi-DBS as an effective treatment for dystonia, and provide the information on predictors of a good outcome.

Detection of boundaries of subthalamic nucleus by multiple-cell spike density analysis in deep brain stimulation for Parkinson's disease

When microelectrode recording of single cell activity is employed for targeting the subthalamic nucleus (STN), multiple sampling of single cells is needed to determine whether the electrode has passed through the ventral boundaries of the STN. In contrast, stepwise recording of multiple cell activities by a semimicroelectrode reveals robust changes in such activities at the dorsal and ventral boundaries. We attempted to quantify changes in multiple cell activities by computing multiple-cell spike density (MSD). We analyzed MSD in 60 sides of 30 patients with Parkinson's disease. Neural noise level was defined as the lowest cut-off level at which neural noise is separated from larger amplitude spikes. MSD was analyzed at cut-off levels ranging from 1.2 to 2.0-fold the neural noise level in the white matter in each trajectory. Both the dorsal and ventral boundaries were clearly identified by an increase and a decrease (p < 0.0001) in MSD, respectively, in all the 60 sides. The cut-off level of 1.2-fold showed the clearest change in MSD between the STN and the pars reticulata of substantia nigra. MSD analysis by semimicroelectrode recording represents the most practical means of identifying the boundaries of STN.