Psychopathology of schizophrenia in the context of the superior longitudinal fascicle integrity – a DTI study

Introduction

Schizophrenia is a chronic mental illness with unclear etiology. It is characterized by symptoms in various psychopathological domains (e.g. positive, negative). One of the concepts explaining the etiology of schizophrenia is the disconnection hypothesis. It assumes the existence of structural and functional disorders within the connections of brain regions. White matter is largely responsible for the quality of these connections. One of the important structures of white matter is the superior longitudinal fascicle (SLF) which connects many cortical structures.

Objectives

The main aim of our study was to search for a relationship between the integrity of SLF and various psychopathological dimensions among schizophrenia patients.

Methods

42 schizophrenia subjects (SS) and 32 healthy controls (HC) participated in the study. All study participants underwent DTI-MRI analysis. The psychopathology of SS was assessed using the Positive and Negative Syndrome Scale (PANSS). In the study, we used the PANSS dimensions proposed by Shafer. Then, the SLF analysis was performed using fractional anisotropy (FA) and mean diffusivity (MD) parameters.

Results

The differences in FA and MD values in SLF bilaterally between groups were confirmed. A correlation was found between MD values in left SLF and positive symptoms (p = 0.040) and excitement (p = 0.012). A correlation was found between the MD values in the right SLF and the symptoms of disorganization (p <0.000) and excitement (p = 0.004).

Conclusions

SLF seems to play a role in the etiopathogenesis of schizophrenia. Disturbed SLF integrity may be involved in the development of positive, disorganization and excitement symptoms.

Disclosure

No significant relationships.

The relationship between white matter integrity of superior longitudinal fascicle and cognitive functions in chronic schizophrenia

Introduction

Some evidence suggests that disruption of integrity in the superior longitudinal fascicle (SLF) may influence cognitive functions in chronic schizophrenia (CS) but the results are inconclusive.

Objectives

Using diffusion tensor imaging tractography, we investigated the differences in fiber integrity between patients with CS and healthy controls (HC) together with the relationship between fiber integrity and cognitive functions.

Methods

Forty-two patients with CS and 32 HC took part in the study. Assessment of cognitive functions was performed using Measurement and Treatment Research to Improve Cognition in Schizophrenia.

Results

showed group differences, left and right in fractional anisotropy (FA) and mean diffusivity (MD) of the SLF, where patients showed less integrity than controls. Patients performed worse attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving, and social cognition tasks than HC. However, when premorbid IQ and level of education were controlled for, the differences were no longer statistically significant in verbal learning and social cognition. In patients with CS, a positive correlation was found between FA of the left SLF and attention/vigilance and working memory. Moreover, in this group there was a negative correlation between MD of the left and right SLF and working memory and social cognition.

Conclusions

These findings provide evidence that SLF disruption appears in patients with CS and might account for impairment of cognitive functioning. This research was funded by the Polish Minister of Science and Higher Education’s program named “Regional Initiative of Excellence” number 002/RID/2018/2019 to the amount of 12 million PLN.

Disclosure

No significant relationships.

A pilot study of the associations between inflammatory markers and the presence of „deficit syndrome” in schizophrenia patients

Introduction

According to current knowledge inflammation seems to be strongly associated with pathogenesis of schizophrenia. Multiple studies and meta-analyses showed increased levels of inflammatory markers in plasma of schizophrenia patients. Individual studies have shown a relationship between the levels of inflammatory markers and the presence of deficit syndrome, but their results are inconsistent.

Objectives

Analysis of associations between inflammatory markers and the presence of deficit syndrome in schizophrenia.

Methods

Studied group consisted of 50 patients with diagnosed schizophrenia (F20) for at least 10 years, including 14 patients with deficit schizophrenia (DS) and 36 patients with non-deficit schizophrenia (NDS). DS and NDS did not differ significantly in age, BMI, duration of schizophrenia, types and doses of antipsychotics (chlorpromazine equivalent), but differed in sex (x2=4.28,p=0.039). Concentrations of inflammatory markers i.e. IL-6,IL-8,IL-10,TNFα,IFNγ,CRP were measured in serum using sensitive ELISA assays.

Results

Initial analysis showed significantly lower concentration of IL-8 in DS compared to NDS (t=-3.18,p=0.002). This association remain significant (F=7.63,p=0.0085) after co-varying for age, sex, BMI, duration of schizophrenia, type of antipsychotic medications and antipsychotics doses. Multiple logistic regression showed that female gender (OR=0.18 [0.04-0.87],p=0.034) and higher IL-8 concentrations (OR=0.03 [0.002-0.39],p=0.007) are independent predictors of lower odds of having DS.

Conclusions

Low IL-8 concentrations seem to be promising predictor of the presence of DS in schizophrenia patients, but results need further investigations. The research was funded by Polish Minister of Science and Higher Education’s program named “Regional Initiative of Excellence” in 2019–2022, grant number 002/RID/2018/2019 to the amount of 12000000PLN and by National Science Centre, Poland (2019/03/X/NZ5/00719)

Disclosure

No significant relationships.

Intraoperative C-arm fluoroscopy-based 3D navigation for intraventricular endoscopic intervention

The authors present the technique of retained ventricular catheter removal by means of fluoroscopy-guided neuronavigation. A disconnected free-floating intraventricular catheter is an unusual shunt complication, and in case of shunt infection it should be removed immediately. The operative procedure described here is the first such imaging technique and original approach to retained ventricular catheter endoscopic surgery. The real-time fluoroscopy-guided neuroendoscopy seems to make 3D intraoperative navigation possible.

Maternal tetrahydrobiopterin deficiency: the course of two pregnancies and follow-up of two children in a mother with 6-pyruvoyl-tetrahydropterin synthase deficiency

No reports are available about the course of pregnancies in women with tetrahydrobiopterin (BH(4)) deficiencies or the effects of treatment with BH(4), L-dopa/carbidopa and 5-hydroxytryptophan (5-OHTrp) on fetal development. We present for the first time the case of a mother with late-diagnosed mild form of 6-pyruvoyl-tetrahydropterin synthase (PTPS) deficiency, the course of her two subsequent pregnancies and clinical evaluation with follow-up of two offspring. In both pregnancies neurotransmitter precursors, as well as BH(4) dosages were increased proportionally to the mother's weight gain. To prevent maternal phenylketonuria (MPKU) syndrome, special attention was paid to increasing BH(4) dosages. Both pregnancies were complicated by threatened premature labour, by the mother's nicotinism and additionally, in the first pregnancy, by gestational diabetes mellitus and vaginitis. The first child was born in the 31st week of pregnancy with the symptoms of moderate intrauterine growth retardation (IUGR) and brain malformation in the form of right sided closed-lip schizencephaly with absence of septum pellucidum. Although the girl demonstrates mild left-sided hemiparesis, her psychological development at the age of 8 years is above average. The second child was born in the 37th week of pregnancy without brain anomalies and at the age of 5 years his psychomotor development is appropriate for the age. As the cause of brain malformations resulting in physical impairment in the first child is unknown, more data are essential to verify conclusions about the influence of the mother's BH(4) deficiency and the safety of her treatment for fetal development.

Endolymphatic sac tumours and von Hippel-Lindau disease - case report, molecular analysis and histopathological characterization

Endolymphatic sac tumours (ELST) are aggressive papillary tumours of the temporal bone. The name was finally determined after the endolymphatic sac was determined as the site of their origin. They should be considered in patients with tumours eroding the petrous part of the temporal bone, extending to the cerebellopontine angle or other adjacent structures. These very rare tumours in the general population have much higher prevalence in von Hippel-Lindau disease. Hence molecular analysis of the VHL gene should be performed in patients with ELST and their relatives. The purpose of this study is to present a case report, histopathological characterization of endolymphatic sac tumours, their association with von Hippel-Lindau disease and use of molecular analysis.

Interleukin-10 (IL10) and tumor necrosis factor alpha (TNF) gene polymorphisms in Parkinson's disease patients

Recent studies revealed that inflammatory processes might play an important role in the pathogenesis of Parkinson's disease (PD). We hypothesized that genetically determined differences in the immune response, especially in anti- and pro-inflammatory cytokines production might influence the risk for the development and/or onset of sporadic PD. In the present study, we investigated the genetic polymorphisms of the IL10 (-1082 and -519) and TNF (-308) genes in relation to the risk of PD, and their associations with age of PD onset in a group of 316 patients, divided into two subgroups: Group 1: patients with early onset PD (EOPD), i.e. before 50 years of age (102 patients), and group 2: patients with onset of PD after 50 years of age comprising 214 subjects. Control samples were obtained from 300 randomly selected healthy individuals from the same geographical region with no signs of Parkinsonism as evaluated by a neurologist. PCR-RFLP methods were used for genotyping. No statistically significant differences between PD patients and controls were found in the frequency of a single locus of IL10 promoter. We found TNF -308A allele significantly more frequent in EOPD patients compared to the controls (p=0.007). The overrepresentation of the A allele was reflected by a significant increase in AA homozygous individuals in EOPD patients compared to the controls (p=0.0021). The results from our study revealed that the TNF -308AA genotype might increase the risk of early onset of PD.

Treatment of acute ischemic brain infarction with the assistance of local intraarterial thrombolysis with recombinant tissue-type plasminogen activator

BACKGROUND

Cerebral infarction is usually due to arterial occlusion. Prompt treatment with thrombolytic drugs can restore blood flow and improve recovery from an infarct.

PURPOSE

To evaluate the clinical efficacy and safety of local intraarterial thrombolysis with recombinant tissue-type plasminogen activator (rtPA) in patients with acute middle cerebral artery (MCA) infarctions within 6 hours of the onset of symptoms.

MATERIAL AND METHODS

Sixteen patients (10 females and six males) aged from 42 to 61 years, with acute MCA territory infarcts were selected for treatment with local i.a. rtPA up to 6 hours after the onset of symptoms. Patient selection was based on clinical examination, computed tomography (CT), and digital subtraction angiography (DSA). A clinical evaluation was performed before treatment, at the time of discharge, and 90 days post-procedure on the basis of modified Rankin and NIHSS scores. Controls (n = 16, nine females and seven males) aged from 51 to 70 years were treated only with intravenous anticoagulation using i.v. heparin infusion. The control group was evaluated with multidetector CT (MDCT) angiography performed on entry to the study and at 2-4 hours afterwards.

RESULTS

Eight patients (50%) achieved a modified Rankin score of 2 or less as the primary outcome after 90 days follow-up. The secondary clinical outcome at 90-day follow-up was as follows: NIHSS score < or =1, three (19%) of the patients; NIHSS score > or =50% decrease, nine (56%) of the patients. A recanalization rate of 75% was achieved in 12 of the 16 treated patients, but only 12.5% in two of the 16 patients in the control group. Intracerebral hemorrhage occurred in two (12.5%) of the patients in the treatment group, but in only one patient (6%) in the control group. There were no deaths in the treated group after thrombolysis up to the time of discharge; however, during the 90-day follow-up, two patients died compared to three patients in the control group (19% vs. 12.5% mortality rate).

CONCLUSION

Patients with cerebral infarction who were treated within 6 hours of onset using intraarterial rtPA thrombolysis had a significantly improved clinical outcome 90 days after the procedure compared to patients treated only with intravenous anticoagulation.

The effect of stem cell mobilisation with granulocyte colony-stimulating factor on the morphology of the haematopoietic organs in mice

The cellular mobilisation of mice with granulocyte colony-stimulating factor (G-CSF) results in an egress of haematopoietic stem/progenitor cells from the bone marrow and an increase in their level in the peripheral blood. While the mobilisation process with different agents is widely studied, little is known about the morphology of the murine haematopoietic organs during the mobilisation. The purpose of this study was to examine the morphology of the bone marrow, spleen and liver in mice mobilised with G-CSF. To address this issue mice were injected subcutaneously with G-CSF for 6 consecutive days. Morphological analysis revealed an increase in the number of mature neutrophils close to the wall of sinusoids in the bone marrow as well as hypertrophy of the red pulp in the spleen. At the same time no morphological changes were noticed in the livers of G-CSF-mobilised mice. In conclusion, G-CSF induces discrete ultrastructural changes in the bone marrow, which intensify the transendothelial traverse of haematopoietic stem and progenitor cells from it. The changes in the spleen are related to repopulation of this organ by mobilised early haematopoietic cells circulating in the peripheral blood. We also noticed that the process of migration of haematopoietic cells from the bone marrow into the peripheral blood began on day 2 and was most pronounced on day 4 after stimulation with G-CSF.

Emergency Use of Stent and rtPA with Mechanical Cloth Defragmentation for a Thromboembolic Complication during GDC Coil Treatment of an Acutely Ruptured Basilar Tip Aneurysm

Thrombotic occlusion of both posterior cerebral arteries occurred during embolization of an acutely ruptured basilar tip aneurysm. Intracranial stenting and continuous superselective infusion of rtPA was administered combined with mechanical clot fragmentation to reestablish normal vessel flow. DSA disclosed that normal vessel patency was achieved within 30 min. There were no adverse events related to rtPA administration and the patient recovered from the embolization with minor neurologic deficit as present before the procedure.

An unusual stab wound of the cervical spinal cord: a case report

STUDY DESIGN

A rare case of a laterally directed stab wound injury of the cervical spinal cord is reported.

OBJECTIVE

To describe the unusual mechanism of injury of this case and its clinical features. The surgical indications for penetrating injuries of the spinal cord are discussed.

SUMMARY OF BACKGROUND DATA

Spinal stab wound injuries are rare, and the literature on the subject is scant. There has been only one large clinical review from South Africa, published in 1977. The clinical features and the injury mechanism of a laterally directed stab wound to the cervical spine have not been previously described.

METHODS

An 18-year-old man was stabbed in the right side of the neck at C1-C2. The blade penetrated the spine laterally and went through the ligaments without affecting the bony structures. On admission the patient had tetraplegia and was in respiratory failure. Radiologic investigation showed the retained blade passing through the cord but showed no bony or vascular injuries.

RESULTS

Before extraction, the knife was followed to its tip with careful dissection. Because no cerebrospinal fluid leak was noted in the area, the dura was not exposed. After surgery, magnetic resonance images showed a complete transection of the spinal cord at C1-C2. The patient was neurologically unchanged in follow-up examinations.

CONCLUSION

Laterally directed horizontal stab wounds of the spine are particularly dangerous because the blade can pass between two vertebrae to transect the cord. The neurologic injury that results is irreversible. The more common stab wounds, inflicted from behind, usually produce incomplete cord damage.

[Brain stem auditory evoked potentials in brain death state]

The authors studied auditory brainstem evoked potentials (BAEP) in 27 organ donors aged 40 to 68 years treated in neurosurgery units in Szczecin and Grenoble. Abnormal results were found in all cases. In 63% of cases no evoked action potentials were obtained, in 34% only the 1st wave was obtained, and in two cases evolution was observed with activity extinction. The authors believe that in the process of shaping of BAEP morphotic extinction begins from the later waves to earlier ones in agreement with the rostrocaudal direction of extinction of the functions or brain midline structures, and in a single study various findings may be obtained.

[Spinal reflexes in the determination of brain death]

The authors present the results of spinal cord function evaluation in organ donors by examination of reflexes. The knee reflex and ankle jerk, as well as abdominal reflex and foot withdrawal reaction were tested in 31 donors. At least one of the above was seen in 25 individuals. It is suggested on the basis of data obtained not to hamper the transplant procedure in cases of tested reflex persistency when brain death is revealed on relevant examination.

On the origin of mitosing cells. 1967

A theory of the origin of eukaryotic cells ("higher" cells which divide by classical mitosis) is presented. By hypothesis, three fundamental organelles: the mitochondria, the photosynthetic plastids and the (9+2) [9(2)+2] basal bodies [kinetosomes] of flagella [undulipodia] were themselves once free-living (prokaryotic) cells. The evolution of photosynthesis under the anaerobic [anoxic] conditions of the early atmosphere to form anaerobic bacteria, photosynthetic bacteria and eventually blue-green algae (and protoplastids) is described. The subsequent evolution of aerobic metabolism in prokayotes to form aerobic bacteria (protoflagella [undulipodia] and protomitochondria) presumably occurred during the transition to the oxidizing atmosphere. Classical mitosis evolved in protozoan-type cells millions of years after the evolution of photosynthesis. A plausible scheme for the origin of classical mitosis in primitive amoeboflagellates [amoebomastigotes] is presented. During the course of the evolution of mitosis, photosynthetic plastids (themselves derived from prokaryotes) were symbolically acquired by some of these protozoans to form the ["eukaryotic" deleted] algae and the green plants. The cytological, biochemical and paleontological evidence for this theory is presented, along with suggestions for further possible experimental verification. The implications of this scheme for the systematics of the lower [smaller] organisms is discussed.

+Gz tolerance in man after 14-day bedrest periods with isometric and isotonic exercise conditioning

The purpose of this study was to determine the effects of isometric or isotonic exercise training on post-bedrest +Gz tolerance. Seven male volunteers, 19-22 years, underwent accelerations of +2.1 Gz (740 s), +3.2 Gz (327 s), and +3.8 Gz (312 s) in a selected, randomized order; the ramp to peak acceleration was 1.8 G/min. The centrifugation runs were terminated by loss of central vision (blackout) to a white light with a luminance of 3.15 times 10-5 log candle/cm-2 (0.092 ft-lambert). The study began with a 14-d ambulatory control period, followed by three 14-d bedrest periods (each separated by a 21-d recovery period) and then a final week of recovery. During the ambulatory periods, the subjects exercised on a bicycle ergometer at 50% of their maximal oxygen uptake (max VO2) for 1 h/d. During two of the three bedrest periods, the subjects performed in the supine position one of two routines, either isometric exercise (21% of max leg extension force for 1 min followed by 1-min rest) or isotonic exercise (68% of max VO2) for 0.5 in the morning and afternoon. During the third bedrest period, no exercise was performed. In general +Gz tolerance was reduced by 24% to 35% (p less than or equal to 0.05) after bedrest. Compared with control values, there were significant reductions in average tolerance times after bedrest with no exercise and isotonic exercise at all G levels. With isometric exercise, there was a significant decrease in tolerance at 2.1 Gz but not at 3.2 Gz or 3.8 Gz, even though the latter tolerances were reduced 15.6% and 10.0%, respectively. Both exercise regimens maintained tolerance at levels equal to or above that obtained with no exercise. Compared with control values, average tolerances were lower (p less than or equal to 0.05) after the two recovery periods between the bedrest periods (minus 24% to minus 26% at 3.2 Gz and 3.8 Gz), indicating that 3 weeks of ambulation was not sufficient time for full recovery from the deconditioning induced in this study. A prediction equation was constructed with data from all comparable studies utilizing deconditioned men riding relaxed without protective garments: Tolerance (in seconds) equals minus 334 + (1715/+Gz level). From this equation, the calculated tolerance after bedrest is 13.5 min at 1.5 G, and the point of zero tolerance is 5.1 Gz.

On the origin of mitosing cells

A theory of the origin of eukaryotic cells ("higher" cells which divide by classical mitosis) is presented. By hypothesis, three fundamental organelles: the mitochondria, the photosynthetic plastids and the (9+2) basal bodies of flagella were themselves once free-living (prokaryotic) cells. The evolution of photosynthesis under the anaerobic conditions of the early atmosphere to form anaerobic bacteria, photosynthetic bacteria and eventually blue-green algae (and protoplastids) is described. The subsequent evolution of aerobic metabolism in prokaryotes to form aerobic bacteria (protoflagella and protomitochondria) presumably occurred during the transition to the oxidizing atmosphere. Classical mitosis evolved in protozoan-type cells millions of years after the evolution of photosynthesis. A plausible scheme for the origin of classical mitosis in primitive amoeboflagellates is presented. During the course of the evolution of mitosis, photosynthetic plastids (themselves derived from prokaryotes) were symbiotically acquired by some of these protozoans to form the eukaryotic algae and the green plants. The cytological, biochemical and paleontological evidence for this theory is presented, along with suggestions for further possible experimental verification. The implications of this scheme for the systematics of the lower organisms is discussed.

Studies of chloroplast development in Euglena. XI. Radioautographic localization of chloroplast DNA

Images