Physiologic-pathologic correlation in Guillain-Barré syndrome in children

OBJECTIVE: To correlate electrophysiologic patterns with sural nerve pathology in children with Guillain-Barré syndrome (GBS). BACKGROUND: Based on electrophysiologic and pathologic observations, GBS has been divided into demyelinating and axonal subtypes. The acute motor axonal neuropathy (AMAN) involves predominantly motor nerve fibers with a physiologic pattern suggesting axonal damage, whereas the acute inflammatory demyelinating polyneuropathy (AIDP) involves both motor and sensory nerve fibers with a physiologic pattern suggesting demyelination. In this study, we sought to confirm these observations by correlating sural nerve pathology with electrophysiologic findings in GBS patients. METHODS: Biopsies of sural nerve from 29 of 50 prospectively studied GBS patients were obtained. Nerves were examined by light and electron microscopy, and with immunocytochemistry for macrophages, lymphocytes, and complement activation products. RESULTS: Sural nerves from AMAN patients were normal or had only a few (0.1% to 0.7%) degenerating fibers without lymphocytic infiltration or complement activation. One patient with reduced sural sensory nerve action potential classified as acute motor sensory axonal neuropathy (AMSAN) had many degenerating fibers (2.3%) in the sural nerve. All three AIDP patients displayed active demyelination, and in two patients, lymphocytic infiltration and complement activation products were observed on the abaxonal Schwann cell surface. CONCLUSION: Classification of Guillain-Barré syndrome subtypes based on motor conduction studies correlates closely with pathologic changes seen in sural nerve. In acute motor axonal neuropathy cases, the sural nerve is almost completely spared pathologically. In acute inflammatory demyelinating polyneuropathy cases, macrophage-mediated demyelination and lymphocytic infiltration are common in the biopsies of sural nerves.     

Significant events in Polish psychiatry in 2003?

The aim of this paper was a reflection on the most significant events in Polish psychiatry in 2003. Reform in health care financing and its realisation in 2003 introduced a risk of inhibiting further development of mental health care. The endangerment is a result of allocation of resources, which is inadequate to real costs and promotes in-patient treatment. An additional risk is seen in a project of privatisation of health care institutions. Increasing orientation towards methodology of molecular biology, which is similar to a general global tendency, influences research in psychiatry. Nevertheless the low number of publications resulting from government sponsored studies is disturbing. The situation in forensic psychiatry calls for involvement and studies. Psychiatria Polska published a report indicating low standard of psychiatric expertise for courts and high probability of corruption. The same was reflected in mass media publications later on. Polish Psychiatric Association Board had appointed a special commission to study this problem.     

Cytokine immunoreactivity in cortical and subcortical neurons in periventricular leukomalacia: are cytokines implicated in neuronal dysfunction in cerebral palsy?

The major neuropathological substrate associated with cerebral palsy (CP) is a form of white matter (WM) injury known as periventricular leukomalacia (PVL). Proinflammatory cytokines were recently shown to be implicated in PVL pathogenesis. Many PVL patients develop cortical and deep gray neuronal dysfunctions such as epilepsy, cognitive deficits and extrapyramidal disorders. The precise nature of the relationship between the WM lesion and the subsequent neuronal disorders is unclear. Cytokines were shown to exert neurotoxicity in experimental models. This raises the need to investigate a possible noxious effect by cytokines on neuronal cortical development. In situ immunohistochemical methods were applied on 22 brains from infants both with PVL (study group) and without PVL (control group) to detect any immunoreactivity for cytokines (TNF-alpha, IL-1beta, IL-6) in cortical and gray matter neurons. While cortical and other neuronal structures in PVL brains did not display noticeable pathological anomalies, strong cytokine immunoreactivity was detected in many neurons in the neocortex, hippocampus, basal ganglia and thalamus. There were, however, regional differences in cytokine labeling. In addition, there was more TNF-alpha staining than IL-1beta; IL-6 was negative. In contrast, neuronal cytokine labeling in the "control" brains was negligible. In conclusion, we report and characterize, for the first time, the in situ immunoreactivity for proinflammatory cytokines in cortical and deep gray neurons in PVL. These findings might provide insights into the neuro-anatomical correlate for the intellectual deficits and the other cortical and deep gray neuronal dysfunctions associated with PVL.     

Geschlechtsunterschiede in der Psychopharmakologie – Gendermedizin in der Psychiatrie

Zusammenfassung:  Dieser Beitrag aus dem Bereich der Gendermedizin gibt einen kurzen überblick über aktuelle Studienergebnisse und Entwicklungen der pharmakologischen Therapie bei psychiatrischen Erkrankungen. Drei der am h?ufigsten verschriebenen Medikamentengruppen, Antidepressiva, Stimmungsstabilisierer sowie Antipsychotika werden herausgegriffen und hinsichtlich ihrer geschlechtsspezifisch unterschiedlichen Wirkungsweisen, ihres Nebenwirkungsspektrums sowie speziell zu beachtender Aspekte in der Praxis beschrieben. Zus?tzlich werden Hinweise auf die Einnahme dieser Substanzen w?hrend der Schwangerschaft sowie ihr teratogenes Potential gegeben. Eingelangt am 9. Juli 2009, angenommen am 13. Juli 2009     

A comparative study of psychopathology in Greek adolescents in Germany and in Greece in 1980 and 1998—18 years apart

Abstract.Objective: In the 1980s, we assessed Greek adolescents living in Germany and Greek adolescents living in Greece. Data from this earlier study supported the hypothesis of selective migration with higher psychopathology self-rating scores in Greek adolescents in Greece as compared to Greek adolescents in Germany. The current study uses the same design and instruments so that the comparison of the mental health of populations in the same areas, almost two decades apart, becomes possible.Methods: In 1980, a total of 2631 Greek adolescents were assessed in Munich, Germany or Veria, Greece. In 1998, 2920 Greek adolescents were assessed in Munich, Germany and Veria, Greece. The General Health Questionnaire (GHQ-28) was used to assess mental health status at both times.Results: 1) GHQ-28 scores showed a significant increase from 1980 to 1998 in both locations. 2) While in 1980, Greeks in Veria, Greece had higher psychopathology scores than Greek adolescents in Munich, Germany, this (with the exception of depression) was no longer true for 1998. 3) At both times and both locations adolescent girls scored higher in the GHQ-28 than adolescent boys.Conclusions: While the 1980 data supported the selective migration hypothesis, this was no longer true for the 1998 data. The increase in psychopathology in both locations is alarming and deserves further exploration.     

Current controversies in glia-to-neuron conversion therapy in neurodegenerative diseases

<正>Loss of neurons and disruption of neural circuits are associated with many neurological diseases,including neurodegenerative diseases and mental disorders.The most prevalent pathological feature of neurodegenerative diseases is the aggregate loss of certain neuronal populations.     

Epilepsie in einem ländlichen Krankenhaus in Afrika

Purpose Epilepsy is the commonest brain disorder throughout the developing world. Classification of seizures in view of adequate treatment however has been difficult due to lack of diagnostic tools such as electroencephalograms and imaging. Our study was conducted with the aim of developing a classification system for seizures suitable for local circumstances in resource poor countries. Methods Based on clinical, diagnostic, prognostic and therapeutic needs of 337 people with epilepsy from a clinic in northern Tanzania, we adjusted the International Classification of Epileptic Seizures (ICES) and suggest the following clinically based classification:

1. Generalised types of seizures:
2. Generalised seizures within a specific age range (6-25 years)
3. Generalised seizures outside that specific age range
4. Partial types of seizures:
5. Generalised seizures with diffuse brain damage
6. Generalised seizures with focal signs
7. Complex partial seizures
8. Simple partial seizures

Results Genuine epilepsy was diagnosed in 337 out of 346 patients over a period of 26 months. Two hundred and six patients (59.6%) had primary generalised seizures, split into 147 with generalised seizures which started within a specific age range (42.5%) and 59 with generalised seizures outside that age range (17.1%). A history of focal seizures was found in 102 patients (29.4%) with generalised seizures with focal signs in 60 (17.3%) and generalised seizures with diffuse brain damage in 41 patients (11.8%); one patient had complex partial seizures. Other types of seizures were diagnosed in 29 patients (8.3%), 24 had two different types of seizures (6.9%) and in five (1.4%) no clear diagnosis could be reached due to lack of information. Provoked seizures were found in 9 cases (2.6%). ConclusionWe are suggesting an ICES adjusted and simplified classification system for seizures in developing countries. Based on our suggested diagnostic groups, we were able to classify all our patients but five.     

Nonsuicidal self-harm and suicide attempts in adolescents: differences in kind or in degree?

Purpose

The purpose of the present study was to measure the prevalence of self-harm (SH) behaviours and examine potential differences in characteristics among adolescents reporting on self-harm (SH), depending on whether they had attempted suicide (SA), performed nonsuicidal self-harm (NSSH), or both.

Methods

Cross-sectional survey of 11,440 adolescents aged 14–17 years in the city of Oslo, Norway. Responses regarding measures of lifetime SH and risk factors were collected. The response rate was 92.7 %. Data were analysed by segregating SH responses into the categories of NSSH, SA, and NSSH + SA.

Results

Among all respondents, 4.3 % reported NSSH, 4.5 % reported SA, 5.0 % reported both NSSH and SA, and 86.2 % reported no SH. The group reporting to have engaged in both behaviours comprised more girls and reported more suicidal ideation, problematic lifestyles, poorer subjective health, and more psychological problems compared with the other groups. The four groups could be distinguished by one discriminant function that accounted for most of the explained variance.

Conclusions

Our findings suggest that NSSH and SA are parts of the same dimensional construct in which suicidal ideation carries much of the weight in adolescents from a school-based sample. They also indicate the group of adolescents who seems to alternate between NSSH and SA is more burdened with mental ill-health and behavioural problems compared with others. These adolescents should therefore be targeted by clinicians and school health personnel for identification and provision of adequate help and services.     

Trends in Attempted Suicide in Adolescents and Young Adults in Gent, 1986–1995

This paper describes gender-specific trends in the occurrence and methods of attempted suicide in adolescents and young adults between 1986 and 1995 in Gent. The overall pattern emerging from this study is that following a decrease in the rates of attempted suicide in the second half of the 1980s, rates have clearly increased in the 1990s, especially among adolescent males. A slight predominance of female attempters was found in the 15 to 19 age group while among young adults the female to male ratio was approximately 1.0. Deliberate self-poisoning was involved in the vast majority of attempts, although among young adults significantly more males than females used deliberate self-injury to attempt suicide. In view of increasing rates of suicide among young people in many countries and of the association between attempted suicide and suicide, further study of trends and characteristics of attempted suicide among young people is warranted.     

Deficit in negative emotional information processing in schizophrenia: Does it occur in all patients?

The nature of the impairment in the processing of emotional information in schizophrenia is still being debated. Some authors reported that schizophrenia patients would show deficits in the treatment processing of negative emotional information without a negative bias, as observed in controls, when in a combined emotional situation including positive/negative information. Eighteen subjects with paranoid schizophrenia in remission with a low level of negative symptoms and 18 control subjects were exposed to 108 pairs of pictures (International Affective Picture System) depicting different emotions (N = negative, P = positive, n = neutral) from six different combinations: N/N, P/P, n/n, P/N, P/n, and N/n. The subjects responded by clicking on a right or left button in response to a negative or positive feeling toward the stimuli (forced choice task). They were also asked to classify each of the individual pictures as positive, negative, or neutral (emotion-recognition task). In this well-defined group of paranoid schizophrenia patients in remission, we observed the persistence of a negative bias when an ambiguous situation is displayed (P/N) with the absence of an impairment in negative emotional information recognition and the presence of a positive bias in the recognition of neutral stimuli, reflecting a tendency to keep arousal-provoking perceptual cues from entering into subjective awareness.     

Decreased estrogen receptor-α expression in hippocampal neurons in relation to hyperphosphorylated tau in Alzheimer patients

Emerging evidence has demonstrated the neuroprotection of estrogen in Alzheimer's disease (AD). The hippocampus, an important target of estrogen action, is severely affected in the Alzheimer process. The aim of present study was to detect the distribution of estrogen receptor- (ER-) and the relationship between ER--containing neurons and the pretangles stained by Alz-50 in the hippocampus of AD patients. The results showed that more than half of hippocampal neurons expressed ER-. The number of cytoplasmic ER--positive neurons was significantly decreased in the CA1 and CA2 subfields of AD hippocampus, but the ratio of these ER--expressing neurons to the nucleolated neuronal profiles stained by thionin was not different between the two groups. Interestingly, the number of nuclear ER--staining neurons was also markedly decreased in the CA1 and CA2 subfields of AD hippocampus, and the percentage of these nuclear staining neurons was also significantly decreased in the same subfields. Furthermore, some double-labeled neurons containing ER- and Alz-50 were found in AD patients. However, in these double-labeled neurons, ER- was only located in the cytoplasm. Thus, we hypothesize that the nuclear ER- may play more important roles of neuroprotection during the process of AD.     

αB-Crystallin is present in reactive glia in Creutzfeldt-Jakob disease

Summary -Crystallin is a major eye lens protein, composed of two types of subunits, A and B. The A subunit is restricted to the lens, but B-crystallin has recently also been detected in non-lenticular tissues, including the nervous system. With the use of a polyclonal antiserum directed against a synthetic C-terminal peptide of human B-crystallin, the presence of B-crystallin could be demonstrated immunohistochemically in astrocytes in the brains of patients with Creutzfeldt-Jakob disease (CJD). Most intensive localization was observed in the spongiotic tissue representing abundant progressively changed astrocytes in CJD. In agematched control brains weak positive reaction was located in individual oligodendroglia cells and subpial astrocytes. Prominent increase of B-crystallin in pathological glia in CJD may represent a response to stress.     

Can differences in stress perception and coping explain sex differences in depressive symptoms in adolescents?

A four-year longitudinal study explored the different contribution of low self-esteem, different types of stressors, conflict in close relationships and avoidant coping to the explanation of depressive symptomatology in adolescents. One hundred and ninety adolescents, 101 females and 89 males, participated in four annual assessments using diverse instruments. ANOVAs repeated measurements revealed a higher stress level, more conflicts with mothers and more avoidant coping in females as compared to males at the age of 14 years. Males showed fewer depressive symptoms and higher positive self-esteem at all times. Multiple regression analysis revealed that stress and avoidant coping in early and mid-adolescence explained a significant proportion of depressive symptoms among females in late adolescence. Among males, only the level of conflicts with friends in early adolescence contributed to their level of depressive outcome in late adolescence.