Contribution of different somatosensory afferent input to subcortical somatosensory evoked potentials in humans

ObjectivesTo investigate the subcortical somatosensory evoked potentials (SEPs) to electrical stimulation of either muscle or cutaneous afferents.MethodsSEPs were recorded in 6 patients suffering from Parkinson’s disease (PD) who underwent electrode implantation in the pedunculopontine (PPTg) nucleus area. We compared SEPs recorded from the scalp and from the intracranial electrode contacts to electrical stimuli applied to: 1) median nerve at the wrist, 2) abductor pollicis brevis motor point, and 3) distal phalanx of the thumb. Also the high-frequency oscillations (HFOs) were analysed.ResultsAfter median nerve and pure cutaneous (distant phalanx of the thumb) stimulation, a P1-N1 complex was recorded by the intracranial lead, while the scalp electrodes recorded the short-latency far-field responses (P14 and N18). On the contrary, motor point stimulation did not evoke any low-frequency component in the PPTg traces, nor the N18 potential on the scalp. HFOs were recorded to stimulation of all modalities by the PPTg electrode contacts.ConclusionsStimulus processing within the cuneate nucleus depends on modality, since only the cutaneous input activates the complex intranuclear network possibly generating the scalp N18 potential.SignificanceOur results shed light on the subcortical processing of the somatosensory input of different modalities.     

Emerging therapeutic options in inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic disease that requires chronic treatment throughout the evolution of the disease, with a complex physiopathology that entails great challenges for the development of new and specific treatments for ulcerative colitis and Crohn´s disease. The anti-tumor necrosis factor alpha therapy has impacted the clinical course of IBD in those patients who do not respond to conventional treatment, so there is a need to develop new therapies and markers of treatment response. Various pathways involved in the development of the disease are known and the new therapies have focused on blocking the inflammatory process at the gastrointestinal level by oral, intravenous, subcutaneous, and topical route. All these new therapies can lead to more personalized treatments with higher success rates and fewer relapses. These treatments have not only focused on clinical remission, but also on achieving macroscopic changes at the endoscopic level and microscopic changes by achieving mucosal healing. These treatments are mainly based on modifying signaling pathways, by blocking receptors or ligands, reducing cell migration and maintaining the integrity of the epithelial barrier. Therefore, this review presents the efficacy and safety of the new treatments that are currently under study and the advances that have been made in this area in recent years.     

Audiovisual integration and the P2 component in adult Asperger’s syndrome: An ERP-study

BackgroundA widened temporal window of integration (TWI) in audiovisual processing has been detected for children with autism spectrum disorder. However, research indicates a narrowing of this TWI and an associated change in audiovisual integration in the course of development.MethodsTo further elucidate audiovisual integration processes in adulthood, we compared adult participants with Asperger’s Syndrome (AS) to healthy controls (HC) by using the sound-induced double flash illusion. For a better understanding of underlying neural mechanisms, event-related potentials were measured via electroencephalography (EEG).ResultsThe number of reported sound-induced flash illusions indicated audiovisual integration. A similar TWI size for both, participants with AS and HC, was found. Additionally, enhanced P2 amplitudes were detected for participants with AS compared to HC.ConclusionResults indicate an involvement of attentional processes in audiovisual perception in participants with AS.     

lncRNA-FTX与脑胶质瘤病人预后的相关性分析

目的 探讨长链非编码RNA（lncRNA）FTX表达水平与脑胶质瘤病人预后的相关性。方法 前瞻性收集2016年1月~2018年1月手术切除的脑胶质瘤88例（46例获得瘤旁组织），采用实时逆转录PCR检测lncRNA FTX表达水平，以脑胶质瘤组织lncRNA FTX表达水平均值为界分为高表达组（n=57）和低表达组（n=31）。术后随访3年，主要观察指标为无进展生存期、总生存期。结果 脑胶质瘤组织lncRNA FTX表达水平[（7.54±2.15）]明显高于瘤旁组织[（2.65±0.69）；P<0.001]。多因素Cox比例回归风险模型分析显示，lncRNA FTX高表达是脑胶质瘤生存预后不良的独立危险因素（RR=1.589；95% CI 1.004~2.515；P=0.048）。生存曲线分析显示，高表达组无进展生存期（15.10个月）和总生存期（20.24个月）较低表达组（分别为18.96和25.53个月）明显缩短（P<0.05）。结论 脑胶质瘤lncRNA FTX呈高表达，与病人不良生存预后有关。     

Racial and geographic disparities with gastrostomy tube placement in dementia and parkinsonian disorders

IntroductionMany patients with advanced dementia and Parkinson's disease and related disorders (PDRD) are receiving gastrostomy tube (GT) placement annually, despite its lack of proven benefit for preventing aspiration, enhancing nutrition, or prolonging survival. Given clinical practice variability in the care of people with neurodegenerative disorders, we sought to examine racial and geographic disparities in GT placement for these populations in the United States.MethodData were extracted from a publicly-available national database using diagnostic and procedural codes from 2006 to 2010. GT placement rates and odds ratios were calculated for two groups: PDRD and non-parkinsonian dementia (NPD).ResultsIn the PDRD group, odds of GT placement were higher among patients coded as Black (OR 1.69, CI 0.80–3.56, p = 0.17) and Asian (OR 2.17, CI 0.70–6.78, p = 0.18) than Whites; although these tendencies did not reach statistical significance. In the NPD group, GT placement among Black patients was significantly more likely (OR 2.88, CI 1.90–4.36, p < 0.001) than their white counterparts, while Asian patients were significantly less likely (OR 0.12, CI 0.02–0.91, p = 0.04). Compared to the Northeast region, there were significantly lower odds of GT placement in the Midwest region (OR 0.37, CI 0.24–0.58, p < 0.001) in the NPD group only. No difference in odds was observed between the sexes in both groups.ConclusionThis study showed geographic and racial disparities in GT placement among PDRD and NPD patients. Further studies should aim to clarify best practices for GT placement in PDRD and causes of practice differences within and between PDRD and NPD groups.     

Extracellular vesicles: Their emerging roles in the pathogenesis of respiratory diseases

Alveoli are the basic structure of the lungs, consisting of various types of parenchymal and bone marrow-derived cells including alveolar macrophages. These various types of cells have several important functions; thus, communication between these cells plays an important role in homeostasis as well as in the pathophysiology of diseases in the lungs. For a better understanding of the pathophysiology of lung diseases, researchers have isolated each type of lung cell to investigate the changes in their gene expressions, including their humoral factor or adhesion molecules, to reveal the intercellular communication among these cells. In particular, investigations during the past decade have focused on extracellular vesicles, which are lipid bilayer delimited vesicles released from a cell that can move among various cells and transfer substances, including microRNAs, mRNAs and proteins, thus, functioning as intercellular messengers. Extracellular vesicles can be classified into three general groups: apoptotic bodies, exosomes, and microparticles. Extracellular vesicles, especially exosomes and microparticles, are attracting increasing attention from pulmonologists as tools for understanding pathogenesis and disease diagnosis. Here, we review studies, including our own, on exosomes and microparticles and their roles in both lung homeostasis and the pathogenesis of lung diseases such as idiopathic pulmonary fibrosis, chronic obstructive lung diseases, and acute respiratory distress syndrome. This review also addresses the roles of extracellular vesicles in COVID-19, the current global public health crisis.     

Risk of seizures and subclinical epileptiform activity in patients with dementia: A systematic review and meta-analysis

BackgroundSeizures and subclinical epileptiform activity are common yet easily overlooked among demented patients. We aimed to investigate their epidemiological characteristics in patients with dementia from various aspects.MethodsWe retrieved relevant observational studies from PubMed and Embase Library until March 2021. Pooled estimate effects were calculated using random-effects models. This study is registered with PROSPERO, number CRD42020200949.ResultsOf the 19144 identified studies, 27 were eligible for inclusion. The pooled period prevalence rates of seizures were 4.86% (95%CI: 3.43–6.51%), 2.68% (95%CI: 2.13–3.28%), 2.81% (95%CI: 2.02–3.71%）and 7.13% (95%CI: 2.67–13.14%) among patients with Alzheimer’s disease (AD), Dementia of Lewy Body (DLB), Frontotemporal dementia (FTD) and Vascular dementia (VaD), respectively. The pooled incidence rate of seizures was [8.4 (95%CI: 4.2–12.7) per 1000 person-years] in AD patients. And the pooled relative risk of seizures in patients with AD was 3.35 (95%CI: 2.69–4.19). Besides, the pooled cumulative incidence rate and prevalence rate of subclinical epileptiform activity among AD patients were [21.41% (95%CI: 0.001–63.60%)] and 9.73% (95%CI: 0.26–28.38%), respectively.ConclusionsThe accurate rates of seizures and subclinical epileptiform activities in the four major dementia types are high. Besides, patients with AD are likely at a higher risk of seizures.     

Primary aldosteronism due to bilateral micronodular hyperplasia and concomitant subclinical Cushing’s syndrome: A case report

BACKGROUNDAdrenal incidentaloma (AI) has been frequently encountered in the clinical setting. It has been shown that primary aldosteronism (PA) or subclinical Cushing’s syndrome (SCS) are the representative causative diseases of AI. However, the coexistence of PA and SCS has been reportedly observed. Recently, we encountered a case of AI, in which PA and SCS coexisted, confirmed by histopathological examinations after a laparoscopic adrenalectomy. We believe that there were some clinical implications in the diagnosis of the present case.CASE SUMMARYA 58-year-old man presented with lower right abdominal pain with a blood pressure of 170/100 mmHg. A subsequent computed tomography scan revealed right ureterolithiasis, which was the cause of right abdominal pain, and right AI measuring 22 mm × 25 mm. After the disappearance of right abdominal pain, subsequent endocrinological examinations were performed. Aldosterone-related evaluations, including adrenal venous sampling, revealed the presence of bilateral PA. In addition, several cortisol-related evaluations showed the presence of SCS on the right adrenal adenoma. A laparoscopic right adrenalectomy was then performed. The histopathological examination of the resected right adrenal revealed the presence of a cortisol-producing adenoma, while CYP11B2 immunoreactivity was absent in this adenoma. However, in the adjacent non-neoplastic adrenal, multiple CYP11B2-positive adrenocortical micronodules were detected, showing the presence of aldosterone-producing adrenocortical micronodules. CONCLUSIONCareful clinical and pathological examination should be performed when a patient harboring AI presents with concomitant SCS and PA.     

Motor dysfunction in mild cognitive impairment as tested by kinematic analysis and transcranial magnetic stimulation

ObjectivePrevious studies have demonstrated voluntary movement alterations as well as motor cortex excitability and plasticity changes in patients with mild cognitive impairment (MCI). To investigate the pathophysiology of movement abnormalities in MCI, we tested possible relationships between movement abnormalities and primary motor cortex alterations in patients.MethodsFourteen amnestic MCI (aMCI) patients and 16 healthy controls were studied. Cognitive assessment was performed using clinical scales. Finger tapping was recorded by a motion analysis system. Transcranial magnetic stimulation was used to test the input/output curve of motor evoked potentials, intracortical inhibition, and short-latency afferent inhibition. Primary motor cortex plasticity was probed by theta burst stimulation. We investigated correlations between movement abnormalities, clinical scores, and cortical neurophysiological parameters.ResultsMCI patients showed less rhythmic movement but no other movement abnormalities. Cortical excitability measures were normal in patients, whereas plasticity was reduced. Movement rhythm abnormalities correlated with frontal dysfunction scores.ConclusionOur study in MCI patients demonstrated abnormal voluntary movement and plasticity changes, with no correlation between the two. Altered rhythm correlated with frontal dysfunction.SignificanceOur results contribute to the understanding of pathophysiological mechanisms of motor impairment in MCI.