Brain impedance variation of directional leads implanted in subthalamic nuclei of Parkinsonian patients

ObjectiveConventional deep brain stimulation (DBS) systems with ring-shaped leads generate spherical electrical fields. In contrast, novel directional leads use segmented electrodes. Aim of this study was to quantify the impedance variations over time in subjects with the directional Cartesia-Boston® system.MethodsImpedance records, programming settings, and clinical data of 11 consecutive Parkinsonian patients implanted with DBS directional leads in two Italian centers (Udine and Vicenza) were retrospectively evaluated. Data were collected before starting stimulation (in the operating room and at days 5 and 40) and after switching stimulation on at the successive follow-up visits (1, 6 and 12 months).ResultsDirectional leads have significantly higher impedance than ring leads. Stimulated contacts had always lower impedance compared to non-stimulated contacts. Before DBS-on, all contacts had higher impedance in the operating room, with an initial decrease five days post-surgery and a subsequent increase at day 40, more evident for directional contacts. The impedance of directional leads increased post-implantation at 1 and 6 months with a plateau at 12 months.ConclusionsThere was a significant difference between the directional and ring leads at baseline (before activation of DBS) and during follow-up (chronic DBS).SignificanceOur study reveals new information about the impedance of segmented electrodes that is useful for patient management during the initial test period, as well as during long-term DBS follow-up.     

Steep Decrease of Gender Difference in DSM-IV Alcohol Use Disorder: A Comparison of Two Nation-wide Surveys Conducted 10 Years Apart in Korea

While decreasing trend in gender differences in alcohol use disorders was reported in Western countries, the change in Asian countries is unknown. This study aims to explore the shifts in gender difference in alcohol abuse (AA) and dependence (AD) in Korea. We compared the data from two nation-wide community surveys to evaluate gender differences in lifetime AA and AD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Face-to-face interviews using the Composite International Diagnostic Interview (CIDI) were applied to all subjects in 2001 (n=6,220) and 2011 (n=6,022). Male-to-female ratio of odds was decreased from 6.41 (95% CI, 4.81-8.54) to 4.37 (95% CI, 3.35-5.71) for AA and from 3.75 (95% CI, 2.96-4.75) to 2.40 (95% CI, 1.80-3.19) for AD. Among those aged 18-29, gender gap even became statistically insignificant for AA (OR, 1.59; 95% CI, 0.97-2.63) and AD (OR, 1.18; 95% CI, 0.80-2.41) in 2011. Men generally showed decreased odds for AD (0.55; 95% CI, 0.45-0.67) and women aged 30-39 showed increased odds for AA (2.13; 95% CI 1.18-3.84) in 2011 compared to 2001. Decreased AD in men and increased AA in women seem to contribute to the decrease of gender gap. Increased risk for AA in young women suggests needs for interventions.     

The effects of running and meditation on beta-endorphin, corticotropin-releasing hormone and cortisol in plasma, and on mood

The relations between three hormones of the hypothalamic-pituitary-adrenocortical (HPA) axis, beta-endorphin (β-EP), corticotropin-releasing hormone (CRH) and cortisol, and mood change were examined in 11 elite runners and 12 highly trained meditators matched in age, sex, and personality. Despite metabolic differences between running and meditation, we predicted that mood change after these activities would be similar when associated with similar hormonal change. Compared to pre-test and control values, mood was elevated after both activities but not significantly different between the two groups at post-test. There were significant elevations of β-EP and CRH after running and of CRH after meditation, but no significant differences in CRH increases between groups. CRH was correlated with positive mood changes after running and meditation. Cortisol levels were generally high but erratic in both groups. We conclude that positive affect is associated with plasma CRH immunoreactivity which itself is significantly associated with circulating β-EP supporting a role for CRH in the release of β-EP. Increased CRH immunoreactivity following meditation indicates, however, that physical exercise is not an essential requirement for CRH release.     

新疆拜城县重病区与中病区内外环境无机元素含量的调查

本文于１９９３年４月调查了新疆拜城县重病区查尔齐农场中与中病区赛里木乡的饮水，土壤，粮食，学龄儿童头发中Ｚｎ，Ｃｕ，Ｍｎ，Ｃａ，Ｌｉ，Ｓｅ６种元素无机元素的含量。结果表明，重病区小麦中Ｃａ的含量显著高于中病区（Ｐ〈０．０５），重病区饮水及小麦中Ｍｎ的含量显著低于中病区（Ｐ〈０．０５）。这些结果揭示重病区查尔齐与中病区赛里木乡的病情相比较，除缺碘较为严重这一主要原因之外，高Ｃａ，低Ｍｎ也可能与查尔齐     

An alternative mechanism of actions for neuroleptic and antidepressant drugs

It has earlier been proposed by the author that the aetiology of schizophrenic symptomatology may be due to the presence of abnormally connected interhemispheric fibres which link specialised functions in the brains of schizophrenics that are not connected in normal subjects, and that the neuroleptic drugs may produce their action through a local anaesthetic-like effect in suppression of conduction in these fibres. This line of thought has been extended here to consider the possible mechanism of action of the neuroleptic drugs in more detail, as well as that of the tricyclic antidepressant drugs which are derivatives of the phenothiazine group. Pharmacological similarities with the local anaesthetics both structurally and functionally have been considered, as well as the effects that these drug groups may have in common with the lithium salts. It has been suggested that these drugs all produce their primary effect on cell membranes, though not necessarily at the synapse, that the time course of their clinical effect may correlate with their incorporation into various cell membranes within the CNS, and that they may thus bring about a fundamental alteration in cell membrane microstructure. The possible role of electroconvulsive therapy has also been considered. The corollary of this argument is that the affective disorders may be genetically determined diseases of cell membrane microstructure.     

脑血管意外尿失禁的机制探讨

目的探讨脑血管意外引起尿失禁的可能机制。方法对42例诊断为脑血管意外伴有尿失禁的患者进行尿动力学检查(包括静止期尿道压测定、充盈期及排尿期膀胱尿道功能测定)并按Burney分类进行分析,同时研究病变部位、脑血管意外性质和病变半球侧与尿动力学的关系。结果42例脑血管意外患者中,表现为逼尿肌反射亢进者31例(73.8%):其中外括约肌无抑制性松弛19例(45.2%),逼尿肌-外括约肌不协调3例(7.1%),逼尿肌-外括约肌协调9例(21.4%);逼尿肌反射减低,外括约肌协调者11例(26.2%);无逼尿肌功能正常者。发生膀胱顺应性减低5例(11.9%),发生尿感缺失者11例(26.2%)。初感尿容量(140.00±46.97)ml;膀胱最大容量(293.20±60.71)ml;最大尿道闭合压(65.14±19.83)cmH2O。逼尿肌最大收缩力(Pdetmax)为(60.98±31.11)cmH2O;最大尿流率时逼尿肌压力(Pdet-Qmax)为(35.98±17.46)cmH2O;逼尿肌收缩时间(Tcon)为(86.07±36.09)sec;最大流量(Qmax)为(9.02±5.62)ml/s。中风后尿失禁患者其发病部位多见于基底节、皮层多灶以及额顶叶,脑出血与脑梗塞患者的尿动力学表现无明显差异,左右半球病变对尿动力学也无明显差异。结论脑血管意外后尿失禁的尿动力学异常主要为逼尿肌反射亢进,部分出现逼尿肌反射减弱,但感觉正常,感觉缺失者较少见;外括约肌功能以无抑制性松弛为主,其次为逼尿肌-外括约肌协调,少数出现不协调;较少出现膀胱顺应性降低。     

Antidepressant-associated maniform states in acute treatment of patients with bipolar-I depression

Medical records of 158 patients with bipolar depression were analysed for the incidence of a switch from depression to maniform states (mania and hypomania). Relation to psychopharmacological treatment was investigated. Thirty-nine (25%) patients of the total sample had switched to a maniform state during the treatment period in the hospital. Among that group the phenomenon occurred in 23 patients (15%) as a hypomania and in 16 patients (10%) as a mania. Patients with a switch were significantly more often treated with tricyclic antidepressants (TCA) than patients without switch (79.5% vs 51.3%). Mood stabilising medication might reduce the risk for switching, especially in patients treated with TCA; however, it seems not totally sufficient, since 59% of the switched patients received mood stabilisers. The switch phenomenon was not associated with sociodemographic or clinical data. Received: 23 September 1998 / Accepted: 28 September 1998