Medically induced myopathia

Muscular side effects of various anesthetics, analgetics, antibiotics, antihistaminic drugs, antiretrovirals, cardiotropics, immunosuppressants, lipid-lowering drugs, psychotropic drugs, anticancer drugs, and other substances are more frequent than assumed and are easily overlooked. Clinically, muscular side effects manifest as fatigue, myalgias, persistent or transient weakness, stiffness, intolerance to exercise, psychomotor slowing, muscle cramps, wasting, dyspnea, dysphagia, fasciculations, reduced tendon reflexes, impaired consciousness, myoglobinuria, renal failure, or hyperthermia. Diagnosis of these drug-induced myopathies is based on history, clinical neurologic examination, blood work, urine analysis, repetitive stimulation, electromyography, and muscle biopsy. A drug which induces muscular side effects should never be given again. Particularly in patients suffering from primary myopathy, myotoxic drugs should be applied with caution. The drugs which most frequently induce muscular side effects are steroids, statins, fibrates, antiretrovirals, immunosuppressants, colchicine, amiodarone, and anticancer drugs. Many drugs exhibit their myotoxic potential only in combination with other drugs or premorbid pathologic myogenic conditions.     

Internalized Stigma of Mental Illness (ISMI) Scale: A multinational review

The Internalized Stigma of Mental Illness (ISMI) scale is a 29-item questionnaire measuring self-stigma among persons with psychiatric disorders. It was developed with substantial consumer input and has been widely used, but its psychometric qualities have not been comprehensively evaluated across multiple versions. Here we review the 55 known versions, and provide the 47 available versions, including: Arabic, Armenian, Bengali, Bulgarian, Chinese (Mainland, Taiwan, Hong Kong), Croatian, Dutch, English (USA, South Africa), Estonian, Farsi, Finnish, French, German, Greek, Hebrew, Hindi, Japanese, Khmer, Korean, Lithuanian, Lugandan, Maltese, Polish, Portuguese (Portugal, Brazil), Romanian, Russian, Samoan, Slovenian, Spanish (Spain), Swahili, Swedish, Tongan, Turkish, Urdu, and Yoruba, and qualitative English and Swahili versions, as well as versions for depression, schizophrenia, substance abuse, eating disorders, epilepsy, inflammatory bowel disease, leprosy, smoking, parents and caregivers of people with mental illness, and ethnicity. The various versions show reliability and validity across a wide range of languages, cultures, and writing systems. The most commonly reported findings of studies using the ISMI are that internalized stigma correlates with higher depression, lower self esteem, and higher symptom severity. Initial studies of ways to reduce internalized stigma are promising and warrant further investigation.     

Mu,delta, and kappa opioid receptor mRNA expression in the rat CNS: An in situ hybridization study

The μ, δ, and κ opioid receptors are the three main types of opioid receptors round in the central nervous system (CNS) and periphery. These receptors and the peptides with which they interact are important in a number of physiological functions, including analgesia, respiration, and hormonal regulation. This study examines the expression of μ, δ, and κ receptor mRNAs in the rat brain and spinal cord using in situ hybridization techniques. Tissue sections were hybridized with ³⁵S-labeled cRNA probes to the rat μ (744–1, 064 b), δ (304–1,287 b), and κ (1,351–2,124 b) receptors. Each mRNA demonstrates a distinct anatomical distribution that corresponds well to known receptor binding distributions. Cells expressing μ receptor mRNA are localized in such regions as the olfactory bulb, caudate-putamen, nucleus accumbens, lateral and medial septum, diagonal band of Broca, bed nucleus of the stria terminalis, most thalamic nuclei, hippocampus, amygdala, medial preoptic area, superior and inferior colliculi, central gray, dorsal and median raphe, raphe magnus, locus coeruleus, parabrachial nucleus, pontine and medullary reticular nuclei, nucleus ambiguus, nucleus of the solitary tract, nucleus gracilis and cuneatus, dorsal motor nucleus of vagus, spinal cord, and dorsal root ganglia. Cellular localization of δ receptor mRNA varied from μ or κ, with expression in such regions as the olfactory bulb, allo- and neocortex, caudate-putamen, nucleus accumbens, olfactory tubercle, ventromedial hypothalamus, hippocampus, amygdala, red nucleus, pontine nuclei, reticulotegmental nucleus, motor and spinal trigeminal, linear nucleus of the medulla, lateral reticular nucleus, spinal cord, and dorsal root ganglia. Cells expressing, κ receptor mRNA demonstrate a third pattern of expression, with cells localized in regions such as the claustrum, endopiriform nucleus, nucleus accumbens, olfactory tubercle, medial preoptic area, bed nucleus of the stria terminalis, amygdala, most hypothalamic nuclei, median eminence, infundibulum, substantia nigra, ventral tegmental area, raphe nuclei, paratrigeminal and spinal trigeminal, nucleus of the solitary tract, spinal cord, and dorsal root ganglia. These findings are discussed in relation to the physiologica functions associated with the opioid receptors.     

Selective serotonin-reuptake inhibitors: an update.

Selective serotonin-reuptake inhibitors (SSRIs), including fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram, represent an important advance in the pharmacotherapy of mood and other disorders. They are chemically unrelated to tricyclic, heterocyclic, and other first-generation antidepressants. SSRIs are the treatment of choice for many indications, including major depression, dysthymia, panic disorder, obsessive-compulsive disorder, eating disorders, and premenstrual dysphoric disorder, because of their efficacy, good side-effect profile, tolerability, and safety in overdose, as well as patient compliance. A review of the literature was conducted using Medline and the terms "SSRIs," "fluoxetine," "sertraline," "paroxetine," "fluvoxamine," and "citalopram." Articles were limited to those published in English within the last 15 years. The search revealed that indications for antidepressants include unipolar depression, dysthymia, bipolar depression, treatment-resistant depression, depression in the medically ill, panic disorder, obsessive-compulsive disorder, eating disorders, social phobia, and premenstrual dysphoric disorder. One SSRI, fluoxetine, has demonstrated safety in pregnancy. Side effects of SSRIs include gastrointestinal disturbances, headache, sedation, insomnia, activation, weight gain, impaired memory, excessive perspiration, paresthesia, and sexual dysfunction.     

Genetics of psychiatric disorders in the GWAS era: an update on schizophrenia

The influence of genetic factors in the development of schizophrenia has been convincingly demonstrated by family, twin, and adoption studies. The statistical construct of heritability is generally used for estimating the liability due to genetic factors. Heritability estimates for schizophrenia are reported to be between 60 and 80 %. Due to the technical achievements in whole genome-wide association studies, dissection of the underlying genetic factors was intensified recently, resulting in the conclusion that schizophrenia is essentially a polygenic, complex disorder. Most likely more than 100 genes, each with small effect size, contribute to disease risk. A most recent multi-stage genome-wide association study (Ripke et al. in Nat Genet 2013) identified 22 risk loci and estimated that 8,300 independent single-nucleotide polymorphisms contributed to the risk accounting collectively for 32 % in liability. In addition to this polygenic, complex inheritance, there is also strong indication that in some patients a deletion or insertion of a larger chromosomal region [so-called copy number variation (CNV)] might play a crucial role in pathogenesis. This could be specifically important in sporadic cases with schizophrenia, since a higher frequency of de novo mutations has been associated with these CNVs. Further studies, combining much larger sample sizes as well as application of newer technology, such as deep sequencing technologies will be necessary in order to obtain a more comprehensive understanding of the genetic foundations of schizophrenia.

     

Thiol redox state and lipid and protein oxidation in the mouse striatum after pentylenetetrazol-induced epileptic seizure

PURPOSE: In the present study, we examined the effects of pentylenetetrazol (PTZ) administration on the thiol redox state (TRS), lipid peroxidation, and protein oxidation in the mouse striatum to (a) quantitate the major components of TRS and relate them to oxidative stress, and (b) investigate whether neuronal activation without synchronization, induced by subconvulsive doses of PTZ, can cause similar qualitative effects on TRS in this brain area. Specifically, we examined the TRS components glutathione (GSH), glutathione disulfide (GSSG), cysteine (CSH), protein thiols (PSH), and the protein (P) and nonprotein (NP/R) disulfides PSSR, NPSSR, NPSSC, and PSSP. METHODS: TRS components were measured photometrically (GSSG enzymatically) as were lipid peroxidation and protein oxidation. RESULTS: GSH, GSSG, and NPSSC levels are decreased by 45%, 38% and 26%, respectively, at 15 min after seizure; PSSP and PSSR levels and lipid peroxidation are increased by 47%, 200% and 22%, respectively, whereas CSH, NPSSR, PSH, PSSC, and protein carbonyl levels do not change. At 30 min after seizure, GSH, GSSG, CSH, NPSSC, and protein carbonyl levels are decreased by 26%, 62%, 25%, 40%, and 13%, respectively. PSSP and NPSSR levels are increased by 30% and 42%, respectively, whereas PSH, PSSC, PSSR, and lipid peroxidation remain unchanged. At 24 h after seizure, GSH, NPSSR, PSSR, and lipid-peroxidation levels return to normal; GSSG, CSH, NPSSC, and protein carbonyl levels are decreased by 44%, 22%, 30%, and 27%, respectively. CONCLUSIONS: The significant decrease in GSH, GSSG, CSH, and NPSSC and the increase in PSSP, NPSSR, PSSR, and lipid peroxidation after PTZ-induced seizure strongly suggest increased oxidative stress in the mouse striatum.     

nCPAP治疗伴轻中度OSAHS缺血性卒中患者的随访研究

目的 比较合并轻中度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome,OSAHS）非急性缺血性卒中患者接受经鼻持续气道正压通气（nasal continuous positive airway pressure,nCPAP）治疗与未接受nCPAP治疗患者2年内缺血性卒中复发事件及相关指标变化。 方法 前瞻性连续选取2008年3月～2010年3月北京市海淀医院神经内科住院及门诊的非急性缺血性卒中患者30例,发病90 d后进行多导睡眠图（polysomnography,PSG）监测,符合轻中度OSAHS诊断标准,纳入研究,根据是否应用nCPAP治疗,将患者分为nCPAP治疗组（14例）和非nCPAP治疗组（16例）,分别于入组后第6、12、18、24个月随访观察缺血性卒中复发、呼吸暂停低通气指数（apnea hypopnea index,AHI）、血压、体重指数（body mass index,BMI）、Epworth嗜睡量表评分（Epworth Sleepiness Scale,ESS）、焦虑和抑郁状态发生率等。 结果 nCPAP治疗组和非nCPAP治疗组,入组时年龄、性别、糖尿病、高血压病史、AHI、收缩压、舒张压、BMI、改良Rankin量表评分、ESS评分、焦虑和抑郁状态发生率评分差异无显著性（P值均＞0.05）。随访2年中两组均无缺血性卒中复发事件。第6、12、18、24个月nCPAP治疗组AHI（3.9±0.6、3.8±0.5、3.9±0.5、3.8±0.5）较非nCPAP治疗组（20.8±4.1、21.7±4.5、22.6±4.2、26.8±6.1）改善,差异具有显著性（t值分别为16.2、15.9、17.8、15.0,P值均＜0.001）。治疗组ESS评分在第6、12、18、24个月（3.5±1.7、2.6±1.5、2.2±1.4、2.1±1.1）较对照组（6.8±1.2、7.0±1.3、7.1±1.2、7.2±1.6）改善,差异具有显著性（t值分别为6.1、8.8、9.9、10.0,P值均＜0.001）。在第24个月焦虑发生率改善（nCPAP组7.1%、非nCPAP组43.8%）,差异具有显著性（P=0.039）,抑郁发生率在第6、12、18、24个月无明显变化（nCPAP组14.3%、14.3%、14.3%、14.3%）（非nCPAP组18.8%、18.8%、18.8%、18.8%）,差异无显著性（P值均＞0.05）。在第6、12、18、24个月BMI nCPAP组（22.8±1.4、23.1±1.4、22.7±1.4、22.6±1.4）与非nCPAP组（23.3±1.4、23.7±1.6、23.5±1.6、23.0±1.3）差异无显著性（P值均＞0.05）。 结论 nCPAP治疗可降低合并轻中度OSAHS缺血性卒中患者的AHI,降低患者ESS评分及改善焦虑状态。     

Insular cortex and neuropsychiatric disorders: a review of recent literature.

The insular cortex is located in the centre of the cerebral hemisphere, having connections with the primary and secondary somatosensory areas, anterior cingulate cortex, amygdaloid body, prefrontal cortex, superior temporal gyrus, temporal pole, orbitofrontal cortex, frontal and parietal opercula, primary and association auditory cortices, visual association cortex, olfactory bulb, hippocampus, entorhinal cortex, and motor cortex. Accordingly, dense connections exist among insular cortex neurons. The insular cortex is involved in the processing of visceral sensory, visceral motor, vestibular, attention, pain, emotion, verbal, motor information, inputs related to music and eating, in addition to gustatory, olfactory, visual, auditory, and tactile data. In this article, the literature on the relationship between the insular cortex and neuropsychiatric disorders was summarized following a computer search of the Pub-Med database. Recent neuroimaging data, including voxel based morphometry, PET and fMRI, revealed that the insular cortex was involved in various neuropsychiatric diseases such as mood disorders, panic disorders, PTSD, obsessive-compulsive disorders, eating disorders, and schizophrenia. Investigations of functions and connections of the insular cortex suggest that sensory information including gustatory, olfactory, visual, auditory, and tactile inputs converge on the insular cortex, and that these multimodal sensory information may be integrated there.     

Immunohistochemical distribution of 10 GABAA receptor subunits in the forebrain of the rhesus monkey Macaca mulatta

GABA_A receptors are composed of five subunits arranged around a central chloride channel. Their subunits originate from different genes or gene families. The majority of GABA_A receptors in the mammalian brain consist of two α-, two β- and one γ- or δ-subunit. This subunit organization crucially determines the physiological and pharmacological properties of the GABA_A receptors. Using immunohistochemistry, we investigated the distribution of 10 GABA_A receptor subunits (α1, α2, α3, α4, α5, β1, β2, β3, γ2, and δ) in the fore brain of three female rhesus monkeys (Macaca mulatta). Within the cerebral cortex, subunits α1, α5, β2, β3, and γ2 were found in all layers, α2, α3, and β1 were more concentrated in the inner and outer layers. The caudate/putamen was rich in α1, α2, α5, all three β-subunits, γ2, and δ. Subunits α3 and α5 were more concentrated in the caudate than in the putamen. In contrast, α1, α2, β1, β2, γ2, and δ were highest in the pallidum. Most dorsal thalamic nuclei contained subunits α1, α2, α4, β2, β3, and γ2, whereas α1, α3, β1, and γ2 were most abundant in the reticular nucleus. Within the amygdala, subunits α1, α2, α5, β1, β3, γ2, and δ were concentrated in the cortical nucleus, whereas in the lateral and basolateral amygdala α1, α2, α5, β1, β3, and δ, and in the central amygdala α1, α2, β3, and γ2 were most abundant. Interestingly, subunit α3-IR outlined the intercalated nuclei of the amygdala. In the hippocampus, subunits α1, α2, α5, β2, β3, γ2, and δ were highly expressed in the dentate molecular layer, whereas α1, α2, α3, α5, β1, β2, β3, and γ2 were concentrated in sector CA1 and the subiculum. The distribution of GABA_A receptor subunits in the rhesus monkey was highly heterogeneous indicating a high number of differently assembled receptors. In most areas investigated, notably in the striatum/pallidum, amygdaloid nuclei and in the hippocampus it was more diverse than in the rat and mouse indicating a more heterogeneous and less defined receptor assembly in the monkey than in rodent brain.     

出血性卒中与缺血性卒中危险因素比较

目的探讨不同危险因素对缺血性和出血性卒中发病的影响。方法收集3 102例脑卒中患者的个人疾病史、生活方式、临床检查及生化指标结果等资料,运用Epidata软件建立数据库,采用SAS 9.2进行统计分析。结果脑梗死组发病到入院时间、住院时间、高胆固醇血症、糖尿病史、心脏病史、房颤史、脑卒中史,吸烟的OR值分别是3.36、4.953、3.375、2.224、2.394、2.362、3.573、2.076、2.885。脑出血组呼吸、体温、心率、血压、高血糖、Tbil、高血压史OR值分别是0.824、0.390、0.673、0.425、0.594、0.598、0.934。结论发病到入院时间、住院时间、高胆固醇血症、糖尿病史、心脏病史、房颤史、脑卒中史、吸烟等对脑梗死的影响更大,而呼吸、体温、心率、高血压、高血糖、Tbil、高血压史对脑出血的影响更大。     

Book Reviews

Exacting Beauty: Theory, Assessment, and Treatment of Body Image Disturbance, J. Kevin Thompson, Leslie J. Heinberg, Madeline Al-tabe, & Stacey Tantleff-Dunn, Washington, DC, American Psychological Association, 1999, 396 pages, $39.95

The Don't Diet, Live-It! Workbook: Healing Food, Weight, and Body Issues, by Andrea LoBue and Marsea Marcus, Carlsbad, California: Gurze Books, 1999, 255 pages, $17.95     

Progress report on new antiepileptic drugs: a summary of the Eigth Eilat Conference (EILAT VIII)

The Eigth Eilat Conference on New Antiepileptic Drugs (AEDs)-EILAT VII, took place in Sitges, Barcelona from the 10th to 14th September, 2006. Basic scientists, clinical pharmacologists and neurologists from 24 countries attended the conference, whose main themes included a focus on status epilepticus (epidemiology, current and future treatments), evidence-based treatment guidelines and the potential of neurostimulation in refractory epilepsy. Consistent with previous formats of this conference, the central part of the conference was devoted to a review of AEDs in development, as well as updates on marketed AEDs introduced since 1989. This article summarizes the information presented on drugs in development, including brivaracetam, eslicarbazepine acetate (BIA-2-093), fluorofelbamate, ganaxolone, huperzine, lacosamide, retigabine, rufinamide, seletracetam, stiripentol, talampanel, valrocemide, JZP-4, NS1209, PID and RWJ-333369. Updates on felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine and new extended release oxcarbazepine formulations, pregabalin, tiagabine, topiramate, vigabatrin, zonisamide and new extended release valproic acid formulations, and the antiepileptic vagal stimulator device are also presented.     

Distribution of neurokinin A in the cat diencephalon: An immunocytochemical study

The distribution of neurokinin A-like immunoreactive cell bodies and fibers in the diencephalon of the cat was studied using an indirect immunoperoxidase technique. A high or moderate density of immunoreactive neurons was observed in the nuclei habenularis lateralis, median's dorsalis, parafascicularis, hypothalamus posterior, area hypothalamica dorsalis, hypothalamus lateralis, periventricularis hypothalami, above the corpus mamillare, and in the perifornical area, whereas scarce immunoreactive perikarya were visualized in the nuclei reuniens, hypothalami ventromedialis, hypothalamus dorsomedialis, and mamillaris lateralis. The highest density of fibers containing neurokinin A was found in the nuclei periventricularis anterior, rhomboidens, centralis medialis, periventricularis hypothalami, and supraopticus. In the regio praeoptica, area hypothalamica dorsalis, hypothalamus posterior, and in the perifornical area a moderate density of immunoreactive fibers was observed, whereas the nuclei habenularis lateralis, medialis dorsalis, mamillaris lateralis, parataenialis, reuniens, habenularis medialis, filiformis, hypothalamus dorsomedialis, hypothalami ventromedialis, arcuatus, and suprachiasmaticus showed a low density of neurokinin A immunoreactive fibers.     

Acupuncture at Waiguan (TE5) influences activation/deactivation of functional brain areas in ischemic stroke patients and healthy people A functional MRI study

In the present study, 10 patients with ischemic stroke in the left hemisphere and six healthy controls were subjected to acupuncture at right Waiguan (TE5). In ischemic stroke subjects, functional MRI showed enhanced activation in Broadmann areas 5, 6, 7, 18, 19, 24, 32, the hypothalamic inferior lobe, the mamillary body, and the ventral posterolateral nucleus of the left hemisphere, and Broadmann areas 4, 6, 7, 18, 19 and 32 of the right hemisphere, but attenuated activation of Broadmann area 13, the hypothalamic inferior lobe, the posterior lobe of the tonsil of cerebellum, and the culmen of the anterior lobe of hypophysis, in the left hemisphere and Broadmann area 13 in the right hemisphere. In ischemic stroke subjects, a number of deactivated brain areas were enhanced, including Broadmann areas 6, 11, 20, 22, 37, and 47, the culmen of the anterior lobe of hypophysis, alae lingulae cerebella, and the posterior lobe of the tonsil of cerebellum of the left hemisphere, and Broadmann areas 8, 37, 45 and 47, the culmen of the anterior lobe of hypophysis, pars tuberalis adenohypophyseos, inferior border of lentiform nucleus, lateral globus pallidus, inferior temporal gyrus, and the parahippocampal gyrus of the right hemisphere. These subjects also exhibited attenuation of a number of deactivated brain areas, including Broadmann area 7. These data suggest that acupuncture at Waiguan specifically alters brain function in regions associated with sensation, vision, and motion in ischemic stroke patients. By contrast, in normal individuals, acupuncture at Waiguan generally activates brain areas associated with insomnia and other functions.     

Italian version of the Epworth sleepiness scale: external validity

We assessed the validity of an Italian language version of the Epworth sleepiness scale (ESS). The translated ESS was compared to the multiple sleep latency test (MSLT), considered the gold standard for the diagnosis of excessive daytime sleepiness (EDS). Within the context of a multicentric national study on narcolepsy (Gruppo Italiano Narcolessia Studio Epidemiologico Nazionale, GINSEN) involving 17 Italian sleep centres, we compared the two diagnostic tests on 91 prospectively recruited subjects with suspected EDS (34 with narcolepsy, 16 with obstructive sleep apnea syndrome, 19 with idiopathic hypersomnia, and 22 with other sleep, neurologic or psychiatric disorders). ESS scores were inversely correlated with mean sleep latency values, as measured with MSLT (rho = −0.31, p<0.01). ESS cut-off scores with best sensitivity and specificity were 12 and 17. For the 5-min MSLT cut-off, sensitivity was 87% and 47% respectively; specificity 39% and 74%. For the 8-min MSLT cut-off, sensitivity was 84% and 49%; specificity 50% and 88%. The Italian version of the ESS is an easy-to-use form useful for preliminary screening of daytime sleepiness level in specialist settings. Received: 26 April 2002 / Accepted in revised form: 28 November 2002 RID="*" ID="*" The Gruppo Italiano Narcolessia Studio Epidemiologico Nazionale (GINSEN) comprises: Brancasi B, Misceo S, Puca F, Savarese M (Sleep Disorders Centre, University of Bari); Servalli C, Ubiali E, Viscardi M (Center for Sleep Studies, Azienda Ospedaliera Ospedali Riuniti, Bergamo); D'Alessandro R, Plazzi G, Vetrugno R, Vignatelli L (Department of Neurological Sciences, University of Bologna); Buzzi G, Cirignotta F, Mostacci B, Sancisi E (Sleep Unit, Policlinico S. Orsola-Malpighi, Bologna); Fassari V, Scrofani A (Neurological Sciences Institute, University of Catania); Beelke M, Ferrillo F, Nobili L (Hypnosis Center, Ospedale S. Martino, Genoa); Costa C, Di Perri R, Raffaele M (Interdepartmental Sleep Center, University of Messina); Ferini-Strambi L, Landi C (Sleep Centre, Hospital San Raffaele, Milan); Rossi M, Spaggiari C, Terzano MG (Sleep Centre, Neurology Institute, Parma); Manni R, Sartori I, Zanotta N (Sleep Centre, C. Mondino Neurologic, Pavia); Bonanni E, Indice A, Murri L (Sleep Disturbances Centre, Department of Neurosciences S Chiara Hospital, Pisa); Guazzelli M, Palagini L, Panicucci P (Sleep Centre, Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, S. Chiara Hospital, Pisa); Antonini G, Bruni O, Ceschini V, Gragnani F, Miano S (La Sapienza University, Rome); Della Marca G, Farina B, Mennuni GF (Sleep Centre, Neurologic Institute UCSC, Rome); Cosentino F, Ferri R (Centre for the Study of Sleep and Sleep Disturbances, Oasis Institute, Troina); Bergonzi P, Marinig R, Pauletto G (Neurologic Clinic, Policlinico Universitario, Udine); Dolso PL, Gigli GL (Sleep Centre, S. Maria della Misericordia Hospital, Udine); Barbato A, Pompei F (Dompé Biotec, Milan). Correspondence to L. Vignatelli     

局灶性皮质发育不良所致难治性癫痫的手术预后影响因素分析

目的探讨影响局灶性皮质发育不良（FCD）所致药物难治性癫痫患者手术预后的相关因素。方法回顾性分析2011年6月至2013年d月北京丰台医院癫痫中心一首都医科大学附属北京天坛医院医疗联盟收治的43例药物难治性癫痫患者的临床资料。所有患者均行手术治疗,且术后病理证实为FCD。分析患者的临床发作类型、视频脑电、MRI表现、正电子发射断层显像术（PET）-CT表现、病灶部位、手术切除范围以及术后病理分型。根据Engel分级评估患者的预后。采用单因素分析和多因素Logistic回归分析探讨影响FCD所致药物难治性癫痫患者手术预后的相关因素。结果43例患者术后随访3．8～5．5年,平均（4．3±1．2）年。单因素分析结果显示,部分性发作、PET—CT阳性、病灶位于颞叶以及完全切除病灶的患者预后更佳（均P〈0．05）。多因素Logistic回归分析结果显示,手术切除范围与FCD所致难治性癫痫的手术预后密切相关（OR=6．857,95％CI：1．583—29．707,P=0．010）。结论手术切除范围与FCD所致难治性癫痫患者的手术预后相关。术前临床发作类型、PET-CT表现、病灶部位可能能够作为评估患者手术预后的重要指标。     

Retrograde transport of brain-derived neurotrophic factor (BDNF) following infusion in neo-and limbic cortex in rat: Relationship to BDNF mRNA expressing neurons

Brain-derived neurotrophic factor (BDNF) was the second member of the nerve growth factor (NGF) family to be isolated. The ability of BDNF to be retrogradely transported following intraparenchymal infusion represents a unique neurobiological tool to determine the location of putative neuron-specific BDNF-responsive neuronal systems. In the present study, we infused recombinant human (rh) BDNF into the rodent neo- and limbic cortex and used a turkey anti-BDNF antibody to determine specific populations of neurons which retrogradely transport this neurotrophin. Frontal cortex infusion retrogradely labeled neurons within the ipsilateral and contralateral frontal cortex, basal forebrain, lateral hypothalamus, centrolateral, mediodorsal, ventrolateral, ventromedial, ventral posterior, rhomboid, reuniens, and medial geniculate thalamic nuclei, and locus coeruleus. Occipital cortex infusion retrogradely labeled neurons in the frontal, temporal, occipital, and perirhinal cortices as well as the claustrum, basal forebrain, thalamus, epithalamus, hypothalamus, and raphe nuclei. Dorsal hippocampal infusion retrogradely labeled neurons within the septal diagonal band, supramammillary nucleus, and entorhinal cortex and was also transported within various hippocampal subfields. Entorhinal cortex infusion retrogradely labeled neurons within the perirhinal cortex, endopiriform nucleus, piriform cortex, dentate gyrus, presubiculum, parasubiculum, CA1-CA4 fields, amygdaloid nuclei, basal forebrain, thalamus, hypothalamus, periaqueductal gray, raphe nuclei, and locus coeruleus. Amygdala infusion labeled neurons in the endopiriform nucleus, temporal cortex, piriform cortex, paralimbic cortex, hippocampus, subiculum, entorhinal cortex, amygdala, basal forebrain, thalamus, hypothalamus, substantia nigra, pars compacta, raphe, and pontine parabrachial-nuclei. In situ hybridization experiments demonstrated that virtually all areas which retrogradely transport BDNF also express its message. Neuroanatomical distributional studies of BDNF will unravel specific central nervous system neurotrophic-responsive systems. © 1996 Wiley-Liss, Inc.     

Clinical aspects of abnormal eye movements]

This paper reviews a variety of abnormal eye movements which include abnormal ocular positions, restricted eye motions, impairment of conjugated eye movements, abnormal smooth pursuit, abnormal saccade, gaze-evoked nystagmus, down-beat nystagmus, internuclear ophthalmoplegia, supranuclear ophthalmoplegia, square wave jerks, roving eye movement, ocular bobbing, ocular dipping, reverse ocular bobbing, and ping-pong gaze. Abnormal eye movements occur from stroke, spinocerebellar degeneration, Parkinson disease, multiple system atrophy, progressive supranuclear palsy, multiple sclerosis, Miller Fisher syndrome, myasthenia gravis, opsoclonus-polymyoclonia syndrome, and Creutzfeldt-Jakob disease. In neurological practice, it is important to observe abnormal eye movements accurately and enthusiastically, to make appropriate anatomical and etiological diagnosis.     

Aberrant inflammatory profile in acute but not recovered anorexia nervosa

Anorexia nervosa (AN) is a severe psychiatric disorder with high mortality and relapse rates. Even though changes in inflammatory markers and cytokines are known to accompany cachexia associated with somatic disorders such as cancer and chronic kidney disorder, studies on inflammatory markers in AN are rare and typically include few individuals. Here, we utilize an Olink Proteomics inflammatory panel to explore the concentrations of 92 preselected inflammation-related proteins in plasma samples from women with active AN (N = 113), recovered from AN (AN-REC, N = 113), and normal weight healthy controls (N = 114). After correction for multiple testing, twenty-five proteins differed significantly between the AN group and controls (lower levels: ADA, CCL19, CD40, CD5, CD8A, CSF1, CXCL1, CXCL5, HGF, IL10RB, IL12B, 1L18R1, LAP TGFß1, MCP3, OSM, TGFα, TNFRSF9, TNFS14 and TRANCE; higher levels: CCL11, CCL25, CST5, DNER, LIFR and OPG). Although more than half of these differences (N = 15) were present in the comparison between AN and AN-REC, no significant differences were seen between AN-REC and controls. Furthermore, twenty-five proteins correlated positively with BMI (ADA, AXIN1, CASP8, CD5, CD40, CSF1, CXCL1, CXCL5, EN-RAGE, HGF, IL6, IL10RB, IL12B, IL18, IL18R1, LAP TGFß1, OSM, SIRT2, STAMBP, TGFα, TNFRSF9, TNFS14, TRANCE, TRAIL and VEGFA) and four proteins correlated negatively with BMI (CCL11, CCL25, CCL28 and DNER).These results suggest that a dysregulated inflammatory status is associated with AN, but, importantly, seem to be confined to the acute illness state.