High‐resolution ultrasound visualization of the deep branch of the ulnar nerve

Introduction: The value of imaging the deep branch of the ulnar nerve (DBUN) over its entire course has not been clarified. Therefore, this study evaluates the feasibility of visualizing the DBUN from its origin to the most distal point. Methods: We performed high‐resolution ultrasound (HRUS) with high‐frequency probes (18–22 MHZ ), HRUS‐guided ink marking, and consecutive dissection in 8 fresh cadaver hands. In both hands of 10 healthy volunteers (n = 20), the cross‐sectional area (CSA) was measured at 2 different locations (R1 and R2). Results: The DBUN was clearly visible in all anatomical specimens and in healthy volunteers. Dissection confirmed HRUS findings in all anatomical specimens. The mean CSA was 1.8 ± 0.5 mm² at R1 and 1.6 ± 0.4 mm² at R2. Discussion: This study confirms that the DBUN can be reliably visualized over its entire course with HRUS in anatomical specimens and in healthy volunteers. Muscle Nerve 56 : 1101–1107, 2017     

Deutsche Leitlinie zur Diagnostik und Therapie der zirkumskripten Sklerodermie

Bei der zirkumskripten Sklerodermie handelt es sich um eine heterogene Gruppe von sklerotischen Erkrankungen der Haut mit je nach Subtyp, Schweregrad und Lokalisation möglicher Beteiligung von hautnahen Strukturen wie Fettgewebe, Muskulatur, Gelenke und Knochen. Dies ist eine Aktualisierung der bereits bestehenden deutschen Leitlinie der AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Wissenschaften) mit dem Klassifizierungsgrad S2k. Die Leitlinie gibt einen Überblick zur Definition, Epidemiologie, Klassifikation, Pathogenese, Labordiagnostik, Histopathologie sowie klinischen Scores und apparativen Diagnostik der zirkumskripten Sklerodermie. Des Weiteren erfolgen konsensbasierte Empfehlungen zum Management der zirkumskripten Sklerodermie in Abhängigkeit vom klinischen Subtyp. Die Behandlungsempfehlungen sind in einem Therapiealgorithmus dargestellt. Eine finanzielle Unterstützung zur Erstellung der Leitlinie durch die pharmazeutische Industrie erfolgte nicht. Die Leitlinie ist bis Juli 2019 gültig.     

Distribution and functional activity of P-glycoprotein and multidrug resistance-associated proteins in human brain microvascular endothelial cells in hippocampal sclerosis

Multidrug resistance protein, also referred as P-glycoprotein (P-gp, MDR1; ABCB1) and multidrug resistance-associated protein (MRP) 1 (ABCC1) and 2 (ABCC2) are, thus far, candidates to cause antiepileptic drug (AED) resistance epilepsy. In this study, we investigated P-gp, MRP1 and MRP2 expression, localization and functional activity on cryosections and isolated human brain-derived microvascular endothelial cells (HBMEC) from epileptic patients (HBMEC-EPI) with hippocampal sclerosis (HS), as compared with HBMEC isolated from normal brain cortex (HBMEC-CTR). We examined the expression and distribution of three transporters, P-gp, MRP1 and MRP2 on two major parts of the resected tissue, the hippocampus and the parahippocampal gyrus (Gph). P-gp showed diffuse expression not only in endothelium but also by parenchymal cells in both the hippocampus and the Gph. MRP1 labeling was observed in parenchymal cells in the Gph. By contrast, MRP2 was mainly found in endothelium of the hippocampus. P-gp and MRP1 expression in the Gph was relatively high in the patient with long-term seizure history. Quantitative RT-PCR analysis of HBMEC revealed that MDR1, MRP1 as well as MRP5 (ABCC5) and MRP6 (ABCC6) were overexpressed in HBMEC-EPI at the mRNA level. HBMEC from both normal and epilepsy groups displayed protein expression of P-gp, whereas MRP1 and MRP2 were seen only in HBMEC-EPI. Accordingly, it is of particular interest that MRP functional activities were observed in HBMEC-EPI, but not in HBMEC-CTR. Our results suggest that complex MDR expression changes not only in the hippocampus but in the Gph may play a role in AED pharmacoresistance in intractable epilepsy patients with mesial temporal lobe epilepsy (MTLE) by altering the permeability of AEDs across the blood-brain barrier (BBB).