Synopses of Posters Presented at the International Workshop on Brain Uptake and Utilization of Fatty Acids,Lipids, and Lipoproteins: Application to Neurological Disorders

Thirty-five posters were presented at the Workshop on Brain Uptake And Utilization Of Fatty Acids, Lipids, and Lipoproteins. They were grouped into four categories: (1) mechanisms of lipid uptake and transport to the brain, (2) lipoproteins and polyunsaturated fatty acids, (3) eicosanoids in brain function, and (4) fatty acids and lipids in brain disorders. This article summarizes the highlights of the research presented in these posters. The individual abstracts follow these synopses.     

Chronic hepatitis B virus infection in patients with “Normal” ALT levels

Not many data exist to guide us in the management of patients with chronic hepatitis B virus infection and “normal” alanine aminotransferase levels. Many of these patients may not have normal levels on long-term follow-up or when the upper limit of normal is determined from a truly healthy reference population. These patients may have significant histologic disease and benefit from further investigation or treatment. This article focuses on the disease course of such patients.     

Research highlights from the literature

Genes influencing the autonomic nervous system continue as a focus of research. Recent publications applied different methods to identify genes influencing autonomic cardiovascular regulation in humans. Two reports relied on a candidate gene approach. Common genetic polymorphisms in the promoter region of the tyrosine hydroxylase gene were shown to influence catecholamine synthesis and blood pressure. The same group tested the hypothesis that the GTP cyclohydrolase 1 (GCH1) gene influences catecholamine excretion and cardiovascular regulation. GCH1 affects tyrosine hydroxylase function indirectly. The authors concluded that the GCH1 gene may influence cardiovascular autonomic regulation through changes in nitric oxide production rather than a change in tyrosine hydroxylase activity. The third genetic study used a single nucleotide polymorphism chip to analyze 100,000 genetic polymorphisms scattered throughout the genome in participants of the Framingham study. The authors identified several polymorphisms that may influence QT interval duration, heart rate, and heart rate variability. The respective genes have not been identified with certainty. Another study suggested that catecholamines may be released from phagocytes and regulate pulmonary inflammation through alpha-2 adrenoreceptor activation in an autocrine or paracrine fashion.     

Growth hormone enhances regeneration of cavernous nerves after their transplantation in rats]

OBJECTIVE: To investigate the effect of growth hormone (GH) on penile erection after reconstruction of cavernous nerves using sural nerve as an interposition nerve graft in rats. METHODS: Twenty-four male Sprague-Dawley rats (3-4 ms of age and 300-400 g in weight) were randomly divided into 2 groups: nerve graft group and GH group, each electrostimulated to determine the erectile potency 2 and 4 months after nerve graft (followed by hypodermic GH injection). The nNOS-positive nerve fibers in the corpora cavemosa were examined by streptavidin-peroxidase immunohistochemistry technique (SP method). Image analysis was used to calculate the area stained in pixel. RESULTS: Electrostimulation at 2 months produced 31.25% of erections in the GH group but none in the grafted rats. There was a significant difference in the erection rate produced by electrostimulation between the two groups at 2 months (P < 0.05). The pixel of the expression of nNOS-positive nerve fibers in the GH group (38971 +/- 7692) was also greater than that of the graft group (16538 +/- 3179, P < 0.05). At 4 months, 43.75% of the graft group and 75% of the GH group produced erections upon electrostimulation, with no significant difference between the two groups (P > 0.05). The pixels of the expression of nNOS-positive nerve fibers were 79276 +/- 12,021 and 91348 +/- 18965, respectively (P > 0.05). CONCLUSION: GH can accelerate the regeneration of cavernous nerves after bilateral nerve grafting, and GH administration may present a new physiological approach to the treatment of erectile dysfunction after radical pelvic surgery.     

Intra-observer and inter-observer agreement of the manual examination of the lumbar spine in chronic low-back pain

Examination is a cornerstone in the manual procedures leading to mobilisation/manipulation of the low back. The observer variation of the more specific segmental tests remains to be investigated. Two skilled specialists in manual medicine examined the segmental changes in the lumbar spine. The patients were unknown to the examiners and no information of the case history was given. All test results were recorded by an observer present in the room who ensured that no conversation was allowed during the examination. The primary outcome measures were the kappa values for each test. The matching was defined as acceptable (acc) within two neighbouring levels and perfect (per) on the same level. Intra-observer variation (tested in 33 patients and 10 subjects without low-back pain): The agreement between first and second segmental diagnosis examination was 70% (per) and 82% (per + acc). Kappa values were: segmental diagnosis 0.60 (per) and 0.70 (per + acc), multifidus test 0.51 (per) and 0.60 (per + acc), sideflexion 0.57 (per) and 0.69 (per + acc), and ventral flexion 0.31 (per) and 0.45 (per + acc). Inter-observer variation (tested in 60 patients): The agreement for segmental diagnosis between the examiner A and B was 42% (per) and 75% (per + acc). Kappa values were: segmental diagnosis 0.21 (per) and 0.57 (acc), multifidus test 0.12 (per) and 0.48 (acc), sideflexion 0.22 (per) and 0.45 (acc), and ventralflexion 0.22 (per) and 0.44 (acc). By manual tests, skilled examiners seem to be able to diagnose segmental dysfunctions in the low back. The clinical implication of these dysfunctions remains to be clarified.     

Modic changes following lumbar disc herniation

Only a small proportion (20%) of patients with LBP can be diagnosed based on a patho-anatomical entity. Therefore, the identification of relevant subgroups, preferably on a patoanatomical basis, is strongly needed. Modic changes have been described by several authors as being closely linked with LBP. The aims of this study were to describe the prevalence of Modic changes, their development as well as their association to LBP, previous disc contour, and surgery in patients with previous severe sciatica. This is a longitudinal cohort study where the patients were recruited from an RCT comparing two active conservative treatments, the 181 patients, who at baseline had radicular pain in or below the knee; all underwent a physical examination and MRI. MRI’s, pain history and physical examination of 166 patients were obtained at follow-up 14 months later. The prevalence of Modic changes type 1 increased from 9% at baseline to 29% at follow-up. At that time, a strong association between Modic changes and non-specific LBP was noted. Apparently, Modic changes type 1 was more strongly associated with non-specific lumbar pain than Modic changes type 2. The development of new Modic changes was closely related to the level of a previous disc herniation. A lumbar disc herniation is a strong risk factor for developing Modic changes (especially type 1) during the following year. Furthermore, Modic changes are strongly associated with LBP.     

Analysis of five specific scores for cervical spondylogenic myelopathy

The ability to compare various results that measure clinical deficits and outcome is a necessity for successful worldwide discussion about cervical spondylogenic myelopathy (CSM) and its treatment. There is hardly any information in literature how to value and compare outcome assessed by different scores. In a retrospective study we objectively evaluated the Nurick-score, Japanese-orthopaedic-association-score (JOA-Score), Cooper-myelopathy-scale (CMS), Prolo-score and European-myelopathy-score (EMS) using the data of 43 patients, all of whom showed clinical and morphological signs of CSM and underwent operative decompression. The scores were assessed pre- and postoperatively. The correlation between the score-results, anamnesis, clinical and diagnostic data was investigated. All the scores show a statistically significant correlation and measure postoperative improvement. With exception of the Prolo-score all scores reflect clinical deficits of CSM. The Prolo-score rates the severity of CSM on the state of the economic situation above clinical symptoms. The main differences of the scores are shown in the number of patients showing postoperative improvement, varying between 33% (Nurick-score) and 81% (JOA-score). The recovery-rates, as a measure of the cumulative improvement of all the symptoms, show less variation (23–37%). The differences of the recovery-rate were only statistically significant between JOA-score, Nurick-score and EMS (P < 0.05), whereas all the other scores showed no significant differences. To assess the postoperative successes, the evaluation of the recovery-rate is essential. There is no significant difference in the recovery-rate amongst the majority of the scores, which allows a good comparison of the results from different studies. Nevertheless, it is always important to differentiate the therapy results of CSM published worldwide.