Intrathecal baclofen in the management of spasticity due to cerebral palsy

Intrathecal baclofen is a cornerstone in the treatment of spasticity in children. However, further research is required to set criteria for treatment. This paper offers insight into the national act on baclofen and the experience at the Nottingham University Hospital.     

Characterizing Changes in the Excitability of Corticospinal Projections to Proximal Muscles of the Upper Limb

BackgroundThere has been an explosion of interest in methods of exogenous brain stimulation that induce changes in the excitability of human cerebral cortex. The expectation is that these methods may promote recovery of function following brain injury. To assess their effects on motor output, it is typical to assess the state of corticospinal projections from primary motor cortex to muscles of the hand, via electromyographic responses to transcranial magnetic stimulation. If a range of stimulation intensities is employed, the recruitment curves (RCs) obtained can, at least for intrinsic hand muscles, be fitted by a sigmoid function.Objective/hypothesisTo establish whether sigmoid fits provide a reliable basis upon which to characterize the input–output properties of the corticospinal pathway for muscles proximal to the hand, and to assess as an alternative the area under the (recruitment) curve (AURC).MethodsA comparison of the reliability of these measures, using RCs obtained for muscles that are frequently the targets of rehabilitation.ResultsThe AURC is an extremely reliable measure of the state of corticospinal projections to hand and forearm muscles, which has both face and concurrent validity. Construct validity is demonstrated by detection of widely distributed (across muscles) changes in corticospinal excitability induced by paired associative stimulation (PAS).Conclusion(s)The parameters derived from sigmoid fits are unlikely to provide an adequate means to assess the effectiveness of therapeutic regimes. The AURC can be employed to characterize corticospinal projections to a range of muscles, and gauge the efficacy of longitudinal interventions in clinical rehabilitation.     

Intraoperative Ketorolac and Bleeding after Laparoscopic Roux-En-Y Gastric By-Pass Surgery

Background : The unspecific non-steroidal anti-inflammatory drug (NSAID) ketorolac is used during surgery as a single dose regimen to reduce immediate postoperative pain. Many studies have shown an increased risk of bleeding in patients treated with NSAIDs. We wanted to investigate whether intraoperative ketorolac administered at the end of surgery resulted in increased bleeding assessed by reduction in haemoglobin and need for blood transfusion. Methods : This was a retrospective review including all patients undergoing laparoscopic Roux-en-Y gastric bypass in the period between January 1^st and March 1^st, 2010. Haemoglobin levels, time of surgery, fluid treatment and the need for blood transfusion or reoperation were registered.

Results : A total of 162 patients were operated in the given period. Of these, the first 47 received intraoperative ketorolac. For the remaining 115 patients, ketorolac was withdrawn. The reduction in haemoglobin in patients receiving intraoperative ketorolac was higher compared with the patients who did not receive ketorolac (-11.3(7.6) % vs. -8.4(6.4) %; p = 0.018). No significant difference was found between the two groups with respect of transfusion requirements (2 out of 47 patients in the ketorolac group versus 0 patients out of 115 in the control group (p = 0.08)). Conclusions : Ketorolac given during surgery may increase the risk of postoperative haemorrhage after laparoscopic Roux-en-Y gastric by-pass.     

Morphology and Variation in Porpoise (Cetacea: Phocoenidae) Cranial Endocasts

Evolution of endocranial anatomy in cetaceans is important from the perspective of echolocation ability, intelligence, social structure, and alternate pathways for circulation to the brain. Apart from the importance of studying brain shape and asymmetries as they relate to aspects of behavior and intelligence, cranial endocasts can show a close correspondence to the hydrostatic shape of the brain in life, and canals and grooves can preserve features of the circulatory system. Multiple samples are rarely available for studies of individual variation, especially in fossils, thus a first step in quantifying variation and making comparisons with fossils is made possible with CT scans of osteological specimens. This study presents a series of high‐resolution X‐ray CT‐derived cranial endocasts of six extant species of Phocoenidae, a clade including some of the smallest and one of the rarest cetaceans. Degree of gyrification varies interspecifically and intraspecifically, possibly resulting from variation in preservation of the ossified meninges. Computed tomographic data show that visually assessed asymmetry in the cranial endocasts is not correlated with volumetric measurements, but nonetheless may reflect torsion in the skull's shape such that the right cerebral and cerebellar hemispheres extend rostrally and laterally more than the left. Vasculature and canals are similar to other described cetacean species, but the hypophyseal casts are unusual. Similarities between brain shape and volume measurements in the different species can be attributed to paedomorphism and concomitant variation in ecological preferences. This may explain similarities Neophocaena phocaenoides and Phocoena sinus share with the juvenile Phocoena phocoena specimen studied. Anat Rec, 296:979–992, 2013. © 2013 Wiley Periodicals, Inc.     

Distribution and size of mucous glands in the ferret tracheobronchial tree

A transgenic ferret model of cystic fibrosis has recently been generated. It is probable that malfunction of airway mucous glands contributes significantly to the airway pathology of this disease. The usefulness of the ferret model may therefore depend in part on how closely the airway glands of ferrets resemble those of humans. Here, we show that in the ferret trachea glands are commonest in its most ventral aspect and disappear about half way up the lateral walls; they are virtually absent from the dorsal membranous portion. Further, the aggregate volume of glands per unit mucosal surface declines progressively by about 60% between the larynx and the carina. The average frequency of glands openings for the ferret trachea as a whole is only about one‐fifth that in humans (where gland openings are found at approximately the same frequency throughout the trachea). Glands in the ferret trachea are on average about one‐third the size of those in the human. Therefore, the aggregate volume of tracheal glands (per unit mucosal surface area) in the ferret is only about 6% that in humans. As in other mammalian species, airway glands in the ferret disappear at an airway internal diameter of ～1 mm, corresponding approximately in this species to airway generation 6. Anat Rec, 296:1768–1774, 2013. © 2013 Wiley Periodicals, Inc.     

Complex craniosynostosis is associated with the 2p15p16.1 microdeletion syndrome

In a screening project of patients with (complex) craniosynostosis using genomic arrays, we identified two patients with craniosynostosis and microcephaly with a deletion in the 2p15p16.1 chromosomal region. This region has been associated with a new microdeletion syndrome, for which patients have various features in common, including microcephaly and intellectual disability. Deletions were identified using Affymetrix 250K SNP array and further characterized by fluorescence in situ hybridization (FISH) analysis and qPCR. The deletions in our two patients overlapped within the 2p15p16.1 microdeletion syndrome area and were 6.8 and 6.9 Mb in size, respectively. FISH and qPCR confirmed the presence of only one copy in this region. Finemapping of the breakpoints indicated precise borders in our patients and were further finemapped in two other previously reported patients. Clinical features of patients with deletions in the 2p15p16.1 region vary. Including data from our patients, now eight out of nine reported patients have microcephaly, one of the major features, and all had intellectual disability. The current reported two patients add different forms of craniosynostosis to the clinical spectrum of this recently recognized microdeletion syndrome. © 2013 Wiley Periodicals, Inc.     

Catechol‐O‐methyltransferase gene val158met polymorphism and depressive symptoms during early childhood

Catechol‐O‐Methyltransferase (COMT) is a critical regulator of catecholamine levels in the brain. A functional polymorphism of the COMT gene, val158met, has been linked to internalizing symptoms (i.e., depression and anxiety) in adolescents and adults. We extended this research by investigating whether the val158met polymorphism was associated with childhood symptoms of depression and anxiety in two independent samples of young children (Ns = 476 and 409). In both samples, preschool‐aged children were genotyped for the COMT val158met polymorphism. Symptoms of psychopathology were assessed via parent interviews and primary caregiver reports. In both samples, children homozygous for the val allele had higher levels of depressive symptoms compared to children with at least one copy of the met allele. Our findings extend previous research in older participants by showing links between the COMT val158met polymorphism and internalizing symptoms in early childhood. © 2013 Wiley Periodicals, Inc.     

Comparing the expression of integrins αvβ3, αvβ5, αvβ6, αvβ8, fibronectin and fibrinogen in human brain metastases and their corresponding primary tumors

Aims: To evaluate the expression of αv-series integrins in brain metastases. Inhibitors targeting these integrins are being tested for their therapeutic potential. Material and Method: The extracellular regions of the αvβ3, αvβ5, αvβ6, αvβ8, the cytoplasmic domain of β3, the αv-chain, and the ECM molecules fibronectin and fibrinogen were studied immunohistochemically in a series of 122 carcinoma and 60 melanomas metastatic to the central nervous system. In addition, 38 matched primary and metastatic tumors to the brain were compared directly. Results: The αv-subunit was generally moderately to highly expressed in most tumors. αvβ3 and cytoplasmic β3 were weakly to moderately detectable in metastatic renal cell carcinomas and melanomas, αvβ5 was prominently expressed in metastatic renal and colorectal carcinomas, αvβ6 was most abundantly detectable in metastatic lung adenocarcinomas, but absent in melanomas. The tumor associated vessels in CNS metastases consistently expressed αvβ3, αvβ5, αv-, fibronectin and fibrinogen, however, mostly at low levels, while αvβ6, αvβ8 were lacking in vasculature. The comparative analysis of 38 matched primary tumors and brain metastases showed comparable levels of expression only for αvβ3 and αvβ8, while αvβ6 and αvβ5 were higher in primaries. Conclusion: We confirmed that integrin expression exhibits considerable heterogeneity according to tumor origin. αvβ5 is the most promising target for integrin targeted treatment in brain metastases.     

Tooth Discoloration after the Use of New Pozzolan Cement (Endocem) and Mineral Trioxide Aggregate and the Effects of Internal Bleaching

Introduction

The aim of this study was to evaluate tooth discoloration after the use of mineral trioxide aggregate (MTA) and to examine the effect of internal bleaching on discoloration associated with MTA.

Methods

Thirty-two teeth were endodontically treated. Three-millimeter plugs of MTA, ProRoot, Angelus, or Endocem were placed on the access cavities of 24 teeth. Eight teeth served as the control group. After 24 hours, the access cavities were restored, and the tooth color was recorded at baseline and at 1, 2, 4, 8, and 12 weeks. After 12 weeks, the MTA materials were removed under a microscope, and an internal bleaching treatment was performed. After removal of the MTA materials and after a 1-week bleaching treatment, the color changes were measured, and the MTA-dentin interfaces were observed under a microscope.

Results

The ProRoot and Angelus groups displayed increasing discoloration during a period of 12 weeks. The discoloration associated with ProRoot and Angelus was observed at the MTA-dentin interface and on the interior surface of the dentin. However, the Endocem groups demonstrated no significant discoloration (P < .05). No marginal discoloration was observed around the material in the Endocem group. Removal of the discolored MTA was effective for resolving the discoloration in all of the experimental groups (P < .05). However, a subsequent internal bleaching treatment was not significantly effective compared with the removal of MTA.

Conclusions

ProRoot and Angelus caused tooth discoloration. However, Endocem did not affect the contacting dentin surface. Removing the discolored MTA materials contributed more to resolving the tooth discoloration than post-treatment internal bleaching.