Deep brain stimulation for medically refractory life-threatening status dystonicus in children

Generalized dystonic syndromes may escalate into persistent episodes of generalized dystonia known as status dystonicus that can be life-threatening due to dystonia-induced rhabdomyolysis and/or respiratory compromise. Treatment of these conditions usually entails parenteral infusion of antispasmodic agents and sedatives and occasionally necessitates a medically induced coma for symptom control. The authors report a series of 3 children who presented with medically intractable, life-threatening status dystonicus and were successfully treated with bilateral pallidal deep brain stimulation. Bilateral globus pallidus internus stimulation appears to be effective in the urgent treatment of medically refractory and life-threatening movement disorders.     

The plateau iris component of primary angle closure glaucoma: developmental or acquired

Primary angle closure glaucoma has been called the most common form of glaucoma in the world, and the leading cause of bilateral blindness. Pupillary block is felt to be the main mechanism of outflow obstruction in this condition. Recent advances in morphologic assessment of angle closure, specifically by means of ultrasound biomicroscopy, have revealed that plateau iris in eyes with angle closure glaucoma is more common than had previously been thought. The most characteristic finding in this disease is thicker and more anteriorly positioned lens. This induces the pupillary block that relives by laser iridotomy. Residual angle closure after laser iridotomy is due to the plateau iris. Peripheral iridoplasty, the standard treatment of plateau iris, tights the peripheral iris and opens the angle but has no effect on the ciliary processes configuration. The ciliary processes are positioned posteriorly after lens extraction but dose not disappears completely. Considering these facts we hypothesized that the plateau iris in primary angle closure glaucoma is a developmental entity that reaches to a critical stage with aging owing to the thickening and forward movement of the lens. Cataract surgery deeps the anterior chamber, widens the irido-corneal angle and reposits the ciliary processes posteriorly, so it can prevents synechia formation and progressive lens-induced angle narrowing and plateau iris progression, the acquired component, with aging.     

Procyanidins: A promising anti-diabetic agent with potential benefits on glucose metabolism and diabetes complications

Diabetes mellitus (DM) is a complex disease with alarming worldwide health implications and high mortality rates, largely due to its complications such as cardiovascular disease, nephropathy, neuropathy, and retinopathy. Recent research has shown that procyanidins (PC), a type of flavonoid, have strong antioxidant and free radical elimination effects, and may be useful in improving glucose metabolism, enhancing pancreatic islet cell activity, and decreasing the prevalence of DM complications. This review article presents a systematic search for peer-reviewed articles on the use of PC in the treatment of DM, without any language restrictions. The article also discusses the potential for PC to sensitise DM medications and improve their efficacy. Recent in vivo and in vitro studies have demonstrated promising results in improving the biological activity and bioavailability of PC for the treatment of DM. The article concludes by highlighting the potential for novel materials and targeted drug delivery methods to enhance the pharmacokinetics and bioactivity of PC, leading to the creation of safer and more effective anti-DM medications in the future.     

Effect of pregabalin on postoperative pain after shoulder arthroscopy

BackgroundPostoperative pain is difficult to be managed with the use of opioids analgesia alone, so multimodal pain management is a method to improve postoperative analgesia with minimal side effects. Pregabalin has an analgesic and opioid sparing effects in postoperative analgesia. The objective of the present study was to evaluate the effect of premedication with pregabalin on postoperative analgesia in patients undergoing shoulder arthroscopy.MethodsEighty patients ASA I-II and aged 18–60 years undergoing elective shoulder arthroscopy were randomized to receive two doses of either placebo or pregabalin 300 mg 12 h and 1 h before surgery. Anesthesia was induced with thiopental (3–5 mg/kg) and atracurium (0.5 mg/kg) and maintained with isoflurane with O₂. Patients were studied at 1, 4, 8, 12 and 24 h postoperatively for Visual Analogue Scale (VAS), nalbuphine consumption (was given when VAS > 4), satisfaction score and side effects of pregabalin.ResultsThe VAS scores of the pregabalin group were significantly lower than the control group at 1, 4 and 8 h after surgery. The total nalbuphine consumption at 24 h postoperatively of pregabalin group (33.8 + 6.89) was highly significant lower than the control group (46.4 + 5.72) (p < 0.001). There were no significant differences between groups in somnolence-dizziness and nausea-vomiting. The satisfaction score was higher in the pregabalin group.ConclusionA 300 mg pregabalin administered 12 h and 1 h preoperatively is a safe and effective method in management of pain after shoulder arthroscopy.     

Combined analysis of cytokine gene polymorphism and the level of expression with allograft function in kidney transplant recipients

Cytokines are important factors determining the outcome of transplantation since host ability in cytokine production may be affected by cytokine gene polymorphisms. The aim of the present study was to investigate the effect of IL-17, IL-23R and IL-21 gene polymorphisms in the outcome of kidney transplantation.A total of 250 kidney transplant recipients were included in this study. Overall 70 recipients (28%) experienced an acute rejection. IL-17 197 A/G, IL-21 + 1472 G/T, IL-21 5250 C/T, and IL-23R C/T gene polymorphisms were evaluated by PCR-RFLP or ARMS-PCR methods. The serum levels of IL-17 and IL-21 were also checked by ELISA.IL-17 GG carriers and G allele were significantly more frequent in patients with acute rejection as compared to patients without any sign of rejection (P = 0.045 and P = 0.032, respectively). In addition after gender classification, IL-23R AA carriers and A allele were significantly more frequent in male patients who experienced an acute rejection as compared to non-rejected patients (P = 0.03, P = 0.011, respectively). The IL-17 serum levels have also shown significant differences between rejected and non-rejected groups (24.37 ± 32.94 for AR and 8.6 ± 9.9 for non-AR groups, respectively; P = 0.035).The mentioned results indicate that IL-17GG genotype, G allele and its serum level have predictive values for acute rejection. GG genotype and G allele of IL-17 is a genetic risk factor for development of acute rejection. Also, AA genotype and A allele of IL-23R is a sex dependent genetic risk factor for the development of acute rejection, but this subject needs to be studied in a different population.     

LncRNAs as putative biomarkers and therapeutic targets for Parkinson’s disease

Neurological Sciences - Parkinson’s disease (PD) is known as one of the most common degenerative disorders related to the damage of the central nervous system (CNS). This brain disorder is...     

Rapid determination of cancellous bone mineral loss in ovariectomized rats by a subtraction technique

We present a rapid technique for determining cancellous bone mineral changes in small experimental animals. We used the distal centimeter of the right femur from ovariectomized (OX) (N = 30) and shamovariectomized (ShOX) (N = 28) rats, aged 90 days at surgery and killed at times from 125-540 days postsurgery. We used dual photon absorptiometry to scan the segment three times: intact, after parasagittal splitting, and after removing all cancellous bone. We equated the difference between the second and third scans to cancellous bone mineral content (Cn.BMC). To validate this, we compared it with histomorphometrically determined bone volume (BV/TV) of the proximal tibial metaphysis of the same rat. Parasagittally splitting the segment removed no detectable mineral. OX rats had 40% less Cn.BMC than ShOX rats. However, OX rats had 80% lower BV/TV than ShOX rats. The subtraction technique not only makes a rapid, reasonable assessment of cancellous bone loss in OX rats but permits a smaller sample size than histomorphometry. The histomorphometric technique finds a greater difference between OX and ShOX rats because it examines a region where cancellous bone loss is more marked than does the scanning technique. The current technique measures bone of not only the central secondary spongiosa but also the juxtacortical region and the primary spongiosa, where OX-related differences are less prominent. The principles of this subtraction technique proved workable. However, for the future, we recommend a two-scan technique using a dual energy X-ray scanner. It is likely to take only 20-30 min per specimen to assess cancellous bone mineral.