Prominent fatigue in spinal muscular atrophy and spinal and bulbar muscular atrophy: Evidence of activity-dependent conduction block

ObjectivesTo clarify whether patients with spinal muscular atrophy (SMA) or spinal and bulbar muscular atrophy (SBMA) suffer disabling muscle fatigue, and whether activity-dependent conduction block (ADCB) contributes to their fatigue. ADCB is usually caused by reduced safety factor for impulse transmission in demyelinating diseases, whereas markedly increased axonal branching associated with collateral sprouting may reduce the safety factor in chronic lower motor neuron disorders.MethodsWe assessed the fatigue severity scale (FSS) in 22 patients with SMA/SBMA, and in 100 disease controls (multiple sclerosis, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy (CIDP), and axonal neuropathy). We then performed stimulated-single fibre electromyography (s-SFEMG) in the extensor digitorum communis (EDC) muscle of 21 SMA/SBMA patients, 6 CIDP patients, and 10 normal subjects.ResultsThe FSS score was the highest in SMA/SBMA patients [4.9 ± 1.1 (mean ± SD)], with 81% of them complaining of disabling fatigue, compared with normal controls (3.5 ± 1.0), whereas patients with multiple sclerosis (4.3 ± 1.6), myasthenia gravis (4.0 ± 1.6) or CIDP (4.3 ± 1.4) also showed higher FSS score. When 2000 stimuli were delivered at 20 Hz in s-SFEMG, conduction block of single motor axons developed in 46% of patients with SMA/SBMA, and 40% of CIDP patients, but in none of the normal controls.ConclusionSMA/SBMA patients frequently suffer from disabling fatigue presumably caused by ADCB induced by voluntary activity.SignificanceADCB could be the mechanism for muscle fatigue in chronic lower motor neuron diseases.     

Distal motor axonal dysfunction in amyotrophic lateral sclerosis

Nerve conduction slowing in amyotrophic lateral sclerosis (ALS) is usually caused by loss of fast motor axons. We studied the frequency, extent, and distribution of prominently prolonged distal motor latencies in ALS. We reviewed results of median, ulnar, and tibial nerve conduction studies in 91 patients with ALS, 24 with lower motor neuron disorders, and 36 with axonal neuropathy. Coincidental carpal tunnel syndrome was found for 4 (4.4%) of the ALS patients who were excluded from analyses. Markedly prolonged distal latencies (>125% of the upper limit of normal) were found only in the median nerve of ALS patients (9%), and in none of the disease controls. Excitability studies suggested membrane depolarization in some ALS patients. Our results show that approximately 10% of ALS patients shows prominently prolonged median distal latency, which cannot be explained by axonal loss and carpal tunnel lesion. The distal nerve conduction slowing may partly be caused by membrane depolarization possibly due to motor neuronal degeneration in ALS. We suggest that recognition of the pattern of distal motor axonal dysfunction predominant in the median nerve is clinically important, and could provide additional insights into the pathophysiology of ALS.     

The relationship between body balance function and occlusal function during the mixed dentition period

The aim of this study was to investigate the relation between body balance and occlusal balance during the mixed dentition stage. Fifty-six healthy children with Hellman's Dental Age IIIA: (31 boys and 25 girls) with an average age of 8.1 years, were selected from an elementary school. The body balance, distance and area of gravity center movement (GCM) were measured with automatic posture analytical devices. Occlusal abilities were measured with pressure-sensitive sheets (Dental Prescale^®), including occlusal contacts area, average occlusal pressure, maximum occlusal pressure, occlusal force and occlusal balance. Analysis of occlusal balance was determined by separating the middle group (| x | ≤ 5 mm) from the deflection group (| x | > 5 mm) based on the position of occlusal balance center. Similarly, the children were instructed to perform the GCM area of eyes-closed exercise. The first 25% of the participants with the best balance were grouped as the good balance group; and the last 25% with the worse balance were grouped as the bad balance group. Results showed that occlusal contact area and occlusal force of the middle group were more than the deflection group, GCM distance and area of the middle group were less than the deflection group. occlusal contacts area and occlusal force of the good balance group were more than the bad group. Body balance function and occlusal balance function were observed to have mutual influence during Hellman's Dental Age IIIA stage in this study.     

Immunoglobulin G (IgG)-Based Imaging Probe Accumulates in M1 Macrophage-Infiltrated Atherosclerotic Plaques Independent of IgG Target Molecule Expression

Purpose

Vulnerable plaques are key factors for ischemic diseases. Thus, their precise detection is necessary for the diagnosis of such diseases. Immunoglobulin G (IgG)-based imaging probes have been developed for imaging biomolecules related to plaque formation for the diagnosis of atherosclerosis. However, IgG accumulates nonspecifically in atherosclerotic regions, and its accumulation mechanisms have not yet been clarified in detail. Therefore, we explored IgG accumulation mechanisms in atherosclerotic lesions and examined images of radiolabeled IgG for the diagnosis of atherosclerosis.

Procedures

Mouse IgG without specificity to biomolecules was labeled with technetium-99m via 6-hydrazinonicotinate to yield [^99mTc]IgG. ApoE^?/? or C57BL/6J mice were injected intravenously with [^99mTc]IgG, and their aortas were excised 24 h after injection. After radioactivity measurement, serial aortic sections were autoradiographically and histopathologically examined. RAW264.7 macrophages were polarized into M1 or M2 and then treated with [^99mTc]IgG. The radioactivities in the cells were measured after 1 h of incubation. [^99mTc]IgG uptake in M1 macrophages was also evaluated after the pretreatment with an anti-Fcγ receptor (FcγR) antibody. The expression levels of FcγRs in the cells were measured by western blot analysis.

Results

[^99mTc]IgG accumulation levels in the aortas were significantly higher in apoE^?/? mice than in C57BL/6J mice (5.1 ± 1.4 vs 2.8 ± 0.5 %ID/g, p < 0.05). Autoradiographic images showed that the accumulation areas highly correlated with the macrophage-infiltrated areas. M1 macrophages showed significantly higher levels of [^99mTc]IgG than M2 or M0 (nonpolarized) macrophages [2.2 ± 0.3 (M1) vs 0.5 ± 0.1 (M2), 0.4 ± 0.1 (M0) %dose/mg protein, p < 0.01] and higher expression levels of FcγRI and FcγRII. [^99mTc]IgG accumulation in M1 macrophages was suppressed by pretreatment with the anti-FcγR antibody [2.2 ± 0.3 (nonpretreatment) vs 1.2 ± 0.2 (pretreatment) %ID/mg protein, p < 0.01].

Conclusions

IgG accumulated in pro-inflammatory M1 macrophages via FcγRs in atherosclerotic lesions. Thus, the target biomolecule-independent imaging of active inflammation should be taken into account in the diagnosis of atherosclerosis using IgG-based probes.

     

Culture-based PCR analysis of plaque samples of Japanese school children to assess the presence of six common cariogenic bacteria and its association with caries risk

The aim of the study was to assess the presence of six common cariogenic bacteria from Cariostat-inoculated plaque samples of Japanese elementary school children through PCR analysis and check its associations with caries risk testing the validity of Cariostat as a caries risk assessment tool. This epidemiological school-based study investigated plaque samples of 399 Japanese elementary school children. Assessed using the Cariostat, 48.2% of the children had high caries risk. DNA detection of Streptococcus mutans, Streptococcus sobrinus, Streptococcus salivarius, Lactobacillus casei, Lactobacillus plantarum, Lactobacillus fermentum and both S. mutans and S. sobrinus was seen in 65.2%, 24.1%, 69.7%, 17.5%, 7.8%, 19.3%, and 17.3% of the participants, respectively. Except for S. salivarius, the presence of all other investigated bacteria resulted in a statistically significant increase among the proportion of subjects with high caries risk. Caries risk assessed using Cariostat was significantly influenced by the presence of cariogenic bacteria. Being a selective medium for cariogenic bacteria, the Cariostat can be a useful and direct source of cariogenic bacterial DNA for PCR analysis while effectively assessing caries risk.     

Neuropathic pain is associated with increased nodal persistent Na+ currents in human diabetic neuropathy

Abstract Peripheral nerve injury alters function and expression of voltage gated Na⁺ channels on the axolemma, leading to ectopic firing and neuropathic pain/paresthesia. Hyperglycemia also affects nodal Na⁺ currents, presumably due to activation of polyol pathway and impaired Na⁺–K⁺ pump. We investigated changes in nodal Na⁺ currents in peripheral sensory axons and their relation with pain in human diabetic neuropathy. Latent addition using computerized threshold tracking was used to estimate nodal persistent Na⁺ currents in radial sensory axons of 81 diabetic patients. Of these, 36 (44%) had chronic neuropathic pain and severe paresthesia. Compared to patients without pain, those with pain had greater nodal Na⁺ currents (p = 0.001), smaller amplitudes of sensory nerve action potentials (SNAP) (p = 0.0003), and lower hemoglobin A1c levels (p = 0.006). Higher axonal Na⁺ conductance was associated with smaller SNAP amplitudes (p = 0.03) and lower hemoglobin A1c levels (p = 0.008). These results suggest that development of neuropathic pain depends on axonal hyperexcitability due to increased nodal Na⁺ currents associated with structural changes, but the currents could also be affected by the state of glycemic control. Our findings support the view that altered Na⁺ channels could be responsible for neuropathic pain/paresthesia in diabetic neuropathy.     

Changes in excitability properties associated with axonal regeneration in human neuropathy and mouse Wallerian degeneration.

OBJECTIVE: The aim of this study was to investigate changes in excitability properties associated with axonal regeneration in human neuropathy and a mouse Wallerian degeneration model. METHODS: Threshold tracking was used to measure axonal excitability indices such as strength-duration time constant (SDTC), threshold electrotonus, supernormality in median motor axons at the wrist of 13 patients with vasculitic neuropathy in their recovery phase, and in tibial motor axons at the ankle of mice with sciatic nerve crush. In the mouse model, excitability testing was performed 4, 8, 12, and 20weeks after the nerve crush. RESULTS: In patients, there were longer SDTC, greater threshold changes at 0.2ms in latent addition, and greater threshold changes in depolarizing and hyperpolarizing threshold electrotonus, compared with controls. The pattern of changes in excitability indices was similar to those in experimental nerve crush, in which the indices remained abnormal for 20weeks after the crush. These changes suggest an increase in nodal persistent sodium currents, whereas multiple factors may also contribute to changes in excitability properties, such as axonal hyperpolarization, increased internodal resistance, and altered potassium currents. CONCLUSIONS: Excitability properties in regenerating axons are characterized by increased nodal persistent currents with variable combination of changes in passive properties, membrane potential, and potassium currents. SIGNIFICANCE: Increased persistent sodium currents are potential reasons for positive symptoms in patients with axonal neuropathy. Sodium channel blockers could be considered a treatment option.     

Current understanding of chronic endometritis

Chronic endometritis (CE) is recognized as unusual plasmacyte infiltration within the endometrial stromal component. CE has been ignored in clinical practice, due to subtle symptoms, time-consuming diagnostic examinations, and benign pathology. The aetiology and pathogenesis of CE remain so far largely unknown. Recent studies, however, suggest the potential involvement of CE in reproductive failure and endometrial polyposis. In this review article, we aimed to outline the clinical and histopathologic features of CE and discuss the current problems and future prospects in its diagnosis, treatment, and management.     

Somatotopic representation of pain in the primary somatosensory cortex (S1) in humans

ObjectiveIn contrast to tactile inputs, the organization and processing of nociceptive inputs in the primary somatosensory cortex (S1) remain largely unexplored. Few studies have examined the arrangement of nociceptive inputs in S1. The aim of this study was to investigate the representation of nociceptive inputs in the human cortex, including the somatosensory and posterior parietal cortices, from widely separated cutaneous sites.MethodsWe examined the somatotopic organization of the nociceptive system in S1, opercular and posterior parietal cortices by measuring the magnetoencephalographic responses (somatosensory-evoked magnetic fields) of four healthy controls in response to intraepidermal electrical stimulation applied to the face, neck, back, elbow, wrist, hand, finger, knee, and foot, which selectively activated the Aδ fibers.ResultsMagnetoencephalography demonstrated clear somatotopy in the S1 responses to noxious stimuli, with the foot representation in the extreme posteromedial position of S1 and the facial area in the extreme anterolateral position. There was little evidence of any clear somatotopic organization in the secondary somatosensory and posterior parietal cortices.ConclusionThese findings suggest that the nociceptive system uses the large body surface map in S1.SignificanceThis is the first MEG study to demonstrate the cortical representation of nociceptive inputs in the human S1. We showed that widely separated cutaneous sites clearly supported Penfield’s homunculus.