Effects of effective fraction of Epimedium,Astragalus,Radix Puerariae on behavioral and pathological changes in a transgenic mouse model of Alzheimer’s disease / 中国药理学通报

Aim To observe the effects of effective fraction of Epimedium,Astragalus,Radix Puerariae on behavioral and pathological changes in a transgenic mouse model of Alzheimer’s disease.Methods Six-month-old APPswe /PS1 ΔE9 transgenic mice were ran-domly divided into 2 groups:model group and effective fraction group,1 0 mice each group.The mice in the effective fraction group were treated with the effective fraction of Astragalus,Radix Puerariae,Epimedium compound for 8 weeks.The C57BL/6J mice were used as negative control group.After 8 weeks,the learning and memory function were measured by Morris water maze,the pathological changes in brain tissue were ob-served by Modified Bielschowsky staining and Nissl 's staining.Results During place navigation trial,the escape latency in the APPswe /PS1 ΔE9 double transgenic model mice was longer than those of the mice of C57 (P 0.05 ). The Modified Bielschowsky staining shows that the neuron fibers of the cerebral cortex of APPswe /PS1 ΔE9 double transgenic mice were enlarged,swelling,and dense.There were senile plaques and nerve fiber tangles in the cerebral cortex of APPswe /PS1 ΔE9 double transgenic mice.The neuron fibers of mice in the effective fraction group were relieved;there was a small amount of senile plaque.The Nissl’s staining shows that the neurons of the cerebral cortex of APPswe /PS1 ΔE9 mice were edema, the number of cells were decreased.The mice in the effective fraction group were free of the disease.Con-clusion The double transgenic APPswe /PS1 ΔE9 mice of AD can simulate the specific pathogenesis of AD, which may be the efficient experimental animal model. The effective fraction of epimedium,astragalus and ra-dix puerariae may have a neuroprotective effect against AD via improving the learning and memory ability,and reduce the cerebral cortex nerve fiber tangles,senile plaques and neurons edema changes.

Parálisis del músculo oblicuo superior atípica / Atypical paralysis of the superior oblique muscle

Las paresias y parálisis oculomotoras implican todos aquellos procesos susceptibles de producir un déficit parcial o total de los movimientos del globo ocular. La lesión puede estar en cualquier parte del sistema oculomotor que incluye la corteza cerebral, el tronco cerebral, nervios, placa neuromuscular y del propio músculo. Las paresias y/o parálisis del músculo oblicuo superior o IV par craneal constituye una de las más frecuentes en la práctica médica estrabológica, puede ser de etiología congénita o adquirida, se caracteriza por hipertropía que aumenta con la inclinación de la cabeza hacia el hombro del lado del ojo afectado signo de Bielschowsky, anisotropía en V, exciclotropía. Los pacientes con paresias y/o parálisis adquirida muestran diplopía vertical y torsional que aumenta con la mirada hacia abajo, tortícolis con inclinación de la cabeza hacia el lado opuesto del ojo afectado y descenso del mentón. El paciente acude a consulta por presentar diplopía vertical y torsional de 13 años de evolución. Al examen de la motilidad ocular había ortotropía en la Posición Primaria de la Mirada con hiperforia al cover test ojo izquierdo, 10 Dp base inferior por barra de prismas, exciclotropía 5*, tortícolis hacia la derecha y Bielschowsky positivo hacia el lado izquierdo. La impresión diagnóstica fue paresia adquirida del músculo OS izquierdo de etiología no precisada. El tratamiento realizado fue la retroinserción del recto superior del ojo izquierdo 4 mm más el desplazamiento temporal de un 1/4 de la inserción con el objetivo de eliminar la diplopía vertical y torsional y la posición anómala de la cabeza

The oculomotor paresis and paralysis involve all those processes capable of producing partial or total deficit of the ocular globe movements. The injure may be located in any part of the oculomotor system that includes the brain cortex, the brain trunk, nerves, neuromuscular plate and of the muscle. Paresis and/or paralysis of the superior oblique muscle or IV cranial nerve is very frequent in the medical practice for strabismus; it can be congenital or acquired, characterized by hypertropia that increases with the head moving toward the shoulder next to the affected eye sign of Bielschowsky, V-anisotropy and excyclotropia. The patients affected by acquired paresis and/or paralysis show vertical and torsional diplopia that increases when they look down, torticollis from inclining the head towards the opposed side of the affected eye, and lowering of the chin. A patient went to the doctor's because he presented with vertical and torsional diplopia of 13 years of progression. The ocular motility exam revealed orthotropia at primary position of look with hyperphoria at cover test in the left eye, 10 Dp inferior basis in bar prism test, excyclotropia 5, torticollis toward the right side and positive Bielschowsky index toward the left side. The diagnosis was acquired paresis of the left oblique superior muscle left of unspecified etiology. The treatment was over 4 mm retroinsertion of the superior rectum of the left eye plus one-fourth temporary displacement of the insertion, with the objective of eliminating the vertical and torsional diplopia and the anomalous position of the head

The Clinical Characteristics of Superior Oblique Palsy Associated With Intermittent Exotropia

PURPOSE: The goal of this study was to determine the clinical characteristics of patients with intermittent exotropia (IXT) associated with hypertropia. METHODS: This study recruited 268 hospital patients with IXT associated with hypertropia. After taking history, measuring the angle of deviation, conducting an ocular motor examination, performing a Bielschowsky head tilt test and taking a fundus photograph, the clinical characteristics of 23 patients diagnosed with superior oblique palsy (SOP) were investigated. RESULTS: Twenty-three patients (8.6%) of the 268 subjects with IXT associated with hypertropia were diagnosed with SOP. The average angle of exodeviation was 17.1+/-3.8PD and the angle of hypertropia at primary position was 12.9+/-5.9PD. Excyclotorsion of an eyeball was observed in 19 patients (82.6%), the Bielschowsky head tilt test was positive in all patients, and head tilt or face turn was found in 12 (52.2%) patients. All subjects had inferior oblique overaction, and 20 (86.9%) had superior oblique underaction. Operations to weaken the inferior oblique muscle of the paralytic eye and for horizontal muscles were conducted at the same time. The angle of exodeviation and the angle of hypertropia were, on average, 1.8+/-3.6PD and 2.4+/-2.2PD, respectively, 6 months after the operation. CONCLUSIONS: When patients with intermittent exotropia have hypertropia, the possibility of SOP should be considered. SOP can be detected by determining a history of head tilt and conducting a Bielschowsky head tilt test. Surgical treatment for SOP is advised.

Influencia vestibular en la respuesta a la maniobra de Bielschowsky en parálisis del cuarto nervio craneal / Vestibular influence in the response to Bielschowsky maneuver in fourth cranial nerve palsy

Objetivo: Describir en una serie de pacientes con parálisis unilateral del cuarto nervio craneal, la diferencia de la desviación vertical en posición erecta y supina. Material y método: Se incluyeron pacientes con diagnóstico de parálisis del cuarto nervio craneal unilateral, realizando exploración oftalmológica completa así como medición de la desviación con prismas y oclusión alterna en posición erecta y en posición supina realizando la maniobra de Bielschowsky. Resultados: Se exploraron 13 pacientes con el diagnóstico antes mencionado; la mayor parte de ellos presentaron menor desviación vertical en posición supina; así mismo al realizar la maniobra de Bielschowsky, la respuesta en posición supina fue menor que la presentada en posición erecta. Conclusiones: Los reflejos vestíbulo oculares, responsable de la mayor desviación vertical al inclinar la cabeza hacia el lado parético en casos de parálisis del nervio troclear, se atenúan en posición supina. La explicación fisiológica se basa en el control de los movimientos oculares por parte de los otolitos, los cuales reciben estimulación de a cuerdo a su posición en relación a la gravedad; esta observación clínica apoya la explicación propuesta por Bielschowsky sobre la participación del aparato vestibular en uno de los principales signos clínicos de esta entidad.

Purpose. To describe vertical deviation differences in a group of patients with unilateral fourth cranial nerve palsy in erect versus supine position. Methods. We included patients with unilateral fourth cranial nerve palsy who underwent full ophthalmologic exploration and measurement of the vertical deviation with prisms and alternate occlusion in erect and supine position performing Bielschowsky´s test. Results. Thirteen patients were explored; most of them showed less vertical deviation in the supine position, the response to the Bielschowsky´s test was smaller in the supine position than in the erect patient. Conclusion. The vestibulo-ocular reflexes responsible for the larger vertical deviation when tilting the head to the paretic side, are attenuated in the supine position; the physiologic explanation of this phenomenon is based on the otholits role in the control of ocular movements; these receptors are stimulated according to their position in relation to gravity. This clinical observation supports the explanation proposed by Bielschowsky about the role of the vestibular system in one of the main clinical sings of this entity.

Clinical Evaluation of Superior Oblique Muscle PalsyAssociated with Horizontal Deviation

PURPOSE: The purpose of this study is to provide useful clinical information for proper diagnosis of the superior oblique muscle palsy (SOP) associated with horizontal deviation. METHODS: The records of 186 patients with SOP treated surgically were reviewed. The patients who underwent surgery for horizontal deviation more than 10 PD were classified into SOP associated with horizontal deviation. RESULTS: Of 186 patients with SOP, 96 (51.6%) patients also showed horizontal deviation. In 59 patients (61.5%) of these 96 patients, chief complaint was horizontal deviation only and 24 patients (25.0%) knew their hyperdeviation. Compensatory head-tilt was shown in 52 patients (54.2%), however only 11 (11.5%) patients complained their head-tilt posture. Of 96 patients, 72 (82.3%) had horizontal deviation in the eye contralateral to the paretic eye and amblyopia occurred in the horizontally deviated eye. The frequency of exodeviation was 82.3 % and was more than that of esodeviation. The mean amount of hyperdeviation was 12.6 +/- 6.77 PD, and that of horizontal deviation was 22.9 +/- 8.13 PD in exodeviation and 22.5 +/- 9.17 PD in esodeviation, respectively ninety three patients (96.9%) showed positive Bielschowsky head-tilt test. All 83 patients who had fundus examination showed foveal extorsion. CONCLUSIONS: This study reveals that Bielschowsky head-tilt test and fundus examination for foveal extorsion are needed to diagnose SOP which is masked by prominent horizontal deviation.

Concomitant Hypertropia with Intermittent Exotropia

PURPOSE: To investigate the incidence and characteristics of vertical deviation in the intermittent exotropia. METHODS: Fifty consecutive intermittent exotropes over age of 5 were prospectively studied. Patients with any significant ocular and neurologic abnormalities or orbital anatomic abnormalities, definite oblique dysfunction with A or V pattern were excluded. Ophthalmologic evaluation included visual acuity, ocular movements, measurements of angle of deviation by prism cover test, Bielschowsky head tilt test, stereoacuity test, and fundus observation for torsion by indirect ophthalmoscopy. RESULTS: We found that 27 children(54%) had concomitant hypertropia in primary position. Mean amount of hypertropia was 4.81 PD(range: 2~20 PD). Thirty nine children(78%) showed positive Bielschowsky head tilt test. No objective torsion was observed. No inferior oblique overaction was found except for only 2 patients. All subjects had good visual acuity and stereopsis. CONCLUSIONS: The incidence of vertical deviation in the intermittent exotropia is much higher than expected. All of the vertical deviations show positive Bielschowsky head tilt test.

Superior Oblique Palsy

I reviewed charts of 26 patients with superior oblique palsy who had been treated surgically. Diagnosis of superior oblique palsy was based on the Bielschowsky head tilt test(BHT) and overacting inferior oblique muscle. Four patients(15%) were diagnosed as having bilateral superior oblique palsy, and 22 patients(85%) were diagnosed as monocular superior oblique palsy. After myectomy of the overacting inferior oblique muscle, 6(27%) out of 22 patients initially diagnosed as monocular superior oblique palsy deveioped findings of superior oblique palsy on the opposite eye; these patients were considered as having masked bilateral superior oblique palsy. Among the 16 patients with unilateral superior oblique palsy, 11 patients(69%) showed negative BHT, 4 patients(25%) showed equivocal BHT and 1 patient(6%) still showed positive BET after surgery. Among the 14 patients who could be followed up for more than 3 months after the operation, 11 patients(79%) showed negative BHT, 2 patients(14.%) showed equivocal BHT, and 1 patient(7%) showed positive BHT. According to these results, the overacting inferior oblique muscle in superior oblique palsy plays a very important role in the elevation of the eye on ipsilateral head tilt, and the mechanism of the BHT classically described should be reconsidered. The primary operation was inferior oblique myectomy and secondary or tertiary operations were inferior oblique myectomy, marginal myotomy or superior rectus recession on the same or the other eye.