Two Cases of Globus Sensation Successfully Treated with Ryokeijutsukanto / 日本東洋医学雑誌

Hangekobokuto is often used for globus sensation. We herein describe two cases in which ryokeijutsukanto was effective for globus sensation, for which hangekobokuto was ineffective. Case 1 was a 28-year-old woman. She had been suffering from postprandial belching, fullness and stuffy throat for a year. She underwent examination, but could not find the cause of her symptoms and visited our department. She was prescribed hangekobokuto, but the feeling of stuffiness in her throat did not improve. Case 2 was a 50-year-old woman. She had been afflicted with a feeling of fullness in the ears, tinnitus, and pain in the back of the eyes for two weeks. She visited the otolaryngology department, but no abnormalities were found so she visited our department. She was prescribed kamishoyosan, and although her ear fullness and tinnitus improved by about 60%, she began to complain of dizziness and throat stuffiness. This did not improve even though she used hangekobokuto with kamishoyosan. In both cases, after changing treatment to ryokeijutsukanto, the symptoms were improved. For globus sensation, it is necessary to select Kampo medicines while paying attention to qi deficiency, qi depression, qi counter flow, static blood, liver depression, lack of fluid, fluid toxicity, and gastrointestinal disorders. We thought that ryokeijutsukanto could be a candidate.

Management of laryngopharyngeal reflux in Brazil: a national surveys / Manejo do refluxo laringofaríngeo no Brasil: pesquisa nacional

Abstract Introduction: Studies assessing the management of laryngopharyngeal reflux by otolaryngologists have reported an important heterogeneity regarding the definition, diagnosis, and treatment, which leads to discrepancies in the management of the patient. Information about the current knowledge and practices of Brazilian otolaryngologists in laryngopharyngeal reflux is lacking. Objective: To investigate the trends in management of laryngopharyngeal reflux disease among Brazilian otolaryngologists. Methods: A survey was sent by email to the members of the Brazilian Association of Otolaryngology-Head Neck Surgery. This survey has initially been conducted by the laryngopharyngeal reflux study group of young otolaryngologists of the International Federation of Otolaryngological Societies. Results: According to the survey responders, the prevalence of laryngopharyngeal reflux was estimated to be 26.8% of patients consulting in otolaryngology and the most common symptoms were globus sensation, throat clearing, cough and stomach acid reflux. Nasal obstruction, Eustachian tube dysfunction, acute and chronic otitis media, vocal fold nodules and hemorrhage were considered not associated with laryngopharyngeal reflux by the majority of responders. About 2/3 of Brazilian otolaryngologists based the diagnosis of laryngopharyngeal reflux on the assessment of both symptoms and findings and a positive response to empiric therapeutic trials. Proton pump inhibitor utilized once or twice daily, was the most commonly used therapeutic scheme. Only 21.4% of Brazilian otolaryngologists have heard about nonacid and mixed laryngopharyngeal reflux and the awareness about the usefulness of multichannel intraluminal impedance pH monitoring (MII-pH) was minimal; 30.5% of responders did not consider themselves as well-informed about laryngopharyngeal reflux. Conclusion: Although the laryngopharyngeal reflux-related symptoms, main diagnostic and treatment approaches referred by Brazilian otolaryngologists are consistent with the literature, the survey identified some limitations, such as the insufficient awareness of the role of laryngopharyngeal reflux in many otolaryngological conditions and of the possibility of non-acid or mixed reflux in refractory cases. Future studies are needed to establish international recommendations for the management of laryngopharyngeal reflux disease.

Resumo Introdução: Estudos que avaliaram o manejo do refluxo laringofaríngeo por otorrinolaringologistas mostraram uma importante heterogeneidade em relação à definição, diagnóstico e tratamento, o que leva a discrepâncias no tratamento do paciente. Faltam informações sobre o conhecimento e as práticas atuais dos otorrinolaringologistas brasileiros sobre o refluxo laringofaríngeo. Objetivo: Investigar as tendências no manejo da doença do refluxo laringofaríngeo entre os otorrinolaringologistas brasileiros. Método: O questionário foi enviado por e-mail aos membros da Associação Brasileira de Otorrinolaringologia-Cirurgia de Cabeça e Pescoço. Esta pesquisa foi inicialmente conduzida pelo LPR Study Group of Young Otolaryngologists da International Federation of Otolaryngological Societies. Resultados: De acordo com os respondentes da pesquisa, a prevalência de refluxo laringofaríngeo foi estimada em 26,8% dos pacientes consultados e os sintomas mais comuns foram sensação de globus, pigarro, tosse e refluxo de ácido estomacal. Obstrução nasal, disfunção da trompa de Eustáquio, otite média aguda e crônica, nódulos nas pregas vocais e hemorragia foram considerados como não associados ao refluxo laringofaríngeo pela maioria dos respondentes. Cerca de 2/3 dos otorrinolaringologistas brasileiros basearam o diagnóstico de refluxo laringofaríngeo na avaliação dos sintomas e achados e na resposta positiva a testes terapêuticos empíricos. Inibidores de bomba de prótons uma ou duas vezes ao dia foi o esquema terapêutico mais usado. Somente 21,4% dos otorrinolaringologistas brasileiros já ouviram falar sobre refluxo laringofaríngeo não ácido e misto e o conhecimento sobre a utilidade do monitoramento de pH por impedância intraluminal multicanal foi mínimo; 30,5% dos respondentes não se consideraram tão bem informados sobre o refluxo laringofaríngeo. Conclusão: Embora os sintomas relacionados ao refluxo laringofaríngeo e as principais abordagens diagnósticas e terapêuticas referidas pelos otorrinolaringologistas brasileiros sejam consistentes com a literatura, a pesquisa identificou algumas limitações, como o conhecimento insuficiente do papel do refluxo laringofaríngeo em diversas condições otorrinolaringológicas e da possibilidade de refluxo não ácido ou misto em casos refratários. Estudos futuros são necessários para estabelecer recomendações internacionais para o manejo de doença do refluxo laringofaríngeo.

Estimulación cerebral profunda del globo pálido interno en el síndrome de distonía mioclónica: serie de 3 casos y revisión de la literatura / Deep brain stimulation of the internal globus pallidus in myoclonus-dystonia syndrome: a case series and review of the literature

RESUMEN INTRODUCCIÓN: La distonía mioclónica es un trastorno del movimiento con poca prevalencia, pero muy discapacitante, en el cual es frecuente la refractariedad al tratamiento médico. Cómo opción terapéutica se ha planteado la estimulación cerebral profunda, buscando con ello mejorar la función motora, la discapacidad y la calidad de vida de estos pacientes. MATERIALES Y MÉTODOS: Se presentan 3 pacientes con diagnóstico clínico de distonía mioclónica sin confirmación genética, que fueron llevados a estimulación cerebral profunda bilateral del globo pálido interno. RESULTADOS: Se evidenció una mejoría significativa en la evaluación de la escala unificada de mioclonías (80-90 %) y en la escala de distonía de Burke-Fahn-Marsden (tanto en movilidad como en discapacidad). La mejoría clínica se evidenció en los tres pacientes, en periodos de seguimiento que estuvieron entre los 6 meses y los 5 años luego de la estimulación cerebral profunda. DISCUSIÓN Y CONCLUSIONES: Los hallazgos en esta serie de 3 pacientes colombianos son consistentes con lo reportado en la literatura. Sin embargo, aportan información sobre el desenlace de pacientes sin genotipificación sometidos a estimulación cerebral profunda, dado que la eficacia de la intervención en pacientes con distonía sin confirmación genética aún no ha sido determinada, y depende de otros factores como la edad, el tiempo de evolución y el tipo de distonía.

ABSTRACT INTRODUCTION: Myoclonic dystonia is a movement disorder with low prevalence, but very disabling, where refractoriness to medical treatment is frequent. Deep brain stimulation has been proposed as a therapeutic option, seeking to improve motor function, disability and quality of life in these patients. MATERIALS AND METHODS: We present 3 patients with a clinical diagnosis of Myoclonic-Dystonia without genetic confirmation, who underwent bilateral deep brain stimulation of the Globus Pallidus Internus. RESULTS: A significant improvement was evidenced in the evaluation of the unified myoclonus scale (80-90 %) and in the Burke-Fahn-Marsden dystonia scale (both in mobility and in disability). The clinical improvement was evidenced in the 3 patients, in follow-up periods that were between 6 months and 5 years after deep brain stimulation. DISCUSSION AND CONCLUSIONS: Findings in this Colombian case series are consistent with that reported in the literature. However, the current description provides information on the outcome of patients without genotyping undergoing deep brain stimulation, considering that the efficacy of the intervention in these types of patients without genetic confirmation has not been determined and depends on other factors.

Late-onset isolated sulfite oxidase deficiency: a case report and literature review / 中华实用儿科临床杂志

The clinical data of a case with late-onset isolated sulfite oxidase deficiency(ISOD)admitted in the Department of Neurology, Children′s Hospital, Zhejiang University School of Medicine in July 2021 were retrospectively analyzed.Fifteen previously published cases of late-onset ISOD were also reviewed.The patient was a girl, who was hospitalized because of " motor regression with mental retardation for 5 days" at 1 year old.The manifestations of the patient were extrapyramidal symptoms, regression of motor development and seizures.The level of urinary sulfites in the patient was increased.Magnetic resonance imaging (MRI) features were bilateral pallidus and substantia nigra.Gene sequencing suggested a pure missense mutation of the sulfite oxidase( SUOX) gene c. 650(exon5)G>A(p.Arg217Gln). In 16 cases of late-onset ISOD, the median age at onset and diagnosis was 10.5 months and 34.0 months, respectively.The common clinical manifestations were hypotonia (13 cases), seizures (10 cases), movement disorders (9 cases), and ectopia lentis (6 cases). The most common brain MRI feature was pallidus changes (11 cases), followed by lesions of substantia nigra (5 cases), and cerebral atrophy (4 cases). Fourteen cases of late-onset ISOD showed a positive urinary sulfite test.The missense mutation of the SUOX gene was found in 9 cases.It suggested that brain MRI involvement of bilateral pallidus, high excretion of urine sulfites and the missense mutation of the SUOX gene were important diagnostic clues for late-onset ISOD.

Stress, coping strategies and quality of life in patients with globus / 中华内科杂志

Objective:To explore the associations of stress, coping strategies and quality of life in globus patients.Methods:A total of 180 patients diagnosed with globus were retrospectively analyzed between September 2018 to July 2020 in the First Affiliated Hospital of Zhengzhou University.The questionnaire included baseline characteristics and assessment scales. Quality of life was measured by short-form health survey-36 (SF-36), which included physical composite score (PCS) and mental composite score (MCS). Perceived stress was measured by perceived stress scale 10 (PSS-10). The coping strategy was evaluated by medical coping modes questionnaire (MCMQ). We analyzed the relationship between baseline characteristics, stress, coping strategies, and quality of life, and the influential factors of quality of life.Results:PCS was affected by the number of previous chronic illness, age, stress, confrontation, and avoidance ( F=3.647, r=-0.263, -0.634, 0.249, -0.329, all P<0.05). MCS was related to monthly income, marital status, stress, confrontation, and resignation ( F=1.963, 5.764, r=-0.312, 0.384, -0.360, all P<0.05). Based on the data of multiple linear regression analysis, stress was negatively correlated with both PCS and MCS ( t=-3.883, -9.708, all P<0.01), confrontation was positively correlated with both PCS and MCS ( t=2.030, 2.798, P=0.044, 0.006), and resignation was negatively correlated with MCS ( t=-1.585, P=0.025). Besides, age was negatively correlated with PCS ( t=-2.736, P=0.007), and monthly income was positively correlated with MCS ( t=2.497, P=0.013). Conclusion:Aging, low income, over stress, resignation rather than confrontation as a coping style impair the quality of life in globus patients.

Validation of Dose Conversion of Banxia Houpotang Based on Systematic Evaluation / 中国实验方剂学杂志

There are many different opinions on dose conversion of famous classical formulas from Treatise on Febrile Diseases or Synopsis of the Golden Chamber, which has become a difficult point in research and development of famous classical formulas. At present, the clinical application dose of Banxia Houpotang is similar to the viewpoint that 1 Liang is equivalent to 3 g, in order to provide scientific basis for this conversion method, this paper systematically evaluated the effectiveness of Banxia Houpotang in intervening globus hystericus. Randomized controlled trials (RCTs) of Banxia Houpotang in intervening globus hystericus from CNKI, VIP, Wanfang Data, China Biology Medicine (CBM), Web of Science and PubMed databases were collected online, the retrieval time was from inception to April 1, 2019. Two reviewers independently screened the literature, extracted the data and assessed the risk of bias of the included studies. Then, Meta analysis was performed by RevMan 5.3 software. A total of 17 RCTs involving 1 575 patients were included. The effective rate [relative risk (RR)=1.24, 95%confidence interval (CI) (1.18, 1.30), P<0.000 01] and the curative rate [RR=1.76, 95%CI (1.45, 2.15), P<0.000 01] of Banxia Houpotang in intervening globus hystericus were all better than the control group. Current evidence shows that Banxia Houpotang under the conversion of 3 g in 1 Liang has a significant effect on intervention of globus hystericus. Due to the limitations of quantity and quality of the included studies, the above conclusions need to be verified by more high-quality studies, but the author suggests that such dose conversion should be considered in the research and development of famous classical formulas.

The clinical significance of globus pallidus MRI signal intensity in the early identification of neonatal bilirubin encephalopathy / 中国新生儿科杂志

Objective To study the clinical significance of globus pallidus signal intensity and the intensity ratio of globus pallidus and putamen (G/P ratio) on magnetic resonance T1WI for the early recognition of neonatal bilirubin encephalopathy.Method From January to December 2017,full-term neonates with hyperbilirubinemia admitted to the neonatology department of our hospital were enrolled in the case group,and full-term neonates without hyperbilirubinemia in the control group.The clinical data,globus pallidus T1WI signal intensity,G/P ratio and the follow-up data were collected.According to the level of hyperbilirubinemia,the neonates in the case group were further assigned into mild hyperbilirubinemia group (serum bilirubin:222 to ＜256 μmol/L),moderate hyperbilirubinemia group (serum bilirubin:256 to ＜342 μmol/L),and severe hyperbilirubinemia group (serum bilirubin:≥ 342 μmol/L).According to the injury score of ABE,the neonates with ABE were assigned into mild ABE group,moderate ABE group and severe ABE group.The correlation of globus pallidus T1WI and T2WI signal values,G/P ratio and the serum bilirubin level and ABE degree were analyzed;receiver operating characteristic (ROC) curve was drawn to explore the predictive value of the T1WI signal value and G/P ratio for the diagnosis of ABE;the changes of globus pallidus T1WI and T2WI signal values during the first 6 months after birth and the results of follow-up to 1 year after discharge were also analyzed.Result A total of 175 neonates were included in the case group (65 in the mild hyperbilirubinemia group,71 in the moderate hyperbilirubinemia group and 39 in the severe hyperbilirubinemia group) and 43 neonates in the control group.39 neonates were diagnosed as ABE (21 mild ABE,12 moderate ABE,and 6 severe ABE).The first T1WI signal value and G/P ratio of neonates in the severe hyperbilirubinemia group was higher than the moderate hyperbilirubinemia group,the mild hyperbilirubinemia group and the control group;the T1WI signal value and G/P ratio in the moderate hyperbilirubinemia group was higher than the mild hyperbilirubinemia group and the control group (P ＜ 0.05).No significant difference existed between the mild group and the control group(P ＞ 0.05).T2WI values showed no differences among neonates with different bilirubin levels (P ＞ 0.05).The first T1WI signal value and G/P ratio in the severe ABE group were significantly higher than the moderate and mild ABE group,and the moderate ABE group higher than the mild ABE group (P ＜ 0.05).The ROC curve indicated the optimal cut-off value of T1WI signal and G/P ratio were 628 and 1.38,respectively.Among all the 175 neonates,9 had a decrease in T1WI signal value and an increase in T2WI signal value at 6 months after birth.After 1 year of follow-up visits,7 children were finally diagnosed as chronic bilirubin encephalopathy.All these children had increased signal intensity on T1WI in the acute phase,plus a decreased T1WI signal and an increased T2WI signal in 1 ～ 6 months after birth.Conclusion The globus pallidus T1WI signal and G/P ratio are closely related to the serum bilirubin level and ABE severity.If T1WI signal value ＞ 628 or G/P value ＞ 1.38,ABE should be considered.The T1WI signal value and G/P ratio play important roles as indicators for the early recognition of neonatal bilirubin encephalopathy.

Subcortical Volume Changes in Migraine with Aura

BACKGROUND AND PURPOSE: Various features of the cerebral cortex and white matter have been extensively investigated in migraine with aura (MwA), but the morphological characteristics of subcortical structures have been largely neglected. The aim of this study was to identify possible differences in subcortical structures between MwA patients and healthy subjects (HS), and also to determine the correlations between the characteristics of migraine aura and the volumes of subcortical structures. METHODS: Thirty-two MwA patients and 32 HS matched by sex and age were analyzed in this study. Regional subcortical brain volumes were automatically calculated using the FSL/FMRIB Image Registration and Segmentation Tool software (https://fsl.fmrib.ox.ac.uk/fsl/fslwiki/Glossary). A general linear model analysis was used to investigate differences in the volume of subcortical structures between the MwA patients and HS. A partial correlation test was used to assess correlations between the volume of subcortical structures and characteristics of MwA. RESULTS: The volumes of the right globus pallidus, left globus pallidus, and left putamen were significantly smaller in MwA patients than in HS (mean±SD): 1,427±135 mm³ vs. 1,557±136 mm³ (p<0.001), 1,436±126 mm³ vs. 1,550±139 mm³ (p=0.001), and 4,235±437 mm³ vs. 4,522±412 mm³ (p=0.006), respectively. There were no significant relationships between subcortical structures and clinical parameters. CONCLUSIONS: These findings suggest that both the globus pallidi and left putamen play significant roles in the pathophysiology of the MwA. Future studies should determine the cause-and-effect relationships, since these could not be discriminated in this study due to its cross-sectional design.

Pivotal Role of Subcortical Structures as a Network Hub in Focal Epilepsy: Evidence from Graph Theoretical Analysis Based on Diffusion-Tensor Imaging

BACKGROUND AND PURPOSE: There is accumulating evidence that epilepsy is caused by network dysfunction. We evaluated the hub reorganization of subcortical structures in patients with focal epilepsy using graph theoretical analysis based on diffusion-tensor imaging (DTI). In addition, we investigated differences in the values of diffusion tensors and scalars, fractional anisotropy (FA), and mean diffusivity (MD) of subcortical structures between patients with focal epilepsy and healthy subjects. METHODS: One hundred patients with focal epilepsy and normal magnetic resonance imaging (MRI) findings and 80 age- and sex-matched healthy subjects were recruited prospectively. All subjects underwent DTI to obtain data suitable for graph theoretical analysis. We investigated the differences in the node strength, cluster coefficient, eigenvector centrality, page-rank centrality measures, FA, and MD of subcortical structures between patients with epilepsy and healthy subjects. RESULTS: After performing multiple corrections, the cluster coefficient and the eigenvector centrality of the globus pallidus were higher in patients with epilepsy than in healthy subjects (p=0.006 and p=0.008, respectively). In addition, the strength and the page-rank centrality of the globus pallidus tended to be higher in patients with epilepsy than in healthy subjects (p=0.092 and p=0.032, respectively). The cluster coefficient of the putamen was lower in patients with epilepsy than in healthy subjects (p=0.004). The FA values of the caudate nucleus and thalamus were significantly lower in patients with epilepsy than in healthy subjects (p=0.009 and p=0.007, respectively), whereas the MD value of the thalamus was higher than that in healthy subjects (p=0.005). CONCLUSIONS: We discovered the presence of hub reorganization of subcortical structures in focal epilepsy patients with normal MRI findings, suggesting that subcortical structures play a pivotal role as a hub in the epilepsy network. These findings further reinforce the idea that epilepsy is a network disease.

Estimulación cerebral profunda del globo pálido interno en pacientes con síndrome de Gilles de la Tourette / Deep brain stimulation of internal globus pallidus in Tourette syndrome

RESUMEN INTRODUCCIÓN: El síndrome de Gilles de la Tourette es un trastorno neuropsiquiátrico caracterizado por tics y comorbilidades que comienza en la infancia. La estimulación cerebral profunda (ECP), aceptada como tratamiento para otros trastornos, se reserva para casos severos y pacientes con farmacorresistencia, aunque sigue permaneciendo en terreno experimental para esta patología. El objetivo de este trabajo es analizar la bibliografía científica actual acerca de la ECP del globo pálido interno en la reducción de tics y comorbilidades asociadas a este Síndrome. MATERIAL Y METODOS: Se ha realizado una revisión sistemática de varios artículos científicos consultando (entre febrero y marzo de 2017) las bases de datos MedLine, PubMed, Scopus, Web of Science y Cochrane. Se ha limitado la búsqueda a todos aquellos artículos publicados entre 2012 y 2017, escritos en inglés y realizados en humanos; se excluyeron revisiones, cartas al editor o aquellos que no se centrasen en el tema de estudio. RESULTADOS: En general, los resultados obtenidos muestran mejoras significativas en casi la totalidad de pacientes, pero, la carencia de estudios controlados aleatorizados con muestras mayores, la falta de resultados fiables, la ausencia de uniformidad en los protocolos y el desconocimiento de la fisiopatología y del área ideal a estimular, hacen que la aplicación de esta técnica no goce de evidencia científica suficiente para ser aceptada como parte del tratamiento de este síndrome hipercinético.

SUMMARY INTRODUCTION: Gilles de la Tourette syndrome is a neuropsyquiatric disorder characterized by tics and comorbidities which starts during the infancy. Deep brain Stimulation, accepted as treatment for other diseases, it is reserved for severe cases and pharmacoresistant patients, even though it still remains on the experimental field for this pathology. The main aim of this review is to analyse the current scientific bibliography about Deep brain Stimulation of the Globus Pallidus Internus on the reduction of tics and associated comorbidities from Gilles de la Tourette Syndrome. MATERIAL AND METHODS: A systematic review of several scientific articles was done checking (February-March, 2017) MedLine, PubMed, Scopus, Web of Science and Cochrane databases. We have restricted the search to all those articles published from 2012 to 2017, written in English and done with humans, excluding those which were reviews, letters to the editor or not focussed on the subject of the study. RESULTS: In general, the outcomes shows significant improvements in almost the totality of patients but the lack of randomised controlled trials with higher samples, the shortage of reliable results and the lack of awareness of the physiopathology and the ideal target to stimulate, don't allow this technique to enjoy scientific evidence enough to be accepted as part of the treatment for this hyperkinetic disorder.

Control temprano de los factores de mal pronóstico en el abordaje de los pacientes con eventos cerebrovasculares isquémicos / Early control of the factors of poor prognosis in the approach of patients with ischemic cerebrovascular events

RESUMEN OBJETIVO: Describir aspectos generales en relación con los eventos cerebrovasculares (ECV) isquémicos, así como los principales factores pronósticos que se han relacionado con el desenlace y la recuperación funcional posterior al evento cerebrovascular. MATERIALES Y MÉTODOS: Se realizó una revisión narrativa utilizando bases de datos (PubMed, Science Direct, MEDLINE), plataformas virtuales (National Institutes of Health) y publicaciones del Acta Neurológica Colombiana. RESULTADOS: Ser mujer, la edad avanzada, la inatención (negligencia), la gravedad del compromiso cognitivo y de la función ejecutiva, la desnutrición, y comorbilidades como la neumonía se asocian con un peor pronóstico en los 90 días posteriores al evento. Las alteraciones en la esfera mental (delirio), alteración de la conciencia, hemiplejia o parálisis de la mirada conjugada y el origen cardioembólico del ECV son algunos de los factores asociados con la mortalidad. La lateralidad hemisférica es una variable importante a tener en cuenta para valorar el pronóstico y la discapacidad funcional residual posevento; sin embargo, la evidencia actual es poco concluyente y algo contradictoria en relación con su rol como factor pronóstico. CONCLUSIONES: Es importante un diagnóstico temprano y una intervención adecuada de los pacientes afectados con ECV isquémico, así como el control precoz de los factores modificables de mal pronóstico. Entre los no modificables, la lateralidad hemisférica podría ser más bien un criterio de selección para un programa de rehabilitación específico y personalizado, pues indudablemente existe un compromiso cognitivo y del lenguaje que difiere sustancialmente en relación con la ubicación topográfica de la lesión.

SUMMARY OBJETIVE: To describe general aspects related to acute ischemic stroke (AIS), as well as to know the main prognostic factors that have been related to the outcome and functional recovery after the AIS. MATERIALS AND METHODS: A narrative review was performed using databases (PubMed, Science-Direct, MEDLINE), virtual platforms (National Institutes of Health) and publications of the Colombian Neurological Record. RESULTS: Being female, advanced age, inattention (neglect), severity of cognitive and executive function impairment, malnutrition, and comorbidities such as pneumonia are associated with a worse prognosis in the 90 days after the event. Alterations in the mental sphere (delirium), altered consciousness, hemiplegia or paralysis of the conjugate gaze and the cardioembolic origin of the AIS are some of the factors that are associated with higher mortality. Hemispheric laterality is an important variable to consider in assessing the prognosis and residual functional disability post-event; however the current evidence is inconclusive and somewhat contradictory. CONCLUSIONS: Early diagnosis and adequate intervention of patients with AIS and early control of modifiable factors of poor prognosis are important. Among the non-modifiable, hemispheric laterality may be more a selection criterion for a specific and personalized rehabilitation program, since there is undoubtedly a cognitive and language compromise that differs substantially in relation to the topographical location of the ischemic lesion.

Magnetic resonance gadolinium-based contrast agent deposition in brain: Status and progress / 第二军医大学学报

Gadolinium-based contrast agents (GBCAs) are widely used in magnetic resonance imaging. Recently, a large amount of evidence indicates that change of magnetic resonance signal in deep brain nuclei is related to repeated injection of GBCAs. Especially in the dentatum and pallidum the gadolinium deposition is most obvious. This paper reviews the research status and policy progress of brain deposition of GBCAs, and introduces the relationship between gadolinium deposition in the brain and the type of GBCAs.

A Case of Globus Pharyngis in Gastroesophageal Reflux Disease Successfully Treated with Seinetsuhoketsuto / 日本東洋医学雑誌

Gastroesophageal reflux disease (GERD) can cause not only esophageal symptoms, but also extraesophageal symptoms such as globus pharyngis. Here, we describe a case of globus pharyngis in GERD successfully treated with seinetsuhoketsuto. A 72-year-old female began to have tingling in her pharyngolarynx in February 20XX. Otolaryngologist did not point out abnormal findings. However, reflux esophagitis was detected by upper gastrointestinal endoscopy. Although treatment with rabeprazole relieved the tingling, she experienced a relapse in September 20XX and visited our clinic in November. We prescribed seinetsuhoketsuto because she exhibited numerous blood deficiency-related symptoms including dryness of the skin and eyes, shallow sleep, coldness in the feet, etc. The tingling then decreased rapidly and disappeared in two months. In addition, dryness of the skin and eyes and her sleep also improved markedly. Seinetsuhoketsuto has been regarded as a medication for inflammation in the mouth such as oral ulcers and erosions. However, this case indicated that seinetsuhoketsuto could also be utilized to treat symptoms in the pharyngolarynx due to GERD.

Atlas of the Striatum and Globus Pallidus in the Tree Shrew: Comparison with Rat and Mouse / 神经科学通报·英文版

The striatum and globus pallidus are principal nuclei of the basal ganglia. Nissl- and acetylcholinesterase-stained sections of the tree shrew brain showed the neuroanatomical features of the caudate nucleus (Cd), internal capsule (ic), putamen (Pu), accumbens, internal globus pallidus, and external globus pallidus. The ic separated the dorsal striatum into the Cd and Pu in the tree shrew, but not in rats and mice. In addition, computer-based 3D images allowed a better understanding of the position and orientation of these structures. These data provided a large-scale atlas of the striatum and globus pallidus in the coronal, sagittal, and horizontal planes, the first detailed distribution of parvalbumin-immunoreactive cells in the tree shrew, and the differences in morphological characteristics and density of parvalbumin-immunoreactive neurons between tree shrew and rat. Our findings support the tree shrew as a potential model for human striatal disorders.

Degeneración hepatocerebral adquirida reporte de caso y revisión de la literatura / Acquired hepatocerebral degeneration. case report and literature review

Acquired hepatocerebral degeneration also termed acquired hepatolenticular degeneration, cirrhosis-related Parkinsonism o pseudo-Wilson is a rare, progressive and chronic neurological syndrome that occurs in patients with chronic liver disease, particularly in those with surgically or spontaneously induced portosystemic shunts. The clinical features of this pathological entity include extrapyramidal signs, ataxia, cognitive decline and neuropsychiatric changes, such as delirium, apathy, lethargy and emotional instability. Brain Magnetic Resonance Imaging classically shows symmetrical T1-weighted hyperintensities in the globus pallidus, substantia nigra and periaqueductal gray matter. Although its pathogenesis is not completely elucidated, it is postulated that the excess manganese accumulation and deposition in the basal ganglia, leading to dysfunctional dopaminergic system in this anatomical location, would have a key role in triggering the disease. Orthotopic liver transplantation is the mainstay of treatment and is considered effective by reducing motor and cognitive alterations. Other therapeutic alternatives that have reported symptomatic improvement are the use of bromocriptine or levodopa and portosystemic shunts occlusion. In this article, we report a case of a 63-year-old woman with clinical manifestations over the course of one year, characterized by cognitive decline, chorea, gait and language disturbances. She was examined with plasma levels of copper and ceruloplasmin, which excluded the possibility of Wilson´s Disease, its main differential diagnosis. Neuroimaging revealed T1-weighted hyperintensity in the pallidum, confirming suspected diagnosis of acquired hepatocerebral degeneration.

Efeitos dos anabolizantes sobre a densidade de neurônios dos núcleos da base / Effects of anabolic agents on the neuron density of the basal nuclei / Efectos de los anabolizantes en la densidad de las neuronas de los núcleos basales

RESUMO Objetivos: Pouco se sabe sobre a atuação dos esteroides androgênicos anabolizantes (EAA) no cérebro humano e, por isso, resolvemos estudar a perda neuronal causada pelo uso e abuso de EAA em camundongos. Métodos: Utilizamos 60 camundongos da linhagem Swiss, sendo 30 machos e 30 fêmeas, divididos em três grupos: 20 animais foram tratados com Deposteron® (cipionato de testosterona); outros 20 animais foram tratados com Winstrol Depot® (stanozolol); os últimos 20 animais foram tratados com solução salina. Todos foram submetidos à natação por 15 minutos. Finalizado o tratamento, os animais foram sacrificados pelo método de inalação de Halotano. Os encéfalos foram retirados e armazenados em solução de formaldeído a 4% por 24 horas. De cada encéfalo foram retiradas amostras homotípicas da região média do cérebro em cortes frontais para que pudéssemos avaliar as áreas estabelecidas para este estudo. Resultados: As análises da estimativa dos perfis celulares mostraram que houve uma diminuição do número de perfis no núcleo pálido dos animais machos tratados com Winstrol Depot®. Conclusão: Esses resultados nos permitem inferir que o uso inadequado e sem orientação médica de EAA pode levar a degenerações celulares.

ABSTRACT Objectives: Little is known about the action of anabolic-androgenic steroids (AAS) on the human brain and, therefore, we decided to study the neuronal loss caused by use and abuse of AAS in mice. Methods: We used 60 Swiss mice, 30 males and 30 females, divided into three groups: 20 animals treated with Deposteron® (testosterone cypionate); another 20 animals were treated with Winstrol Depot® (stanozolol); the last 20 animals were treated with saline solution. All the animals were submitted to swimming for 15 minutes. After the treatment, the animals were euthanized by halothane inhalation (Halotano) method. The brains were removed and stored in 4% formal-dehyde solution for 24 hours. From each brain, homotypic samples were taken from the middle region of the brain in frontal cuts so that we could evaluate the areas established for this study. Results: Analyzes of the estimated cell profiles showed that there was a decrease in the number of profiles in the pallidal nucleus of the male animals treated with Winstrol Depot®. Conclusion: These results allow us to infer that inadequate and non-medical use of AAS can lead to cellular degeneration.

RESUMEN Objetivos: Poco se sabe acerca del efecto de la acción de los esteroides anabólicos androgénicos (EAA) en el cerebro humano y, por este motivo, decidimos estudiar la pérdida neuronal causada por el uso y abuso de EAA en ratones. Métodos: Utilizamos 60 ratones de linaje Swiss, siendo 30 machos y 30 hembras, divididos en tres grupos: 20 animales fueron tratados con Deposteron® (cipionato de testosterona); otros 20 animales fueron tratados con Winstrol Depot® (stanozolol); los últimos 20 animales fueron tratados con solución salina. Todos fueron sometidos a natación durante 15 minutos. Terminado el tratamiento, los animales fue-ron sacrificados por el método de inhalación de Halotano. Los cerebros fueron retirados y almacenados en solución de formaldehído al 4% durante 24 horas. De cada cerebro fueron retiradas muestras homotípicas de la región media del cerebro en cortes frontales, así que pudimos evaluar las áreas establecidas para este estudio. Resultados: El análisis de la estimación de los perfiles celulares mostró que hubo una disminución en el número de perfiles en el globo pálido de los animales machos tratados con Winstrol Depot®. Conclusión: Estos resultados permiten inferir que el uso inadecuado y sin orientación médica de EAA puede conducir a la degeneración celular.

The Application of the Rome IV Criteria to Functional Esophagogastroduodenal Disorders in Asia

The Rome criteria were amended as Rome IV. For functional esophageal disorders, the exclusion criteria have been more specifically revised based on further understanding of other esophageal disorders, including eosinophilic esophagitis and spastic and hypercontractile motor disorders. Another revised point is the more restrictive definition of gastroesophageal reflux disease, indicating that sensitivity to a physiological reflux burden may be placed more firmly within the functional group. For functional dyspepsia (FD), only minor changes were introduced, mainly to improve specificity. Among the major symptoms of FD, not only postprandial fullness, but also epigastric pain, epigastric burning, and early satiation should be “bothersome.” Investigation on the effect of meal ingestion on symptom generation has indicated that not only postprandial fullness and early satiety, but also epigastric pain, epigastric burning sensation and nausea (not vomiting) may increase after meals. Helicobacter pylori infection is considered a possible cause of dyspepsia if successful eradication leads to sustained resolution of symptoms for more than 6 months, and such status can be termed as “H. pylori–associated dyspepsia.” Prompt esophagogastroduodenoscopy and H. pylori testing and treatment would be more beneficial, especially in Asia, which has a high prevalence of gastric cancer. Acotiamide, tandospirone, and rikkunshito are the newly listed as treatment options for FD. For further therapeutic development, clinical studies based on the strict Rome IV criteria should be performed.

Pregnancy and Delivery in a Generalized Dystonia Patient Treated with Internal Globus Pallidal Deep Brain Stimulation: a Case Report

Internal globus pallidus (GPi) deep brain stimulation (DBS) has been widely accepted as an effective treatment modality of medically refractory dystonia. However, there have been few studies regarding the safety issue of pregnancy and childbirth related with DBS. This report describes a female patient who was pregnant and delivered a baby after GPi DBS surgery. A 33-year-old female patient with acquired generalized dystonia underwent bilateral GPi DBS implantation. She obtained considerable improvement in both movement and disability after DBS implantation. Four years later, she was pregnant and the obstetricians consulted us about the safety of the delivery. At 38-weeks into pregnancy, a scheduled caesarian section was carried out under general anesthesia. After induction using thiopental and succinylcholine, intubation was done quickly, followed by DBS turn off. For hemostasis, only bipolar electrocautery was used. Before awakening from the anesthesia, DBS was turned on as the same parameters previously adjusted. After delivery, she could feed her baby by herself, because the dystonia of left upper extremity and hand was improved. Until now, she has been showing continual improvement and being good at housework, carrying for children, with no trouble in daily life. This observation indicates that the patients who underwent DBS could safely be pregnant and deliver a baby.

Effect of Oral Water Intake to Globus Pharyngeus with Non-Organic Diseases

BACKGROUND AND OBJECTIVES: Globus pharyngeus is a sensation of foreign body in the throat. There are many studies evaluate relationships between globus pharyngeus and organic diseases such as laryngopharyngeal reflux, esophageal motility disorders as well as psychotic causes. But, Also many patients without etiologic causes complain of globus sensation. The authors performed a study that evaluate association between oral water intake and symptoms of globus sensation on the basis of a belief that pharyngeal dehydration due to lack of oral water intake causes globus sensation. MATERIALS AND METHODS: A survey using visual analogue scale to evaluate symptoms was performed with 73 patients with globus pharyngeus. RESULTS: Patients who drink water less than 500 mL per day (p=0.04) and less than five times per day (p=0.02) were improved after 6 months due to education and doctor's recommendation. CONCLUSION: Frequent and enough water intake should be recommended to resolve symptoms of globus sensation.

Comparison of Pallidal and Subthalamic Deep Brain Stimulation in Parkinson's Disease: Therapeutic and Adverse Effects

OBJECTIVE: To compare the therapeutic and adverse effects of globus pallidus interna (GPi) and subthalamic nucleus (STN) deep brain stimulation (DBS) for the treatment of advanced Parkinson's disease (PD). METHODS: We retrospectively analyzed the clinical data of patients with PD who underwent GPi (n = 14) or STN (n = 28) DBS surgery between April 2002 and May 2014. The subjects were matched for age at surgery and disease duration. The Unified Parkinson's Disease Rating Scale (UPDRS) scores and levodopa equivalent dose (LED) at baseline and 12 months after surgery were used to assess the therapeutic effects of DBS. Adverse effects were also compared between the two groups. RESULTS: At 12 months, the mean changes in the UPDRS total and part I–IV scores did not differ significantly between the two groups. However, the subscores for gait disturbance/postural instability and dyskinesia were significantly more improved after GPi DBS than those after STN DBS (p = 0.024 and 0.016, respectively). The LED was significantly more reduced in patients after STN DBS than that after GPi DBS (p = 0.004). Serious adverse effects did not differ between the two groups (p = 0.697). CONCLUSION: The patients with PD showed greater improvement in gait disturbance/postural instability and dyskinesia after GPi DBS compared with those after STN DBS, although the patients had a greater reduction in LED after STN DBS. These results may provide useful information for optimal target selection for DBS in PD.