Transdermal drug delivery technology for brain-targeted drug delivery / 药学学报

Intracerebral delivery of drugs for the treatment of central nervous system disorders is usually limited by the blood-brain barrier (BBB). Transdermal drug delivery systems (TDDS) have the advantage of improving patient compliance and avoiding first-pass effects compared to intravenous, oral and intranasal drug delivery, and are an emerging non-invasive drug delivery route that facilitates long-term drug delivery to patients. The discovery of direct subcutaneous targeting of lymphatic pathways to brain tissue has made TDDS a new brain-targeted drug delivery strategy. At the same time, the development of nano-delivery technology has further facilitated the application of TDDS for targeted drug delivery to the brain. This review summarizes the mechanism of transdermal drug delivery into the brain and the application of TDDS in the treatment of brain diseases, providing new ideas and methods for the treatment of central nervous system diseases.

Advances in methods and applications of electroencephalogram microstate analysis / 生物医学工程学杂志

Electroencephalogram (EEG) is characterized by high temporal resolution, and various EEG analysis methods have developed rapidly in recent years. The EEG microstate analysis method can be used to study the changes of the brain in the millisecond scale, and can also present the distribution of EEG signals in the topological level, thus reflecting the discontinuous and nonlinear characteristics of the whole brain. After more than 30 years of enrichment and improvement, EEG microstate analysis has penetrated into many research fields related to brain science. In this paper, the basic principles of EEG microstate analysis methods are summarized, and the changes of characteristic parameters of microstates, the relationship between microstates and brain functional networks as well as the main advances in the application of microstate feature extraction and classification in brain diseases and brain cognition are systematically described, hoping to provide some references for researchers in this field.

Algunos aspectos clínicos y humorales de la insuficiencia hepática en niños y adolescentes / Some clinical and humoral aspects of liver failure in children and adolescents

Introducción: La insuficiencia hepática aguda es una entidad de origen multifactorial, que se presenta en niños previamente sanos y tiene repercusión directa en las funciones de síntesis, coagulación y depuración. Objetivo: Caracterizar niños con insuficiencia hepática aguda según variables clínicas y humorales. Métodos: Se realizó un estudio retrospectivo y descriptivo de 19 pacientes con el diagnóstico de insuficiencia hepática aguda, atendidos en la Unidad de Cuidados Intensivos Pediátricos del Hospital Docente Infantil Sur de Santiago de Cuba, desde abril de 1998 hasta igual mes de 2018, para lo cual se emplearon métodos teóricos y estadísticos. Resultados: En la casuística predominó el sexo femenino (57,9 %), la mediana de la edad fue de 5 años y la infección constituyó la causa más común (73,7 %). Los virus hepatotrópicos como el de la hepatitis A resultaron los más frecuentes. Las complicaciones de mayor observancia fueron la alcalosis respiratoria (63,1 %), la disfunción multiorgánica (42,1 %) y la encefalopatía hepática (31,6 %). Las cifras bajas de colesterol y el tiempo de protrombina mayor de 20 segundos se asociaron a una mayor letalidad. Conclusiones: En los pacientes menores de un año los virus no hepatotrópicos constituyeron el origen más frecuente de dicha enfermedad.

Introduction: The acute liver failure is an entity of multifactorial origin that is presented in previously healthy children and has direct repercussion in the synthesis, clotting and purification functions. Objective: To characterize children with acute liver failure according to clinical and humoral variables. Methods: A retrospective and descriptive study of 19 patients with diagnosis of acute liver failure was carried out, they were assisted in the Pediatric Intensive Cares Unit of the Southern Children Hospital in Santiago de Cuba, from April, 1998 to the same month in 2018, for which theoretical and statistical methods were used. Results: In the case material there was a prevalence of the female sex (57.9 %), the mean age was 5 years and the infection constituted the most common cause (73.7 %). The hepatotropic virus as the hepatitis A were the most frequent. The complications of more observance were the respiratory alkalosis (63.1 %), the multiorganic dysfunction (42.1 %) and the liver brain disease (31.6 %). The low figures of cholesterol and the prothrombin time higher than 20 seconds were associated with a greater lethality. Conclusions: In the patients younger than one year the non hepatotropic virus constituted the most frequent origin in this disease.

Research progress of exosomes as drug delivery systems in the treatment of brain diseases / 药学学报

Exosomes are disk-shaped vesicles with a diameter of 40-100 nm, which are composed of natural lipid bilayers. Most cells can produce exosomes, which play an important role in physiological and pathological processes, affecting signal pathways, intercellular communication, tumor progression and molecular metastasis. Exosomes are characterized by low immunogenicity, good natural stability, long half-life, high delivery efficiency, and the ability to cross the blood-brain barrier, which can be used as a good carrier for drug delivery. This review focuses on the research progress of exosomes as drug delivery systems in the treatment of brain diseases, such as central nervous system degenerative diseases, brain tumors and cerebrovascular diseases and so on.

Reaprendizaje motor orientado a tareas en pacientes con secuelas de enfermedad cerebro vascular: una revisión narrativa

Introducción: en personas con secuelas de enfermedad cerebro-vascular (ECV), la rehabilitación debe ser integral, con un enfoque funcional. En la actualidad, existe una técnica que lo posibilita desde un componente motriz, el reaprendizaje motor orientado a tareas (MRP). Como objetivo, se planteó establecer, a partir de la revisión de la literatura, los efectos de la técnica para miembros superiores, inferiores e independencia funcional en pacientes con secuelas de ECV. Métodos: se realizó una revisión narrativa a partir de consulta de bases de datos en línea (Pubmed, Elsevier, Lilacs, Scholar) y se incluyó literatura con información relevante acerca de fundamentación teórica. Resultados: el entrenamiento con esta técnica reporta efectos, en miembros inferiores, para mejoría de balance y marcha, y a nivel de miembros superiores, en funciones como alcances y agarres, lo que se traduce en una optimización de su independencia funcional. Conclusión: este programa puede ser una opción en la rehabilitación de la función motora en pacientes con estas secuelas.

Introduction: Rehabilitation must be comprehensive with a functional approach in people with sequels of Vascular Brain Disease VBD. There is a technique that allows this through a motor component named task-oriented motor relearning (TMR), it was established as objective to identify based on the literature review the effects of the technique for upper and lower limbs and functional independence in patients with sequels of VBD. Methods: A narrative review was carried out based on online databases (Pubmed, Elsevier, Lilacs, Scholar). Literature with relevant information about theoretical foundation was included. Results: The training with this technique reports effects on lower limbs to improve balance and gait, and for upper limbs in functions such as scopes and grips that results in an optimization of functional independence. Conclusion: This program may be an option for motor function rehabilitation in patients with these sequels.

Introdução. A reabilitação deve ser parte integrante de uma abordagem funcional em pessoas com sequelas de doença cerebrovascular DCV. Existe uma técnica que o faz possível a partir de um componente motriz chamado reaprendizagem motora orientada por tarefa (MRP). O objetivo foi estabelecer a partir da revisão da literatura os efeitos da técnica para membros superiores e inferiores e independência funcional em pacientes com sequelas de DCV. Métodos. Foi realizada uma revisão narrativa a partir da busca em bases de dados online (Pubmed, Elsevier, Lilacs, Scholar), incluindo literatura com informações relevantes sobre fundamentação teórica. Resultados. O treinamento com essa técnica relata efeitos nos membros inferiores para melhorar o equilíbrio e a marcha, no nível dos membros superiores em funções como escopos e manoplas que resultam em uma otimização da independência funcional. Conclusão. Este programa pode ser uma opção na reabilitação da função motora em pacientes com essas sequelas.

Research Progress on Effect of Traditional Chinese Medicine on Blood-brain Barrier Permeability / 中国实验方剂学杂志

The blood-brain barrier is located between blood vessels and brain parenchyma and is a composite tissue composed of brain capillary endothelial cell,astrocyte end foot,pericyte,basement membrane and their tight connections.The blood-brain barrier acts as an important barrier between the blood-brain. It strictly restricts the exchange of blood and brain tissue. On the one hand,it allows the nutrients required by the brain tissue to enter the barrier. On the other hand,the substance that damages the brain tissue is restricted from entering the barrier to maintain the stability of the neuron microenvironment. The barrier function of the blood-brain barrier also limits the concentration of drugs that treat certain diseases into the brain or reduces the concentration of drugs into the brain,affecting the treatment of certain diseases.Studies have found that Chinese medicine has the effect of regulating the permeability of the blood-brain barrier. For example, Chinese herbal medicines such as Moschus,borneol,Styorax,and Benzoinum can increase the permeability of the blood-brain barrier,and can help its medicine into the brain. Its role is mainly related to the reduction of the blood-brain barrier tight junction,the inhibition of the blood-brain barrier transporter,and the inhibition of the active transport of ion channels.Orifice-opening medicinal such as borneol and Moschus can reduce the permeability of the blood-brain barrier.Certain tonifying and replenishing medicinal such as Ginseng Radix et Rhizoma,Astragali Radix,and Paeoniae Radix Alba can also reduce the permeability of the blood-brain barrier to protect the blood-brain barrier and brain tissue.Its role is mainly related to the regulation of inflammatory reactions,increased expression of tight junction-associated proteins,and promotion of vascular endothelial proliferation.The two-way regulation of blood-brain barrier permeability by traditional Chinese medicine(TCM) may be the basis for the prevention and treatment of brain diseases by TCM.In this paper,we systematically sort out the relevant literatures on the study of the permeability of blood-brain barrier and its mechanism of action in Chinese medicine in recent years,and carry out in-depth combing and summary,in order to provide a scientific basis for the clinical application of TCM to prevent and treat brain diseases.

A correlation study of necrotizing enterocolitis and encephalopathy of prematurity in premature infants with gestational age ＜ 32 weeks / 中国新生儿科杂志

Objective To study the correlation of necrotizing enterocolitis (NEC) and encephalopathy of prematurity (EOP) in premature infants with gestational age (GA) ＜ 32 weeks.Method From January 2009 to December 2014,clinical data of preterm infants (GA ＜ 32 weeks) admitted to department of neonatology of Children's Hospital of Fudan University and received brain magnetic resonance imaging (MRI) at corrected GA of full term or near full term were collected.NEC patients were assigned into the NEC group.At the same time,patients with similar GA and birth weight without NEC were assigned into the control group.The incidence and MRI characteristics of EOP were studied using Chi-square method.Result A total of312 preterm infants were included in our study,104 in the NEC group,and 208 in the control group.The incidence of EOP in the NEC group was higher than the control group (27.9％ vs.17.3％).The difference between the two groups were statistically significant (P =0.030).The incidence of non-cystic EOP in the NEC group was significantly higher than the control group (89.7％ vs.63.9％,P =0.017).Conclusion NEC and EOP may be correlated in preterm infants with GA ＜32 weeks.Most of EOP were non-cystic injury.

An International Curriculum and Behavioural Neurology / Un currículo internacional para neuropsiquiatría y neurología conductual

Abstract With major advances in neuroscience in the last three decades, there is an emphasis on understanding disturbances in thought, behaviour and emotion in terms of their neuroscientific underpinnings. While psychiatry and neurology, both of which deal with brain diseases, have a historical standing as distinct disciplines, there has been an increasing need to have a combined neuropsychiatric approach to deal with many conditions and disorders. Additionally, there is a body of disorders and conditions that warrants the skills sets and knowledge bases of both disciplines. This is the territory covered by the subspecialty of Neuropsychiatry from a 'mental' health perspective and Behavioural Neurology from a 'brain' health perspective. This paper elaborates the neuropsychiatric approach to dealing with brain diseases, but also argues for the delineation of a neuropsychiatric territory. In the process, it describes a curriculum for the training of a neuropsychiatrist or a behavioural neurologist who is competent in providing a unified approach to the diagnosis and management of this set of conditions and disorders. The paper describes in some detail the objectives of training in neuropsychiatry and the key competencies that should be achieved in such higher training after a foundational training in psychiatry and neurology. While aiming for an internationally relevant training program, the paper acknowledges the local and regional differences in training expertise and requirements. It provides a common framework of training for both Neuropsychiatry and Behavioural Neurology, while accepting the differences in skills and emphasis that basic training in psychiatry or neurology will bring to the subspecialty training. The future of Neuropsychiatry (or Behavioural Neurology) as a discipline will be influenced by the successful adoption of such a unified training curriculum.

Resumen Los grandes avances en las neurociencias en las últimas 3 décadas han hecho hincapié en la comprensión de las perturbaciones en el pensamiento, el comportamiento y las emociones. Mientras que la psiquiatría y la neurología se ocupan de enfermedades del cerebro, recientemente ha habido una creciente necesidad de tener un enfoque neuropsiquiátrico combinado para tratar muchos trastornos. Además, hay múltiples condiciones en las que confluyen habilidades y bases de conocimiento de ambas disciplinas. Este es el territorio cubierto por la subespecialidad de Neuropsiquiatría desde una perspectiva de salud «mental¼ y la Neurología Conductual desde una perspectiva de salud «cerebral¼. Este artículo elabora el enfoque neuropsiquiátrico para tratar las enfermedades cerebrales, pero también discute los límites del territorio neuropsiquiátrico. En este proceso, se describe un currículo para la formación de un neuropsiquiatra o un neurólogo conductual competente para proveer un abordaje integral en términos diagnósticos y terapéuticos. El documento describe con cierto detalle los objetivos de la formación en neuropsiquiatría y las competencias clave que se debe alcanzar en dicha formación superior, después de una formación inicial en psiquiatría y neurología. Al mismo tiempo que aspira a un programa de formación internacionalmente pertinente, el documento reconoce las diferencias locales y regionales en materia de conocimientos y requisitos de formación. Proporciona un marco común de formación tanto para la Neuropsiquiatría como para la Neurología Conductual, aceptando las diferencias en habilidades y el énfasis que la formación básica en psiquiatría o neurología traerá a la formación de la subespecialidad. El futuro de la Neuropsiquiatría (o Neurología Conductual) como disciplina estará influido por la instauración exitosa de un currículo de capacitación unificado.

PET/fMRI for precise localization of abnormal brain activity: a mini review / 中华核医学与分子影像杂志

Many brain disorders do not show visible lesions and most likely are resulted from abnormalities in regional brain activity or connectivity.Conventional diagnostic neuroimaging techniques are not capable of precisely localizing the abnormal brain activity,but the recently developed integrated PET/MR technology may have the potential to bridge this gap.Integrated PET/MR has been used in clinical practice.However,its primary application is still a combination of functional PET imaging and structural MRI.Simultaneous PET/fMRI,a "functional+functional" imaging technique,holds the advantages of high spatial and temporal resolution,high sensitivity and specificity,and non-invasiveness.Globally,simultaneous PET/fMRI research is still in its beginning stage,and a few initial PET/fMRI studies have shown that voxel-wise correlation between PET and fMRI metrics was not very high,indicating that they may reflect very different aspects of brain activity.To date more than 5 integrated PET/MR scanners have been set up in mainland China.China has the largest patient population,rapidly developing PET imaging techniques,and well-established capabilities in fMRI neuroimaging analytics.PET/fMRI studies require multi-disciplinary collaborations in nuclear medicine,radiology,chemistry,medical physics,computation science,and cognitive neuroscience.At the moment,the research management system in Chinese hospitals is not conducive to such collaborations and further improvement is needed to encourage multi-disciplinary research such as PET/fMRI.Given the known advantages in patient population and other resources,multi-center and multi-disciplinary studies hold the potential to put China at the leading edge of PET/fMRI research and produce high value results that will advance both neuroimaging sciences and future patient care in brain disorders.

MRI features of phenylketonuria in brain / 中国医学影像技术

Objective To observe MRI features of intracranial changes in phenylketonuria (PKU) patients.Methods Brain MRI findings of clinically diagnosed 13 PKU patients were analyzed retrospectively.The structure and signal changes of cerebrum,cerebellum and brainstem were observed.Results Posterior horn and triangle high signals were shown in white matter of bilateral lateral ventricle of all 13 patients on T2WI,while the optic radiation was spared.Periventricular white matter abnormal signals at body and anterior horn bilateral lateral ventricle (n=12),bilateral basal ganglia involvement (n=1),extensive white matter involvement (n=1),backward myelination and agenesis of corpus callosum (n=3),and mild macrogyria deformity (n=1) were found.The high signals in lateral periventricular white matter were shown on DWI,with reduction of ADC values in 6 cases.Conclusion Abnormal high signals in brain posterior horn and triangle white matter,optic radiation spared,and corpus callosum and cortical malformations are brain MRI appearances in brain of PKU.

Manifestación atípica de encefalopatía posterior reversible (PRES) en Miastenia Gravis tratada con inmunoglobulina: reporte de caso / Atypical manifestation of posterior reversible encephalopathy (PRES) in Myasthenia Gravis treated with immunoglobulin: case report

El Síndrome de Encefalopatía Posterior Reversible (PRES por sus siglas en Inglés), es una entidad rara que se asocia a hipertensión arterial, enfermedades autoinmunes y medicamentos oncológicos. Se describe una paciente de 62 años, con crisis miasténica que posterior al tratamiento con inmunoglobulina G presentó deterioro y focalización neurológica, con lesiones en resonancia magnética inicial sugestivas de PRES, las cuales se confirmaron en control imaginológico. Esta entidad debe ser considerada en los pacientes que presenten deterioro neurológico focal posterior al uso de inmunoglobulina.

The Posterior Reversible Encephalopathy Syndrome (PRES), is a rare entity that is associated with hypertension, autoimmune diseases and cancer drugs. We describe a 62 year old female patient with myasthenic crisis that following treatment with immunoglobulin G who presents neurological impairment, with initial MRI lesions suggestive of PRES, which were confirmed in control imaging. This entity should be considered in patients presenting with focal neurological impairment following the use of immunoglobulin.

Muscle Eye Brain Disease; a Rare Form of Syndromic Congenital Muscular Dystrophy

Congenital muscular dystrophy (CMD) is a heterogeneous group of disorders characterized by muscular hypotonia since birth and the histologic features of muscular dystrophy. Syndromic congenital muscular dystrophies are clinically similar autosomal recessive disorders characterized by congenital muscular dystrophy, lissencephaly, and eye anomalies. We present a case of a rare form of syndromic congenital muscular dystrophy in an eight year old girl, born of firstdegree consanguinity. She had: global develop

Influence of History of Brain Disease or Brain Trauma on Psychopathological Abnormality in Young Male in Korea : Analysis of Multiphasic Personal Inventory Test

OBJECTIVE: The purpose of this study is to confirm whether brain disease or brain trauma actually affect psychopathology in young male group in Korea. METHODS: The authors manually reviewed the result of Korean military multiphasic personal inventory (KMPI) in the examination of conscription in Korea from January 2008 to May 2010. There were total 237 young males in this review. Normal volunteers group (n=150) was composed of those who do not have history of brain disease or brain trauma. Brain disease group (n=33) was consisted of those with history of brain disease. Brain trauma group (n=54) was consisted of those with history of brain trauma. The results of KMPI in each group were compared. RESULTS: Abnormal results of KMPI were found in both brain disease and trauma groups. In the brain disease group, higher tendencies of faking bad response, anxiety, depression, somatization, personality disorder, schizophrenic and paranoid psychopathy was observed and compared to the normal volunteers group. In the brain trauma group, higher tendencies of faking-good, depression, somatization and personality disorder was observed and compared to the normal volunteers group. CONCLUSION: Young male with history of brain disease or brain trauma may have higher tendencies to have abnormal results of multiphasic personal inventory test compared to young male without history of brain disease or brain trauma, suggesting that damaged brain may cause psychopathology in young male group in Korea.

The MRI characteristics of Hashimoto encephalopathy / 中华放射学杂志

Objective To study the MRI findings of HE and the pathological mechanism and to improve the diagnosis and differential diagnosis of HE. Methods Five patients of HE diagnosed by clinical and laboratory examination were examined with conventional MRI scan. Additional DWI, MRA and enhancement MRI scan were performed on 3 patients in which abnormal findings was detected on the conventional MRI. The distribution of lesions and signal characteristics were analyzed. The ADC values of the lesions and of the contralateral non-lesion area were measured. Moreover, the possible pathological mechanisms of HE were discussed on the basis of changes of clinical and imaging manifestations in the two cases with serial clinical and MRI data. Results Of 5 patients, brain abnormalities were found in 3 cases,which showed scattered spotted supratentorial white matter lesions of isointensity on T1 WI and DWI, and high signal intensity on T2WI and fluid-attenuated inversion recovery (FLAIR). Meanwhile, multiple plaque-like lesions involving both white matter and gray matter were found, mainly located at the basal ganglia nuclei, hippocampus and cingulate cortex. The lesions demonstrated iso-or hypo-intensity on T1 WI,and iso-or hyper-intensity on T2 WI, FIAIR and DWI at the initial stage. No enhancement was found in these lesions and MRA disclosed no remarkable findings. The ADC value of the lesions [ (0. 449 ± 0. 092) ×10-3 mm2/s] was decreased significantly compared with the contralateral noninvolved area [ (0. 838 ±0. 062) × 10-3 mm2/s] at the early onset. In 2 cases with glucocorticoid therapy, together with symptom relief, MRI follow-up scan demonstrated the reduction of lesion volume, the signal change to hyperintensity on T1 WI and hypo-intensity on DWL The ADC of the lesions increased significantly. Conclusion The MRI could be one of the effective tools for diagnosis, differential diagnosis, and judging the prognosis and therapeutic results of HE. Meanwhile, it may be a non-invasive method to study the pathological mechanism of HE.

A Child With Muscle-eye-brain Disease

PURPOSE: To describe a child with muscle-eye-brain disease as the first case report in Korea. CASE SUMMARY: A 35-month-old girl presented with esotropia and nystagmus since birth. She was born with a birth weight of 3.45 Kg at the gestational age of 39 weeks. She had a history of developmental delay and developmental dislocation of the hip. Her elder sister also had generalized weakness and mental retardation. The patient's creatinine kinase and lactate dehydrogenase serum levels were high. Cycloplegic refraction showed a significant myopic astigmatism in both eyes. She showed nystagmus and 20 prism diopters of esotropia in the primary position with the alternative prism cover test. Slit lamp examination revealed a mild posterior subcapsular cataract and lower lid epiblepharon in both eyes. Funduscopic examination showed diffuse retinal degeneration with remnant hyaloids membranes in both eyes. Both optic nerves were dysplastic with abnormal vascular branching pattern. Flash visual evoked potential was normal and standard electroretinography showed decreased amplitude in both eyes. Brain magnetic resonance imaging (MRI) revealed diffuse T2 high signal lesions of the cerebral white matter, diffuse pachygyria of the cerebral cortices, pontine hypoplasia, and multiple small cerebellar cysts. CONCLUSIONS: When a child with developmental delay has ophthalmologic problems including severe myopia, cataract, strabismus and retinal degeneration, the systemic condition should be examined. In this case, in addition to the ophthalmologic findings, blood test and brain MRI were helpful for the diagnosis of muscle-eye-brain disease.

Espectroscopia cerebral em candidatos a transplante hepático / Cerebral magnetic resonance spectroscopy in patients with hepatic encephalopathy: analysis before and after liver transplantation

OBJETIVOS: Determinar os níveis dos metabólitos (mio-inositol [MI], colina [Cho], glutamina [Glx], creatina [Cr] e N-acetilaspartato [NAA]) por meio da espectroscopia por ressonância magnética em portadores de hepatopatia crônica, antes e após o transplante hepático, correlacionando com a avaliação clínica. MÉTODOS: Foram estudados prospectivamente 25 pacientes portadores de hepatopatia crônica do Serviço de Transplante Hepático da Universidade Federal do Paraná por meio de avaliação clínica e espectroscópica. Trinta voluntários sadios formaram o grupo controle, sendo submetidos às mesmas avaliações. Dezesseis dos 25 pacientes também foram avaliados após o transplante. RESULTADOS: Antes do transplante hepático reduções significativas nos índices de MI/Cr e Cho/Cr e aumento significativo no índice de Glx/Cr foram observadas nos pacientes portadores de encefalopatia hepática comparados ao grupo controle. Os critérios quantitativos de Ross para diagnóstico espectroscópico da encefalopatia hepática (MI/Cr e Cho/Cr < média + 2 desvios padrão do grupo controle) demonstraram uma sensibilidade de 61,54 por cento, especificidade de 91,67 por cento e precisão de 76 por cento, sendo que a Cho/Cr foi o melhor parâmetro isolado. A espectroscopia após o transplante mostrou mudanças nos índices metabólicos comparados com o status pré-transplante. CONCLUSÃO: A espectroscopia permite um diagnóstico preciso da encefalopatia hepática. A melhora dos níveis metabólicos após o transplante hepático sugere um importante papel do MI e da Cho no desenvolvimento da encefalopatia hepática.

OBJECTIVES: To determine the metabolite levels (myo-inositol [MI], choline [Cho], glutamate [Glx], creatine [Cr] and N-acetylaspartate [NAA]) visible on magnetic resonance spectroscopy in patients with chronic hepatic failure, before and after liver transplantation and to correlate these data with results of neuropsychiatric tests and clinical findings. METHODS: Twenty five patients with chronic hepatic failure from the Liver Transplantation Unit of the Federal University of Parana were prospectively studied. Patients were submitted to clinical evaluation and magnetic resonance spectroscopy. Thirty healthy volunteers also submitted to the same evaluations. Sixteen of the 25 patients were evaluated after liver transplantation. RESULTS: Before liver transplantation, significant reductions in MI/Cr and Cho/Cr and a significant increase in Glx/Cr were observed in patients with hepatic encephalopathy compared with healthy subjects. The Ross's criteria for spectroscopic diagnosis of the hepatic encephalopathy (MI/Cr and Cho/Cr lower than 2 SD of controls) demonstrated a sensitivity of 61.54 percent, specificity of 91.67 percent and accuracy of 76 percent, further Cho/Cr was the best parameter. Spectroscopy after liver transplantation showed changes in the metabolite ratios compared with the pretransplantation status. CONCLUSION: Magnetic resonance spectroscopy permits an accurate diagnosis of hepatic encephalopathy. Improvement of metabolic ratios after liver transplantation suggests an important role of MI and Cho in the development of hepatic encephalopathy.

Management of Neglect

A large number of patient with a nondominant parietal lobe brain lesion have visuospatial neglect of hemispace. This hemispatial neglect significantly contributes to disability after brain disease because it has a negative impact on self-care, mobility, learning, and safety awareness in itself and has been found to be associated with poor functional recovery from brain disease. Although numerous therapeutic methods of neglect has been studied, there was limited evidence to confirm the effect of those treatments for this complex and multifactorial syndrome. To promote understanding of neglect rehabilitation, in this review, the effectiveness and practical methods of several different types of therapies will be discussed.

Changes of excitatory amino acids of cerebrospinal fluid in patients with delayed encephalopathy after acute carbon monoxide poisoning / 中国医师进修杂志

Objective To investigate the changes of excitatory amino acids (EAAs) of cerebrospinalfluid (CSF) in patients with delayed encephalopathy after acute carbon monoxide poisoning(DEACMP).Method The EAAs levels of CSF including glutamate (Glu) and aspartate (Asp) in 24 patients with DEACMP and 20 controls with migraine were measured by high performance liquid chromatography( HPLC ).Results Glu and Asp levels in patients with DEACMP were significantly higher than those of the controls [(3.76 ± 1.52) μmol/L vs ( 1.55 ± 1.03 ) μmol/L, (0.73 ± 0.44) μmol/L vs (0.38 ± 0.33 ) μmol/L, P all <0.01]. Glu and Asp levels in moderate and severe DEACMP patients were higher than those in mild DEACMP patients. Conclusion It suggests that EAAs participated in the pathogenesis of DEACMP. The Glu and Asp levels in CSF may be regarded as indicator of DEACMP.

The Change of Cognitive Function after Administration of Tolterodine in Brain Disease Patients with Overactive Bladder

PUROPOSE: It is known that anticholinergics induces cognitive dysfunction and may aggravate the state of it. Tolterodine tartrate (detrusitol(R)) is a widely known selective anticholinergics to bladder, which does not cause a cognitive dysfunction. This study was designed to analyze the change of cognitive function of brain disease patients, whom are taking anticholinesterase inhibitor with tolterodine for overactive bladder (OAB). MATERIAL AND METHODS: From January 2001 to December 2004, with the patients whom have been followed for the brain disease in the department of neurology, we have analyzed 79 patients with tolterodine administered for OAB. We used K-MMSE (Korea minimental status examination) and SNSB (seoul neuropsychological screening battery) to analyze the state of cognition. Mean age of patients was 67.3+/-4.5 (yrs), mean administration period was 4.7+/-9.5 (mon). RESULTS: 7 patients made complaints for the decline of memory, 2 of them with Parkinsonism and 2 with cerebral infarction, 1 with progressive supranuclear palsy and, 2 dementia with lewy body (DLB). Patients with DLB was excluded in this study because the disease had fluctuation of cognitive function. CONCLUSIONS: The result of these studies demonstrates tolterodine tartrate caused the decline of cognitive function in only a few patients with brain disease. We concluded that prospective studies are needed to change the cognitive functions of the brain disease patients with OAB after administration of tolterodine tartrate.

The Analysis of Pathogenesis in the Hypertensive Encephalopathy using Diffusion-Weighted MR Imaging

PURPOSE: To investigate the nature of edematous lesions seen on MR images during acute episodes of hypertensive encephalopathy(HTE) with particular attention to the findings of diffusion-weighted imaging (DWI). MATERIALS AND METHODS: A total of 17 MR examinations in fourteen patients with hypertensive encephalopathy were performed. The diagnoses were idiopathic HTE in eight cases, eclampsia in three, and cyclosporin-induced HTE in three. The apparent diffusion coefficients(ADCs) of edematous lesions and normal white matter revealed by DWI were assessed and compared, and the changes observed at follow-up MR imaging were analysed. RESULTS: DWI obtained within one week of the appearance of acute neurological symptoms revealed the edema as iso-intense in all patients with eclampsia and cyclosporin-induced HTE, and in five of eight patients with idiopathic HTE. In the other three patients with idiopathic HTE, DWI demonstrated slightly hyperintense edema. The ADCs of edematous lesion in patients with idiopathic HTE, eclampsia and cyclosporin-induced HTE were 1.21 +/-0.34, 1.08 +/-0.28, and 1.28 +/-0.22 mm 2 /ms, respectively, while for normal white matter the corresponding figures were 0.77 +/-0.25, 0.71 +/-0.22, and 0.68 +/-0.27mm 2 /ms The differences in ADCs between edema and normal white matter were thus significantly different between the three patient groups (p<0.05), while the ADCs of edematous lesions showed no sisgnificant variation between these groups (p<0.05). Follow-up MRI revealed that in three cases, edematous lesions were reversible and there were no residual signal changes. CONCLUSION: Vasogenic rather than cytotoxic edema is present during the acute stage of HTE.