Changes of adrenal cortical function in children with growth hormone deficiency before and after treatment with recombinant human growth hormone / 临床儿科杂志

Objective To observe the changes of adrenal cortical function in children with growth hormone deficiency before and after treatment with recombinant human growth hormone. Methods Seventy-two children diagnosed with GHD who received rhGH treatment for no less than 6 month were included, among whom there were 32 children who were accompanied with adrenal cortical hormone (ACTH) deficiency. The changes of fasting plasma cortisol (COR) and ACTH levels before and 3 and 6 months after treatment with rhGH were retrospectively analyzed. Results Thirty-two children with ACTH deficiency were treated with rhGH after COR level reached normal by the supplementing exogenous hydrocortisone. There was negative correlation between COR level before treatment and the HC dose that make the COR reach normal lowest limit level (r?=?-0.899, P??0.05). The level of COR was obviously decreased after treatment with rhGH, and there was statistical difference compared with that before treatment (P?

La memoria y el neurocirujano / Memory and the neurosurgeon

A principios del siglo pasado, se encontraron diferencias estructurales en áreas de la corteza cerebral, a veces sutiles y otras más netas, que permitieron el legado de mapas topográficos, que se siguen usando, y que hacían sospechar una diferencia funcional entre ellas. Poco se conocía en ese momento: los centros de Broca y Wernicke, las áreas sensoriales primarias y el área motora. Sin embargo se comenzó a teorizar que los “centros” tendrían funciones simples que se complejizaban mediante el trabajo conjunto gracias a los haces de asociación. Algunos creían que en la realización de las más altas funciones de la mente se involucran muchas, si no todas las áreas cerebrales, esbozando una idea de sistema funcional de órganos corticales, recién concretada con la obra de Luria a mediados del siglo. Para esa época, se comenzó a pensar que la unidad funcional cortical no se extendía en superficie, sino en profundidad, apareciendo el concepto de módulo cortical, sostenido tanto por la estructura de la corteza en columnas, como por su conectividad interna vertical, como así también por su embriología. Los nuevos métodos para seguir a las fibras que conectan distintas zonas de la corteza, permitieron a partir de los 70, realizar estudios detallados de estas conexiones determinando la división de la corteza en áreas de acuerdo a su conectividad, lo que amplió el número de las mismas. Como otras funciones, la memoria almacenaría sus trazas en un espacio cortical distribuído, en forma de circuitos facilitados (engramas) que involucrarían a las mismas áreas que se pusieron en juego para la construcción de la percepción. La codificación significaría un trabajo de asociación consciente para la semántica y contextualización espacial y especialmente temporal para la episódica...

At the beginning of the last century, subtle or net structural differences were founded in cortical areas, allowing the design of cortical maps that are employed until today and supportedthe assumption of functional differences. Little was known atthat moment: Broca’s and Wernicke’s centers, the primary sensory and the motor areas. However, theorization began assuming “simple functions” for the centers and the higher were attributed to the association fascicles that could summate the participation of various centers to the task. Some people believed that for the superior realizations of mind, practically all areas of the cortex were involved, advancing the idea of a functional system of cortical organs, made explicit by Luria at the midcentury. At this moment, the concept of surface area as functional unit gave place to the vertical unit of the cortical module, endorsed by the columnar structure of the cortex, the predominant vertical connectivity and the embryologic development. The new methods to follow the fibers that connect different areas of the cortex allowed detailed studies of them up the 70’s, determining the division of the cortex in areas by connectivity, that enlarged their number. As other cerebralfunctions, memory stores its traces in a distributed cortical space, in the format of facilitated circuits (engrams), that would involve the same areas activated during perception. Codification would mean a task of conscious association for semantics and spatial and specially, temporal contextualization for events.Consolidation of memories could mean a period of conscious or unconscious (reentry) repetition, performed by structures of the midline, diencephalon, hippocampus, amygdala and their connections, in successive conscious states (phasic). The retrieval could be performed by the highest zones in the perceptive hierarchy, that would allow the access to the engram with itsassociations...

A base biológica da atenção / The biological bases of attention

As bases biológicas da função psíquica atenção despertam o interesse de muitos estudiosos. O neuropsicólogo Alexandre Luria é um dos pioneiros a descrever tal processo. Luria teorizou, em 1981, que as estruturas cerebrais envolvidas no processo de atenção seriam a formação reticular, a parte superior do tronco encefálico, o córtex límbico e a região frontal. O presente trabalho fez uma revisão das pesquisas desenvolvidas recentemente nesse campo da neurobiologia, e averiguou que elas confirmam e refinam as proposições feitas há quase três décadas por este autor.

The bases of the psychic function of attention have always been of great concern to such as Alexander Luria, one of the pioneer scientists to study such process. In 1981, Luria stated that the reticular formation, the upper section of the brain stem, the limbic cortex and the frontal region are the brain structures involved in the attention process. This research analyzes the results of contemporary theories in research on the biological basis of attention and verifies what they confirm the statements made almost 30 years ago.

Inattention Behavioral Assessment conducted by the Family at Home : Validity of BAAD (Behavioral Assessment of Attentional Disturbance) / The Japanese Journal of Rehabilitation Medicine

Attentional disturbance following brain damage is usually evaluated by several neuropsychological tests. In a rehabilitation setting, however, the primary concern is not task performance, but rather functional real-world behavior. To address this requirement, a new assessment system for attentional behavior, BAAD (Behavioral Assessment of Attentional Disturbance), has been developed. This assessment is generally completed by the patient's therapist (occupational therapist, OT) during therapy. The aim of this study was to investigate whether BAAD completed by the family at home (BAAD-FM) yields results that are comparable to BAAD completed by an OT during occupational therapy (BAAD-OT). The subjects were 53 patients with brain damage. BAAD consists of six items thought to be associated with attentional behaviors. Each item is rated (0 to 3) based on the frequency with which the problem behaviors appeared during daily living at home and daily sessions of occupational therapy. The intraclass-correlation coefficient of the total score between BAAD-FM and BAAD-OT was 0.89. The mean (SD) values of the total scores were 3.7 (3.7) and 3.7 (3.6), respectively. Similarly, there were no significant differences in any of the item scores between BAAD-FM and BAAD-OT. The coincidence rate between the two BAAD tests on an item-by-item basis was over 64% for all items but one (43%). In conclusion, the total BAAD-FM score seemed comparable to the total BAAD-OT score and valuable for detecting attentional disturbance.

Development and Standardization of the Computerized Higher Cortical Function Assessment for Korean Adults / 신경정신의학

OBJECTIVES: This study was conducted to develop the computerized higher function assessment tools for Korea adults. It also aimed at evaluating the reliability and validity of these tests and providing their normative data. METHODS: Computerized versions of card sorting test, hypothesis formation test, color-word test, and finger tapping test were developed through several steps of preliminary applications and corrections. The test-retest reliability of each test was evaluated by the paired t-test and Pearson's correlation coefficient using the data from 27 normal subjects. The validity of each test was evaluated by the Pearsons's correlation coefficient between the computerized test scores and the pre-existing cognitive function tests using the data from 48 normal subjects. The normative data were obtained from the 150 Korean adults, age 20 to 50, whose educational levels were higher than high school graduate. RESULTS: There were no statistical differences between the means of the test and retest scores except hypothesis formation test, which showed marked practice effect. High correlations were also observed between the tests and the retest scores(r ranged from 0.543 to 0.905). The computerized higher cortical assessment tests scores were highly correlated with the scores of the pre-existing cognitive function tests, such as Standard Progressive Matrices. The scores of the card sorting test and the color-word test were not influenced by age, sex, and education level. However, the scores of the hypothesis formation were greatly influenced by the education level, and the scores of the finger tapping test were greatly influenced by sex. The normative data and guidelines for interpretation were provided. CONCLUSIONS: Clinically applicable computerized higher cortical function assessment tools with high reliability and validity were developed. The normative data for the Korean adults aged 20 to 50 were obtained and the guidelines for the interpretation were provided.

Two cases of anterior choroidal artery territory infarction

Occlusion of the anterior choroidal artery (AChA) can cause infarction in the posterior limb of the internal capsule. Infarction is less frequently observed in the thalamus, midbrain, temporal lobe, and lateral geniculate body (LGB) territories of the AChA. The most common clinical finding is hemiparesis. Hemianesthesia may be severe at onset but is usually transient. Homonymous hemianopia, upper-quadrant anopia, or upper- and lower-quadrant sector anopia can be present. Occasionally these patients are reported to have transient abnormalities of higher cortical function. The most common stroke mechanism is known to be small-vessel occlusive disease, predominantly found in hypertensive and diabetic patients. Vasospasm due to ruptured aneurysm or intraoperative mechanical manipulation, and cardiac origin the AChA territory. The infarct lesion is usually recognized and diagnosed by computed tomography. The best treatment is still unknown.