Revisão de anatomia e correlações clínicas do tronco encefálico, parte i: bulbo / Review of brain anatomy and clinical correlations, part i: medulla

O Tronco encefálico (TE) é uma estrutura singular do sistema nervoso central, pois nele passam tratos sensoriais ascendentes da medula espinal, tratos sensoriais da cabeça e do pescoço, os tratos descendentes motores originados no prosencéfalo (divisão mais rostral do encéfalo), e as vias ligadas aos centros de movimento dos olhos. Contém ainda os núcleos dos nervos cranianos e está envolvido na regulação do nível de consciência através de projeções ao prosencéfalo oriundas da formação reticular. Todas essas estruturas coexistem em um espaço muito exíguo, o que faz com que o TE seja um local muito sensível às alterações patológicas, sendo que os pacientes apresentam muitos sinais neurológicos mesmo com lesões muito pequenas nesse local. Compreender a anatomia interna do TE é essencial para o diagnóstico neurológico e a prática da medicina clínica. Outros profissionais da saúde também se beneficiam desse conhecimento para melhor manejo dos seus pacientes neurológicos. Essa revisão apresenta detalhes da anatomia macroscópica e microscópica do bulbo, bem como seus correlatos clínicos frente às lesões mais comuns dessa divisão particular do TE, conhecidas como síndromes bulbares.

The brainstem is a unique structure in the central nervous system, since it gives way to ascending sensory tracts from the spinal cord, sensory tracts from the head and neck, motor descending tracts originating from the forebrain, and the pathways connected to the eye movement centers. It also contains the cranial nerve nuclei and is involved in the regulation of consciousness levels through projections to the forebrain originating in the reticular formation. All these structures coexist in a very small space, which makes the brainstem very sensitive to pathological changes, with patients presenting several neurological symptoms even with very small brainstem lesions. Understanding the internal anatomy of the brainstem is essential for neurological diagnosis and the practice of clinical medicine. Other health professionals also benefit from this knowledge to better manage their neurological patients. This review presents detailed information on the macroscopic and microscopic anatomy of the medulla, as well as its clinical correlates in the face of the most common lesions of this particular division of the brainstem, known as medullary syndromes.

Interaction of Autonomic and Vestibular System / 대한평형의학회지

The relationship between the vestibular system and the autonomic nervous system has been well studied in the context of the maintenance of homeostasis to the changing internal and external milieus. The perturbations of the autonomic indexes to the vestibular stimuli have been demonstrated in animal studies. In addition, the fluctuation of the blood pressure and the heart rate with other autonomic symptoms such as nausea, vomiting, and pallor are common manifestations in the wide range of vestibular disorders. At the same time, the disorders of the autonomic nervous system can cause dizziness and vertigo in some group of patients. In the anatomical point of view, the relationship between autonomic and vestibular systems is evident. The afferent signals from each system converge to the nucleus of solitary tract to be integrated in medullary reticular formation and the each pathway from the vestibular and autonomic nervous system is interconnected from medulla to cerebral cortex. In this paper, the reported evidence demonstrating the relationship between autonomic derangement and vestibular disorders is reviewed and the further clinical implications are discussed.

Descripción de cambios en la difusibilidad media en resonancia magnética por lesiones del sistema reticular activador ascendente en pacientes adultos con trauma craneoencefálico y alteración del estado de conciencia / Description of changes in mean diffusivity in magnetic resonance of injuries of the ascending reticular system in patients with traumatic brain injury and impaired consciousness

RESUMEN INTRODUCCIÓN: Los pacientes con trauma craneoencefálico severo pueden tener secuelas neurológicas graves que generan discapacidad de rangos diferentes según la escala de Barthel. La alteración del estado de consciencia es la secuela más grave y es causa de dependencia completa de estos pacientes por la pérdida del autocuidado. La relación entre los hallazgos anormales en las neuroimágenes y los diferentes estados de conciencia ha sido objeto de investigación en los últimos años, con la posibilidad de que existan nuevas opciones con el posproceso de imágenes obtenidas por resonancia magnética nuclear. Este estudio pretende describir las alteraciones en la difusibilidad media haciendo posproceso en la secuencia de DWI en 4 pacientes con trauma craneoencefálico severo y alteración del estado de consciencia, quienes en la fase aguda del trauma fueron estudiados con imágenes convencionales de tomografía y resonancia. MATERIALES Y MÉTODOS: Se describe una serie de 4 casos de pacientes con trauma craneoencefálico severo y alteración del estado de consciencia a quienes se realizó resonancia cerebral simple. Las imágenes fueron sometidas a un posproceso de la secuencia de DWI analizando diferentes regiones por donde transcurren las fibras del sistema reticular activador ascendente (SRAA) (cuerpos restiformes, rafe medio del mesencéfalo, tálamo, regiones subinsulares y lóbulos frontales basales). Igualmente se tomaron valores de difusibilidad en regiones similares, en 5 sujetos sin alteración estructural cerebral tomados como controles. RESULTADOS: Se encontró disminución en la difusibilidad media en las diferentes regiones establecidas en el estudio, que tuvieron diferente localización en cada paciente. Los valores disminuyeron aproximadamente en un 50 % respecto a los del grupo control, observando lesiones en áreas que no fueron identificadas en la interpretación de la imagen cuando fue adquirida durante el trauma. CONCLUSIONES: El posproceso de la secuencia DWI muestra disminución en los valores de difusibilidad media en regiones por donde transcurren las vías del sistema reticular activado ascendente, estos cambios que explican las diferentes alteraciones en el estado de conciencia, no fueron visualizados en las imágenes interpretadas bajo las técnicas convencionales. Se requiere nuevos estudios para establecer las características operativas de la prueba que permitan definir su potencial utilidad dentro de los algoritmos de clasificación inicial de los pacientes con trauma craneoencefálico severo.

SUMMARY INTRODUCTION: Patients with severe traumatic brain injury may have severe neurological sequelae that generate disability of different ranges, according to the Barthel scale. The consciousness impairment is the most serious sequela and is a cause of complete dependence of these patients, due to the loss of self-care. The relationship between abnormal findings in neuroimaging and different states of consciousness has been the subject of research in recent years, with the possibility of new options with the post-processing of magnetic resonance imaging (MRI). This study aims to describe the alterations in the mean diffusivity by post-processing of the diffusion weighted imaging (DWI) sequence in 4 patients with severe traumatic brain injury and impairment of consciousness, who were studied with computed tomography (CT) and MRI in the acute phase of the trauma. MATERIALS AND METHODS: We describe a series of 4 cases of patients with severe traumatic brain injury and impaired consciousness in whom a non-enhanced brain MRI was performed. The DWI sequence images were post-processed, analyzing different regions through which the fibers of the Ascending Reticular Activating System (ARAS) (including restiform bodies, midbrain, thalamus, sub-insular regions and basal frontal lobes) pass. Likewise, diffusivity values were taken in similar regions, in 5 subjects without any structural brain abnormality, who were taken as controls. RESULTS: There was a decrease in mean diffusivity in the different regions established in the study, which had different locations in each patient. Values decreased approximately 50 percent from values in normal patients. After post-processing, some lesions were observed in areas that were not identified in the initial MRI interpretation during the trauma. CONCLUSIONS: The post-processing of the DWI sequence shows a decrease in the mean diffusivity values in regions where the ARAS pathways pass through. These changes explaining the different alterations in consciousness were not visualized in the images interpreted under conventional MRI techniques. New studies are required to establish the operative characteristics of this test, that allow to define its potential utility within the algorithms of initial classification of patients with severe traumatic brain injury.

Mechanisms of Alzheimer's Disease Pathogenesis and Prevention: The Brain, Neural Pathology, N-methyl-D-aspartate Receptors, Tau Protein and Other Risk Factors

The characteristic features of Alzheimer's disease (AD) are the appearance of extracellular amyloid-beta (Aβ) plaques and neurofibrillary tangles in the intracellular environment, neuronal death and the loss of synapses, all of which contribute to cognitive decline in a progressive manner. A number of hypotheses have been advanced to explain AD. Abnormal tau phosphorylation may contribute to the formation of abnormal neurofibrillary structures. Many different structures are susceptible to AD, including the reticular formation, the nuclei in the brain stem (e.g., raphe nucleus), thalamus, hypothalamus, locus ceruleus, amygdala, substantia nigra, striatum, and claustrum. Excitotoxicity results from continuous, low-level activation of N-methyl-D-aspartate (NMDA) receptors. Premature synaptotoxicity, changes in neurotransmitter expression, neurophils loss, accumulation of amyloid β-protein deposits (amyloid/senile plaques), and neuronal loss and brain atrophy are all associated with stages of AD progression. Several recent studies have examined the relationship between Aβ and NMDA receptors. Aβ-induced spine loss is associated with a decrease in glutamate receptors and is dependent upon the calcium-dependent phosphatase calcineurin, which has also been linked to long-term depression.

Idosos residentes em uma instituição de longa permanência: adaptação à luz de Callista Roy / Elderly residents in homes for the aged: adjustment in the light of Callista Roy / Residentes mayores en un hogares para ancianos: adaptación a la luz de Callista Roy

Objetivou-se avaliar o processo de adaptação de idosos que buscam, voluntariamente, residir em Instituição de Longa Permanência para Idosos (ILPI), na cidade de Fortaleza-CE, com base no modelo teórico de Roy. Pesquisa descritiva, realizada em uma IPLI com treze idosos residentes. A coleta de dados foi por meio de entrevista, nos meses de outubro e dezembro de 2011. Os dados foram tratados pela análise de conteúdo temática. Emergiram as seguintes temáticas: Eu Físico, subdividido em sensação corporal e imagem corporal; e Eu Pessoal, subdividido em auto coerência, auto ideal e ser moral-ético-espiritual. Assim, a opção de morar em ILPI não mudou efetivamente a vida dos idosos. Estes conseguiram adaptação ao local e convivem bem com os estímulos internos e externos.

This study aimed to evaluate the adaptation of elderly individuals voluntarily reside in Institution for the Aged (LTCF) in the city of Fortaleza-CE, based on the theoretical model of Roy. Descriptive study, in a IPLI involving thirteen elderly residents. Data collect was through interviews in the months of October and December 2011 and organized by thematic content analysis. The following themes has emerged: I Physical subdivided into body sensation and body image; Staff and I, subdivided into self-consistency and auto ideal be moral-ethical-spiritual. Thus, the option to live in ILPI not effectively changed the lives of elderly people. They managed to adapt to the local and coexist well with internal and external stimuli.

Este estudio tuvo como objetivo evaluar la adaptación de las personas mayores que residen voluntariamente en la Institución para la tercera edad (LTCF) en la ciudad de Fortaleza-CE, basado en el modelo teórico de Roy. Estudio descriptivo, en un IPLI con trece ancianos residentes. Los datos fueran recogidos a través de entrevistas en los meses de octubre y diciembre de 2011 y organizados mediante análisis de contenido temático. Emergieron los siguientes temas: subdivide I Física en la imagen corporal y sensación de cuerpo; El personal y yo, subdividen en auto-consistencia y auto ideal ser moral-ético-espiritual. Por lo tanto, la opción de vivir en ILPI no cambió de manera efectiva la vida de los ancianos. Se las arreglaron para adaptarse a lo local y convivir bien con los estímulos internos y externos.

Functional Neuroanatomy of Brain Stem

The brain stem consists of medulla oblongta, pons and midbrain. It is sited in posterior cranial fossa. It contains numerous intrinsic neuron cell bodies and their processes, some of which are the brain stem homologues of spinal neuronal groups. These include the sites of termination and cells of origin of axons that enter or leave the brain stem through the cranial nerves. Cranial nerves provide sensory, motor and autonomic innervations of structures that are mostly in the head and neck. The reticular formation is an extensive network of neurons that extends throughout the length of brain stem and is continuous rostrally to diencephalon and caudally to its spinal counterpart. Clinically, damage to the brain stem is often devastating and life threatening. This is because it is a structurally and functionally compact region. Therefore, it is important to build basic knowledge about neuroanatomy of brain stem.

Normal Sleep in Children and Adolescents / 대한소아신경학회지

Sleep is not just a rest for brain activity during daytime, but also has a vital function for memory consolidation after learning as well as restoration of both body and brain. While restoration of the body mainly occurs during non-rapid eye movement (NREM) sleep, especially during slow wave sleep, restoration of brain and memory consolidation occurs mainly during REM sleep. Adenosine acts as a sleep-inducing agent, so called somnogen or hypnotoxin which accumulates while awake. Sleep deprivation results in the disruption of every aspect of physical, cognitive, and behavioral function, which can be reversed only by sleep. Many neurotransmitter-secreting nuclei in the brain stem, hypothalamus, and basal forebrain are key structures for wakefulness, NREM, and REM sleep. They have been localized in the basal forebrain (acetylcholine), ventrolateral preoptic area (VLPO, GABA and galanin), tuberomamillary nucleus (TMN, histamine), lateral and posterior hypothalamus (orexin/hypocretin), reticular formation (glutamate), substantia nigra/ventral tegmental area (SN/VTA, dopamine), pedunculopontine nucleus and lateral dorsal tegmentum (PPT-LDT, acetylcholine), locus ceruleus (norepinephrine), and the raphe nuclei (serotonin). All are activated during wakefulness except VLPO which secrets GABA and galanin, which suppress other nuclei for sleep induction. Acetylcholine-secreting PPT-LDT is a major locus for REM sleep, and is inhibited by the raphe nuclei and locus ceruleus which act as REM-off neurons inducing NREM sleep. The suprachiasmatic nucleus is a pacemaker for circadian rhythms, which can be modified by bright light and melatonin. It should be emphasized that the best performance of cognitive function including reactivity, abstract thinking, creativity, memory, executive function, and accurate and efficient work as well as physical well-being is achieved by sufficient and appropriate sleep.

[ effect of hydrochloric extraction of valerian on number and size of raphe magnus neurons in adult rats]

Effective materials from Valerian officinalis L. have too much usage in the pharmacological industry. It is used as a sedative, anticonvulsion, and antidepressant drug. Serotonin has a widespread role in vital function such as sleep, awareness and calmness. In this study we evaluated the effect of hydrochloric extract of valerian on number and size of raphe magnus neurons in adult rat. In this experimental study, which was conducted at Yasuj University of Medical Sciences in 2009, forty adult Wistar rats, each 170-250 gr, were divided randomly into four groups [one control group and three experimental groups]. The animals were injected daily for one month with doses of 300, 400 and 600 mg/kg of the extract. The control group just received distilled water. After transcardial perfusion, the whole brain was separated, then 10 micro m sections of the brain stem were prepared, and hematoxylin and eosin [H and E] staining were done. Number and size of raphe magna neurons were observed under light microscope. The gathered data were analyzed by the SPSS software using One-way ANOVA and LSD. The control group did not statistically show significant changes in number of raphe magna neurons. Comparison of the means of long and short diameter neurons showed significant increases in experimental groups with control group [P<0.05]. In experimental groups the neuron nucleuses were more euchromatic than the control group. Hydrochloric extract of valerian has no effect on raphe magnus neurons, but it is effective on neurons' size. It can be concluded that the extract increases both neurons activity and serotonin secretion

Effect of oxysophoridine on electric activities and its power spectrum of reticular formation in rats / 中国中药杂志

<p><b>OBJECTIVE</b>To observe the effect of oxysophoridine (OSR) on the EEG and its power spectrum of reticulum formation in mesencephalon of anaesthetized rat.</p><p><b>METHOD</b>Utilizing the technique of brain stereotactic apparatus, electrodes were implanted into reticulum formation of mesencephalon. Monopolar lead and computerized FFT technique were employed to record and analyse the index of EEG, power spectrum and frequency distribution in order to study the effect of oxysophoridine on the bioelectricity change of mesencephalon reticulum formation in rats.</p><p><b>RESULT</b>After administrating(icy) with oxysophoridine at the dose of 2.5,5, 10 mg/rat, the EEG of mesencephalon reticulum formation mainly characterized with low amplitude and slow waves accompanied by spindle-formed sleeping waves with a significant decrease of total power of EEG (P < 0.05) while the ratio of theta, alpha waves increased in total frequency of rats (P < 0.05).</p><p><b>CONCLUSION</b>Oxysophoridine possesses central inhibitory effects and its inhibitory mechanism may associate with the reduction of bioelectricity in mesencephalon reticulum formation. Mesencephalon reticulum formation may serve as one part of the structure serving as the circuit conducting the central inhibitory effect of oxysophoridine. [Key words] oxysophoridine; reticulum formation; electroencephalogram (EEG) ; rats</p>

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.

Vasodepressive Response of Head-up Tilt-Table Test in Patients With Juvenile Myoclonic Epilepsy

BACKGROUND: Juvenile myoclonic epilepsy (JME) is characterized by myoclonic seizures on awakening and giant somatosensory evoked potentials. Those characteristics suggest that JME is related with dysfunction of the brainstem reticular formation. Cardiovascular reflex is also closely related with the brainstem reticular formation, and head-up tilt-table test (HUT) is frequently employed to evaluate the cardiovascular reflex. We performed HUT to assess the cardiovascular reflex in patients with JME and syncope/presyncope. METHODS: We included 52 patients with alleged JME. HUT was performed in 20 of them with a history of presyncope or syncope. The protocol of HUT included 70 degree table tilting test and isoproterenol infusion test (1~5 microgram/min). We determined the positive responses according to the change of blood pressure and heart rate. The positive responses were classified as vasodepressive, cardioinhibitory, or mixed types. We retrospectively analyzed the clinical findings and responses of HUT. RESULTS: Syncope or presyncope occurred during the seizure-prone situation in 3 (15%), and during the syncope-prone situation in 17 (85%) patients. Fifteen (75%) patients had positive responses in HUT. The positive responses were during the baseline test in 1 (5%), during the low dose (( or = 4 microgram/min) of isoproterenol infusion in the remaining 4 (20%) patients. All the positive responses were vasodepressive type. CONCLUSIONS: In patients with JME, vasomotor reflex may be impaired. Our results suggest dysfunction of the brainstem reticular formation in JME.

Immunohistochemical Study on the Distribution of Kv1.2 in Aged Rat Brain / 체질인류학회지

In the present study, we demonstrated age-related changes in Kv1.2 immunoreactivity in the rat brain for the first time. Twelve adult (4~6 month old) and 15 aged (20~29 month old) Sprague-Dawley rats were examined in this study. Immunohistochemistry was performed in accordance with the free-floating method, and densitometric measurement using a NIH image program (Scion Image) determined the staining density. In the cerebral cortex of aged rats, there was a significant increase in the number of Kv1.2-immunoreactive neurons in the cingulate cortex, infralimbic cortex and piriform cortex, compare to adult rats. In the hippocampal CA1-3 regions, moderate Kv1.2 immunoreactivity was found in the cell bodies and processes of some medium to large-sized neurons in aged rats. The intensity was increased in the cell bodies of Kv1.2-positive neurons in the amygdala of aged rats, whereas the number of immunoreactive neurons was not significantly increased. It was noteworthy that age-related changes in Kv1.2-immunoreactive neurons were prominent in the facial nuclei, raphe magnus nuclei, and pontine and medullary reticular formation. Although the present study has not addressed multiple mechanisms contributing to neuronal degeneration during aging, the first demonstration of age-related changes in Kv1.2 immnuoreactivity may offer a comprehensive understanding of the pathophysiology of aging and age-related neurodegenerative diseases such as Alzheimer's disease.

Catastrophic Respiratory Failure Associated with Unilateral PICA Infarction Involving Lateral Medullar Region

Medullar respiratory centers are composed of ventral and dorsal groups. A direct infarction to their structure could lead to a complete loss of respiratory drive, despite unilateral brainstem lesion is rarely associated with central respiratory dysfunction. A 70-year-old man was admitted with sudden dizziness and disequilibrium without motor weakness. Brain MRI (diffuse weight image) shows high signals intensities on left PICA territory of cerebellum and medulla oblongata including reticular formation, nucleus of tractus solitarius, nucleus ambiguus, and nucleus retroambiguus but sparing corticospinal and corticobulbar pathway. On 3rd hospital day, he had a complete loss of respiratory drive involving both autonomic and voluntary components. He didn't get the respiratory drive during CO2 retention while his consciousness and motor power were preserved.

A Case of Bilateral Horizontal Gaze Palsy due to Pontine Hemorrhage

PURPOSE: To report a case of bilateral horizontal gaze palsy associated with pontine hemorrhage. METHODS: A 51-year-old man developed a sudden decrease in consciousness. Computed tomography reveal a pontine hemorrhage and infarctions of both basal ganglia. The mentality was recovered after conservative treatment, but he complained of difficulty in moving his eyes. We performed ophthalmic and radiologic evaluations to confirm a diagnosis of bilateral horizontal gaze palsy and to reveal the condition. RESULTS: On ophthalmic examination, his eye showed complete bilateral horizontal gaze palsy, but convergence and vertical eye movements were normal. Radiologic evaluation revealed a pontine hemorrhage, and the hemorrhagic area was consistent the bilateral paramedian pontine reticular formation (PPRF).

A Study on the Spinoreticulocerebellar Tract in Chickens

The spicoreticulocerebellar (SRC) tract is an indirect spinocerebellar tract formed by the reticular formation (RF), which is connected to the cerebellum and spinal cord. The RF receives ascending fibers to both the spinal enlargement and sends descending fibers to the cerebellum. This study demonstrated that the connectivity of the neurons in the RF is concerned to the cerebellum and spinal cord using the anterograde projection with biotinylated dextran amine (BDA) and retrograde labeling with wheat germ agglutinin-horseradish peroxidase (WGA-HRP). Until now, a preliminary study in mammals has dealt with the afferent and efferent pathways in separating groups of neurons in the RF. There are only few reports on chickens. This study examined the SRC tract in chickens. Following bilateral injections we injected BDA into chicken spinal cord (lumbosacral enlargement) and WGA-HRP into the cerebellum. Both of single- and double-labeled cells were found within the RF. The spinoreticular axons were mainly distributed from the potomedullary junction to the rostral medulla in the rostro-caudally RF levels, for example, nucleus of reticularis (n. r.) pontis oralis, locus coeruleus, n. r. pontis caudalis, n. r. pars gigantocellularis, n. r. gigantocellularis and n. r. parvocellualris. Reticulocerebellar labeling by the WGA- HRP was found in the same place as well as that of the BDA-projection. We observed that the proportion and location of double labeling cells in the chicken were almost similar in each level, comparing to the rodents. These results suggest that the reticular formation is strongly related to the spicoreticulocerebellar tract in chickens.

An experimental study of newly designed implant with RBM surface in the rabbit tibia: resonance frequency analysis and removal torque study / 대한치과보철학회지

STATEMENT OF PROBLEM: The importance of fixture design and surface treatment. PURPOSE: The clinical success of dental implants is affected by many factors such like as degree of osseointegration, the effective load dispersion for the prostheses, and a lot of attempts have been made to overcome the difficulties. In this study, efforts were made to find the possibility of clinical acceptance of the dental implants of newly designed surface and resorbable blast media surcace. MATERIALS AND METHODS: In this study, two groups of custom-made, screw-shaped implants were prepared. Tthe first with the consisting of Branemark clone design and the other with the new design. These implants were divided into four groups according to the kinds of surface treatment. Four implants(AVANA., Osstem, Busan, Korea) of each group were installed in twenty rabbits. Group A was consisted of Branemark clone implant left as machined, Group B with Branemark clone implants with RBM(Resorbable blast media) surface, Group C with newly designed implants left as machined and Group D with newly designed implants with RBM surface. One of the twenty rabbits died from inflammation and the observation was made for six weeks. Specimens from four groups were observed using scanning electron microscopy with 40, 100, 1000 magnification power and microsurface structures were measured by white-light scanning interferometry for three dimensional surface roughness measurements(Accura 2000., Intek-Plus, Korea.). Removal torque was measured in 17 rabbits using digital torque gauge(MGT 12R, Mark-10 corp., NY, U.S.A.) immediately after the sacrifice and two rabbits were used for the histologic preparation(EXAKT 310., Heraeus Kulzer, Wehrheim, Germany) of specimens and observed under light microscope. Resonance frequency measurement(Osstell(R)) was taken with the 19 rabbits at the beginning of the implant fixation and immediately after the sacrifice. RESULTS: Following results were taken from the experiment. 1. The surface of the RBM implants as seen with SEM had rough and irregular pattern with reticular formation compared to that of turned specimens showing different surface topographies. 2. The newly designed implant with RBM surface had high removal torque value among four groups with no statistical significance. The average removal torque was 49.95+/-6.70Ncm in Group A, 51.15+/-4.40Ncm in Group B, 50.78+/-9.37Ncm in Group C, 51.09+/-4.69Ncm in Group D. 3. The RFA values were 70.8+/-4.3Hz in Group A, 71.8+/-3.1Hz in Group B, 70.9+/-2.5Hz, 72.7+/-2.5Hz in Group D. Higher values were noted in the groups which had surface treatment compared to the untreated groups with no statistical significance. 4. The results from the histomorphometric evaluation showed a mean percentage of bone-toimplant contact of 45+/-0.5% in Group A, 55+/-3% in Group B, 49.5+/-0.5% in Group C, and 55+/-3% in Group D. Quite amount of newly formed bone were observed at the surface RBM-treated implants in bone marrow space.

Neuro-Behcet's Disease Presenting with Foville Syndrome : A Case Report

A Foville syndrome is rare. A 46-year-old man with a 3-year history of Behcet's disease presented with a right facial palsy and a limitation in the rightward movements of the eyes. On neurologic examination, there was no movement of eyes in the right hemifield during all kinds of eye movements, including saccade, smooth pursuit, vestibulo-ocular reflex, and optokinetic nystagmus. However, all the eye movements were normal in the left hemifiled except for slowed saccades toward the right. Additional features were right infranuclear facial paresis and extensor plantar response on left side. Brain MRI revealed high signal intensity lesions in the right pons both in the dorsal tegmentum and in the basis. Neurological signs resolved gradually with steroid treatment. Different clinical features between abducens nucleus syndrome and paramedian pontine reticular formation syndrome are briefly discussed. To the authors' knowledge, this is the first case report of a Foville syndrome caused by neuro-Behcet's disease.

Bruxismo y dolor crónico orofacial / Bruxism and chronic orofacial pain

En el estado actual del conocimiento sobre los factores y mecanismos del bruxismo se han ido abandonando las posiciones de la relación causal estrecha entre oclusión y bruxismo, pero sin descartarla como factor a tener en cuenta por ser parte del complejo proceso perceptivo periférico. Crece la evidencia experimental del papel clave que juegan los mecanismos centrales excitadores e inhibidores de la actividad muscular y cuando se ha vuelto crónico de muy poca posibilidad de solución; salvo el efectgo placebo o la remisión espontánea. El dolor crónico orofacial no guarda una relación causal demostrable con el bruxismo pero, sin embargo, puede coexistir o no. No obstante, como factor irritativo crónico sobre las estructuras profundas perceptivas es muy probable que contribuya a establecer circuitos centrales por la acción neuroendócrina y de neuropéptidos vinculados a la acción neuromuscular y al dolor por el efecto de hiperalgesia central resultante de la estimulación repetitiva (wind up). Por ello, es muy importante el diagnósitoc multifactorial temprano y la terapia biaxial que es interactiva. La llamada vinculación del stress emocional con el dolor es parte de un fenómeno más complejo con los que se llaman fenómenos vivenciales como los culturales; estilo de enfrentamiento; rasgos de personalidad; ansiedad; angustia, miedo y la vinculación de la depresión con el dolor que interactúan con los neuroendócrinos. Dado que el dolor crónico (como otras enfermedades crónicas) es una condición para la cual usualmente la cura no es posible, el objetivo de la mayor parte de los casos de dolor crónico es un programa de tratamiento rehabilitativo más que curativo, para evitar la discapacitación y/o el padecimiento. Estos aspectos deben tratarse con una buena relación interpersonal, una serie de tests y una entrevista estructurada que permita la terapia cognitiva

Intractable Hiccup Induced by Multiple Cerebral Infarct: A case report

Hiccup can be regarded as a failure of the usual alternating excitation-inhibition between glottis closure and inspiration. The coordinating center is located in the brain-stem reticular formation. A wide variety of pathological conditions can cause intractable hiccup: myocardial infarction, brain tumor, renal failure, prostate cancer, abdominal surgery, etc. Stroke is an unusual cause of intractable hiccup. Intractable hiccup is rare but disabling condition which can induce depression, weight loss, sleep deprivation, and even death. Etiological treatment is not always available and intractable hiccup treatment has classically relied on metoclopramide and chlorpromazine. We experienced a case of intractable hiccup induced by multiple cerebral infarct, and we present this rare case with the review of literature.

Study on the change of bFGF in reticular formation of medulla oblongata after primary brain-stem injury / 法医学杂志

OBJECTIVE@#To study the effect of primary brain-stem injury on the expression of basic fibroblast growth factor (bFGF) in the reticular formation of medulla oblongata.@*METHODS@#Immunohistochemical SABC was used to study the change of bFGF expression in the reticular formation of medulla oblongata after brain-stem injury by striking.@*RESULTS@#The numbers of positive cells and positive intensity of the study group in the reticular formation of medulla oblongata were significantly elevated than those of the control group and the postmortem injury group.@*CONCLUSION@#The expression of bFGF is elevated in reticular formation after brain-stem injury.