The regulatory effect of morphine postconditioning in left stellate ganglion on remodeling after myocardial infarction / 中国药理学通报

Aim To investigate the regulatory effect of morphine postconditioning in the LSG on remodeling after myocardial infarction. Methods SD rats were randomly divided into four groups: sham operation group (Sham), myocardial infarction group (MI), myocardial infarction + saline group (Control) and myocardial infarction + morphine postconditioning group (MI + Morphine) . The rat MI model was constructed by ligating the left anterior descending coronary artery, and then morphine was given to the LSG by percutaneous posterior approach. After four weeks, the changes of cardiac function in rats were detected by ultrasound. Masson staining was used to detect fibrosis changes; the expression of Collagen I and Collagen III protein was detected by Western blot. The mRNA expression of ANP and BNP was detected by RT-qPCR. The expression of JJLOR in LSG was detected by immunofluorescence. The concentration of catecholamine in plasma and myocardial tissue was detected by ELISA. Results Compared with the sham group, the cardiac function of the MI group was significantly impaired, the myocardial tissue showed significant fibrosis changes, and the concentration of catecholamine in plasma and myocardial tissue significantly increased. Compared with the control group, the MI + Morphine group reduced myocardial fibrosis collagen deposition in rats after MI, inhibited the expression of ANP and BNP in myocardial tissue, reduced the concentration of catecholamine, and improved the cardiac function of MI rats. Immunofluorescence results showed that JJLOR was expressed in LSG after MI and increased after morphine postconditioning. Conclusions This study shows that morphine postconditioning in the LSG has a protective effect on myocardial remodeling after myocardial infarction. The mechanism may be related to the activation of JJLOR in the LSG by morphine and the reduction of catecholamine release from sympathetic nerve endings.

Chorea Hyperglycemia Basal Ganglia Syndrome: A case report of a rare diabetes complication

Introduction@#We present a patient with long-standing uncontrolled type 2 diabetes mellitus (T2 DM) who developed sudden onset of choreiform movement, which rapidly resolved after insulin therapy and haloperidol.@*Case Description@#A 53-year-old Filipino male, with T2DM and hypertension for more than 10 years, presented with sudden onset of hyperkinetic, involuntary, non-patterned, continuous movements of the left upper and lower extremities. Investigations revealed severe hyperglycemia without acidemia and ketonuria. Cranial computed tomography scan showed hyperdensity on the right caudate and lentiform nuclei. On cranial magnetic resonance imaging, there was T1- weighted hyperintense and T2 - weighted hypointense signal involving the right putamen, globus pallidus and caudate. Cranial magnetic resonance angiography showed stenosis on the cavernous segment of the right internal carotid artery (ICA), left ICA and middle cerebral artery (MCA) junction, the A1 segment of the left anterior communicating artery and proximal P2 segments of the bilateral posterior cerebral arteries. The patient was managed with a basal-bolus insulin regimen to control the blood glucose and haloperidol to manage the extrapyramidal symptoms. Consequently, there was complete resolution of the involuntary movements. @*Conclusion@#This case illustrates the importance of a systematic approach to movement disorders and early recognition of this rare diabetes complication known as chorea hyperglycemia basal ganglia syndrome or diabetic striatopathy.

Lumbar safety triangle: comparative study of coronal and coronal oblique planes in 3.0-T magnetic resonance imaging / Triângulo de segurança lombar: estudo comparativo dos planos coronal e coronal oblíquo em ressonância magnética 3.0-T

Abstract Objective: To compare the measurements of the lumbar safety triangle (Kambin's triangle) and the invasion of the dorsal root ganglion in the triangle in coronal and coronal oblique planes. Materials and Methods: A cross-sectional study, in which 210 3.0-T magnetic resonance images of L2-L5 were analyzed in coronal and coronal oblique planes. Exams with lumbar spine anomalies were excluded. Demographic (sex and age) and radiological variables were recorded by a single evaluator. Results: Most sample was female (57.1%), mean age 45.5 ± 13.3 (18-98 years). The measurements average, as well as the areas, gradually increased from L2 to L5. The dorsal root ganglion invaded the triangle in all images. The safety triangle average area was smaller in the coronal oblique plane than in the coronal plane. Of the seven dimensions of safety triangle obtained for each level of the lumbar spine, six were significantly smaller in the coronal oblique plane than in the coronal plane. The only dimension that showed no difference was the smallest ganglion dimension. Conclusion: The dimensions and areas investigated were smaller in coronal oblique plane, especially the area (difference > 1 mm). The analysis of the triangular zone in this plane becomes important in the preoperative assessment of minimally invasive procedures.

Resumo Objetivo: Comparar as medidas do triângulo de segurança lombar (triângulo de Kambin) e invasão do gânglio da raiz dorsal no triângulo nas incidências coronal e coronal oblíqua. Materiais e Métodos: Estudo transversal, em que foram analisadas 210 imagens de ressonância magnética 3.0-T de L2-L5 nos planos coronal e coronal oblíquo. Foram excluídos exames com anomalias da coluna lombar. Variáveis demográficas (sexo e idade) e radiológicas foram registradas por um único avaliador. Resultados: A maioria da amostra era do sexo feminino (57,1%), com idade média de 45,5 ± 13,3 (18-98 anos). A média das medidas, assim como as áreas, aumentaram gradativamente de L2 a L5. O gânglio da raiz dorsal invadiu o triângulo em todas as imagens. A área média do triângulo de segurança foi menor na incidência coronal oblíqua do que na incidência coronal. Das sete dimensões do triângulo de segurança obtidas para cada nível da coluna lombar, seis foram significativamente menores no plano coronal oblíquo do que no plano coronal. Única dimensão que não apresentou diferença foi a menor dimensão do gânglio. Conclusão: As dimensões e áreas investigadas foram menores na incidência coronal oblíqua, especialmente a área (diferença > 1 mm). A análise da zona triangular nesta incidência torna-se importante na avaliação pré-operatória de procedimentos minimamente invasivos.

Impacto de la superación profesional en la meteoro labilidad de la enfermedad cerebrovascular / Climate change and cardiovascular disease: impact of professional development

Introducción: La enfermedad cerebrovascular (ECV) es una urgencia neurológica que en ocasiones se encuentra influenciada por los cambios del tiempo. La ECV isquémica es una emergencia médica con una ventana estrecha para su diagnóstico y tratamiento. El daño generado por esta enfermedad se estima mediante de la mortalidad, discapacidad e impacto social. Objetivo: Proponer un programa de capacitación basado en los efectos fisiopatológicos que provocan en los pacientes, cambios de tiempo y ritmo circadiano en el contexto de la adaptación al cambio climático. Método: Se desarrolló un estudio multietápico prospectivo en el Hospital Universitario Mártires del 9 de Abril del municipio Sagua la Grande entre los años 1993 a 2017. En la primera etapa se seleccionó un universo de 52 profesionales de la salud que atendieron a estos pacientes; en la segunda, 48 y en la tercera, 61. Resultados: El nivel de conocimiento del personal de salud en una primera etapa era inadecuado (78,85 %); en la tercera, este porcentaje disminuyó (14,75 %). Como resultado de la capacitación mejoraron los tiempos de atención a los pacientes con ECV a su llegada al hospital, y en la tercera, más del 50 % de los enfermos fueron atendidos antes de las seis horas de inicio de los síntomas. Conclusiones: La capacitación sobre ECV basada en los efectos fisiopatológicos que provocan en los pacientes el cambio climático y el ritmo circadiano disminuyó el tiempo de espera, y se asoció con una reducción de la morbilidad y la mortalidad, después de aplicar este programa.

Introduction: cerebrovascular disease (CVD) is a neurological emergency that is sometimes influenced by climate changes. Ischemic CVD is a medical emergency with a narrow window for diagnosis and treatment. The damage generated by this disease is estimated through mortality, disability and social impact. Objective: to propose a training program based on the pathophysiological effects in patients caused by changes in time and circadian rhythm in the context of adaptation to climate change. Methods: a multistage prospective study was conducted at "Mártires del 9 de Abril" University Hospital in Sagua la Grande municipality between 1993 and 2017. A universe of health professionals who cared for these patients was selected as follows: 52 in the first stage; 48 in the second stage, and 61 in the third ones. Results: the level of knowledge of health personnel in the first stage was inadequate (78.85%); this percentage decreased in the third stage (14.75%). Care times for CVD patients improved upon arrival at the hospital as a result of the training, as well as in the third ones, more than 50% of the patients were seen within six hours of the onset of symptoms. Conclusions: CVD training based on the pathophysiological effects of climate change and circadian rhythm on patients decreased waiting time, and was associated with reduced morbidity and mortality, after applying this program.

Choreiform movements and basal ganglia calcification as a presentation of Fahr's disease

Basal ganglia calcifications may be a radiological finding in approximately 20% of the general population. When they are associated with neuropsychiatric and motor symptoms in an idiopathic form, they are known as Fahr's disease. They are termed "Fahr's syndrome" when they are secondary to an identifiable and potentially treatable cause. In this report, we present the clinical case of a 69-year-old woman with the onset of subacute chorea, with no other associated symptoms, in whom extensive basal ganglia calcifications were found on neuroimaging, due to which metabolic disorders were subsequently ruled out. The objective is to contribute to the characterization of the potential motor manifestations which would give rise to clinical suspicion. Due to its low incidence and the little information on this condition in the region, we want to encourage documentation of other cases and the process for ruling out other differential diagnoses, in order to obtain more information on its actual epidemiology and signs and symptoms in Colombia. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2635).

Lesiones metabólicas bilaterales en núcleos basales: Serie de casos y Revisión de literatura

Introducción: Los núcleos basales son sustancias de materia gris, involucradas en la regulación de distintas funciones metabólicas y son vulnerables a situaciones de hipoxia y distintas situaciones patológicas. Los hallazgos imagenológicos no son específicos en la mayoría de los casos. Reporte de caso: Se reportan los casos de diez pacientes con lesiones metabólicas bilaterales en núcleos basales atendidos en un hospital de referencia nacional de Perú y se realiza una revisión de la literatura: 3 casos de Hipoparatiroidismo postquirúrgico, 2 de encefalopatía de Wernicke, 1 con degeneración hepatolenticular, 1 con mielinólisis extrapontina, 1 Intoxicación por metanol y 2 con encefalopatía Hipóxico-isquémica. Conclusión: Las lesiones bilaterales de núcleos basales producto de lesiones metabólicas son en gran parte inespecíficas, por lo que el contexto clínico es de vital importancia, así como las particularidades de los hallazgos imagenológicos, para el adecuado reconocimiento de las entidades etiológicas y su manejo oportuno.

Introduction: Basal nuclei are gray matter substances, involved in the regulation of different metabolic functions and are vulnerable to situations of hypoxia and different pathological situations. Imaging findings are not specific in most cases. Case of report: The cases of ten patients with bilateral metabolic lesions in the basal nuclei treated at a national reference hospital in Peru are reported, and a review of the literature is carried out: 3 cases of postoperative hypoparathyroidism, 2 of Wernicke's encephalopathy, 1 with hepatolenticular degeneration, 1 with extrapontine myelinolysis, 1 methanol intoxication and 2 with hypoxic-ischemic encephalopathy. Conclusion: Bilateral lesions of the basal nuclei as a result of metabolic lesions are nonspecific, so the clinical context is of vital importance, as well as the particularities of the imaging findings, for the adequate recognition of the etiological entities and their timely management.

Effects of transcranial magnetic stimulation combined with radiofrequency ablation of dorsal root ganglia in the treatment of herpes zoster neuralgia / 中华物理医学与康复杂志

Objective:To observe the clinical efficacy of combining repeated transcranial magnetic stimulation (rTMS) with radiofrequency ablation (RF) of dorsal root ganglia in treating herpes zoster infection and neuralgia.Methods:Eighty-four individuals with a herpes zoster infection who had suffered from neuralgia for no more than 7 days were divided randomly into a control group, an rTMS group, an RF group, and an observation group, each of 21. All were treated with gabapentin, valciclovir and mecobalamin. The rTMS group received rTMS treatment, 5 days per week, for 2 consecutive weeks. The RF group received RF treatment of the dorsal root ganglia on the 15th day after enrollment, while the observation group received only the medication. Before the experiment as well as after 3, 7, 16, 30 and 60 days, all of the subjects self-assessed their discomfort using a pain visual analog scale (VAS). The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Quality of Life Assessment Scale (QOL-SF36), and Pittsburgh Sleep Quality Index (PSQI) were also administered.Results:The average VAS, HAMA, HAMD, QOL-SF36, and PSQI scores of the observation group improved continuously and significantly during and after the treatment. Beyond 16 days all of those results were significantly better than the control group′s averages, and the observation group′s average VAS, HAMA and HAMD results were also significantly better than those of the rTMS group. The observation group′s average VAS, HAMA, HAMD and PSQI scores had improved significantly more than the RF group′s averages beyond 30 days.Conclusion:Combining rTMS and dorsal root ganglion RF can effectively alleviate the early pain symptoms of herpes zoster infection and neuralgia, relieve anxiety and depression, and significantly improve sleep and life quality. Such therapy is worthy of clinical promotion and application.

Role of S1PR1 in dorsal root ganglion in remifentanil-induced hyperalgesia in rats with incisional pain / 中华麻醉学杂志

Objective:To evaluate the role of sphingosine-1-phospho-1 receptor(S1PR1)in the dorsal root ganglion in remifentanil-induced hyperalgesia in rats with incisional pain.Methods:Forty-eight male Sprague-Dawley rats with successful intrathecal and caudal vein catheterization, weighing 260-280 g, aged 2-3 months, were divided into 6 groups ( n= 8 each) using a random number table method: control group (group C), S1PR1 antagonist (FTY720) group (group F), remifentanil group (group R), remifentanil + S1PR1 antagonist (FTY720) group (group R+ F), remifentanil + incisional pain group (group R+ I), and remifentanil + incisional pain + S1PR1 antagonist (FTY720) group (group R+ I+ F). In C group, normal saline 0.1 μg·kg -1·min -1 was intravenously infused for 60 min. In R group, remifentanil 1.0 μg· kg -1·min -1 was infused for 60 min through the caudal vein. In F group, FTY720 3 nmol was intrathecally injected, and 10 min later normal saline 1.0 μg· kg -1·min -1 was infused for 60 min via the caudal vein. In R+ F group, FTY720 3 nmol was intrathecally injected, and 10 min later remifentanil 1.0 μg· kg -1·min -1 was infused for 60 min through the caudal vein. In R+ I group, remifentanil 1.0 μg·kg -1·min -1 was infused for 60 min through the caudal vein while the model of incisional pain was developed. In R+ I+ F group, FTY720 3 nmol was intrathecally injected, 10 min later the incisional pain model was prepared, and remifentanil 1.0 μg·kg -1·min -1 was injected for 60 min through the caudal vein at the same time. The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 24 h before remifentanil or normal saline infusion (T 0) and 2, 6, 24 and 48 h after stopping remifentanil or normal saline infusion (T 1-4). Rats were sacrificed after the last measurement of pain threshold, and the L 4-6 segments of dorsal root ganglion were taken for determination of the expression of S1PR1, NOD-like receptor thermal protein domain-associated protein 3 (NLRP3), interleukin-1β (IL-1β) and glutamate transporter-1 (GLT-1) protein and mRNA (by Western blot and quantitative polymerase chain reaction). Results:Compared with C group, the MWT was significantly decreased and TWL was shortened at T 1-4, the expression of S1PR1, NLRP3 and IL-1β protein and mRNA in dorsal root ganglion was up-regulated, and the expression of GLT-1 protein and mRNA in dorsal root ganglion was down-regulated in R group ( P<0.05), and no significant change was found in the parameters mentioned above in group F ( P>0.05). Compared with R group, MWT was significantly decreased and TWL was shortened at T 1-4, the expression of S1PR1, NLRP3 and IL-1β protein and mRNA in dorsal root ganglion was up-regulated, and GLT-1 protein and mRNA expression in dorsal root ganglion was down-regulated in R+ I group, and MWT was significantly increased and TWL was prolonged at T 1-4, the expression of S1PR1, NLRP3 and IL-1β protein and mRNA in the dorsal root ganglion was down-regulated, and GLT-1 protein and mRNA expression in the dorsal root ganglion was up-regulated in R+ F group ( P<0.05). Compared with R+ I group, MWT was significantly increased and TWL was prolonged at T 1-4, the expression of S1PR1, NLRP3 and IL-1β protein and mRNA in the dorsal root ganglion was down-regulated, and the expression of GLT-1 protein and mRNA in the dorsal root ganglion was up-regulated in R+ I+ F group( P<0.05). Conclusions:The mechanism by which remifentanil induces hyperalgesia is associated with up-regulation of S1PR1 expression, activation of inflammatory factors, and down-regulation of GLT-1 expression in the rats with incisional pain.

AGEs in DRG Participates in Gastric Hypersensitivity by Regulating Expression of Kv4.2 in Diabetes Mellitus Rat Model / 胃肠病学

Background: Diabetic gastroparesis (DGP) is one of the most common complications of diabetes mellitus (DM), and its main symptoms include upper abdominal pain, nausea, vomiting, abdominal distension, etc. Gastric hypersensitivity is the main pathogenesis of DGP. Advanced glycation end products (AGEs) is the initiating factor of chronic complications of DM, and its relationship with gastric hypersensitivity has not yet been clear. Kv4.2 channel plays an important role in regulating visceral sensation. Subunit inactivation of Kv4.2 can reduce potassium current, enhance pain sensation, and increase gastric sensitivity. Aims: To investigate the mechanism of AGEs participating in gastric hypersensitivity by regulating the expression or activity of Kv4.2 channel in DM rat model. Methods: Fifty⁃four rats were randomly divided into control group, DM group and DM+AG group. Streptozocin (STZ) was intraperitoneally injected to induce DM rat model. Blood glucose, body weight, gastric sensitivity and gastric emptying rate were monitored. Western blotting and ELISA were used to detect CML content in stomach tissue and serum, respectively. The expression of RAGE and its co⁃expression with Kv4.2 in dorsal root ganglia (DRG) neurons were detected by immunofluorescence. Western blotting was used to detect RAGE expression and phosphorylation levels of ERK1/2 and Kv4.2 in DRG neurons. Results: Compared with control group, gastric sensitivity was significantly increased in DM group (P<0.01), gastric emptying rate was significantly decreased (P<0.05), AGEs marker CML content in serum and gastric tissue were significantly increased (P<0.05), co ⁃ expression rate of RAGE and Kv4.2 in DRG neurons was significantly increased (P<0.01), and phosphorylation levels of ERK1/2 and Kv4.2 were up⁃regulated (P<0.05). After intervention with AG, above⁃mentioned indices were significantly ameliorated (P<0.05). Conclusions: AGEs is an upstream factor leading to gastric hypersensitivity in DM rat model. AGEs increases the excitability of DRG neurons by inhibiting Kv4.2 channel, leading to gastric hypersensitivity. RAGE and ERK1/2 signal may be involved in the above process.

Dorsal root ganglion receptor subtype P2X3R mediates postoperative-hyperalgesic priming in mice / 中国药理学通报

Aim To investigate the differences in the role of different purinergic receptor subtypes at different sites in postoperative-hyperalgesic priming in mice. Methods A postoperative-hyperalgesic priming model was constructed by injecting PGE

Effect of electroacupuncture at the acupoints for Tiaozang Xingshen on cerebral metabolism in the patients with type 2 diabetes mellitus-associated cognitive dysfunction / 中国针灸

OBJECTIVES@#To investigate the cerebral metabolism in the patients with type 2 diabetes mellitus-associated cognitive dysfunction (T2DACD) and explore the mechanism of electroacupuncture (EA) at the acupoints for Tiaozang Xingshen (adjusting zangfu function and rescuing the spirit) in treatment of T2DACD, using magnetic resonance spectroscopy.@*METHODS@#Fifteen patients with T2DACD (observation group) and 22 healthy subjects (control group) were enrolled. In the observation group, the patients were treated with EA for Tiaozang Xingshen at Baihui (GV 20) and Shenting (GV 24), and bilateral Feishu (BL 13), Pishu (BL 20), Shenshu (BL 23), Zusanli (ST 36), Sanyinjiao (SP 6), Hegu (LI 4) and Taichong (LR 3). EA was operated with disperse-dense wave, 2 Hz/100 Hz in frequency and 0.1 mA to 1.0 mA in current intensity; 30 min each time, once daily. One course of EA consisted of 5 treatments, at the interval of 2 days and the intervention lasted 8 courses. Before treatment in the control group, before and after treatment in the observation group, the score of Montreal cognitive assessment scale (MoCA), the score of clinical dementia rating (CDR), Flanker paradigm, Stroop paradigm, Nback paradigm, the score of self-rating anxiety scale (SAS), the score of self-rating depression scale (SDS), and the score of Hamilton depression rating scale (HAMD) were evaluated separately; the glycolipid metabolic indexes (fasting plasma glucose [FPG], glycosylated hemoglobin type A1c [HbA1c], total cholesterol [TC], triacylglycerol [TG], high-density lipoprotein cholesterol [HDL-C] and low-density lipoprotein cholesterol [LDL-C]) were determined；with the magnetic resonance spectroscopy technique adopted, the metabolites in the basal ganglia area were detected. The correlation analysis was performed for the metabolite values with MoCA score, CDR score , Flanker paradigm, Stroop paradigm, and Nback paradigm.@*RESULTS@#Before treatment, compared with the control group, in the observation group, MoCA score was lower (P<0.001), CDR score and the levels of FPG and HbA1c were higher (P<0.001); the reaction times of Flanker non-conflict, Flanker conflict, Stroop neutrality, Stroop congruence, Stroop conflict, and 1-back were prolonged (P<0.05, P<0.001), and the accuracy of Flanker conflict, Stroop conflict, and 1-back decreased (P<0.05, P<0.01); the ratio of N-acetyl aspartate (NAA) to creatine (Cr) in the left basal ganglia area was dropped (P<0.001), and that of myo-inositol (MI) to Cr in the right side increased (P<0.05). In the observation group after treatment, compared with the levels before treatment, MoCA score was higher (P<0.001), the scores of CDR, SAS and HAMD were reduced (P<0.01, P<0.05), the reaction times of Flanker conflict and Stroop conflict shortened (P<0.001, P<0.05), and the accuracy of Flanker conflict and 1-back increased (P<0.001, P<0.05); the ratio of NAA to Cr in the left basal ganglia area and that of the gamma-aminobutyric acid (GABA) to Cr in the right increased (P<0.05), that of MI to Cr in the right decreased (P<0.05). Before treatment, in the observation group, the ratio of MI to Cr in the right basal ganglia area was positively correlated with the reaction time of Stroop congruence (r=0.671, P=0.012) and this ratio was positively correlated with the reaction time of Stroop conflict (r=0.576, P=0.039).@*CONCLUSIONS@#Electroacupuncture for "adjusting zangfu function and rescuing the mind" improves the cognitive function of T2DACD patients, which may be related to the regulation of NAA, MI and GABA levels in the basal ganglia.

Study of karyotype and constitutive heterochromatin of Mansonia spp. (Diptera: Culicidae) in the area surrounding the Jirau Hydroelectric Dam, Rondônia, Brazil

ABSTRACT Background: Mansonia mosquitoes transmit arboviruses to humans. This study describes the karyotypes and C-banding of Mansonia humeralis, Mansonia titillans, Mansonia pseudotitillans, and Mansonia indubitans. Methods: From the 202 larvae, the brain ganglia were dissected (n=120) for the preparation of slides. Twenty slides with well-distended chromosomes for each species (10 for karyotyping and 10 for C-banding) were selected for further study. Results: The haploid genome and the average lengths of the chromosomal arms differed in relation to the centromere between species, and intraspecific differences also occurred in the distribution of the C-bands. Conclusions: These results are useful for better understanding of the chromosomal variability of Mansonia mosquitoes.

Hypoparathyroidism and Fahr's syndrome: case series / Hipoparatireoidismo e síndrome de Fahr: série de casos

Abstract Hypoparathyroidism (HP) is a rare metabolic disorder and causes hypocalcemia because parathyroid hormone secretion is inadequate to mobilize calcium from bone and reabsorb calcium from kidney and gut. Anterior neck surgery is the most common cause of acquired HP and autoimmune HP is the next most common form in adults. The duration, severity, and rate of development of hypocalcemia determine the clinical presentation. A variety of organs can be affected by calcification, more frequently kidneys, but also joints, eyes, skin, vasculature, and other organ systems and, although rarely seen, intracerebral calcifications. We report four cases of bilateral basal ganglia calcifications (BGC) also known as Fahr's syndrome related to hypoparathyroidism. Fahr's syndrome is characterized by bilateral symmetrical calcification of areas of the brain that control movements including basal ganglia, thalamus, and others; it is a rare inherited or sporadic neurological disorder with a prevalence of less than 1/1.000.000. Main symptoms related to bilateral BGC include extra-pyramidal and cerebellar disorders, cognitive impairment, epileptic seizures, and psychiatric changes. BGC has been established as a possible outcome of HP. Its prevalence, demonstrated in the HP cohorts, varied significantly from 12 up to 74%. Currently, computed tomography (CT) is the most valuable method for diagnosis. The treatment include symptomatic support and identification of causes, but there is no specific treatment limiting the progression of calcification in the basal ganglia. Especially in HP, an early treatment can prevent calcification and neurophysiological disorders.

Resumo O hipoparatireoidismo (HP) é um distúrbio metabólico raro e causa hipocalcemia, pois a secreção do paratormônio é inadequada para mobilizar o cálcio dos ossos e reabsorver o cálcio dos rins e intestino. A cirurgia cervical anterior é a causa mais comum de HP adquirido. O HP autoimune é a segunda causa mais comum em adultos. A duração, gravidade e taxa de desenvolvimento da hipocalcemia determinam a apresentação clínica. Diversos órgãos podem ser afetados pela calcificação, mais frequentemente os rins, mas também articulações, olhos, pele, vasculatura e outros órgãos e, embora raramente vista, calcificações intracerebrais. Relatamos quatro casos de calcificações dos gânglios da base (CGB) bilaterais, também conhecidas como síndrome de Fahr relacionadas ao hipoparatireoidismo. A síndrome de Fahr é caracterizada pela calcificação bilateral simétrica de áreas do cérebro que controlam os movimentos incluindo os gânglios da base, tálamo e outros; é um distúrbio neurológico raro, hereditário ou esporádico, com uma prevalência 1/1.000.000. Os principais sintomas relacionados à CGB bilateral incluem distúrbios extrapiramidais e cerebelares, comprometimento cognitivo, convulsões e alterações psiquiátricas. A CGB foi estabelecida como uma possível consequência do HP. Sua prevalência, demonstrada nas coortes de HP, variou significativamente de 12 a 74%. Atualmente, a tomografia computadorizada (TC) é o método mais valioso para o diagnóstico. O tratamento inclui suporte sintomático e identificação de causas, mas não há tratamento específico limitando a progressão da calcificação nos gânglios da base. Especialmente no HP, um tratamento precoce pode prevenir calcificações e distúrbios neurofisiológicos.

Unusual Involvement of Basal Ganglia and Dentate Nucleus in Children with Acute Encephalopathy with COVID-19

Children account for 1% to 5% of diagnosed COVID-19 infection with relatively mild presentation compared to adults. The frequency of neurological involvement in acute COVID-19 infection in children is unclear. COVID-19 is also considered to be a neurotropic virus, but so far, in the pediatric age group, very few cases with involvement of basal ganglia and no case of dentate nucleus involvement have been reported in the literature. The present paper reports two cases of acute encephalopathy with COVID-19, the frst case with basal ganglia involvement and the second with dentate nucleus involvement. Both cases required aggressive management and had complete neurological recovery on follow-up. Hence, these cases are reported to make everyone aware of the neurological presentation with atypical neuroimaging fnding of acute COVID-19 infection in the pediatric age group; timely management improves the outcome.

Necrosis en espejo de ganglios basales en la enfermedad de la orina con olor a jarabe de arce. Presentación de un caso / Mirror necrosis of basal ganglia in maple syrup urine disease. A case report

RESUMEN La enfermedad de la orina con olor a jarabe de arce es una enfermedad genética autosómica recesiva, cerebral degenerativa. Es causada por un déficit en la actividad de la deshidrogenasa de los cetoácidos de cadena ramificada, que provoca inadecuado almacenamiento de los tres aminoácidos esenciales de dicha cadena. Esto genera una neurotoxicidad severa que puede llevar a la muerte. Se manifiesta clínicamente por deterioro neurológico, retraso psicomotor, problemas de alimentación, orina con olor característico. Sus consecuencias cerebrales pueden ser definidas mediante tomografía axial computarizada. Este artículo tiene como objetivo presentar un caso de enfermedad de la orina con olor a jarabe de arce con hipodensidad bilateral de los ganglios basales por necrosis en espejo, detectado mediante estudio tomográfico. Se trata de una paciente femenina, de 9 años de edad con cuadro anterior de cetoacidosis no diabética. Posterior a la realización de apendicectomía, comenzó con cuadro comatoso que requirió estudio tomográfico mediante el cual se constató edema cerebral. Evolucionó tórpidamente, por lo que requirió nuevo estudio tomográfico que demostró empeoramiento de las condiciones neurológicas al reflejarse en la imagen hipodensidad bilateral a nivel de los núcleos basales por necrosis. La enfermedad de la orina con olor a jarabe de arce es una afección rara, con diversas formas clínicas. Requiere de estudios de laboratorio que la confirmen e imágenes como tomografía computarizada que, como en este caso, ayuden a evidenciar el daño neurológico. Fue muy característica la hipodensidad de ganglios basales asociada a edema cerebral.

ABSTRACT Maple syrup urine disease is an autosomal recessive genetic degenerative brain disease. It is caused by a deficit in branched-chain ketoacid dehydrogenase activity, which causes inadequate storage of the three essential amino acids of said chain. This generates severe neurotoxicity that can lead to death. It is clinically manifested by neurological deterioration, psychomotor retardation, feeding problems, urine with a characteristic odor. Its cerebral consequences can be defined by computerized axial tomography. This article aims to present a case of maple syrup urine disease with bilateral hypodensity of the basal ganglia due to mirror necrosis, detected by tomographic study. This is a 9-years-old female patient with a history of non-diabetic ketoacidosis. After the appendectomy, she began with a coma that required a tomographic study, which revealed cerebral edema. She evolved torpidly, requiring a new tomographic study that showed worsening of the neurological conditions as bilateral hypodensity at the level of the basal nuclei due to necrosis was reflected in the image. Maple syrup urine disease is a rare condition with various clinical forms. It requires laboratory studies to confirm it and images such as computed tomography that, as in this case, help to show the neurological damage. The hypodensity of the basal ganglia associated with cerebral edema was very characteristic.

Comparación del rendimiento de pruebas cognitivas en pacientes con Enfermedad de Parkinson con y sin estimulación cerebral profunda / Comparison of the performance of cognitive tests in Parkinson Disease patients with and without Deep Brain Stimulation

Resumen Los pacientes diagnosticados con Enfermedad de Parkinson (EP) presentan alteraciones motoras concomitantes a otras alteraciones de tipo cognitivo, conductual o emocional. Una de las alternativas al tratamiento farmacológico es la estimulación cerebral profunda (ECP). Existen reportes de alteraciones en el rendimiento de tareas cognitivas tras procedimiento de ECP, lo que podría sugerir que el procedimiento es responsable de estos cambios cognitivos. El objetivo del estudio fue comparar los resultados del rendimiento en pruebas cognitivas de pacientes con EP de dos grupos (con ECP y sin ECP). Se recolectaron los resultados de 47 pacientes (n = 16 ECP; n = 31 sin ECP) durante los años de 2011 hasta 2015. Dentro de las funciones y variables evaluadas se encuentran: categorización visual, flexibilidad cognitiva, solución de problemas, atención selectiva, velocidad de procesamiento, inhibición conductual y calidad de vida. En general, no se encontraron diferencias significativas entre los grupos en las funciones evaluadas. En el grupo de participantes con ECP, se encontró mayor cantidad de correlaciones entre las pruebas de semejanzas y las de dígitos inversos, listas de palabras, búsqueda de símbolos y las subpruebas del Wisconsin Card Sorting Test. Así mismo, en los pacientes con ECP se presentó una percepción menor de calidad de vida asociada al tiempo de la enfermedad en comparación con el grupo sin ECP. En conclusión, estos resultados son congruentes con estudios similares de evaluación neuropsicológica y se discute el papel del tratamiento de estimulación en los pacientes, los cuales no siempre tienen un impacto positivo sobre la calidad de vida percibida.

Abstract Patients diagnosed with Parkinson's disease show motor alterations together to cognitive, behavioral, and emotional disturbances. An alternative treatment to the exclusive pharmacological medication is the Deep Brain Stimulation procedure (DBS). Some studies have shown altered behavioral patterns after DBS device implantation, suggesting a relationship between a particular performance in cognitive tests derived from the DBS procedure. Our study aimed to compare the performance of cognitive tests in Parkinson's disease patients with and without DBS. Results were analyzed from 47 patients (n = 16 DBS; n = 31 without DBS) in a range since 2011 to 2015. Functions tested were visual categorization, cognitive flexibility, problem solutions, selective attention, cognitive processing speed, behavioral inhibition, and quality of life. In general, there are non-significative differences between groups in functions tested. However, correlations were found depending on the group (DBS or without DBS patients), with more positive correlations inside the DBS group between the similarity test and inversed digits, list of words, symbol search and the sub-test of the Wisconsin Card Sorting Test. In addition, the DBS group showed a low perception of the quality of life associated with the disorder´s time compared to the without DBS group. In conclusion, these results are congruent with similar studies of neuropsychological evaluation, and the role of treatment is discussed below the perception of the quality of life.

Mitochondrial Reactive Oxygen Species Elicit Acute and Chronic Itch via Transient Receptor Potential Canonical 3 Activation in Mice / 神经科学通报·英文版

Mitochondrial reactive oxygen species (mROS) that are overproduced by mitochondrial dysfunction are linked to pathological conditions including sensory abnormalities. Here, we explored whether mROS overproduction induces itch through transient receptor potential canonical 3 (TRPC3), which is sensitive to ROS. Intradermal injection of antimycin A (AA), a selective inhibitor of mitochondrial electron transport chain complex III for mROS overproduction, produced robust scratching behavior in naïve mice, which was suppressed by MitoTEMPO, a mitochondria-selective ROS scavenger, and Pyr10, a TRPC3-specific blocker, but not by blockers of TRPA1 or TRPV1. AA activated subsets of trigeminal ganglion neurons and also induced inward currents, which were blocked by MitoTEMPO and Pyr10. Besides, dry skin-induced chronic scratching was relieved by MitoTEMPO and Pyr10, and also by resveratrol, an antioxidant. Taken together, our results suggest that mROS elicit itch through TRPC3, which may underlie chronic itch, representing a potential therapeutic target for chronic itch.

Chronic compression of the dorsal root ganglion activates the Wnt/β-catenin signaling pathway in the dorsal horn of the spinal cord in rats / 中华物理医学与康复杂志

Objective:To investigate the effect of chronic compression of the dorsal root ganglion (CCD) on the Wnt/β-catenin signaling pathways in the spinal dorsal horns of rats.Methods:Forty-two adult male Sprague-Dawley rats were randomly divided into a sham group ( n=9) and a CCD group ( n=33). The CCD group was subdivided into a 1d group ( n=6), a 3d group ( n=6), a 7d group ( n=9), a 14d group ( n=6), and a 28d group ( n=6) based on the post-operative time of the experiments. Before the operation for CCD and 1, 3, 5, 7, 14, 21 and 28 days afterward the mechanical withdrawal threshold was detected for all rats. Western blotting was conducted to detect the expression of active β-catenin and glial fibrillary acidic protein (GFAP) in the dorsal horn of the spinal cord 1, 3, 7, 14 and 28 days after the surgery. Seven days after the operation immunofluorescence was employed to detect the nuclear translocation of active β-catenin and the activation of astrocytes in the dorsal horn of the spinal cord. Results:The average mechanical withdrawal thresholds of the CCD groups were significantly lower than that of the sham group at each time point. The western blotting showed that the expression of active β-catenin in the CCD groups was significantly greater than in the sham group at each time point. Seven days after compression the expression of GFAP in the rats′ dorsal horns was significantly higher than in the sham group. Immunofluorescence indicated nuclear translocation of active β-catenin and the activation of astrocytes in the dorsal horn.Conclusion:The Wnt/β-catenin signaling pathways are significantly activated in the dorsal horn of the spinal cord after CCD, at least in rats. It may play an important role in the development of neuropathic pain.

Analysis of a case of corticobasal degeneration started with primary progressive aphasia / 中华神经科杂志

Objective:Through a typical case of corticobasal degeneration (CBD) with primary progressive aphasia (PPA) to analyze the clinical characteristics of CBD and the special manifestations of aphasia with that disease.Methods:Retrospective analysis was performed on a patient with PPA based CBD who was admitted to the First Affiliated Hospital, Sun Yat-sen University in July 2020 to summarize the clinical features and diagnostic thinking of CBD.Results:The patient was a 59-year-old male, manifested rapidly progressive dysfunction of language and memory function. The aphasia was mainly featured as slow speech, reduced content and grammatical errors, and diagnosed as PPA, non-fluent grammatical variation. The imaging results showed the atrophy of the left frontal lobe, parietal lobe, basal ganglia and thalamus, coupled with the reduction in 18F-fluorodeoxyglucose radioactive uptake. The patient was finally diagnosed as possible CBD. Conclusions:PPA as the initial manifestation of CBD is very rare in clinical practice. The high non-specificity of clinical features and the lack of typical motor symptoms result in the difficulty of correct diagnosis of CBD. Timely functional imaging in nuclear medicine and reliable biomarkers help to facilitate early diagnosis of atypical CBD.