The potential role of herbal products in the treatment of Parkinson's disease.

Parkinson's disease (PD) is a multifactorial disorder of the nervous system in which there is a progressive loss of dopaminergic neurons. There is a disturbance in the movement in PD and these include resting tremors, rigidity, bradykinesia or akinesia, disturbance, posture and freezing (motor block). The substantia nigra and other parts of the brain are commonly affected. The disorder could be related to oxidative stress and there is an important role of reactive oxygen species (ROS). A number of herbal products contain active components which are known to possess antioxidant action. Hence, the potential role of herbal products in treating PD cannot be undermined. In the present narrative review, the main aim is to discuss the pathogenesis of PD, define the role of different potential herbal extracts on its pathogenesis which may form the basis of treatment. We also discuss in detail the active chemical compounds present each herb which are effective in the treatment of PD. These herbs include Baicalei, Erythrina velutin, Resveratrol, Peganum Harmal, Curcuma longa (Zingiberaceae), Carthamus tinctorius L. (Safflower), Pueraria lobate, Juglandis Semen (Walnut), Tianma Gouteng Yin (TGY), Lycium barbarum L fruit, Mucuna pruriens (Velvet bean), Chunghyuldan (CHD), Paeoniae Alba Radix. The present review may be beneficial for designing future drugs for effective treatment of PD.

The use of autologous fibrin as a scaffold for cultivating autologous conjunctiva in the treatment of conjunctival defect.

The purpose of this study was to compare the use of autologous fibrin to human amniotic membrane (HAM) as a scaffold in cultivating autologous conjunctiva for transplantation in treatment of conjunctival defect. An experimental study was performed using 18 adult New Zealand white strain rabbits which were divided into 3 groups. Each group consists of 6 rabbits. The conjunctiva on the temporal site was excised to create a conjunctival epithelial defect. The excised area in the Group 1 was transplanted with autologous conjunctiva cultivated on autologous fibrin; Group 2 was transplanted with autologous conjunctiva cultivated on HAM and Group 3 was left bare. The rabbits were followed up at regular intervals until 6 weeks. The mean period of complete conjunctival epithelization was 11.50 ± 8.22 days for the autologous fibrin group, 15.33 ± 11.80 days for the HAM group and 25.33 ± 5.32 days in the bare sclera group. The epithelization rate for the autologous fibrin group was faster compared to the other two groups. However all the results were not statistically significant (p value >0.05). There were no postoperative complications noted during the follow up. Autologous fibrin is comparable to HAM as a scaffold for cultivation of conjunctiva in the treatment of conjunctival defect.

Anomalous structures of the liver: an anatomical insight.

BACKGROUND AND AIMS: Anomalous structures of the liver are incidentally detected during autopsies or during routine cadaveric dissection. The present study aimed to observe the abnormal shapes of quadrate lobe, accessory sulci and ligamentum teres of the liver. MATERIALS AND METHODS: A total of 20 formalin fixed cadaveric livers (n=20), irrespective of the sex, were taken for this study. These specimens belonged to cadavers of unknown origins. The presence of accessory sulci and abnormalities related to the quadrate lobe and ligamentum teres were studied in detail. Morphometric measurements were taken for the abnormal accessory sulci and abnormal quadrate lobes. RESULTS: Variable shapes of the quadrate lobes were observed with 8 (40%) being rectangular, 6 (30%) being pear-shaped, 4 (20%) being triangular and another 2 specimens (10%) which were square in shape. The presences of accessory sulci on the diaphragmatic surface of the liver were observed in 2 specimens (10%). Ligamentum teres traversed the groove in 18 (90%) while in 2 (10%) specimens, the ligamentum teres was embedded in the groove and it was covered by parenchymatous tissue of the liver it from the side of the quadrate lobe. CONCLUSION: Prior anatomical knowledge of the presence of the anomalous structures in the liver with may be helpful for the radiologist and surgeons for correct interpretation of radiographs and planning appropriate hepatobiliary surgeries.

Higher division of the tibial nerve in the leg: gross anatomical study with clinical implications.

BACKGROUND AND OBJECTIVES: Tibial nerve is a branch of the sciatic nerve and it is the main nerve innervating the muscles of the back of the leg. The tibial nerve divides into medial and lateral plantar nerves. The level of division may be important for surgical purpose. The main aim of the present study was to observe the exact level of division of the tibial nerve and discuss its clinical implications. MATERIALS AND METHODS: A total of 20 cadaveric limbs (irrespective of left or right side) were taken randomly. The posterior compartment of the thigh and leg was dissected to trace the tibial nerve and its branches. The specimens were subjected to measurements with respect to an arbitrary horizontal line passing through tip of medial malleolus and the calcaneum. All the specimens were photographed. RESULTS: In 5 cases (25%), the tibial nerve divided deep to the flexor retinaculum. In 15 cases (75%) cases, the tibial nerve divided at a distance of 3.5 cm - 6.5 cm (average 5 cm) above the medial malleolus. CONCLUSION: The tibial nerve and its divisions are important for performing successful nerve blocks and insertion of plates while treating fractures. Variations may account for the various discrepancies between the electromyographic tests and clinical tests.

Absence of the isthmus of the thyroid gland: anatomical and clinical considerations.

The right and left lobes of the thyroid gland are connected by an isthmus. The isthmus lies at the level of the second and third tracheal rings. Occasionaly, the isthmus may be absent. We hereby, report the absence of isthmus in a 52-year-old male cadaver of unknown origin. Both the right and left lobes were normal but they were separated. Both the right and left lobes of the thyroid gland measured 4.3 cm vertically. The separation distance between right and left glands was noted at the upper, middle and lower parts. The upper end of medial border of both lobes were separated by a distance of 1 cm while the separation distance was 0.7 cm and 1.5 cm at the middle and lower parts, respectively. The anatomical and clinical significance of absence of isthmus is important for medical personnel and the surgeons operating on the thyroid gland. The present case report is a an attempt to highlight such.

The association between GJB2 mutation and GJB6 gene in non syndromic hearing loss school children.

Recently, molecular testing for GJB2 mutations has become the standard of care for the diagnosis of patients with non syndromic hearing impairment of unknown cause. The aims of this study are to determine the association between GJB2 mutation and GJB6 and to report the variation of mutations in deaf students who have heterozygous GJB2. This retrospective study was conducted at Universiti Kebangsaan Malaysia Medical Center (UKMMC). Data was collected from previous files and records from Tissue Engineering and Human Genetic Research Group Laboratory. Approval from Ethical Committee was obtained prior to the study. A total of 138 students have been screened in previous studies in UKMMC for the presence of GJB2 mutations as a cause for hearing loss. Thirty four of the 138 subjects have GJB2 mutations; 2 showed homozygous mutations whereas another 32 were heterozygous for GJB2 gene mutation. Only 31 DNA samples of students presented with sensorineural hearing loss with heterozygous mutation in GJB2 gene were included in this study. The sequencing results obtained were analyzed. The degree of hearing loss of those students with association between GJB2 mutation and GJB6 mutation will be discussed. Five out of 31 subjects (16.2%) have mutations in their GJB6 gene, suggesting a digenic inheritance of GJB2/GJB6 mutation. In total, four novel mutations were identified; E137D (n=1), R32Q (n=1), E101K (n=1) and Y156H (n=1) and one mutation deletion; 366delT (n=1). All students with association GJB2 mutation and GJB6 showed severe to profound hearing loss in both ears. Interestingly this study not detected the large deletion of 342 kb in GJB6 gene suggesting that the mutation is very rare in this region compared to certain parts of the world.

An atavastic belly of the flexor digitorum profundus with absence of tendon of flexor digitorum superficialis to the little finger: morphological and histological considerations.

In this case report, we report the absence of the fourth tendon of flexor digitorium superficialis (FDS) to the little finger with a concurrent anomalous muscular belly of flexor digitorum profundus (FDP) in the palm. The FDS originated from the medial epicondyle, divided into three tendons for the index, middle and ring fingers with the little finger devoid of any attachment. The FDP exhibited a muscular belly which passed deep to the flexor retinaculum (FR) and continued for another 4 cm thereby dividing into four slips for the index, middle, ring and little fingers. The presence of the muscular belly of the FDP lead us to think whether it was an adhesion between the tendons of the FDP, so we proceeded to histological analysis. The tissue was processed and stained with Hematoxylin and Eosin. Abundant longitudinal muscle fibers with peripherally situated nuclei confirmed it to be a skeletal muscle. Absence of the tendon of FDS to little finger may influence the flexion movement in the middle and proximal interphalangeal joints. Presence of anomalous muscle belly of FDP in the palm may mimic any soft tissue tumour, compress neurovascular structures or even pose difficulty while performing tendon transplant surgeries.

The effects of a tocotrienol-rich fraction on experimentally induced atherosclerosis in the aorta of rabbits.

This study investigated the effects of a tocotrienol-rich fraction (TTRF) on the microscopic development of atherosclerosis and lipid peroxidation in the aorta of rabbits. Group 1 was fed a normal diet, group 2 received a 2% cholesterol diet and group 3 received a 2% cholesterol diet plus daily oral administration of the TTRF. After 10 weeks, the aortic content of malondialdehyde (MDA) was measured as an index of lipid peroxidation. The MDA was lowest in rabbits that received the TTRF compared to the groups that did not. The degree of intimal thickening was higher in the cholesterol-fed rabbits without the TTRF compared to the cholesterol-fed rabbits with TTRF (P<0.05). The continuity of the internal elastic lamina (IEL) was noted to be preserved in the cholesterol-fed rabbits with TTRF but appeared disrupted in the cholesterol-fed rabbits without the TTRF. The disrupted and fragmented IEL may have resulted from the injury caused by lipid peroxidation that contributed to the more extensive intimal thickening. We conclude that the antioxidant activities of the TTRF can reduce experimental atherosclerosis.