Treatment of Trigeminal Neuralgia with Percutaneous Glycerol Injection into Meckel’s Cavity: Experience in 4012 Patients

Percutaneous glycerol injection into Meckel’s cavity is widely used to treat trigeminal neuralgia. Reports published to date summarized clinical experiences in small or intermediately sized groups of patients. The efficacy of this procedure in a large group of patients has not been evaluated so far. From December 1983 to November 2008, patients with primary trigeminal neuralgia were treated in our clinic using percutaneous glycerol injection into Meckel’s cavity which was conducted according to the Hakanson’s anterior puncture method with some modifications. In total, 4012 patients (2205 female) with a mean age of 56.5 (23–87) years were treated. The majority of patients (99.23%) experienced unilateral pain, while a small cohort of patients (31; 0.77%) had bilateral pain. The immediate success rate of the procedure was 97.1%. There was a significant (P < 0.01) positive correlation between the presence of cerebrospinal fluid (CSF) outflow and the curative effect. Follow-up was done in 3157 patients for the period of 1–25 years. The long-term success rate was 81.18%. No serious adverse effects were observed. The procedure is very effective and applicable to a wide variety of patients with trigeminal neuralgia. The presence of CSF outflow during puncture predicts better immediate and long-term outcomes.     

Impact of Aquaculture on Commercial Fisheries: Fishermen’s Local Ecological Knowledge

The Bay of Fundy along the southwest coast of New Brunswick, Canada is one of the most densely stocked finfish aquaculture areas in the world. An inshore multi-species fishery that dates back to the earliest European settlement shares these waters, and has been the economic mainstay of coastal communities. These inshore fishermen are increasingly displaced by the expanding aquaculture industry. A recent study conducted among fishermen in Southwest New Brunswick recorded their observations about the environmental impact of finfish aquaculture and the consequences for their commercial fishery. Fishermen all reported significant environmental degradation around aquaculture sites. Within 2 years of an operation being established, fishermen reported that gravid female lobsters as well as herring avoid the area, scallop and sea urchin shells become brittle, scallop meat and sea urchin roe becomes discolored. The use of chemicals to control sea lice on farmed salmon has also caused lobster, crab and shrimp kills. These and other concerns suggest that more comprehensive and detailed studies are required to establish the environmental and economic interactions of aquaculture and the inshore fishery, as well as on the stocks on which that fishery rely. The study also points to the need for more effective use of fishermen’s knowledge in designing such studies.     

Patterns and Trends in Accidental Poisoning Deaths: Pennsylvania’s Experience 1979-2014

IntroductionThe purpose of this study was to examine county and state-level accidental poisoning mortality trends in Pennsylvania from 1979 to 2014.MethodsCrude and age-adjusted death rates were formed for age group, race, sex, and county for accidental poisonings (ICD 10 codes X40-X49) from 1979 to 2014 for ages 15+ using the Mortality and Population Data System housed at the University of Pittsburgh. Rate ratios were calculated comparing rates from 1979 to 2014, overall and by sex, age group, and race. Joinpoint regression was used to detect statistically significant changes in trends of age-adjusted mortality rates.ResultsRate ratios for accidental poisoning mortality in Pennsylvania increased more than 14-fold from 1979 to 2014. The largest rate ratios were among 35–44 year olds, females, and White adults. The highest accidental poisoning mortality rates were found in the counties of Southwestern Pennsylvania, those surrounding Philadelphia, and those in Northeast Pennsylvania near Scranton.ConclusionsThe patterns and locations of accidental poisoning mortality by race, sex, and age group provide direction for interventions and policy makers. In particular, this study found the highest rate ratios in PA among females, whites, and the age group 35–44.     

Catecholamine metabolism in children with Asperger’s and Kanner’s syndromes

In a stable state children with Asperger’s and Kanner’s syndromes demonstrate a similar decrease in plasma norepinephrine. In the aggravated state, these changes become more expressed and are characterized by a decrease in plasma tyrosine, norepinephrine, normetanephrine, and by an increase in dopamine and homovanillic acid and a decrease in excretion of norepinephrine and an increase in excretion of homovanillic acid, epinephrine and 3-methoxy-4-hydroxyphenylglycol (MHPG). In the aggravated state children with Kanner’s syndrome were characterized by increased plasma MHPG, decreased excretion of tyrosine and increased expression of normetanephrine. The observed imbalance in dopamine and epinephrine/norepinephrine systems suggests importance of combined analysis of changes in catecholamines and their metabolites as the most informative approach in the study of the effect of autistic disorders.     

Successful Splenectomy for Hypersplenism in Wilson’s Disease: A Single Center Experience from China

Splenomegaly and pancytopenia are common in Wilson’s disease (WD) and splenectomy is one of the conventional treatments for splenomegaly and the associated pancytopenia. However, splenectomy remained controversial for hypersplenism in WD as it was reported that splenectomy leaded to serious emotional and neurological deterioration in WD patients with hypersplenism. In the current study, we present our experiences in 70 WD patients with hypersplenism who had undergone splenectomy, outlining the safety and efficacy of splenectomy in WD. The clinical database of 70 WD patients with hypersplenism who had undergone splenectomy in our hospital between 2009 and 2013 were reviewed and followed-up regularly. Before splenectomy, all the patients accepted a short period of anti-copper treatment with intravenous sodium 2, 3-dimercapto-1-propane sulfonate (DMPS). All the patients demonstrated a marked improvement in platelet and leucocyte counts after splenectomy. No severe postoperative complication was observed. In particular, none of the 37 patients with mixed neurologic and hepatic presentations experienced neurological deterioration after splenectomy, and none of the patients with only hepatic presentations newly developed neurological symptoms. During the one year follow-up period, no patient presented hepatic failure or hepatic encephalopathy, no hepatic patient newly developed neurological presentations, and only 3 patients with mixed neurologic and hepatic presentations suffered neurological deterioration and these 3 patients had poor compliance of anti-copper treatment. Quantative analysis of the neurological symptoms in the 37 patients using the Unified Wilson’s Disease Rating Scale (UWDRS) showed that the neurological symptoms were not changed in a short-term of one week after splenectomy but significantly improved in a long-term of one year after splenectomy. Additionally, compared to that before splenectomy, the esophageal gastric varices in most patients significantly improved one year after splenectomy. Thus, we may conclude that splenectomy is a safe and effective therapeutic measure for hypersplenism in WD patients who had been preoperatively treated with DMPS for powerful anti-copper therapy.     

Management of Type 2 Diabetes Mellitus in the Very Elderly: One Practice’s Experience

ObjectiveType 2 diabetes mellitus (T2DM) affects 25% of adults over age 65. Nevertheless, few clinical trials include patients over age 75.MethodsThis case series reports retrospective data on a cohort of 85 patients aged 80 and over (mean 88.1, range 80-104) with T2DM, managed by a single endocrinologist. The practice’s computerized data base was searched for all patients 80 years of age and older with a diagnosis of T2DM.ResultsThe major observations were the significant decrease in the use of agents associated with hypoglycemia (sulfonylureas and insulin), and the beneficial and well-tolerated use of glucagon like peptide-1 receptor analogues (GLP-1 RA). The mean A1c in the entire cohort dropped from 7.6% to 6.6% over a mean of 9 months. Nearly one-half of the cohort were treated with GLP1-RA, reflecting studies demonstrating the safety and efficacy of this class of drugs in less elderly patients. At presentation, 75% were on sulfonylurea and/or insulin; this number was reduced to 27%. Furthermore, none of the patients required short-acting (bolus) insulin to achieve the individualized A1c target.ConclusionPatients with T2DM aged 80 and over respond well to GLP1-RA drugs, drastically reducing the need for agents associated with hypoglycemia. The important question, which will require larger and prospective studies, is whether the lowering of A1c, as shown in this paper, and the use of GLP-1 RA specifically, are associated with improved morbidity and mortality in the very elderly.     

Dynamic Microtubules in Alzheimer’s Disease: Association with Dendritic Spine Pathology

Alzheimer’s disease (AD) is the most common incurable neurodegenerative disorder that affects the processes of memory formation and storage. The loss of dendritic spines and alteration in their morphology in AD correlate with the extent of patient’s cognitive decline. Tubulin had been believed to be restricted to dendritic shafts, until recent studies demonstrated that dynamically growing tubulin microtubules enter dendritic spines and promote their maturation. Abnormalities of tubulin cytoskeleton may contribute to the process of dendritic spine shape alteration and their subsequent loss in AD. In this review, association between tubulin cytoskeleton dynamics and dendritic spine morphology is discussed in the context of dendritic spine alterations in AD. Potential implications of these findings for the development of AD therapy are proposed.     

Balancing Conservation with Development in Small-Scale Fisheries: Is Ecotourism an Empty Promise?

This paper uses a political ecology approach to examine whether ecotourism along the Pacific Coast of the Baja California peninsula in Mexico promotes stewardship of marine resources, which have been devastated in recent years by uncontrolled commercial harvesting. This case illustrates how conflicts over access to common-pool resources that fueled the demise of area fisheries are now emerging in the rapidly growing industry of recreational whale watching. Even if ecotourism provides a significant new source of income through environmentally friendly, nonconsumptive resource use, it may not be sufficient to discouragelocal people from engaging in other, more destructive forms of consumptive resource use. But resource conflicts may not preclude efforts to promote conservation through ecotourism. Along the shores of Baja's gray whale calving lagoons there are nascent, community-based organizations that could serve as vehicles for mobilizing local people into conservation efforts, if local access rights to marine resources were both secure and accorded preference over outside claims to the same.     

Molecular pharming’s foot in the FDA’s door: Protalix’s trailblazing story

Objectives

This short commentary examines the factors that led to Food and Drug Administration’s approval of the first plant-derived biologic.

Results

In 2012, the first plant-derived protein pharmaceutical (biologic) was approved for commercial use in humans. The product, a recombinant form of human β-glucocerebrosidase marketed as ELELYSO, was developed by Protalix Biotherapeutics (Carmiel, Israel). The foresight to select this particular therapeutic product for development, flawless production pipeline, and serendipity seem to provide the key in explaining how ELELYSO became the first plant-derived biologic to achieve approval by Food and Drug Administration.

Conclusions

While the circumstances that enabled Protalix and its scientists to become the first to arrive at this historic milestone are perhaps unique, it is anticipated that more biologics will follow suit in winning regulatory endorsement.

     

Experience of experimental modelling of Huntington’s disease

Huntington’s disease (HD) is an autosomal dominant neurodegenerative disorder characterized by choreic involuntary movements, decline in cognitive functions, behavioral disturbances, and progressive neuronal death affecting primarily the striatum. The fatal nature of HD makes it important to search for new effective methods of its treatment, which requires the development of experimental models of the disease. These models can be created using 3-nitropropionic acid (3-NPA), which is a neurotoxin causing typical changes in motor skills and memory impairment in animals due to induction of oxidative stress, impaired glutathione defense, and destruction of striatal cells. We modeled HD in rats by chronic daily intraperitoneal administration of 3-NPA for 17 days. Systemic administration of a low dose of 3-NPA (10 mg/kg) induced hyperactivity of animals in the open field test (including movement redundancy as a hyperkinesia analogue) and had no effect on the behavior of the animals in the X-maze test. On the contrary, rats administered with a toxic dose of 3-NPA (20 mg/kg) exhibited a significant decrease in their motor activity and a cognitive decline in behavioral tests. A histopathological analysis revealed damage and loss of neurons and a decrease in expression of dopaminergic markers (tyrosine hydroxylase and plasma membrane dopamine transporter) in the striatum. The gliotoxic effect of 3-NPA was also found in the striatum, which was confirmed by immunohistochemical staining for astrocytic proteins: GFAP, glutamine synthetase, and aquaporin-4. This HD model may be helpful for testing new experimental therapies at different stages of HD-like neurodegeneration, including therapies based on cell neurotransplantation.     

Travelling with tea: a Tuckerella’s tale

Tuckerella japonica Ehara appears strongly associated with tea (Camellia sinensis (L.) Kuntze, Theaceae) and, due to certain cultural practices in tea production, has in fact become a world traveller, accompanying the greatly coveted tea plant as it spread across the planet. The history of tea production and culture, and its arrival in the USA, provides the backdrop for this traveller’s tale. Tuckerella japonica is morphologically similar to T. flabellifera Miller, described from Tasmania in Australia from Bedfordia salicina (Labill.) D.G. (Asteraceae). These two species have historically been misidentified as each other, creating inaccuracies in the collection records. The implications of this in terms of host plant lists and world distribution are discussed further, along with their morphological separation. The male and immature stages of T. japonica are described for the first time. Tuckerella xinglongensis Lin and Fu, from tea in China, is considered a junior synonym of T. japonica. The loss of the ancestral prostigmatan condition of three nymphal stages during ontogeny is confirmed for males of T. flabellifera, which do not retain a tritonymphal stage.     

Attractiveness and Rivalry in Women’s Friendships with Women

Past research suggests that young women perceive their same-sex friends as both facilitating the pursuit of desirable mates and competing for access to desirable mates. We propose that similar levels of physical attractiveness between young adult female friends might be one explanation for the opposing forces in their friendships. Forty-six female friendship pairs completed questionnaires about themselves, their friend, and their friendship; in addition, each woman’s picture was rated by a set of nine naive judges. Friends were similar in both self-rated and other-rated level of attractiveness. Within-pair analyses revealed that women agreed on which friend was more attractive, and the less attractive members of each friendship pair (by pair consensus as well as outside judges’ ratings) perceived more mating rivalry in their friendship than did the more attractive members of each friendship pair. We offer directions for research on women’s friendships over the lifespan.     

Children’s Experience of Posttraumatic Growth: Distinguishing General from Domain-Specific Correlates

Although the five domains of posttraumatic growth (new possibilities, relating to others, personal strength, spiritual change and appreciation of life) have been studied extensively in adults, little is known about these domains and their correlates in children. We aimed to examine whether demographic and/or social characteristics are related to children’s reports of overall posttraumatic growth and of growth in specific domains. In a general population study, children aged 8–12 years who had been exposed to adverse events (N = 1290) filled out questionnaires on their experiences, demographic characteristics (gender, age, time lag since event), stress reactions, peer support, religiosity and posttraumatic growth. All demographic and social characteristics were related to overall posttraumatic growth, except time lag. Associations varied across the five domains with the strongest effects being found for stress reactions and religiosity. A higher level of stress reactions was related to more growth in all domains (general effect), whereas religious children experienced more spiritual growth than non-religious children without differences on other domains (domain specific effect). Other effects were small, and some did not remain significant after Bonferroni corrections. These findings suggest the presence of both general and domain-specific correlates of child posttraumatic growth. Although effects were generally small, the current findings show the need to differentiate between the domains of posttraumatic growth in both further research and clinical practice. This will allow a better understanding of the mechanisms of posttraumatic growth in children as well as more tailored assessment and intervention.     

A Mother’s Heart is Weighed Down with Stones: A Phenomenological Approach to the Experience of Transnational Motherhood

Although recent scholarship on transnational mothers has rigorously examined the effect of migration on gender constructs and ideologies, it neglects analysis of the lived experience of separated mothers and children. In privileging the exploration of transnational separations through the single analytical lens of gender, such research reduces the embodied distress of mothers and children to mere “gender false consciousness.” This paper calls upon anthropologists to redress this oversight by undertaking a phenomenological analysis of the lived experience of transnational motherhood. Eschewing an analysis of mothers and children as isolated social roles, I show that the suffering of mothers and children is profoundly relational. Through analysis of the narratives of undocumented Salvadoran mothers residing in the U.S., I show how the strain of such mothers’ undocumented status is lived and shouldered within the intersubjective space of the family.

Non-Motor Symptoms in Patients with Parkinson’s Disease – Correlations with Inflammatory Cytokines in Serum

Background

Parkinson’s Disease (PD) is the second most common neurodegenerative disorder of the central nervous system. Motor symptoms are the focus of pharmacotherapy, yet non-motor features of the disease (e.g. fatigue, mood disturbances, sleep disturbances and symptoms of anxiety) are both common and disabling for the patient. The pathophysiological mechanisms behind the non-motor symptoms in PD are yet to be untangled. The main objective of this study was to investigate associations between pro-inflammatory substances and non-motor symptoms in patients with PD.

Methods and Materials

We measured C-reactive protein, interleukin (IL)-6, soluble IL-2 receptor (sIL-2R) and tumor necrosis factor-α (TNF-α) in blood samples from PD patients (n = 86) and healthy controls (n = 40). Symptoms of fatigue, depression, anxiety and sleeping difficulties were assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT), the Hospital Anxiety and Depression Scale (HAD), and the Scales for Outcome in PD-Sleep Scale respectively.

Results

IL-6 was significantly higher in PD patients than in healthy controls. Compared to healthy controls, PD patients displayed significantly higher mean scores on HAD and lower scores on FACIT, thus indicating more severe symptoms as measured with these scales. Within the PD sample, high levels of both sIL-2R and TNF-α were significantly associated with more severe symptoms assessed by means of FACIT and HAD (depression and anxiety subscales). SIL-2-R levels were able to significantly predict FACIT and HAD scores after the effects of age, gender, anti-parkinsonian medications, and severity of motor symptoms were controlled for.

Discussion

We suggest that non-motor symptoms in PD patients, such as fatigue and depressive symptoms, might be generated via inflammatory mechanisms. This knowledge might contribute to the development of novel treatment options in PD, specifically targeting non-motor symptoms.     

Cortical cerebral atrophy in patients with Parkinson’s disease: New opportunities for in vivo diagnostics

The Parkinson’s disease (PD) pathology is not limited to degeneration of the nigrostriatal dopaminergic system, but also includes the wide lesion of various regions of cerebral cortex. In our study we aimed to identify differences in the brain cortical thickness in patients with early and advanced PD using MRI morphometry. Sixty-seven patients with Hoehn–Yahr stages 2 and 3 were examined. All patients underwent MRI with subsequent post-processing and estimation of cortical thickness values in different brain regions. Significant differences in the visual and cingulate cortex, fusiform gyri, frontopolar zone of a dominant hemisphere, and Brodmann’s areas 1, 2, 3, and 4 of a non-dominant hemisphere were obtained. These data show relationship between the non-motor manifestations of PD and degeneration of certain cortical regions of the brain.