Transkranielle Magnetstimulation (TMS)- Einflussfaktoren auf die kortikale Erregbarkeit und Retest-Reliabilität der TMS

Die transkranielle Magnetstimulation (TMS) ist ein Verfahren zur Messung der kortikalen Erregbarkeit beim Menschen. Letztere ist durch verschiedene Einflüsse veränderbar und wird in pharmakologischen Studien zur Bestimmung eines Effektprofils, aber auch zu Therapie-zwecken, eingesetzt. Verschiedene neurologische Erkrankungen gehen dabei mit einer veränderten kortikalen Erregbarkeit einher. Bei Epilepsien sind je nach Syndrom verschiedene Parameter sowohl der Inhibition als auch der Exzitation verändert. Der Einfluss von Antikonvulsiva als zentralnervös wirksame Substanzen zum Erreichen einer Anfalls-freiheit wurde untersucht. Die vorliegenden Arbeiten befassten sich einerseits mit stoffwechsel¬bedingten und genetischen Einflussfaktoren auf die mittels TMS gemessene kortikale Erregbarkeit sowie der Retest- Reliabilität, d.h. der Güte der Wiederholbarkeit der TMS. Die prospektive Untersuchung von Patienten mit einer Hyperkalzämie im Rahmen einer endokrinologischen Erkrankung (primärer Hyperparathyroidismus) konnte keine Veränderung der Exzitabilität durch einen geänderten Kalziumspiegel nach erfolgreicher Operation nachweisen. In einer weiteren Studie konnte bei gesunden Probanden mit einem Genpolymorphismus des SCN1A-Gens, ein differenzieller Einfluss desselbigen auf einen inhibitorischen Parameter, nach Einnahme des Natrium¬kanalblockers Carbamazepin, nachgewiesen werden. Die TMS kann hier einen Beitrag zur Klärung pharma¬kogenetischer Einflüsse leisten. Die Messgüte der TMS, im Sinne einer guten Wiederholbarkeit, ist für die meisten Einzel- und Doppelpuls-Parameter, bei einem gut definierten Kollektiv von gesunden Probanden unter Einbeziehung von weiblichen Studienteilnehmern in einer anderen eingegangenen Studie, objektiviert worden. Die TMS ist als non-invasives Verfahren zur Messung der kortikalen Erregbarkeit ein für viele Bereiche einsetzbares, robustes Instrument, welches vor allem in Kombination mit weiteren Messtechniken als wertvolles Instrument für die neurophysiologische Forschung eingesetzt werden kann

Auricular Acupuncture for Pain Relief after Ambulatory Knee Arthroscopy—A Pilot Study

Auricular acupuncture (AA) is effective in treating various pain conditions, but there have been no analyses of AA for the treatment of pain after ambulatory knee surgery. We assessed the range of analgesic requirements under AA after ambulatory knee arthroscopy. Twenty patients randomly received a true AA procedure (Lung, Shenmen and Knee points) or sham procedure (three non-acupuncture points on the auricular helix) before ambulatory knee arthroscopy. Permanent press AA needles were retained in situ for one day after surgery. Post-operative pain was treated with non-steroidal anti-inflammatory ibuprofen, and weak oral opioid tramadol was used for rescue analgesic medication. The quantity of post-operative analgesics and pain intensity were used to assess the effect of AA. The incidence of analgesia-related side effects, time to discharge from the anesthesia recovery room, heart rate and blood pressure were also recorded. Ibuprofen consumption after surgery in the AA group was lower than in the control group: median 500 versus 800 mg, P = 0.043. Pain intensity on a 100 mm visual analogue scale for pain measurement and other parameters were similar in both groups. Thus AA might be useful in reducing the post-operative analgesic requirement after ambulatory knee arthroscopy

Efficacy of Anti-Inflammatory Therapy in a Model of Acute Seizures and in a Population of Pediatric Drug Resistant Epileptics

Targeting pro-inflammatory events to reduce seizures is gaining momentum. Experimentally, antagonism of inflammatory processes and of blood-brain barrier (BBB) damage has been demonstrated to be beneficial in reducing status epilepticus (SE). Clinically, a role of inflammation in the pathophysiology of drug resistant epilepsies is suspected. However, the use anti-inflammatory drug such as glucocorticosteroids (GCs) is limited to selected pediatric epileptic syndromes and spasms. Lack of animal data may be one of the reasons for the limited use of GCs in epilepsy. We evaluated the effect of the CG dexamethasone in reducing the onset and the severity of pilocarpine SE in rats. We assessed BBB integrity by measuring serum S100β and Evans Blue brain extravasation. Electrophysiological monitoring and hematologic measurements (WBCs and IL-1β) were performed. We reviewed the effect of add on dexamethasone treatment on a population of pediatric patients affected by drug resistant epilepsy. We excluded subjects affected by West, Landau-Kleffner or Lennox-Gastaut syndromes and Rasmussen encephalitis, known to respond to GCs or adrenocorticotropic hormone (ACTH). The effect of two additional GCs, methylprednisolone and hydrocortisone, was also reviewed in this population. When dexamethasone treatment preceded exposure to the convulsive agent pilocarpine, the number of rats developing status epilepticus (SE) was reduced. When SE developed, the time-to-onset was significantly delayed compared to pilocarpine alone and mortality associated with pilocarpine-SE was abolished. Dexamethasone significantly protected the BBB from damage. The clinical study included pediatric drug resistant epileptic subjects receiving add on GC treatments. Decreased seizure frequency (≥50%) or interruption of status epilepticus was observed in the majority of the subjects, regardless of the underlying pathology. Our experimental results point to a seizure-reducing effect of dexamethasone. The mechanism encompasses improvement of BBB integrity. Our results also suggest that add on GCs could be of efficacy in controlling pediatric drug resistant seizures

Imaging of the spleen in malaria

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Real-Time Imaging Reveals the Dynamics of Leukocyte Behaviour during Experimental Cerebral Malaria Pathogenesis

During experimental cerebral malaria (ECM) mice develop a lethal neuropathological syndrome associated with microcirculatory dysfunction and intravascular leukocyte sequestration. The precise spatio-temporal context in which the intravascular immune response unfolds is incompletely understood. We developed a 2-photon intravital microscopy (2P-IVM)-based brain-imaging model to monitor the real-time behaviour of leukocytes directly within the brain vasculature during ECM. Ly6Chi monocytes, but not neutrophils, started to accumulate in the blood vessels of Plasmodium berghei ANKA (PbA)-infected MacGreen mice, in which myeloid cells express GFP, one to two days prior to the onset of the neurological signs (NS). A decrease in the rolling speed of monocytes, a measure of endothelial cell activation, was associated with progressive worsening of clinical symptoms. Adoptive transfer experiments with defined immune cell subsets in recombinase activating gene (RAG)-1-deficient mice showed that these changes were mediated by Plasmodium-specific CD8+ T lymphocytes. A critical number of CD8+ T effectors was required to induce disease and monocyte adherence to the vasculature. Depletion of monocytes at the onset of disease symptoms resulted in decreased lymphocyte accumulation, suggesting reciprocal effects of monocytes and T cells on their recruitment within the brain. Together, our studies define the real-time kinetics of leukocyte behaviour in the central nervous system during ECM, and reveal a significant role for Plasmodium-specific CD8+ T lymphocytes in regulating vascular pathology in this disease. © 2014 Pai et al

Telehealth for Transition Age Youth and Young Adults: Privacy, Emotional Safety and Welfare During Covid-19 and Beyond

The past few months have seen a boom in the use of telehealth for providing mental health services as agencies and providers rapidly adapt to the challenges posed by the Covid-19 pandemic. Along with this has come a proliferation of guidance documents and tip sheets on responsibly engaging clients in telehealth. The tips that follow provide options for protecting the emotional safety, privacy and welfare of transition-age youth and young adults while they are participating in virtual mental health care. These were compiled over the course of several conversations with providers currently working with this population, including youth peer support specialists, clinicians, and supervisors. This list is intended as a starting point as services evolve to meet the challenges of this new era

Practice Brief: Supporting the Youth Peer Workforce

Peer support is fast emerging as a promising and widely endorsed addition to the array of mental health services available to young people experiencing serious mental health conditions, yet very little is known about the peer support workforce in general, and even less about the peer workforce engaged specifically in providing services to youth and young adults. While the need for more research into this developing professional population is evident, what data we do have available indicates several challenges that have frequently shown up in implementing the youth peer role, as well as several common themes around what youth peer support specialists need in order to be successful in their positions. This brief may be of interest for anyone preparing to implement the youth peer role in their organization, those who have already introduced the role and may be looking for further guidance around organizational policy and procedure, and anyone who provides training, coaching or supervision to youth peers

Transkranielle Magnetstimulation (TMS)- Einflussfaktoren auf die kortikale Erregbarkeit und Retest-Reliabilität der TMS

Die transkranielle Magnetstimulation (TMS) ist ein Verfahren zur Messung der kortikalen Erregbarkeit beim Menschen. Letztere ist durch verschiedene Einflüsse veränderbar und wird in pharmakologischen Studien zur Bestimmung eines Effektprofils, aber auch zu Therapie-zwecken, eingesetzt. Verschiedene neurologische Erkrankungen gehen dabei mit einer veränderten kortikalen Erregbarkeit einher. Bei Epilepsien sind je nach Syndrom verschiedene Parameter sowohl der Inhibition als auch der Exzitation verändert. Der Einfluss von Antikonvulsiva als zentralnervös wirksame Substanzen zum Erreichen einer Anfalls-freiheit wurde untersucht. Die vorliegenden Arbeiten befassten sich einerseits mit stoffwechsel¬bedingten und genetischen Einflussfaktoren auf die mittels TMS gemessene kortikale Erregbarkeit sowie der Retest- Reliabilität, d.h. der Güte der Wiederholbarkeit der TMS. Die prospektive Untersuchung von Patienten mit einer Hyperkalzämie im Rahmen einer endokrinologischen Erkrankung (primärer Hyperparathyroidismus) konnte keine Veränderung der Exzitabilität durch einen geänderten Kalziumspiegel nach erfolgreicher Operation nachweisen. In einer weiteren Studie konnte bei gesunden Probanden mit einem Genpolymorphismus des SCN1A-Gens, ein differenzieller Einfluss desselbigen auf einen inhibitorischen Parameter, nach Einnahme des Natrium¬kanalblockers Carbamazepin, nachgewiesen werden. Die TMS kann hier einen Beitrag zur Klärung pharma¬kogenetischer Einflüsse leisten. Die Messgüte der TMS, im Sinne einer guten Wiederholbarkeit, ist für die meisten Einzel- und Doppelpuls-Parameter, bei einem gut definierten Kollektiv von gesunden Probanden unter Einbeziehung von weiblichen Studienteilnehmern in einer anderen eingegangenen Studie, objektiviert worden. Die TMS ist als non-invasives Verfahren zur Messung der kortikalen Erregbarkeit ein für viele Bereiche einsetzbares, robustes Instrument, welches vor allem in Kombination mit weiteren Messtechniken als wertvolles Instrument für die neurophysiologische Forschung eingesetzt werden kann

Azolla sporophytes and spores from the late cretaceous and Paleocene of Patagonia, Argentina

Premise of research. While Azolla has a rich fossil record based on dispersed megaspore apparatuses and microspore massulae, fossil sporophytes are relatively rare. In this contribution, we describe two fossil Azolla species based on both sporophytes and spores from Chubut Province, Patagonia, Argentina: Azolla coloniensis De Benedetti & Zamaloa, emend. Hermsen et al., and A. keuja Jud et al., sp. nov. Azolla coloniensis and A. keuja are the first fossil species of Azolla to be represented by vegetative structures (i.e., leaves, stems, and roots) from both South America and the Southern Hemisphere. Methodology. We examined sporophyte material of A. coloniensis from the Cañadón del Irupé locality, Upper Cretaceous, La Colonia Formation, and A. keuja from the Palacio de los Loros locality PL-2, Paleocene, Salamanca Formation. Spores of A. keuja were obtained from a sporophyte specimen and its surrounding rock matrix. Material was studied using standard light microscopy, epifluorescence microscopy, and scanning electron microscopy. Fossils are held at the Museo Paleontológico Egidio Feruglio, Trelew, Chubut Province, Argentina. Pivotal results. Azolla coloniensis produced many-floated megaspore apparatuses and microspore massulae with anchor-tipped glochidia, placing it in the fossil Azolla section Florschuetzia. Azolla keuja sporophytes are structurally similar to those produced by the extant African species A. nilotica and the Late Cretaceous–Paleocene North American species A. schopfii in overall size, growth form, leaf structure, and production of fascicled roots; while all three taxa produce similar microspore massulae, the structure of their megaspore apparatuses differ. Azolla keuja cannot be assigned to any section of Azolla. Conclusions. Azolla coloniensis and A. keuja are important because they provide two new organismal concepts for extinct species of Azolla. Our inability to fully classify A. keuja to section, in combination with the great morphological diversity of fossil Azolla, indicates that a comprehensive reevaluation of phylogeny and taxonomy that incorporates both extant and fossil species is needed.Fil: Hermsen, Elizabeth J.. No especifíca;Fil: Jud, Nathan A.. Williams College; Estados UnidosFil: de Benedetti, Facundo. Museo Paleontologico Egidio Feruglio; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gandolfo, Maria Alejandra. Cornell University; Estados Unido