TMS excitability study in essential tremor: Absence of gabaergic changes assessed by silent period recordings

BACKGROUND: Essential tremor (ET) is thought to emerge from activity in a distributed cerebello-thalamo-cortical network. It has been proposed that the network goes into oscillation because of abnormal GABAergic inhibitory transmission. OBJECTIVE: To test this idea by investigating GABAergic circuitry in motor cortex using transcranial magnetic stimulation (TMS). METHODS: Motor cortex excitability was examined using TMS in 21 patients with essential tremor and in 20 control subjects. Resting and active motor threshold (RMT, AMT) and input-output curves examined corticospinal excitability. Contralateral silent period (cSP) at a different range of stimulation intensities, and the ipsilateral silent period (iSP) using a stimulus intensity of 150% RMT were used as measures of GABAergic function. RESULTS: RMT and AMT were significantly lower in patients than controls and patients had a steeper I/O curve. However, there were no significant differences in either cSP at different intensities or in iSP. CONCLUSION: We found no evidence in favour of the GABA hypothesis in ET

Antibodies against gonadotropin-releasing hormone (GnRH) and destruction of enteric neurons in 3 patients suffering from gastrointestinal dysfunction

Background: Antibodies against gonadotropin-releasing hormone (GnRH) and gastrointestinal dysmotility have been found after treatment with GnRH analogues. The aim of this study was to examine the presence of such antibodies in patients with dysmotility not subjected to GnRH treatment and study the anti-GnRH antibody effect on enteric neurons viability in vitro. Methods: Plasma and sera from 3 patients suffering from either enteric dysmotility, irritable bowel syndrome (IBS) or gastroparesis were analysed for C-reactive protein (CRP), and for GnRH antibodies and soluble CD40 by ELISA methods. Primary cultures of small intestinal myenteric neurons were prepared from rats. Neuronal survival was determined after the addition of sera either from the patients with dysmotility, from healthy blood donors, antiserum raised against GnRH or the GnRH analogue buserelin. Only for case 1 a full-thickness bowel wall biopsy was available for immunohistochemical analysis. Results: All 3 patients expressed antibodies against GnRH. The antibody titer correlated to the levels of CD40 (r(s) = 1.000, p < 0.01), but not to CRP. Serum from case 3 with highest anti-GnRH antibody titer, and serum concentrations of sCD40 and CRP, when added to cultured rat myenteric neurons caused remarkable cell death. In contrast, serum from cases 1 and 2 having lower anti-GnRH antibody titer and lower sCD40 levels had no significant effect. Importantly, commercial antibodies against GnRH showed no effect on neuron viability whereas buserelin exerted a protective effect. The full-thickness biopsy from the bowel wall of case 1 showed ganglioneuritis and decrease of GnRH and GnRH receptor. Conclusion: Autoantibodies against GnRH can be detected independently on treatment of GnRH analogue. Whether the generation of the antibody is directly linked to neuron degeneration and chronic gastrointestinal symptoms in patients with intestinal dysmotility, remains to be answered

Risk factors and in-hospital outcomes in stroke and myocardial infarction patients

BACKGROUND: Acute stroke (AS) and acute myocardial infarction (AMI) share major risk factors such as age, gender, and high blood pressure. The main objective of this study was to compare vascular risk factor profiles with in-hospital outcomes in AS and AMI patients. METHODS: We evaluated 486 consecutive patients who were admitted to Bjelovar General Hospital with diagnoses of AS (ischaemic stroke or intracerebral haemorrhage; N = 380) or AMI (N = 106) during a one year period. The frequency of risk factors and in-patient mortality rates were assessed in both groups. For statistical analysis we used t-tests and χ(2 )tests. RESULTS: AS patients were significantly older than AMI patients: the mean age for AS patients was 68.9 ± 9.1 years, and for AMI patients was 62.8 ± 11.7 years (p < 0.001). AMI was significantly more common than AS in patients younger than 65 years; 51% of this group had AMI and 26% had AS (p < 0.001). Hypertension was a more common risk factor in AS patients (69% AS patients vs. 58% AMI patients; p = 0.042). Patients who died did not differ significantly in age between the groups. In-patient mortality rates were significantly higher in AS than AMI cases (31% vs. 12%, p < 0.001 for all patients; 37% vs.5%, p < 0.001 for men). Women hospitalized for AMI were more likely to die in hospital than men (28% vs. 5%; p = 0.002). CONCLUSIONS: We found that age at the time of presentation was a significant differentiating factor between patients with AS and AMI. The only exceptions were women, whose ages at the onset of AS and AMI were similar. In contrast, patients who died did not differ significantly in age. We observed significantly higher inpatient mortality for men (when adjusted for age) than for women with AS. The five-fold higher in-patient mortality rate in women than in men with AMI is most likely to have resulted from other factors related to treatment

Prevalence and determinants of Internet Addiction among medical students and its association with depression

Background: Internet addiction has been a topic of discussion in the academic literature for many years. As of April 2020, about 60 % of the world's population (nearly 4.6 billion people) were active internet user in their early adulthood. The prevalence among adolescent and college students ranged from 0.9 % to 33 %. The current study aimed to explore internet addiction's prevalence and correlates among undergraduate medical students at an Egyptian university. Also, to assess the relationship between internet addiction, depression symptoms, and socioeconomic status. Methods: A cross-sectional study of 321 undergraduate medical students at Assiut University using the Internet Addiction Scale, Patient Health Questionnaire, and Family Affluence Scale. Results: About 9 % of the study participants screened positive for internet addiction. The most important determinants among medical students were sex, mother's employment status, family affluence, depressive symptoms, and unmonitored internet access. Limitations: We did not investigate another psychiatric disease, daily time of internet usage, most frequent time of usage, type of internet usage, and cost of use. Conclusions: Internet Addiction is an important psychological problem affecting about 9 % of Assiut university medical students during their undergraduate stage, which may interfere with their lives and studies. Students with lower Internet addiction rates were female students whose mothers were employed, lived in a low affluence family, had fewer depressive symptoms, and had unmonitored internet privacy

Changes in recruitment of motor cortex excitation and inhibition in patients with drug-induced tardive syndromes

OBJECTIVES: It has recently been suggested that drug-induced tardive syndromes (TS) might be due to maladaptive plasticity, which increases motor excitability in cerebral cortex and basal ganglia. In order to test this hypothesis, we performed the first measurements of cortical excitability in TS. METHODS: Motor cortex excitability was examined using transcranial magnetic stimulation (TMS) in 22 TS patients and compared with that in 20 age and sex-matched healthy individuals. Resting and active motor threshold (RMT, AMT) and input-output curves (I/O curves) assessed corticospinal excitability. The duration of the contralateral silent period (cSP) at a range of stimulation intensities and ipsilateral silent period (iSP) were used as measures of inhibition. RESULTS: There were no significant differences in RMT and AMT between patients and controls, although the input-output curves were significantly steeper in patients. The cSP (at different stimulus intensities) and iSP were both longer in the patients compared to the control group. However, most of this difference could be accounted for by increased recruitment of motor evoked potentials (MEPs) in patients. CONCLUSION: TS is characterized by hyperexcitability of corticospinal output that might contribute to the lack of selectivity in muscle recruitment and contribute to excess involuntary movement. The findings are opposite to those in naturally-occurring hyperkinesia such as Sydenham's and Huntington's chorea, suggesting a fundamental difference in the pathophysiology

Archean to Recent aeolian sand systems and their preserved successions: current understanding and future prospects

The sedimentary record of aeolian sand systems extends from the Archean to the Quaternary, yet current understanding of aeolian sedimentary processes and product remains limited. Most preserved aeolian successions represent inland sand-sea or dunefield (erg) deposits, whereas coastal systems are primarily known from the Cenozoic. The complexity of aeolian sedimentary processes and facies variability are under-represented and excessively simplified in current facies models, which are not sufficiently refined to reliably account for the complexity inherent in bedform morphology and migratory behaviour, and therefore cannot be used to consistently account for and predict the nature of the preserved sedimentary record in terms of formative processes. Archean and Neoproterozoic aeolian successions remain poorly constrained. Palaeozoic ergs developed and accumulated in relation to the palaeogeographical location of land masses and desert belts. During the Triassic, widespread desert conditions prevailed across much of Europe. During the Jurassic, extensive ergs developed in North America and gave rise to anomalously thick aeolian successions. Cretaceous aeolian successions are widespread in South America, Africa, Asia, and locally in Europe (Spain) and the USA. Several Eocene to Pliocene successions represent the direct precursors to the present-day systems. Quaternary systems include major sand seas (ergs) in low-lattitude and mid-latitude arid regions, Pleistocene carbonate and Holocene–Modern siliciclastic coastal systems. The sedimentary record of most modern aeolian systems remains largely unknown. The majority of palaeoenvironmental reconstructions of aeolian systems envisage transverse dunes, whereas successions representing linear and star dunes remain under-recognized. Research questions that remain to be answered include: (i) what factors control the preservation potential of different types of aeolian bedforms and what are the characteristics of the deposits of different bedform types that can be used for effective reconstruction of original bedform morphology; (ii) what specific set of controlling conditions allow for sustained bedform climb versus episodic sequence accumulation and preservation; (iii) can sophisticated four-dimensional models be developed for complex patterns of spatial and temporal transition between different mechanisms of accumulation and preservation; and (iv) is it reasonable to assume that the deposits of preserved aeolian successions necessarily represent an unbiased record of the conditions that prevailed during episodes of Earth history when large-scale aeolian systems were active, or has the evidence to support the existence of other major desert basins been lost for many periods throughout Earth history