Dystrophic Stage Research Articles

Tomography features of the lamina cribrosa and its scleral canal in different types and stages of the diabetic optic neuropathy

AbstractLamina cribrosa morphology is ever changing in health and disease, and its changes might cause primary optic nerve damage and secondary damage due to decreasing of blood supplying and axoplasmic transport. Anatomical narrowing of the lamina cribrosa scleral canal may be a precondition of optic nerve and retina damage in diabetes mellitus (DM).Purpose: to define the tomography changes of lamina cribrosa (LC) and its scleral canal depending on type and stage of diabetic optic neuropathy (DON).Methods: 575 patients (1150 eyes) with type 2 DM and 50 non‐diabetic control persons (100 eyes) aged 55.9 ± 7.8 years were examined. LC thickness was measured with optical coherent tomography (OCT) using LC_Thickness_programm.m and main_low_noise_filters_programm.m. The area of LC scleral canal was measured with SD OCT using the LC_cut_position_programm.m and LC_diameter_calculation_programm.m.Results: A correlation between type and stage of DON and LC thickness in diabetic patients was found. An average index of LC thickness in diabetic patients without DON was 1.4 times higher than in controls; in subclinical stage of axial DON – 1.9 times higher, in initial stage – 2.1 times higher, in severe stage of axial DON and diabetic papillopathy – 2.6 times higher, in anterior ischemic DON – 2.7 times higher, in dystrophic stage – 3.1 times higher than in controls (303 ± 56 μm) (р < 0.001). Scleral canal area in diabetic papillopathy was 35% less and in anterior ischemic DON was 21.6% less than that in controls. A direct correlation between the area of LC scleral canal and the state of optic nerve head was found in diabetic papillopathy and ischemic DON (r = 0.89, р < 0.001 and r = 0.93, р < 0.001 соrrespondingly).Conclusions: A direct correlation between type and stage of DON and scleral LC thickness in patients with DM was revealed. Narrowing of LC scleral canal and thickening of LC were found to change in diabetic papillopathy and ischemic DON.

Effects of Mirror Therapy in Stroke Patients With Complex Regional Pain Syndrome Type 1: A Randomized Controlled Study

ObjectiveTo investigate the effects of mirror therapy on upper limb motor functions, spasticity, and pain intensity in patients with hemiplegia accompanied by complex regional pain syndrome type 1. DesignRandomized controlled trial. SettingTraining and research hospital. ParticipantsAdult patients with first-time stroke and simultaneous complex regional pain syndrome type 1 of the upper extremity at the dystrophic stage (N=30). InterventionsBoth groups received a patient-specific conventional stroke rehabilitation program for 4 weeks, 5d/wk, for 2 to 4h/d. The mirror therapy group received an additional mirror therapy program for 30min/d. Main Outcome MeasuresWe evaluated the scores of the Brunnstrom recovery stages of the arm and hand for motor recovery, wrist and hand subsections of the Fugl-Meyer Assessment (FMA) and motor items of the FIM-motor for functional status, Modified Ashworth Scale (MAS) for spasticity, and visual analog scale (VAS) for pain severity. ResultsAfter 4 weeks of rehabilitation, both groups had significant improvements in the FIM-motor and VAS scores compared with baseline scores. However, the scores improved more in the mirror therapy group than the control group (P<.001 and P=.03, respectively). Besides, the patients in the mirror therapy arm showed significant improvement in the Brunnstrom recovery stages and FMA scores (P<.05). No significant difference was found for MAS scores. ConclusionsIn patients with stroke and simultaneous complex regional pain syndrome type 1, addition of mirror therapy to a conventional stroke rehabilitation program provides more improvement in motor functions of the upper limb and pain perception than conventional therapy without mirror therapy.

Non-Pollen Palynomorphs Characteristic for the Dystrophic Stage of Humic Lakes in the Wigry National Park, Ne Poland

Abstract The numerous dystrophic (humic) lakes are a very important feature of Wigry National Park, NE Poland. As the most recent palaeoecological data indicate, at the beginning of its development (in the Late Glacial and Early and Middle Holocene) these water bodies functioned as harmonious lakes, and their transformation into dystrophic lakes and the stabilization of the trophic state took place at the beginning of the Subboreal. Palynological analysis of sediments from two such lakes (Lake Ślepe and Lake Suchar II), with special emphasis on non-pollen palynomorphs (NPPs), was aimed at a detailed biological characterization of dystrophic lakes during their long-lasting existence. The obtained results allowed for the designation of organisms characteristic for dystrophic lakes, of which representatives appeared with the decreasing pH of the water and the formation of Sphagnum peat around lakes. These organisms were divided into four groups: algae, fungi, testate amoebas, and animals. Their representatives appear invarious developmental stages of dystrophic lakes.

Complex regional pain syndrome (CRPS), a review

Complex regional pain syndrome is a chronic and painful condition that affects the quality of life of patients. It is usually triggered by a traumatic event of the soft tissues involving the nervous tissue. Although the factors that cause the syndrome are varied and not well known, different etiopathologic concepts have been proposed to explain the presence of this syndrome, such as autonomic dysfunction and changes in CNS plasticity, among others. The patient characteristically presents pain, sensory abnormalities, vasomotor disturbances in the skin, edema, changes in sweating, and motor alterations. The pain is associated with changes in the autonomic nervous system and has a distal predominance. Since there is no definitive diagnostic test, diagnosis is mainly based on a complete medical history and physical examination. Treatment is multidisciplinary and based on pain relief. Although in most cases evolution is favorable, rapid diagnosis and treatment are recommended to avoid dystrophic stage as much as possible.

Persistence of regenerative myogenesis in spite of down-regulation of activity-dependent genes in long-term denervated rat muscle

Contrary to general expectation, in humans, we have recently shown that after complete conus cauda lesion, the lower motoneuron denervated myofibers may survive several years. In adult rats, the sciatectomized muscle progresses in 4–6 months from severe atrophy to a dystrophic stage and undergoes a dramatic weight loss; during this process, myofiber death/regeneration processes maintain a decreasing population of very small, but vital myofibers. At the same time, in vitro electrophysiologic recordings show that denervated fibers can maintain membrane excitability longer than they can retain contractile properties. A certain level of myofiber regeneration seems to have a role in the process, with the early re-expression of embryonic subunits of integrins and acetylcholine receptor subunits. In the present work, using the reliable real-time quantitative PCR, we confirm the long-lasting occurrence of myoblast proliferation-dependent events and their focal nature. In fact, we show here that in sciatectomized muscle, the expression of 12 selected genes was differentially regulated after 3 and 9 month denervation. At both time points, indexes of muscle activity/inactivity and tissue remodeling (proteolysis, energy usage and angiogenic factors) were down-regulated, while indexes of regenerative myogenesis (Myogenin, MyoD, MRF4 and MHCemb) were up-regulated. Immunohistochemistry with anti-MHCemb and anti-NCAM monoclonal antibodies show that such regeneration events were focally distributed. We conclude that myofiber regeneration is a non-compensatory mechanism, which prolongs the chance of reinnervation during long-lasting denervation. It may also contribute to muscle recovery in paraplegic patients, even when rehabilitation strategies based on functional electric stimulation start late after spinal cord injury (SCI).

MULTIDISCIPLINARY PAIN ABSTRACTS: 34 . Neurology (34)

Because recent studies emphasized the role of peripherally distributed N‐methyl‐D‐aspartate (NMDA) receptors in processing the nociceptive information, the authors investigated whether peripheral application of the ointment containing ketoconazole (KET) is able to attenuate the symptoms of local neuropathic pain. They applied ointment containing KET (0.25%–1.5%) to the affected area on limbs in five patients with complex regional pain syndrome type I (CRPS I) and in two patients with type II (CRPS II). One to 2 weeks later, they observed improvement of the report of pain intensity, measured by the visual analog scale, in four patients with acute early dystrophic stage of CRPS I. Swelling of the affected limbs subsided as well. No apparent changes were noticed in one patient with chronic atrophic stage of CRPS I and in both patients with CRPS II. The authors concluded that topical application of KET appears to be beneficial for the patients with acute early dystrophic stage of CRPS I because of either its local anesthetic effect or NMDA receptor antagonist action. Patients with chronic atrophic stage of CRPS I and CRPS II patients do not appear to respond to this treatment.

Analgesic effects of ketamine ointment in patients with complex regional pain syndrome type 1

Objective: Ketamine hydrochloride (KET), an agent used for general anesthesia, has local anesthetic effects and N-methyl-D-aspartate (NMDA) receptor antagonist action. Because recent studies emphasized the role of peripherally distributed NMDA receptors in processing the nociceptive information, we investigated whether peripheral application of the ointment containing KET is able to attenuate the symptoms of local neuropathic pain. Case Reports: We applied ointment containing KET (0.25%-1.5%) to the affected area on limbs in 5 patients with complex regional pain syndrome type I (CRPS I) and in 2 patients with type II (CRPS II). One to 2 weeks later, we observed improvement of the report of pain intensity, measured by the visual analog scale, in 4 patients with acute early dystrophic stage of CRPS I. Swelling of the affected limbs subsided as well. No apparent changes were noticed in 1 patient with chronic atrophic stage of CRPS I and in both patients with CRPS II. Conclusion: Topical application of KET appears to be beneficial for the patients with acute early dystrophic stage of CRPS I because of either its local anesthetic effect or NMDA receptor antagonist action. Patients with chronic atrophic stage of CRPS I and CRPS II patients do not appear to respond to this treatment. Reg Anesth Pain Med 2002;27:524-528.

Histologic and Cell Kinetic Studies of Hair Loss and Subsequent Recovery Process of Human Scalp Hair Follicles Grafted onto Severe Combined Immunodeficient Mice

To establish a model for studying human scalp hair, individually isolated hair follicles were grafted onto back skin of severe combined immunodeficient mice. Histologic changes and cell kinetics in the hair loss and subsequent recovery process were investigated. In the dystrophic stage (from day 7 to 30), all the hair shafts became dystrophic and were shed. Thickening and corrugation of vitreous membrane, apoptosis, and regression of the lower part were observed in the grafted hair follicles. 5-bromo-2'-deoxy-uridine-labeled cells were not detected in the lower end of the follicles, and keratin 19-positive cells appeared there. At the end of this stage their lower part was maximally retracted, secondary germ remained beneath the bulge, and the vitreous membrane disappeared. In the regeneration stage (from day 30 to 50), the same histologic findings as those at the end of the dystrophic stage were observed. The keratin 19-positive cells in the secondary germ, however, were replaced with keratin 19-negative and 5-bromo-2'-deoxy-uridine-labeled cells. Then, differentiation into an inner root sheath and a hair shaft began, and apoptosis was terminated. In the stable growth stage (from day 40 to at least 150), the grafted follicles were immunohistochemically and light microscopically identical with the normal anagen hair follicles except for the presence of melanin incontinence. These findings suggest that the grafted hair follicles entered into dystrophic catagen, subsequently dystrophic telogen, then returned to normal anagen follicles, and that stem cells or their close progeny in the secondary germ play an important part in the recovery process.

Kinetics of corneal fluorescence in experimental keratitis

It was shown by the method of scanning photometry suggested by the authors that rabbits with experimentally-induced keratitis displayed a three-phasic reaction of the area of the corneal burn: that of the enhanced fluorescein sorption at the reactive phase: that of the loss of the sorption capacity in the dystrophic stage, and that of the secondary absorption intensification during the regenerative stage. The mentioned phasic changes can be used for the diagnosis and objective assessment of the clinical course of keratitis.