Archives of Neuroscience
Volume:6 Issue: 4, Oct 2019

Radiation-induced lumbosacral plexopathy is still under-recognized although its symptomatology can really lower the quality of life and impair self-sufficient functions of patients often cured of cancer.

This review aimed to depict radiation-induced lumbosacral plexopathy through a systematic review of the available literature and discuss various aspects of the clinical management of this pathology.

We searched for all English medical papers registered in Web of Knowledge, PubMed, Google Scholar, and ScienceDirect from January 1990 to November 2018.

 From among all articles concerning radiotherapy and lumbosacral plexopathy, we included papers that dealt with human samples and excluded non-human samples and case reports.

Out of 1,312 articles, we selected 42 articles of which 21 met the eligibility criteria and were included in the present analysis. Five papers were general reviews, three focused on the diagnosis of disease, three analyzed the role of different therapies, and the remaining 10 articles concerned the methodology of radiation therapy.

In the next future, we must analyze the dosimetry parameters and the clinical parameters, with appropriate follow-up times, thus providing sufficient data to use for developing organ sparing strategies tailored to individual patients. Therefore, we can reduce this type of side effects that have a huge impact on the quality of life of patients.

Dysphagia is one of the common symptoms observed in more than 80% of patients with Parkinson disease (PD). Dysphagia is a potentially harmful feature that leads to the reduction of the quality of life, malnutrition, and aspiration pneumonia, which is one of the main causes of death in patients with PD. The current study aimed at reviewing therapeutic approaches to dysphagia treatment in PD.
Evidence Acquisition: MEDLINE literature through PubMed until 2017 was reviewed.

Studies on the dysphagia treatment approaches in PD are very diffuse. These studies include the conventional rehabilitation of dysphagia, as well as behavioral-instrumental and electrophysiological treatments. Despite the usefulness of these treatments, due to the poor quality of such studies, the generalization of their results is limited.

It appears that a combination of treatments provides satisfactory results. Therefore, it is necessary to use new treatment methods in addition to the conventional treatments.

Although anxiety is an important mediator of generalized anxiety disorder (GAD), there is inadequate evidence to treat people particularly for anxiety symptoms that improve the state of health in people with GAD.

The present study with pretest and posttest design and experimental and control groups was conducted on patients with GAD in Shiraz, Iran. According to the tendency of the participants, structured diagnostic interview, and inclusion criteria, 20 patients were randomly selected for the treatment group and 20 subjects with GAD for the waitlist control group. Participants were given competitive memory training (COMET) for GAD in four sessions.

The current study findings showed that COMET decreased the rate of worry and anxiety.

The current study illustrated that the COMET protocol for GAD might have a positive effect on worry and anxiety

Epilepsy, which develops in the elderly, is recognized as a major health burden. Although health-related quality of life (HRQoL) is an essential element in the medical treatment of elderly patients with epilepsy, it is a question whether epilepsy and its treatment effectively influence the quality of life (QoL) in the elderly.

The current study aimed at evaluating the relationship between demographic and clinical aspects of epilepsy in HRQoL of elderly patients. Since HRQoL scores are bounded, the Kumaraswamy (Kum) regression model was used to analyze the data.

The current study was conducted on 766 elderly patients diagnosed with epilepsy taking at least one antiepileptic drug (AED) selected from six neurologic clinics in Iran. In addition to demographic information, the Liverpool seizure severity scale (LSSS), medication adherence report scale (MARS-5), and quality of life in epilepsy (QoLIE-31) questionnaire were completed for patients. Data were analyzed using multiple linear regression (MLR) and the Kum regression models.

Most of the patients included in the study had focal (70.2%) epilepsy. Mean duration of disease was 17.71 ± 4.56 years and the average number of seizures was 3.4 ± 3.2 episodes per month. The Kum regression model indicated that seizure frequency (β = -0.157, P < 0.0001) and LSSS score (β = -0.003, P = 0.009) were significant and negative predictors of overall QoLEI-31 score; MARS-5 score was a positive predictor of overall QoLEI-31 score (β = 0.014, P = 0.002). However, disease duration and serum AED level had no significant effects on overall QoLEI-31 score.

The findings suggested that increased seizure frequency and severity were associated with lower QoL and medication adherence was directly associated with HRQoL. The Kum regression could be a suitable alternative to the methods currently used in the analysis of HRQoL data

Previous studies indicated that intensity level might be a determining factor in the beneficial or adverse effects of exercise on spatial memory. As intensive exercise appears to deteriorate learning and memory and recent reports have suggested that one-night sleep deprivation improves mood and neurogenesis in depressed patients for at least one day. The present study was designed to investigate the effect of REM sleep deprivation (REM-SD) on memory impairment induced by intense exercise. Animals had undergone an intense protocol (speed: 18 m/min and no tilt for the first week, the duration and treadmill tilt were increased progressively, 10 minutes and five degrees increased in each week) of treadmill for five days a week for five weeks then deprived of sleep for 24 hours using the water-filled multiple platforms. The level of mammalian Target of Rapamycin (mTOR) in the hippocampus and the prefrontal cortex (PFC) was assessed by Western blotting. Five weeks of intensive exercise and 24h REM-SD were decreased the level of mTOR expression; 24h REM-SD improved intensive exercise-associated decreases in the basal levels of mTOR. The present data suggested that REM-SD might be considered as a compensatory factor for a short time. In addition, increasing in the mTOR level could improve memory impairment-induced by intensive exercise

In the pre-antiretroviral era, the frequency of neurologic complications was associated with low baseline CD4+ T-cell counts. Introduction of antiretroviral therapy (ART) has largely decreased the incidence of opportunistic infections and CNS neoplasia in the recent two decades; however, virus replication persists in the cerebrospinal fluid (CSF) and neuronal tissues due to variable drug penetration as well as development of drug resistance. Although many previous studies have addressed the presence of neurologic manifestations in the course of HIV infection; an update on the type of neurologic involvement, presenting signs and symptoms, radiologic findings, and response to treatment is essential.

In a case series, we recruited 42 patients presenting with neurologic symptoms/signs and concomitant HIV infection in 12 months during 2015 and 2016 at a tertiary academic hospital. Information regarding the course of diagnosis, laboratory findings, radiologic findings, and final diagnosis were documented and analyzed in relation to the survival status of each patient during up to one month of hospitalization.

The mean age of the patients was 39.7; 25 were men, 19 were newly diagnosed. Thirteen patients (31%) died during treatment; from them, six were newly diagnosed. Median CSF white blood cell counts were significantly higher in nonsurvivors; the most common diagnosis was focal brain lesions; toxoplasmosis and tuberculosis were the first common etiologies; 79% recovered with the intended treatment regimen. History of drug abuse, not receiving antiretrovirals, low baseline CD4 counts, and loss of consciousness at the time of admission has been seen more among deceased patients.

Neurologic presentations or complications of HIV infection lead to high mortality rates. Early diagnosis of infection and improvement of patient compliance with antiretroviral treatment can reduce the mortality associated with neurologic diseases.

Alginate scaffolds are extensively used in bone and cartilage tissue engineering because of their chemical similarity to the extracellular matrix. However, for the successful replacement of hard tissue, the properties of alginate scaffolds should be tailored. In this study, for the first time, we optimized the porosity, degradation rate, mechanical, and osteogenic properties of alginate scaffolds by the freeze-drying method. The freeze-drying method was used to prepare different concentrations of alginate scaffolds (4, 8, and 16% (w/v)). Their porosity, mechanical properties, surface-wetting behavior, and osteogenic properties were characterized. The results showed that the 8% (w/v) alginate scaffold had an interconnected porosity of about 80%, a hydrophilic surface with a contact angle of water on the surface of 39º ± 0.56, and compressive strength of 2.7 MPa. This concentration of alginate also showed the degradation rate of 70% in Dulbecco’s Modified Eagle’s Medium (DMEM) with fetal bovine serum. The periodontal ligament stem cells culture results confirmed that the 8% alginate scaffold had good biocompatibility and cell differentiation ability and it could enhance cell ingrowth and attachment. These results showed that the modified 8% (w/v) alginate scaffold is a good candidate in cartilage and bone tissue replacement

Understanding the consequences of perceived self-care ability in stroke patients living at home is of great importance, as it is associated with continuity of care, health promotion, and improved quality of life.

The current study aimed at determining the consequences of perceived self-care ability in stroke patients living at home in Iran.

In this qualitative study, conventional content analysis was performed. Both unstructured and semi-structured interviews were conducted with 10 patients, who had experienced chronic strokes. One interview was conducted at home, while nine others were conducted at the rehabilitation centers of Tehran, Iran. Sampling continued until reaching data saturation. All interviews were recorded, transcribed, and entered in MAXQDA. Content analysis was performed based on Graneheim and Lundman’s five-step approach.

Two main categories and three subcategories were extracted in this study. The two main categories included “promotion of adaptive strategies” (self-efficacy and adaptation to disability) and “maintaining a healthy lifestyle” (individual autonomy).

Based on the findings, the more patients are aware of their abilities and restrictions, the more they will be able to cope with the consequences of their disease during the transition from the acute to chronic phase; these patients can also adopt more suitable coping strategies

Despite the fact that many researches have been done in regards to spinal cord injury (SCI), it remains an undissolved problem that has an effect on the individual’s life and society. It could be due to complicated events that occur after SCI. Inflammation is an important initiator for after SCI events and low-level laser (LLL), which is known as an anti-inflammatory agent.

The aim of this study is the evaluation effects of LLL on the fibroblast invasion, axon number, and functional recovery after SCI.

Twenty-four adult male Wistar rats were randomly divided into three groups as control, SCI, SCI + laser. Thirty minutes after SCI that was induced by aneurysm clip LLL irritated for 45 seconds daily and continued for four weeks. Functional recovery by BBB score, fibroblast invasion by H&E, and Axons number by Bielschowsky silver staining was assessed.

The data indicated LLL therapy improved BBB score, increased axons number, and decreased fibroblasts invasion around cavity comparing to SCI animals (P < 0.001).

Our result showed that the initiation LLL therapy, in a short time after SCI, could be effective in the reduction of SCI side effects and improved functional recovery

Treatment satisfaction is a major contributor to treatment efficacy and its compliance in patients. Sleep disorders are among the common problems with insomnia as the epitome.

The current study aimed at assessing the degree to which patients with insomnia are satisfied with Persian medicine (PM) therapies.

The current cross-sectional study was conducted in the PM Healthcare Clinic affiliated to Iran University of Medical Sciences in 2017. A total of 100 patients with insomnia signed written informed consent and completed the insomnia severity index (ISI) before and one month after receiving PM therapies. Moreover, patients completed the treatment satisfaction questionnaire after completion of the treatment course. The results were analyzed with SPSS software.

The ISI total score changed from 16.49 ± 3.87 to 12.53 ± 4.59 at the end of the study (P < 0.001). The score changed for all ISI items was statistically significant, except for the item “noticeability of sleep problems by others”. It was found that 76% of the subjects were satisfied with the efficacy of the treatments, 71% expressed satisfaction with the convenience and appropriateness of treatments, 81% did not report any complications using PM therapies, and 91% had an overall satisfaction with the treatments.

PM therapeutic procedures can be effective in treating insomnia. According to the patients’ satisfaction with PM therapies for insomnia, it is suggested that the efficacy of these procedures be investigated through clinical trials

Endometrium is recently introduced as an available source of mesenchymal stem cells (EnMSCs), which can be obtained without anesthesia and side effects. Regarding the issues and complexities of cell-based therapies, exosomes gain tremendous attention as a novel tool for cell-free therapies. Although several clinical trials are recently established based on therapeutic potential of EnMSCs, biological roles of EnMSC-derived exosomes are still unclear.

The current study was conducted to investigate the potential effects of EnMSC- derived exosomes on proliferation, migration, and angiogenesis of human umbilical cord vein endothelial cells (HUVECs). For this purpose, EnMSCs and then EnMSC-derived exosomes were isolated and characterized. MTT assay and wound healing assay as well as tube formation assay were applied.

The collected data showed that EnMSC-derived exosomes significantly increased proliferation, migration, and angiogenesis of HUVECs. It was observed that the effects of exosomes were applied in a dose dependent manner. In addition, expression analysis by quantitative real-time PCR showed that increased expression of proliferation and angiogenesis genes in HUVECs were treated with EnMSC-derived exosomes in a dose dependent manner.

The current study results showed that EnMSC-derived exosomes can exert biological effects such as their source cells and become new candidates for cell-free therapies. Taken together, increased angiogenesis makes EnMSC-derived exosomes a promising tool in regenerative medicine, especially wound healing and treatment of vascular disease

Epitheliod hemangioendothelioma (EHE) is a rare spinal neoplasm with vascular provenance, which can present as a primary lesion or metastatic lesion with the secondary involvement of the liver, lung, and long bones. EHE can occur all over the spine from the craniovertebral junction to the lumbosacral area. Usual presenting symptoms are back pain, pathologic fractures, myelopathy, and cauda equina syndrome. Diagnosis and management can be difficult, often requiring coordination between multiple disciplines for selective spinal angiography, surgical resection, the establishment of pathologic diagnosis, and adjuvant treatment, if necessary. There are no widely accepted guidelines for the management of EHE.

We report a 43-year-old male as a case of primary unifocal hemangioendothelioma with two unique features compared to previous reports: first, the presentation with acute cauda equine syndrome and second, the involvement of posterior elements, which made it very difficult to differentiate from aneurysmal bone cyst (ABC).

We review the existing literature on spinal EHE, present management challenges via case review, and propose a management guideline for neurosurgeons, interventional radiologists, pathologists, and radiation oncologists to streamline the diagnosis and management of EHE of the spine