Notes

The part involving High-Density Lipoprotein in COVID-19.
In addition, the number of cases in which FUS-thalamotomy has been applied has been increasing in the past few years due to its minimally invasive nature, which does not require puncture of the brain. As neurosurgeons, we have the responsibility to select and perform appropriate surgical treatment based on sufficient knowledge of tremor to yield beneficial results in patients.Parkinson's disease(PD), a neurodegenerative disorder is caused due to damage in the dopaminergic neurons of the substantia nigra, a part of the midbrain. The disease is characterized by motor symptoms such as tremor, rigidity, akinesia, and bradykinesia. PD is a systemic disease associated with non-motor manifestations such as autonomic neuropathy, depression, behavioral disorders, sleep disorders, cognitive dysfunction, and sensory disorders. Diagnosis of PD was based on the UK Parkinson's Disease Society Brain Bank clinical diagnostic criteria. However, new diagnostic criteria were recently proposed by the International Parkinson and Movement Disorder Society in 2015. This paper describes the diagnosis and drug therapies in Parkinson's disease and discusses the criteria and timing of surgical treatment for the advanced stage of Parkinson's disease.Accurate targeting to the sensorimotor territory of the globus pallidus internus (GPi), the subthalamic nucleus (STN), and the thalamic ventral intermediate nucleus (Vim) is crucial for the stereotactic neurosurgery of lesioning or implantation of a deep brain stimulation electrode. Intra-operative micro-electrode recording can aid in the localization of these structures. Neurons in the GPi are characterized by high-frequency tonic discharge. The STN has a high density of neurons that show irregular discharge. The majority of neurons in the sensorimotor territory of the GPi and STN exhibit neuronal responses to passive manipulation or active movement of the limbs and orofacial parts, and they are somatotopically arranged. Neurons responding to movements of the legs, arms, and face were found along the dorsal-ventral axis in the posterolateral GPi and along the medial-lateral axis in the posterolateral STN. Similarly, in the lateral part of the thalamic Vim nucleus, most neurons exhibit kinesthetic responses that show well-organized somatotopic arrangement, with the leg on the dorsolateral side, arm on the medioventral side, and face on the more medial side. Some Vim neurons have rhythmic bursting discharges synchronous with limb tremor. These electrophysiological findings allow us to achieve better surgical results.Anatomical knowledge of target structures is essential in stereotactic functional neurosurgery. Thus, we created a three-dimensional(3D)atlas comprising frozen sections and histologically stained slides prepared from cadaveric brains. Herein, we describe the anatomical information of stereotactic functional neurosurgery targets gained from our atlas. The subthalamic nucleus(STN)was found to be clearly enclosed by neural fibers with high neuronal density. Based on our 3D models, the mean penetration length of deep brain stimulation leading into the STN was 6.6 mm. The globus pallidus was found to be clearly divided into the grobus pallidus externus(GPe)and internus(GPi)by its neural fibers, and the optic tract was located below the GPi. Although the thalamic lateral nuclear group(ventrooralis, ventrontermedius, and ventrocaudalis)could not be identified from either macroscopic frozen sections or MR images, these structures were clearly discernible from each other based on cell architecture(cell size and cell density)when viewed under a microscope. In contrast, distinguishing ventral and dorsal nuclei in humans is difficult. In addition to the main targets of the basal ganglia, we also investigated the anatomy of other targets in detail(posterior subthalamic area, pedunclopontine nucleus, nucleus accumbens, and nucleus basalis of Meynert). Overall, this anatomical knowledge from the atlas helps functional neurosurgeons interpret intraoperative microelectrode recording and MRI more precisely, helping facilitate more accurate surgeries.The basal ganglia(BG)is composed of four parallel loops the motor, oculomotor, associative, and limbic loops. The motor loop starts from the cortex, travels through the BG and thalamus, and returns to the same area of the cortex with somatotopic organization. The striatum is the major input nucleus of the cortex, and the internal segment of the globus pallidus(GPi)is the main output nucleus. BG is explained by the direct and indirect pathways, and these excitatory or inhibitory pathways are used for several disease models. In Parkinson's disease(PD), dopamine deficiency acts on both direct and indirect pathways to cause the neuronal activity of GPi to becomes disinhibited. Pallidotomy, an effective surgery to improve Parkinsonism, aimed to destroy this hyperactive state. This is based on the rate model. However, a simian PD model with MPTP-treated monkeys exhibited increased GPi activity during effective stimulation of subtalamic nucleus(STN)-DBS, which makes it difficult to explain the pathophysiology of PD based only on the rate model. Instead, the alterative model is now widely prevailing. Local field potentials recorded from the DBS leads implanted in GPi and/or STN uncovered the abnormally synchronized activity in the β range(β oscillation)and abnormal co-synchronization between these nuclei, which is believed to be important in the pathophysiology of PD.Stereotactic and functional neurosurgery(SFN)is one of the oldest subspecialties of neurosurgery. In Japan, functional epilepsy surgery was performed in the Meiji era, even before World War II, when general surgeons used to operate on patients with intractable cancer pain through open myelotomy or cordotomy. Knowledge gathered from such age-old procedures provided the basic understanding of neurophysiology and hence, functional neurosurgery used to be termed as "applied neurophysiology". Human stereotactic surgery was introduced in 1947 and many Japanese neurosurgeons, particularly Hirotaro Narabayashi, Keiji Sano and Chihiro Ohye, contributed to the development of this field. Additionally, we should remember that common procedures of neurosurgery practiced today such as neuroendoscopy, navigation surgery, intraoperative monitoring, and the concept of exo-scope, which are less invasive and involves high accuracy, emerged from the field of SFN. Young doctors should learn from history and understand where we started from, where we at present, and where we are heading in the future.We report a case of primary central nervous system vasculitis (PCNSV) with longitudinally extensive transverse myelitis. A 47-year-old woman presented with malaise, progressive cognitive impairment, and lower limb spasticity. Diffuse hyperintense areas in the deep cerebral white matter on the diffusion-weighted image and T2-weighted images were observed during brain magnetic resonance imaging. Ki16425 price Gadolinium-enhanced T1-weighted images showed multiple linear enhancements. A sagittal T2-weighted image displayed a longitudinal extensive lesion of transverse myelitis in the spinal column from the upper cervical (C7) to the thoracic region (Th12). On brain biopsy, the patient was diagnosed as having granulomatous primary angiitis of the central nervous system (PCNSV). This case suggests that PCNSV could show longitudinally extensive transverse myelitis. (Received 14 January, 2021; Accepted 18 February, 2021; Published 1 August, 2021).While the term 'association areas' is well established among those engaged in neurology and its related sciences, it is difficult to say precisely what it means. This review tries to better define it, and begins with a brief discussion of its history, how it came about and finally gained wide acceptance. I introduce the work of Theodor Meynert (1833-1892), and Paul Flechsig (1847-1929), both of whom played important roles in brain mapping. Furthermore, I review how the term is linked to the work of Joseph Jules Dejerine (1849-1917) on white matter, and to disconnection syndrome as proposed by Norman Geschwind (1926-1984). Lastly, I focus on brain maps, historically essential to the study of association areas, and discuss the numbering of brain areas.The central nervous system (CNS) is an immune-privileged area. The blood-brain barrier (BBB) is thought to separate the CNS from any systemic inflammatory states to maintain homeostasis within this specialized, vulnerable organ. However, accumulating studies have challenged this concept by demonstrating systemic inflammatory effects on brain. Moreover, the coronavirus disease pandemic caused by severe acute respiratory syndrome coronavirus 2 in 2019 has rapidly evoked attention toward the BBB as the systemic-CNS immunological interface. In this review, we focus on microglia, the sole immune cells in the CNS, and briefly introduce our new findings regarding microglial BBB regulation in systemic inflammation. With a close eye on associated literature, we carefully rethink the traditional immune system in the CNS and suggest a new possible mechanism of systemic-CNS immune cell interaction, while an understanding of the BBB develops.Relationships between hearing impairment (HI) and dementia have been reported in elderly adults, and there is growing evidence that HI is an independent modifiable risk factor for dementia. However, there is insufficient evidence to recommend the use of hearing aids to reduce the risk of cognitive decline. To address these issues, we are currently conducting an observational study in cooperation with neurologists, gerontologists, and otorhinologists to investigate the association between cognitive function and HI in elderly adults. As part of this study, we also investigated this association using data from healthcare check-up programs for community dwellers. We analyzed the data of 1602 eligible community-dwellers. Hearing aid users were older and less likely to exhibit cognitive impairment than non-hearing aid users. Multivariate logistic regression analysis showed that HI was independently associated with an inability to draw a clock correctly (odds ratio 1.60, 95% confidence interval 1.12-2.26). Compared with those in Western countries, the usage rate of hearing aids in Japan is lower, although the rate of elderly adults presenting with HI is similar to those in Western countries. Both otorhinologists and geriatricians should be aware of the potential presence of HI in elderly adults.Multiple sclerosis (MS) is a neurological disease in which alterations of the gut microbiota can be confirmed by metagenomic analysis. In addition to the 16S rRNA analysis, whole metagenomic analysis, as well as, metabolomic analysis, has been applied in this field, which convincingly proved that the reduction of short chain fatty acids characterizes the intestinal environment of patients with MS. Further research is needed to elucidate the mechanisms responsible for the alterations of the gut microbiome in patients with MS. Characterization of the virome may shed light on.Gut microbes play a role in modulating the gut-brain axis. Interactions among the gut microbiota, gut, and brain, are often called the "microbiota-gut-brain axis." Here, we review bidirectional signaling between the gut microbiota and the host-stress response based on the present and previous studies.
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