A Case Report on Lateral Proboscis: A Rare Congenital Anomaly

Lateral proboscis is a rare congenital condition characterized by a cylindrical protuberance on the nasofrontal region accompanied by abnormal nasal development on the affected side. We aimed to describe the management of the lateral proboscis in staged repair. A 7-year-old girl came with a tube-like projection on the left medial canthal region and nasal agenesis on the ipsilateral side. She was diagnosed with lateral proboscis, left microphthalmia, lower eye lid coloboma, and asymmetry in the orbital region. The patient has undergone 3 major surgeries at our institution. The first surgery involved the deconstruction of the tube to form the left nasal body and nostril. The second operation involved trimming of the new nose form and the excision of the bony protrusion directly beneath the base of the pedicle through bifrontal craniotomy. The remaining bone defect was closed using a pericranial flap. The orbital floor was reconstructed using titanium mesh. The third operation involved nasal reconstruction using a costal cartilage graft to create a dorsal nasal and alar framework. The patient healed with no complications, had become less reserved and her grades improved significantly after the operation. Further appointments are being scheduled to evaluate growth distortion and the resulting facial asymmetry. Surgical correction will be planned thereafter to further reconstruct the facial features. Evaluation of patient is necessary to explore possible clinical outcomes and corresponding treatment options. Multidisciplinary management is highly recommended, involving plastic surgeons, neurosurgeons, ophthalmologists, pediatricians, and pediatric psychiatrists in order to improve patient's quality of life.

Layer 1 NDNF+ Interneurons Control Bilateral Sensory Processing in a Layer-dependent Manner

ABSTRACTBilateral sensory information is indispensable for navigating the world. In most mammals, signals sensed by either side of the midline will ultimately reach the cortex where they will be integrated for perception and appropriate action selection. Even though information transferred across the hemispheres is routed through the corpus callosum, how and which microcircuits are key in integrating it is not well understood. Here we identify an essential role for layer 1 NDNF+ inhibitory cells of mice in integrating bilateral whisker-evoked information in an NMDA receptor-dependent manner. Direct connections from the contralateral cortex and the ipsilateral side activate NDNF+ neurons, which subsequently inhibit the late spiking activity of underlying layer 2/3 neurons, but not layer 5. Our results identify a feed-forward regulatory pathway for bilateral cortical sensory processing of upper layer cortical neurons actuated via layer 1 NDNF+ interneurons.

Stem cells from human exfoliated deciduous teeth attenuate mechanical allodynia in mice through distinct from the siglec-9/MCP-1-mediated tissue-repairing mechanism

The effects of stem cells from human exfoliated deciduous teeth (SHED) on mechanical allodynia were examined in mice. A single intravenous injection of SHED and conditioned medium from SHED (SHED-CM) through the left external jugular vein significantly reversed the established mechanical allodynia induced by spinal nerve transection at 6 days after injection. SHED or SHED-CM significantly decreased the mean numbers of activating transcription factor 3-positive neurons and macrophages in the ipsilateral side of the dorsal root ganglion (DRG) at 20 days after spinal nerve transection. SHED or SHED-CM also suppressed activation of microglia and astrocytes in the ipsilateral side of the dorsal spinal cord. A single intravenous injection of secreted ectodomain of sialic acid-binding Ig-like lectin-9 and monocyte chemoattractant protein-1 had no effect on the established mechanical allodynia, whereas a single intravenous injection of protein component(s) contained in SHED-CM with molecular weight of between 30 and 50 kDa reversed the pain. Therefore, it may be concluded that protein component(s) with molecular mass of 30–50 kDa secreted by SHED could protect and/or repair DRG neurons damaged by nerve transection, thereby ameliorating mechanical allodynia.

Utility of a novel exoscope, ORBEYE, in gravity-assisted brain retraction surgery for midline lesions of the brain

Background: Midline brain lesions, such as falx meningioma, arteriovenous malformations, and cavernous malformations, are usually approached from the ipsilateral interhemispheric fissure. To this end, patients are positioned laterally with the ipsilateral side up. However, some studies have reported the usefulness of gravity-assisted brain retraction surgery, in which patients are placed laterally with the ipsilateral side down or up, enabling surgeons to approach the lesions through the ipsilateral side or through a contralateral interhemispheric fissure, respectively. This surgery requires less brain retraction. However, when using an operative microscope, performing this surgery requires the surgeon to operate in an awkward position. A recently developed high-definition (4K-HD) 3-D exoscope system, ORBEYE, can improve the surgeon’s posture while performing gravity-assisted brain retraction surgery. Methods: We report five cases with midline brain tumors managed by resectioning with gravity-assisted brain retraction surgery using ORBEYE. We also performed an ergonomic analysis of gravity-assisted brain retraction surgery with a craniotomy model and a neuronavigation system. Results: Gravity-assisted brain retraction surgery to the midline brain tumors was successfully performed for all five patients, using ORBEYE, without any postoperative neurological deficit. Conclusion: Gravity-assisted brain retraction surgery to the midline brain lesions using ORBEYE is feasible, and ORBEYE is ergonomically more favorable than a microscope. ORBEYE has the potential to generalize neurosurgical approaches considered difficult due to the surgeon’s awkward position, such as gravity-assisted brain retraction surgery.

Protective effect of caffeine and/or taurine on the 6-hydroxydopamine-induced rat model of Parkinson’s disease: Behavioral and neurochemical evidence

Background: Caffeine and taurine, which possess neuro-modulatory activity happen to be consumed together as part of the constituents of energy drinks, could have beneficial effects and prevent neuronal deterioration in Parkinson’s disease (PD). Objective: This study aimed to investigate behavioral and neurochemical effects of these two agents in an animal model of PD at two time points to evaluate possible neuro-protective or neuro- modulatory effects. Methods: Stereotaxic injection of 6-hydroxydopamine (6-OHDA) in rat striatum was used to model PD-like behavior in animals. Motor behavior was assessed by a characteristic rotation behavior response to the apomorphine challenge and dopamine levels in the striatum were quantified using HPLC-ED. Results: A reduction in apomorphine induced rotations following administration of caffeine and/or taurine as compared to the untreated lesioned group (controls) was shown. Significant decreases in dopamine levels were also seen in the ipsilateral side of 6-OHDA group, this effect was not significantly reversed in caffeine and taurine treated groups. Treatments partially restored the content of DA levels in the lesioned striatum. Conclusions: Current results demonstrated beneficial effects for the combination of caffeine and taurine in PD animal model, suggesting that consumption of both agents could be a new added therapeutic target for Parkinson’s disease prevention and treatment.

692 Does Sleep Laterality Influence Kidney Stone Formation and Clearance? – A Review of The Current Literature

Introduction Stone disease is a common urological presentation that carries significant morbidity. Patients with renal calculi often experience ipsilateral recurrences. Sleep posture has been implicated in conditions ranging from heart failure to glaucoma. We seek a consensus view on the association between sleep laterality and stone disease and discuss its possible clinical implications. Method A literature search was conducted on the PubMed database from its inception through to September 2020. Publications assessing the correlation between sleep laterality and unilateral stone formation or clearance were included. 19 results were identified, of which 13 were excluded due to irrelevance. Results A review of the literature suggests that sleep laterality is positively correlated with ipsilateral stone formation. Interestingly, a study examining the interaction between sleep laterality and stone clearance following shock wave lithotripsy showed greater clearance of stones in patients who slept on the ipsilateral side. Conclusions Sleep laterality may positively influence both the formation and clearance of unilateral kidney stones. The mechanism for this remains unclear. However, sleep posture aids may prove to be a low-cost intervention with potential for both preventative and therapeutic benefit. This would be of particular value in patients with recurrent unilateral stone disease as well as those with a single-functioning kidney.

A Pilot Study of Changes in the Level of Catecholamines and the Activity of α-2-Macroglobulin in the Tear Fluid of Patients with Parkinson’s Disease and Parkinsonian Mice

Development of differential and early (preclinical) diagnostics of Parkinson’s disease (PD) is among the priorities in neuroscience. We searched for changes in the level of catecholamines and α-2-macroglobulin activity in the tear fluid (TF) in PD patients at an early clinical stage. It was shown that TF in patients is characterized by an increased level of noradrenaline mainly on the ipsilateral side of pronounced motor symptoms (72%, p = 0.049), a decreased level of adrenaline on both sides (ipsilateral—53%, p = 0.004; contralateral—42%, p = 0.02), and an increased α-2-macroglobulin activity on both sides (ipsilateral—53%, p = 0.03; contralateral—56%, p = 0.037) compared to controls. These changes are considered as potential biomarkers for differential diagnosis. Similar changes in the TF were found in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated mice when modeling clinical and preclinical stages of PD. These data show the adequacy of models to the pathogenesis of PD along the selected metabolic pathways, and also suggest that the found TF changes can be considered as potential biomarkers for preclinical diagnosis of PD. In Parkinsonian mice, the level of catecholamines also changes in the lacrimal glands, which makes it possible to consider them as one of the sources of catecholamines in the TF.

Association of Brain Iron Overload With Brain Edema and Brain Atrophy After Intracerebral Hemorrhage

Objective: This study evaluated iron overload after intracerebral hemorrhage (ICH) using ESWAN sequences.Methods: This single-center prospective observational cohort study enrolled supratentorial ICH patients. MRI was obtained with a 3.0-T scanner at day 1, day 14, day 30, and follow-up (300 days or later). R2* mapping was generated based on the ESWAN. R2* value of the ipsilateral side represented iron deposition, and the R2* value of the contralateral side served as control. R2* value was adjusted by volume and used to assess total iron overload. Brain edema was measured on T2 FLAIR-weighted images. Brain atrophy was calculated as the contralateral hemisphere volume minus the injured hemisphere volume.Results: Twnety-seven patients with a spontaneous supratentorial ICH were included in this analysis. The ipsilateral R2* value was 40.27 ± 11.62, 41.92 ± 13.56, and 60.89 ± 14.09 at days 1, 14, and 30, respectively. The R2* value was significantly higher in the ICH side than the contralateral side (p < 0.01). Increased R2* value was seen on day 30 compared to day 14 (p < 0.01). The R2* value showed logistic decay with the distance to the hematoma margin (p < 0.01). Brain edema at day 14 and brain atrophy at follow-up correlated with R2* value adjusted by volume at day 14 (p < 0.01).Conclusions: After ICH, the iron deposition in the perihematomal region was progressively increased during the first month. R2* value adjusted by volume predicted acute brain edema and chronic brain atrophy.

A rare presentation of Takayasu’s arteritis- unilateral finger clubbing – case report

Background Takayasu’s arteritis (TA) is a granulomatous, large vessel vasculitis with a preponderance for young women. The inflammation results in disruption of the arterial endothelium causing stenosis, endoluminal thrombosis and aneurismal dilatation. Early disease presentation is with nonspecific general symptoms, and in such instances, the diagnosis can be missed. Unilateral clubbing is a manifestation of myriad of diseases, but is not a common sign of TA. In medical literature, only three such cases have been reported. Case presentation We present a 24-year-old female who presented with multiple constitutional symptoms such as arthralgia, malaise, poor appetite and two episodes of syncope over 3 months’ duration. On examination, unilateral finger clubbing was observed in the right hand, with very low volume radial, ulnar and brachial artery pulses on the ipsilateral side. Her blood pressure measured on the unaffected arm, was normal. Inflammatory markers were elevated and magnetic resonance angiogram (MRA) confirmed TA. Conclusion Although rare, unilateral clubbing may be a manifestation of TA. Therefore, detection of unilateral clubbing should raise a strong clinical suspicion of TA and prompt early diagnosis and initiation of treatment.

Nose ‐To ‐Brain Delivery of Mitochondria for Treatment of Parkinson’s Disease Model Rats With 6-Hydroxydopamine

BackgroundFeasibility of mitochondrial organelle transport via the olfactory bulb route for Parkinson's disease (PD) therapy was evaluated in the unilateral 6-OHDA-lesioned rats due to the distinct difference based on payload properties. MethodsAn intranasal infusion with 200 μg of allogeneic mitochondria conjugated with Pep-1 (P-Mito) or not (Mito) was executed once a week at the ipsilateral side of lesioned brain for three months of treatments.Results A significant improvement of rotational and locomotor behaviors in PD rats was found in both mitochondria-treating groups in contrast to Sham group or Pep-1 group. There was more than 60% recovery survival of dopaminergic (DA) neurons in substantia nigra (SN) and striatum (ST) of lesioned sides compared to the intact sides in groups of Mito and P-Mito. Treatment effect in P-Mito group was higher in the P-Mito group than Mito group but not significant. The mechanism was associated with the restoration of mitochondrial function and attenuation of oxidative damage in lesioned SN. Notably, Pep-1 modification suppressed the plasma level of inflammatory cytokines induced by infused mitochondria. The 5-bromo-2-deoxyuridine-labelled tracks showed the mitochondrial penetrating into doublecortin-positive neurons of rostral migratory stream (RMS) along with the accessory olfactory bulb in ipsilateral side of lesion and it was expressed in striatal DA neurons, but not in SN, of two cerebral hemispheres via commissural fibers. Conclusion This study showed a promising approach of nose-to-brain delivery for mitochondrial transplantation by confirming the mitochondrial internalization via RMS neurons migration in olfactory bulb for therapeutic action of PD in rats.