Integration of botanicals in contemporary medicine: road blocks, checkpoints and go-ahead signals.

The use of botanicals for maintaining good health and preventing diseases is undisputed. The claimed health benefits of natural health products and herbal medicines are based on traditional claims, positive results obtained in preclinical studies and early phase clinical trials that are not backed by safety and efficacy evidences approved by regulatory agencies. Although, the popularity of botanicals is growing, health care practitioners of modern medicine seldom recommend their use because of ill equipped database of their safety and potency. This review discusses problems that preclude botanicals from integrating into the mainstream contemporary therapeutics and cues that provide impetus for their realisation.

Juvenile polymyositis with unremitting pain and progressive loss of motor and bulbar function on a background of sickle cell disease.

The diagnosis of acute autoimmune rheumatic disorders in sickle cell disease (SCD) can be challenging. Polymyositis is an inflammatory myopathy which, like SCD, may present with myalgia but is usually associated with proximal muscle weakness. We describe an adolescent boy presenting with limb pain, difficulty in mobilisation, with progressive loss of motor function and later bulbar weakness. Investigations showed massive elevation of creatine kinase, and MRI and muscle biopsy findings consistent with severe polymyositis. The patient was treated with corticosteroids, intravenous immunoglobulin and intensive rehabilitation therapy. He made a good recovery and was discharged on azathioprine and prednisolone. In the context of SCD, multisystem symptoms, unexplained muscle pain and weakness, unresponsive to conventional treatment in the presence of steady state haemoglobin, should alert the clinician to autoimmune phenomena. Key factors in making a diagnosis are an autoimmune screen and early discussion with a rheumatology expert.

Self-navigated tissue phase mapping using a golden-angle spiral acquisition-proof of concept in patients with pulmonary hypertension.

PURPOSE: To create a high temporal- and spatial-resolution retrospectively cardiac-gated, tissue phase mapping (TPM) sequence, using an image-based respiratory navigator calculated from the data itself. METHODS: The sequence was based on a golden-angle spiral acquisition. Reconstruction of real-time images allowed creation of an image-based navigator. The expiratory spiral interleaves were then retrospectively cardiac-gated using data binning. TPM data were acquired in 20 healthy volunteers and 10 patients with pulmonary hypertension. Longitudinal and radial myocardial velocities were calculated in the left ventricle and right ventricle. RESULTS: The image-based navigator was shown to correlate well with simultaneously acquired airflow data in 10 volunteers(r=0.93±0.04). The TPM navigated images had a significantly higher subjective image quality and edge sharpness (P<0.0001) than averaged spiral TPM. No significant differences in myocardial velocities were seen between conventional Cartesian TPM with navigator respiratory-gating and the proposed self-navigated TPM technique, in 10 volunteers. Significant differences in the velocities were seen between the volunteers and patients in the left ventricle at systole and end diastole and in the right ventricle at end diastole. CONCLUSION: The feasibility of measuring myocardial motion using a golden-angle spiral TPM sequence was demonstrated, with an image-based respiratory navigator calculated from the TPM data itself.

Attention-related Pearce-Kaye-Hall signals in basolateral amygdala require the midbrain dopaminergic system.

BACKGROUND: Neural activity in basolateral amygdala has recently been shown to reflect surprise or attention as predicted by the Pearce-Kaye-Hall model (PKH)--an influential model of associative learning. Theoretically, a PKH attentional signal originates in prediction errors of the kind associated with phasic firing of dopamine neurons. This requirement for prediction errors, coupled with projections from the midbrain dopamine system into basolateral amygdala, suggests that the PKH signal in amygdala may depend on dopaminergic input. METHODS: To test this, we recorded single unit activity in basolateral amygdala in rats with 6-hydroxydopamine or sham lesions of the ipsilateral midbrain region. Neurons were recorded as the rats performed a task previously used to demonstrate both dopaminergic reward prediction errors and attentional signals in basolateral amygdala neurons. RESULTS: We found that neurons recorded in sham lesioned rats exhibited the same attention-related PKH signal observed in previous studies. By contrast, neurons recorded in rats with ipsilateral 6-hydroxydopamine lesions failed to show attentional signaling. CONCLUSIONS: These results indicate a linkage between the neural instantiations of the basolateral complex of the amygdala attentional signal and dopaminergic prediction errors. Such a linkage would have important implications for understanding both normal and aberrant learning and behavior, particularly in diseases thought to have a primary effect on dopamine systems, such as addiction and schizophrenia.