Can the School Fruit and Vegetable Scheme Be an Effective Strategy Leading to Positive Changes in Children's Eating Behaviours? Polish Evaluation Results.

BACKGROUND: The School Fruit and Vegetable Scheme (SFVS) was developed to form the habit of eating fruit and vegetables (F&V) among children. The survey aimed to identify both the strengths of the scheme and areas that required support and strengthening in the further implementation of school schemes. METHODS: The study was conducted from 2012 to 2015 among students of randomly selected 85 primary schools that participated in the programme (intervention group) or did not participate therein (control group). The F&V consumption among the students was evaluated based on the 3 day food record method. Other behaviours were evaluated via frequency and preference questionnaires. RESULTS: Over the three years of implementing SFVS, fruit consumption significantly increased by approximately 30 g/day, i.e., by 18%. In the control group, it increased only by approximately 4%. At the same time, no increase in vegetable consumption was observed. A number of other positive effects of SFVS were also found. These concerned students' nutritional attitudes and behaviours, such as a further increase in the children's knowledge on the health aspects of F&V consumption, the levels of their consumption and an increased preference for fruit in general. CONCLUSIONS: The results indicate that providing F&V in schools free of charge can be an effective strategy for enhancing F&V consumption among children, in particular by raising the awareness of the health importance of F&V consumption and gradually influencing children's eating habits, especially when it comes to the habit of fruit consumption. The issue of vegetable consumption is an area for intervention enhancement. There is also a need for further, in-depth analyses, taking into account the impact of potential confounding factors.

Risk factors for gastroesophageal reflux disease symptoms related to lifestyle and diet.

Gastroesophageal reflux disease (GERD) is one of the most common diseases of the upper gastrointestinal tract. The most characteristic symptom of the disease is heartburn, which occurs at least once a week. The prevalence of the disease varies and, depending on the region of the world, it may affect from a few to over 30% of an adult population. It is estimated that in Poland this disease may affect up to 35.5% of adults reporting abdominal ailments. If untreated, the disease can lead to serious complications including precancerous conditions and esophageal adenocarcinoma. Pharmacotherapy is considered as the first-line treatment in GERD patients but lifestyle modifications, including diet changes, are an important element supporting the treatment of the disease. Many factors may contribute to the development of the disease. Among them, there are non-modifiable factors such as age, sex or genetic factors and modifiable factors, e.g. lifestyle, diet, excessive body weight. This review focuses on GERD risk factors related to lifestyle and nutrition that include both dietary components and nutritional behaviour. Lifestyle risk factors that may contribute to GERD symptoms include excessive body weight, particularly obesity, moderate/high alcohol consumption, smoking, postprandial and vigorous physical activity, as well as lack of regular physical activity. Many studies indicate fatty, fried, sour, spicy food/products, orange and grapefruit juice, tomatoes and tomato preserves, chocolate, coffee/tea, carbonated beverages, alcohol as triggers for GERD symptoms. Eating habits such as irregular meal pattern, large volume of meals, eating meals just before bedtime may correlate with the symptoms of GERD. The role of lifestyle, diet and eating habits as risk factors for GERD is not clearly understood, and the results of the available studies are often contradictory. Determination of modifiable risk factors for this disease and its symptoms is important for effective dietary prevention and diet therapy of GERD.

Intervention for improvement the diet and physical activity of children and adolescents in Poland.

BACKGROUND: The effects of a two-year educational Programme "Keep Balance" addressed to children and adolescents have been evaluated. Its purpose has been to implement the rules of proper nutrition and increasing the level of physical activity on the population level. OBJECTIVE: The main objective of the evaluation was an indication if, after two years of programme activities, outcome indicators have been achieved. MATERIAL AND METHODS: Approximately 400,000 pupils/students from 1600 educational units from the territory of the whole country have been included in the education programme. The efficiency evaluation has been carried out in a sample of n = 1506 pupils/students in the interventional group and n = 1589 in the control group. Education has been addressed to the entire school environment, pupils, students, parents, teachers, headmasters, and the local community. The survey methodology, body weight and height measurements, the BMI index, and EUROFIT physical fitness tests have been used to assess the effects of the education programme in the scope of knowledge and nutritional behaviour regarding physical activity. There were assumed outcome indicators. The certification of schools/kindergartens with "The Certificate of a School/Kindergarten Friendly to Nutrition and Physical Activity" has been used to evaluate the activation of school environments. RESULTS: There was an improvement achieved over the assumed target points in the level of knowledge of pupils/students in the scope of nutrition and the role of physical activity, in the changes of nutritional habits, and in the results of physical fitness tests. There were achieved 20% increase in knowledge in the scope of nutrition and 5% increase in physical activity. There have been changes in the frequency in the consumption of the first breakfast before going to school (by 25% among the younger ones and by 17% among the older ones), an increase in the consumption of bottled water by 49% and reduction of sweet drinks by 19%. The percentage of the pupils/students consuming the recommended 5 meals increased by 33%. Physical fitness indicators were achieved over assumed 5% increase in the individual exercise tests. The Certificate was obtained after meeting the criteria and documenting the durability of the changes by 65% of 1600 educational units included in the Programme. A decrease in the frequency of overweight and obesity occurrence in the whole intervention sample by 1% was obtained; it was greater (but statistically insignificant) among younger students by 3.3% in comparison to the older ones where there was an increase of 1%. CONCLUSIONS: Summing up all achieved results the educational programme "Keep Balance" implemented on the population level aimed at children and adolescents has turned out to be effective and deserves to be continued after minor adjustments. Many positive changes have been identified as well as those that ought to be improved. Comprehensively included education and sometimes small changes in much of nutritional and physical behaviour have influenced the reduction of the percentage of pupils/students with excessive body weight, despite the fact that the average BMI has basically remained on the same level.

Caffeine intake from carbonated beverages among primary school-age children.

AIM: The aim of the study was to assess caffeine intake from cola beverages and energy drinks, as well as the consumption frequency among primary-school-age children in relation to other dietary habits. MATERIAL AND METHODS: The study included 329 children (aged 11-13 years) from five randomly selected schools in Warsaw. Caffeine intake was assessed from a food frequency questionnaire. The face-to-face interview method was selected. RESULTS: 89.7% of the children consumed carbonated beverages whom caffeine, of which nearly 24% consumed energy drinks. The median caffeine intake from carbonated beverages was 0.12 mg/kg body weight/day, accounting for 4.8% of the recommended maximum daily intake from all dietary sources. Frequent consumers of cola drinks were often found to eat fast foods, as well as salty snacks. CONCLUSIONS: Caffeine intake in the studied group of children turned out to be at a safe level. The safe dose of caffeine does not mean that consumption of carbonated drinks should not raise any concerns. The recently established legal ban on selling unhealthy foods at school is a good idea, since the school should not be a place for improper dietary models.

Differences in the prevalence of overweight, obesity and underweight among children from primary schools in rural and urban areas.

INTRODUCTION: Overweight adversely affects not only the health and development of children and adolescents but also their health in adulthood, increasing the risk of chronic non-communicable diseases and disabilities. The frequency of nutritional disorders among children and adolescents is increasing in many countries worldwide, including Poland. OBJECTIVE: To demonstrate differences in the nutritional well-being of school-age children depending on the school location: rural and urban areas. MATERIALS AND METHODS: The study conducted in 2010 covered a total of 1,255 pupils, 627 girls and 628 boys, aged nine, from the area of five provinces of Poland: Pomorskie, Opolskie, Wielkopolskie, Podkarpackie and Masovian, representing the northern, southern, western, eastern and central regions of the country. Based on the height and weight measurements of children, the body mass index was calculated. The nutritional status was assessed according to the criteria of Cole et al. RESULTS: The prevalence of overweight and obesity in girls and boys in separate regions of the country (villages, cities with less than 100,000 residents and cities with more than 100,000 residents) did not differ significantly. CONCLUSIONS: The prevalence of overweight and obesity among children from rural and urban areas of Poland is similar. Analysis of regional differences in the prevalence of obesity, overweight and underweight among children and adolescents may indicate the direction of national and local activities aiming to reduce the inequalities resulting from nutritional well-being.

Nanofiber mat spinal cord dressing-released glutamate impairs blood-spinal cord barrier.

An excessive glutamate level can result in excitotoxic damage and death of central nervous system (CNS) cells, and is involved in the pathogenesis of many CNS diseases. It may also be related to a failure of the blood-spinal cord barrier (BSCB). This study was aimed at examining the effects of extended administration of monosodium glutamate on the BSCB and spinal cord cells in adult male Wistar rats. The glutamate was delivered by subarachnoidal application of glutamate-carrying electrospun nanofiber mat dressing at the lumbar enlargement level. Half of the rats with the glutamate-loaded mat application were treated systemically with the histone deacetylase inhibitor valproic acid. A group of intact rats and a rat group with subarachnoidal application of an 'empty' (i.e., carrying no glutamate) nanofiber mat dressing served as controls. All the rats were euthanized three weeks later and lumbar fragments of their spinal cords were harvested for histological, immunohistochemical and ultrastructural studies. The samples from controls revealed normal parenchyma and BSCB morphology, whereas those from rats with the glutamate-loaded nanofiber mat dressing showed many intraparenchymal microhemorrhages of variable sizes. The capillaries in the vicinity of the glutamate-carrying dressing (in the meninges and white matter alike) were edematous and leaky, and their endothelial cells showed degenerative changes: extensive swelling, enhanced vacuo-lization and the presence of vascular intraluminal projections. However, endothelial tight junctions were generally well preserved. Some endothelial cells were dying by necrosis or apoptosis. The adjacent parenchyma showed astrogliosis with astrocytic hypertrophy and swelling of perivascular astrocytic feet. Neurons in the parenchyma revealed multiple symptoms of degeneration, including, inter alia, perikaryal, dendritic and axonal swelling, and destruction of organelles. All the damage symptoms were slightly less severe in the rats given valproic acid treatment, and were absent from both the intact rats and the rats with 'empty' nanofiber mat dressing. These results demonstrate that glutamate-loaded nanofiber mat dressing can locally create glutamate levels capable of damaging BSCB and that the resulting damage can be mitigated with concurrent systemic valproate treatment.

Factors within the family environment such as parents' dietary habits and fruit and vegetable availability have the greatest influence on fruit and vegetable consumption by Polish children.

OBJECTIVE: To identify determinants of fruit and vegetable (F&V) consumption among school-aged children. DESIGN: A survey study was conducted in October 2010. The questionnaire contained questions concerning social and demographic data, lifestyle and dietary habits, particularly the frequency of F&V consumption, availability of F&V and knowledge about recommended amounts of F&V intake. SETTING: Polish primary schools. SUBJECTS: Children (n 1255) aged 9 years from randomly selected primary schools and their parents. RESULTS: The children's consumption of fruit and of vegetables was influenced by the fruit consumption and vegetable consumption of their parents (r=0·333 and r=0·273, respectively; P=0·001), parents encouraging their children to eat F&V (r=0·259 and r=0·271, respectively; P=0·001), giving children F&V to take to school (r=0·338 and r=0·321, respectively; P=0·001) and the availability of F&V at home (r=0·200 and r=0·296, respectively; P=0·001). Parental education influenced only the frequency of fruit consumption (r=0·074; P=0·01). A correlation between parents' knowledge of the recommended intakes and the frequency of vegetable and fruit consumption by children was noticed (r=0·258 and r=0·192, respectively, P=0·001). CONCLUSIONS: Factors within the family environment such as parents' dietary habits and F&V availability had the greatest influence on the F&V consumption by children. Educational activities aimed at parents are crucial to increase the consumption of F&V among children.

Protective effect of valproic acid on cultured motor neurons under glutamate excitotoxic conditions. Ultrastructural study.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder that involves the upper and lower motor neurons and leads to the patient's death within 5 years after diagnosis. Approximately 2 per 100,000 people worldwide are affected every year. The only FDA-approved drug available for medical treatment is riluzole. It slows the disease progression and improves limb function and muscle strength for 3-4 months. Thus, looking for new therapeutic agents is a pressing challenge. Valproic acid (VPA) is a short-chain fatty acid, widely used for the treatment of seizures and bipolar mood disorder. The beneficial effect of VPA has been documented in different neurodegenerative experimental models, including amyotrophic lateral sclerosis (ALS). The real mechanisms underlying numerous beneficial effects of VPA are complex, but recently it has been postulated that the neuroprotective properties might be related to direct inhibition of histone deacetylase (HDAC). The aim of this ultrastructural study was to evaluate the beneficial effect of VPA on the spinal cord motor neurons (MNs) in a glutamate (GLU)-induced excitotoxic ALS model in vitro. It had been previously documented that chronic GLU excitotoxicity resulted in various MN injuries, including necrotic, apoptotic and autophagic modes of cell death. The present results demonstrated the neuroprotective properties of VPA associated with inhibition of apoptotic and autophagic changes of spinal MNs in a model of neurodegeneration in vitro.

Risk factors for gastroesophageal reflux disease: the role of diet.

INTRODUCTION: Nutrition can contribute to the development of gastroesophageal reflux disease (GERD). The relevant studies often provide contradictory results. AIM: To determine GERD risk factors associated with dietary habits. MATERIAL AND METHODS: A total of 513 subjects were included. The study group consisted of adults with a recent clinically confirmed diagnosis of GERD, and the control group were healthy adults. The research tool was a proprietary questionnaire. Risk factors were evaluated by logistic regression models. RESULTS: An association was found between the severity of typical GERD symptoms and a certain diet (p < 0.001). The symptoms were experienced more often after fatty, fried, sour, or spicy food and sweets. The univariate logistic regression analysis showed the following risk factors: eating 1-2 meals per day (OR = 3.50, 95% CI: 1.75-6.98), everyday consumption of peppermint tea (OR = 2.00, 95% CI: 1.14-3.50), and eating one, big meal in the evening instead of dinner and supper (OR = 1.80, 95% CI: 1.05-3.11). The multivariate analysis confirmed that frequent peppermint tea consumption was a risk factor (OR = 2.00, 95% CI: 1.08-3.70). CONCLUSIONS: Taking into consideration the results of this study, it seems that patients should be recommended to eat more than three meals a day and eat dinner and supper at appropriate times instead of one, big meal in the evening. The role of frequent peppermint tea consumption in GERD development requires further studies.

Secretory meningiomas: immunohistochemical pattern of lectin and ultrastructure of pseudopsammoma bodies.

Secretory meningioma is an infrequent histological subtype of benign, WHO grade I meningioma, that is characterized by focal epithelial and secretory transformation of meningothelial cells. The leading histopathological feature of neoplastic tissue is the presence of eosinophilic hyaline inclusions, defined as "pseudopsammoma bodies". These inclusions are mostly intracytoplasmic, different in size and often multiple. They are stained with periodic acid-Schiff (PAS) and are immunopositive for epithelial and secretory markers. The aim of this study was to determine the pattern of lectin bindings and ultrastructural features of secretory meningiomas. The examination was performed on 8 cases of secretory meningiomas that occurred in women and were mostly associated with prominent peritumoural oedema. Histologically, the tumours exhibited numerous eosinophilic, PAS positive pseudopsammoma bodies. Immunohistochemical studies revealed a strong, ring-like cytokeratin expression around the pseudopsammoma bodies. The inclusions were CEA and EMA positive but negative for vimentin. The immunolabeling with four lectins (PNA, SBA, Con A and DBA) was studied. The majority of pseudopsammoma bodies and surrounding tumour cells were strongly labelled with PNA and SBA. Immunolabelling with Con A showed irregular staining with high intensity in small inclusions. Immunostaining with DBA was seldom positive in inclusions and negative in the tumour cell cytoplasm. Ultrastructure of pseudopsammoma bodies exhibited advanced heterogeneity. The size of inclusions and the content of intracytoplasmic lumina varied greatly. Some pseudopsammoma bodies seemed to be located extracellularly and lacked the obvious lumina. Our ultrastructural study and lectin binding pattern support the unique epithelial and secretory transformation of neoplastic cells connected with their altered glycosylation.

Non-woven nanofiber mats - a new perspective for experimental studies of the central nervous system?

(Sub)chronic local drug application is clearly superior to systemic administration, but may be associated with substantial obstacles, particularly regarding the applications to highly sensitive central nervous system (CNS) structures that are shielded from the outer environment by the blood-brain barrier. Violation of the integrity of the barrier and CNS tissues by a permanently implanted probe or cannula meant for prolonged administration of drugs into specific CNS structures can be a severe confounding factor because of the resulting inflammatory reactions. In this study, we tested the utility of a novel way for (sub)chronic local delivery of highly active (i.e., used in very low amounts) drugs to the rat spinal cord employing a non-woven nanofiber mat dressing. To this end, we compared the morphology and motoneuron ( + ) counts in spinal cord cervical and lumbar segments between rats with glutamate-loaded nanofiber mats applied to the lumbar enlargement and rats with analogical implants carrying no glutamate. Half of the rats with glutamate-loaded implants were given daily valproate treatment to test its potential for counteracting the detrimental effects of glutamate excess. The mats were prepared in-house by electrospinning of an emulsion made of a solution of the biocompatible and biodegradable poly(L-lactide-co-caprolactone) polymer in a mixture of organic solvents, an aqueous phase with or without monosodium glutamate, and sodium dodecyl sulfate as an emulsifier; the final glutamate content was 1.4 µg/mg of the mat. Three weeks after mat implantation there was no inflammation or considerable damage of the spinal cord motoneuron population in the rats with the subarachnoid dressing of a glutamate-free mat, whereas the spinal cords of the rats with glutamate-loaded nanofiber mats showed clear symptoms of excitotoxic damage and a substantial increase in dying/damaged motoneuron numbers in both segments studied. The rats given systemic valproate treatment showed significantly lower percentages of damaged/dying motoneurons in their lumbar enlargements. These results demonstrate the capacity of nanofiber mats for generation of neurotoxic glutamate in the rat CNS. However, the tested nanofiber mats need further improvements aimed at extending the period of effective drug release and rendering the release more steady.

Giant cell glioblastoma with unique bilateral cerebellopontine angle localization considered as extraaxial tumor growth in a patient with neurofibromatosis Type 1.

Giant cell glioblastoma multiforme (GCGBM) is a rare variant of glioblastoma, occurring predominantly in the cerebral hemispheres. Its infratentorial localization has been documented occasionally, while GCGBM in the cerebellopontine angle (CPA) region has not been described so far. We report a case of GCGBM presenting primarily as an extraaxial bilateral CPA tumor in a 29-year-old woman with neurofibromatosis Type 1 (NF1). The patient died shortly after surgery of the right CPA tumor. Postmortem study of the brain revealed large tumor masses, located in the CPA bilaterally, encasing the brainstem base and cisternal portions of the cranial nerves. Tumor masses were demarcated from the brainstem and cerebellum and covered by leptomeninges. Microscopically, a slight subpial tumor seeding from the leptomeninges into the brain parenchyma was observed in the right CPA region. The tumor showed highly pleomorphic, giant and multinucleated cells, densely cellular sheets of poorly differentiated cells and pseudopalisading necroses. Tumor cells were positive for GFAP, S-100 protein, and p53 and negative for neuronal antigens. The MIB-1 labeling index was very high in densely cellular areas. To our knowledge this is the second report of GCGBM in an NF1 patient and the first reported case of GCGBM presenting as an extraaxial leptomeningeal lesion with bilateral CPA localization, which might be considered as primary leptomeningeal gliomatosis.

Granulomatous inflammation of dura mater--a rare side effect after application of hemostatic and insulation materials in case of two-stage operation of huge meningioma.

Haemostatic and isolating materials may cause local reactions as a foreign body. The case presented here of intracranial granulomatous lesion pertains to a patient operated in two stages due to a huge meningioma. During the first operation the tumour was partially removed. Because of persistent intraoperative haemorrhage haemostatic flakes of Oxycel and Spongostan were applied locally. In order to cover the lack of the dura, an insulation material--Tachosil was used. Histological examination of the tumour specimens confirmed the preoperative diagnosis of benign meningioma, mainly of the angiomatous subtype. The second stage of operation was performed after 3 months and the meningioma was completely removed, as well as dura mater and meningioma attachment with its oncological margin. The resected dura mater was thickened and histologically showed intensive granulomatous infiltrations and foreign body reactions most likely to Oxycel. Clinically no local and general infection and improper healing was observed after the first and the second treatment stage, but an allergic skin lesions and increased eosinophils in peripheral blood smear were noted. It was stated that systemic allergic reaction and granulomatous inflammation of dura mater were an uncommon response to the applied haemostatics and/or insulation material used during the first operation. This report show that haemostatic and isolating agents, generally used in neurosurgical procedure, may rarely cause local granulomatous processes considered as delayed hypersensitivity and the foreign body reactions. Therefore, they may hinder morphological assessment of the tissues during re-exploration and must be differentiate with the other infectious and non-infectious granulomatous processes.

[Evaluation of nutritive value of daily food rations consumed by children attending to primary schools in Warsaw]. / Ocena wartosci odzywczej calodziennych racji pokarmowych dzieci uczeszczajacych do warszawskich szkól podstawowych.

BACKGROUND: Meals served in schools are significant part of proper nutrition of children and adolescents. OBJECTIVE: The aim of the study was to compare nutritive value of daily food rations intake by children attending to primary schools in Warsaw who consumed school lunches regularly with those who don't consume school lunches. MATERIAL AND METHODS: From 2009 to 2010, 380 children in age 11-13 years attending to five randomly selected schools from Warsaw were enrolled. Dietary intake was assessed by using 24h dietary recall for 1 day before the egzamination. RESULTS: 45,5% of examined children declared the consumption school lunches regularly. There was no significant differences in energy and most of the nutrient intake between children who consumed school lunches regularly and children, who didn't eat lunches in school. The exception was sodium and iodine intake which was higher in children who regularly consumed school lunches. Sodium intake in children who consumed school lunches regularly was 3278 +/- 1251 mg and in the group of children who didn't consume lunches in school - 2919 +/- 863 mg (p<0.001). The iodine intake in the group of children who consumed school lunches regularly was 136 +/- 70.5 microg and in the group of children who didn't consume lunches in school - 102 +/- 59 microg (p<0.0001). CONCLUSIONS: Regular consumption of school lunches did not improve the nutritional habits of examined school-aged children from Warsaw. Obligatory standards based on nutritional recommendations relating to nutritional value of school lunches should help to improve the schoolchildren nutrition.

Immunodistribution of amyloid beta protein (Aß) and advanced glycation end-product receptors (RAGE) in choroid plexus and ependyma of resuscitated patients.

RAGE (receptor for advanced glycation end-products) participates in the influx transport of glycated Aß (amyloid beta) from the blood to the brain. Because little is known of the RAGE operating in brain barriers such as those in the choroid plexus and ependyma, the aim of the present study was to examine the immunodistributions of RAGE and Aß peptides in the choroid plexus where the blood-cerebrospinal fluid barrier (B-CSF) is located, and in ependyma of the brain ventricles associated with functions of the cerebrospinal fluid-brain barrier (CSF-B). The study was performed on patients over 65 years successfully resuscitated after cardiac arrest with survival a few weeks. The control group consisted of age-matched individuals who were not resuscitated and died immediately after cardiac arrest. In resuscitated patients, but not in controls, RAGE receptors were localized in choroid plexus (CP) epithelial cells and in ependymal cells bordering the brain ventricles. These cells form the B-CSF and CSF-B barriers. The presence of Aß was detected within the CP blood vessels and in the basement membrane of the CP epithelium. In numerous cytoplasmic vacuoles of CP epithelial and ependymal cells Aß protein was found and our observations suggest that the contents of those vacuoles were undergoing progressive digestion. The results demonstrated that CP epithelium and ependymal cells, equipped with RAGE receptors, not only play an important role in the creation of amyloid deposits in the brain but are also places where Aß may be utilized. The RAGE transportation system should be a main target in the therapy of brain amyloidosis, a well-known risk factor of Alzheimer disease.

Neuroprotective effect of erythropoietin in amyotrophic lateral sclerosis (ALS) model in vitro. Ultrastructural study.

Erythropoietin (EPO) is a chemokine hormone that is widely distributed throughout the body including nervous system. For last years its role as cytokine involved in many physiological processes out of the bone marrow has been suggested. Moreover, it plays a very important role in CNS as potential neuroprotective agent. There is much evidence that EPO protects neuronal cells in vitro and in vivo models of brain injury, independently of its erythropoietic action. The aim of this study was to determine the potential neuroprotective effects of erythropoietin on the glutamate-mediated injury of motor neurons (MNs) in vitro. The study was performed on organotypic cultures of the rat lumbar spinal cord subjected to glutamate uptake blocker, DL-threo-beta-hydroxyaspartate (THA) and pretreated with EPO. Ultrastructural study evidenced that the spinal cord cultures pretreated with EPO exhibited less severe neuronal injury. The cultures exposed to EPO + THA showed inhibition of early MNs degeneration, including various mode of degenerative changes caused by THA, whereas in the later period the typical postsynaptic necrotic changes of neuronal cells occurred. However, the ultrastructural characteristics of apoptotic MNs changes were not observed during the whole period of observation. The results of this study indicate that, in the model of chronic glutamate excitotoxicity, EPO exhibits the neuroprotective ability mainly through prevention of apoptotic neuronal changes.

Occipital neuralgia: possible failure of surgical treatment - case report.

Surgical intervention in severe cases of occipital neuralgia should be considered if pharmacological and local nerve blocking treatment fail. The literature suggests two types of interventions: surgical decompression of the greater occipital nerve (GON) from the entrapment site, as a less invasive approach, and neurotomy of the nerve trunk, which results in ipsilateral sensation deficits in the GON innervated area of the skull. Due to anatomical variations in the division of the GON trunk, typical neurotomy above the line of the trapezius muscle aponeurosis (TMA) may not result in full recovery. The present study discusses a case of a female treated with GON decompression as a result of occipital neuralgia unresponsive to pharmacotherapy, who thereafter was qualified for two consecutive neurotomies due to severe relapse of pain.

Ten years observation and treatment of multifocal pilocytic astrocytoma.

Pilocytic astrocytoma (PA) usually occurs in younger patients. It is a benign, generally well-delineated, WHO grade I tumour with favorable prognosis, which makes it different from diffuse astrocytomas, classified as higher grades of malignancy. A case study of PA was presented in a young female patient, observed and treated at the Neurosurgical Department for the period of 10 years, during which time she had frequent surgical procedures due to recurrence and dissemination of the tumour. The initial symptom of the disease was epileptic seizure at the age of 16. Neuroradiological study revealed cerebral tumour in the right temporal lobe, then the first temporal lobe surgery followed by re-operation and radiotherapy was performed. The patient developed hydrocephalus, treated with the ventriculo-peritoneal shunt. After 5 years local recurrence of the tumour appeared in the right temporal region. The patient was operated and the tumour was totally removed. Initially, the histopathological diagnosis of ganglioglioma was suggested for primary tumour, finally the diagnosis of pilocytic astrocytoma for both recurrent and primary tumour was established. During the next years of observation increasing neurological symptoms in lower limbs developed. Subsequently, the patient reported pain syndrome in lumbosacral and perineal area. Consecutive MRI studies revealed a spinal canal tumours localized at the thoracic level and next at sacral level. The spinal tumour was surgically treated in both locations; the last operation was done 10 years after surgery of the primary temporal lobe tumour. Histopathological examinations of the excised foci from spinal canal revealed neoplasm consistent with WHO grade I pilocytic astrocytoma. The presented case indicates that despite the spread of the neoplastic process, a histopathologically benign tumour (WHO I grade) allows for long-term survival and observation period. Unfortunately, multifocal tumour involving midline structures causes major neurological symptoms and deficits. In the presented case we dealt now with the ascending spread process and the occurrence of the new foci in both subtentorial and parameningeal spaces inside the cranial cavity. It is a rare clinical manifestation of a disease ever described in the literature.

Asymptomatic and symptomatic glial cysts of the pineal gland.

Glial cysts of the pineal gland are benign and mostly asymptomatic incidental lesions found in the brain MRI or at autopsy examinations. In rare cases pineal cysts become symptomatic and require surgical intervention. Symptomatic glial cysts may be clinically and radiologically indistinguishable from cystic neoplasms of the pineal region; therefore, histopathological diagnosis is critical for further prognosis and therapy in operated patients. In this paper we present detailed histopathological characteristics of symptomatic glial cysts in 2 surgical cases and of asymptomatic cysts of the pineal gland found at random in 3 autopsy cases. Both surgical patients, a 19-year-old girl and a 17-year-old boy, presented with severe headaches, associated with syncope in one case and insomnia in the second one. Preoperative MR imaging suggested tumour of the pineal gland in case no. 2. Histopathological and immunohistochemical examination of the specimens from both surgical and all autopsy cases revealed a characteristic pattern of cystic structures within the pineal gland, surrounded by layers of a dense fibrillar glial tissue and pineal parenchyma, consistent with non-neoplastic glial cysts. Although histopathological findings in asymptomatic and symptomatic cysts are essentially the same, the cyst in surgical case 1 was unilocular and partly lined with ependymal cells, whereas the cysts in other cases were multilocular, comprising cavities of various size, formed in the central part of gliotic tissue or directly within the pineal parenchyma, and lacked ependymal lining. Possible pathophysiological and clinicopathological significance of some morphological variants of pineal glial cysts is discussed.

CDP-choline protects motor neurons against apoptotic changes in a model of chronic glutamate excitotoxicity in vitro.

Cytidine-5-diphosphocholine (CDP-choline, citicoline) is an endogenous nucleoside involved in generation of phospholipids, membrane formation and its repair. It demonstrates beneficial effects in certain central nervous system injury models, including cerebral ischaemia, neurodegenerative disorders and spinal cord injury. Defective neuronal and/or glial glutamate transport is claimed to contribute to progressive loss of motor neurons (MNs) in amyotrophic lateral sclerosis (ALS). Our previous ultrastructural studies, performed on an organotypic tissue culture model of chronic glutamate excitotoxicity, documented a subset of various modes of MN death including necrotic, apoptotic and autophagocytic cell injury. The aim of this ultrastructural study was to determine the potential neuroprotective effect of CDP-choline on neuronal changes in a glutamate excitotoxic ALS model in vitro. Organotypic cultures of the rat lumbar spinal cord subjected to 100 microM DL-threo-beta-hydroxyaspartate (THA) were pretreated with 100 microM of CDP-choline. The exposure of spinal cord cultures to CDP-choline and THA distinctly reduced the development of typical apoptotic changes, whereas both necrotic and autophagocytic THA-induced MN injury occurred. These results indicate that CDP-choline treatment might exert a neuroprotective effect against neuronal apoptotic changes in a model of chronic excitotoxicity in vitro.