A case of novel DYT6 dystonia variant with serious complications after deep brain stimulation therapy: a case report.

BACKGROUND: DYT6 dystonia belongs to a group of isolated, genetically determined, generalized dystonia associated with mutations in the THAP1 gene. CASE PRESENTATION: We present the case of a young patient with DYT6 dystonia associated with a newly discovered c14G>A (p.Cys5Tyr) mutation in the THAP1 gene. We describe the clinical phenotype of this new mutation, effect of pallidal deep brain stimulation (DBS), which was accompanied by two rare postimplantation complications: an early intracerebral hemorrhage and delayed epileptic seizures. Among the published case reports of patients with DYT6 dystonia, the mentioned complications have not been described so far. CONCLUSIONS: DBS in the case of DYT6 dystonia is a challenge to thoroughly consider possible therapeutic benefits and potential risks associated with surgery. Genetic heterogeneity of the disease may also play an important role in predicting the development of the clinical phenotype as well as the effect of treatment including DBS. Therefore, it is beneficial to analyze the genetic and clinical relationships of DYT6 dystonia.

Predictors of whole exome sequencing in dystonic cerebral palsy and cerebral palsy-like disorders.

INTRODUCTION: Cerebral palsy (CP) is a group of permanent disorders attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. Cerebral palsy-like (CP-like) disorders may clinically resemble CP but do not fulfill CP criteria and have often a progressive course and/or neurodevelopmental regression. To assess which patients with dystonic CP and dystonic CP-like disorder should undergo Whole Exome Sequencing (WES), we compared the rate of likely causative variants in individuals regarding their clinical picture, co-morbidities, and environmental risk factors. METHOD: Individuals with early onset neurodevelopmental disorder (ND) manifesting with dystonia as a core feature were divided into CP or CP-like cohorts based on their clinical picture and disease course. Detailed clinical picture, co-morbidities, and environmental risk factors including prematurity, asphyxia, SIRS, IRDS, and cerebral bleeding were evaluated. RESULTS: A total of 122 patients were included and divided into the CP group with 70 subjects (30 males; mean age 18y5m±16y6m, mean GMFCS score 3.3 ± 1.4), and the CP-like group with 52 subjects (29 males; mean age 17y7m±1y,6 m, mean GMFCS score 2,6 ± 1,5). The WES-based diagnosis was present in 19 (27.1%) CP patients and 30 CP-like patients (57.7%) with genetic conditions overlap in both groups. We found significant differences in diagnostic rate in CP individuals with vs. without risk factors (13.9% vs. 43.3%); Fisher's exact p = 0.0065. We did not observe the same tendency in CP-like (45.5% vs 58.5%); Fisher's exact p = 0.5. CONCLUSION: WES is a useful diagnostic method for patients with dystonic ND, regardless of their presentation as a CP or CP-like phenotype.

Atypical presentations of DYT1 dystonia with acute craniocervical onset.

DYT1 gene mutations lead to early-onset dystonia that begins with focal limb onset and spreads to other body regions within 5 years, with typical sparing of the oromandibular muscles. In the present study, we describe two patients with an unusual presentation of the disease.

Individual demands of human embryos on IVF culture medium: influence on blastocyst development and pregnancy outcome.

The elucidation of the metabolic requirements of human embryos in vivo or in vitro remains, despite being intensively investigated, a work in progress. The adoption of extended embryo culture to the blastocyst stage during the last decade has entailed new challenges. With the increased attention to culture media formulations, more evidence on the sensitivity of embryos to their early environmental conditions is accumulating which might affect phenotype and developmental potential. A retrospective study was conducted that comprised 286 IVF cycles to evaluate the effect of two different culture media on blastocyst development and pregnancy outcome. Embryos were either cultured in a one step or a sequential medium. Higher fertilization rates and augmented blastocyst rates as well as higher implantation rates were observed when embryos were cultured in one step medium (P<0.05). Interestingly, the transfer of two embryos where one embryo was cultured in either medium resulted in a significantly higher rate of twin pregnancies. Although multiple pregnancies should be avoided in assisted reproduction treatment to reduce risks for offspring and mother, this higher frequency of twin pregnancies resulting from the transfer of embryos derived from different culture media suggests that each embryo makes individual demands on its early environment.

The potential of δ2Hn-alkanes and δ18Osugar for paleoclimate reconstruction - A regional calibration study for South Africa.

The hydrogen isotopic composition of leaf wax-derived n-alkanes (δ2Hn-alkanes) is a widely applied proxy for (paleo)climatic changes. It has been suggested that the coupling with the oxygen isotopic composition of hemicellulose-derived sugars (δ18Osugar) - an approach dubbed 'paleohygrometer' - might allow more robust and quantitative (paleo)hydrological reconstructions. However, the paleohygrometer remains to be evaluated and tested regionally. In this study, topsoil samples from South Africa, covering extensive environmental gradients, are analysed. δ2Hn-alkanes correlates significantly with the isotopic composition of precipitation (δ2Hp), whereas no significant correlation exists between δ18Osugar and δ18Op. The apparent fractionation (εapp) is the difference between δ2Hn-alkanes and δ2Hp (εapp 2H) and δ18Osugar and δ18Op (εapp 18O), respectively, and integrates i) isotopic enrichment due to soil water evaporation, ii) leaf (and xylem) water transpiration and iii) biosynthetic fractionation. We find no correlation of εapp 18O nor for εapp 2H with temperature, and no correlation of εapp 2H with potential evapotranspiration and an aridity index. By contrast, εapp 18O correlates significantly with both potential evapotranspiration and the aridity index. This highlights the strong effect of evapotranspirative enrichment on δ18Osugar. In study areas without plant predominance using Crassulacean Acid Metabolism (CAM), coupling δ18Osugar and δ2Hn-alkanes enables to reconstruct δ2Hp and δ18Op with an offset of Δδ2H = 6 ± 27‰ and Δδ18O = 0.8 ± 3.7‰, respectively, as well as relative humidity (RH) with an offset of ΔRH = 6 ± 17%. The paleohygrometer does, however, not work well for our study areas where CAM plants prevail (reconstructed δ18Op, δ2Hp and RH are off by 3.1‰, 27.2‰ and 31.7%). This probably reflects plant-specific (phenological) adaptations and/or post-photosynthetic exchange reactions related to CAM metabolism. Overall, our findings corroborate that δ2Hn-alkanes and δ18Osugar are valuable proxies, and the paleohygrometer is a promising approach for paleoclimate reconstructions in southern Africa.

Ovarian stimulation in ART - Unwinding pressing issues.

Conventional controlled ovarian stimulation (cCOS) can cause significant discomfort, including ovarian hyperstimulation syndrome (OHSS). Clearly, management of OHSS and poor responder patients requires new strategies to overcome these problems and facilitate the birth of a healthy child with the fewest stimulation cycles. Several alternative methods have been developed. Non-conventional controlled ovarian stimulation (non-cCOS) is based on low-dose stimulation regimens and is often termed "light", "soft", "mini", "minimal", "mild", "low cost", or "low dose IVF". Non-controlled ovarian stimulation therapies (non-COS) include natural cycle IVF or a mixture between non-controlled and non-cCOS, termed "modified natural IVF" or "antiestrogen/aromatase inhibitor/low dose FSH-cycles", in which cycles are monitored but not controlled. These approaches promise to reduce the physical, emotional, and financial burden of IVF therapy while maintaining acceptable pregnancy rates. Such approaches might reduce the risk of OHSS. However, the overall cost per baby increases due to the higher number of stimulation cycles required, and the inconvenience of ovum pick-up still remains. The primary focus should be to obtain several good quality blastocysts after a single cCOS cycle. Thus, adequate numbers of mature oocytes are mandatory. What is more difficult and expensive for patients: several non-COS/non-cCOS cycles to obtain a baby or a single cCOS cycle with a high probability to obtain more than one child? Classic cCOS using the GnRH agonist long protocol followed by single embryo transfer (SET) at the blastocyst stage and aseptic vitrification of surplus embryos optimizes the IVF outcome. This strategy, combined with outpatient management in the case of OHSS, minimizes inconvenience and risks of OHSS. Accumulation cycles (AC) by repeated COS with subsequent freezing of blastocysts, combined with preimplantation genetic screening (PGS), is a promising new approach for low responders, especially in cases of advanced maternal age (AMA).

Gliosis in schizophrenia: a survey.

Increased gliosis has been previously described in schizophrenic brain. In this study, the degree of gliosis in schizophrenic and control brains was assessed quantitatively using an antibody to glial fibrillary acidic protein, immunocytochemical techniques, and a computed image analysis system. Twenty separate brain areas were assessed, and no significant differences were found between the schizophrenic and control groups. It seems unlikely that a specific pattern of pathologically significant gliosis is present in schizophrenic brains. These negative findings are of note because of previously reported structural differences in the temporal lobe in the schizophrenic group in this series.

Normalization of serum prolactin levels in hemodialysis patients on recombinant human erythropoietin.

Correction of anemia in long-term hemodialysis patients by recombinant human erythropoietin (r-HuEPO) has been reported to improve sexual function. As elevated serum prolactin levels are believed to contribute to altered sexual function in uremia, we followed serum prolactin and testosterone levels during four months of r-HuEPO therapy. Within these four months, hematocrit values rose from 23.7 +/- 1.2 to 35.7 +/- 0.2% and hemoglobin from 7.3 +/- 0.3 to 11.3 +/- 0.4 g/100 ml. In parallel, serum prolactin values decreased significantly, from 66.9 +/- 9.3 to 9.6 +/- 2.6 ng/ml in females and from 39.5 +/- 10.5 to 10.3 +/- 1.0 ng/ml in male dialysis patients. Testosterone concentrations were in the lower normal range in male patients and remained unchanged during r-HuEPO therapy. Sexual function improved in four out of seven males, and five out of nine female patients started to have regular menstruations again. It appears that treatment of anemia in end-stage renal disease by r-HuEPO may improve sexual function by lowering elevated serum prolactin concentrations.

Treatment of the anemia of hemodialysis patients with recombinant human erythropoietin.

Fifteen long-term hemodialysis patients suffering from stable anemia received recombinant human erythropoietin (r-huEPO). The hormone was given intravenously at the end of each dialysis session starting with a dose of 24 IU/kg. This dose was doubled when hemoglobin levels did not rise within 2 weeks. The number of reticulocytes started to increase after 14 days of treatment. The hematocrit rose from baseline values of 23.7 +/- 1.2% to 32.4 +/- 1.3% after 24 weeks of treatment. In parallel, hemoglobin values increased from 7.3 +/- 0.3 g/100 ml to 10.1 +/- 0.4 g/100 ml. As for side effects, 3 patients developed hypertension and 2 patients suffered from occlusions of their arterio-venous fistulas. There was no evidence of major organ dysfunctions, toxic effects, allergic reactions, or antibody formation. These data show that r-HuEPO is able to correct the anemia of patients undergoing hemodialysis treatment.

Fermi surface and pseudogap evolution in a cuprate superconductor.

The unclear relationship between cuprate superconductivity and the pseudogap state remains an impediment to understanding the high transition temperature (T(c)) superconducting mechanism. Here, we used magnetic field-dependent scanning tunneling microscopy to provide phase-sensitive proof that d-wave superconductivity coexists with the pseudogap on the antinodal Fermi surface of an overdoped cuprate. Furthermore, by tracking the hole-doping (p) dependence of the quasi-particle interference pattern within a single bismuth-based cuprate family, we observed a Fermi surface reconstruction slightly below optimal doping, indicating a zero-field quantum phase transition in notable proximity to the maximum superconducting T(c). Surprisingly, this major reorganization of the system's underlying electronic structure has no effect on the smoothly evolving pseudogap.

[Vitrification and the use of high concentrations of cryoprotectants: is it a justified argument to prefer slow freezing?]. / Vitrification et utilisation de concentrations élevées en cryoprotecteurs: ceci justifie-t-il de préférer la congélation lente?

The use of high levels of cryoprotectants (CPs) in solutions applied to vitrify oocytes or embryos is an argument to still prefer slow freezing procedure. Is it a justified argument? Out of three studies using mice zygotes we may assume that (i) the intracellular concentration of CPs is far lower than the one in the vitrification solutions, (ii) the intracellular concentration of CPs in the vitrified zygote is in contrary to the common beliefs even lower than the one observed after a slow freezing procedure, (iii) survival after slow freezing reflects the presence of an intracellular vitrified state in these cells.

Scanning tunneling spectroscopy and vortex imaging in the iron pnictide superconductor BaFe1.8Co0.2As2.

We present an atomic resolution scanning tunneling spectroscopy study of superconducting BaFe1.8Co0.2As2 single crystals in magnetic fields up to 9 T. At zero field, a single gap with coherence peaks at Delta=6.25 meV is observed in the density of states. At 9 and 6 T, we image a disordered vortex lattice, consistent with isotropic, single flux quantum vortices. Vortex locations are uncorrelated with strong-scattering surface impurities, demonstrating bulk pinning. The vortex-induced subgap density of states fits an exponential decay from the vortex center, from which we extract a coherence length xi=27.6+/-2.9 A, corresponding to an upper critical field Hc2=43 T.

Methionine-enkephalin and substance P in the basal ganglia of normals, Parkinson patients, Huntington patients, and schizophrenics. A qualitative immunohistochemical study.

The distribution of methionine-enkephalin (ME)-like and substance P (SP)-like immunoreactivity in the basal ganglia of untreated schizophrenics as compared with normal control cases, and untreated Huntington and Parkinson patients was studied using the unlabeled peroxidase-antiperoxidase (PAP) method. ME but not SP was reduced in the pallidum of one of six schizophrenics. The remaining five cases showed no differences to the controls. In contrast, no or only very faint homogeneously distributed ME and SP was found in any part of the basal ganglia in Huntington's disease. In Parkinson's disease, SP immunoreactivity was within normal range.

[An accessory muscle and additional variants of the forearm]. / Ein akzessoricher Muskel und zusätzliche Varianten am Unterarm.

A report is given on an accessory muscle of the forearm. The muscle originates from the medial epicondyle and the fascia of the forearm and inserts into the pisiform bone and retinaculum. The accessory muscle has a great similarity with the flexor carpi ulnaris muscle.

Binding Sites of E. coli DNA-dependent RNA polymerase on spinach chloroplast DNA.

Under stringent conditions E. coli DNA-dependent RNA polymerase holoenzyme binds selectively to some spinach chloroplast DNA fragments generated by restriction endonucleases. The strongest of these binding sites, as judged by the initial rate of complex formation, are located in the large single-copy DNA region (Crouse et al. 1978) of this molecule and correspond in map location with known protein coding sequences. Some of these binding sites have characteristics of complex formation comparable with those of the PR and PL promoters of phage lambda DNA.Binding sites located close to the rRNA operons on the chloroplast DNA bind polymerase less strongly than those described above. Since the rRNAs are the most abundant transcription products in vivo and in isolated chloroplasts (Hartley and Head 1979; Bohnert et al. 1977) this suggests that the E. coli and chloroplast enzymes do not recognize all of the major promoters in chloroplast DNA with the same efficiency of binding.We have investigated in detail one region of the chloroplast DNA from spinach which contains three strong binding sites. This region has been shown to contain at least the gene for a 32,000 dalton protein (Driesel et al. 1980) which is most probably the so-called photogene (Bedbrook et al. 1978).One of these three E. coli RNA polymerase binding sites is not more than approximately 150 by apart from what, by hybridization studies using isolated mRNA, we know to be the coding sequence for this protein.The results suggest that for some genes on the chloroplast DNA the bacterial RNA polymerase may be used to search for transcription initiation sites.

[Biomechanics of human tendons: connection between stress relaxation and stress recovery (author's transl)]. / Zur Biomechanik menschlicher Sehnen: Zusammenhänge von Relaxation und Spannungsrückgewinn

108 tendons of the m. extensor hallucis longus were examined with a tensile testing machine within 36 h after death. The specimen were kept at a resting length of 20 mm. After the "steady state" was reached by cyclic loading, the tendons were stretched up to a maximum load of 18 kp, then deloaded to a certain level and after that the elongation was kept constant. At high loading level the tension of the tendon decreases with time (relaxation). At medium and low loading level the tension increases slightly (mechanical recovery). Between that two regions there is a certain load, where the tension will not change with time (isorheological point). The position of the isorheological point depends on the velocity of the elongation. At low velocity (2 mm/min) the isorheological point is situated at 70%, at high velocity (12 mm/min) at 60% of the maximum load. One will find the maximum relaxation, when no deloading occurs. The mechanical recovery, however, has its maximum at 5--25% of the maximum load. But when the tendon is totally deloaded, there seems to occur no recovery. The maximum relaxation is 5 to 6 times larger than the maximum recovery. Supposingly the relaxation- and recovery-processses will happen at the same time but with different intensity depending on the loading level. At least the relaxation-process consists of different relaxation components with different relaxation times. This will explain the phenomenon of a "secondary relaxation": After a long time of registration the recovery will turn into a slight relaxation.

Phospholipase A activities in ascites, serum, lymph, and urine in acute pancreatitis following pancreas stimulation with secretin-ceruletid.

As a result of pancreas stimulation with secretin-ceruletid we were able to measure the release of phospholipase A in ascites, serum, lymph, and urine in acute experimental pancreatitis in the dog. After induction of acute pancreatitis we found no increase over the normal range in serum, lymph, and urine phospholipase A activities. In addition, the stimulation of the exocrine pancreas did not show a significant change in phospholipase A activity. The excessively high phospholipase A activity in ascites following induction of acute pancreatitis fell significantly after pancreas stimulation with secretin-ceruletid.

[Therapy of renal anemia with recombinant human erythropoietin]. / Therapie der renalen Anämie mit rekombinantem humanem Erythropoietin.

The effectiveness of recombinant human erythropoietin (r-HEPO) was tested in 15 haemodialysis patients. The dosage was started at 24 IU/kg three times weekly, as an intravenous bolus at the end of the dialysis session, and then doubled every two weeks as long as the rise in haemoglobin was less than 2 g/dl. During treatment the reticulocyte count rose from 31 +/- 5 x 10(3)/microliters to 152 +/- 11 x 10(3)/microliters after 16 weeks. The haematocrit rose from 0.24 +/- 0.01 to 0.36 +/- 0.002. At the beginning of treatment the haemoglobin level was 7.3 +/- 0.3 g/dl and rose during treatment to 11.3 +/- 0.2 g/dl. Three patients developed hypertension and in two their Cimino shunt closed. but there were no toxic side effects, organ damage, allergic reactions or antibodies against the hormone. The results show that the anaemia of patients on chronic dialysis can be treated effectively and without serious side effects with r-HEPO.

Neuropeptides in the amygdala of controls, schizophrenics and patients suffering from Huntington's chorea: an immunohistochemical study.

The location of the neuropeptides methionine-enkephalin (ME), neurotensin (NT), neuropeptide Y (NPY) and vasoactive intestinal polypeptide (VIP) within the amygdaloid complex of healthy human individuals, schizophrenics and patients suffering from Huntington's chorea was studied qualitatively by means of immunohistochemistry. VIP-like immunoreactivity (IR) was present predominantly in a dense cluster of fibers and terminals in the central amygdaloid nucleus. ME-IR was observed in fibers, terminals and cell bodies in the same subnucleus, exhibiting a characteristical distribution pattern. NT-positive cell bodies were situated within the center of the central amygdaloid nucleus, fibers and terminals being encountered mainly at the periphery. NPY-IR was found to be evenly distributed throughout the amygdala. Distribution and staining intensity of ME, NPY and NT in the amygdala showed no qualitatively recognizable difference between the normal and schizophrenic specimens, whereas VIP-IR appeared to be slightly increased in the central amygdaloid nucleus of schizophrenics. In the choreic cases, the considerably shrunken amygdala exhibited only very low staining intensity of the four investigated neuropeptides.