Introdução: O diagnóstico da esclerose múltipla (EM) embora seja clínico, se completa com os resultados de imagem de ressonância magnética, somados ainda com a análise do líquido cefalorraquidiano (LCR), que se constituem em ferramentas indispensáveis. A presença das bandas oligoclonais (BOC) no LCR faz parte do estudo da EM, assim como auxilio no diagnóstico. Existem grandes variações quanto à frequência de BOC em pacientes com EM nas diferentes populações, desde 90% em países nórdicos europeus, até 30 a 60% no Japão, China, Índia e Líbano. O presente estudo tem o objetivo de estabelecer o valor da análise do LCR para o diagnóstico da EM em nossa população, com ênfase na pesquisa de BOC. O estudo também objetiva correlacionar os resultados destas análises com as características clínicas e demográficas da amostra selecionada. Casuística e Métodos: Foram estudados 145 pacientes selecionados do Centro de Referência de Doenças Desmielinizantes do Hospital das Clínicas da Faculdade de Medicina de Universidade de São Paulo, no período de agosto de 2005 a janeiro de 2008. Foram registrados para o estudo os dados demográficos, clínicos e da evolução da doença. O diagnóstico da EM foi estabelecido segundo o painel internacional de McDonald, revisado em 2005. A técnica utilizada para a pesquisa de BOC foi a focalização isoelétrica, seguida do immunoblotting, simultaneamente no LCR e no soro sanguíneo. Os resultados desta análise não foram utilizados para estabelecer o diagnóstico, ou para incluir pacientes na casuística da pesquisa. O grupo controle foi selecionado entre aqueles que se submeteram à anestesia raquidiana para cirurgias de pequeno porte. Resultados: Apresentaram BOC: 54,4% dos 90 pacientes com EM; 31,2% dos 16 pacientes com síndrome clínica isolada; 17,9% dos 39 pacientes com doenças neurológicas inflamatórias. No grupo controle, os 19 pacientes não apresentaram BOC. A sensibilidade das BOC foi calculada em 54,4%. A especificidade foi de 100% quando comparado ao grupo controle. Quando comparado com o grupo de pacientes com doenças neurológicas inflamatórias, a especificidade foi de 82,1%. Nos pacientes que se autodeclaram de cor parda ou preta, a frequência de BOC foi maior, com significância na borda do nível de significância de 5% (p=0,0518). Quanto aos aspectos clínicos evolutivos foi constatada maior presença de BOC nas formas progressivas recorrentes (100%); seguida da forma primariamente progressiva (87,5%); secundariamente progressiva (54,5%) e forma remitente recorrente (44,3%). A homogeneidade das BOC segundo as formas clínicas foi significante (p=0,0103), ao nível de significância de 5%. Conclusões: Este trabalho demonstra que a frequência de BOC em pacientes com EM foi de 54,4%, sendo menor que em outras séries mundiais. Estes resultados também não confirmam aqueles obtidos em estudos brasileiros prévios. A etnia e as formas de evolução clínica da doença influenciaram com significância na frequência de aparecimento das BOC. A baixa frequência das BOC no LCR de pacientes com EM pode ser decorrente de fatores associados à baixa e média prevalência da doença nesta região. / Introduction: The diagnosis of multiple sclerosis (MS) although clinical, is rounded out with the results of magnetic resonance imaging, in addition to an analysis of the cerebrospinal fluid (CSF), which form a set of indispensible tools. The presence of oligoclonal bands (OCB) in the CSF is used in the study and for the diagnosis of MS. The frequency of OCB in MS patients varies widely in different populations, ranging from 90% in Nordic countries, to 30 to 60% in Japan, China, India and Lebanon. The objective of the present study is to establish a reference value for the analysis of CSF for the diagnosis of MS in our population, with an emphasis on the study of OCB. A further objective of the study is to correlate the results of these analyses with the clinical and demographic characteristics of the sample selected. Methods: The sample was composed of 145 patients selected from the Demyelinating Diseases Reference Center of the Clinical Hospital of the University of São Paulo, from August 2005 to January 2008. Records containing demographic, clinical and disease progression were used for the study. The diagnosis of MS was established according to 2005 Revisions of the McDonald Criteria. To detect OCB, isoelectric focusing was employed, followed by immunoblotting, simultaneously in both the CSF and blood serum. The results of this analysis were not used to establish the diagnosis or to include patients in the study sample. The control group was selected from those who were submitted to spinal tap for anesthesia in minor surgery. Results: OCB were found in 54.4% of the 90 patients with MS, 31.2% of the 16 patients with isolated clinical syndrome, and 17.9% of the 39 patients with inflammatory neurological diseases. In the control group, 19 patients did not present OCB. The sensitivity of OCB was calculated to be 54.4%. The specificity was 100% when compared to the control group. When compared with the group of patients with inflammatory neurological diseases, the specificity was 82.1%. For the patients who classified themselves as colored or black, the frequency of OCB was higher, with borderline significance using a significance level of 5% (p=0.0518). With regard to clinical evolution of MS, the highest presence of OCB was found in the relapsing progressive types (100%); followed by the primary progressive type (87.5%); secondary progressive type (54.5%); and relapsing remitting type (44.3%). The homogeneity of the OCB in relation to the clinical types was significant (p=0.0103), at a significance level of 5%. Conclusions: This study shows that the frequency of OCB in patients with MS was 54.4%, lower than the findings of other worldwide series. Moreover, these results do not confirm those obtained in other Brazilian studies. Race and clinical progression of the disease influenced, in a statistically significant manner, the frequency of the presence of OCB. The low frequency of OCB in the CSF of patients with MS may be the result of factors associated with the low and medium prevalence of this disease in this region.

The meningitis is a serious inflammatory illness of meninges, the membranes that recover and protect encephalo and the spinal cord. The main causing agents of the meningitis are the viruses and the bacteria. Some works affirm that the adenosine, the final product of ATP hydrolysis (when degraded by ectonucleotidases), have an important protective role in brain disorders. Breakdown of extracellular ATP to adenosine is catalyzes by ecto-nucleotidases family, the NTPDase hydrolyze extracellular nucleotide tri and diphosphates (ATP and ADP) to nucleotide monophosphate (AMP) and the 5'-nucleotidase catalyzes the hydrolysis of AMP to adenosine. In this work we verified adenine nucleotides hydrolysis in the CSF of aseptic and bacterial meningitis patients, in order to compare with adenine nucleotides hydrolysis in controls patient (absence of neural inflammatory process). Were used patients with age between 18 and 59 years of both the sex in a sampling of 15 patient controls, 15 patients with aseptic meningitis and 15 patients with bacterial meningitis. For the criteria of inclusion and exclusion had been analyzed parameters like, aspect of the CSF, total counting of leukocytes, distinguishing counting of leukocytes, values of protein, glucose and lactate. We got as resulted a significant reduction of hydrolysis of the ATP in the patients with aseptic and bacterial meningitis when compared with patient controls. In contrast we got a significant increase of hydrolysis of the ADP and the AMP in the two groups of meningitis when compared with the controls. The increase in ADP and AMP hydrolysis maybe means the attempt of increase the adenosine production, that have a recognized neuroprotective actions in brain insults. / A meningite é uma grave doença inflamatória das meninges, as membranas que recobrem e protegem o encéfalo e a medula espinhal. Os principais agentes causadores da meningite são os vírus e as bactérias. Vários trabalhos afirmam que a adenosina, produto final da degradação do ATP (quando degradado pelas ectonucleotidases), possui um importante papel protetor nas desordens cerebrais. A degradação do ATP até adenosina é catalisada pela família das ecto-nucleotidases, a NTPDase hidrolisa nucleotídeos extracelulares tri e di-fosfatados (ATP e ADP) até nucleotídeos mono-fosfatados (AMP), e a 5'-nucleotidase catalisa a hidrolise do AMP até adenosina. Neste trabalho verificou-se a hidrólise dos nucleotídeos de adenina no líquor de pacientes com meningite asséptica e bacteriana, a fim de comparar a hidrólise destes nucleotídeos com pacientes controles (ausência de processo inflamatório neural). Foram utilizados pacientes com idade entre 18 e 59 anos de ambos os sexos em uma amostragem de 15 pacientes controles, 15 pacientes com meningite asséptica e 15 paciente com meningite bacteriana. Para os critérios de inclusão e exclusão foram analisados parâmetros tais como: aspecto do líquor, contagem total de leucócitos, contagem diferencial de leucócitos, valores de proteína, glicose e lactato. Obtivemos como resultado uma diminuição significativa da hidrólise do ATP nos pacientes com meningite asséptica e bacteriana quando comparados com pacientes controles. Ao contrário obtivemos um aumento significativo da hidrólise do ADP e do AMP nos dois grupos de meningites quando comparados com os controles. A hidrólise aumentada do ADP e do AMP refere-se talvez a tentativa de aumentar a produção de adenosina, que por sua vez possui um conhecido papel neuroprotetor frente a insultos cerebrais.

No description available.

A epilepsia compreende um grupo de alterações neurológicas frequentes em humanos e animais, caracterizada pela ocorrência periódica de crises convulsivas. A causa do processo pode ter várias origens sendo necessária a realização de exames complementares para o diagnóstico definitivo. A análise de biomarcadores, em especial as proteínas de fase aguda, como a proteína C-reativa (PCR), auxilia na identificação de doenças neurológicas inflamatórias e infecciosas, já que após serem produzidas pelo fígado conseguem atingir o tecido danificado e ter suas concentrações elevadas rapidamente na circulação. A concentração de PCR está diretamente relacionada à resposta de fase aguda, independentemente da origem ou natureza do estímulo, podendo ser um processo inflamatório, infeccioso ou até mesmo de origem neoplásica. Embora a PCR tenha sido estudada e monitorada em pacientes com as mais variadas doenças, até o momento não foi determinada a presença de PCR no soro e líquor de cães com epilepsia idiopática. O objetivo deste estudo foi avaliar as concentrações de PCR no líquor e soro de cães apresentando epilepsia idiopática e verificar se essa protéina pode ser utilizada como biomarcador para auxiliar no diagnóstico da doença. Para tanto foram compostos três grupos. O primeiro, denominado A, com 23 animais clinicamente normais; o segundo denomindo B, composto por 17 cães manifestando convulsão em até 24 horas anteriores ao momento da coleta de mateiral; e o terceiro denominado C, com 16 cães apresentando convulsões de 24 horas até 120 horas antecedendo o momento da coleta do líquor e do soro. Foram mensuradas as proteínas totais séricas e realizadas as eletroforeses, além da análise do líquor e tomografia computadorizada. Animais com alterações estruturais detectadas na tomografia foram excluidos do estudo. As concentrações de PCR séricas foram avaliadas por meio da técnica ELISA utilizando-se kit comercial Tridelta Development Ltd, espécie específico. Além desta avaliação, os grupos B e C foram alivados quanto à concentração de PCR no liquor. Os resultados foram analisados pelo teste de Kruskal Wallis, seguido pelo teste de Dunn, enquanto para eletroforese e análise de PCR no líquor utilizou-se teste T não pareado. Não houve diferença significante em relação à eletroforese de proteínas séricas nos três grupos, assim como não se observaram alterações na análise do líquor nos grupos B e C. As concentrações séricas de PCR em cães normais variaram níveis não detectáveis a 6,36 µg/mL, com média de 0,98 µg/mL. As concentrações séricas nos animais do grupo B variaram de 1,04 µg/mL a 5,03 µg/mL, com média 2,14 µg/mL, enquanto no grupo C as concentrações foram de níveis não detectáveis a 1,9 µg/mL com média 0,51 µg/mL. A análise estatística demonstrou diferença significante entre os grupos sendo a média do grupo B superior aos demais (p= 0,0002). As concentrações liquóricas de PCR foram muito baixas quando comparadas àquelas observadas em cães com afecções inflamatórias e infecciosas e não foram em sua maioria detectáveis no líquor quando o período entre a convulsão e a coleta foi superior ao período de 24 horas. Concluiu-se que as convulsões associadas à epilepsia idiopática promovem uma resposta de fase aguda caracterizada pelo aumento de PCR sérica e liquórica nas primeiras 24 horas e que essas concentrações decaem após esse período, podendo estar associadas à liberação de mediadores inflamatórios no SNC e às contrações musculares. Assim sendo, a PCR sérica pode ser utilizada como um biomarcador para diferenciar a epilepsia idiopática de outras causas de convulsão. A técnica ELISA para análise de PCR no líquor, pode se somar às outras análises liquóricas, necessitando ainda de validação. / Epilepsy is a group of neurological disorders of humans and animals characterized by recurrent seizures. Epilepsy can have a number of causes and some complementary tests can help with a precise diagnosis. Biomarkers analysis, in special acute protein phase such as C reactive protein (PCR) can help identify inflammatory and infection neurological disease. Acute phase proteins are produced by liver and reach damaged tissue increasing blood concentration. Today studies show that increases in the PCR blood concentration is related to acute inflammatory response independent of mint, whether it is inflammatory, neoplastic or infection. Although PCR has been studied in many diseases, in special neurological disorder followed or not by seizures, until now PCR has not been founded in blood or liquor of dogs with idiopathic epilepsy. The purpose of this study is to evaluate PCR concentration in blood and liquor of patients with idiopathic epilepsy and verify if the protein can be considered a biomarker to help its diagnose. The study has 3 groups. The first named control group A, with 23 healthy animals, the second named B with 17 dogs that have had seizures within 24h, and the third named C with 16 dog that have had seizures after 24 to 120 hours from blood or liquor collection. The investigation is based on analyzing total protein and electrophoretic protein profile, liquor analysis and tomography. Patients with structural brain damages detected by tomography were excluded from the study. In the control group PCR concentration were analyzed by ELISA method and kit Tridelta Development Ltd, species specific. In groups B and C were also procedure PCR analyses in liquor sample. The results were analyzed by the Kruskal Wallis test and the Dun test, while electrophorese and PCR of liquor where analyzed by the T test not parried. There was no significant difference in electrophorese in the three groups and there were not found alterations in the liquor analyzes of the groups B and C. PCR blood concentration in healthy dogs vary between not detectable values to 6,36mcg/ml, with an average of 0,98mcg/ml. Blood concentrations from animal of group B vary from 1,04 mcg/ml to 5,03, with and average of 2,14mcg/ml. Meanwhile in group C blood concentration values were from not detectable to 1,9 mcg/dl, with an average 0,50 mcg/ml. Statistic analyses show significant difference between groups. Group B average was higher (p=0,0002). PCR liquor concentration was lower to those found on dogs with inflammatory infection diseases and the majority were not detectable in the liquor when the sample has been collected after 24 hours from the seizures. It is able to conclude that seizures associated with idiopathic epilepsy promote an acute phase response characterized by an increase of blood and liquor PCR concentrations within 24 hours, and after this period PCR concentrations declined due to the liberation of inflammatory mediators by the CNS and muscle contractions. Therefore blood can be used as a biomarker to differentiate idiopathic epilepsy from other seizures causes. The ELISA technique for PCR liquor analysis still needs to be validated.

The principles of neurosurgical and neurointensive care liquorology We observed the development of the cerebrospinal fluid (CSF) patterns in 120 patients after bleeding in the CNS (central nervous system). We used our original cytological- energetic principle to investigate 1453 samples of the CSF from these patients. The principal aim of our investigation is the detection of immunocompetitive cells in the CSF and the specification of their activation via the coefficient of energy balance (KEB). Furthermore we evaluated the numbers of erythrocytes and leucocytes in the CSF and also the catalytic activities of the aspartate aminotranspherase (AST) in the CSF as biomarkers of structural disorder of the CNS. Our goal was to evaluate a three week long development of the CSF patterns to gain more accurate information for a more effective therapy and for a better prediction of further clinical development of these patients. We confirmed that following biomarkers were unfavourable for the development of the CSF compartment and probably the CNS as a whole: higher extent of bleeding in the CNS; higher frequency of the neutrophile granulocytes in the CSF compartment; higher extent of anaerobic metabolism in the CSF compartment; higher level of the catalytic activity of the AST in the CSF; higher age...

Normotensive hydrocephalus (NPH) is a neurodegenerative disease that occurs mainly in patients of high age. The disorder causes accumulation of cerebrospinal fluid (CSF), which leads to enlargement of ventricles and pressure exerted on cerebral structures. Clinical manifestations (gait disorders, development of dementia, incontinence) can be easily confused with symptoms of other neurodegenerative diseases; unlike other such disorders, however, NPH can be treated by surgery, if diagnosed in time. Patients are indicated for the procedure by a lumbar drainage test. There are currently no reliable laboratory biomarkers known that could be the basis of NPH diagnostics. In the past, steroids proved to be linked to neuronal activity in neurodegenerative diseases with the help of specific diagnostic markers. An instrumental method has been developed for the purposes of this thesis and it was used to gauge the level of certain steroids in CSF in a sample group of NPH patients and a control sample group of healthy individuals. A significant difference has been found in levels of aldosterone and cortisone. Aldosterone was higher in NPH sufferers, while cortisone levels were higher in the control group. It is crucial to differentiate patients with NPH from patients with similar clinical manifestations during...

Radio-frequency (RF) lesioning is a method utilising high frequency currents for thermal coagulation of pathological tissue or signal pathways. The current is delivered from an electrode with a temperature sensor, permitting control of the current at a desired target temperature. In the brain RF-lesioning can e.g. be used for severe chronic pain and movement disorders such as Parkinson’s disease. This thesis focuses on modelling and simulation with the aim of gaining better understanding and predictability of the lesioning process in deep brain structures. The finite element method (FEM) together with experimental comparisons was used to study the effects of electrode dimensions, electrode target temperature, electric and thermal conductivity of the brain tissue, blood perfusion and cerebrospinal fluid (CSF) filled cysts. Equations for steady current, thermal transport and incompressible flow were used together with statistical factorial design and regression analysis for this purpose. Increased target temperature, electrode tip length and electrode diameter increased the simulated lesion size, which is in accordance with experimental results. The influence of blood perfusion, modelled as an increase in thermal conductivity in non-coagulated tissue, gave smaller simulated lesions with increasing blood perfusion as heat was more efficiently conducted from the rim of the lesion. If no consideration was taken to the coagulation the lesion became larger with increased thermal conductivity instead, as the increase in conducted heat was compensated for through an increased power output in order to maintain the target temperature. Simulated lesions corresponded well to experimental in-vivo lesions. The electric conductivity in a homogeneous surrounding had little impact on lesion development. However this was not valid for a heterogeneous surrounding. CSF-filled cysts have a much higher electric conductivity than brain tissue focussing the current to them if the electrode tip is in contact with both. Heating of CSF can also cause considerable convective flow and as a result a very efficient heat transfer. This affected simulated as well as experimental lesion sizes and shapes resulting in both very large lesions if sufficient power compared to the cysts size was supplied and very small lesions if the power was low, mitigating the heat over a large volume. In conclusion especially blood perfusion and CSF can greatly affect the lesioning process and appear to be important to consider when planning surgical procedures. Hopefully this thesis will help improve knowledge about and predictability of clinical lesioning.

Traumatic brain injuries (TBIs) are a major public health problem worldwide where the symptoms can be anything from mild concussion to severe swelling of the brain tissue. As a result of TBI the intracranial pressure (ICP) can elevate to pathological levels with severe consequences such as hypoxia, ischemia and brain hemorrhage. TBI and the subsequent ICP increase could hence lead to disability or in worst cases death. Therefore to understand the severity of a head injury and the path regarding further treatments, monitoring of a patient's ICP is crucial in the intensive care units (ICU) environment. Invasive methods of ICP monitoring are at this present date the standard in ICU because of the accuracy when compared to non-invasive methods. All invasive ICP monitoring methods come with a risk to the patient and require the presence of a neurosurgeon. The thesis's objective was to develop a gradually increasing ICP testbed for a new non-invasive microwave based skin patch sensor. The aim with this project was to verify if a dependence in the resonance characteristic of the NASA SansEC microwave sensor with respect to ICP exists as suggested by previous works in a novel testbed and to provide a correlation model based on the testbed experiment. The developed testbed simulate increasing ICP by increasing volume of an artificial cerebro-spinal fluid (aCSF) liquid, a liquid emulating the CSF. The microwave sensor's resonance frequency is due to the permittivity changes caused by the change (increasing) in the fluid volume, which for this setup is directly correlated to the pressure change as well. Trials with different aCSF samples were made to ensure that the used aCSF in the testbed had the same dielectric properties as human CSF. The developed testbed had a simple structure made with several plastic containers of rectangular shape which were found to be well suited for the purpose of the experiment. For the microwave sensor trials an Fieldfox microwave analyzer was used and the sensor was evaluated around 1 - 4 GHz. The testbed pressure was increasing from 0 - 47 mmHg covering most useful ICP ranges. Larger pressures were also possible but limited by the height of the work room and the increase of complexity in the testbed design. The results from the trials showed a total resonance frequency shift of 76 MHz from 4 - 30 mmHg with an linear correlation of R2 = 0,91. The sensor measurements above 30 mmHg showed a saturation where the first principal frequencies were stable at 1,368 GHz. The linear relationship obtained for 4-30 mmHg is a reassurance that the Nasa SansEC sensor should be studied further. Future work should include new trials with modifications to the testbed setup and sensor design.

The focus of this thesis is to explore “the inner spiritual architecture” (prāṇa, nāḍī, cakra) through the lens of the pañcamayakośa model concerning raising kuṇḍalinī. We will discuss how the components of the “spiritual architecture” are directly influenced by four select techniques (mula bandhā uḍḍīyāna bandhā, jālandhara bandhā, and mahabandā). These are known as bandhās/mudras, which are specific to The Medieval Transformation for raising kuṇḍalinī. Our focus will explore the mechanics of the bandhās and the recorded, effects. The thesis’s secondary focus is cerebrospinal fluid (CSF). Under the traditional lens of the pañcamayakośa model, a comparison will be made between the movement of CSF and the recorded movement kuṇḍalinī when engaging mula bandhā uḍḍīyāna bandhā, jālandhara bandhā, and mahabandā. We will also consider the benefits associated with well-regulated cerebrospinal fluid (CSF) flow and compare them to the traditional benefits gained with the practice of raising kuṇḍalinī. Finally, our discussion will shift to parallels between a negative kuṇḍalinī experience and irregular CSF flow and an anecdotal account of irregular CSF flow. The conclusion will show how understanding the philosophy and techniques of raising kundalini under the lens of the pañcamayakośa model can provide unique insights regarding function, flow and manipulation of CSF health.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18461号 / 医博第3916号 / 新制||医||1005(附属図書館) / 31339 / 京都大学大学院医学研究科医学専攻 / (主査)教授 村井 俊哉, 教授 竹内 理, 教授 長田 重一 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM