Search results for: cerebral asymmetry

Authors: Rafat Alwazna

Abstract:

Technical lexicon is witnessing a large upsurge in the use of new terminologies whose emergence is an inevitable result of the spread of high-quality technology, the existence of scientific paradigms and the fast growth of research in different disciplines. One important subfield of terminology is legal terminology, which forms a crucial part of legal studies, and whose translation from one legal system into another is deemed a formidable and arduous task that needs to be properly performed by legal translators. Indeed, the issue of untranslatability of legal terms, particularly between originally unrelated languages, like legal Arabic and legal English, has long been a real challenge in legal translation. It stems from the conceptual incongruency between legal terms of different legal languages, which are derived from different legal cultures and legal systems. Such conceptual asymmetry is owing to the fact that law has no universal reference and that legal language is what determines the degree of difference in conceptual correspondence. The present paper argues that although conceptual asymmetry, which is the main reason for the issue of untranslatability of legal terms, cannot be denied in legal translation, there exist certain translation techniques which, if properly adopted, would resolve the issue of untranslatability of legal terms and therefore achieve acceptable legal translation. Hence, the question of untranslatability of legal terms should no longer exist within the context of legal translation.

Keywords: conceptual incongruency, Legal terms, translation techniques, untranslatability

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Authors: Finbarr Murphy, Wei Xu, Xian Xu

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The embedding of digital technologies in the global economy has attracted increasing attention from economists. With a large and detailed dataset, this study examines the specific case where consumers have a choice between offline and digital channels in the context of insurance purchases. We find that digital channels screen consumers with lower unobserved risk. For the term life, endowment, and disease insurance products, the average risk of the policies purchased through digital channels was 75%, 21%, and 31%, respectively, lower than those purchased offline. As a consequence, the lower unobserved risk leads to weaker information asymmetry and higher profitability of digital channels. We highlight three mechanisms of the risk screening effect: heterogeneous marginal influence of channel features on insurance demand, the channel features directly related to risk control, and the link between the digital divide and risk. We also find that the risk screening effect mainly comes from the extensive margin, i.e., from new consumers. This paper contributes to three connected areas in the insurance context: the heterogeneous economic impacts of digital technology adoption, insurer-side risk selection, and insurance marketing.

Keywords: digital economy, information asymmetry, insurance, mobile application, risk screening

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Authors: Elham Azimzadeh, Hamidollah Hassanlouei, Hadi Nobari, Georgian Badicu, Jorge Pérez-Gómez, Luca Paolo Ardigò

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Children with cerebral palsy (CP) have weak physical abilities and their limitations may have an effect on performing everyday motor activities. One of the most important and common debilitating factors in CP is the malfunction in the upper extremities to perform motor skills and there is strong evidence that task-specific training may lead to improve general upper limb function among this population. However, augmented feedback enhances the acquisition and learning of a motor task. Practice conditions may alter the difficulty, e.g., the reduced frequency of PG could be more challenging for this population to learn a motor task. So, the purpose of this study was to investigate the effect of physical guidance (PG) on learning a tracking task in children with cerebral palsy (CP). Twenty-five independently ambulant children with spastic hemiplegic CP aged 7-15 years were assigned randomly to five groups. After the pre-test, experimental groups participated in an intervention for eight sessions, 12 trials during each session. The 0% PG group received no PG; the 25% PG group received PG for three trials; the 50% PG group received PG for six trials; the 75% PG group received PG for nine trials; and the 100% PG group, received PG for all 12 trials. PG consisted of placing the experimenter's hand around the children's hand, guiding them to stay on track and complete the task. Learning was inferred by acquisition and delayed retention tests. The tests involved two blocks of 12 trials of the tracking task without any PG being performed by all participants. They were asked to make the movement as accurate as possible (i.e., fewer errors) and the number of total touches (errors) in 24 trials was calculated as the scores of the tests. The results showed that the higher frequency of PG led to more accurate performance during the practice phase. However, the group that received 75% PG had significantly better performance compared to the other groups in the retention phase. It is concluded that the optimal frequency of PG played a critical role in learning a tracking task in children with CP and likely this population may benefit from an optimal level of PG to get the appropriate amount of information confirming the challenge point framework (CPF), which state that too much or too little information will retard learning a motor skill. Therefore, an optimum level of PG may help these children to identify appropriate patterns of motor skill using extrinsic information they receive through PG and improve learning by activating the intrinsic feedback mechanisms.

Keywords: cerebral palsy, challenge point framework, motor learning, physical guidance, tracking task

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Authors: Kalai Lamia, Jilani Faouzi

Abstract:

Measuring and controlling risk is one of the most attractive issues in finance. With the persistence of uncontrolled and erratic stocks movements, volatility is perceived as a barometer of daily fluctuations. An objective measure of this variable seems then needed to control risks and cover those that are considered the most important. Non-linear autoregressive modeling is our first evaluation approach. In particular, we test the presence of “persistence” of conditional variance and the presence of a degree of a leverage effect. In order to resolve for the problem of “asymmetry” in volatility, the retained specifications point to the importance of stocks reactions in response to news. Effects of shocks on volatility highlight also the need to study the “long term” behaviour of conditional variance of stocks returns and articulate the presence of long memory and dependence of time series in the long run. We note that the integrated fractional autoregressive model allows for representing time series that show long-term conditional variance thanks to fractional integration parameters. In order to stop at the dynamics that manage time series, a comparative study of the results of the different models will allow for better understanding volatility structure over the Tunisia stock market, with the aim of accurately predicting fluctuation risks.

Keywords: asymmetry volatility, clustering, stylised facts, leverage effect

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Authors: Eun Jae Ko, In Young Sung, Eui Soo Joeng

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Oropharyngeal dysphagia is prevalent in children with cerebral palsy (CP). There are many studies concerning this problem, however, studies examining long term outcomes of dysphagia using videofluoroscopic study (VFSS) are very rare. The Aim of this study is to investigate long-term outcomes of dysphagia in children with severe CP using initial VFSS. It was a retrospective study and chart review was done from January 2000 to December 2013. Thirty one patients under 18 years who have been diagnosed as CP in outpatient clinic of Rehabilitation Medicine, and who did VFSS were included. Long-term outcomes such as feeding method, height percentile, weight percentile, and body mass index (BMI) were tracked up for at least 3 years by medical records. Significant differences between initial and follow-up datas were investigated. The patients consisted of 18 males and 13 females, and the mean age was 31.0±18.0 months old. 64.5% of patients were doing oral diet, and 25.8% of patients were doing non-oral diet. When comparing VFSS findings among oral feeding patients, oral and non-oral feeding patients, and non-oral feeding patients at initial period, dysphagia severity, supraglottic penetration, and subglottic aspiration showed significant differences. Most of the patients who could feed orally at initial period were found to have the same feeding method at follow-up. But among eight patients who required non-oral feeding initially, three patients became possible to feed orally, and one patient was doing oral and non-oral feeding method together at follow-up. Follow up feeding method showed correlation with dysphagia severity by initial VFSS. Weight percentile was decreased in patients with GMFCS level V at follow up, which may represent poor nutritional status due to severe dysphagia compared to other patients. Initial VFSS severity would play a significant role in making an assumption about future diet in children with severe CP. Patients with GMFCS level V seem to have serious dysphagia at follow up and have nutritional deficiency over time, therefore, more careful nutritional support is needed in children with severe CP are suggested.

Keywords: cerebral palsy, child, dysphagia, videofluoroscopic study

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Authors: Sohanur Rahman, Elisabeth Sinnewe, Larelle (Ellie) Chapple, Sarah Osborne

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Greater political attention to global climate change exposes firms to a higher level of political uncertainty, which can lead to adverse capital market consequences. However, a higher level of discourse on environment-specific political risk (EPR) between management and investors can mitigate information asymmetry, followed by less stock price crash risk. This study examines whether EPR discourse in discourse in the earnings conference calls (ECC) reduces firm-level stock price crash risk in the US market. This research also explores if adverse disclosures via media channels further moderates the association between EPR on crash risk. Employing a dataset of 28,933 firm-year observations from 2002 to 2020, the empirical analysis reveals that EPR discourse in ECC reduces future stock price crash risk. However, adverse disclosures via media channels can offset the favourable effect of EPR discourse on crash risk. The results are robust to the potential endogeneity concern in a quasi-natural experiment setting.

Keywords: earnings conference calls, environment, environment-specific political risk discourse, environmental disclosures, information asymmetry, reputation risk, stock price crash risk

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Authors: Shantanu Vyas, Neerja Meena

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Facial infiltrating lipomatosis is a rare lipomatous lesion, first described by Slavin in 1983. It is a benign pseudotumor pathology. It corresponds to a non-encapsulated collection of mature adipocytes infiltrating the local tissue and hyperplasia of underlying bone leading to a craniofacial deformity. Very few cases have been reported in the literature. We report the case of a 19-year-old female patient, who was consulted for a swelling of the right hemiface progressively evolving since birth. Physical examination revealed facial asymmetry. On palpation, the mass was soft, painless, not compressible, not pulsatile, not fluctuating. In view of the asymptomatic nature and slow progression of the lesion, a lipomatous tumour, namely lipoma, was suggested. CT scan image shows a hyperplastic subcutaneous fat on the right hemiface. On the right jugal and temporal areas, there is a subcutaneous formation of fatty density, poorly limited, with no detectable peripheral capsule. It merges with the adjacent fat. In the bone window, there was a hyperplasia of underlying bone. Facial lipomatosis infiltration of the face is a benign pseudotumor pathology. As a result, it can be confused with other disorders, in particular, hemifacial hyperplasia. Combination of physical and radiological findings can establish the diagnosis. Surgical treatment is done for cosmetic purposes.

Keywords: cosmetic correction and facial assemetry, aesthetic results, facial infiltration, surgery

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Authors: Mohsun Rasim Alizada, Azar Inshalla Ahmdov

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Prompt photons are perhaps the most versatile tools for studying the dynamics of relativistic collisions of heavy ions. The study of photon radiation is of interest that in most hadron interactions, photons fly out as a background to other studied signals. The study of the birth of prompt photons in nucleon-nucleon collisions was previously carried out in experiments on Relativistic Heavy Ion Collider (RHIC) and the Large Hadron Collider (LHC). Due to the large energy of colliding nucleons, in addition to prompt photons, many different elementary particles are born. However, the birth of additional elementary particles makes it difficult to determine the accuracy of the effective section of the birth of prompt photons. From this point of view, the experiments planned on the Nuclotron-based Ion Collider Facility (NICA) complex will have a great advantage, since the energy obtained for colliding heavy ions will reduce the number of additionally born elementary particles. Of particular importance is the study of the processes of birth of prompt photons to determine the gluon leaving hadrons since the photon carries information about a rigid subprocess. At present, paper production of prompt photon in Compton scattering of quark-gluon and annihilation of quark–antiquark processes is investigated. The matrix elements Compton scattering of quark-gluon and annihilation of quark-antiquark pair processes has been written. The Square of matrix elements of processes has been calculated in FeynCalc. The phase volume of subprocesses has been determined. Expression to calculate the differential cross-section of subprocesses has been obtained: Given the resulting expressions for the square of the matrix element in the differential section expression, we see that the differential section depends not only on the energy of colliding protons, but also on the mass of quarks, etc. Differential cross-section of subprocesses is estimated. It is shown that the differential cross-section of subprocesses decreases with the increasing energy of colliding protons. Asymmetry coefficient with polarization of colliding protons is determined. The calculation showed that the squares of the matrix element of the Compton scattering process without and taking into account the polarization of colliding protons are identical. The asymmetry coefficient of this subprocess is zero, which is consistent with the literary data. It is known that in any single polarization processes with a photon, squares of matrix elements without taking into account and taking into account the polarization of the original particle must coincide, that is, the terms in the square of the matrix element with the degree of polarization are equal to zero. The coincidence of the squares of the matrix elements indicates that the parity of the system is preserved. The asymmetry coefficient of annihilation of quark–antiquark pair process linearly decreases from positive unit to negative unit with increasing the production of the polarization degrees of colliding protons. Thus, it was obtained that the differential cross-section of the subprocesses decreases with the increasing energy of colliding protons. The value of the asymmetry coefficient is maximal when the polarization of colliding protons is opposite and minimal when they are directed equally. Taking into account the polarization of only the initial quarks and gluons in Compton scattering does not contribute to the differential section of the subprocess.

Keywords: annihilation of a quark-antiquark pair, coefficient of asymmetry, Compton scattering, effective cross-section

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Authors: Debasis Mondal, Chandan Datta, S. K. Sazim

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Quantum coherence is a key resource like entanglement and discord in quantum information theory. Wigner- Yanase skew information, which was shown to be the quantum part of the uncertainty, has recently been projected as an observable measure of quantum coherence. On the other hand, the quantum speed limit has been established as an important notion for developing the ultra-speed quantum computer and communication channel. Here, we show that both of these quantities are related. Thus, cast coherence as a resource to control the speed of quantum communication. In this work, we address three basic and fundamental questions. There have been rigorous attempts to achieve more and tighter evolution time bounds and to generalize them for mixed states. However, we are yet to know (i) what is the ultimate limit of quantum speed? (ii) Can we measure this speed of quantum evolution in the interferometry by measuring a physically realizable quantity? Most of the bounds in the literature are either not measurable in the interference experiments or not tight enough. As a result, cannot be effectively used in the experiments on quantum metrology, quantum thermodynamics, and quantum communication and especially in Unruh effect detection et cetera, where a small fluctuation in a parameter is needed to be detected. Therefore, a search for the tightest yet experimentally realisable bound is a need of the hour. It will be much more interesting if one can relate various properties of the states or operations, such as coherence, asymmetry, dimension, quantum correlations et cetera and QSL. Although, these understandings may help us to control and manipulate the speed of communication, apart from the particular cases like the Josephson junction and multipartite scenario, there has been a little advancement in this direction. Therefore, the third question we ask: (iii) Can we relate such quantities with QSL? In this paper, we address these fundamental questions and show that quantum coherence or asymmetry plays an important role in setting the QSL. An important question in the study of quantum speed limit may be how it behaves under classical mixing and partial elimination of states. This is because this may help us to choose properly a state or evolution operator to control the speed limit. In this paper, we try to address this question and show that the product of the time bound of the evolution and the quantum part of the uncertainty in energy or quantum coherence or asymmetry of the state with respect to the evolution operator decreases under classical mixing and partial elimination of states.

Keywords: completely positive trace preserving maps, quantum coherence, quantum speed limit, Wigner-Yanase Skew information

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Authors: Santi Termprasertsakul, Jakkrich Jearviriyaboonya

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This paper studies the market power and pricing behavior of products in iron and steel industry by investigating the impact of vertical product differentiation (VPD) on exchange rate pass-through (ERPT). Vietnam has become one of the major trading partners of Thailand since 2017. The iron and steel export value to Vietnam is more than $300 million a year. Particularly, the average growth rate of importing iron and steel is approximately 30% per year. The VPD is applied to analyze the quality difference of iron and steel between Thailand and Vietnam. The 20 products in iron and steel industry are investigated. The monthly pricing behavior of Harmonized Commodity Description and Coding System 4-digit products is observed from 2010 to 2019. The Nonlinear Autoregressive Distributed Lag is also used to analyze the asymmetry of ERPT in this paper. The empirical results basically reveal an incomplete pass-through between Thai Baht and Vietnamese Dong. The ERPT also varies with the degree of VPD. The product with higher VPD, indicating higher unit values, has higher ERPT. This result suggests the higher market power of the Thai iron and steel industry. In addition, the asymmetry of ERPT exists.

Keywords: exchange rate pass-through, iron and steel industry, pricing behavior, vertical product differentiation

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Authors: Wajid Mumtaz, Aamir Saeed Malik, Syed Saad Azhar Ali, Mohd Azhar Mohd Yasin

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In this paper, a technique based on electroencephalogram (EEG) analysis is presented, aiming for diagnosing major depressive disorder (MDD) among a potential population of MDD patients and healthy controls. EEG is recognized as a clinical modality during applications such as seizure diagnosis, index for anesthesia, detection of brain death or stroke. However, its usability for psychiatric illnesses such as MDD is less studied. Therefore, in this study, for the sake of diagnosis, 2 groups of study participants were recruited, 1) MDD patients, 2) healthy people as controls. EEG data acquired from both groups were analyzed involving inter-hemispheric asymmetry and composite permutation entropy index (CPEI). To automate the process, derived quantities from EEG were utilized as inputs to classifier such as logistic regression (LR) and support vector machine (SVM). The learning of these classification models was tested with a test dataset. Their learning efficiency is provided as accuracy of classifying MDD patients from controls, their sensitivities and specificities were reported, accordingly (LR =81.7 % and SVM =81.5 %). Based on the results, it is concluded that the derived measures are indicators for diagnosing MDD from a potential population of normal controls. In addition, the results motivate further exploring other measures for the same purpose.

Keywords: major depressive disorder, diagnosis based on EEG, EEG derived features, CPEI, inter-hemispheric asymmetry

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Authors: Canan Gunay Yazici, Zubeyir Sarı, Devrim Tarakci

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Background: Hippotherapy considered as global techniques used in rehabilitation of children with cerebral palsy as it improved gait pattern, balance, postural control, balance and gross motor skills development but it encounters some problems (such as the excess of the cost of horses' care, nutrition, housing). Hippotherapy simulator is being developed in recent years to overcome these problems. These devices aim to create the effects of hippotherapy made with a real horse on patients by simulating the movements of a real horse. Objectives: To evaluate the efficacy of hippotherapy simulator on gross motor functions, sitting postural control and dynamic balance of children with cerebral palsy (CP). Methods: Fourteen children with CP, aged 6–15 years, seven with a diagnosis of spastic hemiplegia, five of diplegia, two of triplegia, Gross Motor Function Classification System level I-III. The Horse Riding Simulator (HRS), including four-speed program (warm-up, level 1-2-3), was used for hippotherapy simulator. Firstly, each child received Neurodevelopmental Therapy (NDT; 45min twice weekly eight weeks). Subsequently, the same children completed HRS+NDT (30min and 15min respectively, twice weekly eight weeks). Children were assessed pre-treatment, at the end of 8th and 16th week. Gross motor function, sitting postural control, dynamic sitting and standing balance were evaluated by Gross Motor Function Measure-88 (GMFM-88, Dimension B, D, E and Total Score), Trunk Impairment Scale (TIS), Pedalo® Sensamove Balance Test and Pediatric Balance Scale (PBS) respectively. Unit of Scientific Research Project of Marmara University supported our study. Results: All measured variables were a significant increase compared to baseline values after both intervention (NDT and HRS+NDT), except for dynamic sitting balance evaluated by Pedalo®. Especially HRS+NDT, increase in the measured variables was considerably higher than NDT. After NDT, the Total scores of GMFM-88 (mean baseline 62,2 ± 23,5; mean NDT: 66,6 ± 22,2; p < 0,05), TIS (10,4 ± 3,4; 12,1 ± 3; p < 0,05), PBS (37,4 ± 14,6; 39,6 ± 12,9; p < 0,05), Pedalo® sitting (91,2 ± 6,7; 92,3 ± 5,2; p > 0,05) and Pedalo® standing balance points (80,2 ± 10,8; 82,5 ± 11,5; p < 0,05) increased by 7,1%, 2%, 3,9%, 5,2% and 6 % respectively. After HRS+NDT treatment, the total scores of GMFM-88 (mean baseline: 62,2 ± 23,5; mean HRS+NDT: 71,6 ± 21,4; p < 0,05), TIS (10,4 ± 3,4; 15,6 ± 2,9; p < 0,05), PBS (37,4 ± 14,6; 42,5 ± 12; p < 0,05), Pedalo® sitting (91,2 ± 6,7; 93,8 ± 3,7; p > 0,05) and standing balance points (80,2 ± 10,8; 86,2 ± 5,6; p < 0,05) increased by 15,2%, 6%, 7,3%, 6,4%, and 11,9%, respectively, compared to the initial values. Conclusion: Neurodevelopmental therapy provided significant improvements in gross motor functions, sitting postural control, sitting and standing balance of children with CP. When the hippotherapy simulator added to the treatment program, it was observed that these functions were further developed (especially with gross motor functions and dynamic balance). As a result, this pilot study showed that the hippotherapy simulator could be a useful alternative to neurodevelopmental therapy for the improvement of gross motor function, sitting postural control and dynamic balance of children with CP.

Keywords: balance, cerebral palsy, hippotherapy, rehabilitation

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Authors: Karen L. Middlemiss, Denham G. Cook, Peter Jaksons, Alistair Jerrett, William Davison

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Lateralisation of cognitive function is a common phenomenon found throughout the animal kingdom. Strong biases in functional behaviours have evolved from asymmetrical brain hemispheres which differ in structure and/or cognitive function. In fish, lateralisation is involved in visually mediated behaviours such as schooling, predator avoidance, and foraging, and is considered to have a direct impact on species fitness. Currently, there is very little literature on the role of lateralisation in fish schools. The yellow-eyed mullet (Aldrichetta forsteri), is an estuarine and coastal species found commonly throughout temperate regions of Australia and New Zealand. This study sought to quantify visually mediated behaviours in yellow-eyed mullet to identify the significance of lateralisation, and the factors which influence functional behaviours in schooling fish. Our approach to study design was to conduct a series of tank based experiments investigating; a) individual and population level lateralisation, b) schooling behaviour, and d) optic lobe anatomy. Yellow-eyed mullet showed individual variation in direction and strength of lateralisation in juveniles, and trait specific spatial positioning within the school was evidenced in strongly lateralised fish. In combination with observed differences in schooling behaviour, the possibility of ontogenetic plasticity in both behavioural lateralisation and optic lobe morphology in adults is suggested. These findings highlight the need for research into the genetic and environmental factors (epigenetics) which drive functional behaviours such as schooling, feeding and aggression. Improved knowledge on collective behaviour could have significant benefits to captive rearing programmes through improved culture techniques and will add to the limited body of knowledge on the complex ecophysiological interactions present in our inshore fisheries.

Keywords: cerebral asymmetry, fisheries, schooling, visual bias

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Authors: Fen-Ling Kuo, Hsin-Chieh Lee, Han-Yun Hsiao, Jui-Chi Lin

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Background: Children with cerebral palsy (CP) usually suffered from mild to maximum upper limb dysfunction such as having difficulty in reaching and picking up objects, which profoundly affects their participation in activities of daily living (ADLs). Robot-assisted rehabilitation provides intensive physical training in improving sensorimotor function of the hand. Many researchers have extensively studied the effects of robot-assisted therapy (RT) for the paretic upper limb in patients with stroke in recent years. However, few studies have examined the effect of RT on hand function in children with CP. The purpose of this study is to investigate the effectiveness of Gloreha Sinfonia, a robotic device with a dynamic arm support system mainly focus on distal upper-limb training, on improvements of hand function and ADLs in children with CP. Methods: Seven children with moderate CP were recruited in this case series study. RT using Gloreha Sinfonia was performed 2 sessions per week, 60 min per session for 6 consecutive weeks, with 12 times in total. Outcome measures included the Fugl-Meyer Assessment-upper extremity (FMA-UE), the Box and Block Test, the electromyography activity of the extensor digitorum communis muscle (EDC) and brachioradialis (BR), a grip dynamometer for motor evaluation, and the ABILHAND-Kids for measuring manual ability to manage daily activities, were performed at baseline, after 12 sessions (end of treatment) and at the 1-month follow-up. Results: After 6 weeks of robot-assisted treatment of hand function, there were significant increases in FMA-UE shoulder/elbow scores (p=0.002), FMA-UE wrist/hand scores (p=0.002), and FMA-UE total scores (p=0.002). There were also significant improvements in the BR mean value (p = 0.015) and electrical agonist-antagonist muscle ratio (p=0.041) in grasping a 1-inch cube task. These gains were maintained for a month after the end of the intervention. Conclusion: RT using Gloreha Sinfonia for hand function training may contribute toward the improvement of upper extremity function and efficacy in recruiting BR muscle in children with CP. The results were maintained at one month after intervention.

Keywords: activities of daily living, cerebral palsy, hand function, robotic rehabilitation

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Authors: Mohamed Alsafy, Samir El-Gendy, Ashraf Karkoura, Doha Shokry

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The purpose of the current study was to investigate the development of the chicken ovary. One hundred fertilized egg of Alexandria breed of chicken used. The whole embryo has undergone the light microscopic examination at HH20 (E.3), HH21 (E.3.5), HH23 (E.4), HH29 (E.6) and HH34 (E.8). The ovary has undergone the light microscopic examination at HH38 (E.12) and HH42 (E.16), SEM at HH26 (E.5), HH29 (E.6), HH36 (E.10), HH38 (E.12), HH39 (E.13) and HH42 (E.16), TEM at HH38 (E.12) and HH42 (E.16). The genital ridge appeared by a thickening of the coelomic epithelium medioventral surface of the developing mesonephroi at HH20 (E.3). The boundaries of the undifferentiating gonads defined clearly separated from the mesonephroi. The undifferentiated gonads bulged as a distinct organ in the coelomic cavity at HH23 (E.4). At the initial stages of the gonadogenesis, the germinal epithelium was stratified squamous epithelium. The PGCs appeared at the genital ridge at HH21 (E.3.5). The PGCs observed at the dorsal mesentery with few microvilli and showed positive PAS reaction due to the glycogen content in their cytoplasm. The left-right gonadal asymmetry firstly detected by the number of PGCs migrating toward the left gonadal ridge more than the right at HH20 (E.3) and the macroscopic examination of gonadal asymmetry began at HH34 (E.8). The left ovary appeared a smooth rod-shape, its stroma showed lipid droplets, and its parenchyma showed an extensive arrangement of interstitial cords at HH42 (E.16).

Keywords: ovary, Alexandria chicken, light microscopy, SEM, TEM

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Authors: Yu-Chieh Chen, Kuei-Feng Shen, Chia-Ling Chao

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The purpose of this report was to present the nursing experience and case of an unexpected cerebellar hemorrhagic stroke with acute hydrocephalus patient after lumbar spine surgery. The patient had been suffering from an emergent external ventricular drainage and stayed in the Surgical Intensive Care Unit from July 8, 2016, to July 22, 2016. During the period of the case, the data were collected for attendance, evaluation, observation, interview, searching medical record, etc. An integral evaluation of the patient's physiological 'psychological' social and spiritual states was also noted. The author noticed the following major nursing problems including ineffective cerebral perfusion 'physical activity dysfunction' family resource preparation for disability. The author provided nursing care to maintain normal intracranial pressure, along with a well-therapeutic relationship and applied interdisciplinary medical/nursing team to draft an individualized and appropriate nursing plan for them to face the psychosocial impact of the patient disabilities. We also actively participated in the rehabilitation treatments to improve daily activity and confidence. This was deemed necessary to empower them to a more positive attitude in the future.

Keywords: family resourace preparation inability, hemorrhagic sroke, ineffective tissue cerebral perfusion, lumbar spine surgery

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Authors: Tahsien Mohamed Okasha

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We hypothesized that Post cardiac arrest patients with Glasgow coma scale (GCS) score of less than (8) and who will be exposed to therapeutic hypothermia protocol will exhibit improvement in their neurological performance. Purposive sample of 17 patients who were fulfilling the inclusion criteria during one year collected. The study carried out using Quasi-experimental research design. Four Tools used for data collection of this study: Demographic and medical data sheet, Post cardiac arrest health assessment sheet, Bedside Shivering Assessment Scale (BSAS), and Glasgow Pittsburgh cerebral performance category scale (CPC). Result: the mean age was X̅ ± SD = 53 ± 8.122 years, 47.1% were arrested because of cardiac etiology. 35.3% with initial arrest rhythm ventricular tachycardia (VT), 23.5% with ventricular fibrillation (VF), and 29.4% with A-Systole. Favorable neurological outcome was seen among 70.6%. There was significant statistical difference in WBC, Platelets, blood gases value, random blood sugar. Also Initial arrest rhythm, etiology of cardiac arrest, and shivering status were significantly correlated with cerebral performance categories score. therapeutic hypothermia has positive effects on neurological performance among post cardiac arrest patients with GCS score of less than (8). replication of the study on larger probability sample, with randomized control trial design. Further study for suggesting nursing protocol for patients undergoing therapeutic hypothermia.

Keywords: therapeutic hypothermia, neurological performance, after resuscitation from cardiac arrest., resuscitation

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Authors: Masahiro Takimoto

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The present study explored how the metaphor awareness-raising approach affects the involvement of the right hemisphere in developing EFL learners’ knowledge regarding the different degrees of politeness embedded within different request expressions. The present study was motivated by theoretical considerations regarding the conceptual projection and the metaphorical idea of politeness is distance, as proposed; this study applied these considerations to develop Japanese learners’ knowledge regarding the different politeness degrees and to explore the connection between the metaphorical concept projection and right-hemisphere dominance. Japanese EFL learners do not know certain language strategies (e.g., English requests can be mitigated with biclausal downgraders, including the if-clause with past-tense modal verbs) and have difficulty adjusting the politeness degrees attached to request expressions according to situations. The present study used a pre/post-test design to reaffirm the efficacy of the cognitive technique and its connection to right-hemisphere involvement by mouth asymmetry technique. Mouth asymmetry measurement has been utilized because speech articulation, normally controlled mainly by one side of the brain, causes muscles on the opposite side of the mouth to move more during speech production. The present research did not administer the delayed post-test because it emphasized determining whether metaphor awareness-raising approaches for developing EFL learners’ pragmatic proficiency entailed right-hemisphere activation. Each test contained an acceptability judgment test (AJT) along with a speaking test in the post-test. The study results show that the metaphor awareness-raising group performed significantly better than the control group with regard to acceptability judgment and speaking tests post-test. These data revealed that the metaphor awareness-raising approach could promote L2 learning because it aided input enhancement and concept projection; through these aspects, the participants were able to comprehend an abstract concept: the degree of politeness in terms of the spatial concept of distance. Accordingly, the proximal-distal metaphor enabled the study participants to connect the newly spatio-visualized concept of distance to the different politeness degrees attached to different request expressions; furthermore, they could recall them with the left side of the mouth being wider than the right. This supported certain findings from previous studies that indicated the possible involvement of the brain's right hemisphere in metaphor processing.

Keywords: metaphor awareness-raising, right hemisphere, L2 politeness, mouth asymmetry

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Authors: Tariq Ali Gujar, Anita Hökelmann

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Postural balance plays essential role throughout life in daily activities. Somatosensory, visual and vestibular inputs play the fundamental role in maintaining body equilibrium to balance the posture. The aim of this study was to find out electroencephalography (EEG) responses during balance activity of young people during Sensory Organization Balance Test. The outcome of this study will help to create the fitness and neurorehabilitation plan. 25 young people (25 ± 3.1 years) have been analyzed on Balance Master NeuroCom® with the coupling of Brain Vision 32 electrode wireless EEG system during the Sensory Organization Test. From the results it has been found that the balance score of samples is significantly higher under the influence of somatosensory input as compared to visual and vestibular input (p < 0.05). The EEG between somatosensory and visual input to balance the posture showed significantly higher (p < 0.05) alpha and beta activities during somatosensory input in somatosensory, attention and visual functions of the cortex whereas executive and motor functions of the cerebral cortex showed significantly higher (p < 0.05) alpha EEG activity during the visual input. The results suggest that somatosensory and attention function of the cerebral cortex has alpha and beta activity, respectively high during somatosensory and vestibular input in maintaining balance. In patients with balance impairments both physical and cognitive training, including neurofeedback will be helpful to improve balance abilities.

Keywords: balance, electroencephalography activity, somatosensory, visual, vestibular

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Authors: Ali Essam El Shazly

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The slum survey of 'Sequina' area in Alexandria details the building rooms of twenty-building samples according to the integral measure of space syntax. The essence of room organization sets the most integrative 'visitor' domain between the 'inhabitant' wings of less integrated 'parent' than the 'children' structure with visual ring of 'balcony' space. Despite the collective real relative asymmetry of 'pheno-type' aggregation, the relative asymmetry of individual layouts reveals 'geno-type' structure of spatial diversity. The multifunction of rooms optimizes the integral structure of graph and visibility merge, which contrasts with the deep tailing structure of distinctive social domains. The most integrative layout inverts the geno-type into freed rooms of shallow 'inhabitant' domain against the off-centered 'visitor' space, while the most segregated layout further restricts the pheno-type through isolated 'visitor' from 'inhabitant' domains across the 'staircase' public domain. The catalyst 'kitchen & living' spaces demonstrate multi-structural dimensions among the various social domains. The former ranges from most exposed central integrity to the most hidden 'motherhood' territories. The latter, however, mostly integrates at centrality or at the further ringy 'childern' domain. The study concludes social structure of spatial integrity for redevelopment, which is determined through the micro-level survey of rooms with integral dimensions.

Keywords: Alexandria, Sequina slum, spatial integration, space syntax

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Authors: Ana Bermudez de Castro Muela, Xiomara Santos Salas, Silvia Cayon Somacarrera

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The aim of this review is to explain what is the intracranial hypotension and its main causes, and also to approach to the diagnostic management in the different clinical situations, understanding radiological findings, and physiopathological substrate. An approach to the diagnostic management is presented: what are the guidelines to follow, the different tests available, and the typical findings. We review the myelo-CT and myelo-RM studies in patients with suspected CSF fistula or hypotension of unknown cause during the last 10 years in three centers. Signs of intracranial hypotension (subdural hygromas/hematomas, pachymeningeal enhancement, venous sinus engorgement, pituitary hyperemia, and lowering of the brain) that are evident in baseline CT and MRI are also sought. The intracranial hypotension is defined as a lower opening pressure of 6 cmH₂O. It is a relatively rare disorder with an annual incidence of 5 per 100.000, with a female to male ratio 2:1. The clinical features it’s an orthostatic headache, which is defined as development or aggravation of headache when patients move from a supine to an upright position and disappear or typically relieve after lay down. The etiology is a decrease in the amount of cerebrospinal fluid (CSF), usually by loss of it, either spontaneous or secondary (post-traumatic, post-surgical, systemic disease, post-lumbar puncture etc.) and rhinorrhea and/or otorrhea may exist. The pathophysiological mechanisms of hypotension and CSF hypertension are interrelated, as a situation of hypertension may lead to hypotension secondary to spontaneous CSF leakage. The diagnostic management of intracranial hypotension in our center includes, in the case of being spontaneous and without rhinorrhea and/or otorrhea and according to necessity, a range of available tests, which will be performed from less to more complex: cerebral CT, cerebral MRI and spine without contrast and CT/MRI with intrathecal contrast. If we are in a situation of intracranial hypotension with the presence of rhinorrhea/otorrhea, a sample can be obtained for the detection of b2-transferrin, which is found in the CSF physiologically, as well as sinus CT and cerebral MRI including constructive interference steady state (CISS) sequences. If necessary, cisternography studies are performed to locate the exact point of leakage. It is important to emphasize the significance of myelo-CT / MRI to establish the diagnosis and location of CSF leak, which is indispensable for therapeutic planning (whether surgical or not) in patients with more than one lesion or doubts in the baseline tests.

Keywords: cerebrospinal fluid, neuroradiology brain, magnetic resonance imaging, fistula

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Authors: Elizabeth Grier, Meg Gemmill, Mary Martin, Leora Reiter, Herman Tang, Alexandra Donaldson, Isis Lunsky, Mia Wu

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Background: Individuals with Cerebral Palsy (CP) and/or IDD face numerous physical and mental health challenges, including difficulty accessing effective palliative care. The aim of this study is to assess the knowledge and comfort of healthcare providers in providing community-based palliative care for patients with Cerebral Palsy (CP) and severe to profound Intellectual and Developmental Disabilities (IDD). Methods: This study includes a mixed methods approach obtaining both quantitative and qualitative data. Quantitative data from palliative care practitioners was obtained through an online survey assessing comfort in symptom management, grief assessment, and goals of care discussion. This survey was distributed to physicians and allied health practitioners across Canada through the College of Family Physicians of Canada Member Interest Groups for Palliative Care and for IDD. Survey results guided the development of a semi-structured interview template, which was used to conduct a focus group on the same topic. Participants were four palliative care providers (3 physicians and one spiritual care practitioner). The focus group transcript is currently undergoing thematic analysis using NVivo 12 software. Results: 57 palliative care practitioners completed the survey. 87% of participants indicated they have provided palliative care services for persons with CP and/or IDD. Findings suggest practitioners are somewhat confident in identifying specific physical symptoms (dyspnea, pressure ulcers) but less confident in identifying physical/emotional pain, addressing grief, and prognosticating life expectancy in this population. 54% of responses indicated they had little/no training on palliating those with CP or IDD, and 45% somewhat or strongly disagree members of their profession can manage symptoms for this population. Focus group analysis is underway, and results will be available at the time of the poster presentation. Conclusion: Persons with CP and IDD are more likely to experience severe health inequities when accessing palliative care. Results of this study suggest further education is needed for palliative care professionals to address the barriers and challenges in providing palliative care to this patient population.

Keywords: palliative care, symptom management, health equity, community healthcare, intellectual and developmental disabilities

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Authors: Reshma Parvin Nuri, Heather Michelle Aldersey, Setareh Ghahari

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Objectives: Worldwide, it is well known that taking care of children with disabilities (CWD) can have a significant impact on the entire family unit. Over the last few decades, an increased number of studies have been conducted on families of CWD in higher income countries, and much of this research has identified family needs and strategies to meet those needs. However, family needs are incredibly under-studied in developing countries. Therefore, the aims of this study were to: (a) explore the needs of families of children with cerebral palsy (CP) in Bangladesh; (b) investigate how some of the family needs have been met and (c) identify the sources of supports that might help the families to meet their needs in the future. Methods: A face to face, semi-structured in-depth interview was conducted with 20 family members (12 mothers, 4 fathers, 1 sister, 2 grandmothers, and 1 aunt) who visited the Centre for the Rehabilitation of the Paralysed (CRP), Bangladesh between June and August 2016. Constant comparison method of grounded theory approach within the broader spectrum of qualitative study was used to analyze the data. Results: Participants identified five categories of needs: (a) financial needs, (b) access to disability-related services, (c) family and community cohesion, (d) informational needs, and (e) emotional needs. Participants overwhelmingly reported that financial need is their greatest family need. Participants noted that families encountered additional financial expenses for a child with CP, beyond what they would typically pay for their other children. Participants were seeing education as their non-primary need as they had no hope that their children would be physically able to go to school. Some participants also shared their needs for social inclusion and participation and receiving emotional support. Participants further expressed needs to receive information related to the child’s health condition and availability/accessibility of governmental support programs. Besides unmet needs, participants also highlighted that some of their needs have been met through formal and informal support systems. Formal support systems were mainly institution-based and run by non-governmental organizations, whereas participants identified informal support coming from family, friends and community members. Participants overwhelmingly reported that they receive little to no support from the government. However, participants identified the government as the key stakeholder who can play vital role in meeting their unmet needs. Conclusions: In the next phase of this research, the plan is to understand how the Government of the People’s Republic of Bangladesh is working to meet the needs of families of CWD. There is also need for further study on needs of families of children with conditions other than CP and those who live in the community and do not have access to the CRP Services. There is clear need to investigate ways to enable children with CP have better access to education in Bangladesh.

Keywords: Bangladesh, children with cerebral palsy, family needs, support

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Authors: Mangala Kohli, P. A. Athira, Reeha Mahajan

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The subthalamic nucleus (STN) is a biconvex nucleus situated in the diencephalon. The knowledge of the morphometry of the subthalamic nucleus is essential for accurate targeting of the nucleus during Deep Brain Stimulation. The present study aims to note the morphometry of the subthalamic nucleus in both the cerebral hemispheres which will prove to be of great value to radiologists and neurosurgeons. A cross‐sectional observational study was conducted in the Departments of Anatomy and Forensic Medicine, Lady Hardinge Medical College & Associated Hospitals, New Delhi on thirty adult cadaveric brain specimens of unclaimed and donated corpses. The specimens were categorized into 3 age groups: 20-35, 35-50 and above 50 years. All samples were collected after following the standard protocol for ethical clearance. The morphometric study of 60 subthalamic nucleus was thus conducted. Transverse section of the brain was made at a plane 4mm ventral to the plane containing mid commissural point. The dimensions of the subthalamic nucleus were measured bilaterally with the aid of digital Vernier caliper and magnifying glass. In the present study, the mean length and width and AC-PC length of the subthalamic nucleus was recorded on the right and left side in Group A, B and C. On comparison of mean of subthalamic nucleus dimensions between the right and left side in Group C, no statistically significant difference was observed. The length and width of subthalamic nucleus measured in the 3 age groups were compared with each other and the p value calculated. There was no statistically significant difference between the dimensions of Group A and B, Group B and C as well as Group A and C. The present study reveals that there is no significant reduction in the size of the nucleus was noted with increasing age. Thus, the values obtained in the present study can be used as a reference for various invasive and non-invasive procedures on subthalamic nucleus.

Keywords: cerebral hemisphere, deep brain stimulation, morphometry, subthalamic nucleus

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Authors: Muhsin Kizhisseri, Jorg Schluter, Saleh Gharie

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Atherosclerosis is the main reason of stroke, which is one of the deadliest diseases in the world. The carotid artery in the brain is the prominent location for atherosclerotic progression, which hinders the blood flow into the brain. The inclusion of computational fluid dynamics (CFD) into the diagnosis cycle to understand the hemodynamics of the patient-specific carotid artery can give insights into stroke prediction. Realistic outlet boundary conditions are an inevitable part of the numerical simulations, which is one of the major factors in determining the accuracy of the CFD results. The Windkessel model-based outlet boundary conditions can give more realistic characteristics of the distal vascular branches of the carotid artery, such as the resistance to the blood flow and compliance of the distal arterial walls. This study aims to find the most influential distal branches of the carotid artery by using the Windkessel model parameters in the outlet boundary conditions. The parametric study approach to Windkessel model parameters can include the geometrical features of the distal branches, such as radius and length. The incorporation of the variations of the geometrical features of the major distal branches such as the middle cerebral artery, anterior cerebral artery, and ophthalmic artery through the Windkessel model can aid in identifying the most influential distal branch in the carotid artery. The results from this study can help physicians and stroke neurologists to have a more detailed and accurate judgment of the patient's condition.

Keywords: stroke, carotid artery, computational fluid dynamics, patient-specific, Windkessel model, distal vascular branches

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Authors: Kasra Afsahi, Maryam Soheilifar, S. Hossein Hosseini

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Background: There is growing evidence that Cerebral Vascular Accident (CVA) can be a consequence of Covid-19 infection. Understanding novel treatment approaches are important in optimizing patient outcomes. Case: This case explores the use of Virtual Reality (VR) in the treatment of a 23-year-old COVID-positive female presenting with left hemiparesis in August 2020. Imaging showed right globus pallidus, thalamus, and internal capsule ischemic stroke. Conventional rehabilitation was started two weeks later, with virtual reality (VR) included. This game-based virtual reality (VR) technology developed for stroke patients was based on upper extremity exercises and functions for stroke. Physical examination showed left hemiparesis with muscle strength 3/5 in the upper extremity and 4/5 in the lower extremity. The range of motion of the shoulder was 90-100 degrees. The speech exam showed a mild decrease in fluency. Mild lower lip dynamic asymmetry was seen. Babinski was positive on the left. Gait speed was decreased (75 steps per minute). Intervention: Our game-based VR system was developed based on upper extremity physiotherapy exercises for post-stroke patients to increase the active, voluntary movement of the upper extremity joints and improve the function. The conventional program was initiated with active exercises, shoulder sanding for joint ROMs, walking shoulder, shoulder wheel, and combination movements of the shoulder, elbow, and wrist joints, alternative flexion-extension, pronation-supination movements, Pegboard and Purdo pegboard exercises. Also, fine movements included smart gloves, biofeedback, finger ladder, and writing. The difficulty of the game increased at each stage of the practice with progress in patient performances. Outcome: After 6 weeks of treatment, gait and speech were normal and upper extremity strength was improved to near normal status. No adverse effects were noted. Conclusion: This case suggests that VR is a useful tool in the treatment of a patient with covid-19 related CVA. The safety of newly developed instruments for such cases provides new approaches to improve the therapeutic outcomes and prognosis as well as increased satisfaction rate among patients.

Keywords: covid-19, stroke, virtual reality, rehabilitation

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Authors: Stephanie PB Caligiuri, Harold M Aukema, Delfin Rodriguez-Leyva, Amir Ravandi, Randy Guzman, Grant N. Pierce

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Background: Hypertension leads to cardiac and cerebral events and therefore is the leading risk factor attributed to death in the world. Oxylipins may be mediators in these events as they can regulate vascular tone and inflammation. Oxylipins are derived from fatty acids. Dietary flaxseed is rich in the n3 fatty acid, alpha-linolenic acid, and, therefore, may have the ability to change the substrate profile of oxylipins. As a result, this could alter blood pressure. Methods: A randomized, double-blinded, controlled clinical trial, the Flax-PAD trial, was used to assess the impact of dietary flaxseed on blood pressure (BP), and to also assess the relationship of plasma oxylipins to BP in 81 patients with peripheral arterial disease (PAD). Patients with PAD were chosen for the clinical trial as they are at an increased risk for hypertension and cardiac and cerebral events. Thirty grams of ground flaxseed were added to food products to consume on a daily basis for 6 months. The control food products contained wheat germ, wheat bran, and mixed dietary oils instead of flaxseed. Central BP, which is more significantly associated to organ damage, cardiac, and cerebral events versus brachial BP, was measured by pulse wave analysis at baseline and 6 months. A plasma profile of 43 oxylipins was generated using solid phase extraction, HPLC-MS/MS, and stable isotope dilution quantitation. Results: At baseline, the central BP (systolic/diastolic) in the placebo and flaxseed group were, 131/73 ± 2.5/1.4 mmHg and 128/71 ± 2.6/1.4 mmHg, respectively. After 6 months of intervention, the flaxseed group exhibited a decrease in blood pressure of 4.0/1.0 mmHg. The 6 month central BP in the placebo and flaxseed groups were, 132/74 ± 2.9/1.8 mmHg and 124/70 ± 2.6/1.6 mmHg (P<0.05). Correlation and logistic regression analyses between central blood pressure and oxylipins were performed. Significant associations were observed between central blood pressure and 17 oxylipins, primarily produced from arachidonic acid. Every 1 nM increase in 16-hydroxyeicosatetraenoic acid (HETE) increased the odds of having high central systolic BP by 15-fold, of having high central diastolic BP by 6-fold and of having high central mean arterial pressure by 15-fold. In addition, every 1 nM increase in 5,6-dihydroxyeicosatrienoic acid (DHET) and 11,12-DHET increased the odds of having high central mean arterial pressure by 45- and 18-fold, respectively. Flaxseed induced a significant decrease in these as well as 4 other vasoconstrictive oxylipins. Conclusion: Dietary flaxseed significantly lowered blood pressure in patients with PAD and hypertension. Plasma oxylipins were strongly associated with central blood pressure and may have mediated the flaxseed-induced decrease in blood pressure.

Keywords: hypertension, flaxseed, oxylipins, peripheral arterial disease

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Authors: Wu Liching

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Aim This case aims to discuss the pathogenesis, clinical manifestations and medical treatment of strokes caused by mitochondrial gene mutations. Methods Diagnosis of ischemic stroke caused by mitochondrial gene defect by means of "next-generation sequencing mitochondrial DNA gene variation detection", imaging examination, neurological examination, and medical history; this study took samples from the neurology ward of a medical center in northern Taiwan cases diagnosed with acute cerebral infarction as the research objects. Result This case is a 49-year-old married woman with a rare disease, mitochondrial gene mutation inducing ischemic stroke. She has severe hearing impairment and needs to use hearing aids, and has a history of diabetes. During the patient’s hospitalization, the blood test showed that serum Lactate: 7.72 mmol/L, Lactate (CSF) 5.9 mmol/L. Through the collection of relevant medical history, neurological evaluation showed changes in consciousness and cognition, slow response in language expression, and brain magnetic resonance imaging examination showed subacute bilateral temporal lobe infarction, which was an atypical type of stroke. The lineage DNA gene has m.3243A>G known pathogenic mutation point, and its heteroplasmic level is 24.6%. This pathogenic point is located in MITOMAP and recorded as Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like episodes (MELAS) , Leigh Syndrome and other disease-related pathogenic loci, this mutation is located in ClinVar and recorded as Pathogenic (dbSNP: rs199474657), so it is diagnosed as a case of stroke caused by a rare disease mitochondrial gene mutation. After medical treatment, there was no more seizure during hospitalization. After interventional rehabilitation, the patient's limb weakness, poor language function, and cognitive impairment have all improved significantly. Conclusion Mitochondrial disorders can also be associated with abnormalities in psychological, neurological, cerebral cortical function, and autonomic functions, as well as problems with internal medical diseases. Therefore, the differential diagnoses cover a wide range and are not easy to be diagnosed. After neurological evaluation, medical history collection, imaging and rare disease serological examination, atypical ischemic stroke caused by rare mitochondrial gene mutation was diagnosed. We hope that through this case, the diagnosis of rare disease mitochondrial gene variation leading to cerebral infarction will be more familiar to clinical medical staff, and this case report may help to improve the clinical diagnosis and treatment for patients with similar clinical symptoms in the future.

Keywords: acute stroke, MELAS, lactic acidosis, mitochondrial disorders

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Authors: Azza A. Ali, Hebatalla I. Ahmed, Asmaa Abdelaty

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Background: Manganese (Mn) is a naturally occurring element. Exposure to high levels of Mn causes neurotoxic effects and represents an environmental risk factor. Mn neurotoxicity is poorly understood but changing of AChE activity, monoamines and oxidative stress has been established. Bisphenol A (BPA) is a synthetic compound widely used in the production of polycarbonate plastics. There is considerable debate about whether its exposure represents an environmental risk. Caffeine is one of the major contributors to the dietary antioxidants which prevent oxidative damage and may reduce the risk of chronic neurodegenerative diseases. Epigallocatechin-3-gallate is another major component of green tea and has known interactions with caffeine. It also has health-promoting effects in CNS. Objective: To evaluate the potential protective effects of Caffeine and/or EGCG against Mn-induced neurotoxicity either alone or in the presence of BPA in rats. Methods: Seven groups of rats were used and received daily for 5 weeks MnCl2.4H2O (10 mg/kg, IP) except the control group which received saline, corn oil and distilled H2O. Mn was injected either alone or in combination with each of the following: BPA (50 mg/kg, PO), caffeine (10 mg/kg, PO), EGCG (5 mg/kg, IP), caffeine + EGCG and BPA +caffeine +EGCG. All rats were examined in five behavioral tests (grid, bar, swimming, open field and Y- maze tests). Biochemical changes in monoamines, caspase-3, PGE2, GSK-3B, glutamate, acetyl cholinesterase and oxidative parameters, as well as histopathological changes in the brain, were also evaluated for all groups. Results: Mn significantly increased MDA and nitrite content as well as caspase-3, GSK-3B, PGE2 and glutamate levels while significantly decreased TAC and SOD as well as cholinesterase in the striatum. It also decreased DA, NE and 5-HT levels in the striatum and frontal cortex. BPA together with Mn enhanced oxidative stress generation induced by Mn while increased monoamine content that was decreased by Mn in rat striatum. BPA abolished neuronal degeneration induced by Mn in the hippocampus but not in the substantia nigra, striatum and cerebral cortex. Behavioral examinations showed that caffeine and EGCG co-administration had more pronounced protective effect against Mn-induced neurotoxicity than each one alone. EGCG alone or in combination with caffeine prevented neuronal degeneration in the substantia nigra, striatum, hippocampus and cerebral cortex induced by Mn while caffeine alone prevented neuronal degeneration in the substantia nigra and striatum but still showed some nuclear pyknosis in cerebral cortex and hippocampus. The marked protection of caffeine and EGCG co-administration also confirmed by the significant increase in TAC, SOD, ACHE, DA, NE and 5-HT as well as the decrease in MDA, nitrite, caspase-3, PGE2, GSK-3B, the glutamic acid in the striatum. Conclusion: Neuronal degeneration induced by Mn showed some inhibition with BPA exposure despite the enhancement in oxidative stress generation. Co-administration of EGCG and caffeine can protect against neuronal degeneration induced by Mn and improve behavioral deficits associated with its neurotoxicity. The protective effect of EGCG was more pronounced than that of caffeine even with BPA co-exposure.

Keywords: manganese, bisphenol a, caffeine, epigallocatechin-3-gallate, neurotoxicity, behavioral tests, rats

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Authors: Ming-Juei Chang, Hui-Ing Ma, Tsung-Hsueh Lu

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Introduction: Because of the advance of medical care (e.g., ventilation techniques and gastrostomy feeding), more and more children with CP can live to adulthood. However, little is known about the use of health care services from children to adults who have CP. The patterns of utilization of ambulatory care are heavily influenced by insurance coverage and primary care gatekeeper regulation. The purpose of this study was to examine patterns of ambulatory care utilization among individuals with CP in Taiwan, a country with universal coverage and no gatekeeper regulation. Methods: A representative sample of one million patients (about 1/23 of total population) covered by Taiwan’s National Health Insurance was used to analyze the ambulatory care utilization in individuals with CP. Data were analyzed by 3 different age groups (children, youth and adults) during 2000 to 2003. Participants were identified by the presence of CP diagnosis made by pediatricians or physicians of physical and rehabilitation medicine and stated at least three times in claims data. Results: Annual rates of outpatient physician visits were 31680 for children, 16492 for youth, and 28617 for adults with CP (per 1000 persons). Individuals with CP received over 50% of their outpatient care from hospital outpatient department. Higher use of specialist physician services was found in children (54.7%) than in the other two age groups (28.4% in youth and 18.8% in adults). Diseases of respiratory system were the most frequent diagnoses for visits in both children and youth with CP. Diseases of the circulatory system were the main reasons (24.3%) that adults with CP visited hospital outpatient care department or clinics. Conclusion: This study showed different patterns of ambulatory care utilization among different age groups. It appears that youth and adults with CP continue to have complex health issues and rely heavily on the health care system. Additional studies are needed to determine the factors which influence ambulatory care utilization among individuals with CP.

Keywords: cerebral palsy, health services, lifespan, universal coverage

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