bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuromuscular complications of jejunoileal shunt for morbid obesity: case report and literature review
Authors: Ariatti A , Cappelli G , Suozzi R , Galassi G
Published: April 2004

Intestinal malabsorption by jejunoileal bypass has been used to treat morbid obesity. Although the procedure is considered safe, several long‐term neurological complications have been described. A 47‐year‐old man was evaluated because of increasing gait difficulties five years after jejunoileal bypass at age 42. Neurological examination showed upper, lower extremities proximal weakness, distal sensory loss for touch, pin‐prick, vibration and position. Deep jerks were absent. Electrophysiology was consistent with axonal neuropathy. Blood tests revealed microcitic anemia (Hb 9 g/dl), normal thyroid function, tumor marker titer, and viral screenings. Vitamin A was 1.12 umol/l (n.v. 0.56–4.25) and vitamin E was 10.7 umol/l (n.v. 11.5–31). B12, folate levels were within normal range. A 42‐year‐old obese man had a similar surgery. Two years later he developed an acute episode of confusion and unsteadiness due to lactic acidosis, from which he recovered. He was first evaluated neurologically fifteen years after jejunoileostomy because of muscle cramps, paraesthesias, and progressive imbalance. On examination there were trunk, extremity ataxia, proximal and distal muscle weakness, distal atrophy, loss of reflexes, and severe loss of all sensory modalities. Electrophysiology confirmed a sensorimotor neuropathy. Blood tests showed macrocitic anemia, low free calcium (3.7 mEq/l, n.v. 4–5), increased PTH (75 pg/ml, n.v. 10–65), and low serum level of vitamins A and E. Brachial biceps biopsy showed neurogenic changes. General conditions progressively deteriorated because of repeated episodes of dehydration leading to terminal uremia within 27 years.
An unusual cosegregation of cmt1a duplication and hnpp PMP22 point mutation in a family with CMT1 disease
Authors: Milani M , Pareyson D , Taroni F
Published: April 2004

The common CMT1A duplication and HNPP deletion arise from unequal crossing over and homologous recombination during meiosis between flanking repeats (CMT1A‐REP). CMT1A and HNPP thus result from an altered copy number of the dosage‐sensitive myelin gene PMP22 which is included in the duplicated/deleted tract. However, both diseases can also be caused by rare PMP22 point mutations. We report here a unique family carrying both the CMT1A duplication and an HNPP PMP22 point mutation. A CMT1 child (III‐1), the only affected member of her family, was found to carry the duplication. Surprisingly, the mutation was also found in the mother (II‐2) who had normal clinical and electrophysiologic phenotype. PMP22 sequence analysis in both individuals uncovered a truncating frameshift mutation (Leu145fs) in the healthy mother but not in the affected child. In the mother, this mutation, which had been previously identified by us in 3 other HNPP families, would inactivate the extra copy of the PMP22 gene, functionally compensating the effects of the duplication. Further investigations in the family demonstrated that the healthy maternal grandmother (I‐1) also carried both the duplication and the point mutation, while her other son (II‐1) had neither of them, which indicates that both mutations were harbored by the same chromosome. Microsatellite analysis suggests that a meiotic homologous recombination event has occurred in the affected child, replacing the mutated PMP22 copy with a functional one and resulting in CMT1 phenotype.
Leprous neuropathy: a clinical and neurophysiological study
Authors: Ghiglione E , Beronio A , Reni L , Abruzzese M
Published: April 2004

Leprosy is one of the most common treatable causes of neuropathy in the world. Peripheral nerves and skin are commonly affected. We reported the clinical features and electrophysiological findings in 46 patients with leprosy. The aim of our study was to evaluate the nature of damage in the nerve fibres, especially in the first phase of disease. Forty‐six patients (mean age: 44.8 ± 17.8) with diagnosed leprosy were studied by neurological examination and nerve conduction studies (NCS). Twenty‐eight patients were examined for a mean period of 34.8 months. The number of tests for patients varied from 1 to 13 controls. Amplitude of sensory and motor action potentials (SNAP and MAP), sensory‐motor conduction velocity of median, ulnar, tibialis, peroneal and sural nerves were evaluated. Abnormalities were found in 282 of 647 nerves investigated (37.56%), sensory nerve abnormalities being more frequent than motor (50.16% 29.45). Of 282 nerves with neurophysiological abnormalities, 123 were clinically asymptomatic (43.62%). A statistically significant correlation between duration of disease and number of electrophysiological abnormalities was demonstrated. In 19 nerves partial “conduction‐block”(reduction of cMAP > 50% in the proximal response) was individuated. The first electrophysiological alteration, suggesting segmental demyelination, was detected in 41 nerves of 21 patients (33.3 %). According to this view, our data support the hypothesis that leprosy induces a neuropathy of demyelinating nature in the first phase.
Painful sensory neuropathy and dysimmunity: is there a relation?
Authors: Carpo M , Scarlato M , Bardella MT , Terrani C , Peracchi M , Allaria S , Nobile‐Orazio E , Bresolin N
Published: April 2004

Painful sensory neuropathies consist of a wide range of neuropathies that can involve large as well as small nerve fibres. Even if most cases remain of unknown cause, some of them may be associated with an underlying disorder such as diabetes, HIV, infections, amyloidosis, and Sjogren's syndrome. Since in some cases an autoimmune mechanism has been postulated, we investigated a panel of circulating autoantibodies including anti‐gliadin (AGA), anti‐endomysium (EmA), anti‐transglutaminase (tTGA) and anti‐nuclear (ANA) antibodies in the sera of patients with unexplained painful sensory neuropathies in order to identify other potentially treatable disorders. We tested the sera of 10 patients (4M; 6F) previously investigated for other causes of neuropathies, including anti‐nerve, onconeural, anti‐extractable nuclear, anti‐neutrophil cytoplasmic, anti‐thyroglobulin (TgA) and anti‐peroxidase (TPOA) antibodies. We found the presence of AGA positivity in 4 patients (40%), ANA in 7 (70%) and AGA + ANA in 4 (40%), two of whom were negative for celiac disease by gastrointestinal biopsy. None of the patients had EmA positivity. Three (30%) had TgA and TPOA and none had anti‐nerve or onconeural antibodies. Whether the presence of circulating autoantibodies in patients with unexplained painful neuropathy reflects an autoimmune involvement which may be amenable to immune therapy and not only to symptomatic treatment remains to be established.
Fatal lamivudine‐induced exacerbation of peripheral neuropathy in a patient with HBV and HCV positivity: evidence for iatrogenic mitochondrial damage
Authors: Mazzeo A , Fodale V , Aguennouz M , Praticò C , Santamaria LB , Vita G , Toscano A
Published: April 2004

A 57‐year‐old man with diabetes, HBV and HCV positivity, cryoglobulinemia and mild neuropathy was treated by the nucleoside reverse transcriptase inhibitor (NRTI), Lamivudine (300 mg/daily). Three months later he presented dysphonia, progressive muscle weakness at lower limb with mild upper limb involvement. Three weeks later, he was unable to walk and developed acute tetraparesis followed by an acute respiratory failure and cardiac arrest that required assisted ventilation. Electrophysiological studies evidenced a worsening of a sensorimotor axonal neuropathy. Nerve biopsy showed complete lack of myelinated fibers with vasculitic features whereas muscle biopsy presented denervation and reinnervation with diffuse type grouping. Mitochondrial respiratory chain enzyme activities demonstrated a marked reduction of complex I and IV, whereas Southern and dot blot analyses evidenced a ∼60% depletion of mtDNA. Lamivudine administration was discontinued. One week later the patient was awake and able to move his fingertips and his respiratory drive resumed with partial mechanical support, but he died a few days later. Lamivudine is often administered in HBV treatment. In the last few years, it has been considered neurotoxic and capable of exacerbating a peripheral neuropathy. Its NRTI mechanism may cause mitochondrial toxicity and cellular polymerase inhibition. In our patient, polyneuropathy worsened after lamivudine treatment; biochemical and molecular results of our studies suggest possible diffuse iatrogenic mitochondrial damage.
A novel 9bp insertion in GJB1 gene causing late onset, intermediate CMT in an italian patient
Authors: Zortea M , Merlini L , Mostacciolo ML
Published: April 2004

Charcot‐Marie‐Tooth disease constitutes a clinically and genetically heterogeneous group of hereditary motor and sensory peripheral neuropathies. On the basis of electrophysiologic properties and histopathology, CMT has been divided into demyelinating (type 1) and axonal (type 2) neuropathies. The form of Charcot‐Marie‐Tooth neuropathy that maps to Xq13 may present mild electrophysiological changes (NCV > 40 M/s), mixed neuropathy (NCV: Intermediate (30–40 M/s), or demyelinating neuropathy (NCV: Slow (<37 M/s). On molecular grounds, CMTX is caused by mutations in GJB1 gene, coding for Connexin 32 protein. A 42‐year‐old man, with no other affected family members, was clinically evaluated for CMT. Three years ago he noticed thumb abductor atrophy and then leg muscle atrophy. He presented with hand and leg muscle atrophy, bilateral pes cavus, areflexia, and apallesthesia. The median and ulnar motor NVC were 35–38 m/s, and the median sensory NVC was 35 m/s. Both motor and sensory nerve action potentials were markedly reduced. After exclusion of CMT1A and 1B, analysis for CMTX was performed. The mutation screening of GJB1 gene showed a 9bp insertion upstream the 194ATG codon (Met194) with preservation of the downstream sequence. The three new amino acids (Thr‐Val‐Phe) inserted are localized between the end of the second extracellular domain and the beginning of the fourth transmembrane domain. This is the first 9bp insertion found in GJB1 gene; a genotype‐phenotype correlation may be deduced.
Total neuropathy scale items as early predictors of chemotherapy‐induced peripheral neurotoxicity
Authors: Piatti M , Bogliun G , Marzorati L , Zincone A , Giussani G , Colombo N , Parma G , Lissoni A , Fei F , Cundari S , Zanna C , Cavaletti G
Published: April 2004

We investigated the possible use of individual Total Neuropathy Scale (TNS) items to predict the neurological outcome in patients undergoing cisplatin and paclitaxel combination chemotherapy in a series of thirty‐four women divided, according to the worst TNS score reached during the period of observation, into three groups, i.e. with a score <5 (n = 14), >5 but <10 (n = 5) or >10 (n = 15). At the visit performed before the onset of the worst neuropathy signs, 14 out of the 15 patients with the worst TNS had a change of 2 or more points in the sum of the semiquantitative vibration score (tuning fork) plus the DTR examination. In 12 of them the change was due to both vibration perception and DTR impairment. A change in the combined score was observed also in 7 out of the 14 patients with the better neurological outcome, but none of them had any change in the vibration perception. Early disappearance of DTR in the lower limbs (i.e. both ankle and patellar reflexes bilaterally) was observed in 7 out of the 15 patients with a worst outcome, while only 1 patient in the better outcome group had this clinical sign. The results of the VDT score obtained with a vibrameter did not improve the accuracy of the neurological assessment. Our study indicates that the accurate clinical evaluation of the patients treated with platinum and taxane combination polychemotherapy can be used to predict the final neurological outcome of the treatment.
Agreement between diagnostic hypothesis and results of the electrodiagnostic tests
Authors: Tavella A , Ciaramitaro P , Costa P , Paolasso I , Poglio F , Duranda E , Cocito D
Published: April 2004

Descriptive study will be carried out on patients examined in the neurophysiology laboratory of Neurological Clinic of Turin University and in the neurophysiology laboratory of C.T.O. Hospital of Turin in the period February‐April 2004. Our purpose is to evaluate the following issues: 1) physicians requiring electrodiagnostic (EDX) test (general and/or specialist practitioner), 2) diagnostic hypothesis or the symptomatology reported from the patients that have induced the doctor to demand the test and 3) the agreement or disagreement with results of EDX test. Moreover, the outcome of EDX study will be compared with eventual previous EDX tests. Anagraphic data and the profession of the patient, eventual presence of concomitant pathologies or therapeutic use of neurotoxic drugs, possible responsibilities of peripheral nervous system diseases, will be also investigated. Our goal is to evaluate the appropriateness of the EDX test relative to requiring physicians (general or specialist practitioner). We would also improve efficiency of the service, optimizing the economic and human resources, and reducing the number of inappropriate EDX tests.
Peripheral nervous system involvement as presenting symptom of systemic B‐cell lymphoma
Authors: Casellato C , Di Troia A , Terenghi F , Nobile‐Orazio E
Published: April 2004

Peripheral nervous system involvement has been reported in systemic B or T cell lymphoma and may result from intraneural localization of lymphoma resulting in meningo‐radiculopathy or mononeuropathies, or manifest as a sensory‐motor polyneuropathy sometimes mimicking chronic inflammatory demyelinating polyneuropathy. We report two patients with a previously unknown NHL presenting in both with a stepwise progressive asymmetric multiradiculoneuropathy initially misdiagnosed as inflammatory radiculopathy. A 58‐year‐old man presented with a 2 year history of stepwise progressive peroneal sensory loss, impotence, and lower limb painful asymmetric neuropathy. Lumbosacral MRI was normal. Electrophysiological studies were consistent with an axonal multiradiculoneuropathy while CSF examinations repeatedly showed increased protein levels (80–91 mg/dl) with slightly increased white cells (<10 mm3) but no malignant cell. The patient repeatedly failed to respond to steroids although he consistently deteriorated at their suspension. An MRI performed 2 years later when multiple cranial nerve palsies appeared showed bilateral T1 and T2 hyperintensities in the brain and cervical spinal cord. An extensive investigation for neoplasm was negative. The patient died from an intracranial hemorrhage during anticoagulant therapy for deep vein thrombosis. Autoptic studies revealed a widespread non‐Hodgkin's type B lymphoma with massive systemic and neural involvement including cauda equina and spinal cord. A 54‐year‐old man presented with a 1 year history of impotence, urinary incontinence, progressive asymmetric painful distal sensorimotor impairment at four limbs and prominent weight loss. Four previous CSF examinations revealed increased protein levels (80–100 mg/dl), and slightly but inconsistently increased white cells (1–11/mm3) but no malinant cells. Steroids were repeatedly ineffective although the patient consistently deteriorated whenever steroids were discontinued. On admission electrophysiological studies showed an axonal asymmetric polyradiculoneuropathy. Brain and spinal MRI was normal while bone marrow biopsy and aspiration disclosed a B cell lymphoma.
Poems syndrome: role of two angiogenic factors, VEGF and EPO.
Authors: Scarlato M , Carpo M , Previtali S , Pareyson D , Briani C , Casellato C , Nobile‐Orazio E , Comi GP , Bresolin N , Quattrini A
Published: April 2004

POEMS syndrome is a rare disorder characterized by the combination of polyneuropathy, organomegaly, endocrinopathy, M‐protein and skin changes. The pathogenesis of this multisystemic disease is not known. Recently, an association with high levels of serum VEGF (vascular endothelial growth factor), a multifunctional cytokine that induces angiogenesis and microvascular hyperpermeability, has been reported. Both VEGF and erythropoietin (EPO), an acidic glycoprotein hormone that also promotes endothelial proliferation, are under the control of a transcription factor called hypoxia‐inducible factor (HIF). To determine whether these angiogenic factors may have a pathogenic role in POEMS, we longitudinally evaluated VEGF and EPO serum concentrations by ELISA in ten patients during the clinical course and in relation to the therapy response. All patients had initially high levels of VEGF and low EPO concentration and there was an inverse correlation between VEGF and EPO levels during the disease progression. We have also analyzed sural nerve biopsies of seven POEMS patients. The presence of VEGF/VEGF‐R and EPO/EPO‐R immunostaining in the endoneurial and perineurial vessels has been shown, as well as in some of the non‐myelin forming Schwann cells identified as glial fibrillary acidic protein (GFAP) positive cells.
Specific recognition of rpsO mRNA and 16S rRNA by Escherichia coli ribosomal protein S15 relies on both mimicry and site differentiation
Authors: Mathy Nathalie , Pellegrini Olivier , Serganov Alexander , Patel Dinshaw J. , Ehresmann Chantal , Portier Claude
Published: April 2004

The ribosomal protein S15 binds to 16S rRNA, during ribosome assembly, and to its own mRNA (rpsO mRNA), affecting autocontrol of its expression. In both cases, the RNA binding site is bipartite with a common subsite consisting of a G•U/G‐C motif. The second subsite is located in a three‐way junction in 16S rRNA and in the distal part of a stem forming a pseudoknot in Escherichia coli rpsO mRNA. To determine the extent of mimicry between these two RNA targets, we determined which amino acids interact with rpsO mRNA. A plasmid carrying rpsO (the S15 gene) was mutagenized and introduced into a strain lacking S15 and harbouring an rpsO–lacZ translational fusion. Analysis of deregulated mutants shows that each subsite of rpsO mRNA is recognized by a set of amino acids known to interact with 16S rRNA. In addition to the G•U/G‐C motif, which is recognized by the same amino acids in both targets, the other subsite interacts with amino acids also involved in contacts with helix H22 of 16S rRNA, in the region adjacent to the three‐way junction. However, specific S15–rpsO mRNA interactions can also be found, probably with A(−46) in loop L1 of the pseudoknot, demonstrating that mimicry between the two targets is limited.
Morphing molecular specificities between Arm‐peptide and NUT‐RNA in the antitermination complexes of bacteriophages λ and P22
Authors: Franklin Naomi C.
Published: April 2004

Bacteriophage λ's N‐protein includes a 17‐amino‐acid segment, Arm, rich in arginine and having specific affinity for a 15‐nucleotide RNA stem–loop called BOX‐B. Parallel but different Arm/BOX‐B sequences in λ's cousin, phage P22, account for some of the type specificity that distinguishes λ from P22: the N of each works only with its cognate BOX‐B in vivo. We find that the specificity of Nλ can be shifted gradually to that of N22 by substituting sets of particular amino acids from Arm22 into Arm of Nλ. The determinative amino acids are generally those shown by nuclear magnetic resonance to contact BOX‐B RNA; gain or loss of these contact amino acids is reasonably expected to contribute to the affinity of each amino acid sequence. Intermediate sequences may show no function with either BOX‐B, or weak function with both BOX‐Bλ and BOX‐B22, the latter suggesting possible evolutionary paths for specificity shifts.
A new Ralstonia solanacearum high‐affinity mannose‐binding lectin RS‐IIL structurally resembling the Pseudomonas aeruginosa fucose‐specific lectin PA‐IIL
Authors: Sudakevitz Dvora , Kostlánová Nikola , Blatman‐Jan Gitit , Mitchell Edward P. , Lerrer Batia , Wimmerová Michaela , Katcoff Don J. , Imberty Anne , Gilboa‐Garber Nechama
Published: April 2004

The plant pathogen Ralstonia solanacearum produces two lectins, each with different affinity to fucose. We described previously the properties and sequence of the first lectin, RSL (subunit Mr 9.9 kDa), which is related to fungal lectins (Sudakevitz, D., Imberty, A., and Gilboa‐Garber, N., 2002, J Biochem 132: 353–358). The present communication reports the discovery of the second one, RS‐IIL (subunit Mr 11.6 kDa), a tetrameric lectin, with high sequence similarity to the fucose‐binding lectin PA‐IIL of Pseudomonas aeruginosa. RS‐IIL recognizes fucose but displays much higher affinity to mannose and fructose, which is opposite to the preference spectrum of PA‐IIL. Determination of the crystal structure of RS‐IIL complexed with a mannose derivative demonstrates a tetrameric structure very similar to the recently solved PA‐IIL structure (Mitchell, E., et al., 2002, Nature Struct Biol 9: 918–921). Each monomer contains two close calcium cations that mediate the binding of the monosaccharide and explain the outstandingly high affinity to the monosaccharide ligand. The binding loop of the cations is fully conserved in RS‐IIL and PA‐IIL, whereas the preference for mannose versus fucose can be attributed to the change of a three‐amino‐acid sequence in the ‘specificity loop’.
MotE serves as a new chaperone specific for the periplasmic motility protein, MotC, in Sinorhizobium meliloti
Authors: Eggenhofer Elke , Haslbeck Martin , Scharf Birgit
Published: April 2004

The flagella of Sinorhizobium meliloti rotate solely clockwise and vary their rotary speed to provoke changes in the swimming path. This mode of motility control has its molecular corollary in two novel motility proteins, MotC and MotD, present in addition to the ubiquitous MotA/MotB energizing proton channel. MotC binds to the periplasmic portion of MotB, whereas MotD interacts with FliM at the cytoplasmic face of the rotor. We report here the assignment and analysis of a fifth motility protein, MotE. Deletion of motE resulted in aggregation and decay of the periplasmic MotC protein and, as a consequence, in paralysis of the cell. The 179‐residue MotE protein bears an N‐terminal signal peptide and is rapidly secreted to the periplasm, where it forms stable dimers that are linked by a disulphide bridge between the cysteine 53 residues. Both, the monomeric and the dimeric MotE bind to MotC, and dimerization is essential for MotE stability in the periplasm. We conclude that MotE is a periplasmic chaperone specific for MotC being responsible for its proper folding and stability. We also propose that the MotE dimer serves as a shuttle to target MotC to its binding site at MotB.
Identification of AbrB‐regulated genes involved in biofilm formation by Bacillus subtilis
Authors: Hamon Mélanie A. , Stanley Nicola R. , Britton Robert A. , Grossman Alan D. , Lazazzera Beth A.
Published: April 2004

Bacillus subtilis is a ubiquitous soil bacterium that forms biofilms in a process that is negatively controlled by the transcription factor AbrB. To identify the AbrB‐regulated genes required for biofilm formation by B. subtilis, genome‐wide expression profiling studies of biofilms formed by spo0A abrB and sigH abrB mutant strains were performed. These data, in concert with previously published DNA microarray analysis of spo0A and sigH mutant strains, led to the identification of 39 operons that appear to be repressed by AbrB. Eight of these operons had previously been shown to be repressed by AbrB, and we confirmed AbrB repression for a further six operons by reverse transcription‐PCR. The AbrB‐repressed genes identified in this study are involved in processes known to be regulated by AbrB, such as extracellular degradative enzyme production and amino acid metabolism, and processes not previously known to be regulated by AbrB, such as membrane bioenergetics and cell wall functions. To determine whether any of these AbrB‐regulated genes had a role in biofilm formation, we tested 23 mutants, each with a disruption in a different AbrB‐regulated operon, for the ability to form biofilms. Two mutants had a greater than twofold defect in biofilm formation. A yoaW mutant exhibited a biofilm structure with reduced depth, and a sipW mutant exhibited only surface‐attached cells and did not form a mature biofilm. YoaW is a putative secreted protein, and SipW is a signal peptidase. This is the first evidence that secreted proteins have a role in biofilm formation by Bacillus subtilis.
Effect of Orally Administered Egg Yolk Antibodies onSalmonella enteritidisContamination of Hen's Eggs
Authors: Gürtler M. , Methner U. , Kobilke H. , Fehlhaber K.
Published: April 2004

The influence of oral application of anti‐Salmonellaegg yolk antibodies on thein vivoSalmonellacontamination rate of eggs laid by experimentally infected hens was investigated. Antibody containing egg powder was obtained by spray drying of whole egg contents from hens immunized with twoSalmonella enteritidis(S. enteritidis) strains. The whole egg powder was administered orally to a laying hen group. The effects of anti‐Salmonellaegg yolk antibodies in this experimental group were compared with a control group. In experiment 1, hens were infected orally with 2 × 109colony‐forming units (CFU) ofS. enteritidisper hen, compared with experiment 2 with an infection dose of 2 × 108 CFU/hen. Eggs laid by the experimental and the control groups were monitored forS. enteritidis; egg shells, the albumen and the egg yolk were sampled separately. Results indicated that the rate ofSalmonellacontaminated eggs of laying hens – experimentally infected withS. enteritidisat an infection dose of 2 × 108 CFU/hen – could be reduced by oral administration of whole egg powder containingS. enteritidis‐specific antibodies. In the experimental group 13.3% of the eggs wereSalmonellapositive, which was significantly different from 29.4%Salmonella‐positive eggs in the control group (P ≤ 0.001). The use of antibody containing whole egg powder as a feed additive may be an alternative way to reduce theSalmonellacontamination rate of hens eggs. The protective effect may have been due to the antibodies raised by vaccination of hens againstS. enteritidis.
Epidural sufentanil during paediatric cardiac surgery: effects on metabolic response and postoperative outcome
Authors: BICHEL THIERRY , ROUGE JEAN‐CLAUDE , SCHLEGEL SUZANNE , SPAHR‐SCHOPFER ISABELLE , KALANGOS AFKSENDIYOS
Published: April 2004

The metabolic and neuroendocrine effects of caudal epidural analgesia were studied during paediatric cardiac surgery. Combined epidural and general anaesthesia (EPI group; n=12) was compared with deep opioid anaesthesia (DOA group; n=12). During anaesthesia and surgery, haemodynamic stability was similar in the two groups. There was no significant difference between groups concerning the metabolic response to surgery but circulating catecholamines were significantly lower in the EPI group during and after surgery. Perioperative release of IL‐6 was higher in the EPI group possibly reflecting a longer aortic clamp time. Incidence of postoperative life‐threatening dysrhythmias was very low in the two groups. No significant reduction of postoperative mechanical ventilation, intensive care unit or hospital stays was reported with epidural analgesia. The incidence of postoperative infections was higher than expected in the two groups because of the poor properative clinical status of most of the children included in the study.
Plasma concentrations of bupivacaine after combined spinal epidural anaesthesia in infants and neonates
Authors: FRAWLEY GEOFF , RAGG PHILIP , HACK HENRIK
Published: April 2004

The unbound and bound plasma concentration of bupivacaine in 50 infants less than 55 weeks postconceptual age was determined following combined spinal and epidural anaesthesia (CSEA). Plasma concentrations were determined at 15‐min intervals up to 60 min postspinal anaesthesia. Maximum plasma bupivacaine levels were recorded between 45 and 60 min post CSEA. Total plasma concentrations above a toxic threshold level of 4 μg·ml−1 were recorded in 4% of patients and above 2.5 μg·ml−1 in 10% of patients. Unbound bupivacaine levels were greater than a presumed toxic level of 0.25 μg·ml−1 in 16% of cases and above 0.3 μg·ml−1 in 14% of cases. A wide range of protein binding was measured (varying from 53.8–98.2%) and could not be correlated with standard indicators of local anaesthetic binding. Two neonates had brief apnoeas in the immediate perioperative phase but no adverse cardiac or central nervous system events attributable to the performance of CSEA were demonstrated.
Perioperative management of infants with the linear naevus sebaceous syndrome of Jadassohn: a report of two cases
Authors: DIAZ JAMES H.
Published: April 2004

Neurofibromatosis and tuberous sclerosis are the most well‐recognized of the congential phakomatoses, a group of six hereditary neuro‐oculo‐cutaneous disorders. Although easily diagnosed at birth by a parasagittal line of facial sebaceous naevi, the linear naevus sebaceous syndrome (LNSS) of Jadassohn is the rarest phakomatosis, one often characterized by airway and anaesthetic considerations that do not apply to the other phakomatoses. In addition to its obvious cutaneous manifestations, LNSS is characterized by hemifacial asymmetry, an anatomic predictor of difficult trachael intubation, and intractable seizure activity, a condition that limits selection of anaesthetics. The perioperative management challenges of LNSS are depicted in the presentation of two cases of LNSS with different outcomes and contrasted with the major anaesthetic considerations in the perioperative management of other, more common phakomatoses.
Regime shifts in the breeding of an Atlantic puffin population
Authors: Durant Joël M. , Anker‐Nilssen Tycho , Hjermann Dag Ø. , Stenseth Nils Chr.
Published: April 2004

Timing of breeding is a key factor determining the reproductive success in bird populations and known to be affected by climate fluctuations. We investigated the long‐term (1978–2002) relationship between climate and hatching date within a population of Atlantic puffin Fratercula arctica at Røst in the Norwegian Sea. The timing of puffin breeding was found to be influenced by the North Atlantic Oscillation winter index (NAO). We isolated two temporal regimes, one where NAO had a significant effect on hatching date (1978–1986 and 1995–2002) and one where these variables were independent (1987–1994). Hatching date could be modelled using, in addition to NAO, hatching date and food abundance in the preceding breeding season (possibly proxies of parental effort). The models remained significant for regime 1 but not for regime 2. NAO differed between the two regimes suggesting that the shifts were induced by climate change, possibly via its effect on the availability of prey in the preceding year. The novelty of our study is the identification of temporal regimes in the effects of climate within one population.
Scaling up evolutionary responses to elevated CO2: lessons from Arabidopsis
Authors: Ward Joy K. , Kelly John K.
Published: April 2004

Results from norm of reaction studies and selection experiments indicate that elevated CO2 will act as a selective agent on natural plant populations, especially for C3 species that are most sensitive to changes in atmospheric CO2 concentration. Evolutionary responses to CO2 may alter plant physiology, development rate, growth, and reproduction in ways that cannot be predicted from single generation studies. Moreover, ecological and evolutionary changes in plant communities will have a range of consequences at higher spatial scales and may cause substantial deviations from ecosystem level predictions based on short‐term responses to elevated CO2. Therefore, steps need to be taken to identify the plant traits that are most likely to evolve at elevated CO2, and to understand how these changes may affect net primary productivity within ecosystems. These processes may range in scale from molecular and physiological changes that occur among genotypes at the individual and population levels, to changes in community‐ and ecosystem‐level productivity that result from the integrative effects of different plant species evolving simultaneously. In this review, we (1) synthesize recent studies investigating the role of atmospheric CO2 as a selective agent on plants, (2) discuss possible control points during plant development that may change in response to selection at elevated CO2 with an emphasis at the primary molecular level, and (3) provide a quantitative framework for scaling the evolutionary effects of CO2 on plants in order to determine changes in community and ecosystem productivity. Furthermore, this review points out that studies integrating the effects of plant evolution in response to elevated CO2 are lacking, and therefore more attention needs be devoted to this issue among the global change research community.
Perturbation and abrupt shift in trophic control of biodiversity and productivity
Authors: Schmitz Oswald J.
Published: April 2004

Ecology is founded on the view that ecosystem properties like biodiversity and productivity change smoothly with changing environmental conditions. However, emerging theory predicts that environmental change may cause abrupt shifts to alternate states. In many ecosystems, top predators play a pivotal role in controlling plant productivity and diversity. Yet it remains uncertain if altering this control shifts systems to alternate states. I report on a test of the hypothesis that loss of predator control of ecosystem function causes abrupt state changes in diversity and productivity. In this meadow ecosystem, predators enhance plant diversity by causing a highly productive, competitively dominant plant species to be suppressed by herbivores. Experimental predator removal caused rapid proliferation of the competitively dominant plant. Moreover, temporally staggered predator reintroductions failed to restore the ecosystem. This loss of resilience confirmed that the ecosystem crossed a critical threshold and entrained into an alternate state.
Resource dynamic plays a key role in regional fluctuations of the spruce bark beetles Ips typographus
Authors: Økland Bjørn , Berryman Alan
Published: April 2004

Abstract  1 We analysed time series of spruce bark beetles (Nt) caught in pheromone traps from 1979 to 2000 in approximately 100 localities throughout south‐east Norway.

2 The analysis was performed at two spatial scales (whole area and 12 subregions), and included additional analyses of the time‐series sequences before and after a large windfelling (1987) that appeared to induce a shift in the dynamics.

3 Regression of Rt (logarithmic per‐capita growth rate) on Nt − d indicated that the endogenous dynamics were dominated by lag 1 density dependence. This was particularly so in the sequence after the large windfelling (R2 = 0.79), probably due to intraspecific competition for breeding substrate.

4 The sequence before the windfelling (1979–1987) was declining without significant density dependence. We suggest this to be a transition period, reflecting a drop in carrying capacity due to depletion of susceptible trees during the preceding outbreak period (1970s) and a drop in beetle number to below the density required to kill trees.

5 Windfelling (Wt − 1) appears to be an important predictor of the dynamics; however, it was difficult to evaluate the statistical significance of this factor due to only one large windfall event.

6 The weak influence of drought stress (Dt − 1) could be due to the absence of severe drought periods within the time series.
Feeding responses of carabid beetles to dimethoate‐contaminated prey
Authors: Mauchline Alice L. , Osborne Juliet L. , Powell Wilf
Published: April 2004

Abstract  1 The feeding responses of Pterostichus madidus Fab., P. melanarius Illiger and Nebria brevicollis Fab. (Coleoptera: Carabidae) to dimethoate‐contaminated prey were investigated in ‘no‐choice’ and ‘choice’ feeding tests.

2 In the no‐choice tests, starved beetles were presented with aphid prey treated with four concentrations of dimethoate. In the choice tests, treated and untreated prey were presented together and the feeding preferences of the starved beetles observed.

3 No avoidance or rejection behaviour was seen in any of the carabids in either of the tests, i.e. no discrimination of the treated and untreated prey was observed.

4 Sufficient dimethoate was consumed with the aphid prey to cause significant mortality levels in the carabids.

5 The concentrations of dimethoate used in these experiments are comparable to field exposure, so carabids feeding in treated fields and field margins could potentially suffer lethal effects via the indirect exposure route of consuming contaminated prey.
Mixed mating strategies and pollination by insects and wind in coconut palm (Cocos nuciferaL. (Arecaceae)): importance in production and selection
Authors: Meléndez‐Ramírez V. , Parra‐Tabla V. , Kevan P. G. , Ramírez‐Morillo I. , Harries H. , Fernández‐Barrera M. , Zizumbo‐Villareal D.
Published: April 2004

Abstract 1 Coconut is one of the most important tropical crops. It is threatened by Lethal yellowing disease. Production and selection by breeding require pollination, yet little is known of the pollination requirements and breeding system of this palm.

2 This study was carried out from 1999 to 2001 in coconut plantations represented by five coconut ecotypes commonly found in Mexico. It is the first study in the Neotropics on pollination and the breeding system of this palm.

3 Hymenoptera were the most numerous and diverse visitors to coconut flowers. The greatest period of insect abundance occurred during the rainy season (July to October). Insect abundance on the flowers correlated highly and positively with precipitation.

4 The abundance of visitors to pistillate flowers did not vary with season but there were significant differences between palm ecotypes; the most insect‐visited flowers were of the Atlantic Tall ecotype.

5 The introduced honeybee (Apis mellifera) had the most appropriate foraging behaviour, visiting both pistillate and staminate flowers. These insects were probably the most efficient pollinators as they carry pollen on their ventral surface. Ants were present on flowers day and night but had no effect on pollination.

6 Pollination experiments indicated a mixed mating strategy: self‐pollination by geitenogamy produced almost 19% of the fruit set, but cross‐pollination (xenogamy) was the most important contribution (c. 30%). Anemophilous cross‐pollination only accounted for 10% of fruit set, whereas entomophily became the most important pollination mechanism under Yucatan conditions.

7 As coconut palm grows naturally on the oceanic strand in a wide variety of seasonal conditions of wind and rain, we suggest that they may have evolved pollination, breeding and mating systems that ensure fruit production under a wide variety of conditions, while maximizing the probability of cross‐pollination.
A retrospective evaluation of rectal irrigation in the treatment of disorders of faecal continence
Authors: Crawshaw A. P. , Pigott L. , Potter M. A. , Bartolo D. C. C.
Published: April 2004

Objectives  The aim of this study was, firstly, to evaluate the efficacy and acceptability of rectal irrigation in the treatment of patients with disorders of faecal continence that have not responded to other treatment modalities. Secondly, to see if standard anorectal physiology measures can identify patients who might have successful treatment with rectal irrigation.

Patients and methods  All patients who had been treated with rectal irrigation, between 1998 and 2000, were sent a postal questionnaire. Patients were asked to quantify their symptoms (before and after rectal irrigation) using a visual analogue scale to determine the efficacy of rectal irrigation. An increase of 10 (10 mm) in this score was regarded as successful treatment and incontinence scores obtained. The acceptability of rectal irrigation was determined using a Quality of Life questionnaire. Data regarding presenting symptoms, previous therapies, pretreatment anorectal physiology measurements were obtained from a retrospective case note and database review.

Results  Completed questionnaires were obtained from 48 (52%) of 92 patients, 39 patients had had previous medical and/or surgical treatment before trying rectal irrigation. At the time of the questionnaire 44 of 48 patients were still using rectal irrigation. Using the linear analogue scores 24 of 48 (50%) reported an improvement in their symptoms using rectal irrigation. Most patients found the treatment acceptable. Incontinence scores and anorectal physiology measures did not predict those patients who responded successfully to rectal irrigation.

Conclusion  Rectal irrigation can offer symptomatic improvement to patients with faecal evacuatory disorders where other therapies have failed. Most patients find the treatment acceptable. Standard anorectal physiology measures and incontinence scores do not predict those patients likely to have successful treatment.
Parastomal hernia repair
Authors: Rieger N. , Moore J. , Hewett P. , Lee S. , Stephens J.
Published: April 2004

Objective  The aim of this study was to audit the results of parastomal hernia repair.

Methods  A retrospective review was made of all patients having parastomal hernia repair at 2 teaching hospitals over a 12‐year period.

Results  Forty‐three patients had 51 parastomal hernia repairs. Three types of hernia repair were used: 14 (28%) local suture, 19 (37%) local mesh repair and 18 (35%) stoma relocation. Three patients died and significant complications occurred in 65% of repairs. Parastomal hernia recurred in 18 (38%) of repairs. This was greatest with a sutured repair (59%) and least in patients having stoma relocation (24%). Repair with mesh was associated with a 39% recurrence rate. No significant statistical difference was found for the results of these repairs.

Conclusion  Parastomal hernia repair is associated with high rates of morbidity, mortality and recurrence. Repair should not be undertaken without a good indication.
Artificial bowel sphincter in severe anal incontinence
Authors: Casal E. , San Ildefonso A. , Carracedo R. , Facal C. , Sánchez J. A.
Published: April 2004

Objective  The artificial anal sphincter has been suggested as an alternative in the treatment of severe anal incontinence when conventional surgical methods are not possible or have failed. Experience in this procedure is still limited and the results have not yet been sufficiently established. The aim of this study is to evaluate the efficacy of the ACTICON® (American Medical Systems, Minneapolis, MN) on patients operated upon in our Unit.

Patients and method  In this prospective study an ACTICON® sphincter was implanted in 10 patients (8 women) with an average age of 56 years and with an average period of severe anal incontinence of 151 months. The origin of incontinence was obstetric injury (n: 4), neuropathy (n: 3) and sphincteral injury from previous anal surgery (n: 3). The degree of continence was measured using the Fecal Incontinence Scoring System (FISS) and the pre‐ and postoperative anal manometric parameters at 6‐month intervals. The average follow‐up time for the efficacy of the implanted system was 29 months.

Results  A total of 6 patients[60%] displayed complications in the immediate postoperative period: subaponeurotic reimplantation of the connecting tubes was necessary after infection of the abdominal wound (n:1); superficial dehiscence of the perianal wound (n: 2), infection of the perianal wound (n: 1) and perianal haematoma (n: 2) that were resolved by conservative treatment. For 3 patients[30%] the system was explanted, definitively in one and in 2 of them reimplanted successfully. At the end of the follow‐up period, 9 patients[90%] still have an activated artificial sphincter. The score on the Fecal Incontinence System decreased significantly after the system was activated (P < 0,0001) and the pressure with the cuff closed was significantly higher than pre‐operative anal pressure (P < 0,0001). All the patients are now continent for solid stool, 56% have occasional involuntary losses of gases and 33% occasionally have involuntary losses of gases and liquid stool. Only 2 patients[22%] have complete continence.

Conclusions  Our findings indicate that the ACTICON® artificial anal sphincter is well tolerated and can be an effective alternative in the treatment of severe anal incontinence. Although complete continence is only achieved in a low percentage of cases, for the rest of the patients the ACTICON® neosphincter reduces the symptoms considerably.
Durable‐Goods Monopoly with Endogenous Innovation
Authors: Nahm Jae
Published: April 2004

While selling an existing product, a durable‐goods monopolist may develop a new, improved product. The firm must consider the interaction between its intertemporal pricing and research and development (R&D) decisions. The interactions show a sharp dichotomy depending on pricing regimes. When it is optimal for the firm to continue to sell the old model along with the new model, the interactions disappear. However, when it is optimal for the firm to discontinue the sale of the old model after introducing the new model, the firm will face a time‐inconsistency problem in its R&D decision.
Entrepreneurial Boldness and Excessive Investment
Authors: Brocas Isabelle , Carrillo Juan D.
Published: April 2004

We analyze investment by a population of hyperbolic discounting entrepreneurs. In order to avoid inefficient procrastination, agents with good prospects about their chances of success may choose to forego free information and to invest boldly. This explains an excessive level of investment in the economy. Building on this observation, we show that low risk‐free interest rates favor bold entrepreneurship and entry mistakes. Furthermore, public intervention can be socially desirable: Forcing agents to acquire information before deciding whether to invest may reduce competitive interest rates and may be beneficial for all individuals in the economy.

And thus the native hue of resolution  Is sicklied o'er with the pale cast of thought,  And enterprises of great pith and moment  With this regard their currents turn awry,  And lose the name of action.            Hamlet, Act 3: Scene 1.
Developing A Database to Describe the Practice Patterns of Adult Nurse Practitioner Students
Authors: O'Connor Nancy A. , Hameister Alicia D. , Kershaw Trace
Published: April 2004

Purpose:To describe the practice patterns of adult nurse practitioner students using a database composed of core health data elements and standardized nursing language.

Design:Descriptive study of 3,733 patient visits documented by 19 adult nurse practitioner students in the academic year 1996–1997.

Methods:A database was designed for documenting the full scope of practice of adult nurse practitioner students by use of core health data elements and the standardized nursing languages of NANDA and NIC. Nurse practitioner students used the database to document every linical encounter during their final clinical year of study. Most visits occurred in ambulatory care settings in a midwestern American city.

Findingsx:Based on the American Medical Association's Evaluation/Management coding system, data indicated that 50% of visits were classified as problem focused, while 31.9% were expanded, 10% were detailed, and 8.1% were comprehensive. The most frequently occurring NANDA diagnoses were pain, health‐seeking behavior, altered health maintenance, and knowledge deficit. The most frequently reported Nursing intervention classifications (NIC) were patient education, drug management, information management, and risk management.

Conclusions:Using standardized nursing language to describe clinical encounters made visible the complex clinical decision‐making patterns of adult nurse practitioner students. Systematic use of a database designed for documenting the full scope of practice of nurse practitioner students showed the applicability of standardized nursing language to advanced practice nursing contexts.