bluuebunny/crossref_metadata_2025 huggingface dataset:
Phosphorus and nitrogen losses to surface waters from a forested feedlot for bulls in Finland
Authors: Uusi‐Kämppä J. , Jauhiainen L. , Huuskonen A.
Published: September 2007

Phosphorus and nitrogen losses to water from a forested feedlot (10 000 m2) for 10 bulls was studied for 2 years in northwestern Finland. The nutrient loading was estimated by monitoring nutrient accumulation and migration in a feedlot soil profile and run‐off to a nearby ditch. Ditch water was sampled for total phosphorus (TP), dissolved reactive P (DRP), total nitrogen (TN), NH4‐N and NO3‐N analyses. The concentrations of ammonium acetate extractable phosphorus (PAAAc), NH4‐N and NO3‐N in the soil were measured before and during the study. The mean PAAAc rose in the surface soil layer (0–5 cm) from 5.0 to 13.8–21.3 mg L−1, being the highest in the areas where bulls congregated. Also the mean contents of NH4‐N and NO3‐N in the 0.6‐m soil layer rose from 5.4 and 0.5 kg ha−1 up to 270 and 30 kg ha−1, respectively; an approximately 50‐ to 60‐fold increase. Although the annual losses of DRP, TP, NH4‐N, NO3‐N and TN (0.6, 0.9, 1.4, 0.3 and 3.5 kg ha−1, respectively) increased only moderately in ditch water during the study period, our results suggest that forested feedlots may represent a long‐term source of increased nutrient loading to water if cattle rearing with high stock numbers continues for a long time in the same place.
SOCIAL SECURITY BENEFITS AS A RETIREMENT RESOURCE FOR U.S. NEAR‐RETIREES
Authors: Bridges Benjamin , Choudhury Sharmila
Published: September 2007

This paper analyzes Social Security benefits as a retirement resource (wealth and income) for U.S. near‐retirees. We look at how the average values of several measures of benefits such as Social Security wealth and earnings replacement rates have changed from earlier cohorts to today's near‐retirement cohort, examine differences among demographic and socioeconomic groups within cohorts, and discuss reasons for these changes and differences. We use improved data (actual earnings history data) to produce more accurate measures of benefits. The paper also uses some new benefit measures. Three key findings are: (1) average real Social Security wealth increases markedly as we move to later cohorts primarily because of increases in average real lifetime earnings; (2) replacement rates fall as we move from the cohorts of persons reaching 61 in 1993–97 to later cohorts primarily because of the phase‐in of increases in the age of eligibility for full benefits and the increasing labor market activity of women; and (3) median Social Security wealth is much higher for women than for men because women live longer.
FAMILIES, TIME AND MONEY IN CANADA, GERMANY, SWEDEN, THE UNITED KINGDOM AND THE UNITED STATES
Authors: Burton Peter , Phipps Shelley
Published: September 2007

Using microdata from the Luxembourg Income Study, we assess “time crunch” for families with children in Canada, Germany, Sweden, the U.K. and the U.S. Both theory and empirical evidence suggest that both time and money are important inputs to the well‐being of parents and children. We present cross‐country comparisons of “total available adult hours” under different assumptions about the varying time needs of families of different size. We also present estimates of “time shortages.” In all cases, we provide separate estimates for families located at different points in the country income distributions, since being short of both time and money is likely to be particularly problematic. Although paid work hours are highest for high‐income families, we nonetheless find significant numbers of lower‐income families in which parents work very long hours in the paid labor market; this is particularly the case in the U.S.
HAS WORLD POVERTYREALLYFALLEN?
Authors: Reddy Sanjay G. , Minoiu Camelia
Published: September 2007

We evaluate the claim that world consumption poverty has fallen since 1990 in light of alternative assumptions about the extent of initial poverty and the rate of subsequent poverty reduction in China, India, and the rest of the developing world. We use two poverty indicators: the aggregate headcount and the headcount ratio, and consider two widely‐used international poverty lines ($1/day and $2/day). We conclude that, because of uncertainties in relation to the extent and trend of poverty in China, India, and the rest of the developing world, global poverty may or may not have increased. The extent of the estimated increase or decrease in world poverty is critically dependent on the assumptions made. Our conclusions highlight the importance of improving the quality of global poverty statistics.
A METHOD FOR IMPROVED CAPITAL MEASUREMENT BY COMBINING ACCOUNTS AND FIRM INVESTMENT DATA
Authors: Raknerud Arvid , Rønningen Dag , Skjerpen Terje
Published: September 2007

We propose a new method for estimating capital stocks at the firm level by combining business accounts information and investment data. The method also produces capital estimates at the sector or industry level by summing individual firms' capital stocks and appropriately inflating this sum to account for firms not included in the data set. Our approach has two major advantages compared with the much used Perpetual Inventory Method (PIM). First, long investment series are not necessary. Second, sector capital estimates are automatically adjusted for changes in the capital stock because of entry and exit of firms. While capital growth rates in Norwegian manufacturing were only 1 percent on average during 1993–2004 according to national accounts figures, our method yields much higher growth rates of 5.5 percent on average.
REAL GDP IN PRE‐WAR EAST ASIA: A 1934–36 BENCHMARK PURCHASING POWER PARITY COMPARISON WITH THE U.S.
Authors: Fukao Kyoji , Ma Debin , Yuan Tangjun
Published: September 2007

This article provides estimates of purchasing power parity (PPP) converters for expenditure side GDP of Japan/China, Japan/U.S. and China/U.S. in 1934–36 through a detailed matching of prices for more than 50 types of goods and services in private consumption and about 20 items or sectors for investment and government expenditure. Linking with the earlier studies on the price levels of Taiwan and Korea relative to Japan, we derive the mid‐1930s benchmark PPP adjusted per capita income of Japan, China, Taiwan and Korea at 32, 11, 23, and 12 percent of the U.S. level respectively. These estimates correct the consistent downward bias in East Asian income levels based on market exchange rate conversions. Compared with Angus Maddison's estimates based on the 1990 benchmark back‐projection, our current‐price based result are 18 and 44 percent lower for Japan and Korea, and 4 and 10 percent higher for Taiwan and China respectively in the mid‐1930s. We develop a preliminary theoretical and empirical framework to examine the possible source of the biases in the back‐projection method. The article ends with a discussion on historical implications of our findings on the initial conditions and long‐term growth dynamics in East Asia.
Vasopressin therapy in dogs with dopamine‐resistant hypotension and vasodilatory shock
Authors: Silverstein Deborah C. , Waddell Lori S. , Drobatz Kenneth J. , King Lesley G.
Published: September 2007

Objective: To describe the therapeutic use of vasopressin in dogs with dopamine‐resistant hypotension and vasodilatory shock.

Series summary: We report the effects of intravenous vasopressin therapy on mean arterial blood pressure and central venous pressure (CVP) in 5 dogs with dopamine‐resistant hypotension from vasodilatory shock. All subjects had documented hypotension and vasodilation, despite adequate intravascular volume and catecholamine therapy. There was an increase in mean arterial pressure following vasopressin administration. No cardiac arrhythmias were noted, nor were there clinically significant changes in CVP.

New information provided: Mean arterial blood pressure increased following vasopressin therapy in all of the dogs. Vasopressin may prove useful in the treatment of vasodilatory shock, however further research is warranted.
NIM811, a nonimmunosuppressive cyclosporine analogue, suppresses collagen production and enhances collagenase activity in hepatic stellate cells
Authors: Kohjima Motoyuki , Enjoji Munechika , Higuchi Nobito , Kotoh Kazuhiro , Kato Masaki , Takayanagi Ryoiichi , Nakamuta Makoto
Published: September 2007

Background/Aims: A recent decrease in patient survival has been reported among hepatitis C virus (HCV)‐infected liver transplant recipients and this may be attributable to progression of fibrosis. We reported previously that cyclosporine suppressed the proliferation of, and collagen production in, hepatic stellate cells (HSCs). Here, we investigated the effects of NIM811, a cyclosporine analogue, on cell growth, collagen production and collagenase activity in HSCs.

Methods: Rat HSCs and human HSC‐derived TWNT‐4 cells were cultured for the study. The expression of collagen, matrix metalloproteinase 1 (MMP‐1) and tissue inhibitor of metalloproteinase‐1 (TIMP‐1) and collagenase activity was evaluated. Cell proliferation and apoptosis were measured. Phosphorylation of mitogen‐activated protein kinases (MAPKs), Smad2 and Smad3 was evaluated. The expression of the tumour growth factor‐β (TGF‐β)‐receptor and Smad7 genes was also evaluated.

Results: NIM811, as well as cyclosporine, suppressed the transcription and synthesis of collagen and stimulated the production of MMP‐1 with a concomitant enhancement of collagenase activity, although it did not change the expression of TIMP‐1. NIM811 inhibited proliferation without induction of apoptosis. In the MAPKs and TGF‐β signalling pathways, NIM811 enhanced the phosphorylation of JNK and p38, but not extracellular signal‐regulated kinases 1 and 2, and suppressed the phosphorylation of Smad2 and Smad3, accompanied by increased Smad7 transcription and decreased TGF‐β‐receptor transcription.

Conclusion: These findings demonstrate that NIM811 not only suppresses collagen production and proliferation but also increases collagenase activity. These effects are accompanied by inhibition of TGF‐β signalling pathways.
Performance of Doppler ultrasound in the prediction of severe portal hypertension in hepatitis C virus‐related chronic liver disease
Authors: Vizzutti Francesco , Arena Umberto , Rega Luigi , Romanelli Roberto Giulio , Colagrande Stefano , Cuofano Stefania , Moscarella Stefania , Belli Giacomo , Marra Fabio , Laffi Giacomo , Pinzani Massimo
Published: September 2007

Purpose: To evaluate the correlation between hepatic vein pressure gradient measurement and Doppler ultrasonography (DUS) in patients with chronic liver disease (CLD).

Patients and methods: Sixty‐six patients with fibrotic to cirrhotic hepatitis C virus‐related CLD, were consecutively included upon referral to our haemodynamic laboratory. Superior mesenteric artery pulsatility index (SMA‐PI), right interlobar renal and intraparenchymal splenic artery resistance indices, were determined, followed by hepatic venous pressure gradient (HVPG) measurement.

Results: A correlation was found between HVPG and intraparenchymal splenic artery resistance index (SA‐RI) (r=0.50, P<0.0001), SMA‐PI (r=−0,48, P<0.0001), right interlobar renal artery resistance index (RRA‐RI) (r=0.51, P<0.0001) in the whole patient population. However, dividing patients according to the presence/absence of severe portal hypertension (i.e. HVPG ≥12 mmHg), a correlation between HVPG and intraparenchymal SA‐RI (r=0.70, P<0.0001), SMA‐PI (r=−0.49, P=0.02), RRA‐RI (r=0.66, P=0.0002) was observed only for HVPG values <12 mmHg. HVPG but not DUS correlated with the presence of esophageal varices (P<0.0001).

Conclusions: Superior mesenteric artery pulsatility index, intraparenchymal splenic and right interlobar renal artery resistance indices do not adequately predict severe portal hypertension.
Glycine reduces hepatic warm ischaemia–reperfusion injury by suppressing inflammatory reactions in rats
Authors: Yamanouchi Kosho , Eguchi Susumu , Kamohara Yukio , Yanaga Katsuhiko , Okudaira Sadayuki , Tajima Yoshitsugu , Kanematsu Takashi
Published: September 2007

Background: Glycine, a non‐essential amino acid, is known to have an anti‐inflammatory effect on haemorrhagic and endotoxic shock in animals. In the present study, we examined the effects of glycine on inflammatory reactions and hepatocellular damage after hepatic warm ischaemia–reperfusion (I–R) in rats.

Methods: Using Sprague–Dawley rats, ischaemia was induced in 92% of the liver by clamping the hepatic inflows for 60 min, and part of the non‐ischaemic lobe was resected after reperfusion. Before the induction of I–R, rats were treated by an intravenous administration of either glycine (Glycine group) or normal saline (Control group). The severity of hepatocellular injury was determined by serum levels of hepatic enzymes and histological necrosis. To evaluate the effect of glycine on inflammatory reactions, tumour necrosis factor (TNF)‐α mRNA expression in the liver, serum levels of TNF‐α and chemokine‐induced neutrophil chemoattractant (CINC) and the number of neutrophils in the liver were compared between the groups.

Results: At 60 min after reperfusion, the serum levels of hepatic enzymes in the Glycine group were significantly lower than those in the Control group (P<0.05). TNF‐α mRNA expression was also suppressed in the livers in the Glycine group. Furthermore, the serum levels of TNF‐α and CINC in the Glycine group were significantly lower than those in the Control group (P<0.05). Pretreatment with glycine also significantly reduced hepatic necrosis and the number of neutrophils at 24 h after reperfusion.

Conclusion: Glycine has a protective effect against inflammatory reactions, and reduces hepatocellular injury induced by hepatic warm I–R in rats.
Apoptosis versus necrosis rate as a predictor in acute liver failure following acetaminophen intoxication compared with acute‐on‐chronic liver failure
Authors: Bechmann Lars P. , Marquitan Guido , Jochum Christoph , Saner Fuat , Gerken Guido , Canbay Ali
Published: September 2007

Cell death is known to play a crucial role in liver diseases. We compared the clinical courses of two cases of liver failure of different origins correlated with the extent of cell death (apoptosis and/or necrosis), measured in the patient's blood. Patient 1 was admitted with acute liver failure following acetaminophen intoxication. Intravenous therapy with acetylcysteine was performed. The percentage of apoptotic cell death measured by M30 was three times higher than normal and the overall cell death measured by M65 was more than 30 × higher than normal. High levels of aminotransferases were detected, indicating high rates of necrosis. M30 and M65 values rapidly returned to normal levels, while the liver function test (LFT) levels decreased with latency. Patient 2 was admitted with acute‐on‐chronic liver failure with known liver fibrosis. M30 values were 16 × higher than normal. In contrast, M65 values were lower than in the first case. This time, no movement in M30 levels was seen until the M30 levels rapidly increased indicating the inevitable death of the patient, while LFTs did not change. These results indicate the role of M30 and M65 immunoexpression as markers for functioning liver cell mass, capacity for recovery and therefore as predictive markers in acute liver failure.
Treating nonalcoholic fatty liver disease
Authors: Méndez‐Sánchez Nahum , Arrese Marco , Zamora‐Valdés Daniel , Uribe Misael
Published: September 2007

Nonalcoholic fatty liver disease (NAFLD) is a chronic illness with multiple consequences. The spectrum of disease ranges from simple steatosis, with benign prognosis, to a potentially progressive form, nonalcoholic steatohepatitis, which may lead to liver fibrosis and cirrhosis, leading to an increase in morbidity and mortality. Furthermore, hepatocellular carcinoma incidence in NAFLD is comparable with that observed in hepatitis C‐infected patients once cirrhosis is established. Current therapy is limited to lifestyle changes and control of associated metabolic disorders; however, new treatments are on the way from basic research to bedside. A review of the current literature on treatment of nonalcoholic fatty liver disease is presented in this article.
Commentary: Trzeciak S et al. (2006). Translating research to clinical practice: a 1‐year experience with implementing early goal‐directed therapy for septic shock in the emergency department
Authors: Robson Wayne P.
Published: September 2007

Early goal‐directed therapy (EGDT) has been shown to decrease mortality in patients with severe sepsis and septic shock. Consensus guidelines now advocate EGDT for the first 6 h of sepsis resuscitation. However, EGDT has not yet been widely adopted in practice. A need for effective collaboration between emergency medicine and critical care medicine services has been identified as an obstacle to implementation. We aimed to determine if EGDT end‐points could reliably be achieved in real‐world clinical practice. EGDT was implemented as a collaborative emergency medicine/critical care quality improvement initiative. EGDT include the following: intravenous (IV) fluids (IVF) targeting central venous pressure ≥8 mmHg, vasopressors targeting mean arterial pressure ≥65 mmHg, and (if necessary) packed RBCs (PRBCs) and/or dobutamine targeting central venous oxygen saturation ≥70%. A retrospective analysis was performed of emergency department (ED) patients with persistent sepsis‐induced hypotension (systolic blood pressure <90 mmHg despite 1.5 L of IVF) treated with EGDT during the first year of the initiative. Primary outcome measures included successful achievement of EGDT end‐points and time to achievement. A secondary analysis was performed, comparing EGDT cases to historical control cases (non‐protocolized control subjects without invasive monitoring). All end‐points were achieved in 20 of 22 cases (91%). The median time to reach end‐point was ≤6 h. In the secondary analysis, patients (n = 38; EGDT, n = 22; pre‐EGDT, n = 16) had similar age, do‐not‐resuscitate status, severity scores, hypotension duration and vasopressor requirement (p = not significant). In the ED, EGDT used more IVF and included PRBC/dobutamine utilization, without any effect on the overall use of these therapies through the first 24 h in the ICU. EGDT was associated with decreased intensive care unit pulmonary artery catheter (PAC) utilization (9.1% versus 43.7%, p = 0.01). With effective emergency medicine/critical care collaboration, we demonstrate that EGDT end‐points can reliably be achieved in real‐world sepsis resuscitation. ED‐based EGDT appears to decrease ICU PAC utilization.

Abstract reprinted from the Chest volume 129, Trzeciak et al., ‘Translating research to clinical practice: a 1–year experience with implementing early goal‐directed therapy for septic shock in the emergency department.’, pages 225–232. © 2006, with permission from Blackwell Publishing Ltd.
Implementing the severe sepsis care bundles outside the ICU by outreach
Authors: Carter Chris
Published: September 2007

Sepsis is not a new challenge facing the health care team, it remains a complex disease, which is difficult to identify and treat. Mortality from sepsis remains high and continues to be a common cause of death among critically ill patients, despite advances in critical care. Sepsis accounts for an estimated 27% of all intensive care admissions in England, Wales and Northern Ireland, and accounted for 46% of all intensive care bed days. Recent research studies and the surviving sepsis campaign have shown that identifying and providing key interventions to patients with severe sepsis and septic shock prior to their admission to the intensive care unit significantly improve outcomes. The aim of this paper was to identify how the Critical Care Outreach Team at one local hospital implemented the severe sepsis resuscitation care bundle for patients in the emergency department (ED) and on the general wards. It will include a presentation on the various ways the team raised the profile of severe sepsis and the care bundle at hospital and at national level. It also includes audit data that have been collected. The results showed that if the resuscitation care bundle was implemented within the first 24 h of hospital admission, mortality was 29%, whereas if the care bundle was instigated after this time mortality was more than at 49%. Audit data showed that the commonest sign of severe sepsis seen in patients in the ED and on wards was tachypnoea. This article discusses the successful implementation of the severe sepsis resuscitation care bundle and the positive impact an Outreach team can have in changing practice in the way patients are managed with severe sepsis. The audit data support the need for regular physiological observations and the use of a Patient At Risk Trigger scoring tool to identify patients at risk of deterioration. This allows referral to the Outreach team, who assess the patient and if appropriate initiate the care bundle.
Magnetic Resonance Imaging in Animal Models of Epilepsy—Noninvasive Detection of Structural Alterations
Authors: Gröhn Olli , Pitkänen Asla
Published: September 2007

Summary:  Small animal magnetic resonance imaging (MRI) has opened a window through which brain abnormalities can be observed over time in rodents noninvasively. We review MRI studies done during epileptogenesis triggered by status epilepticus in rat. Most of these studies have used quantitative T2, diffusion, and/or volumetric MRI. The goal has been to identify the distribution and severity of structural lesions during the epileptogenic process, that is, soon after status epilepticus, during epileptogenesis, and after the appearance of spontaneous seizures. Data obtained demonstrate that MRI can be used to associate the development of brain pathology with the evolution of clinical phenotype. MRI can also be used to select animals to preclinical studies based on the severity and/or distribution of brain damage, thus making the study population more homogeneous, for example, for assessment of novel antiepileptogenic or neuroprotective treatments. Importantly, follow‐up data collected emphasize interindividual differences in the dynamics of development of abnormalities that could have remained undetected in a typical histologic analysis providing a snapshot to brain pathology. A great future challenge is to take advantage of interanimal variability in MRI in the development of surrogate markers for epilepsy or its comorbidities such as memory impairment. Understanding of molecular and cellular mechanisms underlying changes in various MRI techniques will help to better understand complex progressive pathological processes associated with epileptogenesis and epilepsy.
Magnetic Resonance Imaging of Functional Anatomy: Use for Small Animal Epilepsy Models
Authors: Obenaus Andre , Jacobs Russell E.
Published: September 2007

Summary:  Neuroimaging has greatly assisted the diagnosis and treatment of epilepsy. Volumetric analysis, diffusion‐weighted imaging, and other magnetic resonance imaging (MRI) modalities provide a clear picture of altered anatomical structures in both focal and nonfocal disease. More recently, advances in novel imaging methodologies have provided unique insights into this disease. Two examples include manganese‐enhanced MRI (MEMRI) and diffusion tensor imaging (DTI). MEMRI involves injection of MnCl2 to evaluate neuronal activity where it is actively transported. Areas of neuronal hyperactivity are expected to have altered uptake and transport. Mapping of activation along preferential uptake pathways can be confirmed by T1‐weighted imaging. DTI uses the intrinsic preferential mobility of water movement along axonal pathways to map anatomical regions. DTI has been used to investigate white matter disease and is now being applied to clinical and, to a lesser extent, animal investigations of seizure disorders. These two diverse MRI methods can be applied to animal models to provide important information about the functional status of anatomical regions that may be altered by epilepsy.
Functional MRI Studies of Animal Models in Epilepsy
Authors: Blumenfeld Hal
Published: September 2007

Summary:  Functional magnetic resonance imaging (fMRI) has become a widely used imaging modality in the past decade in both human studies and animal models. Epilepsy presents unique challenges for neuroimaging due to subject movement during seizures, and the need to correlate the timing of often unpredictable seizure events with fMRI data acquisition. These challenges can readily be overcome in animal models of epilepsy. Animal models also provide an opportunity to investigate the fundamental relationships between fMRI signals and brain electrical activity through invasive studies not possible in humans. fMRI studies in animal models of epilepsy can enable us to correctly interpret fMRI signal increases and decreases in human studies, ultimately elucidating specific networks that will be targeted for improved treatment of epilepsy.
Quantitative Approaches to Functional MRI: Applications in Epilepsy
Authors: Keogh Bart P. , Cordes Dietmar
Published: September 2007

Summary: The application of functional magnetic resonance imaging (fMRI) to elucidation of seizures and epilepsy has been built primarily upon a framework derived from cortical responses to periodic sensory (and cognitive) stimuli. This analytical approach relies upon assumptions that may be less applicable to the problem of seizure origination. Because of the heterogeneous and complex nature of seizures, a number of quantitative methodologies have been derived to understand fMRI changes that are associated with epileptiform neural activity. Separated broadly, these can be divided into those making some set of assumptions about the form of the MRI signal response to neural activation (the general linear model), and those that are data driven. It is likely that a combination of methodologies, where data driven methods are “informed” by knowledge of the underlying neurobiological process will provide the greatest insight into the underlying neurobiological basis of seizure origination.
EEG Monitoring during Functional MRI in Animal Models
Authors: Mirsattari Seyed M. , Ives John R. , Leung L. Stan , Menon Ravi S.
Published: September 2007

Summary:  Despite its excellent temporal resolution, electroencephalogram (EEG) has poor spatial resolution to study the participation of different brain areas in epileptic discharges, and the propagation of seizures to subcortical areas is not revealed. Furthermore, EEG provides no information about metabolic changes that occur in the brain before and during the epileptic discharges. Thus, monitoring variations in blood flow and oxygenation in response to epileptic discharges can provide additional complementary information. Functional magnetic resonance imaging (fMRI) technology can be used to study the hemodynamic changes associated with interictal epileptiform discharges or epileptic seizures (i.e., before, during or after them) in experimental animal models and may noninvasively monitor these changes over time. Blood oxygenation level‐dependent fMRI has superior spatial resolution compared with other functional imaging modalities and utilizes changes in local magnetic field properties to measure the amount of deoxyhemoglobin in each brain areas as an indicator of brain activity. Simultaneous recording of EEG and fMRI is required to achieve this objective. This article describes methods of acquiring and monitoring EEG during fMRI studies in experimental animals. Particular attention will be paid to methods used to eliminate artifacts induced in the acquired magnetic resonance images by EEG equipment and MR‐related artifacts in EEG recordings.
Magnetic Resonance Spectroscopy in Animal Models of Epilepsy
Authors: Hiremath Girish K. , Najm Imad M.
Published: September 2007

Summary:  The noninvasive localization of the epileptogenic zone continues to be a challenge in many patients that present as candidates for possible epilepsy surgery. Magnetic resonance imaging (MRI) techniques provide accurate anatomical definition, but despite their high resolution, these techniques fail to visualize the pathological neocortical and hippocampal changes in a sizable number of patients with focal pathologies. Further, visualized lesions on MRI may not all produce seizures. One of the keys to the understanding of the epileptogenic zone lies in the recognition of the metabolic alterations that occur in the setting of epileptic seizures. Magnetic resonance spectroscopy (MRS) is a valuable tool that can be used to study the metabolic changes seen in both acute and chronic animal models of epilepsy. Such study allows for the identification of epileptic tissue with high sensitivity and specificity. We present here a review of the use of MRS in animal models of epilepsy.
Positron Emission Tomography in Basic Epilepsy Research: A View of the Epileptic Brain
Authors: Dedeurwaerdere Stefanie , Jupp Bianca , O'Brien Terence J.
Published: September 2007

Summary:  The neurobiological processes that result in epilepsy, known as epileptogenesis, are incompletely understood. Moreover, there is currently no therapy that effectively halts or impedes the development or progression of the condition. Positron Emission Tomography (PET) provides valuable information about the function of the brain in vivo, and is playing a central role in both clinical practice and research. This technique reliably reveals functional abnormalities in many epilepsy syndromes, particularly temporal lobe epilepsy. Unfortunately, epileptogenesis is extremely difficult to study in human patients who usually present with established epilepsy, rather than at the early stages of the process. Animal models offer the advantage of permitting the assessment of the pre‐, developing, and chronic epileptic states. However, traditional techniques (e.g., histology) are only able to examine the brain at one time point during epileptogenesis in any one individual. Recent advances in dedicated small animal PET (saPET) allow researchers for the first time to study in vivo biomolecular changes in the brain during epileptogenesis by means of serial acquisitions in the same animal. Repeated application of in vivo imaging modalities in the same animal also decreases the effect of biological inter‐individual variability and the number of animals to be used. The availability of novel PET tracers permits the investigation of a broad range of biochemical and physiological processes in the brain. Besides research on epileptogenesis, saPET can also be applied to investigate in vivo the biological effect of novel treatment strategies. saPET is widely used in many fields of pathophysiological investigation and is likely to significantly enhance epilepsy research.
Imaging of Intrinsic Optical Signals in Primate Cortex during Epileptiform Activity
Authors: Haglund Michael M. , Hochman Daryl W.
Published: September 2007

Summary:  Localized increases in neuronal activity are known to alter the distribution and oxygen content of blood within the surrounding brain tissue. In the neocortex, these activity‐evoked hemodynamic changes are predominantly mediated through the dilation of the microscopic pial arterioles that lie on the surface of the brain, nearest to the site of activation. Since hemoglobin absorbs light throughout the visible and near‐infrared spectrum, optical microscopy combined with computer imaging techniques can be used to map the patterns of hemodynamic changes associated with neuronal activity. Examples of optical imaging data are provided here to demonstrate four points. First, depending on the optical wavelength chosen for illumination of the cortex, different spatial and temporal patterns of optical changes are elicited by similar stimuli yielding distinctly different types of physiological information. Second, by selecting the appropriate wavelengths, it is possible to generate maps from optical‐imaging data that represent changes predominately due to either blood volume (at 535 nm) or blood oxygenation (at 660 nm). Third, “negative” optical signals are negative only relative to a given optical wavelength, and appear to be associated with more intense types of neuronal activation. Fourth, optical imaging is a useful technique for studying neocortical seizure activity in animal models, with the caveat that species‐specific differences in cortical size and vascularization patterns may be important to consider in the interpretation of optical imaging data.
Epileptic Automatisms in the Criminal Courts: 13 Cases Tried in England and Wales between 1975 and 2001
Authors: Reuber Markus , Mackay Ronnie D.
Published: September 2007

Summary

Objectives:To explore the relationship of epilepsy and criminal behavior.

Methods:Case series based on all criminal cases found “not guilty by reason of insanity” (NGRI) because of epilepsy in England and Wales between 1975 and 2001. Data were extracted from medico‐legal reports held by the Mental Health Unit at the Home Office and the Department for Constitutional Affairs in London, UK.

Results:Thirteen cases were identified, accounting for 7.3% of all verdicts of NGRI. Charges included murder (1), attempted murder (1) assault (7), arson (2), abduction/kidnapping (3), and burglary (1). Of the defendants, 92.3% were male, 76.9% had neuropsychological impairments, 84.6%% had psychiatric comorbidity, 92.3% were unemployed at the time of the offence, and 69.2% had been convicted of criminal offences previously. Eight of 10 defendants treated with antiepileptic drugs were complying poorly with medication. A total of 61.5% offenses were committed in a state of alcohol intoxication. Psychotic symptoms may have been present when the offense was committed in 52.8% of cases. Over two‐thirds of offenses probably occurred during the postictal period.

Conclusions:This case series suggests that it is exceptional for epileptic seizures to cause criminal acts or omissions. The relatively low standard of proof required means that some of cases found NGRI on account of epilepsy were not actually related to seizures. There were no definite examples of ictal criminal behavior. Most offenses related to seizures are likely to have occurred in the postictal phase.
Mechanisms of Epileptogenesis in Tuberous Sclerosis Complex and Related Malformations of Cortical Development with Abnormal Glioneuronal Proliferation
Authors: Wong Michael
Published: September 2007

Summary

Malformations of cortical development (MCDs) are increasingly recognized as causes of medically intractable epilepsy. In order to develop more effective, rational therapies for refractory epilepsy related to MCDs, it is important to achieve a better understanding of the underlying mechanisms of epileptogenesis, but this is complicated by the wide variety of different radiographic, histopathological, and molecular features of these disorders. A subset of MCDs share a number of characteristic cellular and molecular abnormalities due to early defects in neuronal and glial proliferation and differentiation and have a particularly high incidence of epilepsy, suggesting that this category of MCDs with abnormal glioneuronal proliferation may also share a common set of primary mechanisms of epileptogenesis. This review critically analyzes both clinical and basic science evidence for overlapping mechanisms of epileptogenesis in this group of disorders, focusing on tuberous sclerosis complex, focal cortical dysplasia with balloon cells, and gangliogliomas. Specifically, the role of lesional versus perilesional regions, circuit versus cellular/molecular defects, and nonneuronal factors, such as astrocytes, in contributing to epileptogenesis in these MCDs is examined. An improved understanding of these various factors involved in epileptogenesis has direct clinical implications for optimizing current treatments or developing novel therapeutic approaches for epilepsy in these disorders.
Utility of Magnetoencephalography in the Evaluation of Recurrent Seizures after Epilepsy Surgery
Authors: Mohamed Ismail S , Otsubo Hiroshi , Ochi Ayako , Elliott Irene , Donner Elizabeth , Chuang Sylvester , Sharma Rohit , Holowka Stephanie , Rutka James , Snead O. Carter
Published: September 2007

Summary

Purpose: To study the role of magnetoencephalography (MEG) in the surgical evaluation of children with recurrent seizures after epilepsy surgery.

Methods: We studied 17 children with recurrent seizures after epilepsy surgery using interictal and ictal scalp EEG, intracranial video EEG (IVEEG), MRI, and MEG. We analyzed the location and distribution of MEG spike sources (MEGSSs) and the relationship of MEGSSs to the margins of previous resections and surgical outcome.

Results: Clustered MEGSSs occurred at the margins of previous resections within two contiguous gyri in 10 patients (group A), extended spatially from a margin by ≤3 cm in three patients (group B), and were remote from a resection margin by >3 cm in six patients (group C). Two patients had concomitant group A and C clusters. Thirteen patients underwent second surgeries. IVEEG was used in four patients. Six of seven patients with group A MEGSS clusters did not require IVEEG for second surgeries. Follow‐up periods ranged from 0.6 to 4.3 years (mean: 2.6 years). Eleven children, including eight who became seizure‐free, achieved Engel class I or II.

Conclusion: Our data demonstrate the utility of MEG for evaluating patients with recurrent seizures after epilepsy surgery. Specific MEGSS cluster patterns delineate epileptogenic zones. Removing cluster regions adjacent to the margins of previous resections, in addition to removing recurrent lesions, achieves favorable surgical outcome. Cluster location and extent identify which patients require IVEEG, potentially eliminating IVEEG for some. Patients with remotely located clusters require IVEEG for accurate assessment and localization of the entire epileptogenic zone.
Treatment of Dementia in Community‐Dwelling and Institutionalized Medicare Beneficiaries
Authors: Gruber‐Baldini Ann L. , Stuart Bruce , Zuckerman Ilene H. , Simoni‐Wastila Linda , Miller Ram
Published: September 2007

OBJECTIVES: To establish nationally representative estimates of the use of agents to treat Alzheimer's disease and related dementias (ADRDs) and related behavioral symptoms in Medicare beneficiaries and to describe medication use according to residential status and other patient characteristics.

DESIGN: Cross‐sectional prevalence study.

SETTING: Community and various long‐term care (LTC) settings.

PARTICIPANTS: Twelve thousand six hundred ninety‐seven beneficiaries from the 2002 Medicare Current Beneficiary Survey (MCBS), of whom 11,593 were community dwelling and 1,104 resided in various LTC settings.

MEASUREMENTS: ADRDs were identified according to International Classification of Diseases, Ninth Revision, codes in Medicare claims and self‐ and proxy reports. Medication use was derived from self‐reports (community) and extracts of facility medication administration records (LTC).

RESULTS: In 2002, an estimated 3.4 million Medicare beneficiaries were diagnosed with ADRDs (8.1%), of whom 58.9% resided in the community (prevalence rate=5.1%) and 41.1% resided in LTC facilities (prevalence rate=57.2%). Use of antidementia drugs was similar across settings, with 24.7% of subjects with dementia in the community and 26.3% of those in LTC receiving prescriptions for donepezil, galantamine, or rivastigmine. Use of haloperidol was comparable (and low) in both settings. Use of atypical antipsychotics, especially risperidone, olanzapine, and quetiapine, was much higher in LTC residents (21.0%, 11.9%, and 7.1%, respectively) than in the community (5.1%, 4.0%, and 2.3%).

CONCLUSION: The prevalence of ADRDs in LTC settings is much larger than in the community, but there is little difference in the proportions receiving antidementia drugs, although LTC residents are more likely to be treated with atypical antipsychotics (risperidone, olanzapine, and quetiapine), presumably for behavioral symptoms.
Symptom Experience of Dying Long‐Term Care Residents
Authors: Hanson Laura C. , Eckert J. Kevin , Dobbs Debra , Williams Christianna S. , Caprio Anthony J. , Sloane Philip D. , Zimmerman Sheryl
Published: September 2007

OBJECTIVES:To describe the end‐of‐life symptoms of nursing home (NH) and residential care/assisted living (RC/AL) residents, compare staff and family symptom ratings, and compare how staff assess pain and dyspnea for cognitively impaired and cognitively intact residents.

DESIGN:After‐death interviews.

SETTING:Stratified random sample of 230 long‐term care facilities in four states.

PARTICIPANTS:Staff (n=674) and family (n=446) caregivers for dying residents.

MEASUREMENTS:Interview items measured frequency and severity of physical symptoms, effectiveness of treatment, recommendations to improve care, and staff report of assessment.

RESULTS:Decedents' median age was 85, 89% were white, and 77% were cognitively impaired. In their last month of life, 47% had pain, 48% dyspnea, 90% problems with cleanliness, and 72% symptoms affecting intake. Problems with cleanliness, intake, and overall symptom burden were worse for decedents in NHs than for those in RC/AL. Treatment for pain and dyspnea was rated very effective for only half of decedents. For a subset of residents with both staff and family interviews (n=331), overall ratings of care were similar, although agreement in paired analyses was modest (kappa=−0.043–0.425). Staff relied on nonverbal expressions to assess dyspnea but not pain. Both groups of caregivers recommended improved application of treatment and increased staffing to improve care.

CONCLUSION:In NHs and RC/AL, dying residents have high rates of physical symptoms and need for more‐effective palliation of symptoms near the end of life.
Prevalence of Anemia in the Nursing Home: Contribution of Chronic Kidney Disease
Authors: Robinson Bruce , Artz Andrew S. , Culleton Bruce , Critchlow Cathy , Sciarra Angela , Audhya Paul
Published: September 2007

OBJECTIVES: To assess the independent contribution of chronic kidney disease (CKD) and age to anemia in older nursing home residents.

DESIGN: Retrospective.

SETTING: Skilled nursing facility.

PARTICIPANTS: Nursing home residents with records in the Beverly Healthcare Data Warehouse who were admitted to a nursing home between January 1, 2002, and December 31, 2003; were alive as of January 31, 2004; and had hemoglobin and serum creatinine (SCr) values available for analysis.

MEASUREMENTS: Prevalence of anemia (hemoglobin <13 g/dL for men and <12 g/dL for women) and CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2, according to Modification of Diet in Renal Disease criteria) and the contribution of CKD and age to the prevalence of anemia.

RESULTS: Six thousand two hundred resident records were analyzed (70% female, 85% Caucasian). Overall, 59.6% of residents were anemic, and 43.1% had CKD, and residents with CKD were more likely to have anemia (64.9% with vs 55.7% without CKD; odds ratio (OR)=1.47, 95% confidence interval (CI)=1.33–1.63). Although older age was associated with lower hemoglobin values primarily in residents without CKD (Spearman rank correlation coefficient (r)=−0.10, P<.001), age had no association with hemoglobin in CKD (Spearman r=0.01, P=.60). The greater risk of anemia in the presence of CKD persisted in each age category (OR=2.07, 95% CI=1.53–2.80, aged 65–74; OR=1.44, 95% CI=1.21–1.70, aged 75–84; and OR=1.35, 95% CI=1.15–1.57, aged ≥85).

CONCLUSION: Overall, these results suggest that CKD contributes more strongly than older age to the high prevalence of anemia in older nursing home residents.
Three‐Year Change in Inflammatory Markers in Elderly People and Mortality: The Invecchiare in Chianti Study
Authors: Alley Dawn E. , Crimmins Eileen , Bandeen‐Roche Karen , Guralnik Jack , Ferrucci Luigi
Published: September 2007

OBJECTIVES: To describe changes in interleukin‐6 (IL‐6) and C‐reactive protein (CRP) and to determine how changes are related to mortality in elderly people.

DESIGN: Prospective cohort study.

SETTING: Two communities in the Tuscany region of Italy.

PARTICIPANTS: Randomly selected residents aged 65 and older who participated in the first two waves of data collection (N=736).

MEASUREMENTS: Two serum measurements of IL‐6 and CRP taken 3 years apart. Mortality was observed for the 3 years after the second measurement; 79 deaths were observed in 2,079 person‐years.

RESULTS: Correlations indicated marginal to moderate stability in IL‐6 and CRP, with clinical categories remaining relatively stable over time. Baseline levels were not related to mortality between follow‐up Years 3 and 6, but increases in IL‐6 and CRP predicted 3‐ to 6‐year mortality. Controlling for follow‐up IL‐6 and CRP attenuated the relationship between inflammatory changes and mortality, but increases in CRP continued to increase odds of mortality. After controlling for sociodemographic characteristics, biological risk factors, health behaviors, and disease at both times, increases in CRP, but not IL‐6, were related to mortality. Odds of death were more than three times as great in subjects in whom any CRP increase was observed (odds ratio=3.10, 95% confidence interval=1.25–7.68) as in subjects with stable or declining CRP.

CONCLUSION: CRP and IL‐6 levels within individuals vary over time, and increases in CRP are associated with greater mortality risk. Three‐year changes in inflammatory markers are better predictors of mortality than baseline measures.
Association Between Aspects of Oral Health–Related Quality of Life and Body Mass Index in Community‐Dwelling Older Adults
Authors: Makhija Sonia K. , Gilbert Gregg H. , Litaker Mark S. , Allman Richard M. , Sawyer Patricia , Locher Julie L. , Ritchie Christine S.
Published: September 2007

OBJECTIVES: To investigate whether underweight, normal‐weight, overweight, and obese older adults differ in aspects of their oral health–related quality of life (OHRQoL).

DESIGN: Cross‐sectional study using a 54‐item OHRQoL questionnaire.

SETTING: Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Hale, Bibb, and Pickens (rural).

PARTICIPANTS: The 291 subjects were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility. Participants ranged in age from 65 to 90 (60.5% women, 50.5% non‐Hispanic white, and 50.5% rural).

MEASUREMENTS: Participants completed an in‐home interview about their OHRQoL using a 54‐item questionnaire and were classified into four categories of body mass index (BMI) (<20.0 (underweight), 20.0–24.9 (normal), 25.0–29.9 (overweight), and ≥30.0 (obese)). Multivariate analyses were used to examine associations between BMI and OHRQoL, adjusting for age, race, sex, depression, education, perceived income, comorbidity score, life‐space mobility, and physical activity level.

RESULTS: The results suggested that a parabolic effect existed, with strongest associations occurring in the underweight and obese categories. With the normal BMI group as the reference group, obese participants were more likely to avoid eating foods they would like to eat, overweight participants were less likely to cook foods differently and reported better chewing ability, and underweight persons were more likely to limit foods they eat because of mouth dryness.

CONCLUSION: Objective measures may not accurately reflect peoples' perceptions; therefore, OHRQoL determined according to response to subjective questions is important to properly assess a patient's overall health status. Older adults who are under‐ or overweight should be evaluated for oral health conditions that may affect their nutritional status.