bluuebunny/crossref_metadata_2025 huggingface dataset:
How Accurate Is CBCT in Measuring Bone Density? A Comparative CBCT‐CT In Vitro Study
Authors: Cassetta Michele , Stefanelli Luigi Vito , Pacifici Andrea , Pacifici Luciano , Barbato Ersilia
Published: January 2013

Purpose

Recently, cone beam computed tomography (CBCT) has become widely used for oral and maxillofacial imaging. Twenty dry mandibles were CBCT and conventional multislice CT scanned to evaluate if there is a statistically significant difference between the bone density values they produce, defined as gray density values, and to determine any correlation between them.

Materials and Methods

Using software and a radiographic template, the CT and CBCT scan images were overlapped, and two data sets were created, each one giving the respective gray values (voxel value [VV] or Hounsfield unit [HU]) of the same area with the same spatial coordinates. For the statistical analysis, t‐test, Pearson's correlation, and Pearson's r were used.

Results

The differences between the CBCT (VV) and CT (HU) gray density values were statistically significant (p ≤ .05), whereas the Pearson's correlation coefficients and Pearson's r‐values demonstrated a statistically significant linear correlation between VV and HU gray density values.

Conclusion

The lower radiation dose and reduced costs of CBCT make this a useful substitute for CT; however, this study has shown that, in order to more accurately define the bone density with CBCT, a conversion ratio needs to be applied to the VV.
Autogenous bone combined with anorganic bovine bone for maxillary sinus augmentation: analysis of the osteogenic potential of cells derived from the donor and the grafted sites
Authors: de Melo Willian M. , de Oliveira Fabiola S. , Marcantonio Élcio , Beloti Marcio M. , de Oliveira Paulo T. , Rosa Adalberto L.
Published: January 2013

Objectives

This study aimed to comparatively evaluate the in vitro osteogenic potential of cells obtained from the mandibular ramus (MR, autogenous bone donor site) and from the maxillary sinus (MS) bone grafted with a mixture of anorganic bovine bone (ABB) and MR prior to titanium implant placement (MS, grafted implant site).

Material and methods

Cells were obtained from three patients subjected to MS floor augmentation with a 1 : 1 mixture of ABB (GenOx Inorg®) and MR. At the time of the sinus lift procedure and after 8 months, prior to implant placement, bone fragments were taken from MR and MS, respectively, and subjected to trypsin–collagenase digestion for primary cell culturing. Subcultured cells were grown under osteogenic condition for up to 21 days and assayed for proliferation/viability, osteoblast marker mRNA levels, alkaline phosphatase (ALP) activity and calcium content/Alizarin red staining. ALP activity was also determined in primary explant cultures exposed to GenOx Inorg® (1 : 1 with MR) for 7 days. Data were compared using either the Mann–Whitney U‐test or the Kruskal–Wallis test.

Results

MS cultures exhibited a significantly lower osteogenic potential compared with MR cultures, with a progressive increase in cell proliferation together with a decrease in osteoblast markers, reduced ALP activity and calcium content. Exposure of MR‐derived primary cultures to GenOx Inorg® inhibited ALP activity.

Conclusion

These results suggest that the use of GenOx Inorg® in combination with MR fragments for MS floor augmentation inhibits the osteoblast cell differentiation at the implant site in the long term.
Longitudinal Analysis of Attitudes Toward Wolves
Authors: TREVES ADRIAN , NAUGHTON‐TREVES LISA , SHELLEY VICTORIA
Published: January 2013

Understanding individual attitudes and how these predict overt opposition to predator conservation or direct, covert action against predators will help to recover and maintain them. Studies of attitudes toward wild animals rely primarily on samples of individuals at a single time point. We examined longitudinal change in individuals’ attitudes toward gray wolves (Canis lupus). In the contiguous United States, amidst persistent controversy and opposition, abundances of gray wolves are at their highest in 60 years. We used mailed surveys to sample 1892 residents of Wisconsin in 2001 or 2004 and then resampled 656 of these individuals who resided in wolf range in 2009. Our study spanned a period of policy shifts and increasing wolf abundance. Over time, the 656 respondents increased agreement with statements reflecting fear of wolves, the belief that wolves compete with hunters for deer (Odocoileus virginianus), and inclination to poach a wolf. Endorsement of lethal control of wolves by the state and public hunting of wolves also increased. Neither the time span over which respondents reported exposure to wolves locally nor self‐reported losses of domestic animals to wolves correlated with changes in attitude. We predict future increases in legal and illegal killing of wolves that may reduce their abundance in Wisconsin unless interventions are implemented to improve attitudes and behavior toward wolves. To assess whether interventions change attitudes, longitudinal studies like ours are needed.

Análisis Longitudinal de las Actitudes Hacia Lobos
The Effect of Scene Variation on the Redundant Use of Color in Definite Reference
Authors: Koolen Ruud , Goudbeek Martijn , Krahmer Emiel
Published: January 2013

This study investigates to what extent the amount of variation in a visual scene causes speakers to mention the attribute color in their definite target descriptions, focusing on scenes in which this attribute is not needed for identification of the target. The results of our three experiments show that speakers are more likely to redundantly include a color attribute when the scene variation is high as compared with when this variation is low (even if this leads to overspecified descriptions). We argue that these findings are problematic for existing algorithms that aim to automatically generate psychologically realistic target descriptions, such as the Incremental Algorithm, as these algorithms make use of a fixed preference order per domain and do not take visual scene variation into account.
Young Children's Trust in Overtly Misleading Advice
Authors: Heyman Gail D. , Sritanyaratana Lalida , Vanderbilt Kimberly E.
Published: January 2013

The ability of 3‐ and 4‐year‐old children to disregard advice from an overtly misleading informant was investigated across five studies (total n = 212). Previous studies have documented limitations in young children's ability to reject misleading advice. This study was designed to test the hypothesis that these limitations are primarily due to an inability to reject specific directions that are provided by others, rather than an inability to respond in a way that is opposite to what has been indicated by a cue. In Studies 1 through 4, a puppet identified as The Big Bad Wolf offered advice to participants about which of two boxes contained a hidden sticker. Regardless of the form the advice took, 3‐year olds performed poorly by failing to systematically reject it. However, when participants in Study 5 believed they were responding to a mechanical cue rather than the advice of the Wolf, they were better able to reject misleading advice, and individual differences in performance on the primary task were systematically correlated with measures of executive function. Results are interpreted as providing support for the communicative intent hypothesis, which posits that children find it especially difficult to reject deceptive information that they perceive as being intentionally communicated by others.
In silico analysis of molecular mechanisms of legume lectin‐induced apoptosis in cancer cells
Authors: Shi Z. , An N. , Zhao S. , Li X. , Bao J. K. , Yue B. S.
Published: January 2013

Objectives

The legume lectin family, one of the most extensively studied plant lectin families, has received increasing attention for the remarkable anti‐tumor activities of its members for binding specific cancer cell surface glycoconjugates. MicroRNAs, a class of small, non‐coding RNAs, control translation and stability of mRNAs at post‐transcriptional and translational levels. To date, accumulating evidence has revealed that microRNAs are involved in progression of a number of human diseases, especially cancers. However, the molecular manners of microRNA‐modulated apoptosis in legume lectin‐treated cancer cells are still under investigation.

Materials and methods

We performed in silico analyses to study the interactions between three typical legume lectins (ConA, SFL and SAL) and some specific sugar‐containing receptors (for example, EGFR, TNFR1, HSP70 and HSP90). Additionally, we predicted some relevant microRNAs which could significantly regulate these aforementioned targetreceptors and thus inhibiting down‐stream cancer‐related signaling pathways.

Results

The results showed that these three legume lectins could competitively bind sugar‐containing receptors such as EGFR, TNFR1, HSP70 and HSP90 in two ways, via anti‐apoptotic or survival pathways. On the one hand, the legume lectins could induce cancer cell death through triggering receptor‐mediated signaling pathways, which resulted from indirect binding between legume lectins and mannoses resided in receptors. On the other hand, direct binding between legume lectins and receptors could lead to steric hindrance, which would disturb efficient interactions between them, and thus, the legume lectins would induce cancer cell death by triggering receptor‐mediated signaling pathways. In addition, we identified several relevant microRNAs that regulated these targeted receptors, thereby ultimately causing cancer cell apoptosis.

Conclusions

These findings provide new perspectives for exploring microRNA‐modulated cell death in legume lectin‐treated cancer cells, which could be utilized in combination therapy for future cancer drug development.
Development, differentiation and manipulation of chicken germ cells
Authors: Nakamura Yoshiaki , Kagami Hiroshi , Tagami Takahiro
Published: January 2013

Germ cells are the only cell type capable of transmitting genetic information to the next generation. During development, they are set aside from all somatic cells of the embryo. In many species, germ cells form at the fringe of the embryo proper and then traverse through several developing somatic tissues on their migration to the emerging gonads. Primordial germ cells (PGCs) are the only cells in developing embryos with the potential to transmit genetic information to the next generation. Unlike other species, in avian embryos, PGCs use blood circulation for transport to the future gonadal region. This unique accessibility of avian PGCs during early development provides an opportunity to collect and transplant PGCs. The recent development of methods for production of germline chimeras by transfer of PGCs, and long‐term cultivation methods of chicken PGCs without losing their germline transmission ability have provided important breakthroughs for the preservation of germplasm , for the production of transgenic birds and study the germ cell system. This review will describe the development, migration, differentiation and manipulation of germ cells, and discuss the prospects that germ cell technologies offer for agriculture, biotechnology and academic research.
Neural basis of imprinting behavior in chicks
Authors: Nakamori Tomoharu , Maekawa Fumihiko , Sato Katsushige , Tanaka Kohichi , Ohki‐Hamazaki Hiroko
Published: January 2013

Newly hatched chicks memorize the characteristics of the first moving object they encounter, and subsequently show a preference for it. This “imprinting” behavior is an example of infant learning and is elicited by visual and/or auditory cues. Visual information of imprinting stimuli in chicks is first processed in the visual Wulst (VW), a telencephalic area corresponding to the mammalian visual cortex, congregates in the core region of the hyperpallium densocellulare (HDCo) cells, and transmitted to the intermediate medial mesopallium (IMM), a region similar to the mammalian association cortex. The imprinting memory is stored in the IMM, and activities of IMM neurons are altered by imprinting. Imprinting also induces functional and structural plastic changes of neurons in the circuit that links the VW and the IMM. Of these neurons, the activity of the HDCo cells is strongly influenced by imprinting. Expression and modulation of NR2B subunit‐containing N‐methyl‐D‐aspartate (NMDA) receptors in the HDCo cells are crucial for plastic changes in this circuit as well as the process of visual imprinting. Thus, elucidation of cellular and molecular mechanisms underlying the plastic changes that occurred in the HDCo cells may provide useful knowledge about infant learning.
Complications from submental endotracheal intubation: a prospective study and literature review
Authors: de Toledo Guilherme Lacerda , Bueno Sebastião Cristian , Mesquita Ricardo Alves , Amaral Márcio Bruno Figueiredo
Published: January 2013

Submental endotracheal intubation, as compared to the use of tracheotomy, is an alternative for the surgical management of maxillofacial trauma, as described by Altemir FH (The submental route for endotracheal intubation: a new technique. J Maxillofac Surg 1986; 14: 64). Although the submental endotracheal intubation is a useful technique, a wide range of complications have been reported in the literature. The core aim of this article is to present additional data from 17 patients who have undergone submental endotracheal intubation and who have received at least 6 months of postoperative follow up. A prospective study was carried out on patients who suffered maxillofacial trauma between 2008 and 2011. Age, gender, etiology of trauma, fracture type, complications, and follow up were evaluated. Case series, as well as retrospective and prospective studies regarding submental endotracheal intubation in maxillofacial trauma, were also reviewed. This study demonstrated a low rate of complications in submental endotracheal intubation and no increase in operative time within the evaluated sample. The submental endotracheal intubation may be considered a simple, secure, and effective technique for operative airway control in major maxillofacial traumas.
Can anthocyanins improve maintenance therapy of Ph+ acute lymphoblastic leukaemia?
Authors: Köchling Joachim , Schmidt Manuel , Rott Yvonne , Sagner Michael , Ungefroren Hendrik , Wittig Burghard , Henze Günter
Published: January 2013

Chemotherapy and tyrosine kinase inhibitors provide high remission rates. However, prognosis of adult patients with Philadelphia chromosome–positive acute lymphoblastic leukaemia (Ph+ ALL) still remains poor. Because most adults eventually relapse without allogeneic stem cell transplantation, which is not available for all patients, novel strategies are required for relapse prevention. As the integrity of the immune system is essential for the control of remaining leukaemia cells, we compared the efficacy of anthocyanins, imatinib and a DNA‐based vaccine as non‐immunosuppressant components with 6‐mercaptopurine (6‐MP) to control minimal residual disease in vitro and in vivo using different leukaemia cell lines and syngeneic mice. Proliferation of Ph+ ALL was significantly better inhibited by anthocyanin‐rich berry extract or imatinib compared with 6‐MP. Although anthocyanins induced apoptosis in some leukaemia cell lines, the level of caspase‐3, caspase‐8 and caspase‐9 was significantly lower compared with imatinib and 6‐MP. When used as single components, anthocyanins and imatinib mesylate failed to eradicate pre‐existing Ph+ ALL in syngeneic mice, while 6‐MP led to 10% and DNA vaccination to 56% survival. Intriguingly, only the combination of DNA vaccination with berry extract but not with the isolated anthocyanin, cyanidin‐3‐rutinoside or imatinib further increased leukaemia‐free and overall survival, and 90% of lethally challenged mice survived. We suggest that induction and enhancement of a leukaemia‐specific immunity by DNA vaccination and anthocyanin‐rich berry extract can also decrease the relapse rate in patients with Ph+ ALL. Furthermore, this approach may serve as strategy for maintenance therapy of other malignancies.
Seasonal female brain plasticity in processing social vs. sexual vocal signals
Authors: Cousillas Hugo , George Isabelle , Alcaix Sandrine , Henry Laurence , Richard Jean‐Pierre , Hausberger Martine
Published: January 2013

While cerebral plasticity has been extensively studied and demonstrated – during ontogenetic development, few studies have considered adult plasticity in different social contexts using relevant social communication signals. Communication requires adaptability throughout the life of an individual, especially in species for which breeding periods (when intersexual signaling prevails) are interspersed with more ‘social’ (non‐sexual) periods when intrasexual bonding prevails. In songbirds, structure or frequency of songs or song elements may convey different information depending on the season. This is the case in the European starling, where some song structures characterize social bonds between females while other song structures are more characteristic of male courtship. We hypothesized that the female perceptual system may have adapted to these changes in song structure and function according to season, and we tested for potential seasonal brain plasticity. Electrophysiological recordings from adult female starlings during playback of song elements with different functions showed clear seasonal (breeding/non‐breeding) changes in neuronal responses in the primary auditory area. The proportion of responsive sites was higher in response to social (non‐sexual) songs during the non‐reproductive season, and higher in response to sexual songs during the reproductive season.
Density and genetic relatedness increase dispersal distance in a subsocial organism
Authors: Bitume E. V. , Bonte D. , Ronce O. , Bach F. , Flaven E. , Olivieri I. , Nieberding C. M.
Published: January 2013

Although dispersal distance plays a major role in determining whether organisms will reach new habitats, empirical data on the environmental factors that affect dispersal distance are lacking. Population density and kin competition are two factors theorised to increase dispersal distance. Using the two‐spotted spider mite as a model species, we altered these two environmental conditions and measured the mean dispersal distance of individuals, as well as other attributes of the dispersal kernel. We find that both density and relatedness in the release patch increase dispersal distance. Relatedness, but not density, changes the shape of the dispersal kernel towards a more skewed and leptokurtic shape including a longer ‘fat‐tail’. This is the first experimental demonstration that kin competition can shape the whole distribution of dispersal distances in a population, and thus affect the geographical spread of dispersal phenotypes.
Emergency call from gynecologists: how to treat restless legs syndrome during pregnancy?
Authors: Trenkwalder C.
Published: January 2013

Click here to view the accompanying paper in this issue.
The evoked potentials score improves the identification of benign MS without cognitive impairment
Authors: Margaritella N. , Mendozzi L. , Tronci F. , Colicino E. , Garegnani M. , Nemni R. , Gilardi E. , Pugnetti L.
Published: January 2013

Background and purpose

The presence of cognitive impairments (CI) among Benign MS (BMS) patients has challenged actual BMS criteria. We hypothesized that a low evoked potentials score (EP‐score) at first neurological evaluation would help identify BMS patients without CI.

Methods

The EP‐score was retrospectively computed in 29 putative BMS patients who were then tested for CI during 2012. The difference in the prevalence of CI between low EP‐score patients and the recent literature was assessed using resampling methods.

Results

Among 23 low EP‐score patients, only 3 (13%) had CI. This percentage was significantly reduced (P‐values 0.05–0.005) compared to recent literature (39–46%).

Conclusion

We conclude that a low EP‐score at first neurological evaluation successfully helps to identify BMS patients without CI.
Ischaemic stroke at a young age is a serious event – final results of a population‐based long‐term follow‐up in Western Norway
Authors: Waje‐Andreassen U. , Thomassen L. , Jusufovic M. , Power K. N. , Eide G. E. , Vedeler C. A. , Naess H.
Published: January 2013

Background and purpose

Our population‐based long‐term follow‐up of young ischaemic stroke patients and controls showed 10‐fold increased mortality and fivefold increased arterial event rate nearly 12 years after study inclusion. We now assess memory, anxiety, depression and sleep in relation to employment and functional outcome, treatment goals and results from a last alive–dead survey.

Methods

Patients (n = 232) ≤ 49 years with an index‐stroke between 1988 and 1997 were retrospectively selected and compared with age‐ and sex‐matched controls (n = 453). At follow‐up from 2004 to 2005, 144 (77%) of 187 patients were clinically examined. Self‐assessment information about memory problems, anxiety, depression, sleeping problems, education and employment was compared with answers from standardized questionnaires from 167 controls. Functional outcome was measured by the modified Rankin Scale (mRS).

Results

Patients compared with controls had more memory problems (41.0% vs. 5.4%, P < 0.001), anxiety (19.4% vs. 9%, P = 0.009), depression (29.2% vs. 13.2%, P = 0.001) and sleeping problems (36.1% vs. 19.2%, P = 0.001). In the multiple regression analysis male gender (OR 9.3, 95%CI 0.10–0.61, P = 0.002), normal memory (OR 12.7, 95%CI 0.07–0.47, P < 0.001) and mRS 0–1 (OR 15.7, 95%CI 0.002–0.12, P < 0.001) were factors for full‐time employment. Blood pressure was < 140/90 mmHg in 39% of patients, 49% stopped smoking and 38.2% used statins. After a mean observation time of 18.3 years, 63 (27.2%) of 232 patients were dead.

Conclusions

Our data show a heterogeneous prognosis and high mortality even for long‐time survivors of ischaemic stroke at a young age. Prospective studies of young stroke patients and controls are necessary for direct comparison.
Subcutaneous immunoglobulin in responders to intravenous therapy with chronic inflammatory demyelinating polyradiculoneuropathy
Authors: Markvardsen L. H. , Debost J.‐C. , Harbo T. , Sindrup S. H. , Andersen H. , Christiansen I. , Otto M. , Olsen N. K. , Lassen L. L. , Jakobsen J. ,   The Danish CIDP and MMN Study Group
Published: January 2013

Background and purpose

We hypothesized that subcutaneous administration of immunoglobulins (SCIG) in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is feasible, safe and superior to treatment with saline for the performance of muscle strength.

Methods

Thirty patients with motor involvement in maintenance therapy with intravenous immunoglobulin (IVIG) fulfilling the EFNS/PNS criteria for CIDP, aged 18–80 years, were randomized either to SCIG at a dose corresponding to their pre‐study IVIG dose or to subcutaneous saline given twice or thrice weekly for 12 weeks at home. At the start and end of the trial as well as 2 weeks before (−2, 0, 10, 12 weeks), isokinetic strength performance of four predetermined and weakened muscle groups was measured. Also, an Overall Disability Sum Score (ODSS), 40‐m‐walking test (40‐MWT), nine‐hole‐peg test, Neurological Impairment Score (NIS), Medical Research Council (MRC) score, grip strength, standardized electrophysiological recordings from three nerves, and plasma IgG levels were evaluated.

Results

SCIG treatment was well tolerated in all 14 patients. Six patients complained of mild side‐effects at the injection site. In the SCIG group there was an increase of isokinetic muscle strength of 5.5 ± 9.5% (P < 0.05) as compared with a decline of 14.4 ± 20.3% (P < 0.05) in the placebo group; the difference between the two groups being significant (P < 0.01). ODSS, NIS, MRC, grip strength and 40‐MWT improved following SCIG versus saline.

Conclusions

SCIG treatment in CIDP is feasible, safe and effective, and seems an attractive alternative to IVIG.
Research implications of the Institute of Medicine Report, Epilepsy Across the Spectrum: Promoting Health and Understanding
Authors: Hesdorffer Dale C. , Beck Vicki , Begley Charles E. , Bishop Malachy L. , Cushner‐Weinstein Sandra , Holmes Gregory L. , Shafer Patricia O. , Sirven Joseph I. , Austin Joan K.
Published: January 2013

In March 2012 the Institute of Medicine (IOM) released the report, Epilepsy Across The Spectrum: Promoting Health and Understanding. This report examined the public health dimensions of the epilepsies with a focus on the following four areas: public health surveillance and data collection and integration; population and public health research; health policy, health care, and human services; and education for providers, people with epilepsy and their families, and the public. The report provided recommendations and research priorities for future work in the field of epilepsy that relate to increasing the power of data on epilepsy; prevention of epilepsy; improving health care for people with epilepsy; improving health professional education about epilepsy; improving quality of life for people with epilepsy; improving education about epilepsy for people with epilepsy and families; and raising public awareness about epilepsy. For this article, the authors selected one research priority from each of the major chapter themes in the IOM report: expanding and improving the quality of epidemiologic surveillance in epilepsy; developing improved interventions for people with epilepsy and depression; expanding early identification/screening for learning impairments in children with epilepsy; evaluating and promoting effective innovative teaching strategies; accelerating research on the identification of risk factors and interventions that increase employment and improve quality of life for people with epilepsy and their families; assessing the information needs of people with epilepsy and their families associated with epilepsy‐related risks, specifically sudden unexpected death in epilepsy; and developing and conducting surveys to capture trends in knowledge, awareness, attitudes, and beliefs about epilepsy over time and in specific population subgroups. For each research priority selected, examples of research are provided that will advance the field of epilepsy and improve the lives of people with epilepsy. The IOM report has many other research priorities for researchers to consider developing to advance the field of epilepsy and better the lives of people with epilepsy.
Localizing value of ictal SPECT is comparable to MRI and EEG in children with focal cortical dysplasia
Authors: Krsek Pavel , Kudr Martin , Jahodova Alena , Komarek Vladimir , Maton Bruno , Malone Stephen , Miller Ian , Jayakar Prasanna , Resnick Trevor , Duchowny Michael
Published: January 2013

Purpose

To assess the predictive value of ictal single‐photon emission computed tomography (SPECT) for outcome after excisional epilepsy surgery in a large population of children with focal cortical dysplasia (FCD).

Methods

One hundred seventy‐three ictal SPECT studies in 106 children with histologically proven FCD were retrospectively analyzed. The extent and location of ictal hyperperfusion and completeness of surgical removal were assessed. Completeness of resection of epileptogenic regions defined by ictal SPECT, electroencephalography (EEG), and magnetic resonance imaging (MRI) were compared and correlated with postoperative seizure outcome. In addition, subcortical activation of the cerebellum, basal ganglia, and thalamus were analyzed.

Key Findings

The extent of hyperperfusion was focal or lobar in 58%, whereas multilobar activations occurred in only 32%; hemispheric or bilateral findings were rare. Favorable postsurgical seizure outcome was achieved in 67% patients with nonlocalized SPECT findings, 45% with nonresected ictal hyperperfusion, 36% with partially resected ictal hyperperfusion, and 86% when the zone of ictal hyperperfusion was completely resected (p = 0.000198). The favorable postsurgical outcome after complete removal of the SPECT hyperperfusion zone surpassed the 75% rate of seizure freedom in patients with removal of MRI/EEG‐defined epileptogenic region. A similar predictive value of ictal SPECT for seizure outcome was found in nonoperated patients and subjects who were undergoing reoperation. Subcortical activation conferred no predictive value.

Significance

Ictal SPECT helps to define the epileptogenic zone in a high proportion of children with FCD undergoing surgical evaluation. Complete removal of both SPECT and MRI/EEG‐defined regions is a strong predictor of surgical success and has important implications for surgical planning.
The relationship between the localization of the generalized spike and wave discharge generators and the response to valproate
Authors: Szaflarski Jerzy P. , Kay Benjamin , Gotman Jean , Privitera Michael D. , Holland Scott K.
Published: January 2013

Purpose

Up to 30% of patients with idiopathic generalized epilepsy (IGE) have seizures that are refractory to medication despite appropriate therapy that commonly includes valproate (VPA). The aim of this study was to compare patients withVPA‐refractory andVPA‐responsiveIGEin order to determine whether there are group differences in generalized spike and wave discharge (GSWD) generators that may be associated withVPAresistance.

Methods

Of 89IGEpatients who underwent electroencephalography (EEG) combined with functional magnetic resonance imaging (fMRI;EEG/fMRI), 25 withGSWDs identified inEEG/fMRIdata were included. Simultaneous acquisition of 64 channels ofEEGdata at 10 kHz was performed using anMRI‐compatibleEEGcap and amplifier at 4T.VPAresistance was defined as lack of seizure control despite therapeutic dose ofVPA.

Key Findings

ThefMRIblood oxygen–level dependent (BOLD) correlates ofGSWDin the entire group involved midline thalamus, frontal regions comprisingBrodmann areas 6, 24, and 32, and temporal lobes diffusely. WhenVPA‐responsive andVPA‐resistant patients were compared,BOLDsignal increases were noted in theVPA‐resistant patients in medial frontal cortex, along the paracingulate gyrus (Montreal Neurological Institute;MNIx = 2, y = 13.6, z = 45.9), and anterior insula bilaterally (rightMNIx = 37.6, y = 7.8, z = 0.6, leftMNIx = −35.3, y = 13.6, z = −5.3).

Significance

Our findings support the hypothesis thatVPA‐resistant andVPA‐responsive patients may have differentGSWDgenerators. Furthermore, we hypothesize that these differences inGSWDgenerators may be the reason for different responses toVPA.
Mortality and recovery from refractory status epilepticus in the intensive care unit: A 7‐year observational study
Authors: Sutter Raoul , Marsch Stephan , Fuhr Peter , Rüegg Stephan
Published: January 2013

Purpose

Refractory status epilepticus (RSE) is a life‐threatening neurologic emergency with high mortality and morbidity. The aim of this study was to identify and quantify associations between clinical characteristics of adult RSE patients and outcome.

Methods

Comprehensive medical chart review was performed of all consecutive adult RSE patients treated on the intensive care units of an academic tertiary care center between 2005 and 2011. Demographics, RSE etiologies and duration, comorbidities, as well as outcomes were assessed. Associations between clinical characteristics and death were quantified.

Key Findings

Of 260 patients with status epilepticus, 111 developed RSE. Hypoxic encephalopathy (23%), brain tumors (14%), known and uncontrolled epilepsy (10%), and ischemic stroke (8%) were the main etiologies. During hospitalization 38% of patients died. Hypoxic encephalopathy (HE) and brain tumors were independently associated with death (relative risk [RR] 2.41, 95% confidence interval [CI] 1.40–4.12; p = 0.001 and RR 2.81, 95%CI 1.59–4.96; p < 0.0001). The estimated hazard ratio of death was 3.1 (95% CI1.6–6.0; p = 0.001) for patients with HE and 1.1 (95% CI 0.5–2.3; p = 0.745) for patients with brain tumors. RSE duration and nonconvulsive status epilepticus in coma were independently associated with death (for every hour RR 1.001; 95%CI 1.00–1.002; p = 0.011 and RR 3.62; 95%CI 1.34–9.77; p = 0.005).

Significance

Brain tumors and HE had high relative risks for death and were independently associated with mortality in our cohort of critically ill RSE patients. Other clinical characteristics, as well as the use of intravenous anesthetic drugs and mechanical ventilation, may not be strongly related to outcome and should therefore be used cautiously for informed decision making regarding treatment.
Clinical genetic study of the epilepsy‐aphasia spectrum
Authors: Tsai Meng‐Han , Vears Danya F. , Turner Samantha J. , Smith Robert L. , Berkovic Samuel F. , Sadleir Lynette G. , Scheffer Ingrid E.
Published: January 2013

Purpose

To characterize the frequency and nature of the family history of seizures in probands with epilepsy falling within the epilepsy‐aphasia spectrum (EAS) in order to understand the genetic architecture of this group of disorders.

Methods

Patients with epileptic encephalopathy with continuous spike‐and‐wave during sleep (ECSWS), Landau‐Kleffner syndrome (LKS), atypical benign partial epilepsy (ABPE), and intermediate epilepsy‐aphasia disorders (IEAD) were recruited. All affected and available unaffected relatives up to three degrees of relatedness underwent phenotyping using a validated seizure questionnaire. Pedigrees were constructed for all families. The proportion of affected relatives according to each degree of relatedness was calculated. The epilepsy phenotypes in close relatives were analyzed. The data were compared to the families of probands with benign childhood epilepsy with centrotemporal spikes (BECTS) using the same methodology.

Key Findings

Thirty‐one probands, including five ECSWS, three LKS, one ABPE, and 22 IEAD were recruited. The mean age of seizure onset was 3.9 (range 0.5–7) years. A male predominance was seen (68%, 21/31) . Sixteen (51.6%) of 31 had a positive family history of seizures. Among 1,254 relatives, 30 (2.4%) had a history of seizures: 13 (10.2%) of 128 first‐degree relatives, 5 (1.7%) of 291 second‐degree relatives, and 12 (1.4%) of 835 third‐degree relatives. Thirteen had febrile seizures, including two who had both febrile seizures and epilepsy. Of the 19 relatives with epilepsy, 4 had BECTS, 4 epilepsies with focal seizures of unknown cause, 3 IEAD, and 7 unclassified. One had genetic generalized epilepsy. In the families of the BECTS probands, 9.8% of first‐degree, 3% of second‐degree, and 1.5% of third‐degree relatives had seizures, which was not significantly different from the EAS cohort families.

Significance

The frequencies of seizures in relatives of probands with EAS suggest that the underlying genetic influence of EAS is consistent with complex inheritance and similar to BECTS. The phenotypic pattern observed in the affected relatives comprised predominantly febrile seizures and focal seizures. These findings suggest that a shared genetic predisposition to focal epilepsies underpins the epilepsy‐aphasia spectrum.
Alterations in regional homogeneity of resting‐state brain activity in mesial temporal lobe epilepsy
Authors: Zeng Hongwu , Pizarro Ricardo , Nair Veena A. , La Christian , Prabhakaran Vivek
Published: January 2013

Purpose

The purpose of the present study was to identify abnormal areas of regional synchronization in patients with mesial temporal lobe epilepsy and hippocampus sclerosis (mTLE‐HS) compared to healthy controls, by applying a relatively novel method, the Regional Homogeneity (ReHo) method to resting state fMRI (RS‐fMRI) data.

Methods

Eyes closed RS‐fMRI data were acquired from 10 mTLE‐HS patients (four right‐side, six left‐side) and 15 age‐ and gender‐matched healthy subjects, and were analyzed by using ReHo. For group analysis, four right‐side MTLE‐HS patients' functional images were flipped, in order to make a homogeneous left MTLE‐HS group (10 cases) and increase the sample size.

Key Findings

Compared to the healthy control group, patients showed significantly increased ReHo in ipsilateral parahippocampal gyrus, midbrain, insula, corpus callosum, bilateral sensorimotor cortex, and frontoparietal subcortical structures, whereas decreased ReHo was observed mainly in default mode network (DMN) (including precuneus and posterior cingulate gyrus, bilateral inferior lateral parietal, and mesial prefrontal cortex) and cerebellum in patients relative to the control group.

Significance

This study identified that ReHo pattern in mTLE‐HS patients was altered compared to healthy controls. We consider decreased ReHo in DMN to be responsible for wide functional impairments in cognitive processes. We propose that the increased ReHo in specific regions may form a network that might be responsible for seizure genesis and propagation.
Language lateralization by fMRIand Wada testing in 229 patients with epilepsy: Rates and predictors of discordance
Authors: Janecek Julie K. , Swanson Sara J. , Sabsevitz David S. , Hammeke Thomas A. , Raghavan Manoj , E. Rozman Megan , Binder Jeffrey R.
Published: January 2013

Purpose

To more definitively characterize Wada/functional magnetic resonance imaging (fMRI) language dominance discordance rates with the largest sample of patients with epilepsy to date, and to examine demographic, clinical, and methodologic predictors of discordance.

Methods

Two hundred twenty‐nine patients with epilepsy underwent both a standardized Wada test and a semantic decision fMRIlanguage protocol in a prospective research study. Language laterality indices were computed for each test using automated and double‐blind methods, and Wada/fMRIdiscordance rates were calculated using objective criteria for discordance. Regression analyses were used to explore a range of variables that might predict discordance, including subject variables, Wada quality indices, and fMRIquality indices.

Key Findings

Discordant results were observed in 14% of patients. Discordance was highest among those categorized by either test as having bilateral language. In a multivariate model, the only factor that predicted discordance was the degree of atypical language dominance on fMRI.

Significance

fMRI language lateralization is generally concordant with Wada testing. The degree of rightward shift of language dominance onfMRItesting is strongly correlated with Wada/fMRIdiscordance, suggesting thatfMRImay be more sensitive than Wada to right hemisphere language processing, although the clinical significance of this increased sensitivity is unknown. The relative accuracy offMRIversus Wada testing for predicting postsurgical language outcome in discordant cases remains a topic for future research.
Epilepsy after head injury in dogs: A natural model of posttraumatic epilepsy
Authors: Steinmetz Sonja , Tipold Andrea , Löscher Wolfgang
Published: January 2013

Purpose

In humans, traumatic brain injury (TBI) is one of the most common causes of acquired (symptomatic) epilepsy, but as yet there is no treatment to prevent the development of epilepsy afterTBI. Animal models of posttraumatic epilepsy (PTE) are important to characterize epileptogenic mechanisms ofTBIand to identify clinically effective antiepileptogenic treatments. The prevalence and phenomenology of naturally occurring canine epilepsy are similar to those in human epilepsy. However, the risk of epilepsy afterTBIhas not been systemically studied in dogs. We therefore performed a large retrospective study in 1,000 dogs referred to our clinical department over a period of 11.5 years with the aim to determine the incidence of early and late seizures after head trauma in this species.

Methods

Two strategies were used: in group I (n = 392), we evaluated whether dogs referred for the treatment of a head trauma (group Ia) or other trauma (group Ib) developed seizures after the trauma, whereas in groupII(n = 608) we evaluated whether dogs referred for the treatment of recurrent epileptic seizures had a history of head trauma. Data for this study were obtained from our clinical database, questionnaires sent to the dogs' owners, and owner interviews.

Key Findings

In group Ia, 6.6% of the dogs developedPTE, which was significantly different from group Ib (1.9%), indicating that head trauma increased the risk of developing epilepsy by a factor of 3.4. The risk ofPTEincreased with severity ofTBI; 14.3% of the dogs with skull fracture developedPTE. In groupII, 15.5% of the dogs with epilepsy had a history of head injury, which was significantly higher than the incidence ofPTEdetermined for group Ia.

Significance

Our study indicates that head trauma in dogs is associated with a significant risk of developing epilepsy. Therefore, dogs with severeTBIare an interesting natural model ofPTEthat provides a novel translational platform for studies on humanPTE.
Evidence for a shared genetic susceptibility to migraine and epilepsy
Authors: Winawer Melodie R. , Connors Robert ,   the EPGP Investigators
Published: January 2013

Purpose

Although epilepsy and migraine are known to co‐occur within individuals, the contribution of a shared genetic susceptibility to this comorbidity remains unclear. We investigated the hypothesis of shared genetic effects on migraine and epilepsy in the Epilepsy Phenome/Genome Project (EPGP) cohort.

Methods

We studied prevalence of a history of migraine in 730 EPGP participants aged ≥12 years with nonacquired focal epilepsy (NAFE) or generalized epilepsy (GE) from 501 families containing two or more individuals with epilepsy of unknown cause. Information on migraine without aura (MO) and migraine with aura (MA) was collected using an instrument validated for individuals ≥12 years. Because many individuals have both MO and MA, we considered two nonoverlapping groups of individuals with migraine: those who met criteria for MA in any of their headaches (MA), and those who did not (“MO‐only”). EPGP participants were interviewed about the history of seizure disorders in additional nonenrolled family members. We evaluated associations of migraine prevalence in enrolled subjects with a family history of seizure disorders in additional nonenrolled relatives, using generalized estimating equations to control for the nonindependence of observations within families.

Key Findings

Prevalence of a history of MA (but not MO‐only) was significantly increased in enrolled participants with two or more additional affected first‐degree relatives.

Significance

These findings support the hypothesis of a shared genetic susceptibility to epilepsy and MA.
Adverse events related to extraoperative invasive EEG monitoring with subdural grid electrodes: A systematic review and meta‐analysis
Authors: Arya Ravindra , Mangano Francesco T. , Horn Paul S. , Holland Katherine D. , Rose Douglas F. , Glauser Tracy A.
Published: January 2013

Purpose

Implantation of subdural grids and invasive electroencephalography (EEG) monitoring is important to define the ictal‐onset zone and eloquent cortex in selected patients with medically refractory epilepsy. The objective of this systematic review is to summarize data about adverse events related to this procedure.

Methods

English‐language studies published up to July 2012, reporting such adverse events were reviewed. Outcome measures included demographic variables; surgical protocol including number of subdural electrodes implanted per patient, duration of monitoring, antibiotic, and steroid prophylaxis; and adverse events.

Key Findings

Twenty‐one studies were identified including a total of 2,542 patients. The reported mean number of electrodes per patient and duration of monitoring varied from 52 to 95 and 5 to 17 days, respectively. There is a trend toward more uniform use of antibiotics and steroids in the perioperative period. Neurologic infections (pooled prevalence 2.3%, 95% confidence interval 1.5–3.1), superficial infections (3.0%, 1.9–4.1), intracranial hemorrhage (4.0%, 3.2–4.8), and elevated intracranial pressure (2.4%, 1.5–3.3) were found to be the most common adverse events. Up to 3.5% of patients required additional surgical procedure(s) for management of these adverse events. Increased number of electrodes (≥67) was found to be independently associated with increased incidence of adverse events.

Significance

Although providing critical information for patients with medically refractory epilepsy, subdural grids implantation and invasive EEG monitoring entails risks of infection, hemorrhage, and elevated intracranial pressure. The prevalence estimates, likely to be conservative due to selective reporting, are expected to be helpful in counseling patients.
Even with the Best of Intentions: Paternal Involvement and the Theory of Planned Behavior
Authors: Perry Armon Rashard , Langley Cheri
Published: January 2013

Implicit in much of the fatherhood discourse is the assumption that if fathers want to take an active role in their children's lives, they could and would do so. While research has highlighted the factors associated with fathers' involvement, very few, if any, of these studies have been guided by a theory that accounts for both fathers' involvement intentions and their ability to follow through on those intentions. The theory of planned behavior and its emphasis on attitudes, the beliefs of significant others, and whether one has control over engaging in behavior is a conceptual fit to respond to questions related to the complex nature of paternal involvement. Using data from the Fragile Families and Child Well‐being Study, the purpose of this study was to test the utility of the theory of planned behavior in predicting fathers' involvement intentions and reports of involvement. The results revealed that the theory of planned behavior can be useful in examining paternal involvement and should be used in future research to enhance the fatherhood literature.
Effects of stream flooding on the distribution and diversity of groundwater‐dependent vegetation in riparian areas
Authors: BAATTRUP‐PEDERSEN ANNETTE , JENSEN KAREN M. B. , THODSEN HANS , ANDERSEN HANS E. , ANDERSEN PETER M. , LARSEN SØREN E. , RIIS TENNA , ANDERSEN DAGMAR K. , AUDET JOACHIM , KRONVANG BRIAN
Published: January 2013

1. Effects of the frequency and duration of flooding on the structural and functional characteristics of riparian vegetation were studied at four sites (n = 80, 50 × 50 cm, plots) along medium‐sized naturally meandering lowland streams. Special focus was on rich fens, which – due to their high species richness – are of high priority in nature conservation.

2. Reed beds, rich fens and meadows were all regularly flooded during the 20‐year study period, with a higher frequency in reed bed areas than in rich fen and meadow areas. In rich fens, species richness was higher in low frequency flooded areas (≤3 year−1) than in areas with a high frequency of flooding (>3 year−1) or no flooding, whereas species richness in reed beds and meadows was unaffected by flood frequency.

3. The percentage of stress‐tolerant species was higher in low intensity flooded rich fen areas than in high intensity and non‐flooded areas, indicating that the higher species richness in low frequency flooded rich fens was caused by competitive release. We found no indication that increased productivity was associated with high flooding frequencies.

4. We conclude that the restoration of morphological features in stream channels to increase the flooding regime can be beneficial for protected vegetation within riparian areas, but also that groundwater discharge thresholds and critical levels for protected vegetation should be identified and considered when introducing stream ecosystem restoration plans.