bluuebunny/crossref_metadata_2025 huggingface dataset:
Structural characterization of the maytansinoid–monoclonal antibody immunoconjugate, huN901–DM1, by mass spectrometry
Authors: Wang Lintao , Amphlett Godfrey , Blättler Walter A. , Lambert John M. , Zhang Wei
Published: August 2005

Immunoconjugates are being explored as novel cancer therapies with the promise of target‐specific drug delivery. The immunoconjugate, huN901–DM1, composed of the humanized monoclonal IgG1 antibody, huN901, and the maytansinoid drug, DM1, is being tested in clinical trials to treat small cell lung carcinoma (SCLC). huN901–DM1 contains an average of three to four DM1 drug molecules per huN901 antibody molecule. The drug molecules are linked to huN901 through random modification of huN901 at ε‐amino groups of lysine residues, thus yielding a heterogeneous population of conjugate species. We studied the drug distribution profile of huN901–DM1 by electrospray time‐of‐flight mass spectrometry(ESI‐TOFMS), which showed that one to six DM1 drug molecules were attached to an antibody molecule. Both light and heavy chains contained linked drugs. The conjugation sites in both chains were determined by peptide mapping using trypsin and Asp‐N protease digestion. Trypsin digestion identified modified lysine residues, since these residues were no longer susceptible to enzymatic cleavage after conjugation with the drug. With respect to Asp‐N digestion, modified peptides were identified by observing a mass increase corresponding to the modification. The two digestion methods provided consistent results, leading to the identification of 20 modified lysine residues in both light and heavy chains. Each lysine residue was only partially modified. No conjugation sites were found in complementarity determining regions (CDRs). Using structural models of human IgG1, it was found that modified lysine residues were on the surface in areas of structural flexibility and had large solvent accessibility.
Selective exploitation of early running fish may induce genetic and phenotypic changes in Atlantic salmon
Authors: Consuegra S. , De Leániz C. García , Serdio A. , Verspoor E.
Published: August 2005

Genetic evidence for the selective exploitation by anglers of early running fish was examined in four Iberian Atlantic salmon populations using protein and mtDNA markers. The populations studied had been exploited exclusively by anglers since 1949 during a fixed fishing season that ran approximately from March to July. Genetic variation at six protein loci was small and was accounted for by the MEP‐2* and MDH‐3,4* polymorphisms, which generally remained stable over time and were in Castle–Hardy–Weinberg equilibrium during the fishing season. Early running fish that had spent multiple winters at sea (MSW) generally had higher frequencies of the common MEP‐2*(100) allele than did late running, one sea winter (1SW) grilse that were significantly smaller and tended to escape the fishery. Spawners differed from angler caught fish in their mtDNA frequencies and consistently had a lower sea‐age and a smaller body size. Spawners also smolted at an older age and displayed lower frequencies of the MEP‐2*(100) allele in three of the four populations studied. These results suggest that in these rivers anglers selectively exploit a distinct component of the population and inadvertently cause a differential mortality of genetic types that is likely to be detrimental to population viability.
First confirmation of a native bird‐pollinated plant in Europe
Authors: Ortega‐Olivencia Ana , Rodríguez‐Riaño Tomás , Valtueña Francisco J. , López Josefa , Devesa Juan A.
Published: August 2005

The pollination of Anagyris foetida L. (Fabaceae), a Mediterranean species that is a relict of the Tertiary, was studied in two populations of SW Spain over a three‐year period. Numerous censuses of birds and insects were carried out, the floral nectar was quantified, and specific tests were performed to determine the pollinators' pollen load, the pollen's effective transfer to the pistil, and spontaneous self‐pollination. The most important pollinators were three species of passeriforms –Phylloscopus collybita Vieillot, Sylvia atricapilla L. and S. melanocephala Gmelin– a result coherent with findings in populations of S and E Spain. The negligible existence of insect visitors and pollinators of A. foetida flowers could be explained by the early flowering of this species during the autumn–winter, coinciding with the coolest and wettest months of the year (cold, high winds, almost daily mists that persist until nightfall, and above all, abundant rainfall). The pollen loads carried by the birds were high, as were also the loads transferred to the pistil. The fruit‐set of bagged flowers was very low, evidence of the plant's need for the birds as pollinators. This is the first proof of the existence of a native European bird‐pollinated plant, since besides its peculaliarities (flowers odourless, pseudotubular, with no landing platform, pendulous, diurnal populations were mainly pollinated by three passeriform species.
A koinobiont parasitoid mediates competition and generates additive mortality in healthy host populations
Authors: Cameron Tom C. , Wearing Helen J. , Rohani Pejman , Sait Steven M.
Published: August 2005

Insects are subject to attack from a range of natural enemies. Many natural enemies, such as parasitoids, do not immediately, or ever, kill their victims but they are nevertheless important in structuring biological communities. The lag that often occurs between attack and host death results in mixed populations of healthy and parasitised hosts. However, little is understood about how the effects of parasitism during this lag period affect the competitive ability of parasitised hosts and how this, in turn, affects the survival and dynamics of the surviving healthy host populations. Here we investigate the impact of the timing of introduction, and the strength of that introduction, of a parasitoid natural enemy Venturia canescens (Gravenhorst) on the outcome of intraspecific competition between larvae of the Indian meal moth, Plodia interpunctella (Hübner). In contrast to healthy hosts alone, we find reduced survival of healthy larvae with increasing periods of exposure to greater numbers of parasitised conspecifics. This represents indirect mortality of the host, which is in addition to that imposed by parasitism itself. Furthermore, longer periods of exposure to parasitised larvae resulted in an increase in development time of healthy individuals and they were larger when they emerged as adults. These results are relevant to both insect–parasitoid and insect–pathogen systems where there is a lag in host death following infection or attack.
Participation of disadvantaged parents in child care research
Authors: Joseph D. , Wailoo M. P. , Jackson A. , Petersen S. A. , Anderson E. S.
Published: August 2005

Aim  To assess the level to which parents from deprived and socially dysfunctional families collaborate in complex and time‐consuming research.

Design  Home‐based study, of early physiological development in infants from a severely deprived area. Overnight continuous recordings of deep‐body temperature with twice daily urine collection, parental daily diary of life‐events and completion of child care social and psychological assessment by interview questionnaire. Measurements taken between age 6–12 weeks, each lasted 8–12 h per night, averaging four nights per baby. Level of parental participation assessed in relation to ongoing lifestyle pressures.

Setting  Home based. Inner city deprived estate.

Participants  Random sample of mothers with newborn healthy infants.

Measurements  A total of 87 overnight deep body temperature recordings were made on 22 infants each lasting 8–12 h; 174 urine samples were taken; and 22 sets of questionnaires were completed.

Results  Of 62 inner city deprived parents, 39 (62%) agreed to participate. 22 (35%) completed the study. Ongoing lifestyle pressures were high including incidents of burglary, fire and family violence. Family and partner pressures and life crises overwhelmed 10 non‐participations.

Conclusions  Research partnerships can be developed with underprivileged families facing severe life‐events. Parents were highly motivated to complete what they perceived as important infant care research.
A prospective cohort study comparing hospital admission for gastro‐enteritis with home management
Authors: Small F. , Alderdice F. , McCusker C. , Stevenson M. , Stewart M.
Published: August 2005

Objectives  To compare physical and psychological outcomes in children presenting at Accident and Emergency Departments (A&E), diagnosed with gastro‐enteritis and admitted to hospital with those of a similar age, sex and severity of illness discharged home. The physical and psychological well‐being of children in these two groups, in the month after the episode, were compared as was further use of health care services.

Design  A prospective cohort study.

Methods  A comparison of 116 children aged 1–6 years with gastro‐enteritis, presenting at A&E over a 6 months period. Admitted children were compared with children discharged, of a similar age, sex and illness severity (triage score) with follow‐up at 1 week and 1 month. Clinical history, psychosocial factors, investigations and outcomes were recorded at presentation and physical, psychological and family outcomes at 1 week and 1 month.

Results  Of 116 children, 112 (97%) completed the study (56 in each group). No differences were detected in psychosocial factors, socio‐economic status, family factors, time of arrival at A&E or waiting times. Parental perception of illness was greater in the admitted group (P < 0.005), but was recorded after the decision on admission was made. At 1 week follow‐up admitted children had increased separation anxiety compared with children who were discharged (P < 0.05), but this difference disappeared at 1 month. Clinical outcomes were the same for both groups, although admitted children had more investigations (91% vs. 39%). Parents were equally satisfied with their child's treatment, but one‐third of children in both groups sought further consultation with a health professional in the following week.

Conclusions  There is no statistically significant difference in socio‐demographic data, time of arrival at A&E, waiting times, clinical and psychosocial outcomes in children with acute gastro‐enteritis admitted to hospital compared with a group of children of similar age, gender and severity of illness managed at home. However, parents seek reassurance and follow‐up of acutely ill children, even if the child is admitted to hospital, which has service and resource implications.
Informational and emotional needs of long‐term survivors of breast cancer
Authors: Vivar Cristina García , McQueen Anne
Published: August 2005

Aims. This paper presents a review of the informational and emotional needs of long‐term breast cancer survivors, with particular attention to the different needs of women according to their age and to critiquing healthcare provision to these women.

Background. Women with a history of breast cancer are the largest group of cancer survivors. While they may be disease‐free, their cancer diagnosis has ongoing physical and psychosocial implications for their lives and well‐being.

Methods. A literature search for the period 1985 to March 2004 was undertaken using the CINAHL, MEDLINE, CANCERLIT, PubMed and CUIDEN databases and the keywords long‐term, breast cancer survivors, needs and social support. Hand‐searching was also done, and reference lists of papers were examined for relevant studies.

Results. Survivors of breast cancer continue to experience informational and emotional needs during their long‐term survivorship, and variation in the amount and type of support required is age‐related. However, women's needs are often unmet by oncology teams and they have to find other sources of support, such as self‐help groups. Thus, ongoing care is required after completion of medical treatment, and nurses have a significant contribution to make here.

Conclusions. Nursing research on long‐term breast cancer survivorship is limited. Future studies need to investigate the unmet needs of long‐term survivors of breast cancer and, specifically, explore the kind of support women would like to receive from oncology teams, and particularly from breast cancer nurses.
Ageing, care dependency, and care for older people in Egypt: a review of the literature
Authors: Boggatz Thomas , Dassen Theo
Published: August 2005

Aims.  The purpose of this study was to gain an overview of the current situation of ageing and elderly care in Egypt and to consider the ensuing socio‐economical problems, which provide the framework for the provision of care.

Background.  Recent discussions about demographic transition in developing countries suggest a change in their age group composition. Possible implications of this development for nursing care require closer examination.

Method.  Literature about ageing and elderly care in Egypt of the period from 1980–2004 was researched and reviewed.

Results.  Despite the scarcity of literature and the lack of precision in many cases, it is possible to outline an overall development. Ageing is a slowly emerging phenomenon in Egypt contributing to a change in the country's age group composition. The ensuing care dependency appears to become a problem especially for lower and middle class members due to economical restrictions and life‐style changes. In relation to the need, there is a shortage of care‐providing institutions. Furthermore, geriatric homes seem to differ in their quality according to the residents’ social status.

Conclusion.  The existing types of geriatric homes will serve as prototypes for future development. There is however, a need for additional homecare services to reduce care givers’ strain in the families.
The meaning of work for nursing assistants who stay in long‐term care
Authors: Secrest Janet , Iorio Daniel H. , Martz Wallis
Published: August 2005

Aims and objectives.  The purpose of this study was to investigate the meaning of work for nursing assistants who stay in long‐term care.

Background.  Nursing assistants are important caregivers in long‐term agencies. While studies have examined why nursing assistants leave, their motivation to stay has not been well studied.

Design.  An existential‐phenomenological study was conducted using Pollio's approach.

Methods.  In‐depth interviews were conducted with 11 nursing assistants in four nursing homes. Interviews were analysed within the context of an interpretive research group. Findings were represented in a diagram of interrelated figural/ground themes.

Conclusions.  The meaning of work emerged as an experience of family, pride and control, in spite of an environment fraught with hostility, disrespect and lack of control.

Relevance to clinical practice.  Nursing assistants provide most of the care to residents of long‐term facilities. Understanding their perspective offers insight into nursing administrators in creating environments in which safe, compassionate and cost‐effective care co‐exist. Implications for clinical practice are framed within King's theory of goal attainment.
YaeT (Omp85) affects the assembly of lipid‐dependent and lipid‐independent outer membrane proteins of Escherichia coli
Authors: Werner John , Misra Rajeev
Published: August 2005

The Omp85 family of proteins has been found in all Gram‐negative bacteria and even several eukaryotic organisms. The previously uncharacterized Escherichia coli member of this family is YaeT. The results of this study, consistent with previous Omp85 studies, show that the yaeT gene encodes for an essential cellular function. Direct examinations of the outer membrane fraction and protein assembly revealed that cells depleted for YaeT are severely defective in the biogenesis of outer membrane proteins (OMPs). Interestingly, assemblies of the two distinct groups of OMPs that follow either SurA‐ and lipopolysaccharide‐dependent (OmpF/C) or ‐independent (TolC) folding pathways were affected, suggesting that YaeT may act as a general OMP assembly factor. Depletion of cells for YaeT led to the accumulation of OMPs in the fraction enriched for periplasm, thus indicating that YaeT facilitates the insertion of soluble assembly intermediates from the periplasm to the outer membrane. Our data suggest that YaeT's role in the assembly of OMPs is not mediated through a role in lipid biogenesis, as debated for Omp85 in Neisseria, thus advocating a conserved OMP assembly function of Omp85 homologues.
Documented cases of post‐transfusion malaria occurring in England: a review in relation to current and proposed donor‐selection guidelines
Authors: Kitchen A. D. , Barbara J. A. J. , Hewitt P. E.
Published: August 2005

Background and Objectives  Although uncommon, five cases of transfusion‐transmitted malaria have been documented in England over the last 20 years. With the reappearance onto the market of high‐quality malaria antibody assays, and by utilizing the results of analysis of these five cases, it has been possible to review the donor malaria‐deferral guidelines.

Materials and Methods  Details of the five cases of post‐transfusion malaria were reviewed against the proposed new donor‐deferral guidelines for malaria.

Results  Three of the five cases of post‐transfusion malaria were directly attributable to the deferral guidelines, allowing infectious donors to be bled.

Conclusions  The proposed new guidelines will prevent further cases of transmission from semi‐immune individuals.
Blood infectivity, processing and screening tests in transmissible spongiform encephalopathy
Authors: Brown P.
Published: August 2005

Surprising advances have been made in the areas of blood infectivity, infectivity removal and, especially, blood screening tests for transmissible spongiform encephalopathy (TSE) in the past few years. In fact, if anyone as recently as last year had suggested that a screening test for preclinical human infection might be available before the end of 2005, the statement would have been met with smiling disbelief. Nevertheless, it can be confidently predicted that the diagnostic misfolded ‘prion’ protein (PrPTSE) will soon be reliably detectable in blood during the symptomatic phase of disease, and it is highly probable that it will also be detectable in blood from at least a proportion of infected individuals during the preclinical phase of disease.
Perceived threat in compliance and adherence research
Authors: Carpenter Roger
Published: August 2005

Within the broader agenda of adherence research, health beliefs have been identified as being significant predictors of adherence. Specifically, perceived threat as a health belief has received considerable attention in compliance and adherence research from multiple perspectives in multiple patient populations. The purpose of this paper is to analyze the concept of perceived threat as it relates to treatment adherence through a series of perspectives: conceptual, methodological, and empirical. Analysis of the literature reveals that there is lack of consistency in operationalization of perceived threat as it relates to treatment adherence. Perceived threat is most commonly cited in studies that focus on health beliefs or utilize a stress and coping paradigm. Instruments have been developed with items that measure perceived threat. Measures of threat occur primarily through uni‐dimensional measures that do not reflect the inter‐relatedness of the threat experience to personal and contextual factors. Future research examining perceived threat from a cognitive appraisal perspective, where both primary and secondary appraisals can be examined, may provide additional insight into factors affecting treatment adherence.
The impact of the re‐engineered world of health‐care in Canada on nursing and patient outcomes
Authors: Shannon Valerie , French Susan
Published: August 2005

The healthcare environment is knowledge driven and knowledge and human resource dependent. Despite the paucity of evidence on which to shape and evaluate organizational change, health‐care in Canada has undergone many changes in the last 15 years. In the pursuit of enhanced productivity, healthcare administrators have turned to industrial and engineering models. Using available Canadian research and policy reports, and where necessary, American literature, this paper describes the impact of re‐engineering on nursing and on the relationship between nursing and patient outcomes. It also identifies emerging trends and ways forward.
Gender and embodiment in nursing: the role of the female chaperone in the infertility clinic
Authors: Allan Helen T.
Published: August 2005

This paper develops previous work on theories of embodiment by drawing on empirical data from a study into the experiences of infertile women in the UK. I suggest experiences of embodiment shape the preferences of infertile women for a female nurse as chaperone during intimate medical procedures. I explore the impact of this role on the understandings and meanings of nursing in a highly gendered field of practice. I present data from an ethnographic study of infertile women who chose to attend a British infertility clinic for investigation and fertility treatment cycles. Data were collected over 2 years using participant observation and semistructured interviews with 15 women and 20 members of staff in a British fertility unit. Data analysis was completed using a modified thematic analysis following Boyle and McEvoy. I discuss women's experiences of intimacy and bodily care and how these experiences might be understood by exploring the phenomenological concept of embodiment. I argue that women benefit from having a female nurse as chaperone because of their expectations of gender, nursing and caring. Women's expectations reinforce both notions of gendered caring and the gendered role of nursing. These data challenge notions of patriarchal professionalism prevalent in nursing, which seek to move away from the gendered role of the nurse (which traditionally included a chaperone role) towards a model of professional development based on a mind–body split. I suggest that these data offer a way of understanding the female embodied subject in the field of gendered caring, which is potentially transgressive because they suggest ways in which both mind and body can be integrated through the role of the female chaperone.
DIMINISHING RETURNS? RISK AND THE DUTY TO CARE IN THE SARS EPIDEMIC
Authors: REID LYNETTE
Published: August 2005

The seriousness of the risk that healthcare workers faced during SARS, and their response of service in the face of this risk, brings to light unrealistic assumptions about duty and risk that informed the debate on duty to care in the early years of HIV/AIDS. Duty to care is not based upon particular virtues of the health professions, but arises from social reflection on what response to an epidemic would be consistent with our values and our needs, recognizing our shared vulnerability to disease and death. Such reflection underwrites a strong duty of care, but one not to be borne solely by the altruism and heroism of individual healthcare workers.
Reported Peer Conflicts of Children in the United States and Indonesia
Authors: French Doran C. , Pidada Sri , Denoma Jill , McDonald Kristina , Lawton Allison
Published: August 2005

U.S. and Indonesian 9‐ to 11‐year‐old children (N=147) reported on multiple occasions conflicts that they experienced with peers. The precursors of conflict, behavior during conflict episodes, and resolutions were coded. Teacher ratings of aggression and social preference were obtained. The conflicts of children in both countries most often occurred between friends, were short, amicably settled, and solved without aggression. Indonesian children reported disengaging from conflict more often than did U.S. children, whereas U.S. children more frequently reported using negotiation. Reports of aggression during conflict were associated with U.S. and Indonesian children's teacher‐rated aggression, whereas reports of disengagement were associated with Indonesian children's teacher‐rated social preference and aggression.
The Effect of Father–Toddler and Mother– Toddler Role Reversal on the Development of Behavior Problems in Kindergarten
Authors: Macfie Jenny , Houts Renate M. , McElwain Nancy L. , Cox Martha J.
Published: August 2005

Role reversal is a relationship disturbance in which a parent looks to a child to meet a parent's need for comfort, parenting, intimacy or play, and the child attempts to meet these needs. The current study examined, within a developmental psychopathology framework, the effect of father and mother role reversal with toddlers on the development of attention problems, externalizing symptoms, internalizing symptoms, and social problems in kindergarten. In a normative sample, N=57, role reversal was assessed in an observational paradigm, and teachers rated behavior problems. Father role reversal predicted attention problems and externalizing symptoms, whereas mother role reversal predicted social problems. Gender was an important moderator such that father role reversal predicted social problems for boys and mother role reversal predicted social problems for girls. The importance of a developmental psychopathology perspective, the role of fathers, and implications for the development of diagnosable disorders and for preventive interventions are discussed.
Visual constraints in written word recognition: evidence from the optimal viewing‐position effect
Authors: Brysbaert Marc , Nazir Tatjana
Published: August 2005

In this paper we review the literature on visual constraints in written word processing. We notice that not all letters are equally visible to the reader. The letter that is most visible is the letter that is fixated. The visibility of the other letters depends on the distance between the letters and the fixation location, whether the letters are outer or inner letters of the word, and whether the letters lie to the left or to the right of the fixation location. Because of these three factors, word recognition depends on the viewing position. In languages read from left to right, the optimal viewing position is situated between the beginning and the middle of the word. This optimal viewing position is the result of an interplay of four variables: the distance between the viewing position and the farthest letter, the fact that the word beginning is usually more informative than the word end, the fact that during reading words have been recognised a lot of times after fixation on this letter position and the fact that stimuli in the right visual field have direct access to the left cerebral hemisphere. For languages read from right to left, the first three variables pull the optimal viewing position towards the right side of the word (which is the word beginning), but the fourth variable counteracts these forces to some extent. Therefore, the asymmetry of the optimum viewing‐position curve is less clear in Hebrew and Arabic than in French and Dutch.
Integration of the visual and auditory networks in dyslexia: a theoretical perspective
Authors: Pammer Kristen , Vidyasagar Trichur R.
Published: August 2005

In addition to an intrinsic difficulty in reading and spelling, one of the defining characteristics of dyslexia is an enduring and pervasive difficulty in phonological coding, such that dyslexic readers find it particularly challenging to process and manipulate the constituent sounds of a language. Coexistent with this finding is the evidence that some dyslexic readers also demonstrate subtle sensory coding problems in the visual and auditory domains. Few theories have been proposed to unite these different findings within a coherent model of reading. Here the evidence for visual, auditory and phonological coding problems in dyslexia is briefly reviewed, and a hypothesis is proposed for how adequate early sensory coding may be intrinsic to phonological awareness and subsequent reading ability. In this hypothesis, a cortical network is assumed that incorporates the visual, auditory and phonological skills of reading. The visual sub‐component of the network is mediated by the dorsal visual pathway, which is responsible for the accurate spatial encoding of letters, words and text. The auditory component of the network in pre‐readers is intrinsic to the development of phonological sensitivity, and then grapheme‐phoneme assimilation as reading skills develop. In this hypothesis, some of the symptoms of dyslexia may result from subtle problems in the encoding of both visual and auditory information and their role in maintaining the synchronicity of the reading network.
Coping with their lives – women, learning disabilities, self‐harm and the secure unit: a Q‐methodological study
Authors: James Melissa , Warner Sam
Published: August 2005

Deliberate self‐harm represents a significant, yet it can be argued, a poorly theorized area of concern with respect to women who have learning disabilities – particularly in the context of secure service provision. Utilizing ideas from social constructionism we explore how some ways of understanding dominate the professional literature and, thereby, restrict how such women can be understood. We recognize that despite this, multiple understandings about why women with learning disabilities self‐harm do exist and are drawn upon by practitioners and the women themselves. In order to identify how women with learning disabilities who self‐harm are understood a Q‐methodological study was conducted with patients and professionals in a medium secure unit. Six distinct accounts of why women self‐harm emerged. These accounts emphasized that self‐harming behaviour is meaningful and that women with learning disabilities are understood to have complex needs and a range of strategies for coping with these. The study, therefore, suggests that when working with such women consideration should be given to how they understand and manage their experiences, cognitions and emotions.
Complainants with learning disabilities in sexual abuse cases: a 10‐year review of a psycho‐legal project in Cape Town, South Africa
Authors: Dickman Beverley Jo , Roux Amanda Jane
Published: August 2005

We describe a project established in 1990 to assist complainants with learning disabilities in sexual assault cases in Cape Town, South Africa. Complainants are prepared for court and psychologists advise investigating officers and prosecutors, and provide expert testimony. There has been an enormous increase in the utilization of the project by justice personnel. This paper examines 100 cases seen over a 10‐year period. We describe the demographics and sexual abuse history of the cohort as well as documenting speed of investigation and outcome of the trials. Almost all charges were of rape and most complainants had learning disabilities in the mild or moderate categories. No men with learning disabilities were among the accused. We raise questions about which cases are perceived as evidentially strong. The conviction rate of 28% was almost identical to the best conviction rate in such cases in the general population in South Africa. In contrast to recent research into conviction rates in South Africa, these cases appear to have been vigorously pursued.
Misoprostol versus expectant management in premature rupture of membranes at term
Authors: da Graça Krupa Fabiana , Cecatti José Guilherme , de Castro Surita Fernanda Garanhani , Milanez Helaine Maria Besteti Pires , Parpinelli Mary Ângela
Published: August 2005

Objective  To compare the effectiveness of immediate induction of labour with vaginal misoprostol versus expectant management for 24 hours followed by oxytocin induction in women with premature rupture of membranes at term (term PROM).

Design  An open, randomised, controlled trial.

Setting  Public university hospital in Campinas City, Brazil.

Population  One hundred and fifty pregnancies, half of them allocated to each group.

Methods  Statistical analysis used Student's t test, the χ2 test, Fisher's exact test, survival analysis and risk ratio estimates with 95% CI.

Main outcome measures  Latency period, recruitment to delivery period, period of hospitalisation, mode of delivery, contractility pattern, fetal wellbeing, labour and delivery complications, neonatal and maternal morbidity.

Results  Both groups had similar general characteristics, but the misoprostol group had a significantly shorter latency period (9.4 vs 15.8 hours), a shorter time interval from recruitment to delivery (18.9 vs 27.5 hours), a shorter period of maternal hospitalisation and a slightly higher proportion of alterations of contractility when compared with the expectant group. Caesarean section rates were 20% in the misoprostol group and 30.7% in the other. There were no differences between them regarding fetal wellbeing, complications during labour and delivery and neonatal or postpartum maternal morbidity. Within 24 hours, 44% of women had delivered in the expectant group against 73.3% in the misoprostol group.

Conclusions  Immediate labour induction with misoprostol in cases of term PROM shortens the latency period, the total time between recruitment to delivery and the time of maternal hospitalisation, increasing the occurrence of alterations of contractility without any maternal and perinatal outcomes disadvantages.
REVIEW: Malaria in pregnancy
Authors: Whitty Christopher J.M. , Edmonds Sally , Mutabingwa Theonest K.
Published: August 2005

Malaria in pregnancy is one of the major causes of maternal morbidity worldwide, and leads to poor birth outcomes. There is a complex interaction between pregnancy and parasite—all favour the parasite and disadvantage the pregnant woman. Women who are semi‐immune lose much of that immunity. They may present with placental malaria but with no parasites in their peripheral blood. A non‐immune pregnant women and her fetus are at serious risk from falciparum malaria. The diagnosis and management of malaria in pregnancy, including the safety of antimalarial drugs and interactions of malaria with HIV in pregnancy are reviewed.
Epilepsy in Children: Prevalence, Disability, and Handicap
Authors: Sillanpää Matti
Published: August 2005

Summary: Little is known about the handicapping effect of epilepsy without other neurological deficits on an epileptic individual's life. The purpose of this study was to collect information on the occurrence of disabilities and handicaps in an unselected population sample of children, 4–15 years of age, and to compare the results with matched controls. The prevalence of epilepsy in the study population was 0.68% (143/21,104). Time elapsed from last seizure was at least 1 year in 62.1% of the cases. There was marked neurologic comorbidity in the children with epilepsy; an accessory neurological deficit was found in 39.9%, the most frequent neurological impairments being mental retardation (31.4%), speech disorders (27.5%), and specific learning disorders (23.1%). A handicap was experienced in 20.7% of children with epilepsy only; i.e., with no other neurologic impairments, compared to 0.9% of matched controls. This means a 21.7‐fold (95% CI, 6.3–74.5) risk of the occurrence of a handicap in children with epilepsy compared to controls. Orientation and social integration handicaps were significantly more frequent in children with epilepsy only compared to controls. Occurrence of communication disability, situational disability, or satisfactory to poor economic status of the family were the independent predictors of the occurrence of a handicap in children with epilepsy only.
Usefulness of Blue Sunglasses in Photosensitive Epilepsy
Authors: Takahashi Takeo , Tsukahara Yasuo
Published: August 2005

Summary: The suppressive effect of sunglasses upon photoparoxysmal responses (PPRs) elicited by 15‐Hz flicker stimuli with a low luminance of nearly 10 nits was studied in eight patients with photosensitive epilepsy. Using three commercially available sunglasses of neutral density (ND), blue, and brown, the influence upon generalized PPRs elicited by a flickering dot pattern (FDP) and red flicker (RF) stimuli was separately examined in six patients; the luminance of the visual stimuli decreased from roughly one‐fifth (ND and brown sunglasses) to one tenth (blue sunglasses). With FDP stimulation, four of the six patients wearing each of the three sunglasses had no provocation of PPRs, whereas two of the six patients had provocation of generalized PPRs with all of the sunglasses. With RF stimulation, two of the six patients wearing ND sunglasses had provocation of generalized PPRs; three of the six patients wearing brown sunglasses had similar provocation; in contrast, none of the six patients showed provocation of PPRs while wearing blue sunglasses. These results suggest that the suppressive effect of the three sunglasses on FDP stimulation is mainly due to a luminance diminution, whereas that of blue sunglasses on RF stimulation is produced by an inhibitory effect of short wavelengths and possibly by a luminance diminution. Thus, blue sunglasses are thought to be useful in the treatment of patients with photosensitive epilepsy.
Somatosensory Evoked Potentials in Juvenile Myoclonic Epilepsy
Authors: Salas‐Puig J. , Tuñon A. , Diaz M. , Lahoz C. H.
Published: August 2005

Summary: We analyzed the somatosensory evoked potentials (SEP) of 35 patients with juvenile myoclonic epilepsy (JME), 26 patients with idiopathic generalized epilepsy (IGE), and a control group consisting of 24 healthy people. The N19‐P25 interval was significantly prolonged in the IGE group both as compared with the JME and control groups. This finding may be related to antiepileptic drug (AED) treatment, principally phenytoin (PHT). No differences were noted in N 19 amplitude in any group. The P25 and N33 amplitudes were significantly higher in the JME group. In 5 patients of the JME group (14%) “giant SEP” were observed, but no differences were evident in the electroclinical characteristics with respect to the other JME patients. JME is one of the causes of giant SEP.
Comparison of AccuLevel and TDx: Evaluation of On‐Site Monitoring of Antiepileptic Drugs
Authors: Nielsen I.‐M. , Gram L. , Dam M.
Published: August 2005

Summary: Therapeutic drug monitoring, an important aid in antiepileptic drug (AED) therapy, has a lag time before results are obtained from clinical laboratories. The AccuLevel test is an enzyme immunochromatographic method for quantitative measurement of AEDs including phenol barbital (PB), phenytoin (PHT), and carbamazepine (CBZ), with results available within 20 min. A comparison between AccuLevel and TDx, (fluorescence polarization immunoassay) was conducted in 233 paired blood samples from patients with AED therapy, including 12 Eskimo children receiving treatment in Greenland. Forty‐five blood samples were analyzed for PB, 80 for PHT, and 108 for CBZ. Linear regression analysis showed good agreement between the two methods (r= 0.951, 0.958, and 0.945, respectively). The test is easy to perform, but care must be taken to follow the correct procedure, or inaccuracies will result. That happened in some of our results. A reduction in lag time, using on‐site drug monitoring, was demonstrated. The AccuLevel is a rapid, accurate, and convenient method for use in AED monitoring.
Relative Anticonvulsant Effects of GABAmimetic and GABA Modulatory Agents
Authors: Holland Katherine D. , McKeon Ann C. , Canney Daniel J. , Covey Douglas F. , Ferrendelli James A.
Published: August 2005

Summary: Anticonvulsant properties of compounds that enhance GABA‐mediated inhibition through modulatory sites on the GABAA receptor [phenobarbital (PB), clonazepam (CZP), α‐ethyl‐α‐methyl‐γ‐thiobutyrolactone (α‐EMTBL)] were compared with anticonvulsant effects of compounds believed to be antagonists at these modulatory sites (Ro 15‐ 1788 and a‐isopropyl‐α‐methyl‐γ‐butyrolactone γ‐IMGBL)] and to 4,5,6,7‐tetrahy‐droisoxazolo‐[4,5‐c]‐pyridin‐3‐ol (THIP, GABAA receptor agonist), (±) baclofen (GABAB receptor agonist), and γ‐vinyl GABA, a compound that increases endogenous GABA. The compounds were tested for their ability to block experimental seizures caused by maximal electroshock, pentylenetetrazol, picrotoxin, methyl‐6,7‐dirnethoxy‐4‐ethyl‐β‐carboline‐3‐carboxylate (DMCM), bicuculline (BIC), aminophylline, strychnine, and τ‐butyl‐bicyclophosphorothionate (TBPS) in mice. CZP blocked all but strychnine seizures. PB was also highly effective, blocking all but TBPS seizures. α‐EMTBL, representing a new class of experimental anticonvulsant drugs, prevented all seizures except strychnine (STR)‐ and aminophylline‐induced seizures. The antagonists are effective only against one convulsant stimulus. Rol S‐1788 and α‐IMGBL prevented only DMCM‐ and pentylenetetrazol (PTZ)‐induced seizures, respectively. THIP and γ‐vinyl GABA both blocked only BIC and picrotoxin seizures. Baclofen had no anticonvulsant activity. These data demonstrate that compounds that increase neuronal inhibition by potentiating the action of GABA have a broader spectrum of anticonvulsant action than either antagonists or GABAmimetic agents or compounds that increase endogenous GABA.
Inhibition of Experimental Seizures in Canines by Repetitive Vagal Stimulation
Authors: Zabara Jacob
Published: August 2005

Summary: Repetitive electrical stimulation of the canine cervical vagus nerve interrupts or abolishes motor seizures induced by strychnine and tremors induced by pentylenetetrazol (PTZ). Tremors were defined as rhythmic alternating contractions of opposing muscle groups, exerting much less force than seizure contractions. Seizures were induced by injection boluses of strychnine or PTZ at 1‐ to 4‐min intervals until sustained muscle activity was observed electromyographically (EMG). Vagal stimulation terminated seizures in 0.5‐5 s. There were prolonged periods with no spontaneous EMG activity after stimulation. The period of protection was approximately four times the stimulation period. The antiseizure actions of vagal stimulation were not altered by transection of the vagus distal to the stimulating electrode. Optimal stimulus parameters were estimated: strength, ‐20 V (electrode resistance 1‐5 ω); frequency 20–30 Hz; duration, ‐0.2 ms. These data suggest that the antiseizure effects derive from stimulation of small‐diameter afferent unmyelinated fibers in the vagus nerve. These results may form the basis of a new therapeutic approach to epilepsy.
Epilepsy and Persian Culture: An Overview
Authors: Vanzan Anna , Paladin Francesco
Published: August 2005

Summary: This article reviews the manner in which Persian culture viewed the problem of epilepsy. Beginning with the Avesta, the earliest Persian text on health and sickness, the medical literature on treatments of epilepsy common in Iran are reviewed. The article also explores popular Persian concepts that try to explain the causes of the morbus sacer.
Angelman Syndrome in Three Siblings: Characteristic Epileptic Seizures and EEG Abnormalities
Authors: Sugimoto Tateo , Yasuhara Akihiro , Ohta Tohru , Nishida Naoki , Saitoh Shinji , Hamabe Jun‐ichi , Niikawa Norio
Published: August 2005

Summary: Neurologic findings in 3 siblings with Angelman syndrome (AS) with apparently normal karyotype but DNA deletion of 15q11‐q12 deriving from their mother are described. Increased auditory brainstem response (ABR) thresholds were noted in all 3. Interictal EEG findings included periodic 2‐ to 3‐Hz high‐voltage slow wave bursts bioccipitally and sporadic slow spike wave complexes mainly bifrontally. EEG findings suggestive of minor epileptic status were apparent in the elder brother and may be a characteristic feature in young AS patients. Seizures suggestive of generalized epilepsy have been reported in 90% of AS patients. AS is considered a good model of symptomatic generalized epilepsy associated with chromosomal DNA deletion of the (GABA), receptor β3‐subunit gene.
Studies on pH Regulatory Mechanisms in Cultured Astrocytes of DBA and C57 Mice
Authors: Chow Sien‐Yao , Yen‐Chow Yuan‐Chung , Woodbury Dixon M.
Published: August 2005

Summary: pH regulatory mechanisms in primary cultures of astrocytes from the cerebral cortex of neonatal audiogenic‐seizure‐susceptible DBA/2J (DBA) and genetically controlled C57BL/6J (C57) mice were studied with [14C]dimethyloxazolidine‐2‐4‐dione (DMO) and [3H]‐methyl‐D‐glucose (MDG). Effects of changing the concentration of Na+, K+, HCO3‐ or Cl‐ in medium, and/or of different transport blockers and metabolite inhibitor on intracellular pH (pHi) of cultured astrocytes were also studied. In nominal HCO3‐‐free HEPES‐buffered Hanks’balanced salt solution (HEPES HBSS), when the pH of medium (pHo) was maintained at 7.4, the steady‐ state pHi of cultured astrocytes from DBA mice was 6.98 ± 0.03, and that from C57 mice was 7.01 ± 0.03. When the cells were incubated in HBSS containing 25 mM HCO3‐ and equilibrated with 5% CO2 (HCO3‐ HBSS, pHo= 7.4), pHi of both DBA and C57 astrocytes was ∼0.1–0.15 pH units higher than that in HEPES HBSS. Reducing the pH or the Na+ concentration in media (pHo, [Na+]o) of either HEPES HBSS or HCO3‐ HBSS, pHi of both DBA and C57 astrocytes decreased markedly (0.25–0.45 pH units lower than the controls). The decrease in pH, was greater in HEPES HBSS than in HCO3‐ HBSS. Reducing the Cl‐ concentration ([Cl‐]o) in either HEPES or HCO3‐ HBSS, pHi of astrocytes increased by 0.05–0.1 pH units. Increasing the K+ concentration ([K+]o) of or adding Ba2+ to the media increased the pHi of both DBA and C57 astrocytes accordingly. SITS, an anion transport inhibitor, decreased the pHi of both DBA and C57 astrocytes in HCO3‐ HBSS but not in HEPES HBSS. It enhanced the response of pHi to reduction in pHi. Amiloride, a Na+‐H+ exchange inhibitor, decreased the pHi of both DBA and C57 astrocytes more in HEPES HBSS than in HCO3‐ HBSS. It enhanced the response of pHi to reduction in pHo and [Na+]o. Ouabain, an Na+, K+‐ATPase inhibitor, decreased the pHi of cultured astrocytes in HEPES HBSS, but not in HCO3‐ HBSS. It also enhanced the response of pHi to changing pHo and [Na+]o in HEPES HBSS. Acetazolamide, a carbonic anhydrase inhibitor, decreased the pHi of astrocytes in both HEPES and HCO3‐ HBSS. Both bumetanide, an Na+, K+/Cl‐ cotransport blocker, and KCN, a metabolic inhibitor, produced no significant effect on the steady‐state pH, or the response of pHi to changing ionic concentration in media in both DBA and C57 astrocytes.
Lidocaine in Refractory Status Epilepticus: Confirmation of Efficacy with Continuous EEG Monitoring
Authors: De Giorgio Christopher M. , Altman Karen , Hamilton‐Byrd Elizabeth , Rabinowicz Adrian L.
Published: August 2005

Summary: Lidocaine was efficacious in 2 patients with refractory status epilepticus (RSE) unresponsive to several antiepileptic drugs (AEDs), including high‐dose barbiturates. We confirmed the efficacy of lidocaine with, for the first time in adults, continuous EEG monitoring. Lidocaine, when properly used, may be a treatment option in RSE.