bluuebunny/crossref_metadata_2025 huggingface dataset:
EXPRESSED EMOTION, ATTRIBUTIONS AND COPING IN STAFF WHO HAVE BEEN VICTIMS OF VIOLENT INCIDENTS
Authors: Cottle Mandy , Kuipers Liz , Murphy Glynis , Oakes Peter
Published: August 2010

In some occupations, there is an increased risk of becoming a victim of a violent incident. Nursing and care work, in settings for people with learning disabilities and challenging behaviour, or who have mental health needs, are occupations which can involve such a risk. This study examined how staff felt, after a violent incident, towards the perpetrator of die incident (expressed emotion), and the reasons (attributions) that the care staff gave as to their belief about the cause of the incident. Coping was investigated by looking at measures of anxiety. Results indicated that anxiety was often increased a week after the incident but then returned to baseline levels after a month. Expressed emotion was often high after an incident, and remained high a month later. Reasons that staff gave about the cause of the violent incident varied but they seldom blamed themselves for die incident. They tended to make attributions which were internal to the client, external to themselves, personal to the client, uncontrollable by themselves, and neither controllable nor uncontrollable by the client.
FACTOR ANALYSIS OF THE SCHALOCK & KEITH (1993) QUALITY OF LIFE QUESTIONNAIRE: A REPLICATION
Authors: Rapley Mark , Lobley John
Published: August 2010

The Quality of Life of people with learning disabilities has become a topic of much concern to academics, policy makers, human service providers and evaluators. As yet there has been little progress towards the goal of developing an instrument which adequately reflects the subjective QOL perceptions of people with learning disabilities. To assist in die development of a psychometrically sound and internationally acceptable QOL measure, factor analyses of the Schalock & Keith (1993) Quality of Life Questionnaire (QOL. Q). were undertaken widi a British sample. Discrepancies between the factor solution reported in the QOL. Q Standardisation Manual (Schalock, Keith & Hoffman, 1990) and that obtained for the UK sample are reported. It is concluded that the QOL. Q shows broad cross‐cultural comparability.
RESIDENT BEHAVIOUR AND STAFF INTERACTION WITH PEOPLE WITH INTELLECTUAL DISABILITIES AND SERIOUSLY CHALLENGING BEHAVIOUR IN RESIDENTIAL SERVICES
Authors: Felce David , Lowe Kathy , Blackman Derek
Published: August 2010

The behaviour of 16 residents with severe intellectual disabilities and severely challenging behaviour and the interactions they received from staff were observed. Eight people lived in traditional hospitals and eight in community settings. The two groups were individually matched by adaptive ability. Differences in the occurrence of various categories of staff/resident interaction and resident activity between die two groups were not statistically significant. There was some indication that interaction and engagement in activity were improved in those community settings which were genuinely small and based on ordinary housing. However, a more striking finding for all residents was their lack of constructive occupation and the low level of assistance given by staff to help individuals participate more. Although generally responsive to the social overtures of residents, staff were otherwise not found to have an evident focus on encouraging resident engagement in activity. Two case studies are presented which, with other recent research, point to the impact which the content and focus of staff attention can have on resident activity patterns. Comparison to research on people with less severe challenging behaviour supports the contention that individuals with the most severe challenging behaviours tend to lead more impoverished lives.
STAFF ATTITUDES TOWARDS INDIVIDUALS WITH LEARNING DISABILITIES AND AIDS: THE ROLE OF ATTITUDES TOWARDS CLIENT SEXUALITY AND THE ISSUE OF MANDATORY TESTING FOR HIV INFECTION
Authors: Murray James L. , MacDonald Raymond A. R. , Minnes Patricia M.
Published: August 2010

This study investigated staff attitudes towards individuals with learning disabilities and AIDS in combination with staff attitudes towards client sexuality. Two hundred and forty‐six respondents (55% of those invited to participate) from one organisation in Scotland voluntarily and anonymously returned the nine‐item Staff Attitudes Towards persons with Learning Disabilities and AIDS (LDAIDS) scale (Murray & Minnes, 1994b) and the Sexuality and Persons with Learning Disabilities Attitude Inventory (SPLDAI; Brantlinger, 1983; Murray & Minnes 1994a). Results indicated that staff held moderately positive attitudes towards individuals with a learning disability and AIDS. Regression analysis showed that while controlling for staff demographic and contact variables, attitudes towards client sexuality (SPLDAI) predicted 22% of the variance in scores of attitudes towards clients with learning disabilities and AIDS., Forty‐four percent of participants employed in a direct residential care capacity agreed with mandatory testing of clients for HIV infection. The implications of these findings are discussed with relevance to issues raised by Cambridge (1994) who explored the informed consent/mandatory testing issue. Directions for future research and limitations of the study are also discussed.
Pollinators exert natural selection on flower size and floral display inPenstemon digitalis
Authors: Parachnowitsch Amy L. , Kessler André
Published: August 2010

Featured paper: See Commentary p303
Effects of visual and verbal presentation on cognitive load in vigilance, memory, and arithmetic tasks
Authors: Klingner Jeff , Tversky Barbara , Hanrahan Pat
Published: August 2010

Degree of pupil dilation has been shown to be a valid and reliable measure of cognitive load, but the effect of aural versus visual task presentation on pupil dilation is unknown. To evaluate effects of presentation mode, pupil dilation was measured in three tasks spanning a range of cognitive activities: mental multiplication, digit sequence recall, and vigilance. Stimuli were presented both aurally and visually, controlling for all known visual influences on pupil diameter. The patterns of dilation were similar for both aural and visual presentation for all three tasks, but the magnitudes of pupil response were greater for aural presentation. Accuracy was higher for visual presentation for mental arithmetic and digit recall. The findings can be accounted for in terms of dual codes in working memory and suggest that cognitive load is lower for visual than for aural presentation.
Efficient and cost‐effective estimation of the influence of respiratory variables on respiratory sinus arrhythmia
Authors: Egizio Victoria B. , Eddy Michael , Robinson Matthew , Jennings J. Richard
Published: August 2010

Researchers are interested in respiratory sinus arrhythmia (RSA) as an index of cardiac vagal activity. Yet, debate exists about how to account for respiratory influences on quantitative indices of RSA. T. Ritz, M. Thons, and B. Dahme (2001) developed a within‐individual correction procedure by which the effects of respiration on RSA may be estimated using regression models. We replicated their procedure substituting a spectral high‐frequency measure of RSA for a time‐domain statistic and a respiratory belt's relative measure of tidal volume for the direct assessment provided by a pneumotachograph. The standardized slopes from the respiratory belt and pneumotachography‐derived regression equations (estimated across a 6‐min paced breathing protocol) were positively correlated (r=0.93, p<.001); correlations were similar across 2‐ and 4‐min time courses parsed from the 6‐min protocol. Our results offer methodological alternatives to the research community.
Recurrence risk of stillbirth in the second pregnancy
Authors: Herring AH , Reddy UM
Published: August 2010

Please cite this paper as: Herring A, Reddy U. Recurrence risk of stillbirth in the second pregnancy. BJOG 2010;117:1173–1174.
Implementing the national invasive cervical cancer audit: a local perspective
Authors: Moss EL , Pearmain P , Askew S , Owen G , Reynolds TM , Prabakar IM , Douce G , Parkes J , Menon V , Todd RW , Redman CWE
Published: August 2010

Please cite this paper as: Moss E, Pearmain P, Askew S, Owen G, Reynolds T, Prabakar I, Douce G, Parkes J, Menon V, Todd R, Redman C. Implementing the national invasive cervical cancer audit: a local perspective. BJOG 2010;117:1411–1416.

Objective  To monitor the effectiveness of the cervical screening programme and identify suboptimal management in order to improve patient care.

Design  Retrospective study.

Setting  A university hospital serving a population of 1 million people.

Population  All women diagnosed with a cervical cancer between 2003 and 2006.

Methods  Analysis of data from invasive cervical cancer reviews.

Main outcome measure  Categorisation of cervical cancer cases according to the Invasive Cervical Cancer Audit classification.

Results  Eighty‐seven women were diagnosed with cervical cancer during the 3‐year study period. The ‘lapsed attender’ group accounted for the greatest number of cases (30%), followed by screen detected (26%), interval cancers (13%), never attended (12%), lost to follow‐up (10%) and never invited (9%). Women who had never attended for cytology presented with higher stage disease, stage‐II or above, compared with the screen‐detected cases: 60% were stage II or above, compared with 13.0%, Chi‐square P = 0.018. The most frequently identified screening programme problem was patient compliance, which was determined to be the principle contributing factor in 39 cases (45%) and a secondary factor in a further ten cases.

Conclusions  The categorisation of cervical cancer cases has the potential of yielding invaluable information for improving programme effectiveness. Patient compliance is the greatest challenge to the screening programme, and the need for regular screening and adherence to follow‐up regimens needs to be reinforced in order to maximise the efficacy of the national screening programme.
BIODIVERSITY RESEARCH: Turning up the heat: the impacts of Andropogon gayanus (gamba grass) invasion on fire behaviour in northern Australian savannas
Authors: Setterfield Samantha A. , Rossiter‐Rachor Natalie A. , Hutley Lindsay B. , Douglas Michael M. , Williams Richard J.
Published: August 2010

Aim  This study aimed to quantify changes in fire severity resulting from the invasion of Australia’s tropical savannas by the African grass Andropogon gayanus Kunth. (gamba grass).

Location  Mesic savannas of the Northern Territory, Australia.

Method  Byram’s fire‐line intensity (If), fuel load and architecture, and two post‐fire indicators of fire intensity – scorch height (SH) and char height (CH) of woody vegetation – were determined for fires in native grass savanna and A. gayanus invaded savanna. Leaf scorch is the height at which the fire’s radiant heat browns leaf tissue, and leaf char is the height that radiant heat blackens or consumes leaf tissue and provides an indirect measure of flame height. These data, and 5 years of similar data collected from the Kapalga Fire Project in Kakadu National Park, were used to develop empirical relationships between If and the post‐fire indices of fire intensity.

Results  A relationship between A. gayanus If and SH could not be developed because complete canopy scorch occurred in most A. gayanus fires, even at low If. In contrast, A. gayanus If was strongly correlated with CH. This empirical relationship was substantially different from that for native grass fires. For a given If, there was a significantly greater CH in invaded sites. This increase in radiant heat is attributable to the increased biomass (mean 3.6 t ha−1 in native grasses compared to 11.6 t ha−1 in A. gayanus) and height (approximately 0.5 m in native grasses compared to 4 m in A. gayanus) of the standing fine fuel.

Main conclusion  Andropogon gayanus invasion resulted in substantial changes in fire behaviour. This has important regional implications owing to the current (10,000–15,000 km2) and predicted (380,000 km2) area of invasion and the negative consequences for the native savanna biota that has evolved with frequent but relatively low‐intensity fire.
BIODIVERSITY RESEARCH: Conserving macroinvertebrate diversity in headwater streams: the importance of knowing the relative contributions of α and β diversity
Authors: Clarke Amber , Mac Nally Ralph , Bond Nick R. , Lake P. S.
Published: August 2010

Aim  We investigated partitioning of aquatic macroinvertebrate diversity in eight headwater streams to determine the relative contributions of α and β diversity to γ diversity, and the scale dependence of α and β components.

Location  Great Dividing Range, Victoria, Australia.

Methods  We used the method of Jost (Ecology, 2007, 88, 2427–2439) to partition γ diversity into its α and β components. We undertook the analyses at both reach and catchment scales to explore whether inferences depended on scale of observation.

Results  We hypothesized that β diversity would make a large contribution to the γ diversity of macroinvertebrates in our dendritic riverine landscape, particularly at the larger spatial scale (among catchments) because of limited dispersal among sites and especially among catchments. However, reaches each had relatively high taxon richness and high α diversity, while β diversity made only a small contribution to γ diversity at both the reach and catchment scales.

Main conclusions  Dendritic riverine landscapes have been thought to generate high β diversity as a consequence of limited dispersal and high heterogeneity among individual streams, but this may not hold for all headwater stream systems. Here, α diversity was high and β diversity low, with individual headwater stream reaches each containing a large portion of γ diversity. Thus, each stream could be considered to have low irreplaceability since losing the option to use one of these sites in a representative reserve network does not greatly diminish the options available for completing the reserve network. Where limited information on individual taxonomic distributions is available, or time and money for modelling approaches are limited, diversity partitioning may provide a useful ‘first‐cut’ for obtaining information about the irreplaceability of individual streams or subcatchments when establishing representative freshwater reserves.
Quantitative criteria for species delimitation
Authors: TOBIAS JOSEPH A. , SEDDON NATHALIE , SPOTTISWOODE CLAIRE N. , PILGRIM JOHN D. , FISHPOOL LINCOLN D. C. , COLLAR NIGEL J.
Published: August 2010

Species are the fundamental units of biology, ecology and conservation, and progress in these fields is therefore hampered by widespread taxonomic bias and uncertainty. Numerous operational techniques based on molecular or phenotypic data have been designed to overcome this problem, yet existing procedures remain subjective or inconsistent, particularly when applying the biological species concept. We address this issue by developing quantitative methods for a classic technique in systematic zoology, namely the use of divergence between undisputed sympatric species as a yardstick for assessing the taxonomic status of allopatric forms. We calculated mean levels of differentiation in multiple phenotypic characters – including biometrics, plumage and voice – for 58 sympatric or parapatric species‐pairs from 29 avian families. We then used estimates of mean divergence to develop criteria for species delimitation based on data‐driven thresholds. Preliminary tests show that these criteria result in relatively few changes to avian taxonomy in Europe, yet are capable of extensive reassignment of species limits in poorly known tropical regions. While we recognize that species limits are in many cases inherently arbitrary, we argue that our system can be applied to the global avifauna to deliver taxonomic decisions with a high level of objectivity, consistency and transparency.
Receipt of Care and Reduction of Lower Extremity Amputations in a Nationally Representative Sample of U.S. Elderly
Authors: Sloan Frank A. , Feinglos Mark N. , Grossman Daniel S.
Published: August 2010

Objective. To determine effectiveness of receipt of care from podiatrist and lower extremity clinician specialists (LEC specialists) on diabetes mellitus (DM)‐related lower extremity amputation.

Data Sources. Medicare 5 percent sample claims, 1991–2007.

Study Design. Individuals with DM‐related lower extremity complications (LECs) were followed 6 years. Visits with podiatrists, LEC specialists, and other health professionals were tracked to ascertain whether receipt of such care reduced the hazards of an LEC amputation.

Data Collection. Individuals were stratified based on disease severity, Stage 1—neuropathy, paresthesia, pain in feet, diabetic amyotrophy; Stage 2—cellutis, charcot foot; Stage 3—ulcer; Stage 4—osteomyelitis, gangrene.

Principal Findings. Half the LEC sample died within 6 years. More severe lower extremity disease increased risk of death and amputation. Persons visiting a podiatrist and an LEC specialist within a year before developing all stage complications were between 31 percent (ulceration) and 77 percent (cellulitis and charcot foot) as likely to undergo amputation compared with individuals visiting other health professionals.

Conclusions. Individuals with an LEC had high mortality. Visiting both a podiatrist and an LEC specialist in the year before LEC diagnosis was protective of undergoing lower extremity amputation, suggesting a benefit from multidisciplinary care.
Contact Sensitization in Children
Authors: Manzini Bianca Maria , Ferdani Graziella , Simonetti Vito , Donini Massimo , Seidenari Stefania
Published: August 2010

Abstract: Our study concerns contact sensitization in children, the frequency of which is still debated in the literature, even though specific reports are increasing. During a 7 year period (1988–1994) 670 patients, 6 months to 12 years of age, were patch tested with the European standard series, integrated with 24 haptens, at the same concentrations as for adults. We observed positive results in 42% of our patients. Thimerosal, nickel sulfate, Kathon CG, fragrance mix, neomycin, wool alcohols, and ammoniated mercury induced most of the positive responses. The highest sensitization rate was found in children from 0 to 3 years of age. Comments on main positive haptens are reported. Seventy‐seven percent of our sensitized patients were atopics, suggesting that atopy represents a predisposing factor for contact hypersensitivity. Patch testing represents a useful diagnostic procedure for the definition of childhood eczematous dermatitis and for the identification of agents inducing contact sensitization which is frequently associated with atopic dermatitis.
Calcinosis Cutis Following Calcium Chloride Electrode Paste Application for Auditory‐Brainstem Evoked Potentials Recording
Authors: Puig L. , Rocamora V. , Romaní J. , Saavedra M. , Alomar A.
Published: August 2010

Abstract: Circumscribed calcification in the dermis (calcinosis cutis) has been reported following electroencephalographic and electromyographic studies at sites of electrode placement following application of an electrode paste containing calcium chloride. Prolonged exposure and skin microabrasions seem to increase the risk of this rare complication of electrode placement, which has not been previously reported following auditory brainstem evoked potential recordings. We report the appearance of localized dermal calcifications at the sites of electrode placement (forehead and retroauricular areas) following auditory brainstem evoked potential recordings in two children, aged 3 and 2 years, respectively. In both cases the electrodes were applied after gentle scrubbing with an ethanol‐impregnated gauze and interposition of a calcium chloride bentonite magma paste. The recording took about 1 hour. Erythematous macules and plaques ranging from 4 to 12 mm in diameter, studded with small stony excrescences, appeared at the areas of electrode application 1 and 5 days later, respectively. Histopathologic study of 4 mm punch biopsy specimens showed amorphous dermal deposits of calcium salts. There was superficial ulceration and transepidermal elimination of the calcium deposits, as well as a foreign body tissue reaction in the surrounding dermis. In both patients small stony pellets were extruded during the healing process, which took 11 and 9 weeks, respectively, and left no scars.
Physiological Sleep Disturbance in Children with Atopic Dermatitis: A Case Control Study
Authors: Stores Gregory , Burrows Alison , Crawford Christina
Published: August 2010

Abstract: It is generally acknowledged that sleep disturbance commonly complicates atopic dermatitis (AD), but the nature of this disturbance, including its physiologic aspects, has been little studied, especially in children. The results of home polysomnography (PSG) were compared for 20 school‐age children with AD and sex‐and age‐matched healthy controls. The findings provided objective confirmation of disruption of sleep by both brief and longer awakenings associated with scratching episodes. Sleep efficiency was reduced but other sleep variables were not significantly affected. Home sleep studies offer advantages for further investigation of the factors involved in the link between AD and sleep disturbance, and the assessment of the contribution made by this disturbance to the daytime psychological problems of children with AD.
Wegener's Granulomatosis: Case Report and Literature Review
Authors: Stein Sarah L. , Miller Laurie C. , Konnikov Nellie
Published: August 2010

Abstract: Wegener's granulomatosis (WG) is a necrotizing granulomatous vasculitis usually affecting the upper and lower respiratory tracts and kidneys. Any organ system can be affected by the pathologic process, which remains an etiologic enigma. Limited forms of the disease are recognized in which few extrapulmonary and no renal lesions occur. Cutaneous manifestations occur in 40% to 50% of patients with WG (1). Early diagnosis is imperative because treatment regimens reduce morbidity and mortality in this potentially fatal disease. We report WG in a 10‐year‐ old boy whose upper respiratory tract symptoms began at age 8 years. The case is illustrative of the difficulties that can be encountered in attempting to make this diagnosis. Skin is an easily accessible organ for biopsy, thus an increasing familiarity with the typical biopsy specimen findings within a consistent clinical setting may aid in earlier diagnosis of WG.
Harlequin Sign (Hemifacial Flushing and Contralateral Hypohidrosis) in a 4‐year‐old Girl with Horner Syndrome
Authors: Abe Masatoshi , Tamura Atsushi , Sogabe Yoko , Hashimoto Chie , Shyuto Tomoko , Ishikawa Osamu
Published: August 2010

Abstract:  We report a Japanese infant with Horner syndrome whose clinical examination and testing suggested the location of the causative lesion. A 4‐year‐old Japanese girl had an acquired right ocular ptosis and unequal pupils presenting shortly after birth. She also exhibited left hemifacial flushing and loss of sweating on the contralateral side (harlequin sign). Physical examination demonstrated 2.0 mm of ptosis of the right upper lid with normal elevator function. The diameters of the pupils were 4 mm on the left and 2.5 mm on the right. No sweating was induced in the right frontal region at 40°C for 15 minutes of sweat challenge test. Otherwise, no abnormalities were found by the neurophysiologic examinations or magnetic resonance imaging of the brain. Based on the clinical examination, we speculated that the responsible lesion might be in the preganglionic areas. Harlequin sign was informative for making the diagnosis of Horner syndrome.
Nail Changes in Childhood Psoriasis: A Study from Kuwait
Authors: Al‐Mutairi Nawaf , Manchanda Yashpal , Nour‐Eldin Osama
Published: August 2010

Abstract:  Psoriasis is a widespread skin disorder in which nail involvement can be seen in up to two‐thirds of those affected. Childhood psoriasis is a distinct entity and the literature focused on nail changes associated with childhood psoriasis is scant. Our objectives were to evaluate the frequency of nail involvement in childhood psoriatic patients, assess the types of nail changes in childhood psoriasis, and compare our clinical findings with the few reports available in the literature. Two hundred and one consecutive new patients with childhood (age ≤ 16 years) psoriasis of both sexes were selected for the study of nail changes. The diagnosis of psoriasis was made on clinical grounds. Each patient underwent a thorough dermatologic examination with special attention paid to the nail changes. If a clinical suspicion of fungal infection of the nails existed, further mycologic investigations were performed. We found the prevalence of nail changes to be 37.81% (boys > girls) in children who had psoriasis. Nail pitting was found to be the most common manifestation (61.84%) followed by onycholysis (30.26%), subungual hyperkeratosis (13.16%), and discoloration of the nail plate (7.90%). Nail involvement had no relationship to the type of psoriasis, patient's sex, or duration or extent of disease.
Onychomatricoma: First Description in a Child
Authors: Piraccini Bianca Maria , Antonucci Angela , Rech Giulia , Starace Michela , Misciali Cosimo , Tosti Antonella
Published: August 2010

Abstract:  Onychomatricoma is an uncommon benign tumor of the nail matrix, with peculiar clinical and histologic features and electron microscopic findings. The main clinical signs are longitudinal ridging, yellow coloration along the entire length of the nail plate with splinter hemorrhages in its proximal portion, and a tendency towards transverse overcurvature of the affected nails. We report onychomatricoma associated with onychomycosis in the same nail in a 4‐year‐old girl.
EFFICACY OF A VIBRATORY STIMULUS FOR THE RELIEF OF HIV‐ASSOCIATED NEUROPATHIC PAIN
Authors: Paice Ja , Shott S , Oldenburg Fp , Zeller J , Swanson B.
Published: August 2010

Pain related to HIV disease is frequently debilitating. Of the many pain syndromes that occur in persons with HIV, distal symmetrical polyneuropathy (DSPN) is particularly devastating. Because DSPN often responds, at best, only partially to available pharmacologic interventions, non‐pharmacologic interventions need to be investigated. Vibration has been suggested to be effective for reducing pain in other populations with chronic pain. This randomized, sham‐controlled, double‐masked study tested the short‐term efficacy of a 45‐min vibration treatment for DSPN foot pain in persons infected with HIV. Vibration therapy was delivered using a portable platform foot vibrator that provided stimulation at a frequency of 60 Hz. For all patients, the control box for the vibrator emitted an audible hum and part of the control box lit up during treatment, but only patients randomized to active treatment received vibration. Pain intensity (0–10) was measured immediately prior to and after treatment. Subjects were also questioned regarding pain relief (0–100%) immediately after the treatment. The mean percentage pain relief was 61.0 +/− 33.1% (median 70.0; range 0–100) for all patients, 67.3 +/− 34.0% (median 80.0; range 0–100) for vibration patients, and 55.0 +/− 32.0% (median 60.0; range 0–100) for sham patients. No statistically significant differences were found between the vibration and sham groups with respect to percentage pain relief (Mann‐Whitney test; P = 0.19) or the pre‐ and post‐treatment current‐pain difference (Mann‐Whitney test; P = 0.92). These results underscore the necessity for control groups in studies of non‐pharmacologic therapies for pain.
SCREENING FOR HIV‐ASSOCIATED DISTAL‐SYMMETRIC POLYNEUROPATHY IN CDC‐CLASSIFICATION STAGES 1, 2 AND 3
Authors: Husstedt Iw , Evers S , Reichelt D , Grotemeyer Kh , Kammer‐Suhr B , Bockenholt S , Heese C.
Published: August 2010

OBJECTIVES—A total of 670 patients were screened for distal symmetric HIV‐associated polyneuropathy during CDC stages 1–3 and its correlation to immunological deterioration. MATERIAL AND METHODS—Clinical examinations of 670 patients admitted to the neurological outpatient clinic at the Department of Neurology, University of Munster. Neurophysiological investigations were performed on the sural and peroneal nerve for detection of axonal and myelin lesion. RESULTS—Clinical examination proved progressive clinical signs and symptoms indicating distal symmetric polyneuropathy from CDC 1 (32%) to CDC 3 (55%). At least one neurophysiological result was impaired in CDC 1 in 25% and in CDC 3 in 45%. Significant correlation between neurophysiological changes and CDC 4(+)‐cells and beta‐microglobuline were detected for stage CDC 3 C. CONCLUSION—Results show stage related prevalence of distal symmetric polyneuropathy already in early stages. In late stages of HIV‐infection prevalence of distal symmetric polyneuropathy seems to be directly correlated to immunodeficiency syndrome. The pathogenesis of distal symmetric polyneuropathy during HIV‐infection is up to now incompletely understood, but results indicate a clear dependency between progressive immunological dysfunction and neuropathy. High active antiretroviral therapy in patients suffering from distal symmetric polyneuropathy is a main topic of future studies.
IMMUNOHISTOCHEMICAL LOCALIZATION OF CYTOKINES, C5B‐9 AND ICAM‐1 IN PERIPHERAL NERVE OF GUILLAIN‐BARRE SYNDROME
Authors: Putzu Ga , Figarella‐Branger D , Bouvier‐Labit C , Liprandi A , Bianco N , Pellissier Jf
Published: August 2010

The spectrum of the Guillain‐Barre Syndrome (GBS) has recently been widened by the newly identified forms of acute motor axonal neuropathy (AMAN) and acute motor sensory axonal neuropathy (AMSAN). An important question has been raised regarding the possibility for the axon to be a target in immune‐mediated damage. Although myelin breakdown is the characteristic feature of classic acute inflammatory demyelinating polyradiculoneuropathy (AIDP), axonal degeneration may occasionally be observed in this form, especially in cases with explosive onset and severe clinical course. Immunohistochemical findings of five frozen sural nerves biopsies of patients with GBS (AIDP variant) tested with a panel of monoclonal antibodies raised against different molecules implicated in immune‐mediated processes have principally disclosed an immunoreactivity of tumor necrosis factor‐alpha (TNF‐alpha) on both Schwann cell membranes and in myelinated and unmyelinated axons. On the other hand, interleukin 1‐beta (IL1‐beta) labeled Schwann cells, endothelial cells and macrophages; interferon‐gamma (IFN‐gamma) was observed both in endothelial cells and lymphocytes. Membrane attack complex (C5b‐9) deposits were observed on Schwann cell membranes and finally intercellular adhesion molecule‐1 (ICAM‐1) was localized both on endothelial cells and macrophages. Our findings strongly suggest that TNF‐alpha is an important factor in the cascade of events leading to immune‐mediated demyelination and axonal damage in GBS.
PRENATAL DETECTION OF A 17P11.2 DUPLICATION RESULTING FROM A RARE RECOMBINATION EVENT AND NOVEL PCR‐BASED STRATEGY FOR MOLECULAR IDENTIFICATION OF CHARCOT‐MARIE‐TOOTH DISEASE TYPE 1A
Authors: Bernard R , Labelle V , Negre P , Tardieu S , Azulay Jp , Malzac P , Mattei Jf , Leguern E , Philip N , Levy N.
Published: August 2010

Charcot‐Marie‐Tooth disease, type 1A (CMT1A) is caused in most cases by a 1.5 Mb duplication on chromosome 17p11.2 arising after unequal crossing‐over between repeated sequences called CMT1A‐REPs, flanking the 1.5 Mb unit. A 3.2 kb recombination hot spot has been defined, resulting in a junction fragment between EcoRI (distal CMT1A‐REP) and Sad (proximal CMT1A‐REP). This was further reduced to a 1.7kb EcoRI‐Nsil fragment, and recently to a 731 bp hot spot region within this fragment. We describe the CMT1A‐REPs‐based PCR method used to identify CMT1A duplications and report on a family case in which a 29‐year‐old pregnant woman requested prenatal diagnosis for two successive pregnancies because her husband was affected with CMT1A. Our method enabled us to characterise the duplication in both foetuses and demonstrate that it arose from a rare recombination event taking place outside the 1.7 kb region. Since our approach is simple and enables the entire set of duplications occurring after recombination in the enlarged 3.2 kb region including the hot spot to be detected, we suggest it might be considered for use in primary screening for pre‐ and postnatal diagnosis of CMT1A.
REVERSIBILITY OF AUTONOMIC NERVE FUNCTION IN RELATION TO RAPID IMPROVEMENT OF GLYCEMIC CONTROL
Authors: Isotani H , Fukumoto Y.
Published: August 2010

To determine the reversibility of autonomic nerve function in relation to the rapid improvement of glycemic control, we studied 54 patients with type 2 diabetes mellitus (33 men and 21 women; mean age, 49 +/− 8 years; mean duration of diabetes, 10 +/− 7 years). For 4 weeks of admission, the subjects were placed on strict dietary therapy, and 10 of them were under dietary therapy, 16 initially continued treatment with oral hypoglycemic agents, while 28 were treated with insulin. We measured the dark‐adapted pupillary area (DAPA) by infrared photography, an indicator of diabetic autonomic neuropathy, on the second and 28th day after hospitalization. The change in FPG (Delta FPG = −111 +/− 49 mg/dl; mean +/− SD, p < 0.001) and the change in HbA1c (Delta HbA1c = −1.3 +/− 0.3%, p < 0.001) were significantly improved. We observed significant improvements in the change in DAPA (Delta DAPA) of all patients (25.1 +/− 11.0 vs. 25.7 +/− 11.6 mm(2), Delta DAPA = 0.6 +/− 1.4 mm(2), p < 0.01) and in those of patients without retinopathy (Delta DAPA = 1.0 +/− 0.6 mm(2), p < 0.01). No change was observed in those of patients with retinopathy (Delta DAPA = −0.02 +/− 0.3 mm(2), NS). The Delta DAPA was related to the Delta HbA1c (r = −0.479, p < 0.001) and also to the diabetic duration (years, r = −0.517, p < 0.001). These findings suggest that a rapid improvement of glycemic control improves autonomic nerve function observed in type 2 diabetes with shorter duration. Particular attention should be paid to maintaining strict glycemic control at the stage of diabetic patients without retinopathy and those with shorter duration.
UNMYELINATED NERVE FIBER DEGENERATION IN CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY
Authors: Bosboom Wmj , Van den Berg Lh  , Dieks Hjg , Plante E , Veldman H , Franssen H , Wokke Jhj
Published: August 2010

To determine whether unmyelinated nerve fibers escape degeneration as one might expect in an immune response exclusively directed at myelin, we performed a morphometric examination of unmyelinated axons and myelinated nerve fibers in sural nerve biopsy specimens of 14 patients with a chronic inflammatory demyelinating polyneuropathy (CIDP) and of 12 age‐matched normal controls. The numbers of unmyelinated axons, myelinated nerve fibers, denervated Schwann cell units and collagen pockets were quantified and related to the clinical and electrophysiological data of the patients with CIDP. In 4 patients with a rapid onset of the neuropathy and a highly elevated CSF protein, the numbers of both unmyelinated axons and myelinated nerve fibers were decreased equally. In 8 patients we found that the unmyelinated axons were relatively spared compared with the loss of myelinated nerve fibers. In these patients, however, the presence of denervated Schwann cell units and of collagen pockets was increased. We conclude that unmyelinated nerve fibers are affected in patients with CIDP.
GABAPENTIN USE IN NEUROPATHIC PAIN SYNDROMES
Authors: Nicholson B.
Published: August 2010

The development of neuropathic pain involves a series of changes including primary and secondary hyperalgesia, peripheral and central sensitization, and wind‐up phenomena. Neurotransmitters play a critical role in this process. For example, glutaminergic subtypes of alpha‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid (AMPA) and neurokinin prime the N‐methyl‐D‐aspartate (NMDA) receptor by triggering the release of intracellular calcium ions, thus unblocking the magnesium ion plug on the NMDA receptor and allowing Ca2+ influx into the cell. Ca2+ ions acting as secondary messengers initiate protein kinase C activation, phospholipase C and nitric oxide synthetase production, and proto‐oncogene expression. The activation of the NMDA receptor thereby increases the responsiveness of the nociceptive system. Anticonvulsant drugs—including carbamazepine, phenytoin, and felbamate—have been used to treat neuropathic pain. Gabapentin is a novel anticonvulsant that may have a unique effect on voltage‐dependent Ca2+ channel currents at postsynaptic dorsal horn neurons. Thus, gabapentin may interrupt an entire series of events, not just a single process, that lead to the development of neuropathic pain. Preclinical models of anti‐inflammatory and neuropathic pain indicate that gabapentin effectively antagonizes the maintenance of this pain. Additionally, in preemptive surgical models, gabapentin has been shown to prevent the induction of pain. Gabapentin has been shown to be efficacious in numerous smaller clinical studies, case reports, and chart reviews in a variety of neuropathic pain syndromes. Two large multicenter studies, one in postherpetic neuralgia (PHN) and one in diabetic peripheral neuropathy (DPN), support preclinical findings. In the PHN study, patients treated with gabapentin demonstrated a significant difference (P < 0.001) in their average daily pain score at endpoint compared to placebo patients. In the DPN trial, mean weekly pain was significantly (P<0.001) different for gabapentin‐treated patients compared to placebo‐treated patients at endpoint. Consistent with the known side‐effect profile of gabapentin, the most common adverse events noted in both studies were dizziness and somnolence. Gabapentin should be considered an important addition to the management of neuropathic pain syndromes.
QUANTITATIVE ASSESSMENT AND CORRELATION OF SYMPATHETIC, PARASYMPATHETIC, AND EFFERENT SMALL FIBER FUNCTION IN PERIPHERAL NEUROPATHY
Authors: Schuller Tb , Hermann K , Baron R.
Published: August 2010

We compared three neurophysiological methods for assessing small nerve fiber function in 40 patients with peripheral neuropathy to determine the various manifestation types of peripheral small fiber neuropathy. Heart rate variation tests were used to assess cardiac parasympathetic small fiber function. Cutaneous vasoconstrictor responses (sympathetic C fibers) induced by deep inspiration were examined with laser Doppler flowmetry. Cutaneous afferent C fiber function was assessed by measurement of axon reflex vasodilatation induced by histamine iontophoresis. All test parameters were significantly lower in patients with peripheral neuropathy than in control subjects. Comparison of the three small fiber systems revealed that functionally different systems are damaged independently, and isolated affection of each fiber type was frequently observed. The three tests are useful noninvasive tools with which to evaluate sympathetic, parasympathetic, and afferent small fiber function in patients with peripheral neuropathy. In many patients functionally different small fiber systems are affected selectively. To diagnose small fiber neuropathy and to evaluate the individual type of manifestation complementary testing of several small somatic and autonomic fiber systems is necessary.
MUTATIONS IN CONNEXIN 32: THE MOLECULAR AND BIOPHYSICAL BASES FOR THE X‐LINKED FORM OF CHARCOT‐MARIE‐TOOTH DISEASE
Authors: Abrams Ck , Oh S , Ri Y , Bargiello Ta
Published: August 2010

The connexins are a family of homologous integral membrane proteins that form channels that provide a low resistance pathway for the transmission of electrical signals and the diffusion of small ions and non‐electrolytes between coupled cells. Individuals carrying mutations in the gene encoding connexin 32 (Cx32), a gap junction protein expressed in the paranodal loops and Schmidt‐Lantermann incisures of myelinating Schwann cells, develop a peripheral neuropathy—the X‐linked form of Charcot‐Marie‐Tooth disease (CMTX). Over 160 different mutations in Cx32 associated with CMTX have been identified. Some mutations will lead to complete loss of function with no possibility of expression of functional channels. Some mutations in Cx32 lead to the abnormal accumulation of Cx32 proteins in the cytoplasm, particularly in the Golgi apparatus; CMTX may arise due to incorrect trafficking of Cx32 or to interference with trafficking of other proteins. On the other hand, many mutant forms of Cx32 can form functional channels. Some functional mutants have conductance voltage relationships that are disrupted to a degree which would lead to a substantial reduction in the available gap junction mediated communication pathway. Others have essentially normal steady‐state g‐V relations. In one of these cases (Ser26Leu), the only change introduced by the mutation is a reduction in the pore diameter from 7 Angstrom for the wild‐type channel to less than 3 Angstrom for Ser26Leu. This reduction in pore diameter may restrict the passage of important signaling molecules. These findings suggest that in some, if not all cases of CMTX, loss of function of normal Cx32 is sufficient to cause CMTX.
FREQUENT GOOD PARTIAL REMISSIONS FROM THALIDOMIDE INCLUDING BEST RESPONSE EVER IN PATIENTS WITH ADVANCED REFRACTORY AND RELAPSED MYELOMA
Authors: Juliusson G , Celsing F , Turesson I , Lenhoff S , Adriansson M , Malm C.
Published: August 2010

Twenty‐three patients with advanced and heavily pretreated myeloma were treated with thalidomide. Starting dose was 200 mg/d, and 20 patients had dose escalations up to 400 (n = 5), 600 (n = 12) or 800 mg/d (n = 3), usually in divided doses. Nineteen patients were refractory to recent chemotherapy, and four had untreated relapse after prior intensive therapy. Ten out of 23 patients (43%) achieved partial response (PR; nine with refractory and one with relapsed disease), six patients had minor response or stabilization of the disease and four had disease progression. Another three patients died early from advanced myeloma at less than 3 weeks of thalidomide therapy. Of the 10 patients with PR, seven had a better response than after any prior therapy, despite vincristine‐doxorubicin‐dexamethasone (VAD)‐based treatment in all but one and high‐dose melphalan with autologous stem cell support in four. Time to achieve PR was rapid in patients receiving thalidomide in divided doses (median 31 d). Responses also included reduced bone marrow plasma cell infiltration and improved general status. Normalized polyclonal gammaglobulin levels were seen in four cases. Six out of 10 patients with PR remained in remission with a median time on treatment of 23 weeks (range 15–50 weeks). Sedation was common but usually tolerable, and some patients continued full‐ or part‐time work. Four patients had skin problems, three patients had pneumonia, one hypothyrosis, one sinus bradycardia and one minor sensory neuropathy. Thalidomide may induce good partial remissions in advanced refractory myeloma with tolerable toxicity, and should be evaluated in other settings for myeloma patients. Divided thalidomide doses seem to reduce time to achieve remission and may improve response rate.
GAMMA‐DIKETONE PERIPHERAL NEUROPATHY—I. QUANTITATIVE MORPHOMETRIC ANALYSES OF AXONAL ATROPHY AND SWELLING
Authors: Lehning Ej , Jortner Bs , Fox Jh , Arezzo Jc , Kitano T , LoPachin Rm
Published: August 2010

Quantitative morphometric analysis was used to characterize expression of myelinated axon swelling and atrophy in rat peripheral nerve during 2,5‐hexanedione (HD) intoxication. HD was administered by gavage according to different daily dosing regiments (100, 175, 250, or 400 mg/kg/day) and four proximodistal nerve regions (5th lumbar spinal nerve, proximal and distal sciatic nerve, and tibial nerve) were examined morphometrically. Morphometric determinations were made at four behavioral endpoints (unaffected, slight, moderate, and severe toxicity) and were correlated to electrophysiologic measurements of peripheral nerve function. Results show that, for all HD dose rates, onsets of behavioral neurotoxicity and nerve dysfunction were generally related to development of abundant axon atrophy. The proximodistal manifestation of atrophy was dependent upon the dosing rate; i.e., the atrophy response produced by subacute intoxication with higher daily dosing rates (250 and 400 mg/kg/day) was restricted to distal nerve regions whereas subchronic induction with lower dosing rates (100 and 175 mg/kg/day) produced abundant fiber atrophy in all proximodistal areas. In contrast to atrophy, axonal swellings constituted an inconsistent minor morphologic response, the expression of which was dependent upon subchronic dosing rates (100–250 mg/kg/day). Subacute HD administration (400 mg/kg/day) produced significant changes in neurobehavior and nerve electrophysiologic parameters in the absence of peripheral axon swelling. Thus, conditional expression of swellings suggests they are an epiphenomenon related to low‐dose induction rates. Fiber atrophy, however, was numerically dominant, correlated with nerve dysfunction, and occurred at all dosing levels. These characteristics suggest atrophy is a neurotoxicologically significant feature of gamma‐diketone peripheral neuropathy.
TEMPORAL DEVELOPMENT OF 2′,3′‐DIDEOXYINOSINE (DDI)‐INDUCED PERIPHERAL MYELINOPATHY
Authors: Patterson Ta , Schmued Lc , Sandberg Ja , Slikker W.
Published: August 2010

The anti‐HIV therapeutic dideoxyinosine (ddI) has been reported to produce a painful, dose‐limiting peripheral myelinopathy in HIV‐infected patients after chronic administration. We have previously demonstrated ddI‐induced myelinopathy in a non‐HIV‐infected rat model after 20 weeks of dosing, characterized by myelin splitting and intramyelin edema. The present study examined the time course needed to produce the ddI‐induced neuropathy. Adult male Sprague‐Dawley rats were gavaged with vehicle of 415 mg/kg ddI twice daily for up to 20 weeks. Groups of treated (n = 6‐8) and control (n = 3–5) animals were killed after 5, 10, 15, and 20 weeks of dosing and the distal end of the sciatic nerve was removed. The nerve was postfixed by immersion in neutral phosphate‐buffered formalin, dehydrated in graded alcohols, and embedded in plastic embedding media. One‐micrometer‐thick sections were cut and stained with toluidine blue and basic fuchsin. Plasma levels of ddI on the day the animals were killed were greater than 10 mu g/ml within the first hour after dosing and fell rapidly to less than 1 mu g/ml (clinical range 1–2 mu g/ml) within 3 h after dosing. The abnormalities observed in the sciatic nerve were few, if any, after 5 or 10 weeks, but very prominent after 15 weeks of dosing. Four of the six ddI‐treated rats exhibited abnormal morphology as evidenced by myelin splitting and ballooned myelin sheaths. Although abnormal morphology was present at 20 weeks of dosing, the effect was not as robust as at 15 weeks. This suggests that the nerve may partially recover from the effects of ddI with time.