bluuebunny/crossref_metadata_2025 huggingface dataset:
Pregnancy outcome in Type 1 diabetes mellitus treated with insulin lispro (Humalog)
Authors: Masson E. A. , Patmore J. E. , Brash P. D. , Baxter M. , Caldwell G. , Gallen I. W. , Price P. A. , Vice P. A. , Walker J. D. , Lindow S. W.
Published: March 2003

Aims The use of insulin lispro in pregnancy has not been systematically investigated despite its increasing use. Pooled data from seven centres with experience in the use of insulin lispro were accumulated to evaluate pregnancy outcome in women with Type 1 diabetes.

Methods Seven units with specialist obstetric diabetes services were recruited to describe their total experience with insulin lispro in pregnancy. Outcomes with respect to the rate of miscarriage, congenital abnormality, perinatal mortality and maternal parameters were recorded in a standardized format.

Results Outcomes on 71 babies from 76 pregnancies were documented. There were six (7.8%) early miscarriages. All 71 babies were liveborn with a mean gestational age of 37.2 weeks, and median birthweight of 3230 g. Seven babies weighed > 4 kg. There were four congenital abnormalities (5.6%). There was a 72% increase in the mean insulin dose (0.75–1.29 IU/kg per day). Maternal glycaemic control improved throughout pregnancy. No women developed retinopathy de novo during pregnancy and six with established retinopathy required laser therapy during pregnancy.

Conclusions The use of insulin lispro in Type 1 diabetes during pregnancy results in outcomes comparable to other large studies of diabetic pregnancy.
A protocol for improved glycaemic control following corticosteroid therapy in diabetic pregnancies
Authors: Kaushal K. , Gibson J. M. , Railton A. , Hounsome B. , New J. P. , Young R. J.
Published: March 2003

Aims Diabetic pregnancies have an increased risk of respiratory distress syndrome (RDS) and preterm delivery. Antenatal corticosteroids can prevent RDS but induce acute severe hyperglycaemia. We have developed a protocol which prevents hyperglycaemia and can be used easily by ward staff.

Methods Intramuscular dexamethasone is given in two doses 12 h apart. Subcutaneous insulin and diet are continued but from the first dexamethasone dose until 12 h after the second, supplementary intravenous insulin is infused according to hourly blood glucose measurements. The protocol incorporates four graded sliding scales. The initial scale is selected according to the patient's current subcutaneous insulin dose and advanced if the blood glucose is ≥ 10.1 mmol/l for 2 consecutive hours.

Results In a 10‐month period eight (three gestational, five pre‐gestational) women received antenatal corticosteroids from a total of 37 diabetic pregnancies. The median amount of supplementary intravenous insulin required was 74 U (range 32–88 U); the median glucose values achieved were 5.8–8.9 mmol/l. Seventy‐five percent of glucose measurements were within an acceptable range of 4–10 mmol/l. Only one baby developed RDS.

Discussion Large amounts of supplementary intravenous insulin are needed to achieve even moderate glycaemic control. This protocol enables routine ward staff to manage this successfully.
Long‐term outcome after gastrectomy for intractable diabetic gastroparesis
Authors: Watkins P. J. , Buxton‐Thomas M. S. , Howard E. R.
Published: March 2003

Aims To examine the long‐term outlook for patients with intractable vomiting from diabetic gastroparesis who underwent major gastric surgery.

Methods Of 18 patients with problems from vomiting referred to the King's Diabetes Centre during the years 1994–2000, seven were considered to suffer irreversible symptoms not alleviated by protracted periods of medical treatment. They were all Type 1 Caucasian diabetic women, mean age 32 years (range 28–37 years) with multiple symptoms of severe autonomic neuropathy. They underwent major gastric surgery comprising 70% gastric resection including pylorus and antrum, with a 60‐cm Roux‐en‐Y loop of jejunum to prevent reflux gastritis.

Results The vomiting was relieved in six of the seven patients almost immediately after surgery and during review up to more than 6 years post‐operatively. There have been no serious relapses, resulting in considerable improvement in quality of life. Unfortunately, three of the patients developed renal failure, two of them needing renal support treatments 2 and 3 years after successful gastrectomy. One patient died suddenly 5 months after successful surgery and one 3 months after starting dialysis.

Conclusions Major gastric surgery can, after careful patient selection, effectively relieve distressing vomiting from severe gastroparesis and give a greatly improved quality of life to a small group of seriously disadvantaged patients where risk of subsequent renal failure is high and where life expectancy is poor.
Factor analysis of the metabolic syndrome among elderly Koreans—the South‐west Seoul Study
Authors: Choi K. M. , Lee J. , Kim K. B. , Kim D. R. , Kim S. K. , Shin D. H. , Kim N. H. , Park I. B. , Choi D. S. , Baik S. H.
Published: March 2003

Aims  To examine the relationship between the components of the metabolic syndrome and to explore whether insulin resistance unifies the clustering of components of the metabolic syndrome among urban elderly Koreans using exploratory factor analysis.

Methods  We included 1314 non‐diabetic subjects over the age of 60 years, selected from a cross‐sectional study, which was conducted in 1999 in Seoul, Korea. Factor analysis was carried out using the principle components analysis with Varimax orthogonal rotation of the components of the metabolic syndrome.

Results  We found four major factors of cardiovascular disease risk variables in our study subjects. Impaired glucose tolerance, dyslipidaemia, hypertension and obesity aggregated as the major domain. Obesity and dyslipidaemia variables were closely related and loaded on the same factor. However, hypertension was not linked closely with other factors of the metabolic syndrome.

Conclusions  Insulin resistance is not the only contributor to the metabolic syndrome among urban elderly Koreans. Although the components of the metabolic syndrome were closely related, the finding of more than one factor suggests that more than one pathophysiological mechanism underlies full expression of the metabolic syndrome among elderly Koreans.
Distribution, abundance and niche breadth of birds: scale matters
Authors: Brändle Martin , Brandl Roland
Published: March 2003

We used local habitat niche breadth, local abundance and body size of non‐passerine afrotropical birds in Tsavo East National Park (Kenya) to predict species distributional ranges in Kenya and across Africa. Univariate analysis revealed a significant positive correlation between local abundance and distribution only on the scale of Kenya. Performing a multiple regression analysis, local abundance, local habitat niche breadth and body size explained a significant part of the variance in bird distribution, again only on the Kenyan scale. From these results, we speculate that on continental scales distributions may be more influenced by macroclimatic conditions and historical factors, whereas distributions on regional scales are predominantly influenced by ecological factors.
Contrasting patterns of change in the distribution and abundance of farmland birds in relation to farming system in lowland Britain
Authors: Chamberlain D. E. , Fuller R. J.
Published: March 2003

Patterns of change in distribution (presence/absence) and abundance since the late 1960s were examined in 20 species of farmland bird in southern Britain in predominantly arable (eastern), predominantly mixed (central) and predominantly grassland (western) regions. Comparisons were made between changes in distribution and in abundance to determine whether these measures show similar relationships to environmental change. Local extinctions of selected species and reductions in species richness were significantly greater in the predominantly grassland region. Decreases in abundance were greatest in seven species in the predominantly arable region, two in the mixed region and nine in the grassland region. Changes in distribution and abundance showed consistent patterns in three species, turtle dove Streptopelia turtur L., yellow wagtail Motacilla flava L. and reed bunting Emberiza schoeniclus L. In another four species, grey partridge Perdix perdix L., lapwing Vanellus vanellus L., tree sparrow Passer montanus L. and corn bunting Miliaria calandra L., decreases in abundance were greatest in the arable region, yet declines in distribution were lowest. For other individual species, changes in distribution were too small to draw any conclusions in relation to farm type. We suggest that modern grassland systems are suboptimal habitats compared to arable or mixed agricultural land for many farmland species that occur at relatively low density in the more western, grass‐dominated region. Declines in abundance are therefore more likely to lead to local extinction in these areas than in eastern areas where abundance is higher. However, the role of changes in grassland management on bird populations requires further research. It is suggested that conclusions drawn from changes in distribution alone, in the absence of supporting data on changes in abundance, may be misleading where the aim is to assess how large‐scale spatial dynamics of populations relate to environmental change.
Forest expansion and grassland contraction within a Eucalyptus savanna matrix between 1941 and 1994 at Litchfield National Park in the Australian monsoon tropics
Authors: Bowman D. M. J. S. , Walsh A. , Milne D. J.
Published: March 2003

Analysis of digitized aerial photographs taken in 1941 and 1994, using image processing and geographical information system technology, enabled the quantification of change in the coverage of forest and grassland patches that occur within a Eucalyptus savanna matrix in a subcoastal region of the Australian monsoon tropics. The 3058 ha study area was orientated along a low escarpment that separated a sandstone plateau from lowlands that comprised 58% and 42% of the area, respectively.

 In the 53‐year period, humans modified less than 1% of the study area, primarily for road building, and primarily in savanna areas. More than 85% of the study area at both sample times was covered by savanna. However, over the same period, the forest coverage increased from 5.03% to 9.91% of the study area and coverage of grassland decreased from 6.70% to 2.47%. The aerial photography also showed that tree density in the savanna had increased, although this was not assessed quantitatively.

 There was an increase in the number of forest patches from 116 to 142. The number of grassland patches decreased (particularly those > 1 ha) from 87 to 59, although the size class distribution of forest and grassland patches was statistically similar for both sample times.

 A 50‐m GIS buffer was used to distinguish creek‐lines environments from surrounding catchments. Using this criterion, 14% of the study area was classified as plateau creek‐lines and 9% lowland creek‐lines. Although the expansion of forest and loss of grassland varied significantly amongst catchment and creek‐lines on the plateau and lowlands, the 1941 rank order of coverage of each vegetation type was maintained in these four landscape categories in 1994. In both years the greatest extent of forest and grassland occurred on the lowland catchments, despite their accounting for only one‐third of the study area.

 Transition matrices for vegetation change among the four landscape categories demonstrated that, unlike the other vegetation types, grasslands, particularly on the plateau, had a low probability of remaining unchanged during the study period.

The cause(s) of the overall increase of woody biomass across the topographic and edaphic gradient remains unclear but may be related to a period of increased rainfall since the 1970s, as well as to the cessation of Aboriginal landscape burning at the beginning of the study period.
Representation of vegetation dynamics in the modelling of terrestrial ecosystems: comparing two contrasting approaches within European climate space
Authors: Smith Benjamin , Prentice I. Colin , Sykes Martin T.
Published: March 2003

Advances in dynamic ecosystem modelling have made a number of different approaches to vegetation dynamics possible. Here we compare two models representing contrasting degrees of abstraction of the processes governing dynamics in real vegetation.

 Model (a) (GUESS) simulates explicitly growth and competition among individual plants. Differences in crown structure (height, depth, area and LAI) influence relative light uptake by neighbours. Assimilated carbon is allocated individually by each plant to its leaf, fine root and sapwood tissues. Carbon allocation and turnover of sapwood to heartwood in turn govern height and diameter growth.

 Model (b) (LPJ) incorporates a ‘dynamic global vegetation model’ (DGVM) architecture, simulating growth of populations of plant functional types (PFTs) over a grid cell, integrating individual‐level processes over the proportional area (foliar projective cover, FPC) occupied by each PFT. Individual plants are not simulated, but are replaced by explicit parameterizations of their growth and interactions.

 The models are identical in their representation of core physiological and biogeochemical processes. Both also use the same set of PFTs, corresponding to the major woody plant groups in Europe, plus a grass type.

 When applied at a range of locations, broadly spanning climatic variation within Europe, both models successfully predicted PFT composition and succession within modern natural vegetation. However, the individual‐based model performed better in areas where deciduous and evergreen types coincide, and in areas subject to pronounced seasonal water deficits, which would tend to favour grasses over drought‐intolerant trees.

 Differences in model performance could be traced to their treatment of individual‐level processes, in particular light competition and stress‐induced mortality.

 Our results suggest that an explicit individual‐based approach to vegetation dynamics may be an advantage in modelling of ecosystem structure and function at the resolution required for regional‐ to continental‐scale studies.
The importance of rapid, disturbance‐induced losses in carbon management and sequestration
Authors: Breshears David D. , Allen Craig D.
Published: March 2003

Management of terrestrial carbon fluxes is being proposed as a means of increasing the amount of carbon sequestered in the terrestrial biosphere. This approach is generally viewed only as an interim strategy for the coming decades while other longer‐term strategies are developed and implemented — the most important being the direct reduction of carbon emissions. We are concerned that the potential for rapid, disturbance‐induced losses may be much greater than is currently appreciated, especially by the decision‐making community. Here we wish to: (1) highlight the complex and threshold‐like nature of disturbances — such as fire and drought, as well as the erosion associated with each — that could lead to carbon losses; (2) note the global extent of ecosystems that are at risk of such disturbance‐induced carbon losses; and (3) call for increased consideration of and research on the mechanisms by which large, rapid disturbance‐induced losses of terrestrial carbon could occur.Our lack of ability as a scientific community to predict such ecosystem dynamics is precluding the effective consideration of these processes into strategies and policies related to carbon management and sequestration. Consequently, scientists need to do more to improve quantification of these potential losses and to integrate them into sound, sustainable policy options.
Lidar remote sensing of above‐ground biomass in three biomes
Authors: Lefsky Michael A. , Cohen Warren B. , Harding David J. , Parker Geoffrey G. , Acker Steven A. , Gower S. Thomas
Published: March 2003

Estimation of the amount of carbon stored in forests is a key challenge for understanding the global carbon cycle, one which remote sensing is expected to help address. However, estimation of carbon storage in moderate to high biomass forests is difficult for conventional optical and radar sensors. Lidar (lightdetection andranging) instruments measure the vertical structure of forests and thus hold great promise for remotely sensing the quantity and spatial organization of forest biomass. In this study, we compare the relationships between lidar‐measured canopy structure and coincident field measurements of above‐ground biomass at sites in the temperate deciduous, temperate coniferous, and boreal coniferous biomes. A single regression for all three sites is compared with equations derived for each site individually. The single equation explains 84% of variance in above‐ground biomass (P < 0.0001) and shows no statistically significant bias in its predictions for any individual site.
Range size and environmental calcium requirements of British freshwater gastropods
Authors: Briers Robert A.
Published: March 2003

Calcium is an essential requirement for the successful growth and development of gastropod molluscs. Data for British freshwater gastropods were used to examine the relationship between environmental calcium requirements and British and European range sizes. At both spatial scales calciphile species, which require a high level of environmental calcium, had significantly smaller range sizes than species able to exploit a wide range of environmental calcium levels. However, at least in Britain, range size may also be influenced by the availability of suitable habitat. British and European range sizes were significantly correlated. This study provides evidence for niche‐based explanations of range size variation, and suggests that both niche breadth and niche availability are important in determining range size.
Genetic control of lipoprotein phenotypes in the laboratory opossum, Monodelphis domestica
Authors: Rainwater David L. , Kammerer Candace M. , Singh Amareshwar T. K. , Moore Perry H. , Poushesh Mahmood , Shelledy Wendy R. , VandeBerg Jane F. , Robinson Edward S. , VandeBerg John L.
Published: March 2003

Introduction  Monodelphis (Monodelphis domestica) shows 20‐fold differences, that may be under genetic control, in individual responses to a high‐fat challenge diet.

Materials and methods

Two partially inbred lines of animals were derived by selectively breeding among high responders and low responders and we analysed data from these pedigreed animals and their F1 progeny. A blood sample was taken from each animal while consuming the basal diet (basal sample). Each animal was then fed a high‐fat, high‐cholesterol challenge diet for 8 weeks prior to collection of a second blood sample (challenge sample). Lipoprotein measurements included cholesterol concentrations of high‐density lipoproteins (HDL‐C) and low‐density lipoproteins (non‐HDL‐C) and particle size phenotypes for both.

Results

Quantitative genetic analyses indicated strong heritabilities (range, 0.382–0.827) for each of the eight traits. We also tested for single genes with large effects on each trait (major genes). Segregation analyses provided evidence of major genes for three traits: basal non‐HDL‐C, challenge non‐HDL‐C, and challenge HDL‐C; no major genes were detected for the lipoprotein size traits. Tests for pleiotropy, using bivariate one‐locus segregation analyses, showed that the major locus for challenge HDL‐C had no effect on the basal HDL‐C and that the major locus for challenge non‐HDL‐C had no effect on basal non‐HDL‐C. However, the major gene for basal non‐HDL‐C did significantly influence challenge non‐HDL‐C.

Conclusion

We have found evidence for at least three genes influencing lipoprotein phenotypes under two dietary regimes. Identification of these genes may provide valuable insights into lipoprotein metabolism in other species, including man.
The freshwater fish of Neogene Africa (Miocene–Pleistocene): systematics and biogeography
Authors: Stewart Kathlyn M
Published: March 2003

While the modern freshwater fish fauna of Africa has been the subject of considerable biological attention, there are few studies on the biogeography that include recent fossil reports. Since the publication of comprehensive reviews of Cenozoic freshwater fish faunas in Africa by Greenwood in the mid 1970s and updates in the late 1970s by Van Couvering, considerable collection and reporting of Cenozoic Africa fish has occurred. These specimens and reports have provided a considerable database from which to derive zoogeographical and biogeographical inferences. A pan‐African fish fauna can be documented at the generic level throughout the Miocene in northern, central and eastern Africa, including Protopterus, Polypterus, Labeo, Alestes/Brycinus, Clarias/Heterobranchus, Synodontis, and Lates. The extinct genus Semlikiichthys (formerly Lates) may also be included in this pan‐African fauna. Where the Miocene fish records were widely distributed through much of the African continent and were primarily fluvial‐derived faunas, the Early Pliocene record is strictly a central and eastern one, mainly from lacustrine deposits. These reflect the new lacustrine habitats created through severe tectonic change, in the form of rifting and volcanism. The Pliocene faunas are characterised both by extinct taxa not previously recorded, and by immigrant taxa. By the Pleistocene the Rift systems were completely formed. However, ongoing volcanism and tectonics continued to alter the hydrological systems. In the Early and Middle Pleistocene, Lakes Albert and Edward both still had the widespread modern genera Lates and Synodontis, and several taxa known from previous deposits. However, all extinct taxa had disappeared, except Sindacharax (Characidae), which was still found in Lake Edward. In the Turkana Basin, there is continuity of most taxa from the Pliocene (except for Semlikiichthys, which is absent), as well as Miocene and Pliocene Sindacharax species. In the Middle Pleistocene, Sindacharax disappears from the African fossil record. Also, in the Pleistocene, several hydrological systems lose their pan‐African faunas, including Lake Edward, Lake Victoria and the Maghreb. The modern faunas are not as diverse at the family level as previously. This history of the Neogene African fish fauna is necessarily incomplete without fossil records from many regions of Africa, particularly in the west and south.
Reconciling sustainability, economic efficiency and equity in fisheries: the one that got away?
Authors: Cochrane Kevern L
Published: March 2003

Concern about the global state of fisheries and fish resources has highlighted the three primary considerations in fisheries management: sustainable utilisation, economic efficiency and equity in access to resources. We appear to be failing in pursuit of all three goals. Living marine resources are particularly threatened by overfishing, leading to many of the world’s fish stocks being heavily, fully or over exploited. Similarly, the economic diagnosis is that costs of fishing exceeded the value of the world’s catch by about US$ 40 billion at the beginning of the decade. Statistics on equity are less available, but the necessary spread of limited access to fisheries frequently has the greatest impact on the small scale, traditional fisher.

This paper considers the reasons underlying the general failure of fisheries management and the solutions that are being proposed. Factors contributing to the problems include high biological uncertainty, conflict between the constraint of sustainability and social and economic priorities, poorly defined objectives, and institutional failures related to access rights and participation in management by the users. These issues point to the real complexity of fisheries management. It is argued that this complexity can be abused by all interest groups to avoid responsibility and to suit their own objectives. It is suggested that there are eight simple principles controlling fisheries management that are generally well‐understood and, if properly considered in fisheries management systems, would lead to improved performances.

Responsible management will, however, only be effective if there is a genuine desire to achieve the objectives. Fishing capacity, frequently reflecting dependency of users on fisheries resources, is commonly in excess of the sustainable production of the resources. Excess dependency can preclude the political will to consider alternative strategies and only once it has been overcome, probably requiring solutions borrowed from outside fisheries, is effective management likely to be considered seriously. Thereafter, responsible management requires setting unambiguous objectives and management measures in co‐operation with users and other interest groups. The agreed strategy must be included in legislation to ensure transparency and accountability and to constrain decision‐makers. The performance of the strategy must be monitored and revised as necessary.
Ecosystem goals can reinvigorate fisheries management, help dispute resolution and encourage public support
Authors: Pitcher Tony J
Published: March 2003

This paper argues that if rebuilding of ecosystems is adopted as the goal for fisheries management, recent disputes over political interference in the scientific process would be reduced in severity through a clarification of objectives and procedures. The use of an ecosystem approach enables alternative end states of current harvesting policy to be evaluated more objectively. Moreover, support from the general public for fisheries policy is likely to be greater when they are given a clear and important role to play as sentinels reporting upon the status of a wide range of organisms in aquatic ecosystems.
The Palaeozoic, Mesozoic and Early Cenozoic fishes of Africa
Authors: Murray A.M.
Published: March 2003

Africa has provided many fossil fishes from sediments laid down over a 400 million year period. The large array of fossil fishes come from diverse localities throughout the continent, representing a variety of environments. The marine fossil fishes of Africa have not been reviewed as a whole, while the freshwater Cenozoic fishes of Africa were last reviewed over 25 years ago. Since that time, many new finds have increased our knowledge of the history of African fishes. This paper summarizes the known fish fossils, excluding otoliths, from marine and freshwater deposits throughout Africa from the Palaeozoic, Mesozoic and first part of the Cenozoic (Palaeogene). Much new work is ongoing, in areas such as Mali and South Africa, from which more information on the ichthyofaunas should come to light. New information presented here includes the Eocene site of Mahenge, Tanzania, from which have come the oldest known members of the family Cichlidae.
Broadbill swordfish: status of established fisheries and lessons for developing fisheries
Authors: Ward P. , Porter J.M. , Elscot S.
Published: March 2003

Guidelines for the assessment and management of developing swordfish fisheries are derived through an examination of five swordfish fisheries. As they develop, swordfish fisheries may be inclined to local depletion around underwater features, such as seamounts and banks. Few nations have applied the precautionary approach in managing their developing swordfish fisheries. Without controls, swordfish fisheries expand geographically and fishing effort increases, often overshooting optimum levels. However, it is difficult to distinguish clear evidence of fishery collapse; modern longliners harvest widely distributed tuna and swordfish and they are able to relocate to distant areas or switch between target species in response to fluctuations in species abundance and price. Furthermore, the wide distribution of swordfish combined with year‐round spawning and high growth rates amongst juveniles probably contribute to the apparent resilience of swordfish stocks to intensive harvesting.

Over half the world’s swordfish catch is taken as an incidental catch of longliners fishing for tuna. In several areas, such as the North Atlantic, catch quotas have sometimes caused tuna longline fishers to discard swordfish. Minimum size limits have also resulted in discarding of swordfish in tuna fisheries and in dedicated swordfish fisheries. In addition to weakening the effectiveness of those management measures, bycatch and discarding add to the complexities of managing swordfish fisheries and to uncertainties in assessing the stocks.

Longliners that target swordfish often fish at high latitudes where interactions with marine wildlife, such as seabird, are generally more frequent than at low latitudes. Concern over incidental catches of marine wildlife and other species is becoming a driving force in the management of several swordfish fisheries. Fishery management organisations will need to implement management measures to protect non‐target species and gather reliable data and information on the situation by placing observers on boats fishing for swordfish.
Anadromy and homing: two life‐history traits with adaptive synergies in salmonid fishes?
Authors: McDowall
Published: March 2003

Anadromy and homing are two traits found widely amongst teleost fishes. They co‐occur in salmonid fishes, and probably also in other fish families. Anadromy provides fish with the opportunity for more rapid growth, larger size, and higher fecundity through the exploitation of rich food resources and favourable growing temperatures in the sea, but may result in higher predation mortalities and has the tendency to disperse stocks very widely. Homing fosters adaptation of stocks to favourable local spawning conditions, but the dispersive effects of anadromy, in the absence of homing, may tend to break down such local adaptation. A low percentage of straying in species that home may have long‐term evolutionary advantages. This paper explores the question of whether homing may be a preadaptation for successful evolution of anadromy, or whether the two attributes have coevolved.
Ecological effects of regime shifts in the Bering Sea and eastern North Pacific Ocean
Authors: Benson Ashleen J , Trites Andrew W
Published: March 2003

Large‐scale shifts occurred in climatic and oceanic conditions in 1925, 1947, 1977, 1989 and possibly 1998. These shifts affected the mix and abundance of suites of coexisting species during each period of relative environmental stability—from primary producers to apex predators. However, the 1989 regime shift was not a simple reversal of the 1977 shift. The regime shifts occurred abruptly and were neither random variations nor simple reversals to the previous conditions. Timing of these anomalous environmental events in the North Pacific Ocean appears to be linked to physical and biological responses in other oceanic regions of the world. Changes in the atmospheric pressure can alter wind patterns that affect oceanic circulation and physical properties such as salinity and depth of the thermocline. This, in turn, affects primary and secondary production. Data from the North Pacific indicate that regime shifts can have opposite effects on species living in different domains, or can affect similar species living within a single domain in opposite ways. Climatic forcing appears to indirectly affect fish and marine mammal populations through changes in the distribution and abundance of their predators and prey. Effects of regime shifts on marine ecosystems are also manifested faster at lower trophic levels. Natural variability in the productivity of fish stocks in association with regime shifts indicates that new approaches to managing fisheries should incorporate climatic as well as fisheries effects.
Seasonal variation in the occurrence of ischemic stroke and subarachnoid hemorrhage in Siberia, Russia. A population‐based study
Authors: Feigin V.L. , Nikitin Y.P.
Published: March 2003

Epidemiological studies on the relationship between stroke occurrence and the seasons in different countries produced inconsistent results and little is known about these associations in a general population. We report a population‐based study of 214 patients with first‐ever ischemic stroke (IS, data for 1992) and 64 patients with first‐ever subarachnoid hemorrhage (SAH) registered in the 25–74 years old population of Oktiabrsky District of Novosibirsk, Russia in 1982–92. IS and SAH incidence in four seasons (winter, spring, summer, autumn) was evaluated by means of a chi‐square test. Poisson regression analysis was used to compute the rate ratios (RRs) and corresponding confidence intervals (CIs) for the occurrence ofIS and SAH in winter, spring, and autumn compared with summer. Seasonal variations in the occurrence of IS were significant for the group of young men (25–64 years) and the group of older women (65–74 years) only. The age and sex adjusted RR of the occurrence of IS in winter was 49% greater than in summer (95%CI 1–119%). When men and women were analyzed separately and the rates were adjusted for age, a significantly higher risk of IS was found only in men (RR = 2.48; 95% CI 1.27–4.83) in spring compared with summer. No seasonality was observed for the occurrence of SAH in both men and women. Our findings indicate that there is a significantly greater incidence of ischemic stroke during winter in Siberia, Russia, whereas the incidence of SAH does not show a seasonal variation.
Seizure occurrence during ovulatory and anovulatory cycles in patients with temporal lobe epilepsy: a prospective study
Authors: Bauer J. , Burr W. , Elger C.E.
Published: March 2003

We investigated the influence of ovulatory and anovulatory menstrual cycles on seizure occurrence in female patients with complex partial seizures. We prospectively documented seizures in relation to menstrual cycles (defined by measurement of basal body temperature and progesterone serum concentrations) in 39 female patients. One hundred and thirty‐two cycles of 35 patients entered final analysis. Only eight patients had anovulatory cycles, in 18 patients all cycles were ovulatory. In the remaining nine patients anovulatory as well as ovulatory cycles were documented. In ovulatory cycles the mean frequency of seizures during the days of menstruation was significantly higher as compared to the periovulatory or the luteal phase of the cycles. During anovulatory cycles seizure frequency was significantly lower during menstruation than in the remaining days of the cycles. Since progesterone is known to exhibit anticonvulsant effects, seizure occurrence during menstruation seems to be related to ovulatory cycles, possibly due to the premenstrual decrease of progesterone. Therapeutic recommendations for the treatment of seizures related to the menstrual cycle (catamenial seizures) include the administration of hormones, as progesterone (recommended especially for women with catamenial epilepsy who have a documented inadequate luteal phase) or the suppression of the menstrual hormonal cycle by synthetic gonadotropin releasing hormone analogs.
Antineuronal antibody‐associated paraneoplastic neuropathy in Hodgkin's disease
Authors: Blaes F. , Strittmatter M. , Schwamborn J. , Heide G. , Hamann G.F. , Merkelbach S. , Schimrigk K.
Published: March 2003

Paraneoplastic neurological syndromes in patients with Hodgkin's disease are rare findings. Subacute, paraneoplastic cerebellar degeneration or autonomic dysfunctions were described before. In some of these cases, autoantibodies against central or peripheral nervous system structures were found in serum and CSF. We present a 30‐year‐old white male who developed a progredient, clinical and electrophysiological distal sensomotoric neuropathy. Six months after the beginning of the neurological disturbances, Hodgkin's disease (Stadium III BE) was diagnosed. Other reasons for neuropathy, such as direct impairment of the peripheral nervous system by tumor masses or drug‐induced neuropathy, were excluded. Cerebrospinal fluid (CSF) analysis showed a mild pleocytosis, elevated total protein (9.8 g/I) and identical oligoclonal bands in serum and CSF. Blood–CSF barrier damage was detected by Reiber formula. Indirect immunofluorescence and western blot analysis demonstrated an autoantibody against peripheral and central nervous system structures in serum and CSF. Although the autoantibody responded to a 38–40 kDa‐protein in western blot and showed nuclear staining of myenteric plexus and Purkinje cell nuclei in the immunofluorescence test, this antibody was shown to be not identical to anti‐Hu. An intrathecal synthesis of the antineuronal antibody was detected by antibody specificity index. Tumor therapy, plasmapheresis and treatment with intravenous immunoglobulins did not improve the neuropathy. According to our knowledge this is the first case of antineuronal antibody‐associated sensomotoric neuropathy in Hodgkin's disease.
Limb shaking in multiple system atrophy
Authors: D'Olhaberriague L. , Horoupian D. , Wenning G.K. , Litvan I.
Published: March 2003

Limb shaking is a form of carotid transient ischemic attack caused by hemodynamic ischemia not usually triggered by orthostatic hypotension. We report a patient who presented with limb shaking during episodes of severe arterial hypotension in the setting of multiple system atrophy. Extreme orthostatic hypotension may result in limb shaking even in absence of relevant arterial occlusive disease.
Immunological and endocrinological disturbances in patients after prolonged coma following head injury
Authors: Formisano R. , Grelli S. , Matteucci C. , Santilli V. , Vinicola V. , Scivoletto G. , Castellano V. , D'Agostini C. , Mastino A. , Favalli C.
Published: March 2003

It has been previously reported that following severe brain damage, a deficit of cellular immunity could be detected in the early phase after the occurence of the lesion. We report here the results of a cross‐sectional study on long term effects of severe brain damage on immunological and neuro‐endocrine changes in patients who recovered from prolonged coma caused by head injury. Results obtained from post‐comatose (PC) patients were compared with those obtained from two control groups made up of spinal‐cord injury (SCI) patients and healthy subjects, respectively. The following parameters were studied: lymphomonocyte subsets; interleukin 2 (IL‐2) production; natural killer (NK) activity and serum levels of adrenocorticotrophic hormone (ACTH), cortisol, follicle‐stimulating hormone (FSH), luteinizing hormone (LH), prolactin, tri‐iodothyronine (T3) and thyroxine (T4). With respect to healthy controls the PC1 subgroup, i.e. patients examined 3–6 months after injury, showed a statistically significant decrease in IL‐2 production, NK activity and CD25+ lymphocytes. Similar immunological disturbances were observed in SCI but not in the PC2 subgroup, i.e. patients examined later than 6 months after injury. The same sub‐group of PC1 patients showed high serum levels of cortisol and PRL. These results could be related to the immunological status and may be interpreted as a transient but prolonged condition of chronic stress or “chronic alarm reaction”.
The platelet serotonin transporter in primary headaches
Authors: Bendtsena L. , Mellerup E.T.
Published: March 2003

Serotonin (5‐HT) plays a major role in the pathophysiology of primary headaches. The presynaptic 5‐HT uptake mechanism, which is important for the regulation of 5‐HT levels in the neuronal synapses, can be examined indirectly by measuring the number of 5‐HT transporters in membranes from platelets. The aim of the present study was to investigate the platelet 5‐HT transport system in patients with primary headache disorders. Bmax, an index of the number of platelet 5‐HT transporters, was measured in 40 patients with chronic tension‐type headache, in 30 patients with migraine without aura, and in 40 healthy controls using a binding analysis with tritiated paroxetine as the ligand. The Bmax was 664 (589–846) (median (quartiles)) fmol/mg protein in patients with tension‐type headache and 662 (534–781) fmol/mg protein in healthy controls, P= 0.40. The Bmax was 675 (558–747) fmol/mg protein in patients with migraine, which was not significantly different from the Bmax in controls, P= 0.94. In conclusion, the present results indicate that the number of platelet 5‐HT transporters is normal in patients with chronic tension‐type headache and in patients with migraine without aura.
Neuropsychological, neuroradiological and clinical findings in multiple sclerosis. A 3 year follow‐up study
Authors: Patti F. , Failla G. , Ciancio M.R. , L'Episcopo M.R. , Reggio A.
Published: March 2003

Cognitive impairment is a frequent feature in multiple sclerosis patients. To assess its evolution in comparison with clinical and neuroradiological evolution, we followed up 57 multiple sclerosis patients over a 3‐year period. During this time EDSS deteriorated significantly but not the MRI lesional load nor the cognitive test performance; nevertheless both at the beginning and at the end of the follow‐up neuropsychological results showed a significant correlation with both EDSS and lesional load. No clinical or paraclinical features could reliably predict neuropsychological evolution.
The histomorphology of the thymus in late onset, non‐thymoma myasthenia gravis
Authors: Myking Andreas O. , Skeie Geir O. , Varhaug Jan E. , Andersen Knut S. , Gilhus Nils E. , Aarli Johan A.
Published: March 2003

Twenty‐two late‐onset, non‐thymoma myasthenia gravis (MG) patients were selected for study based on the combined presence of MG and involution of the thymus. Thymectomy specimens from all the patients were examined histologically and immunohistologically and compared with an age‐matched control group in which tissue was removed from the thymic gland during operations for various cardiac conditions. We were not able to find any morphological differences between thymi from MG patients and patients in the control group. Germinal centres were present in 7/22 in the patient group and 6/20 in the control group. Seven of our 22 MG patients had auto‐antibodies to titin. Germinal centres in the thymus were found in only one. In contrast germinal centres were present in the thymus of 6/15 MG patients with no detectable antibody response to titin (p= 0.01). Our study suggests that late‐onset MG is pathogenetically heterogeneic with different modes of auto‐sensitisation.
Tissue nerve growth factor concentrations in neuromuscular diseases
Authors: Stuerenburg Hans Joerg , Kunze Klaus
Published: March 2003

In order to investigate the possible influences of pathological processes on muscle NGF levels in human subjects, we measured the NGF concentrations in muscle biopsies from 35 male and 16 female subjects (controls, n= 14; amyotrophic lateral sclerosis, n= 20; inflammatory myopathy, n= 6; muscular dystrophy, n= 11). The NGF concentration in each group was as follows: controls, 1.73 ± 0.3 pg/mg protein (mean ± S.E.M.); muscular dystrophies, 1.73 ± 0.48 pg/mg protein; inflammatory myopathies, 2.28 ± 1.45 pg/mg protein; amyotrophic lateral sclerosis, 4.15 ± 0.79 pg/mg protein. The tissue NGF concentrations were significantly (140%) higher in patients with ALS than in the control subjects (P < 0.05, Wilcoxon signed rank test). Age and gender had no influence on tissue NGF concentrations. We conclude that the NGF increases observed here in affected muscle in amyotrophic lateral sclerosis can best be explained in terms of rapidly progressing denervation processes.
Pulmonary arteriovenous fistula and brain abscess
Authors: Velioǧlu Sibel K. , Özmenoǧlu Mehmet , Alioǧlu Zekeriya , Bölükbasl Okan , Arl Nejdet
Published: March 2003

Patients with pulmonary arteriovenous fistulas (PAVFs) are at risk for the development of brain abscesses. The history of a 26‐year‐old man with PAVF, which has remained unrecognized for many years, is reported. Within four years, the patient presented life threatening cerebral abscesses twice at different sites. Treatment consisted of parenteral antibiotics. Finally, the pulmonary arteriovenous fistula has been treated by embolization. This case emphasizes the importance of early diagnosis and treatment of PAVF in preventing central nervous system infections.
The effect of aspirin, ticlopidine and their low‐dose combination on platelet aggregability in acute ischemic stroke: a short duration follow‐up study
Authors: Akyüz Aytekin , Bolayir Ertugrul , Dener Sefik , Topalkara Kamil , Topaktas Suat
Published: March 2003

We investigated the effects of aspirin (300 mg/d), ticlopidine (500 mg/d) and their low‐dose combination (aspirin 100 mg/d plus ticlopidine 250 mg/d) on the platelet aggregability using the Wu and Hoak method. Each treatment group consisted of 25 patients with acute ischemic stroke. Platelet aggregation ratios (PAR) were measured on the 1st (before treatment), 10th and 90th days in the treatment groups and compared with those of 25 control cases. On the first day, comparison of PAR in each treatment group with the control was significant, while the differences between treatment groups were not significant. On the 90th day, differences of PAR between aspirin and control were significant, but differences between the other treatment groups and the control group were not significant, indicating a lower anti‐aggregant efficacy of aspirin.

Our study suggests that PAR determination can be used to assess the efficacy of anti‐aggregant drugs. Our crude observation also suggests a higher anti‐aggregant efficacy of ticlopidine, and aspirin plus ticlopidine, than aspirin. In addition, proper doses of aspirin plus ticlopidine may be a good choice for the prevention of ischemic stroke. Further studies are required to assess whether PAR determination could be useful for assessing patients at risk of stroke, and for drug selection for the prevention of stroke.
A multidisciplinary memory clinic in a neurological setting: diagnostic evaluation of 400 consecutive patients
Authors: Høgh Peter , Waldemar Gunhild , Knudsen Gitte M. , Bruhn Peter , Mortensen Henrik , Wildschiødtz Gordon , Bech Rachid Azeddine , Juhler Marianne , Paulson Olaf B.
Published: March 2003

This report describes the operation of a multidisciplinary university hospital memory clinic in a neurological setting, and the diagnostic evaluations in 400 consecutive patients referred for cognitive symptoms and possible dementia during a period of 27 months (1 September 1995–31 December 1997). The mean age of the patients was 63.6 years (range 19–97). On clinical and neuropsychological examination, 46% of the patients fulfilled DSM IV criteria for dementia, 5% had selective amnesia, and 14% had other selective cognitive deficits. The remaining patients had either no significant cognitive deficits (31%) or were not evaluable (4%). A wide range of disorders from the fields of neurology, psychiatry, neurosurgery and internal medicine were identified as the underlying etiologies for the cognitive symptoms. Potentially reversible conditions were observed in 26% of the patients, not including the 11% in whom no specific underlying disease was identified. Concomitant conditions or risk factors with a potential influence on cognitive functions were identified in 61% of the patients. Diagnostic evaluation of patients with mild to moderate cognitive symptoms and possible dementia is an integrated multidisciplinary task, which should focus on the identification of non‐progressive and potentially reversible etiologies, co‐morbidity, selective cognitive deficits, and rare or atypical neurological conditions, as well as on the early identification of common progressive dementia disorders.