bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic analysis of acd6‐1 reveals complex defense networks and leads to identification of novel defense genes in Arabidopsis
Authors: Lu Hua , Salimian Sasan , Gamelin Emily , Wang Guoying , Fedorowski Jennifer , LaCourse William , Greenberg Jean T.
Published: January 2009

Pathogen infection leads to the activation of defense signaling networks in plants. To study these networks and the relationships between their components, we introduced various defense mutations into acd6‐1, a constitutive gain‐of‐function Arabidopsis mutant that is highly disease resistant. acd6‐1 plants show spontaneous cell death, reduced stature, and accumulate high levels of camalexin (an anti‐fungal compound) and salicylic acid (SA; a signaling molecule). Disruption of several defense genes revealed that in acd6‐1, SA levels/signaling were positively correlated with the degree of disease resistance and defense gene expression. Salicylic acid also modulates the severity of cell death. However, accumulation of camalexin in acd6‐1 is largely unaffected by reducing the level of SA. In addition, acd6‐1 shows ethylene‐ and jasmonic acid‐mediated signaling that is antagonized and therefore masked by the presence of SA. Mutant analysis revealed a new relationship between the signaling components NPR1 and PAD4 and also indicated that multiple defense pathways were required for phenotypes conferred by acd6‐1. In addition, our data confirmed that the size of acd6‐1 was inversely correlated with SA levels/signaling. We exploited this unique feature of acd6‐1 to identify two genes disrupted in acd6‐1 suppressor (sup) mutants: one encodes a known SA biosynthetic component (SID2) and the other encodes an uncharacterized putative metalloprotease (At5g20660). Taken together, acd6‐1 is a powerful tool not only for dissecting defense regulatory networks but also for discovering novel defense genes.
Two Arabidopsis AGC kinases are critical for the polarized growth of pollen tubes
Authors: Zhang Yan , He Junmin , McCormick Sheila
Published: January 2009

Reproduction of flowering plants requires the growth of pollen tubes to deliver immotile sperm for fertilization. Pollen tube growth resembles that of polarized metazoan cells, in that some molecular mechanisms underlying cell polarization and growth are evolutionarily conserved, including the functions of Rho GTPases and the dynamics of the actin cytoskeleton. However, a role for AGC kinases, crucial signaling mediators in polarized metazoan cells, has yet to be shown in pollen tubes. Here we demonstrate that two Arabidopsis AGC kinases are critical for polarized growth of pollen tubes. AGC1.5 and AGC1.7 are pollen‐specific genes expressed during late developmental stages. Pollen tubes of single mutants had no detectable phenotypes during in vitro or in vivo germination, whereas those of double mutants were wider and twisted, due to frequent changes of growth trajectory in vitro. Pollen tubes of the double mutant also had reduced growth and were probably compromised in response to guidance cues in vivo. In the agc1.5 background, downregulation of AGC1.7 using an antisense construct phenocopied the growth defect of double mutant pollen tubes, providing additional support for a redundant function of AGC1.5/1.7 in pollen tube growth. Using the actin marker mouse Talin, we show that pollen tubes of double mutants had relatively unaffected longitudinal actin cables but had ectopic filamentous actin, indicating disturbed control of polarity. Our results demonstrate that AGC1.5 and AGC1.7 are critical components of the internal machinery of the pollen tube leading to polarized growth of pollen tubes.
Weed biology serves practical weed management
Authors: VAN ACKER R C
Published: January 2009

Weed science is an applied science that serves practical weed management. Traditionally, effective weed management has been dependent upon farmers gaining knowledge of the characteristics of the weeds they were managing. The advent of herbicides has not made this knowledge‐based approach redundant and problems, including herbicide resistant weeds, have made weed biology studies necessary even in the herbicide era. Weed populations continue to evolve and weed problems persist, sustaining a requirement for effective management strategies. In this paper, we exhibit several approaches to linking weed biology studies to practical weed management. These approaches demonstrate both the value of and synergy between an in‐depth knowledge of weed biology and weed management practices to provide practical solutions in the field.
Resting energy expenditure in manic episode
Authors: Caliyurt Okan , Altiay Gundeniz
Published: January 2009

Objective:  We aimed to assess the resting energy expenditure in bipolar I disorder, manic episode patients.

Method:  Forty‐two bipolar I disorder, manic episode patients that were treated in the inpatient psychiatry clinic of Trakya University Hospital and had met the necessary study criteria were included along with 27 controls. DSM‐IV criteria and the Bech‐Rafaelsen Mania Rating Scale were used to evaluate patients’ diagnosis and severity of the manic episodes. The indirect calorimetry device was used to measure resting energy expenditure values.

Results:  Resting energy expenditure values of manic patients were found to be higher than those of the controls. Controls showed significant correlations between body mass index and resting energy expenditure, but manic patients did not exhibit similar correlations. There was also no relation between Bech‐Rafaelsen Mania Rating Scale scores and resting energy expenditure values in manic patients.

Conclusions:  We found significantly increased resting energy expenditure values in bipolar I disorder, manic episode patients. These findings suggest a possible clinical use of resting energy expenditure for evaluation of bipolar I disorder manic episode and also suggest resting energy expenditure as a possible biological marker.
Polarity at illness onset in bipolar I disorder and clinical course of illness
Authors: Forty Liz , Jones Lisa , Jones Ian , Smith Daniel J , Caesar Sian , Fraser Christine , Gordon‐Smith Katherine , Hyde Sally , Craddock Nick
Published: January 2009

Objectives:  Studies have suggested that episode polarity at illness onset in bipolar disorder may be predictive of some aspects of lifetime clinical characteristics. We here examine this possibility in a large, well‐characterized sample of patients with bipolar I disorder.

Methods:  We assessed polarity at onset in patients with bipolar I disorder (N = 553) recruited as part of our ongoing studies of affective disorders. Lifetime clinical characteristics of illness were compared in patients who had a depressive episode at first illness onset (n = 343) and patients who had a manic episode at first illness onset (n = 210).

Results:  Several lifetime clinical features differed between patients according to the polarity of their onset episode of illness. A logistic regression analysis showed that the lifetime clinical features significantly associated with a depressive episode at illness onset in our sample were: an earlier age at illness onset; a predominantly depressive polarity during the lifetime; more frequent and more severe depressive episodes; and less prominent lifetime psychotic features.

Conclusions:  Knowledge of pole of onset may help the clinician in providing prognostic information and management advice to an individual with bipolar disorder.
Conceptualizing impulsivity and risk taking in bipolar disorder: importance of history of alcohol abuse
Authors: Kathleen Holmes M , Bearden Carrie E , Barguil Marcela , Fonseca Manoela , Serap Monkul E , Nery Fabiano G , Soares Jair C , Mintz Jim , Glahn David C
Published: January 2009

Background:  Elevated levels of impulsivity and increased risk taking are thought to be core features of both bipolar disorder (BD) and addictive disorders. Given the high rates of comorbid alcohol abuse in BD, alcohol addiction may exacerbate impulsive behavior and risk‐taking propensity in BD. Here we examine multiple dimensions of impulsivity and risk taking, using cognitive tasks and self‐report measures, in BD patients with and without a history of alcohol abuse.

Methods:  Thirty‐one BD subjects with a prior history of alcohol abuse or dependence (BD‐A), 24 BD subjects with no history of alcohol abuse/dependence (BD‐N), and 25 healthy control subjects (HC) were assessed with the Barratt Impulsiveness Scale (BIS) and the computerized Balloon Analogue Risk Task (BART).

Results:  Both BD groups scored significantly higher than controls on the BIS. In contrast, only the BD‐A group showed impaired performance on the BART. BD‐A subjects popped significantly more balloons than the BD‐N and HC groups. In addition, subjects in the BD‐A group failed to adjust their performance after popping balloons. Severity of mood symptomatology was not associated with performance on either task.

Discussion:  The current study supports a primary role of prior alcohol abuse in risk‐taking propensity among patients with bipolar disorder. In addition, findings suggest that impulsivity and risky behavior, as operationalized by self‐report and experimental cognitive probes, respectively, are separable constructs that tap distinct aspects of the bipolar phenotype.
Characterizing impulsivity in mania
Authors: Strakowski Stephen M , Fleck David E , DelBello Melissa P , Adler Caleb M , Shear Paula K , McElroy Susan L , Keck Paul E , Moss Quinton , Cerullo Michael A , Kotwal Renu , Arndt Stephan
Published: January 2009

Objective:  To determine whether specific aspects of impulsivity (response disinhibition, inability to delay gratification, inattention) differ between healthy and bipolar manic subjects, and whether these aspects of impulsivity were associated with each other and severity of affective symptoms.

Methods:  Performance of 70 bipolar I manic or mixed patients was compared to that of 34 healthy subjects on three tasks specifically designed to study response inhibition, ability to delay gratification, and attention; namely, a stop signal task, a delayed reward task, and a continuous performance task, respectively. Correlations among tasks and with symptom ratings were also performed.

Results:  Bipolar subjects demonstrated significant deficits on all three tasks as compared to healthy subjects. Performance on the three tasks was largely independent. Task performance was not significantly associated with the severity of affective symptom ratings. However, measures of response inhibition and attention were sensitive to medication effects. Differences in the delayed reward task were independent of medication effects or symptom ratings. During the delayed reward task, although bipolar patients made their choices more slowly than healthy subjects, they were significantly more likely to choose a smaller, but more quickly obtained reward. Moreover, performance on this task was not associated with performance on the other impulsivity measures. Manic patients showed more impulsive responding than mixed patients.

Conclusions:  Bipolar I manic patients demonstrate deficits on tests of various aspects of impulsivity as compared to healthy subjects. Some of these differences between groups may be mediated by medication effects. Findings suggested that inability to delay gratification (i.e., delayed reward task) was not simply a result of the speed of decision making or inattention, but rather that it reflected differences between bipolar and healthy subjects in the valuation of reward relative to delay.
Comparison of manic and depressive symptoms between children and adolescents with bipolar spectrum disorders
Authors: Birmaher Boris , Axelson David , Strober Michael , Gill Mary Kay , Yang Mei , Ryan Neal , Goldstein Benjamin , Hunt Jeffrey , Esposito‐Smythers Christianne , Iyengar Satish , Goldstein Tina , Chiapetta Laurel , Keller Martin , Leonard Henrietta
Published: January 2009

Objective:  To compare the most severe lifetime (current or past) mood symptoms, duration of illness, and rates of lifetime comorbid disorders among youth with bipolar spectrum disorders [BP (bipolar‐I, bipolar‐II and bipolar–not otherwise specified)].

Methods:  A total of 173 children (<12 years) with BP, 101 adolescents with childhood‐onset BP, and 90 adolescents with adolescent‐onset BP were evaluated with standardized instruments.

Results:  Depression was the most common initial and frequent episode for both adolescent groups, followed by mania/hypomania. Adolescents with childhood‐onset BP had the longest illness, followed by children and then adolescents with adolescent‐onset BP. Adjusting for sex, socioeconomic status, and duration of illness, while manic, both adolescent groups showed more ‘typical’ and severe manic symptoms. Mood lability was more frequent in childhood‐onset and adolescents with early‐onset BP. While depressed, both adolescent groups showed more severe depressive symptoms, higher rates of melancholic and atypical symptoms, and suicide attempts than children. Depressed children had more severe irritability than depressed adolescents. Early BP onset was associated with attention‐deficit hyperactivity disorder, whereas later BP onset was associated with panic, conduct, and substance use disorders. Above‐noted results were similar when each BP subtype was analyzed separately.

Conclusions:  Older age was associated with more severe and typical mood symptomatology. However, there were differences and similarities in type, intensity, and frequency of BP symptoms and comorbid disorders related to age of onset and duration of BP and level of psychosocial development. These factors and the normal difficulties youth have expressing and modulating their emotions may explain existing complexities in diagnosing and treating BP in youth, particular in young children, and suggest the need for developmentally sensitive treatments.
FUNDING EXTERNALITIES, ASSET PRICES AND INVESTORS' ‘SEARCH FOR YIELD’
Authors: Gai Prasanna , Trivedi Kamakshya
Published: January 2009

This note presents a simple model that nests the ‘excess liquidity’ and ‘savings glut’ hypotheses of the debate on the recent asset price boom. It clarifies the notion of investors' ‘search for yield’ and shows how financial frictions influence asset price dynamics.
BUSINESS FAILURES AND MACROECONOMIC FACTORS IN THE UK
Authors: Liu Jia
Published: January 2009

We examine the interactions between business failures and macroeconomic aggregates, and specifically the accounts of policy‐induced changes in the macroeconomy for the observed fluctuations of UK business failures in the period 1966–2003 using the vector error‐correction model (VECM). The results demonstrate that macroeconomic aggregates, i.e., interest rate, credit, profits, inflation and business births, exert differential impacts on business failures both in the short run and in the long run. The study reveals that structural changes in the financial and real sectors during the examined period have made an impact on the way in which the macroeconomy affects business failures. In particular, business failures are increasingly reacting to monetary policy changes in the post‐1980 period. Furthermore, the shocks to business failures can generate large fluctuations in macroeconomic aggregates, suggesting the importance of corporate balance sheets in financial stability and economic growth. The paper's findings carry policy implications that are related to the survival of firms in distress and finance‐driven business cycles.
Second Generation of Active Structural Control in Civil Engineering
Authors: Housner G. W. , Soong T. T. , Masri S. F.
Published: January 2009

Abstract: Research and development in active control of civil engineering structures in the United States has approximately a 20‐year history. Under the leadership of the U.S. National Science Foundation in forming the U.S. Panel on Structural Control Research and in launching a program initiative in the area of structural control, there has been a surge of interest in this research field. Recent progress in active control research in the United States is first summarized in this paper. In the second part, an attempt is made to identify areas of research needs and to recommend future directions for the next generation of active control activities in civil engineering.
Theoretical Perspectives on European Governance
Authors: Jachtenfuchs Markus
Published: January 2009

Abstract:The paper reviews some theories of social science which could contribute to the development of a concept of European governance going beyond traditional notions, such as federal states' or ‘international organisation’. The theoretical argument is based on the culturalist version of neo‐institutionalism, which stresses the role of ideas in the functioning and transformation of a political order. It is claimed that both globalisation and functional differentiation transform existing nation‐states and shape the emerging European polity. European governance is characterised as poly‐centric and non‐hierarchical. Finally, different approaches to the legitimation of such a polity are discussed. The paper comes to the conclusion that the emergence of a European political order is part of a process which could require a rethinking of basic social scientific concepts.
The Collective Labour Law of the European Union
Authors: Bercusson Brian
Published: January 2009

Abstract: The collective labour law of the European Union is embedded in a variety of legal measures incorporating principles of collective labour law reflecting national experience. The dynamic of its development has been the spill‐over effect of these principles, through their translation into the status of EU law, and their development by decisions of the European Court of Justice. The article outlines a framework of principles which, it is argued, are currently embodied in the collective labour law of the EU. They include collectively bargained labour standards, workers' collective representation, workers' participation, and protection of strikers against dismissal. In addition, there is a parallel principle of collective solidarity emerging in the social security law of the EU. The principle of collective negotiation of labour law introduced by the Protocol and Agreement on Social Policy may be seen as the founding constitutional basis for the collective labour law of the European Union.
Independent Agencies: Hierarchy Beaters?
Authors: Everson Michelle
Published: January 2009

Abstract: The business of modern government is efficient policy‐formation, regulation and implementation. In common with conventional Governments, the European Union may be facing a serious mismatch between the increasingly specialised functions of government and the administrative instruments at its disposal. Arguably, independent European Agencies might aid in combatting this mismatch, and in establishing efficient administration. Article 4 of the Treaty of Rome seems severely to curtail the possible use of independent agencies within Europe. Nevertheless, American constitutional experience may yet serve to demonstrate how this barrier might be overcome in the European setting: the development of novel and flexible means of governmental oversight might secure the independence of European agencies, whilst at the same time laying renewed emphasis upon traditional ‘constitutional’ principles such as the control of power and public accountability.
Codification of EC Administrative Procedures? Fitting the Foot to the Shoe or the Shoe to the Foot
Authors: Harlow Carol
Published: January 2009

Abstract:There are two basic models of EC Administrative Process: Direct, where the procedures are carried out by the Commission and Indirect, where Member States act as agents for the Community. In the first case, the development of general principles to structure the procedures has to date been undertaken by the ECJ. The problem posed by indirect administration, governed by the National Principles of Administrative Law, is one of variable standards. For different reasons, both models raise the question whether EC administrative procedures should be codified. This article contrasts two styles of codification found in the Member States: the first, a short statement of general principles, favoured by the Council of Europe and resembling the standards set out in the jurisprudence of the ECJ; the second, a detailed codification typified by the German Administrative Procedures Code. The author concludes that the first method may be more appropriate for the EC.
The European Agency for the Evaluation of Medicines and European Regulation of Pharmaceuticals
Authors: Gardner John S.
Published: January 2009

Abstract: The new European Agency for the Evaluation of Medicinal Products is the focus of the EC's new regulatory framework for approval of pharmaceuticals for human and veterinary use. This article considers past efforts at European pharmaceutical regulation, discusses the new ‘centralised’ and ‘decentralised’ procedures, and offers a functional analysis of the new system. It addresses European regulation of biotechnology, including Parliament's 1995 rejection of the proposed biotechnology directive using its codecision powers. It also reviews European case law and suggests that the Court of Justice's decision in Keck provides a useful way to analyse pharmaceuticals' place in the free movement of goods. While the new framework will likely improve approval of pharmaceuticals and over time lead to greater centralisation of the process, Member States will still retain some autonomy over the actual use of approved drugs, particularly through their continued control of conditions of reimbursement in national health systems.
Intergovernmental Conference 1996: Which Constitution For The Union?
Authors: Nentwich Michael , Falkner Gerda
Published: January 2009

Abstract: This paper addresses the five major structural issues on the agenda of the 1996 Intergovernmental Conference of the Member States of the European Union: the option of replacing the treaty framework by a European constitution; the issue of fundamental rights in the Union; the future of the three‐pillar structure; the puzzling question of how to allow for variations in European integration without endangering unity; and, finally, the political ‘evergreen’ of the division of competences between the Union and its Member States. The analysis is based on contributions by EC institutions and prominent groups of experts and scholars published before the political bargaining started.
Dismantling or Strengthening Labour Law: The Case of the European Court of Justice
Authors: Simitis Spiros
Published: January 2009

Abstract: The European Court of Justice is increasingly accused of dismantling labour law. The unusually sharp criticism is mainly motivated by four determining, though concealed reasons. First, the fact that many decisions address conflicts familiar to national law which are however largely repressed in the national context; second, the crisis of the national labour markets and the ensuing attempts to fence them off from the consequences of advancing integration; third, the inconsistent policies of a Union caught between the prevailing orientation towards a distinctly economic Community and the demands of a slowly progressing political Union; and fourth, the Union's difficulties to meet its own claims. As a result, the Court of Justice is more and more distracted from its judicial role and forced into a regulatory function. Hence, it is important to recall that a consistent integration process inevitably requires abandoning national regulations and creating a growing body of common rules intended to realise the common objectives. Further, the Union must more than ever attempt to correct its structural deficiencies and lay down fundamental rights, both in order to give direction to its regulatory interventions, and to limit them. Finally, the time has come for a clear specialisation of the European Court of Justice itself, as well as a systematic review of the conditions governing preliminary rulings, in order to avoid any further instrumen‐talisation of the Court for the solution ofinternal conflicts of the Member States.
The Many Meanings of Equality and Positive Action in Favour of Women under European Community Law ‐ A Conceptual Analysis
Authors: Peters Anne
Published: January 2009

Abstract: The principle of equality of men and women as understood by Community institutions covers four distinguishable aspects. The first is equal treatment, defined in Community texts as the absence of legal gender discrimination. This concept focuses on individual rights and does not take into account the social context in which rules function. Second, the Community seeks to realise equal opportunities, understood as factual equality of chances. Third, Community law displays a concern for factually equal outcomes. The institutions accept legally different treatment that seeks to equalise unequal living conditions and inversely admit that facially neutral rules can have discriminatory effects. Finally, various documents conceive of gender equality as equal representation of the sexes in professional and public life. In the Kalanke decision of October 1995, the Court for the first time dealt with quotas in favour of women. It held that a national provision granting female candidates an automatic preference is incompatible with the right to equal treatment. The Court failed to acknowledge the tensions that arise from the coexistence of paradigms. An awareness of the multiplicity of concepts of equality, exhibited in Community law and rooted in the common constitutional heritage of the Member States, is however a prerequisite for a more sophisticated discussion of the issue of positive action.
Francovich and the Problem of the Disobedient State
Authors: Harlow Carol
Published: January 2009

Abstract: This paper is an attempt to evaluate the rapidly expanding line of jurisprudence which derives from Francovich and Bonifaci v Italian Republic (Cases 6, 9190). The paper argues that there is a serious mismatch between the priorities of the EC and national legal orders and that the impact of the superior order on national legal systems may be both unexpected and detrimental. Section I argues: that the theoretical underpinnings for state liability in EC law are in fact weak and raise objections of principle; that ‘infection’ of national liability systems by the new principle is both inevitable and problematic; and that damage may be caused to the EC liability system through ‘cross‐infection’. Section II argues that in the modern state, balance between the Rule of Law doctrine and principles of political and democratie supremacy are both hard to attain and inevitably the subject of controversy. This problem is heightened within the Community by the existence of competing legislative systems, lack of clarity over sovereignty and worries over democratic deficit. The contribution of Francovich to the resolution of these problems is largely negative.
Motive Unmasked: The European Court of Justice, the Free Movement of Goods, and the Search for Legitimacy
Authors: Friedbacher Todd J.
Published: January 2009

Abstract: In exempting from scrutiny under Article 30 EC certain measures constituting ‘selling arrangements’, the author examines whether the European Court of Justice in Keck and Mithouard and its progeny sought more than mere clarification of its jurisprudence on the free movement of goods. To wit, he claims that the Court was motivated by a sense of waning faith in its institutional legitimacy, initiating in Keck an attempt to more vigorously police the Community‐Member State jurisdictional divide in favour of Member State prerogatives, banishing the Community judicial and legislative branches from the realm of ‘selling arrangements’. After critical assessment of this hypothesis and of the Court's success, a final section queries whether the ECJ has adopted similar strategies in the Competition law and services realms.
Ex Pluribus Unum: Fusion of the European Communities into the European Union
Authors: von Bogdandy Armin , Nettesheim Martin
Published: January 2009

Abstract:This article presents the main legal approaches used in constructing the relationships between the TEU, TEC, TEAC and TECSC and the institutions set up by them. It argues that the dominant approaches which separate the European Union from the European Communities run into serious difficulties when explaining the normative framework and the actual practice of the EU institutions. In contrast, the proposed ‘unity thesis’ asserts that de lege lata the European Union can be considered one entity from the point of view of the organisation, its actions and its law, The article develops in detail the legal premises and some of the consequences of this thesis.
Efficacy of fixed low‐dose isotretinoin (20 mg, alternate days) with topical clindamycin gel in moderately severe acne vulgaris
Authors: Sardana K , Garg VK , Sehgal VN , Mahajan S , Bhushan P
Published: January 2009

Background  In view of the potentially serious side‐effects of standard isotretinoin (0.5–1.0 mg/kg per day) therapy for acne, we studied the safety and efficacy of low‐fixed dose isotretinoin plus topical 1%clindamycin gel in the treatment of moderate grade of acne.

Methods  In this prospective, non‐comparative study, 320 adult patients, with moderately severe acne were enrolled and treated with fixed‐dose isotretinoin at 20 mg every alternate day (approximately 0.15 mg/kg/day to 0.28 mg/kg/day) for 6 months along with topical clindamycin gel. All female patients were assessed for polycystic ovarian disease. Patients were followed up for 6 months.

Results  A total of 305 patients completed the study. Overall, patients received a mean of 38.4 mg/kg cumulative dose of isotretinoin, and very good results were observed in 208 (68.20%), while good response was seen in 59 (19.34%) of patients. Failure of the treatment occurred in 38 (12.46%), while relapses occurred in 50 (16.39%) of patients. Relapses were commoner in females, and 37 of 43 (86.04%) patients had polycystic ovarian disease. Though mild chelitis (91%) and xerosis (43%) were common, laboratory abnormalities in the form of elevated hepatic enzymes (5%) and elevated serum lipids (6%) were rare.

Conclusion  Six months of treatment with fixed‐dose, alternate‐day isotretinoin (20 mg) plus topical 1%clindamycin gel was found to be effective in the treatment of moderate acne in adult patients, with a low incidence of side‐effects.

Conflicts of interest

None declared
Recommendations for the management of “febrile seizures” Ad hoc Task Force of LICE Guidelines Commission
Authors: Capovilla Giuseppe , Mastrangelo Massimo , Romeo Antonino , Vigevano Federico
Published: January 2009

Febrile seizures are the most common seizure disorder in childhood, affecting 2–5% of children. Simple febrile seizure is defined as a short (<15 min) generalized seizure, not recurring within 24 h, that occurs during a febrile illness not resulting from an acute disease of the nervous system in a child aged between 6 months and 5 years, with no neurologic deficits and no previous afebrile seizures. These recommendations address the instructions for management of the first febrile seizures, giving criteria for hospital admission, diagnosis, differential diagnosis, and treatment of a prolonged seizure. The authors stressed the benign prognosis of the majority of cases and the risk factors for recurrence of febrile seizures and appearance of epilepsy later on. Both continuous and intermittent anticonvulsant therapy are efficacious in preventing single febrile seizures, but side effects may be so important to overcome the benefits. These treatments are indicated in very selected patients.
Italian Consensus Conference on Epilepsy and Pregnancy, Labor and Puerperium
Authors: Aguglia Umberto , Barboni Giancarlo , Battino Dina , Battista Cavazzuti Giovan , Citernesi Angela , Corosu Roberto , Maria Guzzetta Francesco , Iannetti Paola , Mamoli Daniela , Patella Alfredo , Pavone Lorenzo , Perucca Emilio , Primiero Francesco , Pruna Dario , Savasta Salvatore , Specchio Luigi Maria , Verrotti Alberto
Published: January 2009

To facilitate an integrated and rational approach to the care of women with epilepsy of childbearing potential, a group of experts appointed by Italian scientific societies in the fields of epileptology, neonatology, pediatrics, neuropediatrics, child neuropsychiatry, obstetrics, and gynecology held a joint meeting in Santa Trada di Cannitello, Reggio Calabria, Italy, on October 15–16, 2004, with the aim of reaching consensus on the optimal management of these women. An ad hoc system for the classification of available published evidence and the opinions of experts was developed and used to grade recommendations on different aspects related to counseling, diagnostic, and treatment issues. The present document summarizes available evidence on the reciprocal interactions between epilepsy, antiepileptic drugs, fertility, contraception, pregnancy, delivery, breastfeeding, and the offspring. Recommendations are made concerning the information and counseling that should be provided to women with epilepsy with respect to issues related to contraception, conception, pregnancy, labour, and puerperium. More detailed recommendations on the same issues are provided to physicians and other healthcare professionals involved in the care of these women, with special reference to choice of effective contraception, optimization of antiepileptic drug therapy, use of prenatal diagnostic tests and other monitoring procedures, and appropriate management practices in relation to childbirth, puerperium, and the care of the child.
Epilepsy and postpartum depression
Authors: Turner Katherine , Piazzini Ada , Franza Albertina , Marconi Anna Maria , Canger Raffaele , Canevini Maria Paola
Published: January 2009

Purpose:  Postpartum depression occurs in 10–20% of women who have recently given birth, but less than half of cases are recognized. The purpose of this study was to examine whether there was a difference in the rate of postpartum depression between patients with epilepsy and healthy controls, and to determine the relationship between epilepsy and postpartum depression.

Methods:  The sample consisted of 55 patients with epilepsy and 55 patients without epilepsy. All patients were recruited at the Regional Epilepsy Center and at the Department of Obstetrics and Gynecology, University of Milan, St. Paolo Hospital (Italy). Every woman was assessed with the Edinburgh Postnatal Depression Scale and a clinical interview to screen for postpartum depression.

Results:  We found a statistically significant higher rate of postpartum depression in patients with epilepsy compared with controls (p < 0.05).

Discussion:  These findings highlight the importance of screening for postpartum depression; it can improve the recognition of the disorder and can provide adequate treatment and follow‐up.
Changes in sex steroid levels in women with epilepsy on treatment: Relationship with antiepileptic therapies and seizure frequency
Authors: Galimberti Carlo Andrea , Magri Flavia , Copello Francesco , Arbasino Carla , Chytiris Spyridon , Casu Massimo , Ameri Pietro , Perucca Piero , Murialdo Giovanni
Published: January 2009

Purpose:  Reproductive dysfunction in epilepsy is attributed to the seizures themselves and also to antiepileptic drugs (AEDs), which affect steroid production, binding, and metabolism. In turn, neuroactive steroids may influence neuronal excitability. A previous study in this cohort of consecutive women with epilepsy showed that patients with more frequent seizures had higher cortisol and lower dehydroepiandrosterone sulfate levels than those with rare or absent seizures. The present study was aimed at evaluating, in these same women, the possible relationship between some clinical parameters, seizure frequency, AED therapies, and sex hormone levels.

Methods:  Estradiol (E2), progesterone (Pg), sex hormone‐binding globulin (SHBG), and free estrogen index (FEI) were measured during the luteal phase in 113 consecutive females, 16–47 years old, with different epilepsy syndromes on enzyme‐inducing AED (EIAED) and/or non–enzyme‐inducing AED (NEIAED) treatments, and in 30 age‐matched healthy women. Hormonal data were correlated with clinical parameters (age, epilepsy syndrome, disease onset, and duration), seizure frequency assessed on the basis of a seizure frequency score (SFS), and AED therapies.

Results:  E2, Pg, and FEI were lower, whereas SHBG levels were higher in the epilepsy patients than in the controls. However, sex steroid and SHBG levels were not different between groups of patients categorized according to SFS. Therapies with EIAEDs accounted for changes in E2 levels and FEI.

Conclusions:  Despite globally decreased sex steroid levels in serum, actual hormone titers were not significantly correlated with SFS in consecutive epilepsy women; rather, these hormonal changes were explained by AED treatments, mainly when EIAED polytherapies were given.
Incidence of epilepsy in extremely low‐birthweight infants (<1,000 g): A population study of central and southern Sardinia
Authors: Falchi Melania , Palmas Giuliana , Pisano Tiziana , Meloni Marta , Gaspa Giorgio , Puddu Melania , De Martinis Mattia , Fanos Vassilios , Cianchetti Carlo , Pruna Dario
Published: January 2009

Purpose:  With the development of intensive care, the survival of extremely low‐birthweight (ELBW) infants (<1,000 g) has greatly improved. The aim of our study was to report the incidence of epilepsy after a follow‐up of >7 years in a population of ELBW children, born in central and southern Sardinia between 1991 and 2000.

Methods:  We analyzed data of 104 children. All infants had had serial cranial ultrasound echography (CUE) in the neonatal period and some also had magnetic resonance imaging (MRI). At last follow‐up we evaluated the occurrence of epilepsy through a review of clinical charts and a structured telephone interview.

Results:  In 11 (10.6%) of 104 of children we observed febrile seizures (FS). Epilepsy occurred in 9 (8.6%) of 104 ELBW children, and in these patients a frequent positive family history for epilepsy and/or FS was present. In four epilepsy patients CUE was highly pathologic, showing intraventricular hemorrhage (IVH) of grade IV and in two mildly abnormal (IVH of grade I–II). In three additional children with normal neonatal ultrasound scan, a later magnetic resonance imaging (MRI) study revealed lesions related to neonatal insult.

Discussion:  In our ELBW population, epilepsy had an incidence clearly superior to that expected in infancy (8.6% vs. 0.6–0.8%). A frequent positive familiar history for epilepsy and/or FS suggests that a genetic predisposition may also play a role. Subjects with highly abnormal CUE are a subgroup with high risk for seizures; however, epilepsy can occur even with normal CUE.
Prognostic factors in patients with mesial temporal lobe epilepsy
Authors: Pittau Francesca , Bisulli Francesca , Mai Roberto , Fares Jean Elia , Vignatelli Luca , Labate Angelo , Naldi Ilaria , Avoni Patrizia , Parmeggiani Antonia , Santucci Margherita , Capannelli Diana , Di Vito Lidia , Gambardella Antonio , Baruzzi Agostino , Tinuper Paolo
Published: January 2009

Purpose:  To disclose clinical, electrophysiologic, and neuroradiologic factors correlated to prognosis in patients with mesial temporal lobe epilepsy (MTLE).

Methods:  One hundred thirty‐six MTLE patients were studied for family history, clinical characteristics, instrumental data [electroencephalography (EEG), video‐EEG, neuroimaging], and outcome. The population was divided into drug‐resistant (DR: 108 patients, 79.4%) and non–drug‐resistant (NDR: 28 patients, 20.6%) groups; all variables were analyzed in the two groups.

Results:  The comparison between the two groups shows a relation between resistance to therapy and febrile seizures (FS) (DR 43.5% vs. NDR 17.8%, p = 0.008), mesial temporal sclerosis (MTS) (DR 64.8% vs. NDR 32.1%, p = 0.0025), early age at seizure onset (DR 23.1% vs. NDR 3.6% p = 0.0160), and epileptiform interictal abnormalities (DR 89.7% vs. NDR 68%, p = 0.010). FS were more frequent in patients with MTS than in patients without (46.28% vs. 26.3%, p = 0.0199). Sixty‐nine patients underwent surgery and 85.3% of them had a good outcome.

Conclusion:  MTLE is a heterogeneous syndrome. Establishing the factors responsible for and associated with drug resistance is important for therapeutic purposes, as prompt diagnosis of drug resistance must lead to early surgical management. This study shows that FS, MTS, early age at seizure onset, and epileptiform interictal abnormalities are negative prognostic factors and that FS are related to MTS.
Neurosteroids and epileptogenesis in the pilocarpine model: Evidence for a relationship between P450scc induction and length of the latent period
Authors: Biagini Giuseppe , Longo Daniela , Baldelli Enrica , Zoli Michele , Rogawski Michael A. , Bertazzoni Giuliano , Avoli Massimo
Published: January 2009

Purpose:  Cytochrome P450 cholesterol side‐chain cleavage enzyme (P450scc) catalyzes the initial step in the biosynthesis of neurosteroids within the brain. We sought to determine which cells express P450cc and whether neurosteroids play a role in the regulation of epileptogenesis following pilocarpine‐induced status epilepticus (SE).

Methods:  Rats experienced uninterrupted SE or SE terminated with diazepam at 60, 120, and 180 min. P450scc induction in CA3 hippocampus was determined by double immunolabeling with P450scc antiserum and monoclonal antibodies against GFAP (astrocytes), RIP (oligodendrocytes), or heme oxygenase‐1 (microglia).

Results:  SE was associated with P450scc induction in many astrocytes and a small number of microglia and oligodendrocytes in the hippocampal CA3 strata radiatum and lacunosum‐moleculare. The extent of P450scc induction increased with increasing SE duration. Paradoxically, increased P450scc induction in rats experiencing SE for 180 min or more was associated with the delayed onset of spontaneous recurrent seizures. Treatment with the 5α‐reductase inhibitor finasteride (100 mg/kg/day for 25 days), which inhibits the synthesis of γ‐aminobutyric acid (GABA)A receptor modulating neurosteroids such as allopregnanolone, was associated with a significant reduction in time to the onset of spontaneous seizures in rats exposed to 180‐min but not 90‐min SE.

Discussion:  P450scc is induced by SE in a diverse population of hippocampal glia. Induction of P450scc is associated with the delayed onset of spontaneous seizures. Conversely, inhibition of neurosteroid synthesis accelerated the onset of spontaneous seizures, but only in animals exhibiting significant increases in P450scc. These findings suggest that induction of neurosteroid synthesis in reactive glial cells is associated with delayed onset of spontaneously recurrent seizures.
Lack of α1b‐adrenergic receptor protects against epileptic seizures
Authors: Pizzanelli Chiara , Lazzeri Gloria , Fulceri Federica , Giorgi Filippo S. , Pasquali Livia , Cifelli Giuseppe , Murri Luigi , Fornai Francesco
Published: January 2009

Purpose:  The role of α1b‐adrenergic receptor (α1b‐AR) in relation with neuronal degeneration, drug addiction, and seizure susceptibility has recently emerged. In particular, mice that overexpress α1b‐AR undergo spontaneous epileptic seizures and progressive neuronal loss in a variety of brain areas. Therefore, one should expect that the blockade of α1b‐AR leads to anticonvulsant and neuroprotective effects. However, the lack of α1b‐AR antagonists does not allow testing of this hypothesis.

Methods:  The development of α1b‐AR knockout (KO) mice led us to measure seizure susceptibility and neurodegeneration following systemic excitotoxins in these mice.

Results:  We found that α1b‐AR KO mice are markedly resistant to kainate‐ and pilocarpine‐induced seizures. Moreover, when marked seizure duration and severity are obtained by doubling the dose of chemoconvulsants in α1b‐AR KO, neuronal degeneration never occurs.

Conclusions:  These data indicate that α1b‐AR per se plays a fundamental role in the mechanisms responsible for seizure onset, severity, and duration, whereas the brain damage observed in α1b‐AR–overexpressing mice is likely to be a secondary phenomenon. In fact, the absence of α1b‐AR confers resistance to neurotoxicity induced by seizures/chemoconvulsants. These data, although confirming a pivotal role of α1b‐AR in modulating seizure threshold and neuronal death, offer a novel target, which may be used to develop novel anticonvulsants and neuroprotective agents.
Autologous platelet concentrates for bone graft enhancement in sinus lift procedure
Authors: Bettega Georges , Brun Jean‐Pierre , Boutonnat Jean , Cracowski Jean‐Luc , Quesada Jean‐Louis , Hegelhofer Harald , Drillat Philippe , Richard Marie Jeanne
Published: January 2009

BACKGROUND: Autologous platelet (PLT)‐rich plasma has been reported in some studies to promote osteogenesis. The goal of this study was to demonstrate that osteogenesis gained by mixing autologous PLT concentrates (APCs) with a small quantity of autologous bone graft could give a sufficient quality to lead to dental implant placement. The second goal was to compare this osteogenesis with that obtained by a traditional method (iliac bone graft), through clinical, radiologic, and histologic methods.

STUDY DESIGN AND METHODS: Eighteen patients needing bilateral sinus floor augmentation were enrolled. One sinus was grafted with iliac crest bone alone, and the other sinus with a small quantity of bone and APC. Panoramic view, computed tomography scan, and biopsies were performed 6 months after the initial surgery to compare ossification.

RESULTS: The adjunction of APCs permitted a 60 percent reduction of bone graft required for sinus floor elevation. The bone obtained with APCs had the same histologic and mechanical characteristics as the bone obtained by traditional graft.

CONCLUSION: Topical use of APCs might be helpful in bone reconstruction. No clinical, radiologic, or histologic osteogenesis inhibition of high PLT concentration was observed. The resulting osteogenesis was adapted to dental implant placements.
Reassessment of deferrals for tattooing and piercing
Authors: Goldman Mindy , Xi Guoliang , Yi Qi‐Long , Fan Wenli , O'Brien Sheila F.
Published: January 2009

BACKGROUND: In August 2005, the Canadian Blood Services decreased the deferral period for tattooing and ear or body piercing from 12 to 6 months. This study assessed the impact of this change on blood safety and availability.

STUDY DESIGN AND METHODS: The prevalence of these activities was assessed on an anonymous mail‐out survey of 40,000 recent donors. Transmissible disease (TD) marker rates were calculated using the National Epidemiology Donor Database. A case‐control study was performed comparing risk factors in TD‐positive donors with matched controls. Donor deferral rates were assessed before and after the change in deferral period.

RESULTS: The prevalence rates of tattoo, ear piercing, and body piercing were 13.7, 53.6, and 10.4 percent in survey respondents, respectively, with up to 0.7 percent of activity likely to represent deferrable risk. TD marker rate was low and stable at 21.6 per 100,000 donations before and 19.2 per 100,000 donations after the change in deferral length. Remote tattoo was associated with hepatitis C virus (HCV) risk (odds ratio, 5.43; 95% confidence interval, 1.82‐16.2), but neither recent tattoo nor piercing was a risk factor for HCV or hepatitis B virus. Shortening of the deferral period reduced deferrals by 20 percent for tattoo and 32 percent for piercing.

CONCLUSION: There was no measurable adverse effect on safety and a positive but less than expected effect on blood availability after shortening the deferral period for tattoo and piercing. The length of other temporary deferrals should be reassessed, since their current contribution to blood safety may be negligible.