bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of poverty on the prevalence of diabetes and its complications in urban southern India
Authors: Ramachandran A. , Snehalatha C. , Vijay V. , King H.
Published: March 2003

Aim The impact of poverty on the profile of diabetes and its complications was studied.

Methods A comparative study of low income group (LIG) (family income Rs. < 30 000/annum (approx. £432) and high income group (HIG) (family income Rs. ≥ 60 000/annum (approx. £864) subjects of ≥ 40 years was done in Madras, India. By screening 1748 LIG subjects (M/W 844/904) 301 diabetic subjects were identified and 218 underwent tests for diabetic complications. Population data available in 635 (M/W 309/326) HIG subjects from the survey were used for comparison of glucose tolerance profile. Complications were studied in 221 diabetic HIG subjects.

Results Age‐standardized prevalences of diabetes (12.6% vs. 25.5%; χ2 = 56.9, P < 0.0001) and impaired glucose tolerance (IGT) (8.9% vs. 19.0%) were significantly lower (χ2 = 57.7; P < 0.0001) in the LIG. Hypertension was more common in LIG (53.7% vs. 40.0% in HIG; χ2 = 34.9; P < 0.0001). LIG subjects were more physically active; 73.8% did not go to school. Parameters significantly associated with diabetes were body mass index (BMI), age, higher income, waist–hip ratio and physical inactivity. Higher income, BMI and age were associated with IGT. Diabetic LIG subjects had a higher prevalence of cardiac disease, neuropathy and cataract and a lower prevalence of retinopathy than HIG subjects. The risk variables such as hyperglycaemia, dyslipidaemia, hypertension, smoking and alcohol consumption were more in the LIG group.

Conclusions The urban poor in the developing world has a lower prevalence of diabetes than the urban poor in developed societies. However, they have higher rates of complications of diabetes.
Coefficient of failure: a methodology for examining longitudinal β‐cell function in Type 2 diabetes
Authors: T. M. Wallace , D. R. Matthews
Published: March 2003

Aims We describe a new method, the determination of the coefficient of failure, which allows the assessment of β‐cell failure from any index of glycaemia. Previous methods using glycaemic thresholds and calculating time‐to‐failure have systematic deficiencies relating to bias, reproducibility and statistical power. Analyses using threshold methodologies and conventional survival analysis have an intrinsic disadvantage in that they use categorical data and thus make no allowance for near‐failure, or progression towards failure. In contrast, the coefficient of failure includes all data in the analysis and takes into account improvement of glycaemia as well as deterioration of glycaemia.

Methods We describe the use of a ‘coefficient of failure’ defined as the slope of the least‐squares regression line of a glycaemic index vs. time calculated for each individual patient on constant monotherapy. We exemplify the method using HbA1c levels from data from patients on chlorpropamide (n = 64) or glibenclamide (n = 65) monotherapy in the Oxford cohort of the UKPDS.

Results Chlorpropamide‐treated patients showed a mean coefficient of failure of 0.34 HbA1c%/year (0.44%/year sd) and glibenclamide‐treated patients 0.50 HbA1c%/year (0.50%/year sd) (P = 0.046; unpaired two‐tailed t‐test). Kolmogorov–Smirnov testing demonstrated that the coefficients did not differ significantly from a normal distribution (chlorpropamide P = 0.12; glibenclamide P = 0.13).

Conclusions The coefficient of failure gives an estimate of β‐cell failure using any index of glycaemia. The coefficient is not constrained by predetermined glycaemic thresholds for failure and it allows the rate of decline in β‐cell function to be determined on any therapy or combination of therapies.
Age of onset possibly associated with the degree of heteroplasmy in two male siblings with diabetes mellitus having an A to G transition at 3243 of mitochondrial DNA
Authors: Kato Y. , Miura Y. , Inagaki A. , Itatsu T. , Oiso Y.
Published: March 2003

We describe two male siblings with diabetes mellitus caused by mitochondrial 3243 mutation. The level of heteroplasmy in peripheral blood leucocytes was determined by a last‐cycle hot PCR method. The younger brother, who had 39% heteroplasmy, developed diabetes at age of 25, and demonstrated a lean body habitus and blunted insulin secretion. The elder brother, who had 22% heteroplasmy, was diagnosed at the age of 42. The younger brother showed a higher increment of serum lactate after exercise. In these siblings the level of heteroplasmy in their peripheral blood leucocytes appeared to be associated with age of onset of diabetes.
A randomized control trial of the effect of negotiated telephone support on glycaemic control in young people with Type 1 diabetes
Authors: Howells L. , Wilson A. C. , Skinner T. C. , Newton R. , Morris A. D. , Greene S. A.
Published: March 2003

Aim To evaluate changes in self‐efficacy for self‐management in young people with Type 1 diabetes participating in a ‘Negotiated Telephone Support’ (NTS) intervention developed using the principles of problem solving and social learning theory.

Methods One‐year RCT with 79 young people (male 39; mean age ± sd 16.5 ± 3.2 years, duration 6.7 ± 4.4 years, HbA1c 8.6 ± 1.5%) randomized into: Group 1 (control group), continued routine management, n = 28; Group 2, continued routine management with NTS, n = 25; Group 3, annual clinic with NTS, n = 26. Outcome measures: HbA1c, self‐efficacy, barriers to adherence, problem solving, and diabetes knowledge.

Results There were no differences between the groups at baseline. Participants in Groups 2 and 3 received an average of 16 telephone calls/year (range 5–19), median duration 9 min (2–30), with a median interval of 3 weeks (1–24) between calls. Significant correlations were found between age and average length of call (r = 0.44, P < 0.01) and frequency of contact (r = 0.36, P < 0.05). Social and school topics were discussed frequently. After 1 year, while the participants in the two intervention groups showed significant improvements in self‐efficacy (P = 0.035), there was no difference in glycaemic control in the three groups. Barriers to insulin use adherence were a significant predictor of HbA1c (P < 0.001) after controlling for baseline.

Conclusions NTS is an effective medium to deliver a simple theory‐based psychological intervention to enhance self‐efficacy for diabetes self‐management. Reduced clinic attendance, combined with NTS, did not result in a deterioration of HbA1c. Intensive personal support needs to be combined with intensive diabetes therapy to improve glycaemic control in this age group.

Diabet. Med. 19, 643–648 (2002)
Increasing prevalence of diabetes mellitus in Oman
Authors: Al‐Lawati J. A. , Al Riyami A. M. , Mohammed A. J. , Jousilahti P.
Published: March 2003

Aims To determine the prevalence of diabetes mellitus and impairedfasting glucose by age, gender, and by region and compare resultswith the 1991 survey; and estimate previously undiagnosed diabetesmellitus in the Omani population.

Methods Cross‐sectional survey containing a probability random sample of5838 Omani adults aged ≥ 20 years. Diabetesand impaired fasting glucose (IFG) were assessed by fasting venous plasmaglucose using 1999 World Health Organization's diagnosticcriteria (normoglycaemia < 6.1 mmol/l, IFG ≥ 6.1 but < 7 mmol/l,and diabetes ≥ 7 mmol/l). The 1991 surveywas reanalysed using the same diagnostic criteria, and results werecompared.

Results In 2000, the age‐adjusted prevalence of diabetes among Omanis aged30–64 years reached 16.1% (95% confidenceinterval (CI) 14.7–17.4) compared with 12.2% (95% CI11.0–13.4) in 1991. IFG was found among 7.1% (95% CI6.2–8.1) of males and 5.1% (95% CI 4.4–6.0)of females. Generally, diabetes was more common in urban then ruralregions. Only one‐third of diabetic subjects knew that they haddiabetes. Nearly half of the study population had a body mass index > 25 kg/m2.

Conclusions The prevalence of diabetes is high in Oman and has increasedover the past decade. The high rate of abnormal fasting glucosetogether with high rates of overweight and obesity in the population makeit likely that diabetes will continue to be a major health problem inOman. Primary prevention programmes are urgently needed to counteract majorrisk factors that promote the development of diabetes.

Diabet. Med. 19, 954–957 (2002)
Acute effect of orlistat on post‐prandial lipaemia and free fatty acids in overweight patients with Type 2 diabetes mellitus
Authors: Tan K. C. B. , Tso A. W. K. , Tam S. C. F. , Pang R. W. C. , Lam K. S. L.
Published: March 2003

Aims Post‐prandial lipaemia is prolonged and exaggerated in patients with Type 2 diabetes mellitus, with an accumulation of atherogenic triglyceride‐rich lipoprotein remnants. We postulate that orlistat, a gastrointestinal lipase inhibitor, may cause changes in post‐prandial lipoprotein metabolism by reducing dietary triglyceride absorption.

Methods The acute effect of a single dose of 120 mg orlistat on post‐prandial glucose, lipids, remnant lipoproteins and free fatty acids (FFA) was evaluated in a randomized, double‐blind, placebo‐controlled cross‐over study of 63 overweight patients with Type 2 diabetes mellitus (body mass index 30.4 ± 3.8 kg/m2). Either a single dose of orlistat or placebo was given before a standard mixed meal containing 70 g of fat and plasma triglyceride (TG), remnant‐like particles cholesterol (RLP‐C) and FFA were sampled at 2‐h intervals for 8 h. RLP‐C was measured by an immunoseparation assay and FFA by an enzymatic colorimetric method.

Results The concentrations of plasma TG (P < 0.0001), RLP‐C (P = 0.003), and FFA (P < 0.0001) were significantly lower at 2 h after orlistat compared with placebo. Both plasma RLP‐C (P = 0.04) and FFA (P < 0.0001) remained lower after orlistat than placebo at 4 h. The incremental area under the curve (iAUC) above baseline fasting level for both TG and RLP‐C was significantly more reduced after orlistat than placebo (iAUC‐TG 5.8 (3.7–8.2) mmol/l × h−1 vs. 5.7 (4.1–10.9), respectively, P = 0.04; iAUC‐RLP‐C: 0.53 (0.23–1.04) mmol/l × h−1 vs. 0.56 (0.35–1.40), respectively, P = 0.02). The test meal was well tolerated by all subjects, with only three subjects reporting faecal urgency after orlistat.

Conclusions Orlistat has a beneficial effect on post‐prandial lipaemia in overweight Type 2 diabetic patients and lowers plasma TG, RLP‐C and FFA in the early post‐prandial period.

Diabet. Med. 19, 944–948 (2002)
Geographic variation in reef‐fish assemblages along the Brazilian coast
Authors: Floeter Sergio R. , Guimarães Ricardo Z. P. , Rocha Luiz A. , Ferreira Carlos Eduardo L. , Rangel Carlos A. , Gasparini João Luiz
Published: March 2003

The species composition of reef‐fish assemblages from nine Brazilian major coastal sites and four oceanic islands are compared. Canonical correspondence analysis (CCA) was utilized to identify groups of sites based on similarity of composition, and to correlate environmental trends with such groups. Five distinct groups of sites were recognized: (1) the South and South‐eastern coastal reefs (from Guarapari Islands to Santa Catarina, the southernmost Brazilian reefs); (2) the North‐eastern coast (extending from the Manuel Luis Reefs to Abrolhos Archipelago); (3) Trindade Island; (4) Fernando de Noronha and Atol das Rocas; and (5) St Paul’s Rocks. Water temperature, coral richness, distance from mainland, primary production and shelf width strongly correlated with the diversity and composition of the reef sites.
Modern pollen samples from alpine vegetation on the Tibetan Plateau
Authors: Yu Ge , Tang Lingyu , Yang Xiangdong , Ke Xiankun , Harrison Sandy P.
Published: March 2003

A set of 316 modern surface pollen samples, sampling all the alpine vegetation types that occur on the Tibetan Plateau, has been compiled and analysed. Between 82 and 92% of the pollen present in these samples is derived from only 28 major taxa. These 28 taxa include examples of both tree (AP) and herb (NAP) pollen types.

 Most of the modern surface pollen samples accurately reflect the composition of the modern vegetation in the sampling region. However, airborne dust‐trap pollen samples do not provide a reliable assessment of the modern vegetation. Dust‐trap samples contain much higher percentages of tree pollen than non‐dust‐trap samples, and many of the taxa present are exotic. In the extremely windy environments of the Tibetan Plateau, contamination of dust‐trap samples by long‐distance transport of exotic pollen is a serious problem.

 The most characteristic vegetation types present on the Tibetan Plateau are alpine meadows, steppe and desert. Non‐arboreal pollen (NAP) therefore dominates the pollen samples in most regions. Percentages of arboreal pollen (AP) are high in samples from the southern and eastern Tibetan Plateau, where alpine forests are an important component of the vegetation. The relative importance of forest and non‐forest vegetation across the Plateau clearly follows climatic gradients: forests occur on the southern and eastern margins of the Plateau, supported by the penetration of moisture‐bearing airmasses associated with the Indian and Pacific summer monsoons; open, treeless vegetation is dominant in the interior and northern margins of the Plateau, far from these moisture sources.

 The different types of non‐forest vegetation are characterized by different modern pollen assemblages. Thus, alpine deserts are characterized by high percentages of Chenopodiaceae and Artemisia, with Ephedra and Nitraria. Alpine meadows are characterized by high percentages of Cyperaceae and Artemisia, with Ranunculaceae and Polygonaceae. Alpine steppe is characterized by high abundances of Artemisia, with Compositae, Cruciferae and Chenopodiaceae. Although Artemisia is a common component of all non‐forest vegetation types on the Tibetan Plateau, the presence of other taxa makes it possible to discriminate between the different vegetation types.

 The good agreement between modern vegetation and modern surface pollen samples across the Tibetan Plateau provides a measure of the reliability of using pollen data to reconstruct past vegetation patterns in non‐forested areas.
Above‐ground biomass estimation in closed canopy Neotropical forests using lidar remote sensing: factors affecting the generality of relationships
Authors: Drake Jason B. , Knox Robert G. , Dubayah Ralph O. , Clark David B. , Condit Richard , Blair J. Bryan , Hofton Michelle
Published: March 2003

AimPrevious studies have developed strong, site‐specific relationships between canopy metrics from lidar (light detecting and ranging) remote sensing data and forest structural characteristics such as above‐ground biomass (AGBM), but the generality of these relationships is unknown. In this study, we examine the generality of relationships between lidar metrics and forest structural characteristics, including AGBM, from two study areas in Central America with different precipitation patterns.

LocationA series of tropical moist forest sites in Panama and a tropical wet forest in Costa Rica.

MethodsCanopy metrics (e.g. canopy height) were calculated from airborne lidar data. Basal area, mean stem diameter and AGBM were calculated from measurements taken as a part of ongoing forest dynamics studies in both areas. We examined the generality of relationship between lidar metrics and forest structure, and possible environmental effects (e.g. leaf phenology).

ResultsWe found that lidar metrics were strongly correlated (R2: 0.65–0.92) with mean stem diameter, basal area and AGBM in both regions. We also show that the relationships differed between these regions. Deciduousness of canopy trees in the tropical moist forest area accounted for the differences in predictive equations for stem diameter and basal area. The relationships between lidar metrics and AGBM, however, remained significantly different between the two study areas even after adjusting for leaf drop. We attribute this to significant differences in the underlying allometric relationships between stem diameter and AGBM in tropical wet and moist forests.

ConclusionsImportant forest structural characteristics can be estimated reliably across a variety of conditions sampled in these closed‐canopy tropical forests. Environmental factors such as drought deciduousness have an important influence on these relationships. Future efforts should continue to examine climatic factors that may influence the generality of the relationships between lidar metrics and forest structural characteristics and assess more rigorously the generality of field‐derived allometric relationships.
Land use and cover with intensity of agriculture for Canada from satellite and census data
Authors: Kerr Jeremy T. , Cihlar Josef
Published: March 2003

Aim To develop the first national databases on land use and agricultural land use intensity in Canada for a wide variety of environmental monitoring applications.

Location Canada.

Methods In this paper, we describe a new system for the construction of both land use and land use intensity (within agricultural regions) called LUCIA (land use and cover with intensity of agriculture). Our methodology combines the highly detailed Canadian Census of Agriculture and recent growing season composites derived from the SPOT4/VEGETATION sensor. Census data are of much coarser resolution than the remotely sensed data but, by removing non‐agricultural pixels from each census sampling area, we were able to refine the census data sufficiently to allow their use as ground truth data in some areas. The ‘refined’ census data were then used in the final step of an unsupervised classification of the remotely sensed data.

Results and main conclusions The results of the land use classification are generally consistent with the input census data, indicating that the LUCIA output reflects actual land use trends as determined by national census information. Land use intensity, defined as the principal component of census variables that relate to agricultural inputs and outputs (e.g. chemical inputs, fertilizer inputs and manure outputs), is highest in the periphery of the great plains region of central Canada but is also very high in southern Ontario and Québec.
The genetic characteristics of the osteoporosis phenotype
Authors: MacGregor A. J.
Published: March 2003

Osteoporosis fits well into the category of complex disease with multiple genes and environmental factors likely to be involved in its development. The osteoporosis phenotype itself comprises a number of component parts, aspects of which are captured differently by a range of different clinical and laboratory measurements. This review discusses the nature of the genetic factors that underlie this complex phenotype and considers approaches that take into account this complexity in modelling the effects of specific genes.
The genetics of type 2 diabetes: the consequences of complexity
Authors: McCarthy Mark
Published: March 2003

Type 2 diabetes affects a significant proportion of the World’s population and shows strong familial association. A richer molecular understanding of the aetiological mechanisms is a prerequisite for the development of improved therapeutic and preventative options to ameliorate the burden of disease. The genome‐scale analyses now possible should allow the major susceptibility genes for type 2 diabetes to be identified, provided due respect is paid to the inevitable complexities associated with the genetic analysis of multifactorial traits.
A test for linkage and association in general pedigrees
Authors: Kaplan Norman L. , Monks Stephanie A. , Martin Eden R.
Published: March 2003

Family‐based tests of linkage disequilibrium are usually based on nuclear family data including affected individuals and their parents or their unaffected siblings. A problem with these tests is that they are not valid tests of association when data from related nuclear families from larger pedigrees are used. One way to ensure validity when testing for association is to select a single nuclear family from each extended pedigree in the sample. When data are available for larger pedigrees, it would be desirable to have a valid test of linkage disequilibrium that can use all potentially informative data. In this paper we present such a test: the Pedigree Disequilibrium Test (PDT). The PDT can use data from related nuclear families from extended pedigrees and remains valid when there is population substructure. Power simulations demonstrate that, when extended pedigree data are available, gains in power can be obtained by using the PDT rather than existing methods that only use a subset of the data. The PDT can also be more powerful than current methods when the data consist of a sample of independent nuclear families or sibships.
The power of genome‐wide sib pair linkage scans for quantitative trait loci using the new Haseman–Elston regression method
Authors: Sham P. C. , Zhao J. H.
Published: March 2003

Power calculations for linkage analysis are typically conducted on the assumption of a single locus that affects the trait. Here we report a simple procedure for conducting a power analysis for a genome‐wide linkage scan of a quantitative trait under the influence of multiple loci. This procedure is designed for sib pair data analysed by the new Haseman–Elston regression method. The results show that samples as large as 10 000 sib pairs will often not allow quantitative trait loci (QTLs) to be clearly identified. Instead, linkage genome scan using sib pairs must be regarded as a blunt screening tool that will help to focus attention to 10%, or more, of the genome.
Physical mapping of the MEGF1 gene, human homologue of the Drosophila tumour suppressor gene fat, to the critical region of the 5q‐syndrome
Authors: Fidler Carrie , Nakayama Manabu , Jabs Ethylin Wang , Cheng Jan‐Fang , Strickson Amanda , Ohara Osamu , Wainscoat James S. , Boultwood Jacqueline
Published: March 2003

Introduction  The 5q‐syndrome is a myelodysplastic syndrome with the 5q deletion as the sole karyotypic abnormality. The MEGF1 gene is the human homologue of the Drosophilafat tumour suppressor gene.

Results  We have mapped this gene to the 3 Mb critical region of the 5q‐syndrome within 5q31–32, using gene dosage analysis. Fine physical mapping of the MEGF1 gene within this genomic interval was then performed by screening YAC and BAC contigs spanning the critical region using PCR amplification. The MEGF1 gene maps between the genes for SPARC and Annexin‐6 at 5q32, and is flanked by the genetic markers D5S2146 and D5S2077. We have demonstrated the expression of MEGF1 in a range of haematological tissues using RT‐PCR analysis.

Discussion  Genomic localization, expression and predicted function would suggest that the MEGF1 gene represents a candidate gene for the 5q‐syndrome.
Assigning individual fish to populations using microsatellite DNA markers
Authors: Hansen Michael M. , Kenchington Ellen , Nielsen Einar E.
Published: March 2003

New statistical developments combined with the use of highly polymorphic microsatellite DNA markers enable the determination of the population of origin of single fish, resulting in numerous new research possibilities and applications in practical management of fish populations. We first describe three main categories of methods available, i.e. (i) assignment tests and related methods, (ii) discriminant function analysis and (iii) artificial neural networks. In all these, individuals can be assigned to the population from which their multilocus genotypes are most likely to be derived. Assignment tests are based on calculations of the likelihood of multilocus genotypes in populations, based on allele frequencies. Discriminant function analysis is based on multivariate statistics, whereas artificial neural networks formulate predictions through exposure to correct solutions. Assignment tests are the methods of choice when considering genetic data alone, whereas discriminant function analysis and artificial neural networks may be useful when genetic data are combined with, for instance, morphological and ecological data. Assignment tests can be used to assess the genetic distinctness of populations, for discriminating among closely related species and to directly identify immigrants or individuals of immigrant ancestry, and thereby study patterns of dispersal among populations, including sex‐biased dispersal. In a conservation context, assignment tests can be used to assess the genetic impact of domesticated fish on wild populations and for determining if extant fish populations are in fact indigenous or descendants from stocked fish or strayers, and they can be applied in forensics, for instance to reveal poaching. Assignment tests are at present most useful for studies of freshwater and anadromous fishes owing to stronger genetic differentiation among populations than in marine fishes. However, some genetically divergent populations of marine fishes have been discovered, which could be used as natural laboratories for studying dispersal and gene flow. It is foreseen that ongoing developments in statistical methods, combined with improved techniques for screening large numbers of loci, will permit assignment methods to become standard tools in studies on the biology of fishes.
A new role for MSY in single‐species and ecosystem approaches to fisheries stock assessment and management
Authors: Mace
Published: March 2003

In 1977, Peter Larkin published his now‐famous paper, ‘An epitaph for the concept of maximum sustained yield’. Larkin criticized the concept of single‐species maximum sustained yield (MSY) for many reasons, including the possibility that it may not guard against recruitment failure, and the impossibility of maximising sustainable yields for all species simultaneously. However, in recent years, there has been a fundamental change in the perception of the fishing mortality associated with MSY (FMSY) as a limit to be avoided rather than a target that can routinely be exceeded. The concept of FMSY as a limit is embodied in several United Nations Food and Agriculture Organization (FAO) agreements and guidelines, and has now been incorporated into the US Magnuson–Stevens Fishery Conservation and Management Act. As a result, the United States now requires the development of overfishing definitions based on biological reference points that treat the FMSY as a limit reference point and must also define a lower limit on biomass below which rebuilding plans with strict time horizons must be developed. This represents a major paradigm shift from the previously mandated (but often unachieved) objective to simply maintain fishing mortalities at levels below those associated with recruitment overfishing. In many cases, it requires substantial reductions in current fishing mortality levels. Therefore, the necessity of the new paradigm is continually questioned. This paper draws on examples from several fisheries, but specifically focuses on the recent US experience illustrating the practical difficulties of reducing fishing mortality to levels below those corresponding to MSY. However, several studies suggest that even more substantial reductions in fishing mortality may be necessary if ecosystem considerations, such as multispecies interactions, maintenance of biodiversity and genetic diversity, and reduction of bycatch and waste, are taken into account. The pros and cons of moving beyond single‐species assessment and management are discussed. A US plan for improving stock assessments indicates that even a ‘basic’ objective such as ‘adequate baseline monitoring of all managed species’ may be extremely costly. Thus, the suggestion of Larkin (1983, 1997) that the costs of research and management should not exceed 10–20% of the landed value of the catch may preclude comprehensive ecosystem management. More importantly, neither single‐species nor ecosystem‐based fisheries management is likely to improve appreciably unless levels of fishing capacity are aligned with resource productivity, as is currently being promoted by FAO and several individual nations.
The management and outcome of patients with myasthenia gravis treated acutely in a neurological intensive care unit
Authors: O'Riordan J.I. , Miller D.H. , Mottershead J.P. , Hirsch N.P. , Howard R.S.
Published: March 2003

The management and clinical course of patients with myasthenia gravis admitted to a neurological intensive therapy unit (ITU) over a 66 month period were reviewed. Twenty‐seven patients were admitted in myasthenic crisis, eight of whom had multiple admissions. One patient had a cholinergic crisis and a further patient an acute myocardial infarction. A specific aetiological factor precipitating myasthenic crisis was identified in 19 instances: infection (8), reduction in medication (5), menstruation (4), and steroid administration (2). Thirteen patients with crisis had had a previous thymectomy, six with thymoma. Twenty‐three out of 35 (66%) patients admitted in crisis required intubation; nine subsequently needed a tracheostomy. Twenty‐nine patients received plasma exchange and seven intravenous immunoglobulin. Four patients in myasthenic crisis died in ITU [adult respiratory distress syndrome (1), disseminated intravascular coagulation and cytomegalovirus (CMV) pneumonitis (1), cardiac failure (1) and multiple organ failure (1)]. Appropriate management of myasthenia gravis requires the easy availability of specialised neuro‐intensive care facilities.
Stroke following internal carotid artery occlusion — a contra‐indication for intravenous thrombolysis?
Authors: Rudolf Jobst , Neveling Michael , Grond Martin , Schmülling Susanne , Stenzel Christoph , Heiss Wolf‐Dieter
Published: March 2003

Between March 1996 and December 1997, 15 consecutive patients with carotid artery occlusion diagnosed with duplex sonography were treated with intravenous recombinant tissue plasminogen activator (rt‐PA), following a protocol similar to that of the National Institute of Neurological Disorders and Stroke (NINDS) study. On the basis of ultrasound findings, six of the 15 patients had internal carotid artery dissection (ICD), and the remaining nine had atherothrombotic internal carotid artery (ICA) occlusion. No relevant haemorrhagic complications were observed after rt‐PA treatment of ICA occlusion. Excellent late functional outcome was observed in three of the 15 patients with ICA occlusion, moderate and poor outcome in four patients. Four patients died, and mortality was related to stroke severity upon admission. A good outcome seemed to be more likely in the small group of patients with ICD, than in the patients suffering atherothrombotic ICA occlusion.

As the results of rt‐PA treatment in this case series are by no means devastating, our data do not corroborate the hypothesis that patients with acute ischemic stroke following ICA occlusion should a priori be excluded from intravenous thrombolysis. The possible benefit of rt‐PA treatment in stroke following acute or chronic ICA occlusion should be assessed in a larger prospective trial, for which this case series might serve as a pilot study.
Apolipoprotein E phenotypes in demented and cognitively impaired patients with and without cerebrovascular disease
Authors: Traykov Latchezar , Rigaud Anne‐Sophie , Caputo Ludovica , Couderc Remy , Coste Joël , Michot Jean‐Luc , de Rotrou Jocelyne , Amouyel Philippe , Forette Françoise , Boller François
Published: March 2003

Controversy exists regarding the apolipoprotein E (ApoE) ɛ4 allele association with vascular dementia (VaD), ranging from increased ɛ4 frequency, similar to that found for Alzheimer's disease (AD), to no association between the ɛ4 allele and VaD. To clarify further the relationship between ApoE alleles polymorphism and cerebrovascular disease (CVD) in demented and cognitively impaired patients, we examined the ApoE phenotypes in a sample of 280 patients: 155 with AD, 21 with VaD, 32 with mixed dementia (MD), 45 with mild cognitive impairment (MCI) but without CVD, and 27 in which vascular disease was the most probable cause of cognitive decline [vascular mild cognitive impairment (VMCI)]. Our results show that the frequency of the ApoE ɛ4 allele in patients over 70 years old with clinically diagnosed VaD and VMCI does not differ significantly from that of controls. In contrast, ApoE ɛ4 allele‐bearing individuals had greater risk of having late‐onset AD (OR=8.8; 95% Cl 3.7–21.0), or non‐vascular cognitive impairment (OR=7.0; 95% Cl 2.5–19.0).
Magnetically evoked motor potentials in demyelinating and axonal polyneuropathy: a comparative study
Authors: Takada H. , Ravnborg M.
Published: March 2003

We investigated the value of magnetically evoked motor potentials (MEPs) for the differentiation of demyelinating and axonal polyneuropathies. The study population comprised 107 patients, with polyneuropathy verified by electromyography (EMG) and nerve conduction study (NCS), who had also been examined by means of MEP. MEPs were evoked by magnetic stimulation of the cortex and the spinal roots and were recorded from three upper limb muscles and two lower limb muscles bilaterally. From the EMG/NCS results 53 patients were characterized as having primary demyelination (demyelinating patients) and 54 as having axonal involvement (axonal patients). Demyelinating patients were classified as acute (acute inflammatory demyelinating polyradiculoneuropathy: AIDP ) or chronic (chronic inflammatory demyelinating polyradiculoneuropathy: CIDP ) according to the duration of illness. A series of indices were calculated from MEP results. One demyelinating patient and two axonal patients had normal MEPs. The MEPs of the demyelinating patients showed significantly longer peripheral conduction times, larger interside differences and lower amplitudes than the axonal patients. The central conduction index and the amplitudes upon cortical stimulation were significantly higher in patients with CIDP than in those with AIDP. Peripheral conduction time prolonged by more than 85% in at least one of the 10 muscles studied or a peripheral conduction index of above 9.4 were pathognomonic for demyelination . By combining all criteria 75% of the patients could be categorized as CIDP vs. AIDP in accordance with the EMG/NCS diagnosis. Likewise, 83% were categorized correctly as demyelinating versus axonal according to the EMG/NCS data.
Are there any unique epidemiological and vascular risk factors for ischaemic strokes that occur in the morning hours?
Authors: Gur A. Y. , Bornstein N. M.
Published: March 2003

It is now accepted that the incidence of ischaemic stroke is significantly increased in the morning. Any attempts to prevent its occurrence must be based on determining the mechanisms, special risk factors and appropriate protective measures needed during this vulnerable period. We studied the epidemiological features of morning stroke and reviewed the records of 2312 consecutive patients recorded prospectively in the Tel Aviv Stroke Register. Information about time of stroke onset was obtained from the patient, family members or other observers. The study parameters of age, sex, vascular distribution (carotid versus vertebrobasilar), ischaemic heart disease, myocardial infarction, diabetes mellitus, arterial hypertension, smoking, hyperlipidaemia, stroke severity and recurrence were compared between patients with morning stroke and those with stroke occurring at other times. In 599 patients (34%) stroke occurred between 06:00 and 10:00 h. No evaluated parameter was found to be statistically different among the morning stroke patients compared with stroke occurring at other times (P < 0.2). Patients with arterial hypertension and ischaemic heart disease and male patients had a greater likelihood of stroke occurrence between 22:00 and 02:00 h (P < 0.05). Our data suggest that none of the common vascular risk factors could explain the morning peak of stroke occurrence. The next step in the quest for understanding the phenomenon of circadian variation is to identify other physiological factors and the effects of pharmacological agents in morning stroke protection.
Evidence‐based pharmacological treatment of dementia
Authors: Emre M. , Hanaĝası H. A.
Published: March 2003

The current literature on the pharmacological treatment of dementia was reviewed and the strength of evidence for the efficacy of each drug was categorized using an evidence‐based approach. Acetylcholinesterase‐inhibitors represent the only category of drugs with consistently demonstrable efficacy in well‐designed studies of Alzheimer’s disease, although the effect is not large. There is a lack of prospective, controlled, randomized studies for most of the nootropics. Epidemiological evidence suggests prophylactic effects of oestrogens and anti‐inflammatory agents, and a single large‐scale trial suggests that long‐term administration of vitamin E or selegiline may be associated with improved outcome in patients with Alzheimer’s disease. A number of drugs were reported to be effective in the treatment of non‐cognitive symptoms of dementia including classical and atypical neuroleptics, antidepressants and anticonvulsants. The evidence for efficacy, however, is not strong for the majority of these compounds.
Complex regional pain syndrome with selective emotional sudomotor failure
Authors: Julu P. O. O. , McCarron M. O. , Hansen S. , Job H. , Jamal G. A. , Ballantyne J. P.
Published: March 2003

We report a patient with sympathetically maintained pain following a mild limb injury. Only emotional sudomotor failure was found in the painful limb. Thermoregulatory vasomotor function was intact. However, the patient had other target‐specific sympathetic lesions, including thermoregulatory vasomotor failure in a different limb, not associated with pain. We hypothesize that the sympathetic failure preceded the symptoms and that the mild injury may have provoked collateral sprouting of emotional sudomotor fibres, coupling them with somatic sensory fibres to cause continuous pain.
Acute isolated cerebral mucormycosis in a patient with high grade  non‐Hodgkins lymphoma
Authors: Zarei M. , Morris J. , Aachi V. , Gregory R. , Meanock C. , Brito‐Babapulle F.
Published: March 2003

A 57‐year‐old female in complete remission of grade IV non‐Hodgkin lymphoma whilst on intensive chemotherapy, suddenly developed unilateral hemispheric stroke with a fatal outcome in 3 days. She was apyrexial and had received antifungal prophylaxis during her treatment. Post‐mortem examination showed complete thrombosis of the internal carotid artery leading to infarction in the territory of the middle and anterior cerebral arteries. Microscopic examination of the brain showed involvement of intra‐cranial vessel walls and brain parenchyma by mucormyces, with no evidence of systemic mucormycosis. Isolated cerebral mucormycosis is a rare occurrence, more commonly found in intravenous drug abusers, but can occur in patients with haematological malignancy.
Three‐dimensional transcranial colour‐coded duplex sonography of the transverse sinus
Authors: Stolz E. , Kern A. , Pflästerer D.
Published: March 2003

The case of a patient with partial superior sagittal sinus and partial right sided transverse sinus thrombosis, and posterior fossa venous collaterals is presented. We report on the use of venous transcranial colour‐coded duplex sonography (TCCS), combined with a new three‐dimensional transcranial duplex data acquisition system, which allows free hand scanning of the region of interest. TCCS with three‐dimensional image reconstruction allowed a more precise spatial localization of venous flow signals in the posterior fossa and facilitated the understanding of the haemodynamics of the venous collateral network.
Malondialdehyde, glutathione peroxidase and superoxide dismutase in peripheral blood erythrocytes of patients with acute cerebral ischemia
Authors: Demirkaya S. , Topcuoglu M. A. , Aydin A. , Ulas U. H. , Isimer A. I. , Vural O.
Published: March 2003

The levels of malondialdehyde (MDA), glutathione peroxidase (GSH‐Px) and superoxide dismutase (SOD‐1) were measured in the red blood cells (RBC) of 34 patients with acute ischemic hemispheric stroke on the first and seventh day after their stroke onset, and compared with 30 control individuals matched for sex, age and stroke risk factors. Within the first 24 h after stroke, SOD and GSH‐Px activities were significantly decreased and MDA levels were significantly elevated in the patients compared with control subjects. Decrease in SOD and GSH‐Px activities and increase in MDA levels showed significant correlation with infarct size, initial stroke severity assessed by NIH stroke scale and poor short‐term prognosis. Observed changes in the RBC oxygen scavenging process returned to values not different from those of control subjects within seven days after stroke. Our results indicated that antioxidant enzyme concentrations decreased below normal levels in the acute period following ischemic stroke. Until the recovery of antioxidant defence mechanisms, which occurred up to seven days after stroke onset according to our results, the use of neuroprotective therapy against oxyradical injury seems reliable.
An ischemic stroke during intravenous recombinant tissue plasminogen activator infusion for evolving myocardial infarction
Authors: Chang Gregory Youngnam
Published: March 2003

A 56‐year‐old man without a previous history of stroke received intravenous recombinant tissue plasminogen activator (tPA) for an evolving myocardial infarction. During the infusion, the patient developed aphasia and right hemiparesis. The CT and MRI confirmed an ischemic stroke without evidence of hemorrhage. Although the cerebral hemorrhage after tPA infusion is relatively more common, in rare cases, tPA infusion may result in fragmentation of a cardiac thrombus resulting in an ischemic cerebral stroke.
Side‐effects of intradermal injections of botulinum A toxin in the treatment of palmar hyperhidrosis: a neurophysiological study
Authors: Swartling Carl , Färnstrand Catarina , Abt Gregor , Stålberg Erik , Naver Hans
Published: March 2003

Focal palmar hyperhidrosis can be effectively abolished by intradermal injections with botulinum toxin. Muscle weakness of finger grip has been reported as a reversible side‐effect of this new treatment. The objective of this work was to measure muscular side‐effects after treatment of palmar hyperhidrosis with botulinum toxin. As botulinum toxin has been used in the treatment of pain, we studied whether the toxin might influence afferent thin‐fibre function by measuring temperature perception thresholds. Thirty‐seven patients treated with botulinum toxin (Botox, Allergan Pharmaceuticals, Irvine, CA, USA) showed a decrease in compound muscle action potential (CMAP) for both abductor pollicis brevis (APB) and abductor digiti minimi (ADM) compared with pre‐injection values on average by 64 and 36%, respectively, at 3 weeks which returned nearly to normal at 37 weeks. Muscle power for both finger abduction and finger opposition decreased to a lesser extent. Repetitive nerve stimulation and single fibre electromyography (EMG) showed a disturbed neuromuscular transmission. Thus, despite careful technique with small doses of botulinum toxin injected intradermally, the toxin diffuses to underlying muscles. With regard to the present results, one should be careful in using higher doses of Botox than 0.8 mU/cm2 in the palmar skin above intrinsic muscles. No influence on thin‐fibre function was seen.
Neuropsychological deficits in essential tremor: an expression of cerebello‐thalamo‐cortical pathophysiology?
Authors: Tröster A. I. , Woods S. P. , Fields J. A. , Lyons K. E. , Pahwa R. , Higginson C. I. , Koller W. C.
Published: March 2003

Few studies have been published regarding the neuropsychological characteristics of patients with essential tremor (ET), but preliminary findings suggest that mild attentional and executive dysfunction accompany the disorder. A consecutive series of 101 patients with ET referred for thalamotomy and/or thalamic deep brain stimulation candidacy work‐up also underwent neuropsychological evaluation. Average neuropsychological test scores were calculated, along with the proportions of subjects whose scores fell within or more than one SD above or below the mean (using demographically corrected normative data). Significantly lower than average (T‐score of 50) scores were evident on measures of complex auditory attention, visual attention and response inhibition, recall of a word list, verbal fluency, and visual confrontation naming. A significantly greater proportion of patients (ranging from about 34 to 60%) than might be expected on the basis of a normal distribution obtained scores more than one SD below the normative mean on select measures of attention, verbal fluency, immediate word list recall, semantic encoding, and facial matching. Consistent with prior research, notable, albeit clinically subtle, deficits in attention and select executive functions are evident in patients with ET. Although not specific to ET or cerebellar dysfunction, the observed pattern of cognitive deficits is consistent with cerebello‐thalamo‐cortical circuit dysfunction.
Stroke in a scuba diver with patent foramen ovale
Authors: Buttinelli Carla , Beccia Mario , Argentino Corrado
Published: March 2003

Patent foramen ovale (PFO) is a frequent condition which carries a significant risk for stroke when associated with deep venous thrombosis and primary or secondary coagulation abnormalities. Here, we describe a patient in which scuba diving is thought to be associated with stroke in a subject with an otherwise clinically silent PFO.

During a rapid ascent a 43‐year‐old‐scuba diver reported weakness and paresthesias in the right arm which lasted about 10 min. He presented similar symptoms 2 days later 1 h after diving, and a third time on his flight back home.

The MRI showed multiple hyperintense areas on T2‐weighted images in the white matter. Transoesophageal echocardiography (TEE) showed a PFO, whilst all haematological and haemocoagulation tests were negative.

Scuba diving may constitute a patho‐physiological condition in the presence of PFO as breath‐holding promotes right‐to‐left shunt and arterialization of venous bubbles.
Blood glucose increases early after stroke onset: a study on serial measurements of blood glucose in acute stroke
Authors: Christensen H. , Boysen G.
Published: March 2003

The aim of this study was to evaluate if blood glucose levels change within the first 12 h after stroke onset and to investigate if the degree of change is related to stroke severity, type of stroke, or prognosis. This was a retrospective, descriptive trial based on 445 stroke patients with two blood glucose tests within 12 h of stroke onset and no history of diabetes mellitus. Blood glucose increased in the first 12 h after stroke onset; in mild to moderate stroke from 5.8 to 6.1 mmol/l (P < 0.001) and in severe stroke from 6.2 to 6.7 mmol/l (P < 0.001). In patients who died within 7 days of stroke onset, blood glucose increased from 6.8 to 7.1 mmol/l (P < 0.001). In conclusion, blood glucose increases after the onset of acute stroke and the increase is related to the severity of the stroke.