bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical uro‐neurophysiological investigation in multiple sclerosis
Authors: Rodi Z. , Vodušek D. B. , Denišlič M.
Published: January 2011

Subjective complaints of urinary dysfunction are common in multiple sclerosis patients. Uro‐neurophysiological investigation, namely somatosensory evoked potentials (SEP) to stimulation of tibial and pudendal nerves, sacral reflex measurements and external anal sphincter electromyography (EMG) were employed in a group of 21 patients with mild to moderate multiple sclerosis and urinary symptoms. Tibial SEP showed abnormality in 86% and pudendal SEP in 48% of patients. Sacral reflexes were abnormal in 33% and external anal sphincter EMG showed abnormalities in 42% of patients (54% of women and 13% of men). Even in multiple sclerosis patients with urinary complaints tibial SEP seem to be more useful in evaluating nervous system dysfunction than pudendal SEP. On the other hand, abnormal pudendal SEP acconmpanied by normal tibial SEP may strengthen the suspicion of a conus lesion, the presence of which is some patients seems to be the cause of otherwise unexplained abnormalities of external anal sphincter EMG and sacral reflexes.
Acute disseminated encephalomyelitis: the importance of early magnetic resonance imaging
Authors: Tahan A. Al , Arora S. , Alzeer A. , Tahan F. Al , Malabarey T. , Daif A.
Published: January 2011

The diagnosis of acute disseminated encephalomyelitis (ADEM) is frequently missed or delayed with consequent delay in instituting therapy in the crucial phase of the illness. The role of MRI in the diagnosis of ADEM is well established, however, the value of its early utilization of treatment on the outcome of patients has not been adequately stressed. Three patients with ADEM are described. Delay in the diagnosis of the first was associated with severe sequelae, while in the other two early diagnosis and institution of corticosteroid therapy which was facilitated by MRI, was associated with a better outcome. MRI should be carried out early once the diagosis of ADEM is entertained.
Botulinum toxin type A in cerebellar tremor caused by multiple sclerosis
Authors: Clarke C. E.
Published: January 2011

The intention tremor seen in chronic progressive multiple sclerosis is often disabling and existing treatments are of limited benefit The present pilot study was designed to assess the role of Botulinum toxin type A (BOTOX®) in such cases. Five patients with the condition received 40 mouse units of toxin into the flexor and extensor compartments of the forearm. Two of these went on to receive a further 100 mouse units 2 months after the previous injection. Tremor was assessed at 0, 2 and 8 weeks post‐injection using a validated clinical rating scale, spirography and handwriting samples, and a clinician's global rating scale; functional capacity was measured using an activities of daily living (ADL) scale adapted for use in tremor. No statistically significant improvement occurred in intention tremor, although there was a trend toward a mild improvement in the clinician's global rating scale. Patients noted an increase in their pre‐existing corticospinal weakness which proved to be dose‐limiting. No change occurred in ADL scores. It is concluded that pre‐existing weakness limits the use of Botulinum toxin in the intention tremor seen in multiple sclerosis, but further work in disabling primary and secondary cerebellar degenerations without corticospinal weakness may be worthwhile.
Fatigue in multiple sclerosis is not due to sleep apnoea
Authors: Wunderlin B. W. , Kesselring J. , Ginzler H. , Walser B. , Kuhn M. , Reinhart W. H.
Published: January 2011

Fatigue is a frequent and disabling phenomenon among patients with multiple sclerosis (MS). Daytime sleepiness is a typical symptom of the sleep apnoea/hypopnoea syndrome due to nocturnal hypoxia and recurrent arousals causing sleep fragmentation. Since MS plaques are often found in the midbrain, brain stem and upper cervical cord on magnetic resonance imaging (MRI) we hypothesized that fatigue in MS patients might be caused by a central respiratory dysfunction. We investigated 10 patients with definite MS by oligography, two questionnaires assessing fatigue (Fatigue Severity Scale, FSS) and daytime sleepiness (Epworth Sleepiness Scale, ESS), MRI and pulmonary function tests. A total of six patients had either an elevated FSS and/or an elevated ESS. None of the six patients with an elevated FSS and/or ESS has an apnoea index > 5/hour. CT90 was normal in nine patients. We conclude that fatigue and daytime sleepiness in MS cannot be explained by nocturnal apnoeas or oxygen desaturations. The Fatigue Severity Scale should be integrated to the extended Barthel index, which is a new instrument for disability assessment in MS patients.
Detection of deletions within the dystrophin gene in Polish families affected with Duchenne/Becker muscular dystrophy
Authors: Zimowski J. G. , Bisko M. U. , Fidziańska E. J. , Fidziańska A. Z. , Badurska B. , Niebrój‐Dobosz I. , Koztowska M. , Hausmanowa‐Petrusewicz I. , Zaremba J. S.
Published: January 2011

DNA analysis was performed in 190 cases of Duchenne and Becker muscular dystrophies (DMD/BMD), including 150 cases with DMD and 40 cases with BMD, using Southern blotting and PCR multiplex techniques with application of 25 pairs of primers. Deletions in the overall material were found in 109 cases: 81 (54%) in patients with DMD and 28 (70%) in patients with BMD. All the deletions in DMD were out of frame with the exception of two cases, whereas in BMD all the deletions but two were in frame. Junction fragments were detected in 12 cases of DMD. In five cases duplications were found: four in patients with DMD and one in a patient with BMD.
Fulminant inflammatory demyelination: long‐term course and magnetic resonance imaging findings
Authors: De Andrés C. , Dobato J. L. , Mateo D. , Benito C. , Giménez‐Roldàn S.
Published: January 2011

The course and prognosis of adult patients who recover from acute and extensive inflammatory demyelination, variously termed fulminant or Marburg's type of multiple sclerosis (MS), is poorly known. We report long‐term magnetic resonance imaging (MRI) and neuropsychological findings in two patients who developed acute psychosis and a state resembling akinetic mutism, with CT scan evidence of extensive cerebral white matter damage. Both patients ultimately recovered, but were left with a severe, non‐progressive dementia with prominent frontal lobe signs unassociated with motor impairment. Extensive residual MRI lesions with evidence of tissue destruction in the white matter and callosal atrophy were visible many years after the initial event One of the patients developed a single relapsing–remitting episode with multifocal neurological deficits several years after the onset, whereas the condition remained monophasic in the other patient during an 8 year follow‐up. Our observations suggest that while patients with so‐called “fulminant” demyelinating disorders may nowadays survive with supportive measures, the disorder may remain stabilized for many years following disease onset.
A methylenetetrahydrofolate reductase gene polymorphism in multiple sclerosis
Authors: Huang W.‐X. , He B. , Hillert J.
Published: January 2011

There have been several indications that cellular methylation pathways might be affected in multiple sclerosis (MS). We have investigated 150 MS patients for a biallelic polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene, since the less frequent of these alleles is functionally relevant and is associated with reduced enzymatic function. However, the distribution of alleles and genotypes was found to be close to identical in MS patients and healthy controls, regardless of subgroup analysis after clinical form or HLA class II phenotype. We conclude that this polymorphism does not influence susceptibility to MS.
Progressive expansion of the myotonic dystrophy CTG repeat in asymptomatic individuals in three successive generations of a family
Authors: Combarros O. , Paz J. , Berciano J. , Fernández‐Luna J. L.
Published: January 2011

We report a family in which expansion of CTG repeats was detected in asymptomatic carriers of the myotonic dystrophy allele in three successive generations. PCR‐based analysis of the expanded CTG repeat revealed intergenerational amplification of the mutation. We show here that the myotonic dystrophy mutation may remain clinically silent, not only in the oldest generation of a family, but even among siblings and offspring of symptomatic cases. This may represent a mechanism for the maintenance of the myotonic dystrophy gene in the population
PET study in subjects from two Italian FAD families with APP717 Val to Ileu mutation
Authors: Perani D. , Grassi F. , Sorbi S. , Nacmias B. , Piacentini S. , Piersanti P. , Provinciali L. , Amaducci L. , Fazio F.
Published: January 2011

Cerebral glucose metabolism was investigated with 2‐[18F]‐fluoro‐2‐deoxy‐D‐glucose ([18F]FDG) and positron emission tomography (PET) in seven members belonging to two Italian families with familial Alzheimer's disease (FAD) and APP717 Val to Ileu mutation. The aim of the study was to identify the pattern of cerebral hypometabolism in the affected patients and the possible occurrence of brain metabolic changes in the APP mutated subjects. The two patients with FAD, when compared with normal age matched controls, showed a severe bilateral hypometabolism in parietal and temporal regions, as well as in the prefrontal areas, which were more affected on the left side. Subcortical thalamic structures were also involved in one patient. In a comparison with a group of patients with sporadic AD, the most affected cerebral areas in the FAD patients were the prefrontal regions and the thalamus, bilaterally. One of the four mutated subjects, with an age close to the family age of disease onset, in a comparison with normals, showed metabolic reductions in the right thalamus, in the left dorsolateral frontal cortex and, bilaterally, in the frontal orbital regions. This regional brain hypometabolism was present in a preclinical phase, 1 year before the onset of dementia. In the three younger subjects carrying the mutation, a metabolic reduction was detected in the thalamus, bilaterally. These results demonstrate that a pattern of cerebral hypometabolism involving cortical and subcortical structures is present in FAD patients with APP717 Val to Ileu mutation. Cerebral hypometabolism may occur in pre‐symptomatic and young asymptomatic APP717 mutated FAD subjects and it can be detected by a highly sensitive procedure such as PET.
Premorbid personality characteristics in Alzheimer's disease: an exploratory case—control study
Authors: Malinchoc M. , Rocca W. A. , Colligan R. C. , Offord K. P. , Kokmen E.
Published: January 2011

Linking data from a case–control study of Alzheimer's disease (AD) with data from a Minnesota Multiphasic Personality Inventory (MMPI) outpatient study, we identified 13 AD cases and 16 controls for case–control comparison. The mean time between personality testing and onset of AD (or corresponding age for controls) was 13 years in cases and 14 years in controls. AD cases, but not the controls, had scores significantly greater than the normative reference on MMPI scales measuring social introversion (p = 0.05) and pessimism (p = 0.01). When compared to controls, AD cases had significantly greater scores on the social introversion scale (p = 0.03). Despite the small sample size and some design limitations of this exploratory study, our findings may suggest that subjects who score higher on these personality scales have a greater risk for AD.
SPECT findings in Alzheimer's disease and Parkinson's disease with dementia
Authors: Starkstein S. E. , Vázquez S. , Petracca G. , Sabe L , Merello M. , Leiguarda R.
Published: January 2011

We examined, with single photon emission tomography (SPECT) and (99mTc)‐HMPAO, 18 patients with idiopathic Parkinson's disease and no dementia (PD), 12 patients with PD and dementia, 24 patients with probable Alzheimer's disease (AD) and 14 controls. While the three patient groups showed significantly lower perfusion in frontal inferior and temporal inferior areas as compared to controls, both demented groups showed significantly more severe bilateral hypoperfusion in superior frontal, superior temporal and parietal areas as compared to non‐demented PD patients and controls. On the other hand, no significant differences in cerebral perfusion were found between patients with AD and patients with PD and dementia. In conclusion, our findings demonstrated specific but similar cerebral perfusion deficits in demented patients with either AD or PD.
Long‐term therapy with high‐dose intravenous immunoglobulins (IVIG) in inflammatory neuropathies
Authors: Grehl H. , Jaspert A. , Claus D. , Neundörfer B.
Published: January 2011

Clinical data about the course of long‐term IVIG treatment in chronic inflammatory demyelinating polyneuropathy (CIDP) and in multifocal motor neuropathy (MMN) are sparse. Twenty patients with CIDP or MMN were investigated during up to 65 months of high‐dose intravenous immunoglobulin (IVIG) therapy in an open and prospective study. In all therapy‐responders (18/20), amelioration of symptoms was evident within the first 3 weeks of treatment. Dosage was reduced slowly according to the clinical symptoms. All 18 patients now show very few or no symptoms. The mean value of the Rankin disability scale changed from 2.5 to 1.1 during therapy. Ten patients are still regularly given IVIG. In eight patients no further therapy has been necessary for 7–63 months. Treatment could even be stopped in one patient after 46 months of therapy. No marked clinical side‐effects were observed during 529 months of IVIG therapy. IVIG therapy is safe, and remains effective in the long‐term treatment of CIDP and MMN.
Neurosarcoidosis mimicking meningioma en‐plaque: report of two cases and review of the literature
Authors: Sender P. L. , Jäger H. R. , Hersch M. , Chaudri K. Ray , Bajaj N. , Frackowiak R. S. J.
Published: January 2011

We describe two patients who presented with seizures and in whom imaging studies showed extra‐axial disease which was simulating meningioma en‐plaque. The diagnosis of neurosarcoidosis was obtained by meningeal biopsy. The clinical and MRI features of neurosarcoidosis presenting as an extra‐axial mass lesion are reviewed. In cases in which clinical or radiological features place the diagnosis of meningioma in doubt, frozen section biopsy is advocated to avoid unwarranted excision of a lesion caused by sarcoidosis.
Dementia associated with haemochromatosis: a report of two cases
Authors: Harvey R. J. , Summerfield J. A. , Fox N. C. , Warrington E. K. , Rossor M. N.
Published: January 2011

Two patients presenting to a pre‐senile dementia clinic with dementia were also found to have genetic haemochromatosis. In both instances the haemochromatosis was mild and the cognitive dysfunction could not be attributed to hepatic failure. The association of these uncommon diseases may reflect genetic linkage.
Efficacy and safety of tolcapone in levodopa‐treated Parkinson's disease patients with “wearing‐off” phenomenon: a multicentre, double‐blind, randomized, placebo‐controlled trial
Authors: Myllylä V. V. , Jackson M. , Larsen J. P. , Baas H. ,   Tolcapone International Parkinson's Disease Study (TIPS) Group I
Published: January 2011

To assess the effect of tolcapone added to levodopa plus benserazide or carbidopa on the “wearing‐off” phenomenon in patients with Parkinson's disease, we undertook a double‐blind, randomized, placebo‐controlled, parallel‐group study of tolcapone 50, 200, or 400 mg three times daily (t.i.d.) for 6 weeks in addition to levodopa therapy. We studied 154 parkinsonian patients, aged 40 years or more, who presented with the “wearing‐off” phenomenon despite “optimal” antiparkinsonian therapy. The main outcome measures were “on”‐ and “off”‐time, Investigator's Global Assessments, Subscales of the Unified Parkinson's Disease Rating Scale, changes in levodopa dosage, and safety and tolerability. Tolcapone was more effective than placebo in reducing the “wearing‐off” phenomenon between baseline and week 6 at all three dosages. Tolcapone 200 mg t.i.d. increased “on”‐time from 37.9% of the waking day to 50.8% (p< 0.01) and reduced “off”‐time from 26.7% of the waking day to 16.4% (p< 0.05). Tolcapone treatment was generally well tolerated at all dosages. Initial exacerbation of adverse dopaminergic effects was controlled by levodopa dosage adjustment; at week 6, the mean total daily levodopa dosage had decreased by 80 mg, from 694 mg at baseline, in the tolcapone 200 mg t.i.d. group (p< 0.01). We conclude that the addition of tolcapone to levodopa plus a decarboxylase inhibitor effectively and safely reduces the “wearing‐off” phenomenon in parkinsonian patients.
Hypermetabolism in multiple sclerosis patients
Authors: Deisenhammer F. , Balogh D. , Grubwieser G. , Pohl P.
Published: January 2011

Hypermetabolism, which can lead to wasting syndrome, is well recognized in diseases such as AIDS, cancer, rheumatoid arthritis, sepsis and burns. In these conditions proinflammatory cytokines are thought to be essentially involved. In experimental allergic encephalitis (EAE), which is regarded as an animal model of multiple sclerosis (MS), wasting syndrome and elevated levels of cytokines have also been reported. The aim of this study was to investigate whether hypermetabolism does occur in MS patients. After a 3‐day standard diet the basal metabolic rate (BMR) was measured by indirect calorimetry in 20 MS patients and 10 healthy controls. Body composition was assessed using an impedance analyser and lean body mass (LBM) was calculated. Other metabolic disturbances and infectious disease were ruled out by clinical examination and various laboratory tests. Tested by analysis of variance (ANOVA), the BMR corrected for LBM was increased by an average of 6% in the patients group (p < 0.05) as compared to the controls. As far as we know this is the first study demonstrating the presence of hypermetabolism in MS.
Kinematic and kinetic analysis of “la marche à petits pas”*
Authors: Patchay S. , Gahéry Y. , Serratrice G.
Published: January 2011

To better understand “la marche à petits pas”, we focused on ground reactions forces, a key interface between muscular activity and gait kinematics. Computerized recordings were used to measure kinematic and kinetic variables in 11 patients aged between 65 and 84 years and 13 control subjects aged between 65 and 86 years. Kinematics was studied with an ELITE 3D motion analysis system. Anteroposterior and vertical reaction forces were measured under each foot with three force platforms. Free gait and gait with comparable stride lengths in the patients and the control subjects were analysed. Patients displayed higher vertical displacements of toes, ankle, and knee during gait and difficulty in initiating and maintaining rhythmic stepping. In patients, the amplitude and direction of anteroposterior forces were impaired under the starting foot and under both feet during gait. Their vertical forces were weaker and less symmetrical than in control subjects at the start and while walking. Short stride lengths, high vertical foot displacements and laborious rhythm installation seem to be due to perturbations observed in amplitude and regularity of the time course in both vertical and anteroposterior ground reaction forces.
Lead‐induced excessive lipid peroxidation and changes in local cerebral blood flow in rabbit brain
Authors: Linnamägi Ü. , Zilmer K. , Zilmer M. , Kaasik A.‐E.
Published: January 2011

Lead‐poisoning is a disease of environmental origin. The primary target for lead is the nervous system. Lead ions are able to accelerate lipid peroxidation (LP) and, hence, induce cellular damage. Endothelial cell alteration and cerebral microvessel dysfunction are important in lead‐induced encephalopathy. It is possibile that the altered functional state of brain microvasculature cannot ensure the adequate level of local cerebral blood flow (LCBF). The purpose of the present study was to evaluate LP in brain tissue homogenates of the cerebral cortex (CTX) and hypothalamus (HYP) of 15 lead‐exposed vs seven control rabbits after a short‐time lead exposure (5 and 10 days, 40 mg/kg). Another aim was to compare the dynamics of changes in LP and LCBF, detected by the H2clearance method in another group (seven lead‐exposed rabbits vs seven controls). The basal level of thiobarbituric acid reactive substances (TBARS), the Fe‐stimulated part of the TBARS (Fe‐TBARS) and diene conjugates (DC) were used for the evaluation of LP in the brain tissue. A tendency to the slight enhancement of TBARS and DC concentrations in brain homogenates 5 days after the 10 days lead exposure period was found (CTXp< 0.05). The enhancement of the Fe TBARS was expressed maximally on 1 day after 10 day exposure period (CTXp< 0.05, HYPp< 0.001 compared to controls). The biphasic reaction of changes in LCBF was detected: during (5th day) and in 1 day after a 10 day exposure period a decrease of LCBF in both investigated regions was found (10.5 and 9.3 ml/100g/min i.e. 28.6 and 24.1%, respectively, in CTX,p< 0.05; and 11.2 and 10.1 ml/100g/min i.e. 19.9 and 18.7%, respectively in HYP,p< 0.05); on the 5th day after exposure minimal tendency to increase was found (7.1 ml/100g/min,p< 0.01 in HYP compared with controls). In conclusion, lead induces excessive LP in brain homogenates and disturbances in LCBF. However, the causal relationship between those events remains to be proven.
Neuroplastic effects of neonatal capsaicin on barrel cortex of adult rat. An electrophysiological and autoradiographic study
Authors: Farkas T. , Rojik I. , László F. , Varga C. , Toldi J.
Published: January 2011

Capsaicin (50 mg/kg s.c./25 μl) was administered to rats on the 2nd and 5th days after birth. The animals were raised, and from the age of 3 months the properties of the evoked activity were tested in the contralateral barrelfield. This neonatal capsaicin treatment was found to induce profound changes in the responsiveness of the barrel cortex in the adult rats: (1) the receptive field of the neurons in the Cl barrel was expanded; units within a particular barrel were driven by a significantly larger number of vibrissae than in the controls. (2) The rate of discharge evoked by the related vibrissa deflection was enhanced, while (3) the angular sensitivity of the neurons was decreased. (4) The most prominent change in cortical activity was observed by autoradiography: capsaicin‐treated rats exhibited an enhanced labelling of different types of neurons throughout the hemisphere (surpassing the cortical representation of stimulated vibrissae). The present observations indicate that neonatal capsaicin affects the functional activity of the rat somatosensory cortex. It is suggested that unmyelinated sensory afferents play a role in the development of the rat somatosensory system.
Intracranial hypertension as an unusual presentation of adrenoleukodystrophy
Authors: Smadja D. , Cabre Ph. , Kujas M. , Vernant J.‐C. , Rivierez M.
Published: January 2011

A 19‐year‐old man with a history of adrenal insufficiency and epilepsy for several years presented with headache, obtundation, status epilepticus and papilloedema. A computed tomography‐scan was consistent with a fronto‐collosal glioma. However, this patient's condition spontaneously improved after a brain biopsy. Therefore, the diagnosis of adrenoleukodystrophy (ALD) was established, based on histological findings, positive family history and plasma fatty acid analysis. In ALD, an acute and reversible worsening of brain demyelination with increased intracranial pressure may be evocative of a cerebral neoplasm.
Nephrotic syndrome developing in association with thymoma and myasthenia gravis
Authors: O'Riordan J. I. , Brenner R. , Howard R. S. , Miller D. H.
Published: January 2011

Three patients with thymoma associated myasthenia gravis complicated by the nephrotic syndrome are described. There were two male and one female patients with a mean age at presentation of 55.6 years (27–75). In all cases anti striated‐muscle and acetylcholine‐receptor antibodies were present. Thymectomy was performed 1.4 years (1–3) after diagnosis of myasthenia gravis; histology revealed invasive mixed lymphocytic/epithelial (1), invasive epithelial (1) and non‐invasive lymphocytic/epithelial (1) cell thymoma. All patients were receiving pyridostigmine, prednisolone and azathioprine at the time nephrotic syndrome developed (a mean of 2 years after thymectomy). Renal biopsy demonstrated a minimal change nephropathy alone in all three. Remission following increased steroids occurred in two despite continuing azathioprine. Myasthenic symptoms remained stable throughout. The third patient died 3 weeks after onset of nephrotic syndrome. The cause of the nephrotic syndrome is uncertain, but an immune mechanism, possibly in genetically predisposed individuals, is perhaps most likely.
Update paper of the scientist panel on demyelinating diseases: is multiple sclerosis still a diagnostic and therapeutic enigma?
Authors: Wender M. , Losy J.
Published: January 2011

Despite great progress in the diagnosis and therapy of multiple sclerosis (MS) some problems remain unsolved. For example, should immunologically negative cases also be classified as multiple sclerosis? In addition, we are still waiting for medication which will have a definite impact on the natural course of the disease.
Out of my Head
Authors: Jellinger K. A.
Published: January 2011

Book reviewed in this article:

Vivian Martin. The Book Guild Ltd, East Sussex (1997)
Multiple sclerosis: myelin basic protein induced mRNA expression of proinflammatory cytokines in mononuclear cells is suppressed by interferon‐β 1b in vitro
Authors: Kivisäkk P. , Tian W. , Fredrikson S. , Link H. , Söderström M.
Published: January 2011

Beta‐interferon (IFN‐β) is a promising treatment in multiple sclerosis (MS), reducing the exacerbation rate and MRI lesion burden, as well as the disease progression in relapsing‐remitting MS. IFN‐β was originally defined by its antiviral effects, but the interest has recently been focused on its immunomodulatory properties. Myelin basic protein (MBP) is one of several autoantigens considered to be the target for autoaggressive immune responses, which eventually might lead to the development of MS. To studyin‐vitroeffects of IFN‐β1b on MBP induced cytokine expression, mRNA for the Th1 cytokines IFN‐γ and TNF‐α, the Th2 related IL‐4 and IL‐6, the cytolytic perforin and the immune response downregulating TGF‐β was measured within situhybridization after culture of blood mononuclear cells (MNC) in the presence and absence of MBP. Numbers of cells expressing IFN‐γ, TNF‐α, perforin and IL‐4 mRNA were significantly suppressed after culture with 10 U/ml IFN‐β1b. No such effect was seen on MBP induced IL‐6 or TGF‐β mRNA expression. These observations suggest that one of the major effects of IFN‐β1b is the induction of a shift in the cytokine mRNA profile towards a more immunosuppressive pattern. In parallelin vitrotests, the control substance dexametasone (40 μg/ml) reduced the numbers of cells expressing mRNA for all cytokines under study with the exception of TGF‐β, to an extent equal to or even more pronounced than IFN‐β1b.
Autoantigen‐induced IL‐13 mRNA expression is increased in blood mononuclear cells in myasthenia gravis and multiple sclerosis
Authors: Matusevicius D. , Kivisäkk P. , Navikas V. , Xiao B.‐G. , Söderström M. , Olsson T. , Pirskanen R. , Fredrikson S. , Link H.
Published: January 2011

Evidence has been presented for the involvement of immune mechanisms in the pathogenesis of myasthenia gravis (MG) and multiple sclerosis (MS). The production of autoantibodies in both diseases is regulated by T‐cells by means of cytokines. Interleukin‐13 (IL‐13) is mainly produced by T‐helper type 2 cells and induces B‐cell proliferation and antibody class switch. The role of IL‐13 in MG and MS is not known. We employed in situ hybridization with synthetic radiolabelled oligonucleotide probes to detect and enumerate blood and cerebrospinal fluid (CSF) mononuclear cells (MNC) expressing IL‐13 mRNA from patients with MG, MS, optic neuritis (ON), other inflammatory neurological diseases (OIND) and healthy controls. MG is associated with elevated levels of acetylcholine receptor (AChR) reactive IL‐13 mRNA expressing blood MNC compared to control patients. In MS, numbers of MBP‐reactive IL‐13 mRNA expressing MNC were higher compared to cultures without antigen stimulation. The levels of MBP‐reactive IL‐13 mRNA positive MNC were higher in MS compared to MG, but not other controls. There were no differences in spontaneous IL‐13 mRNA expressing blood MNC numbers between MG, MS, ON and control patients. The data suggest the involvement of IL‐13 in both MG and MS.
The prognostic value of the acute‐phase response in stroke recurrence
Authors: Chamorro A. , Vila N. , Blanc R. , Saiz A. , Ascaso C. , Deulofeu R.
Published: January 2011

We measured the erythrocyte sedimentation rate (ESR) in 318 acute stroke patients receiving heparin to evaluate its predictor value on the risk of early recurrence (first two weeks). The cumulative risks of early recurrence were 2.93 ± 1.85% for the low ESR group, and 9.77 ± 3.25% for the high ESR group. With logistic regression the risk of early stroke recurrence was associated to the ESR group (OR 3.55, 95% IC 1.24‐10.15), and a history of recent (< 1 week) (OR 6.95, 95% IC 2.06–23.42), or remote TIA (OR 4.27, 95% IC 1.22‐14.91). These results pointed to an inflammatory component in the pathogenesis of early recurrent stroke.
Clinical signs and serial MRI in Listeria Rhombencephalitis: a case report
Authors: Ciccarelli O. , Bastianello S. , Inghilleri M. , Trasimeni G. , Manfredi M. , Francia A.
Published: January 2011

A case of Listeria Rhombencephalitis in a 63‐year‐old‐man under corticosteroid treatment for suspected rheumatoid arthritis is described. The diagnosis was based on the clinical signs, cerebrospinal fluid findings, blood culture and MRI. Radiological and clinical correlation, clinical aspects and therapeutical problems are discussed.
Assessment of MRI criteria for abnormal brain MRI in acute monosymptomatic optic neuritis. Comparison to findings in healthy persons
Authors: Frederiksen J. L. , Larsson H. B. W. , Christiansen P. , Olesen J.
Published: January 2011

To evaluate various MRI criteria we studied a representative group of 149 consecutive patients below 50 years with acute monosymptomatic optic neuritis (AMON), a frequent first manifestation of multiple sclerosis (MS). The presence, number, size, and localization of areas of increased signal (AIS) on T2‐weighted brain MRIs obtained at 1.5 T were described and compared with findings in 71 healthy persons aged 21–50 years without diabetes, cerebrovascular or neurologic diseases. MRI was performed within 2–145 days, median 16 days from onset of AMON and showed from 0 to 26 AIS, sized 2–30 mm, in 79 of 149 (53%) patients compared to 0–18 AIS, sized 2–12 mm, in 31 of 71 (44%) healthy persons. In patients, AIS were significantly more frequent in women than in men (χ2 = 4.67, p > 0.05). Periventricular AIS were revealed in 70 (47%) patients and in 14 (20%) healthy persons. Subcortical AIS were present in 5 (3%) patients and in 18 (25%) healthy persons. Infratentorial AIS were present in only 3 (2%) patients. The sensitivity and specificity of previously proposed diagnostic MRI criteria for MS were unsatisfactory in our group of patients and have previously only been validated in definite MS. We therefore constructed and tested four new sets of criteria. The set with the best relation between sensitivity (e.g. 41%) and specificity (e.g. 93%) was the following: presence of two or more AIS, of which at least one is periventricular or infratentorial, combined with the absence of subcortical AIS. These criteria are recommended for patients with AMON and might be used in other patients with possible or probable MS.
Cerebrospinal fluid analyses in HIV patients: a longitudinal study through six years
Authors: Pirskanen R. , Samuelsson K. , Sönnerborg A. , Waldenlind L. , Sandström E.
Published: January 2011

The human immunodeficiency virus (HIV) can cause neurological symptoms. It is not known how the the cerebrospinal fluid (CSF) may change during the infection. Thirty‐eight neurologically asymptomatic HIV patients with CD4 lymphocyte count > 280 × 106/1, were included in the prospective study. CSF was analysed once a year for cell count, oligoclonal IgG, IgG index and CSF:S albumin ratio. Cell free CSF was cultivated for HIV isolation. At inclusion, at year three and six, the CSF anti‐HIV antibody synthesis was measured. HIV‐DNA in CSF cells were analysed at inclusion. More than 80% of the patients had abnormal CSF. At consecutive investigations the IgG index and/or CSF:S albumin ratio were unchanged in most of the patients. These findings resemble those seen in MS, neuroborreliosis or neurolues. HIV was isolated in about half of the patients the first four times but in about one‐third of them later on. At inclusion, HIV‐DNA was found in CSF cells in 95% and intrathecal anti‐HIV antibody synthesis in 65% of the patients. The findings did not correlate with the HIV duration, patients' age or the amount of blood CD4 cells. The results speak in favour of the early penetration of HIV in CSF but for its low neurovirulence.
Psychological consequences of genetic testing for spinocerebellar ataxia in the Japanese
Authors: Abe K. , Itoyama Y.
Published: January 2011

To evaluate the psychological consequences of genetic testing for spinocerebellar ataxia (SCA), state and trait anxiety inventories (SAI and TAI) and social desirability scale (SDS) were assessed and analyzed in patients and their family members diagnosed with spinocerebellar ataxias such as spinocerebellar ataxia type 1 and Machado—Joseph disease (MJD). The results obtained prior to and after the genetic testing were compared to a control group that included more severe hereditary neurological disorders such as Huntington's disease and familial amyotrophic lateral sclerosis. Genetic counseling was undertaken during the study. Of the 62 total participants, 37 were diagnosed with SCA, and 25 as asymptomatic family members. The SCA patients had higher baseline SAI, TAI and SDS scores than their asymptomatic family members. Genetic testing did not significantly increase the scores for all the patients and their asymptomatic family members, whereas the SAI value was greatly reduced in those subjects who received negative results and were not carriers of the defective gene. Similar results were obtained even in the control group with more severe diseases except for a reduction of SAI values in the patients. Patients, their SCA asymptomatic family members, and the disease control generally had some apprehension for the testing, but, at the same time, were not so anxious if remedial or curative therapy was available. Furthermore, most participants in this study showed a high degree of acceptance and did not express much regret in undergoing the genetic testing regardless of having the disease or finding out the results of the predictive testing. These results suggest that the psychological health of the asymptomatic family members with negative results for SCA gene abnormality recovered after genetic testing, and genetic testing was not disadvantageous for the psychological well‐being of the patients and even for those with positive predictive results.
Persistent amnesic syndrome as long‐term outcome of cognitive function after Whipple's disease
Authors: Fertl E. , Schnider P. , Müller C , Auff E.
Published: January 2011

Despite current antibiotic treatment, a 51‐year‐old man suffering from Whipple's disease (WD) presented with cerebral symptoms. Clinical, cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) findings revealed encephalitis resulting from WD, which was subsequently treated. The response to antibiotics was protracted, but 6 months after the onset of cerebral illness the inflammation had ceased. Thirty months later, the patient is still suffering from severe anterograde amnesia as well as a lack of initiative. Behavioural and neuropsychological assessment data were consistent with the Korsakoff syndrome. Retrospectively, a concomitant thiamine deficiency in the acute phase of cerebral manifestation was thought likely, and could have contributed to the unfavourable outcome. We therefore propose that thiamine deficiency should be considered and treated immediately in patients with established WD who present with cerebral symptoms.
What You Don't Know Can Help You: The Ethics of Placebo Treatment
Authors: GROLL DANIEL
Published: January 2011

abstract

Is it permissible for a doctor or nurse to knowingly administer a placebo in a clinical setting? There is certainly something suspicious about it: placebos are typically said to be ‘sham’ treatments, with no ‘active’ properties and so giving a placebo is usually thought to involve tricking or deceiving the patient who expects a genuine treatment. Nonetheless, some physicians have recently suggested that placebo treatments are sometimes the best way to help their patients and can be administered in an honest way. These physicians conclude that placebo treatments are a perfectly acceptable, and ethically unproblematic, mode of treatment.

While I grant the common idea that placebos are deceptive is correct, I argue that widespread misunderstandings concerning why this is so has led proponents of placebo treatments to respond to the charge of deception in a way that misses the mark entirely. My goal in this paper, then, is to develop a precise conception of what makes something a placebo, which in turn will clarify the central charge concerning the ethics of placebo treatment, viz. that it is deceptive.
How to Hunt a Very Reliable Organization
Authors: Rochlin Gene I.
Published: January 2011

A summary of my long engagement with Todd R. LaPorte as colleague, mentor, and fellow field worker in the study of large, reliability‐seeking organizations that manage risk‐bearing technologies is used to explore the relationship of our fieldwork approaches and techniques to other ethnographic means of sociological research. In particular, I discuss three organizations that have been at the core of what is generally known as the ‘high reliability organization’ project: air traffic control; nuclear power plant operations; and nuclear‐powered aircraft carriers at sea. In retrospect, our fieldwork was as intimate as that characterizing participant observers; yet, because of the complexity and risk involved in the sites of our study, we could only observe, and not participate.
Problems in the Organization of Organization Theory: An Essay in Honour of Todd LaPorte
Authors: Schulman Paul R.
Published: January 2011

This essay examines a peculiar problem in organization theory – its failure to achieve useful research‐based prescriptions for organizational design and practice in the face of challenges posed by new technology and evolving social problems. It is argued that an important part of this problem in organization theory is the under‐specification of its major concepts. Three under‐specified concepts in particular are examined – complexity, interdependence and scale. The analysis of these concepts is undertaken in the context of Todd LaPorte's work to promote, through well‐posed questions, clearer and more specific formulations of these and other concepts as independent variables in organizational analysis. The essay concludes with suggestions for continuing the specification of major concepts in organization theory in ways inspired by LaPorte.
Inhaled innate immune ligands to prevent pneumonia
Authors: Evans Scott E , Tuvim Michael J , Fox Cory J , Sachdev Nidhi , Gibiansky Leonid , Dickey Burton F
Published: January 2011

Epithelial surfaces throughout the body continuously sample and respond to environmental stimuli. The accessibility of lung epithelium to inhaled therapies makes it possible to stimulate local antimicrobial defences with aerosolized innate immune ligands. This strategy has been shown to be effective in preclinical models, as delivery of innate immune ligands to the lungs of laboratory animals results in protection from subsequent challenge with microbial pathogens. Survival of the animal host in this setting correlates directly with killing of pathogens within the lungs, indicating the induction of a resistance mechanism. Resistance appears to be mediated primarily by activated epithelial cells rather than recruited leucocytes. Resistance reaches a peak within hours and persists for several days. Innate immune ligands can interact synergistically under some circumstances, and synergistic combinations of innate ligands delivered by aerosol are capable of inducing a high level of broad host resistance to bacteria, fungi and viruses. The induction of innate antimicrobial resistance within the lungs could have clinical applications in the prevention of lower respiratory tract infection in subjects transiently at high risk. These include cancer patients undergoing myeloablative chemotherapy, intubated patients being mechanically ventilated, vulnerable individuals during seasonal influenza epidemics, asthmatic subjects experiencing a respiratory viral infection, and healthy subjects exposed to virulent pathogens from a bioterror attack or emergent pandemic. In summary, stimulation of the lung epithelium to induce localized resistance to infection is a novel strategy whose clinical utility will be assessed in the near future.

LINKED ARTICLES This article is part of a themed issue on Respiratory Pharmacology. To view the other articles in this issue visit http://dx.doi.org/10.1111/bph.2011.163.issue‐1
Classification Tree Model Identifies Home‐based Service Needs of Japanese Long‐term Care Insurance Consumers
Authors: Naruse Takashi , Nagata Satoko , Taguchi Atsuko , Murashima Sachiyo
Published: January 2011

ABSTRACT
Objectives: To clarify care receivers' needs and unmet needs for home help or home nursing services during daytime and/or nighttime hours, and to identify the characteristic of elders who are most likely to need home care services.

Design and Sample: We used a chi‐squared automatic interaction detection technique to analyze data from 92 care management researchers, who interviewed 280 caregivers.

Measures: Demographic information, assessments of the statuses and service needs of elders.

Results: We found that care receivers had more unmet needs at night than during the day. Daytime home help was needed by elders who (1) lived alone or (2) lived with just one person and whose primary caregiver was not their wife. Nighttime home help was needed by those who required assistance eating, and whose primary caregiver was male. Daytime home nursing was needed by elders who (1) received medical treatment instead of day care or (2) did not receive medical treatment, but had difficulty eating. Nighttime home nursing was needed by those who had unstable illnesses and whose medical treatments continued during the night.

Conclusions: Our findings may help public health nurses assess community needs in order to effectively and efficiently manage health care resources.
A Win‐Win Partnership Between Academia and Public Health Practice
Authors: Petroro Rita A. , Marola Marianne , Ferreira Tina , Raboin Katie , Lewis Katharine Kranz
Published: January 2011

ABSTRACT Partnerships are fundamental to successful public health practice, and collaborations between academia and public health practice, as recommended by the Institute of Medicine and the Council on Linkages between academia and public health practice, are vital to ensuring a competent public health workforce. During times of economic crisis, graduate public health nursing students with clinical expertise, people and communication skills, and critical thinking capabilities are uniquely positioned to bridge the gap between academia and public health practice. In 2009, 5 registered nurses enrolled in a master of science in nursing program with a focus on public health partnered with public health professionals from the state Department of Public Health to conduct an active surveillance study to understand the increase in vancomycin‐resistant enterococci incidences that occurred since 2005. The purpose of this paper is to describe the successes and challenges of the collaboration to provide an insight for those who wish to build similar collaborations. Even in light of the challenges that occurred during this collaboration, faculty should strongly consider developing partnerships with public health practice in order to contribute to important public health surveillance and other functions, and to provide relevant experiences for students.
Occult hepatitis B virus infection in Thai blood donors
Authors: Louisirirotchanakul Suda , Oota Sineenart , Khuponsarb Kalayanee , Chalermchan Wilai , Phikulsod Soisaang , Chongkolwatana Viroje , Sakuldamrongpanish Tasanee , Kitpoka Pimpun , Chielsilp Pimol , Tanprasert Srivilai , Tirawatnapong Thaweesak , Wasi Chantapong ,   the Working Group for NAT Study in Thai Blood Donations
Published: January 2011

BACKGROUND: An evaluation by the National Blood Center, the Thai Red Cross Society, of two commercial multiplex nucleic acid tests (NATs; the Chiron PROCLEIX ULTRIO test and the Roche Cobas TaqScreen MPX test) for screening Thai blood donors for hepatitis B virus (HBV), hepatitis C virus, and human immunodeficiency virus Type 1 identified 175 HBV NAT–reactive/hepatitis B surface antigen (HBsAg)‐negative donors. The classification of the HBV infection of these donors was confirmed by follow‐up testing.

STUDY DESIGN AND METHODS: Index samples were tested for HBV serologic markers and HBV viral loads were determined. Donors were followed for up to 13 months and samples were tested with both NAT assays and for all HBV serological markers.

RESULTS: Of 175 HBV NAT–yield donors, 72 (41%) were followed. Based on the follow‐up results, the majority of donors who were followed had an occult HBV infection (66.7%), followed by donors with a primary, acute infection (26.4%). The majority of donors in this latter group (20.8%) were in the window period. Three donors (4.2%), who were anti‐HBs positive, had a reinfection or breakthrough infection.

CONCLUSION: The majority of donors detected during routine screening, who were HBsAg negative and NAT reactive, had an occult HBV infection, thus validating the decision to introduce NAT for blood donations in Thailand.
The Relationship Between Undergraduate Attendance and Performance Revisited: Alignment of Student and Instructor Goals
Authors: Westerman James W. , Perez‐Batres Luis A. , Coffey Betty S. , Pouder Richard W.
Published: January 2011

We revisit the relationship between attendance and performance in the undergraduate university setting and apply agency theory in the instructor–student context. Building on agency theory propositions in the educational setting advanced by Smith, Zsidisin, and Adams (2005), we propose that the student and instructor must align goals to promote the student's achievement of performance learning outcomes, and attendance functions as a behavior‐based alignment mechanism to encourage the convergence of faculty and student interests. Further, we propose that attendance does not equally affect lower‐ and higher‐performing students and that absences are also negatively related to students' cumulative grade point average. We test these hypotheses with data from undergraduates enrolled in management courses at a state university in the southeast. Our results show that attendance is positively related to exam performance, there are more pronounced negative effects of an absence for lower‐performing students than for higher performers, and absences are negatively related to a student's cumulative grade point average. We discuss the implications of our findings for students, instructors, and universities as well as practice in teaching and learning.