bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Glucose in Dialyzing Fluid on Purine Concentrations in Hemodialyzed Patients with Chronic Renal Failure
Authors: Bober Joanna , Kędzierska Karolina , Safranow Krzysztof , Kwiatkowska Ewa , Jakubowska Katarzyna , Herdzik Edyta , Dołęgowska Barbara , Domański Leszek , Ciechanowski Kazimierz
Published: October 2003

Background: In chronic renal failure the accumulation of some purine nucleotides (in erythrocytes) develops both in patients undergoing conservative treatment and in hemodialyzed patients. The aim of the study was: (1) To find if hemodialysis (HD) sessions using dialyzing fluid containing glucose leads to an increase in ATP concentration and changes in the concentration of other nucleotides, nucleosides and oxypurines in erythrocytes. The potential consequence of such purine concentration changes is the increase of 2,3-DPG concentration and an improved transportation of oxygen in erythrocytes which are more resistant to hemolysis. (2) To compare blood concentrations of purine nucleotides, nucleosides and oxypurines in patients undergoing chronic HD with dialyzing fluid containing or lacking glucose. Significant differences could suggest the long-term influence of glucose in dialyzing fluid on erythrocyte energetic state. Methods: Whole blood nucleotide concentrations were evaluated with the use of a high-performance liquid chromatography technique. Results: Before the HD session the patients in the ‘plus glucose’ group had significantly higher concentrations of ATP, ADP, AMP, TAN, NAD, NADP, GTP + GDP, GMP, Urd and HYP than patients in the ‘no glucose’ group. After the HD the patients in the ‘plus glucose’ group had significantly higher concentrations of ADP, AMP, TAN, NAD, NADP, Urd and HYP than in the ‘no glucose’ group. Both before and after the HD session, the uric acid concentrations and AEC were significantly lower in the ‘plus glucose’ group than in the ‘no glucose’ group. A significant decrease in the whole blood hypoxanthine (p < 0.05) and uric acid (p < 0.001) concentrations after HD was found in the ‘no glucose’ group while a significant increase in ADP concentration (p < 0.05) was detected in the patients’ erythrocytes in the ‘plus glucose’ group. In this group a significant decrease of GTP + GDP and GMP (p < 0.05), uric acid concentration (p < 0.001) and adenylate energy charge (p < 0.05) were observed after the dialysis. However, no significant differences in nucleotide concentrations before and after the HD were found in the ‘no glucose’ group. Conclusion: The presence of glucose in the dialyzing fluid causes a significant modification of the energetic state of cells which is reflected by the purines’ and their metabolites’ concentrations in the erythrocytes. Higher ATP concentrations in patients with renal failure who have been dialyzed with the fluid containing glucose can be considered as an organism adaptation to a decreased amount of RBC and hemoglobin concentration.
Profiling Gene Expression in Kidney Development
Authors: Dekel Benjamin
Published: October 2003

Insights into the normal development of the kidney have been derived from metanephric organ cultures, knockout mice and the later definition of the responsible single genetic abnormalities in some human congenital renal tract malformations. Deciphering of the human genome and the ability to examine multiple messenger RNA has opened new vistas and the capacity to begin to understand the complex kidney developmental process. In this review we focus on recent large-scale gene expression profiles performed during normal murine and human nephrogenesis and suggest how they might provide insights into normal kidney development as well as aberrations of this normal process that may result in renal dysplasia or pediatric renal malignancy (Wilms’ tumor).
Role of Fcγ Receptors in Glomerulonephritis
Authors: Tarzi Ruth M. , Cook H. Terence
Published: October 2003

Many forms of glomerulonephritis involve immune complex localization in the kidney. Fcγ receptors (FcγR) expressed on the surface of leukocytes bind the Fc (constant) portion of IgG. They link immune complex deposition to innate immune responses, including phagocytosis, cytokine release, formation of reactive oxygen species, and antibody-dependent cytotoxicity. Activator and inhibitor FcγR co-exist on the surface of cells and set thresholds for immune responses. Inhibitor FcγR also have a specific role in the maintenance of B cell tolerance. Studies of gene-targeted mice lacking specific FcγR have demonstrated that animals lacking activator FcγR on circulating leukocytes were protected from immune complex induced glomerular injury, both in models of systemic lupus erythematosus (SLE) and anti-glomerular basement membrane antibody disease. In contrast, mice lacking inhibitor FcγR developed SLE-like auto-immunity on certain genetic backgrounds and were more susceptible to anti-glomerular basement membrane disease, with evidence of enhanced immune responses and dysregulated effector cells. There is also evidence for FcγR dysfunction in human SLE and for an association of ‘low-binding’ polymorphisms of FcγR with SLE. In the future, therapeutic possibilities may exist for the manipulation of the FcγR pathway in the treatment of glomerulonephritis.
Oxidative Stress in a Novel Model of Chronic Acidosis in LLC-PK1 Cells
Authors: Rustom Rana , Wang Bohan , McArdle Frank , Shalamanova Liliana , Alexander John , McArdle Anne , Thomas Carol E. , Bone J. Michael , Shenkin Alan , Jackson Malcolm J.
Published: October 2003

Chronic metabolic acidosis occurs commonly in chronic renal failure (CRF). The proximal renal tubular cell is the site in the kidney of high oxidative metabolic activity and in CRF is associated with adaptive hypertrophy and hypermetabolism. We hypothesised that chronic acidosis may lead to increased generation of reactive oxygen species due to increased oxidative activity. We developed a novel model of chronic acidosis in LLC-PK1 cells and measured markers of oxidative stress and metabolism. Acidosis led to a reduction in cellular total glutathione and protein thiol content and an increase in glutathione peroxidase activity and NH3 generation. The expression of constitutively expressed heat stress protein (HSP) HSC70 and HSP60 increased at pH 7.0.
Role of Thyroid Hormones on the Synthesis and Release of Atrial Natriuretic Peptide in Rats with Acute Renal Failure
Authors: Rodríguez Ernesto , García Ana María , Foyo Enrique , Amato Dante , Paniagua Ramón
Published: October 2003

Background/Aims: High atrial natriuretic peptide (ANP) serum levels are seen in acute renal failure (ARF) due to impaired ANP clearance, but the response of ANP to blood volume expansion is blunted. ARF-associated hypothyroidism influences ANP clearance but it may also play a role in the synthesis and release of ANP because in primary hypothyroidism both mechanisms are disturbed. The aim of this study is to analyze whether thyroxin (T4) supplementation improves the synthesis and release of ANP in ARF. Methods: Four groups of rats were studied: group C (control); group ARF; Group ARF-T4 (ARF supplemented with T4), and group Tx (thyroidectomized). Serum creatinine (SCr), creatinine clearance (CrCl), total T4, total triiodothyronin (T3), plasma ANP, ANP response to acute saline load and atrial content of mRNA-ANP were measured 5 days after ARF induction with potassium dichromate. Results: CrCl was 1.8 ± 0.4 ml/min in group C, and it significantly dropped to 0.6 ± 0.5 in ARF (p < 0.01), T4 improved it (1.7 ± 0.7 in ARF-T4, p < 0.01) and Tx did not change it. Plasma ANP was higher in ARF as compared with C (152 ± 23 vs. 52 ± 21 fmol/l, p < 0.01). In ARF-T4, ANP was higher than in C but lower than in ARF (85 ± 28 fmol/l, p < 0.01). No changes were observed in Tx rats (48 ± 17 fmol/l). The atrial content of mRNA-ANP was 0.06 ± 0.025 mRNA-ANP/mRNA-β-actin ratio units in group C, it was higher in ARF (0.13 ± 0.025, p < 0.01) and lower in Tx (0.04 ± 0.01, p < 0.05) as compared to C. Supplementation with T4 increased the mRNA-ANF content (0.18 ± 0.2 mRNA-ANP/mRNA-β-actin ratio units, p < 0.05) over ARF. Plasma ANP response to saline load was 45 ± 7% in C, but it was reduced in ARF and Tx (20 ± 10 and 26 ± 10%, p < 0.01). In ARF-T4 the response was restored (36 ± 9%, p < 0.01 vs. ARF). Conclusion: Thyroid hormones modulate the synthesis and release of ANP in ARF. Although the effect is probably direct, T4-induced amelioration of renal damage may also play a significant role by improving the uremic milieu.
Angiotensin-Converting Enzyme Inhibition Modulates High-Glucose-Induced Extracellular Matrix Changes in Mouse Glomerular Epithelial Cells
Authors: Morano S. , Cipriani R. , Cerrito M.G. , Santangelo C. , Vasaturo F. , Pantellini F. , Sensi M. , Guidobaldi L. , Scarpa S. , Di Mario U.
Published: October 2003

Background/Aim: Extracellular matrix alterations are involved in the pathogenesis of diabetic nephropathy. We evaluated the effects of high glucose concentrations and inhibition of angiotensin-converting enzyme on the laminin and fibronectin production by glomerular epithelial cells. Methods: Glomerular epithelial cells were cultured in 5 and 30 mmol/l glucose, with and without enalaprilat (0.3 mmol/l). Laminin and fibronectin were measured (35S-methionine, immunoprecipitation), and their mRNA expression was evaluated (RT-PCR). Results: The laminin concentration was higher in the cells than in the medium, where an increase of its content was observed under high-glucose conditions (p < 0.01). Fibronectin, found only in the medium, was not modified by the high glucose concentration. Following enalaprilat administration, the laminin concentration was decreased under high-glucose conditions, both in the cell and in the medium (p < 0.001), whereas the fibronectin concentration was increased under high-glucose conditions (p < 0.001). The mRNA expression of laminin and fibronectin under high-glucose conditions only slightly increased. Enalaprilat decreased the fibronectin mRNA synthesis dramatically (>50%, p < 0.0001) under high-glucose conditions. Conclusions: Enalaprilat normalizes the abnormal, high-glucose-induced concentration of laminin, while it decreases the fibronectin synthesis. The improvement of the renal function in diabetic patients treated with angiotensin-converting enzyme inhibitors may, in part, be due to a modulator effect on extracellular matrix content and composition.
Involvement of p300 in TGF-β/Smad-Pathway-Mediated α2(I) Collagen Expression in Mouse Mesangial Cells
Authors: Kanamaru Yutaka , Nakao Atsuhito , Tanaka Yuichi , Inagaki Yutaka , Ushio Hiroko , Shirato Isao , Horikoshi Satoshi , Okumura Ko , Ogawa Hideoki , Tomino Yasuhiko
Published: October 2003

Background: Transforming growth factor beta 1 (TGF-β1) induces α2(I) collagen gene (COL1A2) expression in mesangial cells through physical and functional cooperation of Smad proteins and Sp1. A transcriptional coactivator, p300, is also suggested to play an important role in TGF-β1/Smad signal transduction. However, the role of p300 in TGF-β1/Smad-pathway-mediated transcriptional activation of the COL1A2 gene in mesangial cells is still obscure. Methods: Endogenous p300 expression and its modulation by TGF-β1 were evaluated by Western blotting and immunofluorescence. The physical interaction of p300 with Smad2/3 was examined by immunoprecipitation followed by Western blotting. The functional role of p300 in TGF-β1/Smad-pathway-mediated COL1A2 transcription was investigated in cotransfection experiments using a COL1A2 promoter-luciferase reporter gene construct and p300 expression plasmids. Results: TGF-β1 induced COL1A2 gene expression in cultured mouse mesangial cells which was blocked by overexpression of inhibitory Smad7. In addition, TGF-β1-induced nuclear export of endogenous Smad7 was observed in mouse mesangial cells. Endogenous p300 was expressed in the nucleus of the cells. TGF-β1 induced interaction of endogenous p300 with Smad2/3, and a dominant negative construct of p300 inhibited the TGF-β1-induced COL1A2 expression in cultured mouse mesangial cells. Conclusions: p300 may be involved in TGF-β1/Smad-pathway-mediated type I collagen gene transcription in mouse mesangial cells. Our findings would reveal a molecular basis of TGF-β1-induced type I collagen gene transcription in mouse mesangial cells.
Effect of Poly(ADP-Ribose) Polymerase Inhibition on Outer Medullary Hypoxic Damage
Authors: Darmon David , Goldfarb Marina , Shina Ahuva , Rosen Seymour , Heyman Samuel N.
Published: October 2003

Poly(ADP-ribose) polymerase (PARP) activation after free-radical-induced DNA damage depletes cellular energy stores and participates in ischemia-reflow injury. We studied the potential protective effect of the water-soluble PARP inhibitor 3-aminobenzamide (3-AB) in a rat model of acute renal failure (ARF) from combined administration of radiocontrast, indomethacin and Nω-nitro-L-arginine methyl ester. Kidney function at 24 h was better preserved in rats treated with 3-AB as compared to control animals. However, the extent of tubular hypoxic damage was not significantly mitigated. It is concluded that PARP inhibition may attenuate renal dysfunction in this model of ARF with medullary hypoxic tubular injury even while the extent of tubular necrosis is not significantly altered. Further studies of this dyssynchrony of structure and function may provide important insights into the sequence of events that promotes renal failure after medullary injury.
Extraction of Uraemic Toxins with Activated Carbon Restores the Functional Properties of Albumin
Authors: Sarnatskaya Veronika V. , Lindup W. Edward , Ivanov Adrej I. , Yushko Larisa A. , Tjia John , Maslenny Vitaly N. , Gurina Natalia M. , Nikolaev Vladimir G.
Published: October 2003

Background: Previous work has demonstrated that a partial normalization of the conformation of albumin from uraemic plasma and a substantial restoration of its binding abilities can be achieved by extraction with activated charcoal. This is best achieved at pH 3, but exposure of whole plasma to this low pH leads to the loss of some essential components. Methods: The melting curves and ligand-binding abilities of uraemic albumin have been investigated after extraction with a new generation of activated carbon at three pH values (7.2, 3.0 and 5.08). Results: Albumin isolated from uraemic plasma had a characteristically increased melting temperature because of bound ligands. Extraction of uraemic plasma at pH 7.2, 5.08 and 3.0 induced low-temperature shifts of albumin thermo-adsorption maximum T1 of 1.4, 3.8, 2.4°C and T2 of 0.8, 3.9 and 1.2°C, respectively. Flow microcalorimetry data demonstrated a decrease in the ability of uraemic albumin to bind octanoate, phenol red, salicylic acid, warfarin and diazepam. Purification of uraemic plasma at pH 5.08 completely restored the binding affinity of albumin for all the marker ligands. Conclusions: Highly efficient activated carbons, with clinically feasible acidification of plasma, can remove strongly albumin-bound uraemic toxins. Investigation of the melting curve of the isolated albumin is a new biophysical way to monitor both its molecular condition and the extent of removal of protein-bound toxins by dialysis. The melting curve provides new qualitative and quantitative information about albumin in an analogous way to an electrocardiogram and the heart.
Major Depressive Disorder with Anger: A Bipolar Spectrum Disorder?
Authors: Benazzi Franco
Published: October 2003

Background: Depression with anger may be more common in bipolar disorders. The aim of the study was to assess whether major depressive disorder (MDD) with anger could be included in the bipolar spectrum, by comparing it to MDD without anger and to bipolar II disorder. Methods: Consecutive outpatients (281 bipolar II disorder and 202 MDD) presenting for major depressive episode (MDE) treatment were interviewed with the DSM-IV structured clinical interview. Clinical variables used to support the inclusion of MDD with anger in the bipolar spectrum were age of onset, many MDE recurrences, atypical features of depression, depressive mixed state (an MDE plus some concurrent hypomanic symptoms), and bipolar family history. Results: Frequency of MDE with anger was 50.5% [61.2% in bipolar II, and 35.6% in MDD (z = 5.5, p = 0.0000, 95% CI 16.8–43.3%)]. Logistic regression of MDE with anger (dependent variable) versus bipolar variables showed that MDE with anger was significantly associated with all bipolar variables, apart from recurrences. MDD with anger, compared with MDD without anger, had significantly lower age of onset, more marked depressive mixed state, a bipolar family history with more cases, but comparable atypical features and Global Assessment of Functioning scores. MDD with anger, compared with bipolar II disorder, had significantly higher age of onset, less atypical features, and a bipolar family history with less cases. Conclusions: MDE with anger was common in outpatients (more in bipolar II disorder). MDD with anger may be midway between MDD without anger and bipolar II disorder, and might be included into the bipolar spectrum. However, MDD with anger does not appear to be associated with the often reported negative response to monotherapy with antidepressants.
Alexithymia, Depression and Social Support among Japanese Workers
Authors: Kojima Masayo , Senda Yoshihiro , Nagaya Teruo , Tokudome Shinkan , Furukawa Toshiaki A.
Published: October 2003

Background: A number of studies have shown that social support has a direct beneficial effect on well-being and also serves as a buffer to protect people from health problems due to excessive stress. Although preliminary studies report a positive relationship of alexithymia both with depression and reduced social support, there is no study examining whether the beneficial effect of social support on depression differs with the presence of alexithymia. Methods: A total of 120 workers aged 19–39 completed the 20-item Toronto Alexithymia Scale (TAS-20) to measure alexithymia, the Beck Depression Inventory-II (BDI-II) to evaluate depressive symptomatology, and the Job Content Questionnaire (JCQ) to assess job strain based on Karasek’s demand-control-support model. The interrelationship among TAS-20, BDI-II and 3 subscales of JCQ (job demand, control, and support) were examined. Results: A significant association of depression with low support and high alexithymia was observed. Alexithymia was also associated with reduced support. Further, a statistically significant interaction between alexithymia and support in terms of their effect on depression was observed. Nonalexithymic individuals with low support showed a significantly higher depression score than those who received high support, while alexithymics did not differ in their depression score depending on the degree of support. Consistent results were obtained from the logistic regression analysis examining the odds ratio for depression by support by alexithymia; a significantly increased odds ratio for depression associated with low social support was observed only among nonalexithymics. Conclusions: Alexithymic individuals might be unable to benefit from social support because of their cognitive deficits of emotion.
The Use of Defenses and Physician Health Care Costs: Are Physician Health Care Costs Lower in Persons with More Adaptive Defense Profiles?
Authors: MacGregor Michael William , Davidson Karina W. , Rowan Paul , Barksdale Cheryl , MacLean David
Published: October 2003

Background: The objective of the present study was to determine if persons who use more adaptive defenses have lower physician health care costs compared to those who use less adaptive defenses. Methods: We randomly selected 667 persons from the 1995 population-based Nova Scotia Health Survey who completed a videotaped structured interview. Each interview was rated for typical defense use by the Defense-Q. We obtained physician health care costs for 3 months before and after the interview, as well as medical diagnoses and measures of psychological functioning. Results: A more adaptive defense profile significantly predicted lower future physician health care costs. These results were found when controlling for other psychosocial variables, before and after controlling for previous physician health care costs, and when testing only within a physically healthy subsample. Results of secondary analyses showed that a more adaptive defense profile was positively related to a number of psychosocial variables, such as nurse’s rating of competence, lack of depressive symptoms, and days at work. Conclusions: The adaptiveness of a person’s defense use in managing affect is important in predicting physician health care costs as well as psychosocial functioning.
Ageing Styles: Subjective Well-Being and Somatic Complaints in Inpatients Aged ≥60 Years
Authors: Schneider Gudrun , Driesch Georg , Kruse Andreas , Wachter Michael , Nehen Hans-Georg , Heuft Gereon
Published: October 2003

Background: Recent gerontological research shows a high variability in the elderly population. The aim of the present study is to investigate by means of cluster analysis, as to whether different ‘ageing styles’ can be identified in a sample of cognitively not impaired older persons, and to assess discrepancies between self-rated and expert-rated psychological and physical health. Method: 243 patients aged 60 years and older in a general hospital were investigated using a clinical psychiatric interview, expert ratings, and self-report scales after extensive internal medical diagnostic evaluation. Results: Five clusters, representing significantly different ‘ageing styles’ with regard to subjective well-being and subjective physical complaints, could be identified. Two clusters, which together constituted 57% of the sample, represented quite positive and desirable ageing styles. In two clusters (altogether 23% of the sample), there was a discrepancy between medical findings and subjective physical complaints. Conclusions: These findings support the notion of high variability in the elderly and the existence of subgroups, which show a discrepancy between subjective assessment of well-being and expert assessment of psychological and physical health and impairment. The recording of subjectively perceived physical complaints should, therefore, be part of the evaluation of older peoples’ subjective well-being.
Prevalence and Risk Factors of Posttraumatic Stress Disorder in Older Adults
Authors: van Zelst Willeke H. , de Beurs Edwin , Beekman Aartjan T.F. , Deeg Dorly J.H. , van Dyck Richard
Published: October 2003

Background: Posttraumatic stress disorder (PTSD) has scarcely been researched in the elderly. There is no population-based information on prevalence and risk factors in older persons. Patients with PTSD are often not recognized or incorrectly diagnosed. As the disorder has great implications for the quality of life, a correct diagnosis and treatment are crucial. Increased knowledge on vulnerability factors for PTSD can facilitate diagnostic procedures and health management in the elderly. Methods: PTSD cases were found following a two-phase sampling procedure: a random selection of 1,721 subjects were screened and in 422 subjects a psychiatric diagnostic interview was administered. Prevalence of PTSD and subthreshold PTSD were calculated. Vulnerability factors regarding demographics, physical health, personality, social factors, recent distress and adverse events in early childhood were assessed. Results: 6-month prevalence of PTSD and of subthreshold PTSD was 0.9 and 13.1%, respectively. The strongest vulnerability factors for both PTSD and subthreshold PTSD were neuroticism and adverse events in early childhood. Conclusions: This is the first population-based study on PTSD in older persons. With a 6-month prevalence of almost 1% the disease is not rare. Comparisons with younger populations suggest some accumulation of cases among older people reflecting the chronic risk factors, which are found in this study: neuroticism and adverse events in early childhood.
Psychological Assessment in Cardiac Rehabilitation
Authors: Rafanelli Chiara , Roncuzzi Renzo , Finos Livio , Tossani Eliana , Tomba Elena , Mangelli Lara , Urbinati Stefano , Pinelli Giuseppe , Fava Giovanni A.
Published: October 2003

Background: While there has been an upsurge of interest in the psychiatric correlates of myocardial infarction, little is known about the presence of psychological distress in the setting of cardiac rehabilitation. Methods: A consecutive series of 61 patients with recent myocardial infarction who participated in a cardiac rehabilitation program was evaluated by means of both observer-rated (DSM and DCPR) and self-rated (Psychosocial Index) methods. A follow-up of this patient population was undertaken (median = 2 years). Survival analysis was used to characterize the clinical course of patients. Results: Twenty percent of patients had a DSM-IV diagnosis (in half of the cases minor depression). An additional 30% of patients presented with a DCPR cluster, such as type A behavior and irritable mood. Only high levels of self-perceived stressful life circumstances and psychological distress approached statistical significance as a psychological risk factor for cardiovascular events after myocardial infarction. Conclusions: Psychological evaluation of patients undergoing cardiac rehabilitation needs to incorporate both clinical (DSM) and subclinical (DCPR) methods of classification. Type A behavior was present in about a quarter of patients and can be studied in specific subgroups of cardiovascular patients defined by DCPR.
Principles of Nidotherapy in the Treatment of Persistent Mental and Personality Disorders
Authors: Tyrer Peter , Sensky Tom , Mitchard Sarah
Published: October 2003

Background: The principles of a psychological intervention for psychiatric disorders, nidotherapy, are described following its use in the treatment of patients with severe mental illness, most of whom also have personality disorders. Nidotherapy is the collaborative systematic assessment and modification of the environment to minimise the impact of any form of mental disorder on the individual or on society. It is particularly appropriate to consider for chronic and recurring disorders in which there is no prospect of short-term improvement. Methods: An analysis of the treatment suggests its main tenets are the development of a joint consensus (collateral collocation) of environmental change needed, formulation of targets, consequent monitoring and adjustments made to test the effectiveness of intervention, and a joint structure (arbitrage solving) to adjudicate when changes are considered feasible or impractical by one party and not the other. Results: Case vignettes are used to describe the main features of the treatment. Although nidotherapy includes some of the elements of cognitive, occupational and family therapy, and even social work, it is different in that it focuses on changing the environment, not the person. It is therefore much more acceptable to those patients who have repeatedly challenged the justification of conventional therapy for their conditions. Conclusions: Nidotherapy deserves further enquiry as a useful addition to existing psychological treatments.
Primary and Secondary Stroke Prevention in Nonrheumatic Atrial Fibrillation by Oral Anticoagulation
Authors: Stöllberger Claudia , Finsterer Josef
Published: October 2003

The risk of stroke or embolism in atrial fibrillation (AF) patients can be reduced by 68% by oral anticoagulation (OAC). This review is aimed to (1) summarize indications for OAC in patients with AF, (2) give an overview of the current knowledge of risk factors for bleeding complications of OAC and (3) give practical recommendations for an optimal OAC therapy in the neurological setting. Indications for OAC are increased age (>75 years), arterial hypertension, diabetes mellitus, previous thromboembolism, heart failure and, probably, coronary heart disease. Risk factors for bleeding complications are overanticoagulation with international normalized ratios (INRs) >3.0, increased age, arterial hypertension, diabetes mellitus, previous thromboembolism, polypharmacy, the early phase of OAC therapy and a lack of patients’ education. Before initiation of OAC, the patient should be screened for potential bleeding sites. Careful monitoring of OAC comprises fixed appointments for the INR value determination, tracking for the patient, if he does not attend, advices about pain therapy, information about the influence of diet on the INR value and drug interaction, unscheduled INR determination in case of acute disorders and regular assessment if OAC is still indicated. Monitoring of OAC needs an effort, which has to be adequately estimated by the health care system.
Etiology and Long-Term Prognosis of Unilateral Paramedian Pontine Infarction with Progressive Symptoms
Authors: Kunz Stefanie , Griese Harald , Busse Otto
Published: October 2003

Progressive pure motor hemiparesis is a common feature in paramedian pontine infarction. To assess the etiology, clinical course and long-term prognosis of this stroke subtype, we identified 26 patients with progressive symptoms in a retrospective study, treated in our hospital between 1993 and 1998. All patients had more than one stroke risk factor, and in 20, basilar branch disease, an atherosclerotic occlusion of basilar perforating arteries, was causative. Most patients developed severe hemiparesis after a mean time of 3 days, nearly 50% showed deterioration in connection with a fall in systolic blood pressure. The patients were followed up for 4–9 years: 4 patients had further strokes, 5 died, and 17 patients were independent, which may be interpreted as a good long-term prognosis.
Microembolus Detection in Four Patients with Fabry’s Disease: Further Support for a Primarily Microangiopathic Origin of Early Cerebrovascular Symptoms
Authors: Ritter Martin , Dittrich Ralf , Droste Dirk W.
Published: October 2003

Fabry’s disease is a sex-linked recessive storage disorder leading to cerebrovascular symptoms in many cases. Whether the primary origin of cerebrovascular symptoms in these patients is due to autochthonous thrombosis of small vessels or embolic infarction from large vessels is under debate. Microembolic signals (MES) indicative of an active embolic source can be recorded by transcranial Doppler sonography. We report four patients (34, 44, 62 and 66 years old) with Fabry’s disease from one kindred in whom we carried out microembolus detection recordings to disclose active embolic sources. Three of the patients had had transient focal neurological deficits. Two patients had angina pectoris and one had exercise dyspnea, but no patient had clear evidence of disease of the large coronary vessels or brain-supplying arteries. No MES were found in 1-hour recordings in any patients, supporting the hypothesis that early cerebrovascular symptoms arise from small vessel occlusion and not from embolic sources as an indicator of disease of large brain-supplying arteries or cardiac embolism.
Neurophysiological Diagnosis of Acquired Sensory Ganglionopathies
Authors: Lauria Giuseppe , Pareyson Davide , Sghirlanzoni Angelo
Published: October 2003

We examined 29 patients with chronic progressive ganglionopathy of different etiology. Neurophysiological abnormalities were dominated by a widespread decrease in sensory nerve action potential amplitudes, which involved both upper and lower limb nerves, even in patients with asymmetrical or patchy clinical presentation. This impairment of sensory nerve conduction, reflecting a nonlength-dependent pattern of peripheral axon degeneration, should be considered the hallmark of ganglionopathies. The evidence of central sensory pathway impairment, which allows to localize the pathology to the dorsal root ganglion neurons, could be better confirmed by cervical magnetic resonance imaging, which showed a diffuse hyperintensity in the posterior columns in all patients, than by somatosensory evoked potentials, which were undetectable in most of the patients. Few patients showed an impairment of individual motor nerves, which appeared more severe in paraneoplastic associated ganglionopathies. Neurophysiological abnormalities did not appear significantly changed at the 4-year follow-up. We emphasize that distinct abnormalities allow to differentiate ganglionopathies from axonal sensory neuropathies on routine neurophysiological examination.
Movement Disorders Possibly Induced by Traditional Chinese Herbs
Authors: Wang X.P. , Yang R.M.
Published: October 2003

The authors describe the neurological presentation and CT/MRI findings in 4 patients exposed to overdoses of decoctions of two different Chinese herbs. Case 1, a 15-year-old boy, ingested herba serissae along with the safe-dosage Salvia miltiorrhiza for treating a left renal stone. Sophora subprostrata root (SSR) was primarily used for treating three other diseases: viral B hepatitis in case 2, a 9-year-old boy; infection of the throat and a low fever in case 3, a 11-year-old girl, and a minor facial infection in case 4, a 12-year-old boy. All patients showed complex neurological manifestations primarily including convulsions, mental changes and dystonia syndromes. Their CT and/or MRI revealed abnormal density lesions in the striatum and globus pallidus bilaterally. They excluded the possibility of Wilson’s disease in each of the 4 patients and suggested that overdosage of SSR and herba serissae could cause intoxications of the central nervous system, particularly damage to the basal ganglia. Chemically, coumarin (case 1) and matrine and oxymatrine (cases 2–4) in the two medicinal herbs are suggested to be possibly responsible for the morbidity.
Assessment of Driving Performance in Patients with Relapsing-Remitting Multiple Sclerosis by a Driving Simulator
Authors: Kotterba Sylvia , Orth Maritta , Eren Esma , Fangerau Tanja , Sindern Eckhart
Published: October 2003

Objective: To compare the driving performance using a driving simulator with physical and cognitive functions as measured by the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite (MSFC) in patients suffering from the relapsing-remitting form of multiple sclerosis (RRMS). Methods: 31 RRMS patients (18 women, 13 men, mean age 35.6 ± 8.3 years, EDSS 2.8 ± 1.4) were compared with 10 healthy controls (8 men, 2 woman, age 45.1 ± 7.8 years). Results: Compared with controls, the accident rate (5.3 ± 3.8 vs. 1.3 ± 1.5, p < 0.001) and concentration faults (21.1 ± 15.5 vs. 7.1 ± 2.6, p < 0.01) of RRMS patients using the driving simulator were increased. While there was no correlation with the EDSS score, the accident rate was correlated with the MSFC (r = –0.5, p < 0.05). Regarding the three dimensions of the MSFC, accidents were related to the number of correct answers and Z-score in the paced auditory serial addition test (PASAT) as a measure for cognitive function (r = –0.33, p < 0.05). Conclusion: The current study demonstrates the need to focus also on driving skills in MS patients. The risk of accidents should be evaluated after relapses in particular. However, there are great interindividual differences. In the MSFC, most deficits could be evaluated in the PASAT. As there was a significant correlation between the accident rate in the driving simulator and the PASAT results, accidents seem to be more influenced by cognitive decline than by physical impairment. This indicates that the MSFC is a broader, more dimensional scale than the EDSS and should be preferred in the case of driving assessment. At the present time, the driving simulator seems to be a useful instrument judging driving ability, especially in cases with ambiguous neuropsychological results.
Is the Reduction of Spasticity by Botulinum Toxin A Beneficial for the Recovery of Motor Function of Arm and Hand in Stroke Patients?
Authors: Woldag Hartwig , Hummelsheim Horst
Published: October 2003

To determine the functional benefit of botulinum toxin A (BtxA) in spasticity of arm flexors, we conducted an open-label study with 10 stroke patients. 480 mouse units BtxA (Dysport®) were injected into flexor muscles. Outcome measures were done by the Modified Ashworth Scale, Rivermead Motor Assessment (arm section), active and passive ranges of motion (ROM), grip strength and a 3-dimensional motion analysis. The functional capacity of the entire arm, even of the shoulder, and the ROM of fingers and wrist increased. Despite a diminution of muscle tone, grip strength remained unchanged or increased. An improvement of forearm extension was only observed in cases of preserved voluntary extensor motricity. Injection of BtxA into spastic distal flexor muscles may lead to a functional improvement of the entire arm. Grip strength is not necessarily reduced.
Therapy with Intravenous Immunoglobulins: Complications and Side-Effects
Authors: Wittstock Matthias , Benecke Reiner , Zettl Uwe K.
Published: October 2003

Therapy with intravenous immunoglobulins (IVIG) is thought to be a safe treatment for a number of immune-mediated neurological diseases. Published data about prevalence of adverse effects range from 11 to 81%. The purpose of our study was to present a representative view on adverse effects by analysis of a large cohort of patients treated by IVIG. In a prospective study, we analysed 117 patients (age 17–79 years) who were treated with IVIG for various neurological diseases including chronic inflammatory demyelinating polyneuropathy, diabetic amyotrophy, inclusion body myositis, multiple sclerosis, Guillain-Barré syndrome, Miller-Fisher syndrome, multifocal motor neuropathy, myasthenia gravis and polymyositis. IVIG therapy was applied at a dose of 0.4 g/kg body weight/day in a total of 408 therapy courses. 42.7% showed adverse events. The majority of patients presented with minor adverse effects, mostly asymptomatic laboratory changes. Rash or mild headache occurred in 8 patients, especially when IVIG was given with infusion flow higher than 10 g/h. Two patients showed a severe complication with deep vein thrombosis. In summary, beside its effectiveness in immune mediated neurological diseases, therapy with IVIG seems to be a safe therapy. Most patients show no or minor adverse effects. Patients with pre-existent disorders like heart or renal insufficiency or immobilised patients, however, may be at higher risk for complications.
Effect of Sleep Deprivation on Saccades and Eyelid Blinking
Authors: Crevits Luc , Simons Brian , Wildenbeest Joanne
Published: October 2003

In this study the effect of sleep deprivation on specific components of eye and eyelid movement was investigated in a group of young and healthy subjects. The duration of sleep deprivation was 20 h. Each subject had to execute different saccade tasks: reflexive saccades, voluntary prosaccades and antisaccades. Saccade latency, number of saccade errors and blink rate during the saccade tasks were evaluated as predictors of performance decrements resulting from sleep deprivation. The present study showed no significant deterioration of latency and number of errors in the different saccade tasks. However, the blink rate was significantly higher after a night without sleep than before. It is concluded that the blink rate appears to be a promising psychophysical measurement and a more sensitive parameter than saccade performance to evaluate the effects of 20 h of sleep deprivation. These results encourage further research on this topic.
Family History of Hypertension and Diabetes in Relation to Preeclampsia Risk in Peruvian Women
Authors: Sanchez Sixto E. , Zhang Cuilin , Qiu Chun-Fang , Williams Michelle A.
Published: October 2003

In a case-control study of 169 preeclamptics and 201 controls, we assessed maternal parental history of chronic hypertension and diabetes in relation to preeclampsia risk among Peruvian women. Participants provided information on parental history of the two conditions and other covariates during postpartum interviews. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for confounding by age, parity and prepregnancy adiposity. In this population, women were more likely to know the diabetes status of their parents than their hypertension status. Compared with women without a parental history of hypertension, women with a parental history of hypertension experienced a 20% increased risk of preeclampsia (OR = 1.2; 95% CI 0.7–2.2) that did not reach statistical significance. Women with a positive parental history for diabetes had a 3.4-fold increased risk of preeclampsia (95% CI 1.4–8.4). Women with a positive parental history of both hypertension and diabetes, as compared with those whose parents had neither condition, experienced a 4.6- fold increased risk of preeclampsia (OR = 4.6; 95% CI 0.9–23.0). Our results are generally consistent with the thesis that parental history of hypertension and diabetes reflects genetic and behavioral factors whereby women may be predisposed to an increased risk of preeclampsia.
Intervention Rates after Elective Induction of Labor Compared to Labor with a Spontaneous Onset
Authors: van Gemund N. , Hardeman A. , Scherjon S.A. , Kanhai H.H.H.
Published: October 2003

Introduction: Elective induction of labor has become a widely used procedure in obstetrics. A number of studies have shown an increased incidence of operative deliveries. The objective of this study was to evaluate the rate of interventions in our hospital, including operative delivery. Methods: A matched cohort study in which labor of 122 electively induced women and 122 women with labor with a spontaneous onset were analyzed retrospectively. These women were matched for parity and gestational age. Results: Pain relief, fetal scalp blood sampling and operative deliveries were recorded more frequently in the electively induced labor group. Cesarean delivery was found in 15% of women with induced labor, and in 1% of labors with a spontaneous onset (relative risk 18 (95% CI 2.4–132.7)). No differences were found in neonatal outcomes. Conclusions: Elective induction of labor leads to increased intervention rates during labor. The rate of cesarean delivery is high, particular in nulliparous women and multiparous women without a previous vaginal birth.
Doppler Velocimetry and Cytofluorimetric Analysis inUterine Myomas
Authors: Testa Antonia Carla , Pomini Francesco , Fattorossi Andrea , Battaglia Alessandra , Ferrandina Gabriella , Mansueto Donata , Mastromarino Carmen , Scambia Giovanni , Caruso Alessandro
Published: October 2003

Background: To correlate resistance indices (RI) of vessels detected by transvaginal Doppler velocimetry to the proliferative fraction (PF) calculated by flow cytometry in uterine myomas. A prospective study was carried out on patients scheduled for surgery because of symptomatic uterine myomas. A group of 26 myomas characterized by the presence of detectable vessels at Doppler analysis in the inner part of the mass were included in the study. Methods: The day before surgery patients were studied with both conventional and color Doppler ultrasonography. The volume of the myoma was recorded. The lowest value of RI obtained by Doppler analysis of the vessels within the myoma was considered for the study. Samples from myomas were processed and analyzed by flow cytometry. A PF, representing the cumulative frequency of cells in the S and G2/M phases of the cell cycle, was considered for the analysis. Results: No statistically significant correlation was observed between RI and PF (r = 0.06, p = 0.74). Regression analysis of the intratumoral RI values on the volume of the myoma showed a significant negative correlation (r = –0.46, p = 0.012). Conclusions: Preoperative Doppler evaluation of uterine myomas did not provide predictive information of the proliferative status of the neoplasm. A significant correlation was found between the volume of the myoma and RI.
The Role of Nitric Oxide on Apoptosis in Human Luteinized Granulosa Cells
Authors: Jee Byung Chul , Kim Seok Hyun , Moon Shin Yong
Published: October 2003

This study was designed to investigate the role of nitric oxide (NO) on the apoptosis of human luteinized granulosa cells and its possible pathways. Granulosa cell suspensions were incubated for 48 h after adding NO donor (S-nitroso-N-acetyl-penicillamine, SNAP) and NO synthase inhibitor (nitro-L-arginine methyl ester, L-NAME) at different concentrations. Apoptosis was examined using a terminal deoxynucleotide-transferase-mediated dUTP-biotin nick end labeling method in 70 patients, and immunocytochemical staining was performed for six apoptosis-related proteins in 50 patients. Apoptotic rates were significantly lower in cells incubated with 0.5 mM SNAP, but higher with 0.5, 1.0, and 5.0 mM L-NAME. SNAP (0.5 mM) lowered the expression of Fas and p53 in luteinized granulosa cells, but Bcl-2 expression was increased, and Fas ligand or Bax remained unchanged. Using L-NAME (0.5 and 5.0 mM), the expression of p53 and Bax was increased, but Bcl-2 was unchanged. Fas/Fas ligands were also activated especially in 5.0 mM L-NAME. In conclusion, NO may inhibit apoptosis via decreased Fas and p53, and increased Bcl-2 expression in human luteinized granulosa cells.
Conservative Management of Ectopic Pregnancy with Fetal Cardiac Activity by Combined Local (Sonographically Guided) and Systemic Injection of Methotrexate
Authors: Halperin Reuvit , Vaknin Zvika , Schneider David , Yaron Michal , Herman Arie
Published: October 2003

Objective: To evaluate the efficacy of conservative management of ectopic pregnancy with fetal cardiac activity by combined local sonographically guided and systemic injection of methotrexate. Study Design: The study group included 12 patients with ectopic pregnancy and fetal cardiac activity, treated by combined local and systemic injection of methotrexate in the period from January 1, 2000 to July 1, 2002. The outcome of these patients was compared with the outcome of 53 patients who had ectopic pregnancy without fetal cardiac activity and were being treated only by systemic injection of methotrexate during the same period of time. Results: The success rate was 91.6% (11 out of 12) in the group of patients with ectopic fetal cardiac activity and 90.5% (48 out of 53) in the group of patients with ectopic pregnancy, but without fetal cardiac activity. There was also no significant difference between the two groups comparing the percentage of cases treated by an additional dose of methotrexate (8.3 and 13.2%, respectively), nor comparing the number of days to resolution of β-human chorionic gonadotrophin (BHCG; 40 ± 2 and 34 ± 10 days, respectively). Conversely, there was a significant difference in the initial BHCG level comparing the group of patients treated by combined local and systemic injection of methotrexate (12,616 ± 9,585 mIU/ml) and the group of patients treated by systemic injection of methotrexate (1,499 ± 2,065 mIU/ml) (p < 0.00001). Seventy-five percent of patients (6 out of 8) diagnosed with ectopic fetal cardiac activity, who desired to become pregnant, succeeded to conceive within 6 months following the combined local and systemic injection of methotrexate. Conclusion: The combined local sonographically guided and systemic injection of methotrexate is associated with a successful outcome in asymptomatic patients presenting with ectopic pregnancy and fetal cardiac activity.
17β-Estradiol- and Lipopolysaccharide-Induced Changes in Nitric Oxide, Tumor Necrosis Factor-α and Vascular Endothelial Growth Factor Release from RAW 264.7 Macrophages
Authors: Tomaszewska Agnieszka , Guevara Ibeth , Wilczok Tadeusz , Dembinska-Kiec Aldona
Published: October 2003

The present study investigated the effect of 17β-estradiol (17βE2) and lipopolysaccharide (LPS) on the release and expression of nitric oxide (NO), tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) in the macrophage cell line RAW 264.7. The cells were pre-incubated with 17βE2 at physiological as well as supraphysiological concentrations (12.5–1,000 pg/ml) and subsequently activated with LPS (100 ng/ml). The changes in NO, TNF-α and VEGF release into culture medium and also their gene expression in cells were assessed. A concentration-dependent inhibitory effect of 17βE2 on NO and TNFα release was observed at low physiological concentrations, whereas the VEGF gene expression and protein levels were upregulated by 17βE2 in RAW 264.7 cells.