bluuebunny/crossref_metadata_2025 huggingface dataset:
INTERACTION AND ENGAGEMENT OF WORKERS IN SUPPORTED EMPLOYMENT: A BRITISH COMPARISON BETWEEN WORKERS WITH AND WITHOUT LEARNING DISABILITIES
Authors: Beyer Stephen , Kilsby Mark , Willson Claire
Published: August 2010

Supported employment represents an important alternative to traditional forms of day service in Britain. Social integration in the workplace has been seen as one of its primary aims and this has been a key outcome measure in research. Few studies have looked at engagement in meaningful activity as an outcome measure. This paper describes a direct observation study which compared patterns of interaction and engagement for eight people with learning disabilities being supported in ordinary work settings and eight non‐disabled co‐workers. The results for engagement were favourable, showing no significant difference in percentage of time engaged for the two groups, although supported workers spent more time in on‐task activities than their colleagues. There was no significant difference in frequency of interaction, and who people talked with, between the groups, except where Job Coaches were present, where they became the main focus of interaction for supported workers. Content of interaction differed, co‐workers being more frequently involved in directing others and teasing and joking, while supported workers received praise and greetings more frequently. Reasons for the observed differences and implications for supported employment services are discussed.
ADAPTIVE FUNCTIONING AND BEHAVIOUR OF CHILDREN WITH SPECIAL NEEDS: COMPARISON BETWEEN ETHNIC GROUPS
Authors: Bickerton Wai‐Lin , Vostanis Panos , Cumella Stuart , Chung Man Cheung , Doran John , Winchester Caroline
Published: August 2010

This study investigated the relationship between behaviour and adaptive functioning in 70 children of 5–16 years of age with special needs from three ethnic groups who lived in an urban health district. Parents were interviewed and completed the Vineland Adaptive Behaviour Scale (VABS) and the Aberrant Behaviour Checklist (ABC). The most pronounced developmental deficits were found in communication and daily living skills. Two‐thirds of the subjects were rated as having a moderately severe behaviour problem on at least one item of the ABC. Asian children presented slightly more difficulties in communication, and Afro‐Caribbean children did better than the other children on all domains (though this was not statistically significant). In addition, European children were rated significantly higher than the other two groups in the behavioural scales of hyperactivity and inappropriate speech. Within the whole sample, domains of adaptive functioning, particularly socialisation, were negatively correlated with behavioural problems. Inappropriate speech, as rated by the ABC, was associated with developmental delay on all three VABS domains.
PSYCHOTROPIC DRUGS IN A HOSPITAL FOR INTELLECTUAL DISABILITY: THE STORY OF 18 YEARS
Authors: Etherington J. , Sheppard L. C. , Ballinger B. R. , Fenton G. W.
Published: August 2010

Psychotropic prescribing was surveyed over an 18‐year period in an intellectual disability hospital between 1972 and 1990. The number of inpatients fell from 605 to 242 but the proportion receiving psychotropic drugs rose from 33% to 47% widi an increase in die percentage of the population receiving neuroleptics and lidiium. Polypharmacy applied to 29% of the patients receiving psychotropic drugs in 1990. The changes in prescribing may be partly related to the increased proportion of individuals with more severe psychiatric symptomatology in the population.
INTER‐INFORMANT AGREEMENT ON THE MOTIVATION ASSESSMENT SCALE: ANOTHER FAILURE TO REPLICATE
Authors: Thompson Sarah , Emerson Eric
Published: August 2010

The present study evaluated inter‐informant agreement on the Motivation Assessment Scale across 42 topographies of challenging behaviour in five children with severe intellectual disabilities. The results revealed unacceptably low levels of inter‐rater reliability on all sub‐scales of the MAS and unacceptably low levels of inter‐informant agreement on the purported behavioural function of the rated challenging behaviours.
STRESS AND RESIDENTIAL STAFF: TOWARDS AN INTEGRATION OF EXISTING RESEARCH
Authors: Rose John
Published: August 2010

This paper examines the literature relating to stress in staff who care for people with learning disabilities. The majority of published studies have considered stress in residential staff. When assessing the studies, it soon becomes apparent that there is considerable variability between them in terms of methodology and results. However, the main reason for the range of results probably represent differences in organisational structure of the services surveyed. Despite this variability some simple general trends emerge which suggest that potential stressors and supports vary depending upon their proximity within the organisational structure. Models are presented on how these inter‐relationships might be considered.
UNDERSTANDING FACTORS THAT INFLUENCE STAFF RESPONSES TO CHALLENGING BEHAVIOURS: AN EXPLORATORY INTERVIEW STUDY
Authors: Hastings Richard P.
Published: August 2010

Staff beliefs about challenging behaviours, and their perception of their working environment, are important for two main reasons. Firstly, the manner in which staff define challenging behaviour affects who is labelled as a challenge, and who is referred to specialist services. Secondly, staff views of their working environment may help us to understand why staff interact with people with learning disabilities in the apparently counter‐habilitative ways outlined in previous reasearch. These issues were investigated in a systematic semi‐structured interview of 19 care staff. The interview covered staff definitions of challenging behaviour, the reasons for its occurrence, and strategies for its amelioration; their views on training and behavioural programmes; and their reported emotional responses to challenging behaviour. Content analysis of the interview transcripts revealed several patterns that may help in generating an account of staff behaviour. For example, staff's beliefs about the causes of challenging behaviour were partially congruent with those of psychological analyses, but their reported interventions for challenging behaviour could not be characterised as ‘functional’ strategies. Staff reports also revealed some of the factors in the service environment that may explain why they respond ‘inappropriately’ to challenging behaviour in the short term. These included: an emphasis in staff training on techniques for managing behaviour rather than understanding it, the (possibly resulting) belief that challenging behaviour is to be controlled, and the aversive nature of challenging behaviours. These findings, and their implications for research and practice, are discussed.
Switch‐specific and general preparation map onto different ERP components in a task‐switching paradigm
Authors: Karayanidis Frini , Provost Alexander , Brown Scott , Paton Bryan , Heathcote Andrew
Published: August 2010

We examined whether the cue‐locked centroparietal positivity is associated with switch‐specific or general preparation processes. If this positivity (300–400 ms) indexes switch‐specific preparation, faster switch trials associated with smaller RT switch cost should have a larger positivity as compared to slower switch trials, but no such association should be evident for repeat trials. We extracted ERP waveforms corresponding to semi‐deciles of each participant's RT distribution (i.e., fastest to slowest 5% of trials) for switch and repeat conditions. Consistent with a switch‐specific preparation process, centroparietal positivity amplitude was linked to slower RT and larger RT switch cost for switch but not repeat trials. A later pre‐target negativity (500–600 ms) was inversely correlated with RT for both switch and repeat trials, consistent with a general anticipatory preparation processes.
A randomised controlled trial of low‐dose misoprostol and dinoprostone vaginal pessaries for cervical priming
Authors: Tan T‐C , Yan SY , Chua TM , Biswas A , Chong Y‐S
Published: August 2010

Please cite this paper as: Tan T‐C, Yan S, Chua T, Biswas A, Chong Y‐S. A randomised controlled trial of low‐dose misoprostol and dinoprostone vaginal pessaries for cervical priming. BJOG 2010;117:1270–1277.

Objective  We studied the efficacy of 25‐μg misoprostol pessaries as either single or double dose compared with a 3‐mg dinoprostone pessary for cervical priming.

Design and setting  A randomised controlled trial in Singapore.

Population  One hundred and seventy‐one women with term pregnancies and modified Bishop scores (mBS) ≤6 from 2003 to 2004.

Method  Patients were randomised to single misoprostol dose, double misoprostol dose or the current dinoprostone regimen.

Main outcome measures  Primary outcome was number of women who achieved favourable mBS >6 or active labour by day 2. Secondary outcomes were time interval from insertion to delivery, cardiotocographic abnormalities, delivery and neonatal outcome.

Results  More women in the misoprostol double‐dose group (96.6%) and dinoprostone group (93%) achieved the primary outcome compared with the single‐dose group (77.8%) (P = 0.003 and P = 0.03, respectively). There was no difference in secondary outcomes. More multiparous women achieve primary outcome compared with nulliparous women (odds ratio 0.21, 95% confidence interval 0.06–0.77).

Conclusion  Double‐dose misoprostol 25 μg is as effective as dinoprostone 3 mg inserts for cervical priming; both are more efficacious than a single‐dose misoprostol pessary. Parity prognosticates the success of induction.
Invasive procedures for fetal karyotyping: no cause of subsequent gestational hypertension or pre‐eclampsia
Authors: Lindgren P , Cederholm M , Haglund B , Axelsson O
Published: August 2010

Please cite this paper as: Lindgren P, Cederholm M, Haglund B, Axelsson O. Invasive procedures for fetal karyotyping: no cause of subsequent gestational hypertension or pre‐eclampsia. BJOG 2010;117:1422–1425.

The aim was to estimate the risk of maternal hypertensive complications following first‐ or second‐trimester invasive diagnostic procedures, i.e. chorionic villus sampling (CVS) and amniocentesis (AC). Odds ratios (ORs) for gestational hypertension, mild pre‐eclampsia or severe pre‐eclampsia were calculated for women who underwent CVS (n = 1 984) or AC (n = 21 748) compared with non‐exposed women (n = 47 854). No increase in the development of gestational hypertension, mild pre‐eclampsia or severe pre‐eclampsia was observed. The results do not support an association between invasive procedures for fetal karyotyping and subsequent gestational hypertension or pre‐eclampsia.
Antiretroviral therapy and preterm delivery—a pooled analysis of data from the United States and Europe
Authors: Townsend CL , Schulte J , Thorne C , Dominguez KL , Tookey PA , Cortina‐Borja M , Peckham CS , Bohannon B , Newell M‐L ,   for the Pediatric Spectrum of HIV Disease Consortium, the European Collaborative Study and the National Study of HIV in Pregnancy and Childhood
Published: August 2010

Please cite this paper as: Townsend C, Schulte J, Thorne C, Dominguez K, Tookey P, Cortina‐Borja M, Peckham C, Bohannon B, Newell M, for the Pediatric Spectrum of HIV Disease Consortium, the European Collaborative Study and the National Study of HIV in Pregnancy and Childhood. Antiretroviral therapy and preterm delivery—a pooled analysis of data from the United States and Europe. BJOG 2010;117:1399–1410.

Objective  To investigate reported differences in the association between highly active antiretroviral therapy (HAART) in pregnancy and the risk of preterm delivery among HIV‐infected women.

Design  Combined analysis of data from three observational studies.

Setting  USA and Europe.

Population  A total of 19 585 singleton infants born to HIV‐infected women, 1990–2006.

Methods  Data from the Pediatric Spectrum of HIV Disease project (PSD), a US monitoring study, the European Collaborative Study (ECS), a consented cohort study, and the National Study of HIV in Pregnancy and Childhood (NSHPC), the United Kingdom and Ireland surveillance study.

Main outcome measure  Preterm delivery rate (<37 weeks of gestation).

Results  Compared with monotherapy, HAART was associated with increased preterm delivery risk in the ECS (adjusted odds ratio [AOR] 2.40, 95% CI 1.49–3.86) and NSHPC (AOR 1.43, 95% CI 1.10–1.86), but not in the PSD (AOR 0.92, 95% CI 0.67–1.26), after adjusting for relevant covariates. Because of heterogeneity, data were not pooled for this comparison, but heterogeneity disappeared when HAART was compared with dual therapy (P = 0.26). In a pooled analysis, HAART was associated with 1.5‐fold increased odds of preterm delivery compared with dual therapy (95% CI 1.19–1.87, P = 0.001), after adjusting for covariates.

Conclusions  Heterogeneity in the association between HAART and preterm delivery was not explained by study design, adjustment for confounders or a standard analytical approach, but may have been the result of substantial differences in populations and data collected. The pooled analysis comparing HAART with dual therapy showed an increased risk of preterm delivery associated with HAART.
BIODIVERSITY RESEARCH: Fidelity to foraging sites, consistency of migration routes and habitat modulation of home range by sea turtles
Authors: Schofield Gail , Hobson Victoria J. , Fossette Sabrina , Lilley Martin K. S. , Katselidis Kostas A. , Hays Graeme C.
Published: August 2010

Aim  Resources can shape patterns of habitat utilization. Recently a broad foraging dichotomy between oceanic and coastal sites has been revealed for loggerhead sea turtles (Caretta caretta). Since oceanic and coastal foraging sites differ in prey availability, we might expect a gross difference in home‐range size across these habitats. We tested this hypothesis by equipping nine adult male loggerhead sea turtles with GPS tracking devices.

Location  National Marine Park of Zakynthos (NMPZ) Greece, central and eastern Mediterranean (Adriatic, Ionian and Aegean seas).

Methods  In 2007, 2008 and 2009, Fastloc GPS‐Argos transmitters were attached to nine male loggerheads. In addition, a Sirtrack PTT unit was attached to one male in 2007. Four of the turtles were tracked on successive years. We filtered the GPS data to ensure comparable data volumes. Route consistency between breeding and foraging sites of the four re‐tracked turtles was conducted. Foraging site home range areas and within site movement patterns were investigated by the fixed kernel density method.

Results  Foraging home range size ranged between circa 10 km2 at neritic habitats (coastal and open‐sea on the continental shelf) to circa 1000 km2 at oceanic sites (using 90% kernel estimates), the latter most probably reflecting sparsely distributed oceanic prey. Across different years individuals did not follow exactly the same migration routes, but did show fidelity to their previous foraging sites, whether oceanic or neritic, with accurate homing in the final stages of migration.

Main conclusions  The broad distribution and diverse life‐history strategies of this population could complicate the identification of priority marine protected areas beyond the core breeding site.
Ranking Hospitals on Surgical Mortality: The Importance of Reliability Adjustment
Authors: Dimick Justin B. , Staiger Douglas O. , Birkmeyer John D.
Published: August 2010

Objective. We examined the implications of reliability adjustment on hospital mortality with surgery.

Data Source. We used national Medicare data (2003–2006) for three surgical procedures: coronary artery bypass grafting (CABG), abdominal aortic aneurysm (AAA) repair, and pancreatic resection.

Study Design. We conducted an observational study to evaluate the impact of reliability adjustment on hospital mortality rankings. Using hierarchical modeling, we adjusted hospital mortality for reliability using empirical Bayes techniques. We assessed the implication of this adjustment on the apparent variation across hospitals and the ability of historical hospital mortality rates (2003–2004) to forecast future mortality (2005–2006).

Principal Findings. The net effect of reliability adjustment was to greatly diminish apparent variation for all three operations. Reliability adjustment was also particularly important for identifying hospitals with the lowest future mortality. Without reliability adjustment, hospitals in the “best” quintile (2003–2004) with pancreatic resection had a mortality of 7.6 percent in 2005–2006; with reliability adjustment, the “best” hospital quintile had a mortality of 2.7 percent in 2005–2006. For AAA repair, reliability adjustment also improved the ability to identify hospitals with lower future mortality. For CABG, the benefits of reliability adjustment were limited to the lowest volume hospitals.

Conclusion. Reliability adjustment results in more stable estimates of mortality that better forecast future performance. This statistical technique is crucial for helping patients select the best hospitals for specific procedures, particularly uncommon ones, and should be used for public reporting of hospital mortality.
Neonatal Lupus Erythematosus: An Unusual Congenital Presentation with Cutaneous Atrophy, Erosions, Alopecia, and Pancytopenia
Authors: Crowley Eileen , Frieden Ilona J.
Published: August 2010

Abstract: Neonatal lupus erythematosus (NLE) is a rare disorder believed to be caused by the transplacental passage of specific autoantibodies from the mother to the fetus. Affected infants typically present with either characteristic skin lesions developing in the first month or later in life or congenital heart block. We report a very unusual case of NLE that was characterized by congenital skin atrophy, erosions, alopecia, and profound pancytopenia. Ro, La, and RNP antibodies were absent, and the diagnosis was made because of light microscopic and immunofluorescent findings. This case emphasizes that NLE can have widespread congenital skin involvement and suggests that at least some cases are mediated by antibodies other than Ro, La, and RNP.
Unilateral Laterothoracic Exanthem in a Child with Acute Lymphoblastic Leukemia
Authors: Fort Daniel W. , Greer Kenneth E.
Published: August 2010

Abstract: Unilateral laterothoracic exanthem (ULE) is a rare childhood condition of unknown etiology characterized by a morbilliform rash that usually begins in the axilla and spreads centrifugally. The condition is usually self‐limited, does not require specific treatment, and disappears within 4 to 6 weeks. Pruritus may be relieved by oral antihistamines and topical emollients and/or bath oils. We describe ULE in a 6‐year‐old girl with acute lymphoblastic leukemia, the first report of ULE in a patient with malignancy.
Terbinafine Pulse Therapy Is Effective in Tinea Capitis
Authors: Gupta Aditya K. , Adam Paul
Published: August 2010

Abstract: Terbinafine pulse therapy was found to be effective and safe in the treatment of tinea capitis in an open study of 13 children (age range 3–13 years, mean 6.4 years, 7 males, 6 females, Tricohphyton tonsurans 7 patients, T. violaceum 6 patients). Each pulse of active therapy lasted 1 week with a 2 weeks off period between the first two pulses and a 3 weeks off period between the second and third pulses of treatment. The dosage of terbinafine was determined by the weight of the child: > 40 kg, 250 mg/day, 20 to 40 kg, 125 mg/day and < 20 kg, 62.5 mg/day. Twelve (92.3%) of 13 children achieved complete clinical and mycological cure when evaluated 12 weeks after starting therapy with the number of pulses for complete (clinical and mycological) cure being one pulse (two patients with mild severity of tinea capitis), two pulses (four patients with mild disease) and three pulses (mild disease: two patients, moderate disease: two patients, and severe disease: three patients). One child with moderate severity disease failed to clear after three pulses of terbinafine. There were no adverse effects observed in any of the 13 patients during the course of therapy. All the parents found it easy to administer therapy and the compliance was high.
A Double‐Blind, Randomized, Placebo‐Controlled Trial of Eutectic Lidocaine/Prilocaine Cream 5% (EMLA)® for Analgesia Prior to Cryotherapy of Warts in Children and Adults
Authors: Gupta Aditya K. , Koren Gideon , Shear Neil H.
Published: August 2010

Abstract: Liquid nitrogen cryotherapy is an effective treatment modality for verrucae in children. However, sometimes the pain of the procedure is too much for the young child. In such instances the availability of an effective topical anesthetic would be of tremendous benefit. Warts are usually present on hardened skin, that is, the palms, periungual areas, and soles. In a double‐blind, randomized, placebo‐controlled, single‐center, parallel‐group trial with one visit, children (6–18 years old) and adults (> 18 years old) had 2.5 g of lidocaine/prilocaine cream 5% applied under an occlusive dressing to the wart and a 1 to 2 mm area surrounding it 1 hour prior to liquid nitrogen cryotherapy. In both age groups the warts were subdivided by location—hardened skin areas versus nonhardened skin sites. The topical anesthetic was then removed and cryotherapy applied for 5 to 10 seconds. The pain of cryotherapy was assessed by the patient on a visual analogue scale (VAS) immediately after the cryotherapy and 4 and 8 hours later. There was no statistically significant difference in the pain of cryotherapy experienced following the application of active cream (n= 64) and placebo (n = 64). Exploratory subgroup analysis by wart location showed promising results for lidocaine/ prilocaine cream 5% over placebo in children with warts on hardened skin sites (palms and soles). The topical anesthetic was safe and generally well‐tolerated. Lidocaine/prilocaine cream 5% may provide some anesthesia in children receiving cryotherapy when the wart is on the palms or soles. Further studies are needed to better understand the site and age specificity of the anesthetic properties of lidocaine/prilocaine cream 5% when used to reduce the pain experienced during cryotherapy of warts.
S. Aureus Isolation from the Lesions, the Hands, and the Anterior Nares of Patients with Atopic Dermatitis
Authors: Williams Judith V. , Vowels Benjamin R. , Honig Paul J. , Leyden James J.
Published: August 2010

Abstract: Staphylococcus aureus colonization is common in atopic dermatitis (AD) and can exacerbate the disease. Additionally, some evidence shows that patients with AD may act as reservoirs for S. aureus transmission to others. This study compared S. aureus colonization in AD patients and their caregivers with control patients and their caregivers. Quantitative cultures were obtained from the lesions, clinically normal skin, hands, and anterior nares of 100 patients with AD, 100 controls with other cutaneous disorders, and 200 caregivers. AD patients had a significantly greater carriage of S. aureus from lesional and clinically normal skin as well as the hand. Significant increases in carriage of S. aureus were found in the anterior nares and hands of caregivers of AD patients compared with control caregivers. Topical corticosteroid use did not affect recovery of S. aureus. There was a significant correlation between recovery of S. aureus from lesional skin and recovery from the anterior nares (p = .002) and hands (p < .0001). These findings suggest that the anterior nares and the hands may be important reservoirs and vectors for transmission of S. aureus to lesional skin and to close contacts of these patients.
Treatment of Widespread Alopecia Areata in Young Patients with Monthly Oral Corticosteroid Pulse
Authors: Sharma Vinod K. , Muralidhar S.
Published: August 2010

Abstract: Sixteen patients up to 18 years of age with widespread alopecia areata (AA) were recruited for the study. They included 10 patients with extensive AA (≥40% loss of scalp hair and or more than 10 patches scattered over the scalp and body) and 3 each with alopecia totalis and circumscribed alopecia areata. Patients were divided into two groups. In group A, aged 12 to 18 years, patients received 300 mg of prednisolone in a monthly oral pulse; in group B, aged 3 to 11 years, patients received betamethasone sodium phosphate as soluble tablets or syrup equivalent to prednisolone 5 mg/kg body weight every month. The pulsed doses of corticosteroid were continued for a minimum of three doses or until cosmetically acceptable hair growth was obtained. All patients but one 5‐year‐old girl received a minimum of three doses. Excellent hair growth was obtained in 9 (60%) of 15 patients evaluated at 6 months. Four patients out of 13 (>12 month follow‐up), including two each in group A and B, developed a localized relapse during mean follow‐up of 16.4 and 33.7 months in group A and B, respectively. Side effects of pulsed corticosteroid were minimal and were recorded in two patients (transient giddiness and headache, epigastric burning in one each). We recommend pulsed doses of prednisolone as one of the modalities in the treatment of widespread AA in young patients, including children.
The Mucocutaneous Manifestations Associated with Celiac Disease in Childhood and Adolescence
Authors: Seyhan Muammer , Erdem Teoman , Ertekin Vildan , Selimoğlu Mukadder Ayşe
Published: August 2010

Abstract:  This study was performed to detect the prevalence of mucocutaneous manifestations of celiac disease in childhood and adolescence and to investigate the relationship between these findings and duration of disease and a gluten‐free diet. The study included 55 children and adolescents with a mean age of 10.0 ± 4.61 years (2–19 years). Mucocutaneous manifestations were evaluated with respect to age, gender, duration of illness, and of gluten‐free diet and compliance with this diet. Cutaneous, mucosal, nail, and hair findings were detected in 74.5%, 27.3%, 20.0%, and 7.3% of patients, respectively. The most prevalent dermatologic diagnosis was xerosis (69.1%). No significant relationship was detected between the cutaneous findings and the duration of illness (p > 0.05). However, the duration was longer in patients with mucosal findings compared to those without mucosal findings (p < 0.05). It was found that all patients without cutaneous findings were on a strict gluten‐free diet (p < 0.05). Ours is one of the few studies describing skin findings in children with celiac disease. We believe that both pediatricians and dermatologists should be aware of the various mucocutaneous manifestations of celiac disease, because a careful skin, mucosa, nail, and hair examination may lead to a diagnosis of celiac disease, particularly in atypical presentations.
Precalcaneal Congenital Fibrolipomatous Hamartoma
Authors: Warren Richard B. , Verbov Julian L. , Ashworth M.
Published: August 2010

Abstract:  A 9‐month‐old female infant presented with asymptomatic, skin‐colored nodules over the medial plantar aspects of both heels, which were noted immediately after birth and increased in size with the growth of the infant. The diagnosis was precalcaneal congenital fibrolipomatous hamartoma. This condition is rarely reported; however, as biopsy is sometimes not performed, it may be underrepresented. We present a further histopathologically proved instance of this entity, with discussion of the differential diagnosis.
DENSITY OF SYMPATHETIC AXONS IN SURAL NERVE BIOPSIES OF NEUROPATHY PATIENTS IS RELATED TO PAINFULNESS
Authors: Bickel A , Butz M , Schmelz M , Handwerker Ho , Neundorfer B.
Published: August 2010

In this study, differences of unmyelinated nerve fiber density in sural nerve biopsy material from patients suffering from neuropathies of unknown origin with (n = 14) or without pain (n = 13) were analyzed. Immunocytochemistry was applied to differentiate afferent sensory and efferent sympathetic nerve fibers. All patients were evaluated for deficits of small fiber function with thermotesting, quantitative sudomotor‐axon reflex‐testing and testing of painfulness of mechanical stimuli before performing the biopsy. No difference was found between patients with and without pain concerning clinical deficits or results in any of the neurophysiological examinations. There were also no histopathological differences concerning the density of afferent C‐fibers. However, absolute and relative density of efferent sympathetic nerve fibers was significantly higher in patients with painful neuropathy (P < 0.001), although none of the patients demonstrated clinical sympathetic abnormalities. We conclude that an imbalance between afferent and sympathetic nerve fiber density in the periphery may contribute to neuropathic pain even in those patients without obvious clinical autonomic disturbances.
Photochemically‐induced ischemic injury of the rat sciatic nerve: A light‐ and electron microscopic study
Authors: Yu Wei , Kauppila Timo , Hultenby Kjell , Persson Jonas K.E. , Xu Xiao‐Jun , Wiesenfeld‐Hallin Zsuzsanna
Published: August 2010

Abstract   Lesion of presumably ischemic origin of the rat sciatic nerve was induced photochemically by laser irradiation combined with systemic administration of a photosensitizing organic dye, erythrosin B. We have studied the pathologic features of the nerve after the photochemical insult with light‐ and electronmicroscopy and related them to behavioral signs of neuropathic pain. At the irradiated nerve site, occlusion of blood vessels was seen and the vessels were packed with aggregated thrombocytes, fibrins and deformed erythrocytes, supporting the notion that photochemical reaction caused intraneural ischemia. The degree of the nerve injury at the center of irradiation was related to the duration of the laser exposure. Brief irradiation (30 seconds) only caused identifiable injury to myelinated fibers, whereas longer irradiation (2 minutes) caused greater injury to myelinated and unmyelinated fibers, characterized by extensive axonal degeneration and demyelination. The rats irradiated for 2 minutes, but not 30 seconds, exhibited neuropathic pain‐like behaviors, expressed as mechanical and cold allodynia. The nerve injury was most severe 7 days after ischemia and regeneration of both myelinated and unmyelinated fibers was observed 3 months later. The nerve caudal to the irradiation exhibited Wallerian degeneration 7 days after the insult, whereas at 10 mm proximal to the irradiation the nerve was largely normal. It is thus concluded that photochemically induced intraneural ischemia caused injury to both myelinated and unmyelinated fibers, with myelinated fibers being more susceptible. However, the development of neuropathic pain‐like behaviors may require injury to the unmyelinated fibers.
Stretch of mammalian nerve in vitro: Effect on compound action potentials
Authors: Ochs Sidney , Pourmand Rahman , Si Kenan , Friedman Richard N.
Published: August 2010

Abstract   Stretch of nerve has been reported to decrease the amplitude of the compound action potential (CAP) with a complete block appearing in approximately 30 minutes. But for the most part, those experiments were carried out in vivo, and it is generally accepted that the failure of responses was due to a closure of vessels supplying the nerve with a resulting ischemia and anoxia. These studies were undertaken to determine if stretch of nerve has effects that are independent of interference with its vascular supply. In the studies, lengths of rat sciatic and dog peroneal nerves were removed and placed in a chamber supplied with oxygen in which their CAPs were continuously elicited and recorded. This in vitro preparation obviated interference with the nerve's metabolism on stretching. We have previously shown that the form change termed ‘beading,’ appearing within 10 seconds and reversing as quickly on relaxation, can be elicited with tensions of only several grams. We wished to determine if stretch adequate to produce beading could alter CAPs with the same rapidity. Tensions below 2 g had little effect. On applying tensions of 10–100 g, levels well above those needed to bead the fibers, both increases and decreases of CAP amplitude were seen. The changes occurred within 10 seconds of stretch application, the time at which beading arises with stretch. Although the decreases of CAP amplitudes could be accounted for by beading, the degree of CAP change did not correspond to the amount of tension applied. We hypothesize that the constrictions in the beaded fibers increase axial resistivity and diminish local currents so as to block conduction. The lack of an increasing degree of decreased CAP amplitude with increases in tension is ascribed to the inhibition of elongation offered by the collagen fibrils present in nerve. Collagenase applied to nerves allowed a further increase in length, producing a ‘hyperbeading,’ showing much longer lengths of beading constrictions on stretch. This would further increase axial resistance and is taken to account for the greater decreases of CAP amplitudes seen following collagenase treatment. To account for those cases where increases of CAP amplitude were seen on stretch, we hypothesize that stretch can also cause an increase in the excitability of the nodes. The outcome of stretch in any given nerve would be the resultant of two opposing actions; beading of the internodes causes a decrease of local currents leading to block of CAPs, while an increased excitability of the nodes acts to augment the responses.
Influence of aging on peripheral nerve function and regeneration
Authors: Verdú Enrique , Ceballos Dolores , Vilches Jorge J. , Navarro Xavier
Published: August 2010

Abstract   Aging deeply influences several morphologic and functional features of the peripheral nervous system (PNS). Morphologic studies have reported a loss of myelinated and unmyelinated nerve fibers in elderly subjects, and several abnormalities involving myelinated fibers, such as demyelination, remyelination and myelin balloon figures. The deterioration of myelin sheaths during aging may be due to a decrease in the expression of the major myelin proteins (P0, PMP22, MBP). Axonal atrophy, frequently seen in aged nerves, may be explained by a reduction in the expression and axonal transport of cytoskeletal proteins in the peripheral nerve. Aging also affects functional and electrophysiologic properties of the PNS, including a decline in nerve conduction velocity, muscle strength, sensory discrimination, autonomic responses, and endoneurial blood flow. The age‐related decline in nerve regeneration after injury may be attributed to changes in neuronal, axonal, Schwann cell and macrophage responses. After injury, Wallerian degeneration is delayed in aged animals, with myelin remnants accumulated in the macrophages being larger than in young animals. The interaction between Schwann cells and regenerative axons takes longer, and the amount of trophic and tropic factors secreted by reactive Schwann cells and target organs are lower in older subjects than they are in younger subjects. The rate of axonal regeneration becomes slower and the density of regenerating axons decrease in aged animals. Aging also determines a reduction in terminal and collateral sprouting of regenerated fibers, further limiting the capabilities for target reinnervation and functional restitution. These age‐related changes are not linearly progressive with age; the capabilities for axonal regeneration and reinnervation are maintained throughout life, but tend to be delayed and less effective with aging.
DEJERINE‐SOTTAS DISEASE WITH A NOVEL DE NOVO DOMINANT MUTATION, SER 149 ARG, OF THE PERIPHERAL MYELIN PROTEIN 22
Authors: Ohnishi A , Yamamoto T , Izawa K , Yamamori S , Takahashi K , Mega H , Jinnai K.
Published: August 2010

The Ser149Arg mutation of peripheral myelin protein 22 (PMP22) was found in a 19‐year‐old woman with a sporadic case of Dejerine‐Sottas disease. The patient showed delayed motor development. She walked for the first time with support at the age of 2 years. Scoliosis developed at age 4 years. Her walking ability was best at age 11. Thereafter, she showed progressive muscle weakness and sensory disturbances in the distal extremities. At the age of 18 years, the use of a wheelchair became necessary. Motor and sensory nerve conduction studies showed absent motor and sensory responses on electrical stimulation of the limb nerves. A sural nerve biopsy specimen showed marked decreases in the numbers of both large and small myelinated fibers, abundant onion‐bulb formation, and hypomyelination. Electron microscopic observation revealed the presence of demyelinated axons and myelin sheaths disproportionately thin relative to axon diameter. That this was a de novo mutation was established by parentage testing and PMP22 gene analysis of the parents. The mutation seems to be novel and dominant.
HYPOGLYCAEMIC NEUROPATHY: OCCURRENCE OF AXON TERMINALS IN PLANTAR SKIN AND PLANTAR MUSCLE OF DIABETIC BB/WOR RATS TREATED WITH INSULIN IMPLANTS
Authors: Mohseni S , Lillesaar C , Theodorsson E , Hildebrand C.
Published: August 2010

It is generally believed that diabetic neuropathy is due to chronic hyperglycaemia. However, experience from insulinoma patients and experimental studies show that hypoglycaemia may also cause neuropathy. Accordingly, the plantar nerves of diabetic eu‐/hypoglycaemic BB/Wor rats treated with insulin implants exhibit a distinct neuropathy. To what extent hypoglycaemic neuropathy affects axon terminals in skin and muscle is unknown. In the present study we examine the occurrence of epidermal axon profiles and the neuropeptide calcitonin gene‐related peptide (CGRP) in plantar skin, and of end plate axon terminals in a plantar muscle of diabetic BB/Wor rats subjected to long periods of hypoglycaemia. The number of protein gene product‐immunoreactive axon profiles was found to be normal in heel skin biopsy specimens from eu‐/hypoglycaemic rats, but many profiles were short and thin. The content of CGRP in the skin biopsy samples was significantly below normal. After staining with antibodies against the vesicular acetyl choline transporter protein, the occurrence of end plate axon terminals was significantly reduced in sections from the flexor hallucis brevis muscle of eu‐/hypoglycaemic rats. Moreover, the end plate axon terminals tended to be abnormally small in these rats. We conclude that the hypoglycaemic neuropathy seen in plantar nerve trunks of diabetic BB/Wor rats treated with insulin implants is accompanied by mild alterations in the epidermal innervation of plantar skin and a more obviously abnormal nerve terminal pattern in plantar muscle.
DO NERVE GROWTH FACTOR‐RELATED MECHANISMS CONTRIBUTE TO LOSS OF CUTANEOUS NOCICEPTION IN LEPROSY?
Authors: Facer P , Mann D , Mathur R , Pandya S , Ladiwala U , Singhal B , Hongo Ja , Sinicropi Dv , Terenghi G , Anand P.
Published: August 2010

While sensory loss in leprosy skin is the consequence of invasion by M. leprae of Schwann cells related to unmyelinated fibres, early loss of cutaneous pain sensation, even in the presence of nerve fibres and inflammation is a hallmark of leprosy, and requires explanation. In normal skin, nerve growth factor (NGF) is produced by basal keratinocytes, and acts via its high affinity receptor (trk A) on nociceptor nerve fibres to increase their sensitivity, particularly in inflammation. We have therefore studied NGF‐ and trk A‐like immunoreactivity in affected skin and mirror‐site clinically‐unaffected skin from patients with leprosy, and compared these with non‐leprosy, control skin, following quantitative sensory testing at each site. Sensory tests were within normal limits in clinically‐unaffected leprosy skin, but markedly abnormal in affected skin. Sub‐epidermal PGP 9.5‐ and trk A‐positive nerve fibres were reduced only in affected leprosy skin, with fewer fibres contacting keratinocytes. However, NGF‐immunoreactivity in basal keratinocytes, and intra‐epidermal PGP 9.5‐positive nerve fibres, were reduced in both sites compared to non‐leprosy controls, as were nerve fibres positive for the sensory neurone specific sodium channel SNS/PN3, which is regulated by NGF, and may mediate inflammation‐induced hypersensitivity. Keratinocyte trk A expression (which mediates an autocrine role for NGF) was increased in clinically affected and unaffected skin, suggesting a compensatory mechanism secondary to reduced NGF secretion at both sites. We conclude that decreased NGF‐ and SNS/PN3‐immunoreactivity, and loss of intra‐epidermal innervation, may be found without sensory loss on quantitative testing in clinically‐unaffected skin in leprosy; this appears to be a sub‐clinical change, and may explain the lack of cutaneous pain with inflammation. Sensory loss occurred with reduced sub‐epidermal nerve fibres in affected skin, but these still showed trk A‐staining, suggesting NGF treatment may restore pain sensation.
LOW‐DOSE LIDOCAINE REDUCES SECONDARY HYPERALGESIA BY A CENTRAL MODE OF ACTION
Authors: Koppert W , Ostermeier N , Sittl R , Weidner C , Schmelz M.
Published: August 2010

Sodium channel blockers are approved for intravenous administration in the treatment of neuropathic pain states. Preclinical studies have suggested antihyperalgesic effects on the peripheral as well as the central nervous system. The objective of this study was to determine mechanisms of action of low‐dose Lidocaine in experimental induced, secondary hyperalgesia. In a first experimental trial, participants (n = 12) received lidocaine systemically (a bolus injection of 2 mg/kg in 10 min followed by an intravenous infusion of 2 mg kg(−1) h(−1) for another 50 min). In a second trial, a modified intravenous regional anesthesia (IVRA) was administered to exclude possible central analgesic effects. In one arm, patients received an infusion of 40 mi lidocaine, 0.05%; in the other arm 40 mi NaCl, 0.9%, served as a control. In both trials capsaicin, 20 mu g, was injected intradermally and time course of capsaicin‐induced pain, allodynia and hyperalgesia as well as axon reflex flare was determined. The capsaicin‐induced pain was slightly reduced after systemic and regional application of the anesthetic. The area of pin‐prick hyperalgesia was significantly reduced by systemic lidocaine, whereas the inhibition of hyperalgesia was absent during regional administration of lidocaine. In contrast, capsaicin‐induced flare was significantly decreased after both treatments. We conclude that systemic lidocaine reduces pin‐prick hyperalgesia by a central mode of action, which could involve blockade of terminal branches of nociceptors. A possible role for tetrodotoxin resistant sodium channels in the antihyperalgesic effect of low‐dose lidocaine is discussed.
CAMPYLOBACTER JEJUNI LIPOPOLYSACCHARIDES FROM GUILLAIN‐BARRE SYNDROME PATIENTS INDUCE IGG ANTI‐GM1 ANTIBODIES IN RABBITS
Authors: Ang Cw , Endtz Hp , Jacobs Bc , Laman Jd , De Klerk Ma , Van Der Meche Fga  , Van Doorn Pa
Published: August 2010

Lipopolysaccharides (LPS) from Campylobacter jejuni strains isolated from patients with Guillain‐Barre syndrome (GBS) display molecular mimicry with GM1. We immunized rabbits with C. jejuni LPS from GBS‐associated strains containing a GM1‐like epitope. All animals produced high titre anti‐LPS antibodies that were cross‐reactive with GM1. We conclude that C. jejuni strains from GBS patients are able to induce antibodies that cross‐react with gangliosides and LPS. This study further confirms the role of molecular mimicry in the induction of anti‐ganglioside antibodies in GBS patients.
CHARACTERISATION OF AUTOANTIBODIES TO PERIPHERAL MYELIN PROTEIN 22 IN PATIENTS WITH HEREDITARY AND ACQUIRED NEUROPATHIES
Authors: Ritz Mf , Lechner‐Scott J , Scott Rj , Fuhr P , Malik N , Erne B , Taylor V , Suter U , Schaeren‐Wiemers N , Steck  , AJ.
Published: August 2010

To investigate the possibility that an autoimmune mechanism may play a role in the hereditary neuropathy Charcot‐Marie‐Tooth type 1A (CMT1A), sera were analysed by Western blot for anti‐peripheral myelin protein 22 (PMP22) autoantibodies. These sera were compared with sera from patients with CMT type 2 (CMT2), acquired peripheral neuropathies such as chronic inflammatory demyelinating neuropathy (CIDP), anti‐MAG IgM neuropathy, Miller‐Fisher syndrome (MFS), diabetic neuropathy and with control blood donors. Anti‐PMP22 positive sera were detected in 70% of patients with CMT1 and unexpectedly in 60% of patients with CMT2. Interestingly, 44% of the patients with other peripheral neuropathies and 23% of the apparently healthy controls showed also anti‐PMP22 antibody reactivity. Immunohistochemical analysis of the human anti‐PMP22 antisera on healthy sural nerve sections and on PMP22‐expressing COS cells revealed that these sera did not recognize endogenous PMP22. Our results indicate that anti‐PMP22 autoantibodies are found in sera of patients with different types of peripheral neuropathies, but their role in the pathogenesis of these diseases remains to be determined.
LONG‐TERM PROGNOSIS OF NEUROPATHY ASSOCIATED WITH ANTI‐MAG IGM M‐PROTEINS AND ITS RELATIONSHIP TO IMMUNE THERAPIES
Authors: Nobile‐Orazio E , Meucci N , Baldini L , Di Troia A , Scarlato G.
Published: August 2010

Many data point to a pathogenetic role for IgM antibodies to the myelin‐associated glycoprotein (MAG) in the neuropathy associated with IgM monoclonal gammopathy, supporting the use of immune therapies in affected patients. Almost 50% of patients have been reported to improve with these therapies, but the effect of treatment on the long‐term prognosis of the neuropathy remains unclear. We analysed the outcome of 25 of the 26 patients (mean age at entry 65 years, range 45–85 years) with neuropathy and high anti‐MAG IgM, first examined by us between 1984 and 1994. By January 1999, after a mean follow‐up of 8.5 years (range 2–13 years) and a mean duration of neuropathy symptoms of 11.8 years (range 3–18,> 10 years in 16), 17 patients (68%) (aged 58–84 years, mean 73.4) were alive, while eight (32%) (aged 69–78 years, mean 73.1) had died 3–15 years (mean 10.6) after neuropathy onset; in none of them was death caused by the neuropathy, although in three it was possibly related to the therapy for the neuropathy. By the time of last follow‐up or patients' death, 11 patients (44%) were disabled by severe hand tremor, gait ataxia or both. The disability rates at 5, 10 and 15 years from neuropathy onset were 16, 24 and 50%, respectively. Of the 19 patients treated during the follow‐up for 0.5–11 years (mean 4 years) with various immune therapies, five reported a consistent and four a slight improvement in the neuropathy (total 47%) after one treatment or more, but in only one patient was improvement persistent throughout, to the end of follow‐up. In 10 patients (53%), severe adverse events, possibly related to therapy, occurred during treatment and were considered responsible for the patient's death in three. The neurological impairment did not differ between treated and untreated patients at the end of a similar follow‐up. Our findings indicate that (i) the majority of patients with neuropathy and anti‐MAG IgM have a favourable prognosis even after several years, and (ii) current immune therapies, though temporarily effective in half of the patients, are associated with considerable side effects which limit their prolonged use and efficacy, suggesting that until more effective or safer therapies become available, they should probably be reserved for patients impaired in their daily life or in a progressive phase of the disease.
NEUROLOGIC DISORDERS MASQUERADING AS CARPAL TUNNEL SYNDROME: 12 CASES OF FAILED CARPAL TUNNEL RELEASE
Authors: Witt Jc , Stevens Jc
Published: August 2010

We describe 12 patients with a diagnosis of carpal tunnel syndrome in whom carpal tunnel release was unsuccessful and another neurologic disorder was diagnosed subsequently. Final diagnoses included polyneuropathy, radiculopathy, motor neuron disease, spondylotic myelopathy, syringomyelia, and multiple sclerosis. Sources of error by the electromyographer and treating physician were identified. Care must be taken to avoid an inappropriate carpal tunnel operation when clinical or electrodiagnostic features are atypical.