bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing Measures of Cystatin C in Human Sera by Three Methods
Authors: Hossain Mohammad Akhtar , Emara Mahmoud , El moselhi Hamdi , Shoker Ahmed
Published: November 2008

Background: Cystatin C (Cys C) is measured by particle-enhanced nephelometric immunoassay (PENIA), particle-enhanced turbidimetric immunoassay (PETIA) and ELISA. Aim: To determine differences among these methods. Method: 80 normal human sera and 20 from patients with renal and/or heart disease were simultaneously assayed. Statistical analyses including receiver operating characteristics (ROC) of the three methods were compared. Results: There was a highly significant correlation across the assay range between the ELISA and PENIA (r2 = 0.94) and PETIA methods (r2 = 0.95). Analysis of variance and bias were poor between the ELISA and the other two methods. Mean difference between ELISA and PETIA was 0.65 ± 0.63 μg/ml, while it was 0.58 ± 0.53 μg/ml between ELISA and PENIA. Accuracy (at 30% range) was 17 and 11% between ELISA and PETIA and ELISA and PENIA, respectively. Normalization of the ELISA by a factor of 0.66 improved this relationship. AUC of ROC curves of PENIA, ELISA and normalized ELISA to predict Cys C levels measured from PETIA were all above 0.87 (p = not significant between curves). Criterion values of ELISA*.66 method was close to PETIA measurements. Conclusion: There is a significant difference in measured human Cys C levels among the three methods, and normalization of ELISA narrows these differences.
Continuous Positive Airway Pressure and Liver Enzymes in Obstructive Sleep Apnoea: Data from a Randomized Controlled Trial
Authors: Kohler Malcolm , Pepperell Justin C.T. , Davies Robert J.O. , Stradling John R.
Published: November 2008

Background: Obstructive sleep apnoea syndrome (OSAS) has been suggested to be an independent risk factor for non-alcoholic fatty liver disease (NAFLD), possibly via intermittent hypoxia that influences blood pressure, lipid levels and insulin resistance, factors themselves known to cause NAFLD. In observational studies, OSAS has been associated with elevated levels of liver enzymes. Continuous positive airway pressure (CPAP) is the treatment for OSAS, but the effects of CPAP on liver enzymes have not been studied in a randomized controlled trial. Objective: To determine if 4 weeks of CPAP influence alanine-aminotransferase (ALT) and aspartate-aminotranferase (AST) levels. Methods: 94 patients with moderate-to-severe OSAS were randomized to therapeutic or sub-therapeutic CPAP treatment. Plasma ALT and AST were measured before and after 4 weeks of CPAP. Results: Results are means ± SD. ALT levels decreased from 39.1 ± 26.3 to 30.3 ± 16.4 IU/l in patients treated with therapeutic CPAP, but also decreased from 36.9 ± 20.7 to 31.5 ± 16.5 IU/l in patients treated with sub-therapeutic CPAP (difference between mean changes –3.4, 95% CI –7.8 to 1.0 IU/l, p = 0.13 between groups). AST levels did not change significantly with therapeutic CPAP (from 29.1 ± 14.7 to 30.2 ± 13.6 IU/l), nor with sub-therapeutic CPAP (from 28.2 ± 16.2 to 29.5 ± 12.6 IU/l; difference between mean changes –0.2, 95% CI –3.0 to 2.6 IU/l, p = 0.87 between groups). Conclusions: Four weeks of active CPAP has no beneficial effect on aminotransferase levels when compared to sub-therapeutic CPAP in patients with OSAS. Therefore, CPAP does not seem to improve biochemical markers of potential NAFLD in OSAS patients.
A Randomized Trial of On-Pump Beating Heart and Conventional Cardioplegic Arrest in Coronary Artery Bypass Surgery Patients With Impaired Left Ventricular Function Using Cardiac Magnetic Resonance Imaging and Biochemical Markers
Authors: Pegg Tammy J. , Selvanayagam Joseph B. , Francis Jane M. , Karamitsos Theodoros D. , Maunsell Zoe , Yu Ly-Mee , Neubauer Stefan , Taggart David P.
Published: November 2008

Background—

Beating heart coronary artery bypass grafting (CABG) improves early postoperative cardiac function in patients with normal ventricular function, but its effect in patients with impaired function is uncertain. We compared a novel hybrid technique of on-pump beating heart CABG (ONBEAT) with conventional on-pump CABG (ONSTOP) in patients with impaired ventricular function.

Methods and Results—

In a single-center randomized trial, 50 patients with impaired ventricular function were randomly assigned to ONBEAT or ONSTOP. Patients underwent cardiac magnetic resonance imaging for function and delayed hyperenhancement early and later after surgery. Serial assessment of biochemical markers was also undertaken. Preoperative characteristics were well matched; cardiac index was 2.85±0.53 (ONBEAT) and 2.62±0.59 L · min
−1
· m
−2
(ONSTOP). Early after surgery, there was a trend toward a greater reduction in end-systolic volume index in ONSTOP patients versus ONBEAT (−9±8 versus −4±11 mL · m
−2
;
P
=0.06). The changes were sustained and significant at 6 months (−14±18 versus −2±19 mL · m
−2
;
P
=0.04). Furthermore, the incidence of new hyperenhancement at 6 days was higher in ONBEAT patients (
P
=0.05), with 6 of 17 (35%) sustaining 8.2±5.2 g of new hyperenhancement each versus 2 of 23 (9%) in the ONSTOP group, each with 9.8±9.0 g (
P
=0.86). Finally, median area under the curve for troponin was higher in ONBEAT at 461 (interquartile range, 226 to 1141) μg/L versus 160 (interquartile range, 98 to 357) μg/L for ONSTOP (
P
=0.002).

Conclusions—

The incidence of new irreversible myocardial injury was significantly higher in ONBEAT than in ONSTOP patients. Furthermore, at 6 months, only ONSTOP patients demonstrated an improvement in ventricular geometry. The most likely mechanism is inadequate coronary perfusion to distal myocardial territories in patients with severe proximal coronary disease.
Exercise-Induced Pulmonary Arterial Hypertension
Authors: Tolle James J. , Waxman Aaron B. , Van Horn Teresa L. , Pappagianopoulos Paul P. , Systrom David M.
Published: November 2008

Background—

The clinical relevance of exercise-induced pulmonary arterial hypertension (PAH) is uncertain, and its existence has never been well studied by direct measurements of central hemodynamics. Using invasive cardiopulmonary exercise testing, we hypothesized that exercise-induced PAH represents a symptomatic stage of PAH, physiologically intermediate between resting pulmonary arterial hypertension and normal.

Methods and Results—

A total of 406 consecutive clinically indicated cardiopulmonary exercise tests with radial and pulmonary arterial catheters and radionuclide ventriculographic scanning were analyzed. The invasive hemodynamic phenotype of exercise-induced PAH (n=78) was compared with resting PAH (n=15) and normals (n=16). Log-log plots of mean pulmonary artery pressure versus oxygen uptake (V̇
o
2
) were obtained, and a “join-point” for a least residual sum of squares for 2 straight-line segments (slopes m1, m2) was determined; m2m1=“takeoff” pattern. At maximum exercise, V̇
o
2
(55.8±20.3% versus 66.5±16.3% versus 91.7±13.7% predicted) was lowest in resting PAH, intermediate in exercise-induced PAH, and highest in normals, whereas mean pulmonary artery pressure (48.4±11.1 versus 36.6±5.7 versus 27.4+3.7 mm Hg) and pulmonary vascular resistance (294±158 versus 161±60 versus 62±20 dyne · s · cm
−5
, respectively;
P
<0.05) followed an opposite pattern. An exercise-induced PAH plateau (n=32) was associated with lower V̇
o
2
max (60.6±15.1% versus 72.0±16.1% predicted) and maximum cardiac output (78.2±17.1% versus 87.8±18.3% predicted) and a higher resting pulmonary vascular resistance (247±101 versus 199±56 dyne · s · cm
−5
;
P
<0.05) than takeoff (n=40). The plateau pattern was most common in resting PAH, and the takeoff pattern was present in nearly all normals.

Conclusions—

Exercise-induced PAH is an early, mild, and clinically relevant phase of the PAH spectrum.
Collectrin Is Involved in the Development of Salt-Sensitive Hypertension by Facilitating the Membrane Trafficking of Apical Membrane Proteins via Interaction With Soluble
N
-Ethylmaleiamide-Sensitive Factor Attachment Protein Receptor Complex
Authors: Yasuhara Akihiro , Wada Jun , Malakauskas Sandra M. , Zhang Yanling , Eguchi Jun , Nakatsuka Atsuko , Murakami Kazutoshi , Kanzaki Motoko , Teshigawara Sanae , Yamagata Kazuya , Le Thu H. , Makino Hirofumi
Published: November 2008

Background—

Collectrin, a homologue of angiotensin converting enzyme 2, is expressed in pancreatic β cells and renal proximal tubular and collecting duct cells under the control of hepatocyte nuclear factors-1α and -1β. Because collectrin interacts with the soluble
N
-ethylmaleiamide-sensitive factor attachment protein receptor (SNARE) complexes, we investigated whether collectrin is involved in sodium handling in hypertension by vesicle trafficking of apical membrane proteins.

Methods and Results—

Collectrin physically interacts with the SNARE complex: snapin, synaptosomal-associated protein 23 kDa, syntaxin-4, and vesicle-associated membrane protein-2 in mIMCD-3 cells. siRNA knockdown of collectrin resulted in a reduction in membrane-associated aquaporin-2, α-epithelial Na
+
channel, and H
+
-ATPase. Collectrin and SNARE proteins were abundantly expressed in collecting ducts of Wistar-Kyoto rats. Wistar-Kyoto rats and spontaneously hypertensive rats 7 weeks of age were subjected to normal-salt (1% NaCl) and high-salt (8% NaCl) chow for 10 weeks. High-salt chow prominently elevated blood pressure, oral intake, and urinary excretion of NaCl and water in both groups. Although urinary excretion of aldosterone was significantly suppressed in both groups, collectrin expression was upregulated and associated with the maintenance of aquaporin-2, α-epithelial Na
+
channel, and H
+
-ATPase in membrane fractions. Collectrin promoter activities and mRNA and protein expressions were upregulated and ubiquitinated collectrin was reduced by high NaCl (175 to 225 mmol/L) and not altered by 1 μmol/L aldosterone in mIMCD-3 cells.

Conclusions—

Upregulation of collectrin by high NaCl independent of aldosterone functionally links to the trafficking of apical membrane proteins via the SNARE complex, and collectrin may be responsible for the sodium retention in salt-sensitive hypertension.
Day-by-Day Variability of Blood Pressure and Heart Rate at Home as a Novel Predictor of Prognosis
Authors: Kikuya Masahiro , Ohkubo Takayoshi , Metoki Hirohito , Asayama Kei , Hara Azusa , Obara Taku , Inoue Ryusuke , Hoshi Haruhisa , Hashimoto Junichiro , Totsune Kazuhito , Satoh Hiroshi , Imai Yutaka
Published: November 2008

Day-by-day blood pressure and heart rate variability defined as within-subject SDs of home measurements can be calculated from long-term self-measurement. We investigated the prognostic value of day-by-day variability in 2455 Ohasama, Japan, residents (baseline age: 35 to 96 years; 60.4% women). Home blood pressure and heart rate were measured once every morning for 26 days (median). A total of 462 deaths occurred over a median of 11.9 years, composing 168 cardiovascular deaths (stroke: n=83; cardiac: n=85) and 294 noncardiovascular deaths. Using Cox regression, we computed hazard ratios while adjusting for baseline characteristics, including blood pressure and heart rate level, sex, age, obesity, current smoking and drinking habits, history of cardiovascular disease, diabetes mellitus, hyperlipidemia, and treatment with antihypertensive drugs. An increase in systolic blood pressure variability of +1 between-subject SD was associated with increased hazard ratios for cardiovascular (1.27;
P
=0.002) and stroke mortality (1.41;
P
=0.0009) but not for cardiac mortality (1.13;
P
=0.26). Conversely, heart rate variability was associated with cardiovascular (1.24;
P
=0.002) and cardiac mortality (1.30;
P
=0.003) but not stroke mortality (1.17;
P
=0.12). Similar findings were observed for diastolic blood pressure variability. Additional adjustment of heart rate variability for systolic blood pressure variability and vice versa produced confirmatory results. Coefficient of variation, defined as within-subject SD divided by level of blood pressure or heart rate, displayed similar prognostic value. In conclusion, day-by-day blood pressure variability and heart rate variability by self-measurement at home make up a simple method of providing useful clinical information for assessing cardiovascular risk.
Exogenousl-Arginine Ameliorates Angiotensin II-Induced Hypertension and Renal Damage in Rats
Authors: Rajapakse Niwanthi W. , De Miguel Carmen , Das Satarupa , Mattson David L.
Published: November 2008

Experiments were performed to determine whether exogenousl-arginine could ameliorate angiotensin II-induced hypertension and renal damage. Rats were instrumented with chronic indwelling femoral venous and arterial catheters for infusions of drugs and measurement of conscious arterial pressure. Arterial blood pressure significantly increased from 124±1 to 199±4 mm Hg, after 9 days of continuous infusion of angiotensin II (20 ng/kg per minute; IV; n=6 to 9). In contrast, the increase in arterial pressure after 9 days of angiotensin II infusion was significantly blunted by 45% (P=0.0003) in rats coadministeredl-arginine (300 μg/kg per minute; IV; n=7 to 9). The glomerular injury index was significantly greater in rats administered angiotensin II in comparison with rats administered saline vehicle (P<0.001). Coinfusion ofl-arginine significantly increased plasma nitrate/nitrite concentrations (P<0.001) and completely prevented angiotensin II-induced glomerular damage (P<0.001). Angiotensin II infusion alone and combined angiotensin II plusl-arginine infusion significantly increased urinary albumin excretion. Albuminuria in rats administered angiotensin II plusl-arginine is likely to be because of increased intraglomerular pressure. Our experiments demonstrate thatl-arginine can blunt angiotensin II-induced hypertension and associated renal damage. This latter observation is most exciting because it indicates that increasing NO bioavailability, in addition to lowering arterial pressure, can greatly reduce hypertension-induced renal damage.
Hydrochlorothiazide, but not Candesartan, Aggravates Insulin Resistance and Causes Visceral and Hepatic Fat Accumulation
Authors: Eriksson Jan W. , Jansson Per-Anders , Carlberg Bo , Hägg Anders , Kurland Lisa , Svensson Maria K. , Ahlström Håkan , Ström Conny , Lönn Lars , Öjbrandt Kristina , Johansson Lars , Lind Lars
Published: November 2008

Treatment with angiotensin II receptor blockers is associated with lower risk for the development of type 2 diabetes mellitus compared with thiazide diuretics. The Mechanisms for the Diabetes Preventing Effect of Candesartan Study addressed insulin action and secretion and body fat distribution after treatment with candesartan, hydrochlorothiazide, and placebo. Twenty-six nondiabetic, abdominally obese, hypertensive patients were included in a multicenter 3-way crossover trial, and 22 completers (by predefined criteria; 10 men and 12 women) were included in the analyses. They underwent 12-week treatment periods with candesartan (C; 16 to 32 mg), hydrochlorothiazide (H; 25 to 50 mg), and placebo (P), respectively, and the treatment order was randomly assigned and double blinded. Intravenous glucose tolerance tests and euglycemic hyperinsulinemic (56 mU/m
2
per minute) clamps were performed. Intrahepatic and intramyocellular and extramyocellular lipid content and subcutaneous and visceral abdominal adipose tissue were measured using proton magnetic resonance spectroscopy and MRI. Insulin sensitivity (M-value) was reduced following H versus C and P (6.07±2.05, 6.63±2.04, and 6.90±2.10 mg/kg of body weight per minute, mean±SD;
P
≤0.01). Liver fat content was higher (
P
<0.05) following H than both P and C. The subcutaneous to visceral abdominal adipose tissue ratio was reduced following H versus C and P (
P
<0.01). Glycosylated hemoglobin, alanine aminotransferase, aspartate aminotransferase, and high-sensitivity C-reactive protein levels were higher (
P
<0.05) after H, but not C, versus P. There were no changes in body fat, intramyocellular lipid, extramyocellular lipid, or first-phase insulin secretion. Blood pressure was reduced similarly by C and H versus P. In conclusion, visceral fat redistribution, liver fat accumulation, low-grade inflammation, and aggravated insulin resistance were demonstrated after hydrochlorothiazide but not candesartan treatment. These findings can partly explain the diabetogenic potential of thiazides.
Brain Imaging Findings Predict Blood Pressure Response to Pharmacological Treatment
Authors: Jennings J. Richard , Muldoon Matthew F. , Whyte Ellen M. , Scanlon Joelle , Price Julie , Meltzer Carolyn C.
Published: November 2008

Hypertension appears to alter brain morphology, as well as the cerebrovascular support for information processing. Because these effects might reflect progressive effects of essential hypertension on the brain, we asked whether structural and functional brain indices would predict the success of pharmacological treatment of hypertension among 45 previously unmedicated individuals. After initial structural MRI and functional positron emission tomography imaging, subjects were randomly assigned in a double-blind fashion for treatment for 1 year with either lisinopril or atenolol. Systolic and diastolic blood pressure decreases after treatment stabilization were correlated to a pretreatment index of brain aging (combined ratings of ventricle and sulcal size and white matter hyperintensities) and the pretreatment change in regional cerebral blood flow during working memory in the thalamus and posterior parietal regions of interest. In multiple regression analyses, the structural brain index and the blood flow response in the thalamus predicted 20% of the variance in the systolic blood pressure response to treatment controlling for pretreatment blood pressure, age, gender, and type and dose of medication. Alcohol use influenced the thalamic response measure, but covariates did not alter the relation between greater indices of brain aging and less successful blood pressure response to treatment. The state of the brain may be an important factor in the remediation of blood pressure.
Aliskiren Accumulates in Renin Secretory Granules and Binds Plasma Prorenin
Authors: Krop Manne , Garrelds Ingrid M. , de Bruin René J.A. , van Gool Jeanette M.G. , Fisher Naomi D.L. , Hollenberg Norman K. , Jan Danser A.H.
Published: November 2008

The vascular effects of aliskiren last longer than expected based on its half life, and this renin inhibitor has been reported to cause a greater renin rise than other renin-angiotensin system blockers. To investigate whether aliskiren accumulation in secretory granules contributes to these phenomena, renin-synthesizing mast cells were incubated with aliskiren, washed, and exposed to forskolin in medium without aliskiren (0.1 to 1000 nmol/L). (Pro)renin concentrations were measured by renin- and prorenin-specific immunoradiometric assays, and renin activity was measured by enzyme-kinetic assay. Without aliskiren, the culture medium predominantly contained prorenin, the cells exclusively stored renin, and forskolin doubled renin release. Aliskiren dose-dependently bound to (pro)renin in the medium and cell lysates and did not alter the effect of forskolin. The aliskiren concentrations required to bind prorenin were 1 to 2 orders of magnitude higher than those needed to bind renin. Blockade of cell lysate renin activity ranged from 27±15% to 79±5%, and these percentages were identical for the renin that was released by forskolin, indicating that they represented the same renin pool, ie, the renin storage granules. Comparison of renin and prorenin measurements in blood samples obtained from human volunteers treated with aliskiren, both before and after prorenin activation, revealed that ≤30% of prorenin was detected in renin-specific assays. In conclusion, aliskiren accumulates in renin granules, thus allowing long-lasting renin-angiotensin system blockade beyond the half-life of this drug. Aliskiren also binds to prorenin. This allows its detection as renin, and might explain, in part, the renin rise during renin inhibition.
Banning of Minarets: Addressing the Validity of a Controversial Swiss Popular Initiative
Authors: Stüssi Marcel
Published: November 2008

The proposal to ban minarets is controversial by its very nature. On the one hand Swiss citizens are sovereign and act as the ultimate supreme authority. By their will they may seek via popular initiative to enact, revoke or alter such, and any, constitutional provision as they see fit. On the other hand there are so-called material bars to Swiss constitutional amendments—such as human rights—arising from the provisions of international law. Not surprisingly, these material bars to absolute sovereignty are fiercely contested because they mean either greater or lesser powers to the citizen and, indirectly, to the political parties. The popular initiative to ban minarets raises not only questions in respect of the relationship between domestic and international law, but also appears to challenge the legal architecture of Switzerland. The initiative may be held invalid by the Swiss General Assembly (henceforth 'General Assembly' or 'Assembly') on the grounds that it breaches the peremptory norms of international law. If this proves to be the case, the Swiss people will not be given the opportunity to vote on it. Arguably, such interference is feasible only if the material bar to initiatives is widened beyond its originally accepted scope. Apparently, the powers of the Swiss Sovereign became thereby unequivocally curbed. The relationship between Swiss domestic law and international law is pivotal also should the General Assembly declare the initiative to be valid. The people would as a consequence of the Assembly's decision possess the right to vote either for or against the initiative. But regardless of the poplar vote's outcome, the second option prima facie implies that the sovereignty of the Swiss citizens has been upheld, and concessions need only to be made by those who are either for or against the proposed ban. Yet in its international context the matter is more complex and more far-reaching than that. The first part of this paper concentrates on the question of whether it is advisable for the General Assembly to compromise the people's sovereignty by widening the original scope of peremptory norms. The second part explores what a popular vote in favour of the ban on minarets could mean in law. In order to raise the awareness of the subject matter beyond its legal dimension, the introduction and conclusion of this paper will shed specific light on the rule of law as a philosophical doctrine.
The Influence of the Ethos of Conflict on Israeli Jews' Interpretation of Jewish—Palestinian Encounters
Authors: Bar-Tal Daniel , Raviv Amiram , Raviv Alona , Dgani-Hirsh Adi
Published: November 2008

This study investigates the psychological effects of a set of societal beliefs termed the ethos of conflict, which develops in the context of intractable conflict—as, for example, the Israeli—Arab conflict. The premise was that the ethos of conflict constitutes a type of ideology that serves as a powerful prism through which individuals perceive the reality of an intractable conflict. The study's findings confirmed this premise, showing that participants with a high level of ethos of conflict tended to perceive photos depicting encounters between Jews and Palestinians differently than did those with a low level of ethos of conflict. The former tended to perceive the Palestinians as more aggressive, to blame them more for such attributed aggressiveness, and to explain this perceived aggressiveness more in terms of internal and stable causes. They also tended to stereotype Palestinians more negatively and Jews more positively.
Neuropsychological, Behavioral, and Adaptive Functioning of Swiss Children With Congenital Central Hypoventilation Syndrome
Authors: Ruof Helge , Hammer Juerg , Tillmann Bettina , Ghelfi Daniela , Weber Peter
Published: November 2008

This study collected data about developmental problems in a cohort of children with congenital central hypoventilation syndrome. In 2003, in Switzerland, 11 children with this disease were registered. Nine of them gave their informed consent to participate in the study and were examined. Clinical assessments were conducted, including examinations of neuropsychological, behavioral, and adaptive functions using Kaufman-Assessment Battery for Children, Child Behavior Checklist, and Vineland Adaptive Behavior Scales. The mean age (± standard deviation) was 7.5 ± 2.5 years. The cognitive tests showed problems in working memory functions with a near-to-normal full-range intelligence quotient (87.4 ± 23.3). The children showed normal values (t-values < 67) on problem scales of behavior, although 5 of the 9 children showed elevated values on the attention and on the social interaction problem scales. Adaptive function problems were identified in communication and daily living skills.
Effect of Acupuncture on the Brain in Children With Spastic Cerebral Palsy Using Functional Neuroimaging (fMRI)
Authors: Wu Yun , Jin Zhen , Li Ke , Lu Zhong-Li , Wong Virginia , Han Tong-Li , Zheng Hua , Caspi Opher , Liu Gang , Zeng Ya-Wei , Zou Li-Ping
Published: November 2008

We study the effect of acupuncture on brain activation patterns in children with cerebral palsy using functional magnetic resonance imaging (fMRI). fMRI of the whole brain was performed in 11 children with cerebral palsy and 10 healthy children during stimulation of a common acupoint in Traditional Medicine [Liv3 (Taichong)] on the left foot. We use both twisting and nontwisting methods with a blocked paradigm on a 2.0 Tesla MRI scanner. Functional data were analyzed by using Statistical Parametric Mapping software (SPM 99). Both signal increase and decrease in various regions of the brain were found in both groups of children. However, the pattern was different for the 2 groups, especially with decreases in signal regions. We suggest that the observed differences between children with cerebral palsy and healthy children with the stimulation of acupoint Liv3 might be due to blockage of the liver meridian in children with cerebral palsy.
Spontaneous Intracranial Hypotension: A Case Report
Authors: Uysal Serap , Albayram Sait , Ercan Tugba Erener
Published: November 2008

Spontaneous intracranial hypotension is a rare syndrome of low cerebrospinal fluid pressure due to spontaneous cerebrospinal fluid leaks. The main feature is orthostatic headache. We describe a case of spontaneous intracranial hypotension in a 5-year-old girl with a 1-month history of headache, sudden onset hearing loss, and ataxia. Magnetic resonance imaging (MRI) showed an enlargement of cervical venous plexus and lumbar puncture revealed a low opening pressure. Magnetic resonance myelography showed leakage of the contrast material at the level of the third and fourth lumbar vertebra. Bed rest and caffeine treatment yielded no resolution of symptoms. Following a lumbar epidural blood patch, her headache and ataxia resolved completely without any improvement in hearing. A second blood patch also yielded no effect on hearing. Spontaneous intracranial hypotension should be considered in the differential diagnosis of headache, also in the pediatric age group.
High-Dose Ribof lavin for Migraine Prophylaxis in Children: A Double-Blind, Randomized, Placebo-Controlled Trial
Authors: MacLennan, Suzanna C. , Wade Fiona M. , Forrest Katharine M. L. , Ratanayake Pyara D. , Fagan Elizabeth , Antony Jayne
Published: November 2008

This is the first study to evaluate the efficacy of riboflavin for migraine prophylaxis in children. This was a randomized, double-blind study of riboflavin (200 mg daily) versus placebo in 48 children. The primary efficacy measure was the number of patients achieving a 50% or greater reduction in the number of migraine attacks per 4 weeks. Other outcome measures were the mean severity of migraine per day, mean duration of migraine, days with nausea or vomiting, analgesic use, and adverse effects. A 50% or greater reduction in headaches was seen in 14/21 patients in the placebo group and 12/27 patients in the riboflavin group (not significant P = .125). There were no differences between riboflavin and placebo for primary or secondary outcome variables. These results suggest that riboflavin is not an effective therapy for preventing migraine in children. A high placebo responder rate was seen, with implications for other studies of migraine in children.
Cerebrovascular Disorders in the Prenatal Period
Authors: Dicuonzo Franca , Palma Michele , Fiume Marina , Scarpello Roberto , Lefons Velia , Maghenzani Marilena , Carella Aristide
Published: November 2008

Fetal stroke can occur between the 14th week of pregnancy and the beginning of labor. The incidence is approximately 17-35 of 100 000 live births. Risk factors are correlated to the mother, the pregnancy, or the factors associated with the fetus itself. Computerized tomography and magnetic resonance imaging are the most commonly used imaging techniques. The authors studied 3 cases with neurological symptoms by magnetic resonance imaging and magnetic resonance-angiography. In these cases, the authors found massive involvement of the left hemisphere that was presumptively correlated with the persistence of the oval foramen. Magnetic resonance-angiography showed a flow reduction in the left cerebral vessels, and in 1 case, there was also persistence of the fetal primitive trigeminal artery. The discrepancy between the extent of the cerebral lesions and the neurological symptoms is associated with cerebral plasticity, which is greater in damage occurring early in fetal life.
Partial Seizures and Atypical Absence Seizures as a Single Ictal Event in a Patient With Lennox-Gastaut Syndrome
Authors: Yang Zhixian , Liu Xiaoyan , Qin Jiong , Zhang Yuehua , Bao Xinhua , Xiong Hui
Published: November 2008

The authors report a patient with Lennox-Gastaut syndrome who was a fraternal twin. The twins encountered myoclonic seizures at the age of 4 years, but the seizures in the other patient were controlled very quickly without intellectual development damage. With the disease evolving, other characteristic seizures of Lennox-Gastaut syndrome appeared and failed to be controlled by multiple antiepileptic drugs, so levetiracetam was added on. At this time, frequent partial seizures from the left occipital and posterior temporal regions occurred, which always intermixed with atypical absence seizures in a single ictal event. To control the status epilepticus, levetiracetam was withdrawn immediately, and clonazepam, midazolam, and corticotropin in turn were used. The partial seizures were gradually alleviated. The results obtained in this study suggest that there might be some correlative mechanisms between partial seizures and atypical absence seizures in a single event. There is a temporal relationship between the occurrence of partial seizures and the introduction of levetiracetam.
Ischemic Cerebral Infarction in an Infant Following Gonadotropin Treatment for Undescended Testes
Authors: Dundar Nihal Olgac , Duman Ozgur , Aralasmak Ayse , Haspolat Senay
Published: November 2008

Cerebrovascular disorders are increasingly recognized as important causes of mortality and morbidity in the pediatric population. Risk factors for stroke in childhood are different from those in adults. Human chorionic gonadotropin is a polypeptide hormone produced by the human placenta and is composed of an α-subunit and a β-subunit. Pregnyl (human chorionic gonadotropin for injection) is a highly purified pyrogen-free preparation obtained from the urine of pregnant females. Ischemic cerebral infarction is seen in the young infertile male and female patients after gonadotropin treatment. The authors describe the case of a boy with right-sided hemiparesis following Pregnyl injection and discuss its possible pathogenetic mechanisms.
Isolated Vitamin E Deficiency Mimicking Distal Hereditary Motor Neuropathy in a 13-Year-Old Boy
Authors: Fusco Carlo , Frattini Daniele , Pisani Francesco , Gellera Cinzia , Giustina Elvio Della
Published: November 2008

We report an atypical neurophysiologic pattern of isolated vitamin E deficiency in a 13-year-old boy. Electroneurography— electromyography, somatosensory evoked potentials, serum vitamin E concentration and genetic analysis of the α-tocopherol transfer protein gene were performed. Nerve conduction study failed to show peripheral neuropathy whereas needle electromyography of distal muscles demonstrated chronic neurogenic motor unit potentials. Both clinical and neurophysiologic data fulfilled the criteria of distal hereditary motor neuropathy. Later on, somatosensory-evoked potential displayed absence of spinal and central response. The serum vitamin E level was low, and the patient was found to be homozygous for a 513insTT mutation in exon 3 of the α-tocopherol transfer protein gene. To our knowledge this is the first case of isolated deficiency of vitamin E that presents the classic neurophysiologic and clinical features of distal hereditary motor neuropathy.
Dystonia With Secondary Contractures: A Psychogenic Movement Disorder Mimicking Its Neurological Counterpart
Authors: Ziegler Julia Stephanie , von Stauffenberg Maya , Vlaho Stefan , Böhles Hansjosef , Kieslich Matthias
Published: November 2008

We report the case of an 11-year-old girl presenting with a 1.5-year history of swan neck-like deformed joint contractures of both hands. A possible diagnosis was sought in a wide range of rheumatological, metabolic, and neurological disorders. After detailed diagnostic procedures to exclude an organic pathology, steps were taken to establish a psychogenic origin. She showed symptoms that were incongruent with an organic neurological disorder, for example, a paroxysmal fluctuating course, reaction to placebo, and complete remission with psychotherapy and physiotherapy. The psychosomatic evaluation revealed a highly emotional conflict. This bizarre case demonstrates that secondary contractures are by no means an exclusion criterion for a psychogenic dystonia.
Cerebral Infarct in Pediatric Neuro-Behçet's Disease
Authors: Atkinson Marie , Moore Ellen , Altinok Deniz , Acsadi Gyula
Published: November 2008

Behçet's disease is a multisystem inflammatory vasculitic disorder with a chronic course for which the etiology is unknown. The central nervous system can be affected in 5% to 30% of all Behçet patients, yet it has been rarely reported in children or in Western countries. We describe a 14-year-old girl with Behçet's disease that presented initially as a cerebral infarct without venous sinus thrombosis.
Central Nervous System Complications of Blastic Hyperleukocytosis in Childhood Acute Lymphoblastic Leukemia: Diagnostic and Prognostic Implications
Authors: Koenig Mary Kay , Sitton Clark W. , Wang Min , Slopis John M.
Published: November 2008

Intracranial hemorrhage during blastic crisis is a rare but critically important occurrence in children with acute lymphoblastic leukemia. This form of hemorrhage has not been described since the advent of magnetic resonance imaging (MRI), leaving radiologists and clinicians unfamiliar with its unique imaging features. The authors describe 2 boys with severe intracranial pathology secondary to blastic hyperleukocytosis. Both patients were followed with serial MRI. Imaging findings in relation to the pathophysiology of white matter leukostasis are discussed and implications for treatment and prognosis are considered.
Lipid Profile, Apolipoproteins A and B in Children With Epilepsy
Authors: Tomoum Hoda Yahya , Awadallah Maha Mohammed , Fouad Dina Adel , Ali Ahmed Hanafy
Published: November 2008

In this study, lipid profile was assessed, and the intimal wall thickness of both carotid arteries in children with idiopathic epilepsy was measured. The study comprised 22 children with idiopathic epilepsy on either carbamazepine or valproate. A profile including triglycerides, total cholesterol, low-density and high-density lipoproteins cholesterol, apolipoproteins AI and B, and Duplex estimation of intimal wall thickness of carotid arteries were performed. Patients on carbamazepine showed increase in total cholesterol, low-density and high-density lipoproteins cholesterol, and decrease in apolipoprotein AI levels compared with controls. Levels of total cholesterol, low-density lipoproteins cholesterol, and apolipoprotein AI were reduced in patients receiving valproate compared with controls, whereas total cholesterol, high-density lipoproteins cholesterol, and apolipoprotein AI were reduced compared with those receiving carbamazepine. Carotid arteries intimal wall thickness was not significantly changed in any of the studied groups. Although atherogenic ratios are not changed, the lowered apolipoprotein AI levels may suggest an increased risk for coronary heart disease.
Clinical Presentation of Patients With Neurofibromatosis Type 1 in Infancy and Childhood: Genetic Traits and Gender Effects
Authors: Suenobu So-ichi , Akiyoshi Kensuke , Maeda Tomoki , Korematsu Seigo , Izumi Tatsuro
Published: November 2008

The clinical presentations of 32 patients with neurofibromatosis type 1 were examined based on genetic traits, clinical findings, electroencephalogram, and neuroimaging findings. Twenty-eight sequential magnetic resonance images showed multifocal hyperintense T2-weighted images in 14 patients. Seven (5 boys and 2 girls) of the 8 patients (88%) who inherited neurofibromatosis type 1 from affected mothers, and 7 (2 boys and 5 girls) of the 16 de novo patients (44%) had multifocal hyperintense T2-weighted images. In contrast, the patients who inherited this disease from affected fathers did not have any multifocal hyperintense T2-weighted images. Multiple plexiform neurofibromas were observed in 4 patients, of whom 3 boys inherited through at least 3 generations of women. They all presented severe psychomotor delay and epilepsy. These findings suggest that genetic traits, especially through the passage of several generations of women, may affect the clinical presentation in patients with neurofibromatosis type 1.
Long-Term Outcome of Symptomatic Infantile Spasms Established by Video-Electroencephalography (EEG) Monitoring
Authors: Montenegro Maria A. , Eck Karen , Jacob Susan , Cappell Joshua , Chriboga Claudia , Emerson Ronald , Patterson Marc C. , Akman Cigdem I.
Published: November 2008

In this study, we examine the long-term clinical outcome of children with symptomatic infantile spasm. The children between 2 and 18 years of age diagnosed with symptomatic infantile spasms were reviewed. Sixty-eight children (age range, 2-13 years; mean, 4.5 years) met the inclusion criteria. Children who underwent epilepsy surgery were excluded. Age of onset for infantile spasms ranged from 1 to 24 months (mean, 7.1 months). Developmental delay was noted in all; there was seizure freedom in 14 children (20.5%). Infantile spasms were reported as the only seizure type in 10 (14.5%) children older than age 2 years. During the follow-up; symptomatic generalized epilepsy was diagnosed in 23 childern (34%) and focal epilepsy in 21 (31%). The long-term outcome of these children remains unchanged in the majority of the children with symptomatic infantile spasms. We could not establish any risk factor that might be related to favorable or adverse outcome.
Juvenile Dermatomyositis Presenting With Anasarca
Authors: Saygi Semra , Alehan Füsun , Baskin Esra , Bayrakci Umut Selda , Ulu Esra Meltem Kayahan , Ozbek Namik
Published: November 2008

Generalized edema can occur during the course of juvenile dermatomyositis. In this article, a 4-year-old boy with generalized nonpitting edema and proximal weakness is reported. Characteristic cutaneous lesions, laboratory tests, results of electromyography, and magnetic resonance imaging findings resulted in a diagnosis of juvenile dermatomyositis. He was treated with corticosteroids and methotrexate. It is concluded that the generalized edema may appear as the presenting cutaneous manifestation of juvenile dermatomyositis.
Central Nervous System Involvement in Turkish Children With Primary Hemophagocytic Lymphohistiocytosis
Authors: Gurgey Aytemiz , Aytac Selin , Balta Gunay , Oguz Kader K. , Gumruk Fatma
Published: November 2008

This report mainly presents the clinical and laboratory findings in a group of 15 primary hemophagocytic lymphohistiocytosis patients with central nervous system involvement (group 1) and compares some of the findings with those of 13 hemophagocytic lymphohistiocytosis patients without central nervous system involvement (group 2). Statistical analysis showed that age and sodium level at diagnosis were significantly higher while alanine aminotransferase and bilirubin levels were significantly lower in group 1 than group 2 ( P < .05). There were no statistically significant differences between the 2 groups in the other clinical, laboratory, and overall survival parameters. Three patients in group 1 initially had central nervous system involvement in the absence of systemic findings, which led to the initial misdiagnosis of these patients as central nervous system disorders other than hemophagocytic lymphohistiocytosis.
The Perceived Impact of a Child Maltreatment Report From the Perspective of the Domestic Violence Shelter Worker
Authors: Steen Julie A.
Published: November 2008

The purpose of this study is to examine domestic violence shelter workers’ perceptions of child maltreatment reporting. A sample of 82 professionals from domestic violence shelters across the United States participated in a survey focusing on a variety of different types of reports and the frequency of both positive and negative outcomes arising from these reports. Possible outcomes included in the study are damage to the relationship between the worker and the battered woman, disempowerment of the battered woman, discouragement from seeking further help, protection of the child, further traumatization of the child, further disruption to the family, and damage to the woman’s likelihood of maintaining custody. Significant differences in perceived impact are found based on identity of abuser (spousal batterer vs. battered woman) and nature of report (child as witness to domestic violence vs. child as victim of abuse). These results point to the complexity of perceptions regarding the impact of reporting.
Unruly ethics: on the difficulties of a bottom-up approach to ethics in the field of genomics
Authors: Felt Ulrike , Fochler Maximilian , Müller Annina , Strassnig Michael
Published: November 2008

This paper explores the difficulties of addressing ethical questions of genome research in a public engagement setting where laypeople and scientists met for a longer period of time. While professional ethics mostly ignores public meaning, we aimed at a bottom-up approach to ethics in order to broaden the way in which ethical aspects of genomics can be addressed. However, within this interaction we identified a number of difficulties that constrained an open discussion on ethical issues. Thus, we analyze how ethical issues were approached, framed, debated, displaced or closed. We then elaborate on the possibilities and limits of dealing with ethics in such a participatory setting. We conclude by hinting at what should be taken into consideration when approaching issues of science and ethics more “upstream.”
Adolescent responses toward a new technology: first associations, information seeking and affective responses to ecogenomics
Authors: Bos Mark J.W. , Koolstra Cees M. , Willems Jaap T.J.M.
Published: November 2008

This paper reports on an exploratory study among adolescents ( N = 752) who were introduced to the emerging technology of ecogenomics for the first time. An online survey focused on their associations with the term ecogenomics, their planned information seeking behaviors if they were to acquire information about the new technology, and their first affective responses toward ecogenomics after having read some introductory information about it. Adolescents were found to associate ecogenomics most frequently with economy. Although the Internet was the most popular medium to be used in their planned information seeking behaviors, books and science communication professionals were judged as the most trustworthy information sources. After having read the introductory information about ecogenomics most adolescents reported positive affective responses toward the new technology.
Negotiating uncertainty: asteroids, risk and the media
Authors: Mellor Felicity
Published: November 2008

Natural scientists often appear in the news media as key actors in the management of risk. This paper examines the way in which a small group of astronomers and planetary scientists have constructed asteroids as risky objects and have attempted to control the media representation of the issue. It shows how scientists negotiate the uncertainties inherent in claims about distant objects and future events by drawing on quantitative risk assessments even when these are inapplicable or misleading. Although the asteroid scientists worry that media coverage undermines their authority, journalists typically accept the scientists’ framing of the issue. The asteroid impact threat reveals the implicit assumptions which can shape natural scientists’ public discourse and the tensions which arise when scientists’ quantitative uncertainty claims are re-presented in the news media.
“The post-antibiotic apocalypse” and the “war on superbugs”: catastrophe discourse in microbiology, its rhetorical form and political function
Authors: Nerlich Brigitte , James Richard
Published: November 2008

Discourses evoking an antibiotic apocalypse and a war on superbugs are emerging just at a time when so-called “catastrophe discourses” are undergoing critical and reflexive scrutiny in the context of global warming and climate change. This article combines insights from social science research into climate change discourses with applied metaphor research based on recent advances in cognitive linguistics, especially with relation to “discourse metaphors.” It traces the emergence of a new apocalyptic discourse in microbiology and health care, examines its rhetorical and political function and discusses its advantages and disadvantages. It contains a reply by the author of the central discourse metaphor, “the post-antibiotic apocalypse,” examined in the article.
A Comparison of Systematic Screening Tools for Emotional and Behavioral Disorders
Authors: Lane Kathleen Lynne , Little M. Annette , Casey Amy M. , Lambert Warren , Wehby Joseph , Weisenbach Jessica L. , Phillips Andrea
Published: November 2008

Early identification of students who might develop emotional and behavioral disorders (EBD) is essential in preventing negative outcomes. Systematic screening tools are available for identifying elementary-age students with EBD, including the Systematic Screening for Behavior Disorders (SSBD) and the Student Risk Screening Scale (SRSS). The SSBD is considered the gold standard for systematic EBD screening. The brevity of the SRSS is often favored with respect to resource allocation. The authors evaluated the concurrent validity of the SRSS to predict SSBD results when used to detect school children with externalizing or internalizing behavior concerns. Between low- and high-risk categories, the SRSS had excellent accuracy for predicting both externalizing (95%) and internalizing (93%) problems on the SSBD. Sensitivity (94%) and specificity (95%) were both excellent for externalizing behavior, but for internalizing behavior, sensitivity was lower (44%), while specificity was excellent (95%). Receiver-operating characteristic analysis also suggested that the SRSS was more accurate for detecting externalizing than internalizing behaviors. Limitations and future directions are offered.