bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of the pest risk from Grapevine flavescence dorée phytoplasma to Austrian viticulture
Authors: Steffek R. , Reisenzein H. , Zeisner N.
Published: April 2007

In 2004, Scaphoideus titanus, vector of Grapevine flavescence dorée phytoplasma, was first recorded in Austrian vineyards. The absence of the phytoplasma in 2004‐06 was confirmed by molecular analyses of grapevine and vector samples. To estimate the risk to Austrian viticulture a Pest Risk Analysis (PRA) was conducted, following the EPPO decision support scheme. The highest risk of introduction arises from the extensive trade in rootstocks and, especially for vineyards located along traffic routes and waterways, from the passive or active spread of the vector. Climate will not limit the establishment of the vector in the large northern Austrian vine‐growing regions of Niederösterreich and Burgenland. At present the probability that the disease and vector become associated is restricted to parts of South Styria. Plant protection practice cannot prevent the establishment and spread of vector populations, especially in sustainable production systems, which forms more than 70% of the total Austrian viticulture area. The possibility for containment or even eradication is given, but requires an early recognition of the vector and disease and the immediate initiation of measures. Otherwise, losses to vine growers, follow‐up costs for eradication and additional efforts in the production of plants would be substantial. Following the assessment, legal measures and recommendations to prevent disease entry and to minimise impacts of established vector populations are considered.
Challenges faced by the IR‐4 Programme and US specialty crop growers
Authors: Holm R. E. , Baron J. J. , Kunkel D. L.
Published: April 2007

The Food Quality Protection Act (FQPA) was enacted in August 1996 and required the US Environmental Protection Agency (EPA) to reassess all existing and new crop protection active substances using a new set of health and environmental standards to further protect infants and children. The initial fear that many minor or specialty crop use registrations would be lost without adequate replacements has largely been overcome by an aggressive programme by the International Research Project no. 4 (IR‐4) in partnership with the EPA and the crop protection industry to register new, safer, reduced risk products for specialty crop pest control needs. Since the FQPA, the EPA has approved over 5600 new specialty crop uses resulting from IR‐4 residue programmes. This amounts to about 56% of the over 10 000 clearances received by the IR‐4 programme in its 43 year history and about 50% of all new uses granted by the EPA since FQPA. The positive outcomes from these efforts have been partially negated by the lack of tolerances or Maximum Residue Levels (MRLs) in countries to which US produce is exported. This has forced some US specialty crop growers to continue to use older, less desirable products. IR‐4 has been addressing this challenge by cooperating in the NAFTA (North American Free Trade Agreement) countries with Agriculture and Agri‐Food Canada's Pest Management Centre and Health Canada's Pest Management Regulatory Agency to harmonize MRLs through joint projects and regulatory reviews. IR‐4 has also provided leadership for the International Crop Grouping Consulting Committee to harmonize specialty/minor crop groupings and representative crops for residue studies with the long‐term goal being to globally harmonize MRLs.
Climate variation: a simple geological perspective
Authors: Fookes Peter G. , Lee E. Mark
Published: April 2007

There is much talk about current global warming, but that is not the main subject under discussion here. There is fairly general agreement on climate changes through geological time, and the cause or causes are becoming clearer. In this Feature, a simple backward look is given to climate events, particularly climatic cycles, in geological time, to help get in perspective some of the predictions for our near future.
Advances in renal replacement therapy as a bridge to renal transplantation
Authors: Goldstein Stuart L.
Published: April 2007

Abstract:  While renal transplantation remains the most prevalent treatment for children with end‐stage renal disease, the majority of children incident to ESRD receive dialytic therapy prior to receiving a renal allograft and 25% of children are still receiving dialytic therapy 36 months after achieving ESRD. The current review discusses the most recent advancements in both hemodialysis and PD therapies to provide optimal care for children as a bridge until renal transplantation. Areas covered include dialysis dose assessment, target dry weight assessment, vascular access and advancements in PD technology.
Unrelated partially matched lymphocyte infusions in a patient with complete DiGeorge/CHARGE syndrome
Authors: Janda Ales , Sedlacek Petr , Mejstrikova Ester , Zdrahalova Katerina , Hrusak Ondrej , Kalina Tomas , Sieglova Zuzana , Zizkova Hana , Formankova Renata , Keslova Petra , Hubacek Petr , Sediva Anna , Bartunkova Jirina , Dlask Karel , Stary Jan
Published: April 2007

Abstract:  We present an infant with cDGS overlapping with CHARGE syndrome, who suffered from T‐cell deficiency treated with screened healthy DLI from an unrelated donor (8/10 match). The first dose of DLI (1.1 × 106 CD3+/kg) was administered at the age of six months, the second one (0.9 × 106 CD3+/kg) 36 days later. No conditioning was employed, GvHD prophylaxis consisting of CsA was used only during the second infusion. Since day+10 after the first DLI, split chimerism showing T‐cell engraftment has been documented. Proliferative response to PHA was detected on day+145. The treatment was complicated by severe acute GvHD (grade II‐III) after the first DLI and prolonged chronic liver cholestatic GvHD developing after the second DLI. Vigorous EBV proliferation four wk after the second DLI was accompanied by peripheral expansion of CD8+ donor cells. The patient, 26‐months old, is clinically well and has slowly started to gain his developmental milestones. We believe that infusions of small doses of DLI from an unrelated donor represent a potentially helpful therapeutic option in patients with cDGS/CHARGE phenotype.
Limitations of cyclosporine C2 monitoring in pediatric heart transplant recipients
Authors: Hmiel S. Paul , Canter Charles , Shepherd Ross , Lassa‐Claxton Sherry , Nadler Michelle
Published: April 2007

Abstract:  Monitoring CSA levels at two h after dosing (C2) has been shown effective in providing adequate CSA‐based immunosuppression in clinical trials in adult transplant recipients, but there is limited data regarding C2 monitoring in pediatric transplant recipients. Given the differences in CSA pharmacokinetics between children and adults, a cohort of stable pediatric transplant recipients was converted from monitoring CSA trough (C0) to C2 levels, to establish the clinical utility and safety of C2 monitoring. After an abbreviated AUC0–5 to establish baseline exposure, subsequent CSA dosing was adjusted based on C2 levels. Additional evaluation included monitoring for rejection, changes in CSA dose, toxicity, serum chemistries, and infection. Twelve heart transplant recipients were enrolled, with mean age 4.8 yr (range: 0.6–14.0). All patients received microemulsified CSA (Neoral®; Novartis Pharmaceuticals, East Hanover, NJ, USA) twice daily. Baseline CSA dose was 5.39 ± 2.05 mg/kg/day (mean ± s.d.), with mean C0 = 267 ± 112, C2 = 1065 ± 565, and AUC0–5 = 3817 ± 1435. Only seven participants showed clear CSA peak levels at two h, with five exhibiting delayed peaks at three to five h post‐dose. These seven participants completed 48 wk of study, with mean CSA dose decreasing to 4.55 ± 3.61 mg/kg/day, maintaining mean C2 599 ± 211 (vs. target C2 = 800). No significant change in serum creatinine was observed, although GFR increased from 76.9 to 107.6 mL/min/1.73 m2 (p = 0.11). Five patients failed to achieve target C2 levels (>800) during the first four wk, despite comparable AUC values, and were maintained on trough monitoring (C0). Mean systolic and diastolic blood pressures fell slightly, three minor infections were noted during the study period, and one episode of acute rejection occurred, despite stable CSA dosing. Nearly 50% of stable pediatric transplant recipients failed to achieve adequate peak C2 CSA levels during conversion from C0 to C2 monitoring. Age‐dependent differences in CSA absorption and/or clearance pharmacokinetics may explain these findings.
Set‐up and statistical validation of a new scoring system for obstructed defaecation syndrome
Authors: Altomare D. F. , Spazzafumo L. , Rinaldi M. , Dodi G. , Ghiselli R. , Piloni V.
Published: April 2007

Objective  There is no objective means to assess the obstructed defaecation syndrome (ODS), to allow evaluation of outcome or to compare the efficacy of treatment including surgery. The study aimed to validate a disease‐specific index to quantify severity to allow assessment of the results of treatment in clinical trials, to permit comparison between them.

Method  Seventy‐six patients with ODS and 30 healthy controls entered the study after proctologic and ano‐rectal physiological investigation. Hirschsprung's disease and slow transit constipation were excluded. An eight‐item questionnaire with four or five possible answers was administered by two independent researchers at two different times. The ODS score was the sum of all points with a maximum possible of 31 points. Agreement between the two operators was evaluated by the Kappa coefficient for each single item. The coefficient of repeatability (CR) was assessed by the Bland and Altman plot. The internal consistency was evaluated by the Crohnbach‐alpha test. A cluster analysis was carried out on each clinical finding. The Mann–Whitney U‐test was used to compare median ODS score between patients and controls.

Results  The ODS score of the two operators was normally distributed and strongly correlated (r = 0.89). The correlation coefficient between the score assigned to each item by two operators ranged from 0.79 to 0.98. The degree of agreement between the operators was good and the two methods were reproducible (CR = 3.13). There was a significant difference between the mean ODS score for patients and controls (t = 20.70, P < 0.001). The Crohnbach alpha value for internal reliability was +0.513. Cluster analysis showed a different profile between cluster 1 (a nonhomogenous group including rectocoele, intussusception or perineal descent), and cluster 2 (pelvic dysynergia).

Conclusion  The ODS score offers a validated severity of disease index in grading the severity of disease and monitoring the efficacy of therapy.
A Model of Reputation in Cheap Talk*
Authors: Frisell Lars , Lagerlöf Johan N. M.
Published: April 2007

We study a dynamic game of advice where the sender's preferences are unknown to the receiver. The novel feature of the model is that there is more than one type of biased sender. We show that the more equal the proportions of different biases in the sender population, the greater the credibility of the information transmitted. Somewhat surprisingly, however, we also find that the receiver does not benefit from this equality. We discuss our results in the context of political lobbying and show that institutions that increase transparency lower lobbyists' incentives for truthtelling, but unambiguously promote the policymaker's welfare.
Global Social Preferences and the Demand for Socially Responsible Products: Empirical Evidence from a Pilot Study on Fair Trade Consumers
Authors: Becchetti Leonardo , Rosati Furio Camillo
Published: April 2007

We analyse behaviour and motivations of a sample of about 1,000 consumers purchasing ‘fair trade (FT) goods’, i.e. food and artisan goods which include socially responsible (SR) characteristics and a price premium for primary product producers with respect to equivalent non‐FT products. By estimating a simultaneous two‐equation treatment effect model we find that FT products have less than unit of income elasticity and their demand is negatively (positively) correlated with geographical distance from the nearest shop (age and awareness of SR criteria). Awareness of SR criteria depends, in turn, on a series of factors (consumption habits, membership of volunteer associations) which, indirectly (via increased awareness), significantly affect consumption. We also measure consumers’ willingness to pay in excess for the SR features of FT products with a contingent evaluation approach and find that it is positively correlated with awareness of SR criteria.
Bargaining Coalitions in the WTO Agricultural Negotiations
Authors: Costantini Valeria , Crescenzi Riccardo , De Filippis Fabrizio , Salvatici Luca
Published: April 2007

This paper aims to understand the structural features of bargaining coalitions in the Doha Round of the WTO. We provide an empirical assessment of the preferences of each negotiating actor considering general economics indicators, development levels, structure of agricultural sectors and trade policies. Bargaining coalitions are analysed by grouping countries using a cluster analysis procedure. The clusters are compared with existing coalitions in order to assess their degree of internal homogeneity as well as their common interests. Such a comparison allows the identification of possible ‘defectors’, i.e. countries that, according to their economic conditions and policies, seem to be relatively less committed to the positions of the coalition they join. In addition, the ex‐post analysis of the counterfactual coalitions sheds light on the ‘distance’ between different coalitions as well as between individual countries and the best alternative group available. Empirical results confirm our research hypothesis: clusters of structurally homogeneous countries well represent existing bargaining coalitions. In particular, the G‐20 shows a high degree of internal coherence, which, in our framework, may provide a clue to the ‘sustainability’ of this coalition and to its relevance in the Doha Round negotiations.
Why the Middle is Unstable: The Political Economy of Exchange Rate Regimes and Currency Crises
Authors: Willett Thomas D.
Published: April 2007

The contribution of sticky exchange rates to the rash of currency crises over the past decade has become a major topic of international monetary analysis and policy discussion. While there is widespread agreement among economists that the middle of the exchange rate spectrum, adjustable pegs, is highly crisis‐prone in a world of substantial capital mobility, Jeffrey Frankel has recently argued that, surprisingly, we lack a clear theoretical rationale for why this is so. This paper attempts to fill that void. It argues that Frankel is correct in terms of economic analysis alone, but that when political economy considerations are introduced then a satisfactory explanation is at hand. Key aspects of this political economy perspective are laid out and implications for exchange rate policy are considered. The analysis suggests that for promoting currency stability the traditionally debated distinctions between crawling bands and managed floats are likely less important than the political environments in which they are operated.
USING AND ABANDONING ROUNDHOUSES: A REINTERPRETATION OF THE EVIDENCE FROM LATE BRONZE AGE–EARLY IRON AGE SOUTHERN ENGLAND
Authors: WEBLEY LEO
Published: April 2007

Summary.  It has recently been demonstrated that a number of roundhouses of the early first millennium BC in southern England show a concentration of finds in the southern half of the building. It has thus been argued that this area was used for domestic activities such as food preparation, an idea which has formed the basis for discussion of later prehistoric ‘cosmologies’. However, reconsideration of the evidence suggests that this finds patterning does not relate to the everyday use of the buildings, being more likely to derive from a particular set of house abandonment practices. Furthermore, evidence can be identified for the location of domestic activities within contemporary roundhouses that appears to contradict the established model.
SOCIAL NETWORKS AND CROSS‐CULTURAL INTERACTION: A NEW INTERPRETATION OF THE FEMALE TERRACOTTA FIGURINES OF HELLENISTIC BABYLON
Authors: LANGIN‐HOOPER STEPHANIE M.
Published: April 2007

Summary.  In the study of the Hellenistic period in Babylon, cross‐cultural interactions between Greeks and native Babylonians have been primarily interpreted using colonialist theories of Hellenisation, domination, and cultural isolation. This paper finds, however, that such theories cannot adequately explain the types of cross‐cultural combinations seen in the archaeological record of female Hellenistic Babylonian terracotta figurines. The forms and functions of these terracotta figurines were substantially altered and combined throughout the Hellenistic period, resulting in Greek‐Babylonian multicultural figurines as well as figurines that exhibited new features used exclusively in Hellenistic Babylonia. In order to facilitate a greater understanding of the full complexity of these Greek–Babylonian interactions, a new interpretation of cross–cultural interaction in Hellenistic Babylon is developed in this paper. This Social Networks model provides an alternative framework for approaching both how a hybrid material culture of terracotta figurines was developed and how Hellenistic Babylon became a multicultural society.
Sisters organising in Japan and Korea: the development of women‐only unions
Authors: Broadbent Kaye
Published: April 2007

In this article, I explore the development of women‐only unions in Japan and Korea. Women‐only unions, which organise women workers across enterprises and employment status boundaries in both countries, have appeared only recently and are new areas of research. While the strategy to form autonomous women‐only unions in Japan and Korea is a recent phenomenon, women workers in both countries are continuing a tradition of women's activism that has challenged both management and the male domination of the union movement. By taking a broad scope and by organising the growing non‐full‐time workforce and women employed in small workplaces, the formation of women‐only unions in Japan and Korea is a positive development for both non‐unionised women workers and for the broader workers' movement in general.
Narrowband UVB therapy for vitiligo: does the repigmentation last?
Authors: Sitek JC , Loeb M , Ronnevig JR
Published: April 2007

Background  Since 1997, a number of trials have shown promising results in treating generalized vitiligo with narrowband ultraviolet B (UVB) both in adults and children. However, there is little knowledge concerning the duration and permanency of the treatment‐induced repigmentation.

Objective  Our main objective was to perform a follow‐up trial of successfully treated patients receiving narrowband UVB for generalized vitiligo.

Methods  We have investigated to what degree the treatment‐induced repigmentation remains stable for up to 2 years post‐treatment. We performed an initial open trial including 31 patients with generalized vitiligo. They received narrowband UVB thrice weekly for up to 12 months. Patients experiencing > 75% repigmentation were defined responders and were included in the follow‐up trial. Responders were followed every 6 months for up to 2 years after cessation of treatment. We observed the pigmentation status and registered any changes indicating loss of pigmentation and relapse.

Results  Eleven of the 31 treated patients were included in the follow‐up trial. Six patients had relapse and five patients had stable response 24 months after cessation of treatment. Four out of six relapses were within 6 months post‐treatment.

Conclusion  In our study population of 31 patients with generalized vitiligo, five patients (16%) experienced > 75% stable repigmentation 2 years after cessation of a treatment programme of up to 1 years narrowband UVB therapy.
Eosinophilic, polymorphic and pruritic eruption associated with radiotherapy (EPPER) in two patients with breast tumour
Authors: García‐Donoso C , Tardío JC , Arias D , Romero A , Borbujo JM
Published: April 2007

Eosinophilic polymorphic and pruritic eruption associated with radiotherapy (EPPER) is a rare entity that appears in oncological patients after radiotherapy. We describe two patients with breast tumour who presented with EPPER in a different area from the one that had been irradiated. One of them needed different types of treatment, topical and systemic corticosteroids, antihistamines and narrowband ultraviolet B. The other one responded to the application of topical corticosteroids. We suggested that this eruption could be more frequent than has been reported.
Walkley–Black analysis of forest soil organic carbon: recovery, limitations and uncertainty
Authors: De Vos B. , Lettens S. , Muys B. , Deckers J. A.
Published: April 2007

Organic carbon levels of 542 soil samples from temperate lowland forest were determined by the original and modified Walkley–Black (WB) dichromate methods and total organic carbon (TOC) analysis. The performance and the lower and upper quantification limits of the WB method were assessed. Variable recovery rates were related to laboratory and field conditions and to the sample composition. The percentage carbon recovered by the original WB method was found to be systematically lower than commonly accepted, and the correction factor was estimated at 1.58 instead of 1.30–1.35. However, a good linear relationship with TOC enabled acceptable prediction of soil organic carbon which was most precise when using the original WB method. Texture class and pedogenetic horizon showed significant differences in recovery. Depending on the modifications of the WB method, recoveries varied significantly between laboratories, explaining up to 29% of the total variation of the topsoil carbon assessment of a site. Low recovery from samples was partly attributed to charcoal and resistant elementary carbon particles. No interference was found to be caused by iron or manganese compounds. In order to use WB carbon data of forest soils, laboratory‐ and method‐specific determination of the recovery rate using a total analyser is strongly recommended. The original WB method was unable to predict reliably forest soil carbon contents higher than 8% TOC.
The American Enlightenment
Authors: Reid‐Maroney Nina
Published: April 2007

The American Enlightenment is enjoying a revival of scholarly interest. While still mindful of the rich associations between their work and the history of the American Revolution, historians of the Enlightenment have moved beyond the traditional focus on political history, joining scholars of the Enlightenment elsewhere in exploring new theoretical terrain, and the place of the American Enlightenment in the Atlantic community of letters.
Assessment of Hairline EEG as a Screening Tool for Nonconvulsive Status Epilepticus
Authors: Kolls Brad J. , Husain Aatif M.
Published: April 2007

Summary:  Purpose: Because of the high incidence of nonconvulsive status epilepticus (NCSE), the attraction of a “quick and easy” screening electroencephalogram (EEG) is obvious. Previous studies have shown utility of hairline EEG in diagnosing epilepsy. However, this technique has not been evaluated as a screening tool for NCSE. We wanted to provide proof of principle that a screening hairline EEG has sufficient sensitivity to use as a screening tool for diagnosing NCSE.

Methods: A total of 120, 2‐ to 3‐min EEG samples of normal and various abnormal digital EEG studies were reformatted in three six‐channel montages (A, longitudinal bipolar; B, referential to ipsilateral ear; C, referential to contralateral ear) that mimicked a hairline recording and were interpreted by five neurophysiologists. The test data interpretation was compared with the original EEG interpretation.

Results: Performance was best with montages A and B; 71% and 70.5% of the samples were interpreted correctly by using these montages. Only 65% of the samples were correctly interpreted by using montage C. With the best montage (A), the sensitivities ranged from 91% for normal EEG to 54% for periodic lateralized epileptiform discharges (PLEDs). The sensitivity for seizures was only 72%. Seizures were frequently misinterpreted as more benign patterns such as normal and diffuse slowing.

Conclusions: EEG data reformatted to resemble a hairline EEG had low sensitivity for detecting seizures. As a result, we do not recommend further pursuit of hairline EEG as a “quick and easy” screening tool for NCSE.
The Effects of Ascorbic Acid on Penicillin‐induced Epileptiform Activity in Rats
Authors: Ayyildiz Mustafa , Coskun Sule , Yildirim Mehmet , Agar Erdal
Published: April 2007

Summary: Purpose:Epileptic seizure results from excessive discharge in a population of hyperexcitable neurons. A number of studies help to document the effects of active oxygen free radical scavengers such as α‐tocopherol or ascorbic acid (vitamin C). In the present study, we examined the effects of ascorbic acid, at the six different doses, on penicillin‐induced epileptiform activity.

Methods:A single microinjection of penicillin (2.5 μl, 500 units, intracortically) into the left sensorimotor cortex induced epileptiform activity within 2–5 min, progressing to full seizure activity lasting ∼3–5 h. In the first set of experiments, 30 min after penicillin injection, six different doses of ascorbic acid (25, 50, 100, 200, 400, or 800 mg/kg) were administered intraperitoneally (IP). The other group of animals received the effective dose of ascorbic acid (100 mg/kg, IP) for 7 days. Ascorbic acid administration was stopped 24 h before penicillin treatment. Another group of rats received the effective dose of ascorbic acid (100 mg/kg, IP) 30 min before penicillin treatment. In the second set of experiments, the lipid peroxidation (MDA) and reduced glutathione (GSH) levels of brain were measured in the control, control + ascorbic acid, penicillin, and penicillin + ascorbic acid groups.

Results:Ascorbic acid, at the low dose (50, 100 mg/kg, 30 min after penicillin injection), decreased both the frequency and amplitude of penicillin‐induced epileptiform activity in rats. Ascorbic acid, at intermediate doses (200, 400 mg/kg, 30 min after penicillin injection), decreased the frequency of epileptiform activity without changing the amplitude. Ascorbic acid, at the lowest dose (25 mg/kg) and highest dose (800 mg/kg) (30 min after penicillin injection), did not change either the frequency or amplitude of epileptiform activity. Ascorbic acid, at the low dose (100 mg/kg) was the most effective dose in changing the frequency and amplitude of penicillin‐induced epileptiform activity. Pretreatment with ascorbic acid (100 mg/kg) 30 min before penicillin treatment caused a significant delay in the onset of penicillin‐induced epileptiform activity. Pretreatment with ascorbic acid (100 mg/kg) for 7 days did not change the latency of epileptiform activity. The most effective dose of ascorbic acid (100 mg/kg) prevented both the decrease in GSH level and the increase in lipid peroxidation level (MDA) occurring after penicillin‐induced epileptiform activity.

Conclusions:These data indicate that ascorbic acid has neuroprotective activity against penicillin‐induced epileptiform electrocorticogram activity.
Risk Factors in Sudden Death in Epilepsy (SUDEP): The Quest for Mechanisms
Authors: Nashef Lina , Hindocha Neeti , Makoff Andrew
Published: April 2007

Summary:  People with epilepsy may die suddenly and unexpectedly without a structural pathological cause. Most SUDEP cases are likely to be related to seizures. SUDEP incidence varies and is <1:1,000 person‐years among prevalent cases in the community and ∼1:250 person years in specialist centres. Case–control studies identified certain risk factors, some potentially amenable to manipulation, including uncontrolled convulsive seizures and factors relating to treatment and supervision. Both respiratory and cardiac mechanisms are important. The apparent protective effect of lay supervision supports an important role for respiratory factors, in part amenable to intervention by simple measures. Whereas malignant tachyarrhythmias are rare during seizures, sinus bradycardia/arrest, although infrequent, is well documented. Both types of arrhythmias can have a genetic basis. This article reviews SUDEP and explores the potential of coexisting liability to cardiac arrhythmias as a contributory factor, while acknowledging that at present, bridging evidence between cardiac inherited gene determinants and SUDEP is lacking.
Autonomic Status Epilepticus in Panayiotopoulos Syndrome and Other Childhood and Adult Epilepsies: A Consensus View
Authors: Ferrie Colin D , Caraballo Roberto , Covanis Athanasios , Demirbilek Veysi , Dervent Aysin , Fejerman Natalio , Fusco Lucia , Grünewald Richard A. , Kanazawa Osamu , Koutroumanidis Michael , Lada Christina , Livingston John H , Nicotra Alessia , Oguni Hirokazu , Martinovic Zarko , Nordli Douglas R , Parisi Pasquale , Scott Rod C. , Specchio Nicola , Verrotti Alberto , Vigevano Federico , Walker Matthew C. , Watanabe Kazuyoshi , Yoshinaga Harumi , Panayiotopoulos Chrysostomos P
Published: April 2007

Summary: Purpose:To discuss and propose a definition of autonomic status epilepticus (SE), describe its clinical and EEG features, and review what is known about its epidemiology, pathophysiology, differential diagnosis, and management.

Methods:An international consortium of established researchers in the field was identified from their published work, agreed the purpose of the project, searched the literature, and, by use of e‐mail communication, agreed the consensus document.

Results:Autonomic SE is a condition lasting at least 30 min and characterized by epileptic activity causing altered autonomic function of any type at seizure onset or in which manifestations consistent with altered autonomic function are prominent (quantitatively dominant or clinically important) even if not present at seizure onset. It is best described, and probably most commonly encountered in children, with Panayiotopoulos syndrome. However, it also occurs in children with symptomatic epilepsies and, exceptionally, in adults. Its pathogenesis and most appropriate management are poorly understood

Conclusions:It is hoped that this document will help clinical recognition of Autonomic SE, reduce misdiagnosis, and promote further interest and studies into what has been a relatively neglected area.
The Association of MRI Findings and Neuropsychological Functioning after the First Recognized Seizure
Authors: Byars Anna W. , DeGrauw Ton J. , Johnson Cynthia S. , Fastenau Philip S. , Perkins Susan M. , Egelhoff John C. , Kalnin Andrew , Dunn David W. , Austin Joan K.
Published: April 2007

Summary:  Purpose: To explore relationships between MRI abnormalities of the brain and neuropsychological functioning in children who were evaluated following their first recognized seizure.

Methods: Subjects were children aged 6 to 14 years with a first recognized seizure within the past 3 months who participated in a larger prospective study of child adaptation. The 249 children with neuropsychological testing and neuroimaging were studied. Children underwent neuropsychological examination an average of 2.8 months and MRI examination an average of 1.3 months after the first recognized seizure. On factor analysis four factors were found for neuropsychological function: LANG = Language, PS = Processing Speed, EC = Executive/ Construction, VMEM = Verbal Memory and Learning. For analysis, structural abnormalities found on MRI were classified as significant (yes/no) based on whether they were presumed to be related to the seizure condition.

Results: On MRI, 34 (14%) had structural abnormalities that were judged to be significant in that they were possibly related to their seizures. Children with significant abnormalities had significantly lower estimated IQ scores and significantly lower language, processing speed, executive/constructional ability, and verbal memory and learning factor scores than did children without significant abnormalities.

Conclusions: Children who have structural brain abnormalities at onset have slightly lower cognitive functioning overall, and all neuropsychological domains seemed to be affected relatively equally. This pattern was apparent even when we restricted the analysis to children with intellectual functioning in the broadly normal range.
The Pharmacokinetics of Antiepileptic Drugs in Rats: Consequences for Maintaining Effective Drug Levels during Prolonged Drug Administration in Rat Models of Epilepsy
Authors: Löscher Wolfgang
Published: April 2007

Summary: Rodent models of chronic epilepsy with spontaneous recurrent seizures likely represent the closest parallel to the human condition. Such models may be best suited for therapy discovery for pharmacoresistant epilepsy and for antiepileptogenic or disease‐modifying therapeutics. However, the use of such rodent models for therapy discovery creates problems with regard to maintaining effective drug levels throughout a prolonged testing period. This is particularly due to the fact that rodents such as rats and mice eliminate most drugs much more rapidly than humans. Thus, knowledge about elimination rate of a test drug in a laboratory species is essential for development of a treatment paradigm that allows maintaining adequate drug levels in the system over the period of treatment. Currently, the most popular models of epilepsy with spontaneous seizures are poststatus epilepticus models of temporal lobe epilepsy in rats. Such models are both used for studies on antiepileptogenesis and drug resistance. For validation of these models, current antiepileptic drugs (AEDs) have to be used. In this article, the elimination rates of these AEDs and their effective plasma levels in rats are reviewed as a guide for developing treatment protocols for chronic drug testing. The advantages and disadvantages of several technologies for drug delivery are discussed, and some examples for calculation of adequate treatment protocols are given. As shown in this review, because of the rapid elimination of most AEDs in rats, it is no trivial task to maintain effective steady‐state AED levels in the plasma throughout the day over multiple days to ensure that there will be adequate levels in the system for the purpose of the experiment. However, the use of an adequate dosing regimen that is based on elimination rate is an absolute prerequisite when using rat models for discovery of new antiepileptogenic therapies or therapies for pharmacoresistant epilepsy, because otherwise such models may lead to erroneous conclusions about drug efficacy.
Panayiotopoulos Syndrome: An Important Electroclinical Example of Benign Childhood System Epilepsy
Authors: Koutroumanidis Michael
Published: April 2007

Summary: As a result of the converging evidence from multiple large independent studies, Panayiotopoulos syndrome (PS) is now formally recognized as a distinct clinical entity within the spectrum of benign focal epilepsies of childhood. Clinically, PS is manifested by predominantly autonomic seizures and electrographically with multifocal interictal spikes, while the few published ictal recordings have documented onsets of variable lobar topography. These typical electroclinical features do not allow straightforward assignment to a distinctive cortical area, rendering the term “focal”—as we currently understand it—problematic. This is a critical review of the clinical and EEG features of PS, focusing on those characteristics that may shed some light on its so far elusive pathophysiology. We also explore its electroclinical similarities to other idiopathic “focal” epilepsies and its differences to symptomatic focal epilepsies that may also manifest with autonomic ictal symptoms and signs. This methodology allows the formation of a rational hypothesis on the pathophysiology of PS that seems to be emerging as a good model for the so‐called “system” (nonsymptomatic) epilepsies, with potentially important taxonomic implications.
Nonconvulsive Status Epilepticus in a Neurological Intensive Care Unit: Profile in a Developing Country
Authors: Narayanan Jaishree T. , Murthy Jagarlapudi M. K.
Published: April 2007

Summary: Purpose:Nonconvulsive status epilepticus (NCSE) is an under‐recognized cause of altered mental status. There are hardly any reported data on NCSE in developing countries.

Material and Methods:Prospectively 210 consecutive patients with altered mental status admitted to neurological intensive care unit (NICU) of a tertiary care center in south India were studied for the frequency of NCSE. All patients were evaluated initially with 60‐min emergent EEG (EmEEG) and subsequently by continuous EEG (cEEG) monitoring.

Results:Of the 210 with altered mental status admitted to NICU, the diagnosis of NCSE was established in 22 (10.5%) patients, in 12 (55%) patients with 60‐min EmEEG and in 10 (45%) after cEEG monitoring for 12 to 48 hours.

Of the 22 patients with NCSE, 32% had subtle motor phenomena, these were not an initial presenting features, but were apparent during cEEG recording. Acute medical or neurologic etiology was the risk factor in 68% of patients. Central nervous system (CNS) infections and cortical sino‐venous thrombosis (CSVT), respectively, accounted for 23% and 14% of the etiologies. Intravenous midazolam terminated NCSE in 19 patients and valproate in 2. Of the 15 patients with acute symptomatic NCSE, 4 (18%) had poor prognosis (3 deaths and one persistent vegetative state). The etiological risk factors in the 9 (41%) patients with excellent outcome included epilepsy (3), remote symptomatic (2), cryptogenic (1), and metabolic and drugs (3).

Conclusions:The frequency of NCSE in the current study was comparable with those in prior reports from developed countries. CNS infections accounted for about a fifth of the etiology. Outcome was excellent in patients with nonacute symptomatic NCSE. Initial 60‐min EmEEG may be performed in establishing the diagnosis of NCSE, but almost half of patients with NCSE will be missed with this approach.
Sodium Valproate, Hyperandrogenism and Altered Ovarian Function in Indian Women with Epilepsy: A Prospective Study
Authors: Prabhakar Sudesh , Sahota Preeti , Kharbanda Parampreet Singh , Siali Ravinder , Jain Vanita , Lal Vivek , Khurana Dheeraj
Published: April 2007

Summary:  Purpose: To assess the association of long‐term sodium valproate therapy with reproductive endocrine disorders in Indian women with generalized epilepsy.

Methods: Clinical parameters, ovarian morphology, and serum reproductive hormone concentrations were evaluated in 30 clinically normal and eumenorrheic reproductive age women with generalized epilepsy who were newly initiated on valproate. Longitudinal evaluations were done in 25 of these women after 1 year, and in some of them after 2 and 3 years of therapy.

Results: Of the 25 women who completed 1 year follow‐up, we observed clinically relevant weight gain in 40%, hirsutism in 20%, menstrual abnormalities in 24%, polycystic ovaries (PCO) in 16%, polycystic ovarian syndrome (PCOS) in 20%, and a significant increase in mean serum testosterone (p = 0.046). A significant positive correlation existed between weight gain and the development of menstrual abnormalities (r = 0.66, p < 0.0001), hirsutism (r = 0.53, p = 0.006) and PCO (r = 0.51, p = 0.012). No correlation existed between weight change and serum reproductive hormonal changes. Yearly follow‐up for next 2 years in some of these women revealed persistence of menstrual abnormalities, hirsutism and PCO, a significant linear increase in mean body weight, body mass index, and serum testosterone concentrations, and an increase in serum LH levels from second year onwards.

Limitations: Limitations include small sample size and a high dropout rate on follow‐up.

Conclusions: Long‐term valproate therapy in Indian women with generalized epilepsy is associated with development of hirsutism, significant weight gain, stable or progressive alterations in reproductive hormonal function, and ultimately a higher occurrence of PCOS.
The Incidence of First Provoked and Unprovoked Seizure in Pediatric Patients with and without Psychiatric Diagnoses
Authors: McAfee Andrew T. , Chilcott Karen E. , Johannes Catherine B. , Hornbuckle Ken , Hauser W. Allen , Walker Alexander M.
Published: April 2007

Summary:  Purpose: To estimate the rate of new‐onset afebrile provoked and unprovoked seizure in a general pediatric population and subgroups of patients with and without psychiatric diagnoses other than attention deficit hyperactivity disorder (ADHD).

Methods: A retrospective cohort study of 133,440 pediatric patients, between the ages of 6 and 17 years, and without history of seizure or prior use of anticonvulsant medications, with follow‐up during 2003. The data source for this study was Ingenix's research database containing pharmacy and medical claims for members of a large US‐based managed care organization. The main outcome measure was new‐onset nonfebrile seizure. Incidence rates of seizure and 95% confidence intervals (CI) were calculated and expressed as rates per 100,000 person‐years.

Results: There were 132 new‐onset provoked and unprovoked seizures in 78,423 person‐years of follow‐up among the general pediatric population sample. The incidence rate of seizure among the general pediatric population was 168 per 100,000 p‐y (95% CI 141–200). The incidence rate of seizure among patients without psychiatric diagnoses was 149 per 100,000 p‐y (95% CI 122–180). The incidence rate of seizure among patients with psychiatric diagnoses other than ADHD was 513 per 100,000 p‐y (95% CI 273–878). There were increases in the incidence rates of seizure in all of the seizure risk factor groups, but this was more pronounced among males ages 6–12 with psychiatric diagnoses.

Conclusions: The results of this study are consistent with previous reports showing that pediatric patients with psychiatric disorders have a higher incidence rate of seizure than the general pediatric population.
Increased Drinking During Withdrawal From Intermittent Ethanol Exposure Is Blocked by the CRF Receptor Antagonistd‐Phe‐CRF(12–41)
Authors: Finn Deborah A. , Snelling Christopher , Fretwell Andrea M. , Tanchuck Michelle A. , Underwood Lisa , Cole Maury , Crabbe John C. , Roberts Amanda J.
Published: April 2007

Background:Studies in rodents have determined that intermittent exposure to alcohol vapor can increase subsequent ethanol self‐administration, measured with operant and 2‐bottle choice procedures. Two key procedural factors in demonstrating increased alcohol intake are the establishment of stable alcohol self‐administration before alcohol vapor exposure and the number of bouts of intermittent vapor exposure. The present studies provide additional behavioral validation and initial pharmacological validation of this withdrawal‐associated drinking procedure.

Methods:Studies at 2 different sites (Portland and Scripps) examined the effect of intermittent ethanol vapor exposure (3 cycles of 16 hours of ethanol vapor+8 hours air) on 2‐hour limited access ethanol preference drinking in male C57BL/6 mice. Separate studies tested 10 or 15% (v/v) ethanol concentrations, and measured intake during the circadian dark. In one study, before measuring ethanol intake after the second bout of intermittent vapor exposure, mice were tested for handling‐induced convulsions (HICs) indicative of physical dependence on ethanol. In a second study, the effect of bilateral infusions of the corticotropin‐releasing factor (CRF) receptor antagonistd‐Phe‐CRF(12–41) (0.25μg/0.5μL) into the central nucleus of the amygdala (CeA) on ethanol intake was compared in vapor‐exposed animals and air controls.

Results:Intermittent ethanol vapor exposure significantly increased ethanol intake by 30 to 40%, and the mice had higher blood ethanol concentrations than controls. Intra‐amygdala infusions ofd‐Phe‐CRF(12–41) significantly decreased the withdrawal‐associated increase in ethanol intake without altering ethanol consumption in controls. Following the second bout of intermittent vapor exposure, mice exhibited an increase in HICs, when compared with their own baseline scores or the air controls.

Conclusions:Intermittent alcohol vapor exposure significantly increased alcohol intake and produced signs of physical dependence. Initial pharmacological studies suggest that manipulation of the CRF system in the CeA can block this increased alcohol intake.
Radiofrequency identification technology can standardize and document blood collections and transfusions
Authors: Sandler S. Gerald , Langeberg Al , DeBandi Leo , Gibble Joan , Wilson Charles , Feldman Charles L.
Published: April 2007

BACKGROUND: We evaluated the potential for radiofrequency (RF) transponder microchips to standardize and document key steps in the blood collection and transfusion process.

STUDY DESIGN AND METHODS: Using the blood center's standard operating procedures for blood collections, we programmed a laptop computer and 10 multiwrite 256‐byte RF microchips to prompt operators to enter data for key steps in blood collection. Before collections, RF microchips were attached to blood collection sets at the blood center. In parallel with actual collections, we added data to the microchips with the computer and a hand‐held scanner‐programmer. After labeling, we shipped the RF microchip‐tagged blood units to the hospital where unit‐related data (whole blood number, ABO and Rh, expiration date, special laboratory test results) were uploaded from the RF microchip to the transfusion service's information system. The microchip was subsequently used as a cross‐match label for blood unit–recipient matching.

RESULTS: Data were successfully uploaded to the RF microchip at key steps during blood collections. Software programs in the laptop computer and hand‐held scanner‐programmer successfully prompted operators to enter key data. At any stage in a blood collection, authorized operators were able to review electronic records of prior steps using the laptop computer or by scanning the microchip attached to the blood bag. Unit‐related data were successfully transferred to the hospital transfusion service through the RF microchip. These data were successfully incorporated in the RF microchip cross‐match label, which was used to confirm recipient–blood unit matching at the bedside.

CONCLUSION: RF microchips can collect key data during blood collections, facilitate information transfer from the blood center to the hospital, and confirm recipient–blood unit matching at the bedside before transfusions.