bluuebunny/crossref_metadata_2025 huggingface dataset:
Progression of Brain Damage after Status Epilepticus and Its Association with Epileptogenesis: A Quantitative MRI Study in a Rat Model of Temporal Lobe Epilepsy
Authors: Nairismägi Jaak , Gröhn Olli H. J. , Kettunen Mikko I. , Nissinen Jari , Kauppinen Risto A. , Pitkänen Asla
Published: August 2004

Summary:  Purpose: This study examined the hypothesis that neurodegeneration continues after status epilepticus (SE) ends and that the severity of damage at the early phase of the epileptogenic process predicts the outcome of epilepsy in a long‐term follow‐up.

Methods: SE was induced in rats by electrical stimulation of the amygdala, and the progression of structural alterations was monitored with multiparametric magnetic resonance imaging (MRI). Absolute T2, T1ρ, and diffusion (Dav) images were acquired from amygdala, piriform cortex, thalamus, and hippocampus for ≤4.5 months after SE. Frequency and type of spontaneous seizures were monitored with video‐electroencephalography recordings. Histologic damage was assessed from Nissl, Timm, and Fluoro‐Jade B preparations at 8 months.

Results: At the acute phase (2 days after SE induction), quantitative MRI revealed increased T2, T1ρ, and Dav values in the primary focal area (amygdala), reflecting disturbed water homeostasis and possible early structural damage. Pathologic T2 and T1ρ were observed in mono‐ or polysynaptically connected regions, including the piriform cortex, midline thalamus, and hippocampus. The majority of acute MRI abnormalities were reversed by 9 days after SE. In later time points (>20 days after induction), both the T1ρ and diffusion MRI revealed secondarily affected areas, most predominantly in the amygdala and hippocampus. At this time, animals began to have spontaneous seizures. The initial pathology revealed by MRI had a low predictive value for the subsequent severity of epilepsy and tissue damage.

Conclusions: The results demonstrate progressive neurodegeneration after SE in the amygdala and the hippocampus and stress the need for continued administration of neuroprotectants in the treatment of SE even after electrographic seizure activity has ceased.
Outcome of Prolonged Video‐EEG Monitoring at a Typical Referral Epilepsy Center
Authors: Benbadis Selim R. , O'Neill Edward , Tatum William O. , Heriaud Leanne
Published: August 2004

Summary:  Purpose: When seizures do not respond to medications, video‐EEG monitoring is the best available diagnostic tool and is the principal activity of epilepsy centers. The purpose of this study was to analyze the eventual disposition of patients who undergo video‐EEG monitoring at a typical referral epilepsy center.

Methods: We reviewed the diagnoses and dispositions of all patients (adults and children) who underwent inpatient video‐EEG monitoring (≥24 h) at our center (University of South Florida–Tampa General Hospital) over a 1‐year period (2002).

Results: In total, 251 inpatient video‐EEG monitoring sessions were performed. Nonepileptic seizures were diagnosed in 75 (30%); 58 (23%) were found to be surgical candidates; seven were implanted with the vagus nerve stimulator. In 47 (19%) patients, seizures were recorded, and the diagnosis of epilepsy was confirmed and clarified (symptomatic/cryptogenic generalized epilepsy, seven; localization‐related epilepsy, 35; idiopathic generalized epilepsy, five).

Conclusions: The eventual outcome of video‐EEG monitoring is diverse. The largest groups, as expected, are psychogenic nonepileptic seizures (30%), and surgery (23%).
Early Visual Seizures and Progressive Myoclonus Epilepsy in Neuronopathic Gaucher Disease Due to a Rare Compound Heterozygosity (N188S/S107L)
Authors: Filocamo Mirella , Mazzotti Raffaella , Stroppiano Marina , Grossi Serena , Dravet Charlotte , Guerrini Renzo
Published: August 2004

Summary:  Purpose: Gaucher disease, the inherited deficiency of the lysosomal enzyme glucocerebrosidase, is characterized by genotypic and phenotypic heterogeneity. We recently characterized the glucocerebrosidase alleles of a patient with an unusual clinical presentation of type 3 Gaucher disease.

Methods: Initial clinical manifestations appeared at age 11 years as visual seizures.

Results: Subsequent progressive myoclonus and generalized seizures were consistent with an adolescent‐onset form of progressive myoclonus epilepsy. However, a specific diagnosis was established only at age 16, because of the absence of hematologic abnormalities and a fairly moderate hepatomegaly. Bone marrow aspirate was slightly positive for Gaucher cells. Demonstration of reduced glucocerebrosidase in the fibroblasts confirmed the diagnosis. The child died at age 19 years. Postmortem sequencing of the glucocerebrosidase gene from cultured fibroblasts demonstrated a rare compound heterozygote for N188S/S107L.

Conclusions: This unusual presentation of Gaucher disease indicates that if clinical and neurophysiological findings in adolescents with initial visual seizures and myoclonus suggest a progressive disorder, enzymatic assay is mandatory, even in the absence of the classic neurologic and systemic signs of the disease. Early differential diagnosis from other forms of progressive myoclonus epilepsy with similar clinical presentation may help provide appropriate genetic counseling.
High‐frequency Oscillations after Status Epilepticus: Epileptogenesis and Seizure Genesis
Authors: Bragin Anatol , Wilson Charles L. , Almajano Joyel , Mody Istvan , Engel Jerome
Published: August 2004

Summary:  Purpose: To investigate the temporal relation between high‐frequency oscillations (HFOs) in the dentate gyrus and recurrent spontaneous seizures after intrahippocampal kainite‐induced status epilepticus.

Methods: Recording microelectrodes were implanted bilaterally in different regions of hippocampus and entorhinal cortex. A guide cannula for microinjection of kainic acid (KA) was implanted above the right posterior CA3 area of hippocampus. After recording baseline electrical activity, KA (0.4 μg/0.2 μl) was injected. Beginning on the next day, electrographic activity was recorded with video monitoring for seizures every day for 8 h/day for ≥30 days.

Results: Of the 26 rats studied, 19 revealed the appearance of sharp‐wave activity and HFOs in the frequency range of 80 to 500 Hz in the dentate gyrus ipsilateral to the KA injection. In the remaining seven rats, no appreciable activity was noted in this frequency range. In some rats with recurrent seizures, HFOs were in the ripple frequency range (100–200 Hz); in others, HFOs were in the fast ripple frequency range (200–500 Hz), or a mixture of both oscillation frequencies was found. The time of detection of the first HFOs after status epilepticus varied between 1 and 30 days, with a mean of 6.3 ± 2.0 (SEM). Of the 19 rats in which HFO activity appeared, all later developed recurrent spontaneous seizures, whereas none of the rats without HFOs developed seizures. The sooner HFO activity was detected after status epilepticus, the sooner the first spontaneous seizure occurred. A significant inverse relation was found between the time to the first HFO detection and the subsequent rate of spontaneous seizures.

Conclusions: A strong correlation was found between a decreased time to detection of HFOs and an increased rate of spontaneous seizures, as well as with a decrease in the duration of the latent period between KA injection and the detection of spontaneous seizures. Two types of HFOs were found after KA injection, one in the frequency range of 100 to 200 Hz, and the other, in the frequency range of 200 to 500 Hz, and both should be considered pathological, suggesting that both are epileptogenic.
A Dissociation between Implicit and Explicit Verbal Memory in Left Temporal Lobe Epilepsy
Authors: Del Vecchio Nicole , Liporace Joyce , Nei Maromi , Sperling Michael , Tracy Joseph
Published: August 2004

Summary:  Purpose: Temporal lobe epilepsy patients are well known to present deficits on explicit verbal memory procedures (e.g., recall, recognition). The integrity of implicit memory procedures in these patients is not established. Previous studies in this area used implicit memory measures contaminated by the effects of explicit memory.

Methods: We examined the integrity of verbal implicit and explicit memory in left temporal lobe epilepsy (LTLE) patients and hypothesized that a clear dissociation in performance would be found with a relative preservation of implicit memory. TLE patients (n = 15) and age‐ and education‐matched healthy normal patients (n = 15) were shown a 40‐word study list, followed by a test phase requiring completion of word stems based on the study words or new/unseen words. Experimental conditions involved instructions to provide either the old (study) words or novel/nonlist words when completing the stem. Measures of automaticity and recollection provided uncontaminated indices of implicit and explicit memory, respectively.

Results: The data showed a significant difference (p < 0.001) between the patients (Recollection, 0.12; SD, 0.18) and controls (0.50, SD, 0.15) on the measure of explicit memory. In contrast, the patients (Automaticity, 0.51; SD, 0.11) and controls (0.45, SD, 0.18) performed similarly on the implicit memory measure, with patient scores clearly at normative levels based on other Process Dissociation Procedure data.

Conclusions: The data demonstrate the integrity of implicit memory in LTLE patients. Finding a dissociation between the two forms of verbal memory in LTLE patients provides evidence that they rely on different neuroanatomic systems.
Familial Partial Epilepsy with Variable Foci: Clinical Features and Linkage to Chromosome 22q12
Authors: Berkovic Samuel F. , Serratosa Jose M. , Phillips Hilary A. , Xiong Lan , Andermann Eva , Díaz‐Otero Fernando , Gómez‐Garre Pilar , Martín Mercedes , Fernández‐Bullido Yolanda , Andermann Frederick , Lopes‐Cendes Iscia , Dubeau Francois , Desbiens Richard , Scheffer Ingrid E. , Wallace Robyn H. , Mulley John C. , Pandolfo Massimo
Published: August 2004

Summary:  Background: Familial partial epilepsy with variable foci (FPEVF) is an autosomal dominant syndrome characterized by partial seizures originating from different brain regions in different family members in the absence of detectable structural abnormalities. A gene for FPEVF was mapped to chromosome 22q12 in two distantly related French‐Canadian families.

Methods: We describe the clinical features and performed a linkage analysis in a Spanish kindred and in a third French‐Canadian family distantly related to the original pedigrees.

Results: Onset of seizures was typically in middle childhood, and attacks were usually easy to control. Seizure semiology varied among family members but was constant for each individual. In some, a pattern of nocturnal frontal lobe seizures led to consideration of the diagnosis of autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE). The Spanish family was mapped to chromosome 22q (multipoint lod score, 3.4), and the new French‐Canadian family had a multipoint lod score of 2.97 and shared the haplotype of the original French‐Canadian families.

Conclusions: Identification of the various forms of familial partial epilepsy is challenging, particularly in small families, in which insufficient individuals exist to identify a specific pattern. We provide clinical guidelines for this task, which will eventually be supplanted by specific molecular diagnosis. We confirmed linkage of FPEVF to chromosome 22q12 and redefined the region to a 5.2‐Mb segment of DNA.
Lamotrigine versus Valproic Acid as First‐line Monotherapy in Newly Diagnosed Typical Absence Seizures: An Open‐label, Randomized, Parallel‐group Study
Authors: Coppola Giangennaro , Auricchio Gianfranca , Federico Rosario , Carotenuto Marco , Pascotto Antonio
Published: August 2004

Summary: Purpose:To compare the efficacy of lamotrigine (LTG) and valproic acid (VPA) in newly diagnosed children and adolescents with typical absence seizures.

Methods:A randomized,open‐label parallel‐group design was used. After undergoing an awake video‐EEG recording, which included one to two trials of 3 min of hyperventilation and intermittent photic stimulation, eligible patients were randomized to receive LTG or VPA. LTG was initiated at a daily dose of 0.5 mg/kg for 2 weeks in two divided doses, followed by 1.0 mg/kg/day for an additional 2 weeks. Thereafter, doses were increased in 1‐mg/kg/day increments every 5 days until seizures were controlled, intolerable adverse effects occurred, or a maximum dose of 12 mg/kg/day had been reached. VPA was equally uptitrated according to clinical response, starting at 10 mg/kg and increasing by 5 mg/kg/24 h every 3 days, if required, to a maximum of 30 mg/kg/day in three divided doses. Patients were seen in the clinic every month for ≤12 months.The primary efficacy end point at each visit was seizure freedom, defined as lack of clinically observed seizures since the previous visit and lack of electroclinical seizures during ambulatory 24‐h EEG testing and a video‐EEG session with hyperventilation.

Results: Thirty‐eight children (17 boys, 21 girls), aged from 3 to 13 years (mean, 7.5 years), all newly diagnosed with childhood or juvenile typical absence seizures, were enrolled. After 1 month of treatment, 10 (52.6%) of 19 children taking VPA and one (5.3%) of 19 taking LTG were seizure free (p = 0.004). By the 3‐month follow‐up, 12 (63.1%) children taking VPA and seven (36.8%) taking LTG were controlled (p = 0.19). After 12 months, 13 children taking VPA (dose range, 20–30 mg/kg/day; mean serum level, 76.8 mg/L; range, 51.4–91 mg/L) and 10 taking LTG (dose range, 2–11 mg/kg/day; mean serum level, 8.1 mg/L; range, 1.1–18 mg/L) were seizure free (p = 0.51). Side effects were mostly mild and transient and were recorded in two (10.6%) children treated with VPA and in six (31.8%) treated with LTG.

Conclusions:Both VPA and LTG can be efficacious against absence seizures, although VPA shows a much faster onset of action, at least in part because of its shorter titration schedule.
Metabolic Changes of Subcortical Structures in Intractable Focal Epilepsy
Authors: Benedek Krisztina , Juhász Csaba , Muzik Otto , Chugani Diane C. , Chugani Harry T.
Published: August 2004

Summary: Purpose:Intractable focal epilepsy is commonly associated with cortical glucose hypometabolism on interictal 2‐deoxy‐2[18F]‐fluoro‐d‐glucose (FDG) positron emission tomography (PET). However, subcortical brain structures also may show hypometabolism on PET and volume changes on magnetic resonance imaging (MRI) studies, and these are less well understood in terms of their pathophysiology and clinical significance. In the present study, we analyzed alterations of glucose metabolism in subcortical nuclei and hippocampus by using FDG‐PET in young patients with intractable epilepsy.

Methods:Thirty‐seven patients (mean age, 7.5 years; age range, 1–27 years) with intractable frontal (n = 23) and temporal (n = 14) lobe epilepsy underwent FDG‐PET scanning as part of their presurgical evaluation. Normalized glucose metabolism was measured in the thalamus and caudate and lentiform nuclei, as well as in hippocampus, both ipsi‐ and contralateral to the epileptic focus, and correlated with duration and age at onset of epilepsy, presence or absence of secondary generalization, location of the epileptic focus, and extent of cortical glucose hypometabolism.

Results:Long duration of epilepsy was associated with lower glucose metabolism in the ipsilateral thalamus and hippocampus. Duration of epilepsy was a significant predictor of ipsilateral thalamic glucose metabolism in both temporal and frontal lobe epilepsy. Presence of secondarily generalized seizures also was associated with lower normalized metabolism in the ipsilateral thalamus and hippocampus. Extent of cortical hypometabolism did not correlate with subcortical metabolism, and glucose metabolism in the caudate and lentiform nuclei did not show any correlation with the clinical variables.

Conclusions:The findings suggest that metabolic dysfunction of the thalamus ipsilateral to the seizure focus may become more severe with long‐standing temporal and frontal lobe epilepsy, and also with secondary generalization of seizures.
Univerricht‐Lundborg Disease: Underdiagnosed in the Netherlands
Authors: De Haan Gerrit‐Jan , Halley Dicky J.J. , Doelman Jan C. , Geesink Huibert H. , Augustijn Paul B. , Jager‐Jongkind Anke D. , Majoie Marianne , Bader Adri J. , Doeschate Lian A.W.M. Leliefeld‐ten , Deelen Wout H. , Bertram Ed , Lehesjoki Anna E. , Lindhout Dick
Published: August 2004

Summary:  Purpose: Univerricht‐Lundborg disease (ULD), with its major symptom of action myoclonus, is supposed to be very rare in the Netherlands and western Europe. We hypothesized that the syndrome may be underdiagnosed in patients with myoclonus epilepsy.

Methods: Mutation analysis of the cystatin B gene was performed in 21 cases with uncontrolled myoclonus.

Results: Seven of the 21 evaluated cases carried mutations in the cystatin B gene. Diagnosis of ULD was made with a mean delay of 20 years from symptom onset.

Conclusions: This study from a country without previous reports of ULD suggests that underdiagnosis of the syndrome is likely. These findings also indicate that persons with juvenile‐onset myoclonus epilepsy with action myoclonus should be analyzed for ULD.
Is Intraoperative Electrocorticography Reliable in Children with Intractable Neocortical Epilepsy?
Authors: Asano Eishi , Benedek Krisztina , Shah Aashit , Juhász Csaba , Shah Jagdish , Chugani Diane C. , Muzik Otto , Sood Sandeep , Chugani Harry T.
Published: August 2004

Summary: Purpose:To study the relation between the spike frequency during intraoperative electrocorticography (ECoG) under general anesthesia with isoflurane and that during extraoperative ECoG monitoring in children with intractable neocortical epilepsy.

Methods:Twenty‐one children (age, 1–16 years; 15 boys and six girls) who underwent intraoperative and extraoperative ECoG monitoring with subdural electrode arrays were studied. The spike frequency and the spatial pattern of spike frequency were compared between intraoperative and extraoperative ECoGs for each patient (by using Wilcoxon signed‐ranks and Spearman's rank correlation, respectively).

Results:In 15 of 21 patients, the spike frequency was significantly lower during intraoperative than during extraoperative ECoG (mean z =–6.3; p < 0.001). In four of 21 patients, no significant difference was found in the spike frequency between intraoperative and extraoperative recordings. In two of 21 patients, spike frequency reached one spike/min neither during intraoperative nor extraoperative recording; therefore appropriate comparison of spike frequency was not possible. A significant positive correlation in the spike‐frequency pattern was seen between intraoperative and extraoperative recordings in nine of nine cases who had ≥10 spikes/min during intraoperative ECoG (mean rho = 0.62; p < 0.01), in five of six cases with one to nine spikes/min (mean rho = 0.50; p < 0.01), and in none of five cases with less than one spike/min (mean rho = 0.13).

Conclusions:General anesthesia often decreases the spike frequency in children with neocortical epilepsy, yet intraoperative ECoG can reliably reflect the awake interictal spiking pattern when spike frequency exceeds one spike/min during intraoperative ECoG recording.
Reaction to Epilepsy in the Workplace
Authors: Harden Cynthia L. , Kossoy Amy , Vera Susanne , Nikolov Blagovest
Published: August 2004

Summary:  Purpose: The purpose of this study was to determine the characteristics of epilepsy that produce avoidant behavior in the workplace and therefore contribute to the actual stigma that persons with epilepsy are subjected to on the job.

Methods: We developed a survey consisting three vignettes briefly describing a coworker with either depression, multiple sclerosis, or epilepsy. Each vignette was followed by eight identical questions addressing the level of comfort during interactions with the vignette subject. The epilepsy vignette did not describe a seizure. The surveys were hand‐distributed in two companies in New York City and returned anonymously by mail. The results of the responses to each illness were compared by χ2, and the responses were correlated with demographic information by using Pearson's correlation.

Results: Seventy‐four of 200 distributed questionnaires were returned. Respondents reported more anxiety at the thought of interacting with a coworker with epilepsy than with depression or multiple sclerosis, but this difference did not reach significance. Worry about sudden, unpredictable behavior for the coworker with epilepsy was significantly greater than that with multiple sclerosis (p = 0.014). The level of comfort regarding providing first aid for the coworker with epilepsy was significantly less (p = 0.018) than that for depression and multiple sclerosis. Lower job level and lower income level correlated with more social discomfort for all three illnesses.

Conclusions: The idea of a having a coworker with epilepsy may produce some social avoidance. However, the worry about a sudden, unpredictable event and the discomfort regarding providing first aid for a coworker with epilepsy is significant when compared with that with depression or multiple sclerosis. These findings suggest that education about first aid for epilepsy will reduce the worry and discomfort surrounding persons with epilepsy in the workplace.
Clinical Manifestations of Insular Lobe Seizures: A Stereo‐electroencephalographic Study
Authors: Isnard Jean , Guénot Marc , Sindou Marc , Mauguière François
Published: August 2004

Summary:  Purpose: In this study, we report the clinical features of insular lobe seizures based on data from video and stereo‐electroencephalographic (SEEG) ictal recordings and direct electric insular stimulation of the insular cortex performed in patients referred for presurgical evaluation of temporal lobe epilepsy (TLE).

Methods: Since our first recordings of insular seizures, the insular cortex has been included as one of the targets of stereo‐electroencephalographic (SEEG) electrode implantation in 50 consecutive patients with TLE whose seizures were suspected to originate from, or rapidly to propagate to, the perisylvian cortex. In six, a stereotyped sequence of ictal symptoms associated with intrainsular discharges could be identified.

Results: This ictal sequence occurred in full consciousness, beginning with a sensation of laryngeal constriction and paresthesiae, often unpleasant, affecting large cutaneous territories, most often at the onset of a complex partial seizure (five of the six patients). It was eventually followed by dysarthric speech and focal motor convulsive symptoms. The insular origin of these symptoms was supported by the data from functional cortical mapping of the insula by using direct cortical stimulations.

Conclusions: This sequence of ictal symptoms looks reliable enough to characterize insular lobe epileptic seizures (ILESs). Observation of this clinical sequence at the onset of seizures on video‐EEG recordings in TLE patients strongly suggests that the seizure‐onset zone is located not in the temporal but in the insular lobe; recording directly from the insular cortex should occur before making any decision regarding epilepsy surgery.
Ceratocystis species infecting stem wounds on Eucalyptus grandis in South Africa
Authors: Roux J. , Van Wyk M. , Hatting H. , Wingfield M. J.
Published: August 2004

Reports of Ceratocystis spp. causing disease of exotic plantation hardwood species have increased in recent years. Ceratocystis fimbriata causes wilt and canker on Eucalyptus spp. in Africa and South America, and C. albofundus results in wilt and death of Acacia mearnsii in Africa. Ceratocystis spp. generally infect wounds on trees, and artificial stem wounding can thus be used to determine the presence of these fungi. The aim of this study was to identify Ceratocystis spp. infecting wounds on Eucalyptus grandis in South Africa. Isolated Ceratocystis spp. were identified using morphological characteristics and comparisons of DNA sequence data for the ITS and 5·8S regions of the rRNA operon. Pathogenicity trials were conducted in the greenhouse to determine the possible role that these Ceratocystis spp. could have in disease development. These trials were also conducted under field conditions. Three Ceratocystis spp. were collected: C. fimbriata, C. moniliformis and C. pirilliformis. This is the first report of C. fimbriata and C. pirilliformis from Eucalyptus spp. in South Africa, and the first report of the latter fungus outside Australia. Both C. fimbriata and C. pirilliformis caused significant lesions on inoculated E. grandis trees. This is the first evidence that C. pirilliformis is a pathogen of Eucalyptus spp. From the results of both greenhouse and field trials, it has the potential to cause serious disease problems in Eucalyptus plantations.
Population dynamics of Aspergillus flavus in the air of an intensively cultivated region of south‐west Arizona
Authors: Bock C. H. , Mackey B. , Cotty P. J.
Published: August 2004

Airborne propagules of Aspergillus flavus were quantified to investigate population dynamics of A. flavus in a region of south‐west Arizona prone to epidemics of aflatoxin contamination of cottonseed. Air was sampled continuously from May 1997 to March 1999 at two sites using Burkard cyclone samplers. One sampler was initially at the centre of 65 ha of cotton treated with an atoxigenic strain of A. flavus to manage aflatoxin contamination of cottonseed. The second sampler was 0·6 km from the treated field. Total fungal colony‐forming units (CFU) sampled ranged from 17 to 667 and from 9 to 1277 m−3 at the untreated and treated sites, respectively. Counts of A. flavus ranged from 0 to 406 m−3 and from 0 to 416 per m−3 at the untreated and treated sites, respectively. Aspergillus flavus comprised 1–46 and 1–51% of the total cultured fungi at the treated and untreated sites, respectively. Peaks in total fungal and A. flavus CFU coincided with boll maturation and cotton harvest (days 251–321). Autoregression analysis suggested that there was no difference in total fungal CFU between treated and untreated sites, but the analysis showed that the quantity of A. flavus decreased at the treated site. This is probably caused by changes in cropping making the conditions less conducive to growth and reproduction of A. flavus in the surrounding fields. The incidence of the S strain of A. flavus was highest between May and August. The L strain accounted for up to 100% of the A. flavus sampled in the other months, and autoregression analysis showed that the L strain accounted for a greater overall proportion of the A. flavus population at the treated site compared with the untreated site. Autoregression analysis also showed the vegetative compatibility group of the applied strain was a greater proportion of L‐strain A. flavus at the treated site (5–75%) than at the untreated site (0–65%), although this decreased with time. The quantity of A. flavus sampled at both treated and untreated sites was correlated with air and soil temperature. Large quantities of A. flavus occurred in the soil (up to 34 474 CFU g−1) of cotton fields and on cotton plant parts and debris (up to 272 461 CFU g−1) adjacent to the cyclone samplers. Aspergillus flavus is a major constituent of the airborne mycoflora associated with cotton fields in south‐west Arizona when temperature is conducive to fungal growth. Although application of atoxigenic A. flavus altered the proportion of A. flavus strains and vegetative compatibility groups in the aerial mycoflora, the total quantity of A. flavus remained similar to that in untreated fields. Dispersal of A. flavus between fields suggests that atoxigenic fungi will be most effective in area‐wide management programmes.
The Wisdom of Our Young
Authors: Tripi Gina
Published: August 2004

I am privileged to share with you a commencement address from one of our recent baccalaureate graduates. Her passion and the clarity of her vision for nursing brought the faculty to their feet.

Roxie Foster, Editor
Recurrent Abdominal Pain in Children: Forerunner to Adult Irritable Bowel Syndrome?
Authors: Jarrett Monica , Heitkemper Margaret , Czyzewski Danita I. , Shulman Robert
Published: August 2004

ISSUES AND PURPOSE Review the etiology and pathophysiology of recurrent abdominal pain (RAP) and its potential role as a precursor to irritable bowel syndrome (IBS) in adults.

CONCLUSIONS Physiological mechanisms not easily identifiable as an organic cause may underlie symptoms in RAP patients. They may be triggered by psychosocial factors that result in greater functional disability, more clinic visits, and lower academic and social competence. Of these children, 25% will experience similar symptoms as adults; many will be diagnosed with IBS.

PRACTICE IMPLICATIONS Nurses can provide early and efficient management of these children's care if they view the issues of abdominal pain/discomfort from a broader focus that includes the context of the child's experiences.
Healthcare Providers' Attitudes Toward Parent Participation in the Care of the Hospitalized Child
Authors: Daneman Susan , Macaluso Joy , Guzzetta Cathie E.
Published: August 2004

ISSUES AND PURPOSE To examine healthcare providers' attitudes toward parent participation in the care of their hospitalized child.

DESIGN AND METHODS In this descriptive, comparative study, 504 pediatric healthcare providers were surveyed to measure attitudes toward parent participation.

RESULTS Results from 256 respondents indicated support for parent participation, but there was substantially less support for parental activities usually carried out by healthcare providers and those involving complex patient care tasks.

PRACTICE IMPLICATIONS Although pediatric healthcare providers support parent participation, they tend to draw the line on what they believe are suitable parent activities. Newly developed pain standards and cardiopulmonary resuscitation guidelines incorporating parent participation have important implications for expanding the boundaries of parental involvement.
Post‐Traumatic Stress Disorder in Children and Adolescents With Motor Vehicle–Related Injuries
Authors: Zink Kathleen A. , McCain Gail C.
Published: August 2004

ISSUES AND PURPOSE Motor vehicle crashes account for the greatest number of childhood injuries, but there has been little study of the psychological responses.

DESIGN AND METHODS This longitudinal, descriptive study included 143 children 7 to 15 years of age who experienced a motor vehicle–related injury. Parents/guardians completed the Child Behavior Checklist Behavioral Problem Scale. Each child and parent completed the post‐traumatic stress disorder (PTSD) section of the Diagnostic Interview for Children and Adolescents at 2 and 6 months postinjury.

RESULTS Twenty‐two percent of the children met criteria for PTSD. There were no associations for presence or absence of PTSD with age, gender, race, injury, or cause of injury.

PRACTICE IMPLICATIONS Children who are injured in motor vehicle crashes are at risk for PTSD. Anticipatory guidance about behavioral distress symptoms should be provided to parents of children who experience motor vehicle related injuries.
A Guidelines‐Based Approach for Managing Acute Gastroenteritis in Children
Authors: Gallagher Carolyn , McDowell Betsy M.
Published: August 2004

Ask the Expert provides research‐based answers to practice questions submitted by JSPN readers.
Descriptive Statistics, Part II: Most Commonly Used Descriptive Statistics
Authors: McHugh Mary L. , Hudson‐Barr Diane
Published: August 2004

Scientific Inquiry provides a forum to facilitate the ongoing process of questioning and evaluating practice, presents informed practice based on available data, and innovates new practices through research and experimental learning.
Mothering in Public: A Meta‐Synthesis of Homeless Women With Children Living in Shelters
Authors: Meadows‐Oliver Mikki
Published: August 2004

ISSUES AND PURPOSE The purpose of this paper is to synthesize the current qualitative literature on homeless women with children living in shelters.

METHODS Eighteen qualitative studies on homeless women with children living in shelters were included in the synthesis. The meta‐synthesis was conducted using the meta‐ethnographic approach of Noblit and Hare (1988).

RESULTS Six reciprocal translations (themes) of homeless mothers caring for their children in shelters emerged: On becoming homeless, protective mothering, loss, stressed and depressed, survival strategies, and strategies for resolution.

PRACTICE IMPLICATIONS The results may be used by healthcare workers as a framework for developing intervention strategies directed toward helping mothers find new solutions to dealing with shelter living and innovative ways to resolve their homelessness.
The Development of Trust in Parents of Hospitalized Children
Authors: Thompson Virginia L. , Hupcey Judith E. , Clark Mary Beth
Published: August 2004

ISSUES AND PURPOSE The purpose of this study was to investigate the development of trust in parents of hospitalized children.

METHODS Using grounded theory, semistructured interviews were conducted with 15 parents of children previously hospitalized, focusing on parents' experiences during their child's hospitalization. Data were analyzed using a constant comparative process. Themes and the core variable were identified and a model of trust developed.

RESULTS The core variable related to the development of trust in healthcare providers was whether parents' expectations for care were met. Thematic areas that influenced whether expectations for care were met included preexisting trust; evaluation of care, including evaluation of technical skills and the meeting of parental and child needs; and behaviors of nurses and other healthcare providers that inhibited and fostered trust.

PRACTICE IMPLICATIONS Strategies to enhance trust are discussed.
Rapid‐Cycle Improvement in Pediatric Health Care: A Solution for Patients With Similar or Same Last Names
Authors: Martin Michelle L. , Hudson‐Barr Diane
Published: August 2004

Scientific Inquiry provides a forum to facilitate the ongoing process of questioning and evaluating practice, presents informed practice based on available data, and innovates new practices through research and experimental learning.
Care Teams of Respiratory Therapists and Nurses in a PICU Setting
Authors: Schultz Theresa Ryan , Napoli Linda Allen , Kuntz Kathleen Ryan
Published: August 2004

Collaborative Practice provides a forum for healthcare professionals to share expertise and enhance communication.
Ethical Considerations for a Child's Participation in Research
Authors: Kanner Sheri , Langerman Susan , Grey Margaret
Published: August 2004

ISSUES AND PURPOSE To analyze ethical considerations for a child's involvement in research.

CONCLUSIONS Pediatric research can proceed only when the welfare of children is protected. Although research with children as research subjects constitutes only a small portion of research efforts, its continual growth requires nurses be aware of the rights of pediatric subjects.

PRACTICE IMPLICATIONS As nursing research increases in sophistication, the nurse should include an assessment of the informed consent process in the care of the patient, including the child's comprehension, the age and development of the child, and the child's perception of the research.
Waiting Together: Translating the Principles of Therapeutic Relationships One Step Further
Authors: Allenbach Alyce , Steinmiller Elizabeth A.
Published: August 2004

ISSUES AND PURPOSE Inconsistent nursing practices created nurse‐patient boundary issues on a cardiac step‐down unit related to confidentiality, limit setting, and professionalism with patients and families awaiting organ transplantation.

CONCLUSIONS A staff work group designed and implemented a plan to translate the principles of therapeutic relationships into daily practice.

PRACTICE IMPLICATIONS A work plan developed for nursing staff outlined concrete solutions and resources available within the hospital. This framework can be used to empower staff in the ongoing effort to manage relationships with chronically ill patients and their families.
SIDS Risk‐Reduction Language in State Childcare Regulations as of July 2002: Lessons Learned
Authors: Stubbs‐Wynn Phyllis E. , Krajicek Marilyn J. , Hamilton Barbara , Collins Shannon , Torrey Virginia , Ekegren Kathryn
Published: August 2004

The Advocate is a forum for exploring our roles as advocates for the children and families we serve.
Clinicians' Views on Reproductive Needs and Services for Teens With Negative Pregnancy Tests
Authors: Daley Alison Moriarty , Sadler Lois S. , Leventhal John M. , Cromwell Polly , Reynolds Heather D.
Published: August 2004

ISSUES AND PURPOSE To explore services available to adolescent girls at the time of the negative pregnancy test (NPT) in an urban community.

DESIGN AND METHODS Clinicans focus groups were conducted to identify the needs of adolescents at the time of a NPT result.

RESULTS Teens access care in a variety of ways, services provided at the time of a NPT were agency and clinical dependent, and strategies for follow‐up care often were unstructured. Few services were available for parents or partners. Barriers included difficulty communicating with agencies, lack of staff trained to work with adolescents, and time/financial constraints.

CONCLUSION Adolescents need comprehensive, teen‐friendly reproductive care at the time of a NPT results.
Impoverished Children With Asthma: A Pilot Study of Urban Healthcare Access
Authors: Wallace Andrea , Scott Jill , Klinnert Mary , Anderson Mark E.
Published: August 2004

ISSUES AND PURPOSE Using Andersen's Behavioral Model of Health Care Use, this pilot study was conducted to better understand the experiences of children with asthma as they access an urban healthcare system.

DESIGN AND METHODS This descriptive study used a convenience sample of 34 families of pediatric asthma patients who participated in semistructured interviews and closed medical record review.

RESULTS Only one patient reported having a written exacerbation management plan. Beliefs regarding medication addiction and side effects were frequently reported as barriers to medication adherence, and children seeking asthma care in primary care settings saw many care providers.

PRACTICE IMPLICATIONS Exploring how expanded nursing roles can help address both family and system factors serving as barriers to health care ought to be a key priority for nursing.
Liver Transplantation in Children: Maternal and Family Stress, Coping, and Adaptation
Authors: LoBiondo‐Wood Geri , Williams Laurel , McGhee Charles
Published: August 2004

ISSUES AND PURPOSE This study examined the relationship of family stress, severity of the stressor, uncertainty, coping, and family adaptation from pretransplantation to posttransplantation.

DESIGN AND METHODS A descriptive, longitudinal study of 15 mothers whose children were at least 5 years posttransplantation.

RESULTS Maternal stress, coping, and uncertainty demonstrated significant changes over time, whereas family stress did not. Pretransplantation family stress, anger, and confusion were related to poorer family adaptation.

PRACTICE IMPLICATIONS Interventions for mothers pretransplantation should account for the coping, levels of stress, and uncertainty present at each phase of the transplantation process. Interventions need to be tailored to the transplantation phase. Long‐term interventions remain necessary and should be directed at reinforcement of teaching, as well as assessment and provision of parental support relevant to the long‐term needs of the family.
Body Piercing: Issues in Adolescent Health
Authors: Gunter Theresa E. , McDowell Betsy M. , McDowell Betsy M.
Published: August 2004

Ask the Expert provides research‐based answers to practice questions submitted by JSPN readers.
Haematopoietic stem cell transplantation for autoimmune disorders: the American perspective
Authors: Popat Uday , Krance Robert
Published: August 2004

The hypothesis that haematopoietic stem cell transplantation (HSCT) might be useful in treating refractory autoimmune diseases (AID) was suggested by studies in animal models and by the improvement of concurrent autoimmune diseases in patients who had undergone transplantation for haematological disorders. This concept has now been tested in a substantial number of phase I/II clinical trials of autologous HSCT. These early results are promising, even in patients who have failed on multiple standard therapies for AID. Transplantation‐related toxicity has decreased with growing experience in the application of this procedure, better patient selection and the modification of treatment protocols. Randomized trials currently under way or under consideration should clarify the role of HSCT in patients with autoimmune disorders.
Deep vein thrombosis in patients with multiple myeloma treated with thalidomide and chemotherapy: effects of prophylactic and therapeutic anticoagulation
Authors: Zangari Maurizio , Barlogie Bart , Anaissie Elias , Saghafifar Fariba , Eddlemon Paul , Jacobson Joth , Lee Choon‐Kee , Thertulien Raymond , Talamo Giampaolo , Thomas Teri , Rhee Frits Van , Fassas Athanasios , Fink Louis , Tricot Guido
Published: August 2004

A group of 256 newly diagnosed myeloma patients were enrolled in a phase III study that included 4 monthly cycles of induction chemotherapy and tandem transplant. All patients were randomized to either receive or not receive thalidomide. A total of 221 patients (86%) received no prophylactic anticoagulation (cohort I); 35 patients received low dose coumadin (cohort II). The incidence of deep vein thrombosis (DVT) was significantly higher in the thalidomide arm hazard ratio: 4·5; P < 0·0001). As low dose coumadin (1 mg/d) failed to decrease thrombotic complications in 35 patients (cohort II), low molecular weight heparin (LMWH, enoxaparin 40 mg s.c. q.d.) was instituted as DVT prophylaxis in the thalidomide‐treated patients (n = 68) of the subsequent cohort (n = 130, cohort III). This intervention eliminated the difference in DVT incidence between the two arms (thalidomide and no thalidomide). Within cohorts I and II, 36 patients, in whom thalidomide was discontinued after experiencing a thrombotic episode during chemotherapy, subsequently resumed the drug on full anticoagulation; with a median follow‐up of 22 months, DVT recurred in four patients (11%). After completing induction and tandem transplantation, 55 patients were re‐exposed to thalidomide and chemotherapy during consolidation treatment. Thrombotic complications were observed in 4%. Our experience, although not based on a randomized study, suggests that the excess frequency of thrombosis in patients treated with chemotherapy and thalidomide can be safely reduced by the prophylactic use of LMWH. The rate of DVT recurrence observed in our study upon thalidomide resumption was sufficiently low to allow its continuation in patients who may benefit from this therapeutic intervention.
β‐thalassaemia‐87 C→G: relationship of the Hb F modulation and polymorphisms in compound heterozygous patients
Authors: De Angioletti Maria , Lacerra Giuseppina , Pagano Leonilde , Alessi Mario , D'Avino Rossana , Manca Laura , Carestia Clementina
Published: August 2004

A clinical, haematological, biochemical and molecular study was carried out in 17 patients affected with thalassaemia intermedia, who were compound heterozygotes for the β‐thalassaemia mutation β‐87 C→G to determine the genetic basis of their clinical heterogeneity. The β‐87 was found associated with haplotype VIII (β‐87/VIII) or V (β‐87/V). The 10 patients with the β‐87/VIII showed milder clinical conditions, with significantly higher levels of haemoglobin (Hb) (9·8 ± 1·1 g/dl vs. 8·5 ± 1·3 g/dl) and fetal haemoglobin (Hb F) (6·2 ± 1·5 g/dl vs. 2·6 ± 1·5 g/dl; P = 0·0034) and higher synthesis of Gγ (Gγ/Totalγ 69·4 ± 2·6% vs. 42·8 ± 16·2%; P = 0·0042) than the seven patients with the β‐87/V. The β‐87/VIII showed a configuration of rare polymorphisms in the 5′ sub‐haplotype, which have been reported to exert an increasing effect on Hb F. They were ‘T’−158 Gγ‐globin gene, T‐A‐G in pre‐Gγ framework, (TG)11(CG)3 in the Gγ‐IVS2, (AT)9N12(AT)10 in LCR‐HS2; in contrast, the haplotype V had, respectively, ‘C’, T‐G‐A (TG)19(CG)2CACG in the Gγ‐IVS2, and (AT)10N12(AT)11. In all patients the β‐87 was associated with the (AT)9T5 motif 5′ β‐globin gene with increased affinity for the BP‐1 protein, and with the (TG)13 in the Aγ‐IVS2. The high increase of the Hb F, mostly of the Gγ‐type, strongly suggests the hypothesis that the ‘T’−158 Gγ plays a principal role and that the other polymorphisms could exert a cooperative role in the modulation of Hb F in patients with erythropoietic stress.
Role of receptor activator of nuclear factor‐kappa B ligand (RANKL), osteoprotegerin and macrophage protein 1‐alpha (MIP‐1a) in monoclonal gammopathy of undetermined significance (MGUS)
Authors: Politou Marianna , Terpos Evangelos , Anagnostopoulos Athanasios , Szydlo Richard , Laffan Michael , Layton Mark , Apperley Jane F. , Dimopoulos Meletios‐Athanasios , Rahemtulla Amin
Published: August 2004

The aim of this study was to evaluate the role of markers of bone remodelling, and osteoclast activation/function in patients with monoclonal gammopathy of undetermined significance (MGUS). We have measured serum levels of soluble RANKL (sRANKL), osteoprotegerin (OPG), macrophage inflammatory protein‐1alpha (MIP‐1α), markers of bone resorption [N‐telopeptide of collagen type‐I (NTX), and tartrate‐resistant acid phosphatase isoform‐5b (TRACP‐5b)] and bone formation [bone‐alkaline phosphatase (bALP)] in 40 MGUS patients. These parameters were compared with those of 42 newly diagnosed myeloma patients, and 45 healthy, gender‐ and age‐matched controls. MGUS patients had elevated levels of NTX, sRANKL, and sRANKL/OPG ratio compared with controls (P < 0·0001). Furthermore, TRACP‐5b, MIP‐1α and NTX were decreased in patients with MGUS compared with myeloma patients (P < 0·001), while OPG and bALP were increased (P < 0·001). Serum levels of MIP‐1α, as well as TRACP‐5b, and sRANKL/OPG ratio were reduced, while bALP was increased in MGUS patients, even when compared with myeloma patients who had stage I/II disease. These results demonstrate that increased osteoclastogenesis leading to increased bone resorption is present in MGUS but seems to be compensated for by normal bone formation, which is absent in MM. Furthermore MIP‐1α, bALP, and sRANKL/OPG may be useful tools for distinguishing between cases of MGUS and early myeloma.
Clearance of coagulation factor VIII in very low‐density lipoprotein receptor knockout mice
Authors: Bovenschen Niels , van Dijk Ko Willems , Havekes Louis M. , Mertens Koen , van Vlijmen Bart J. M.
Published: August 2004

Low‐density lipoprotein receptor‐related protein (LRP) contributes to factor VIII (FVIII) catabolism in vivo. Besides LRP, FVIII also interacts with very low‐density lipoprotein receptor (VLDLR) in vitro. We investigated the physiological role of VLDLR in FVIII catabolism, using knockout mouse models for VLDLR and LRP, alone and in combination. VLDLR−/− mice displayed normal plasma FVIII, whereas VLDLR−/− LRP− double‐knockout mice had slightly increased FVIII compared with LRP‐deficient mice. Remarkably, VLDLR deficiency slightly accelerated FVIII clearance. Adenovirus‐mediated overexpression of VLDLR did not lower plasma FVIII in LRP‐deficient mice. We conclude that VLDLR does not act in concert with LRP in FVIII clearance in vivo.