bluuebunny/crossref_metadata_2025 huggingface dataset:
Distinct developmental changes in the distribution of calcium, phosphorus and sulphur during fetal growth‐plate development
Authors: Van Donkelaar C. C. , Janssen X. J. A. , De Jong A. M.
Published: December 2006

Gradients in the concentrations of free phosphate (Pi) and calcium (Ca) exist in fully developed growth zones of long bones and ribs, with the highest concentrations closest to the site of mineralization. As high concentrations of Pi and Ca induce chondrocyte maturation and apoptosis, it has been hypothesized that Ca and Pi drive chondrocyte differentiation in growth plates. This study aimed to determine whether gradients in the important spectral elements phosphorus (P), Ca and sulphur (S) are already present in early stages of development, or whether they gradually develop with maturation of the growth zone. We quantified the concentration profiles of Ca, P, S, chloride and potassium at four different stages of early development of the distal growth plates of the porcine femurs, using particle‐induced X‐ray emission and forward‐ and backward‐scattering spectrometry with a nuclear microprobe. A Ca concentration gradient towards the mineralized area and a stepwise increase in S was found to develop slowly with tissue maturation. The increase in S co‐localizes with the onset of proliferation. A P gradient was not detected in the earliest developmental stages. High Ca levels, which may induce chondrocyte maturation, are present near the mineralization front. As total P concentrations do not correspond with former free Pi measurements, we hypothesize that the increase of free Pi towards the bone‐forming site results from enzymatic cleavage of bound phosphate.
Isolation and characterization of polymorphic microsatellite markers for the endangered Korean freshwater fish Hemibarbus mylodon
Authors: KIM WOO‐JIN , LEE YOON‐A , BANG IN‐CHUL
Published: December 2006

Korean barbel, Hemibarbus mylodon, is an endangered freshwater species endemic to Korea. In order to undertake a conservation program for this species in Korea, it is essential to evaluate its genetic diversity and population structure. For this purpose, we developed 10 polymorphic microsatellite markers and examined their allelic variation using a total of 60 wild individuals collected from three different localities. The number of alleles per locus ranged from three to 26. The expected and observed heterozygosities per locus ranged from 0.19 to 0.94 and from 0.20 to 0.98, respectively. Significant departures from Hardy–Weinberg equilibrium expectations occurred in four loci. These markers will be useful for the assessment of genetic diversity for this species.
Isolation and characterization of microsatellites in yellow perch (Perca flavescens)
Authors: LI L. , WANG H. P. , GIVENS C. , CZESNY S. , BROWN B.
Published: December 2006

A total of 45 microsatellite loci from yellow perch, Perca flavescens, were isolated and characterized. Among the 45 microsatellite loci, 32 had more than two alleles. A wild population of P. flavescens (n = 48) was used to examine the allele range of the microsatellite loci. Mendelian inheritance of alleles was confirmed by examining the amplified products in pair‐mated families. The number of alleles for the 32 polymorphic loci varied from two to 16, and observed heterozygosity ranged between 0.024 (YP79) and 0.979 (YP60). Cross‐species polymorphic amplification in four other Percidae species was successful for 22 loci.
A simple PCR procedure for discovering microsatellites from small insert libraries
Authors: WANG X. W. , TRIGIANO R. N. , WINDHAM M. T. , DEVRIES R. E. , SCHEFFLER B. E. , RINEHART T. A. , SPIERS J. M.
Published: December 2006

Microsatellite discovery from genomic libraries is tedious because of the low number of clones that contain inserts and costly because of screening methodologies. A new procedure for screening clones for microsatellite DNA is described herein. Instead of colony hybridization, a polymerase chain reaction (PCR) with two vector standard primers and one synthesized repeat primer was used to directly screen colonies. PCR of colonies that produced a strong smear in gels contained the desired motif, whereas a single strong band indicated the lack of the desired motif. This simple screening method is a cost‐effective way to identify microsatellite‐containing colonies.
Protective effect of Withania somnifera root powder in relation to lipid peroxidation, antioxidant status, glycoproteins and bone collagen on adjuvant‐induced arthritis in rats
Authors: Rasool M. , Varalakshmi P.
Published: December 2006

The present investigation was carried out to evaluate the protective effect of Withania somnifera Linn.Dunal (family‐Solanaceae), commonly known as Ashwagandha, on adjuvant‐induced arthritic rats. Results were compared with those for Indomethacin, a nonsteroidal anti‐inflammatory drug. Arthritis was induced by intradermal injection of complete Freund's adjuvant (0.1 mL) into the right hind paw of Wistar albino rats. Withania somnifera root powder (1000 mg/kg/day) and Indomethacin (3 mg/kg/day) were orally administered for 8 days (from 11th to 18th day) after adjuvant injection. The anti‐arthritic effect of W. somnifera root powder was assessed by measuring changes in lipid peroxidation, antioxidant status, and glycoprotein levels in plasma and spleen of arthritic animals. In addition, cartilage degradation was also assessed by estimating bone collagen, and urinary constituents in arthritic animals. Results of the present investigation showed significant increase in the level of lipid peroxides, glycoproteins, and urinary constituents with the depletion of antioxidant status and bone collagen in arthritic animals. These biochemical alterations observed were ameliorated significantly by oral administration of W. somnifera root powder (1000 mg/kg body weight) in arthritic animals. The results of this study clearly indicate that W. somnifera root powder is capable of rectifying the above biochemical changes in adjuvant arthritis.
Endocannabinoid receptor CB2 in nonalcoholic fatty liver disease
Authors: Mendez‐Sanchez N. , Zamora‐Valdes D. , Pichardo‐Bahena R. , Barredo‐Prieto B. , Ponciano‐Rodriguez G. , Bermejo‐Martínez L. , Chavez‐Tapia N. C. , Baptista‐González H. A. , Uribe M.
Published: December 2006

Background and Aim: Fatty infiltration and fibrosis are major issues in chronic liver disease. Recent reports suggest a role for the endocannabinoid system in these processes.

Aim: To characterize localization and expression of CB2 in normal liver and nonalcoholic fatty liver.

Methods: We studied 64 liver biopsies: eight were considered normal; 56 had a diagnosis of nonalcoholic fatty liver disease (NAFLD); 32 with nonalcoholic steatosis and 24 nonalcoholic steatohepatitis (NASH). CB2 immunolocalization was studied in 38 samples in paraffin blocks using immunohistochemistry, and a computerized semiquantitative analysis was carried out. CB2 mRNA expression was assessed through RT‐PCR in 26 frozen liver samples and the ratio CB2/β‐actin was used to evaluate differences between groups. Statistical analysis was performed with central tendency measures and the Mann–Whitney U‐test. We considered as significant differences those with a P‐value <0.05.

Results: Neither parenchymal nor nonparenchymal cells in normal liver tissue react towards anti‐CB2 antibodies. All the samples from patients with steatosis and nonalcoholic steatohepatitis showed hepatocellular immunoreactivity. Cholangiocytes were positive only in the NAFLD group. Normal liver tissue showed a normalized CB2/β‐actin ratio of 0.001±0.01, steatosis 6.52±17.3 (P=0.05 vs normal) and NASH 6.49±12.2 (P=0.06 vs normal and P=0.6 vs steatosis).

Conclusion: CB2 receptors are expressed by hepatocytes in nonalcoholic fatty liver disease but not in normal liver.
Valproic Acid–induced Hepatopathy: Nine New Fatalities in Germany from 1994 to 2003
Authors: Koenig Stephan A. , Buesing Deike , Longin Elke , Oehring Randi , Häussermann Peter , Kluger Gerhard , Lindmayer Friedemann , Hanusch Ralf , Degen Ingrid , Kuhn Hans , Samii Kamrun , Jungck Albrecht , Brückner Reinhard , Seitz Reinhild , Boxtermann Wolfgang , Weber Yvonne , Knapp Rolf , Richard Hans Helmut , Weidner Birgit , Kasper Johannes‐Martin , Haensch Carl‐Albrecht , Fitzek Sabine , Hartmann Margarete , Borusiak Peter , Müller‐Deile Andrea , Degenhardt Volker , Korenke Georg‐Christoph , Hoppen Thomas , Specht Ulrich , Gerstner Thorsten
Published: December 2006

Summary:  Purpose: Valproic acid (VPA) is an antiepileptic drug (AED) commonly used for generalized and focal epilepsies. We provide an update on hepatotoxic side effects in Germany between 1994 and 2003.

Methods: We mailed a questionnaire to all members of the German Section of the International League Against Epilepsy, asking for VPA‐induced side effects, especially severe side effects such as hepatopathy.

Results: As a result of our questionnaire, we found 31 cases of reversible hepatotoxicity and nine cases of lethal hepatopathies in Germany from 1994 to 2003.

Conclusions: The outcome of patients with severe hepatotoxicity is better than that in the past. The risk of a VPA‐induced hepatopathy is not limited to patients younger than 2 years, receiving polytherapy, or patients with congenital or acquired metabolic diseases.
Diagnosis and Treatment of the First Epileptic Seizure: Guidelines of the Italian League Against Epilepsy
Authors: Beghi Ettore , De Maria Giovanni , Gobbi Giuseppe , Veneselli Edvige
Published: December 2006

Summary:  The diagnosis and treatment of a first epileptic seizure are made by physicians with different types of expertise. Heterogeneous patterns of care are thus expected, which explain the need for shared patterns of care. These guidelines were developed by a group of experts from the Italian League against Epilepsy (LICE) in accordance with the requirements of evidence‐based medicine. An accurate assessment of the seizure is required, with active questioning about circumstances of occurrence, clinical manifestations, and postictal symptoms. For seizures with loss of consciousness, the presence of cyanosis, hypersalivation, tongue biting, and postictal disorientation has a specific diagnostic value. Laboratory tests and toxicological screening should be performed only in the presence of circumstances suggesting a metabolic or toxic encephalopathy. Elevated prolactin levels 10–20 min. after the event help in differentiating generalized tonic‐clonic or partial seizures from psychogenic nonepileptic seizures. Except for infants less than six months of age, CSF examination is recommended only when a cerebral infection is suspected. An EEG should be performed within 24 h. after a seizure, particularly in children. If the EEG is normal during wakefulness, a sleep EEG is recommended. A CT scan is strictly indicated when a severe structural lesion is suspected or when the etiology is unknown. MRI may not be indicated in the emergency room, but it should be preferred to CT as part of the diagnostic assessment. The added value of other diagnostic tools (neuropsychological tests, ambulatory EEG, functional MRI, SPECT, and PET) is as yet unknown. These tests may be used on a case‐by‐case basis. In the presence of an acute symptomatic seizure, treatment of the cause is recommended. Symptomatic therapy is not justified unless the seizure has the characteristics of status epilepticus. Long‐term treatment may be considered in patients with abnormal EEG and imaging data and after consideration of the social, emotional, and personal implications of seizure relapse.
Treatment of Status Epilepticus in Adults: Guidelines of the Italian League Against Epilepsy
Authors: Minicucci Fabio , Muscas Giancarlo , Perucca Emilio , Capovilla Giuseppe , Vigevano Federico , Tinuper Paolo
Published: December 2006

Summary: Status epilepticus (SE) is a medical emergency which can lead to significant morbidity and mortality and requires prompt diagnosis and treatment. SE is differentiated into generalized or partial SE on the basis of its electro‐clinical manifestations. The guidelines for the management of SE produced by the Italian League against Epilepsy also distinguish three different stages of SE (initial, established and refractory), based on time elapsed since the onset of the condition and responsiveness to previously administered drugs. Treatment should be started as soon as possible, particularly in generalized convulsive SE, and should include general support measures, drugs to suppress epileptic activity and, whenever possible, treatments aimed at relieving the underlying (causative) condition. Benzodiazepines are the first line antiepileptic agents, and i.v. lorazepam is generally preferred because it is associated with a lower risk of early relapses. If benzodiazepines fail to control seizures, i.v. phenytoin is usually indicated, though i.v. phenobarbital or i.v. valproate may also be considered. Refractory SE requires admission to an intensive care unit (ICU) to allow adequate monitoring and support of respiratory, metabolic and hemodynamic functions and cerebral electrical activity. In refractory SE, general anesthesia may be required. Propofol and thiopental represent first line agents in this setting, after careful assessment of potential risks and benefits.
Locus Coeruleus and Neuronal Plasticity in a Model of Focal Limbic Epilepsy
Authors: Giorgi Filippo S. , Mauceli Giuseppe , Blandini Fabio , Ruggieri Stefano , Paparelli Antonio , Murri Luigi , Fornai Francesco
Published: December 2006

Summary:  Purpose: A lesion of the noradrenergic nucleus Locus Coeruleus (LC) converts sporadic seizures evoked by microinfusion of bicuculline into the anterior piriform cortex (APC) of rats into limbic status epilepticus (SE). The purpose of this study was to evaluate the chronic effects of this new model of SE on the onset of secondary epileptogenesis. We further related the loss of noradrenaline (NE) with hippocampal mossy fiber sprouting.

Methods: Male Sprague Dawley rats were treated with systemic saline or DSP‐4 (a neurotoxin selective for noradrenergic terminals originating from the LC), microinfused with bicuculline into the APC three days later, and sacrificed after 45 days. Naïve and DSP‐4 pretreated sham‐operated rats served as respective controls. The following evaluations were performed: (a) monitoring of acute seizures and delayed occurrence of spontaneous recurrent seizures (SRS); (b) NE levels in the hippocampus, frontal and olfactory cortex; (c) occurrence of mossy fiber sprouting into the inner molecular layer of the dentate gyrus of the dorsal hippocampus.

Results: In 30% of rats lacking noradrenergic terminals, SE evoked from the APC was followed by SRS. Conversely, seizures evoked in intact rats did not result in chronic epileptogenesis. Seizures/SE did not modify NE levels as compared with baseline levels both in naïve and DSP‐4‐pretreated rats. Rats undergoing SE following DSP‐4 + bicuculline developed SRS which were accompanied by hippocampal mossy fiber sprouting.

Conclusions: Noradrenergic loss converts focally induced sporadic seizures into an epileptogenic SE, which is accompanied by mossy fiber sprouting within the dentate gyrus.
Benign Myoclonic Epilepsy in Infancy (BMEI): A Longitudinal Electroclinical Study of 22 Cases
Authors: Darra Francesca , Fiorini Elena , Zoccante Leonardo , Mastella Laura , Torniero Claudia , Cortese Samuele , Meneghello Lisa , Fontana Elena , Bernardina Bernardo Dalla
Published: December 2006

Summary:  Purpose: Benign myoclonic epilepsy in infancy (BMEI) is a nosologically well‐defined entity, characterized by myoclonic seizures (MS) in normal children younger than 3 years and by a good long term prognosis. In some cases the seizures are reflex. We studied 22 cases to better define the electroclinical semeiology and evolution of the disorder.

Methods: Serial electroclinical and neuropsychological assessments, both during wakefulness and during sleep, were performed in 22 otherwise healthy children with spontaneous (17) or reflex (5) MS, recorded by video‐EEG‐polygraphy since clinical onset.

Results: Seizure onset was between 3 months and 4 years 10 months (50% during first year, 86% before the third year); in reflex cases onset, was earlier than the 14th month. MS recurred during wakefulness and slow sleep in all cases and during REM sleep in reflex cases. MS and related EEG discharges were synchronous or asynchronous. Often ictal EEG discharges were limited to the rolandic and vertex regions (falsely focal paroxysms). Several seizures were subtle and could have escaped recognition. Unusually frequent sleep startles were recorded mostly in reflex cases. MS were well controlled by treatment. At follow‐up, between ages 3 and 19 years, four patients had occasional seizures; two had cognitive impairment and three had learning difficulties. No other seizures or cognitive deficits were observed in reflex cases.

Conclusions: Seizures associated with BMEI are rarely truly generalized and are often so subtle and related to falsely focal paroxysms that their frequency can be underestimated. The reflex form is a well‐defined variant with an early onset, peculiar electroclinical features, and a good prognosis.
Long‐Term Outcome of Pattern‐Sensitive Epilepsy
Authors: Brinciotti Mario , Matricardi Maria , Cantonetti Laura , Lauretti Giada , Pugliatti Maria
Published: December 2006

Summary:  Purpose: To evaluate the long‐term outcome of patients with pattern‐sensitive epilepsy.

Methods: We prospectively studied 35 patients (21 females and 14 males) with pattern‐sensitive epilepsy (follow up ≥5 years; mean 13.9; range 6.4 – 27.6). All cases had regular clinical examinations and serial electroencephalographic (EEG) recordings. Photosensitivity and pattern sensitivity were ascertained neurophysiologically in all cases. Outcome was evaluated according to the following variables: duration of photosensitivity, rate of remission (seizure‐free period ≥ 2 years), withdrawal of therapy, and recurrence after drug discontinuation.

Results: The epilepsy was generalized in 18 cases (17 idiopathic, one symptomatic) and partial in 17 (13 idiopathic, four symptomatic). Sixteen patients (46%) had a family history of seizures. The mean age at the last examination was 21.4 years (range 11.2–35.5 years). Five patients (14%) had only reflex seizures. The most common type of spontaneous seizures was generalized (60%), whereas reflex seizures were more frequently partial (74%). Mean epilepsy duration was 8.7 ± 6.3 years. Patients with only reflex seizures were instructed to avoid precipitating stimuli and were not treated with antiepileptic drugs. Treatment was gradually withdrawn in 10 out of 30 treated patients, with relapse in only two cases. At the end of follow up, 28 patients (80%) were seizure‐free.

Conclusion: The long‐term outcome of patients with pattern‐sensitive epilepsy indicates a good prognosis with a favorable course for both spontaneous and reflex seizures.
Emotions Induced by Intracerebral Electrical Stimulation of the Temporal Lobe
Authors: Meletti Stefano , Tassi Laura , Mai Roberto , Fini Nicola , Tassinari Carlo Alberto , Russo Giorgio Lo
Published: December 2006

Summary:  Purpose: To assess the quality and frequency of emotions induced by intracerebral electrical stimulation of the temporal lobe.

Methods: Behavioral responses were obtained by electrical stimulation in 74 patients undergoing presurgical video‐stereo‐EEG monitoring for drug‐resistant epilepsy. Intracerebral electrical stimulation was performed by delivering trains of electrical stimuli of alternating polarity; the intensity could vary from 0.2 to 3 mA. Stimulation frequency was 1 Hz or 50 Hz. Nine hundred thirty‐eight stimulation procedures were performed.

Results: Seventy‐nine emotional responses (ERs) were obtained (8.4%). Of these, 67 were “'fear responses.” Sad feelings were evoked 3 times, happy‐pleasant feelings 9 times. Anger and disgust were never observed. The following variables affected the incidence of ER: (a) Anatomical site of stimulation. ERs (always fear) were maximal at the amygdala (12%) and minimal for lateral neocortical stimulation (3%, p < 0.01). (b) Pathology. Stimulation of a temporal lobe with hippocampal sclerosis was associated with a lower frequency of ERs compared with stimulation of a temporal lobe with no evidence of atrophy in the medial temporal structures. (c) Stimulation frequency. ERs were 12% at 50 Hz versus 6.0% at 1 Hz (p < 0.01). (d) Gender. In women fear responses were 16% compared with 3% in men (p < 0.01). There were no gender differences when analyzing nonemotional responses.

Conclusions: These data confirm the role of the medial temporal lobe region in the expression of emotions, especially fear‐related behaviors. Fear was observed more frequently in the absence of medial temporal sclerosis, supporting the hypothesis that emotional behaviors induced by stimulation are positive phenomena, strictly related to the physiological function of these regions. Further investigations should address why women express fear behaviors more frequently than men.
EEG/fMRI Study of Ictal and Interictal Epileptic Activity: Methodological Issues and Future Perspectives in Clinical Practice
Authors: Bonaventura Carlo Di , Vaudano Anna E. , Carnì Marco , Pantano Patrizia , Nucciarelli Valter , Garreffa Girolamo , Maraviglia Bruno , Prencipe Massimiliano , Bozzao Luigi , Manfredi Mario , Giallonardo Anna T.
Published: December 2006

Summary:  Purpose: Electroencephalography/functional magnetic resonance imaging (EEG/fMRI) has been proposed recently as a tool to study electrophysiological activity and, consequently, detect brain regions activated during epileptiform EEG abnormalities. The purpose of the study was to review our two‐year experience with studying ictal and interictal activities in patients with epilepsy.

Methods: Using EEG/fMRI, we studied hemodynamic changes associated with ictal and interictal EEG abnormalities in 43 patients with partial (31 cases) or generalized (12 cases) epilepsy. Using two different paradigms (block design and event‐related design), we studied several forms of EEG activity consisting of (i) interictal abnormalities constantly elicitable by specific stimulation (8 cases); (ii) focal and generalized interictal activity, such as focal spikes or typical and atypical generalized spike‐and‐wave discharges (18 cases); and (iii) focal and generalized ictal electro‐clinical activity, such as tonic seizures or pseudo‐absences in frontal lobe epilepsy, typical absences in idiopathic generalized epilepsy, complex partial seizures in temporal lobe epilepsy, and perisylvian seizures in special syndromes (17 patients).

Results: EEG/fMRI revealed clear hemodynamic changes related to EEG abnormalities in 21 patients. In 18 of these patients, the changes were highly concordant with electro‐clinical findings. In the remaining 22 patients, fMRI analysis data failed to show activation or deactivation clusters, probably owing either to lack or inadequate amount of temporal distribution of abnormal EEG activity, or to intrinsic methodological problems.

Conclusions: By defining the electro‐clinical and hemodynamic correlates of EEG activity, fMRI may shed light on the neurophysiological mechanisms underlying epileptic phenomena. However, as several methodological issues have yet to be addressed, further studies are warranted to assess the reliability and usefulness of EEG/fMRI in clinical practice.
Ictal Grasping: Prevalence and Characteristics in Seizures with Different Semiology
Authors: Gardella Elena , Rubboli Guido , Tassinari Carlo Alberto
Published: December 2006

Summary:  Purpose: The aim of this study was to investigate ictal grasping (IG), defined as the act of gripping something firmly during focal epileptic seizures, and to evaluate whether it characterizes specific seizure types.

Methods: We analyzed the video‐recordings of 694 seizures in 109 consecutive candidates to epilepsy surgery. Seizures with motor manifestations (n = 511) were selected and divided into four semiological groups: (a) frontal “hyperkinetic” seizures (FHS): 30 seizures, 12 patients, (b) frontal lobe seizures (FLS) other than FHS: 228 seizures, 26 patients, (c) temporal lobe seizures (TLS): 194 seizures, 55 patients, (d) extra‐frontal/extra‐temporal seizures (EF/ETS): 59 seizures, 16 patients. We evaluated IG features by means of video‐analysis.

Results: IG was observed in 96.7% of FHS (100% of patients), with a mean latency of 3 s, and a mean prevalence of 7.9 IG per seizure, directed to a limited number of surrounding objects or body parts. In 22.4% of FLS (11.5% of patients) 1–3 prolonged IGs were present, with a mean latency of 2 s and mainly directed to a fixed external point. IG was occasionally present in TLS (10.3%, in 20% of patients) and EF/ETS (5.1%, in 12.5% of patients), with longer latencies and without any stereotypy. We did not find a reliable lateralizing value of IG.

Conclusions: Prevalence of IG in FHS was significantly higher than in other seizure groups. In FHS and FLS, IG had shorter latency and stereotyped features, characterizing an automatic (“release”?) behavior. In extra‐frontal seizures, IG seemed to be an occasional purposeful movement.
Video‐EEG Study of Psychogenic Nonepileptic Seizures: Differential Characteristics in Patients with and without Epilepsy
Authors: Mari Francesco , Di Bonaventura Carlo , Vanacore Nicola , Fattouch Jinane , Vaudano Anna Elisabetta , Egeo Gabriella , Berardelli Alfredo , Manfredi Mario , Prencipe Massimiliano , Giallonardo Anna Teresa
Published: December 2006

Summary:  Purpose: Psychogenic nonepileptic seizures (PNES) are episodes that may resemble epileptic seizures (ES) but are not associated with abnormal electrical discharges in the brain. Video‐EEG recording of a typical episode is considered the best diagnostic tool available. PNES are, however, also documented in patients with epilepsy (PNES/ES). The purpose of this study was to assess this comorbid population, focusing on the differences between patients with PNES/ES and patients with PNES alone.

Methods: We reviewed 110 PNES episodes, occurring spontaneously or induced by means of suggestion techniques, recorded in our video‐EEG laboratory over a period of eight years. We identified two subgroups of patients, consisting of 85 PNES cases and 25 PNES/ES cases, and assessed any differences in their characteristics by reviewing a number of variables (age, sex, clinical features, antiepileptic therapy, age of onset, time to diagnosis, pathological history, and length of follow‐up).

Results: The comparison between the two subgroups revealed that PNES/ES patients displayed some statistically significant differences when compared with PNES alone patients, i.e., younger age, a higher percentage of spontaneously activated events, a shorter disease duration, a longer time to PNES diagnosis, and a lower percentage lost at follow‐up.

Conclusions: This study confirms that PNES is a common, though probably underestimated, occurrence in epilepsy services. Our results shed light on some different characteristics between PNES and PNES/ES patients.
ICD Implantation in Infants and Small Children: The Extracardiac Technique
Authors: KRIEBEL THOMAS , RUSCHEWSKI WOLFGANG , GONZALEZ MARIA GONZALEZ Y , WALTER KATHARINA , KROLL JOHANNES , KAMPMANN CHRISTOPH , HEINEMANN MARKUS , SCHNEIDER HEIKE , PAUL THOMAS
Published: December 2006

Background: There is no clear methodology for implantation of an internal cardioverter‐defibrillator (ICD) in infants and small children. The aim of this study was to assess efficacy and safety of an extracardiac ICD implantation technique in pediatric patients.

Patients and Methods: An extracardiac ICD system was implanted in eight patients (age: 0.3–8 years; body weight: 4–29 kg). Under fluoroscopic guidance a defibrillator lead was tunneled subcutaneously starting from the anterior axillar line along the course of the 6th rib until almost reaching the vertebral column. After a partial inferior sternotomy, bipolar steroid‐eluting sensing and pacing leads were sutured to the atrial wall (n = 2) and to the anterior wall of the right ventricle (n = 8). The ICD device was implanted as “active can” in the upper abdomen. Sensing, pacing, and defibrillation thresholds (DFTs) as well as impedances were verified intraoperatively and 3 months later, respectively.

Results: In seven of eight patients, intraoperative DFT between subcutaneous lead and device was <15 J. In the eighth patient ICD implantation was technically not feasible due to a DFT >20 J. During follow‐up (mean 14.5 months) appropriate and effective ICD discharges were noted in two patients. DFT remained stable after 3 months in four of six patients retested. A revision was required in one patient due to lead migration and in another patient due to a lead break.

Conclusions: In infants and small children, extracardiac ICD implantation was technically feasible. Experience and follow‐up are still limited. The course of the DFT is unknown, facing further growth of the patients.
Acute and Chronic Effects of Extensive Radiofrequency Lesions in the Canine Caval Veins: Implications for Ablation of Atrial Arrhythmias
Authors: FENELON GUILHERME , FRANCO MARCELLO , ARFELLI ELERSON , OKADA MIEKO , DE ARAÚJO SÉRGIO , DE PAOLA ANGELO A.V.
Published: December 2006

Background: Although radiofrequency (RF) ablation within the caval veins has been increasingly used to treat a variety of atrial tachyarrhythmias, the consequences of RF ablation in the caval veins are unknown. We explored the acute and chronic angiographic and pathological effects of extensive RF ablation in the caval veins.

Methods: Under fluoroscopy guidance, conventional (4 mm tip, 60°C, 60 seconds) RF applications (n = 6–7) were delivered in each vena cava (from ±2 cm into the vein to the veno‐atrial junction) of 15 dogs (10 ± 3 kg). Animals were killed 1 hour and 5 weeks after ablation for histological analysis. Angiography was performed before ablation (acute dogs only) and at sacrifice to assess the degree of vascular stenosis.

Results: In acute dogs (n = 5), luminal narrowing was noted in 10/10 (100%) targeted veins (mild in two; moderate in three and severe in five, including two total occlusions). In the six chronic animals that completed the protocol (four died during follow‐up), stenosis was also observed in 12/12 (100%) ablated veins (mild in six; moderate in four and severe in two). Of these, one superior vena cava was suboccluded with development of extensive collateral circulation. Histologically, acute lesions displayed typical transmural coagulative necrosis, whereas chronic lesions revealed intimal proliferation, necrotic muscle replaced with collagen, endovascular contraction, and disruption and thickening of the internal elastic lamina.

Conclusion: In this model, extensive RF ablation in the caval veins may result in significant vascular stenosis. These findings may have implications for catheter ablation of arrhythmias originating within the caval veins.
Significance and Utility of Plasma Brain Natriuretic Peptide Concentrations in Patients with Idiopathic Ventricular Arrhythmias
Authors: TADA HIROSHI , ITO SACHIKO , SHINBO GORO , TADOKORO KAZUYOSHI , ITO ITARU , HASHIMOTO TOHRU , MIYAJI KOHEI , KASENO KENICHI , NAITO SHIGETO , NOGAMI AKIHIKO , OSHIMA SHIGERU , TANIGUCHI KOICHI
Published: December 2006

Background: Secretion of B‐type natriuretic peptide (BNP) appears to be regulated mainly by wall tension, and an increase in the plasma BNP concentration is considered to reflect ventricular structural and functional abnormalities. The aim of this study was to clarify the significance and utility of the measurement of the plasma BNP in the setting of idiopathic ventricular arrhythmias (I‐VT/PVCs).

Methods: This study included 135 patients with symptomatic, monomorphic I‐VT/PVCs (73 women; 53 ± 17 years; 50 ventricular tachycardias [VTs], 85 premature ventricular contractions) who underwent radiofrequency catheter ablation. None had structural heart disease or renal dysfunction.

Results: The plasma BNP concentration exceeded the normal range (>18.4 pg/mL; high BNP concentration) in 79 patients (56%). The high BNP concentration was found more often in I‐VT/PVCs originating from the left ventricle (LV; 74%) than the right ventricle (RV; 49%; P < 0.01). The plasma BNP concentration correlated with the age (P = 0.0001) and frequency of premature ventricular contractions (P < 0.0001), and left‐sided I‐VT/PVCs and the presence of controlled hypertension were independent predictors of a high BNP concentration (both P < 0.05). In patients with a successful ablation and high BNP concentration before the ablation, the BNP concentration decreased to the normal range in 61% of patients after ablation. In patients with a failed ablation, the BNP concentration did not decrease to the normal range after ablation in any of the patients (P < 0.0005).

Conclusions: The plasma BNP concentration was elevated in about 60% of the patients with symptomatic I‐VT/PVCs. Normalization of the high BNP concentration after ablation may indicate a successful ablation.
Optimization of Device Programming for Cardiac Resynchronization Therapy
Authors: BURRI HARAN , SUNTHORN HENRI , SHAH DIPEN , LERCH RENÉ
Published: December 2006

Cardiac resynchronization therapy may lead to remarkable improvement in clinical status in selected patients with heart failure. However, approximately 20–30% of patients may not respond to this treatment. One of the reasons for this may be suboptimal programming of the device, which has particular considerations as compared to standard pacemakers. Hemodynamic response to pacing may be affected by timing of the atrioventricular (AV) interval, affecting synchronicity of atrial and ventricular contraction. In addition current biventricular devices have separate right and left ventricular channels that allow programming of an interventricular (VV) interval with right or left ventricular preexcitation. This article focuses on the parameters that may be optimized for biventricular pacing, and reviews the different techniques currently available for this application, with special emphasis paid to echocardiography.
Using Computers to Improve the Psychosocial Care of Implantable Cardioverter Defibrillator Recipients
Authors: KUHL EMILY A. , SEARS SAMUEL F. , CONTI JAMIE B.
Published: December 2006

Person‐to‐person psychosocial interventions (e.g., psychological, social) enhance the well‐being of implantable cardioverter defibrillator (ICD) patients. Computerized care, though, represents an opportunity to further capitalize on techniques that have already been deemed effective. This includes the provision of tailored, effective patient education; reducing device‐specific anxiety; and enhancing social support networks. The aim of this paper is to identify the ways in which computerized psychosocial care could potentially enhance the well‐being of ICD recipients. For example, computers may be particularly adept at providing patient education due to the ease in which content can be adapted to meet patient needs. Further, evidenced‐based treatments for anxiety and depression (e.g., cognitive behavioral therapy) have demonstrated good applicability to computerized formats. Social support can also be provided online in the form of bulletin boards, email list‐servs, or structured online support groups. Despite the existence of some limitations, the use of computers in affecting psychosocial outcomes in implantable defibrillator recipients warrants greater attention.
Bundle Brunch Reentrant Ventricular Tachycardia with Two Distinct Conduction Patterns in a Patient with Complete Right Bundle Branch Block
Authors: ENJOJI YOSHIHISA , MIZOBUCHI MASAHIRO , SHIBATA KENSAKU , ONO TSUYOSHI , FUNATSU ATSUSHI , KANBAYASHI DAISUKE , KOBAYASHI TOMOKO , NAKAMURA SHIGERU
Published: December 2006

We report a rare case of bundle branch reentrant ventricular tachycardia [BBRVT]. A 67‐year‐old female was admitted for management of wide QRS tachycardia (right bundle branch block [RBBB] and a southwest axis). The mapping procedure revealed the tachycardia circuit consisted of the left anterior fascicle (LAF) as an antegrade, and the right bundle as a retrograde pathway. She presented RBBB during sinus rhythm. LAF ablation changed the tachycardia configuration to a northwest axis and prolonged the cycle length. Left posterior fascicle ablation terminated the tachycardia, and complete atrioventricular block occurred, which showed the unidirectional conduction over the right bundle.
Cardiac Magnetic Resonance and Cardiac Magnetic Field Mapping in a Patient with Stress‐Induced Cardiomyopathy (Tako‐Tsubo)
Authors: FISCHER ROBERT , SCHIRDEWAN ALEXANDER , KUMAR ANDREAS , GAPELYUK ANDREJ , SCHULZ‐MENGER JEANETTE , DIETZ RAINER
Published: December 2006

We encountered a 65‐year‐old woman with typical electrocardiogram (ECG) changes and new‐onset left ventricular dysfunction with apical ballooning that exhibited typical changes of tako‐tsubo‐like cardiomyopathy. We used cardiac magnetic resonance (CMR) and cardiac magnetic field mapping (CMFM) to detect changes in structural, mechanical, and electrophysiological myocardial properties during follow‐up. CMR displayed an acute myocardial injury, but neither fibrosis nor necrosis. CMFM exhibited severely disturbed repolarization with an inhomogeneous magnetic field. These pathological findings persisted much longer than the abnormalities detected by CMR and the ECG.
Multiple Premature Beats Triggered Ventricular Arrhythmias During Pilsicainide Infusion in a Patient with Inferior ST‐Segment Elevation
Authors: CHINUSHI MASAOMI , IZUMI DAISUKE , FURUSHIMA HIROSHI , WATANABE HIROSHI , AIZAWA YOSHIFUSA
Published: December 2006

A 17‐year‐old man was referred to our hospital for treatment of common paroxysmal atrial flutter. His electrocardiogram at rest showed subtle ST‐segment elevation in leads II, III, and aVF. Intravenous pilsicainide caused further ST‐segment elevation in the inferior leads, new ST‐segment depression in leads V2–V6, two distinct forms of premature ventricular complexes (PVCs) triggering short runs of polymorphic ventricular tachycardia (VT). An infusion of isoproterenol suppressed these arrhythmias and normalized the ST‐segment. Pilsicainide may induce PVCs and polymorphic VT in atypical Brugada syndrome.
Reduced midbrain‐pons serotonin transporter binding in patients with obsessive–compulsive disorder
Authors: Hasselbalch S. G. , Hansen E. S. , Jakobsen T. B. , Pinborg L. H. , Lønborg J. H. , Bolwig T. G.
Published: December 2006

Objective:  To evaluate current hypothesis regarding the pathophysiology of obsessive–compulsive disorder (OCD) by studying the serotonin receptor binding in patients with OCD using single photon emission computerized tomography (SPECT).

Method:  We studied nine patients (four men and five women, age range 21–56 years) fulfilling the DMS‐III‐R criteria for OCD using SPECT and the serotonin transporter (SERT) tracer 123I‐β‐CIT. SERT binding potential (BP2) was determined by Logan plot derived from seven scans obtained during 10–400 min.

Results:  The binding of 123I‐β‐CIT in midbrain‐pons was reduced in OCD patients when compared with controls (BP2 0.97 ± 0.07 vs. 0.84 ± 0.12, P = 0.011). There was no correlation between BP2 and any of the clinical variables (age at onset, disease duration, and Yale‐Brown Obsessive–Compulsive Scale score).

Conclusion:  This study suggests a reduced serotonergic input into the fronto‐subcortical circuits in OCD, thereby diminishing the inhibitory regulation of serotonin on these circuits.
Patch test frequency to p‐phenylenediamine: follow up over the last 6 years
Authors: Patel Sheena , Basketter David A. , Jefferies Donna , White Ian R. , Rycroft Richard J. G. , Mcfadden John P. , Ho Stephanie Y.
Published: December 2006

While the frequency of patch test reactivity to many cosmetic allergens has decreased over the last 20 years, we have previously shown that in our clinic, the patch test reactivity to p‐phenylenediamine (PPD) has remained stubbornly high between 2.5% and 4.2% in the years when patch testing was performed with 1% PPD. Further retrospective analysis of the PPD patch test frequency over the last 6 years shows an increasing rate of PPD patch test frequency, showing an upward linear trend. This increasing trend cannot be fully explained by any increase in patch testing of Southern Asian patients or of sensitization caused by PPD exposure from ‘temporary henna tattoos’. An alternative explanation may be the increasing use of permanent hair dyes.
Allergic contact dermatitis to pimecrolimus
Authors: Saitta Peter , Brancaccio Ronald
Published: December 2006

Pimecrolimus suppresses the proinflammatory cytokine production of cutaneous T and mast cells (1). It is used to treat atopic dermatitis and is the active ingredient in the topical formulation pimecrolimus 1.0% cream (Elidel®, Novartis Pharma AG, Basel, Switzerland).
Allergic contact sensitization in the general adult population: a population‐based study from Northern Norway
Authors: Dotterud Lars Kåre , Smith‐Sivertsen Tone
Published: December 2006

Few studies have so far addressed the prevalence and risk factors for contact sensitization in the general adult population; however, many such studies have been conducted in hospitals. We present the prevalence of contact sensitization in a general adult population and its relationship to potential risk factors like smoking, ear piercing and atopic diseases. 1236 adults (44.2% men and 55.8% women) were randomly selected from a cross‐section of the population in Sør‐Varanger municipality, Norway, and patch tested with TRUE Test (Pharmacia, Hillerød, Denmark). Contact sensitivity to at least 1 out of 24 allergens was found in 35.4% of the women and in 14.8% of the men. The most common allergens were nickel (17.6%), cobalt (2.8%), thiomersal (1.9%), fragrance mix (1.8%) and colophony (1.2%). All other allergens were observed in 1.0% or less. In women, ear piercing was an important risk factor for nickel sensitization. No such significant correlation was seen in men [in women relative risk (RR) = 3.30, 95% confidence interval (CI) = 2.01–5.43, and in men RR = 1.82, 95% CI = 0.66–5.00], and contact sensitivity was associated with atopic dermatitis (AD) [adjusted odds ratio (OR) = 1.58, 95% CI = 1.04–2.40] and smoking (adjusted OR = 1.42, 95% CI = 1.01–1.99) in women but not in men. The prevalence of contact sensitivity was common in this general population, especially in women. Smoking and AD might be a risk factor for contact sensitization.
Variation in the amount of petrolatum preparation applied at patch testing
Authors: Bruze Magnus , Frick‐Engfeldt Malin , Gruvberger Birgitta , Isaksson Marléne
Published: December 2006

The elicitation of a positive patch test reaction in a given individual depends upon the dose of the sensitizer applied, the patch test technique and the occlusion time. The dose is determined by the concentration and volume/amount of test preparation applied. If the same amount/volume of a test preparation is applied all the time with the same test technique (same area of skin) and occlusion time, it is appropriate to use concentration as a dose parameter. Most contact sensitizers are incorporated in petrolatum (pet.). With pet. as vehicle, it is impossible to repeatedly apply an exact volume/amount. This study was performed to investigate the inter‐ and intra‐individual variation of pet. preparation applied at patch testing by 3 technicians. Weighing demonstrated that the 3 technicians had about the same precision in their pet. application. The investigation demonstrates that there is both an inter‐individual (statistically significant) and intra‐individual variation in the amounts of pet. applied at patch testing for the 3 technicians. Presently, there is no recommendation on what amount of pet. preparation to apply, which merits a decision to be taken based on thorough investigations on the appropriate volumes of pet. preparation to be applied in various patch test systems.
Is it possible to improve the patch‐test diagnostics for isocyanates? A stability study of petrolatum preparations of diphenylmethane‐4,4′‐diisocyanate and polymeric diphenylmethane diisocyanate
Authors: Frick‐Engfeldt Malin , Zimerson Erik , Karlsson Daniel , Skarping Gunnar , Isaksson Marléne , Bruze Magnus
Published: December 2006

We have previously shown that the concentration of diphenylmethane‐4,4′‐diisocyanate (4,4′‐MDI) in commercial test preparations was so low that patch testing with the same was not reliable. The stability of 4,4′‐MDI in petrolatum (pet.) was compared with pet. preparations of polymeric diphenylmethane diisocyanate (PMDI), which consists of a complex mixture of monomeric isomers and oligomers of MDI. Preparations of 4,4′‐MDI and PMDI were stored under 3 different conditions, i.e. at room temperature, refrigerated and frozen. They were analysed continuously during 1 year with regard to the content of 4,4′‐MDI, 3‐ring oligomers and 4‐ring oligomers using liquid chromatography–mass spectrometry. PMDI preparations kept frozen were stable for a year. All other preparations failed to fulfil the requirements of stability, i.e. ±20% of the initial concentration. Storage in a freezer prolonged the lifetime for 4,4′‐MDI. The decrease in concentration for preparations kept at room temperature and refrigerated was less rapid in PMDI preparations than in 4,4′‐MDI preparations. PMDI preparations are better suited for patch testing patients exposed to MDI because they are more stable and homogeneous than 4,4′‐MDI preparations. They better reflect possible allergens that workers are exposed to because products used in industry contain both monomers and oligomers.
Abnormality of CD4+CD25+ regulatory T cells in idiopathic thrombocytopenic purpura
Authors: Liu Bin , Zhao Hui , Poon Man‐Chiu , Han Zhibo , Gu Dongsheng , Xu Maoqiang , Jia Hairong , Yang Renchi , Han Zhong Chao
Published: December 2006

Objectives: The aim of this study was to explore the profile and function of CD4+CD25+ regulatory T cells (Treg cells) in idiopathic thrombocytopenic purpura (ITP) patients. Methods: Treg cell numbers were analyzed by flow cytometric analysis in peripheral blood mononuclear cells collected from healthy donors or patients with ITP. Quantification of cell proliferation was assayed by an enzyme‐linked immunosorbent assay kit, based on the measurement of BrdU incorporation during DNA synthesis. Results: The percentage of Treg cells was significantly decreased in ITP patients in active and non‐remission state(5.79 ± 1.22%) when compared with the patients in remission(11.63 ± 4.56%) and to healthy subjects(12.68 ± 3.59%). The suppressive activity of Treg cells in ITP patients was also found to be impaired. Conclusion: These results suggest that decreased number and function of Treg cells might be one of mechanisms that cause immune regulation dysfunction in ITP.