bluuebunny/crossref_metadata_2025 huggingface dataset:
Subscapular skinfold thickness distinguishes between transient and persistent impaired glucose tolerance: Study on Lifestyle‐Intervention and Impaired Glucose Tolerance Maastricht (SLIM)
Authors: Mensink M. , Feskens E. J. M. , Kruijshoop M. , De Bruin T. W. A. , Saris W. H. M. , Blaak E. E.
Published: December 2004

Aims To assess whether adding anthropometric measurements to an oral glucose tolerance test (OGTT) can help to distinguish between transient and persistent impaired glucose tolerance (IGT).

Methods From the SLIM project (Study on Lifestyle‐Intervention and IGT Maastricht), a study designed to evaluate whether diet and physical activity intervention can improve glucose tolerance in subjects at risk for diabetes, 108 subjects with IGT underwent a repeated OGTT 2–4 months after the initial OGTT. Following the second test, subjects were classified as transient IGT, or persistent IGT. Anthropometric measurements, including body mass index, waist and hip circumference, sagittal and transverse abdominal diameters and skinfold thickness measurements, were done during the second OGTT.

Results Persistent IGT was diagnosed in 47 subjects (44%), transient IGT in 40 (37%), impaired fasting glucose in eight subjects (7%), and diabetes in 13 cases (12%). Two‐hour blood glucose levels at the initial OGTT and subscapular skinfold thickness were significantly higher in subjects with persistent IGT (2‐h blood glucose 9.8 ± 0.1 mmol/l vs. 10.2 ± 0.1 mmol/l for transient IGT and persistent IGT, respectively; subscapular skinfold thickness 25.4 ± 1.4 mm vs. 29.8 ± 1.2 mm for transient IGT and persistent IGT, respectively). After adjustment for age, sex and family history of diabetes mellitus, logistic regression indicated that 2‐h blood glucose level during the initial OGTT represented the strongest predictor of persistent IGT (P < 0.02), followed by subscapular skinfold thickness (P < 0.05). After adjustment for 2‐h blood glucose levels during the first OGTT, subscapular skinfold thickness remained significantly associated with persistent IGT (odds ratio 1.84; P < 0.05).

Conclusions In addition to the 2‐h blood glucose level, subscapular skinfold thickness was the best predictor of persistent IGT, suggesting that adding simple anthropometric measures to oral glucose tolerance testing may improve the distinction between persistent and transient glucose intolerance.

Diabet. Med. 20, 552–557 (2003)
A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathy
Authors: Olson J. A. , Strachan F. M. , Hipwell J. H. , Goatman K. A. , McHardy K. C. , Forrester J. V. , Sharp P. F.
Published: December 2004

Aims To compare the respective performances of digital retinal imaging, fundus photography and slit‐lamp biomicroscopy performed by trained optometrists, in screening for diabetic retinopathy. To assess the potential contribution of automated digital image analysis to a screening programme.

Methods A group of 586 patients recruited from a diabetic clinic underwent three or four mydriatic screening methods for retinal examination. The respective performances of digital imaging (n = 586; graded manually), colour slides (n = 586; graded manually), and slit‐lamp examination by specially trained optometrists (n = 485), were evaluated against a reference standard of slit‐lamp biomicroscopy by ophthalmologists with a special interest in medical retina. The performance of automated grading of the digital images by computer was also assessed.

Results Slit‐lamp examination by optometrists for referable diabetic retinopathy achieved a sensitivity of 73% (52–88) and a specificity of 90% (87–93). Using two‐field imaging, manual grading of red‐free digital images achieved a sensitivity of 93% (82–98) and a specificity of 87% (84–90), and for colour slides, a sensitivity of 96% (87–100) and a specificity of 89% (86–91). Almost identical results were achieved for both methods with single macular field imaging. Digital imaging had a lower technical failure rate (4.4% of patients) than colour slide photography (11.9%). Applying an automated grading protocol to the digital images detected any retinopathy, with a sensitivity of 83% (77–89) and a specificity of 71% (66–75) and diabetic macular oedema with a sensitivity of 76% (53–92) and a specificity of 85% (82–88).

Conclusions Both manual grading methods produced similar results whether using a one‐ or two‐field protocol. Technical failures rates, and hence need for recall, were lower with digital imaging. One‐field grading of fundus photographs appeared to be as effective as two‐field. The optometrists achieved the lowest sensitivities but reported no technical failures. Automated grading of retinal images can improve efficiency of resource utilization in diabetic retinopathy screening.

Diabet. Med. 20, 528–534 (2003)
Serum levels of low molecular weight advanced glycation end products in diabetic subjects
Authors: Sharp P. S. , Rainbow S. , Mukherjee S.
Published: December 2004

Aims One of the principal theories of the development of diabetic complications proposes that increased levels of advanced glycation end products (AGE) are formed in diabetes by prolonged exposure of proteins, lipids and nucleotides to glucose. Such AGEs may contribute to the development of diabetic complications by a number of mechanisms. Circulating AGEs can be detected in serum, and in the present study, we analysed the clinical correlates of circulating serum low molecular weight AGE (LMW‐AGE).

Methods Serum LMW‐AGE was measured in 106 non‐diabetic and 499 diabetic subjects using fluorescence spectroscopy. Results were calibrated against an in‐house AGE albumin preparation, and expressed as absolute fluorescence units (AFU).

Results Serum LMW‐AGE values were significantly higher in diabetic than non‐diabetic subjects [median 7.5 (range 0–595.5) vs. 5.3 (1.0–15.5) AFU, P < 0.01]. In the normal subjects, there were significant correlations between serum LMW‐AGE and age (r = 0.42, P < 0.01) and serum creatinine (r = 0.39, P < 0.01). In the diabetic patients, serum LMW‐AGE correlated significantly with age (r = 0.315, P < 0.01), systolic blood pressure (r = 0.141, P = 0.002), serum creatinine (r = 0.449, P < 0.01) and urinary albumin/creatinine ratio (ACR) (r = 0.265, P < 0.01). There was no correlation between serum LMW‐AGE and HbA1c. On regression analysis, with serum LMW‐AGE as the dependent variable, serum creatinine emerged as the most significant factor (t = 8.1, P < 0.01), followed by age (t = 4.0, P < 0.01) and ACR (t = 2.9, P = 0.004). There was no significant difference in serum LMW‐AGE between those with and without retinopathy or in those with vascular disease.

Conclusions We conclude that circulating LMW‐AGEs are increased in diabetic subjects. The major determinant appears to be renal dysfunction in the form of raised albumin/creatinine ratio or creatinine. There was no association with other markers of vascular disease or presence of diabetic complications.

Diabet. Med. 20, 575–579 (2003)
A postnatal fasting plasma glucose is useful in determining which women with gestational diabetes should undergo a postnatal oral glucose tolerance test
Authors: Holt R. I. G. , Goddard J. R. , Clarke P. , Coleman M. A. G.
Published: December 2004

Aims It is recommended that women with gestational diabetes (GDM) should have a 6‐week postnatal oral glucose tolerance test (OGTT). As this test may be unpleasant, time‐consuming and has resource implications, we evaluated whether the 6‐week postnatal fasting glucose could be used to determine which women should undergo an OGTT.

Methods All women with GDM, diagnosed according to the World Health Organization criteria, who were delivered at the Princess Anne Hospital, Southampton between May 2000 and May 2002, were recommended to have an OGTT. The results of the fasting plasma glucose concentration were assessed in relation to the 2‐h glucose value.

Results One‐hundred and fifty‐two women with GDM were delivered. Thirty (19.7%) women refused an OGTT or failed to attend. In the 122 OGTTs, three (2.4%; 95% confidence interval 0.8, 7) women had diabetes, three had impaired glucose tolerance and four had impaired fasting glycaemia. No woman with a normal test had fasting glucose of ≥ 6.0 mmol/l. Fasting glucose was correlated with the 2‐h glucose (r = 0.62, P < 0.0001). Only 10 (8.1%) of the OGTTs would have been performed if only women with fasting glucose of ≥ 6.0 mmol/l underwent the test. The sensitivity and specificity of this approach for the diagnosis of postnatal diabetes is 100% and 94%, respectively. Linear regression methods indicate that it would miss fewer than three in 10 000 cases.

Conclusions In our population, a 6‐week postnatal fasting plasma glucose is useful in determining which women with gestational diabetes should undergo an OGTT. Consequently we now perform OGTT only in women whose postnatal fasting plasma glucose is ≥ 6.0 mmol/l.

Diabet. Med. 20, 594–598 (2003)
Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetes
Authors: Ben‐Haroush A. , Yogev Y. , Hod M.
Published: December 2004

Gestational diabetes (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. Although it is a well‐known cause of pregnancy complications, its epidemiology has not been studied systematically. Our aim was to review the recent data on the epidemiology of GDM, and to describe the close relationship of GDM to prediabetic states, in addition to the risk of future deterioration in insulin resistance and development of overt Type 2 diabetes. We found that differences in screening programmes and diagnostic criteria make it difficult to compare frequencies of GDM among various populations. Nevertheless, ethnicity has been proven to be an independent risk factor for GDM, which varies in prevalence in direct proportion to the prevalence of Type 2 diabetes in a given population or ethnic group. There are several identifiable predisposing factors for GDM, and in the absence of risk factors, the incidence of GDM is low. Therefore, some authors suggest that selective screening may be cost‐effective. Importantly, women with an early diagnosis of GDM, in the first half of pregnancy, represent a high‐risk subgroup, with an increased incidence of obstetric complications, recurrent GDM in subsequent pregnancies, and future development of Type 2 diabetes. Other factors that place women with GDM at increased risk of Type 2 diabetes are obesity and need for insulin for glycaemic control. Furthermore, hypertensive disorders in pregnancy and afterwards may be more prevalent in women with GDM. We conclude that the epidemiological data suggest an association between several high‐risk prediabetic states, GDM, and Type 2 diabetes. Insulin resistance is suggested as a pathogenic linkage. It is possible that improving insulin sensitivity with diet, exercise and drugs such as metformin may reduce the risk of diabetes in individuals at high risk, such as women with polycystic ovary syndrome, impaired glucose tolerance, and a history of GDM. Large controlled studies are needed to clarify this issue and to develop appropriate diabetic prevention strategies that address the potentially modifiable risk factors.

Diabet. Med. 20, ***–*** (2003)
Hypoglycaemia in insulin‐treated Type 2 diabetes: frequency, symptoms and impaired awareness
Authors: Henderson J. N. , Allen K. V. , Deary I. J. , Frier B. M.
Published: December 2004

Aims  Hypoglycaemia is considered to be less common in people with insulin‐treated Type 2 diabetes than in Type 1 diabetes. A retrospective survey was made of 215 people with insulin‐treated Type 2 diabetes to quantify the frequency and nature of hypoglycaemia experienced.

Methods  The frequencies of mild (self‐treated) and severe (required assistance) hypoglycaemia during the preceding year were estimated retrospectively. The usual symptoms of hypoglycaemia and state of awareness of hypoglycaemia were scored using validated questionnaires and any history suggestive of impaired hypoglycaemia awareness was documented.

Results  In this cohort, 157 (73%) had experienced hypoglycaemia since commencing insulin, the frequency of which increased with duration of diabetes and of insulin therapy and was inversely related to current HbA1c (all P < 0.05). During the preceding year, 32 individuals (15%) had experienced severe hypoglycaemia, with an estimated incidence for the entire group of 0.28 episodes/patient/year. Principal components analysis revealed two underlying symptom groups (autonomic and neuroglycopenic), similar to those reported previously by young adults with Type 1 diabetes, but the total symptom score declined with advancing age. Of the 157 with a history of hypoglycaemia, the 13 (8%) individuals who gave a history of impaired awareness of hypoglycaemia had experienced a ninefold higher incidence of severe hypoglycaemia than those with normal awareness, and reported experiencing mainly neuroglycopenic symptoms.

Conclusions  While the overall frequencies of mild and severe hypoglycaemia were lower in insulin‐treated Type 2 diabetes than have been reported previously in Type 1 diabetes, the risk of hypoglycaemia was greater with increasing duration of diabetes and of insulin therapy. Although impaired awareness of hypoglycaemia was uncommon, it was associated with a higher incidence of severe hypoglycaemia.

Diabet. Med. 20, ***–*** (2003)
A pilot randomized trial in primary care to investigate and improve knowledge, awareness and self‐management among South Asians with diabetes in Manchester
Authors: Vyas A. , Haidery A. Z. , Wiles P. G. , Gill S. , Roberts C. , Cruickshank J. K.
Published: December 2004

Aims  To investigate whether a secondary–primary care partnership education package could improve understanding of diabetes care among South Asians.

Methods  In a pilot randomized controlled trial, in the setting of eight general practices randomized to intervention or control, patients were invited to four or more rotating visits per year by one of a diabetes specialist nurse, dietician or chiropodist working with general practice staff. Participants were from lists of South Asian patients with known Type 2 diabetes in each (general) practice.

Results  Patients and practice scores at baseline and 1‐year follow‐up, from an interview using a questionnaire on knowledge, awareness and self‐management of diabetes. Responses were developed into educational packages used during intervention. Of the 411 patients listed at baseline only 211 were traced for interview (refusal only 4%). Mean age was 55.4 years, age of diabetes onset 47.1 years. Fourteen percent were employed and 35% were able to communicate in English fluently. Only 118 could be traced and interviewed at 1 year, although there was no significant difference in demography between those who completed the study and those who did not. Despite a mean of four visits/patient, intervention had no impact on scores for diabetes knowledge, or awareness [score change 0.14, 95% confidence interval (CI) −0.20, 0.49] or self‐management (−0.05, 95% CI −0.48, 0.39) between baseline and 1 year.

Conclusions  This form of secondary/primary care support did not transfer information effectively, and we suspect similar problems would arise in other similar communities. Different methods of clinician/patient information exchange need to be developed for diabetes in this South Asian group.
Effectiveness of screening in preventing blindness due to diabetic retinopathy
Authors: Arun C. S. , Ngugi N. , Lovelock L. , Taylor R.
Published: December 2004

Aims Diabetes remains the commonest cause of blindness in the working age population of the UK, but little information exists about the individuals who are currently losing sight from this cause. We determined the current blindness incidence (1998–2000) in Newcastle Health District and the clinical characteristics of these patients.

Methods Data were collected for 1998–2000 from the Royal National Institute for the Blind Liaison Office of the Newcastle Ophthalmology Department. The Ophthalmology Clinic notes on each individual were retrieved to verify clinical details, including previous eye diagnosis, dates of previous laser photocoagulation and eye surgery. The diabetes clinical records were studied to obtain information on type and duration of diabetes, blood pressure, HbA1c and other biochemical parameters. To ensure completeness of data, details of all patients registered blind attending the Newcastle Diabetic Centre were examined.

Results Twenty‐eight patients were registered blind due to diabetes and 26 partially sighted during this period. The annual incidence of blindness and partial sightedness due to diabetes in the Newcastle district were 0.35 and 0.56 per 1000, respectively. The average ages in the two groups were 65.9 ± 12.5 and 67.2 ± 12.3 years and duration of diabetes 15.5 ± 13.9 and 15.3 ± 10.6 years, respectively. Proliferative retinopathy accounted for 30 and maculopathy for 24 registrations. The times from ophthalmology referral to registration were 6.2 ± 3.5 and 4.4 ± 3.3 years in these groups, respectively. No cases resulted from false‐negative screening.

Conclusions In Newcastle district, where the retinal screening programme has been running since 1986, the rates of blindness and partial sightedness are less than one‐third of those reported in the surveys prior to 1997, confirming that objectives of the St Vincent's declarations are being achieved.

Diabet. Med. 20, 186–190 (2003)
The trigemino‐cervical reflex in tension‐type headache
Authors: Nardone R. , Tezzon F.
Published: December 2004

To investigate the pathophysiology of tension‐type headache (TTH) with special reference to central mechanisms and to the involvement of the trigeminal system. Short latency responses can be recorded in tonically active sternocleidomastoid muscle after stimulation of the infraorbital branch of the trigeminal nerve (the trigemino‐cervical reflex). This brainstem reflex was studied in 15 healthy subjects, in 15 patients with episodic tension‐type headache (ETTH) and in 15 patients with chronic tension‐type headache (CTTH) outside of the pain attacks. The trigemino‐cervical response was abnormal, in the size or latency, in 13 patients with CTTH and in only one patient with ETTH. This finding strongly suggests that only in the CTTH the underlying pathophysiology involves the trigeminal system. The trigemino‐cervical reflex is a sensitive method to evaluate the involvement of the trigeminal brainstem neurones in TTH and their assessment may provide useful diagnostic and prognostic information.
Cutaneous stimulation improves function of a chronic patient with cerebellar damage
Authors: Chan A. S. , He W‐J. , Cheung M‐C. , Bai Z‐K. , Poon W‐S. , Sun D. , Zhu X‐L. , Chan Y‐L.
Published: December 2004

The prognosis of cerebellar hemorrhage with brain stem compression is known to be poor, and patients who can usually survive are severely disabled with limited benefit from conventional rehabilitation. An innovative cutaneous stimulation was administered to a chronic patient (2 years after the incidence) who has severe ataxia, gait imbalance and limb spasticity caused by cerebellar hemorrhage. After 8 months of intervention, patient's function as evaluated by two functional measures has improved by 40%. In addition, the patient's ataxia and hypotonia have improved significantly in which he has regained the abilities to grasp objects, sit upright, control his equilibrium, and monitor an electric wheelchair. The present case study demonstrated a significant improvement of a chronic severely disabled patient who received the intervention 2 years after the accident, suggesting that the cutaneous stimulation may be a possible effective neurologic intervention.
Quality of neurology residency programmes: an Italian survey
Authors: Bonifati D. M. , Scaravilli T. , Leone M. , De Biasia F. , Naccarato M. , Ottina M. , Triggiani L. , Mancuso M.
Published: December 2004

In recent years there has been a growing interest in medical and particularly neurological education and how this should be related to the needs for patient care. To evaluate neurological training in Italy, we conducted a survey of the residency programmes aimed at different aspects of training. The survey was conducted in the 38 neurological Italian teaching hospitals and 27 of these answered. Six of the 27 centres organized all of the scheduled teaching courses. The quality of courses was considered ‘not sufficient’ in 11 schools and ‘good’ in 12. Seminars were regularly performed in 18 centres but in 60% of these the number was <1 per week. Questionnaires to evaluate the quality of teaching were lacking in all centres. Regarding the procedures performed by each resident there was a large variation between the different schools. A regular rotation of each resident in the neurophysiology services was performed in 14 schools. Ward and out patient activity varied widely and details are given. We conclude that there is marked heterogeneity in training programmes between different centres. Some important activities such as seminars and rotation in neurophysiology are performed poorly.
Rpr100893, A Substance-P Antagonist, is Not Effective in the Treatment of Migraine Attacks
Authors: Diener H-C
Published: December 2004

A global, double-blind, randomized, placebo-controlled, dose-finding, parallel-group trial was conducted to compare three oral doses of RPR100893 (1, 5, 20 mg), a substance-P antagonist, and placebo in 139 patients with migraine attacks with moderate or severe headache intensity. Headache intensity and improvement of headache after 2 h were not different in the four treatment groups. Therefore, it is concluded that this oral substance-P antagonist in the doses used here is not effective.
Diversity of native and alien plant species on rubbish dumps: effects of dump age, environmental factors and toxicity
Authors: Pyšek Antonín , PyšEk Petr , Jarošík Vojtěch , Hájek Miroslav , Wild Jan
Published: December 2004

Abstract. The flora of 96 rubbish dumps consisting of organic, inorganic and industrial wastes was studied in the Czech Republic. Some dumps contained toxic substances (heavy metals, chlorethylenes, phenols, polychlorinated biphenyls, oil hydrocarbons and biogas). Statistically significant factors explaining the number and proportional representation of native plant species, archaeophytes (introduced before 1500) and neophytes (introduced later) were determined. In total, 588 species of vascular plants were recorded, with archaeophytes (133 species) over‐represented and native species (322 species) and neophytes (133 species) under‐represented compared to their proportions in the national flora. Minimum adequate models were used to determine the effects of several factors on species numbers and proportions, independent of other factors. Dump area, human density in the region and altitude (non‐significant only in archaeophytes) were correlated positively with species numbers. Dump age, expressed as time since dump establishment, interacted with the dump toxicity; species numbers increased with dump age on non‐toxic dumps, whereas on toxic dumps no increase in numbers was noted. For neophytes, dump toxicity also interacted with human density; the increase in numbers of neophytes with human density is more pronounced on toxic than on non‐toxic dumps. The variables measured failed to explain observed differences in proportional representation of native species, archaeophytes and neophytes. This suggests that the occurrence of species growing in such extreme habitats is driven overwhelmingly by factors such as anthropogenic disturbance. A possible explanation for the positive effect of altitude on species numbers on dumps is that the effect of heating of the deposited substrate by microbiological processes, documented by previous studies, overrides the effect of altitude which was shown repeatedly to have a negative effect on species richness. Neophyte distribution is driven by an interplay of factors distinct from those influencing the distribution of native species, namely toxicity and human density (the latter we interpret as a surrogate for propagule pressure). Their distribution on studied dumps is more restricted than that of native taxa and archaeophytes, and they are more limited by toxic substrata; more intensive propagule pressure is required for their establishment at dumps with higher toxicity levels.
Floristic variation, chorological types and diversity: do they correspond at broad and local scales?
Authors: Ferrer‐Castán Dolores , Vetaas Ole R.
Published: December 2004

Abstract. The relationships between biogeographical patterns and local‐scale patterns based on microscale features, such as topoclimate, are well known in plant biogeography. Here we present a method of determining this correspondence using constrained ordination and correlations. We examined compositional gradients at two different scales, biogeographical chorotypes, and diversity. Compositional data (124 taxa × 113 plots) were sampled at four regularly spaced sites in south‐eastern Spain. Longitude (LONGI) was used as a spatial variable representing an east–west climate gradient, together with a radiation index (RADIN), elevation, and a disturbance indicator. All factors correlated with the compositional gradients, but the local‐topoclimate factor (RADIN) and the broad‐scale factor (LONGI) were most important. These two, spatially independent factors were both correlated with the two first ordination axes, and therefore should relate to the same general trend in species‐turnover. There was a significant Spearman's rank correlation between the species order along these two gradients. This is interpreted as an ecological self‐similar pattern, i.e. coenoclines repeating at different scales. A consistent order of species along local‐ and broad‐scale coenoclines may indicate that similar operational factors act at several scales, here related to moisture and temperature. The distribution of Mediterraneo–Macaronesian, Mediterraneo–Saharo–Arabian and Ibero–Maghribian species confirmed the correspondence between the broad‐ and local‐scale gradients. The former group decreases in number with increasing aridity along both gradients, whereas the two latter groups increase. A discordant pattern was found with south‐eastern Iberian endemics, but this may be explained by several of them being edaphic (saxicolous) specialists. There is a significant decrease in species richness with high radiation, but the expected increase along the longitudinal gradient from west (dry) to east (moist) was not statistically significant. This may be due to the correspondence between high richness and disturbance, both occurring in the middle of the broad‐scale gradient.
Multivariate mapping of spatial variation in biodiversity in Peruvian Amazonia
Authors: Rose Sam , Grainger Alan
Published: December 2004

Abstract. Variation of biodiversity over 72 600 km2 of tropical rain forest was mapped by multiple characteristics using a new combined nominal–numerical classification system. Three hundred and sixty‐nine tree genera were grouped into classes by eight taxonomic, geographical, phylogenetic and ecological characteristics. Each grid cell was assigned to a nominal biodiversity type by its dominant classes and classified numerically by its share of total variation in study area biodiversity. Differentiation of 0.5° cells by nominal classification was inferior to numerical classification, but improved at higher resolution. The nominal and numerical classifications were shown to have potential for complementary roles in conservation planning.
Identifying spatial components of ecological and evolutionary processes for regional conservation planning in the Cape Floristic Region, South Africa
Authors: Rouget Mathieu , Cowling Richard M. , Pressey Robert L. , Richardson David M.
Published: December 2004

Abstract.Conservation seeks ultimately to protect and maintain biodiversity indefinitely. Most biodiversity features targeted in past conservation planning have been largely aspects of ecological and biogeographical pattern rather than process. However, the persistence of biodiversity can only be ensured through consideration of the ecological and evolutionary processes that underpin biodiversity, as well as its present spatial pattern. This paper identifies spatial surrogates of ecological and evolutionary processes for regional conservation planning in one of the world's biodiversity hotspots, the Cape Floristic Region. We identified six types of spatial components (namely edaphic interfaces, upland–lowland interfaces, sand movement corridors, riverine corridors, upland–lowland gradients and macroclimatic gradients) as surrogates for key processes such as ecological and geographical diversification, and species migration. Spatial components were identified in a GIS using published data and expert knowledge. Options for achieving targets for process components have been seriously compromised by habitat transformation. Between 30 and 75% of the original extent of the spatial components currently remain functional. Options for achieving upland–lowland and macroclimatic gradients are very limited in the lowlands where most of the habitat has been transformed by agriculture. We recommend that future studies place their research on ecological and evolutionary processes in a spatially explicit framework. Areas maintaining adaptive diversification (e.g. environmental gradients, ecotones) or containing historically isolated populations should be identified and protected. The spatial dimensions of eco‐logical processes such as drought and fire refugia also need to be determined and such insights incorporated in conservation planning. Finally, connectivity within these areas should be ensured to maintain species migration and gene flow.
Acute changes in neuromuscular excitability after exhaustive whole body vibration exercise as compared to exhaustion by squatting exercise
Authors: Rittweger Jörn , Mutschelknauss Marcus , Felsenberg Dieter
Published: December 2004

The effects of hard squatting exercise with (VbX+) and without (VbX−) vibration on neuromuscular function were tested in 19 healthy young volunteers. Before and after the exercise, three different tests were performed: maximum serial jumping for 30 s, electromyography during isometric knee extension at 70% of the maximum voluntary torque, and the quantitative analysis of the patellar tendon reflex. Between VbX+ and VbX− values, there was no difference found under baseline conditions. Time to exhaustion was significantly shorter in VbX+ than in VbX− (349 ± 338 s versus 515 ± 338 s), but blood lactate (5·49 ± 2·73 mmol  l−1 versus 5·00 ± 2·26 mmol  l−1) and subjectively perceived exertion (rate of perceived exertion values 18·1 ± 1·2 versus 18·6 ± 1·6) at the termination of exercise indicate comparable levels of fatigue. After the exercise, comparable effects were observed on jump height, ground contact time, and isometric torque. The vastus lateralis mean frequency during isometric torque, however, was higher after VbX+ than after VbX−. Likewise, the tendon reflex amplitude was significantly greater after VbX+ than after VbX− (4·34 ± 3·63 Nm versus 1·68 ± 1·32 Nm). It is followed that in exercise unto comparable degrees of exhaustion and muscular fatigue, superimposed 26 Hz vibration appears to elicit an alteration in neuromuscular recruitment patterns, which apparently enhance neuromuscular excitability. Possibly, this effect may be exploited for the design of future training regimes.
Expression of enhancers is altered in Drosophila melanogaster hybrids
Authors: Hämmerle Bárbara , Ferrús Alberto
Published: December 2004

SUMMARY The molecular foundations of evolution are difficult to trace because most protein sequences are virtually identical in closely related species. The largest fraction of sequence within the genome, however, is composed of noncoding sequences where regulatory elements locate to various sites. It has been suggested that changes in the activity of these elements may trigger evolutionary change. In Drosophila, the enhancer trap procedure identifies regulatory sequences in the genome after the insertion of a P‐element–based construct. We generated new insertions and characterized their expression domains in the adult eye and larval imaginal disks using the white and LacZ reporter genes. Lines with robust expression patterns in D. melanogaster were analyzed in hybrids to test the conservation of regulatory mechanisms between species. Most of the enhancers used in this study modified their expression in hybrids with the mating species D. mauritiana and D. simulans. Expression changes resulted either in gain or loss of expression and were cell‐type or hybrid‐genome specific. Further characterization of a limited number of enhancers in D. melanogaster showed that expression domains could adapt to changes in cell number during development but not after the completion of cell proliferation. Also, expression of some enhancers appeared to be sensitive to heterochromatin from the Y but not the X chromosome. Taken together, these results demonstrate the high sensitivity of regulatory mechanisms of gene expression as a prime source of evolutionary change and suggest quantitative changes in available transcription factors as one of the mechanisms involved.
Mimicry: developmental genes that contribute to speciation
Authors: Naisbit Russell E. , Jiggins Chris D. , Mallet James
Published: December 2004

SUMMARYDespite renewed interest in the role of natural selection as a catalyst for the origin of species, the developmental and genetic basis of speciation remains poorly understood. Here we describe the genetics of Müllerian mimicry inHeliconius cydnoandH. melpomene(Lepidoptera: Nymphalidae), sister species that recently diverged to mimic otherHeliconius.This mimetic shift was a key step in their speciation, leading to pre‐ and postmating isolation. We identify 10 autosomal loci, half of which have major effects. At least eight appear to be homologous with genes known to control pattern differences within each species. Dominance has evolved under the influence of identifiable “modifier” loci rather than being a fixed characteristic of each locus. Epistasis is found at many levels: phenotypic interaction between specific pairs of genes, developmental canalization due to polygenic modifiers so that patterns are less sharply defined in hybrids, and overall fitness through ecological selection against nonmimetic hybrid genotypes. Most of the loci are clustered into two genomic regions or “supergenes,” suggesting color pattern evolution is constrained by preexisting linked elements that may have arisen via tandem duplication rather than having been assembled by natural selection. Linkage, modifiers, and epistasis affect the strength of mimicry as a barrier to gene flow between these naturally hybridizing species and may permit introgression in genomic regions unlinked to those under disruptive selection. Müllerian mimics inHeliconiususe different genetic architectures to achieve the same mimetic patterns, implying few developmental constraints. Therefore, although developmental and genomic constraints undoubtedly influence the evolutionary process, their effects are probably not strong in comparison with natural selection.
Evolution of predetermined germ cells in vertebrate embryos: implications for macroevolution
Authors: Johnson Andrew D. , Drum Matthew , Bachvarova Rosemary F. , Masi Thomas , White Mary E. , Crother Brian I.
Published: December 2004

Summary The germ line is established in animal embryos with the formation of primordial germ cells (PGCs), which give rise to gametes. Therefore, the need to form PGCs can act as a developmental constraint by inhibiting the evolution of embryonic patterning mechanisms that compromise their development. Conversely, events that stabilize the PGCs may liberate these constraints. Two modes of germ cell determination exist in animal embryos: (a) either PGCs are predetermined by the inheritance of germ cell determinants (germ plasm) or (b) PGCs are formed by inducing signals secreted by embryonic tissues (i.e., regulative determination). Surprisingly, among the major extant amphibian lineages, one mechanism is found in urodeles and the other in anurans. In anuran amphibians PGCs are predetermined by germ plasm; in urodele amphibians PGCs are formed by inducing signals. To determine which mechanism is ancestral to the tetrapod lineage and to understand the pattern of inheritance in higher vertebrates, we used a phylogenetic approach to analyze basic morphological processes in both groups and correlated these with mechanisms of germ cell determination. Our results indicate that regulative germ cell determination is a property of embryos retaining ancestral embryological processes, whereas predetermined germ cells are found in embryos with derived morphological traits. These correlations suggest that regulative germ cell formation is an important developmental constraint in vertebrate embryos, acting before the highly conserved pharyngula stage. Moreover, our analysis suggests that germ plasm has evolved independently in several lineages of vertebrate embryos.
Biology and meaning: a reappraisal of semantic biology—a review of The organic codes: an introduction to semantic biology, by Marcello Barbieri
Authors: Fusco Giuseppe
Published: December 2004

The Organic Codes: An Introduction to Semantic Biology. Barbieri, M. 2002. Cambridge University Press, Cambridge. 316 pp. Hardback $75.00. ISBN 0‐521‐82414‐1. Paperback $25.00. ISBN 0‐521‐53100‐4.
Phenotypic Comparison of Two Scottish Families with Mutations in Different Genes Causing Autosomal Dominant Nocturnal Frontal Lobe Epilepsy
Authors: McLellan Ailsa , Phillips Hilary A. , Rittey Christopher , Kirkpatrick Martin , Mulley John C. , Goudie David , Stephenson John B. P. , Tolmie John , Scheffer Ingrid E. , Berkovic Samuel F. , Zuberi Sameer M.
Published: December 2004

Summary:  Purpose: Mutations in genes coding for the α4 and β2 subunits of the neuronal nicotinic acetylcholine receptor receptor (CHRN) are known to cause autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE). Here we examined the phenotypes in two families, from the same ethnic and geographic backgrounds, with ADNFLE as a result of mutations in these two different subunits of CHRN.

Methods: All affected family members underwent a detailed clinical evaluation and review of available EEG, neuroimaging, and videotapes of seizures. The molecular study of family D is reported here; family S has a previously reported mutation in the β2 subunit of CHRN.

Results: A total of 16 individuals with ADNFLE were identified in the two families. In both families, seizure semiology, age at seizure onset, and the natural history of the seizure disorder was similar. Intrafamilial variation in terms of severity of epilepsy syndrome was present in both families. A significant number of individuals from each family had a history of psychological problems. The molecular study of family D revealed a Ser248Phe mutation in the α4 subunit of CHRN.

Conclusions: The epilepsy phenotype is not distinguishable in the two families who have ADNFLE as a result of mutations in genes coding for different CHRN subunits. This is likely to be due to the similar functional consequences of each mutation on the CHRN receptor.
Factors Predicting Outcome of Surgery for Intractable Epilepsy with Pathologically Verified Mesial Temporal Sclerosis
Authors: Hardy Steven G. , Miller John W. , Holmes Mark D. , Born Donald E. , Ojemann George A. , Dodrill Carl B. , Hallam Danial K.
Published: December 2004

Summary:  Purpose: To examine the subgroup of patients with medically intractable epilepsy receiving temporal lobectomies who have pathologically verified mesial temporal sclerosis (MTS) and to determine the relation of demographic and clinical factors, results of diagnostic testing, and details of the surgical procedure with prognosis for achieving control of seizures.

Methods: All patients receiving surgical treatment for intractable epilepsy between 1991 and 1998 at the University of Washington were reviewed. There were 118 patients who met inclusion criteria of adequate pathological analysis showing MTS without a progressive process and a minimum of 1‐year follow‐up.

Results: Only personal history of status epilepticus demonstrated significant (p = 0.0276) prediction of outcome, increasing the risk of surgical failure. No other factors were significant predictors of outcome, including history of febrile seizures, possible etiologic factors, EEG, magnetic resonance imaging (MRI) or neuropsychological testing results, or extent of resection.

Conclusions: Many factors that have been previously described to predict favorable outcome in the overall group of patients receiving temporal lobe resections for intractable epilepsy are, in fact, predictors of MTS and lose their predictive value when the subgroup of patients with confirmed MTS is examined. Neurosurgical treatment of MTS can be very effective even in the presence of significant etiologic factors, or of bilateral or extratemporal abnormalities on EEG or MRI.
Surgical Strategy and Outcomes for Epileptic Patients with Focal Cortical Dysplasia or Dysembryoplastic Neuroepithelial Tumor
Authors: Kameyama Shigeki , Fukuda Masafumi , Tomikawa Masaru , Morota Nobuhito , Oishi Makoto , Wachi Manabu , Kanazawa Osamu , Sasagawa Mutsuo , Kakita Akiyoshi , Takahashi Hitoshi
Published: December 2004

Summary:  Purpose: The purpose of this study was to clarify and compare the influence of surgical strategy on relief from seizures in patients with focal cortical dysplasia (FCD) and those with dysembryoplastic neuroepithelial tumor (DNT).

Methods: Six patients with FCD and five patients with DNT, all of whom underwent surgical resection for medically intractable epilepsy, were compared in terms of presurgical seizure types and frequency, location of lesions, magnetic resonance imaging (MRI), single‐photon emission computed tomography (SPECT) with 99mTc‐ECD, scalp electroencephalogram (EEG), and long‐term video‐EEG recording. Prolonged subdural recordings and intraoperative electrocorticograms (ECoG) were analyzed. The influences of surgical strategies on seizure outcomes were retrospectively analyzed.

Results: In all the FCD patients, ictal SPECT revealed hyperperfusion in the regions where MRI showed FCD. Interictal epileptiform activity and ictal seizure onset on ECoG performed with subdural electrodes were localized on the FCD itself. In contrast, the tumors of all the DNT patients were depicted as hypoperfuse areas on interictal SPECT scans. Ictal SPECT in one DNT patient showed hyperperfusion in the area enclosing the tumor. Interictal spiking in all DNT patients and ictal seizure onset in two DNT patients were not in the lesions themselves but in an area enclosing the lesion. All but one patient with FCD who underwent total lesionectomy became seizure free. All DNT patients who underwent resection of the epileptogenic cortex associated with lesionectomy became seizure free or achieved a 90% reduction in seizures.

Conclusions: FCD has intrinsic epileptogenicity, whereas DNT is encompassed by epileptogenic cortical areas. Therefore, total lesionectomy is an essential strategy for FCD, whereas resection of the epileptic focus associated with lesionectomy of a DNT lesion is necessary to control seizures.
The Epidemiology of Traumatic Brain Injury: A Review
Authors: Bruns John , Hauser W. Allen
Published: December 2004

Summary:  Purpose: Traumatic brain injury (TBI) not only has considerable morbidity and mortality, but it is a major cause of epilepsy. We wish to determine the frequency of TBI, special groups at risk for TBI, and mortality from TBI.

Methods: We reviewed studies of TBI that are either population based or derived from definable catchment areas that allow determination of incidence, identification of risk groups, and mortality. We review methodology used in epidemiologic studies of TBI and try to distinguish this data from that of head injury not necessarily affecting the brain. We report epidemiologic characteristics of TBI, including incidence, differences by age, gender, race and ethnic group, and geographic variation, and mortality.

Results: Population‐based studies in the United States suggest that the incidence of TBI is between 180 and 250 per 100,000 population per year. Incidence may be higher in Europe and South Africa. There are groups at high risk for TBI. This includes males and individuals living in regions characterized by socioeconomic deprivation. There are selective age groups at risk for TBI. This includes the very young, adolescents and young adults, and the elderly. Mortality varies by severity but is high in those with severe injury and in the elderly.

Conclusions: TBI is a major public health problem as well as a major cause of epilepsy. If primary prevention is to be undertaken, we must understand the epidemiology of the condition. The primary causes of TBI vary by age, socioeconomic factors, and geographic region, so any planned interventions must be tailored accordingly.
The Recognition and Management of Mood Disorders as a Comorbidity of Epilepsy
Authors: Barry John J.
Published: December 2004

Summary:  Mood disorders, especially as a comorbid finding in people with medical disorders in general, and in those with epilepsy in particular, have become increasingly recognized as a serious health concern. Unfortunately, affective disorders are underrecognized, and appropriate treatment is infrequent. The consequences of poor detection of mood disorders in people with epilepsy are discussed, along with a review of risk factors and the appearance of the disorder in this population. Prevalence rates of both depressive and bipolar spectrum disorders in people with epilepsy appear to be higher than in the general population. Recent data from community samples show elevated rates of both disorders in people with epilepsy, significantly above those in people with and without other chronic diseases. Assessment issues, including the positive and negative side effects of antiepileptic drugs, are reviewed. Treatment options are discussed, along with caveats concerning the use of antidepressants in people with epilepsy, with a focus on safety, utility, and drug interactions. Electroconvulsive therapy can also be used safely in people with epilepsy, and vagus nerve stimulation may have some utility in the treatment of depressive disorders as well. However, despite improved detection methods and effective treatments, implementation of this knowledge in neurology outpatient clinics is still problematic.