Efficacy of antimicrobial and nutraceutical treatment for canine acute diarrhoea: A systematic review and meta-analysis for European Network for Optimization of Antimicrobial Therapy (ENOVAT) guidelines

Systemic antimicrobial treatments are commonly prescribed to dogs with acute diarrhoea, while nutraceuticals (prebiotics, probiotics, and synbiotics) are frequently administered as an alternative treatment. The aim of this systematic review and meta-analysis was to assess the effectiveness of antimicrobials and nutraceutical preparations for treatment of canine acute diarrhoea (CAD). The results of this study will be used to create evidence-based treatment guidelines. PICOs (population, intervention, comparator, and outcome) were generated by a multidisciplinary expert panel taking into account opinions from stakeholders (general practitioners and dog owners). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to evaluate the certainty of the evidence. The systematic search yielded six randomised controlled trials (RCT) for antimicrobial treatment and six RCTs for nutraceutical treatment meeting the eligibility criteria. Categories of disease severity (mild, moderate, and severe) were created based on the presence of systemic signs and response to fluid therapy. Outcomes included duration of diarrhoea, duration of hospitalization, progression of disease, mortality, and adverse effects. High certainty evidence showed that antimicrobial treatment did not have a clinically relevant effect on any outcome in dogs with mild or moderate disease. Certainty of evidence was low for dogs with severe disease. Nutraceutical products did not show a clinically significant effect in shortening the duration of diarrhoea (based on very low to moderate certainty evidence). No adverse effects were reported in any of the studies.

A porous geopolymer based on aluminum-waste with acoustic properties

Paval, a solid waste stream from the aluminum industry, is used as a pore generation agent in geopolymers. Paval was mixed with coal combustion fly ash, as a geopolymeric precursor, and activated with alkaline solution with the aim of obtaining porous geopolymers to be used as noise barriers. Both geopolymeric and pore generation reactions happen simultaneously. Aluminum from Paval can react with water and OH¯ from the geopolymerization activating solution, producing hydrogen. The hydrogen gas released generates a highly porous material. The influence of the fly ash-paval proportion and the setting temperature on open porosity, compressive strength and noise-absorbing properties were evaluated. To better understand these influences, the setting time, volume expansion and mineral composition were also studied. The obtained results showed that a higher Paval content (fly ash-Paval ratio 50:50) and setting temperature (70 °C) produced a lower setting time and higher volume expansion, increasing the open porosity and improving acoustic properties, but reducing the compressive strength. The material manufactured under these conditions showed similar amorphous phase content to the non-porous geopolymers made without Paval. On the other hand, the obtained materials did not raise environmental concerns in a normalised leaching test.

Fueguian crania and the circum-Pacific rim variation

OBJECTIVES

The Fueguians are descendants of the first settlers of America, a 'relict' isolated geographically for 10,000 years. We compared their cranial variation with other Americans, and samples from Asia and Australia to know whether the modern extinct Fueguians can be considered Paleoamericans or not.

MATERIALS AND METHODS

Herein we study 176 Fuego-Patagonian skulls, the largest cranial sample to be studied, refined and well documented, using CVA, and the D² of Mahalanobis. The affinities between populations and sexual dimorphism were jointly studied.

RESULTS

Terrestrial hunters (Selknam) have a different cranial morphology from sea canoeists (Yamana, Alakaluf) particularly with regard to cranial size and robustness. In the American context, there are extreme differences between the canoeists of Santa Cruz (California) and the Eskimos and canoeists of Fuego-Patagonia in terms of cranial size, prognathism and development of the frontal region. Fueguian canoeists are cranially closer to the Californian ones than to their Fueguian neighbors, the Selknam. Our results favor the hypothesis of two different flows for the origin of the first populators of Tierra del Fuego.

DISCUSSION

We concluded that the robusticity of some Fuegians (Selknam) might be the result of an allometric pattern of overall robusticity expression well as a result of epigenetics or differential reproduction (Larsen, 2015:264) or hypothetical endocrine changes (Bernal et al. in Am J Hum Biol 2006;18:748-765). When compared with three Australian-Melanesian series, the group comprising Amerindians, Ainu, and Eskimos clusters together as they are all extremely different from the former in terms of both cranial size and shape.

Adjuvant therapy for highly malignant canine mammary tumours: Cox-2 inhibitor versus chemotherapy: a case-control prospective study

Cyclooxygenase-2 (Cox-2) enzyme participates in different steps of the carcinogenetic process and in canine mammary tumours (CMTs), a high expression of Cox-2 is associated with malignancy and tumour angiogenesis. The objectives of the study were to evaluate the disease-free survival (DFS) and overall survival (OS) of a Cox-2 inhibitor as adjuvant therapy in dogs with highly malignant (HM)-CMTs and compare it with that of dogs treated with chemotherapy and with control dogs. Twenty-eight dogs were prospectively included. After surgery, dogs were alternatively allocated into two treatment groups (chemotherapy with mitoxantrone n=8; Cox-2 inhibitor, firocoxib n=7). Control group (n=13) included dogs whose owners rejected adjuvant therapy. All dogs were followed up for two years or until death. The DFS was significantly higher in dogs that received adjuvant treatment (mitoxantrone or firocoxib) (P=0.030) than in control dogs. Dogs on firocoxib treatment had significantly higher DFS (P=0.015) and OS (P=0.048) than control dogs. The DFS and OS of dogs on mitoxantrone treatment were not statistically different from controls. In conclusion, this study supports the use of firocoxib for the treatment of HM-CMTs. Further studies are needed to compare the efficacy of chemotherapy drugs versus Cox-2 inhibitors as adjuvant treatment in these cases.

The effect of levosulpiride on in vitro motor patterns in the human gastric fundus, antrum, and jejunum

BACKGROUND

Levosulpiride is a 5HT4 agonist/D2 antagonist prokinetic agent used to improve gastric emptying in patients with functional dyspepsia or gastroparesis. The aim of this study was to characterize its effect on the main in vitro motility patterns in the human fundus, antrum, and jejunum.

METHODS

Circular muscle strips from human stomach (antrum and fundus) and jejunum, obtained from 46 patients undergoing bariatric surgery, were studied using organ baths. Enteric motor neurons (EMNs) were stimulated by electrical field stimulation (EFS).

KEY RESULTS

Levosulpiride, caused an increase in the EFS-induced cholinergic contractions in the gastric antrum (+37 ± 15.18% at 100 μM, pEC50 = 4.46 ± 0.14; p < 0.05, n = 8) and jejunum (+45.4 ± 22.03% at 100 μM, pEC50 = 3.78 ± 6.81; p < 0.05, n = 5), but not in the gastric fundus. It also caused a slight decrease in tone and frequency of spontaneous contractions in the jejunum, but did not have any major effect on tone or spontaneous contractions in the stomach. It did not have any effect on EFS-induced relaxations mediated by nitric oxide (NO) in the stomach (antrum and fundus) and by NO and ATP in the jejunum.

CONCLUSIONS & INFERENCES

Our results suggest that the prokinetic effects of levosulpiride in humans are mainly due to the facilitation of the release of acetylcholine by enteric motor neurons in the gastric antrum and the jejunum.

Individual inversions or their combinations: which is the main selective target in a natural population of Drosophila subobscura?

It is generally accepted that chromosomal inversions have been key elements in adaptation and speciation processes. In this context, Drosophila subobscura has been, and still is, an excellent model species due to its rich chromosomal polymorphism. In this species, many analyses from natural populations have demonstrated the adaptive potential of individual inversions (and their overlapped combinations, the so-called arrangements). However, little information is available on the evolutionary role of combinations generated by inversions located in homologous and nonhomologous chromosomes. The aim of this research was to ascertain whether these combinations are also a target for natural selection. For this objective, we have studied the inversion composition of homologous and nonhomologous chromosomes from a D. subobscura sample collected in a well-studied population, Mount Avala (Serbia). No significant deviation from H-W expectations was detected, and when comparing particular karyotypic combinations, likelihood ratios close to 1 were obtained. Thus, it seems that for each pair of homologous chromosomes inversions no deviation from randomness was detected. Finally, no linkage disequilibrium was observed between inversions located in different chromosomes of the karyotype. For all these reasons, it can be assumed that, at the cytological level, the individual inversions rather than their combinations in different chromosomes are the main target of selection.

Development of fly ash boards with thermal, acoustic and fire insulation properties

This paper presents an experimental analysis on a new board composed of gypsum and fly ashes from coal combustion, which are mutually compatible. Physical and mechanical properties, sound absorption coefficient, thermal properties and leaching test have been obtained. The mechanical properties showed similar values to other commercial products. As far as the acoustic insulation characteristics are concerned, sound absorption coefficients of 0.3 and 0.8 were found. The board presents a low thermal conductivity and a fire resistance higher than 50 min (for 4 cm of thickness). The leaching of trace elements was below the leaching limit values. These boards can be considered as suitable to be used in building applications as partitions.

Changes in the response to excitatory antagonists, agonists, and spasmolytic agents in circular colonic smooth muscle strips from patients with diverticulosis

BACKGROUND

Colonic samples from asymptomatic diverticulosis (DS) patients presented enhanced electrical field stimulation (EFS)-contractions, in an earlier study of ours, suggesting increased endogenous responses. The aim of this study was to explore changes in excitatory neuromuscular transmission and to assess the pharmacodynamics of spasmolytic agents in DS.

METHODS

Circular muscle strips from sigmoid colon of DS patients (n = 30; 69.5 ± 14.8 years) and controls (n = 32; 64.7 ± 16.2 years) were studied using organ baths to evaluate the direct effect of excitatory agonists (carbachol, neurokinin A [NKA] and substance P [SP]), and the effect of antagonists (atropine and NK2 antagonist GR94800) and spasmolytic drugs (otilonium bromide [OB] and N-butyl-hyoscine) on the contractions induced by EFS-stimulation of excitatory motorneurons. qRT-PCR was also performed to compare mRNA expression of M2 , M3 , NK2 receptors and L-type calcium channels.

KEY RESULTS

Contractions to carbachol (Emax : 663.7 ± 305.6% control vs 2698.0 ± 439.5% DS; p < 0.0005) and NKA (Emax : 387.8 ± 35.6% vs 1102.0 ± 190.1%; p < 0.0005) were higher in DS group, without differences for SP. Higher potency for DS patients was observed in the concentration-response curves for atropine (pIC50  = 8.56 ± 0.15 control vs pIC50  = 9.95 ± 0.18 DS group; p < 0.005) and slightly higher for GR94800 (pIC50  = 7.21 ± 0.18 control vs pIC50  = 7.97 ± 0.32 group; p < 0.0001). Lower efficacy (Emax ) and potency (pIC50 ) was observed for spasmolytic drugs in DS, whereas no differences were found regarding the relative expression of the receptors evaluated between groups.

CONCLUSIONS & INFERENCES

The greater response to cholinergic and tachykinergic agonists and greater potency for muscarinic and NK2 antagonists observed in DS might play a role in the spasticity found in diverticular disease.

Mast cell degranulation inhibits motor patterns of human ileum and sigmoid colon in vitro: relevance for postoperative ileus

BACKGROUND

Local release of mast cell proteases during gastrointestinal surgery is associated with the inhibition of motility and postoperative ileus (POI). We determined whether activation of intramuscular mast cell affects the motor patterns of the human ileum and colon and whether proteases are involved.

METHODS

Motor response of ileal and colonic circular muscle strips was measured in organ bath. Mast cell degranulation was induced by compound 48/80 (c48/80; 25-675 μg/mL). Motor response was quantified as tone, rhythmic phasic contractions (RPCs) and contractions to electric field stimulation (EFS; 40 Hz), and bethanechol-evoked contractions. Ketotifen (10(-6) mol/L) and a protease inhibitor cocktail (P8340) were used to evaluate the role of mast cell mediators.

KEY RESULTS

(a) c48/80 impaired the spontaneous and the electrically evoked motor response in small bowel and colonic strips (sigmoid colon EC50 : 460.0 μg/mL for RPCs and 8.9 μg/mL for electrically evoked contraction amplitudes) and bethanechol-evoked contractions. (b) Preincubation with ketotifen (10(-6) mol/L, 1 h) prevented the impairment of RPCs and EFS-evoked contractions in the sigmoid colon and ileum but not in the right colon. (c) Preincubation with P8340 also prevented the impairment of contractions in the sigmoid colon but not in the ileum or the right colon.

CONCLUSIONS & INFERENCES

Mast cell degranulation by c48/80 inhibits the spontaneous and the nerve-mediated motor response in the human ileum and colon. The effect is partially mediated by mast cell proteases and could be relevant in the pathophysiology of POI.

Inversion polymorphism in two Serbian natural populations of Drosophila subobscura: analysis of long-term changes

To study whether inversions (or arrangements) by themselves or karyotypes are the main global warming adaptive target of natural selection, two Drosophila subobscura Serbian populations (Apatin and Petnica) were re-analyzed using different statistical approaches. Both populations were sampled in an approximately 15 years period: Apatin in 1994 and 2008 + 2009 and Petnica in 1995 and 2010. For all chromosomes, the four collections studied were in Hardy-Weinberg equilibrium. Thus, it seems that inversions (or arrangements) combined at random to constitute populations' karyotypes. However, there were differences in karyotypic frequencies along the years, although they were significant only for Apatin population. It is possible to conclude that inversions (or arrangements) are likely the target of natural selection, because they presented long-term changes, but combine at random to generate the corresponding karyotypic combinations. As a consequence, the frequencies of karyotypes also change along time.

Long-term survival of dogs with adrenal-dependent hyperadrenocorticism: a comparison between mitotane and twice daily trilostane treatment

Background

Treatment of adrenal‐dependent hyperadrenocorticism (ADH) involves either surgical resection of the adrenal tumor or medical therapy. For many years, mitotane has been considered the medical treatment of choice for dogs with ADH.

Objectives

The aim of this study was to determine survival and prognostic factors for dogs with ADH treated with mitotane and trilostane.

Animals

Twenty‐six dogs with ADH were included in the study.

Methods

Fourteen dogs were treated with mitotane and 12 dogs were treated with trilostane. Medical records were reviewed. Epidemiologic factors, signalment, clinicopathologic abnormalities, endocrine test results, and treatment protocols were evaluated to identify potential predictive factors of overall survival time.

Results

Survival times of dogs treated with mitotane (median, 15.6 months) or trilostane (median, 14.0 months) were not significantly different. Using univariate analysis, age and postadrenocorticotropic hormone cortisol concentrations were inversely correlated with survival time. The multivariate model also identified weakness at presentation as a negative prognostic indicator.

Conclusion and Clinical Importance

The type of medical treatment (mitotane versus trilostane) does not influence survival time in dogs with ADH; therefore, trilostane, a drug with less frequent and milder adverse effects, might be used as the primary medical treatment when adrenalectomy cannot be performed.

O-chromosome lethal frequencies in Serbian and Montenegrin Drosophila subobscura populations

Lethal chromosomal frequencies were obtained from three Drosophila subobscura samples from the Mt. Avala (Serbia) population in September 2003 (0.218), June 2004 (0.204) and September 2004 (0.250). These values and those from other Balkan populations studied previously (Petnica, Kamariste, Zanjic and Djerdap) were used to analyze the possible effect of population, year, month and altitude above sea level on lethal chromosomal frequencies. According to ANOVAS no effect were observed. Furthermore, the lethal frequencies of the Balkan populations did not vary according to latitude. This is probably due to the relative proximity and high gene flow between these populations. From a joint study of all the Palearctic D. subobscura populations so far analyzed, it can be deduced that the Balkan populations are located in the central area of the species distribution. Finally, it seems that lethal chromosomal frequencies are a consequence of the genetic structure of the populations.

Seasonal record from recent fluvial tufa deposits (Monasterio de Piedra, NE Spain): sedimentological and stable isotope data

Physical and hydrochemical parameters and sedimentation rates were monitored twice a year from August 1999 to March 2003 at the Monasterio de Piedra area (NE Spain). Different tufa facies related to distinct fluvial subenvironments were characterized and the isotopic composition of water was analysed seasonally. Sedimentary features (thickness, texture and structure) and stable isotope composition of the seasonal record on tablets were analysed. The seasonal intervals were identified from six-monthly thickness measurements on tablets.

Sedimentation rates had a strong seasonal pattern with higher values in warm periods than in cool ones, although erosive events and sporadic, warmer-than-normal climate conditions altered it. Three main types of fluvial facies were studied in detail: dense, stromatolitic tufa; dense to porous, massive tufa; and spongy, moss- and alga-bearing, crudely laminated tufa. Textural features of deposits from warm and cool periods had a variable pattern.

The sediment δ18O composition showed a rhythmic variation, with higher values in cool periods and lower in warm ones, caused by the fractionation due to seasonal temperature variations. The calculated temperatures for a theoretical equilibrium precipitation accord with the actual measured temperatures. The sediment δ13C composition had an irregular pattern, indicating that other parameters than temperature intervened in the fluvial system.

INCA: new statistic for estimating the number of clusters and identifying atypical units

This paper presents a solution to two problems that arise in the classification of data such as types of tumor, samples of gene expression profiles or general biomedical data. First, to estimate the real number of clusters in a data set and second to decide whether a new unit belongs to one of these previously identified clusters or it is an outlier or atypical unit. We propose a new statistic which allows us to solve these problems. As our approach is based on a measure of distance or dissimilarity between any pair of units, it can be applied to any kind of multivariate data (continuous, binary or multi-attribute data) and it has applications in many biomedical fields. We validated the approach in simulated examples and applied it to the diagnosis of dermal diseases and to the analysis of lymphatic cancer data, showing the good performance of our approach.

CLUM: a cluster program for analyzing microarray data

Microarray technology is increasingly being applied in biological and medical research to address a wide range of problems. Cluster analysis has proven to be a very useful tool for investigating the structure of microarray data. This paper presents a program for clustering microarray data, which is based on the so call path-distance. The algorithm gives in each step a partition in two clusters and no prior assumptions on the structure of clusters are required. It assigns each object (gene or sample) to only one cluster and gives the global optimum for the function that quantifies the adequacy of a given partition of the sample into k clusters. The program was tested on experimental data sets, showing the robustness of the algorithm.

Comparison of non-selective adrenocorticolysis with mitotane or trilostane for the treatment of dogs with pituitary-dependent hyperadrenocorticism

Forty-six dogs with pituitary-dependent hyperadrenocorticism were treated with mitotane by the non-selective adrenocorticolysis protocol and 40 were treated twice a day with trilostane. The treatment groups were compared by chi-squared tests, and survival data were analysed using Kaplan-Meier survival plots and a Cox proportional hazard method. The non-selective adrenocorticolysis protocol was very effective (89 per cent), its toxicity was moderate (24 per cent) and there were fewer recurrences (29 per cent) than reported with the classical selective adrenocorticolysis protocol (58 per cent). In a multivariate model, age and bodyweight at diagnosis were significantly negatively correlated with survival time. The median survival time of the dogs treated with trilostane twice a day (900 days) was longer (P=0.05) than that of the dogs treated with mitotane (720 days).

Treatment of pulmonary sequestration by video-assisted thoracic surgery (VATS)

Pulmonary sequestration is a rare malformation of the respiratory tract that accounts for 0.15-6.4% of all congenital lung anomalies. Treatment requires resection of the lesion, provided that there is no technical contraindication. The lesion should first be evaluated using video thoracoscopy and then resected whenever possible by video-assisted thoracic surgery (VATS). We report a case of extralobar pulmonary sequestration in a 48-year-old woman. She underwent lobectomy by VATS and achieved an excellent outcome.

Colonization of America by Drosophila subobscura: heterotic effect of chromosomal arrangements revealed by the persistence of lethal genes

About 20 years ago Drosophila subobscura, a native Palearctic species, colonized both North and South America. In Palearctic populations lethal genes are not associated in general with particular chromosomal arrangements. In colonizing populations they are not randomly distributed and usually are associated to a different degree with chromosomal arrangements caused by the founder event. The persistence of two lethal genes in the colonizing populations, one completely associated with the O(5) inversion and the other partially associated with the O(3+4+7) arrangement, has been analyzed. In all populations studied (five North American and six South American) the observed frequency of the lethal gene completely associated with the O(5) inversion is higher than expected, the difference being statistically significant in all South American and one North American populations. The observed frequency of the lethal gene partially associated with the O(3+4+7) arrangement is also significantly higher than expected. Taking into account that the O(5) inversion exhibits significant latitudinal clines both in North and South America, an overdominant model favoring the heterokaryotypes seems to be in operation. From this model, a polynomial expression has been developed that allows us to estimate the relative fitness and the coefficient of selection against all karyotypes not carrying the O(5) inversion. The relative fitness of the O(5) heterokaryotypes is higher in South American than in North American populations. Furthermore, the observed frequencies of the lethal genes studied are in general very close to those of the equilibrium. This case is an outstanding demonstration in nature of an heterotic effect of chromosomal segments associated with lethal genes on a large geographic scale.

A statistical analysis of nucleotide substitutions in the Drosophila Adh region reflects irregularities in molecular clocks

Substitutions rates are expected to be rather constant when a gene is compared between species. To analyze this feature, Ka/Ks ratios have been studied for Alcohol dehydrogenase (Adh) and Alcohol dehydrogenase duplication (Adh-dup) genes in Drosophila species. Adh Ka/Ks values are lower in intrasubgenus comparisons involving species of the Sophophora group than when these species are compared to the D. immigrans and S. lebanonensis, and this difference does not occur in the Adh-dup comparisons.

Colonization of America by Drosophila subobscura: spatial and temporal lethal-gene allelism

About twenty years ago Drosophila subobscura, a western Palearctic species, colonized both North and South America. Lethal genes in the O chromosome has been subject to much research. Lethal gene allelisms between American populations far away have been studied. These allelisms were not negligible, but all cases were due to the lethal gene completely associated to the O5 chromosomal inversion. Here we analyze the lethal genes in a new American population of D. subobscura (Centralia, Washington), located fairly close to a previously studied population (Bellingham, Washington) and separated in space and time with other American populations (Gilroy I and II in California and Santiago de Chile). The frequencies of lethal and semilethal genes of Centralia were 16.9+/-4.6 and 6.2+/-3.0, respectively. The intrapopulational allelism of Centralia was 0.122+/-0.036. Interpopulational allelisms were studied using the lethal genes from the populations separated in space and time from Centralia. The interpopulational allelisms between Centralia and Gilroy I (California) and between Centralia and Bellingham (Washington) were higher than the intrapopulational allelism (0.155+/-0.032 and 0.153+/-0.024, respectively). In all these cases allelism was due to a complete association between a lethal gene and the O5 chromosomal inversion. Accordingly, no other lethal genes are shared in these populations.

[Analysis of a programme of direct referral between primary and specialist care in potential surgery patients]

OBJECTIVE

To describe the results of a programme of direct referral of potential surgery patients between primary and specialist care, designed to lessen waiting-times.Design. Prospective, longitudinal and descriptive study.

SETTING

Health Area N. masculine 19 (Valencian Health Service): Surgery Service of Elche Hospital and 6 Health Centres.

PARTICIPANTS

Patients with pathologies that do not need special techniques for diagnosis except examination and who have a clear irrefutable indication of surgery without risk factors (ASA I-II).Intervention. The referral protocol consists of: a) diagnosis of pathology and pre-operative study in primary care (PC); b) appointment made by phone for the surgery clinic at the hospital, where diagnosis and pre-operative study are confirmed; c) referral and operation in the unit of non-hospital major surgery (UCMA); d) monitoring post-operation by the home hospitalisation unit (HHU) or preferably by the health centre, and e) check-up at the surgery clinic. Main measurements. The degree of agreement between PC and the specialist, assessment of the pre-operative study, and waiting time.

RESULTS

86 patients were referred (average age, 35; 76% male) by 28 doctors. The most common pathologies were hernia (36%), pilonidal sinus (23.2%) and miscellaneous (32.5%). There was general agreement in diagnosis in 90.7% of cases. 89.5% of patients brought the proper pre-operative study. Mean waiting time between the primary care consultation in the different procedures and the first hospital consultation was 19 days; with 44 more days elapsing till the surgical operation.

CONCLUSIONS

This new programme is effective and economic, in that there is <<adequate referral>> of patients, waiting time is reduced by over 7 months for pilonidal sinus and by over 2 years for hernia pathology, and the procedure can be used for a large number of patients, as the pathologies involved are very common.

[Analysis of the changes observed in the sleep EEG recording of patients with juvenile myoclonic epilepsy]

OBJECTIVE

The initial phases and transitional periods of sleep facilitate electroclinical manifestations of juvenile myoclonic epilepsy (JME). The period at the time of waking is identified in the different phases of sleep by cyclic electrophysiological oscillations, which in turn are synchronous with the spike-and-wave or multiple spike-and-wave activity of the electric crises seen in JME and other epileptic syndromes. This observation supports the theory of an alternating cyclical pattern (ACP) as the trigger of these discharges.

PATIENTS AND METHODS

Following classical macrostructural and microstructural patterns of EEG sleep analysis, we investigated electrophysiological behavior in 13 patients diagnosed as having JME, and 5 persons of homogeneous epidemiological characteristics as controls.

RESULTS

In our study we observed that both groups had similar macrostructural sleep parameters. However, in patients prone to crises, these were concentrated in the first two hours recorded and showed no differences in sleep-waking transition or ACP of phase I sleep. These were significant when both periods were compared with the remaining NREM sleep.

CONCLUSION

We conclude from this study that ACP is the microstructural element of sleep which modulates and permits classification of epileptiform anomalies, mainly in studies at the time of wakening.

[Concurrence of short and long lasting episodes of nocturnal paroxysmal dystonia in an epileptic patient]

We report the case of a patient with nocturnal paroxysmal dystonia (NPD) meeting not only the diagnostic criteria described by Lugaresi et al. in 1981, but also presenting with features suggestive of underlying epilepsy as well as other differences from the diagnostic criteria originally described for NPD, such as short- and long-lasting episodes and poor response to antiepileptic drugs. The case we describe suggests a different entity, one that is unrelated to epilepsy or true NPD.

[Devic's optic neuromyelitis. Follow-up of the evolution of the medullary lesions using magnetic resonance]

The nosology of Devic's optic neuromyelitis (NMOD) is controversial. Although classically considered to be a variety of multiple sclerosis, there are a number of differentiating characteristics which would permit classification as a separate condition. The evolution of changes in the medulla, as shown by magnetic resonance, is described in a patient with recurrent episodes of myelitis and optic neuritis. In successive exacerbations widening of the medulla was seen, with the appearance of areas of cavitation which later gave rise to atrophy of the medulla. During an 18 year follow-up period the symptoms were only of visual and medullary pathology, on magnetic resonance no other lesions were found in other parts of the central nervous system. The condition corresponded to Devic's optic neuromyelitis (NMOD). Whether it is a variant type of multiple sclerosis or a distinct entity, NMOD shows differentiating characteristics.

[The effect of angioplasty on cerebral vasomotor reactivity in patients with important stenosis of the internal carotid artery]

INTRODUCTION

We present the preliminary results of the effects on percutaneous translumenal angioplasty (PTA) cerebral haemodynamics in thirty patients with important stenosis of the internal carotidal artery.

MATERIALS AND METHODS

Using transcranial doppler (TCD) with acetazolamide (ACZ) as a vasodilatory stimulus, we assessed vasomotor reactivity (VR and pulsatility index (Pl) both before and three months after angioplasty. We also carried out single photon emission computerized tomography (SPECT) and cartography and frequency measurement by electroencephalogram (EEG) again both before and after PTA.

RESULTS

Of the first twelve patients who completed the study, VR was maintained in nine and PI increased after PTA in seven. In three patients VR was exhausted and in two recovered after PTA.

CONCLUSIONS

PTA improved cerebral haemodynamics. Similar more exhaustive studies are needed if revascularization techniques are to be useful in treating patients with this level of stenosis but who are asymptomatic as to the risk of haemodynamic cerebral vasomotor angioplasty.

[Congenital myopathy with cores and nemaline rods in one family]

We present a mother and 2 children with congenital myopathy whose clinical signs were facial paresis in all three, and mild involvement of the lower extremities in the mother and one son. All three presented skeletal abnormalities, hypertelorism, arched palate, retraction of the Achilles tendon or short neck. Symptoms were not progressive and muscle biopsies showed central cores and nemaline rods in the mother and only nemaline rods in the 2 sons. The mother also suffered carpal tunnel syndrome, as had other members of the family as the result of autosomal dominant inheritance.

[Sumatriptan and cluster headache]

Double-blind studies have demonstrated the efficacy of sumatriptan for the treatment of cluster headache (CH) but little is known about its use on a daily basis. The open trial reported here analyzed the efficacy, tolerance and appropriateness of subcutaneous administration of sumatriptan; the results are compared with findings for other treatments of CH. Sumatriptan was used in 232 attacks suffered by 16 patients and its effect was very rapid. Pain began to diminish a mean 9 minutes after injection and the most intense had disappeared in less than 15 minutes. All the patients preferred sumatriptan to other treatments. No serious side effects were recorded and the patients were satisfied with subcutaneous injection. Sumatriptan was considered the first choice medication for treatment of CH symptoms, although its high cost is a drawback that had to be taken into account.

[Complete recovery from transient coma in bilateral paramedian thalamic infarctions]

Bilateral paramedian thalamic infarcts (BPTI) can begin clinically with transient coma, after which symptoms of fluctuating hypersomnolence, irrational behaviour, or amnesic states may be observed. We present two patients with BPTI who began with coma, recovering spontaneously in under eight hours, with no accompanying symptoms.

[Recessive distal myopathies. Five cases]

We present five patients with distal weakness in the lower extremities with onset in adolescence. Paresis tended to occur in the gastrocnemia in 3 patients and was accompanied by marked elevation of CPK (> 10 times higher than normal). Muscle biopsies showed signs of dystrophy. The clinical picture for these patients was consistent with the diagnosis of recessive distal myopathy (Miyoshi's form). The differential sign in the other 2 cases was greater involvement of the anteroexternal leg muscles and the presence of rimmed vacuoles similar to those characteristic of Nonaka's vacuolar distal myopathy.

[Chronic cluster headache: course and outcome of treatment]

We analyze the results of treatment and the course of disease in 20 patients suffering from chronic cluster headache. Patients were followed for an average of 5 years. Sumatriptan provided the most effective relief of symptoms in those who used that medication. The results of surgical and medical prophylaxes were poor. The disease either remitted or changed to an episodic variety after several months or years in most patients. There is no evidence to suggest that these changes were related to any particular treatment.

[Alien limb behavior associated with Alzheimer's disease]

A 48-year-old female developed apraxia, followed by aphasia and dementia. Clinical examination also showed an alien member sign, supranuclear gaze paresis, myoclonus and rigidity on the right arm. The examination of the frontal lobe biopsy showed typical lesions of Alzheimer's disease as the only neuropathological abnormality. The association of this clinical syndrome with Alzheimer's pathology is unusual.

Anti-Ri antibodies associated with opsoclonus and progressive encephalomyelitis with rigidity

A 57-year-old woman without a known neoplasia developed opsoclonus, myoclonus, and ataxia. Positive anti-Ri antibodies were present in both serum and CSF. The patient also had progressive encephalomyelitis with rigidity, an association not previously described.

Regulation of the rab17 gene promoter in transgenic Arabidopsis wild-type, ABA-deficient and ABA-insensitive mutants

The abscisic acid-responsive gene rab17 is induced during maize embryo maturation and in vegetative tissues under water stress conditions. To investigate how ABA is involved in the induction of the rab17 gene, we present here a genetic approach to analyse the transcriptional regulation of the 1.3 kb rab17 promoter fragment in transgenic wild-type Arabidopsis and mutants which are deficient (aba) and insensitive (abi1, abi2 and abi3) to ABA. During seed development the rab17 promoter fragment confers similar temporal and spatial regulation on the reporter gene GUS, both in transgenic wild-type and ABA-deficient and ABA-insensitive mutants. The rab17 promoter was only active in embryo and endosperm during late seed development, although the ABA-deficient embryo mutant showed a reduction in the level of GUS activity. During germination rab17 promoter activity decreases, and GUS activity is not enhanced by water stress in transgenic wild-type and mutant plants. In contrast, transcription of the Arabidopsis endogenous rab gene is stimulated by water stress, both in wild-type and ABA-insensitive mutants. Our data suggest that different molecular mechanisms mediate seed-specific expression and ABA water stress induction of the rab17 gene and indicate strong conservation of the seed-specific regulatory mechanism for rab genes in monocot and dicot plants.

[Cluster headache with a familial presentation]

Four out of 190 patients suffering from cluster headache (CH) were of familial presentation. In three families the affected relative was either the brother or the father of the proband. In the other family the disorder affected the father, two brothers, and perhaps the grand mother of the patient. The prevalence of the disease seems to be higher among relatives of CH patients compared to general population. It is unclear whether this familial aggregation depends up on genetic factors.

Two different Em-like genes are expressed in Arabidopsis thaliana seeds during maturation

Using a radish cDNA probe, we have isolated and characterized two genomic clones from Arabidopsis thaliana (GEA1 and GEA6) encoding two different proteins that are homologous to the "Early methionine-labelled" (Em) protein of wheat. GEA1 differs from GEA6 and Em clones of wheat in that a sequence coding for 20 amino acid residues is tandemly repeated 4 times. These two genomic clones correspond to two genes named AtEm1 and AtEm6. Sequencing of several cDNA clones showed that both genes are expressed. The transcription start site was determined for both genes by RNase mapping. The site of polyadenylation is variable and there is no obvious consensus sequence for polyadenylation at the 3' ends of the genes. mRNA corresponding to GEA6 is present only in nearly dry and dry seeds, whereas the corresponding to GEA1 appears in immature seeds and is maximum in dry seeds. No expression of either gene could be detected in leaf, stem, or floral buds. Expression of both genes could be detected in immature seeds when the siliques were incubated with abscisic acid (ABA), demonstrating that both genes are ABA responsive. However, examination of the 5' upstream region does not reveal any extensive homology, suggesting that regulation of the two genes differs. In situ hybridization with a GEA1 probe demonstrated that the expression of this gene is essentially located in the provascular tissues of the cotyledons and axis of the dry seed as well as in the epiderm and outer layers of the cortex in the embryo axis.

Antihypercholesterolemic effect of dipyridamole in chickens

The administration of a 4 mg/kg dose of dipyridamole daily in chickens fed a diet supplemented with 2% cholesterol reversed the hypercholesterolemic effects of the diet. In particular, it reduced the plasma cholesterol concentration in approximately 18%; the levels of very-low-density lipoproteins and intermediate-density lipoproteins and the liver cholesterol content. Although the mechanism was not fully elucidated, the increased excretion of cholesterol seemed to be responsible for the lipid lowering effect. When dipyridamole was administered in chickens fed the same diet without cholesterol no significant changes were observed. Inasmuch as the chicken lipoprotein metabolism differs in several aspects to human, the extrapolation of the hypocholesterolemic effect of dipyridamole to man must be made with care.

The upper arm fasciocutaneous flap in breast reconstruction

We present a woman who, after a modified mastectomy, underwent a breast reconstruction with a tissue expander that soon afterward developed a Baker grade 4 capsular contracture. The result was improved with a capsulotomy and a deepithelialized upper arm fasciocutaneous flap, to give fullness to the lateral aspect of the breast. We think that the upper arm fasciocutaneous flap can be a good adjunct in breast reconstruction when lack of tissue in the lateral aspect of the breast or axilla jeopardizes the aesthetic results.

[Repeated cerebral embolism in a patient with papillary fibroelastoma of the mitral valve detected by two-dimensional echocardiography]

We report a 68 years-old woman with repeated cerebral embolism, secondary to a papillary fibroelastoma of mitral valve, located in its ventricular side. It was detected by two-dimensional echocardiography. Surgical treatment was satisfactory.