Single-center long-term results of vagus nerve stimulation for pediatric epilepsy: a 10-17-year follow-up study.

PURPOSE: A retrospective study, based on a prospectively built database, presents the results of long-term follow-up care of pediatric vagus nerve stimulation (VNS) patients in terms of seizure outcome, surgical aspects, the potential impact of maturation, and medication changes. METHODS: From a prospectively built database, 16 VNS patients (median age 12.0 years, range 6.0 to 16.0 years; median seizure duration 6.5 years, range 2.0 to 15.5 years) followed for at least 10 years were graded as non-responder - NR (seizure frequency reduction < 50%), responder - R (reduction ≥ 50% and < 80%), and 80% responder - 80R (reduction ≥ 80%). Data about surgical aspects (battery replacement, system complications), seizure dynamics, and medication changes were taken from the database. RESULTS: The early percentages of good results (80R + R) were 43.8% (year 1), 50.0% (year 2), and 43.8% (year 3). These percentages remained stable between years 10 and 12 (50% year 10; 46.7% year 11; 50% year 12) and increased in years 16 (60%) and 17 (75%). Depleted batteries were replaced in ten patients, six of whom were either R or 80R. In the four NR, the indication for replacement was improved quality of life. Three patients had VNS explanted or switched off-one had repeated asystolia and two were NR. The effect of hormonal changes in menarche on seizure was not proven. During the study, antiseizure medication was changed in all patients. CONCLUSIONS: The study proved the efficacy and safety of VNS in pediatric patients over an exceptionally long follow-up period. The demand for battery replacements indicates a positive treatment effect.

COVID-19 associated Paediatric Inflammatory Multisystem Syndrome (PIMS) in children.

The clinical course of the SARS-CoV-2 virus infection (COVID-19 disease) in paediatric patients is predominantly mild. However, in a small percentage of paediatric patients, the COVID-19 could lead to the development of with the Paediatric Inflammatory Multisystem Syndrome (PIMS) presenting as high fever, gastrointestinal symptoms, neurological symptomatology and even as multiorgan dysfunction. These three cases represent the first published report of critically ill paediatric patients with PIMS in the Czech Republic.

Brivaracetam use in children with epilepsy: A retrospective multicenter study.

PURPOSE: This retrospective multicenter study aimed to assess the efficacy and safety of brivaracetam (BRV) in pediatric epilepsy. METHODS: Our cohort consisted of 93 children (mean age 11.5 ± 7.5 years) with a wide spectrum of pediatric epilepsy, including epileptic encephalopathy and generalized epilepsy. Of these, 61 (60.4%) were diagnosed with focal epilepsy, 19 (15.8%) with generalized epilepsy, and 16 (15.8%) with combined epilepsy, while 8 patients (7.9%) had an unknown epilepsy type. The cohort included rare epilepsy syndromes: 8 patients with Lennox-Gastaut syndrome, 3 with Dravet syndrome, and 1 with Rasmussen syndrome. Patients had a history of various antiseizure medications (ASMs) (6.42 ± 3.15), and on average, were being treated with more than two (2.57 ± 1.16) drugs at the time of BRV deployment. RESULTS: Retention rates were high, with 80.6% of patients adhering to treatment at 3 months, 66.7% at 6 months, and 45.2% at 12 months. In 29 patients (30.1%), BRV was added in an overnight switch from levetiracetam (LEV), resulting in a reduction of behavioral adverse effects (AEs) in 5 patients (17.2%). The response rate was 25.8% at 3 months, 16.1% at 6 months, and 17.2% at 12 months, with no responders in the epileptic encephalopathy group. Therapy tolerance was notable, with 70 patients (75.3%) reporting no AEs. Transient AEs occurred in 10 patients (10.7%), and in 13 cases (14.0%), the AEs warranted dose adjustment or discontinuation of BRV. CONCLUSION: Approximately one-fifth of pediatric patients with drug-resistant epilepsy responded to BRV, with the best response observed in patients with focal seizures. However, the impact on patients with epileptic encephalopathy was limited.

Immobilising of Cd, Pb, and Zn contaminated arable soils close to a former Pb/Zn smelter: a field study in Austria over 5 years.

Numerous smelter sites are surrounded by rural land. The entrance of non-essential metals such as lead or cadmium into the food chain is very likely as well as phytotoxicity effects of zinc. Finding a realistic solution for these large-scale contaminations was one aim of this study. Previous results from pot experiments showed a high potential for the reduction of metals entering the food chain via crops grown on smelter-contaminated soils from Arnoldstein, Austria, by the use of amendments for immobilisation. A further aim was to optimise a field experiment for overcoming the gap between pot and field experiments and to look for long-term efficiency of the treatments [lime (CA), red mud (RM), gravel sludge + red mud (GS + RM)]. Field experiment results were obtained for 5 years. Besides soil and soil pore water samples, the following harvests were yielded: spring barley (Hordeum distichon ssp. L.) (2004-2005), narrowleaf plantain (Plantago lanceolata L.) (2006-2007) and velvet grass (Holcus lanatus L.) (2007-2008). The long-term efficiency of GS + RM led us to conclude that their application seems to be a realistic and practical measure for extensively contaminated land, best in combination with metal excluding cultivars.

Remediation of contaminated agricultural soils near a former Pb/Zn smelter in Austria: batch, pot and field experiments.

Metal contaminated crops from contaminated soils are possible hazards for the food chain. The aim of this study was to find practical and cost-effective measures to reduce metal uptake in crops grown on metal contaminated soils near a former metal smelter in Austria. Metal-inefficient cultivars of crop plants commonly grown in the area were investigated in combination with in-situ soil amendments. A laboratory batch experiment using 15 potential amendments was used to select 5 amendments to treat contaminated soil in a pot study using two Barley (Hordeum vulgare L.) cultivars that differed in their ability to accumulate cadmium. Results from this experiment identified 3 of these amendments for use in a field trial. In the pot experiment a reduction in ammonium nitrate extractable Cd (<41%) and Pb (<49%) compared to the controls was measured, with a concurrent reduction of uptake into barley grain (Cd<62%, Pb<68%). In the field extractable fractions of Cd, Pb, and Zn were reduced by up to 96%, 99%, and 99%, respectively in amended soils.

Genotoxic effects of heavy metals: comparative investigation with plant bioassays.

The potential use of micronucleus assays in plants for the detection of genotoxic effects of heavy-metal ions was investigated. Three different plant systems were comparatively investigated in micronucleus tests with Tradescantia pollen mother cells (Trad MCN) and micronucleus tests with meristematic root tip cells of Allium cepa and Vicia faba (Allium/ Vicia MCN). As3+, Pb2+, Cd2+, Zn2+ caused a dose-dependent increase of MCN frequencies in all three test systems. Cu2+ gave consistently negative responses in all three tests; Zn2+ caused only a moderate, statistically not significant increase of MCN frequencies in Vicia. The ranking of genotoxic potencies in all three tests was in the descending order: As3+ > Pb2+ > Cd2+ > Zn2+ Cu2+. In experiments with Tradescantia, induction of MCN was observed in a concentration range between 1 and 10 mM, whereas in tests with root tip cells, higher concentrations (10-1,000 mM) were required to show significant effects. Further increase of the exposure levels caused toxic effects (reduction of root growth), cell division delays, and a decrease of MCN frequencies. Comparisons by linear regression analyses indicated that the sensitivity of the three bioassays for heavy metals decreases in the order: Trad MCN > Vicia root MCN > Allium root MCN. In further experimental series, a soil sample which contained high concentrations of the five metals and a control soil were investigated. Aqueous soil extracts induced only weak effects in Trad MCN tests and no effects in the root tip assays, whereas cultivation of the plants in the soils resulted in a pronounced induction of MCN in the Tradescantia system and moderate effects in Vicia and Allium. In conclusion, the results of the study indicate that the Trad MCN assay detects the genotoxic effects of heavy metals and can be used for biomonitoring metal-contaminated soils.

Rhizosphere characteristics of indigenously growing nickel hyperaccumulator and excluder plants on serpentine soil.

The role of rhizosphere processes in metal hyperaccumulation is largely unexplored and a matter of debate, related field data are virtually not available. We conducted a field survey of rhizosphere characteristics beneath the Ni hyperaccumulator Thlaspi goesingense Hálácsy and the metal-excluder species Silene vulgaris L. and Rumex acetosella L. growing natively on the same serpentine site. Relative to bulk soil and to the rhizosphere of the excluder species, we found significantly increased DOC and Ni concentrations in water extracts of T. goesingense rhizosphere, whereas exchangeable Ni was depleted due to excessive uptake of Ni. Chemical speciation analysis using the MINTEQA2 software package revealed that enhanced Ni solubility in Thlaspi rhizosphere is driven by the formation of Ni-organic complexes. Moreover, ligand-induced dissolution of Ni-bearing minerals is likely to contribute to enhanced Ni solubility. Increased Mg and Ca concentrations and pH in Thlaspi rhizosphere are consistent with ligand-induced dissolution of orthosilicates such as forsterite (Mg(2)SiO(4). Our field data reinforce the hypothesis that exudation of organic ligands may contribute to enhanced solubility and replenishment of metals in the rhizosphere of hyperaccumulating species.

[Variation in the R-R intervals on the electrocardiogram. A new diagnostic method in cardiology]. / Variabilita intervalu R-R elektrokardiogramu. Novejsí pomocná diagnostická metoda v kardiologii.

Periodic heart rate fluctuation depends on the oscillation of sympathetic and vagal activation of the heart. Periodic retardation and acceleration of heart rate related to respiration and to blood pressure changes can be registered on the ECG as the "variability of R-R intervals". Testing procedures of the variability of R-R intervals at rest, during deep breathing, daily activities, during exercise and other stress tests are described in the paper. For the evaluation of the R-R interval's variability, current statistical methods are used (e.g. mean with standard deviation, variation coefficient, mean beat to beat differences in R-R intervals etc.). Power spectral analysis in the variability of 200-600 successive R-R intervals commonly performed today uses either rapid Fourier transformation or the autoregulation model. The analysis shows high- and low frequency peaks corresponding to the rapid and slow oscillations in heart rate. Evaluation of the R-R interval variability, especially using power spectrum analysis, gave good results in testing drugs, e.g., beta blockers, calcium antagonists and antiarrhythmic drugs. Variability of R-R intervals is reduced in conditions affecting the cardiac autonomous nervous system such as diabetes. It is also decreased in patients with ischaemic heart disease and in those with cardiac failure of different aetiology. The decrease is not an expression of the disease itself: it shows an alteration in neurovegetative tonicity in the particular disease condition. The decreased variability of R-R intervals in patients with ischaemic heart disease has an important prognostic value. The predominance of the sympathetic over the depressed vagal activity signalizes an increased risk of sudden coronary death.