Efficacy and tolerability of oral lacosamide as adjunctive therapy in pediatric patients with pharmacoresistant focal epilepsy.

The results of adjunctive lacosamide treatment in 18 pediatric patients with pharmacoresistant focal epilepsy are reported. All had severe forms of focal epilepsy with or without secondary generalization and were concurrently receiving one to three other antiepileptic drugs. Lacosamide was administered orally, and final dose, after slow titration, ranged between 1.7 and 10 mg/kg. Mean treatment duration was 8 months (range=3 weeks-17 months). Treatment efficacy was assessed at two time points with a 1-year interval. The reported greater than 50% reduction in seizure frequency was 36% in the initial short-term and 20% in the following long-term assessment. Side effects, mostly somnolence and irritability, were reported by 39% of patients in both evaluations. Our data suggest that lacosamide treatment in pediatric patients is safe at doses up to 10 mg/kg/day without any major side effects, but studies in larger series are needed to validate and extend these findings.

Management of vesico-urethral anastomosis disruption after radical prostatectomy.

BACKGROUND/AIMS: Disruption of vesico-urethral anastomosis is a complication which can have dramatic results on the post-operative quality of life of the patient who has had radical prostatectomy. We present our own experience of this complication and discuss the aetiology, treatment and outcome with reference to published data on the subject. We suggest means by which to prevent this complication. METHODS: A retrospective notes review was performed on our own series of 4 patients with disruption of the vesico-urethral anastomosis after radical prostatectomy. A literature review was performed on the subject. RESULTS: We explore ways of managing this complication based on our own series and the published data. We find that urethral disruption is most often significant if a blind attempt at catheter reinsertion by an inexperienced doctor is made. Replacement over a guide-wire using a flexible cystoscope is reasonable provided a significant distraction injury has not already occurred. CONCLUSIONS: Replacement of the urethral catheter which has fallen out/is blocked should be done using cystoscopic guidance, if it needs to be replaced at all. We find that outcome, in terms of urinary continence, is better if, having sustained a significant disruption of the anastomosis, immediate surgical revision of anastomosis is performed.

Fluorescence component in the reflectance spectra from coastal waters. II. Performance of retrieval algorithms.

Retrieval of chlorophyll fluorescence magnitude using Fluorescence Height algorithms in coastal waters is more complicated than in the open ocean because of the strong deviations of elastic reflectance within the fluorescence band from the derived fluorescence baseline. We use results of our recently established relationship between fluorescence magnitude and concentrations of water constituents together with extensive HYDROLIGHT simulations, field and satellite data to analyze the performance and retrieval limitations of MODIS and MERIS FLH algorithms in the variety of coastal waters and to examine improvements for spectral band selection suitable for future sensors.

Retrieving quantum yield of sun-induced chlorophyll fluorescence near surface from hyperspectral in-situ measurement in productive water.

Magnitude and quantum yield (eta) of sun induced chlorophyll fluorescence are determined in widely varying productive waters with chlorophyll concentrations from 2- 200 mg/m(3). Fluorescence was estimated using linear fitting of in-situ measured surface reflectance with elastic and inelastic reflectance spectra. Elastic reflectance spectra were obtained from Hydrolight simulations with measured absorption and attenuation spectra as inputs. Eta is then computed based on a depth integrated fluorescence model and compared with Hydrolight calculation results. Despite the large variability of coastal environments examined the ? values are found to vary over a relatively narrow range 0.1%-1% with mean values of 0.33%+/-0.17%.

Presentation of automated procedural guidance in surgical simulation: results of two randomised controlled trials.

OBJECTIVE: To investigate the effectiveness and usability of automated procedural guidance during virtual temporal bone surgery. METHODS: Two randomised controlled trials were performed to evaluate the effectiveness, for medical students, of two presentation modalities of automated real-time procedural guidance in virtual reality simulation: full and step-by-step visual presentation of drillable areas. Presentation modality effectiveness was determined through a comparison of participants' dissection quality, evaluated by a blinded otologist, using a validated assessment scale. RESULTS: While the provision of automated guidance on procedure improved performance (full presentation, p = 0.03; step-by-step presentation, p < 0.001), usage of the two different presentation modalities was vastly different (full presentation, 3.73 per cent; step-by-step presentation, 60.40 per cent). CONCLUSION: Automated procedural guidance in virtual temporal bone surgery is effective in improving trainee performance. Step-by-step presentation of procedural guidance was engaging, and therefore more likely to be used by the participants.

Fluorescence component in the reflectance spectra from coastal waters. Dependence on water composition.

Based on HYDROLIGHT simulations of more than 2000 reflectance spectra from datasets typical of coastal waters with highly variable optically active constituents as well as on intercomparisons with field measurements, the magnitude of chlorophyll fluorescence was analyzed and parameterized as a function of phytoplankton, CDOM, and suspended inorganic matter concentrations. Using the parameterizations developed, we show that variations in the fluorescence component of water leaving radiance in coastal waters are due more to the variability of attenuation in the water than to the variability of the fluorescence quantum yield, which we estimate to be relatively stable at around 1%. Finally, the ranges of water conditions where fluorescence plays a significant role in the reflectance NIR peak and where it is effectively undetectable are also determined.

Effects of anatomical variation on trainee performance in a virtual reality temporal bone surgery simulator.

OBJECTIVE: To investigate the importance of anatomical variation in acquiring skills in virtual reality cochlear implant surgery. METHODS: Eleven otolaryngology residents participated in this study. They were randomly allocated to practice cochlear implant surgery on the same specimen or on different specimens for four weeks. They were then tested on two new specimens, one standard and one challenging. Videos of their performance were de-identified and reviewed independently, by two blinded consultant otolaryngologists, using a validated assessment scale. The scores were compared between groups. RESULTS: On the standard specimen, the round window preparation score was 2.7 ± 0.4 for the experimental group and 1.7 ± 0.6 for the control group (p = 0.01). On the challenging specimen, instrument handling and facial nerve preservation scores of the experimental group were 3.0 ± 0.4 and 3.5 ± 0.7 respectively, while the control group received scores of 2.1 ± 0.8 and 2.4 ± 0.9 respectively (p < 0.05). CONCLUSION: Training on temporal bones with differing anatomies is beneficial in the development of expertise.

Presence of glucocorticoid responsive elements in the mitochondrial genome.

Glucocorticoids rapidly affect nuclear RNA synthesis by binding, as hormone-receptor complexes, to Glucocorticoid Responsive Elements (GRE), differently positioned in glucocorticoid inducible genes. Glucocorticoids also affect, within minutes, mitochondrial RNA synthesis. We therefore searched for GREs in the mitochondrial genome of human (H), rat (R) and mouse (M) and found a number of such potential elements as follows: one within the 12s - rRNA gene (H1, R1 and M1) one within (H2), or at the start (R2, M2), of the presumptive protein 1 gene and three within the mouse cytochrome oxidase subunit 1 gene (COX1, COX2 and COX3). The nucleotide sequence of H1, R1 and M1 reveals the possibility of the formation of hairpin structures, stabilized by hydrogen bond formation, between three or four consecutive bases. The presence of potential GREs in the mitochondrial genome suggests an adjustment of mitochondrial metabolic control to the general control mechanisms of the cell.

Haemorrhagic diathesis in a ram with Anaplasma phagocytophilum infection.

A 10-month-old ram with fever, inappetence and haemorrhagic diathesis had petechiae and ecchymoses at various body sites and was infested by ticks. Haematological examination revealed pancytopenia, while serum biochemistry indicated hepatic dysfunction. Blood smears were negative for Ehrlichia spp. and other haemoparasites. Paired sera revealed infection by Anaplasma phagocytophilum, but testing by polymerase chain reaction was negative. Treatment with oxytetracycline was effective. This is the first reported clinical case of ovine anaplasmosis in Greece caused by A. phagocytophilum.

Murine typhus in Cyprus: 21 paediatric cases.

The aim of this article is to present the manifestations of Rickettsia typhi infection in childhood. Twenty-one children under 15 years of age were hospitalised in the Department of Paediatrics of the Archbishop Makarios Hospital in Nicosia, Cyprus, from 2000 to 2006 with Rickettsia typhi infection. Ten of them were boys and 11 were girls. The median age was eight years (range four to 13 years). The most common clinical features were fever (100%) and rash (57%). Lymphadenopathy, usually cervical, was also a frequent finding (37%). Severe headache was rather infrequent (29%). Splenomegaly or hepatomegaly were less frequent findings (24% and 10%, respectively). Mild elevation of liver enzymes (AST and ALT elevated >1-fold in 81% and 75%, respectively) was the most frequent laboratory finding. Thrombocytopenia (28%) and leucopenia (17%) were less frequent. Nearly half of the patients (10/21) came from four neighbouring villages, where most residents work in agriculture. All of the children were treated with appropriate antibiotic regimens and had complete recovery. Rickettsia typhi infection should be considered in the differential diagnosis of children who present during the summer or early autumn months with prolonged fever and rash with or without lymphadenopathy.

Localization of the glucocorticoid receptor in rat liver cells: evidence for plasma membrane bound receptor.

1. The cytoplasmic glucocorticoid receptor of rat liver cells is in part recovered in the plasma membrane fraction. 2. After in vivo administration of [3H]dexamethasone, 0.35% of the radioactivity recovered is bound on plasma membranes. 3. Dexamethasone also binds in vitro specifically to plasma membranes. Expressed as fmol/mg protein, binding of dexamethasone to plasma membranes is comparable to binding to the soluble cytoplasmic fraction (cytosol). 4. Using polyclonal antibody to the glucocorticoid receptor and the indirect immunofluorescence technic, an intense decoration of the plasma membranes is observed, denoting a high concentration of glucocorticoid receptor on plasma membranes. 5. The localization of the receptor on plasma membranes could be of potential importance for its interaction with agents (mitogens, growth factors) initially acting on the cell membrane, regulating subsequent cell proliferation and growth at the level of the cell nucleus.