Energy loss function of samarium.

We present a combined experimental and theoretical work to obtain the energy loss function (ELF) or the excitation spectrum of samarium in the energy loss range between 3 and 200 eV. At low loss energies, the plasmon excitation is clearly identified and the surface and bulk contributions are distinguished. For the precise analysis the frequency-dependent energy loss function and the related optical constants (n and k) of samarium were extracted from the measured reflection electron energy loss spectroscopy (REELS) spectra by the reverse Monte Carlo method. The ps- and f-sum rules with final ELF fulfils the nominal values with 0.2% and 2.5% accuracy, respectively. It was found that a bulk mode locates at 14.2 eV with the peak width ~6 eV and the corresponding broaden surface plasmon mode locates at energies of 5-11 eV.

Ataxic sensory neuronopathy in a patient with systemic lupus erythematosus.

The occurrence of ataxic sensory neuronopathy (ASN) is rare in patients with connective tissue diseases (CTDs). ASN has been described in case reports and case series in patients with CTDs, mostly Sjögren's syndrome, and most often occurring during middle or old age. ASN in association with systemic lupus erythematosus (SLE) is extremely rare; there has been only one reported case in the literature. In addition, to our knowledge, adolescent onset of symptoms in CTD-associated ASN has not been reported previously. We report the case of a young woman who presented with ASN, characterized by sensory ataxia, with elevated antinuclear antibodies, leukopenia and anemia; she fulfilled the diagnostic criteria for SLE about 7 years after the onset of sensory ataxia. Our case points out that ASN may be the initial presenting feature of SLE. SLE should be included in the differential diagnosis of ASN, especially in patients of young age.

Oestrogen receptor-alpha polymorphism and risk of fracture: a meta-analysis of 13 studies including 1279 cases and 6069 controls.

A meta-analysis was performed to evaluate the effect of oestrogen receptor-alpha (ESR1) gene PvuII polymorphism on fracture risk. It included published data from relevant studies (up to May 2010) identified from Medline, Embase and Current Contents. The 13 included studies contained 1279 fracture cases and 6069 controls. The combined results based on these studies showed no relationship between ESR1 gene PvuII polymorphism and fracture risk. No significant difference in genotype distribution was found when stratifying by race. When stratifying by fracture type, it was found that vertebral fracture cases had a significantly higher frequency of the PvuII pp genotype than controls in five studies (552 cases and 2350 controls). This meta-analysis suggests a modest but statistically significant association between the ESR1 PvuII pp genotype and vertebral fracture.

Solid-phase microextraction coupled with liquid chromatography for determination of beta-carotene in food.

Beta-carotene in vegetables and nutritional products is analyzed using solid-phase microextraction (SPME) coupled with liquid chromatography (LC) to improve the speed of analysis and to reduce the consumption of organic solvents. The relative standard deviations (RSDs) of this analytical method for beta-carotene determinations in vegetables and nutritional products are approximately 10% and 5%, respectively. The amount of beta-carotene was found to vary from 0.35 +/- 0.05 ppm to 76.5 +/- 6.9 ppm for several vegetables in Taiwan. This method was linear over the range of 0.4-40 ppm with correlation coefficients higher than 0.997. The experimentally determined level of beta-carotene in nutritional products varied from 3.8 +/- 0.2 ppm to 24.6 +/- 1.1 ppm following SPME-LC. The recoveries of beta-carotene for these measurements following SPME were all higher than 97% +/- 2% (n = 3). The detection limits of beta-carotene for this method were from 0.027 to 0.054 ppm. Conventional solvent extractions take approximately 4-6 h for extraction and reconcentration but SPME takes approximately 1 h. From several tens to hundreds of milliliters, organic solvents can be saved using SPME. SPME provides better analyses on beta-carotene than conventional solvent extraction for nutritional products in terms of speed, precision, simplicity, and solvent consumption.

Radon, helium and uranium survey in some thermal springs located in NW Himalayas, India: mobilization by tectonic features or by geochemical barriers?

Radon, helium and uranium measurements have been carried out in hot water springs in the Parbati and Beas valleys of Himachal Himalaya. Most of these hot springs are known as famous pilgrimage centers. The activity of dissolved radon in the liquid phase is found to vary widely, by an order of magnitude, between 10 and 750 Bq L(-1), whereas, the dissolved helium content in these thermal springs varies between 10 and 100 ppm. The uranium contents are low and vary from <0.01 to 5 microg L(-1). The measured values of radon, helium and uranium are possibly controlled by structural geology, namely the presence of pervious fault systems, and by the lithology of the leached host rocks. Redox-potential geochemical barriers cause the mobilization of uranile ions in solution (UO2+); the most plausible hypothesis is when the conditions are oxidising, confirming the importance of physico-chemical conditions up to the supergenic environment, to control the fluid geochemistry of the U-He-222Rn system. Some evidence is available from both geothermometric considerations and geochemical data which will be reported elsewhere, whereas the present study is focused on U decay series-noble gas geochemistry. The first analysis of collected 3He/4He data is consistent with a crustal signature at the studied thermal springs.

Automatic optimum order selection of parametric modelling for the evaluation of abnormal intra-QRS signals in signal-averaged electrocardiograms.

Abnormal intra-QRS potentials (AIOPs) in signal-averaged electrocardiograms have been proposed as a risk evaluation index for ventricular arrhythmias. The purpose of the paper was to develop an automatic algorithm for selecting the optimum parametric model order in the analysis of AIOPs to make the modelling approach clinically more feasible. A total of 130 normal Taiwanese subjects and 87 patients with ventricular premature contractions and 23 with sustained ventricular tachycardia were recruited. The unpredictable AIQP signal was estimated from the modelling residual. The cross-correlation coefficient between the original signal and the ORS estimate was employed to evaluate the accuracy of the estimate. A pre-selected threshold cross-correlation coefficient of 0.9999 was used to determine the optimum order. The mean AIQP in lead Y for ventricular tachycardia patients was 3.9 microV, which was significantly smaller than 4.9 microV for ventricular premature contraction patients (p < 0.01) and 6.3 microV for normal subjects (p < 0.001). The linear combination of AIQP in lead Y and the time-domain parameter RMS40 provided the best global performance (the area under the receiver operating characteristic curve was 89.1%). A higher risk of ventricular arrhythmias was associated with lower AIQP in lead Y, and the automatic modelling algorithm improved the clinical feasibility of AIQP analysis.

Power spectrum analysis of heart rate variability in children with epilepsy.

OBJECT: Children with epilepsy have been found to be at increased risk of death during childhood. Sudden unexpected death (SUDEP) has accounted for at least 12% of deaths of children with epilepsy. The exact mechanisms of SUDEP are unknown; however, theories suggested have, to date, focused on autonomic instability. The purpose of this study was to investigate autonomic function in children with chronic epilepsy by means of power spectrum analysis of heart rate variability. METHODS: Thirty patients with epilepsy and 30 control subjects, all between the ages of 4 and 10 years, were enrolled in this study. Power spectrum analysis of heart rate variability (HRV) was performed under standardized conditions after the patients had rested for 15 min. Each patient was tested in a supine position first and then again in a head-up tilted position, with 15 min between the two tests. RESULTS: There was no significant difference between the low-frequency component (LF) and the high-frequency component (HF) of heart rate variability, or the LF/HF ratio, between the study and control groups, whether the test subjects were in the supine or the head-up tilt position. In the control group, however, the subjects showed a significantly greater LF component and a smaller HF component of heart rate variability, and a greater LF/HF ratio in the head-up position than in the supine position. This implies a normal sympathovagal balance. This phenomenon was not observed in the study group. This implies that the modulating effects on autonomic function deriving from the hemisphere were probably disturbed, owing to the brain lesions that each of the study group patients had already sustained. CONCLUSIONS: A disturbed balance of activity between the sympathetic and parasympathetic nervous system might result from the loss of hemispheric influence in patients with epilepsy. Nevertheless, further investigation is clearly necessary to ascertain the possible association of this disturbed balance with SUDEP. Further investigation is also needed to establish the exact location of the region in the brain that gives rise to this modulating influence.

Measurement of the bioactivity of interleukin and tumour necrosis factor in synovial fluid of Kashin-Beck disease.

We studied the bioactivity of interleukin (IL-1) and tumour necrosis factor (TNF) in the synovial fluid of 12 patients with Kashin-Beck disease (KBD), 8 patients with osteoarthritis (OA) and 8 normal controls. C57 female mouse T cell proliferation method was used to test the bioactivity of IL-1, and lethality method with L929 cells to test the bioactivity of TNF. The bioactivities of IL-1 and TNF in the synovial fluid from patients with KBD were higher than those in the synovial fluid of osteoarthritis and normal controls, indicating the participation of IL-1 and TNF in the pathogenesis of KBD.

The outcome of shunted hydrocephalic children.

BACKGROUND: Neurological sequelae and mental retardation may result from different etiological types of hydrocephalus. The aim of our study is to determine the intellectual development and the "shunt history" of these children with regard to the complications and revision rates. METHODS: We reviewed the medical history of non-tumoral pediatric hydrocephalic patients who had received first shunt insertions between 1983 and 1997 and had been regularly followed up at the out-patient clinics of Taipei Veterans General Hospital. These patients were categorized into five different etiological groups. Their intelligence test scores and the surgical morbidity encountered over this period were used as the main outcome measures. RESULTS: Out of the seventy-three patients, post-meningitis hydrocephalus patients had the significantly highest shunt revision rate (2.50 +/- 0.82, p = 0.01). They also showed retardation in IQ scores, but the different was not significant when compared with other groups. The results of IQ tests were not related to either the age of initial shunt insertion (p = 0.461) or revision rates (p = 0.292). For physical disabilities, post-meningitis hydrocephalic patients showed-highest incidence of epilepsy (40%) while hydrocephalic patients associated with myelomeningocele had the highest incidence of motor deficits (56.25%). CONCLUSIONS: Childhood hydrocephalic patients had different developmental neuroimpairments with respect to different etiologies. This study provides information about the physical and mental outcome of post-operative hydrocephalic patients which is valuable to assist in counsel of their families.

Seizure outcomes after anterior callosotomy in patients with posterior-dominant and with anterior-dominant epileptiform discharges.

OBJECTS: We wished to find whether there was any difference in the postoperative seizure outcome between patients with bisynchronous anterior-dominant and those with posterior-dominant EDs after anterior callosotomy. METHODS: Seizure outcomes after anterior callosotomy in 7 patients with bisynchronous posterior-dominant epileptiform discharges and in 54 patients with anterior-dominant seizures were compared. All 61 cases had been followed up for more than 2 years after operation. One patient (14.3%) had become seizure free. Two patients (28.6%) had more than 50% reduction in seizure frequency, but 4 patients (57.2%) showed no improvement at all. The percentage of cases with significant improvement (more than 50% reduction of seizure frequency) was 43% (3 in 7), which is lower than in the patients with bisynchronous anterior-dominant EDs (64.8%). CONCLUSIONS: Our preliminary results suggest that anterior partial callosotomy could still be helpful in cases with bisynchronous posterior-dominant epileptiform discharges but the prognosis may be less optimistic than for those with anteriorly located discharges.

Electromyographic evaluation in children with spina bifida.

BACKGROUND: It is controversial to predict ambulation potential using neurological level or specific pattern of muscle strength in patients with spina bifida. We attempted to analyze the relationship between the mobility outcome and its influencing factors utilizing electromyography to study motor unit activity in lower limbs. A subsidiary aim was to evaluate the external anal sphincter with electromyography and to determine the relevant factors of bowel and bladder functions. METHODS: Among 156 patients with spina bifida who had received electromyographic examination and were followed at the out-patient clinic between 1998 and 2000, functional assessment with Pediatric Evaluation of Disability Inventory (PEDI) was applied in 47 randomly selected patients. Other assessments included clinical neurological examination, bowel and bladder function survey, and ambulation evaluation. We correlated the parameters of electromyography with the ambulatory ability and PEDI scores. The innervation of external sphincter was compared between groups with or without neurogenic bowel or bladder dysfunction. RESULTS: The innervations of hip adductor and quadriceps were found to correlate with walking ability (p < 0.01); above muscles as well as anterior tibialis, and gastrocnemius were related to PEDI scores (p < 0.01). The neurological level still manifested correlation with walking ability (p < 0.05) and PEDI scores (p < 0.01). Both denervation potentials and recruitment pattern were important parameters for ambulation and mobility prediction. Significant difference was obtained in denervation patentials of sphincter within bowel groups (p = 0.036) and bladder groups (p = 0.016). CONCLUSIONS: Both traditional neurological level and specific muscle innervation exert crucial influence on walking and mobility functions. Electromyographic assessment demonstrates its contribution in prediction of functional outcome in spina bifida.

Postcallosotomy seizure outcome in hemiconvulsion-hemiatrophy-epilepsy syndrome.

Recently, three patients with hemiconvulsion-hemiplegia-epilepsy syndrome who underwent callosotomy were monitored for more than four years. All patients had atrophy of the right brain hemisphere with left hemiparesis and seizures. Two cases were probably the result of traumatic intracranial hemorrhage and one was due to an unknown cause. Wada tests were done in cases 1 and 2, which showed spared motor function of the atrophic hemisphere, supporting the choice of callosotomy instead of hemispherectomy. Patient 1 had atypical absence seizures and asymmetric generalized tonic seizures before surgery, the latter of which decreased by about 60% after callosotomy. Patient 2 had simple partial seizures of the motor type and complex partial seizures, the latter of which were also induced by touch (somatosensory-induced reflex epilepsy). This patient's complex partial seizures disappeared completely, but the simple partial seizures remained unchanged. Patient 3 had generalized tonic seizures, simple partial seizures of the sensory type and complex partial seizures. After surgery, the frequency of the generalized tonic seizures decreased more than 90%. The simple partial seizures of the sensory type remained unchanged. There were two new types of seizures after surgery, simple partial seizures of the motor type and brief generalized myoclonic jerks. All patients had significant reductions in numbers of seizures of more than 50%.

Postoperative seizure outcome after corpus callosotomy in reflex epilepsy.

Flickering light and color patterns, reading, language, movement, decision making, eating, tapping and touching, hot water immersion and auditory stimulation can induce seizures in some epileptic patients. These are known as the "reflex epilepsies". The mechanism of reflex epilepsy is not clear. Recently, we performed anterior two-thirds corpus callosotomies in two reflex epilepsy patients (ages 12 and 14 years), with follow-up for more than three years. Patient 1 had Lennox-Gastaut syndrome with auditory-induced generalized atonic or tonic seizures (startle epilepsy), which decreased by 60% after callosotomy. Patient 2 had Lennox-Gastaut syndrome with somatosensory-induced generalized tonic seizures (tap epilepsy). He was seizure-free for one year immediately after callosotomy, but his seizures recurred with the same degree and frequency as before surgery. The nonsignificant postoperative seizure outcome suggests that the corpus callosum only plays a partial role in seizure generation. Our report also discusses the possible mechanisms of generation of reflex seizures.

Seizure outcome after corpus callosotomy: the Taiwan experience.

From September 1989 to August 1996, we performed anterior corpus callosotomy in 83 patients. Unfortunately, 9 patients were lost to follow-up. Among the remaining 74 patients, 59 had Lennox-Gastaut syndrome (evolved from infantile spasms in 22), 9 had complex partial seizures with or without secondary generalized seizures, 1 had multifocal independent epileptogenic foci (MISF) syndrome, 3 had hemiconvulsion-hemiplegia-epilepsy (HHE), and 2 had infantile spasms. All cases were followed up for at least 2 years after surgery. The highest rate of significant improvement (more than 50% reduction in seizure frequency) was noted in the patients with generalized tonic-clonic seizures, 82.1% of whom experienced significant improvement, followed by those with generalized tonic seizures (76. 7%), atonic seizures (72.7%), myoclonic seizures (64.9%), atypical absences (58.6%), and complex partial seizure with or without secondary generalization (61.5%). Complete freedom from seizures was noted in 14 cases (18.9%). One patient had the anterior half of his right palm amputated following radial artery thrombosis complicated by insertion of an arterial line during anesthesia. Otherwise, there were no major postoperative complications except for brief mutism and multifocal jerks in some patients during the 1st postoperative week. Thus, we conclude that corpus callosotomy is a safe alternative treatment for all kinds of medically intractable seizures, especially generalized epilepsy.

Acute jaundice in pregnancy: acute fatty liver or acute viral hepatitis?

In this case, the difficulty in differential diagnosis between acute viral hepatitis and acute fatty liver of pregnancy was analyzed. These 2 conditions often raise controversal question regarding the decision making on emergency anesthesia for cesarean section to avert complications and optimize management. The dilemma in which an anesthesiologist is put is whether to promise the anesthesia straightaway in the face of a demonstrable acute jaundice in pregnancy to advise a postponement of surgery until a turn for the better. In this embarrassing situation, the authors suggest that a postpronement of surgery is rational to observe the development during which both the mother and the fetus should be closely monitored. Once the necessity of a cesarean section outweighs the benefit of transitional conservative treatment, it should be performed immediately.

Comparison of patient-controlled analgesia (PCA) with tramadol or morphine.

PURPOSE: To compared the clinical efficacy of tramadol and morphine using a patient-controlled analgesia (PCA) delivery system. METHODS: In a prospective, randomized, double blind study, we evaluated 80 adult patients scheduled for elective hip or knee arthroplasty with general inhalational anesthesia. When patients complained of pain in the recovery room, patients were randomized to receive either tramadol or morphine by titration in 30 min to achieve analgesia (VAS < or =4). Equivalent volumes containing either 30 mg x ml(-1) tramadol or 1 mg x ml(-1) morphine were used for PCA with a lockout interval of 10 min. The patients were followed six-hourly for 48 hr for VAS, satisfaction rate, analgesic dose, and side effects. RESULTS: Patients obtained adequate analgesia with either drug. More patients had very good satisfaction scores in the morphine group in the recovery room (43% vs. 23%, P<0.05) and at 24 hr (40% vs. 20%, P<0.05) than those in the tramadol group. More nausea was evident in the tramadol group (48% vs. 11% in recovery room and 28% vs. 12% in 24 hr, P<0.05) than in the morphine group. Vomiting was also more (28% vs. 5% in recovery room, 15% vs. 3% in 24 hr, P<0.05). Morphine produced more sleepiness (45% vs. 23% in recovery room, P<0.05 and 35% vs. 15% in 24 hr, P<0.05). CONCLUSION: Tramadol PCA can provide effective analgesia following major orthopedic surgery provided sufficiently high doses are given for loading and by patient demand. However, the incidence of nausea/vomiting is also higher causing decreased satisfaction.

[Reconstruction of hip joint function: old fracture-dislocation of hip joint complicated with deformed healing of upper 1/3 of fractured femur--a case report].

OBJECTIVE: To explore a method of reconstruction of hip joint function after deformed healing of the upper 1/3 of fractured femur as a complication of old fracture dislocation of hip joint. METHODS: A patient with loss of function in hip joint and fusion of knee joint was treated with lock for femur intra-medullary fixation in April 1997. RESULTS: Before operation, the diseased hip joint lost its most functions and the entire lower extremity was disabled because the knee joint had been fused. One year after operation, the follow-up examination revealed that the patient could walk by crutches without discomfort, his daily life and work recovered to normal. CONCLUSION: It is effective to treat a patient suffering old fracture-dislocation of hip joint complicated with deformed healing of the upper 1/3 of fractured femur by means of individualized artificial joint replacement and a prosthesis body with lock for femur intra-medullary fixation, and it is helpful for the development of a new clinical idea to reconstruct functions in the management of some particular cases.

Treatment of cerebral palsy with botulinum toxin: evaluation with gross motor function measure.

The objective of this study was to investigate the effects of botulinum toxin A (BTA) injection in reducing muscular spasticity and improving locomotor function in children with cerebral palsy. Thirty-eight children with spastic cerebral palsy who were undergoing regular physical therapy were enrolled. Twenty-eight of these received BTA injection at the hip adductors and/or gastrocnemius, while the other 10, whose parents refused the BTA treatment protocol, served as the comparison group. The main outcome measures were: improvements in the severity of spasticity, walking distance, gross motor function (as assessed with the Gross Motor Function Measure, GMFM), and gait pattern (as assessed with the Physician Rating Scale, PRS), all measured 6 and 12 weeks after the start of BTA treatment. The severity of spasticity and walking distance at baseline did not differ significantly between the two groups. However, the severity of spasticity improved markedly in the BTA group, from 2.7 to 1.5 (Modified Ashworth Scale) at the hip adductor, and from 2.9 to 1.9 at the gastrocnemius at the 6-week follow-up. The walking distance improved from 46.17 m to 55.32 m at the 6-week follow-up, and to 66.6 m at the 12-week follow-up in the BTA group. Marked improvements in the quality of several gross motor functions were also noted in the BTA group. The improvements in spasticity, walking distance, and gross motor function were significantly greater in the BTA group than in the comparison group. The improvements in gait pattern did not differ significantly between the BTA and comparison groups. The findings of this study show BTA injection to be an effective treatment for reducing spasticity and improving gross motor function in children with spastic cerebral palsy. GMFM provides objective evidence regarding functional improvement after treatment in this patient population.

Compound muscle action potential amplitude and area changes in normal subjects and patients with carpal tunnel syndrome.

Lesions of mixed peripheral nerves are often diagnosed by means of electrodiagnostic tests, especially by motor and sensory conduction studies. In order to clarify the varying degrees of motor nerve involvement in patients with carpal tunnel syndrome (CTS), we designed this study for comparing the results of compound muscle action potential (CMAP) amplitude and area under the negative phase between normal persons (n = 662) and patients having CTS (n = 250). The CTS cases were categorized into two distinct groups, i.e., CTS-D (n = 120) having prolonged median sensory latency and normal needle examination, CTS-AD having prolonged median sensory latency and abnormal needle findings (n = 130). Subjects in the CTS-AD group showed significant reduction, both in CMAP amplitude and area from 3rd to 7th decades; however, in the CTS-D group there were significantly smaller CMAP amplitude from 5th to 7th decades but CMAP area demonstrated wide variations. These data indicate that CMAP amplitude and area are helpful in documenting motor nerve axonal loss, but care must be exercised when attempt is made to define axonal loss based either on area or amplitude because of the temporal dispersive effects.

Intradermal injection of tramadol has local anesthetic effect: a comparison with lidocaine.

BACKGROUND: We observed that intravenous retention of tramadol with a pneumatic tourniquet on the arm inflated to 70 mmHg for one minute could effectively reduce the subsequent propofol injection pain. Tramadol is a central-acting analgesic. The local analgesic effect of tramadol on reducing propofol injection pain is not well known. METHODS: To explore this problem we conducted a double-blind study on intradermal injections of tramadol 25 mg, lidocaine 5 mg and normal saline (all in 0.5 ml volume) which were given to each of the 10 healthy volunteers on the forearm at random. Pain on injections and the degree of local analgesia to pinprick, light touch and cold at each injection site were scored on a 0-4 scale at designated intervals. RESULTS: 5% tramadol, similar to 1% lidocaine, rendered loss of sensation to pin prick, light touch and cold for 30 min after intradermal injection as compared with normal saline (p < 0.01). CONCLUSIONS: We concluded that intradermal injection of tramadol or lidocaine can produce local anesthetic effect.