Why we prefer levetiracetam over phenytoin for treatment of status epilepticus.

Over last fifty years, intravenous (iv) phenytoin (PHT) loading dose has been the treatment of choice for patients with benzodiazepine-resistant convulsive status epilepticus and several guidelines recommended this treatment regimen with simultaneous iv diazepam. Clinical studies have never shown a better efficacy of PHT over other antiepileptic drugs. In addition, iv PHT loading dose is a complex and time-consuming procedure which may expose patients to several risks, such as local cutaneous reactions (purple glove syndrome), severe hypotension and cardiac arrhythmias up to ventricular fibrillation and death, and increased risk of severe allergic reactions. A further disadvantage of PHT is that it is a strong enzymatic inducer and it may make ineffective several drugs that need to be used simultaneously with antiepileptic treatment. In patients with a benzodiazepine-resistant status epilepticus, we suggest iv administration of levetiracetam as soon as possible. If levetiracetam would be ineffective, a further antiepileptic drug among those currently available for iv use (valproate, lacosamide, or phenytoin) can be added before starting third line treatment.

Photocatalytic degradation of humic acid using a novel photocatalyst: Ce-doped ZnO.

This study aimed at investigating the photocatalytic degradation of humic acid (HA) as a representative of natural organic matter (NOM) by using Ce-doped ZnO as a novel material. Following photocatalysis, HA degradation was characterized by specified UV-vis and fluorescence spectroscopic parameters as well as by the dissolved organic carbon (NPOC) content. Excitation-Emission Matrix (EEM) fluorescence features were also evaluated by using advanced techniques. Comparison of Ce-doped ZnO photocatalysis to TiO2 P-25 photocatalytic treatment of the HA samples was elucidated under similar experimental conditions. Kinetic modeling of the photocatalytic removal of HA expressed promising results indicating that Ce-doped ZnO could serve as an efficient catalyst for the degradation of NOM.

Ultrasound-based lectures on cardiovascular physiology and reflexes for medical students.

Ultrasound has become a widely used diagnostic technique. While its role in patient evaluation is well known, its utility during preclinical courses such as anatomy and physiology is becoming increasingly recognized. The aim of the present study was to assess the feasibility/utility of integrating ultrasound-based sessions into conventional undergraduate medical school programs of physiology of the cardiovascular system and cardiovascular reflexes and to evaluate student perceptions of an ultrasound-based didactic session. Second-year medical students enrolled in the University of Padova attended a didactic session during which basic concepts regarding ultrasound instrumentation, image production, and spatial orientation were presented. Five anatomic sectors (the heart, aorta, neck vessels, inferior vena cava, and femoral veins) were then examined on a volunteer. Student perceptions of the images that were projected, the usefulness of the presentation, and the reproducibility of the experience were assessed at the end of the lecture with an anonymous questionnaire consisting of positive and negative items that were rated using a 5-point Likert scale and with two questions. One hundred eleven students attended the lecture; 99% of them found it very interesting, and none considered it boring or a waste of time. More than 96% thought it helped them to gain a better comprehension of the subject and would recommend it to a colleague. In conclusion, as ultrasound has been found to be a valuable resource for the teaching of physiology of the cardiovascular system and cardiovascular reflexes, efforts should be made to integrate ultrasound sessions into the traditional human physiology curriculum.

Clinical heterogeneity in Italian patients with amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a rare and devastating neurodegenerative disorder. The majority of cases are sporadic ALS (SALS), with 5-10% being familial ALS (FALS), and are inherited mostly as autosomal dominant. Mutations in Cu/Zn superoxide dismutase (SOD1) and the TAR DNA-binding protein (TARDBP) gene are the most commonly known cause of ALS. We analyzed these genes in 61 Italian ALS patients using high-resolution melting analysis to confirm the role of SOD1 and TARDBP in the physiopathology of ALS. The screenings showed a single mutation in SOD1 (Asp109Tyr) and three in TARBDP (Ala382Thr, Gly295Ser, Gly294Val) in five unrelated ALS patients. This report enlarges the spectrum of clinical phenotypes associated with genetic mutations in SOD1 and TARDBP genes confirming the variability of phenotypes associated with the same mutation and emphasizes the importance of genetic analysis. The different genotype-phenotype correlations suggest the implication of other factors possibly influencing clinical manifestation of the disease, such as an epigenetic or epistatic effect with other genes not yet identified.

The nitrogen-boron paramagnetic center in visible light sensitized N-B co-doped TiO(2). Experimental and theoretical characterization.

Nitrogen boron co-doped TiO(2) prepared via sol-gel synthesis and active under visible light, contains two types of paramagnetic extrinsic defects, both exhibiting a well resolved EPR spectrum. The first center is the well characterized [N(i)O]˙ species (i = interstitial) also present in N-doped TiO(2), while the second one involves both N and B. This latter center (labeled [NOB]˙) exhibits well resolved EPR spectra obtained using either (14)N or (15)N which show a high spin density in a N 2p orbital. The structure of the [NOB]˙ species is different from that previously proposed in the literature and is actually based on the presence of interstitial N and B atoms both bound to the same lattice oxygen ion. The interstitial B is also linked to two other lattice oxygen ions reproducing the trigonal planar structure typical of boron compounds. The energy level of the [NOB]˙ center lies near the edge of the valence band of TiO(2) and, as such, does not contribute to the visible light absorption. However, [NOB]˙ can easily trap one electron generating the [NOB](-) diamagnetic center which introduces a gap state at about 0.4 eV above the top of the valence band. This latter species can contribute to the visible light activity.

Progress in restorative neurosurgery: human fetal striatal transplantation in Huntington's disease. Review.

The purpose of this paper was to offer a review of the rationale, methods, biological and clinical results of human fetal striatal transplantation (HFST) in the treatment of Huntington's disease (HD). HD is a heritable neurodegenerative disease in which degeneration of neurons in the striatum leads to motor, psychiatric and cognitive deficits. The disease is progressive and inexorably lethal. At present there are no curative treatments for HD. A restorative therapy based on the intrastriatal transplantation of striatal neuroblasts taken from human fetus is currently being explored as potential treatment in selected HD patients. Pilot clinical trials of HFST have been started in few neurosurgery restorative centres. Results demonstrated that HFST is feasible and safe without relevant adverse effects; grafted neuroblasts survive, grow without evidence of neoplasia or teratoma, build new tissue with striatal-like imaging features, and move into the host brain towards short and long-distance cortical and sub-cortical targets. HFST delays disease progression and provides a period of improvement and stability. Even though larger-scale studies are still necessary to establish the true value of such a treatment, at this time, HFST represents a promising experimental therapy for patients with HD and one of the most interesting clinical application of restorative neurosurgery.

Recognition of category-related visual stimuli in Parkinson's disease: before and after pharmacological treatment.

Visual-sensory dysfunctions and semantic processing impairments are widely reported in Parkinson's disease (PD) research. The present study investigated the category-specific deficit in object recognition as a function of both the semantic category and spatial frequency content of stimuli. In the first experiment, the role of dopamine in object-recognition processing was assessed by comparing PD drug naïve (PD-DN), PD receiving levodopa treatment (PD-LD), and control subjects. Experiment 2 consisted of a retest session for PD drug naïve subjects after a period of pharmacological treatment. All participants completed an identification task which displayed animals and tools at nine levels of filtering. Each object was revealed in a sequence of frames whereby the object was presented at increasingly less-filtered images up to a complete version of the image. Results indicate an impaired identification pattern for PD-DN subjects solely for animal category stimuli. This differential pharmacological therapy effect was also confirmed at retest (experiment 2). Thus, our data suggest that dopaminergic loss has a specific role in category-specific impairment. Two possible hypotheses are discussed that may account for the defective recognition of semantically different objects in PD.

Assessment of the abatement of acelsulfame K using cerium doped ZnO as photocatalyst.

In the present study, we investigated the possibility to abate Acesulfame K, a persistent emerging contaminant, in aqueous media using zinc oxide based materials. For this purpose, bare and Ce-doped zinc oxide was prepared via an easy and cheap hydrothermal process using different cerium salts as precursors. Their photocatalytic performance was evaluated in different media, namely ultrapure and river water under both UV-vis and visible light. Commercial TiO2 P25 was also employed and used as a reference photocatalyst for comparison purposes. The obtained results pointed out that cerium doped zinc oxide composites exhibit higher performance than TiO2 P25, especially under visible light and in the presence of organic matter, when the activity of the latter is greatly depressed. In particular, ZnO doped with cerium (1%) was the most effective material, and could be a promising alternative to TiO2 P25, especially in the treatment of natural waters.

Active surveillance cultures: comparison of inguinal and rectal sites for detection of multidrug-resistant bacteria.

BACKGROUND: Rectal swabs are the most widely used surveillance technique for detecting multidrug-resistant bacteria colonizing the intestinal tract. Obtaining these samples may cause embarrassment and discomfort to patients. Prior studies indicate that perirectal swabs are as sensitive and specific as rectal swabs with greater patient acceptance. AIM: To compare inguinal and rectal swabs for the detection of multidrug-resistant bacteria colonizing the intestinal tract. METHODS: An epidemiological, comparative, prospective, and controlled study was undertaken with 102 Brazilian patients. Inguinal and rectal swabs were collected for culture and compared. FINDINGS: Compared to rectal swabs, the sensitivity and specificity of inguinal swabs was 91.8% and 88.7%, respectively. Even when there were low colony counts from rectal samples, there were more than 100 colonies from inguinal samples. CONCLUSION: The inguinal region can be considered an acceptable alternative for collecting surveillance cultures for multidrug-resistant bacteria colonizing the intestinal tract. The inguinal swab technique is sensitive and specific for assessing multidrug-resistant micro-organisms, less embarrassing for patients, and simple to implement in hospital practice.

Acute changes of blood ammonia may predict short-term adverse effects of valproic acid.

Valproic acid (VPA) was given to 24 epileptic patients who were already being treated with other antiepileptic drugs. A standardized loading dose of VPA was administered, and venous blood was sampled at 0, 1, 2, 3, and 4 hours. Ammonia (NH3) was higher in patients who, during continuous therapy, complained of drowsiness (7 patients) than in those who were symptom-free (17 patients), although VPA plasma levels were similar in both groups. By measuring VPA-induced changes of blood NH3 content, it may be possible to identify patients at higher risk of obtundation when VPA is given chronically.

Valproate-induced hyperammonaemia in two epileptic identical twins.

The cases of two epileptic identical twins are described, one of whom had presented an episode of valproate (VPA)-induced stupor associated with very high blood ammonia (NH3) concentrations. Both twins showed a similar marked increase of venous NH3 concentrations after the administration of a single loading dose of VPA (800 mg).

Cognitive potentials: ipsilateral corticocortical interconnections in prefrontal human cortex ablations.

The research deals with the possible role of the essentially monosynaptic bidirectional corticocortical connections between occipito-temporo-parietal association cortical areas and frontal areas in the genesis of some contingent negative variation (CNV) components, especially on the supramodal dorsolateral prefrontal regions. With standard and topographic mapping methods of analysis, the multicomponent CNV complex formation was examined in 7 patients with extensive frontal cortex ablations exactly identified through CT/MRI examinations, and in 10 normal subjects. On the scalp over the ablated frontocortical areas, no consistent post-warning auditory N100 a-b-c, P200, P300, early and late CNV components were recordable. The hypothesis is proposed that the bidirectional ipsilateral long-distance pathways which interconnect uni-polymodal occipito-temporo-parietal cortical areas to prefrontal ones, in particular the arcuate-superior longitudinal and superior/inferior occipito-frontal fasciculi, play an important role in the genesis of several CNV complex components, especially the multicomponent post-S1 auditory N100. The posteroanterior sequential latency differences of these neurocognitive components, roughly measured along the scalp or on MRI imagings, is probably accounted for by the transcortical ipsilateral conduction time of about 1 cm/ms (10 m/s).

Smooth-pursuit eye movements: alterations in Alzheimer's disease.

Smooth-pursuit eye movements induced by targets moving at constant velocities (from 5 to 100 deg/sec) were recorded from 13 patients with Alzheimer's disease (AD) and from 11 healthy subjects. Four variables were evaluated to quantify the patients' response to the eye movement tests: (1) average peak velocity of smooth-pursuit; (2) percent target matching index after saccade removal (percent ratio between the area of the velocity curve of smooth-pursuit eye movement after saccade removal and the area of target velocity) which is related to the eye performance for each value of target velocity; (3) total amplitude of anticipatory saccades; (4) total number of anticipatory saccades. Compared to the controls, AD patients were found to have significantly lower values of average peak velocity of smooth pursuit and of percent target matching index and a significantly increased number and amplitude of anticipatory saccades. A discriminant stepwise analysis indicated that 5 oculographic variables were significantly associated with the patient's clinical condition (healthy volunteer or AD patient). These statistics yielded an equation for predicting the patient's status according to which the percentage of cases classified correctly was 82.6% in the overall group (n = 23). The predictive performance was similar between the healthy volunteers subgroup (81.8%, n = 11) and the AD subgroup (83.3%, n = 12). The discriminant score was significantly correlated with the score resulting from the MiniMental test (r = 0.67). A significant correlation was also found between the MiniMental score and the number of anticipatory saccades (r = -0.61). No significant correlation was present between the gain of smooth pursuit and the patients' cognitive decline.(ABSTRACT TRUNCATED AT 250 WORDS)

Langerhans cell histiocytosis of the spine causing cord compression: case report.

A case of Langerhans cell histiocytosis of the spine causing myeloradiculopathy is reported. Almost complete regression of symptoms and signs was observed in the patient after surgical treatment and radiotherapy. The clinical and histological features of the disease are discussed. The literature dealing with the previously reported cases of spinal histiocytosis involving neural structures is reviewed.

Effects of acute valproic acid administration on carnitine plasma concentrations in epileptic patients.

Serial plasma samples collected after an acute administration of valproic acid, (VPA, 15 mg/kg as oral solution) in epileptic patients were selected for this study. The plasma samples were selected from three different groups of patients; patients on phenobarbital and phenytoin with clinical VPA intolerance (group A); patients on phenobarbital and phenytoin without clinical VPA toxicity (group B); and patients without phenobarbital and phenytoin and without clinical VPA toxicity (group C). Plasma samples from 6 patients per group were analyzed for carnitines and ammonia. Ammonia levels during acute study increased significantly (P less than 0.05) in patients who experienced VPA intolerance, while no changes were found in the other patients. After acute VPA administration, total carnitine was unchanged but free carnitine was decreased (P less than 0.05) and carnitine esters were increased (P less than 0.05) in all groups of patients studied. No difference in carnitine profiles was seen between patients with or without evidence of VPA administration has an important effect on carnitine metabolism. However, unlike the acute effect on ammonia metabolism, this acute effect does not seem to be correlated with any associated antiepileptic therapy, nor does it predict clinical VPA intolerance.

Decreased EEG microstate duration and anteriorisation of the brain electrical fields in mild and moderate dementia of the Alzheimer type.

Spatially oriented segmentation allows researchers to break down the continuous stream of the ongoing EEG into microstates with stable topography of the brain electrical landscapes. The resulting microstates were shown to be related to conscious mental experience as well as to psychiatric disorders typically associated with thought disorders. In the present study, the microstates of the resting EEG of patients presenting with mild or moderate probable dementia of the Alzheimer type (DAT) were investigated. A significant anteriorisation of the centers of gravity of the microstate fields, an increase of the microstates' optimal window size and a reduced duration of sustained microstates were found. These differences were statistically more robust than the typical changes in the frequency domain (diffuse slowing) and were significantly correlated with the cognitive decline. The adaptive spatial segmentation into microstates is discussed as a method to extract meaningful EEG parameters for the early diagnosis and staging of Alzheimer's disease.

Changes in bit-mapped contingent negative variation (CNV) activity due to initial normal involutional processes of the human brain.

Bit-color mapped multicomponent CNV complexes and RTs to S2 evoked with a simple warned CNV/RT paradigm were recorded and measured in 20 selected right-handed very healthy volunteers (10 young adults and 10 presenile subjects, mean age 28.3 and 59.6, respectively). EEG and CNV components (post S1, N1, P2, P3; early CNV; N1200; late CNV; CNV resolution) were recorded from Fz, C3, Cz, C4, P3, Pz, and P4 referenced to linked mastoid electrodes. EOG, RT and stimuli were also recorded. The presenile group differed significantly from the younger group in the auditory post-S1 N1 and early (O-wave) and late (P-wave) CNV complex components. A progressive amplitude reduction limited to frontal leads between O-wave and P-wave, the lowest point being reached in the P-wave, was characteristic in the presenile group. Moreover, presenile subjects showed relatively flat CNV waveshapes of low amplitude and, on the whole, performed a little less well than young ones. This finding suggests that the statistically significant changes in auditory post-S1 N1 and CNV activity recorded in our presenile subjects, without any appreciable deficits in behavioral or mental performance, could be alerting signs of early brain involutional processes related to minimal and subclinical decline in orienting, attentiveness and response preparation capabilities. If such is the case, and it could be confirmed in a larger sample of very healthy subjects, these age-related changes in the presenium might prove to be of considerable practical importance for clinical research.

Topographic CNV activity mapping, presenile mild primary cognitive decline and Alzheimer-type dementia.

The CNV complex evoked with a standard paradigm (S1-2 sec-S2-motor response) and reaction time (RT) to the imperative signal (S2) were recorded and measured in 12 patients with initial presenile idiopathic cognitive decline (PICD), 12 with presenile Alzheimer-type dementia (PAD) and 10 healthy age-matched controls. Significant group differences were obtained for measures of some CNV components, particularly of the late pre-S2 CNV. No significant CNV activity, very prolonged RTs and sometimes characteristic post-imperative negative variations (PINV) were observed in the majority of patients with PAD. These results suggest that similar CNV complex and RT changes to those observed in our patients may constitute a valuable clue in the study of pathophysiological brain functioning in the early stages of presenile idiopathic mental deterioration.