Successful liver, kidney, and pancreas transplantation from a donor with cerebral emboli from a left atrial myxoma

Although transmission and engraftment of donor-derived malignancies is rare in recipients of solid organ transplants, it is associated with unfavorable allograft and patient survival. Therefore, a recent history of malignancy is considered a contraindication to organ donation. Although atrial myxomas are benign cardiac tumors of stromal origin, they can lead to systemic embolization with ectopic myxoma formation. We report successful liver, kidney, and pancreas transplantation into 3 recipients from a donor with cerebral emboli from a left atrial myxoma. Eighteen months after transplantation, all 3 patients enjoy good allograft function and are free of donor-derived atrial myxoma. Although the duration of follow-up in this report is limited, we suggest that the presence of atrial myxoma should not be viewed as an absolute contraindication to organ recovery, particularly in view of the shortage of organ donors and the attendant morbidity and mortality for patients on waiting lists.

Deuteron transfer in N=Z nuclei

Predictions are obtained for T=0 and T=1 deuteron-transfer intensities between self-conjugate N=Z nuclei on the basis of a simplified interacting boson model which considers bosons without orbital angular momentum but with full spin-isospin structure. These transfer predictions can be correlated with nuclear binding energies in specific regions of the mass table.

Two-nucleon transfer reactions uphold supersymmetry in atomic nuclei

The spectroscopic strengths of two-nucleon transfer reactions constitute a stringent test for two-nucleon correlations in the nuclear wave functions. A set of closed analytic expressions for ratios of spectroscopic factors is derived in the framework of nuclear supersymmetry. These ratios are parameter independent and provide a direct test of the wave functions. A comparison between the recently measured 198Hg(d-->,alpha)196Au reaction and the predictions from the nuclear quartet supersymmetry lends further support to the validity of supersymmetry in nuclear physics.

The importance of refuge habitat in the local conservation of stripe-faced dunnarts Sminthopsis macroura on arid rangelands

ANTHROPOGENIC change to Australian habitats accelerated rapidly during the late 1800s as sheep grazing spread across the continent. In particular, intensive grazing in arid and semi-arid regions is believed to have vastly altered vegetation communities, triggered extensive soil erosion, and reduced shelter available to small mammals, thus increasing their vulnerability to predation (Morton 1990). It is not surprising, then, that since European settlement 32 species (42%) of mammals inhabiting the arid zone of Australia have become extinct (Landsberg et al. 1997), and many others have suffered major range reductions or are currently considered widespread but rare. This faunal collapse was due to multiple factors (Burbidge and McKenzie 1989; Morton 1990), but the most consistent predictor of marsupial decline is geographic overlap with domestic sheep (Fisher et al. 2003). While overgrazing is a serious broadscale problem, the destruction of naturally occurring pockets of highquality habitat probably played a critical role in the extirpation of species that relied on refugia for survival during droughts (Morton 1990).

Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease

OBJECTIVE

To evaluate the efficacy of a cognitive-motor program in patients with early Alzheimer disease (AD) who are treated with a cholinesterase inhibitor (ChEI).

METHODS

Patients with mild cognitive impairment (MCI) (12), mild AD (48), and moderate AD (24) (Global Deterioration Scale stages 3, 4, and 5) were randomized to receive psychosocial support plus cognitive-motor intervention (experimental group) or psychosocial support alone (control group). Cognitive-motor intervention (CMI) consisted of a 1-year structured program of 103 sessions of cognitive exercises, plus social and psychomotor activities. The primary efficacy measure was the cognitive subscale of the AD Assessment Scale (ADAS-cog). Secondary efficacy measures were the Mini-Mental State Examination, the Functional Activities Questionnaire, and the Geriatric Depression Scale. Evaluations were conducted at 1, 3, 6, and 12 months by blinded evaluators.

RESULTS

Patients in the CMI group maintained cognitive status at month 6, whereas patients in the control group had significantly declined at that time. Cognitive response was higher in the patients with fewer years of formal education. In addition, more patients in the experimental group maintained or improved their affective status at month 12 (experimental group, 75%; control group, 47%; p = 0.017).

CONCLUSIONS

A long-term CMI in ChEI-treated early Alzheimer disease patients produced additional mood and cognitive benefits.

An X-ray outburst from the rapidly accreting young star that illuminates McNeil's nebula

Young, low-mass stars are luminous X-ray sources whose powerful X-ray flares may exert a profound influence over the process of planet formation. The origin of the X-ray emission is uncertain. Although many (or perhaps most) recently formed, low-mass stars emit X-rays as a consequence of solar-like coronal activity, it has also been suggested that X-ray emission may be a direct result of mass accretion onto the forming star. Here we report X-ray imaging spectroscopy observations which reveal a factor approximately 50 increase in the X-ray flux from a young star that is at present undergoing a spectacular optical/infrared outburst (this star illuminates McNeil's nebula). The outburst seems to be due to the sudden onset of a phase of rapid accretion. The coincidence of a surge in X-ray brightness with the optical/infrared eruption demonstrates that strongly enhanced high-energy emission from young stars can occur as a consequence of high accretion rates. We suggest that such accretion-enhanced X-ray emission from erupting young stars may be short-lived, because intense star-disk magnetospheric interactions are quenched rapidly by the subsequent flood of new material onto the star.

Subacute meningoencephalitis in a subset of patients with AD after Abeta42 immunization

BACKGROUND

AD is characterized by cerebral deposition of beta-amyloid plaques with amyloid beta-peptide (Abeta) 42 as the major peptide constituent, along with neurofibrillary tangles and neuronal loss. In transgenic mice, active immunization against Abeta42 removes these plaques and improves cognitive function. A Phase I study in AD patients demonstrated good safety and tolerability of multiple injections of aggregated Abeta42 (AN1792) with QS-21 as adjuvant.

METHODS

Three hundred seventy-two patients with mild to moderate AD were randomized to receive IM injections of AN1792 or placebo (4:1) at baseline and at months 1, 3, 6, 9, and 12 in a multicenter Phase II safety, tolerability, and pilot efficacy study. Dosing was terminated after four early reports of meningoencephalitis, but follow-up continued. The study remains blinded, and further results will be reported after its termination.

RESULTS

Symptoms and laboratory findings consistent with meningoencephalitis occurred in 18 of 298 (6%) patients treated with AN1792 compared with 0 of 74 on placebo (p = 0.020). Sixteen of the 18 had received two doses, one had received one dose, and one had received three doses of the study drug before symptoms occurred. The median latency from the first and last injections to symptoms was 75 and 40 days. No case occurred later than 6 months after the first immunization. Anti-Abeta42 antibody titers were not correlated with the occurrence or severity of symptoms or relapses. Twelve patients recovered to or close to baseline within weeks, whereas six remain with disabling cognitive or neurologic sequelae. All 18 patients remain alive to date (December 31, 2002), 6 months to >1 year after symptom onset.

CONCLUSIONS

Postvaccination meningoencephalitis occurred without clear relation to serum anti-Abeta42 antibody titers. Potential mechanisms such as T-cell and microglial activation may be responsible and are under consideration to develop a safer anti-Abeta immunotherapy for AD.

How atypical is atypical language dominance?

Atypical, right-hemisphere language dominance is poorly understood. It is often observed in patients with brain reorganization due to lesions early in life. It can also be encountered in seemingly normal individuals. We compared the patterns of neural language activation in 7 individuals with left- and 7 with right-hemisphere language dominance, none of whom had any evidence of brain lesions. We speculated that incongruencies in the activation patterns in atypical, right-hemisphere language dominance could indicate a reorganized neural language system after undetected early brain damage. Functional magnetic resonance imaging analysis of brain activation during phonetic word generation demonstrated (1). no increased activation in the subdominant hemisphere in right compared to left language dominance, (2). a similar variability in the pattern of activation in both groups, and (3). a mirror reverse pattern of activation in right- compared to left-hemisphere dominant subjects. These findings support the view that in individuals with an unrevealing medical history right-hemispheric dominance constitutes a natural rather than an abortive variant of language lateralization.

APOE genotype in cerebrovascular disease and vascular dementia

BACKGROUND

The fact that the allele epsilon 4 of the Apolipoprotein E (APOE) gene could act like a risk factor not only in late-onset familial and sporadic Alzheimer's disease (AD) but also in cerebrovascular disease (CVD) and vascular dementia (VaD) is still controversial.

METHODS

In order to study if epsilon 4 allele is overrepresented not only in AD but also in CVD and VaD, APOE genotyping was undertaken in a series of 247 patients: 26 cases with VaD, 41 cases with CVD but without cognitive impairment (CVD-C), 83 cases with AD and 97 aged-matched "healthy controls" (HC).

RESULTS

Percentages of subjects bearing one or two copies of the epsilon 4 allele was much higher in AD patients (54%) than in either CVD-C (29%) (p<0.05), VaD (15%) (p<0.001) or HC (13%) (p<0.001).

CONCLUSIONS

These results strengthen the hypothesis that involves the APOE epsilon 4 allele as a predisposing factor for AD, but not for CVD or VaD.

[Influence of positioning on the quality of unilateral spinal anesthesia]

OBJECTIVE

Unilateral spinal anaesthesia ("hemi-spinal") is theoretically associated with the advantages of fewer cardiovascular effects and longer duration of action while offering high density motor block of the extremity affected.

METHODS

In a prospective, randomised study 60 patients received 2 mls of 4 % hyperbaric mepivacaine intrathecally. Group I (n = 30) was returned into the supine position after 5 minutes in the lateral position, Group II (n = 30) was kept in the lateral position for 15 minutes. Spread and subsequently offset of sensory and motor block were assessed separately for each side at predetermined time intervals pre-, intra-, and postoperatively.

RESULTS

Both groups were identical regarding their morphometric parameters. In Group I (5 minutes), the mean cephalad spread of sensory block of the initially dependent side was T6 after 15 mins and T4 after 25 mins. On the initially non-dependent side, the sensory block reached to T5 after 25 mins. In Group II (15 mins), the initial mean difference was equivalent to two segments (T7/T9). After 25 minutes there was no difference to the results in Group I.

CONCLUSIONS

Unilateral spinal anaesthesia ("hemi-spinal") is an attractive concept, supposed to be associated with the above mentioned advantages and the additional benefit of a partially maintained sensation of one limb. The results demonstrated in this study seriously question this theoretical concept. The most likely reason for the lack of inter-lateral differences in sensory block is the high concentration of hyperbaric local anaesthetic in the cerebrospinal fluid on the dependent side, which, on turning the patient to the supine position, will transit to the previously non-dependent side subsequently leading to a significant block.

Using geographical information systems for management of back-pain data

In the medical world, statistical visualisation has largely been confined to the realm of relatively simple geographical applications. This remains the case, even though hospitals have been collecting spatial data relating to patients. In particular, hospitals have a wealth of back pain information, which includes pain drawings, usually detailing the spatial distribution and type of pain suffered by back-pain patients. Proposes several technological solutions, which permit data within back-pain datasets to be digitally linked to the pain drawings in order to provide methods of computer-based data management and analysis. In particular, proposes the use of geographical information systems (GIS), up till now a tool used mainly in the geographic and cartographic domains, to provide novel and powerful ways of visualising and managing back-pain data. A comparative evaluation of the proposed solutions shows that, although adding complexity and cost, the GIS-based solution is the one most appropriate for visualisation and analysis of back-pain datasets.

Contribution of APOE promoter polymorphisms to Alzheimer's disease risk

OBJECTIVE

To determine whether the effects of APOE promoter polymorphisms on AD are independent of the APOE-epsilon4 allele.

BACKGROUND

Recently, the -491 A-->T and -219 G-->T polymorphisms located in the APOE promoter have been suggested to be risk factors for AD. However, the effects of these polymorphisms have not always been reproduced in case-control studies, possibly because of the strong linkage disequilibrium existing at this locus or the characteristics of the populations studied.

METHODS

Data collection was performed from six independent samples (1,732 patients with AD and 1,926 control subjects) genotyped for APOE exon 4 and the two APOE promoter polymorphisms. The risks associated with the APOE polymorphisms for developing AD were estimated using logistic regression procedures and calculation of odds ratios with 95% CI adjusted by age, sex, and collection center. Independence of the APOE promoter polymorphisms was tested by stratification for APOE-epsilon4 and tertile design was used for age stratification.

RESULTS

The independence of the -491 AA genotype was observed in the whole sample whereas the independence of the -219 TT genotype was observed only in the oldest population.

CONCLUSION

The -491 and -219 APOE promoter polymorphisms incur risk for AD in addition to risk associated with the APOE-epsilon4 allele, with age accentuating the effect of the -219 TT genotype. Because these polymorphisms appear to influence apoE levels, these results suggest that APOE expression is an important determinant of AD pathogenesis.

Changes in heart rate variability following acclimation to heat

We studied the sympatho-vagal balance during acclimation to heat in eight healthy individuals. The subjects, dressed in shorts and tennis shoes, underwent a 10 d procedure of acclimation. Daily exposure lasted 115 min--5 min rest followed by 2 bouts of 50 min exercise (walking on a treadmill at a work load of approximately 350 watt) separated by 10 min rest-at 40 degrees C and 40% relative humidity. We analyzed the time and frequency domains of 256 R-R intervals, toward the end of the second bout of exercise, on the first and tenth days of acclimation. Typical changes for heat acclimation (a reduction in rectal temperature and heart rate, an increase in sweat rate) were observed. Concomitant to a decrease in the final heart rate on the tenth day, sympathetic tone increased. We suggest that, except for the chronotropic response, changes in the sympatho-vagal balance may reflect several adaptive mechanisms of the cardiovascular system. Peripheral factors rather than intrinsic cardiac factors are of relatively greater importance in the direct control of cardiac function.

Impact of psychosocial treatments on associated problems of cocaine-dependent patients

A previous report from the National Institute on Drug Abuse Collaborative Cocaine Treatment Study (P. Crits-Christoph et al., 1999) found relatively superior cocaine and drug use outcomes for individual drug counseling plus group drug counseling compared with other treatments. Using data from that study, the authors examined the relative efficacy of 4 treatments for cocaine dependence on psychosocial and other addiction-associated problems. The 487 patients were randomly assigned to 6 months of treatment with cognitive therapy, supportive-expressive therapy, or individual drug counseling (each with additional group drug counseling), or to group drug counseling alone. Assessments were made at baseline and monthly for 6 months during the acute treatment phase, with follow-up visits at 9 and 12 months. No significant differences between treatments were found on measures of psychiatric symptoms, employment, medical, legal, family-social, interpersonal, or alcohol use problems. The authors concluded that the superiority of individual drug counseling in modifying cocaine use does not extend broadly to other addiction-associated problems.

Impact of psychosocial treatments on associated problems of cocaine-dependent patients

A previous report from the National Institute on Drug Abuse Collaborative Cocaine Treatment Study (P. Crits-Christoph et al., 1999) found relatively superior cocaine and drug use outcomes for individual drug counseling plus group drug counseling compared with other treatments. Using data from that study, the authors examined the relative efficacy of 4 treatments for cocaine dependence on psychosocial and other addiction-associated problems. The 487 patients were randomly assigned to 6 months of treatment with cognitive therapy, supportive-expressive therapy, or individual drug counseling (each with additional group drug counseling), or to group drug counseling alone. Assessments were made at baseline and monthly for 6 months during the acute treatment phase, with follow-up visits at 9 and 12 months. No significant differences between treatments were found on measures of psychiatric symptoms, employment, medical, legal, family-social, interpersonal, or alcohol use problems. The authors concluded that the superiority of individual drug counseling in modifying cocaine use does not extend broadly to other addiction-associated problems.

Comparison between phase space structures in coupled Morse systems and in various su(2) approximations

While Hamiltonians written in terms of position and momentum provide a transparent picture of the motion of a system, Hamiltonians written in terms of Lie algebras are easier to handle quantum mechanically. Therefore we are interested to know how to transform one into the other. Since the exact transformation often leads to complicated expressions, we look for approximations which preserve the essential features. As basic criterion we look for the degree of equality of the classical phase space structures. We illustrate our ideas for the case of two coupled Morse systems and its approximation in terms of the Lie algebra su(2), which is relevant to anharmonic models of molecular spectroscopy. (c) 2001 American Institute of Physics.

Maximal respiratory pressures in myasthenia gravis. Relation to single fiber electromyography

OBJECTIVES

The respiratory muscle weakness was evaluated in mild forms of myasthenia gravis (MG) and was compared with single fiber electromyography results (SFEMG) in the extensor digitorum communis muscle.

MATERIAL AND METHODS

We assessed 61 treated MG patients without clinical respiratory involvement (13 ocular forms, 28 form IIa and 20 form IIb patients) by maximal respiratory pressure (MRP) to ascertain whether they were consistent with SFEMG results.

RESULTS

Maximal expiratory pressure (MEP) and maximal inspiratory pressure (MIP) were reduced below the lower limit for healthy subjects in 85% and 77% of ocular patients; in 93% and 89% of form IIa, respectively; and in 95% of form IIb. The highest percentage of MEP and MIP reduction showed a positive correlation with increased jitter (r=0.45, P<0.001; r=0.27; P<0.05 respectively) and impulse blocking (r=0.35, P<0.01; r=0.28, P<0.05 respectively).

CONCLUSION

We consider MRP measure useful for assessing respiratory muscle weakness in MG patients with subclinical respiratory involvement.