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Dai HR, Guo HL, Hu YH, Xu J, Ding XS, Cheng R, Chen F. Precision caffeine therapy for apnea of prematurity and circadian rhythms: New possibilities open up. Front Pharmacol 2022; 13:1053210. [DOI: 10.3389/fphar.2022.1053210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
Caffeine is the globally consumed psychoactive substance and the drug of choice for the treatment of apnea of prematurity (AOP), but its therapeutic effects are highly variable among preterm infants. Many of the molecular underpinnings of the marked individual response have remained elusive yet. Interestingly, the significant association between Clock gene polymorphisms and the response to caffeine therapy offers an opportunity to advance our understanding of potential mechanistic pathways. In this review, we delineate the functions and mechanisms of human circadian rhythms. An up-to-date advance of the formation and ontogeny of human circadian rhythms during the perinatal period are concisely discussed. Specially, we summarize and discuss the characteristics of circadian rhythms in preterm infants. Second, we discuss the role of caffeine consumption on the circadian rhythms in animal models and human, especially in neonates and preterm infants. Finally, we postulate how circadian-based therapeutic initiatives could open new possibilities to promote precision caffeine therapy for the AOP management in preterm infants.
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Dvir H, Elbaz I, Havlin S, Appelbaum L, Ivanov PC, Bartsch RP. Neuronal noise as an origin of sleep arousals and its role in sudden infant death syndrome. SCIENCE ADVANCES 2018; 4:eaar6277. [PMID: 29707639 PMCID: PMC5916514 DOI: 10.1126/sciadv.aar6277] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/08/2018] [Indexed: 06/08/2023]
Abstract
In addition to regular sleep/wake cycles, humans and animals exhibit brief arousals from sleep. Although much is known about consolidated sleep and wakefulness, the mechanism that triggers arousals remains enigmatic. Here, we argue that arousals are caused by the intrinsic neuronal noise of wake-promoting neurons. We propose a model that simulates the superposition of the noise from a group of neurons, and show that, occasionally, the superposed noise exceeds the excitability threshold and provokes an arousal. Because neuronal noise decreases with increasing temperature, our model predicts arousal frequency to decrease as well. To test this prediction, we perform experiments on the sleep/wake behavior of zebrafish larvae and find that increasing water temperatures lead to fewer and shorter arousals, as predicted by our analytic derivations and model simulations. Our findings indicate a previously unrecognized neurophysiological mechanism that links sleep arousals with temperature regulation, and may explain the origin of the clinically observed higher risk for sudden infant death syndrome with increased ambient temperature.
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Affiliation(s)
- Hila Dvir
- Department of Physics, Bar-Ilan University, Ramat Gan, Israel
| | - Idan Elbaz
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
- The Leslie and Susan Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Shlomo Havlin
- Department of Physics, Bar-Ilan University, Ramat Gan, Israel
| | - Lior Appelbaum
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
- The Leslie and Susan Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Plamen Ch. Ivanov
- Keck Laboratory for Network Physiology, Department of Physics, Boston University, Boston, MA 02215, USA
- Harvard Medical School and Division of Sleep Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Institute of Solid State Physics, Bulgarian Academy of Sciences, Sofia, Bulgaria
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Bueno C, Menna-Barreto L. Development of sleep/wake, activity and temperature rhythms in newborns maintained in a neonatal intensive care unit and the impact of feeding schedules. Infant Behav Dev 2016; 44:21-8. [PMID: 27261553 DOI: 10.1016/j.infbeh.2016.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 01/03/2023]
Abstract
UNLABELLED Biological rhythms in infants are described as evolving from an ultradian to a circadian pattern along the first months of life. Recently, the use of actigraphy and thermistors with memory has contributed to the understanding of temporal relations of different variables along development. The aim of this study was to describe and compare the development of the rhythmic pattern of wrist temperature, activity/rest cycle, sleep/wake and feeding behavior in term and preterm newborns maintained in a neonatal intensive care unit (NICU). METHODS Nineteen healthy preterm and seven fullterm newborns had the following variables monitored continuously while they were in the NICU: activity recorded by actigraphy, wrist temperature recorded with a thermistor and observed sleep and feeding behavior recorded by the NICU staff with diaries. Subjects were divided in 3 groups according to their gestational age at birth and rhythmic parameters were compared. RESULTS A dominant daily rhythm was observed for wrist temperature since the first two weeks of life and no age relation was demonstrated. Otherwise, a daily pattern in activity/rest cycle was observed for most preterm newborns since 35 weeks of postconceptional age and was more robust in term babies. Feeding and sleep/wake data showed an almost exclusive 3h rhythm, probably related to a masking effect of feeding schedules. CONCLUSIONS We found that wrist temperature develops a daily pattern as soon as previously reported for rectal temperature, and with acrophase profile similar to adults. Moreover, we were able to find a daily rhythm in activity/rest cycle earlier than previously reported in literature. We also suggest that sleep/wake rhythm and feeding behavior follow independent developmental courses, being more suitable to masking effects.
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Affiliation(s)
- Clarissa Bueno
- Department of Physiology and Biophysics, Biomedical Sciences Institute, University of São Paulo, Brazil.
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Bach V, Telliez F, Chardon K, Tourneux P, Cardot V, Libert JP. Thermoregulation in wakefulness and sleep in humans. HANDBOOK OF CLINICAL NEUROLOGY 2011; 98:215-227. [PMID: 21056189 DOI: 10.1016/b978-0-444-52006-7.00014-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Veronique Bach
- Laboratory DMAG-INERIS, Faculty of Medicine, University of Picardy Jules Verne, Amiens, France.
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Wrobel LC, Ginalski MK, Nowak AJ, Ingham DB, Fic AM. An overview of recent applications of computational modelling in neonatology. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2010; 368:2817-34. [PMID: 20439275 PMCID: PMC2944385 DOI: 10.1098/rsta.2010.0052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This paper reviews some of our recent applications of computational fluid dynamics (CFD) to model heat and mass transfer problems in neonatology and investigates the major heat and mass-transfer mechanisms taking place in medical devices, such as incubators, radiant warmers and oxygen hoods. It is shown that CFD simulations are very flexible tools that can take into account all modes of heat transfer in assisting neonatal care and improving the design of medical devices.
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Affiliation(s)
- Luiz C Wrobel
- School of Engineering and Design, Brunel University, Uxbridge UB8 3PH, UK.
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Stern G, Beel J, Suki B, Silverman M, Westaway J, Cernelc M, Baldwin D, Frey U. Long-range correlations in rectal temperature fluctuations of healthy infants during maturation. PLoS One 2009; 4:e6431. [PMID: 19641615 PMCID: PMC2713399 DOI: 10.1371/journal.pone.0006431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 05/22/2009] [Indexed: 11/20/2022] Open
Abstract
Background Control of breathing, heart rate, and body temperature are interdependent in infants, where instabilities in thermoregulation can contribute to apneas or even life-threatening events. Identifying abnormalities in thermoregulation is particularly important in the first 6 months of life, where autonomic regulation undergoes critical development. Fluctuations in body temperature have been shown to be sensitive to maturational stage as well as system failure in critically ill patients. We thus aimed to investigate the existence of fractal-like long-range correlations, indicative of temperature control, in night time rectal temperature (Trec) patterns in maturing infants. Methodology/Principal Findings We measured Trec fluctuations in infants every 4 weeks from 4 to 20 weeks of age and before and after immunization. Long-range correlations in the temperature series were quantified by the correlation exponent, α using detrended fluctuation analysis. The effects of maturation, room temperature, and immunization on the strength of correlation were investigated. We found that Trec fluctuations exhibit fractal long-range correlations with a mean (SD) α of 1.51 (0.11), indicating that Trec is regulated in a highly correlated and hence deterministic manner. A significant increase in α with age from 1.42 (0.07) at 4 weeks to 1.58 (0.04) at 20 weeks reflects a change in long-range correlation behavior with maturation towards a smoother and more deterministic temperature regulation, potentially due to the decrease in surface area to body weight ratio in the maturing infant. α was not associated with mean room temperature or influenced by immunization Conclusions This study shows that the quantification of long-range correlations using α derived from detrended fluctuation analysis is an observer-independent tool which can distinguish developmental stages of night time Trec pattern in young infants, reflective of maturation of the autonomic system. Detrended fluctuation analysis may prove useful for characterizing thermoregulation in premature and other infants at risk for life-threatening events.
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Affiliation(s)
- Georgette Stern
- Division of Respiratory Medicine, Department of Pediatrics, Inselspital and University of Bern, Bern, Switzerland.
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Patural H, Pichot V, Jaziri F, Teyssier G, Gaspoz JM, Roche F, Barthelemy JC. Autonomic cardiac control of very preterm newborns: a prolonged dysfunction. Early Hum Dev 2008; 84:681-7. [PMID: 18556151 DOI: 10.1016/j.earlhumdev.2008.04.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2007] [Revised: 04/26/2008] [Accepted: 04/30/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Autonomic nervous system (ANS) activity is fundamental to infant health. ANS activity of preterm newborns seems to be reduced at term equivalent age, but follow-up of ANS activity has rarely been performed in that population during the weeks after birth. The aim of the study was to perform such a follow-up in preterm newborns of different gestational ages, up to their term equivalent ages. METHODS Prolonged electrocardiographic recordings were prospectively performed in a group of 39 premature newborns, each week, up to term equivalent age before discharge. Control values were obtained from a group of 19 full-term newborns, recorded at the first week of their life. ANS indices were calculated from recordings during quiet sleep periods by spectral-domain analysis (Fourier transform): Ptot (total power), VLF (very low-frequencies), LF (low-frequencies), HF (high-frequencies), LF/HF ratio, LFnu (normalized low-frequencies) and HFnu (normalized high-frequencies) values. RESULTS Ptot, VLF, LF and HF were significantly lower in the preterm group at birth compared to the control group, while LFnu, HFnu and LF/HF ratio were not significantly different. The results were similar when comparing the control group to any ANS values at a given post-natal corrected age of preterm newborns. Furthermore, preterm newborns did not demonstrate any significant increase in ANS values from birth to theoretical term. CONCLUSION The finding of substantial reduced ANS activity and failure of maturation in preterm infants up to term equivalent age needs confirming by other research groups, and mechanisms and implications for infant health explored.
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Affiliation(s)
- Hugues Patural
- Laboratoire de Physiologie Clinique et de l'Exercice, The Synapse Research Group, France.
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Ginalski MK, Nowak AJ, Wrobel LC. Modelling of heat and mass transfer processes in neonatology. Biomed Mater 2008; 3:034113. [DOI: 10.1088/1748-6041/3/3/034113] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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De Rogalski Landrot I, Roche F, Pichot V, Teyssier G, Gaspoz JM, Barthelemy JC, Patural H. Autonomic nervous system activity in premature and full-term infants from theoretical term to 7 years. Auton Neurosci 2007; 136:105-9. [PMID: 17556047 DOI: 10.1016/j.autneu.2007.04.008] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Revised: 04/03/2007] [Accepted: 04/30/2007] [Indexed: 11/30/2022]
Abstract
The premature population reaching theoretical term suffers from a major deficit in autonomic nervous system (ANS) activity, as can be seen from heart rate variability indices. Whether this autonomic function recovers in the long term is not yet established. Thus, we analyzed and compared ANS activity indices, at birth or at the time of the theoretical term, and at ages 2-3 and 6-7 years, in two populations: a group of 30 premature children and a reference group of 14 full-term age-matched newborns. Using Fourier Transform analysis, we studied 24-h ECG Holter recordings to establish heart rate variability indices: Ptot, VLF, LF, HF, ratio LF/HF, LFnu, HFnu. In the neonatal period, sympathetic and even more markedly, parasympathetic activities were very low in prematures compared to the reference full-term group. At ages 2-3 and 6-7 years, prematures had recovered and had similar ANS activity as the full-term group. These data suggest a fast ANS maturation in prematures during the two first years of life, with a higher speed of recovery for the parasympathetic arm. Furthermore, compared evolution shows a faster ANS maturation in premature. Potential mechanisms are discussed.
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MESH Headings
- Age Factors
- Aging/physiology
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/physiopathology
- Autonomic Nervous System/growth & development
- Autonomic Nervous System/physiopathology
- Autonomic Nervous System Diseases/etiology
- Autonomic Nervous System Diseases/physiopathology
- Blood Pressure Monitoring, Ambulatory
- Child
- Child, Preschool
- Cohort Studies
- Electrocardiography
- Fourier Analysis
- Heart Rate/physiology
- Humans
- Infant
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/physiopathology
- Parasympathetic Nervous System/growth & development
- Parasympathetic Nervous System/physiopathology
- Recovery of Function/physiology
- Sleep/physiology
- Sympathetic Nervous System/growth & development
- Sympathetic Nervous System/physiopathology
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Ginalski MK, Nowak AJ, Wrobel LC. A combined study of heat and mass transfer in an infant incubator with an overhead screen. Med Eng Phys 2006; 29:531-41. [PMID: 17030142 DOI: 10.1016/j.medengphy.2006.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Revised: 06/09/2006] [Accepted: 07/17/2006] [Indexed: 11/16/2022]
Abstract
The main objective of this study is to investigate the major physical processes taking place inside an infant incubator, before and after modifications have been made to its interior chamber. The modification involves the addition of an overhead screen to decrease radiation heat losses from the infant placed inside the incubator. The present study investigates the effect of these modifications on the convective heat flux from the infant's body to the surrounding environment inside the incubator. A combined analysis of airflow and heat transfer due to conduction, convection, radiation and evaporation has been performed, in order to calculate the temperature and velocity fields inside the incubator before and after the design modification. Due to the geometrical complexity of the model, computer-aided design (CAD) applications were used to generate a computer-based model. All numerical calculations have been performed using the commercial computational fluid dynamics (CFD) package FLUENT, together with in-house routines used for managing purposes and user-defined functions (UDFs) which extend the basic solver capabilities. Numerical calculations have been performed for three different air inlet temperatures: 32, 34 and 36 degrees C. The study shows a decrease of the radiative and convective heat losses when the overhead screen is present. The results obtained were numerically verified as well as compared with results available in the literature from investigations of dry heat losses from infant manikins.
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Affiliation(s)
- Maciej K Ginalski
- Institute of Thermal Technology, Silesian University of Technology, Konarskiego 22, 44-100 Gliwice, Poland.
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Bach V, Telliez F, Libert JP. The interaction between sleep and thermoregulation in adults and neonates. Sleep Med Rev 2002; 6:481-92. [PMID: 12505480 DOI: 10.1053/smrv.2001.0177] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The interaction between sleep and thermoregulation leads to different thermoregulatory responses depending on the sleep stage and alterations in sleep when in a cool or warm environment. In the human adult, differences in thermoregulatory efficiency during rapid eye movement (REM) sleep and slow wave sleep (SWS) are less pronounced compared to other mammals: although thermoregulatory processes persist in REM sleep, they are less efficient than during SWS. Cold and warm loads disturb the efficiency and structure of sleep. The duration of REM sleep and (to a lesser extent) of SWS decreases. In contrast, pre-sleep warm loads enhance SWS and improve sleep continuity. This procedure may promote and maintain sleep in depressed patients, whose sleep and body temperature rhythms are modified. In contrast to adults, homeothermic processes in neonates are maintained or even enhanced during active sleep (AS) when compared to quiet sleep (QS). Sleeping in a cool environment increases the duration of AS at the expense of QS. As a result, the thermoregulatory function overcomes the need to conserve energy that would otherwise lead to increased QS. An interaction between sleep, respiration, and thermoregulation may be involved in Sudden Infant Death Syndrome: an alteration in the thermal balance may perhaps induce respiration instability, especially during AS.
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Affiliation(s)
- Veronique Bach
- Unité de Recherches sur les Adaptations Physiologiques et Comportementales, Faculté de Médecine, Université de Picardie Jules Verne, 3 rue des Louvels, F- 80 036 Amiens, France.
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Bach V, Telliez F, Leke A, Libert JP. Gender-related sleep differences in neonates in thermoneutral and cool environments. J Sleep Res 2000; 9:249-54. [PMID: 11012863 DOI: 10.1046/j.1365-2869.2000.00206.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although thermoregulation and sleep exhibit gender differences in adults, the question is still debated in neonates. The aim of this study was to examine the relationship between gender-related sleep differences and cool defence mechanisms in neonates. Sleep and thermoregulation were recorded in healthy preterm neonates (21 boys and 17 girls, 37 +/- 2 weeks post-conceptional age) exposed to thermoneutral and cool conditions. Sleep was analysed for continuity and structure. Although the cool exposure did not strongly impair body homeothermia, sleep was altered but without any significant gender difference. However, when data recorded under each of the thermal conditions were pooled, some gender differences emerged: boys slept less, with more wakefulness after sleep onset, more active sleep and less quiet sleep than girls. In contrast to sleep architecture, most of the sleep continuity parameters exhibited greater variability in boys than in girls. This variability may bias the statistical analyses and probably explains the varying conclusions reported in the literature regarding gender-specific sleep-related differences.
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Affiliation(s)
- V Bach
- Unité de Recherches sur les Adaptations Physiologiques et Comportementales, Université de Picardie Jules Verne, Amiens, France
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Abstract
Increased body temperature (fever or hyperthermia) is a physiological response to many different stimuli. In fact, fever (a 1-4°C elevation of the body temperature) is not only a clinical symptom common to many infectious diseases but also a side effect of immunostimulating or antiviral therapies. Hyperthermic reactions, on the other hand, can be observed after treatment with antipsychotic drugs, 5-hydroxytryptamine-receptor agonists, and acetylcholinesterase inhibitors and as a reaction to anesthesia. Moreover, hyperthermic reactions can be related to particularly stressful emotional states, to the menstrual ovulatory cycle, and to pregnancy. Transient hyperthermia or fever is also a common consequence of cerebral ischemic events, and it is present during stress as well as intense physical exercise. This review focuses on fever, one of the main components of the systemic acute-phase reaction to external proinflammatory stimuli. Special emphasis is given to neuronal mechanisms of fever induction, in which the hypothalamus plays a crucial role in both control of the febrile response as well as other centrally mediated neurological signs of inflammation, such as increased sleep, activation of the hypothalamic-pituitary-adrenal axis, anorexia, and sickness behavior. This review pays particular attention to the role of proinflammatory cytokines as endogenous pyrogens. NEUROSCIENTIST 4:113-121, 1998
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Affiliation(s)
- Anna K. Sundgren-Andersson
- Department of Neurochemistry and Neurotoxicology (AKS-A), Arrhenius Laboratories for Natural Sciences, Stockholm University, Stockholm, Sweden, Research (SG), Pharmacia and UpJohn, S.p.A., Nerviano, Italy, Department PharmaResearch Preclinical Nervous System (TB), F. Hoffmann-La Roche, Ltd., Basel, Switzerland
| | - Silvia Gatti
- Department of Neurochemistry and Neurotoxicology (AKS-A), Arrhenius Laboratories for Natural Sciences, Stockholm University, Stockholm, Sweden, Research (SG), Pharmacia and UpJohn, S.p.A., Nerviano, Italy, Department PharmaResearch Preclinical Nervous System (TB), F. Hoffmann-La Roche, Ltd., Basel, Switzerland
| | - Tamas Bartfai
- Department of Neurochemistry and Neurotoxicology (AKS-A), Arrhenius Laboratories for Natural Sciences, Stockholm University, Stockholm, Sweden, Research (SG), Pharmacia and UpJohn, S.p.A., Nerviano, Italy, Department PharmaResearch Preclinical Nervous System (TB), F. Hoffmann-La Roche, Ltd., Basel, Switzerland
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