Microscopic Nature of the First-Order Field-Induced Phase Transition in the Strongly Anisotropic Ferrimagnet HoFe_{5}Al_{7}

We report on x-ray magnetic circular dichroism experiments in pulsed fields up to 30 T to follow the rotations of individual magnetic moments through the field-induced phase transition in the ferrimagnet HoFe_{5}Al_{7}. Near the ground state, we observe simultaneous stepwise rotations of the Ho and Fe moments and explain them using a two-sublattice model for an anisotropic ferrimagnet with weak intersublattice exchange interactions. Near the compensation point, we find two phase transitions. The additional magnetization jump reflects the fact that the Ho moment is no longer rigid as the applied field acts against the intersublattice exchange field.

Two spin-canting textures in the antiferromagnetic phase AF1 of MnWO4 based on the new polar atomistic model in P2

The low temperature antiferromagnetic (AF) phase of MnWO₄ (the so-called AF1 phase) exhibits different spin-canting configurations at two Mn²⁺ sublattices of the (3  +  1)-dimensional magnetic structure. The suggested superspace group [Formula: see text] is a significant consequence of the polar space group [Formula: see text]2 true for the nuclear structure of MnWO₄. Density functional theory calculations showed that its ground state prefers this two spin-canting system. The structural difference between two independent atomic sites for Mn (Mn _a , Mn _b ) is too small to allow microscopically detectable electric polarisation. However, this hidden intrinsic polar character allows AF1 two commensurately modulated spin-canting textures. This is considered as the prerequisite onset of the improper ferroelectricity enhanced by the helical spin order in the multiferroic phase AF2 of MnWO₄.

57Co-Bleomycin Scintigraphy for the Preoperative Detection and Staging of Lung Tumors

Twenty-five consecutive patients with lung tumors were classified according to the presence of metastases by the use of 57Co-Bleomycin scintigraphy. Twenty-two of the tumors were visualized but metastatic spread to hilar lymph nodes was not detected. Reliable separation of central tumors with and without growth into neighbouring organs was not possible. Mediastinal uptake was found in eight cases but only a part of these could be verified by operation. The method can contribute to the evaluation of lung tumors and can be helpful to avoid some unnecessary thoracotomies.

New high-throughput measurement systems for radioactive wastes segregation and free release

This paper addresses the measurement facilities for pre-selection of waste materials prior to measurement for repository acceptance or possible free release (segregation measurement system); and free release (free release measurement system), based on a single standardized concept characterized by unique, patented lead-free shielding. The key objective is to improve the throughput, accuracy, reliability, modularity and mobility of segregation and free-release measurement. This will result in a more reliable decision-making with regard to the safe release and disposal of radioactive wastes into the environment and, resulting in positive economic outcomes. The research was carried out within "Metrology for Decommissioning Nuclear Facilities" (MetroDecom) project.

Detection of Combined n/γ Fission Signatures Induced by an Epithermal Neutron Source

In this paper, a method is presented for the detection of special nuclear materials (SNMs) in shielded containers, which is both sensitive and applicable under field conditions. The method uses an external pulsed neutron source to induce fission in SNM and subsequent detection of the fast prompt fission neutrons. The detectors surrounding the container under investigation are liquid scintillation detectors able to distinguish gamma rays from fast neutrons by means of pulse shape discrimination method (PSD). One advantage of these detectors, besides the ability for PSD analysis, is that the analog signal from a detection event is of very short duration (typically few tens of nanoseconds). This allows the use of very short coincidence gates for the detection of the prompt fission neutrons in multiple detectors, while benefiting from a low background coincidence rate, yielding a low detection limit. Another principle advantage of this method derives from the fact that the external neutron source is pulsed. By proper time gating, the interrogation can be conducted by epithermal source neutrons only. These neutrons do not appear in the fast neutron signal following the PSD analysis, thus providing a fundamental method for separating the interrogating source neutrons from the sample response in the form of fast fission neutrons. This paper describes laboratory tests with a configuration of eight detectors in the Pulsed Neutron Interrogation Test Assembly (PUNITA). Both the photon and neutron signature for induced fission is observed, and the methods used to isolate these signatures are described and demonstrated.

Ultra-high vacuum compatible induction-heated rod casting furnace

We report the design of a radio-frequency induction-heated rod casting furnace that permits the preparation of polycrystalline ingots of intermetallic compounds under ultra-high vacuum compatible conditions. The central part of the system is a bespoke water-cooled Hukin crucible supporting a casting mold. Depending on the choice of the mold, typical rods have a diameter between 6 mm and 10 mm and a length up to 90 mm, suitable for single-crystal growth by means of float-zoning. The setup is all-metal sealed and may be baked out. We find that the resulting ultra-high vacuum represents an important precondition for processing compounds with high vapor pressures under a high-purity argon atmosphere up to 3 bars. Using the rod casting furnace, we succeeded to prepare large high-quality single crystals of two half-Heusler compounds, namely, the itinerant antiferromagnet CuMnSb and the half-metallic ferromagnet NiMnSb.

Long-wavelength helimagnetic order and skyrmion lattice phase in Cu2OSeO3

We report a long-wavelength helimagnetic superstructure in bulk samples of the ferrimagnetic insulator Cu2OSeO3. The magnetic phase diagram associated with the helimagnetic modulation inferred from small-angle neutron scattering and magnetization measurements includes a skyrmion lattice phase and is strongly reminiscent of MnSi, FeGe, and Fe(1-x)Co(x)Si, i.e., binary isostructural siblings of Cu2OSeO3 that order helimagnetically. The temperature dependence of the specific heat of Cu2OSeO3 is characteristic of nearly critical spin fluctuations at the helimagnetic transition. This provides putative evidence for effective spin currents as the origin of enhancements of the magnetodielectric response instead of atomic displacements considered so far.

A genome-wide scan in affected sibling pairs with idiopathic recurrent miscarriage suggests genetic linkage

Previously, siblings of patients with idiopathic recurrent miscarriage (IRM) have been shown to have a higher risk of miscarriage. This study comprises two parts: (i) an epidemiological part, in which we introduce data on the frequency of miscarriage among 268 siblings of 244 patients with IRM and (ii) a genetic part presenting data from a genome-wide linkage study of 38 affected sibling pairs with IRM. All IRM patients (probands) had experienced three or more miscarriages and affected siblings two or more miscarriages. The sibling pairs were genotyped by the Affymetrix GeneChip 50K XbaI platform and non-parametric linkage analysis was performed via the software package Merlin. We find that siblings of IRM patients exhibit a higher frequency of miscarriage than population controls regardless of age at the time of pregnancy. We identify chromosomal regions with LOD scores between 2.5 and 3.0 in subgroups of affected sibling pairs. Maximum LOD scores were identified in four occurrences: for rs10514716 (3p14.2) when analyzing sister-pairs only; for rs10511668 (9p22.1) and rs341048 (11q13.4) when only analyzing families where the probands have had four or more miscarriages; and for rs10485275 (6q16.3) when analyzing one sibling pair from each family only. We identify no founder mutations. Concluding, our results imply that IRM patients and their siblings share factors which increase the risk of miscarriage. In this first genome-wide linkage study of affected sibling pairs with IRM, we identify regions on chromosomes 3, 6, 9 and 11 which warrant further investigation in order to elucidate their putative roles in the genesis of IRM.

Skyrmion lattices in metallic and semiconducting B20 transition metal compounds

High pressure studies in MnSi suggest the existence of a non-Fermi liquid state without quantum criticality. The observation of partial magnetic order in a small pocket of the pressure versus temperature phase diagram of MnSi has additionally inspired several proposals of complex spin textures in chiral magnets. We used neutron scattering to observe the formation of a two-dimensional lattice of skyrmion lines, a type of magnetic vortices, under applied magnetic fields in metallic and semiconducting B20 compounds. In strongly disordered systems the skyrmion lattice is hysteretic and extends over a large temperature range. Our study experimentally establishes magnetic materials lacking inversion symmetry as an arena for new forms of spin order composed of topologically stable spin textures.

Screening for abdominal aortic aneurysms in Western Australia

A study of ultrasound screening for abdominal aortic aneurysms (AAA) was performed. During a 6 month period, 1225 men and women aged 60-80 years were screen at a variety of community venues. Screening was well received by the public and logistically simple to perform. Thirty-three AAA were detected with sizes between 30 and 81 mm. In the 60-80 year age group, the prevalence of AAA > 30 mm in diameter was 4.7% in men and 0.35% in women, and the prevalence of AAA > 50 mm was 0.6% in men and 0.17% in women. Cigarette smoking, but not hypertension or diabetes, was found to be a significant risk factor for AAA. This study confirms that screening for AAA is feasible and yields high prevalence rates in major population centres.

Assessment of D-dimer in plasma: diagnostic value in suspected deep venous thrombosis of the leg

D-dimer, a fibrin degradation product containing the gamma-gamma crosslink of fibrin, can now be assayed by the use of highly specific monoclonal antibodies. Such assays are not influenced by fibrinogenolysis and measurements can be performed on citrated plasma. The diagnostic values of four such assays--two based on ELISA technique and two on latex agglutination--were evaluated in 108 out of 118 consecutive patients admitted with suspected deep venous thrombosis of the leg. With cut-off limits defined by a pilot study and with venography as reference, a negative D-dimer test was confirmed in 45 of 46 patients (98%; 95% confidence limits: 88-99.9%) after ELISA-M, in 43 of 44 (98%; 88-99.9%) after ELISA-S, in 54 of 67 (81%; 69-89%) after Latex-M and in 40 of 44 (91%; 78-97%) after Latex-S. A positive D-dimer test was confirmed in 61% (48-73%), 59% (46-71%), 63% (47-78%), and 55% (42-67%) respectively. These data suggest the use of one of the ELISA assays for screening. A negative D-dimer test excludes deep venous thrombosis, whereas a positive D-dimer should be followed by venography. By this procedure a 40% reduction of venographic examinations can be expected.

Role of cardiac myocyte tissue factor in heart hemostasis

BACKGROUND

The tissue-specific pattern of tissue factor (TF) expression suggests that it plays a major role in the hemostatic protection of specific organs, such as the heart and lung. In support of this notion, we found that mice expressing very low levels of TF exhibit hemostatic defects in the heart and lung. Hemosiderosis and fibrosis are observed in the hearts of all low TF mice as early as 3 months of age. In contrast, TF(+/-) mice expressing approximately 50% of wild-type levels of TF had no detectable hemostatic defects.

OBJECTIVE AND METHODS

The objective of this study was to determine the threshold of TF that is required to maintain hemostasis under normal and pathologic conditions, and to investigate the specific role of cardiac myocyte TF in heart hemostasis using mice with altered levels of TF expression in cardiac myocytes.

RESULTS

First, we found that mice with 20% of wild-type levels of TF activity in their hearts had hemosiderosis and fibrosis by 6 months of age. Secondly, mice with a selective deletion of the TF gene in cardiac myocytes had a mild hemostatic defect under normal conditions but exhibited a significant increase in hemosiderosis and fibrosis after challenge with isoproterenol. Finally, we showed that cardiac myocyte-specific overexpression of TF abolished hemosiderin deposition and fibrosis in the hearts of low TF mice.

CONCLUSIONS

Taken together, our results indicate that TF expression by cardiac myocytes is important to maintain heart hemostasis under normal and pathologic conditions.

Design and characterisation of a pulsed neutron interrogation facility

The Joint Research Centre recently obtained a license to operate a new experimental device intended for research in the field of nuclear safeguards. The research projects currently being planned for the new device includes mass determination of fissile materials in matrices and detection of contraband non-nuclear materials. The device incorporates a commercial pulsed neutron generator and a large graphite mantle surrounding the sample cavity. In this configuration, a relatively high thermal neutron flux with a long lifetime is achieved inside the sample cavity. By pulsing the neutron generator, a sample may be interrogated by a pure thermal neutron flux during repeated time periods. The paper reports on the design of the new device and the pulsed fast and thermal neutron source. The thermal neutron flux caused by the neutron generator and the graphite structure has been characterised by foil activation, fission chamber and (3)He proportional counter measurements.

MEAD: an interdisciplinary study of the marine effects of atmospheric deposition in the Kattegat

This paper summarises the results of the EU funded MEAD project, an interdisciplinary study of the effects of atmospheric nitrogen deposition on the Kattegat Sea between Denmark and Sweden. The study considers emissions of reactive nitrogen gases, their transport, transformations, deposition and effects on algal growth together with management options to reduce these effects. We conclude that atmospheric deposition is an important source of fixed nitrogen to the region particularly in summer, when nitrogen is the limiting nutrient for phytoplankton growth, and contributes to the overall eutrophication pressures in this region. However, we also conclude that it is unlikely that atmospheric deposition can, on its own, induce algal blooms in this region. A reduction of atmospheric nitrogen loads to this region will require strategies to reduce emissions of ammonia from local agriculture and Europe wide reductions in nitrous oxide emissions.

Impact of the sex of first child on the prognosis in secondary recurrent miscarriage

BACKGROUND

The carriage of a male fetus often initiates maternal immunological reactions against male-specific minor histocompatibility (HY) antigens, which, in theory, could result in subsequent recurrent miscarriage (RM).

METHODS

Information about subsequent pregnancy outcome was procured among 182 women with RM after a birth (secondary RM) referred since 1986 using questionnaires, telephone interviews and registers.

RESULTS

Significantly more of the women had had a male first-born as compared with a female first-born (110 versus 72; P < 0.02). By January 2002, 58% of those who had a male first-born had given birth to a second live infant compared with 76% of those who previously had had a female first-born (P = 0.01). Women in the former group had a significantly lower chance of having a second child than those in the latter (adjusted hazard ratio 0.59; 95% confidence interval 0.41-0.86). The number of miscarriages after admission and the risk of secondary infertility were significantly greater in women with a male first-born than among those with a female first-born (P < 0.001 and P = 0.02; respectively).

CONCLUSIONS

A male first-born seems to be associated with a less favourable reproductive potential among women with secondary RM. Maternal immunization against HY antigens may be responsible for these findings.

Disordered quasicrystals: diffuse scattering in decagonal Al–Ni–Fe

High-resolution synchrotron data of near-Bragg diffuse scattering from decagonal Al71.5Ni23.5Fe5quasicrystals were recorded. A dominant phasonic origin is ruled out because of the absence of a significantG⊥dependence. An analysis solely in the frame of thermal diffuse scattering (TDS) theory (phonon scattering) showed a good match between experimental and calculated data in the quasiperiodic layers, but with an improbable ratio of elastic constants,c66/c11 = 4.0.In situhigh-temperature measurements up to 1000 K revealed an increase of the intensity distribution perpendicular to the scattering vectorG. Huang diffuse scattering (HDS) arising from quenched local defects has a general appearance that qualitatively reproduces the observed symmetry and anisotropy. An interpretation based on both TDS and HDS contributions is given.

Tissue factor deficiency causes cardiac fibrosis and left ventricular dysfunction

Exposure of blood to tissue factor (TF) activates the extrinsic (TF:FVIIa) and intrinsic (FVIIIa:FIXa) pathways of coagulation. In this study, we found that mice expressing low levels of human TF ( approximately 1% of wild-type levels) in an mTF(-/-) background had significantly shorter lifespans than wild-type mice, in part, because of spontaneous fatal hemorrhages. All low-TF mice exhibited a selective heart defect that consisted of hemosiderin deposition and fibrosis. Direct intracardiac measurement demonstrated a 30% reduction (P < 0.001) in left ventricular function in 8-month-old low-TF mice compared with age-matched wild-type mice. Mice expressing low levels of murine FVII ( approximately 1% of wild-type levels) exhibited a similar pattern of hemosiderin deposition and fibrosis in their hearts. In contrast, FIX(-/-) mice, a model of hemophilia B, had normal hearts. Cardiac fibrosis in low-TF and low-FVII mice appears to be caused by hemorrhage from cardiac vessels due to impaired hemostasis. We propose that TF expression by cardiac myocytes provides a secondary hemostatic barrier to protect the heart from hemorrhage.

Guidelines for the use of EEG methodology in the diagnosis of epilepsy. International League Against Epilepsy: commission report. Commission on European Affairs: Subcommission on European Guidelines

The Commission of European Affairs of the International League Against Epilepsy published 'Appropriate Standards for Epilepsy Care Across Europe' which contained recommendations for the use of electroencephalography (EEG) in the diagnosis of epilepsy (Brodie et al. Epilepsia 1997; 38:1245). The need for a more specific basic document of EEG methodology was recognized and the Subcommission on European Affairs was asked to produce more detailed guidelines to be used across Europe recognizing the range of practices in EEG laboratories. There are many general guidelines published on EEG methodology but this document focuses on the diagnosis of epilepsy. Details from previously published guidelines are included in references and in an appendix. These guidelines are not meant to be used as minimal standards but recommendations that can be applied to all EEG laboratories despite variations in equipment.

Pretreatment leukaemia cell drug resistance is correlated to clinical outcome in acute myeloid leukaemia

In 85 adult patients diagnosed with acute myeloid leukaemia (AML) and treated at the same institution during a 5-yr period, the clinical significance of in vitro cellular drug resistance to the anthracyclines aclarubicin (Acla) and daunorubicin (Dau) as well as the nucleoside analogue cytarabine (Ara-C) was investigated using a 4-d MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide) assay. In 59 patients of whom 40 were treated by the combination of Acla and Ara-C we found that leukaemia cell drug resistance towards Acla was higher (by a factor 2.80) in patients who failed to enter complete remission (CR) after the first cycle of induction chemotherapy as compared to patients who entered complete remission. The relationship was significant in univariate as well as multivariate analysis (p=0.02 and 0.03, respectively). By contrast, no in vitro single drug resistance values were consistently correlated to other parameters of clinical outcome (overall CR rate, overall survival (OS), or continuous complete remission (CCR)), whereas the combined Acla and Ara-C drug resistance profile (Acla/Ara-C DRP) was of prognostic significance to overall survival of all 85 patients (p=0.004) as well as to the CCR of 39 complete responders (p=0.04). These findings remained statistically significant in multivariate analyses correcting for other variables influencing clinical outcome including patient age, leukocyte count, karyotype, FAB-subtype, and presence/absence of secondary AML. We conclude that the in vitro drug resistance of leukaemia cells at time of disease presentation appears to be independent of prognostic significance to short- and long-term clinical outcome in AML.

Activation of natural killer T cells potentiates or prevents experimental autoimmune encephalomyelitis

Natural killer (NK) T cells recognize lipid antigens in the context of the major histocompatibility complex (MHC) class 1-like molecule CD1 and rapidly secrete large amounts of the cytokines interferon (IFN)-gamma and interleukin (IL)-4 upon T cell receptor (TCR) engagement. We have asked whether NK T cell activation influences adaptive T cell responses to myelin antigens and their ability to cause experimental autoimmune encephalomyelitis (EAE), a model for multiple sclerosis. While simultaneous activation of NK T cells with the glycolipid alpha-galactosylceramide (alpha-GalCer) and myelin-reactive T cells potentiates EAE in B10.PL mice, prior activation of NK T cells protects against disease. Exacerbation of EAE is mediated by an enhanced T helper type 1 (Th1) response to myelin basic protein and is lost in mice deficient in IFN-gamma. Protection is mediated by immune deviation of the anti-myelin basic protein (MBP) response and is dependent upon the secretion of IL-4. The modulatory effect of alpha-GalCer requires the CD1d antigen presentation pathway and is dependent upon the nature of the NK T cell response in B10.PL or C57BL/6 mice. Because CD1 molecules are nonpolymorphic and remarkably conserved among different species, modulation of NK T cell activation represents a target for intervention in T cell-mediated autoimmune diseases.

[Is visual assessment of MRI adequate in the investigation of patients with temporal lobe epilepsy? Evaluation of the diagnostic accuracy of the visual assessment of MRI in mesial temporal sclerosis]

INTRODUCTION

Is visual assessment of MRI adequate in patients with temporal lobe epilepsy? Visual versus quantitative MRI assessment of mesial temporal sclerosis (hippocampal gliosis (HG) and hippocampal atrophy (HA)).

MATERIAL AND METHODS

The MRIs of 25 patients with temporal lobe epilepsy were assessed visually by three radiologists with different levels of neuroradiological MRI experience (expert, trained, and inexperienced). Diagnosis obtained earlier by T2-relaxometry and volume measurements were considered to be the gold standard.

RESULTS

The diagnostic accuracy of visual assessment was high for unilateral HA, but low for bilateral HA and unilateral and bilateral HG, and it was not better for the expert eye than for the inexperienced. Interobserver agreement on the visual diagnosis of HG and HA (Cohen's Kappa coefficient): 0.49 (HG) and 0.84 (HA). Intraobserver reliability for the expert/trained/inexperienced observer for visual diagnosis (Kappa): 0.83/0.64/0.47 (HG) and 0.88/0.69/0.73 (HA).

DISCUSSION

Reproducibility and diagnostic accuracy of visual assessment varied unacceptably from the quantitative MRI-based diagnosis. Quantitative measurements are recommended in patients suspected of MTS.

Predicting spring moth emergence in the pink bollworm (Lepidoptera: Gelechiidae): implications for managing resistance to transgenic cotton

Cultural control methods have been central in the southwestern United States for reducing pink bollworm, Pectinophora gossypiella (Saunders), damage to cotton. Nevertheless, it is not clear at present how such methods could be integrated within the novel pest management framework allowed by introduction of cotton producing a toxin from Bacillus thuringiensis (Bt) for pink bollworm control. Using statewide pheromone trapping and climatic data in conjunction with deterministic simulation models, we investigated whether manipulation of cotton planting date and use of other cultural control methods could represent valuable tactics for control of the pink bollworm in Arizona. Accumulation of heat units from one January accurately predicted the rate of pink bollworm emergence from diapause in 15 cotton-producing regions. Significant variation in rate of emergence from diapause was present among regions, with earlier emergence at higher altitudes. Most adults emerge from diapause too early to reproduce successfully on cotton, a phenomenon known as suicidal emergence. A method for prediction of the fraction of suicidal emergence resulting from adoption of a given cotton planting date is presented. Results from simulation models suggest that manipulation of planting date and implementation of other control cultural methods reduce the rate of application of insecticides and delay the evolution of resistance to Bt cotton in the pink bollworm.

FAB M4 and high CD14 surface expression is associated with high cellular resistance to Ara-C and daunorubicin: implications for clinical outcome in acute myeloid leukaemia

In 145 adult patients diagnosed with non-M3 acute myeloid leukaemia (AML) the relevance of FAB-subtype and immunophenotype to in vitro cellular drug resistance towards the anthracyclines aclarubicin (Acla) and daunorubicin (Dau), and the nucleoside analogue cytarabine (Ara-C), as well as other antileukaemic drugs, was investigated using a 4-d MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide) assay. We demonstrate that high CD14 expression is highly significantly associated with high cellular Ara-C and Dau resistance in univariate as well as multivariate analyses. FAB subtypes with highest and lowest cellular Ara-C resistance were M4 and M5, respectively (P < 0.01, one-way anova), whereas FAB subtypes with highest and lowest cellular Dau resistance were M4 and M1, respectively (P < 0.01, one-way anova). By contrast, no significant differences in cellular drug resistance towards Acla could be demonstrated among FAB subtypes. Furthermore, in two cohorts of AML patients treated by two different regimens for remission induction over a period of 15 yr (1985-94, n = 159 and 1995-99, n = 76, respectively) we demonstrate in univariate analyses a significance of CD14 expression with respect to clinical outcome. With the exception of significance to probability of obtaining complete remission in the first cohort (P = 0.03, logistic regression), this significance was, however, lost in multivariate analyses. It was demonstrated that FAB-M4 patients were older than M5 patients and that high CD14 expression was associated with the presence of secondary AML and older age. We conclude that although cases with high blast cell CD14 expression (and FAB-M4 cases) were more resistant to Ara-C as well as Dau in vitro, the clinical and biological significance of this may be debatable because of interactions with major prognostic factors in AML.

Epilepsy in the elderly: the use of tiagabine

The incidence of epilepsy increases sharply in patients older than 60 years. There is a clear need for clinical trials designed specifically for this age group, as elderly patients differ from younger patients with epilepsy with respect to seizure etiology, coexisting diseases, concomitant drug therapy, and drug disposition. The new antiepileptic drugs (AEDs) are often associated with fewer side effects than are the traditional AEDs and may be particularly useful in the elderly. The pharmacokinetics of tiagabine (TGB) are not significantly modified in elderly patients, although elimination is more rapid in the presence of enzyme-inducing AEDs. Efficacy and tolerability data on TGB in elderly patients is currently limited, and a formal trial of TGB monotherapy in this age group is needed.

Recommendations on the clinical use of oxcarbazepine in the treatment of epilepsy: a consensus view

Extensive clinical use and a series of clinical trials have shown that oxcarbazepine is a valuable antiepileptic drug for the treatment of adults and children with partial onset seizures both in initial monotherapy, for conversion to monotherapy and as adjunctive therapy. The clinically recommended titration scheme for all forms of therapy in adults is to start with 150 mg/day at night and to increase by 150 mg/day every second day until a target dose of 900-1200 mg/day is reached. If necessary, one can go faster and start with up to 600 mg/day and titrate with weekly increments of up to 600 mg/day. In children, treatment can be initiated with 8-10 mg/kg/day body weight in two to three divided doses. Dosage can be increased by 8-10 mg/kg/day in weekly increments if necessary for seizure control. Hyponatremia (serum sodium <125 mmol/l) can develop gradually during the first months of oxcarbazepine therapy in approximately 3% of patients with a previously normal serum sodium. However, there is no need to measure baseline serum sodium concentrations unless the patient has renal disease, is taking medication which may lower serum sodium levels (such as diuretics, oral contraceptives or nonsteroidal anti-inflammatory drugs) or--in rare cases--has clinical symptoms of hyponatremia. During oxcarbazepine maintenance therapy measurement of serum sodium levels should also be considered if medications known to decrease sodium levels are added or symptoms of hyponatremia develop. Oxcarbazepine does not appear to have any clinically notable effects on other safety parameters such as renal and liver function or haematological test results. In summary, oxcarbazepine is a safe and well tolerated antiepileptic drug for partial epilepsy.

Expansion of repetitive DNA into cytogenetically visible elements

Two cases of amplified repetitive elements accidentally identified in cancer samples are reported. In both cases, repeated DNA that is normally not visible by traditional chromosome banding had increased in amount to become cytogenetically visible. In one case, an addition to the short arm of chromosome 1 was originally diagnosed. However, upon molecular analysis the diagnosis could be corrected to an amplification of the D1Z2 repeat. In the second case, a strongly DAPI-positive band was visible at the top of the short arm of chromosome 22, and the original diagnosis was add(22). Staining for telomeric repeats revealed their presence inside the DAPI-positive element, thus confirming that the element in question was truly added to the end of the chromosome. Curiously, no telomeric repeats could be detected distal to the DAPI-positive element. The identity of the DAPI-positive element could not be established, as it was not stained by any of the specific probes applied, nor in a scanning hybridization with labeled Cot-1 DNA. It thus seems to represent an expansion from some lowly repetitive AT-rich DNA translocated to the tip of chromosome 22.

A comparison of monotherapy with lamotrigine or carbamazepine in patients with newly diagnosed partial epilepsy

Monotherapy with lamotrigine or carbamazepine was evaluated in a multicentre open trial of patients aged 2 years and above with newly diagnosed partial epilepsy. A total of 417 patients were randomised to treatment with lamotrigine, while 201 patients received carbamazepine. Following a dose escalation period of 6 weeks, maintenance therapy (Weeks 7-24) was adjusted according to response. Efficacy was similar with both treatments (65% with lamotrigine, 73% with carbamazepine, P=0.085). Efficacy was assessed by the proportion of patients seizure free during the last 16 weeks of treatment; all subjects who remained in the study for at least 18 weeks after the week 4 visit were included in the analysis. More patients receiving lamotrigine completed the study (81%), compared with those receiving carbamazepine (77%). This difference was primarily due to discontinuation as a result of adverse events, reported by 34 (8%) of those treated with lamotrigine but 26 (13%) of those treated with carbamazepine. The proportion of patients who experienced adverse events in the lamotrigine group was lower (218 patients, 52%) compared with the carbamazepine group (120 patients, 60%). The proportion of patients with adverse events considered to be drug related was lower in the lamotrigine group (132 patients, 32%) compared with the carbamazepine group (83 patients, 41%). Somnolence was the only adverse event reported at an incidence of greater than 5% and where there was a difference of 5% or more between treatment groups (4% lamotrigine, 11% carbamazepine patients). The small subsets of elderly patients (aged 65 years or over) and paediatric patients (aged 2-12 years) also showed better tolerability to lamotrigine than to carbamazepine. In conclusion, monotherapy with lamotrigine is as effective as carbamazepine in patients with newly diagnosed partial epilepsy. Patients were able to tolerate lamotrigine better than carbamazepine, so more patients receiving lamotrigine were able to remain on therapy.

Complex insomnia: insomnia and sleep-disordered breathing in a consecutive series of crime victims with nightmares and PTSD

BACKGROUND

Sleep disturbance in posttraumatic stress disorder is very common. However, no previous posttraumatic stress disorder studies systematically examined sleep breathing disturbances, which might influence nightmares, insomnia, and posttraumatic stress disorder symptoms.

METHODS

Forty-four consecutive crime victims with nightmares and insomnia underwent standard polysomnography coupled with a nasal pressure transducer to measure airflow limitation diagnostic of obstructive sleep apnea and upper airway resistance syndrome.

RESULTS

Forty of 44 participants tested positive on objective sleep studies based on conservative respiratory disturbance indices of more than 15 events per hour; 22 patients suffered from obstructive sleep apnea and 18 suffered from upper airway resistance syndrome.

CONCLUSIONS

In an uncontrolled study, insomnia and sleep-disordered breathing were extremely prevalent in this small and select sample of crime victims. Research is needed to study 1) prevalence of sleep-disordered breathing in other posttraumatic stress disorder populations using appropriate controls and nasal pressure transducers and 2) effects of sleep treatment on posttraumatic stress symptoms in trauma survivors with comorbid obstructive sleep apnea or upper airway resistance syndrome. In the interim, some posttraumatic stress disorder patients may benefit from sleep medicine evaluations.

Large-scale management of insect resistance to transgenic cotton in Arizona: can transgenic insecticidal crops be sustained?

A major challenge for agriculture is management of insect resistance to toxins from Bacillus thuringiensis (Bt) produced by transgenic crops. Here we describe how a large-scale program is being developed in Arizona for management of resistance to Bt cotton in the pink bollworm, Pectinophora gossypiella (Saunders) (Lepidoptera: Gelechiidae), and other insect pests of cotton. Financial support from growers makes this program possible. Collaboration between the Arizona Cotton Research and Protection Council, the University of Arizona, and government agencies has led to development of resistance management guidelines, a remedial action plan, and tools for monitoring compliance with the proposed guidelines. Direct participation in development of resistance management policies is a strong incentive for growers to invest in resistance management research. However, more research, regularly updated regulations, and increased collaboration between stakeholders are urgently needed to maintain efficacy of Bt toxins in transgenic crops.