Investigation of the motor system in two siblings with Canavan's disease: a combined transcranial magnetic stimulation (TMS) - diffusion tensor imaging (DTI) study

Canavan's disease (CD) is a hereditary leukodystrophy caused by mutations in the aspartoacylase gene (ASPA), leading to spongiform degeneration of the white matter and severe impairment of psychomotor development. We present the cases of two non-Jewish sisters with CD that have a milder and protracted clinical course compared to typical CD. MRI imaging revealed bilateral high-signal-intensity areas in the thalami and the internal capsule and MR spectroscopy showed typical findings for CD (a marked increase in N-acetylaspartate (NAA) levels). FA values of the right and left corticospinal tracts at the level of the posterior limb of the internal capsule, and the centrum semiovale were found to be significantly reduced compared to healthy controls. From a neurophysiological point of view, the peripheral motor system was normal. In contrast, cortical stimulation at maximal intensity failed to elicit facilitated or resting MEPs and silent periods (SPs) in upper and lower limbs, providing evidence for significant upper motor pathway dysfunction.

The role of P53 and Bcl-2 proteins in 7, 12-dimethylbenz-(a)-anthracene-induced tumor growth

7, 12- Dimethylbenz-(a)-anthracene (DMBA) has been used for a long time to induce rat mammary gland carcinogenesis. In a previous paper we described the effects of diet, of non-steroidal anti-inflammatory drugs and the combination of these two factors on breast cancer. We also pointed out that DMBA tumor generating process is still poorly understood. The present study attempts to explore whether P53 or the pro-apoptotic protein Bcl-2 are potential targets of DMBA in its induction of breast tumors in the Sprague-Dawley rat breast tumorigenesis model. Our results indicate that the DBMA-induced tumors are apparently the result of P53 inactivation. This inactivation results in tumorigenesis, probably aided by the absence of Bcl-2 in the tumor cells of the Sprague-Dawley rat animal model. We discuss the potential mechanisms by which P53 inactivation results in tumorigenesis.

The role of cytokines in pulp inflammation

Pulpitis is a typical inflammatory disease of dental pulp, characterized by the local accumulation of inflammatory mediators, including cytokines and chemokines. In addition to serving as intercellular messengers mediating the inflammatory response, cytokines and chemokines induce the expression and stimulate the activity of molecular and cellular agents which participate actively in destructive and reparative processes in the pulp. It is the balance between these processes which eventually determines the extent of pulp inflammation and the viability of the affected tooth. Over the last decade, a number of studies have attempted to correlate cytokine gene expression in the pulp with various stages of inflammation, with possible diagnostic applications in mind. A small survey of relevant information is presented in this paper.

Consensus statement on dementia education and training in Europe

OBJECTIVES

The aim of the current statement is to agree on: (1) what is the current situation with education and training on dementia in Europe; (2) what are the minimum educational requirements for professionals (neurologists, psychiatrists, primary care providers, nurses, biologists, neuroradiologists, etc.) regarding Alzheimer's disease and dementia, and (3) how to start a course of action for the future.

DESIGN

In 2005, a simple questionnaire was sent to members of the European Alzheimer's Disease Consortium (EADC) concerning the education and training on dementia in their countries. Fourteen universities of the respective countries responded to this simple questionnaire. The answers varied, and the conclusion of this effort was that little was done concerning the training of students and health professionals on dementia. In 2008, another more structured and specified questionnaire was sent to professors in different universities of the same countries.

RESULTS

The answers obtained were different from those of the previous questionnaire and demonstrated that it is very difficult to know about training and education in the field of dementia in every European country.

CONCLUSION

From the data collected, it seems that although in the recent past little had been done concerning training on dementia, nowadays training has been developed in most European countries, and relevant educational projects exist both for medical students and doctors during their specialty training. Our main purpose is to develop training material or develop specific courses to improve the professional knowledge about dementia so that best medical and non-medical practice is implemented.

Progression of mild cognitive impairment to Alzheimer's disease: improved diagnostic value of the combined use of N200 latency and beta-amyloid(1-42) levels

BACKGROUND/AIMS

The aim of this study was to investigate the role of cerebrospinal fluid beta-amyloid(1-42) levels and auditory event-related potentials (AERPs) in the progress of mild cognitive impairment (MCI) to Alzheimer's disease (AD).

METHODS

In 53 MCI patients, lumbar puncture was performed and beta-amyloid(1-42) levels were determined. Twenty patients were reexamined after 11 months. During this period, 5 of them progressed to AD. Neuropsychological and ERP analyses were performed on all patients during both baseline and endpoint examinations.

RESULTS

Compared to stable MCI patients, those that progressed to AD had significantly lower beta-amyloid(1-42) levels (Mann-Whitney test, Z = -2.952, p = 0.003; effect size r = -0.41) and significantly prolonged N200 latencies (Mann-Whitney test, Z = -3.561, p < 0.001, effect size r = -0.49). From ERP variables, only the N200 latency significantly correlated with beta-amyloid(1-42) levels (baseline examination: r(s) = -0.421, p = 0.002; follow-up examination: r(s) = -0.574, p = 0.008).

CONCLUSIONS

The combined use of these two parameters enabled discrimination of stable MCI patients from those who developed AD, with 100% sensitivity and specificity. Therefore, this method could be of high diagnostic value for the early diagnosis of AD.

Effects of Rich-in-Fat Diets and Highly Selective COX-2 Inhibitors on 7,12-Dimethylbenz-(A)-Anthracene-Induced Tumor Growth

The effects of diet, of non-steroidal anti-inflammatory drugs, or of their combination on carcinogenesis continue to be a case for controversy. Diets that are high in fat have been linked to increased risk of various tumors. At the same time there is substantial, but not conclusive, evidence that the risk of breast and colon cancer correlates with total fat intake rather than a specific type of fat. On the other hand, non-steroidal anti-inflammatory drugs (NSAIDs) have been studied extensively because they appear to delay or inhibit the development of malignant and pre-malignant lesions. 7,12-Dimethylbenz-(a)-anthracene (DMBA) has been used for a long time to induce carcinogenesis in a number of rat animal models. The present study attempts to identify the effects on DMBA-induced tumor growth (a) of diets rich in fat and (b) of the highly selective COX-2 inhibitor Celecoxib, which has been claimed to offer substantial protection against carcinogenesis.

The proteins and the mechanisms of apoptosis: a mini-review of the fundamentals

Apoptosis or programmed cell death is a physiological mechanism, characterized by specific morphological and biochemical changes such as cell shrinkage, chromatin condensation, protein cleavage, DNA breakdown and phagocytosis. Apoptosis is a significant contributor to the morphologic and functional development of multicellular organisms. It is also involved in the pathogenesis of several diseases including degenerative diseases of the central nervous system (CNS) like Alzheimer's disease or Parkinson's disease, cancer and immune system dysfunction. There are many factors, mainly proteins, which are involved in the activation, regulation and execution of related events. A fairly detailed outline of apoptotic mechanisms has also started to emerge and to be verified. In this short, focused mini-review, we attempt to outline current evidence regarding the mechanisms and the regulation of apoptosis.

Interleukin -1beta (IL-1 beta), interleukin 6 (IL-6) and tumor necrosis factor (TNF) in plasma and pleural fluid of pneumonia, lung cancer and tuberculous pleuritis

Interleukins IL-1beta, IL-6 and TNF are increased in plasma of patients with severe infections and septic shock. Our objective was the evaluation of IL-1beta, IL-6 and TNF in plasma and exudates of pleural fluid and their contribution to the diagnosis. We studied 44 patients, 27 men and 17 women with mean age 66.81 +/- 11.75 years; 16 with pneumonia and parapneumonic effusion, 14 with primary lung cancer and pleural effusion and 14 with tuberculous pleuritis. We measured IL-1beta, IL-6 and TNF in serum and pleural fluid with ELISA. In patients with pneumonia and parapneumonic effusion the mean value of IL-1beta IL-6 and TNF in plasma was 9.05, 19.24 and 21.34 pg/ml and in pleural fluid 10.34, 32.19 and 25.30 pg/ml. In patients with lung cancer the mean values of IL-1beta, IL-6 and TNF were 5.33, 11.74 and 11.51 pg/ml and 6.70, 13.13, 20.89 pg/ml, respectively. In those with tuberculous pleuritis the respective mean values were 10.33, 49.94, 21.27 pg/ml and 14, 56.59, 23.58 pg/ml. In conclusion, IL-1beta and IL-6 were found increased in plasma and tuberculous pleural fluid, indicating an inflammatory status.

Skin Prick Tests in Patients with Chronic Urticaria

Acute or chronic urticaria is not a common manifestation of systemic disease. However it affects 15% of the population at least once during their lives. The most common causes of urticaria are allergic. In all, we studied 130 patients (mean age 54.8) with chronic urticaria, 88 women and 42 men, in an effort to identify common causes of urticaria, using environmental and food allergens. 90 of our patients (69.2%) did not present with skin sensitivity. The remaining 40 individuals presented with skin sensitivity: 20 (15.3%) to food allergens, 14 (10.7%) to environmental allergens and 6 patients (4.6%) to both allergens (environmental and food). We note that in chronic urticaria it is unusual to find underlying causes.

The Safety of Immunotherapy in Patients with Allergic Asthma and Allergic Rhinitis

We studied systemic reactions associated with immunotherapy in a group of 50 patients with mean age 31.4 years. The group consisted of 36 women and 14 men who followed a three-year immunotherapy treatment with pollen and mite allergen extracts (HAL-Holland Corporation). A total number of 2550 injections were administered. Eight patients developed systemic reactions; 6 had allergic rhinitis and 2 allergic asthma. None developed severe anaphylaxis. Seven of the systemic reactions occurred immediately after injection while one was a late reaction manifested as generalized urticaria, local edema and rubor at the site of the injection. From the 7 patients who showed an immediate reaction, 5 developed generalized urticaria with local edema and rubor at the site of the injection, while 2 presented with bronchial spasm. We did not observe any reaction when the quantity of the extract injection was reduced by 50%. Our study points out that, in the vast majority of cases, immunotherapy is free of severe systemic reactions. Those that occur are associated with the injection of high-density extracts and none of them is severe.

Bronchial Hyperresponsiveness in Patients with Inflammatory Bowel Disease

Pulmonary complications have been described in patients with inflammatory bowel disease. The aim of this study was to evaluate bronchial hyppersponsiveness (BHR) in patients with Crohn's disease (CD) and ulcerative colitis (UC). Fifteen patients (8 men, 7 women, mean age: 42.20 ± 12.20 years) participated in the study. None of the patients had a prior history of respiratory disease or suffered from other systematic disease. Skin prick tests for common allergens (such as pollens, mites, foods and moulds) were administered to all patients of the study. The control group included 15 healthy volunteers (10 men, 5 women, mean age: 40.33 ± 5.06 years). The skin tests showed that 3 of 15 patients with inflammatory bowel disease were sensitive to common allergens (two patients to mix grasses and one to D. Pteronysinnus). In the control group, one subject was sensitive to D. Pteronysinnus. BHR was estimated after methacholine challenge. The frequency of BHR among the patients with inflammatory bowel disease was 7 of 15 (46.60%), compared with only one in the control group who was positive at the maximum dosage of methacholine (16 mg/dl). Our results indicate that there is an increased frequency of BHR in patients with inflammatory bowel disease.

The Effects of Long-Term Treatment by Immunotherapy and Fluticazone on Broncial Hyperreactivity

Thirty subjects (20 female and 10 male), all allergic to the mites D. Pteronyssinus and D. Farinae, participated in the present study which covered a period of four years. The subjects were randomly divided in two groups. Group I included 10 female and 5 male subjects, with an average age of 25.8 (+/− 3.5) years who received immunotherapy only. Group II had an average age of 31.5 (+/− 4) years and they received immunotherapy along with fluticazone propionate (1000mcg/day). The protocol for immunotherapy was the same for both groups. The basis FEV1 was determined for each subject of both Groups I and II and afterwards they were subjected to provocation tests of nebulized methacholine solution administered in consecutively larger concentrations until a drop in FEV1 >20 % (PC20), was observed. Three years later, when their therapy was completed, all subjects were subjected to the same provocation test and a significant reduction in bronchial hyperactivity was documented for both groups. In particular, for Group I, the percentage of change in FEV1 values was 27.25 +/- 5.23 % and PC20 5.11 +/− 2.64 mg/ml before immunotherapy, while after immunotherapy the same indicators were 22.22 +/- 7.08 % (P<0.05) and 6.85 +/− 4.03 mg/ml, (P<0.05) respectively. For Group II, the percentage of change in FEV1 values was 26.28 +/− 2.5 % and PC20 5.42 +/− 2.5 mg/ml before immunotherapy, while after immunotherapy the same indicators were 12.27 +/- 2.49 % (P<0.01)and 11.64 +/− 5.14 mg/ml, P<0.01 respectively. It is concluded that although significant reduction in hyperreactivity can be achieved through immunotherapy, the combination of immunotherapy with daily fluticazone propionate administration shows the most promising results.

Intranet health clinic: Web-based medical support services employing XML

In this paper, the implementation of an Internet-based telematic service for medical support is presented, which operates in pilot form within the INTRANET HEALTH CLINIC project--a two-year project supported by the European Commission under the Health Telematics Programme. The aim of the application is to offer high quality care to users of health services over inexpensive communication pathways, using Internet-based, interactive communication tools, like remote access to medical records and transmission of multimedia information. The XML technology was employed to achieve customised views on patient data, according to the access rights of different users. Strict security and access control policy were implemented to ensure secure transmission of medical data through the Internet. The system is designed to collaborate with existing clinical patient record systems and to be adjustable to different medical applications. Current pilot implementations are under clinical evaluation and include oncological patients (Greece), Lupus Erythrematosis (Canada), Obstetrics (Belgium) and Chronic Obstructive Pulmonary disease (Spain).

Utilising multimedia for training merchant mariners as paramedics

MERMAID is a telemedicine project with global reach and a 24-hour, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model is not limited to medical diagnostics but it encompasses all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications are considered while the full range of network choices is explored in terms of the cost/performance tradeoffs inherent to them and the developmental stage each of these options occupies in its life cycle. MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialty care best suited to each particular case. Finally, the development of programme modules for training and education of the seafarers in the use of the MERMAID medical communications system is given top priority as such modules constitute the firmest basis for the promotion of proper practice of telemedicine at sea.

A convincing case for the provision of telemedicine services to ocean going vessels: the MERMAID paradigm

MERMAID is an EU financed telemedicine project with global reach and 24-hour, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model will not be limited to medical diagnostics but it will encompass all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low, medium and high bandwidth data requirements) are considered while the full range of network choices (Digital land lines, Cellular/Wireless, Satellite and Broadband) are being tested in terms of cost/performance tradeoffs that are inherent to them and the developmental state each of these options occupies in their in its life cycle. Finally, out that MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.

Relief for maritime medical emergencies through telematics

MERMAID is a European Union (EU)-financed maritime telemedicine project with global reach and 24-h multilingual capability, so as to serve multinational crews working in the isolation of the world's oceans. It provides a model for the provision of healthcare services based on the electronic transmission of medical information via ISDN-based video conferencing. This model is not limited to medical diagnostics, but it encompasses all cases in which the actual delivery of healthcare services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an extensive telecommunications infrastructure that includes both satellite transmission for ship to shore communication and an extensive ground-based network for summoning expert medical help from around the world so as to meet the project's multilinguality requirements and, therefore, the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low-, medium-, and high-bandwidth data requirements) are considered, while the full range of network choices (digital land lines, cellular/wireless, satellite, and broadband) are being tested in terms of cost/performance tradeoffs that are inherent to them and the developmental stage each of these options occupies in their lifecycle. Finally, out of that, MERMAID utilizes advanced land-based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.

Medical emergency aid through telematics: design, implementation guidelines and analysis of user requirements for the MERMAID project

MERMAID is an EU financed telemedicine project with global reach and 24-h, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model will not be limited to medical diagnostics but it will encompass all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low, medium and high bandwidth data requirements) are considered while the full range of network choices (digital land lines, cellular/wireless, satellite and broadband) are being tested in terms of cost/performance tradeoffs that are inherent to them and the developmental stage each of these options occupies in their in its life cycle. Finally, out that MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.

Induction of monocyte chemotactic protein-1 (MCP-1) and TNF alpha by Trichinella spiralis in serum of mice in vivo

MCP-1 is a small (8-10 KDa) protein and a prototype member of the CC chemokine beta subfamily, which plays a critical role in acute and chronic inflammation. Recent evidence suggests an important role for MCP- 1, MCP-2 and MCP-3 in a number of pathological states, including delayed type hypersensitivity conditions, parasitic infections and rheumatoid arthritis. Forty BALB-c mice were treated with the parasite Trichinella spiralis. After the infection the animals were sacrificed at different periods from the initial infection and MCP-1 and TNFalpha were quantified in the mouse serum. The level of MCP-1 in the serum of mice infected with 100 larvae increases from 27.5+/-7.0 pg/ml at day 23, to a maximum level of 31.5+/-5.0 pg/ml at day 33, then decreased to 14.6+/-2.0 pg/ml at day 47. When the mice were infected with 200 larvae of T. spiralis the maximum increase was 34.4+/-2.5 pg/ml found on day 23. From day 33 to day 47 MCP-1 levels were decreased. In addition, in infected mice levels of TNFalpha were detectable in the serum as early as day 1. The level of TNFalpha was maximum at day 35 (3812+/-224 pg/ml). Serum from non-infected mice contained no detectable levels of either MCP-1 or TNFalpha. However, even if MCP-1 seems to be implicated in Trichinellosis, its exact role and function in inflammatory parasitic diseases remains to be determined.

ATTRACT--applications in telemedicine taking rapid advantage of cable television network evolution

ATTRACT is a project that intends to provide telemedicine services over Cable Television Networks. ATTRACT is an European Commission funded project (Healthcare Telematics). The main objective of ATTRACT is to take advantage of emerging European Cable Television network infrastructures and offer cost-effective care to patients at home. This will be achieved through a set of broadband network applications that competitively provide low cost interactive health-care services at home. The applications will be based on existing or developing European Cable Television network infrastructures in order to provide all kind of users with affordable homecare services. It is ATTRACT's intention that citizens and users benefit from high quality access to home telemedical services which also implies cost savings for patients, their families and the already over burdened health institutions. In addition, the European industries will have extensive opportunities to develop, evaluate and validate broadband network infrastructures providing multimedia and interactive telemedical services at home. ATTRACT contributes to the EU telecommunications and telematics policy objectives that promote the development and validation of "applications and services" which "provide an intelligent telematic environment for the patient in institutions and other points of care that helps the patient to continue, as far as possible, normal activities and external communication".

Massive infiltration of basophilic cells in inflamed tissue after injection of RANTES

Regulated upon activation normal T expressed and secreted (RANTES) is a new inducible protein member of the human C-C branch of chemokines. RANTES is a potent monocyte and lymphocyte chemoattractant and is a mediator of inflammatory responses. In these studies we found that RANTES 10 ng/50 microl chemoattracts basophilic cells in a dose-dependent manner 4 h after an intradermal injection in rat skin sites, as revealed by optic microscopy. Moreover, in biopsy specimens from rat skin injection sites histamine release was significantly higher (P < 0.05) than in controls (PBS 50 microl) after 4 h from RANTES treatment. The presence of basophilic cells in rat skin injection sites after RANTES-treatment was also confirmed by electron microscopy studies. In addition, histidine decarboxylase (HDC) mRNA was increased in rat skin sites injected with RANTES compared to sites injected with PBS (controls). Our report describes additional biological activities for RANTES, suggesting that this human chemoattractant protein may play a fundamental role in histamine and HDC generation, along with basophilic cell recruitment.

Infra-red laser irradiation enhances interleukin-1 receptor antagonist, increases 3H-thymidine incorporation and the release of [3H]arachidonic acid in human monocytes

The effect of infra-red laser irradiation has been experimented on various biological systems and particularly in human tissues, in vitro as well as in vivo. In order to examine the influence of laser irradiation on cells of the monocytic lineage we have irradiated human peripheral blood mononuclear cells with an infra-red laser at a wavelength of 904 nm, at 2000 Hz frequency and 15 mW for 2 min. Here, we report that laser irradiation for 2 min. at different preincubation times (T = 0 and T = 30 min) enhances LPS (10 micrograms/ml or PHA (10 micrograms/ml, suboptimal concentration)-stimulated monocytes by modifying cell proliferation, as judged by [3H] thymidine incorporation. IL-1 receptor antagonist (IL-1ra) along with an increased release of [3H] Arachidonic acid production, is also influenced by laser irradiated monocytes when treated for 2 min after 1 h incubation. IL-1RA production increased 4-5 fold after laser irradiation, while 3H-arachidonic acid incorporated from PMA-stimulated cells increased and the effect was significant at T = 0 and T = 30 min; while at T = 1 h the effect was negligible. These results may provide new information regarding the effect of laser irradiation on the immune system.

Medical liability, safety and confidentiality in maritime telemedicine--the MERMAID position on issues of importance

Telemedicine dates to the days of "wireless telegraphy". As an "extraordinary" arrangement for medical services delivered at time of need, telemedicine has thus far escaped the developments that have taken place over the last 50 years in the areas of medical liability, safety and confidentiality. Today, however, telemedicine is also used to increase quality and cost effectiveness of healthcare provision. This trend is set by the U.S. where the U.S. federal government funds telemedicine at an annual rate of more than $100 million i.e., at a rate 30 times or more than what the EU does while state and local agency support and private business investment in telemedicine is 3 to 4 times larger than that of the U.S. federal government. In this respect it must be stressed that technology tends to satisfy the relevant demand for telecommunications. Telemedicine is used in diverse areas such as pathology, surgery, physical therapy, and psychiatry. It is expected to revolutionise health care in the coming decade and, therefore, it will certainly take into account requirements for medical liability, safety and confidentiality in the same way as traditional "establishment" medicine does.

MERMAID 1996--report on the implementation of a European Project on "medical emergency aid through telematics"

MERMAID is a project that intends to provide multilingual medical emergency services to seaborne vessels around the world. MERMAID uses two-way transmission of live images in marine medical teleconsultation, greatly improving services that up to now depended on short-wave and VHF radio alone. Transmission of high resolution still pictures is also possible, so that the teleconsulting physician may closely (visually) examine his patient, along with transmission of biological signals and patient anamnesis details. Telemedical interventions are critically dependent on local paramedics. Merchant marine officers are trained in first-aid procedures and basic medical transactions. In practice, however, this training is often inadequate. For this reason MERMAID uses a multimedia medical guide that covers the absolutely necessary basics to handle medical emergencies and common medical problems on board. This application is based on the WHO "Medical guide for ships" and EU Council Directive 92/29. The delivery of medical and mental health care to distant populations has never been easy. In addition, the progress of technology has widened the disparity between the quality of care available to the urban citizen and that available to the rural or remote location resident. The only viable solution to the problem seems to come from telecommunications technologies. Indeed, ISDN is the first widely available public network that supports integrated services and can serve as a reliable backbone for telemedical services. Communications satellites provide a means of expanding ISDN network to geographically remote locations. Against this background, MERMAID combines mobile satellite technologies, VSAT technologies and ISDN protocols in order to realise a Global Telemedicine System that is reliable, exhibits, continuity, is seamlessly connected, has low cost and is downward compatible.

Transeuropean network for the provision of added-VAlue Services in Telemedicine--(VAST-Net)

Populations most likely to use telemedicine are usually located far away from ISDN networks in contrast to providers of telemedical services who normally dwell in urban centers. VAST-Net is a consortium that aspires to reach such populations by introducing added-value ISDN-based telemedical services across Europe, through networking a small number of selected, strategically distributed, points-of-care and by focusing on a series of well defined health care provision scenaria. This will be achieved by relying on: (1) the Euro-ISDN infrastructure, (2) satellite based ISDN medical networks (e.g. the INMARSAT/VSAT based MERMAID network), (3) private ISDN networks. The VAST-Net telemedical network will be initially operated on a small but transnational scale in order to assess: (1) the acceptance of telemedical services by end users, (2) the economic viability of the telemedical sector, especially in an international context (3) the legal implications of telemedical practice (4) the regulatory framework within which telemedicine will be developed in the E.U. Based on this assessment the VAST-Net Consortium will proceed to develop appropriate business plans that will allow PTTs and other Telecom operators, medical groups, insurance companies and public health authorities to offer transnationally ISDN-based telemedical services. Potential forms of cooperation may include: (1) "Framework agreements" between PTTs, telemedical service providers (e.g. doctors, hospitals etc.) and "bulk users" (insurance companies, public health authorities), (2) PTT provision of "telecommunications backbones" over which competing telemedical networks can be organised, (3) organisation of a European Economic Interest Group (EEIG), modeled upon international companies such as INMARSAT, that will undertake the operation of VAST-Net.

Computer-aided prescription--a prototype system

This study intends to satisfy two purposes: To prove the necessity of an electronical prescription aid and to propose a structure that can be interpreted into software which will be able to cover that need. The complicated market reality and the disadvantages of the written pharmaceutical directories make the existence of an electronical aid absolutely necessary. The structure of a prescription system should be based upon the drastic substance with its consequences (adverse effects, relative and absolute contraindications, pharmakokinetics and interactions). Every drastic substance will lead to the connection of pharmacology with the market reality and its own consequences (product identification through text and image, trade name, pharmaceutical company, strength, package information). The whole structure constitutes a completed relation--database system that is capable of answering any simple question or query that concerns the field of prescribing. The final production of such an aid is believed to help in a very high degree prescribing in a more precise and correct way, saving financial means for the patient and the health insurance as well as saving the doctor's time.

Medical emergency aid through telematics: design, implementation guidelines and analysis of user requirements for the MERMAID project

MERMAID is an EU financed telemedicine project with global reach and 24-hour, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model will not be limited to medical diagnostics but it will encompass all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low, medium and high bandwidth data requirements) will be considered while the full range of network choices (Digital land lines, Cellular/Wireless, Satellite and Broadband) will be tested in terms of cost/performance tradeoffs that are inherent to them and the developmental stage each of these options occupies in their in its life cycle. Finally, out that MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.

Human recombinant interleukin-1 beta induces thromboxane A2 release in polymorphonuclear leukocytes, macrophages and platelets: effect of IL-1 receptor antagonist

Prostaglandins and thromboxanes (Txs) are produced by polymorphonuclears (PMNs) and macrophages (Mphis) in response to various stimuli. PMNs were separated from other human blood cells and Mphis were separated from rat peritoneal lavage. In this paper we show that human recombinant interleukin-1 (hrIL-1) can stimulate the release of thromboxane B2 (TxB2) by PMNs and Mphis. In addition, we have shown that aggregation of PMNs may occur when calcium ions (7 mM) and hrIL-1 (100 ng/ml) are added to the cell preparation, but not when Ca2+ alone, hrIL-1 alone, or first hrIL-1 then calcium are added to the cell preparation. The treatment of human platelets with hrIL-1 shows that after 15 min incubation TxB2 is released. In addition, we compared the aggregation of platelets caused by ADP with that caused by hrIL-1. Human recombinant IL-1 at a concentration of 100 ng/ml also causes little aggregation of platelets, in this case the aggregation is reversible. In conclusion, hrIL-1 beta stimulates TxB2 release in PMNs, Mphis and platelets and this effect increases with addition of Ca2+ ions. The mixture of hrIL-1 and Ca2+ causes little aggregation of PMNs. In monocyte suspensions, pretreated with human recombinant IL-1 receptor antagonist (IL-1ra) 500 ng/ml for 10 min and then treated with LPS or hrIL-1 beta 10 micrograms/ml, the release of TxB2 was partially inhibited. IL-1ra may play a significant role in the control of IL-1 and LPS induction in the release of TxB2.

Generation of TNF alpha, IFN gamma, IL-6, IL-4 and IL-10 in mouse serum from trichinellosis: effect of the anti-inflammatory compound 4-deoxypyridoxine (4-DPD)

Infections caused by the nematode Trichinella spiralis is characterized in the host by an inflammatory response with cytokine production. In these studies we have detected TNF alpha, IL-6, IFN gamma, IL-4 and IL-10 in the serum of 10 mice infected with T. spiralis. Moreover, we detected, for the first time, these cytokines in the serum of mice treated with 4-DPD, a potent antagonist of vitamin B6 coenzyme which has anti-inflammatory properties. 4-DPD was used at 100, 400, 800 micrograms/bolus for 20 days, starting one day before the infection. After 15 days of T. spiralis infection, TNF alpha reached a maximum level, while IL-6 was maximal after 7 days, IFN gamma at 20 days and IL-4 at 14 days. IL-10 was not affected by the T. spiralis infection. When the animals were treated with 4-DPD at the reported dosages and infected with T. spiralis the inhibition of TNF alpha and IL-6, were dose-dependent in the first 7 days while IL-4 was reduced only at 400-800 micrograms/bolus. 4-DPD-treated mice did not statistically (P > 0.05) affect the generation of IFN gamma. In healthy animals the production of cytokines were not measurable, just as it was in non-infected animals treated with 4-DPD. The increase of cytokines such as, TNF alpha and IL-6 may be related to the severity of the disease, boosting the host's resistance to the pathogen and inhibiting parasite survival. In addition, the augmentation of IL-4 production enhances T and B cells and macrophage responses and may stimulate T-cell antibody-mediated response to the pathogen. 4-DPD, an inhibitor of IL-1 and inflammatory reactions, proved to be most effective on TNF alpha and IL-6, which are mainly produced by macrophages.

Biomagnetic methodologies for the noninvasive investigations of the human brain (MAGNOBRAIN)

Magnetoencephalography (MEG) non-invasively infers the distribution of electric currents in the brain by measuring the magnetic fields they induce. Its superb spatial and temporal resolution provides a solid basis for the 'functional imaging' of the brain provided it is integrated with other brain imaging techniques. MAGNOBRAIN is an applied research project that developed tools to integrate MEG with MRI and EEG. These include: (1) software for MEG oriented MRI feature extraction; (2) the Brain Data Base (BDB) which is a reference library of information on the brain used for more realistic and biologically meaningful functional localisations through MEG and EEG; and (3) a database of normative data (age and sex matched) for the interpretation of MEG. It is expected that these tools will evolve into a medical informatics environment that will aid the planning of neurosurgical operations as well as contribute to the exploration of mental function including the study of perception and cognition.

Ultrastructural alterations of the rabbit sciatic nerve, spinal cord and cerebellum, following methionine sulphoximine administration

Methionine sulphoximine (MSO) is a centrally acting neurotoxin which inhibits the glutamate metabolism enzymes and has convulsive properties. Small doses of MSO were administered to rabbits, either intravenously (i.v.) or intracerebroventricularly (ICV), and electron microscopic examination of the cerebellum, the spinal cord and the sciatic nerve was performed on the first day of rabbit hind leg rigid paralysis (myopathy with histological findings resembling myositis), which set in by the 2nd to 4th day after MSO administration. In the cerebellum focal minor alterations were found in the astrocytes (swelling and lucidity, diminution of glycogen granules) and sparsely in the presynaptic terminals (lucidity and clumping), whereas most of the neuron presented a normal appearance. In the spinal cord and in the sciatic nerve a dissociation of the axon from the myelin sheath was evident in a small number of myelinated nerve fibres, along with the appearance of vacuolated spaces. Mitochondrial disorganisation in the axons, as well as glial cell alterations, were also seen. The ultrastructural alterations were non specific, and since they were induced 2 to 4 days after the administration of either minimum doses (i.v.) or of extremely low doses (ICV) of MSO, they may be attributed to the inordinate increase of metabolism during the period of convulsions.

On AR modelling for MEG spectral estimation, data compression and classification

The use of the autoregressive (AR) model for magnetoencephalogram (MEG) processing is examined and compared to other methods. Spectral estimation, classification and data compression of MEG signals are studied. In application to spectral estimation the AR model is compared to the classical modified periodogram method. Also, AR modelling appears to perform very successfully when used for the classification of normal and epileptic MEG signals. Finally, the 17:1 to 23:1 data compression achieved by AR modelling, along with the above-mentioned advantages, render it suitable for storage applications. For comparison, the method of feature selection via orthogonal expansion is used as a tool to achieve data reduction. It is seen that while effective, this is less drastic than the compression of data volume achieved by AR modelling.

The influence of piracetam on digoxin up-take by different rabbit tissues in vitro

The action of increasing piracetam concentration on the digoxin up-take by various rabbit tissues was investigated in vitro. 125J-digoxin was used and radioactivity was counted in a gamma scintillation counter. Piracetam 100 micrograms/ml has a small increasing action on digoxin up-take by parenchymatous rabbit tissues. This action may be due to the beneficial effect of the substance on tissue microcirculation and cell metabolism. This action is equilibrated or reversed by piracetam 200 micrograms/ml and 400 micrograms/ml. It is suggested that piracetam displays digoxin from its binding-sites but these concentrations are above those ones used for clinical purposes.

Long-term effects of the administration of the convulsive substance DL-methionine-DL-sulfoximine to the rabbit

Methionine sulfoximine (MSO) is a centrally acting neurotoxin which inhibits the glutamate metabolism enzymes and has convulsive properties. Administration of a small dose of MSO to rabbits, either intravenously or intracerebroventricularly, except for the already known convulsive effects, may also be responsible for hind leg myopathy (rigid paralysis with histological findings resembling myositis) which sets in by the 4th day after MSO administration.

Evaluation of epileptic patients by means of magnetoencephalography

Studies of the magnetoencephalogram (MEG) in epileptic patients suffering from focal epilepsies showed that activities in the MEG appear which are detectable in the scalp-recorded electroencephalogram. A novel technique was developed (Anninos et al., 1987) characterized by mapping the scalp distribution of the amplitude of the spectral components (or specific bands) of the MEG and which was termed "ISO-Spectral-Amplitude (ISO-SA) mapping." The most important findings in the 19 patients we studied from these maps were that in the frequency domain 2-7 HZ the major concentrated activity were projected on the scalp of the epileptic focus. Thus with the above noninvasive method we believe that it is possible to determine the localization of epileptiform foci via a method which will be a very useful tool for clinicians.

Tonotopic organization of the human auditory cortex revealed by transient auditory evoked magnetic fields

The tonotopic organization of the human auditory cortex has been investigated by systematic measurements of magnetic fields evoked by tone-bursts with carrier frequencies of 250, 500, 1000, 2000 and 4000 Hz. The measured field distribution changes with both time elapsed since stimulus onset and frequency of the stimulus. Nevertheless, the field distribution has always the same overall features and can be approximated by that of an equivalent current dipole located in a semi-infinite volume. This model can be described in terms of 5 parameter values: 3 orthogonal coordinates specifying the dipole location, and amplitude and angle of the dipole moment. The amplitude of the dipole moment is maximal at about 100 msec ('component 100m') and 160 msec ('component 160m') after stimulus onset. The depth estimated for the generator site of the 100m component shows a logarithmic dependence on test frequency whereas no similar behaviour could be observed for the 160m component. Anatomical studies performed in cadaver heads suggest that the equivalent current dipoles of both the 100m and the 160m component are located in the transverse temporal gyri.

Localization of epileptiform foci by means of MEG measurements

Systematic studies of the magnetoencephalogram (MEG) in normal and pathological subjects (mainly with focal epilepsies) showed that the MEG may evidence significant brain activities even if they are not identifiable in the electroencephalogram (EEG). They also showed that the MEG has a considerably higher spatial resolution than the EEG. A two-dimensional mapping technique was used to get such a representation of the data that would enable the investigator to draw his conclusions mainly from inspecting the plots. The technique is characterized by an isospectral synchronized power (iso-SSP) mapping of the scalp distribution of specified frequency bands of the MEG power spectrum. In this way the precise projection on the scalp of an epileptiform focus can be determined without applying a strong eliciting stimulus or relying on the analysis of the simultaneously recorded EEG. Our results compare very favourably with the clinical picture of our pathological subjects.

A neural net model for the release of prolactin during pseudopregnancy in the rat

A theoretical probabilistic neural net model is proposed here based on the interaction between two subsystems, the connections of which are made up by means of chemical markers. The activity of such a system at t = n tau is exclusively dependent on the firing record of the system at t = (n-1) tau, on the level of spontaneous activity and on an external inhibitory influence which we have found that may play an important role in the prolactin release level during pseudopregnancy in rats. We explore some of the implications of this model on the possible role of the hippocampus in the phenomenon.

Biomagnetic measurements using squids

Systematic studies of the magnetoencephalogram (MEG) in normal and pathological subjects (mainly with focal epilepsies) showed that the MEG may evidence significant brain activities even if they are not present in the electroencephalogram (EEG). They also showed that the MEG has a considerably higher spatial resolution than the EEG. A novel mapping technique was introduced to get such a representation of the data that would enable the investigator to draw his conclusions mainly from inspecting the plots. This technique is characterized by an isospectral amplitude (iso-SA) mapping of the scalp distribution of specified spectral components or frequency bands of the MEG power spectrum. With the above method we were able to localize an epileptiform focus using a noninvasive technique without applying an eliciting stimulus. Furthermore using SQUID measurements we were able to describe the behavior of the MEG when the brains of different subjects were subjected to low frequency sinusoidal binaural stimuli. Under these conditions it has been shown that the MEG tends to organize around discrete frequencies that depend on the interference pattern (beat) between the two inputs.

Involvement of the caudate nucleus in the modulation of the brain somatosensory evoked potentials

The participation of the caudate nucleus in the modulation of the cortical somatosensory evoked potentials was investigated in male rabbits. The power spectra of the somatosensory evoked potential recorded from the scalp in the intact animal was compared with that recorded after kainic acid lesion of specific regions of the caudate nucleus (i.e., anterior and or posterior portions of the head of the nucleus) and the "destructive" interference patterns which appeared were investigated. It was found that the caudate's head modulates the waveform at the end of the early phase of the cortical somatosensory evoked potentials, i.e., the period from 20.8 ms to 29.4 ms. These results suggest that the caudate nucleus is part of the sensory pathways belonging to the nonspecific projection system and participates in the integrating processes of the somatosensory information.