Early Controversies over Athetosis: I. Clinical Features, Differentiation from other Movement Disorders, Associated Conditions, and Pathology

Background: Since the description of athetosis in 1871 by American neurologist William Alexander Hammond (1828-1900) the disorder has been a source of controversy, as were many aspects of Hammond's career. Methods: Primary sources have been used to review controversies in the 50-year period since the initial description of athetosis, in particular those concerning clinical features, differentiation from other movement disorders, associated conditions, and pathology. Controversies concerning treatment will be addressed in a subsequent article. Results: Hammond struggled to establish athetosis as a distinct clinical–pathological entity, and had successfully predicted the striatal pathology in his initial case (albeit somewhat serendipitously). Athetosis was, nevertheless, considered by many neurologists to be a form of post-hemiplegic chorea or part of a continuum between chorea and dystonia. European neurologists, and particularly the French, initially ignored or discounted the concept. Additional controversies arose over whether the movements persisted during sleep, whether athetosis was, or could be, associated with imbecility or insanity, and how it should be treated. Discussion: Some controversies concerning athetosis served to identify areas where knowledge was insufficient to make accurate statements, despite prior self-assured or even dogmatic statements to the contrary. Other controversies illustrated established prejudices, even if these biases were often only apparent with the greater detachment of hindsight

A Clean Look at Anilox Cleaning Systems

Anilox plugging issues have been around since the dawn of flexography. In a never-ending push for better print quality, anilox manufacturers’ are continually pushed to create smaller, higher linecount cells. As cell sizes have decreased, a two-fold problem has arisen. The microscopic cell architecture, so critical to color density and print quality, has become so fine that ink tends to build up in the cells that determine color density and print quality. This presents increased challenge in removing dried ink from a fine cell structure. Many approaches have been devised to combat these issues. There are currently arguably seven off-press anilox cleaning methods. Each has its own pros and cons. Issues of cost and effectiveness have to be weighed against environmental concerns and potential for damage to the anilox rolls. Virtually any of these methods can be effective if used properly. Used improperly, they can result in damage and deterioration of the cell structure they are designed to rejuvenate.Ope

APOAV (T-1131>C) variant has no effect on mother's height in a large population study

The important role of APOAV gene T-1131>C variant in determination of plasma triglyceride levels has been proved on many population studies. Recently, associations between C-1131 allele and higher mother's height as well as with longer fetal birth length were suggested. In 1,305 females, aged between 28 and 67 years and having at least one child, we have analyzed a putative association between T-1131>C APOAV variant (analyzed by PCR and restriction analysis) and body height. Mother's body height did not differ between T/T homozygotes (N = 1093, 162.5 ± 6.5 cm) and C allele carriers (N = 212, 162.1 ± 6.4 cm). Thus we have failed to confirm, that mothers with APOAV C-1131 allele are higher than T/T-1131 homozygotes

Extracorporeal Immunoglobulin Elimination for the Treatment of Severe Myasthenia Gravis

Myasthenia gravis (MG) is a neuromuscular disorder leading to fluctuating muscle weakness and fatigue. Rarely, long-term stabilization is not possible through the use of thymectomy or any known drug therapy. We present our experience with extracorporeal immunoglobulin (Ig) elimination by immunoadsorption (adsorbers with human Ig antibodies). Acetylcholine receptor antibodies (AChRAs) were measured during long-term monitoring (4.7 ± 2.9 years; range 1.1–8.0). A total of 474 samples (232 pairs) were analyzed, and a drop in AChRA levels was observed (P = .025). The clinical status of patients improved and stabilized. Roughly 6.8% of patients experienced clinically irrelevant side effects. The method of Ig elimination by extracorporeal immunoadsorption (IA) is a clinical application of the recent biotechnological advances. It offers an effective and safe therapy for severe MG even when the disease is resistant to standard therapy

Assessing observational studies of medical treatments

BACKGROUND: Previous studies have assessed the validity of the observational study design by comparing results of studies using this design to results from randomized controlled trials. The present study examined design features of observational studies that could have influenced these comparisons. METHODS: To find at least 4 observational studies that evaluated the same treatment, we reviewed meta-analyses comparing observational studies and randomized controlled trials for the assessment of medical treatments. Details critical for interpretation of these studies were abstracted and analyzed qualitatively. RESULTS: Individual articles reviewed included 61 observational studies that assessed 10 treatment comparisons evaluated in two studies comparing randomized controlled trials and observational studies. The majority of studies did not report the following information: details of primary and ancillary treatments, outcome definitions, length of follow-up, inclusion/exclusion criteria, patient characteristics relevant to prognosis or treatment response, or assessment of possible confounding. When information was reported, variations in treatment specifics, outcome definition or confounding were identified as possible causes of differences between observational studies and randomized controlled trials, and of heterogeneity in observational studies. CONCLUSION: Reporting of observational studies of medical treatments was often inadequate to compare study designs or allow other meaningful interpretation of results. All observational studies should report details of treatment, outcome assessment, patient characteristics, and confounding assessment

B-type natriuretic peptide: powerful predictor of endstage chronic heart failure in individuals with systolic dysfunction of the systemic right ventricle

Aim To assess whether B-type natriuretic peptide (BNP) can serve as a predictor of end-stage chronic heart failure (CHF) in patients with severe systolic dysfunction of the systemic right ventricle (SRV). Methods We performed a retrospective analysis in 28 patients with severe systolic dysfunction of the SRV (ejection fraction 23 ± 6%) who were evaluated as heart transplant (HTx) candidates between May 2007 and October 2014. The primary endpoints of the study (end-stage CHF) were progressive CHF, urgent HTx, and ventricular assist device (VAD) implantation. Plasma BNP levels were measured using a chemiluminescent immunoassay. Results During median follow-up of 29 months (interquartile range, 9-50), 3 patients died of progressive CHF, 5 patients required an urgent HTx, and 6 patients underwent VAD implantation. BNP was a strong predictor of end-stage CHF (hazard ratio per 100 ng/L: 1.079, 95% confidence interval, 1.042-1.117, P<0.001). The following variables with corresponding areas under the curve (AUC) were identified as the most significant predictors of end-stage CHF: BNP (AUC 1.00), New York Heart Association functional class class III or IV (AUC 0.98), decompensated CHF in the last year (AUC 0.96), and systolic dysfunction of the subpulmonal ventricle (AUC 0.96). Conclusion BNP is a powerful predictor of end-stage CHF in individuals with systolic dysfunction of the SRV

Prenatal Diagnosis of Fetal Seizure: A Case Report

A 35-yr-old woman carrying a 17-week-old fetus presented with right hydronephrosis and a single umbilical artery. Karyotyping was normal and targeted ultrasonography showed an otherwise normal fetus. After 28 weeks of gestation, the mother felt rapid, repetitive fetal movement and an ultrasound at 30 weeks of gestation revealed tonic clonic movements of the fetal trunk and extremities. At 36 weeks of gestation, an emergency repeat Cesarean section was performed because of a premature rupture of the membranes and a male infant weighing 4,295 gm was delivered. After birth, the infant continued to have movements suggestive of a generalized tonic clonic seizure. Brain computed tomography and magnetic resonance imaging revealed normal structures and an electroencephalography showed generalized suppression. Treatment with phenobarbital resulted in substantial improvement in the number of seizure episodes, however fine seizure-like movement continued in both of the hands, feet and in the tongue until the five-month follow-up. This is the first Korean report of a fetal seizure being diagnosed during the prenatal period