Factors predicting cessation of status epilepticus in clinical practice: Data from a prospective observational registry (SENSE).

To investigate the initial termination rate of status epilepticus (SE) in a large observational study and explore associated variables. Data of adults treated for SE were collected prospectively in centers in Germany, Austria, and Switzerland, during 4.5 years. Incident episodes of 1,049 patients were analyzed using uni- and multivariate statistics to determine factors predicting cessation of SE within 1 hour (for generalized convulsive SE [GCSE]) and 12 hours (for non-GCSE) of initiating treatment. Median age at SE onset was 70 years; most frequent etiologies were remote (32%) and acute (31%). GCSE was documented in 43%. Median latency between SE onset and first treatment was 30 minutes in GCSE and 150 minutes in non-GCSE. The first intravenous compound was a benzodiazepine in 86% in GCSE and 73% in non-GCSE. Bolus doses of the first treatment step were lower than recommended by current guidelines in 76% of GCSE patients and 78% of non-GCSE patients. In 319 GCSE patients (70%), SE was ongoing 1 hour after initiating treatment and in 342 non-GCSE patients (58%) 12 hours after initiating treatment. Multivariate Cox regression demonstrated that use of benzodiazepines as first treatment step and a higher cumulative dose of anticonvulsants within the first period of treatment were associated with shorter time to cessation of SE for both groups. In clinical practice, treatment guidelines were not followed in a substantial proportion of patients. This underdosing correlated with lack of cessation of SE. Our data suggest that sufficiently dosed benzodiazepines should be used as a first treatment step. ANN NEUROL 2019;85:421-432

International Veterinary Epilepsy Task Force consensus proposal: Medical treatment of canine epilepsy in Europe

In Europe, the number of antiepileptic drugs (AEDs) licensed for dogs has grown considerably over the last years. Nevertheless, the same questions remain, which include, 1) when to start treatment, 2) which drug is best used initially, 3) which adjunctive AED can be advised if treatment with the initial drug is unsatisfactory, and 4) when treatment changes should be considered. In this consensus proposal, an overview is given on the aim of AED treatment, when to start long-term treatment in canine epilepsy and which veterinary AEDs are currently in use for dogs. The consensus proposal for drug treatment protocols, 1) is based on current published evidence-based literature, 2) considers the current legal framework of the cascade regulation for the prescription of veterinary drugs in Europe, and 3) reflects the authors’ experience. With this paper it is aimed to provide a consensus for the management of canine idiopathic epilepsy. Furthermore, for the management of structural epilepsy AEDs are inevitable in addition to treating the underlying cause, if possible

An analysis of interspecific hybrids and phylogenetic implications in Cucumis (Cucurbitaceae)

Investigations on interspecific crossability in 8Cucumis species (2n = 24) and chromosome pairing and pollen fertility of their hybrids from 15 combinations have been utilized for tracing the phylogenetic relationships among these taxa and factors responsible for their differentiation. A collective evaluation of data suggests that there are three broad groups of species, one of the spiny fruited interfertile species, whose hybrids show varying degree of chromosome associations and low to high pollen fertility; the second of species with non-spiny fruits, which are completely incompatible with the former but weakly compatible with the cultivated species,C. melo L. to produce partly developed seeds, and the third group ofC. metuliferusE. Mey. exSchrad. andC. melo and its different botanical varieties. The species with spiny fruits can be further divided based on karyomorphological similarities and/or on relative genomic affinity, indicated by chromosome pairing and hybrid pollen fertility

New Non-Intravenous Routes for Benzodiazepines in Epilepsy: A Clinician Perspective.

Benzodiazepines represent the first-line treatment for the acute management of epileptic seizures and status epilepticus. The emergency use of benzodiazepines must be timely, and because most seizures occur outside of the hospital environment, there is a significant need for delivery methods that are easy for nonclinical caregivers to use and administer quickly and safely. In addition, the ideal route of administration should be reliable in terms of absorption. Rectal diazepam is the only licensed formulation in the USA, whereas rectal diazepam and buccal midazolam are currently licensed in the EU. However, the sometimes unpredictable absorption with rectal and buccal administration means they are not ideal routes. Several alternative routes are currently being explored. This is a narrative review of data about delivery methods for benzodiazepines alternative to the intravenous and oral routes for the acute treatment of seizures. Unconventional delivery options such as direct delivery to the central nervous system or inhalers are reported. Data show that intranasal diazepam or midazolam and the intramuscular auto-injector for midazolam are as effective as rectal or intravenous diazepam. Head-to-head comparisons with buccal midazolam are urgently needed. In addition, the majority of trials focused on children and adolescents, and further trials in adults are warranted

Haze in Pluto's atmosphere: Results from SOFIA and ground-based observations of the 2015 June 29 Pluto occultation

On UT 29 June 2015, the occultation by Pluto of a bright star (r′ = 11.9) was observed from the Stratospheric Observatory for Infrared Astronomy (SOFIA) and several ground-based stations in New Zealand and Australia. Pre-event astrometry allowed for an in-flight update to the SOFIA team with the result that SOFIA was deep within the central flash zone (~22 km from center). Analysis of the combined data leads to the result that Pluto's middle atmosphere is essentially unchanged from 2011 and 2013 (Person et al. 2013; Bosh et al. 2015); there has been no significant expansion or contraction of the atmosphere. Additionally, our multi-wavelength observations allow us to conclude that a haze component in the atmosphere is required to reproduce the light curves obtained. This haze scenario has implications for understanding the photochemistry of Pluto's atmosphere

Epstein-Barr Virus Stimulates Torque Teno Virus Replication: A Possible Relationship to Multiple Sclerosis

Viral infections have been implicated in the pathogenesis of multiple sclerosis. Epstein-Barr virus (EBV) has frequently been investigated as a possible candidate and torque teno virus (TTV) has also been discussed in this context. Nevertheless, mechanistic aspects remain unresolved. We report viral replication, as measured by genome amplification, as well as quantitative PCR of two TTV-HD14 isolates isolated from multiple sclerosis brain in a series of EBV-positive and -negative lymphoblastoid and Burkitt's lymphoma cell lines. Our results demonstrate the replication of both transfected TTV genomes up to day 21 post transfection in all the evaluated cell lines. Quantitative amplification indicates statistically significant enhanced TTV replication in the EBV-positive cell lines, including the EBV-converted BJAB line, in comparison to the EBV-negative Burkitt's lymphoma cell line BJAB. This suggests a helper effect of EBV infections in the replication of TTV. The present study provides information on a possible interaction of EBV and TTV in the etiology and progression of multiple sclerosis

АКТУАЛЬНЫЕ ПРИРОДНО-ОЧАГОВЫЕ ИНФЕКЦИИ, ПЕРЕДАВАЕМЫЕ КЛЕЩАМИ, В САНКТ-ПЕТЕРБУРГЕ

Purpose: to conduct a comparative analysis and to identify the epidemiological and clinical features of tick-borne encephalitis (TBE) and Lyme borreliosis as a mono- and coinfections in St. Petersburg. Materials and methods. 718 cases of TBE, 4353 cases of Lyme borreliosis and 127 combined diseases registered by the St. Petersburg epidemiological bureau in 2006-2017 were studied. Identification of combined diseases was carried out by a special software that allows to identify co-morbid diseases from the array of monoinfections. To identify clinical and epidemiological features, 144 cases of TBE, 286 Lyme borreliosis, and 43 cases of co-infection were studied. Age and sex characteristics, places of human contagion, infection rates of ticks, clinical forms of mono- and associated diseases, morbidity dynamics changes and patients’ IgM seropositivity were studied. Results. The long-term dynamics of TBE and Lyme borreliosis incidence had did not have significant upward or downward trends, it was characterized by synchronous fluctuations. The priority of the incidence of men over women is revealed. 61–69% cases of TBE and Lyme borreliosis occurred in Leningrad region, 19–30% – in the adjacent territories of Russia, 5,7–6,7% of cases were imported from other countries. High tick infection rates of TBE virus and Borrelia was revealed. Borrelia аnd virus of TBE and were detected in 81,6–87,5% of the examined ticks removed from patients with a later established diagnosis. Seasonal distribution of Lyme borreliosis was shifted by a month to the right in comparison with TBE. The clinical forms of both diseases did not differ in their structure from the country data, however after 2012 subclinical forms were more common in women. The proportion of non-erythematous forms of Lyme borreliosis in 2011–2015 compared with the 2006–2010 observation period increased almost 1,5-fold mainly forms, including those with co-infection. The IgM seropositivity rate in the dynamics of the disease testifies to the incomplete rehabilitation of patients. Conclusion. The clinical and epidemiological characteristics of TBE, Lyme borreliosis and combined infection in the North-West region of Russia, with the example of St. Petersburg, have certain distinctive features. The reasons for the revealed features need further study.Цель: провести сравнительный эпидемиологический анализ и выявить эпидемиологические и клинические особенности клещевого энцефалита и боррелиоза как моно- , так и одновременного сочетания этих инфекций у больных в Санкт-Петербурге. Материалы и методы: ретроспективно изучено 718 случаев клещевого энцефалита, 4353 случая клещевого боррелиоза и 127 сочетанных заболеваний, зарегистрированных в отделе учета и регистрации инфекционных и паразитарных заболеваний Центра гигиены и эпидемиологии Санкт-Петербурга за 2006–2017 гг. Идентификация сочетанных заболеваний происходила с помощью специальной программы, позволяющей выявлять сочетанные заболевания из массива моноинфекций. Для выявления клинико-эпидемиологических особенностей изучено 144 истории болезни клещевым энцефалитом, 286 – клещевым боррелиозом и 43 истории болезни в случаях сочетания этих инфекций. Проанализированы возрастно-половые характеристики, места заражения людей, вирусо- и борелиафорность клещей, клинические формы моно- и сочетанных заболеваний, изменения, происходящие во времени. Коэффициент серопозитивности IgM у больных оценивался в динамике обследования пациентов. Результаты: многолетняя динамика заболеваемости клещевым энцефалитом и клещевым боррелиозом не имела выраженных тенденций к росту или снижению и характеризовалась синхронными колебаниями. Выявлен приоритет заболеваемости мужчин над женщинами. Заражения клещевым энцефалитом и боррелиозами в 61–69% случаев происходили в Ленинградской области, в 19–30% – на сопредельных территориях России, в 5,7–6,7% – в странах ближнего и дальнего зарубежья. Выявлена высокая инфицированность клещей вирусом клещевого энцефалита и боррелиями. Боррелии и вирус клещевого энцефалита выявлены у 81,6 и 87,5% исследованных переносчиков, снятых с больных с позднее установленным диагнозом. Сезонное распределение заболеваний боррелиозом было сдвинуто на месяц вправо по сравнению с клещевым энцефалитом. Клинические формы как клещевого энцефалита, так и боррелиоза по своей структуре не отличались от литературных данных по стране, однако субклинические формы чаще встречались у женщин в период после 2012 г. Доля безэритемных форм боррелиоза в 2011–2015 гг. по сравнению с 2006–2010 гг. наблюдения увеличилась почти в 1,5 раза, в том числе и при сочетанной инфекции. Коэффициент серопозитивности IgM в динамике болезни свидетельствует о неполном выздоровлении больных. Заключение: клинико-эпидемиологическая картина клещевого энцефалита, клещевого боррелиоза и сочетания этих инфекций в Северо-Западном регионе России на примере Санкт-Петербурга имеет определенные отличительные особенности. Причины выявленных особенностей нуждаются в дальнейшем изучении