Mycophenolate mofetil as second line immunosuppressant in myasthenia gravis - a long-term prospective open-label study

<p>Abstract</p> <p>Background</p> <p>The preferred immunosuppressive drug for long term treatment of myasthenia gravis (MG) is azathioprine (AZA). Mycophenolate mofetil (MMF) was suggested as an effective and safe second line alternative to AZA.</p> <p>Methods</p> <p>In a prospective open-label study, 11 patients with acetylcholine receptor antibody (AchR-ab) positive MG (n = 4 ocular MG, n = 7 generalized MG) were treated with MMF which replaced AZA. Reasons for the change of immunosuppressant therapy were side effects (n = 9) or unresponsiveness under AZA (n = 3).</p> <p>Results</p> <p>Mean duration of MMF treatment was 16.9 months (6-46 months). During MMF treatment AZA side effects resolved in 8/9 patients, concomitant therapy could be discontinued in 4 patients and reduced in 5 patients, and 5 patients remitted and 3 remained in remission. One MMF-refractory patient required add-on IVIG therapy and another with ocular MG showed signs of generalization after 20 months of MG treatment. One patient was diagnosed with bronchial carcinoma after 10 months of MMF treatment.</p> <p>Conclusion</p> <p>Due to its favourable spectrum of side effects compared to AZA MMF might serve as a second-line immunosuppressant in those MG patients who have not tolerated AZA.</p

Network Resources for Astronomers

The amount of data produced by large observational facilities and space missions has led to the archiving and on-line accessibility of much of this data, available to the entire astronomical community. This allows a much wider multi-frequency approach to astronomical research than previously possible. Here we provide an overview of these services, and give a basic description of their contents and possibilities for accessing them. Apart from services providing observational data, many of those providing general information, e.g. on addresses, bibliographies, software etc. are also described. The field is rapidly growing with improved network technology, and our attempt to keep the report as complete and up-to-date as possible will inevitably be outdated shortly. We will endeavor to maintain an updated version of this document on-line.Comment: 53 pages; uuencoded compressed PostScript; includes one table, no figures; Lyon-41 (Aug'94) and ESO-1033 (Sept'94), to appear in PASP, November 1994 issu

Maintenance electroconvulsive therapy for comorbid pharmacotherapy-refractory obsessive-compulsive and schizoaffective disorder

<p>Abstract</p> <p>Objective</p> <p>There is a high comorbidity of schizophrenia and obsessive-compulsory disorder (OCD) associated with more severe symptoms. Standard pharmacotherapy achieve symptom improvement in approximately 60% only.</p> <p>Results</p> <p>We report about a 48-old women treated for depression which developed successively psychotic symptoms (ideas of reference, psychotic worries), negative symptoms (blunted affect, impoverished thinking, difficulties in planning), and obsessive-compulsive symptoms (mainly repeating rituals, avoidance behaviour, collecting and hoarding). She did not respond to combined treatment with neuroleptics and high dose selective serotonin re-uptake inhibitors. She acutely improved during a course of electroconvulsive therapy (ECT) and was maintained on outpatient ECTs fortnightly together with 12 mg sertindol and 45 mg mirtazapine for 42 weeks.</p> <p>Conclusion</p> <p>Maintenance ECT is not an approved therapy in OCD but might be an option in pharmacotherapy refractory cases of comorbid OCD and schizophrenic/schizoaffective disorder.</p

The Energy Spectrum of Primary Cosmic Ray Electrons in Clusters of Galaxies and Inverse Compton Emission

Models for the evolution of the integrated energy spectrum of primary cosmic ray electrons in clusters of galaxies have been calculated, including the effects of losses due to inverse Compton (IC), synchrotron, and bremsstrahlung emission, and Coulomb losses to the intracluster medium (ICM). The combined time scale for these losses reaches a maximum of ~3e9 yr for electrons with a Lorentz factor ~300. Only clusters in which there has been a substantial injection of relativistic electrons since z <~ 1 will have any significant population of primary cosmic ray electrons at present. In typical models, there is a broad peak in the electron energy distribution extending to gamma~300, and a steep drop in the electron population beyond this. In clusters with current particle injection, there is a power-law tail of higher energy electrons with an abundance determined by the current rate of injection. A significant population of electrons with gamma~300, associated with the peak in the particle loss time, is a generic feature of the models. The IC and synchrotron emission from these models was calculated. In the models, EUV and soft X-ray emission are nearly ubiquitous. This emission is produced by electrons with gamma~300. The spectra are predicted to drop rapidly in going from the EUV to the X-ray band. The IC emission also extends down the UV, optical, and IR bands with a fairly flat spectrum. Hard X-ray (HXR) and diffuse radio emission due to high energy electrons (gamma~10e4) is present only in clusters which have current particle acceleration. Assuming that the electrons are accelerated in ICM shocks, one would only expect diffuse HXR/radio emission in clusters which are currently undergoing a large merger.Comment: Accepted for publication in the Astrophysical Journal, with minor revisons to wording for clarity and one additional reference. 19 pages with 16 embedded Postscript figures in emulateapj.sty. Abbreviated abstract belo

Towards a Notion of Distributed Time for Petri Nets

We set the ground for research on a timed extension of Petri nets where time parameters are associated with tokens and arcs carry constraints that qualify the age of tokens required for enabling. The novelty is that, rather than a single global clock, we use a set of unrelated clocks --- possibly one per place --- allowing a local timing as well as distributed time synchronisation. We give a formal definition of the model and investigate properties of local versus global timing, including decidability issues and notions of processes of the respective models

Dysphagia affecting quality of life in cerebellar ataxia - a large survey

Dysphagia is a common symptom in neurodegenerative disorders and is generally associated with increased mortality. In the clinical care setting of ataxia patients, no systematical and standardized assessment of dysphagia is employed. Its impact on patients' health-related quality of life is not well understood. To assess the impact of dysphagia in ataxia patients on diet, body weight, and health-related quality of life. We conducted a large survey using self-reported questionnaires for swallowing-related quality of life (Swal-QOL) and a food frequency list in combination with retrospective clinical data of 119 patients with cerebellar ataxia treated in the neurological outpatient clinic of a large German university hospital. Seventeen percent of ataxia patients suffered from dysphagia based on the Swal-QOL score. Less than 1% of all patients reported dysphagia as one of their most disabling symptoms. Dysphagia was associated with unintentional weight loss (p = 0.02) and reduced health-related quality of life (p = 0.01) but did not affect individual nutritional habits (p > 0.05; Chi-squared test). Dysphagia is a relevant symptom in cerebellar ataxia. A systematic screening for dysphagia in patients with cerebellar ataxia would be desirable to enable early diagnosis and treatment

Lattice dependence of saturated ferromagnetism in the Hubbard model

We investigate the instability of the saturated ferromagnetic ground state (Nagaoka state) in the Hubbard model on various lattices in dimensions d=2 and d=3. A variational resolvent approach is developed for the Nagaoka instability both for U = infinity and for U < infinity which can easily be evaluated in the thermodynamic limit on all common lattices. Our results significantly improve former variational bounds for a possible Nagaoka regime in the ground state phase diagram of the Hubbard model. We show that a pronounced particle-hole asymmetry in the density of states and a diverging density of states at the lower band edge are the most important features in order to stabilize Nagaoka ferromagnetism, particularly in the low density limit.Comment: Revtex, 18 pages with 18 figures, 7 pages appendices, section on bcc lattice adde